Specialities 2013-2016 Flashcards
drugs of abuse- one was a kid with cracked nose and lips
solvents
bleeding/unwell post partum
Tone, tear, tissues, thrombosis (clotting disorder). Infection.
Endometritis: fever/discharge
Lochia: 2-6 weeks
Next period 6-8 weeks
Retained products
14 year old primary amenorrhoea + ejection systolic murmur
Turner’s - bicuspid aortic valve (15%), coarctation of the aorta (5-10%)
What gives you macrosomia
gestational diabetes
Cyclical pain, no heavy menstrual bleed, never sexually active
Active endometriosis
Ethics – 14 year old pregnant, comes with sister, wants a TOP. What should you do?
Persuade her to tell her parents if she refuses and gillick competent, you can give her TOP.
When to use donor eggs
POF
What do you test for in Hep B infection antenatally?
HBsAg
What is not a risk factor for primary PPH?
a. B thalassaemia trait
b. Retained products
c. Sepsis
d. Vaginal tear
e. Multiparity
B thalassaemia trait
At antenatal check, woman with BP 150/90, what would you do?
oral labetalol and check BP twice weekly, admit if over 160/110
Urogynae – leak urine when laughing and going up stairs, initial management?
Pelvic floor exercise.
Next consider tension-free tape (less invasive) and trans-obturator tape (less risk of bladder perf) Can use duloxetine if they don’t want surgery but not first line
What is the treatment for a bartholian abscess
marsupialisation
Women with previous GDM what is the best way to investigation her blood glucose?
OGTT as soon as possible after booking and then again at 24-28 weeks if results of first one normal
Risk factors for GDM
body mass index above 30 kg/m2
previous macrosomic baby weighing 4.5 kg or above
previous gestational diabetes
family history of diabetes (first-degree relative with diabetes)
minority ethnic family origin with a high prevalence of diabetes.
What type of contraception can increase risk of osteoporosis?
Depo-provera
Women with excessive vomiting, under what circumstance would you admit her?
Continued nausea and vomiting and is unable to keep down liquids or oral antiemetics.
Continued nausea and vomiting with ketonuria and/or weight loss (greater than 5% of body weight), despite treatment with oral antiemetics.
A confirmed or suspected comorbidity (for example she is unable to tolerate oral antibiotics for a urinary tract infection).
Which drug is likely to be teratogenic?
Sodium valproate
Someone comes in at 28w with a Hb of 10.5, MCV, 82, MCH 27 what would you do
Simple advice about including dark green leafy vegetables, pulses, beans, nuts, seeds and brown rice in the
diet
Menopause treatment – what HRT would you give
a. premature menopause and wants a bleed
b. bone protection
c. menopausal symptoms, has had hysterectomt, doesnt want oral tablets
d. perimenopausal woman with menopause symptoms, irregular menstruaton, swims and doesn’t want patch
e. menopausal symptoms and has eczema
a. cyclical oral HRT (COCP?)
b. bisphosphonates (tibolone according to woodlawn doc?)
c. transdermal oestrogen HRT
d. cyclical oral HRT
e. oral combined HRT
Clue cells
Bacterial vaginosis
strawberry cervix
trichomonas
painful multiple lesions on labia
herpes
curdy white-yellow discharge
candida
blue dots on cervix
endometriosis
Mother with stillborn baby, generalized oedematous when born, mother had fever at 18w with rash on trunk
Parvovirus
Smear comes back as moderate dyskaroysis
CIN2
76 year old had a single brown discharge
atrophic vaginitis/endometrial cancer
Intermittent pain + vomiting
ovarian torsion
47yo women with menorrhagia + dysmenorrhea, US showed multiple fibroids
hysterectomy
32 yo has 2 children done with family, had COCP before
mirena
Women going away for holiday and would like to delay her periods.
If you are already on COCP then you just go back to back. If not give Norethisterone
other being prepared for CS, sudden tingling around her mouth?
Spinal block
Mother being prepared for CS and has a regional block, sudden tachycardia, SOB, difficulty in breathing
Anaphylaxis?
Mother had previous CS, sudden abdo pain and abnormal CTG
uterine rupture
Kid with fever of >39 what to do next
Either full septic screen or IV cef and admit, so Ix on ward
Mother with girl who doesn’t speak
refer for hearing assessment
Kid fitting for over 5mins, normal glucose, what do you give?
(Rectal diazepam)/Buccal Midazolam 0.5mg/kg or IV lorazepam 0.1mg/kg if IV access
Asthma management. Kid with acute exacerbation, been given salbutamol and steroids. On listening to the chest, you hear a quiet chest, respiratory rate 60. What to do?
Call PICU ready for intubation.
Cross eye kid, what other piece of information would you like?
Vomiting before breakfast? (For SOL)
Dehydration + ill kid – weight 15kg what do you give initially?
300ml bolus IV - remember bolus in DKA is 10ml/kg and only if they’re in shock
Aspiration pneumonia what would you do?
??
Strawberry tongue
Scarlet fever = Maculo papular rash sparing faces /sandpaper like rash.
Or
Kawasaki = polymorphous rash, conjunctivitis
What is the purpose of debriefing after a child’s death in resuscitation?
To address emotional needs of everyone in the team.
Child who pass stool every few days, when he does go, stools are pellet like and smelly, what is the likely diagnosis?
Overflow constipation - Mx = laxatives - council: may make it worse before it gets better
Child with pruritus ani worse at night, what would you give to treat?
Mebendazole
Scabies
permethrin 5% is first-line, malathion 0.5% is second-line
Age a child sits without support
6-8m, refer by 8m
Walks
By 15m, refer by 18m
Hops on one leg
3-4 years, refer by 5y
pincer grip
10m, refer by 12m
smiles
6wks, refer by 8wks
Investigation for drunk/intoxicated kid
urine drug screen
Dehydrated, seizures, mother been giving some herbal oral rehydration fluid or something
Plasma sodium (urine tox and blood glucose)
Sick kid with fever, vomiting, photophobia
Lumbar puncture
Neonate getting progressively worse at breathing over first 3h with opacities
GBS pneumonia
Still needs oxygen
bronchopulmonary dysplasia
Ground grass appearance
RDS/primary surfactant deficiency
Nitrogen washout test
Congenital heart disease:
The infant is placed in 100% oxygen (headbox or ventilator) for 10 min. If the right radial arterial PaO2 from a blood gas remains low (<15 kPa, 113 mmHg) after this time, a diagnosis of ‘cyanotic’ congenital heart disease can be made if lung disease and persistent pulmonary hypertension of the newborn (persistent fetal circulation) have been excluded. If the PaO2 is >20 kPa, it is not cyanotic heart disease
Posterior fossa tumour
medulloblastoma
Kid with sore throat, cervical lymphademopathy, been given antibiotics, rash comes on.
EBV
Rash that started from behind the ears and spread to trunk, parents are vegetarians and kid goes to school in north London
Measles
Intermittent pain, dehydrated, vomited 3 times
Intussesception - Redcurrent jelly = late sign. 3mo-2yo, palpable sausage mass, draws legs up
Sudden abdo pain, well child, something indentable on the L lower quadrant
Wilm’s nephroblastoma
Scaphoid abdomen
Congenital diaphragmatic hernia
78 year old fell and sustained a fractured NoF and refuse surgery, son is a lawyer and says his mother does not have capacity, what should you do?
Assess capacity
Someone who just started on an antipsychotic and becomes tachycardia, hyperthermia, sweating, urine drug screen negative.
Neuroleptic malignant syndrome
Which of the following condition would a kid’s twin brother have if he was diagnosed with it?
ADHD (80% inheritance)
Diagnosed bipolar disorder – sudden renal failure, what do you check?
Lithium levels
Starting 21 year old with depression + suicidal idealization on antidepressants, what is your follow up plan?
Start citalopram and review in 1w
Is this right? Idk anymore
Someone who is sectioned and came back from their leave agrees and threatens to harm the staff. After discussion with nursing staff what would you do?
Hold a meeting with the patient and nursing staff present
Someone is brought in by their mother to A&E and appears psychotic what section would you put them under?
4 for emergency assessment
Someone with acute dystonia what would you give?
Procyclidine
Someone with bulimia, BMI 22, well and keen to get treatment.
Fluoxetine + CBT
Someone who lost her husband 7 months ago and started hearing voices of him saying to join him a month ago
Abnormal grief response
Someone with depression and has made plans to end his life comes to your GP surgery with his sister what would you do?
Get them to go to A&E
Who is more likely to kill themselves?
a. Women
b. People who work in managerial roles
c. People who are 40-50
d. People who are married
People who are 40-50
78yo guy has issues with organisation, troubles with understanding words
frontal temporal dementia
Treatment mild depression
CBT
Woman with sudden confusion
urine dip/BM
Criteria for learning disability
IQ <70 Mild >50, Moderate >35, Severe >20, Profound <20
diagnostic overshadowing
a diagnosis of a LD obscuring diagnosis of other disorders – physical and mental
Failed 2 antipsychotics
clozapine
Someone who was started on haloperidol and has acute muscle spasm (acute dystonic)
Procyclidine
Someone who is aggressive and needs rapid tranqulisation
oral/IM lorazepam
Who would you refer a schizophrenic patient to if they are being discharged and needs support in the community regarding treatment?
Community psychiatric nurse – Discharge of Schizophrenic: Care Programme Approach (CPA), Core Care Co-Cordinator, Make care plan
Who to refer to: Someone with schizo and need help organizing their activities after they are being discharged?
Occupational therapist
Who to refer to: Girl who overdose in front of her boyfriend after a row, no previous suicide/ self-harm attempts. Good health. Only did it because she wanted attention from her boyfriend
GP
Substance misuse: Something that works on 5HT receptors?
MDMA
Lady has a diagnostic laparotomy. She has suprapubic pain that
not even IV paracetamol is helping. What is the likely reason?
Urinary retention
Somali lady comes in doesn’t speak much English says she’s 42
weeks. Examination of abdomen suggests a 32 week uterus. What is
next in management?
do a
transabdominal scan
Leading cause of maternal mortality in UK?
Sepsis
Management of 4 year old with enuresis - dry by day.
Reassure
Child with Downs has an NJ tube at home. It comes out and
needs re-inserting. Who should put it back in?
Hospital nursing staff
You’re the duty GP. Mum calls about child with fever/non-
blanching rash. What do you do/advise?
Go to A&E
Child diagnosed with functional abdo pain. Associated with
school. What’s the best management plan?
Encourage her to go
to school and come back when her tummy starts to hurt
Child is slow to get dressed. Likes to arrange his toys in a
particular way.
ASD
Child is an arsonist. Gets in fights. Attacks teachers. What
is he likely to have at age 20?
Dissocial PD
Talking about a ~8 month child with cerebral palsy. Which of
their milestones is likely to suggest CP:
Using right hand more than left
Neonate. Ortolani test positive. What you do?
Ultrasound
Child with downs in residence. Short term history of attacking
people, anger outbursts etc. Best management?
Neuropsychiatric assessment
Asthmatic child in A&E. Mother has been giving two puffs of
salbutamol with spacer every 4 hours. Description given
correlated to severe asthma. What your management?
call picu and prep for
intubation
child with inspiratory stridor since birth
Laryngomalacia
A child with short stature. Estimated mid parental height is
on 25th centile. His measurements are plotted on the chart (which
was printed extremely faint. You could only make out the crosses
and some of the centiles. It appeared the child was crossing
multiple centiles since young age). What is the cause?
[Constitutional delay; Malabsorption; Hypothyroidism; Familial
short stature]
Constitutional delay
Hyperactive child at home.
Doesn’t pay attention at school.
ADHD
Child takes 4 tablets of grandmothers benzodiazepines 4 hours
ago. She’s currently asleep, but was fully awake with GCS 15.
Your next step?
Admit for monitoring
Afebrile child with D+V. Description alludes to shock. She is
15kg. How much/what fluid do you give her initially?
300ml bolus of 0.9% saline
7 year old goes to a new school. School complains that he
keeps soiling himself. What is most likely reason?
Stool holding
A child who recently started solids has been suffering from
constipation. On examination no fecal masses felt per abdomen.
Management?
Increase fluid intake
What IQ defines a mild learning disability?
<70
Which of the following is not an RF for suicide? [FHx of
depression; FHx of suicide; Prev suicide attempt; Male; Heroin-use]
Heroin use
What bloods would you test for, to monitor Lithium toxicity?
U&E/Lithium levels/TFTs
A teenage girl takes an OD of paracetamol after being “dumped” by
boyfriend. Which feature is likely to suggest further suicide risk? [She got
dumped for another girl; She took the OD in front of him saying she
wanted to teach him a lesson; N-acetyl cysteine was required; she felt
hopeless]
She felt hopeless
Elderly lady consented for operation by GP. Day of op decides not to
have it but son insists she should go ahead. What should the doctor do.
Assess capacity
When interviewing a recovered Schizophrenic, what on MSE would
make you think they were getting relapse?
Visual hallucination
Sign of social phobia
People noticing you blush
Impetigo tx
Fusidic acid
Scabies treatment
permethrin
Inpatient with Mania detained under section 2, reaching the end
of the term. He is still not showing signs of improvement and poses a
risk to himself/others. What section?
3
Two fetal poles, one gestational sac
Monoamniotic
Snowstorm appearance
Mole
Side effect of eating cheese plus MAO-I
Hypertension
S/E of clozapine
Hypersalivation? Lol
Child bought in by grandmother. Said to have knocked knee in
cupboard which has become swollen. His brother had swelling having
banged head when he was young.
Haemophilia
Post rib fracture in child and other injuries
NAI
Hypercontractility of uterus, then fetal compromise, reduced fetal movements and bradycardia with haematuria and suprapubic pain
uterine rupture
history of poor memory, difficulty in word finding and difficulty in planning.
Alzheimers
Mild migraines treatmen t
paracetamol
Blistering lesions, malaise and fevers as a complication of
childhood eczema
herpes simplex virus
Maternal febrile illness with rash and arthralgias associated with subsequent still birth and hydrops foetalis.
Parvovirus
urogynae- they had listed 3 types of pessary too- ring, shelf, hodgson (?). One qn I rmr was 80 yr old, uterine prolapse- app answer was ring, but look up the differences
Ring – for 1st/2nd degree prolapse
Shelf – if ring pessary falls out/ineffective
Hodge pessary – used for cystocele/stress urinary incontinence
weight loss- )- it was q tricky sometimes cos the criteria for anorexia and bulimia were often not quite met but there wasn’t a better option at times..learn the diagnostic criteria well and what isn’t allowed to diagnose.
Anorexia nervosa • BMI <17.5 or 15% less than expected • Self-induced weight loss: avoidance of fatty foods, self-induced vomiting, laxatives, exercise, appetite suppressants, diuretics • Body image distortion/dread of fatness • Endocrine dysfunction o Amenorrhea o Loss of libido o Elevated GH, cortisol (abnormal thyroid/insulin)
Bulimia nervosa
• Binge eating: 2x per week for 3 months
• Persistent preoccupation with eating/cravings to eat
• Efforts to counter weight gain: vomiting, purging, starvation, drugs
• Self-perception of being too fat/dread of fatness
yellow dots on cervix
nathobian cyst
white pupillary reflex and a squint
retinoblastoma
