Written Flashcards
When is the active phase of the first stage of labour considered to be abnormal?
Cervical dilatation of less than 2cm in 4 hours
How should the active stage of labour be managed?
10iU oxytocin with the birth of the anterior shoulder
How often should foetal HR be checked if there are no indications for continuous CTG?
15 minutes
How often should frequency of contractions be checked in labour?
Every 30 minutes
How often should maternal HR be checked in labour?
Every hour
How often should maternal BP & temperature be checked, and how often should a vaginal exam be performed in labour?
4 hours
How long after birth should maternal obs be checked?
2 hours
When should APGAR score be checked?
1, 5, 10 mins post birth
When should breastfeeding be initiated?
Within the 1st hour after birth
When should vitamin K be administered to a newborn?
In the delivery room
When should vaginal progesterone be used to prevent preterm labour?
16-24wks
If Hx spontaneous preterm birth
If Hx mid trimester loss
If cervical length <25mm on TV USS
How is preterm labour managed?
Maternal Corticosteroids
Tocolytics (Nifedipine, Atosiban)
IV Magnesium Sulphate
What is the antidote for magnesium sulphate toxicity?
Calcium Gluconate
How is P-PROM managed?
Speculum
Erythromycin
Betamethasone
Magnesium Sulphate
How is PROM managed with clear amniotic fluid?
Admit, 24h foetal surveillance
Offer IOL after 24h
How long should you monitor a neonate for signs of infection after delivery with PROM?
12 hours
How is shoulder Dystocia managed?
Call for help Mcrobert's Manoeuvre with suprapubic pressure Episiotomy Rubin II Wood's Screw Deliver posterior arm
What is the risk of delivering the posterior arm in shoulder dystocia?
Humeral fractures
How is breech managed?
ECV at 36 if P0, 37 if PX
If declined, CS/breech delivery
How would you manage delivery if the baby is in the mento-posterior position (chin posterior)?
C Section
What is the main risk of vaginal prostaglandins in induction of labour?
Uterine Hyperstimulation
What is the main risk of artificial rupture of membranes?
Umbilical Cord Prolapse
How would you induce labour in a woman with a bishop’s score of more than 6?
Amniotomy
How would you induce labour in a woman with a bishop’s score of 6 or less?
Vaginal Prostaglandin if no Hx of hyperstimulation
Balloon catheter otherwise
How should you proceed if 2 hours after amniotomy labour has not begun?
IV Syntocinon
How should you proceed if umbilical cord prolapse is suspected?
Call for help
Continuous CTG
Theatre for immediate delivery
Elevate presenting part, reposition mother to all fours
How does PPH prophylaxis differ in C Section vs Vaginal delivery?
Vaginal -> IM oxytocin
CS -> IV Oxytocin
How should chronic hypertension be managed in pregnancy?
Labetalol -> Nifedipine
Aspirin from 12wks to birth
Growth scans every 4 weeks
How often should diabetics monitor glucose during pregnancy?
7x a day
How is thyrotoxicosis managed in the postpartum period?
Propranolol
Which drug should be avoided in the intrapartum period in asthmatics and those with heart disease?
Ergometrine
What is the second line treatment for UTI in pregnant women?
Amoxicillin
Cefalexin
How is toxoplasmosis treated in a pregnant woman?
Spiramycin
Which drug may be used to treat pregnant women with a high viral load of hepatitis B?
Tenofovir
How are neonates treated when mum had hep B?
Hep B Ig and Hep B vaccine given within 24h
What is the third line treatment for gestational hypertension?
Methyldopa
How should methyldopa use be managed in the postpartum period?
Stopped within 2 days of birth
How long after resolution should someone take a pregnancy test to see if their miscarriage is complete?
3 Weeks
What is the first line option for medical management of miscarriage?
Vaginal Misoprostol
What is the first line option for medical management of an ectopic?
Methotrexate
How would you follow up after salpingotomy for ectopic?
serum hCG every week until negative
How would you follow up after salpingectomy for ectopic?
Pregnancy test after 3 weeks
What is the first line management for molar pregnancies?
Suction curettage
For how long after sex can Ulipristal be used as emergency contraception?
120 hours
For how long can Levonorgestrel be used as emergency contraception after upsi?
72 hours
What is the recommended form of emergency contraception for women with a bmi >26?
EllaOne (Ulipristal)
Missed 2 coc pills in week 1?
Take 2 pills
Use condoms for 7 days
Emergency contraception
Missed 2 coc pills in week 2?
Take 2 pills
Use condoms for 7 days
No need for emergency contraception
Missed 2 coc pills in week 3?
2 Pills
Use condoms for 7 days
Finish current pack and omit pill-free break
How long should you use condoms if starting POP in the first 5 days of your cycle?
No need, immediate protection
How should cleft palates be managed surgically?
Primary lip closure at 3m
Primary closure at 6-12m
How should a neonate with cmv be managed?
Barrier nursing
Valganciclovir
How should neonatal conjunctivitis be managed?
Same day referral to Opthalmologist
Chloramphenicol eye drops if mild
What might 10% of children with Down Syndrome display on FBC?
Transient Abnormal Myelopoiesis
How is neonatal GBS managed?
Penicillin (Benpen if csf +ve)
Gentamicin
When is exchange transfusion indicated in a neonate?
Rapidly rising bilirubin despite phototherapy
Significant anaemia <100
How is NEC managed?
Stop feeding
NG Tube
Cefotaxime and Vancomycin
Surgery if failure to respond
When is IV dextrose indicated in a neonate?
<1.5
Symptomatic
How is persistent pulmonary hypertension of the newborn managed?
Maintain High kPa
Intubate
High-frequency oscillatory ventilation
Inhaled Nitric acid if demand remains high
How is Hyaline membrane disease managed?
ABC Resp Support Fluids IV Abx CXR
How is sudden infant death syndrome prevented?
Sleep on back No Overheating Feet to foot No smoking Parent's room for 6m Don't sleep w baby in same bed Breastfed
How is toxoplasmosis treated in the newborn?
Pyrimethamine
Sulfadiazine
Folinic Acid
How is tracheoesophageal fistula managed?
Surgery
When should antibiotics be used in management of transient tachypnoea of the newborn?
Persistent tachypnoea after 4-6h
How is paediatric aortic stenosis managed?
Balloon Valvulotomy
Transcatheter Aortic Valve Replacement if severe
When is paediatric ASD treated?
Pulmonary to Systemic Blood Flow ratio >1.5
If symptomatic
How is paediatric ASD treated?
Transcatheter closure
Open heart surgery
How is the hyperoxia test carried out?
10 minutes 100% oxygen
If sats remain low = likely congenital cyanotic heart disease
What may be used to close a PDA if medical management fails?
Surgical Ligation
Percutaneous catheter
How is acute rheumatic fever treated?
High dose aspirin
Benzathine Benzylpenicillin if signs of persistent infection
How is TOF managed?
Prostaglandin E1
Blalock-Taussig Shunt
Surgery after 4 months
How is transposition of the great arteries managed?
Prostaglandin E1
Balloon Atrial Septostomy
What is a Blalock-Taussig Shunt?
Maintains shunt between subclavian and pulmonary arteries
What can be used to stop fainting when warning signs appear?
Physical counter-pressure manoeuvres and tilt training
How are VSDs managed?
Observation
Prophylactic Amoxicillin
Surgical repair if large (3-6m)
When should antibiotics be used in acute otitis media?
Amoxicillin if systemically unwell or rapid deterioration
Which Abx are indicated in Acute Epiglottitis?
Ceftriaxone
Rifampicin prophylaxis to close contacts
How is rapidly developing angioedema managed?
Chlorphenamine
Hydrocortisone
How should asthma be managed in a 5-16yo if an LTRA is ineffective?
Stop LTRA, add LABA
No? Switch to a MART regime
No? Increase to Moderate ICS
No? Seek advice (maybe high dose/theophylline)
How is a severe asthma attack defined?
33-50% Can't complete sentences Sats less than 92 HR > 125 RR > 30 Accessory Muscle use
How is a life-threatening asthma attack defined?
<33% PEFR Sats less than 92% Altered consciousness Exhaustion Silent Chest Hyptoension Cyanosis
How is a life threatening asthma attack managed?
Admit Oxygen aim 94-98% Nebulised Salbutamol Nebulised Ipratropium Nebulised Magnesium Sulphate Prednisolone
Which screening should be done in a child with bronchiectasis?
Sweat test
Antibody Deficiency
How should children with bronchiectasis be managed?
Strep & Flu vaccines
Empirical antibiotics in acute exacerbation
Name an antiviral which may be used in paediatric COVID 19?
Remdesivir
How should severe croup be managed?
Oral Dexamethasone
Oxygen
Nebulised Adrenaline
What is the first line mucoactive agent used for prophylaxis in CF?
rhDNase
What is the second line mucoactive agent used for prophylaxis in CF?
Hypertonic sodium chloride
What is the third line mucoactive agent used for prophylaxis in CF?
mannitol dry powder
What should be used to treat chronic infection in a patient with cystic fibrosis?
Colistimethate sodium
Tobramycin
What should be used to treat intestinal obstruction in CF?
Gastrograffin (diatrizote)
How is foreign body inhalation managed?
Cough
Back Blow/Heimlich
Flexible/Rigid Bronchoscopy
Surgery
How is diptheria managed?
Isolate
BenPen
How is laryngitis managed?
Cefalozin
Cefalexin
Which antibiotic is used for Scarlet Fever?
Phenoxymethylpenicillin (Pen V)
How would you determine if a child needs antibiotics for tonsilitis?
CENTOR score 3 or 4 Fever Exudate No cough LAD 3-14years
How is viral episodic wheeze managed?
Burst Therapy salbutamol
10 puffs using high volume spacer, every 30-60s do a puff
What regimen would you give to a child in need of fluid resuscitation?
0.9% NaCl 20ml/kg in less than 10 mins
How is dehydration corrected in children?
% dehydration x kg x 10
What are routine maintenance fluids for children?
100ml/kg 0-10kg
50ml/kg 10-20kg
20ml/kg over 20kg
Over 24h
How are formula fed children with GORD managed?
Smaller feeds Thick formula Alginate PPI Refer
How are paediatric inguinal hernias managed?
Reducible? Manual reduction & elective surgery
Non-Reducible? Emergency manual reduction and repair after 48h
How are paediatric umbilical hernias managed?
small? observe until 4-5
Large? Elective repair at 2-3
How is Hirchsprung’s managed?
Bowel irrigation
Anorectal pull through
Which strategies might be used to calm a crying infant?
Holding
Gentle Motion
White Noise
Warm bath
How is intussusception managed?
IV Fluids NG Tube Rectal air insufflation Contrast enema Clindamycin, Gentamicin Surgery
How is malrotation managed?
Ladd procedure
Cefazolin
How is pyloric stenosis managed?
Ramstedt Pyloromyotomy after electrolyte correction
How is volvulus managed?
Ladd Procedure
How is biliary atresia managed?
Kasai Hepatopotoenterostomy
How is localised impetigo managed?
Hydrogen peroxide
How is widespread impetigo managed?
Topical Fusidic Acid -> Oral Fluclox
How would you manage a patient with Acne Vulgaris that hasn’t responded to 2 courses of antibiotics and is scarring?
Refer for consideration for Isotretinoin
How is eczema managed?
Emollient -> Steroid
How is erysepilas managed?
Pen V
What is the first line management for guttate psoriasis?
Phototherapy
How are haemangiomas causing functional impairment managed?
Beta Blocker
Steroid
Surgery if severe and unresponsive
How would you manage candida nappy rash?
Topical Imidazole
Name one treatment which may be used in the management of Pediculosis.
Dimeticone lotion
How is scabies managed?
Topical Permethrin
How is TTP managed?
Plasmapheresis
For how long is a congenital hydrocoele considered normal?
2 years
What must be present for a boy to undergo surgery after 3m for hypospadias repair?
Foreskin
What is the aim of hypospadias repair?
Straight Erection
Straight urination
How is Paraphimosis managed?
Surgery, unless acute and not necrotic -> manipulation/puncture therapy
How is retinoblastoma treated in a patient with gross vitreous seeding present?
Enucleation
What may happen if you use desmopressin in children under 1?
Hyponatraemia and Seizures
Name one x ray finding in SUFE.
Trethowan’s Sign
When should you offer medication to a child with ADHD?
Specialist advice after support groups fail.
How would you manage paediatric absence seizures?
Ethosuximide
How would you manage paediatric tonic-clonic seizures?
Sodium Valproate
How can you manage migraine in under 18s?
Nasal triptans
How is status epilepticus managed?
ABCDE
IV Lorazepam/ Buccal Midazolam/Rectal Diazepam
Second dose
Phenytoin
Induce anaesthesia with thiopental sodium
How is West Syndrome managed?
Corticosteroids
How long should it take to replace fluid in DKA?
48 hours
How is myopia managed?
Concave lenses
How is hypermetropia managed?
Convex lenses
How might gonadotrophin dependent precocious puberty be managed?
GnRH Agonist (Leuprolide) GH Therapy
How is congenital adrenal hyperplasia managed?
Life long glucocorticoids
Mineralocorticoids if salt losing
What are the main risk factors for miscarriage?
Increasing Age Hx Chronic Disease Uterine Abnormalities (Including cone biopsies) Smoking/Drug use Weight Invasive prenatal testing
When can a child with scarlet fever return to school?
24h after commencing antibiotics
Why is trace glycosuria common in pregnancy?
Increased GFR
Reduction in tubular reabsorption of filtered glucose
When should you investigate glycosuria further in pregnancy?
1+ 2 or more times
2+ once
Which contraceptive is associated with weight gain?
Injectable Progesterone (Depo-Provera)
For how long after TOP might a pregnancy test remain positive?
4 weeks
Why should you avoid aspirin when breastfeeding?
Risk of Reye Syndrome
What is the school exclusion advice for hand, foot and mouth disease?
No exclusion required
When do infants begin to parallel play?
2 years (Two parallel lines)
How would you confirm menopause/premature ovarian failure?
Raised FSH
Which drug might be used as a deterrent to alcohol use by making it so you violently throw up on consumption?
Disulfiram
Which drug might be used to stop alcohol cravings?
Acamprosate
Which drug, taken sublingually, provides an alternative opiate replacement therapy to methadone?
Buprenorphine
At what age can a child hop on one leg?
3-4y
At what age can a child pull to standing
8-10m
At what age can a child squat?
18m
What is the second line therapy for viral-induced wheeze?
Oral Montelukast or Inhaled corticosteroids
What is required for an instrumental delivery to be considered?
FORCEPS Fully dilated cervix OA position Ruptured membranes Cephalic Engaged presenting part Pain Relief Sphincter (bladder) empty
When is the presenting part considered engaged?
At or below the ischial spines
How is SUFE managed?
Referall to orthopaedics for in situ fixation with a cannulated screw
How is COCP use managed pre and peri-operatively?
Stopped 4 weeks before
Use POP
Restart after mobilisation
What is the triad of results seen on FBC that may indicate ALL in a child?
Neutropaenia
Anaemia
Thrombocytopaenia
What is the algorithm for newborn resuscitation?
Dry the baby and start the clock
Assess tone, breathing and HR
5 inflation breaths
If not adequate, start chest compressions at 3:1 ratio
When is CVS done?
11-13+6 weeks
When is amniocentesis done?
Week 15+
What is the risk of miscarriage in CVS?
1-2%
What is the risk of miscarriage in Amniocentesis?
0.5-1%
How should you proceed if a child younger than 3m old presents with a suspected UTI in GP?
Refer for immediate assessment in secondary care
Which side effects are common with Ipramine?
Dry Mouth
Blurred Vision
A child presents with a multiloculated, hetereogenous cyst above the hyoid bone. What is the most likely diagnosis?
Dermoid Cyst
A child presents with a soft, transilluminate cyst in the posterior triangle of the neck. What is the most likely diagnosis?
Cystic Hygroma
A child presents with a lateral neck cyst which is smooth, fluid filled and has an anechoic appearance on ultrasound. What is the likely diagnosis?
Branchial Cyst
Which location for an ectopic pregnancy carries the highest risk of rupture?
Isthmus
Can bilirubin be measured transcutaneously in the first day of life?
No
What is checked at a booking appointment?
BP Urine Culture BMI Hep B, HIV, Syphylis Rhesus Group and Save
What causes primary amenorrhoea in Turner’s Syndrome?
Gonadal Dysgenesis = high FSH/LH
What are the signs of meconium aspiration syndrome on CXR?
Atelectasis
Patchy Infiltrations
What is the triad for shaken baby syndrome?
Subdural Haematoma
Retinal Haemorrhages
Encepalopathy
How should secondary dysmenorrhoea be managed in the first instance in primary care?
Referral to gynaecology
Name one complication of SSRI use in the third trimester.
Persistent Pulmonary Hypertension of the Newborn
What is the typical prodrome of measles?
Cough, Coryza, Conjunctivitis, cKoplik White Spots
What effect may smoking cessation have on clozapine levels?
Increase
What happens if two COCP pills are missed in the second week of the cycle and the patient has unprotected sex?
No emergency contraception needed as long as first week taken properly
Which form of HRT can be used in a patient with migraine with aura?
Combined -> not contraindicated like COCP
Topical > Oral
Name one absolute contraindication to HRT
Unexplained Vaginal Bleeding
Which scoring test is used to screen for depression?
PHQ-9
What is the key feature of Schizotypal Personality Disorder?
‘Magical Thinking’, Obsession with the paranormal
Odd tone to speech
When can an IUS be used for contraception/ menorrhagia in the presence of fibroids?
Less than 3cm
Not distorting the Uterine Cavity
How is Whooping Cough managed?
Oral Clarithromycin/Azithromycin if within 21 days of onset of cough
When is a radical trachelectomy indicated?
1A2 cervical tumours when the patient wants fertility preserved
Which tests make up the quadruple assessment?
Total hCG
Unconjugated Oestradiol
AFP
Inhibin A
What is the downside for the quadruple test vs the combined test?
4% false positive vs 2%
How might you treat a pregnant woman with breast cancer in the second/third trimesters?
Chemotherapy
Radiotherapy only if lifesaving
Not Tamoxifen
Which term describes firm placental adhesion without extending through the full myometrium?
Placental Accreta
Which term describes firm adhesion of the placenta which extends through the myometrium?
Placental Increta
Which term describes firm adhesion of the placenta with extends through the full myometrium and beyond?
Placental Percreta
What are the risk factors for Placental adhesion disorders?
Asherman’s Syndrome
Uterine Scarring
At what gestation is the earliest you should consider giving steroids for lung maturation?
24 Weeks
How would you investigate a potential PE in a pregnant woman?
V/P scan > CTPA
What happens to stroke volume in pregnancy?
Increases
30% higher by third trimester
What causes anaemia in pregnancy?
Haemodilution by increased plasma volume
What is the failure rate of female sterilisation?
1 in 200
When is warfarin contraindicated in pregnancy?
Third Trimester
Which drug should be offered to treat PE in pregnancy?
Enoxaparin
How does Vasa Praevia typically present?
Painless bleed at the time of rupture of membranes with subsequent foetal compromise
How should you manage a patient found to be in in eclampsia acutely?
ABCDE
Left lateral tilt
Protect Airway
Prepare Magnesium
What are the main complications of Obstetric Cholestasis?
Stillbirth
Preterm Labour
Meconium stained liquor
How do you deal with potential chorioamnionitis pre-24 weeks?
Antibiotics Induce labour (unviable)
Are pre-eclampsia, small for age, a scarred uterus and oligohydramnios complete contraindications to ECV?
No, only relative
How do you manage T1 diabetes post delivery, if the patient was put on a sliding scale during pregnancy?
Return to pre-pregnancy meds once eating and drinking
What risks does SLE bring to a pregnancy?
Miscarriage Foetal Death Pre-eclampsia Preterm Delivery Foetal growth Restriction
What does a patient have if they present, pregnant, with a maculopapular rash, starting as stretch marks before spreading, but with peri-umbilical sparing?
Pruritic urticarial papules and plaques of pregnancy (PUPP)
A pregnant lady presents with blisters that started in the umbilicus and spread. What is the likely diagnosis?
Pemphigoid Gestationis
What is the range for protein-creatinine ratio in pregnancy?
<30
Higher may indicate pre-eclampsia when joined by hypertension
How would you manage a patient who wants a TOP, is haemodynamically stable and has a suspected pseudocyst seen on transvaginal Ultrasound?
B-HCG 48h apart. >67% rise indicates viable intrauterine pregnancy and so can have TOP. Suboptimal rise = likely ectopic
What effect does PCOS have on risk of ovarian and breast cancer?
No increased risk
What is the main role of progesterone?
Enhance endometrial receptivity
What are the main roles of oestrogen?
Stimulate endometrial growth
Increase fat deposition
Increase Bone resorption
Stimulate uterine growth
What is the first line treatment for heavy menstrual bleeding?
IUS
Which analgesia would you use during labour if the patient is failing to progress and the baby is unlikely to be born for a while?
Epidural
What defines a pathological ctg trace?
2 non-reassuring features
1 pathological feature
What are the non-reassuring ctg features?
160-180/100-109 bpm
<5bpm variability for 40-90min
Absent accelerations, otherwise normal trace
Variable decelerations/Single prolonged less than 3 mins
What are the pathological ctg features?
> 180/<100bpm
<5beats variability for 90min
Atypical variable decelerations over 50% contractions/late decelerations for over 30min
Single prolonged deceleration >3min
When must you not give an epidural to a woman in labour?
Hypotensive
Allergies
Systemic infection/infection over epidural site
Bleeding disorders
A woman presents 48 hours after delivery with SOB, tachypnoea and signs of congestive heart failure. CXR shows pulmonary oedema and cardiomegaly. What is the most likely diagnosis?
Postpartum Cardiomyopathy
A newborn presents with hydrocephalus, and chorioretinitis. They are observed to be microcephalic. What is the likely cause?
Toxoplasmosis gondii
How are bartholin’s abscesses treated?
Marsupialisation: Surgery where the abscess is opened and the lining sutured open, so the gland doesn’t later become blocked again
Which cancer does the COCP protect against?
Ovarian
How would you identify a vesico-vaginal fistula?
Pass a a catheter and fill the bladder with methylene blue dye.
Perform speculum to see if dye is in the vagina
What is Meig’s Syndrome
Right sided pleural effusion associated with an ovarian fibroma
How is Risk of Malignancy Score calculated?
One point per ultrasound feature = U U x CA-125 (x3 if post-meonopausal) >250 = 75% cancer 50-250 = 20% cancer <50 = 3% cancer
Which form of hormonal contraception can be used in patients also taking enzyme-inducing drugs?
Depo-provera
Name 4 potential complications of chickenpox.
Disseminated haemorrhagic chickenpox
Secondary Bacterial Infection
Encephalitis
Pneumonia
What are the poor prognostic factors for ALL?
<2yo >10yo
B/T Cell surface markers
WCC >20*10^9/l
Which contraceptive method shouldn’t be used over the age of 50, and why?
Injectable, increases risk of osteoproosis
What proportion of patients with hypospadias also have cryptochordism?
10%
What is the algorithm for management of PPH?
Uterine Compression IV syntocinon Ergometrine ( X HTN) Syntocinon Carboprost Misoprostol (X Asthma)
How is Phimosis managed?
<2yo normal, reassure
What is the first line surgical management for uterine atony?
Itrauterine Balloon Tamponade
Which type of incontinence is associated with tricyclic antidepressants?
Overflow
Which medication is used from 12-14 weeks to prevent pre-eclampsia in high risk individuals?
Low dose aspirin
How long after taking Ulipristal Acetate should you wait before restarting hormonal contraception?
5 days
Which pulse abnormality is associated with PDA?
Collapsing Pulse
Which bacteria causes necrotising fasciitis derived from chickenpox lesions?
GAS
Which medications used for neuropathic pain might cause urinary retention?
Tricyclic Antidepressants
Which emergency contraception is most effective in those with high BMIs?
Copper Coil
Which screening test is used for post-natal depression?
Edinburgh Scale
What are the core symptoms of depression?
Anhedonia
Anergia
Low Mood
What is the first line treatment for primary dysmenorrhoea?
NSAIDS (Mefenamic Acid)
What is the first line non-hormonal management for menorrhagia?
Tranexamic Acid
How would you medically manage abortion?
Oral Mifepristone
Vaginal Prostaglandin
What UKMEC risk level are anti-phospholipid antibodies with regards to the COCP?
4 - Unacceptable risk
Which type of amnesia more commonly occurs due to ECT?
Retrograde, remembering events before the procedure
A teenager presents with intermittent locking of their left knee with pain after jogging. What is the likely diagnosis?
Osteochondritis Dissicans
Which conditions not usually seen in females might present in those with Turner’s Syndrome?
X-Linked Disorders, due to the XO genotype
Which conditions are associated with neonatal hypotonia?
Prader-Willi
Hypothyroidism
Spinal Muscular Atrophy
Neonatal Sepsis
When should a small umbilical hernia be referred for surgical repair?
5yo
If 2 COCP pills are missed in week 1, what would you do if the patient had unprotected sex?
2 pills
Emergency
Barrier for 7d
An elderly woman presents with a single episode of brown stained vaginal discharge. What is the most likely diagnosis?
Atrophic Vaginitis
A woman at 32 weeks gestation presents with reduced foetal movements, bradycardia and haematuria. She also complains of severe suprapubic pain. She has a history of 2 previous C-Sections. What is the most likely diagnosis?
Uterine Rupture
What is the most appropriate set of actions when called to assess an agitated patient in hospital?
Assess the patient in an appropriate environment with another person present. Then telephone a consultant and prescribe a tranquiliser.
A child with eczema presents with blistering lesions, malaise and fever. What is the most likely diagnosis?
Dermatitis Herpetiformis
A woman presents with a small amount of red blood on wiping after sex. Smear and ultrasound both return normal. What is the next best step in investigation?
Hysteroscopy and Biopsy
A patient presents with secondary amenorrhoea. She is found to have a prolactin of 7000 and low LH. What is the most likely diagnosis?
Prolactinoma
A 38 year old woman presents with secondary amenorrhoea for 6 months. She is found to have a high FSH and LH. What is the most likely diagnosis?
Premature Ovarian Failure
A girl presents with secondary amenorrhoea. She is found to have a lacy black rash in her axilla. What is the likely diagnosis?
PCOS (Acanthosis Nigricans)
How would you deliver if one twin is breech and the other cephalic?
C-Section
