Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Final MB Part II - Short Answer Questions > 100 Cases Questions II > Flashcards

100 Cases Questions II Flashcards

1
Q

Which triad of blood test abnormalities are most commonly associated with multiple myeloma? (3)

A
  • Anaemia
  • Hypercalcaemia
  • Renal failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Outline the pathophysiology of renal failure secondary to multiple myeloma?

A

Monoclonal proteins produced by overproliferation of plasma cells accumulate at filtration barrier in the kidney interfering with normal ultrafiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Outline the components of a myeloma screen? (4)

A
  • Serum electrophoresis; to detect monoclonal M-bands
  • 24hr urine collection; to measure urine Bence-Jones proteins
  • Serum β2microglobulin; raised in cells undergoing excess proliferation
  • Full skeletal survey; whole body radiography for lytic lesions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Outline the complications associated with multiple myeloma? (6)

A
  • Anaemia; impaired erythropoiesis
  • Recurrent infections; leukopaenia (neutropaenia)
  • Clotting abnormalities; thrombocytopaenia
  • Renal failure
  • Bone disease; lytic lesions and fractures
  • Amyloidosis; myeloma, hypertension, enlarged tongue, peripheral neuropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Outline the main medical emergency associated with multiple myeloma?

A

Cord compression secondary to vertebral crush fractures as a result of lytic bone lesions in the spine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Why must vitamin B12 deficiency be corrected first in patients who have a combined vitamin B12 and folate deficiency?

A

Because correction of folate first will stimulate the erythropoeisis in the bone marrow thus further depleting B12 stores and increasing the risk of subacute degeneration of the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which group of conditions are vitally important to rule out in patients presenting with lethargy and pancytopaenia?

A

Acute Leukaemias<br></br>- Acute lymphoblastic leukaemia (ALL)<br></br>- Acute myeloid leukaemia (AML)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Outline the causes of macrocytic pancytopaenia? (6)

A
  • Acute leukaemias; due to increased blast cell presence
  • Severe nutrient deficiencies; B12 and folate
  • Cytotoxic medications
  • Viral infections; HIV and EBV
  • Endocrine abnormalities; myxoedema (severe hypothyroidism)
  • Autoimmune disease; systemic lupus erythematosus (SLE)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which single test can be used to exclude acute leukaemias as a cause of pancytopaenia with macrocytosis?

A

Blood film; to look for presence of blast cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the most common cause of macrocytic anaemia?

A

Vitamin B12/folate deficiecies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Outline the most common cause of a retroperitoneal mass?

A

Enlarged retroperitoneal lymph nodes; secondary to infection or malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the most common cause of retroperitoneal lymph node enlargement, how does this differ in young and older patients? (2)

A

Malignancy

  • Young patients; metastases from solid organs draining to para-aortic nodes
  • Older patients; haematological malignancies most likely high-grade lymphoma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the most common infection associated with retroperitoneal lymph node enlargement?

A

Tuberculosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which single blood test can be used as marker of high cell turnover in malignancy?

A

Serum lactate dehydrogenase (LDH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the most common type of Hodgkin lymphoma (HL)?

A

Nodular sclerosis; accounts for around 70% of casess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the most common type of non-Hodgkin lymphoma (NHL)?

A

Diffuse large B cell lymphoma (DLBCL); accounts for around 20% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Outline the standard chemotherapy regimes used in the treatment of Hodgkin and non-Hodgkin lymphoma? (2)

A
  • Hodgkin Lymphoma (HL); ABVD (Doxorubicin, Bleomycin, Vinblastine, Dacarbazine)<br></br>- Non-Hodgkin Lymphoma (NHL); R-CHOP (Rituximab, Cyclophosphamide, Hydroxydaunorubicin, Vincristine, Prednisolone)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Outline the most common chromosomal abnormality associated with Burkitt’s (Non-Hogdkin) lymphoma?

A

t(8;14)(q24;q32); resutling in c-myc expression under control of IGH promoter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Outline the most pathogenic event associated with diffuse large B cell lymphoma (DLBCL)?

A

Dyregulation of BCL-6 transcriptional repressor which leads to stimulation of B-cell differentiation in germinal centres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What type of hypersensitivity reaction is a haemolytic transfusion reaction?

A

Type II Antibody-mediated (IgM or IgG) cytotoxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which immunoglobulin isotype are those generated against A and B blood groups and those against Rhesus D antigens? (2)

A
  • A/B antibodies; IgM<br></br>- Rhesus D antibodies; IgG
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the difference in the haemolysis triggered by ABO antibodies and that triggered by Rhesus D antibodies? (2)

A
  • ABO antibodies; intravascular red cell lysis<br></br>- Rhesus D antibodies; extravascular red cell lysis in reticuloendothelial system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Outline the features of an acute haemolytic transfusion reaction? (4)

A
  • Fever
  • Abdominal pain
  • Hypotension
  • Haemoglobuinuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How can haemoglobinuria be differentiated from haematuria?

A

Centrifugation of the urine

  • Haematuria; RBCs will settle at the bottom of the sample which will return to normal urine colouration
  • Haemoglobinuria; urine will remain red and no red cells will collected at the bottom of the sample
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Outline the two key differentials for a patient who remains pyrexial despite appropriate antimicrobial therapy? (2)

A
  • Antimicrobial Resistence<br></br>- Abscess/Collection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Outline the secondary causes of hyperlipidaemia? (6)

A
  • Nephrotic syndrome<br></br>- Diabetes<br></br>- Hypothyroidism<br></br>- Alcohol<br></br>- Cholestasis<br></br>- Antipsychotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Briefly outline the three main cholesterol transport pathways? (3)

A
  • Exogenous Pathway; absorption of dietary lipids and cholesterol and transport from the gut to the liver<br></br>- Endogenous Pathway; transport of lipids from the liver to the peripheral tissues<br></br>- Reverse Cholesterol Transport Pathway; transport of lipids from the peripheral tissues to the liver
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Which criteria can be used to aid in the diagnosis of familial hypercholesterolaemia? (2)

A
  • Simon Broome Diagnostic Criteria (SBDC)

- Dutch Lipid Clinic Network Score (DLCNS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Outline the triad of features associated with haemolytic uraemic syndrome? (3)

A
  • Haemolytic anaemia; normocytic anaemia with raised urea<br></br>- Renal failure; reduced urine output<br></br>- Thrombocytopaenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What is an education, health and care plan (EHCP) and when are these required? (2)

A

An education, health and care plan (EHCP) is a statement produced by a local authority that documents a child’s special educational needs (SEN) and how they can be supported. These are produced following assessments by the child’s school, an educational psychologist, a doctor and other professionals.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What contributing factors to a child’s learning difficulties must be considered and rectified/optimised if possible? (7)

A
  • Hearing impairments<br></br>- Visual impairments<br></br>- Chronic medical condition(s)<br></br>- Epilepsy<br></br>- Autism spectrum disorder (ASD)<br></br>- Dyspraxia<br></br>- Negelct
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which assessment can be carried out to help support children with special educational needs/learning difficulties?

A

<div>Education, health and care plan (EHCP)</div>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Which diagnoses are particularly important to consider in young childrent presenting with chronic headaches?

A

Organic causes; hence threshold for scanning decreases, the younger the patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Which of the typical features of migraine is more common in children than adults?

A

Nausea and vomiting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Which two organisms are most commonly associated with the development of a Bell’s palsy? (2)

A
  • Herpex simplex virses (HSV)

- Varicella zoster virus (VZV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What differentiates the facial weakness associated with a Bell’s palsy compared to a stroke? (2)

A
  • Bell’s palsy; lower motor neurone (LMN) lesion due to oedema compressing the facial nerve in the stylomastoid foramen causing facial and forehead weakness
  • Stroke; upper motor neurone (UMN) lesion affecting the facial area of the primary motor cortex that only affects the lower face due to additional innervation of the forehead and eyes from the ipsilateral cerebral hemisphere
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Outline the management of Bell’s palsy? (2)

A
  • Prednisolone 1 mg kg-1 OD (PO) up to 60 mg for 7 days<br></br>- Artificial tears such as hypromellose eye drops
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Outline the different aetiologies of back pain in children? (5)

A
  • Developmental abnormalities; spondylolysis, spondylolisthesis, scoliosis<br></br>- Traumatic; vertebral stress fractures, muscle spasm due to overuse, prolapsed intervertebral disc<br></br>- Neoplastic; primary benign or malignant vertebral or spinal cord tumours, leukaemias or lymphomas, metastases (neuroblastoma)<br></br>- Infection; discitis (common before 6 years), vertebral osteomyelitis<br></br>- Rheumatological; oligoarticular juvenile idiopathic arthritis, ankylosing spondylitis, psoriatic arthritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Outline the red flags to be aware of in children with back pain? (5)

A
  • Persistent or worsening pain
  • Systemic features; fever, malaise or weight loss
  • Neurological symptoms or signs
  • Sphincter dysfunction
  • Young age; especially < 4 years (tumours are most likely)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Outline the classification of spinal tumours? (3)

A
  • Intramedullary; within the cord<br></br>- Extramedullary intradural; usually benign <br></br>- Extramedullary extradural; usually metastases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the most likely cause of an abdominal mass associated with back pain in a child?

A

Bladder enlargement; due to loss of sphincter control as a result of spinal cord compression from a malignant process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Outline the triad of features associated with West syndrome? (3)

A
  • Infantile spasms; seizure type causing contraction of axial muscles<br></br>- Development regression; loss of previously obtained milestones<br></br>- Hypsarrhythmia; a chaotic pattern of activity seen on electroencephalogram (EEG)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Outline the specific aetiologies associated with West Syndrome? (4)

A
  • Congenital structural brain abnormalities
  • Acquired brain injury; hypoxia, meningitis
  • Neurometabolic disease; mitochondrial disorders
  • Neurocutaneous syndromes; neurofibromatosis, tuberous sclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What is the most common cause of developmental regression associated with infantile spasms?

A

Tuberous sclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What is the most common cause of hearing impairment in children?

A

Conductive hearing loss secondary to glue ear (OME)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is meant by glue ear?

A

Glue ear; chronic otitis media with effusion (OME)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Which group of paediatric patients are particularly susceptible to glue ear (chronic otitis media with effusion)?

A

<div>Children with Down syndrome; because the have large adenoids a small nasopharynx and narrow Eustachian tubes</div>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Why must children with Down syndrome have regular screening for hearing impairment?

A

<div>Becuse the are particularly vulnerable to 'glue ear' or otitis media with effusion (OME) because they have large adenoids a small nasopharynx and narrow Eustachian tubes which make aeration of the middle ear less efficient</div>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Whick kind of hearing loss is associated with chronic otitis media with effusion (OME) or ‘glue ear’?

A

Conductive hearing loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Outline the two main types of squint? (2)

A
  • Convergent squint; affected eye is deviated toward the nose when attempting to look directly at a target<br></br>- Divergent squint; affected eye is deviated away from the nose when attempting to look directly at a target
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Outline the two main aetiologies of a squint? (2)

A
  • Paralytic squint; due to dysfunction of the cranial nerves controlling eye movements (III, IV and VI) or the muscles of the eye themselves<br></br>- Concomitant squint; due to extraocular muscle imbalance in infants or refractive errors after infancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What is the major risk factor associated with an uncorrected squint?

A

<div>Amblyopia; in the developing brain, the image from the squinting eye is suppressed to avoid diplopia. This leads to irreversible suppression of the visual pathways and subsequent visual impairment in that eye and possible blindness.</div>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Outline the potential management options of concomitant squints? (3)

A
  • Glasses; to correct any refractive errors<br></br>- Patching of good eye; to force use of the other eye and correctextaocular imbalances<br></br>- Surgery; on the extraocular muscles themselves
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Which test can be performed to determine the nature of a squint?

A

Cover-uncover test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Outline the absolute indications for surgical management of an ectopic pregnancy as a first-line treatment? (7)

A
  • Serum β-hCG> 5000 IU L-1<br></br>- > 35 mm adnexal mass <br></br>- Fetal heart beat present<br></br>- Haemodynamic instability<br></br>- Significant pain<br></br>- Significant haemoperitoneum<br></br>- Patient choice
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

What is the likelhood of recurrent ectopic pregnancy following salpingectomy/salpingotomy?

A

10 - 15% chance of subsequent ectopic pregnancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Which contraceptives should be avoided in patients who have had an ectopic pregnancy? (3)

A
  • Progesterone only pill (POP)<br></br>- Intrauterine device (Cu-IUD)<br></br>- Intrauterine system (LNG-IUS)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What percentage of women who experience an ectopic pregnancy will go on to have a live birth within the next 3 years?

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

When should transvaginal ultrasound scanning (TVUS) begin in women with a previous ectopic pregnancy?

A

Early TVUS indicated at 5 weeks gestation in women with a history of ectopic pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Outline the differentials diagnoses for abdominal pain in early pregnancy? (8)

A
  • Corpus luteal cyst
  • Ectopic pregnancy
  • Miscarriage
  • Ovarian cysts
  • Urinary tract infection
  • Renal tract calculus
  • Constipation
  • Appendicitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

What is the definition of a pregnancy of unknown location (PUL)?

A

Pregnancy of unknown location (PUL); woman with a positive pregnancy test but with no ultrasound signs of either intra or extrauterine pregnancy or retained products of conception

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Outline the differential diagnoses of a pregnancy of unknown location? (3)

A
  • Early intrauterine pregnancy; too early to be visualised<br></br>- Failed pregnancy; complete miscarriage<br></br>- Ectopic pregnancy; either in adnexa but too small to be visualised or elsewhere in the pelvis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Outline the rough serum β-hCG concentration at which an intrauterine pregnancy should be able to be visualised on transvaginal ultrasound (TVUS)?

A

From a serum β-hCG concentration around 1000 - 1500 IU L-1 and above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Outline the trend in serum β-hCG concentrations in an early intrauterine pregnancy?

A

Serum β-hCG concentrations should increase by 66% every 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Outline the management of pregnancies of unknown location (PUL)? (4)

A
  • Follow-up serum β-hCG concentrations<br></br>- Serum progesterone concentrations<br></br>- Repeat transvaginal ultrasound scan within a few days<br></br>- Laparoscopy if no pregnancy visualised on second scan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Which clotting factor is deficient in haemophilia A?

A

Clotting factor VIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Which clotting factor is deficient in haemophilia B?

A

Clotting factor IX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Outline the definition of an extended spectrum β lactamase (ESBL) positive organism?

A

Resistance to multiple different classes of β-lactam antibiotics including penicillins, cephalosporins and monobactam antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Resistance to which other class of antibiotics is commonly associated with extended spectrum β-lactam (ESBL) resistance?

A

Aminoglycosides such as gentamicin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

How can neonatal respiratory distress sydrome (NRDS) be prevented aside from administering maternal corticosteroids?

A

Endotracheal administration of surfactant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

What is the most common cause of respiratory distress in newborn term neonates?

A

Transient tachypnoea of the newborn (TTNB)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Why is it vital to intubate neonates with congenital diaphragmatic hernias?

A

To prevent swallowing of air which may distend the herniated bowel and worsen respiratory compromise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Outline the management of a congenital diaphragmatic hernia? (3)

A
  • Intubation; prevent swallowing of air<br></br>- NG tube; aspirate gastric fluid and air<br></br>- Surgery; to return the herniated bowel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

What is the most common complication of a congenital diaphragmatic hernia?

A

Pulmonary hypoplasia due to compression of the lungs by the bowel within the thorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Outline the definition of an apnoeic episode?

A

Episode of cessation of breathing lasting for longer than 20 seconds or less, if associated with bradycardia/colour change

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Outline the main risk factors associated with neonatal sepsis? (6)

A
  • Preterm premature rupture of membranes (PPROM)
  • Prolonged rupture of membranes (PROM)
  • Current maternal group B <i>Streptococcus</i> colonisation
  • Group B<i>Streptococcus</i>infection in previous neonate
  • Preterm birth following spontaneous labour
  • Maternal intrapartum fever/chorioamnionitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Outline the main radiological features of osteomyelitis? (2)

A
  • Chronic inflammatory destruction of the bone resulting from infection<br></br>- Formation of sequestrae; dead pieces of bone contained within living bone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Outline the process of sequestrae formation in osteomyelitis?

A

Pus collection in the bone raises the intraosseous pressure which results in impaired perfusion and subsequent ischaemic necrosis of surrounding bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Which organism is most classically associated with osteomyelitis?

A

<i>Staphylococcus aureus</i>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Outline the two main mechanisms by which osteomyelitis may develop? (2)

A
  • Contiguous spread; from adjacent soft tissue or joints via trauma or direct inoculation, more common in adults<br></br>- Haematogenous spread; from distant sites via the blood stream, more common in children
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Outline the criteria for a diagnosis of osteomyelitis? (4)

A

≥ 2 of the following<br></br>- Pus aspirated from affected bone<br></br>- Positive bone or blood culture<br></br>- Positive imaging findings<br></br>- Classical localised signs; bone pain swelling, redness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Which cohort of patients are particularly at risk of developing osteomyelitis?

A

Diabetics; due to the increased risk of developing foot ulcers and/or peripheral neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Which family of bacteria are most commonly associated with infective endocarditis?

A

Gram positive cocci<br></br>- <i>Staphylococci</i><br></br>- <i>Streptococci</i><br></br>- <i>Enterococci</i>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Under which circumstances are urinary tract infections (UTIs) in adults referred to as complicated? (5)

A
  • Occuring in men<br></br>- Occuring in the elderly<br></br>- Occuring in pregnant women<br></br>- Occuring where the is an in-dwelling catheter<br></br>- Occuring where there is an anatomical or functional abnormality in the urinary tract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Outline the most common symptoms associated with Lyme disease? (2)

A
  • Flu-like symptoms<br></br>- Erythema migrans ‘target-lesions’
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

What is the causative organism in Lyme disease?

A

<i>Borrelia burgdorferi</i>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Outline the main risk factors associated with <i>Clostridium difficile</i> infection? (8)

A

<div>CARE-BLIP</div>

  • Care home resident<br></br>- Antibiotics<div>- Recent hospital admission</div><div>- Elderly<br></br>- Bowel surgery</div><div>- Laxatives<br></br>- Immunosuppression<div>- Proton pump inhibitors (PPIs)<br></br></div></div>
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Which atypical pneumonia-causing organism is associated with hyponatraemia secondary to syndrome of inappropriate ADH release (SIADH)?

A

<i>Legionella pneumophilia</i>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Which antibiotics are used to treat<i>Legionella pneumophilia </i>atypical pneumonia?

A

Macrolides; usually clarithromycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Which organism is most commonly identified as causative in septic arthritis?

A

<i>Staphylococcus aureus</i>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

What is the most common route of spread in septic arthritis?

A

Haematogenous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Which organism is the most commonly identified cause of acute otitis externa?

A

<i>Pseudomonas aeruginosa</i>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Outline the choice of antibiotics in the management of acute otitis externa? (2)

A
  • Mild-to-moderate; topical neomycin plus dexamethasone (otomize)<br></br>- Moderate-to-severe; oral flucloxicillin (erythromycin if penicillin allergic)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Which manoeuvres can be used to exacerbate the pain associated with acute otitis externa?

A

Pulling on the pinna or pushing on the tragus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Which type of organisms are the most common cause of conjunctivitis?

A

Viruses; adenoviruses, coxsackieviruses and herpesviruses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

What is the most common cause of inflammation of the eye?

A

Viral conjunctivitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

How can viral and bacterial causes of conjuncitivitis be differentiated symptomatically? (2)

A
  • Viral conjunctivitis; watery discharge, pre-auricular lymphadenopathy<br></br>- Bacterial conjunctivitis; muco-purulent discharge, eyelid matting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Which organisms are most commonly associated with neonatal bacterial conjunctivitis? (2)

A
  • <i>Neisseria gonorrhoea</i><br></br>- <i>Chlamydia trachomatis</i>
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

How are blanching and non-blanching rashes different in terms of their underlying cause?

A
  • Blanching rashes; caused by inflammation of the skin<br></br>- Non-blanching rashes; caused by bleeding beneath the skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What is the difference between macules and papules?

A
  • Macules are flat lesions < 0.5 mm in diameter<br></br>- Papules are raised lesions < 0.5 mm in diameter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

What is the difference between petechiae and purpura?

A
  • Petechiae; non-blanching lesions < 2 mm in diameter<br></br>- Purpura; non-blanching lesions > 2 mm in diameter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

How can one differentiate petechiae and purpura from macules and papules?

A
  • Petechiae and purpura are flattened and not raised unlike papules
  • Similarly petechiae and purpura do not blanch whereas macules and papules will
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Why can parvovirus B19 infection (erythema infectiosum/fifth disease) precipitate an aplastic crisis in patients with sickle cell disease?

A

Parvovirus B19 infects red cell progenitor cells in the bone marrow which results in a blockade or erythropoeisis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Outline the complications associated with parvovirus B19 infection (erythema infectiosum)? (3)

A
  • Fetal hydrops; due to fetal anaemia and cardiac failure
  • Aplastic crisis; in patients with underlying haemaglobinopathies
  • Chronic infection and anaemia; due to failure to produce IgM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Which patients are at increased risk of complications following parvovirus B19 infections (erythema infectiosum)? (3)

A
  • Pregnant women; risk of fetal hydrops<br></br>- Immunocompromised; risk of chronic infection<br></br>- Haemoglobinopathies; risk of transient aplastic crises
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

What is the most common cause of a sudden deterioration in a ventilated pre-term neonate?

A

Pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

How can pneumothoraces be diagnosed in neonates? (2)

A
  • Cold-light transillumination of the chest<br></br>- Chest X-ray
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Which group of patients are particularly at risk of duodenal atresia?

A

Patients with Down syndrome; around 20% of patients with duodenal atresia have Down syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Which sign seen on abdominal X-ray imaging is classically associated with duodenal atresia?

A

Double-bubble sign; due to dilatation of the stomach and the proximal duodenum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Broadly speaking outline the aetiologies of polyhydramnios and oligohydramnios? (2)

A
  • Polyhdramnios; occurs due to an inability of the infant to swallow amniotic fluid
  • Oligohydramnios; occurs due to an inability to excrete amniotic fluid in the urine due to renal agenesis or dysgenesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

What is the major complication of untreated jaundice in a neonate?

A

<div>Unconjugated bilirubin can cross the blood-brain barrier and very high levels can lead to kernicterus which in-turn can cause deafness and choreoathetoid cerebral palsy.</div>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

Outline the definitive management of extrahepatic biliary atresia?

A

Kasai procudure (hepatoportoenterostomy);roux-en-Y loop of small intestine is anastomosed directly to the hilum of the liver after excision of the remnant biliary system to restore normal bile flow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

Which long-term complication may occur as a result of surgical resection and/or radiotherapy aimed at treating a craniopharyngioma?

A

Hypopituitarism; e.g. secondary adrenal insufficiency due to damage to the pituitary gland and impaired ACTH release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Which genetic conditions are associated with an increased risk of developing phaeochromocytomas? (3)

A
  • Multiple endocrine neoplasm type 2 (MEN2)
  • Von Hippel-Lindau (VHL) Syndrome
  • Neurofibromatosis type 1 (NF1)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

Outline the main features of a phaeochromocytoma? (5)

A
  • Hypertension
  • Headaches
  • Palpitations
  • Sweating
  • Tremor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Why is it that the features of phaeochromocytoma are often transient/episodic?

A
  • Because the tumours intermittently release both noradrenaline and adrenaline.
  • Noradrenaline is an α-selective adrenoceptor agonist that will cause arterial vasoconstriction and thus will increase blood pressure.
  • Adrenaline is a non-selective adrenoceptor agonist that will stimulate both the α-adrenoceptors, triggering an increase in blood pressure, and the β-adrenoceptors, causing a tachycardia.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
117
Q

Outline the two key investigations to be carried out in suspected cases of phaeochromocytoma? (2)

A
  • 24hr urine collection and urine metanephrine levels

- Urinary vanillylmandelic acid (VMA) levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
118
Q

Which organism is the most common cause early-onset neonatal sepsis in the UK?

A

Group B Streptococci (GBS); usually <i>Streptococcus agalactiae </i>which accounts for ~ 75% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
119
Q

Which organism is most commonly associated with haemolytic uraemic syndrome (HUS)?

A

<i>Escherichia coli</i>O157:H7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
120
Q

Which organisms are classically associated with pelvic inflammatory disease (PID)? (2)

A
  • <i>Chlamydia trachomatis</i><br></br>- <i>Neisseria gonorrhoea</i>
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
121
Q

What is the most common cause of pelvic inflammatory disease (PID)?

A

Sexually transmitted infection (STI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
122
Q

Outline the complications associated with pelvic inflammatory disease (PID)? (3)

A
  • Congenital eye/lung infections in neonates<br></br>- Infertility and ectopic pregnancy<br></br>- Fitz-Hugh-Curtis syndrome; perihepatitis due to adhesions within the peritoneum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
123
Q

Outline the classical characteristics of actinomycosis? (4)

A

DAFT

  • Draining sinuses
  • Abscesses
  • Fistulae
  • Tissue fibrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
124
Q

Which region of the body is most commonly affected by actinomycosis?

A

Jaw; accounts for 50-70% of cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
125
Q

Outline the typical presentation of cervicofacial actinomycosis?

A

Chronic and slowly progressive painful swelling of the jaw with purulent exudate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
126
Q

Which organism is classically associated with actinomycosis?

A

<i>Actinomyces israelii</i>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
127
Q

Outline the typical appearance of actinomyces on gram staining?

A

Branching gram positive beaded rods (bacilli) that may be contained within ‘sulfur’ granules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
128
Q

Which special stain can be used to identify actinomycosis?

A

Grocott-Gomori Methenamine-Silver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
129
Q

Outline the types of abnormal red blood cells that can indicate hyposplenism? (3)

A
  • Howell-Jolly bodies (HJ); abnormal RBCs with basophilic staining due to presence of nuclear remnants
  • Acanthocytes (AC); abnormal RBCs with adense, shrunken appearance and spike-like projections of cell membrane
  • Target cells (TC); abnormal RBCs with a central haemoglobinised region surrounded by a ring of pallor indicative of iron-deficiency anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
130
Q

Outline the differential diagnoses of neonatal jaundice presenting within 24hrs of birth? (6)

A
  • Rhesus haemolytic disease of the newborn (HDNB)<br></br>- ABO incompatibility<br></br>- Neonatal sepsis (GBS)<br></br>- Congenital viral infection (CMV, Rubella)<br></br>- Glucose-6-phosphate dehydrogenase (G6PD) deficiency<br></br>- Hereditary spherocytosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
131
Q

Outline the differential diagnoses of neonatal jaundice presenting between 24hrs and 14 days of birth? (4)

A
  • Physiological jaundice<br></br>- Bruising<br></br>- Polycythaemia<br></br>- Infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
132
Q

Outline the differential diagnoses of neonatal jaundice presenting after 14 days from birth? (6)

A
  • Persistent pathological jaundice
  • Breast milk jaundice
  • Neonatal hepatitis
  • Biliary atresia
  • Hypothyroidism
  • Galactosaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
133
Q

Outline the pathophysiology of dermatitis herpetiformis as a complication of coeliac disease?

A

The anti-TTG IgA antibodies bind to epidermal transglutaminase present in dermal papillae causing chronic, intensely itchy, blistering skin lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
134
Q

Which triad of histological features are commonly seen on duodenal biopsies of patients with coeliac disease? (3)

A
  • Crypt hyperplasia
  • Villous atrophy
  • Lymphocytic infiltration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
135
Q

What is the most common causative organism in patients with traveller’s diarrhoea?

A

Enterotoxigenic<i>Escherichia coli </i>(ETEC)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
136
Q

Outline the clinical features associated with giardia-positive traveller’s diarrhoea? (4)

A
  • Chronic watery diarrhoea<br></br>- Steatorrhoea<br></br>- Abdominal cramps<br></br>- Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
137
Q

Outline the most common cause of parasitic traveller’s diarrhoea?

A

<i>Giardia lamblia; </i>aprotozoan parasite acquired by ingestion of cysts in contaminated water or food

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
138
Q

Outline the two essential investigations in all patients presenting with traveller’s diarrhoea? (2)

A
  • Stool microscopy, culture and sensitivity (MC&S)<br></br>- Stool ova, cysts and parasites (OCP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
139
Q

What may be seen on stool ova, cysts and parasite microscopy in patients with giardiasis?

A

Smooth-walled oval cystic structures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
140
Q

Which stain can be used to identify parasitic cysts during microscopy of fecal material?

A

Lugol’s iodine stain; cytst and trophozoite stages seen in 90% of cases of giardiasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
141
Q

Outline the main complications associated with malaria in pregnancy? (6)

A
  • Miscarriage<br></br>- Stillbirth<br></br>- Intrauterine growth restriction (IUGR)<br></br>- Maternal anaemia<br></br>- Placental infection<br></br>- Hypoglycaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
142
Q

Which drug is used first-line to treat malaria in pregnant women?

A

Quinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
143
Q

Which <i>Plasmodium spp.</i>are known to cause disease in humans? (5)

A
  • <i>Plasmodium falciparum</i><br></br>- <i>Plasmodium vivax</i><br></br>- <i>Plasmodium ovale</i><br></br>- <i>Plasmodium malariae</i><br></br>- <i>Plasmodium knowlesi</i>
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
144
Q

How long after a bite from an infected-mosquito will symptoms of malaria first appear?

A

Usually 10 - 15 days after infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
145
Q

Outline the risk factors associated with cervical cancer? (6)

A
  • High-risk human papillomavirus (hrHPV) infection; HPV-16, HPV-18
  • Smoking
  • Combined oral contraceptive (COCP) usage
  • Family history of cervical cancer
  • Immunosuppression
  • High multiparity; > 5 full term live births
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
146
Q

Outline the risk factors associated with endometrial hyperplasia/endometrial cancer? (8)

A
  • Unopposed oestrogen therapy; oestrogen-only HRT, tamoxifen
  • Increasing age
  • Early menarche
  • Late menopause
  • Nulliparity
  • Polycystic ovarian syndrome (PCOS); due to chronic anovulation
  • Obesity
  • Hereditary predisposition; Lynch syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
147
Q

Outline the risk factors associated with ovarian cancer? (10)

A
  • Increasing age
  • Smoking
  • Obesity
  • Endometriosis
  • Asbestos
  • Nulliparity
  • Early menarche
  • Late menopause
  • Unopposed oestrogen therapy; oestrogen-only HRT, tamoxifen, IVF
  • Genetic predisposition; BRCA1/BRCA2, Lynch syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
148
Q

Outline the risk factors associated with developing pre-eclampsia? (6)

A
  • First pregnancy
  • Multiple pregnancy
  • Family history of pre-eclampsia
  • BMI ≥ 35
  • > 10 years since last pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
149
Q

Outline the risk factors associated with ectopic pregnancy? (8)

A
  • Previous ectopic pregnancy
  • Fallopian tube damage
  • Pelvic inflammatory disease (PID)/sexually transmitted infection (STI)
  • Endometriosis
  • Smoking
  • Intrauterine contraceptives (IUD or IUS)
  • Progesterone only contraceptive pill (POCP)
  • In vitro fertilisation (IVF)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
150
Q

Outline the risk factors associated with miscarriage? (9)

A
  • Embryological abnormalities
  • Advancing maternal age
  • Previous miscarriage
  • Thrombophilias; factor V leiden (FVL)
  • Antiphospholipid syndrome (APLS)
  • Anatomical/structural abnormalities
  • Endocrinological disorders
  • Obesity
  • Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
151
Q

Outline the risk factors associated with preterm premature rupture of membranes (P-PROM)? (7)

A
  • Previous preterm birth and/or P-PROM
  • Smoking
  • Polyhydramnios
  • Anatomical/structural abnormalities of the cervix/uterus/placenta
  • Sexually transmitted infection (STI)
  • Low BMI
  • Low socioeconomic status (SES)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
152
Q

Outline the methods of confirming amniotic fluid leakage? (4)

A
  • AmnioQuick; amniotic fluid lateral flow/rapid antigen test; looking forIGFBP-1 presence
  • Speculum examination; fluid expelled when patient asked to cough and/or fluid seen pooling in the posterior vaginal fornix
  • Fern test; examine fluid using microscopy looking for arborisation pattern classical of amniotic fluid
  • Transvaginal ultrasound scan; to look for oligohydramnios as a result of amniotic fluid loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
153
Q

Which class of viruses are the most common cause of viral meningitis? (2)

A

Enteroviruses<br></br>- Coxsackieviruses<br></br>- Echovirus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
154
Q

Give examples of the key clinically relevant bacteria that cause disease via intracellular pathogenicity? (6)

A
  • <i>Neisseria meningitidis</i>
  • <i>Mycobacterium tuberculosis</i>
  • <i>Listeria monocytogenes</i>
  • <i>Legionellae pneumophilia</i>
  • <i>Coxiella burnetti</i>
  • <i>Chlamydia trachomatis</i>
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
155
Q

Outline the typical incubation period before symptomatic onset of meningococcal disease (<i>N. meningitidis</i> bacterial meningitis)?

A

2 - 10 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
156
Q

Outline the most important pathogenic serotypes of <i>Neisseria meningitidis</i>? (6)

A
  • A<br></br>- B<br></br>- C<br></br>- W135<br></br>- X<br></br>- Y
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
157
Q

Outline the most clinically important congenital infections? (9)

A
  • Toxoplasmosis (<i>Toxoplasma gondii</i>)<br></br>- Rubella (Rubella virus)<br></br>- Cytomegalovirus (CMV)<br></br>- Herpes simplex virus (HSV)<br></br>- Coxsackievirus<br></br>- Parvovirus B19<br></br>- Syphalis (<i>Treponema pallidum</i>)<br></br>- Varicella-zoster virus (VZV)<br></br>- Human immunodeficiency virus (HIV)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
158
Q

Which pathogens associated with congenital infections are most commonly associated with placental thickening, microcephaly and intrauterine growth restriction (IUGR)? (4)

A
  • <i>Toxoplasma gondii</i><br></br>- Cytomegalovirus (CMV)<br></br>- Herpes simplex virus (HSV)<br></br>- Varicella-zoster virus (VZV)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
159
Q

Outline the risk of CMV infection of the fetus during the pregnancy of a CMV positive mother?

A

About 33%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
160
Q

Which test can be used to confirm intrauterine infection with CMV and other congenital infection-causing viruses?

A

Amniocentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
161
Q

Which feature seen on ultrasound is heavily indicative of CMV infection of a developing fetus?

A

Periventricular cerebral calcifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
162
Q

Why may neonates born with congenital infections be positive for IgG antibodies?

A

IgG is capable of crossing the placenta hence these are likely maternal antibodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
163
Q

Outline the triad of symptoms consistent with a presentation of pulmonary tuberculosis (PTB)? (3)

A
  • Chronic cough
  • Night sweats
  • Weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
164
Q

Outline the radiological features seen on a PA X-ray film consistent with pulmonary tuberculsis? (3)

A
  • Enlarged hilar regions<br></br>- Upper lobe consolidation<br></br>- Cavitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
165
Q

How can central nervous system and peripheral neuromuscular causes of a floppy infant be differentiated? (2)

A
  • Central nervous system floppiness; deep tendon reflexes present, no significant weakness<br></br>- Peripheral neuromuscular floppiness; deep tendon reflexes absent, significant weakness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
166
Q

How can the causes of a floppy infant be stratified?

A

Based on whether the aetiology is central (nervous) or peripheral (neuromuscular)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
167
Q

Outline the central nervous system aetiologies associated with a floppy (hypotonic) infant? (5)

A
  • Chromosomal disorders; Prader-Willi syndrome, Down syndrome<br></br>- Brain injury; hypoxic ischaemic encephalopathy, intraventricular haemorrhage<br></br>- Brain infection; meningitis, encephalitis, sepsis<br></br>- Metabolic disturbances; hypoglycaemia<br></br>- Drug exposure; pethidine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
168
Q

Outline the peripheral neuromuscular causes of a floppy infant? (5)

A
  • Infantile spinal muscular atrophy (SMA)
  • Congenital myasthenia gravis (CMG)
  • Congenital myotonic dystrophy (DM1)
  • Congenital myopathy (CM)
  • Congenital musclar dystrophy (CMD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
169
Q

What is the most common aetiology of hypotonia in infants?

A

Central causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
170
Q

Why may the first few inflation breaths during neonatal resuscitation not cause observable chest movement?

A

<div>The first few inflation breaths may not produce chest movement because they act to displace lung fluid.</div>

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
171
Q

How can the affectiveness of the first few inflation breaths given during neonatal resuscitation be measured?

A

Checking for an increase in the heart rate associated with the inflation breaths

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
172
Q

What percentage of live births are affected by congenital malformations?

A

Around 3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
173
Q

How can we stratify the causes of congenital malformations? (3)

A
  • Genetic causes
  • Environmental causes
  • Sporadic causes
174
Q

Outline the main genetic causes of congenital malformations? (2)

A
  • Chromosomal abnormalities; DiGeoge syndrome (22q11 deletion)<br></br>- Gene mutations; CHARGE syndrome caused by CHD7 mutation
175
Q

Outline the features of CHARGE syndrome? (6)

A

<div>- Coloboma;a hole or defect of theirisof the eye<br></br>- Heart defects; most commonly a VSD<br></br>- Atresia choanae; blockade of the back of the nasal passage<br></br>- Retardation; affecting growth and/or development<br></br>- Genital abnormalities;hypogonadism,undescended testicles, hypospadias<br></br>- Ear abnormalities;deafness, abnormally bowl-shaped and concave ears</div>

176
Q

Outline the classic presentation of metabolic disease?

A

Sudden deterioration in the neonatal period

177
Q

Outline the common metabolic disorders associated with severe metabolic acidosis? (3)

A
  • Propionic acidaemia
  • Methylmalonic acidaemia
  • Isovaleric acidaemia
178
Q

What kind of acid-base disorder is most commonly associated with congenital metabolic disease?

A

Severe metabolic acidosis with increased anion gap and reduced base excess

179
Q

Outline the normal ratio ofluteinising hormone (LH) to follicle stimulating hormone (FSH) in healthy women of reproductive age?

A

1:1

180
Q

What is the most common cause of a raised luteinising hormone (LH) to follicle stimulating hormone (FSH) ratio in women?

A

Polycystic ovarian syndrome (PCOS)

181
Q

Outline the pathophysiology of polycystic ovarian syndrome (PCOS)? (4)

A
  • Loss of pulsatility and/or increased LH release from the anterior pituitary results in the excessive stimulation of the ovaries
  • This results in the excess production of androgens alongside the development of multiple immature follicles
  • Excess androgen secretion results in hirsuitism and acne whilst development of the follicles causes the classic polycystic appearance of the ovaries
  • In addition to this a state of insulin resistance develops which causes increased insulin release that furtherstimulates the ovaries to produce androgens
182
Q

Outline the most common complications associated with polycystic ovarian syndrome (PCOS)? (6)

A
  • Endometrial hyperplasia +/- progression to endometrial carcinoma<br></br>- Infertility due to anovulation<br></br>- Anxiety and depression<br></br>- Metabolic syndrome; diabetes, atherosclerosis<br></br>- Gestational diabetes (GDM)<br></br>- Cerebrovascular accidents (CVA)
183
Q

Outline the features of the triple assessment of a breast lump? (3)

A
  • Clinical assessment; history and examination<br></br>- Imaging; either ultrasound or mammography<br></br>- Histology; either fine-needle aspiration or core biopsy
184
Q

Outline the benign causes of a breast lump? (10)

A
  • Fibroadenoma<br></br>- Fibrocytstic breast changes<br></br>- Breast cysts<br></br>- Fat necrosis<br></br>- Lipoma<br></br>- Galactocoele<br></br>- Pyllodes tumour<br></br>- Sclerosing adenosis<br></br>- Epithelial hyperplasia<br></br>- Duct papilloma
185
Q

Outline the main histological subtypes of in situ breast carcinoma? (2)

A
  • Ductal carcinoma<br></br>- Lobular carcinoma
186
Q

Outline the main histological subtypes of invasive (infiltrating) breast carcinoma? (5)

A
  • Ductal carcinoma<br></br>- Lobular carcinoma<br></br>- Mucinous carcinoma<br></br>- Medullary carcinoma<br></br>- Tubular carcinoma
187
Q

Outline the first-line investigations carried out in patients presenting with a breast lump? (3)

A

Triple Assessment<br></br>- Clinical assessment; history and examination<br></br>- Imaging; either ultrasound or mammography<br></br>- Histology; either fine-needle aspiration or core biopsy

188
Q

Outline the set investigations carried out in patients following a diagnosis of breast cancer? (5)

A
  • Histopathology; histological subtyping and tumour grading (TNM)
  • Disease staging scans; MRI breast, CT-CAP, CT brain, CXR, liver USS and bone scan
  • Receptor expression; oestrogen (ER), progesterone (PR) and EGF-R (ERBB2/HER2)
  • Assessment of axillae; USS +/- FNA/sentinel node biopsy
  • Genetic testing; DNA microarray of tumour and genetic testing of patient
189
Q

What is Paget’s disease of the breast/nipple? (3)

A
  • Paget’s disease is an eczematoid change of the nipple associated with straw-coloured or bloody discharge and a burning sensation around nipple<br></br>- Often represents an underlying breast malignancy and can be found alongside a breast mass<br></br>- It is thought to be due to malignant ductal cells migrating into the lactiferous sinuses and the nipple skin
190
Q

Outline the investigations required in patients presenting with Paget’s disease of the nipple? (2)

A
  • Imaging; mammography/breast ultrasound

- Punch biopsy; histological and cytological analysis

191
Q

Outline the indications for a coroners referral following a patients’ death? (9)

A

<div>- Unknown cause of death</div>

<div>- Sudden, unexpected death; all deaths < 24 hours of hospital admission</div>

<div>- Deceased had not seen a doctor within 2 weeks</div>

<div>- Death due to accident, self-neglect or neglect</div>

<div>- Death due to occupation</div>

<div>- Death due to abortion</div>

<div>- Death occurred during an operation or prior to anesthetic recovery</div>

<div>- Potential suicide</div>

<div>- Death occurred whilst in police custody</div>

192
Q

Outline the subtypes of non-germ cell testicular tumours? (2)

A
  • Sex cord-stromal; sertoli cell, leydig cell

- Others; lymphoma, metastases

193
Q

What features of a patients transaminitis can suggest a chronic inflammatory process over an acute picture?

A

Mildly raised transaminases point towards a chronic inflammatory process as opposed to an acute picture, particularly in the context of hepatitis

194
Q

Which hepatitis virus is most commonly associated with chronic infection and cirrhosis?

A

Hepatitis C; chronic and cirrhotic

195
Q

Outline the routes of transmission of hepatitis B? (3)

A
  • Parenterally<br></br>- Sexually<br></br>- Vertically
196
Q

What is the approximate incubation period of hepatitis B?

A

~ 3 months

197
Q

What percentage of patients develop chronic hepatitis B infections?

A

5 - 10%

198
Q

Which organisms are known to cause enteric (typhoid) fever? (2)

A
  • <i>Salmonella enterica typhi</i><br></br>- <i>Salmonella enterica paratyphi</i>
199
Q

Outline the gram staining results of a blood culture from a patient with typhoid fever?

A

Gram negative rods (bacilli)

200
Q

Which features specifically raise suspicion of typhoid fever in a patient with fever and abdominal pain? (2)

A
  • Relative bradycardia

- Relatively low or normal WBC and platelet count

201
Q

Which organisms are most commonly associated with infection of the skin and soft tissues? (2)

A
  • <i>Staphylococcus aureus</i><br></br>- <i>Streptococcus pyogenes</i>
202
Q

Which specific strains of <i>Staphylococcus aureus </i>are commonly associated with necrotising pneumonia and necrotising fasciitis?

A

Panton-Valentine Leukocidin (PVL) toxin-producing strains; this is a β-pore forming cytotoxin and virulence factor capable of lysing white blood cells

203
Q

Outline the mainstay treatment used in infected abscesses?

A

Incision and drainage

204
Q

What is the definition of methicillin-resistant <i>staphylococcus aureus</i> (MRSA)?

A

<i>Staphylococcus aureus</i> strains resistant to multiple groups of the β-lactam class of antibiotics (penicillins, cephalosporins, carbapenems) and sometimes aminoglycosides, macrolides and quinolones also

205
Q

Outline the pathogenesis of <i>Streptococcal </i>toxic-shock syndrome (TST)? (2)

A
  • Some<i> Streptococcus pyogenes</i>strains produce streptococcal pyrogenic exotoxins (SPEs)<br></br>- SPE-A, SPE-B and SPE-C act as superantigens directly stimulating T-cells thus resulting in cytokine storm and sepsis
206
Q

Outline the pathogenesis of<i>Staphylococcal</i>toxic-shock syndrome (TST)? (2)

A
  • Some<i>Staphylococcus aureus</i>strains produce the exotoxin toxic-shock syndrome toxin-1 (TSST-1)<br></br>- TSST-1acts as a superantigen directly stimulating T-cells thus resulting in cytokine storm and sepsis
207
Q

Outline the two main categories of urethral discharge? (2)

A
  • Gonococcal urethritis (GU); caused by<i> Neisseria gonorrhoeae</i>
  • Non-gonococcal urethritis (NGU); caused by non-gonococcal organisms
208
Q

Which organisms are associated with non-gonococcal urethrtitis (NGU)? (4)

A

CUM-T<br></br>- <i>Chlamydia trachomatis</i><br></br>-<i>Ureaplasma urealyticum</i><br></br>- <i>Mycoplasma genitalium</i><br></br>- <i>Trichomonas vaginalis</i>

209
Q

What features may allow differentiation of gonococcal and non-gonoccocal urethrtitis? (3)

A
  • Gonoccocal urethritis (GU); acute onset, prominent dysuria, thick-yellow discharge
  • Non-gonoccocal urethritis (NGU); indolent onset, less prominent dysuria, thin, watery discharge
210
Q

Which organism is most commonly associated with non-gonoccocal urethritis (NGU)?

A

<i>Chlamydia trachomatis</i>

211
Q

What is considered the standard test for patients suspected of having gonococcal urethritis (GU)?

A

Nucleic acid amplification test (NAAT)

212
Q

How do the symptoms of gonococcal urethritis differ in men and women? (2)

A
  • Men; mucopurulent yellow urethral discharge<br></br>- Women; endocervical infection
213
Q

Outline the dysmorphic features associated with Down syndrome? (6)

A
  • Flattened face/nasal bridge
  • Upward slanting palpebral fissures
  • Epicanthic folds
  • White speckles in the iris (Brushfield spots)
  • Short broad hands
  • Single palmar and plantar fisssures (Simian crease)
214
Q

Outline the features commonly associated with Down syndrome? (4)

A
  • Low intelligence quotient (IQ)
  • Congenital heart disease
  • Duodenal atresia
  • Short stature
215
Q

Which investigation should all children with confirmed Down syndrome have?

A

Cardiac echocardiogram; even if no murmur is detected as prevelance of cardiac abnormalities is high (~30%)

216
Q

Outline the three different types of down syndrome? (3)

A
  • Trisomy 21; ~96% of cases, due to a complete duplication of chromosome 21<br></br>- Robertsonian translocation; ~3% of cases, caused by translocation 14q21q<br></br>- Mosaic down syndrome; ~1% of cases, mixture of trisomy 21 and non-trisomy 21 cells
217
Q

Outline the significance of the Robertsonian translocation in Down syndrome? (2)

A
  • This is often an inherited translocation that can be passed on from an asymptomatic carrier parent to a child who will manifest the disease
  • As such this is associatedwith a 5-15% risk of any children born to the carrier parent being affected by Down syndrome
218
Q

Outline the causes of hypocalcaemia in infancy? (7)

A
  • Prematurity
  • Hypoxic ischaemic encephalopathy (HIE)
  • Hypoparathyroidism; transient or permanent
  • Hypomagnesaemia; magnesium facilitates PTH release
  • Maternal hypercalcaemia; suppression of fetal PTH release
  • Maternal vitamin D deficiency
  • Familial mutations; calcium-sensing receptor
219
Q

Why do children who experience neonatal siezures need surveillance and follow-up?

A

Neonatal seizures are associated with adverse developmental outcomes

220
Q

Outline the investigations that can be used to inform clinicians whether a women is likely to go into premature labour? (3)

A
  • Fetal fibronectin (fFN) test; elevated levels associated with premature labour<br></br>- Transvaginal ultrasound (TVUS); measurement of cervical length, > 15 mm suggests premature labour unlikely<br></br>- PartoSure; rapid antigen test for placentalα microglobulin 1 (PAMG-1)
221
Q

Which organism is most commonly associated withpuerperal sepsis?

A

Group A Streptococci (<i>Streptococcus pyogenes</i>)

222
Q

Outline the pathophysiology of how infection can lead to preterm premature rupture of membranes (P-PROM)?

A

Bacterial infections trigger a cascade of signalling that results in the release of prostaglandins and matrix metalloproteinases (MMPs) that can break down the fetal membranes and initiate the labour process

223
Q

Outline the risk factors associated with periventricular leukomalacia (PVL)? (3)

A
  • Prematurity
  • Fetal distress at birth
  • Chorioamnionitis
224
Q

<div>Outline the pathophysiology of periventricular leukomalacia (PVL) secondary to infection?</div>

A

Bacterial antigens enter the fetalbrain and trigger the localised production of cytokines which results inoligodendrocyte apoptosis andmyelin degeneration

225
Q

Outline the most common primary tumours associated with boney metastases in men and women? (2)

A
  • Men; prostate cancer<br></br>- Women; breast cancer
226
Q

Which types of tumours do mutations in MLH1/MSH2 particularly predispose patients to? (2)

A
  • Colorectal carcinoma

- Endometrial carcinoma

227
Q

Outline the features associated with an innocent murmur? (6)

A

The 6 S’s<br></br>- Sensitive to position<br></br>- Short duration<br></br>- Sternal edge (left)<br></br>- Soft and blowing<br></br>- Systolic<br></br>- No symptoms

228
Q

Which tumours are most commonly associated with ‘small round blue cells’? (3)

A
  • Ewing sarcoma<br></br>- Neuroblastoma<br></br>- Small cell lung cancer (SCLC)
229
Q

What is the most common cause of gastroenteritis in children?

A

Rotavirus

230
Q

Outline the most common benign and malignant brain tumours in children? (2)

A
  • Benign; pilocytic astrocytoma<br></br>- Malignant; medulloblastoma
231
Q

Oultine the main differences between Ewing sarcoma and osteosarcoma? (3)

A
  • Osteosarcoma; osteoid-producing, affects metaphysis, mesenchymal<br></br>- Ewing sarcoma; osteo-lytic, affects diaphysis, neuroectoderm (CD99)
232
Q

Outline the risk factors associated with developmental dysplasia of the hip (DDH)? (6)

A

The 6 F’s;<br></br>- Feet-first (breech)<br></br>- Female,<br></br>- Fluid low (oligohydramnios)<br></br>-Fat (maternal type 2 diabetes mellitus)<br></br>- First-born<br></br>- Family history

233
Q

Outline the components of the combined screening test in pregnancy? (4)

A

<div>- Free beta human chorionic gonadotropin (β-hCG)<br></br>- Pregnancy-associated plasma protein-A (PAPP-A)</div>

<div>- Nuchal translucency (NT)<br></br>- Crown-rump length (CRL)</div>

234
Q

Outline the components of the quadruple screening test in pregnancy? (4)

A

<div>- Free beta human chorionic gonadotropin (β-hCG)<br></br>-Alpha-fetoprotein (AFP)<br></br>- Unconjugated estriol (uE3)<br></br>- Inhibin A</div>

235
Q

Outline the circumstances in which the quadruple test used instead of the combined test as screening during pregnancy? (4)

A
  • After 13+6 weeks and/or
  • Nuchal translucency (NT) cannot be measured
  • Crown-rump length (CRL) > 84 mm
  • Head circumference (HC) 101 - 172 mm
236
Q

Outline the components of the standard booking bloods offered to all women? (6)

A
  • Full blood count (FBC); anaemia
  • Blood grouping; red cell antigens (ABO) and rhesus-D antigen status
  • Serum antibodies; RhD antibody status
  • Viral serology; HBV, HIV and RV
  • Syphilis serology; anti-treponemal antibodies
  • Haemoglobin electrophoresis; screening for haemoglobinopathies in at-risk women
237
Q

Outline the post-partum management of neonates born to mothers with confirmed hepatitis B infection during pregnancy? (3)

A
  • Accelerated HBV vaccination; 12 hrs, 1-2 months and 6 months<br></br>- Hepaitits B virus immunoglobulin (HBIG); within 12 hrs of birth<br></br>- Consider antivirals; lamivudine if high viral load in mother
238
Q

Outline the classical features of allergic rhinitis? (4)

A
  • Rhinorrhoea<br></br>- Sneezing<br></br>- Nasal congestion<br></br>- Itching eyes
239
Q

Which atopic disease classically presents first in childhood?

A

Eczema; this usually manifests in infancy

240
Q

Outline the classic triad of atopic diseases? (3)

A
  • Asthma
  • Eczema
  • Allergic rhinits
241
Q

Outline the two main tests that can be used to investigate potential allergies? (2)

A
  • Radioallergosorbent testing (RAST); IgE-specific allergen test<br></br>- Skin-prick testing; more sensitive and specific
242
Q

Which types of fracture are particularly suspicious for non-accidental injury (NAI)? (3)

A
  • Metaphyseal fractures; occuring at the widest point of the bone
  • Posterior rib fractures; highly unusual especially in immoble infants
  • Spiral fractures; sharp angular fractures that imply a twisting injury
243
Q

Outline the investigations required in cases of suspected non-accidental injury (NAI)? (3)

A
  • Full skeletal survey; investigate for potential fractures
  • Brain CT; investigate subdural haemorrhage
  • Clotting screen; investigate any bruising
244
Q

Outline the common risk factors associated with non-accidental injury (NAI)? (5)

A
  • First-time parents
  • Young parents
  • No local support
  • Low socioeconomic status
  • Difficulties with feeding/parenting
245
Q

What is the most common cause of malodorous discharge in pre-pubertal females?

A

Vulvovaginitis

246
Q

What is the most common cause of an abnormal head shape in an infant?

A

<div>Positional (deformational) plagiocephaly; caused by asymmetrical pressure on the developing occiput or skull base</div>

247
Q

Outline the differential diagnoses for an infant with an abnormal asymmetrical head? (2)

A
  • Positional (deformational) plagiocephaly; caused by asymmetrical sleeping position, torticollis or cervical spine abnormalities.<br></br>- Craniosynostosis; caused by premature fusion of one or more cranial sutures
248
Q

What is the most common cause of an englarged head in an infant?

A

Famililal macrocephaly

249
Q

Outline the differential diagnoses of an enlarged head in an infant? (5)

A
  • Familial macrocephaly
  • Hydrocephalus
  • Fragile X syndrome
  • Subdural haematoma
  • Space occupying lesion
250
Q

What is the most common cause of accidental poisoning in childhood?

A

<div>Iron poisoning; because iron-containing preparations are widely available and ofren resemble sweets</div>

251
Q

Outline the features of childhood iron poisoning? (5)

A
  • Acute liver dysfunction
  • Tissue hypoxia
  • Encephalopathy
  • Gastrointestinal bleeding
  • Diarrhoea/vomiting
252
Q

Outline the most common differential diagnoses associated with intermenstrual bleeding? (6)

A
  • Endometrial hyperplasia/malignancy<br></br>- Cervcal malignancy<br></br>- Cervical ectropion<br></br>- Endocervical polyp<br></br>- Atrophic vaginitis<br></br>- Pregnancy<br></br>- Irregular bleeding due to POCP
253
Q

Outline the definitive management of an endometrial polyp?

A

Hysteroscopy and resection

254
Q

Outline the main aetiologies that can cause hyperprolactinaemia? (5)

A
  • Physiological; breast feeding, pregnancy, stress<br></br>- Malignancy associated; prolactinoma<br></br>- Drugs; antipsychotics, metoclopramide, methyldopa<br></br>- Idiopathic<br></br>- Others; hypothyroidism, chronic kidney disease
255
Q

Which feature of the history is vitally imporant in women presenting with amenorrhoea/infertility?

A

Medication history; as a number of drugs can cause hyperprolactinaemia

256
Q

Outline the threshold value of the day 21 serum progesterone that is highly suggestive of ovulation?

A

Serum progesterone > 30 nmol L-1 is suggestive of ovulation

257
Q

What percentage of women with hyperprolactinaemia will present with galactorrhoea?

A

< 50%; it is not a common symptom

258
Q

What is the most common presenting complaint seen in women with hyperprolactinaemia?

A

Infertility and/or amenorrhoea

259
Q

Outline the risk factors associated with preterm labour? (8)

A
  • Extremes of maternal age<br></br>- Low SES<br></br>- Infection<br></br>- Previous preterm birth<br></br>- Multiple pregnancy<br></br>- Hypertension in pregnancy<br></br>- Polyhydramnios<br></br>- Structural abnormalities of the cervix and/or uterus
260
Q

Outline the interventions that may be used to prevent preterm delivery in women with risk factors? (2)

A
  • Rescue cervical cerclage; rescue suture<br></br>- Progesterone supplementation;decreases myometrial activity and prevents cervical remodelling<br></br>
261
Q

Outline the management of preterm labour with intact membranes? (6)

A
  • Engange fetal monitoring (CTG)
  • Tocolysis; nifedipine or atosiban if before 34 weeks
  • Maternal corticosteroids; to promote fetal lung maturation
  • IV magnesium sulfate; neuroprotective of fetal brain
  • Intrapartum antibiotics; benzylpenicillin (penicillin G) 3 g IV then 1.5 g IV every 4 hours until delivery
  • Delayed cord clamping; increase circulating volume and haemoglobin
262
Q

Outline the management of preterm premature rupture of membranes (P-PROM)? (4)

A
  • Erythromycin 250 mg (PO) QDS for 10 days<br></br>- Maternal corticosteroids; to promote fetal lung maturation<br></br>- IV magnesium sulfate; neuroprotective of fetal brain<br></br>- Induction of labour if > 34 weels
263
Q

When is co-amoxiclav contraindicated in pregnancy and why?

A

Co-amoxiclav is contraindicated in preterm premature rupture of membranes (P-PROM) due to the risk of the neonate developing necrotising enterocolitis (NEC)

264
Q

Outline the difference between small for gestational age (SGA) fetuses and intrauterine growth restriction (IUGR)? (2)

A
  • Small for gestational age (SGA); consistenly below 10th centile in all indices<br></br>- Intrauterine growth restriction (IUGR); dropping centiles in 1 or more indices
265
Q

Which metric measured as part of the routine monitoring on ultrasound during pregnancy is affected first by intrauterine growth restriction (IUGR)?

A

Fetal abdominal circumference

266
Q

Outline the common metrics measured during a growth scan? (5)

A
  • Fetal abdominal circumference (FAC)<br></br>- Estimated fetal weight (EFW)<br></br>- Biparietal diameter (BPD)<br></br>- Uterine arterial pulsitility index (UA-PI)<br></br>- Amniotic fluid volume (AFV)
267
Q

How can we stratify the risk factors associated with intrauterine growth restriction (IUGR)? (3)

A
  • Fetal; congenital infections, chromosomal abnormalities
  • Maternal; drugs, smoking, extremes of age, HTN, DM, TORCH
  • Placental; PET, multiple pregnancy, placental insufficiency
268
Q

Outline the investigations that should be carried out following a diagnosis of intrauterine growth restriction (IUGR)? (4)

A
  • Maternal doppler ultrasound scan; investigate flow through uterine artery<br></br>- Repeat anomaly scan; investigate any undiagnosed fetal anomalies<br></br>- TORCH screen; checking for new maternal infections<br></br>- Cardiotocography (CTG); assess fetal wellbeing
269
Q

Which investigations should be carried out in all teenagers presenting drunk? (2)

A
  • Blood glucose levels; to rule out hypoglycaemia<br></br>- Cranial CT; if GCS is reduced
270
Q

At what age should pica (repeated/chronic ingestion of non-nutritive substances) be investigated?

A

After the age of 2-years as it may indicate underlying pathology

271
Q

Outline the abnormal red blood cell features that can indicate lead poisoning? (2)

A
  • Microcytosis; due to iron-deficiency anaemia

- Basophilic stippling of RBCs; indicative of disturbed erythropoiesis

272
Q

Which mineral deficiencies are associated with lead poisioning and why?

A

Calcium and iron deficiency; because lead competes with these metals for uptake from the intestines

273
Q

Outline the key risk factors associated with pica in children?

A

Emotional and social neglect

274
Q

What volume of 1/1000 adrenaline should be given to patients < 6 years of age with signs of anaphylactic shock?

A

0.15 mL of 1/1000 adrenaline for a total dose of 0.15 mg

275
Q

What volume of 1/1000 adrenaline should be given to patients 6 - 12 years years of age with signs of anaphylactic shock?

A

0.30 mL of 1/1000 adrenaline for a total dose of 0.30 mg

276
Q

What volume of 1/1000 adrenaline should be given to patients > 12 years years of age with signs of anaphylactic shock?

A

0.50 mL of 1/1000 adrenaline for a total dose of 0.50 mg

277
Q

How does premature ovarian failure often present?

A

Signs of early menopause; hot flushes, vaginal dryness, amenorrhoea

278
Q

Outline the management of premature ovarian failure? (2)

A
  • Continuous oestrogen replacement; for bone and cardiovascular protection<br></br>- Progesterone supplementation; either continuous or cyclical to minimise risks of unopposed oestrogens
279
Q

Which type of lung cancer is most commonly associated with hypercalcaemia?

A

Squamous cell carcinoma (SCC); due to ectopic parathyroid hormone (PTH) secretion

280
Q

Outline the differentials diagnoses associated with an ovarian mass? (4)

A
  • Follicular cyst
  • Corpus luteal cyst
  • Endometrioma
  • Ovarian tumour
281
Q

Outline the main classes of ovarian tumour? (4)

A
  • Epithelial tumours
  • Sex cord-stromal tumour
  • Germ cell tumours
  • Metastases
282
Q

Outline the specific ovarian tumour markers and the specific type of tumour they are associated with? (6)

A
  • LDH; dysgerminomas<br></br>- CA-125; epithelial ovarian tumours<br></br>- CEA; mucinous ovarian tumours<br></br>- AFP; yolk-sac tumours<br></br>- β-hCG; choriocarcinomas<br></br>- Inhibin-A/B; granulosa cell tumours
283
Q

Which genes are most commonly tested for in patients with breast cancer? (3)

A
  • BRCA1
  • BRCA2
  • PALB2
284
Q

Outline the most common type of invasive breast carcinoma?

A

Carcinoma of no special type (NST)

285
Q

Outline the triad of features associated with Meig’s syndrome? (3)

A
  • Benign ovarian tumour; usually a fibroma<br></br>- Pleural effusion<br></br>- Ascites
286
Q

Outline how the Bishop score can be used to guide decisions about induction of labour? (2)

A
  • Score < 5; labour unlikely to start without induction
  • Score ≥ 8; cervix is ripe/favourable and there is a high chance of spontaneous labour, or response to interventions made to induce labour
287
Q

Outline the threshold gestation of pregnancy from which gestational hypertension can be diagnosed?

A
  • From 20 weeks onwards as blood pressure tends to fall in the first trimester
  • Hypertension before this point is therefore most likely chronic (essential) hypertension
288
Q

Which vaccinations are routinely offered to pregnant women in the UK?

A
  • Influenza

- Pertussis

289
Q

Outline the risk factors associated with shoulder dystocia? (4)

A
  • Gestational diabetes
  • Macrosomia
  • Maternal obesity
  • Previous shoulder dystocia
290
Q

Outline the management options that can be used in cases of shoulder dystocia? (4)

A
  • Suprapubic pressure
  • McRoberts manoeuvre
  • Wood’s screw manoeuvre
  • Symphysiotomy
291
Q

Outline the threshold values of protein quantification that can be used to distinguish nephrotic syndrome from nephritic syndrome? (3)

A

Nephrotic Range

  • 24 hr urinary protein > 3.5 g
  • Albumin creatinine ratio > 220
  • Protein creatinine ratio > 300
292
Q

Which glomerulonephritides commonly present with nephritic syndrome? (5)

A
  • Post-streptococcal glomerulonephritis (PSGN)
  • Lupus nephritis (LN)
  • IgA nephropathy (IGAN)
  • Anti-glomerular basemement membrane (anti-GBM) disease; Goodpasture’s syndrome
  • ANCA positive vasculitides; microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), eosinophilic granulomatosis with polyangiitis (EGPA)
293
Q

Which glomerulonephritides commonly present with nephrotic syndrome? (4)

A
  • Minimal change disease (MCD)
  • Focal segmental glomerulosclerosis (FSGS)
  • Membranous nephropathy
  • Renal amyloidosis
294
Q

Why is an abducens nerve (CN VI) palsy often referred to as a ‘false localising sign’ in the context of raised intracranial pressure?

A

As the abducens nerve has the longest intracranial course, it is often the first to be affected by raised intracranial pressure. This results in an abducens nerve palsy due to stretching of the nerve as a result of posterior displacement of the brainstem from where it emerges.

295
Q

What is the most common cause of a subarachnoid haemorrhage (SAH)?

A

Ruptured saccular (berry) aneurysm

296
Q

Outline the most common pathogenic mechanisms resulting in brain abscesses? (3)

A
  • Recent neurosurgical procedures; burr-hole, external ventricular drain
  • Parameningeal infection; contiguous spread from sinusitis, otitis, mastoiditis, dental abscess
  • Distant infection; haematogenous spread from lung abscesses and empyema
297
Q

What is meant by the term leptomeninges?

A

Leptomeninges refers to the innermost layers of the meninges; the pia mater and the arachnoid mater. They are referred to as such as the subarachnoid space is essentially a potential space only in the healthy state

298
Q

Which atypical pneumonia-causing organism is most commonly associated with a concurrent transaminitis alongside pneumonia symptoms?

A

<i>Coxiella burnetti</i> (Q fever)

299
Q

Outline the differential diagnoses associated with failure to pass meconium within the first 48hrs of life? (6)

A
  • Hirschsprungs disease (congenital aganglionic megacolon)
  • Meconium ileus/plugging
  • Intestinal atresia
  • Anorectal malformations
  • Hypoganglioma
  • Ganglioneuromatosis
300
Q

Which test is used to diagnose Hirschsprung’s disease?

A

Suction rectal biopsy

301
Q

Outline the pathophysiology of Hirschsprung’s disease?

A

Failure of migration of neural crest cells to the colon resulting in the absence of enteric ganglia and thus the absence of peristaltic movement in the bowel

302
Q

Outline the definition of hydrops fetalis (fetal hydrops)?

A 
- Accumulation of fluid in ≥ 2 body sites
  • Skin
  • Pleural cavity 
  • Pericardial cavity
  • Peritoneal cavity
303
Q

Outline the features associated with oesophageal atresia? (3)

A
  • Excessive salivation
  • Post-feed vomiting
  • Polyhydramnios during pregnancy
304
Q

What is the most likely cause of a sudden deterioration in symptoms of a patient with known chronic lymphocytic leukaemia (CLL)?

A

Richter’s transformation; a sudden transformation of chronic lymphocytic leukaemia (CLL) into the high-grade non-Hodgkin lympoma (NHL) diffuse large B cell lymphoma (DLBCL)

305
Q

What is different about tuberculous meningitis compared with other bacterial causes of meningitis? (2)

A
  • Tuberculous meningitis tends to predominantly affect the brain stem resulting in cranial nerve palsies
  • Lymphocytes are the predominant white blood cells detected on CSF analysis
306
Q

What threshold value of serum FSH is considered to be associated with a poor prognosis for conception?

A

FSH > 10 IU L-1

307
Q

Which additional test can be used to indicate ovarian reserve in women with infertility who have raised serum FSH?

A

Anti-Mullerian hormone (AMH) levels

308
Q

Outline the rough staging of ovarian cancer? (4)

A
  • Stage 1; confined to the ovaries
  • Stage 2; pelvic spread to uterus or fallopian tubes
  • Stage 3; peritoneal metastases and/or regional lymph nodes
  • Stage 4; distant metastases to liver parenchyma and beyond
309
Q

Outline the typical presenting features of a leiomyoma (uterine fibroid)? (4)

A

PAI(M)

  • Pressure effect from pressure on the bladder, stomach or bowel
  • Abdominal mass
  • Infertility
  • Menorrhagia
310
Q

Which group of patients are at increased risk of developing uterine fibroids (leiomyomas)?

A

Afro-Caribbean women

311
Q

Outline the management options in patients with uterine fibroids (leiomyomas)? (5)

A
  • Gonadotrophin-releasing hormone analogues
  • Gonadotrophin-releasing hormone agonists
  • Uterine artery embolisation
  • Hysteroscopic transcervical resection of the fibroid (TCRF)
  • Hysterectomy or myomectomy
312
Q

Outline the mechanism of action of ulipristal acetate?

A

Ulipristal acetate is a selective progesterone receptor modulator (SPRM) with both progesterone receptor agonist and antagonist properties

313
Q

What is the difference between dyskaryosis and dysplasia in the context of cervical screening? (2)

A
  • Dyskaryosis; refers to the abnormal appearance of cervical epithelial cells observed on a cervical smear
  • Dysplasia; refers to the dedifferentiation of cells as viewed on histological analysis of cervical biopsies
314
Q

What is meant by the term dysfunctional uterine bleeding (DUB)?

A

Excessive heavy, prolonged or frequent bleeding that is not due to pregnancy or any recognisable pelvic or systemic disease

315
Q

Outline the management options used in dysfunctional uterine bleeding (DUB)? (5)

A
  • Tranexamic acid (TxA); during menstruation
  • Levonorgestrel-releasing intrauterine system (LNG-IUS)
  • Combined oral contraceptive pill (COCP); if < 35 years of age
  • Endometrial ablation; if not wanting to preserve fertility
  • Hysterectomy; as a last resort only
316
Q

Which blood tests are vital in women with amennorhoea? (2)

A
  • Serum prolactin

- Thyroid function tests

317
Q

What is the threshold value of prolactin associated with a pituitary adenoma (prolactinoma)?

A

Prolactin levels > 1000 u L-1 ; below this but raised can be a result of stress, venepuncture, breast examination or associated with polycystic ovarian syndrome (PCOS)

318
Q

Which additional investigation should be carried out in women suspected of having a prolactinoma?

A

Visual field testing; prolactinomas can cause a bitemporal superior quadrantanopia

319
Q

Which feature seen on transvaginal ultrasound scan (TVUS) can help to point towards a diagnosis of adenomyosis? (2)

A
  • An indistinct myometrial-endometrial border

- Venetian blind sign; bands of linear shadows along lines of sight, often diverging

320
Q

Outline the features seen on X-rays of patients with osteoarthritis? (4)

A

LOSS;

  • Loss of joint space
  • Osteophytes
  • Subchondral sclerosis; increased density of the bone along the joint line
  • Subchondral cysts; fluid-filled holes in the bone, aka geodes
321
Q

Which long-term complication is associated with haemophilia?

A

Haemophilic arthropathy; osteoarthritis-like disorder with boney joint erosions

322
Q

Outline the abnormal findings that may be seen on blood film analysis of patients with multiple myeloma? (3)

A
  • Rouleaux formation; stacks of RBCs due to monoclonal immunoglobulin protein coating
  • Plasma cells; in end-stage disease, usually confined to the bone marrow
  • Anisocytosis; varying sizes of RBCs consisted with mixed anaemia
323
Q

Outline the causes of a normocytic anaemia? (6)

A

4 A’s, 2 H’s;

  • Anaemia of chronic disease
  • Acute blood loss
  • Anisocytosis; mixed anaemia picture due to macrocytic and microcytic RBCs
  • Aplastic anaemia
  • Haemolytic anaemia
  • Hypothyroidism
324
Q

Outline the pathophysiology behind thrombocytopaenia in haemolytic uraemic syndrome (HUS)?

A

Shiga-like toxin produced by <i>Escherichia coli</i> O157:H7 damages the endothelial cell wall which in-turn leads to the activation of platelets and thus their deposition and consumption

325
Q

Outline the pathophysiology behind renal impairment in haemolytic uraemic syndrome (HUS)? (2)

A
  • Shiga-like toxin produced by <i>Escherichia coli</i> O157:H7 damages the endothelial cell wall which in-turn leads to the activation and deposition of platelets particularly in the kidney
  • This can often be visualised upon histopathological analysis whereby platelet-fibrin thrombi can be seen in the glomeruli
326
Q

Which kind of anaemia is associated with haemolytic uraemic syndrome (HUS)?

A

Microangiopathic haemolytic anaemia (MAHA); microcytic anaemia with raised LDH, thrombocytopaenia and schistocyte presence on blood film analysis

327
Q

Why is the direct antiglobulin/direct Coomb’s test (DAT/DCT) negative in haemolytic uraemic syndrome (HUS)? (2)

A
  • The the direct antiglobulin/direct Coomb’s test (DAT/DCT) is only useful in diagnosing autoimmune haemolytic anaemia where the RBCs are bound by antibodies.
  • In the case of haemolytic uraemic syndrome (HUS) the cause of the haemolysis is shiga-like toxin and therefore the test will be negative.
328
Q

Outline the management of haemolytic uraemic syndrome (HUS)? (3)

A
  • Supportive management; no need for antibiotics
  • Inform Public Health England/Infection Control
  • Isolate patient with barrier nursing
329
Q

What key features allow you to differentiate haemolytic uraemic syndrome (HUS) from thrombotic thrombocytopaenic purpura (TTP)?

A

Thrombotic thrombocytopaenic purpura (TTP) will present with the additional features of neurological deficits and fever.

330
Q

Outline the final common pathophysiological mechanisms that contribute to the development of hydrops fetalis (fetal hydrops)? (3)

A
  • Raised central venous pressure
  • Low plasma oncotic pressure
  • Reduced lymphatic fluid flow
331
Q

Outline the management of women exposed to varicella zoster virus (chickenpox) during pregnancy who are confirmed to be non-immune? (2)

A
  • ≤ 20 weeks gestation; give varicella-zoster immunoglobulin (VZIG) immediately if within 10 days of exposure
  • > 20 weeks gestation; EITHER
    • Antivirals (aciclovir) 7-14 days post-exposure
    • Varicella-zoster immunoglobulin (VZIG) if within 10 days of exposure
332
Q

What is the most common cause of hydrops fetalis (fetal hydrops) in the third trimester of pregnancy?

A

Immune causes; rhesus disease, ABO incompatibility, anti-Kell, anti-Duffy

333
Q

Which test can be used to calculate the dose of anti-RhD to give a mother following a sensitising event?

A

Kleihauer; acid elution test which breaks down adult haemoglobin which can be visualised under the microscope, whilst fetal haemoglobin remains resistant

334
Q

What additional investigation is required in all patients diagnosed with a <i>Staphylococcus aureus</i> bacteraemia?

A

Transthoracic or transoesophageal echocardiogram; due to the risk of <i>Staphylococcus aureus</i> endocarditis

335
Q

Which groups of heart valves are most commonly affected by infective endocarditis? (2)

A
  • Most patients; aortic and mitral valves

- IVDU, CHDs, ICD; pulmonary and tricuspid

336
Q

Outline the organisms most commonly associated with culture negative endocarditis? (5)

A

HACEK

  • <i>Haemophilus spp.</i>
  • <i>Aggregatibacter spp.</i>
  • <i>Cardiobacterium spp.</i>
  • <i>Eikinelia spp.</i>
  • <i>Kingella spp.</i>
337
Q

Which specific organism has been shown to be associated with infective endocarditis in elderly patients with colorectal cancer?

A

<i>Streptococcus bovis</i> (group D β-haemolytic streptococcus)

338
Q

Which organisms are most commonly associated with infective endocarditis and rheumatic heart disease? (2)

A
  • Infective endocarditis; caused by <i>Streptococcus viridans</i> (α-haemolytic <i>Streptococcus</i>)
  • Rheumatic heart disease; caused by <i>Streptococcus pyogenes</i> (group A β-haemolytic <i>Streptococcus</i>)
339
Q

Outline the components of the sepsis six used in the management approach to the septic patient? (6)

A
  • 3 in; oxygen, broad-spectrum antibiotics, IV fluids

- 3 out; urine output, blood cultures, lactate

340
Q

Outline the acute management of the septic patient? (3)

A
  • A-E assessment
  • Alert senior
  • Sepsis six
341
Q

Which electrolyte abnormality is most commonly associated with an acute kidney injury (AKI)?

A

Hyperkalaemia

342
Q

Outline the swab components of a sexually transmitted infection (STI) screen? (3)

A
  • Endocervical swab for gonorrhoea
  • Endocervical swab for chlamydia
  • High vaginal swab for trichomonas and candida
343
Q

Outline the triad of features associated with a renal infarct? (3)

A
  • Flank pain; with acute onset that the patient can pinpoint
  • Hypertension
  • Haematuria
344
Q

Outline the most common complication associated with infective endocarditis?

A

Septic embolism

  • Left-sided valves; septic brain emboli
  • Right-sided valves; septic pulmonary emboli
345
Q

Outline the difference between red infarcts and white infarcts? (2)

A
  • Red infarcts are caused by venous occlusion in tissue with collateral or dual circulation
  • White infarcts are caused by arterial occlusion in tissue without collateral or dual circulation
346
Q

Which organs are most commonly associated with red infarcts? (4)

A
  • Liver
  • Lung
  • Bowel
  • Brain
347
Q

Which organs are most commonly associated with white infarcts? (4)

A
  • Heart
  • Kidney
  • Spleen
  • Brain
348
Q

Outline the three main types of necrosis and the situations in which you might see them? (3)

A
  • Coagulative necrosis; most organs
  • Liquefactive necrosis; brain
  • Caseous necrosis; tuberculosis
349
Q

Outline the two most common risk factors associated with infective endocarditis? (2)

A
  • Previous rheumatic fever/rheumatic heart disease

- Non-native cardiac valves

350
Q

Outline the pathophysiology of glomerulonephritis secondary to infective endocarditis?

A

Antigen-antibody complexes embolise from the site of infection and become deposited in the glomerular basement membrane where they trigger a type III immune complex-mediated hypersensitivity reaction that induces mast cell degranulation via FcγRIII activation. This results in inflammation and impaired renal function.

351
Q

Which empirical antibiotic treatment regimen is used in patients with native valve endocarditis?

A

Amoxicillin plus gentamicin

352
Q

Outline the management of cystic fibrosis? (5)

A
  • High calorie diet; including pancreatic enzymes and fat soluble vitamins (ADEK)
  • Chest physiotherapy; to release secretions and help lung function
  • Mucolytic agents; human recombinant DNase (dornase alpha) plus hypertonic saline nebuliser
  • Prophylactic antibiotics; usually flucloxacillin for Staphylococcus aureus prophylaxis
  • Lumacaftor/Ivacaftor (Orkambi); if homozyogus for δF508 mutation
353
Q

Outline the triad of features associated with shaken-baby syndrome? (3)

A
  • Retinal haemorrhages
  • Subdural haemorrhage
  • Encephalopathy
354
Q

Gives examples of particularly concerning sites/features of lesions that raise suspicion of non-accidental injury (NAI)? (8)

A

Sites;

  • Genitalia
  • Ears
  • Neck
  • Trunk

Features;

  • ≤ 4 years of age
  • Non-mobile infant
  • Patterned bruising
  • Bilateral
355
Q

Which conditions make up the seronegative spondyloarthropathies? (4)

A

PEAR

  • Psoriatic arthritis
  • Enteropathic arthritis
  • Ankylosing spondylitis
  • Reactive arthritis
356
Q

Which scoring system can be used to stratify a woman’s risk of having ovarian cancer?

A

Risk of malignancy index (RMI)

357
Q

Outline the components of the risk of malignancy index (RMI) scoring system that is used to aid investigation suspected of ovarian cancer? (3)

A
  • Ultrasound findings
  • Menopausal status
  • CA-125 levels
358
Q

Outline how the risk of malignancy index (RMI) score is calculated?

A

RMI = U x M x CA125

359
Q

Outline the key complication associated with transcervical resection of fibroids (TCRF)?

A

Fluid overload and consequent hyponatraemia

360
Q

Outline the management of Turner’s syndrome (X0)? (5)

A
  • Psychological management and counselling; if required
  • Human growth hormone; to correct the short stature
  • Oestrogen therapy; to stimulate secondary sex characteristics and protect against osteoporosis
  • Cyclical progesterone; added later to induce withdrawal bleeds
  • Fertility input; ovum donation and hormonal support
361
Q

Outline the first-line investigations that should be carried out in women presenting with symptoms of premenstrual syndrome (PMS)?

A

Symptom diary; a 3-month record of symptoms alongside the days on which menstruation occurs

362
Q

How can premenstrual syndrome (PMS) be differentiated from depressive episodes?

A

Premenstrual syndrome (PMS) can be diagnosed by the presence of symptoms during the luteal phase of the cycle (day 14-0 in a 28-day cycle) and resolving within a 1-2 days of menstruation starting.

363
Q

Outline the physical symptoms that can be associated with premenstrual syndrome (PMS)? (2)

A
  • Breast tenderness

- Feeling bloated

364
Q

Outline the the most frequently used management options in premenstrual syndrome (PMS)? (2)

A
  • Selective serotonin reuptake inhibitors (SSRIs); either taken continuously or during the luteal phase
  • New-generation combined oral contraceptive pill (COCP); drospirenone-containing formulations that interrupt ovulation
365
Q

Outline the management options used in the different stages of cervical cancer? (4)

A
  • CIN I - III; large loop excision of the transformation zone (LLETZ) or cervical cone biopsy
  • Stage 1B - 2A; trachelectomy or radical hysterectomy
  • Stage 2B - 4A: chemotherapy and radiotherapy
  • Stage 4B: combination of surgery, radiotherapy, chemotherapy and palliative care
366
Q

Outline the immediate management of intrauterine death? (2)

A

Induction of labour (IOL)

  • Mifepristone; antiprogesterone
  • Misoprostol; 48 hours after to induce contractions
367
Q

Why is it vital that induction of labour (IOL) should be offered as soon as possible in pregnancies where there is an intrauterine death?

A

Due to the increased risk of the development of sepsis or disseminated intravascular coagulopathy (DIC)

368
Q

Outline the investigations that should be carried out after an intrauterine death? (6)

A

Maternal Investigations

  • FBC and clotting screen; to exclude DIC
  • Kleihauer test; to assess fetomaternal haemorrhage
  • Anticardiolipin and lupus anticoagulant; to assess for antiphospholipid syndrome (APLS)

Fetal Investigations

  • Karyotype; to assess for chromosomal abnormalities
  • Fetal and placental swabs; for MC&S to rule out infection
  • Post-mortem; if agreed to by parents
369
Q

Outline the four main methods of distinguishing pre-renal, renal and post-renal causes of acute kidney injury? (4)

A
  • Urea:creatinine ratio
  • Urine [Na+]
  • Urine osmolality
  • Fractional Na+ excretion (FENa)
370
Q

What is the most common cause of nephrotic syndrome in adults?

A

Membranous nephropathy

371
Q

Outline the triad of paraneoplastic symptoms associated with renal cell carcinoma (RCC)? (3)

A
  • Hypertension
  • Hypercalcaemia
  • Polycythaemia
372
Q

Which genetic conditions are associated with an inherited predisposition to renal cell carcinoma (RCC)? (4)

A
  • Von Hippel-Lindau (VHL) syndrome
  • Tuberous sclerosis (TS)
  • Birt-Hogg-Dubé (BHD) syndrome
  • Hereditary papillary renal carcinoma (HPRC)
373
Q

Which two forms of amyloidosis are particularly associated with renal amyloidosis and nephrotic syndrome? (2)

A
  • Immunoglobulin light chain amyloidosis (AL); associated with multiple myeloma and hypergammaglobulinaemia
  • Serum amyloid A amyloidosis (AA); associated with deposition of the acute-phase protein SAA due to chronic inflammation
374
Q

What is the term used to describe the situation in which an individual possesses two different disease-causing alleles of the same gene?

A

Compound heterozygosity

375
Q

Which conditions are classically associated with a microangiopathic haemolytic anaemia (MAHA)? (3)

A
  • Disseminated intravascular coagulation (DIC)
  • Thrombotic thrombocytopaenic purpura (TTP)
  • Haemolytic uraemic syndrome (HUS)
376
Q

What is the main complication associated with artificial rupture of membranes (ARM)?

A

Umbilical cord prolapse

377
Q

Which group of immunohistochemical markers can be used to determine cancers of epithelial origin?

A

Cytokeratins (CKs)

378
Q

Mutations in which genes are commonly found in lung adenocarcinoma tumours? (2)

A
  • Anaplastic lymphoma kinase (ALK)

- Epidermal growth factor receptor (EGFR)

379
Q

At what value of the crown-rump length (CRL) should the fetal heart beat be visible?

A

At a crown-rump length (CRL) > 7 mm the fetal heart beat should be visible

380
Q

Which conditions are classically associated with a complete hydatidiform mole (gestational trophoblastic disease)? (3)

A
  • Hyperemesis
  • Thyrotoxicosis
  • Pre-eclampsia
381
Q

Outline the management of a complete hydatidiform mole (gestational trophoblastic disease)? (3)

A
  • Surgical evacuation of the uterus
  • Follow-up serial β-hCG levels
  • Chemotherapy if trophoblast persists
382
Q

Outline the complication associated with persistent trophoblast in patients with a complete hydatidiform mole (gestational trophoblastic disease)?

A

Increased risk of developing choriocarcinoma

383
Q

Outline the main caveat to using intramuscular methotrexate in the medical management of ectopic pregnancy?

A

Untrauterine pregnancy must be ruled out; by repeat ultrasound and serial β-hCG measurements

384
Q

From what gestation in pregnancy is anti-RhD required in rhesus negative women who miscarry?

A

From 12 weeks onwards women who miscarry should be given anti-RhD

385
Q

What is the most common gynaecological cause of pain in early pregnancy?

A

Corpus luteal cysts

386
Q

Outline the clinical definition of hyperemesis gravidarum?

A

Severe or protracted vomiting appearing for the first time before the 20th week of pregnancy that is not associated with other coincidental conditions

387
Q

Outline the management of hyperemesis gravidarum? (5)

A
  • Fluids; 3-4L of normal (0.9%) saline per day
  • Potassium; to correct hypokalaemia as a result of vomiting
  • Antiemetics; cyclizine, metoclopramide or prochlorpeazine
  • Thiamine and folic acid; to prevent Wernicke’s encephalopathy and Korsakoff’s syndrome
  • Thromboembolic stockings (TEDS) and heparin; women with hyperemesis are at risk of thrombosis
388
Q

What percentage of cases of vaginal bleeding during pregnancy are associated with miscarriage?

A

50% of women who experience vaginal bleeding during pregnancy will go on to miscarry

389
Q

Outline the management options in stress incontinence? (3)

A
  • Conservative; lifestyle changes and pelvic floor exercises
  • Surgical; tension-free vaginal tape or transoburator tape
  • Medical; duloxetine (SNRI) that reduces incontinent episodes
390
Q

Which endocrinological disorder can be associated with dermoid ovarian cysts (benign teratomas)?

A

Hyperthyroidism; sometimes benign teratomas may contain thyroid tissue within them that causes excess thyroid hormone secretion; these are known as struma ovarii cysts

391
Q

Outline the pathological causes of precocious puberty in women? (5)

A
  • Hypothyroidism
  • CNS lesion; hydrocephaly, neurofibromatosis
  • Ovarian tumours
  • Adrenal tumours
  • Exogenous oestrogens
392
Q

Which type of renal tumour is most commonly diagnosed during the neonatal period?

A

Mesoblastic nephroma

393
Q

Which electrolyte abnormality is associated with mesoblastic nephroma?

A

Hypercalcaemia

394
Q

Outline the trend in serum alpha-fetoprotein (AFP) levels following birth?

A
  • At birth the serum AFP will be at its highest, sometimes several thousand-fold higher than the adult amount
  • Following birth the serum AFP gradually declines until around 8 months
395
Q

What are the threshold values associated with bronchodilator reversibility that indicate a diagnosis of asthma as opposed to chronic obstructive pulmonary disease (COPD)? (2)

A
  • ≥ 12% improvement in FEV1 post-bronchodilator

AND

  • ≥ 200 mL improvement in FEV1 compared to pre-bronchodilator
396
Q

What is the most common cause of a macrocytosis without anaemia?

A

Alcohol intake

397
Q

Which gene is mutated in α1 antitrypsin deficiency (AATD)?

A

SERPINA1 found on chromosome 14

398
Q

What is the mode of inheritance in α1 antitrypsin deficiency (AATD)?

A

Autosomal recessive; homozygotes with the so-called ‘PiZZ’ genotype will have the condition

399
Q

Which human leukocyte antigen (HLA) alleles are associated with coeliac disease? (2)

A
  • HLA-DQ2

- HLA-DQ8

400
Q

Outline the complication that is commonly associated with poorly-controlled coeliac disease?

A

Enteropathy Associated T-cell Lymphoma (EATL)

401
Q

Outline the current hypothesis surrounding the aetiology of endemic Burkitt’s lymphoma in sub-saharan Africa? (2)

A
  • Endemic Burkitt lymphoma in sub-saharan Africa is related to EBV and <i>Plasmodium falciparum</i> co-infection
  • It is thought to arise due to <i>Plasmodium falciparum</i>-induced polyclonal B cell activation or impairment of EBV-specific T-cells
402
Q

When during pregnancy is anti-RhD given routinely to rhesus negative women? (3)

A
  • 28 weeks
  • 34 weeks
  • < 72 hours of delivery; if not already sensitised
403
Q

Outline the pathophysiology of fibroid degeneration? (4)

A
  • Uterine fibroids initially grow in pregnancy due to the increase in circulating oestrogens
  • However there comes a point where the growth of the fibroid actually outgrows its blood supply
  • At this point the fibroid undergoes ‘red degeneration’ characterised by necrosis within the fibroid
  • This causes localised uterine tenderness and may cause some pregnant women to present to hospital
404
Q

Which additional tests should be carried out in women who are IV drug users who are found to be HBsAg positive in pregnancy? (4)

A
  • HBeAg; to determine risk of transmission to the fetus
  • Liver function tests (LFTs); to investigate degree of hepatitis
  • HCV IgG and IgM antibodies; as high risk for hepatitis C
  • Urine toxicology; investigate additional drug-related risks to the fetus
405
Q

What is the threshold value considered to be associated with a high risk of Down syndrome based on the results of the combined screening tests?

A

A risk of 1 in 150 or less is considered high risk (1 in 2 to 1 in 150)

406
Q

How can trisomy 21 (Down syndrome) be differentiated from trisomy 13 (Patau syndrome) and trisomy 18 (Edward syndrome) based on the results of the combined screening test? (2)

A
  • All three have decreased PAPP-A and increased β-hCG and nuchal translucency
  • However down syndrome usually has a higher β-hCG than Edward and Patau syndrome
407
Q

What are the implications of a previous post-partum haemorrhage (PPH) on the management of subsequent labours?

A

Women who have had a previous post-partum haemorrhage (PPH) must have active management of the third stage

408
Q

Outline the management of iron deficiency anaemia during pregnancy? (3)

A
  • Dietary advice; iron-rich diet (meat, lentils, spinach)
  • Oral ferrous sulphate 200 mg (BD); increasing to three times if tolerated
  • Oral iron suspension or parenteral (IM) iron injections; if tablets not tolerated
409
Q

Outline the timing for delivery in women with pre-eclampsia? (2)

A
  • 34-36+6 weeks; continue surveillance unless there are indications for planned early birth
  • ≥ 37 weeks; initiate birth within 24-48 hours either by induction of labour or caesarean section
410
Q

Outline the absolute indications for low-dose aspirin prophylaxis of pre-eclampsia? (5)

A

HDAC;

  • Hypertension; chronic or previous gestational hypertension
  • Diabetes mellitus; type 1 or type 2
  • Autoimmune disease; SLE, anti-phospholipid syndrome
  • Chronic kidney disease (CKD)
411
Q

Outline the risk factors associated with gestational diabetes mellitus (GDM)? (6)

A
  • BMI >30
  • Previous macrosomic baby >4.5kg
  • Previous gestational diabetes
  • First-degree relative with diabetes
  • Ethnic origin; South Asia, Black Caribbean, Middle Eastern
  • Polycystic ovarian syndrome (PCOS)
412
Q

Outline the features associated with McCune-Albright syndrome? (5)

A
  • Fibrous dsyplasia
  • Café-au-lait spots
  • Bone cysts
  • Oestrogen-producing ovarian cysts
  • Precocious puberty
413
Q

Outline the major complication associated with a pituitary adenoma?

A

Pituitary apoplexy; haemorrhage into the pituitary fossa often due to rupture of the blood vessels as the tumour grows, this can result in a global hypopituitarism that renders the patient reliant on exogenous pituitary hormones

414
Q

Outline the standard structure of a death certificate? (4)

A

Part I: Causal Sequence

  • IA: disease or condition that directly lead to death
  • IB: factor(s) that ore-disposed/caused the disease or condition that lead to death
  • IC: the underlying cause of death

Part II: Contributing Factors
- II: factors which contributed to, but not caused death

415
Q

Which neurodevelopmental disorder is commonly associated with Hirschsprung’s disease?

A

Down syndrome

416
Q

Outline the pathognomonic feature of retained products of conception as a cause of secondary post-partum haemorrhage?

A

Open cervical os visualised on speculum examination

417
Q

Outline the features classically associated with uterine rupture? (5)

A
  • Cessation of contractions
  • Abdominal pain
  • Vaginal bleeding in labour
  • Maternal tachycardia
  • Haematuria
418
Q

Outline the main risk factors associated with uterine rupture during labour? (2)

A
  • Previous Caesarean section(s)

- Induction or augmentation of labour

419
Q

Outline the rule of 3’s used during the management of fetal bradycardia? (3)

A
  • Deceleration (bradycardia < 100 bpm) lasting 3 minutes; call for help
  • Deceleration (bradycardia < 100 bpm) lasting 6 minutes; transfer to theatre and prepare for immediate delivery.
  • Deceleration (bradycardia < 100 bpm) lasting 9 minutes; deliver immediately by category one (‘crash’) caesarean section
420
Q

Which investigations should be carried out in women with suspected chorioamnionitis? (2)

A
  • Blood cultures

- High vaginal swab

421
Q

Outline the immediate management in HELLP syndrome?

A

Urgent delivery of the the fetus

422
Q

What is the definition of prolonged pregnancy?

A

Any pregnancy continuing beyond 42 weeks gestation

423
Q

What is the threshold value of the Bishops score needed for artificial rupture of membranes to be carried out?

A

Bishop score ≥ 6

424
Q

What is the main risk associated with a prolonged pregnancy?

A

Increased risk of stillbirth

425
Q

When is induction of labour recommended in women who have carried to term?

A

Between 41 and 42 weeks gestation

426
Q

Outline the potential complications associated with shoulder dystocia? (5)

A
  • Perinatal mortality
  • Hypoxic ischaemic encephalopathy
  • Brachial plexus injury (Erb’s palsy)
  • Post-partum haemorrhage (PPH)
  • Perineal tear
427
Q

Which sign can be seen on ultrasound scans during the first trimester than indicate dichorionic diamniotic (DCDA) twins?

A

Lambda sign

428
Q

Outline the additional monitoring required in cases of twin pregnancy? (4)

A
  • Regular full blood count (FBC)
  • Close blood pressure and urinalysis monitoring
  • Fetal growth surveillance from 28-weeks
  • Screening for gestational diabetes mellitus (GDM)
429
Q

Outline the main features associated with fetal varicella syndrome? (3)

A
  • Skin scarring
  • Limb hypoplasia
  • Neurological abnormalities
430
Q

Outline the surgical sieve framework for stratifying differential diagnoses?

A

VITAMIN CDEF;

  • Vascular
  • Infective/inflammatory
  • Traumatic
  • Autoimmune
  • Metabolic
  • Iatrogenic
  • Neoplastic
  • Congenital
  • Degenerative
  • Endocrine
  • Functional

Final MB Part II - Short Answer Questions (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions