Qs Flashcards

Question

Which progesterones would be more useful for reduced libido C15 C19 C21 C24 C30

Answer 1

Which progesterones would be more useful for reduced libido C15 **C19** - more like 'male progesterones' C21 C24 C30

Answer 2

**Measure FSH** * FSH >30 IU/l (>25 IU/l if < 40 years) * 2 samples >4 weeks apart

Answer 3

A women is having mono-chorionic twins. When would a planned C-section occur? 35 weeks 36 weeks **37 weeks** 38 weeks 39 weeks

Answer 4

A women is having di-chorionic twins. When would a planned C-section occur? 35 weeks 36 weeks 37 weeks **38 weeks** 39 weeks

Answer 5

**34 weeks**

Answer 6

Attempts at Pseudomonas aeruginosa eradication are important in patients with cystic fibrosis - **Commence nebulised colistin and oral ciprofloxacin**

Answer 7

azithromycin is used in CF management, it is primarily used as an anti-inflammatory agent rather than for its antimicrobial properties against Pseudomonas. **Long-term azithromycin is typically reserved for patients with chronic Pseudomonas infection** to reduce exacerbation frequency and improve lung function through its immunomodulatory effects, not as an eradication strategy for first isolation.

Answer 8

Systemic vasculitic symptoms in the presence of hepatitis B signs and in the absence of pulmonary symptoms/signs suggests a diagnosis **polyarteritis nodosa**

Answer 9

Infantile colic normally improves around 3-4 months of age and resolves around **6 months of age**

Answer 10

Hypertension in pregnancy in usually defined as: * **systolic > 140 mmHg or diastolic > 90 mmHg** * or an **increase above booking readings of > 30 mmHg systolic or > 15 mmHg diastolic**

Answer 11

**conus medullaris syndrome** caused by spinal cord compression at the end of the cord just as it tapers from a cord-like structure (upper motor neurons) to peripheral nerves exiting the spine (lower motor neurons). In most patients, this is found at the L1 level. - The syndrome presents with a mixture of upper and lower motor neuron signs. **It is one of the rare causes of loss of ankle jerk reflexes (lower motor neuron signs) with upward plantar responses (upper motor neuron signs).**

Answer 12

**Internal fixation** is the method of choice for patients with good pre-morbid status with an intracapsular NOF fracture

Answer 13

**Bladder re-training exercises**

Answer 14

Renal transplant patients - **skin cancer (particularly squamous cell)** is the most common malignancy secondary to immunosuppression

Answer 15

Pregnant women with blood pressure **≥ 160/110 mmHg** are likely to be admitted and observed

Answer 16

If a newborn baby has an abnormal hearing test at birth they are offered the **auditory brainstem response** test

Answer 17

An **asymmetrical presentation** suggests **psoriatic arthritis rather than rheumatoid**

Answer 18

Management of myasthenic crisis - **intravenous immunoglobulin, plasmapheresis**

Answer 19

Locked-in syndrome - **basilar artery**

Answer 20

**Depo P**

Answer 21

they will have delayed fertlity for a **year**

Answer 22

**CVS**: 11-13+6 weeks **Amniocentesis**: 15 weeks

Answer 23

**Charcot-Marie-Tooth**

Answer 24

**polyphasic, long duration, large amplitude**

Answer 25

polyphasic, short duration, short amplitude

Answer 26

**Hypocalcaemia** hypocalcaemia (myoglobin binds calcium) elevated phosphate (released from myocytes) hyperkalaemia (may develop before renal failure)

Answer 27

Which of the following presents with UMN signs only? ALS **Primary lateral sclerosis** Progressive muscular atrophy Progressive bulbar palsy

Answer 28

**Essential tremor**

Answer 29

anti-ganglioside antibody are associated with MND MD CIDP Charcot-Marie-Tooth **GBS**

Answer 30

- **8-12Hz**

Answer 31

An essential tremor is found to be at which frequency - 1-2 Hz - 3-4 Hz **- 6-8 Hz** - 6-10 Hz - 8-12Hz

Answer 32

**Thoracic**

Answer 33

**Somatoform disorder** * Somatoform disorder describes the presence of physical symptoms that cannot be explained by a physical medical condition. It is an unconscious process, and patients are not fabricating their symptoms. Common presenting symptoms are gastrointestinal symptoms, fatigue, weakness, musculoskeletal symptoms and, as in this patient's case, abdominal pain. **Conversion disorder** * Conversion disorder is a psychiatric condition that results in a presentation of neurological symptoms without any underlying neurological cause.

Answer 34

**Keratoacanthoma** is a benign yet locally invasive skin growth which can be indistinguishable from squamous cell carcinoma clinically. **It may spontaneously resolve within a few months, however surgical excision is usually recommended first-line.** Other options if surgery is not appropriate or declined include cryotherapy, curettage or medical treatment with topical imiquimod or 5-fluorouracil.

Answer 35

**Uncomplicated, closed fractures of the humeral shaft often require nothing more than analgesia and conservative management with a basic sling**. Fractures during hoist transfers can indeed occur, particularly in people with risk factors for fragility fractures. This includes postmenopausal women who are likely to have osteoporosis, and skeletal tumours / metastases (hinted at in this patient with multiple myeloma).

Answer 36

**Pituitary tumour:** - Causes **superior bitemporal HH**

Answer 37

**CRANIOPHARYNGIOMA** - Causes inferior bitemporal HH

Answer 38

**Spinothalamic tract** - loss of pain and temp

Answer 39

Which of the following is most likely to cause psoriasis? Hypercalcaemia **Hypocalcaemia** Hyponatraemia Hyperphosphataemia Hypernatraemia

Answer 40

Which of the following might trigger psoriasis **Lisinopril ** - & BB & Lithium

Answer 41

D = **morpheaform** (or infiltrative) BCC is high-risk due to its extensive local spread and high recurrence rate.

Answer 42

Which of the following would you use for lichen sclerosus? Hydrocortisone 1% Triamcinolone acetonide 0.1% Mometasone furoate 0.1% Fluocinonide 0.05% **Clobetasol propionate 0.05%**

Answer 43

A patient present with this skin rash. They also claim to have had problems with memory and diarrhoea. Which vitamin are they most likely deficient in? **B3** - **pellegra**

Answer 44

Which of the following would you use for bullous pemphigoid? **Clobetasol propionate 0.05%** - super potent

Answer 45

A 54-year-old man with a history of poorly controlled type 2 diabetes presents to the emergency department with severe pain and swelling in his left thigh that started 12 hours ago after he fell while working in his yard. He reports the pain as deep and out of proportion to what he would expect from the small puncture wound he sustained during the fall. On examination, his temperature is 38.9°C (102°F), heart rate is 115 bpm, and blood pressure is 90/60 mmHg. The left thigh is markedly swollen, erythematous, and tender, with areas of dusky discoloration and crepitus on palpation. Laboratory results reveal a white blood cell count of 21,000/mm³ and elevated creatine kinase levels. A CT scan shows gas in the soft tissues. Which type of necrosting fasciitis is this? **Type 3** Type 1 – Polymicrobial (anaerobes + aerobes) Type 2 – Group A beta-haemolytic streptococci Type 3 – Clostridium perfringens; also associated with Vibrio species infection from seafood ingestion or water contamination of wounds. Type 4 - Fungal infection

Answer 46

Dapsone is an antibiotic which helps reduce the pruritic symptoms of Dermatitis Herpetiformis

Answer 47

A diagnosis of pemphigus vulgaris is made. IgG autoantibodies to which protein is the pathogenesis of this disease due? Collagen type XVIII **Desmoglein** Bullous pemphigoid antigen Keratin Desmoplakin

Answer 48

- **Lipids**

Answer 49

**HIV PCR**

Answer 50

**18 months** - before: use viral PCR

Answer 51

**Cryptococcus neoformans** - +ve indian ink staining

Answer 52

**HIV PCR**

Answer 53

**Cryptococcus neoformans**

Answer 54

A 37-year-old man with a history of untreated HIV presents with profuse, watery diarrhea that has persisted for over two weeks. He reports 8–10 bowel movements per day, associated with abdominal cramping, fatigue, and a 5-kg weight loss. He denies recent travel or antibiotic use. His temperature is 37.2°C (99°F), and his blood pressure is 110/70 mmHg. Laboratory results show a CD4 count of 45 cells/mm³. Stool studies are negative for leukocytes, ova, and parasites. Modified acid-fast staining of the stool reveals oocysts. Which of the following is the most likely cause of this patient’s symptoms? A) Giardia lamblia B) Clostridioides difficile **C) Cryptosporidium parvum** D) Entamoeba histolytica E) Salmonella enterica

Answer 55

**C) Cryptosporidium parvum** - **modified Ziehl-Neelsen (acid-fast) staining technique**. This method allows for the **visualization of the parasite's oocysts** in fecal smears, which can be pinkish-red on a green background.

Answer 56

**B) Diffuse large B-cell lymphoma**

Answer 57

**Mycobacterium avium complex (MAC)**

Answer 58

**Mycobacterium avium complex (MAC)**

Answer 59

**6months**

Answer 60

**12months**

Answer 61

**B) Cytomegalovirus (CMV) colitis**

Answer 62

**A) Azithromycin 1g orally as a single dose**

Answer 63

**B. HbA1c** - Rationale: Protease inhibitors can cause insulin resistance and dyslipidaemia. HbA1c is useful for monitoring glucose control over time.

Answer 64

Dolutegravir belongs to which class of antiretroviral drugs? A. Non-nucleoside reverse transcriptase inhibitor (NNRTI) B. Protease inhibitor (PI) C. Nucleoside reverse transcriptase inhibitor (NRTI) **D. Integrase strand transfer inhibitor (INSTI)** E. Entry inhibitor

Answer 65

Which drugs are used in PrEP Tenofovir disoproxil fumarate with dolutegravir Tenofovir disoproxil fumarate with efavirenz **Tenofovir disoproxil fumarate with emtricitabine** Tenofovir disoproxil fumarate with ritonavir Tenofovir disoproxil fumarate with zidovudine

Answer 66

**B) Cabotegravir + Rilpivirine**

Answer 67

Which of the following combinations contains the two drugs licensed as part of the recommended regimen for HIV post-exposure prophylaxis (PEP)? A) Tenofovir disoproxil fumarate (TDF) + Emtricitabine (FTC) B) Rilpivirine + Tenofovir alafenamide (TAF) **C) Raltegravir + Tenofovir alafenamide (TAF)** D) Tenofovir disoproxil fumarate (TDF) + Emtricitabine (FTC) + Raltegravir E) Efavirenz + Zidovudine

Answer 68

**Atazanavir**

Answer 69

Pneumocystis jirovecii pneumonia (PCP) Toxoplasma gondii Mycobacterium avium complex (MAC) Cytomegalovirus (CMV) **Cryptococcus neoformans**

Answer 70

A newborn infant is delivered to an HIV-positive mother. What is the recommended management for the infant to reduce the risk of HIV transmission? A. No treatment needed if the mother’s viral load is undetectable B. Start zidovudine monotherapy for 4–6 weeks immediately after birth C. Start combination antiretroviral therapy only if the infant tests HIV positive D. Start nevirapine alone for 12 weeks and encourage breastfeeding **E. Start zidovudine for 4–6 weeks; add nevirapine if high risk of transmission**

Answer 71

A 28-year-old patient is diagnosed with secondary syphilis. The initial RPR titre is 1:128. After appropriate treatment, which of the following changes in the RPR titre would most likely indicate successful therapy? A. RPR becomes negative immediately after treatment B. RPR titre increases to 1:256 after 3 months **C. RPR titre decreases from 1:128 to 1:32 within 6 months** D. RPR remains at 1:128 indefinitely E. RPR titre decreases from 1:128 to 1:64 within 1 month

Answer 72

titres would increase - e.g. **1:32 --> 1:128**

Answer 73

**Hypercalcaemia** - Hypercalcaemia can induce coma by causing a generalised depression of neuronal activity. This is due to the increased calcium ions interfering with the sodium channels in the neurons, leading to a decreased excitability.

Answer 74

Polar body

Answer 75

The risk of Down’s syndrome in the child of a 40-year-old woman is: 1 in 3000 1 in 1500 1 in 250 **1 in 100** 1 in 50

Answer 76

A 52-year-old woman presents with a long history of pain in both of her big toes. On examination, both affected toes are deviated laterally and there is a tender swelling of the metatarsophalangeal joints. What is the most likely diagnosis? Mallet toe Hammer toe Hallux rigidus **Hallux valgus** Claw toe

Answer 77

**Hallux rigidus** is **osteoarthritis** of the metatarsophalangeal (**MTP**) joint of the great toe.

Answer 78

A 72-year-old woman presents with bilateral shoulder pain and difficulty raising her arms, especially in the morning. Examination reveals restricted active movement due to pain, but passive range of motion is preserved; she was previously treated for subacromial bursitis with little improvement. Which of the following is the most likely diagnosis? A. Rotator cuff tear B. Osteoarthritis of the shoulder C. Subacromial bursitis **D. Polymyalgia rheumatica** E. Polymyositis

Answer 79

What is the starting dose for PMR pred? 60 mg 30 mg **15 mg** 10 mg 5 mg

Answer 80

**B. Posterior ciliary artery**

Answer 81

**Central cord syndrome**

Answer 82

**ACE inhibitors** Angiotensin-converting enzyme (ACE) inhibitors dilate the efferent renal arteriole, thus reducing intraglomerular hypertension and proteinuria, regardless of whether blood pressure is elevated or not.

Answer 83

Crown–rump length

Answer 84

The **dose is 250 IU** before **20 weeks** and **500 IU after** **20 weeks’ gestation.**

Answer 85

After all sensitizing events and delivery, a Kleihauer blood test **should be taken to ensure a higher dose of anti-D is not required if there has been particularly large fetomaternal haemorrhage (FMH).**

Answer 86

Disorganized speech and behaviour and flat affect

Answer 87

The correct answer is Gentamicin therapy. **Gentamicin** is an aminoglycoside antibiotic that is known to be ototoxic. This means it can cause damage to the inner ear, leading to sensorineural hearing loss.

Answer 88

**Type III**

Answer 89

Nail ulcers treated using iv iloprost

Answer 90

**C. Anti-centromere antibody** - Limited SSc: PAH; Diffuse: ILD

Answer 91

**Unilateral**: Enthesitis **Bilateral**: Oligoarticular

Answer 92

**D. Hypermobile Ehlers-Danlos syndrome**

Answer 93

Skin scrapings to be sent for microscopy culture and sensitivities

Answer 94

**Neurosyphilis** is one of the causes of **Charcot joint**. The disease damages the **nerves**, leading to loss of **sensation in the affected joint**. - Loss of sensation in the joint leads to repeated unrecognized trauma. This results in progressive destruction, leading to joint deformity and disability. - The process is self-perpetuating, as the deformity leads to abnormal mechanical stresses which further damage the joint.

Answer 95

**Charcot joint**

Answer 96

**Cardiac disease** Indirect maternal death refers to a death that is not directly caused by obstetric complications but is instead due to a pre-existing or newly developed health condition that is aggravated by the physiological adaptations of pregnancy.

Answer 97

Which RA treatment might cause orange urine MTX LEF MMF Cyclophosphamide **SFZ**

Answer 98

**Hydroxychloroquine** - blue skin mottling

Answer 99

Phenytoin - causes macrocytic anaemia due to folate antagonsim

Answer 100

**Cervical radiculopathy**

Answer 101

The four rotator cuff muscles are: Supraspinatus – suprascapular nerve Infraspinatus – suprascapular nerve **Teres minor – axillary nerve** ✅ Subscapularis – upper and lower subscapular nerves

Answer 102

C. Loss of pain and temperature below the lesion with preserved dorsal column function

Answer 103

A 45-year-old man sustains a spinal cord injury after a motorbike crash. He has bilateral loss of motor function and pain/temperature sensation below the lesion, but vibration and proprioception are intact. What spinal cord syndrome does this describe? A. Central cord syndrome B. Brown-Séquard syndrome **C. Anterior spinal artery syndrome** D. Complete cord transection E. Posterior cord syndrome

Answer 104

D – Spinothalamic tract A – Upper limb weakness greater than lower limb weakness B – Anterior spinal artery infarct C – Ipsilateral motor and dorsal column loss, contralateral pain and temperature loss

Answer 105

A 35-year-old male with a T4 spinal cord injury presented with sudden-onset severe headache, facial flushing, and profuse sweating above the level of injury. His blood pressure was markedly elevated at 180/110 mmHg, significantly above his baseline. Upon examination, a kinked urinary catheter was identified and promptly corrected, leading to rapid resolution of symptoms. Which of the following could be a cause of this presentation? **Overdistended bladder** * An overdistended bladder is a common trigger for **autonomic dysreflexia** in individuals with spinal cord injuries at or above the T6 level. Other potential causes include bowel distension, skin irritations, or any noxious stimuli below the level of injury.

Answer 106

Conus medullaris ends at **L1/L2** L2/L3 L3/L4 L4/L5 L5/S1

Answer 107

Which of the following is the most sensitive test for an ACL injury? Anterior Drawer Test Pivot Shift Test Posterior Drawer Test **Lachman's Test** Slocum Test

Answer 108

A patient suffers from a NOF. Which artery is most likely impacted to cause avascular necrosis? **Medial circumflex femoral artery** Lateral circumflex femoral artery Artery of the ligamentum teres Obturator artery Superior gluteal artery

Answer 109

**Supraglenoid tubercle of the scapula**: - Long head of bicep is the most common cause of bicep tendon tear - which attaches here

Answer 110

**Mallet fracture** - usually caused by a traumatic impaction blow (i.e. sudden forced flexion) to the tip of the finger in the extended position.

Answer 111

A patient presents with ?spinal cord compression. Whilst you are arranging an MRI, what dose of dexamethasone would you prescribe? 6 mg 8 mg 10 mg **16 mg** 24 mg

Answer 112

Supracondylar humerus (and tibial shaft) fractures are the most common cause of **compartment syndrome**

Answer 113

**Thompson Test** (for Achilles tendon rupture) McMurray's Test (for meniscal tears in the knee) Anterior Drawer Test (Ankle) (for assessing ankle ligament instability) Lachman’s Test (for ACL injury in the knee) Talar Tilt Test (for assessing lateral ankle instability)

Answer 114

**C = metaphysis** - most vascularised in children ## Footnote **In adults: A - epiphysis**

Answer 115

Correct Answer: **A. Meralgia paresthetica** **Explanation**: **Meralgia paresthetica** is caused by compression of the **lateral femoral cutaneous nerve,** often due to increased abdominal pressure, such as from **weight** **gain**, which can compress the nerve as it passes under the inguinal ligament. This condition typically presents with sensory symptoms (numbness and tingling) on the lateral thigh, without motor weakness.

Answer 116

A patient has a dynamic hip screw placed in them. What is the recommendation for mobilisation after the surgery? **Immediate post-operative weight bearing** Non-weight bearing for 2 weeks Non-weight bearing for 4 weeks Non-weight bearing for 6 weeks

Answer 117

**Spurling’s sign**

Answer 118

It causes up to 21% of all congenital hearing loss at birth and 10% of all cases of cerebral palsy Refers to **CMV** VZV Rubella Parvovirus Toxoplasmosis

Answer 119

Which of the following best describes CMV in pregnancy Infection is most likely in first trimester; biggest risk to baby in first trimester Infection is most likely in first trimester; biggest risk to baby in third trimester Infection is most likely in third trimester; biggest risk to baby in third trimester **Infection is most likely in third trimester; biggest risk to baby in first trimester**

Answer 120

**Juvenile myoclonic epilepsy (Janz syndrome)**

Answer 121

Which of the following is most associated with paraesthesia (e.g. unilateral face), usually on waking up Juvenile myoclonic epilepsy (Janz syndrome) Lennox-Gastaut syndrome Typical (petit mal) absence seizures West Syndrome **Benign rolandic epilepsy**

Answer 122

Which of the following is most associated with EEG: slow spike? Juvenile myoclonic epilepsy (Janz syndrome) **Lennox-Gastaut syndrome** Typical (petit mal) absence seizures West Syndrome Benign rolandic epilepsy

Answer 123

Which of the following is most associated with EEG: hypsarrhythmia? Juvenile myoclonic epilepsy (Janz syndrome) Lennox-Gastaut syndrome Typical (petit mal) absence seizures **West Syndrome** Benign rolandic epilepsy

Answer 124

B – Infantile spasms (West's syndrome) C – Sodium valproate (ethosuximide is also first-line per NICE, but valproate is commonly used if other seizure types are present) C – Lennox-Gastaut syndrome D – Juvenile myoclonic epilepsy

Answer 125

C – 4–8 years B – Hypsarrhythmia C – Tuberous sclerosis C – Benign rolandic epilepsy C – Lennox-Gastaut syndrome

Answer 126

**Friedrich's ataxia**

Answer 127

**Risperidone**

Answer 128

Correct Answer(s): A Justification for correct answer(s): The symptoms described suggest the diagnosis of trigeminal neuralgia. Carbamazepine is the first-line treatment for this condition and is therefore the most appropriate option among the choices given

Answer 129

Justification for correct answer(s): The case description seems to be of migraine with a surprisingly abrupt onset of headache. It is the abrupt onset of headache is the most worrying feature and suggests a serious underlying cause. Abrupt onset of headache with visual disturbance could be due to subarachnoid haemorrhage (possibly a haemorrhage into the occipital lobe, e.g. from an intracerebral arteriovenous malformation), or haemorrhage into a pituitary macroadenoma with compression of the anterior visual pathway. Other possibilities include reversible cerebral vasoconstriction syndrome, cerebral venous sinus thrombosis or low-pressure headache, though visual disturbance would not be easily explained).

Answer 130

Abrupt onset of headache with visual disturbance could be due to **subarachnoid haemorrhage** (possibly a haemorrhage into the occipital lobe, e.g. from an intracerebral arteriovenous malformation), or **haemorrhage into a pituitary macroadenoma with compression of the anterior visual pathway**. Other possibilities include **reversible cerebral vasoconstriction syndrome, cerebral venous sinus thrombosis or low-pressure headache**, though visual disturbance would not be easily explained).

Answer 131

**Correct Answer(s): E** Justification for correct answer(s): The most likely drug contributing to the patient's hyperkalaemia is irbesartan. Irbesartan is an angiotensin II receptor blocker (ARB) commonly used to treat hypertension, especially in CKD. It leads to reduced aldosterone secretion, which in turn leads to reduced potassium secretion.

Answer 132

Correct Answer(s): D Justification for correct answer(s): This patient has developed oral candidiasis and this is most likely due to local deposition of the inhaled steroid (beclometasone dipropionate). The risk of this happening again can be reduced by using a large volume spacer as there will be less local deposition of the drug in her mouth. Changing to a dry powder or a different steroid inhaler is unlikely to help and may make things worse.

Answer 133

Correct Answer(s): E Justification for correct answer(s): Based on the low testosterone and low LH and FSH levels, the most likely cause of his presentation is a pituitary adenoma leading to hypogonadotropic hypogonadism. The pituitary adenoma would suppress the production of L

Answer 134

Justification for correct answer(s): The most appropriate management for this patient with type 1 diabetes mellitus, burning pain in his feet, difficulty sleeping, and decreased eGFR would be amitriptyline. Although duloxetine can be used in this condition it is not recommended with an eGFR <30 mL/min. Clinical guideline [CG173] Published: 20 November 2013 Last updated: 22 September 2020 https://www.nice.org.uk/guidance/cg173/chapter/Recommendations

Answer 135

**It contains 15-20 cotyledons**

Answer 136

The placenta **originates from the outer cellular layers in the blastocyst, that is the trophoblast**

Answer 137

Placental thickness is highest at the centre and is usually ~ [] cm **2.5** 3.5. 4.5 5.5 6.5

Answer 138

Placental thickness **≥4 cm** is often pathological - Placental thickness ≥4 cm is often pathological, especially in the context of pre-existing or gestational diabetes mellitus

Answer 139

A term placenta contains ~ **15-20 cotyledons**. - Each cotyledon contains **3-4 stem villi**, that are the **functional units of the placenta**.

Answer 140

Each **cotyledon** is usually supplied by a **single spiral artery**.

Answer 141

Pregnancy test is based on urinary detection of hCG. It can detect a pregnancy from **7-10 days** after implantation

Answer 142

. In case of complete miscarriage, in the absence of PV bleeding or abdominal pain, a home pregnancy test is usually advised after **3 weeks.**

Answer 143

Fetal swallowing

Answer 144

Ingestion of amniotic fluid and passage within the fetal lungs is an **essential trigger for development during the canalicular phase of lung maturation** (18-25 weeks). It is also critical for **development of the GIT.**

Answer 145

Many drugs administered to the mother will cross the placenta (exceptions include LMWH but not heparin)

Answer 146

ccording to the SPIKES framework, two of the most critical aspects of communication upon delivering unexpected news are: **S, space (physical and non-physical) to connect and join the patient**, and **P, perceptions, to understand what her perceptions are** (hence asking questions) and what is her language, in order to be able to align with that while delivering the news.

Answer 147

The **pre-ovulatory phase of the menstrual cycle** (also known as **follicular** or proliferative phase) has **variable duration,** while the **post-ovulatory phase is rather fixed, as the lifespan of a corpus luteum is of 14 days.**

Answer 148

The vestible is the anatomical space enclosed by the **labia minora**

Answer 149

**The anatomical space including the vaginal introitus, the urinary meatus, and the clitoris**

Answer 150

The **broad ligament is composed by two sheets of peritoneum**. It extends from the lateral pelvic wall on both sides and folds over the internal female genitalia covering their surfaces anteriorly and posteriorly. It also includes parametrial tissues, vessels, lymphatics, and nerves. **This ligament is prone to collect bloods when complex caesarean sections are carried out with lateral extensions.**

Answer 151

The **round ligament** is a band of fibrous tissue which keeps the uterus in position during pregnancy.

Answer 152

Broad ligament

Answer 153

The uterine body -cervix ratio is 1:1 during infancy, 2:1 during during reproductive age, and goes back to 1:1 in post-menopause as the uterus becomes atrophic.

Answer 154

The **version angle** is between the **long axis of the cervix and the vagina**.

Answer 155

A 32-year-old lady is referred to a gynaecologist due to a 6-month history of pelvic pain, dysmenorrhea, and dyspareunia. Her sexual health screening is negative. A transvaginal ultrasound reveals a retro-verted uterus and multiple adhesions suggestive of endometriosis. Regarding uterine anatomy, which of the following statement is correct? Question 11 Answer a. An anteverted uterus has a version angle greater than 90 degree b. The uterine body-cervix ratio is 2:1 in post-menopause c. **The version angle is between the long axis of the cervix and the vagina ** d. 80% of uteri are axial or retroverted e. Each `Fallopian tube meet the uterus at the infundibulum

Answer 156

Feedback Your answer is correct. The correct answer is: **Most progesterone secretion is taken over by placenta from around 12 weeks**

Answer 157

The cortex is the peripheral part of the ovary

Answer 158

The **ovaries are covered by peritoneum**. They are **attached** to the **posterior surface of the broad ligament by the meso-ovarium** and to the **lateral uterine wall by the ovarian ligament** (not the infundibulo-pelvic ligament, that is a vascular ligament containing the ovarian vessels)

Answer 159

The ovarian artery originates from the **abdominal** **aorta**, below the renal arteries.

Answer 160

In a low-risk primigravida with a post-term pregnancy, meconium is common and **may indicate fetal maturation rather than compromise** However, **fetal distress/chronic hypoxia should always be suspected. Therefore, in the presence of meconium, it is recommended that delivery is expedited.**

Answer 161

A 32-year-old woman in her first pregnancy and labelled as “low-risk” at booking, is admitted to the hospital at 41+5 weeks gestation for induction of labour. The antenatal CTG meets criteria and the tocograph does not record any meaningful uterine activity. Upon examination, the cervix is found to be 3 cm dilated with bulging membranes and an artificial rupture of membranes is carried out. This shows the amniotic fluid to be heavily meconium stained. What is the best next step in this case? Question 6 Answer a. Discuss fetal blood sampling or skull stimulation to exclude fetal acidosis b. Discuss immediate labour augmentation with vaginal prostaglandins c. Allow 24 hours to wait for spontaneous onset of uterine contractions d. Allow 4 hours to wait for spontaneous onset of uterine contractions e. **Discuss immediate labour augmentation with oxytocin**

Answer 162

The clinician in this case needs to expedite labour and reassure themselves that the fetus is not at risk and that it is safe to continue pursuing vaginal birth. The most likely **next step would be vaginal examination** (to see if there is further progress in labour, prior to make a decision regarding expediting delivery) **and fetal scalp stimulation** - **Good reactivity at fetal scalp stimulation** would reassure the **doctor that the reduced variability on the fetal heart trace is unlikely to be due to hypoxia**. **Expediting by CS could be an option**, if the **vaginal examination shows no progress** and **no reactivity to fetal skull stimulation**, or if they were other risks factors such as **sepsis or meconium.**

Answer 163

A bed soaked with blood is estimated to be at least 1000ml of blood, with floor spill 2000ml.

Answer 164

A perimortem caesarean should be performed if the woman is pregnant and the **uterus is approaching or above the umbilicus** and there is **no response in first 4 minutes of resuscitation** (as hypoxic brain damage is evident by 6 minutes). - This should **occur at the site of collapse and CPR must be continued throughout the procedure.**

Answer 165

**Laparoscopy**

Answer 166

**Shrewsbury & Telford Hospital NHS Trust**

Answer 167

The 4 key pillars for essential actions of the Ockended report were **safe staffing, well-trained workforce, learning from incidents and listening to families.**

Answer 168

It is not a legal duty, but it is best practice

Answer 169

The **duty of candour is a general duty to be open and transparent with people receiving care from you**. It means saying sorry, not admitting fault. It is not a legal duty but best practice. It is carried out irrespective of whether there is anyone’s liability, as it is the first step to learning from what happened and preventing it recurring. It applies to any safety incidents, not only to those requiring full investigations. It applies to all health and social care providers that the National Care and Quality Commission (CQC) regulates.

Answer 170

**Age is responsible for 85% of the variation in ovarian reserve**. The remaining 15% is accounted by environmental factors. In women < 25 years, age accounts for 95% of the variation and only 5% is determined by other factors.

Answer 171

**Removal/clipping of hydrosalpinx**

Answer 172

Cardiac disease is also the leading cause of indirect maternal deaths. but maybe covid?

Answer 173

**Thrombosis and thromboembolism** was the leading cause of maternal death in the UK in 2020-22.

Answer 174

A 25-year-old is seen by the GP for a sudden, tender swelling on the left side of the vagina. This is red, painful to touch and makes it difficult to walk or sit. She is otherwise well in herself, and her observations are normal. She is sexually active but currently not in a relationship and her last intercourse was 6 months back. She never experienced this before. Upon examination, the GP confirms a Bartholin’s gland abscess. What is the most likely initial management? Question 14 Answer a. **Broad spectrum antibiotics** b. Conservative management (pain relief and saline baths) c. Surgical marsupialization d. STI screening prior to start antibiotic treatment. e. Incision and drainage

Answer 175

A 16-year-old is brought in by her mother who is concerned about her lack of pubertal signs and menstruation. Her serum gonadotrophin levels are raised. Which of the following causes of delayed puberty is associated with elevated circulating gonadotrophin levels? Question 15 Answer a. Prolactinoma b. Anorexia nervosa c. Kallman syndrome d. **Gonadal** **dysgenesis** e. Still's disease

Answer 176

**Clomiphene/letrozole**

Answer 177

**Oxytocin injection**

Answer 178

**Cord prolapse, fetal head entrapment, premature rupture of membranes and birth asphyxia** are complications of breech delivery.

Answer 179

Category 2

Answer 180

Placental dysfunction

Answer 181

**Caesarean section at full dilatation increases the risk of preterm birth in future pregnancies**. Risk of PPH and deeply engaged head apply to this pregnancy, but not the future ones. Increased risk of abnormally invasive placenta and ectopic pregnancy (including scar pregnancy) apply to all caesarean section and not specifically to the one at full dilatation.

Answer 182

**Fragile X syndrome**

Answer 183

**Haemophilia**: - APTT increased, PT and Thrombin time normal

Answer 184

**It requires increased fetal surveillance**

Answer 185

**Hourly Maxidex drops** (Dexamethasone eye drops)

Answer 186

**Quetiapine** - 2nd generation anti-psychotic causes QT prolongation

Answer 187

Vital signs are normally ok in miscarriage vs not in ectopic Clots in miscarriage

Answer 188

**Risk of Maternal Hypotension** **Changes in Uterine Activity** * Epidurals can alter contraction patterns: * Sometimes they slow down labor, requiring oxytocin augmentation. * They may also affect uterine tone. **Risk of Instrumental or Operative Delivery** * Epidurals may prolong the second stage of labor (pushing phase). * There's an increased likelihood of needing forceps, vacuum, or cesarean delivery **Maternal Immobility and Positioning** * With an epidural, the mother is often less mobile. * This can reduce her ability to naturally change positions, which helps with fetal descent and oxygenation. * Poor positioning may contribute to cord compression or non-reassuring fetal heart rates.

Answer 189

coronal (non-contrast)

Answer 190

**T1-weighted MRI**: Highlights anatomy, provides crisp images, and shows fluids as dark. It is particularly useful for visualizing fat tissue. **T2-weighted MRI**: Focuses on pathology, making **fluids bright**, which is ideal for **visualizing** **inflammation**, **edema**, and **certain lesions** - T2 = H2O

Answer 191

**Right occipital lobe**

Answer 192

Sexual (e.g. loss of libido)

Answer 193

**It is defined as a maternal death associated with pregnancy or childbirth occurring up to 6 weeks after delivery**

Answer 194

a **condition that causes scarring in the deep part of the temporal lobe**, specifically affecting the **hippocampus** and **amygdala**. This scarring is a common cause of **focal seizures and epilepsy in the temporal lobe**

Answer 195

**Collecting an ACR sample** * by collecting a 'spot' sample it avoids the need to collect urine over a 24 hour period in order to detect or quantify proteinuria **should be a first-pass morning urine specimen** * if the **initial ACR is between 3 mg/mmol and 70 mg/mmol, this should be confirmed by a subsequent early morning sample.** * If the initial **ACR is 70 mg/mmol or more, a repeat sample need not be tested.**

Answer 196

a urinary albumin:creatinine ratio (ACR) of **70 mg/mmol or more,** **unless** known to be caused by **diabetes** and already appropriately treated a **urinary ACR of 30 mg/mmol or more,** together with **persistent** **haematuria** (two out of three dipstick tests show 1+ or more of blood) after exclusion of a urinary tract infection consider referral to a nephrologist for people with an ACR **between 3-29 mg/mmol who have persistent haematuria and other risk factors such as a declining eGFR, or cardiovascular disease**

Answer 197

**sputum for acid fast bacillus**

Answer 198

**150 mg for 1 dose**.

Answer 199

The features described are consistent with avoidant personality disorder, which is characterised by **social inhibition, feelings of inadequacy and hypersensitivity to criticism, and a strong desire for affection and acceptance**. People with this disorder tend to **avoid social situations and have few close relationships**, often relying heavily on a **single attachment figure.** They may also experience physical symptoms such as **headaches and stomach aches** when faced with **stress** or anxiety-provoking situations.

Answer 200

Electrocerebral inactivity (ECI) or electrocerebral silence (ECS) is defined as **no EEG activity over 2 uV** when recording from scalp electrode pairs 10 or more cm apart with interelectrode impedances under 10,000 Ohms (10 KOhms), but over 100 Ohms.

Answer 201

**dermatomyositis** **Perifascicular muscle** **fibre** **atrophy** is a specific, histopathological feature of dermatomyositis6 **Inflammatory infiltrates** are predominantly located in the **perimysium and perivascular regions** and include CD4+ T cells2,6, B cells2 and plasmacytoid dendritic cells6

Answer 202

**Corpus callosum lesions** – around the corpus callosum = **MS**

Answer 203

**Optic neuritis** Abnormal signal in the optic chiasm – too bright on the RHS Contrast ehnahces Optic neuritis in the right optic nerve Can be initial manifestation of MS

Answer 204

**Correct Answer(s): B** Justification for correct answer(s): Based on the given information, the most likely cause of their inability to conceive is anovulatory cycles. **The woman’s menstrual cycle is longer than the normal range of 21-32 days, which suggests** that she may not be ovulating regularly. The absence of any other medical conditions or abnormalities in either partner suggests that anovulation is the most likely cause of their infertility.

Answer 205

Correct Answer(s): A Justification for correct answer(s): As the patient is currently unable to answer questions and although his wife reports that he planned to discontinue active treatment, this has not been documented and cannot be verified. The admitting team should therefore decide about the best clinical approach to the patient, including appropriateness or otherwise of CPR.

Answer 206

Social phobia is a type of anxiety disorder characterised by an **excessive and persistent fear of social situations**, including **public speaking**. It can cause significant distress and interfere with daily activities. Treatment options may include cognitive-behavioural therapy and/or medication.

Answer 207

Correct Answer(s): D Justification for correct answer(s): Placement of an oesophageal stent can **provide palliation of dysphagia in patients with oesophageal cancer**. It is a minimally invasive procedure that can be done under sedation or general anaesthesia. It involves placement of a metal or plastic stent into the oesophagus to hold it open, allowing food and liquid to pass through. It is a safe and effective option for patients with dysphagia due to oesophageal cancer, particularly in those with advanced or metastatic disease who may not be candidates for curative treatment

Answer 208

CEA: colorectal AFP: liver

Answer 209

Treatment includes anticholinergic medication such as benztropine or diphenhydramine

Answer 210

**A. Brainstem evoked response test** ustification for correct answer(s): Brainstem evoked response test would be the most appropriate additional assessment in this case. This test measures the electrical activity in the auditory pathway in response to sound and can detect hearing loss even in newborn infants. It is a reliable and objective way of assessing the function of the auditory system and can identify hearing loss at an early stage, which is important for early intervention and treatment.

Answer 211

Up to **8 infections** a year (and some-times up to **12**) is normal for pre-school infection

Answer 212

**Reactive lymphadenopathy** is common in children – this usually occurs with a **viral upper respiratory tract infection**; children will get usually **bilateral cervical lymphadenopathy.** - the lymph nodes are usually **small, mobile and discrete**, and **minimally tender without erythema or warmth**

Answer 213

Cervical lymphadenitis is commonly caused by either **Group A Streptococcus or Staph aureus** - children can either be **managed on oral antibiotics, or admitted to hospital and given intravenous antibiotics**

Answer 214

If they are **recurrent** they can occasionally be associated with **IDA**

Answer 215

**WCC < 50 at diagnosis**

Answer 216

Platelets decreased, PT prolonged, APTT prolonged, INR raised, D Dimer raised, Fibrinogen decreased

Answer 217

Sickle cell disease is diagnosed by **haemoglobin electrophoresis (requested as a haemoglobinopathy screen,) with >80% HbS in Sickle Cell Disease**

Answer 218

**Extremely low birthweight**

Answer 219

A child is born with upslanting palpebral fissures, prominent epicanthic folds, a protruding tongue and a singular palmar crease on both hands. They are hypotonic. Given the suspected diagnosis, which test would provide the quickest confirmatory evidence? Question 4 Select one: a. Karyotype b. Genome sequencing c. **Fluorescent in-situ hybridisation** d. Microarray

Answer 220

Inflate the lungs

Answer 221

**Male, right-sided**

Answer 222

increased work of breathing but normal oxygen saturations – this could be **kussmaul breathing** – **DKA**

Answer 223

**Duodenal atresia** – double bubble sign (gas in the stomach and duodenum only)

Answer 224

A child is admitted with an unexplained fracture and bruising. What is the name of the formal multi-agency meeting which will be held to agree the next steps? A. Professionals meeting B. Multi-agency meeting C. Discharge planning meeting **D. Strategy meeting** E. Child protection panel

Answer 225

**Education and Health care plan (EHCP)** - This outlines any special educational needs a child has and the provision a local authority (LA) must put in place to help them. The funding for this additional support is from school budget and any additional budget is provided by LA.

Answer 226

DLA stands for disability living allowance. For children over 16 years and adults this has now been replaced by PIP (personal independence plan.)

Answer 227

An IEP (Individual Education Plan) is used for children who are not fulfilling their potential at school, or may have an additional need that requires modification of the curriculum or extra learning resources. It is written by teachers, and is a tool to help plan, teach, monitor and evaluate a particular student’s progress.

Answer 228

**The correct answer is referral to Community Paediatrics.** - The red flag in this case is Hand Preference in an infant under 1 year of age. This raises concerns regarding the possibility of unilateral weakness, and thus, cerebral palsy (especially as the child was premature and had a long stay on the neonatal unit, because pre-term infants are at higher risk of brain haemorrhage shortly after birth). - **You may also find abnormal tone on examination**. Once referred to community physio they would l**ikely consider referral to physio and for MIR** (however, this would be done after their assessment).

Answer 229

A lack of **6 words** by 18 months is a developmental red flag

Answer 230

The correct answer is a hearing test. A lack of 6 words by 18 months is a developmental red flag and not having any words at this age shows a delay in the speech, language and hearing functional area of development. **A delay in this functional area would warrant a hearing test as a the first step.**

Answer 231

The Newborn Hearing Screening test uses a Evoked otoacoustic emission test (EOAE), which uses an earphone to produce a sound which produces an echo from the normal ear. **However, amniotic fluid in the ear canal can commonly cause false positives**. - Therefore, it is appropriate to reassure mum that this does not necessarily mean a problem with hearing at this stage, but that baby will need either a repeat test or a different type of test to check the hearing.

Answer 232

Faltering growth is a red flag in infants with vomiting – **infants with weight below the 2nd centile**, or **whose weight has dropped two centiles, should have further investigation**.

Answer 233

Innocent heart murmurs are usually **systolic, short** and have a ‘**musical**’ or ‘**vibratory**’ quality to them. They **do not usually radiat**e, and are less than **grade 4/6 in intensity** (i.e. no thrill present.) Innocent heart murmurs often **vary with respiration and the position of the child.** Tachycardia, tachypnoea and hepatomegaly may suggest possible cardiac failure. If femoral pulses are absent, this is concerning for coarctation of the aorta, and further investigation is required. Children over 1 year of age with features of an asymptomatic innocent heart murmur, with normal examination, do not require any further investigation. The family can be reassured and safety net advice given.

Answer 234

**Presbyacusis (age-related hearing loss)** The pathophysiology of age-related hearing loss (ARHL), or presbycusis, involves a complex interplay between environmental and genetic factors.6 These include noise exposure, genetic predisposition, cell damage and neural degeneration. **Presbycusis is characterised by bilateral hearing loss above 2000Hz.** On a standard audiogram, presbycusis appears as an overall down-sloping line representing **impaired hearing at higher frequency sounds.** **Presbyacusis is classically bilateral and symmetrical.**

Answer 235

**Noise-induced hearing loss** is typically characterised by a notch on the audiogram at 4000 Hz.

Answer 236

**Meniere’s disease** is typically characterised by **low-frequency sensorineural hearing loss.**

Answer 237

**Otosclerosis** is pathologically characterised by abnormal bony remodelling, which includes bone resorption, new bone deposition, and vascular proliferation in the temporal bone. 7 Otosclerosis is characterised by conductive hearing loss with loss in bone conduction at 2000 Hz (referred to as Carhart’s notch).

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