In a pregnant woman at 32 weeks presenting with painless bright red vaginal bleeding vs. painful dark vaginal bleeding with a woody hard uterus, what are the diagnoses and initial investigation rule?

Painless bright red bleeding = Placenta Praevia; Painful dark bleeding + tense woody uterus = Placental Abruption. Digital vaginal examination (VE) is strictly CONTRAINDICATED until placenta praevia is excluded by ultrasound.

In Pre-eclampsia (NICE NG133), what medication is started from 12 weeks gestation in high-risk women for prevention, and what is the first-line antihypertensive in pregnancy?

Prophylaxis: Aspirin 75–150 mg daily from 12 weeks until birth. First-line antihypertensive in pregnancy: Oral Labetalol (Nifedipine modified-release is second-line if asthmatic; Methyldopa is third-line).

What are the 4 Hs and 4 Ts of reversible causes of cardiac arrest in UK ALS?

4 Hs: Hypoxia, Hypovolaemia, Hypo-/hyperkalaemia (and metabolic disorders), Hypothermia. 4 Ts: Thrombosis (coronary or pulmonary), Tension pneumothorax, Tamponade (cardiac), Toxins.

Under NICE NG12, when should an urgent 2-week-wait Breast Clinic referral be made?

Age ≥30 with an unexplained breast lump (with or without pain), OR Age ≥50 with unilateral nipple changes (discharge, retraction, or eczema-like skin changes).

In Paediatric Bronchiolitis (RSV in infants <1 year), what are the NICE NG9 criteria for hospital admission and oxygen supplementation?

Admit if apnoea (observed/reported), SpO2 70/min). Manage supportively with O2 and NG fluids/feeds.

Which vaccines are administered at 1 year (12 months) and 3 years 4 months in the UK NHS Childhood Immunisation Schedule?

1 year: Hib/MenC, MMR (1st dose—live), PCV booster, MenB booster. 3 years 4 months: 4-in-1 pre-school booster (dTaP/IPV) and MMR (2nd dose).

What is the immediate management sequence for Postpartum Haemorrhage (PPH >500 mL vaginal delivery) caused by Uterine Atony ('4 Ts: Tone, Trauma, Tissue, Thrombin')?

Call for help, ABCDE resuscitation, bimanual uterine compression/rubbing up the fundus, empty bladder (catheterize), and pharmacological uterotonics in sequence: slow IV Oxytocin 5–10 IU → IM/IV Ergometrine (avoid in hypertension) → Oxytocin infusion + IV Tranexamic Acid → IM Carboprost (avoid in asthma) → Misoprostol → Bakri balloon / B-Lynch suture.

In a 6-week-old infant presenting with projectile non-bilious vomiting after feeds, hunger ('test feed' reveals palpable olive-shaped RUQ mass), what is the classic electrolyte abnormality and definitive treatment?

Pyloric stenosis: Hypochloraemic, hypokalaemic metabolic alkalosis; resuscitate first with IV 0.9% NaCl + 5% Dextrose + KCl before definitive Ramstedt's pyloromyotomy.

In Ectopic Pregnancy (NICE NG126), what are the strict criteria for medical management with a single IM dose of Methotrexate?

Haemodynamically stable, no significant pain, unruptured ectopic adnexal mass <35 mm with no visible fetal heartbeat, serum bHCG <1,500 IU/L (considered up to 5,000 IU/L), no intrauterine pregnancy, and reliable follow-up compliance.

What is the drug of choice for preventing and treating Eclamptic Seizures (and providing fetal neuroprotection in preterm birth <30 weeks), and what is the antidote for its toxicity?

IV Magnesium Sulfate (4 g loading dose over 5–15 min, then 1 g/hr maintenance for 24h); monitor respiratory rate, urine output, and patellar reflexes (loss of knee jerk is the first sign of toxicity)—antidote is 10 mL of 10% IV Calcium Gluconate.

How do you clinically differentiate Croup (Laryngotracheobronchitis) from Acute Epiglottitis in a stridulous child, and how is Croup treated?

Croup (Parainfluenza virus): barking seal-like cough, hoarse voice, coryzal prodrome—treated with a single dose of oral Dexamethasone (0.15 mg/kg) regardless of severity (plus nebulized adrenaline if severe). Epiglottitis (H. influenzae type b): toxic appearance, drooling, tripod posture, NO cough—do NOT examine throat, call senior anaesthetist/ENT.

Under NICE NG12, what are the age and symptom criteria for an urgent 2-week-wait referral or FIT test for suspected Colorectal Cancer?

Urgent 2WW referral: Age ≥40 with unexplained weight loss AND abdominal pain; Age ≥50 with unexplained rectal bleeding; Age ≥60 with iron-deficiency anaemia OR changes in bowel habit; or any positive quantitative FIT (≥10 µg Hb/g faeces).

In a patient presenting with sudden severe unilateral testicular pain, absent cremasteric reflex, and high-riding testis, what is the surgical time window and operation required?

Testicular torsion requires immediate surgical exploration within 4–6 hours (do NOT delay for ultrasound if clinical suspicion is high) with bilateral orchidopexy (or orchidectomy if necrotic + contralateral fixation).

Under NICE NG12, what are the criteria for an urgent 2-week-wait OGD for suspected Oesophageal or Gastric Cancer?

Dysphagia at ANY age, OR Age ≥55 with weight loss PLUS any of: upper abdominal pain, reflux, or dyspepsia.

According to the Atlanta Classification, how is Acute Pancreatitis diagnosed, and what is the most common cause in the UK?

Requires ≥2 of 3: 1) Characteristic severe epigastric pain radiating to the back, 2) Serum amylase or lipase ≥3 times upper limit of normal, 3) Characteristic imaging findings. Gallstones (#1) and alcohol (#2) account for ~80% of cases ('I GET SMASHED').

In a toddler presenting with episodic screaming, drawing knees to chest, pallor, and 'redcurrant jelly' stool, what is the ultrasound sign and first-line non-surgical reduction?

Intussusception: Ultrasound shows the 'target sign' (or 'doughnut/pseudokidney sign'); after IV fluid resuscitation and excluding perforation/peritonitis, perform pneumatic (air) or hydrostatic enema reduction.

According to the NHS Routine Childhood Immunisation Schedule, which vaccines are given at 8 weeks, 12 weeks, and 16 weeks?

8 weeks: 6-in-1 (DTaP/IPV/Hib/HepB), Oral Rotavirus, MenB. 12 weeks: 6-in-1 (2nd dose), PCV (Pneumococcal), Oral Rotavirus (2nd dose). 16 weeks: 6-in-1 (3rd dose), MenB (2nd dose).

Under NICE NG12, what finding on chest X-ray or clinical history warrants an urgent 2-week-wait Lung Cancer pathway referral?

Age ≥40 with unexplained haemoptysis (direct 2WW referral), OR chest X-ray findings suggestive of lung cancer (offer urgent CXR within 2 weeks in patients ≥40 with ≥2 unexplained symptoms—cough, fatigue, SOB, chest pain, weight loss—or ≥1 symptom if ever-smoker).

After resolving an acute anaphylactic reaction, which blood test confirms mast cell degranulation and at what time intervals should it be taken?

Serum Mast Cell Tryptase: 1st sample as soon as possible after resuscitation begins, 2nd sample at 1–2 hours (no later than 4 hours) after symptom onset, and 3rd baseline sample ≥24 hours later.

What are the age associations of the three classic Paediatric Hip pathologies: Developmental Dysplasia of the Hip (DDH), Perthes Disease, and Slipped Upper Femoral Epiphysis (SUFE)?

DDH: Neonates/infants (Barlow & Ortolani tests, ultrasound <4.5 months, Pavlik harness). Transient synovitis / Perthes (avascular necrosis of femoral head): 4–8 years. SUFE: Obese adolescent boys 10–15 years presenting with hip or referred knee pain and loss of internal rotation.

In Large vs. Small Bowel Obstruction, what are the classic differences in clinical presentation and plain abdominal X-ray findings?

Small bowel obstruction (adhesions, hernias): early bilious vomiting, colicky central pain, dilated loops >3 cm located centrally with valvulae conniventes crossing the full width. Large bowel obstruction (colorectal cancer, volvulus): late faecalulent vomiting, absolute constipation, loops >6 cm (caecum >9 cm) peripherally with haustra crossing partially.

According to NICE NG12 Suspected Cancer (2-Week-Wait) guidelines, when does visible vs. non-visible haematuria require an urgent urological cancer referral?

Age ≥45 with unexplained visible haematuria (without UTI, or persisting after UTI treatment), OR Age ≥60 with unexplained non-visible haematuria PLUS either dysuria or a raised white cell count on a blood test.

What are the signs of Tension Pneumothorax and its immediate decompression landmarks?

Tracheal deviation AWAY from the affected side, absent breath sounds, hyperresonance, distended neck veins, and haemodynamic shock; immediate needle decompression (or finger thoracostomy): 2nd intercostal space mid-clavicular line (or 5th ICS mid-axillary line in updated ATLS).

What are the 6 components of the UK Sepsis Trust 'Sepsis Six' bundle to be completed within 1 hour ('Take 3, Give 3')?

Give 3: 1) Titrated high-flow Oxygen (target 94–98% or 88–92%), 2) IV broad-spectrum Antibiotics, 3) IV Fluid challenge. Take 3: 4) Blood cultures (before antibiotics if no delay), 5) Serum Lactate, 6) Hourly Urine output measurement.

In a child presenting with a palpable purpuric rash over the buttocks and extensor surfaces of the legs, arthralgia, colicky abdominal pain, and haematuria after a URTI, what is the diagnosis?

IgA Vasculitis (Henoch-Schönlein Purpura, HSP)—platelet count and coagulation screen are normal (unlike ITP/meningococcaemia); monitor BP and urinalysis for HSP nephritis.

What are the diagnostic criteria for Kawasaki Disease, its most feared cardiac complication, and its dual medical therapy?

High fever lasting ≥5 days PLUS ≥4 of 5 ('CRASH'): Conjunctivitis (bilateral non-purulent), Rash (polymorphous), Adenopathy (cervical), Strawberry tongue/mucosal fissures, Hands/feet erythema/desquamation. Complication: Coronary artery aneurysms (echocardiogram required). Treatment: IV Immunoglobulin (IVIG) + high-dose Aspirin.

On a non-contrast CT head after trauma, how do you distinguish an Extradural (Epidural) Haematoma from a Subdural Haematoma?

Extradural: biconvex (lentiform/lemon-shaped) hyperdense collection limited by suture lines, caused by Middle Meningeal Artery rupture at the pterion (classic lucid interval). Subdural: crescent-shaped (banana-shaped) collection crossing suture lines, caused by tearing of bridging veins (elderly/alcoholics/infants).

What is the Parkland Formula for 24-hour IV fluid resuscitation in severe burns (>15% TBSA in adults, >10% in children)?

Total fluid (Hartmann's solution) = 4 mL × body weight (kg) × % Total Body Surface Area (TBSA) burned (excluding simple erythema); give 50% in the first 8 hours from the time of the burn, and 50% over the next 16 hours.

What is the Resuscitation Council UK Emergency Treatment of Anaphylaxis algorithm, including exact IM Adrenaline dose and site?

Inject IM Adrenaline 500 micrograms (0.5 mL of 1:1,000) into the anterolateral aspect of the middle third of the thigh (300 mcg for 6–12 yrs; 150 mcg for 6 months–6 yrs; <6 months 100–150 mcg), repeat after 5 minutes if no improvement, plus high-flow oxygen and IV fluid bolus.

In the Resuscitation Council UK Adult Advanced Life Support (ALS) algorithm, what are the two Shockable vs. two Non-Shockable rhythms, and when are IV Adrenaline 1 mg and Amiodarone 300 mg given?

Shockable: VF and Pulseless VT—give Adrenaline 1 mg IV and Amiodarone 300 mg IV AFTER the 3rd shock (then Adrenaline every 3–5 min / alternate loops, and Amiodarone 150 mg after 5th shock). Non-Shockable: Asystole and PEA—give Adrenaline 1 mg IV immediately as soon as vascular access is achieved.

On Intrapartum Cardiotocography (CTG) interpretation (NICE NG229), what are the 4 features assessed ('DR C BRAVADO') and what defines a Pathological trace?

Baseline rate (normal 110–160 bpm), Variability (normal 5–25 bpm), Decelerations (none/early vs. variable/late/prolonged >3 min), and Contractions. Pathological trace (≥1 red feature or ≥2 amber features) mandates immediate obstetric review, conservative resuscitation, or expedited birth.

UKMLA & PLAB 1 Acute Care, Surgery, O&G & Paediatrics: ALS, Sepsis Six, 2-Week-Wait Cancer Referrals, CTG & UK Immunisation Schedule

Master Resuscitation Council UK ALS algorithms, the UK Sepsis Trust 'Sepsis Six', NICE NG12 2-week-wait cancer referral thresholds, RCOG obstetrics & gynaecology guidelines, and NHS paediatric schedules.

Level: advanced
Languages: en → en
Cards: 32
Markdown: UKMLA & PLAB 1 Acute Care, Surgery, O&G & Paediatrics: ALS, Sepsis Six, 2-Week-Wait Cancer Referrals, CTG & UK Immunisation Schedule (.md)

Flashcards (32)

#	Front (Term / Question)	Back (Definition / Answer)
1	In a pregnant woman at 32 weeks presenting with painless bright red vaginal bleeding vs. painful dark vaginal bleeding with a woody hard uterus, what are the diagnoses and initial investigation rule?	Painless bright red bleeding = Placenta Praevia; Painful dark bleeding + tense woody uterus = Placental Abruption. Digital vaginal examination (VE) is strictly CONTRAINDICATED until placenta praevia is excluded by ultrasound.
2	In Pre-eclampsia (NICE NG133), what medication is started from 12 weeks gestation in high-risk women for prevention, and what is the first-line antihypertensive in pregnancy?	Prophylaxis: Aspirin 75–150 mg daily from 12 weeks until birth. First-line antihypertensive in pregnancy: Oral Labetalol (Nifedipine modified-release is second-line if asthmatic; Methyldopa is third-line).
3	What are the 4 Hs and 4 Ts of reversible causes of cardiac arrest in UK ALS?	4 Hs: Hypoxia, Hypovolaemia, Hypo-/hyperkalaemia (and metabolic disorders), Hypothermia. 4 Ts: Thrombosis (coronary or pulmonary), Tension pneumothorax, Tamponade (cardiac), Toxins.
4	Under NICE NG12, when should an urgent 2-week-wait Breast Clinic referral be made?	Age ≥30 with an unexplained breast lump (with or without pain), OR Age ≥50 with unilateral nipple changes (discharge, retraction, or eczema-like skin changes).
5	In Paediatric Bronchiolitis (RSV in infants <1 year), what are the NICE NG9 criteria for hospital admission and oxygen supplementation?	Admit if apnoea (observed/reported), SpO2 <90% (for ≥6 weeks old; <92% if <6 weeks or underlying health conditions), fluid intake <50% of normal, or severe respiratory distress (grunting, marked recession, RR >70/min). Manage supportively with O2 and NG fluids/feeds.
6	Which vaccines are administered at 1 year (12 months) and 3 years 4 months in the UK NHS Childhood Immunisation Schedule?	1 year: Hib/MenC, MMR (1st dose—live), PCV booster, MenB booster. 3 years 4 months: 4-in-1 pre-school booster (dTaP/IPV) and MMR (2nd dose).
7	What is the immediate management sequence for Postpartum Haemorrhage (PPH >500 mL vaginal delivery) caused by Uterine Atony ('4 Ts: Tone, Trauma, Tissue, Thrombin')?	Call for help, ABCDE resuscitation, bimanual uterine compression/rubbing up the fundus, empty bladder (catheterize), and pharmacological uterotonics in sequence: slow IV Oxytocin 5–10 IU → IM/IV Ergometrine (avoid in hypertension) → Oxytocin infusion + IV Tranexamic Acid → IM Carboprost (avoid in asthma) → Misoprostol → Bakri balloon / B-Lynch suture.
8	In a 6-week-old infant presenting with projectile non-bilious vomiting after feeds, hunger ('test feed' reveals palpable olive-shaped RUQ mass), what is the classic electrolyte abnormality and definitive treatment?	Pyloric stenosis: Hypochloraemic, hypokalaemic metabolic alkalosis; resuscitate first with IV 0.9% NaCl + 5% Dextrose + KCl before definitive Ramstedt's pyloromyotomy.
9	In Ectopic Pregnancy (NICE NG126), what are the strict criteria for medical management with a single IM dose of Methotrexate?	Haemodynamically stable, no significant pain, unruptured ectopic adnexal mass <35 mm with no visible fetal heartbeat, serum bHCG <1,500 IU/L (considered up to 5,000 IU/L), no intrauterine pregnancy, and reliable follow-up compliance.
10	What is the drug of choice for preventing and treating Eclamptic Seizures (and providing fetal neuroprotection in preterm birth <30 weeks), and what is the antidote for its toxicity?	IV Magnesium Sulfate (4 g loading dose over 5–15 min, then 1 g/hr maintenance for 24h); monitor respiratory rate, urine output, and patellar reflexes (loss of knee jerk is the first sign of toxicity)—antidote is 10 mL of 10% IV Calcium Gluconate.
11	How do you clinically differentiate Croup (Laryngotracheobronchitis) from Acute Epiglottitis in a stridulous child, and how is Croup treated?	Croup (Parainfluenza virus): barking seal-like cough, hoarse voice, coryzal prodrome—treated with a single dose of oral Dexamethasone (0.15 mg/kg) regardless of severity (plus nebulized adrenaline if severe). Epiglottitis (H. influenzae type b): toxic appearance, drooling, tripod posture, NO cough—do NOT examine throat, call senior anaesthetist/ENT.
12	Under NICE NG12, what are the age and symptom criteria for an urgent 2-week-wait referral or FIT test for suspected Colorectal Cancer?	Urgent 2WW referral: Age ≥40 with unexplained weight loss AND abdominal pain; Age ≥50 with unexplained rectal bleeding; Age ≥60 with iron-deficiency anaemia OR changes in bowel habit; or any positive quantitative FIT (≥10 µg Hb/g faeces).
13	In a patient presenting with sudden severe unilateral testicular pain, absent cremasteric reflex, and high-riding testis, what is the surgical time window and operation required?	Testicular torsion requires immediate surgical exploration within 4–6 hours (do NOT delay for ultrasound if clinical suspicion is high) with bilateral orchidopexy (or orchidectomy if necrotic + contralateral fixation).
14	Under NICE NG12, what are the criteria for an urgent 2-week-wait OGD for suspected Oesophageal or Gastric Cancer?	Dysphagia at ANY age, OR Age ≥55 with weight loss PLUS any of: upper abdominal pain, reflux, or dyspepsia.
15	According to the Atlanta Classification, how is Acute Pancreatitis diagnosed, and what is the most common cause in the UK?	Requires ≥2 of 3: 1) Characteristic severe epigastric pain radiating to the back, 2) Serum amylase or lipase ≥3 times upper limit of normal, 3) Characteristic imaging findings. Gallstones (#1) and alcohol (#2) account for ~80% of cases ('I GET SMASHED').
16	In a toddler presenting with episodic screaming, drawing knees to chest, pallor, and 'redcurrant jelly' stool, what is the ultrasound sign and first-line non-surgical reduction?	Intussusception: Ultrasound shows the 'target sign' (or 'doughnut/pseudokidney sign'); after IV fluid resuscitation and excluding perforation/peritonitis, perform pneumatic (air) or hydrostatic enema reduction.
17	According to the NHS Routine Childhood Immunisation Schedule, which vaccines are given at 8 weeks, 12 weeks, and 16 weeks?	8 weeks: 6-in-1 (DTaP/IPV/Hib/HepB), Oral Rotavirus, MenB. 12 weeks: 6-in-1 (2nd dose), PCV (Pneumococcal), Oral Rotavirus (2nd dose). 16 weeks: 6-in-1 (3rd dose), MenB (2nd dose).
18	Under NICE NG12, what finding on chest X-ray or clinical history warrants an urgent 2-week-wait Lung Cancer pathway referral?	Age ≥40 with unexplained haemoptysis (direct 2WW referral), OR chest X-ray findings suggestive of lung cancer (offer urgent CXR within 2 weeks in patients ≥40 with ≥2 unexplained symptoms—cough, fatigue, SOB, chest pain, weight loss—or ≥1 symptom if ever-smoker).
19	After resolving an acute anaphylactic reaction, which blood test confirms mast cell degranulation and at what time intervals should it be taken?	Serum Mast Cell Tryptase: 1st sample as soon as possible after resuscitation begins, 2nd sample at 1–2 hours (no later than 4 hours) after symptom onset, and 3rd baseline sample ≥24 hours later.
20	What are the age associations of the three classic Paediatric Hip pathologies: Developmental Dysplasia of the Hip (DDH), Perthes Disease, and Slipped Upper Femoral Epiphysis (SUFE)?	DDH: Neonates/infants (Barlow & Ortolani tests, ultrasound <4.5 months, Pavlik harness). Transient synovitis / Perthes (avascular necrosis of femoral head): 4–8 years. SUFE: Obese adolescent boys 10–15 years presenting with hip or referred knee pain and loss of internal rotation.
21	In Large vs. Small Bowel Obstruction, what are the classic differences in clinical presentation and plain abdominal X-ray findings?	Small bowel obstruction (adhesions, hernias): early bilious vomiting, colicky central pain, dilated loops >3 cm located centrally with valvulae conniventes crossing the full width. Large bowel obstruction (colorectal cancer, volvulus): late faecalulent vomiting, absolute constipation, loops >6 cm (caecum >9 cm) peripherally with haustra crossing partially.
22	According to NICE NG12 Suspected Cancer (2-Week-Wait) guidelines, when does visible vs. non-visible haematuria require an urgent urological cancer referral?	Age ≥45 with unexplained visible haematuria (without UTI, or persisting after UTI treatment), OR Age ≥60 with unexplained non-visible haematuria PLUS either dysuria or a raised white cell count on a blood test.
23	What are the signs of Tension Pneumothorax and its immediate decompression landmarks?	Tracheal deviation AWAY from the affected side, absent breath sounds, hyperresonance, distended neck veins, and haemodynamic shock; immediate needle decompression (or finger thoracostomy): 2nd intercostal space mid-clavicular line (or 5th ICS mid-axillary line in updated ATLS).
24	What are the 6 components of the UK Sepsis Trust 'Sepsis Six' bundle to be completed within 1 hour ('Take 3, Give 3')?	Give 3: 1) Titrated high-flow Oxygen (target 94–98% or 88–92%), 2) IV broad-spectrum Antibiotics, 3) IV Fluid challenge. Take 3: 4) Blood cultures (before antibiotics if no delay), 5) Serum Lactate, 6) Hourly Urine output measurement.
25	According to NICE Head Injury guidelines (NG232), which findings mandate an immediate CT head scan within 1 hour in adults?	GCS <13 on initial assessment, GCS <15 at 2 hours post-injury, suspected open/depressed skull fracture, sign of basal skull fracture (haemotympanum, 'panda eyes', Battle's sign, CSF otorrhoea/rhinorrhoea), post-traumatic seizure, focal neurological deficit, or >1 episode of vomiting.
26	In a child presenting with a palpable purpuric rash over the buttocks and extensor surfaces of the legs, arthralgia, colicky abdominal pain, and haematuria after a URTI, what is the diagnosis?	IgA Vasculitis (Henoch-Schönlein Purpura, HSP)—platelet count and coagulation screen are normal (unlike ITP/meningococcaemia); monitor BP and urinalysis for HSP nephritis.
27	What are the diagnostic criteria for Kawasaki Disease, its most feared cardiac complication, and its dual medical therapy?	High fever lasting ≥5 days PLUS ≥4 of 5 ('CRASH'): Conjunctivitis (bilateral non-purulent), Rash (polymorphous), Adenopathy (cervical), Strawberry tongue/mucosal fissures, Hands/feet erythema/desquamation. Complication: Coronary artery aneurysms (echocardiogram required). Treatment: IV Immunoglobulin (IVIG) + high-dose Aspirin.
28	On a non-contrast CT head after trauma, how do you distinguish an Extradural (Epidural) Haematoma from a Subdural Haematoma?	Extradural: biconvex (lentiform/lemon-shaped) hyperdense collection limited by suture lines, caused by Middle Meningeal Artery rupture at the pterion (classic lucid interval). Subdural: crescent-shaped (banana-shaped) collection crossing suture lines, caused by tearing of bridging veins (elderly/alcoholics/infants).
29	What is the Parkland Formula for 24-hour IV fluid resuscitation in severe burns (>15% TBSA in adults, >10% in children)?	Total fluid (Hartmann's solution) = 4 mL × body weight (kg) × % Total Body Surface Area (TBSA) burned (excluding simple erythema); give 50% in the first 8 hours from the time of the burn, and 50% over the next 16 hours.
30	What is the Resuscitation Council UK Emergency Treatment of Anaphylaxis algorithm, including exact IM Adrenaline dose and site?	Inject IM Adrenaline 500 micrograms (0.5 mL of 1:1,000) into the anterolateral aspect of the middle third of the thigh (300 mcg for 6–12 yrs; 150 mcg for 6 months–6 yrs; <6 months 100–150 mcg), repeat after 5 minutes if no improvement, plus high-flow oxygen and IV fluid bolus.
31	In the Resuscitation Council UK Adult Advanced Life Support (ALS) algorithm, what are the two Shockable vs. two Non-Shockable rhythms, and when are IV Adrenaline 1 mg and Amiodarone 300 mg given?	Shockable: VF and Pulseless VT—give Adrenaline 1 mg IV and Amiodarone 300 mg IV AFTER the 3rd shock (then Adrenaline every 3–5 min / alternate loops, and Amiodarone 150 mg after 5th shock). Non-Shockable: Asystole and PEA—give Adrenaline 1 mg IV immediately as soon as vascular access is achieved.
32	On Intrapartum Cardiotocography (CTG) interpretation (NICE NG229), what are the 4 features assessed ('DR C BRAVADO') and what defines a Pathological trace?	Baseline rate (normal 110–160 bpm), Variability (normal 5–25 bpm), Decelerations (none/early vs. variable/late/prolonged >3 min), and Contractions. Pathological trace (≥1 red feature or ≥2 amber features) mandates immediate obstetric review, conservative resuscitation, or expedited birth.