3a (2) Flashcards
1
Q
Feeds using a spoon, dry during day
A
18m
2
Q
Can draw a simple picture of people
A
5y
3
Q
15 y/o girl with 10w history of diarrhoea, bloating, WL. Itchy rash on back of elbow. Positive result for IgA anti-endomysial entibody
A
Coeliac disease
4
Q
7 y/o has dark red-purple spots on legs and buttocks. Sore knees, mild headache. Recently had sore throat. Urine dip positive for haematuria, proteinuria
A
HSP
5
Q
35 y/o male with first psychotic episode was commenced on haloperidol. Vitals 39 degrees, RR 38 breaths, pulse 110, BP 180/104. Raised CK
A
NMS
6
Q
A 25 y/o male decides to start taking St John’s Wort as well as his normal fluoxetine. Presents agitated, confused, shivering. Temp 38, myoclonus, hyperreflexia
A
Serotonin syndrome
7
Q
33 y/o male develops sore throat and lethargy a few days after starting a medication on a psych ward. Pyrexial, leucocytosis, eosinophilia
A
Clozapine
8
Q
22 y/o female recently commenced on a medication and shortly develops nausea, diarrhoea, headache, insomnia and increased anxiety. Decreased libido and anorgasmia
A
Fluoxetine
9
Q
50 y/o male is commenced on a medication and develops dry mouth, blurred vision, drowsiness, palpitations. Hypotensive, mildly prolonged QT
A
Amitriptyline
10
Q
45 y/o female commenced on a medication by her psychiatrist develops severe headaches and blurred vision, BP 196/110. She had some red wine and pickled herring at a restaurant
A
Phenelzine
11
Q
42 y/o woman has been stable on her meds for the last few months. Brought into hospital with slurred speech, ataxia, confusion. Recently diagnosed a diuretic for hypertension and following this complained of diarrhoea, vomiting, coarse tremor
A
Lithium toxicity
12
Q
You are on your neonates’ attachment and you review a baby, 12 hours after being born, who is presenting with jaundice. You perform a direct Coombs’ test which is weakly positive. Diagnosis?
A
ABO haemolytic disease of the newborn/ABO incompatibility
13
Q
What class of immunoglobulin is involved in ABO haemolytic disease of the newborn?
A
IgG
14
Q
What can cause neonatal jaundice in the first 24 hours of life?
A
Rhesus incompatibility|ABO incompatibility|G6PD deficiency|Spherocytosis|Congenital infection
15
Q
Name 5 congenital intrauterine infections that can damage the fetus
A
Toxoplasmosis|Rubella|Cytomegalovirus|Herpes simplex|HIV|Parvovirus B19|Varicella zoster
16
Q
What type of bilirubin causes jaundice in haemolytic disease of the newborn?
A
Unconjugated bilirubin
17
Q
What is bilirubin neurotoxicity also known as?
A
Kernicterus
18
Q
Name the two main methods of treating neonatal jaundice
A
Phototherapy|Exchange transfusion
19
Q
A 1-year-old child presents to the emergency department with a generalised macular rash and high fever. In the department he has a febrile convulsion. Serology was negative for measles, but found to be due to a Herpes virus
A
Roseola infantum
20
Q
Baby, birth weight of 3.2kg, presents to the GP at 4 weeks of age with jaundice and pale stools on-and-off for 3 weeks. On examination you notice hepatosplenomegaly and distended abdomen
A
Biliary atresia
21
Q
Baby birth weight of 4.6kg, with transient hypoglycaemia 6 hours after birth, looking very plethoric
A
Maternal diabetes
22
Q
Baby born with hepatosplenomegaly and jaundice, with microcephaly and IUGR. Mother mentions having a mild non-specific illness during pregnancy
A
Fetal CMV infection
23
Q
Baby turn up to 6-week check at the GP with a 1.5cm diameter raised red spot that the mother mentioned has only appeared in the last few weeks
A
Strawberry naevus
24
Q
Syndrome with extra chromosome inherited by non-disjunction (94%), presenting with typical facial facies, hypotonia, AVSD and ‘double bubble’ appearance on CXR
A
Down’s syndrome
25
A 12 year-old presenting with short stature and on close observation has widely spaced nipples, cubitus valgus and weak femoral pluses (with normal brachial pulses)
Turner's syndrome
26
2-week old boy presents to A&E with vomiting and weight loss, floppiness and circulatory collapse. On further discussion with the family you suspect consanguinity may have taken place
Congenital adrenal hyperplasia
27
Raises head to 45° from horizontal, follows moving objects or face by turning her head, started to smile responsively
6-8w
28
Hops on one leg, can build a tower of 6 bricks, using simple phrases of 2-3 words, enjoys playing with doll as if it were a child, and parents thinking about potty training
2 years
29
Walks around furniture, has a mature pincer grip, uses sounds discriminately to parents, waves bye-bye (if he wants to)
10 months
30
A 3-year-old girl presents with a long history of recurrent productive cough, purulent nasal discharge and has had multiple ear infections over the past 2 years. Her Chest X-ray shows dextrocardia
Primary ciliary dyskinesis
31
A 3-year-old child presents with a spasmodic cough followed by an inspiratory whoop, with a 3-day history of coryza, mild fever and a small subconjunctival haemorrhage
Pertussis
32
A 7-month-old infant presents with coughing particularly after feeding, with excess posseting and vomiting that has been worsening since a few weeks of age. The child has regular screaming episodes in the middle of the night
GORD
33
What constitutes a septic screen?
Blood culture|FBC|CRP|Urine sample|LP|(CXR if indicated)
34
What features are suggestive of an atypical UTI in a child?
Seriously ill or septicaemia|Poor urine flow|Abdo or bladder mass|Raised creatinine|Failure to respond to suitable ABx within 48h|Infection with non-E.coli organism
35
How would you investigate an atypical UTI in a child under 1 year old?
Ultrasound KUB, MCUG, DMSA
36
How do you treat intussusception?
Reduction of intussusception by rectal air insufflation (hydrostatic reduction). If fails, operative reduction
37
What is the name of the type of inheritance shown whereby the disease is different depending on if the defect is inherited from the mother or the father?
Imprinting
38
What are neurofibrillary tangles?
Paired helical axons of degenerated neurones
39
COPD - What measurements would you take to confirm diagnosis? What ratio would you use to confirm this and what is the cut off point?
FEV1, FEV1/FVC, 0.7
40
What is it called when a patient's eyes roll back into their head after being commenced on antipsychotics?
Oculogyric crisis
41
Name 2 drug classes that can cause delirium
Anticholinergics (TCAs)|Benzodiazepines|Beta blockers|NSAIDs
42
SEs of anticholinergics
Blind as a bat (dilated pupils)|Red as a beet C(vasodilation/flushing)|Hot as a hare (hyperthermia)|Dry as a bone (dry skin)|Mad as a hatter (hallucinations/agitation)|Bloated as a toad (ileus, urinary retention)|And the heart runs alone (tachycardia)
43
What type of bilirubin causes dark urine?
Conjugated bilirubin
44
A man is started on antipsychotic medication but develops dysarthria from jaw muscle spasm. Name the condition and why it has occurred. How would you treat?
Acute dystonic reaction|Blockade of dopamine receptors|Offer an antimuscarinic/anticholinergic
45
Which lobe of the brain is most affected in schizophrenia?
Temporal lobe
46
Why might someone develop gynaecomastia after being on an antipsychotic for a few months?
Normally dopamine blocks/regulates prolactin release. With dopamine blockade there is no opposition of prolactin, so levels of prolactin increase. These increased levels promote breast tissue development
47
Why might males on antipsychotics with gynacomastia be impotent?
They will have high prolacting, which has a negative effect on gonadal hormone production
48
State 2 investigations in suspected pre-eclampsia
FBC inc platelets|LFTs|Uric acid level
49
State 3 complications of pre-eclampsia
Eclampsia - seizures|Fetal death|Placental abruption|HELLP|Renal failure|Hepatic failure|CVA|DIC
50
State 2 treatments that an obstetrician could use to alleviate pre-eclampsia and to reduce the risks of complication
Deliver baby if maternal condition deteriorates|IV labetalol|Magnesium sulfate
51
State 2 factors which can predispose to the development of pre-eclampsia
Nulliparity|Strong FH or prev history of pre-eclampsia|Multiple pregnancy|Chronic hypertension|SLE|Renal disease|First baby with new partner
52
Alcoholic is admitted for detox. What 3 specific markers in bloods will verify that he is drinking heavily up to the point of admission?
Gamma GT|MCV|Blood alcohol levels
53
If psychosis is caused by a drug problem, which illicit drug is likely to be responsible, which neurotransmitter does it affect, and in what way does it affect this|neurotransmitter?
Amphetamine, dopamine, increases dopamine levels
54
What 2 blood markers will be significantly raised in this condition?
CPK, WCC
55
What are the complications of NMS?
PE|Pneumonia|High temp|Renal failure
56
State 4 blood tests to assess nephrotic syndrome
Urea and creatinine|Plasma proteins/albumin|Haemoglobin|Cholesterol
57
Boy with nephrotic syndrome develops swollen and tender abdo, fever, ascites. An ascitic tap reveals Gram-positive cocci, lanceolate in shape. What is the diagnosis and bug?
Peritonitis, streptococcus pneumoniae
58
State two cardiovascular complications of nephrotic syndrome and how they should be treated
Hypertension - atenolol|Pericardial effusion - pericardial tap/diuretics and fluid restrictoin
59
What is the drug treatment of glomerulonephritis? What additional prophylactic medication will you start?
Prednisolone, penicillin V
60
What histological finding in glomerulonephritis would indicate a good/bad prognosis?
Good prognosis - minimal lesion change/minimal change disease|Bad prognosis - membranous glomerulonephritis
61
Name one chromosomal abnormality, and one maternal infection during pregnancy that may lead to congenital heart disease
Turners, Down's|Rubella virus
62
Why are some cases of heart disease cyanotic?
There is a right to left shunt
63
3 signs you would look for on physical examination in pre-eclampsia
Hyper-reflexia|Clonus|Epigastric tenderness|Papilloedema|Peripheral oedema
64
A 14 year old boy visits his GP because of a 2-day history of very severe sore|throat. On examination there are enlarged and reddened tonsils and a|follicular exudate, and some cervical lymphadenopathy. Name 2 possible microbial causes of this
Strep pyogenes|EBV|Adenovirus
65
The GP decides to give ampicillin and takes a throat swab. The patient says that the last time he took ampicillin he felt ill within 30 minutes with wheeze, facial swelling and a rash consisting of large red and raised macules.
Type 1 hypersensitivity (anaphylaxis) to penicillin
66
What should be administered to patients with anaphylaxis?
Oxygen|Adrenaline|Hydrocortisone
67
Name some macrolide antibiotics
Erythromycin|Clarithromycin|Azithromycin
68
What 2 drug treatments must be given immediately for hyperkalaemia?
Dextrose|Insulin
69
Name 2 drug therapies which would contraindicate an epidural
Anticoagulants|Aspirin
70
Name 2 obstetric reason why a patient may be denied an epidural
Fetal distress|APH
71
What % of epidurals work satisfactorily?
85-92%
72
List 3 common complications of epidurals
Failure to achieve analgesia|Hypotension|Urinary retention|Headache due to dural tap|Delay of second stage
73
What is the main complication of air reduction of intussusception?
Perforation of bowel
74
Why might intussusception reoccur after air reduction?
Anatomical abnormality acting as lead for intussusception|Meckel's diverticulum|Polyp
75
What is the MOA of Donepezil?
Acetylcholinesterase inhibitor
76
Medical treatment of endometriosis
Analgesia|COCP|Progestogens|GnRH analogues +/- HRT|IUS
77
Surgical treatment of endometriosis
Laparoscopic laser ablation/diathermy, adhesiolysis|Hysterectomy and BSO
78
What are the causes of postmenopausal bleeding?
Endometrial carcinoma|Endometrial hyperplasia|Cervical carcinoma|Atrophic vaginitis|Cervicitis|Ovarian carcinoma|Cervical polyps
79
PMB Ix
Bimanual exam|Speculum exam|Cervical smear|TVUSS|If endometrial thickness >4mm, endometrial biopsy +/- hysteroscopy
80
What are the early, late and intermediate effects of the menopause?
Early - psychological, vasomotor|Intermediate - skin atropy, genital tract atrophy, urinary tract atrophy|Late - CVA, heart disease, bony fractures
81
Name some RFs for osteoporosis
Low BMI, early menopause before 45|Cigarette smoking|Alcohol abuse|Low calcium intake|Sedentary lifestyle|Corticosteroids - >5mg/day pred|RA|CLD|Hyperparathyroidism|Hyperthyroidism
82
Where is the oocyte commonly fertilized?
The ampulla of the fallopian tube
83
Threatened miscarriage
Bleeding but fetus still alive, uterus expected size for dates, cervical os closed
84
Inevitable miscarriage
Heavy bleeding, although fetus may still be alive os is open and miscarriage is about to occur
85
Incomplete miscarriage
Some fetal parts have been passed, os is open
86
Complete miscarriage
All fetal tissue has been passed, bleeding has diminished, uterus no longer enlarged, os closed
87
Missed miscarriage
Fetus has not developed or died in utero, but this is not recognized until bleeding occurs/USS. Uterus small for dates, os closed
88
Where is the most common site of ectopic pregnancy?
Fallopian tube
89
Ectopic pregnancy RFs
Any factor which damages tube; PID, tubal surgery|Prev ectopic|Smoking|Assisted conception
90
What is the management of the symtomatic suspected ectopic pregnancy?
NBM|FBC, cross match blood|Pregnancy test|USS|Laparoscopy, medical management if criteria met|IV access
91
What is hyperemesis gravidarum?
When N and V in early pregnancy are so severe as to cause severe dehydration, weight loss or electrolyte disturbance
92
What is the management of hyperemesis gravidarum?
Exclude predisposing conditions - UTI, multiple or molar pregnancy|IV rehydration|Antiemetics - cyclizine, metoclopramide|Thiamine
93
What delusions would you see in depressive psychosis?
Nihilistic delusions, delusions of guilt, persecutory delusions
94
What delusions would you see in paranoid schizophrenia?
Persecutory delusions
95
Patient says he sees a red car and knows the police are now following him. What is this called and why is it relevant in diagnosis?
Delusional perception - it is a first rank symptom of schizophrenia
96
What is the treatment and route for acute dystonia?
Procyclidine IM
97
What is the treatment for akathisia?
Propanolol PO
98
Name 2 treatments for heroin addiction
Methodone|Buprenorphine
99
23 year old woman comes to your fertility clinic planning to have a baby. She has type I diabetes and hypertension. Taking insulin and Ramipril. Her BP is under control; she has a background of retinopathy and a raised HbA1c at 90mmol/mol. |What 4 changes would you make to her medication?
Change ramipril to labetalol|Increase insulin dose|Add folic acid
100
List 3 fetal/neonatal complications with uncontrolled maternal diabetes
Neonatal hypoglycaemia, fetal macrosomia, shoulder dystocia, increased risk of congenital cardiac disease, sudden fetal death
101
What methods can be used to detect ovulation?
Mid-luteal phase serum progesterone|USS follicular tracking|LH based urine predictor kits
102
What two tests would you check for tubal patency? Which is preferred and why?
Laparoscopy and dye|Hysterosalpingogram, HyCoSy - these are preferred as they are less invasive and safer than laparoscopy
103
How can you investigate the cause of anovulation?
FSH, LH, testosterone, prolactin, TSH
104
Sporty teenagers|Pain, tenderness and swelling over tibial tubercle
Osgood-Schlatter disease
105
3 intestinal and 3 extra intestinal signs of IBD
Intestinal: weight loss, abdo pain, diarrhoea. Narrowing, fissuring, mucosal irregularities, bowel wall thickening.|Extra intestinal: oral lesions/perianal skin tags|Uveitis|Arthralgia|Erythema nodosum
106
Side effects of 15 y/o taking prednisolone
Muscle weakness, osteoporosis, fractures, Cushing's syndrome, immunosuppression and freqent infections, acne
107
Risk factors for pressure sores
Significantly limited mobility|Significant loss of sensation|Previous or current pressure ulcer|Nutritional deficiency|Inability to reposition themselves|Significant cognitive impairment|Being overweight|Diabetes|PVD|Older age
108
What 3 actions can be done to prevent pressure sores and which member of the MDT would do this?
Reposition patient regularly (4-6h)|Ensure adequate nutrition|Use pressure redistributing devices e.g. special foam mattress|Barrier creams to prevent skin damage in adults at risk of developing a moisture lesion |Nurse
109
Osteoporosis treatment
Calcium and vitamin d supplementation|Bisphosphonates - alendronate
110
3 CXR signs of TB
Fibronodular/linear opacities in upper lobe (typically)|Cavitation|Calcification|Miliary disease|Effusion|Lympadenopathy
111
2 tests for TB
Tuberculin skin testing|Interferon gamma release assays|Sputum culture|Sputum smear
112
4 ABx used to treat TB
Rifampicin|Isoniazid|Pyrazinamide|Ethambutol
113
What are the components of Bishop's score?
Cervical position|Cervical consistency|Cervical effacement|Cervical dilatation|Fetal station
114
2 ways to induce labour
Prostaglandin E2 as vaginal gel/pessary|Amniotomy +/- oxytocin
115
4 features assessed on CTG
Baseline rate|Baseline variability|Accelerations|Decelerations
116
3 reassuring features on CTG
Baseline fetal heart rate 110-160 bpm|Variability in fetal heart rate of >5 bpm|Accelerations with movement and contractions
117
What is cerebral palsy?
Abnormality of movement and posture, causing activity limitation, attributed to non-progressive disturbances that occurred in the developing fetal or infant brain
118
Give 3 broad causes of cerebral palsy
Antenatal, hypoxic-ischaemic injury, postnatal
119
What are the 3 clinical subtypes of cerebral palsy?
Spastic, dyskinetic, ataxic
120
How does cerebral palsy usually present?
Abnormal tone and posture, delayed motor milestones, feeding difficulties
121
What are some features of autistic spectrum disorders?
Impaired social interaction|Speech and language disorder|Imposition of routines with ritualistic and repetitive behaviour|Co-morbidities e.g. learning difficulties, seizures
122
What is Asperger's syndrome?
Social impairments of an autistic spectrum disorder but at the milder end with near-normal speech
123
How might a visual impairment present in infancy?
Loss of red reflex (cataracy), white reflex, not smiling responsively by 6w, visual inattention, nystagmus, squint
124
How are squints (misalignments of the visual axis) commonly divided?
Concomitant (non-paralytic), paralytic|Inwards turning squint = convergent|Outwards turning squint = divergent
125
How might you test for squints?
Corneal light reflex, cover test
126
What term describes a potentially permanent loss of visual acuity in an eye that has not received a clear image?
Amblyopia - after 7y improvement unlikely
127
Name 4 early (compensated) clinical signs of shock in a child
Tachypnoea, tachycardia, decreased skin turgor, sunken eyes/fontanelle, increased cap refill time, mottled/pale/cold skin, decreased urinary output
128
How is raised ICP treated?
Head end of bed tilted by 20-30 degrees, isotonic fluids at 60% maintenance, mannitol or 3% saline as osmotic diuretics, maintain normothermia and high normal BP
129
Which factors may cause fixed, pinpoint pupils?
Opioid or barbituates overdose, pontine lesions
130
Give 5 categories of child abuse
Physical, emotional, sexual, neglect, fabricated or induced illness
131
Give 5 typical facial characteristics of children with Down's syndrome
Epicanthic folds, brushfield spots in iris, flattened nasal bridge, round face, upslanted palpebral fissures, small ears
132
Name 4 medical problems that may occur later in life in people with Down's
Learning difficulties, OME, visual impairment, increased risk of leukaemia, hypothyroidism, Alzheimer's
133
Give 3 genetic mechanisms by which you may get an extra 21st chromosome
Non-disjunction, mosaicism, translocation
134
Give 6 features of Turner syndrome
Lymphoedema in hands and feet as neonate, spoon-shaped nails, short stature, neck webbing, cubitus valgus, widely spaced nipples, congenital heart defects (esp CoA), delayed puberty, hypothyroidism, pigmented moles
135
How would you treat the effects of Turner syndrome?
Growth hormone therapy and oestrogen replacement for development of secondary sexual characteristics at time of puberty
136
Which syndrome is associated with a deletion of band q11 on chromosome 22?
DiGeorge syndrome
137
Give 3 examples of X-linked recessive syndromes
Duchenne and Becker muscular dystrophies, Fragile X, G6PD deficiency, haemophilia A and B
138
What is "imprinting"?
The process by which the expression of some genes is influenced by the sex of the parent who has transmitted it e.g. Prader-Will, Angelman syndrome
139
What are some clinical features of boys with Fragile X syndrome?
Learning difficulty, macrocephaly, macro-orchidism
140
Name 3 causes of hypoxic-ischaemic encephalopathy
Failure of gas exchange across placenta (e.g. prolonged uterine contractions, placental abruption), interruption of umbilical blood flow (e.g. cord compression, cord prolapse), compromised fetus (anaemia, IUGR), failure of cardiorespiratory adaptation at birth (failure to breathe)
141
Give 3 examples of soft tissue birth injuries
Caput succedaneum, cephalhaematoma, chignon, bruising to the face, forcep marks
142
What is the underlying mechanism of respiratory distress syndrome and how might this be managed if a preterm delivery is anticipated?
Surfactant deficiency leading to widespread alveolar collapse and impaired gas exchange. Dexamethosone given antenatally to mother stimulate fetal surfactant production
143
What signs might you find on examination of a infant with RDS?
Tachypnoea (>60/min), laboured breathing with chest wall recession (espsternal and subcostalindrawing) and nasal flaring, expiratory grunting, cyanosis
144
What CXR appearance is characteristic of RDS?
Diffuse granular or "ground glass". Heart border becomes indistinct in severe disease. Pneumothoraces may be present
145
What would you give an infant with RDS?
Surfactant therapy via tracheal tube, raised ambient O2
146
Where do brain haemorrhages in preterm infants typically occur?
Germinal matrix above caudate nucleus
147
What complication might be caused by a large intraventicular haemorrhage?
Hydrocephalus (ventriculoperitoneal shunt may be required)
148
What are the XR features of NEC?
Distended loops of bowel and thickening of the bowel wall with intramural gas
149
What is bronchopulmonary dyplasia?
Infants who still have an O2 requirement at 36 weeks. CXR shows wide areas of opacification, sometimes with cystic changes
150
What is the term given to encephalopathy resulting from the deposition of unconjugatedbilirubin in the basal ganglia and brainstem nuclei?
Kernicterus
151
Give 2 treatments available for treating jaundice
Phototherapy, exchange transfusion
152
Give 3 risk factors for neonatal infection in mothers colonised by group B streptococcus
Preterm baby, PROM, maternal fever during labour, maternal choramnionitis or prev infected infant
153
How might gonococcal conjunctivitis present?
Conjunctival injection and swelling of eyelids within first 48h
154
How might chlamydia conjunctivitis present?
Purulent discharge and swelling of eyelids at 1-2w
155
Name 3 factors that increase the risk of neonatal hypoglycaemia
IUGR, preterm, maternal DM, large for dates, hypothermic, polycythaemia
156
Name 3 symptoms of neonatal hypoglycaemia
Jitteriness, irritability, apnoea, lethargy, drowsiness, seizures
157
Give 3 broad causes of delayed puberty
Constitutional|Hypogonadotrophic gonadism - e.g. systemic disease (CF, Crohn's), hypothalamo-pituitary disorders (Kallmann, intracranial tumours)|Hypergonadotrophic hypogonadism e.g. 45 XO
158
Which enzyme deficiency causes over 90% of cases of congenital adrenal hyperplasia? How does this result in the overproduction of adrenal androgens?
21-hydroxylase - needed for cortiosol biosynthesis. Cortisol deficiency stimulates the pituitary to produce ACTH which drives the overproduction of adrenal androgens
159
How is the diagnosis of CAH made?
Raised serum 17-alpha hydroxyprogesterone
160
How might CAH present?
Virilization in females, salt losing adrenal crisis in 80% of males, tall stature in 20% of male non-salt losers
161
How is CAH managed?
Lifelong glucocorticoids (suppress ACTH), mineralocorticoids also if salt loser
162
What may be given prenatally to reduce ACTH drive and therefore virilisation in a female infant?
Parents of a previously affected infant: Dexamethasone to the mother around the time of conception and continued if the fetus is found to be female
163
Name 5 non-modifiable risk factors for cardiovascular disease
Age|Ethnicity|Sex|Socio-economic status|Personal history of CVD|FH of CVD
164
Name 5 modifiable risk factors for cardiovascular disease
Smoking|Hyperlipidaemia|Hypertension|Diet|High BMI|DM|Physical inactivity|Alcohol intake|Coronary-prone behaviour
165
How can you score risk of cardiovascular disease?
QRISK2
166
A 60 y/o man has just been diagnosed with hypertension and is about to be commenced on a suitable treatment. What other investigations would you do?
Investigate other RFs - blood glucose, cholesterol|Look for end-organ damage - ECG, urinalysis, eye examination|Exclude secondary causes - U+Es, calcium, cortisol, aldosterone, renal USS
167
An African lady has just been diagnosed with hypertension. What is the first line treatment?
CCB e.g. amlodipine, diltiazem. Or thiazide like diuretic if not tolerated
168
A 50 y/o white man has just been diagnosed with hypertension. What is the first line treatment?
ACE inhibitor e.g. ramipril. Or CCB e.g. amlodipine if not tolerated
169
Which cholesterol is "good", which "bad"?
LDL = bad|HDL = good
170
How could someone modify their lifestyle to manage hyperlipidaemia?
Reduce fat intake|5 portions of fruit and veg a day|2 portions of oily fish a week|Weight loss|Increase physical activity |Lose weight
171
What are some side effects of statins?
Fatigue|Headache|Nausea|Indigestion|Myopathy (myalgia, myositis, rhabdomyolysis), measure CK
172
What factors can precipitate an episode of angina?
Emotion|Cold weather |Heavy meal
173
What are the different types of angina?
Stable (at rest)|Unstable (at rest or on minimal exertion)|Variant/Prinzmetal (coronary artery spasm during rest)
174
What are the symptoms of angina?
Central chest tightness|Exacerbated by exercise, relieved by rest|Radiates to arm/neck/jaw/teeth
175
What investigations would you perform in someone with symptoms of angina?
ECG (may show ST depression from old infarct)|Exercise ECG|Stress Echo, coronary angiography, cardiac CT
176
How would you manage angina in GP?
Manage RFs|Beta blocker/CCB and GTN spray in first instance|Can also use long acting nitrate monotherapy (ivabradine)|May need PCI if really severe
177
What are some risk factors for heart failure?
IHD, smoking, HTN, valvular disease, obesity, cardiomyopathy
178
Name 4 symptoms of left sided cardiac failure
SOB|PND/orthopnoea|Nocturnal cough (pink frothy sputum)|Poor exercise tolerance|Cold peripheries|Weight loss
179
Name 4 symptoms of right sided heart failure
Peripheral oedema/ascites|Hepatomegaly|Raised JVP|Nausea|Anorexia|Facial engorgement
180
What are the Framingham criteria for?
Diagnosing congestive heart failure
181
How would you diagnose heart failure using the Framingham criteria?
Need 2x major or 1x major and 2x minor
182
How do you classify the severity of heart failure?
Using the New York Heart Association criteria
183
What investigations would you do in suspected heart failure?
Bloods - FBC, U+E, BNP|CXR|ECG (Ischaemia/MI/ventricular hypertrophy)|Echo
184
What are the signs of congestive heart failure on CXR?
ABCDE|Alveolar oedema|Kerley B lines|Cardiomegaly|Dilated upper lobe vessels|Plural effusion
185
What drugs improve mortality in heart failure?
ACEi|Spironolactone|Beta blockers|Hydralazine and nitrates
186
What supportive therapies can you give to people with heart failure?
Flu jab annually|One-off pneumococcal vaccine|RF management|Cardiac rehab
187
What are the ECG signs of AF?
Absent P waves, irregularly irregular rhythm
188
Name 4 causes of AF
Heart failure/ischaemia|Hypertension|MI|PE|Hyperthyroidism|Caffeine|Alcohol|Electrolyte abnormality
189
What are the symptoms of AF?
May be asymptomatic|Chest pain|Palpitations|Dyspnoea, faintness
190
How would you investigate AF?
ECG|U+E|Cardiac enzymes|TFTs|Echo
191
What are the main goals of AF treatment?
Anticoagulation and rate control
192
What drugs are used to treat AF?
Rate control - propanolol/diltiazem. If fails add digoxin then consider amiodarone|Anticoagulation - acute=heparin, chronic=warfarin
193
CHA2DS2Vasc
Calculates stroke risk for patients with AF. 1=consider, 2=anticoagualte
194
HAS-BLED
Calculates risk of major bleeding in patients on anticoagulation for AF
195
What are the signs of asthma in an adult?
Wheeze (expiratory, polyphonic)|Sputum|Hyperinflated chest with hyperresonant percussion
196
What is the RCP 3 questions screening tool for asthma control?
Have you had difficulty sleeping because of your asthma symptoms?|Have you had your usual asthma symptoms during the day?|Has your asthma interfered with your normal activities?|No to all 3 = good control, Yes to 2 or 3 = bad control
197
How would you treat asthma in an adult?
Step 1 = SABA|Step 2 = add ICS|Step 3 = add LABA|Step 4 = increase ICS/add leukotriene receptor antagonist/theophylline|Step 5 = daily oral pred, refer
198
What is COPD and how is it diagnosed?
Progressive disorder characterised by airway obstruction with little or no reversibility|FEV1<80% predicted, FEV1/FVC ratio <0.7
199
What are the 2 types of COPD?
Chronic bronchitis: cough, sputum production on most day for 3 months of 2 successive years|Emphysema: enlarged air spaces distal to terminal bronchioles, with destruction of alveolar walls
200
COPD drug treatment
Step 1: SABA or SAMA (ipratropium) PRN|Step 2: FEV1>50% give LABA and LAMA. FEV1<50% give LABA and ICS in combination inhaler and LAMA|Step 3: LAMA+LABA+ICS
201
How would you diagnose diabetes in an adult?
Abnormal random/OGTT BG>11.1mmol|Abnormal fasting>7mmol|Abnormal HbA1c >48mmol/mol
202
What are the presenting complaints you may get with diabetes?
Polyuria, polydipsia, weight loss, lethargy, recurrent/prolonged infections, pruritus vulvae, acute complications (DKA/hypo)
203
How would you treat T2DM?
Step 1: Diet and exercise as therapy|Step 2: One oral hypoglycaemic|Step 3: Two oral hypoglycaemics, preferably from different classes|Step 4: Three oral hypoglycaemics or one oral hypoglycaemic plus insulin|Step 5: Insulin alone
204
Name 4 complications of uncontrolled DM
CV ischamia (ACS, CVA, PVD)|Nephropathy|Retinopathy|Neuropathy|Diabetic foot
205
Name 3 causes of hyperthyroidism
Grave's disease|De Quervain's thyroiditis|Phaeochromocytoma|Drugs (amiodarone, lithium, thyroxine)|Toxic nodular goitre
206
Name 5 symptoms of hyperthyroidism
Weight loss and increased appetite|Diarrhoea|Sweating, tremor|Irritability|Heat intolerance|Emotional lability|Oligo/amenorrhoea|Proximal myopathy
207
Name 5 signs of hyperthyroidism
Palmar erythema|Sweaty/warm hands|Fine tremor|Tachycardia|Hair thinning|Lid lag|Hyperreflexia|Goitre|Thyroid eye disease
208
What investigations would you do and what would you find in hyperthyroidism?
TFTs (low TSH, high free T3 and T4)|Antibodies (Anti-TPO antibodies, antithyroglobulin)|CRP/ESR|Thyroid USS
209
How would you manage hyperthyroidism?
Carbimazole (propylthiouracil if pregnant)|Beta blocker/CCB for tachycardia|Eye drops for eye disease|Radio-iodine or thyroidectomy
210
Give 2 signs and 2 symptoms of thyroid eye disease
Ocular irritation|Red eyes|Diplopia|Proptosis|Lid lag|Conjunctival injection|Chemosis
211
Name 4 causes of hypothyroidism
Iodine deficiency|Autoimmune (Hashimoto's)|Drugs (amiodarone, lithium, carbimazole)|Iatrogenic (radio-iodine, surgery)|Postpartum thyroiditis
212
Name 4 symptoms of hypothyroidism (adults)
Lethargy|Weight gain and increased appetite|Intolerance to cold|Dry skin, hair loss|Slowing of intellectual ability|Constipation|Menorrhagia
213
Name 4 signs of hypothyroidism (adults)
Dry coarse skin|Cold peripheries|Myxoedema|Reflexes relax slowly|Bradycardia
214
What investigations would you do for an adult with symptoms of hypothyroidism?
TFTs (high TSH, low T3/T4)|Antibodies (anti-TPO antibodies, anti-thyroglobulin)|Raised CK, cholesterol|USS thyroid
215
How would you treat hypothyroidism?
Levothyroxine (T4)
216
What are some RFs for CKD?
Increasing age|CVD|DM|Obesity|Smoking|AKI|Proteinuria
217
How would you diagnose CKD?
Kidney damage (albuminaemia) or GFR<60ml/min)
218
Name 4 causes of CKD
HTN|Glomerulonephritis|DM|Vasculitis (SLE)|Myeloma|Malignancy
219
How might CKD present?
Many asymptomatic|Severe CKD presents with anorexia, nausea and vomiting, peripheral neuropathy, pruritus, peripheral oedema, SOB|Very severe - pericarditis, seizures, coma
220
What type of anaemia might you get with CKD?
Normochromic normocytic anaemia
221
What U+Es might you expect with CKD?
Hyperkalaemia|Low bicarb|High phosphate|Hyperparathyroid hormone|High alk phos
222
How would you manage CKD?
Avoid nephrotoxic drugs|Exercise, stop smoking, weight loss|GFR monitoring|CVD prevention, BP control|Manage anaemia|RRT when severe
223
Name 3 complications of CKD
Anaemia|Coagulopathy|HTN|Peripheral neuropathy|Fluid overload|Malnutrition
224
Describe the risk factors for TB
HIV|Poor nutrition/low body weight|Living in crowded conditions|Being homeless or from a migrant population|DM|Being an IVDU and sharing needles|Immunosuppressive therapy
225
What health issues may be important in a migrant population?
Depression, PTSD|Physical injuries/wounds from travelling or from war|Infectious diseases|Untreated chronic disease or congenital problems|Illnesses specific to their country of origin|No immunizations
226
What measurement made on CXR would tell you that a heart is enlarged?
Cardiothoracic ratio of over 0.5
227
On CXR you can see a double cardiac shadow on the R side of the heart. What is this?
Enlarged L atrium
228
State the ECG features that would raise your suspicion of LVH
R wave in V5 or V6 of over 25mm S wave in V1 or V2 of over 25 mm Sum of S wave in V1 plus R wave in V6 of over 35mm
229
State two long-term complications of untreated aortic stenosis
Sudden death|AF or VT|Left heart failure|ANgina|R heart failure|Cerebral embolus
230
A 72 year-old man is diagnosed with a clinical depression and started on a course of Prozac (Fluoxetine). fly outline the mechanisms of action of this drug as regards its desired therapeutic effects. What neurotransmitter does it affect to lessen depression and in what part of the brain does this occur predominately?
Blockade of the re-uptake of serotonin (5-HT)|Downregulate the number of 5-HT receptors|Pre-frontal cortex
231
A patient remains on fluoxetine for six weeks and feels much better. He requests to stop the drug. What advice would you give him and why?
Continue for at least 6m|Relapse is high before this time
232
What receptors do TCAs effect and what do TCAs do to them?
Blocks muscarinic receptors
233
What findings on clinical examination would make you suspect overdose of TCA?
Tachycardia|Dilated pupils|Enlarged bladder
234
What is the percentage chance that the son of someone with AD will develop Alzheimer's disease and what genetic inheritance pattern is this condition thought to follow?
15%|Autosomal dominant
235
A general practitioner has a medical student with her in her surgery and wishes to demonstrate the 'cog-wheel' rigidity seen in some patients with Parkinson's disease. Initially, this physical sign is not present. What might the patient be asked to do in order to increase the chance of eliciting this physical sign?
Reinforcement
236
What is the most common malignant neoplasm to affect the breast?
Adenocarcinoma
237
State the names of 2 genes responsible for familial causes of breast cancer
BRCA1, BRCA2
238
State 5 common tumours that typically metastasise to bone
Breast|Bronchus|Thyroid|Prostate|Kidney
239
A medical student returns from elective with a fever and splenomegaly. Malaria film is negative. State 3 possible infectious diseases that should be considered as a cause of illness
Typhoid|Glandular fever|Toxoplasmosis|CMV|Hepatitis|Schistosomiasis|Malaria
240
Name one example of an antibiotic which is a DNA gyrase inhibitor
Ciprofloxacin
241
A patient is found to have high concentrations of serum transaminases. State the cell origin of these enzymes
Hepatocyte
242
What blood test diagnoses glandular fever?
EBV IgM (Monospot)
243
2 day old full term baby comes in, looks cyanotic. You examine him and on auscultation hear no additional heart sounds or murmurs, his femoral pulses are normal. Oxy sats on his right hand are 78%.
TGA
244
Parents bring their 3y/o son in to see you regarding his short stature- he was small-for-dates and has been on the lower range of the centile for height since. When you see him you notice he has a triangular-shaped face and a carp shaped mouth. What is his short stature most likely due to?
Russell Silver syndrome
245
3y/o boy is breathless, bilateral wheeze. No significant past medical history. No interval symptoms. His mum has eczema and hayfever. What is this boy most likely to have?
Viral induced wheeze
246
9y/o boy comes in for abdominal cramps. Gets a scope and duodenal biopsy which reveals villous atrophy, increase in intraepithelial lymphocytes and crypt hyperplasia. No PR bleeding. What would you recommend for management?
Gluten free diet
247
Baby comes in with prolonged jaundice, what is the first most important investigation to do?
Unconjugated and conjugated bilirubin
248
9y/o Boy comes in to A&E with painless limp, has no previous medical history of any illnesses or colds/infections recently. U/S shows effusion. What is he most likely to have?
Perthes disease
249
Boy recently treated for severe strep throat, and now has developed nodules on his shin which are tender. What are these called?
Erythema nodosum
250
Male comes in - recently his chest has been tender and both his breasts have been increasing in size. Which medication can be responsible for this?
Spironolactone
251
Woman develops pruritus vulva, PMHx includes PCOS, DHx currently on metformin and clomifene. What additional test do you do?
OGTT
252
Guy experiences a sudden sharp pain in his neck while on a rollercoaster a few days ago. Now ataxic and a few other symptoms. What is the diagnosis?
Carotid artery dissection
253
Pregnant lady with bilateral wrist pain and tingling, worst at night. What is this?
Carpal tunnel syndrome
254
Guy comes in after a car accident, loss of sensation in middle finger. He can flex his elbow but cannot extend it. Where is the site of the lesion?
C7
255
Guy goes into dementia clinic and has a few tests done: verbal fluency, Luria's motor tests... what are they testing him for?
FTD
256
Guy who was bullied at school, now suffering from feeling anxious, no specific triggers, also afraid to leave the house. What is his likely diagnosis?
GAD and agorophobia
257
Lady arrives at A&E having taken an overdose of tricyclics. What is one important investigation you must do?
ECG
258
Elderly lady found confused and wandering around the estates, police finds her. What can they use to bring her to be assessed?
Section 136
259
What is the treatment for acute alcohol withdrawal?
Chlordiazepoxide
260
What is the treatment for overdose of diazepam?
Flumenazil
261
Young guy known to have schizophrenia, sits at a bus stop by himself and starts to take off his shirt. The community mental health team treating him advise him to go and seek help at a clinic that day, but he doesn't... What can the police do to ensure he gets assessment?
Section 135
262
Where does GnRH pulses originate?
Hypothalamus
263
Where are FSH and LH released from?
Anterior pituitary
264
Oestrogen produced by the follicle has a negative feedback effect on FSH production. Why is this?
So only one egg matures
265
Which hormone stimulates the LH surge which causes ovulation?
Oestrogen
266
What produces progesterone?
Corpus luteum
267
What does progesterone do?
Maintains lining of uterus
268
What are the benefits of HRT?
Symptom management|Osteoporosis prevention|Colorectal cancer prevention
269
What are the risks of HRT?
Breast cancer if combined|Endometrial cancer if oestrogen only|Gallbladder disease
270
A married couple in their thirties presents to the gynaecologist. They are struggling to conceive. |The lady has a BMI of 32 and drinks 12 units/week. The man smokes 10/day and drinks 15 units/week. What pre-conception advice do you give them?
Start folic acid, female stop drinking, man stop smoking, lose weight
271
What 3 things are you looking for in a sperm sample?
Count|Morphology|Motility
272
What things may reduce a man's sperm quality?
Smoking, obesity, Klinefelter's, varicocoele, prolactin, hypothalamic hypogonadism
273
What are ovulatory factors for infertility?
PCOS, hypothalamic hypogonadism, hyperprolactin, premature ovarian failure, adrenal tumour, thyroid
274
What are the tubal factors that could cause infertility?
PID, surgical adhesions, endometriosis
275
How could you investigate tubal patency?
Laparoscopy and methylene blue dye, Hysterosalpingogram (less risky)
276
How many cycles of IVF can a 30 y/o infertile couple have on the NHS? What risks are associated?
3 as aged under 40. Multiple pregnancy, ectopic, infection from egg collection, ovarian hyperstimulation syndrome, miscarriage
277
A 19 y/o girl presents to A&E with abdo pain and vaginal bleeding. Her LMP was 8 weeks ago. What is your first investigation? What are your gynaecological differentials?
B-hCG|Miscarriage|Molar pregnancy|Ectopic
278
What are the risk factors for miscarriage?
Age, previous, obesity, smoking, BV, uterine anatomy, medical condition (e.g. antiphospholipid)
279
What would you class as recurrent miscarriages?
3 or more in succession
280
What is the management of molar pregnancy?
Suction curettage, monitor HCG
281
What is the difference between complete and incomplete molar pregnancy?
Complete = sperm plus empty egg|Incomplete = 2 sperm plus 1 egg
282
What is the most common location for an ectopic pregancy?
Ampulla of fallopian tube
283
What are the risk factors for an ectopic pregnancy?
PID, IUD, pelvic surgery, smoking, previous ectopic
284
Why might someone get shoulder tip pain with an ectopic pregnancy?
This means it has ruptured and the blood is causing diaphragmatic irritation
285
What is the characteristic signs on pelvic examination of an ectopic?
Cervical excitation
286
What happens to the hCG level in ectopic?
Doesn't increase by 2/3 in 24h
287
What is your initial management of someone with a ruptured ectopic?
ABCDE|NBM|FBC and crossmatch|Anti-D if Rh-ve
288
What is the surgical treatment of an ectopic?
Laparoscopy and salpingectomy, or salpingotomy
289
What can you use for medical management of an ectopic and when is this appropriate?
Methotrexate injection if HCG<3000, stable, no foetal cardiac activity, unruptured
290
What are the RFs for fibroids?
Perimenopausal women, FHx, Afro-Caribbean
291
What are the protective factors for fibroids?
COCP, injectable progesterones, parity
292
What is the classic appearance of a fibroid if cut transversely?
Whorled
293
What are the complications of fibroids?
Enlargement may lead to worsening symptoms/pressure effects on other organs, torsion and degeneration, progression to malignancy (0.1% > leiomyosarcoma), problems in pregnancy e.g. prem
294
What is the most common type of ovarian tumour?
Epithelial
295
Where might ovarian secondary tumours originate from?
Breast, bowel|10% of ovarian malignancy
296
What are "chocolate cysts"?
Endometriomas
297
What is a cervical ectropion?
Columnar epithelium of endocervix visible as erythema around external os
298
What are the RFs for cervical ectropion?
Increased oestrogens e.g. ovulation, pregnancy, COCP
299
How might cervical ectropion present?
Asymptomatic|PV discharge|PCB
300
How would you manage a suspected cervical ectropion?
Exclude carcinoma by doing a colposcopy|Ablate if symptomatic
301
Who is screened for cervical cancer and how often?
25-64 y/o women|25-49 = every 3y|50-65 = every 5y|Best time is mid cycle|80% uptake
302
What is the most common type of cervical cancer?
Squamous cell carcinoma
303
What is the most common type of endometrial cancer?
Adenocarcinoma
304
What are some risk factors for endometrial cancer?
PCOS, obesity, nulliparity, early menarche, late menopause|Unopposed HRT, tamoxifen
305
What are some risk factors for ovarian cancer?
Nulliparity, early menarche, late menopause|Ovarian cyst may undergo malignant change|BRCA, HNPCC
306
Ovarian cancer Ix
Serum CA125|USS (solid areas, ascites, multilocular cysts, bilateral changes, mets), CT|Symptoms and age
307
Vulval cancer RFs
VIN, oncogenic HPV|Lichen sclerosis, immunosuppression, smoking
308
Vulval cancer presentation
Vulval pain/pruritus, lump, bleeding, discharge, dysuria, dyspareunia
309
Urethrocoele
Prolapse of lower vaginal anterior wall, involving urethra only
310
Cystocoele
Prolapse of upper vaginal anterior wall, involving bladder +/- urethra
311
Apical prolapse
Prolapse of uterus (or vault if hysterectomy), cervix and upper vagina
312
Rectocoele
Prolapse of lower vaginal posterior wall, involving anterior wall of rectum
313
Enterocoele
Prolapse of upper vaginal posterior wall, involving bowel loops into pouch of douglas
314
Genital prolapse risk factors
Multiparity|Pelvic surgery|Pelvic mass|Menopause|Vaginal delivery|Obesity
315
How would you examine someone with a genital prolapse?
Bimanual and sims speculum
316
Genital prolapse management
Lose weight, pelvic floor exercises|Cone, ring, shelf pessary|Surgery: hysteroplexy/hysterectomy, sacrospinous fixation
317
PID management
Multiple ABx to cover all potential causative organisms e.g. ceftriaxone, azithromycin, doxycycline, metronidazole
318
What is the most important risk factor for stroke?
Hypertension
319
A 23 y/o man is stabbed in the neck. MRI shows right hemisection of the cord at C6. What is the expected result of this injury?
Absent sensation to temperature in L hand (Brown-Sequard syndrome)
320
What is the treatment for an acute relapse of MS?
Course of oral steroids e.g. prednisolone
321
78 y/o right handed male collapses and is brought into A&E. Cannot answer questions. Unable to lift R hand or leg. In AF, has HTN. Diagnosis?
Left cortical infarct
322
PD histological findings
Lew bodies - eosinophilic cytoplasmic inclusion consisting of alpha-synuclein
323
PD pathophysiology
Degeneration of dopaminergic neurones in the substantia nigra
324
PD treatment
Dopamine receptor agonists: ropinirole, cabergoline|Levodopa and dopa-decarboxylase inhibitors|MAO-B inhibitors|COMT inhibitors
325
PSP
Progressive supranuclear palsy (eyes)|Postural instability, vertical gaze palsy, trunk rigidity, symmetrical, speech and swallow problems
326
MSA
Multiple system atrophy|Autonomic: impotence/incontinence, postural hypotension, cerebellar signs
327
HD pathology
Defect in huntingtin gene on Cr 4|Trinucleotide repeat disorder: repeat expansion of CAG|Degeneration of cholinergic and GABA neurons in striatum of basal ganglia|Loss of GABA-mediated inhibition
328
LMN signs
Limb weakness|Muscle wasting|Fasciculations
329
UMN signs
Hypertonia|Brisk reflexes|Upgoing plantars|Spasticity
330
MND Ix
NCS - exclude peripheral neuropathy/myopathy|EMG - reduced number of action potentials with increased amplitude|MRI - exclude cervical cord compression, MS, myelopathy
331
MND conservative management
Feeding and resp support - overnight NIV|MDT approach - OT, SALT, physio, dieticians, MND specialist nurses
332
MND pharmacological management
Riluzole|Hyoscine|Baclofen|Antidepressants
333
GBS treatment
IV Ig
334
MG pathophysiology
Autoimmune - ABs to post-synaptic nicotinic acetylcholine receptors|Interferes with muscular transmission|Fatigability due to fewer available AChRs at NMJ
335
MG typical patient
Woman, 30-50, other AI diseases
336
MG presentation
Increasing muscular fatigue extra-ocular (ptosis, diplopia), bulbar (swallowing, chewing, dysphonia), face, neck, limbs (proximal), girdle, trunk.
337
MG Ix
Antibodies - Anti-AChR, MuSK|CT Thorax - thymus|Ice test|Tensilon (edrophonium) Test
338
MG Rx
Acetylcholinesterase inhibitors (pyridostigmine). Immunosuppressants for relapses - pred|Thymectomy
339
Myasthenic crisis
Weakness of respiratory muscles, may need intubation and ventilation, treat with plasmaphereis/IV Ig, treat trigger - infection, medications, post-op
340
Erectile dysfunction
Difficulty in developing or maintaining an erection suitable for satisfactory intercourse
341
ED causes
DM|Vascular disease|Radical surgery e.g. TURP|Spinal cord injury|MS|Endocrine disorders
342
ED RFs
Sedentary lifestyle|Obesity and diet|Smoking and alcohol|DM|Hypertension|Hyperlipidaemia|Depression|Drugs
343
Factors suggestive of organic contribution to ED
Loss of erections in all situations|Gradual onset|Ejaculatory problems|Decrease in flaccid penile size|Other organic RFs - alcohol, tobacco, DM etc
344
Factors suggestive of psychogenic contribution to ED
Morning erections|Nocturnal erections|Situational erections|Fully rigid erections several times a week|Abrupt onset (weeks)
345
What may cause psychogenic ED?
Performance anxiety|Life events - deterioration in non-sexual relationship, divorce, work worries, health problems|Developmental vulnerabilities - low sexual interest, sexual identity confusion, erectile difficulties
346
ED treatment options
Sildenafil|Injectable or intraurethral alprostadil|Vacuum device|Penile/scrotal rings|New stimulating routines e.g. enhancing lubricants, vibrators|Kegel exercises
347
What is FSAD?
Female sexual arousal disorder|Failure of genital response - the principal problem is vaginal dryness or failure of lubrication
348
FSAD causes
Chronic medical conditions - CVD, DM, neurological disease|Hormonal disorders - oestrogen deficiency e.g. postmenopause|Antidepressants|Lactation|Vaginal dryness|Depression|Prev abuse|Couple script/relationship problems|Decreased intimacy
349
FSAD treatment
New sexual routines -| lubricants, vibrators, Eros device|Couples psychosexual therapy|Sensate focus
350
Sensate focus
A staged programme of exercises to enable the couple to identify their own and others sexual likes/dislikes and explore new techniques|Work with therapist to understand and overcome negative beliefs and unhelpful thinking patterns in relation to sexual behaviour|Eros therapy device for women
351
What bloods would you do for someone presenting with sexual dysfunction?
Fasting glucose/lipid ratio (diabetes/CVD)|Testosterone, SHBG, albumin (desire disorders, arousal disorders, orgasmic disorders, pain disorders)|Prolactin (desire disorders, ED)|TSH (desire disorders, rapid ejaculation)|Oestrogen (FSAD, orgasmic disorder)|FBC (desire disorders, orgasmic disorders)
352
Female orgasmic disorder
Orgasm does not occur or is markedly delayed
353
Female orgasmic disorder cause
Chronic medical conditions - CVD, DM, neuro problems|Hormonal disorders - oestrogen and/or androgen insufficiency, hypothyroidism|Pelvic floor weakness|Ageing|SSRIs|Depression|Prev abuse|Relationship problems|Cultural issues|Stress
354
Female orgasmic disorder treatment
Individual psychotherapy|Sex therapy focus|Behavioural - education, personal sexual growth programme, guided masturbation, lubricants and vibrators, Kegel exercises
355
How might the menopause affect sexual function?
Vaginal or pelvic pain|Vaginal atrophy|Dryness|Change in self image, mood, memory, cognition|Changes in desire|Relationship factors|Physical discomfort - sleeplessness, night sweats
356
Rapid ejaculation
The inability to control ejaculation sufficiently for both partners to enjoy sexual interaction
357
Rapid ejaculation causes
Genetic susceptibility|Penile hypersensitivity|Hyperthyroidism|Prostatitis|ED|Anxiety states|Early learned experiences|Lack of experience/infrequent sexual activity|Psychosocial, relationship factors
358
Rapid ejaculation treatment options
Topical local anaesthetic e.g. stud 100 spray|Dapoxetine (beware suicidal thoughts)|Couple psychosexual therapy - education, normalising, partner expectations|Behavioural interventions - stop/start technique, sensate focus, point of inevitability, kegels
359
Vaginismus
Genito-pelvic pain/penetration disorder|Spasm of the pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening
360
Vaginismus causes
Medical conditions where vulva sore to touch e.g. thrush, lichen sclerosis|FGM|Congenital abnormality|Mistaken beliefs e.g. vagina too small, no opening, first intercourse very painful|Religious issues|Fear of pregnancy|Prev trauma|Fear of partner|Relationship issues
361
Vaginismus treatment
Individual psychosexual therapy, explore family, childhood, social, relationships, abuse, culture|Integrated CBT|Behavioural interventions - breathing control and relaxation, self explorations, personal sexual growth programme, kegel, vaginal dilators/trainers
362
Dyspareunia
Pain during intercourse, can be due to local pathology or psychological
363
Dyspareunia physiological causes
Manipulation - infection, irritation, injury, lesions|Superficial - episiotomy, recurrent infection, herpes, urethritis, vaginal atrophy, menopause, poor lubrication, insufficient sexual arousal|Mid-deep - endometriosis, fixed uterine retroversion, pelvic tumours, adhesions, irritable bowel, constipation
364
Dyspareunia psychological causes
Prev experience of pain, sexual abuse|Poor sexual education and understanding of anatomy and physiology|Insufficient relaxation|Poor technique of partner|Fear of intimacy|Anger or resentment towards partner
365
Dyspareunia treatment options
Steroid creams and moisturising|Testosterone replacement|Couple therapy - is there depression, change negative communication|Personal sexual growth |Sensate focus
366
An alcoholic man goes to see his GP, who thinks he looks pale. GP arranges some blood tests which find that the patient's RBCs are abnormal. What is this abnormality and why do they have it?
Macrocytosis|B12 deficiency
367
An alcoholic patient goes and drinks to excess one evening. Following a bout of vomiting he has a small haematemesis and is admitted to an Accident and Emergency Department. State two possible likely causes for his haematemesis
Mallory Weiss tear|Bleeding varices|Gastritis|Peptic ulcer disease
368
State 2 abnormalities you may find on examination of the abdomen of an alcoholic's abdomen
Abdo distention|Ascites|Hepatomegaly|Splenomegaly|Caput medusa
369
State two neurological sites that can account for tremor, blood pressure findings and incontinence.
Basal ganglia|Corpus striatum|Nigrostriatal tract|Sympathetic autonomic nervous system
370
A 19-year-old girl with no previous history of skin problems developed a slightly itchy eruption on the chest and back two weeks after a sore throat. What is the most likely diagnosis?
Guttate psoriasis
371
A boy aged 3 presents with an itchy eruption affecting the antecubital and popliteal fossae present for 6 months. What diagnosis is most likely?
Atopic eczema
372
A 15 year old boy presents at his GP's surgery with a temperature of 38oC, erythematous pharynx with white papillae, and swollen neck glands only. A throat swab reveals an organism which grows on blood agar, with colonies with a clear zone of lysis around them. What organism?
Strep pyogenes
373
A 10 year old boy is seen at his home with a history of sudden onset of fever, cough, sore throat and headache: he now has back and thigh pains, and is confined to bed. Serology eventually reveals that he was infected with an organism that expresses a haemagglutinin and neuraminidase. What organism?
Influenza A
374
A four year old boy has abdominal distension and a large mass in the left flank with hypertension and haematuria. Cause?
Nephroblastoma
375
A 6 month old infant has been passing pale stools since birth and is now deeply jaundiced with ascites and is vomiting blood. Cause?
Portal hypertension
376
A 13 year old girl presents with lower abdominal discomfort and a plain abdominal X-ray reveals teeth.
Dermoid cyst of ovary
377
A young patient with a history of asthma arrives at the accident and|emergency department with acute severe breathlessness, and is obviously wheezy and distressed. The doctors immediately give him a treatment which will rapidly improve his arterial oxygenation.
High flow oxygen
378
The doctors then examine and investigate a patient and make a diagnosis of acute severe asthma. They decide to prescribe the bronchodilator treatment for initial therapy.
SABA via nebuliser
379
A 10 year old with a history of severe head injury 24 hours previously has nausea and vomiting. What electrolyte abnormality may they have?
Low plasma sodium
380
A baby boy with recurrent projectile vomiting. What electrolyte abnormality may he have?
Lowered plasma chloride and raised plasma bicarbonate
381
Severe abdominal pain in a child with mumps. What electrolyte abnormality may they have?
Raised plasma amylase
382
One week after surgery, a baby undergoing prosthetic correction of a Fallot's tetralogy develops a Gram-positive endocarditis. Organism?
Staph epidermis
383
Three days after her first sexual intercourse, an 18 year old woman notices painful and frequent micturition. Organism?
E coli
384
A 7 year old who attends school in Sheffield develops fever and sore throat that is severe enough to warrant admission to hospital. Organism?
Strep pyogenes
385
A 34 year old woman presents with a painful and tender breast lump four weeks after delivery of her second child. Microscopy of a discharge from the nipple reveals Gram-positive cocci. Diagnosis?
Breast abscess
386
A 23 year old female patient presents with an area of dense thickening in the upper outer quadrant of the left breast which is more prominent and tender before her period. Diagnosis?
Fibrocystic change
387
A 62 year old woman presents three weeks after a road traffic accident. She sustained a seat belt injury to the left breast associated with bruising of the skin for a few days after the accident. She now presents with an irregular non-tender mass in the left breast. Diagnosis?
Fat necrosis
388
A 21-year old woman is seen during January by her General Practitioner with a fever, cough, pharyngitis and headache. The symptoms came on suddenly the previous day, and the patient now complains of muscle pains and prostration. Her partner had the same symptoms from two days previously but felt too exhausted to see a doctor, and is now without the above symptoms, but remains feeling very tired. The doctor decides she has a condition that might be treated with a neuraminidase inhibitor. Organism?
Influenza
389
The mother of a 16 year old female patient wakes up because she hears|"funny noises" coming from her daughter's room at 3.00 am. When she gets to the room, she notices that there is blood around her daughter's mouth and that she has wet herself. The daughter appears awake, but is extremely restless and does not respond to commands etc. Dx?
Postictal confusion
390
A 22 year old female first developed a headache and a general feeling of being unwell as well as "a bit of a temperature" two weeks ago according to her boyfriend. Over the last two days she has become more sleepy and appeared at times rather confused. On examination, there is neck stiffness.
Meningoencephalitis
391
An 85 year old woman has a three month history of intermittent diarrhoea but occasionally passes hard small faeces. She frequently has faecal incontinence. Dx?
Constipation
392
A 90 year old male, who lives alone is found wandering in the street outside his house. A neighbour says that he has become confused over the last week. He has had a number of falls recently and has bruising over his hands, knees and face. Dx?
Sub-dural haemorrhage
393
A 5 year old girl is unable to distinguish between red and green. Her father has the same problem and also a maternal aunt. What is the pattern of genetic inheritance of this problem?
X linked recessive
394
A 2 month old baby girl has failure to thrive and recurrent chest infections. She is one of eight children and one of her brothers has to regularly attend the hospital for a similar disorder. The parents are healthy. What is the pattern of genetic inheritance of this problem?
Autosomal recessive
395
A 20 year old develops conjunctivitis and painful joints 3 weeks after he|attended the genitourinary clinic for dysuria.
HLA-associated
396
A 62 year old man presents to the Accident and Emergency Department brought by his wife. His wife has encouraged him to attend because of his increasing symptoms of confusion. He is right-handed. On examination he is fully conscious and speaks fluently and with normal intonation, but his actual words are meaningless. He is unable to name objects or read aloud with comprehension. He cannot follow simple commands. Where in the brain is affected?
Left temporal lobe
397
A 17 year old man presents to his general practitioner complaining of seizure attacks. The attacks comprise a 'racing' epigastric sensation followed by loss of awareness. He describes symptoms of a vacant stare and posturing of his left arm. Where in the brain is affected?
Right temporal lobe
398
Three days after giving birth to a healthy first baby, a 27 year old lady is noted to be irritable with tearful outbursts. She complains of being tired and unable to cope. She has no history of mental health problems and her delivery was uncomplicated. Diagnosis?
Maternity blues
399
A 60 year old woman, who has Type 2 diabetes mellitus and has been a lifelong smoker, awakened this morning and found she was unable to move her right arm and leg. On examination, she is dysarthric and has a flaccid hemiparesis affecting these limbs. Diagnosis?
Left MCA infarct
400
An 80 year old man tripped and fell over four days ago. He says he did not hurt himself or bang his head. The day after the fall however he developed a headache and his wife has noticed that he has become a little confused since then. On examination he has a slight global weakness of the right lower limb with increased L3/4 and S1/2 reflex responses on this side. Diagnosis?
Subdural haematoma
401
A 75 year old man with a long history of hypertension tells his wife that his left arm and leg have suddenly become weak and numb. She calls for an ambulance but before it can get him to the local hospital he has become unconscious. On examination he has a Glasgow Coma Score of 4/15. Both eyes are deviated to the left and both plantar responses are extensor. He has no neck stiffness. Diagnosis?
Intracerebral haemorrhage
402
What would you find on investigation in BV?
Vaginal pH>4.5, clue cells, positive whiff test
403
Gonorrhoea Rx
IM ceftriaxone plus oral azithromycin to cover for chlamydia
404
A 45 y/o lady comes to see you with symptoms of HSDD. Name 4 investigations you would do (endocrine/metabolic)
Testosterone, oestrogen, TSH, prolactin
405
Name 2 non metabolic causes of HSDD
DM, CVD|Psychological - prev abuse|Iatrogenic - SSRI, OCP
406
Name 2 treatment options for HSDD
Psychosexual treatment - CBT, psychodynamic, cognitive, integrative, behavioural|Flibanserin
407
Extrinsic compression of SC symptoms
Sensory loss in saddle distribution
408
Intrinsic compression of SC symptoms
Sacral sparing sensory loss
409
Syringomyelia
Where a fluid-filled cavity develops in the CSF producing characteristic sensory and motor effects. Assoc w/ Arnold-Chiari malformations
410
Syringomyelia signs
Spastic paraparesis lower limbs|Loss of pain and temperature sensation in cape distribution in upper limbs|LMN signs in upper limbs|Posterior column function relatively spared
411
Brown-Sequard syndrome
Cord hemisection produces characteristic signs|Ipsilateral UMN weakness, position and vibration sense loss|Contralateral spinothalamic sensory loss
412
What is the commonest site for intussusception? What is the most serious complication?
Ileum passing into the caecum throught ileocaecal valve|Bowel perf, peritonitis, gut necrosis
413
What is Meckel's diverticulum a remnant of and how might it present?
Vitello-intestinal duct|Generally asymptomatic, bleeding, intussusception, volvulus or diverticulitis
414
How would you investigate and treat a suspected malrotation?
Upper GI contrast study|Surgical correction
415
What is the most common cause of gastroenteritis in children in the UK?
Rotavirus
416
What should you be cautious of when treating a child with hypernatraemic dehydration?
Not reducing plasma sodium too rapidly - shift of water into cerebral cells may result in cerebral oedema and seizures
417
What is the commonest cause of persistent loose stools in preschool children?
Toddler's diarrhoea - stools of varying consistency, sometimes with undigested vegetables
418
What is the classical presentation of Crohn's in children?
25% have abdo pain, diarrhoea, weight loss
419
How is Crohn's diagnosed?
Endoscopic and histological findings on biopsy:|Histological hallmark is caseating epithelial cell granulomata|Small bowel imaging may show narrowing, fissuring, mucosal irregularities, bowel wall thickening
420
How is remission induced in Crohn's?
Nutritional therapy - whole protein modular feeds for 6-8w|Systemic steroids if ineffective
421
How is remission maintained in Crohn's?
Azathioprine, MTX, anti TNF alpha agents
422
How does UC classically present in a child?
Rectal bleed, diarrhoea, colicky pain|Erythema nodosum and arthritis
423
What would be seen in UC on endoscopy (upper and ileocolonoscopy) and biopsy?
Confluent colitis extending from rectum|Mucosal inflammation, crypt damage, ulceration
424
What therapies might you use to induce remission in UC?
Aminosalicylates e.g. mesalazine, topical steroids for rectal disease, systemic steroids for aggressive disease
425
What medical emergency might result from UC and how would you treat it?
Severe fulminating disease|IV fluids and steroids (ciclosporin if this fails to induce remission)
426
What kind of laxative is used first line to treat constipation?
Macrogol laxative (e.g. polyethene glycol + electrolytes a.k.a. Movicol) (+stool softener
427
What is the pathophysiology of Hirschprung disease?
Absence of myenteric and submucosalplexus ganglion cells narrow contracted segment and dilated colon where normal innervation starts |Most commonly rectosigmoid
428
How might Hirschprung's present?
Failure to pass meconium|Abdo distension|Bile stained vomit
429
How is Hirschprung's diagnosed? What might the test show?
Suction rectal biopsy|Absence of ganglion cells|Presence of large, acetylcholinesterase-positive nerve trunks
430
How is Hirschprung's managed?
Initial colostomy followed by anastamosing normally innervated bowel to anus
431
Give 4 red flag features of a febrile child
Fever >38 if <3m, >39 if older|Pale/mottled/blue|Resp distress|Bile stained vomit|Severe dehydration/shock|Decreased consciousness|Neck stiffness|Seuizures|Bulging fontanelle
432
Give 2 causes of non-infectious meningitis
Malignancy, autoimmune disease
433
What are some symptoms of meningitis/encephalitis in children?
Lethargy, drowsiness, seizures, poor feeding/vomiting, irritability, hypotonia, fever, photophobia, headache
434
What is Cushing's triad?
Bradycardia, hypertension, abnormal pattern of breathing
435
Give 5 things you might find on examination of a child with meningitis
Fever, purpuric rash, neck stiffness, bulging fontanelle, Kernig signs, altered consciousnees, papilloedema
436
Give 3 complications of meningitis
Hearing loss, local vasculitis, local cerebral infarction (may lead to epilepsy), subdural effusion, hydrocephalus, cerebral abscess
437
Give 3 contraindications of lumbar puncture
Cardioresp instability|Focal neuro signs|Signs of raised ICP|Coagulopathy|Thrombocytopenia|Local infection at site of LP
438
What are the most common causative organisms for encephalitis?
Enteroviruses|Resp viruses|Herpes viruses e.g. HSV, varicella, HHV6
439
Where in the brain are focal changes especially seen with HSV encephalitis?
Temporal lobes
440
What group of children are particularly susceptible to pneumococcal infection?
Children with hyposplenism e.g. sickle cell, nephrotic syndrome - give prophylactic penicillin V
441
Give 3 serious complications that can|occur from chicken pox infection (primary|VZV infection)
Secondary bacterial infection|Encephalitis|Purpural fulminans|Disseminated disease in immunocompromised
442
How would yo treat adolescents and adults with chickenpox?
Valaciclovir
443
Give 5 signs/symptoms of infectious mononucleosis
Fever, malaise, tonsillopharyngitis,|lymphadenopathy, petechiae on the soft palate, splenomegaly, hepatomegaly,|maculopapular rash, jaundice
444
What drug should you avoid in children|with EBV infection and why?
Amoxicillin/ampicillin - can cause a florid maculopapular rash
445
Give 2 serious complications of mumps
Encephalitis, subacute sclerosing panencephalitis
446
Give 3 symptoms of mumps
Fever, malaise, parotitis
447
Name a complication of mumps in boys
Orchitis (usually unilateral, rarely causes infertility)
448
Give 3 signs/symptoms of rubella infection
Fever, maculopapular rash (initially on face), lymphadenopathy
449
Name 2 complications of rubella infection
Arthritis, encephalitis, thrombocytopenia, myocarditis
450
Name 3 non-infective causes of prolonged fever
Systemic JIA|Malignancy|SLE|Vasculitis|IBD|Fabricated illness
451
What age group is Kawasaki disease most likely to affect?
6mo-4y
452
How is Kawasaki disease diagnosed?
Clinically, fever >5d and 4/5 from:|Conjunctival injection|Strawberry tongue, cracked lips|Cervical lymphadenopathy|Rash|Red and oedematous palms and soles
453
Name 2 things you would find on investigation of a child with Kawasaki disease
Increased WCC, plts, ESR, CRP
454
How do you obtain samples for culture for TB in children?
Gastric washings on 3 consecutive mornings
455
At what age can you diagnose HIV infection by anti-HIV antibodies?
18m
456
What signs/symptoms would warrant HIV testing in children?
Persistent lymphadenopathy,|hepatosplenomegaly, recurrent fever, parotid swelling, thrombocytopeneia or SPUR (serious, persistent, unsual,|recurrent) infections
457
What would you give a HIV+ve child as pneumocystis jiroveci prophylaxis?
Co-trimoxazole
458
Name 5 viruses that are an important cause of respiratory infections in children
RSV, rhinovirus, parainfluenza, influenza, adenoviruses
459
What would you find O/E of a child with acute OM?
Tympanic membrane bright red and bulging with loss of normal light reflection|May have fever
460
Name 2 bacterial causes of acute OM
H influenzae|Moraxella catarrhalis
461
Give 2 serious but uncommon complications of acute OM
Mastoiditis and meningitis
462
What is a common complication of recurrent otitis media and what age range is it commonly seen in? Management?
OME. 2-7y. Grommet insertion, adenoidectomy
463
What is the usual age range for croup, and peak incidence?
6mo-6y|Peak 2y|Commonest in Autumn
464
How does bacterial tracheitis (pseudomembranous croup) differ from croup? What organism usually causes it and how is it managed?
Child has high fever, appears toxic and has rapidly progressive airways|obstruction with copious thick airways|secretion |Staph aureus|IV ABx
465
Which organism is responsible for causing acute epiglottitis?
HiB
466
How does whooping cough present and how long does it normally last?
1 week of coryza, then paroxysmal cough followed by inspiratory whoop develops which lasts 3-6w
467
What age range does bronchiolitis usually|affect?
1-9mo, rare after 1y
468
Name a serious complication of bronchiolitis
Recurrent apnoea
469
What would a CXR typically show in bronchiolitis?
Hyperinflation of the lungs due to small airways obstruction, air trapping and often focal atelectasis
470
Name the 2 general patterns of wheeze in preschool children
Transient early wheezing|Persistent and recurrent wheezing (atopic asthma)
471
Briefly describe the pathophysiology of asthma
Bronchial inflammation|Bronchial hyperresponsiveness|Airway narrowing
472
What additional therapy might be used in a specialist asthma clinic for children with severe persistent asthma?
Anti-IgE therapy (omalizumab)
473
Which protein is defective in CF and on which Cr is it located?
CTFR|Cr 7
474
Which organisms typically tend to result in chronic infection in people with CF?
Pseudomonas aeruginosa, Burkholderia,|Staph aureus (initially) and H influenzae|(initially)
475
When does the ductus arteriosus close?
1-2d after birth
476
Name 7 signs/symptoms of heart failure|in children
Breathlessness (esp on feeding or exertion), sweating, poor feeding, recurrent chest infection, poor weight gain,|tachypnoea, tachycardia, heart murmur, gallop rhythm, cardiomegaly, hepatomegaly, cool peripheries
477
What are the 2 main types of atrial septal defect?
Secundum (80%, involving centre of atrial septum involving foramen ovale)|Partial/primum ASD
478
What kind of murmur would you hear with an ASD?
ULSE ejection systolic|Fixed split 2nd heart sound
479
How would you treat AVSD?
Surgical correction at 3-5y
480
How are VSDs classified into small and large?
Small = smaller than aortic valve in diameter|Large = same size or bigger
481
What symptoms might be present with aortic stenosis?
Asymptomatic murmur. Severe: reduced exercise tolerance, chest pain on exertion or syncope
482
What signs might be present with aortic stenosis?
Small volume slow rising pulse, carotid thrill, ejection systolic murmur (upper R|sternal edge radiating to neck), delayed and soft aortic second sound, apical|ejection click
483
What is the most common childhood arrhythmia?
SVT
484
What bacteria is responsible for rheumatic fever?
Beta-haemolytic strep
485
Give 6 signs/symptoms of infective endocarditis
Fever, anaemia, splinter haemorrhages,|clubbing, necrotic skin lesions, changing|cardiac signs, splenomegaly, neurological|signs from cerebral infarction, retinal|infarcts, arthritis/arthralgia, microscopic haematuria
486
What is the most common causative organism for IE?
Alpha-haemolytic strep (e.g. strep viridans)
487
What are the clinical signs of nephrotic syndrome?
Periorbital oedema (esp on waking),|scrotal/vulval, leg and ankle oedema,|ascites, breathlessness (pleural effusions|and abdo distension)
488
Give 3 complications of nephrotic syndrome
Hypovolaemia, thrombosis, infection (esp|Pneumococcus), hypercholesterolaemia
489
Name a steroid-resistant nephrotic syndrome. How should these children be managed?
Focal segmental glomerulosclerosis,|mesangiocapillary glomerulonephritis,|membranous nephropathy. Diuretic therapy, salt restriction, ACEi, sometimes NSAIDs
490
Give 3 glomerular and 3 non-glomerular causes of haematuria
Glomerular: acute glomerulonephritis, chronic glomerulonephritis, IgA nephropathy, familial nephritis (e.g. Alport's), thin basement membrane|disease|Non-glomerular: infection, trauma,|stones, tumours, sickle cell disease,|bleeding disorders, renal vein thrombosis, hypercalciuria
491
Give 2 causes of acute nephritis
Post-infectious (including strep),|vasculitis, IgA nephropathy and|mesangiocapillary glomerulonephritis, anti-glomerular basement membrane|disease
492
Name 3 signs/symptoms of HSP
Characteristic skin rash, arthralgia,|periarticular oedema, abdominal pain,|glomerulonephritis, fever
493
What is the clinical triad seen in HUS? What infection normally precedes?
Acute renal failure, haemolytic anaemia, thrombocytopenia|E.coli O157
494
Give 4 features of hydrocele
Asymptomatic scrotal swellings, often bilateral,|sometimes with bluish discolouration, non-tender,|transilluminate, may resolve spontaneously
495
How is an undescended testicle classified?
Retractile, palpable, impalpable
496
What are the reasons for surgical management of an undescended testicle?
If not treated - fertility reduction, increased risk of malignancy, cosmetic and psychological reasons
497
How would you manage testicular torsion?
Surgery within 6-12h for good chance of testicular viability|Fixation of contralateral testicle
498
What is hypospadias?
Urethral opening proximal to the normal meatus on the glans
499
What is the pathophysiology of biliary atresia and how would you treat?
Progressive destruction of extrahepatic biliary tree and intrahepatic biliary ducts. Surgical bypass of the fibrotic ducts (hepatoportoenterostomy)
500
Name 4 causes of unconjugated|hyperbilirubinaemia in prolonged neonatal jaundice
Breast milk jaundice, infection,|haemolytic anaemia, hypothyroidism,|high GI obstruction, Crigler-Najjar|syndrome
