Clinical knowledge: specialties (obstetrics, gynaecology, paediatrics, psychiatry)
What the exam asks
Specialties covers obstetrics, gynaecology, paediatrics and psychiatry, testing whether you can spot the time-critical presentation in each and apply UK-specific pathways.
Obstetrics and gynaecology
- Pre-eclampsia: BP 140/90 or more after 20 weeks plus proteinuria or maternal organ dysfunction; give magnesium sulphate for eclampsia or severe disease and plan delivery.
- Postpartum haemorrhage: uterotonics (oxytocin, then ergometrine or carboprost), tranexamic acid 1 g within 3 hours, and escalate early.
- Ectopic pregnancy: any woman of reproductive age with pain and a positive test needs a scan; a rise in hCG below 63% over 48 hours suggests an ectopic.
- Contraception: check UKMEC for contraindications, and remember LARCs are the most effective reversible methods.
Paediatrics and psychiatry
- The paediatric assessment triangle (appearance, work of breathing, circulation) gives an instant severity read before you touch the child.
- Any infant under 3 months with a temperature of 38°C or more needs a full septic screen and IV antibiotics.
- Croup: dexamethasone; add nebulised adrenaline only for stridor at rest or severe recession. Bronchiolitis is supportive - no routine bronchodilators.
- Psychiatry: assess risk (self-harm, suicide, risk to others) at every contact; under the Mental Health Act 1983, section 2 lasts 28 days and section 3 six months.
Worked example
A 30-year-old with 7 weeks of amenorrhoea has left iliac fossa pain and a positive pregnancy test; transvaginal ultrasound shows an empty uterus. This is a pregnancy of unknown location: repeat hCG in 48 hours and act on the trend, not a single value.
Traps
Missing sepsis in a neonate because the chest sounds clear; treating bronchiolitis with routine salbutamol; diagnosing dementia in an acutely confused patient without excluding delirium.