Obs/Gyn
How large is the transverse diameter of the maternal pelvic inlet
13cm
Three causes of EONS
GBS
Listeria
E.Coli
The first-line management of severe or iatrogenic benzodiazepine overdose is
Major risk of this drug?
Flumazenil
Seizures
What is the screening for breast cancer and for what ages?
how often?
Mammogram
50-70yo
every 3 years
What is the worst specialty in medicine
Anything but Derm
First-line management of trichomoniasis
PO Metronidazole
Fine motor at 9 months
Inferior pincer
Object permanence
What are the “first-rank” symptoms of schizophrenia
1. Auditory hallucinations
2. Thought disorder (insertion, withdrawal, broadcast)
3. Passivity phenomena (made feelings, impulses, actions)
4. Delusional perception
What assessment is used to assess for frailty and what score indicates frailty?
CFS
≥5
When making a tierlist for international cuisines, where does Arab food rank
Whatever the lowest answer is
What is the most significant risk factor for umbilical cord prolapse?
When the fetus is in an abnormal lie after 37 weeks gestation
A 5-week-old infant is brought to clinic with persistent jaundice since birth, pale chalky stools, and dark urine. Examination reveals hepatomegaly. Bloods show a conjugated hyperbilirubinaemia. An ultrasound shows an absent or abnormal gallbladder.
What surgical procedure is required to manage this condition, and within what timeframe must it be performed to optimise outcomes?
Kauai Procedure
within 60 days
A 34-year-old man with a history of epilepsy presents to his GP with a 3-month history of low mood, anhedonia, fatigue, and poor sleep. He scores 19 on the PHQ-9. Which of the following is the most appropriate first-line treatment?
A) Guided self-help
B) CBT alone
C) Fluoxetine
D) Amitriptyline
E) Citalopram
Citalopram
A 74-year-old man with advanced prostate cancer and Parkinson’s disease is admitted to the hospice. He is no longer able to swallow and is in the last days of life. The palliative care team decide to commence a syringe driver. He is experiencing pain, nausea, and agitation. The junior doctor proposes prescribing haloperidol for nausea as part of the syringe driver.
Why is this inappropriate, and what would you prescribe instead for each of his three symptoms?
Haloperidol is a dopamine antagonist and is contraindicated in Parkinson’s disease as it will worsen motor symptom
Levomepromazine
When the coach came late because the bridge in Ipswich was closed what time did we get picked up?
Cant remember
A 26-year-old woman, 4 days post-vaginal delivery, presents with a temperature of 38.9°C, uterine tenderness, offensive lochia, and a heart rate of 112 bpm. She appears flushed and unwell. Observations show BP 98/64 mmHg and RR 22/min.
What is the first-line broad-spectrum antibiotic regimen that should be initiated?
Piperacillin-tazobactam (Tazocin) + Clindamyci
A 3-year-old boy presents with a 6-day history of high fever unresponsive to antipyretics. On examination he has bilateral non-purulent conjunctival injection, a strawberry tongue, cracked red lips, a polymorphous rash over his trunk, and swelling and erythema of his hands and feet.
What is the diagnosis, and what are the diagnostic criteria that must be met to confirm it?
Fever ≥5 days PLUS at least 4 of the following CRASH criteria:
A 42-year-old man with schizophrenia was started on haloperidol 2 weeks ago. He presents to A&E with a temperature of 39.8°C, severe muscle rigidity, fluctuating consciousness, and a blood pressure of 168/102 mmHg. His CK is markedly elevated at 4200 U/L.
What is the most likely diagnosis? List its cardinal features [5].
NMS
• Myoglobinuria
• Fever
• Encephalopathy → Agitated delirium with confusion
• Vital instability (Tachycardia, HTN, tachypnoea)
• Increased muscle Enzymes (CK)
• Rigidity
A 58-year-old woman presents with a 6cm hard irregular lump in the upper outer quadrant of her right breast with skin tethering. She has no significant past medical history. Following a triple assessment, core biopsy confirms invasive ductal carcinoma (ER+, HER2-). Axillary ultrasound reveals 5 pathologically enlarged lymph nodes, confirmed malignant on fine needle aspiration.
Outline the full management of this patient.
Surgery - Mastectomy
Radiotherapy
Hormone therapy
Annual mammography for 5 years
A 24-year-old contact lens wearer presents with a 2-day history of severe right eye pain, photophobia, reduced vision, and purulent discharge. He admits to swimming in his contact lenses last week. On examination there is ciliary injection and a corneal ulcer with a white infiltrate visible on the cornea.
Given the diagnosis what is the first-line management?
TOP Ofloxacin
Give at least two second line and two final line interventions that are performed in shoulder dystocia after McRoberts manoeuvre + Suprapubic pressure
List ten red flag features from the NICE Traffic Light System
1. Pale/mottled/ashen/blue colour
2. No response to social cues
3. Appears ill to a healthcare professional
4. Does not wake or if roused does not stay awake
5. Weak, high-pitched or continuous cry
6. Grunting
7. RR >60 breaths/minute
8. Moderate or severe chest indrawing
9. Reduced skin turgor
10. Age <3 months with temperature ≥38°C
11. Non-blanching rash
12. Bulging fontanelle
13. Neck stiffness
14. Status epilepticus
15. Focal neurological signs
16. Focal seizures
68-year-old man presents with a 6-week history of brief, frequent jerking movements of his left arm and face lasting 1-2 seconds, occurring up to 100 times per day. He has become increasingly confused and forgetful over the same period. Routine bloods reveal a sodium of 128 mmol/L. An MRI brain is unremarkable.
LGI1-receptor-antibody encephalitis
What are the domains assessed when determining capacity?
• P — Presence of a mental disorder or impairment
• L — Learn and retain information long enough to make a decision
• U — Understand the information given
• M — Make and communicate a decision
• B — Balance the information by weighing up risks and benefits
A 65-year-old man presents with a 3-month history of fatigue, night sweats, and weight loss. He also reports a 6-week history of loose stools and abdominal discomfort. Examination reveals hepatosplenomegaly and widespread small lymph nodes palpable in multiple nodal regions. Blood tests show a raised WBC with lymphocytosis. A lymph node biopsy shows CD5+, CD23-, cyclin D1 positive cells with a high Ki-67 index. Cytogenetics reveal a t(11;14) translocation.
What is the diagnosis?
Mantle Cell Lymphoma