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Specialties PPQs Flashcards

1
Q

Woman with a little bit of pink post-coital bleeding on wiping. Smear is fine, ultrasound is clear. What is the next investigation?

A

Hysteroscopy with biopsy

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2
Q

Secondary amenorrhoea. Table shows high prolactin (7000) and low LH

A

Prolactinoma

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3
Q

Woman with secondary amenorrhoea for 6 months. High FSH and LH

A

PCOS

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4
Q

Woman had abdo trauma 32 weeks, had anti-D. Had her anti-D at 28 weeks – what to do next?

A

Kleihauer test and give anti-D

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5
Q

Lady who had a tear after delivering baby, a few days later has offensive discharge, no fever or other symptoms

A

Perineal wound breakdown/infection

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6
Q

HIV with undetectable viral load. what is contraindicated in labour?

A

Fetal blood sampling

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7
Q

72 year old woman with PMB and endometrial thickness seen on USS, what’s the diagnosis?

A

Endometrial carcinoma

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8
Q

60 year old woman with PMB and superficial dyspareunia, what is the MOST LIKELY diagnosis?

A

Atrophic vaginitis

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9
Q

A 47 year old woman with a 2 cm simple ovarian cyst seen on USS, as well as 12mm endometrium. What do you do next? Repeat USS, Ca 125 levels, hysteroscopy, Pipelle biopsy, reassure & discharge

A

Pipelle biopsy (there’s a cut off for pre and post menopause: if more than 10 mm in pre and 4mm in post, either way this one had 12mm so qualifies for biopsy)

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10
Q

Woman with rupture of membranes, painless bleeding, and fetal distress on CTG. What was the likely diagnosis?

A

Vasa praevia
(if distress to baby = vasa praevia)

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11
Q

Woman had an implant inserted but she’s getting it removed. What is the most likely reason why?

A

Irregular bleeding

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12
Q

Cervical os is open in a young woman in early pregnancy. What is it?

A

Inevitable miscarriage

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13
Q

Mother had rupture of membranes at 32 weeks but is not in labour. What do you give her?

A

Steroids and erythromycin

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14
Q

Bloods shown with raised LH and FSH and all else normal in couple trying to get pregnant. What is the first question you want to ask the woman? Has the father ever had children, When was your last period, do you have hot flushes

A

When was your last period?

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15
Q

Girl with painful periods in the first 2 days of her period ever since menarche, she has heavy bleeding. What is it? Primary dysmenorrhoea, endometriosis, endometrial cyst

A

Primary dysmenorrhoea

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16
Q

Woman with painful breast after giving birth. She’s breast-feeding and has an abscess secondary to mastitis. Surgical excision, aspirate and culture, Ciprofloxacin

A

Aspirate and culture

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17
Q

Pregnant woman in early pregnancy with depression and anxiety on sertraline. What do you do? Stop sertraline, carry it on (benefits probably outweigh risks), prescribe high-dose folic acid, reduce the dose, amitriptyline

A

carry it on (benefits probably outweigh risks)

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18
Q

What do you do in a woman in labour after 4 hours of checking, she’s 4cm. Vaginal prostaglandin, Cervical sweep, Oxytocin, Ergometrine, ARM

A

ARM

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19
Q

Post partum haemorrhage with high BP - carboprost, misoprostol, ergometrine, syntocinon

A

Syntocinon (Ergo contraindicated in HTN)

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20
Q

Foreign woman has come in and is pregnant. What vaccine should she be offered? Hepatitis A, hepatitis B, whooping cough

A

Whooping cough

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21
Q

Foetus with transverse lie, recent SROM, CTG shows fetal distress. Most likely cause?

A

Cord prolapse

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22
Q

HRT question for a menopausal woman with flushes, last period 10m ago. What do you give her? Cyclical combined HRT, oestrogen only HRT, topical HRT, continuous HRT

A

Cyclical combined HRT
They called cyclical “sequential” in the exam

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23
Q

What’s the management for DVT risk in a pregnant woman after an elective Caesarean?

A

LMWH and Ted stockings

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24
Q

A pregnant woman with an itch. What tests do you test?

A

Bile acids

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25
Q

Woman with blocked tubes on hysterosalpingogram, what treatment should you do for fertility?

A

IVF

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26
Q

Heavy periods in a girl not yet sexually active. What do you give her?

A

Tranexamic acid

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27
Q

Woman previously had an abortion cos of severe spina bifida. No other clinical information given. What do you advice her on folic acid doses for her next pregnancy?

A

5mg folic acid from before conception (1-3 months) till 12 weeks pregnant

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28
Q

Old woman with itchy white vulval patches: VIN, vulvar cancer, lichen sclerosis?

A

Lichen sclerosis

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29
Q

Woman with high BMI (28) who basically had stress incontinence. What’s the first line management?

A

Pelvic floor exercises for 3 months (weight loss only recommended if BMI >30)

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30
Q

Poorly controlled diabetic mother, her newborn has an abnormal asymmetric Moro reflex - what’s wrong? (secondary to probably shoulder dystocia because of diabetes) HIE, fracture of humerus, brachial plexus injury?

A

Brachial plexus injury

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31
Q

What do you measure at booking for hepatitis B?

A

Hep B surface antigen

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32
Q

Man with azoospermia – what is the most likely cause? (think this was a repeat) varicocele, mumps orchitis?

A

Variocele?

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33
Q

Woman on COCP, has missed 6th and 7th day pill, had unprotected sex two days ago, her urine pregnancy is clear. What to do?

A

Emergency contraception. Advise barrier methods until 7 days of pill have been taken

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34
Q

Woman with endometriosis, had laparoscopic adhesiolysis – developed a whole range of sx - high CRP, low Hb, constipation, bowel sounds absents etc – what’s happened? Bowel obstruction, perforation, urinary retention, intrabdominal bleeding?

A

Perforation

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35
Q

Woman with offensive smelly lochia day 2 post-partum, had had some high vaginal swabs? Reassure and discharge, await swab results, give broad-spectrum antibiotics, abdo USS?

A

Give broad-spec abx?

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36
Q

Large mum (BMI >40), head comes out then goes back in, chin not visible. Rupture, short cord, shoulder dystocia, normal mechanism of labour?

A

Shoulder dystocia

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37
Q

The very last question was a bunch of tests for a woman who couldn’t conceive- all test normal and prolactin raised by like 2 points above normal value what’s most likely cause? Unknown (accounts for 30% of subfertility), prolactinoma (prolactin would be in 1000s), raised testosterone suggests PCOS (LH:FSH ratio>2/3)

A

Answer can be unknown

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38
Q

G2p1 woman is worried about delivery of current baby as she had a grade 3 tear in her last. What do you do different in this pregnancy?

A

Elective C-section

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39
Q

Woman gets headache 24hrs after delivery?

A

Post-dural puncture headache

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40
Q

Treatment for candidiasis?

A

Topical clotrimazole

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41
Q

Smoker, which extra tests does she require in pregnancy?

A

serial growth scans (if she smokes more than 10 per day)

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42
Q

Bloating, raised CA125, next step?

A

Pelvic USS

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43
Q

Which test is used to screen for Down syndrome at 15 weeks? Amniocentesis, Non-invasive pre-natal testing, Chorionic villus sampling, Quad test

A

Quad test (NIPT appears to refer to cell free DNA testing

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44
Q

Woman has menopausal symptoms and wants to start HRT, last period 6m ago?

A

Cyclical HRT

45
Q

Woman has come for a sterilisation, has had protected sex since her last menstruation one week ago, just post-ovulation – Immediate tx? Insert IUD, Cancel surgery, Continue with surgery

A

Cancel surgery

46
Q

LH raised more than FSH (3:1)

A

PCOS

47
Q

16 year old girl suffering from PMS – what is the next step?

A

Complete a menstrual diary

48
Q

Woman who is going away for 4 months with heavy, irregular periods, wants something that will regulate her periods + make them lighter: COCP, POP, depot progesterone, IUS?

A

COCP

49
Q

Woman with fever, deep dyspareunia (PID) - Treatment?

A

Send home with oral abx

50
Q

Woman in stage 2 of labour, pushing for 30 minutes, head pressing against perineum, when CTG becomes pathological – what do you do next? Emergency C section, forceps delivery, episiotomy?

A

Forceps delivery

51
Q

45F has a radical hysterectomy (Wertheim’s hysterectomy) for CIN. Last cervical smear 2 years ago. When next smear?

A

6 months (vaginal vault smear, no cervical smear because cervix was removed)

52
Q

Hysterectomy yesterday. How long to stay off work for: 48 hours/ 1 week/ 4 weeks/ 3 months?

A

4 weeks

53
Q

Pregnant woman has scan which shows anencephaly, until when can she have a TOP? Any point during this pregnancy, 24 weeks, 28 weeks, she can’t have one?

A

Any point during this pregnancy

54
Q
  1. Woman with white discharge and itch. Which treatment?
A

Topical clotrimazole

55
Q
  1. 40-year-old with diagnosed premature ovarian failure and wanted medication to deal with the symptoms of menopause. What would you prescribe her?
A

Continuous combined HRT

56
Q
  1. 37 year old wants to have the COCP. Which of the following is an absolute contraindication?
A

Smoking >15 cigarettes a day

57
Q

Mild to moderate eczema treatments?

A

Topical retinoid ± benzoyl peroxide (BPO) Adapalene + BPO
· Topical antibiotic + benzoyl peroxide (BPO) Topical clindamycin 1% + BPO
· Azelaic acid 20%

58
Q

Treatment for acne not responding to topical treatments?

A

Oral antibiotic (max 3m) + BPO / retinoid
* 1st line = tetracyclines (Lymecycline, doxycycline)
* 2nd line = macrolides (Erythromycin)

· COCP + BPO / retinoid

benzoyl peroxide (BPO)

59
Q

Discuss roacutane

A

Roaccutane (synthetic form of vitamin A):
Very teratogenic – must be on 2 forms of contraception
SE: dryness, pruritis, conjunctivitis, muscle aches, teratogenic, deranged LFTs
Associated with low mood and suicidal ideation
Prescription - aim for an accumulated dose = body weight x 100
· I.E. 80kg = 8,000mg accumulated dose

*Dermatologist referral if:
Nodulocystic acne / scarring
Severe form (acne conglobata, acne fulminans)
Severe psychological distress
Diagnostic uncertainty
Failing to respond to medications

o Support:
NHS Choices leaflet on Acne
British Association of Dermatologist

60
Q

What is the Steroid ladder?

A

Help (hydrocortisone) Every (Eumovate) Busy (Betnovate) Dermatologist (Dermovate)

61
Q

School exclusion rules for impetigo?

A

School exclusion (until lesions crusted over or 48 hours after ABx started)

62
Q

Signs of irritant nappy rash and treatment?

A

well-demarcated variety of erythema, oedema, dryness, scaling
Sparing skin folds (just skin in contact with nappy is erythematous)

If mild erythema and the child is asymptomatic:
Advise on the use of barrier preparation (available OTC) – applied thinly at each change
Zinc and Castor oil ointment BP, Metanium ointment, white soft paraffin BP ointment

o If moderate erythema and discomfort:
If >1-month-old = hydrocortisone 1% cream OD (max 7 days)

63
Q

Signs of cadidia nappy rash and treatment?

A

erythematous papules and plaques with small satellite spots or superficial pustules
Sharply demarcated redness
Check for oral candidiasis

Advise against the use of barrier protection
Prescribe topical imidazole cream (e.g. clotrimazole, econazole, miconazole)

64
Q

Signs of sebhorreic nappy rash and treatment?

A

cradle cap and bilateral salmon pink patches, desquamating flakes, skin folds

Prescribe oral flucloxacillin (clarithromycin if pen-allergic) for 7 days
Arrange to review the child

65
Q

Treatment for sebhorreic dermatitis?

A

1st line if scalp affected à regular washing with baby shampoo à gentle brushing to remove scales

§ Soaking crusts overnight with white petroleum jelly or slightly warmed vegetable/olive oil, and shampooing in the morning / soften scales with baby oil, gentle brush, wash off with baby shampoo

§ Emulsifying ointment can be used if these measures don’t work

§ If other areas of skin affected, bathe infant ≥1/day using emollient as a soap substitute

o 2nd line if scalp affected à topical imidazole cream (e.g. clotrimazole, econazole, miconazole)

§ BD or TDS (depending on preparation) until symptoms disappear

§ Consider specialist advice if it lasts >4 weeks

o 3rd line if severe à mild topical steroids (e.g. 1% hydrocortisone)

66
Q

Most common neck lump in children?

A

Lymphadenitis
S/S: transiently enlarged, tender lymph nodes

· There may often be multiple small tender bumps

67
Q

Describe thyroglossal cysts:

A

· Most common midline congenital mass

· Failure of thyroglossal duct to involute

· S/S: midline mass that moves with swallowing

68
Q

Describe branchial cleft abnormality:

A

· Most common lateral congenital mass

· Failure of pharyngeal clefts to involute

· S/S: cyst, sinus or fistula; may be infected

69
Q

Most common cause of congenital adrenal hyperplasia?

A

21-alpha hydroxylase deficiency

70
Q

What is virilisation?

A

The development of male physical characteristics (such as muscle bulk, body hair, and deep voice) in a female or precociously in a boy, typically as a result of excess androgen production.

71
Q

Treatment for CAH Salt-losing crisis?

A

IV hydrocortisone, IV saline, IV dextrose

72
Q

Long-term management of CAH?

A

Life-long glucocorticoids (hydrocortisone) to suppress ACTH levels (and hence testosterone)
Mineralocorticoids (fludrocortisone) if there is salt loss
Monitoring growth, skeletal maturity, plasma androgens and 17a-hydroxyprogesterone levels
Additional hormone replacement at times of illness or surgery [i.e. double hydrocortisone]

73
Q

How much is given in the OGTT?

A

75g oral glucose

74
Q

Complications of DKA treatment?

A

Cerebral oedema (25% mortality), aspiration pneumonia, inadequate resuscitation

75
Q

Most common cause of delyaed puberty in males?

A

Constitutional delay

76
Q

What indicates no testicular development?

A

volume <4ml

77
Q

Signs of constitutional delay

A

S/S: low bone age, no puberty signs, no organic causes

· FHx; M > F – usually FHx of same delay in parent of same sex
Chronic disease, malnutrition
Psychiatric – excessive exercise, depression, anorexia nervosa

78
Q

What is Kallmann’s syndrome?

A

LHRH deficiency and anosmia

79
Q

Hypogonadotrophic (low LH and FSH) hypogonadism?

A

Hypothalamo-pituitary disorders – panhypopituitarism, intercranial tumours

§ Kallmann’s syndrome (LHRH deficiency and anosmia), Prader-Willi syndrome

§ Hypothyroidism (acquired)

80
Q

Hypergonadotrophic (high LH and FSH) hypogonadism?

A

Congenital – cryptorchidism, Klienfelter’s syndrome (47 XXY), Turner’s syndrome (45 XO)
Acquired – testicular torsion, chemotherapy, infection, trauma, autoimmune

81
Q

Management of constitutional delay?

A

CDGP [most do not need treatment; fantastic prognosis]:
1st line: reassure and offer observation

2nd line: short course sex hormone therapy:
· Boys à short course IM testosterone (every 6 weeks for 6 months)
· Girls à transdermal oestrogen (6 months) à cyclical progesterone once established

82
Q

Androgen Insensitivity?

A

N.B. delayed puberty in a ‘girl’ with bilateral groin swellings are undescended testicles (genotype = XY; phenotype = XX)

83
Q

What is breast devleopment staging called?

A

Tanner’s

84
Q

Gonadotrophin-Dependant Precocious Puberty [GDPP] causes?

A

Premature activation of HPG axis
Idiopathic (no cause found in 80% girls and 40% boys)
CNS abnormalities (tumours, trauma, central congenital disorders)

85
Q

Gonadotrophin-Independent Precocious Puberty [GIPP] ?

A

Early puberty from increased gonadal activation independent of HPG

§ Ovarian – follicular cyst, granulosa cell tumour, Leydig cell tumour, gonadoblastoma

§ Testicular – Leydig cell tumour, testotoxicosis (defective LH-R function; a familial GIPP)

§ Adrenal – CAH, Cushing’s syndrome

§ Tumours – b-hCG-secreting tumour of liver, tumours of ovary, testes, adrenals

§ McCune-Albright syndrome – a multiple endocrinopathy of thyrotoxicosis, Cushing’s, acromegaly

· S/S: polyostotic fibrous dysplasia, café-au-lait spots, ovarian cysts

§ Exogenous hormones – COCP, testosterone gels

86
Q

Investigations for precocious puberty?

A

Investigations:

o Females [normally not of concern] → pelvic USS
Premature onset of normal puberty à multicystic ovaries and enlarging uterus
Rule out gonadal tumour, cysts

o Males [organic cause] → examination of testes, MRI (intracranial tumours), GnRH-stimulated LH/FSH
Most commonly has an organic cause

· N.B. if LH and FSH are normal, any virilisation has a primary cause (i.e. adrenal hyperplasia)

· CAH à initial growth spurt (tallest in class) à premature bone fusion (smallest in class)

Prader’s orchidometer measurement and examination of testes:
· Bilateral enlargement → GDPP (intercranial lesion; i.e. optic glioma in NF1)
· Unilateral enlargement→ gonadal tumour

· Small testes → tumour or CAH (adrenal cause)

87
Q

Small testes and precocious puberty indicates what?

A

Tumour or congenital adrenal hyperplasia (adrenal cause)

88
Q

Unilateral large testes and precocious puberty?

A

Gonadal tumour

89
Q

Bilateral enlargement of tests + precocious puberty?

A

GDPP (intercranial lesion; i.e. optic glioma in NF1)

90
Q

General investigations for precocious puberty

A

§ GOLD-STANDARD: GnRH stimulation test – suppressed LH/FSH if G-independent

· FSH, LH low = GIPP à other tests…

· FSH, LH high = GDPP à other tests…

§ Wrist XR (non-dominant) for skeletal age

§ General hormone profile à basal LH/FSH, serum testosterone and oestrogen

§ Urinary 17-OH progesterone if CAH suspecte

91
Q

Management of precocious puberty?

A

REFER TO PAEDIATRIC ENDOCRINOLOGIST

92
Q

Treatment for precocious puberty?

A

o If GDPP with no underlying pathology, often no treatment is required

o Gonadotrophin-Dependent Precocious Puberty (exclude neoplasms; n.b. 90% females no identifiable cause)

GnRH agonist (e.g. leuprolide) + GH therapy:
GnRH agonists overstimulate pituitary à desensitisation à arrest puberty

· GH therapy used as GnRH agonists can stunt growth

GnRH agonist + cryproterone (anti-androgen)
Supresses peripheral androgen action

o Gonadotrophin-Independent Precocious Puberty (exclude neoplasms):
McCune Albright or Testotoxicosis: 1st: ketoconazole or cyproterone; 2nd: aromatase inhibitors
CAH: hydrocortisone + GnRH agonist

93
Q

achondroplasia vs hypochondroplasia?

A

o Achondroplasia (S/S: arms and legs short, normal length thorax)

o Hypochondroplasia (S/S: small stature, micromelia (small extremities), large head

94
Q

Signs of Osteogenesis imperfecta?

A

S/S: blue sclera, short stature, loose joints, hearing loss, breathing problems

o Types = 7 forms (type 1 is the most common = abnormal pro-alpha 1 or 2 collagen polypeptides)

95
Q

What gene is associated with achondroplasia, hypochondroplasia?

A

FGFR3 gene

96
Q

Isolated short stature in a young girl, must exclude what?

A

Turner’s syndrome (45XO)

97
Q

What arteries can be investigated using doppler USS?

A

Umbilical artery, foetal vessels, uterine artery

98
Q

Mutation associated with skeletal dysplasias?

A

FGFR3

99
Q

TTTS is graded in severity according to which scale?

A

Quintero staging

100
Q

Causes of pre-term labour?

A

Cervical weakness, infection (chorioamnioitis), uterine abnormalities,

101
Q

Risk factors for placental abruption:

A

Pre-eclampsia

Hypertension

Previous abruption

Trauma

Smoking

Cocaine

Multiple pregnancy

Polyhydramnios

Thrombophilia

Advanced maternal age

PPROM

102
Q

Indomethacin causes what?

A

Ductus arteriosus closure

103
Q

What maintains PDA?

A

Prostaglandin E1

104
Q

PPROM at 37 weeks gestation?

A

Immediate induction of labour is advised in women > 37 weeks gestation

105
Q

Conservative management of PPROM

A

Conservative Management

Intensive clinical surveillance for signs of chorioamnionitis (including regular recording of maternal temperature, heart rate, CTG and maternal biochemistry)

Rising WCC or CRP indicates development of chorioamnionitis

Lower genital tract swabs are routinely taken but cultures do NOT correlate well with risk of chorioamnionitis

Tocolysis is CONTRAINDICATED due to the increased risk of maternal and foetal infection in patients with PPROM

106
Q

Medication to reduce preterm birth in those with previous history

A

IM hydroxyprogesterone caproate

107
Q

Antibiotics in PPROM

A

Offer women with PPROM oral erythromycin 250 mg 4/day for a maximum of 10 days or until the woman is in established labour

If erythromycin is not tolerated or contra-indicated, consider oral penicillin

108
Q

When to consider cervical cerclage in PPROM

A

Consider rescue cervical cerclage for women between 16-27 weeks with a dilated cervix and exposed, unruptured foetal membranes

Take into account gestational age (benefits are greater for earlier gestations) and extent of cervical dilatation

Explain to women:

Risks of rescue cerclage

That it aims to delay birth, thereby increasing the likelihood of the baby surviving and of reducing serious neonatal morbidity

109
Q

Diagnosing Preterm Labour with Intact Membranes

A

Clinical history taking

Observations

Speculum examination (and digital vaginal examination if the extent of cervical dilatation cannot be assessed)

If clinical assessment suggests that the woman is in preterm labour and she is < 29+6 weeks pregnant, advise that treatment is necessary

If clinical assessment suggests that the woman is in preterm labour and she is > 30 weeks pregnant

Consider transvaginal ultrasound measurement of cervical length to determine likelihood of birth within 48 hours

If cervical length > 15 mm explain that it is unlikely that she is in preterm labour

If cervical length < 15 mm make a diagnosis of preterm labour and treat accordingly

Consider foetal fibronectin testing if transvaginal measurement of cervical length is unavailable or unacceptable

If negative (concentration < 50 ng/mL) explain that they are unlikely to be in preterm labour

If positive (concentration > 50 ng/mL) make a diagnosis of preterm labour and treat accordingly

V Flashcards (17 decks)

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