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Specialities PP > Specialities 2013-2016 > Flashcards

Specialities 2013-2016 Flashcards

1
Q

drugs of abuse- one was a kid with cracked nose and lips

A

solvents

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2
Q

bleeding/unwell post partum

A

Tone, tear, tissues, thrombosis (clotting disorder). Infection.

Endometritis: fever/discharge
Lochia: 2-6 weeks
Next period 6-8 weeks
Retained products

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3
Q

14 year old primary amenorrhoea + ejection systolic murmur

A

Turner’s - bicuspid aortic valve (15%), coarctation of the aorta (5-10%)

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4
Q

What gives you macrosomia

A

gestational diabetes

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5
Q

Cyclical pain, no heavy menstrual bleed, never sexually active

A

Active endometriosis

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6
Q

Ethics – 14 year old pregnant, comes with sister, wants a TOP. What should you do?

A

Persuade her to tell her parents if she refuses and gillick competent, you can give her TOP.

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7
Q

When to use donor eggs

A

POF

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8
Q

What do you test for in Hep B infection antenatally?

A

HBsAg

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9
Q

What is not a risk factor for primary PPH?

a. B thalassaemia trait
b. Retained products
c. Sepsis
d. Vaginal tear
e. Multiparity

A

B thalassaemia trait

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10
Q

At antenatal check, woman with BP 150/90, what would you do?

A

oral labetalol and check BP twice weekly, admit if over 160/110

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11
Q

Urogynae – leak urine when laughing and going up stairs, initial management?

A

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

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12
Q

What is the treatment for a bartholian abscess

A

marsupialisation

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13
Q

Women with previous GDM what is the best way to investigation her blood glucose?

A

OGTT as soon as possible after booking and then again at 24-28 weeks if results of first one normal

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14
Q

Risk factors for GDM

A

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.

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15
Q

What type of contraception can increase risk of osteoporosis?

A

Depo-provera

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16
Q

Women with excessive vomiting, under what circumstance would you admit her?

A

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).

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17
Q

Which drug is likely to be teratogenic?

A

Sodium valproate

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18
Q

Someone comes in at 28w with a Hb of 10.5, MCV, 82, MCH 27 what would you do

A

Simple advice about including dark green leafy vegetables, pulses, beans, nuts, seeds and brown rice in the
diet

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19
Q

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

a. cyclical oral HRT (COCP?)
b. bisphosphonates (tibolone according to woodlawn doc?)
c. transdermal oestrogen HRT
d. cyclical oral HRT
e. oral combined HRT

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20
Q

Clue cells

A

Bacterial vaginosis

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21
Q

strawberry cervix

A

trichomonas

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22
Q

painful multiple lesions on labia

A

herpes

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23
Q

curdy white-yellow discharge

A

candida

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24
Q

blue dots on cervix

A

endometriosis

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25
Q

Mother with stillborn baby, generalized oedematous when born, mother had fever at 18w with rash on trunk

A

Parvovirus

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26
Q

Smear comes back as moderate dyskaroysis

A

CIN2

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27
Q

76 year old had a single brown discharge

A

atrophic vaginitis/endometrial cancer

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28
Q

Intermittent pain + vomiting

A

ovarian torsion

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29
Q

47yo women with menorrhagia + dysmenorrhea, US showed multiple fibroids

A

hysterectomy

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30
Q

32 yo has 2 children done with family, had COCP before

A

mirena

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31
Q

Women going away for holiday and would like to delay her periods.

A

If you are already on COCP then you just go back to back. If not give Norethisterone

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32
Q

other being prepared for CS, sudden tingling around her mouth?

A

Spinal block

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33
Q

Mother being prepared for CS and has a regional block, sudden tachycardia, SOB, difficulty in breathing

A

Anaphylaxis?

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34
Q

Mother had previous CS, sudden abdo pain and abnormal CTG

A

uterine rupture

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35
Q

Kid with fever of >39 what to do next

A

Either full septic screen or IV cef and admit, so Ix on ward

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36
Q

Mother with girl who doesn’t speak

A

refer for hearing assessment

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37
Q

Kid fitting for over 5mins, normal glucose, what do you give?

A

(Rectal diazepam)/Buccal Midazolam 0.5mg/kg or IV lorazepam 0.1mg/kg if IV access

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38
Q

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?

A

Call PICU ready for intubation.

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39
Q

Cross eye kid, what other piece of information would you like?

A

Vomiting before breakfast? (For SOL)

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40
Q

Dehydration + ill kid – weight 15kg what do you give initially?

A

300ml bolus IV - remember bolus in DKA is 10ml/kg and only if they’re in shock

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41
Q

Aspiration pneumonia what would you do?

A

??

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42
Q

Strawberry tongue

A

Scarlet fever = Maculo papular rash sparing faces /sandpaper like rash.

Or

Kawasaki = polymorphous rash, conjunctivitis

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43
Q

What is the purpose of debriefing after a child’s death in resuscitation?

A

To address emotional needs of everyone in the team.

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44
Q

Child who pass stool every few days, when he does go, stools are pellet like and smelly, what is the likely diagnosis?

A

Overflow constipation - Mx = laxatives - council: may make it worse before it gets better

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45
Q

Child with pruritus ani worse at night, what would you give to treat?

A

Mebendazole

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46
Q

Scabies

A

permethrin 5% is first-line, malathion 0.5% is second-line

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47
Q

Age a child sits without support

A

6-8m, refer by 8m

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48
Q

Walks

A

By 15m, refer by 18m

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49
Q

Hops on one leg

A

3-4 years, refer by 5y

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50
Q

pincer grip

A

10m, refer by 12m

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51
Q

smiles

A

6wks, refer by 8wks

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52
Q

Investigation for drunk/intoxicated kid

A

urine drug screen

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53
Q

Dehydrated, seizures, mother been giving some herbal oral rehydration fluid or something

A

Plasma sodium (urine tox and blood glucose)

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54
Q

Sick kid with fever, vomiting, photophobia

A

Lumbar puncture

55
Q

Neonate getting progressively worse at breathing over first 3h with opacities

A

GBS pneumonia

56
Q

Still needs oxygen

A

bronchopulmonary dysplasia

57
Q

Ground grass appearance

A

RDS/primary surfactant deficiency

58
Q

Nitrogen washout test

A

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

59
Q

Posterior fossa tumour

A

medulloblastoma

60
Q

Kid with sore throat, cervical lymphademopathy, been given antibiotics, rash comes on.

A

EBV

61
Q

Rash that started from behind the ears and spread to trunk, parents are vegetarians and kid goes to school in north London

A

Measles

62
Q

Intermittent pain, dehydrated, vomited 3 times

A

Intussesception - Redcurrent jelly = late sign. 3mo-2yo, palpable sausage mass, draws legs up

63
Q

Sudden abdo pain, well child, something indentable on the L lower quadrant

A

Wilm’s nephroblastoma

64
Q

Scaphoid abdomen

A

Congenital diaphragmatic hernia

65
Q

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?

A

Assess capacity

66
Q

Someone who just started on an antipsychotic and becomes tachycardia, hyperthermia, sweating, urine drug screen negative.

A

Neuroleptic malignant syndrome

67
Q

Which of the following condition would a kid’s twin brother have if he was diagnosed with it?

A

ADHD (80% inheritance)

68
Q

Diagnosed bipolar disorder – sudden renal failure, what do you check?

A

Lithium levels

69
Q

Starting 21 year old with depression + suicidal idealization on antidepressants, what is your follow up plan?

A

Start citalopram and review in 1w

Is this right? Idk anymore

70
Q

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?

A

Hold a meeting with the patient and nursing staff present

71
Q

Someone is brought in by their mother to A&E and appears psychotic what section would you put them under?

A

4 for emergency assessment

72
Q

Someone with acute dystonia what would you give?

A

Procyclidine

73
Q

Someone with bulimia, BMI 22, well and keen to get treatment.

A

Fluoxetine + CBT

74
Q

Someone who lost her husband 7 months ago and started hearing voices of him saying to join him a month ago

A

Abnormal grief response

75
Q

Someone with depression and has made plans to end his life comes to your GP surgery with his sister what would you do?

A

Get them to go to A&E

76
Q

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

A

People who are 40-50

77
Q

78yo guy has issues with organisation, troubles with understanding words

A

frontal temporal dementia

78
Q

Treatment mild depression

A

CBT

79
Q

Woman with sudden confusion

A

urine dip/BM

80
Q

Criteria for learning disability

A

IQ <70 Mild >50, Moderate >35, Severe >20, Profound <20

81
Q

diagnostic overshadowing

A

a diagnosis of a LD obscuring diagnosis of other disorders – physical and mental

82
Q

Failed 2 antipsychotics

A

clozapine

83
Q

Someone who was started on haloperidol and has acute muscle spasm (acute dystonic)

A

Procyclidine

84
Q

Someone who is aggressive and needs rapid tranqulisation

A

oral/IM lorazepam

85
Q

Who would you refer a schizophrenic patient to if they are being discharged and needs support in the community regarding treatment?

A

Community psychiatric nurse – Discharge of Schizophrenic: Care Programme Approach (CPA), Core Care Co-Cordinator, Make care plan

86
Q

Who to refer to: Someone with schizo and need help organizing their activities after they are being discharged?

A

Occupational therapist

87
Q

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

A

GP

88
Q

Substance misuse: Something that works on 5HT receptors?

A

MDMA

89
Q

Lady has a diagnostic laparotomy. She has suprapubic pain that
not even IV paracetamol is helping. What is the likely reason?

A

Urinary retention

90
Q

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?

A

do a

transabdominal scan

91
Q

Leading cause of maternal mortality in UK?

A

Sepsis

92
Q

Management of 4 year old with enuresis - dry by day.

A

Reassure

93
Q

Child with Downs has an NJ tube at home. It comes out and

needs re-inserting. Who should put it back in?

A

Hospital nursing staff

94
Q

You’re the duty GP. Mum calls about child with fever/non-

blanching rash. What do you do/advise?

A

Go to A&E

95
Q

Child diagnosed with functional abdo pain. Associated with

school. What’s the best management plan?

A

Encourage her to go

to school and come back when her tummy starts to hurt

96
Q

Child is slow to get dressed. Likes to arrange his toys in a

particular way.

A

ASD

97
Q

Child is an arsonist. Gets in fights. Attacks teachers. What

is he likely to have at age 20?

A

Dissocial PD

98
Q

Talking about a ~8 month child with cerebral palsy. Which of

their milestones is likely to suggest CP:

A

Using right hand more than left

99
Q

Neonate. Ortolani test positive. What you do?

A

Ultrasound

100
Q

Child with downs in residence. Short term history of attacking
people, anger outbursts etc. Best management?

A

Neuropsychiatric assessment

101
Q

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?

A

call picu and prep for

intubation

102
Q

child with inspiratory stridor since birth

A

Laryngomalacia

103
Q

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]

A

Constitutional delay

104
Q

Hyperactive child at home.

Doesn’t pay attention at school.

A

ADHD

105
Q

Child takes 4 tablets of grandmothers benzodiazepines 4 hours
ago. She’s currently asleep, but was fully awake with GCS 15.
Your next step?

A

Admit for monitoring

106
Q

Afebrile child with D+V. Description alludes to shock. She is
15kg. How much/what fluid do you give her initially?

A

300ml bolus of 0.9% saline

107
Q

7 year old goes to a new school. School complains that he

keeps soiling himself. What is most likely reason?

A

Stool holding

108
Q

A child who recently started solids has been suffering from
constipation. On examination no fecal masses felt per abdomen.
Management?

A

Increase fluid intake

109
Q

What IQ defines a mild learning disability?

A

<70

110
Q

Which of the following is not an RF for suicide? [FHx of

depression; FHx of suicide; Prev suicide attempt; Male; Heroin-use]

A

Heroin use

111
Q

What bloods would you test for, to monitor Lithium toxicity?

A

U&E/Lithium levels/TFTs

112
Q

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]

A

She felt hopeless

113
Q

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.

A

Assess capacity

114
Q

When interviewing a recovered Schizophrenic, what on MSE would
make you think they were getting relapse?

A

Visual hallucination

115
Q

Sign of social phobia

A

People noticing you blush

116
Q

Impetigo tx

A

Fusidic acid

117
Q

Scabies treatment

A

permethrin

118
Q

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?

A

3

119
Q

Two fetal poles, one gestational sac

A

Monoamniotic

120
Q

Snowstorm appearance

A

Mole

121
Q

Side effect of eating cheese plus MAO-I

A

Hypertension

122
Q

S/E of clozapine

A

Hypersalivation? Lol

123
Q

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.

A

Haemophilia

124
Q

Post rib fracture in child and other injuries

A

NAI

125
Q

Hypercontractility of uterus, then fetal compromise, reduced fetal movements and bradycardia with haematuria and suprapubic pain

A

uterine rupture

126
Q

history of poor memory, difficulty in word finding and difficulty in planning.

A

Alzheimers

127
Q

Mild migraines treatmen t

A

paracetamol

128
Q

Blistering lesions, malaise and fevers as a complication of

childhood eczema

A

herpes simplex virus

129
Q

Maternal febrile illness with rash and arthralgias associated with subsequent still birth and hydrops foetalis.

A

Parvovirus

130
Q

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

A

Ring – for 1st/2nd degree prolapse
Shelf – if ring pessary falls out/ineffective
Hodge pessary – used for cystocele/stress urinary incontinence

131
Q

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.

A 
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

132
Q

yellow dots on cervix

A

nathobian cyst

133
Q

white pupillary reflex and a squint

A

retinoblastoma

Specialities PP (2 decks)

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