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finals > 3a (2) > Flashcards

3a (2) Flashcards

1
Q

Feeds using a spoon, dry during day

A

18m

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2
Q

Can draw a simple picture of people

A

5y

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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

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13
Q

What class of immunoglobulin is involved in ABO haemolytic disease of the newborn?

A

IgG

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14
Q

What can cause neonatal jaundice in the first 24 hours of life?

A

Rhesus incompatibility|ABO incompatibility|G6PD deficiency|Spherocytosis|Congenital infection

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15
Q

Name 5 congenital intrauterine infections that can damage the fetus

A

Toxoplasmosis|Rubella|Cytomegalovirus|Herpes simplex|HIV|Parvovirus B19|Varicella zoster

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16
Q

What type of bilirubin causes jaundice in haemolytic disease of the newborn?

A

Unconjugated bilirubin

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17
Q

What is bilirubin neurotoxicity also known as?

A

Kernicterus

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18
Q

Name the two main methods of treating neonatal jaundice

A

Phototherapy|Exchange transfusion

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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

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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

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21
Q

Baby birth weight of 4.6kg, with transient hypoglycaemia 6 hours after birth, looking very plethoric

A

Maternal diabetes

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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

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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

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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

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25
Q

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)

A

Turner’s syndrome

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26
Q

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

A

Congenital adrenal hyperplasia

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27
Q

Raises head to 45° from horizontal, follows moving objects or face by turning her head, started to smile responsively

A

6-8w

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28
Q

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

A

2 years

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29
Q

Walks around furniture, has a mature pincer grip, uses sounds discriminately to parents, waves bye-bye (if he wants to)

A

10 months

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30
Q

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

A

Primary ciliary dyskinesis

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31
Q

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

A

Pertussis

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32
Q

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

A

GORD

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33
Q

What constitutes a septic screen?

A

Blood culture|FBC|CRP|Urine sample|LP|(CXR if indicated)

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34
Q

What features are suggestive of an atypical UTI in a child?

A

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

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35
Q

How would you investigate an atypical UTI in a child under 1 year old?

A

Ultrasound KUB, MCUG, DMSA

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36
Q

How do you treat intussusception?

A

Reduction of intussusception by rectal air insufflation (hydrostatic reduction). If fails, operative reduction

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37
Q

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?

A

Imprinting

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38
Q

What are neurofibrillary tangles?

A

Paired helical axons of degenerated neurones

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39
Q

COPD - What measurements would you take to confirm diagnosis? What ratio would you use to confirm this and what is the cut off point?

A

FEV1, FEV1/FVC, 0.7

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40
Q

What is it called when a patient’s eyes roll back into their head after being commenced on antipsychotics?

A

Oculogyric crisis

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41
Q

Name 2 drug classes that can cause delirium

A

Anticholinergics (TCAs)|Benzodiazepines|Beta blockers|NSAIDs

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42
Q

SEs of anticholinergics

A

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)

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43
Q

What type of bilirubin causes dark urine?

A

Conjugated bilirubin

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44
Q

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?

A

Acute dystonic reaction|Blockade of dopamine receptors|Offer an antimuscarinic/anticholinergic

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45
Q

Which lobe of the brain is most affected in schizophrenia?

A

Temporal lobe

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46
Q

Why might someone develop gynaecomastia after being on an antipsychotic for a few months?

A

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

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47
Q

Why might males on antipsychotics with gynacomastia be impotent?

A

They will have high prolacting, which has a negative effect on gonadal hormone production

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48
Q

State 2 investigations in suspected pre-eclampsia

A

FBC inc platelets|LFTs|Uric acid level

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49
Q

State 3 complications of pre-eclampsia

A

Eclampsia - seizures|Fetal death|Placental abruption|HELLP|Renal failure|Hepatic failure|CVA|DIC

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50
Q

State 2 treatments that an obstetrician could use to alleviate pre-eclampsia and to reduce the risks of complication

A

Deliver baby if maternal condition deteriorates|IV labetalol|Magnesium sulfate

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51
Q

State 2 factors which can predispose to the development of pre-eclampsia

A

Nulliparity|Strong FH or prev history of pre-eclampsia|Multiple pregnancy|Chronic hypertension|SLE|Renal disease|First baby with new partner

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52
Q

Alcoholic is admitted for detox. What 3 specific markers in bloods will verify that he is drinking heavily up to the point of admission?

A

Gamma GT|MCV|Blood alcohol levels

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53
Q

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?

A

Amphetamine, dopamine, increases dopamine levels

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54
Q

What 2 blood markers will be significantly raised in this condition?

A

CPK, WCC

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55
Q

What are the complications of NMS?

A

PE|Pneumonia|High temp|Renal failure

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56
Q

State 4 blood tests to assess nephrotic syndrome

A

Urea and creatinine|Plasma proteins/albumin|Haemoglobin|Cholesterol

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57
Q

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?

A

Peritonitis, streptococcus pneumoniae

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58
Q

State two cardiovascular complications of nephrotic syndrome and how they should be treated

A

Hypertension - atenolol|Pericardial effusion - pericardial tap/diuretics and fluid restrictoin

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59
Q

What is the drug treatment of glomerulonephritis? What additional prophylactic medication will you start?

A

Prednisolone, penicillin V

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60
Q

What histological finding in glomerulonephritis would indicate a good/bad prognosis?

A

Good prognosis - minimal lesion change/minimal change disease|Bad prognosis - membranous glomerulonephritis

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61
Q

Name one chromosomal abnormality, and one maternal infection during pregnancy that may lead to congenital heart disease

A

Turners, Down’s|Rubella virus

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62
Q

Why are some cases of heart disease cyanotic?

A

There is a right to left shunt

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63
Q

3 signs you would look for on physical examination in pre-eclampsia

A

Hyper-reflexia|Clonus|Epigastric tenderness|Papilloedema|Peripheral oedema

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64
Q

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

A

Strep pyogenes|EBV|Adenovirus

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65
Q

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.

A

Type 1 hypersensitivity (anaphylaxis) to penicillin

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66
Q

What should be administered to patients with anaphylaxis?

A

Oxygen|Adrenaline|Hydrocortisone

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67
Q

Name some macrolide antibiotics

A

Erythromycin|Clarithromycin|Azithromycin

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68
Q

What 2 drug treatments must be given immediately for hyperkalaemia?

A

Dextrose|Insulin

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69
Q

Name 2 drug therapies which would contraindicate an epidural

A

Anticoagulants|Aspirin

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70
Q

Name 2 obstetric reason why a patient may be denied an epidural

A

Fetal distress|APH

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71
Q

What % of epidurals work satisfactorily?

A

85-92%

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72
Q

List 3 common complications of epidurals

A

Failure to achieve analgesia|Hypotension|Urinary retention|Headache due to dural tap|Delay of second stage

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73
Q

What is the main complication of air reduction of intussusception?

A

Perforation of bowel

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74
Q

Why might intussusception reoccur after air reduction?

A

Anatomical abnormality acting as lead for intussusception|Meckel’s diverticulum|Polyp

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75
Q

What is the MOA of Donepezil?

A

Acetylcholinesterase inhibitor

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76
Q

Medical treatment of endometriosis

A

Analgesia|COCP|Progestogens|GnRH analogues +/- HRT|IUS

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77
Q

Surgical treatment of endometriosis

A

Laparoscopic laser ablation/diathermy, adhesiolysis|Hysterectomy and BSO

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78
Q

What are the causes of postmenopausal bleeding?

A

Endometrial carcinoma|Endometrial hyperplasia|Cervical carcinoma|Atrophic vaginitis|Cervicitis|Ovarian carcinoma|Cervical polyps

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79
Q

PMB Ix

A

Bimanual exam|Speculum exam|Cervical smear|TVUSS|If endometrial thickness >4mm, endometrial biopsy +/- hysteroscopy

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80
Q

What are the early, late and intermediate effects of the menopause?

A

Early - psychological, vasomotor|Intermediate - skin atropy, genital tract atrophy, urinary tract atrophy|Late - CVA, heart disease, bony fractures

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81
Q

Name some RFs for osteoporosis

A

Low BMI, early menopause before 45|Cigarette smoking|Alcohol abuse|Low calcium intake|Sedentary lifestyle|Corticosteroids - >5mg/day pred|RA|CLD|Hyperparathyroidism|Hyperthyroidism

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82
Q

Where is the oocyte commonly fertilized?

A

The ampulla of the fallopian tube

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83
Q

Threatened miscarriage

A

Bleeding but fetus still alive, uterus expected size for dates, cervical os closed

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84
Q

Inevitable miscarriage

A

Heavy bleeding, although fetus may still be alive os is open and miscarriage is about to occur

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85
Q

Incomplete miscarriage

A

Some fetal parts have been passed, os is open

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86
Q

Complete miscarriage

A

All fetal tissue has been passed, bleeding has diminished, uterus no longer enlarged, os closed

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87
Q

Missed miscarriage

A

Fetus has not developed or died in utero, but this is not recognized until bleeding occurs/USS. Uterus small for dates, os closed

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88
Q

Where is the most common site of ectopic pregnancy?

A

Fallopian tube

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89
Q

Ectopic pregnancy RFs

A

Any factor which damages tube; PID, tubal surgery|Prev ectopic|Smoking|Assisted conception

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90
Q

What is the management of the symtomatic suspected ectopic pregnancy?

A

NBM|FBC, cross match blood|Pregnancy test|USS|Laparoscopy, medical management if criteria met|IV access

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91
Q

What is hyperemesis gravidarum?

A

When N and V in early pregnancy are so severe as to cause severe dehydration, weight loss or electrolyte disturbance

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92
Q

What is the management of hyperemesis gravidarum?

A

Exclude predisposing conditions - UTI, multiple or molar pregnancy|IV rehydration|Antiemetics - cyclizine, metoclopramide|Thiamine

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93
Q

What delusions would you see in depressive psychosis?

A

Nihilistic delusions, delusions of guilt, persecutory delusions

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94
Q

What delusions would you see in paranoid schizophrenia?

A

Persecutory delusions

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95
Q

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?

A

Delusional perception - it is a first rank symptom of schizophrenia

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96
Q

What is the treatment and route for acute dystonia?

A

Procyclidine IM

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97
Q

What is the treatment for akathisia?

A

Propanolol PO

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98
Q

Name 2 treatments for heroin addiction

A

Methodone|Buprenorphine

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99
Q

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?

A

Change ramipril to labetalol|Increase insulin dose|Add folic acid

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100
Q

List 3 fetal/neonatal complications with uncontrolled maternal diabetes

A

Neonatal hypoglycaemia, fetal macrosomia, shoulder dystocia, increased risk of congenital cardiac disease, sudden fetal death

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101
Q

What methods can be used to detect ovulation?

A

Mid-luteal phase serum progesterone|USS follicular tracking|LH based urine predictor kits

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102
Q

What two tests would you check for tubal patency? Which is preferred and why?

A

Laparoscopy and dye|Hysterosalpingogram, HyCoSy - these are preferred as they are less invasive and safer than laparoscopy

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103
Q

How can you investigate the cause of anovulation?

A

FSH, LH, testosterone, prolactin, TSH

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104
Q

Sporty teenagers|Pain, tenderness and swelling over tibial tubercle

A

Osgood-Schlatter disease

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105
Q

3 intestinal and 3 extra intestinal signs of IBD

A

Intestinal: weight loss, abdo pain, diarrhoea. Narrowing, fissuring, mucosal irregularities, bowel wall thickening.|Extra intestinal: oral lesions/perianal skin tags|Uveitis|Arthralgia|Erythema nodosum

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106
Q

Side effects of 15 y/o taking prednisolone

A

Muscle weakness, osteoporosis, fractures, Cushing’s syndrome, immunosuppression and freqent infections, acne

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107
Q

Risk factors for pressure sores

A

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

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108
Q

What 3 actions can be done to prevent pressure sores and which member of the MDT would do this?

A

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

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109
Q

Osteoporosis treatment

A

Calcium and vitamin d supplementation|Bisphosphonates - alendronate

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110
Q

3 CXR signs of TB

A

Fibronodular/linear opacities in upper lobe (typically)|Cavitation|Calcification|Miliary disease|Effusion|Lympadenopathy

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111
Q

2 tests for TB

A

Tuberculin skin testing|Interferon gamma release assays|Sputum culture|Sputum smear

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112
Q

4 ABx used to treat TB

A

Rifampicin|Isoniazid|Pyrazinamide|Ethambutol

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113
Q

What are the components of Bishop’s score?

A

Cervical position|Cervical consistency|Cervical effacement|Cervical dilatation|Fetal station

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114
Q

2 ways to induce labour

A

Prostaglandin E2 as vaginal gel/pessary|Amniotomy +/- oxytocin

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115
Q

4 features assessed on CTG

A

Baseline rate|Baseline variability|Accelerations|Decelerations

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116
Q

3 reassuring features on CTG

A

Baseline fetal heart rate 110-160 bpm|Variability in fetal heart rate of >5 bpm|Accelerations with movement and contractions

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117
Q

What is cerebral palsy?

A

Abnormality of movement and posture, causing activity limitation, attributed to non-progressive disturbances that occurred in the developing fetal or infant brain

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118
Q

Give 3 broad causes of cerebral palsy

A

Antenatal, hypoxic-ischaemic injury, postnatal

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119
Q

What are the 3 clinical subtypes of cerebral palsy?

A

Spastic, dyskinetic, ataxic

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120
Q

How does cerebral palsy usually present?

A

Abnormal tone and posture, delayed motor milestones, feeding difficulties

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121
Q

What are some features of autistic spectrum disorders?

A

Impaired social interaction|Speech and language disorder|Imposition of routines with ritualistic and repetitive behaviour|Co-morbidities e.g. learning difficulties, seizures

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122
Q

What is Asperger’s syndrome?

A

Social impairments of an autistic spectrum disorder but at the milder end with near-normal speech

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123
Q

How might a visual impairment present in infancy?

A

Loss of red reflex (cataracy), white reflex, not smiling responsively by 6w, visual inattention, nystagmus, squint

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124
Q

How are squints (misalignments of the visual axis) commonly divided?

A

Concomitant (non-paralytic), paralytic|Inwards turning squint = convergent|Outwards turning squint = divergent

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125
Q

How might you test for squints?

A

Corneal light reflex, cover test

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126
Q

What term describes a potentially permanent loss of visual acuity in an eye that has not received a clear image?

A

Amblyopia - after 7y improvement unlikely

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127
Q

Name 4 early (compensated) clinical signs of shock in a child

A

Tachypnoea, tachycardia, decreased skin turgor, sunken eyes/fontanelle, increased cap refill time, mottled/pale/cold skin, decreased urinary output

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128
Q

How is raised ICP treated?

A

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

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129
Q

Which factors may cause fixed, pinpoint pupils?

A

Opioid or barbituates overdose, pontine lesions

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130
Q

Give 5 categories of child abuse

A

Physical, emotional, sexual, neglect, fabricated or induced illness

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131
Q

Give 5 typical facial characteristics of children with Down’s syndrome

A

Epicanthic folds, brushfield spots in iris, flattened nasal bridge, round face, upslanted palpebral fissures, small ears

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132
Q

Name 4 medical problems that may occur later in life in people with Down’s

A

Learning difficulties, OME, visual impairment, increased risk of leukaemia, hypothyroidism, Alzheimer’s

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133
Q

Give 3 genetic mechanisms by which you may get an extra 21st chromosome

A

Non-disjunction, mosaicism, translocation

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134
Q

Give 6 features of Turner syndrome

A

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

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135
Q

How would you treat the effects of Turner syndrome?

A

Growth hormone therapy and oestrogen replacement for development of secondary sexual characteristics at time of puberty

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136
Q

Which syndrome is associated with a deletion of band q11 on chromosome 22?

A

DiGeorge syndrome

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137
Q

Give 3 examples of X-linked recessive syndromes

A

Duchenne and Becker muscular dystrophies, Fragile X, G6PD deficiency, haemophilia A and B

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138
Q

What is “imprinting”?

A

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

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139
Q

What are some clinical features of boys with Fragile X syndrome?

A

Learning difficulty, macrocephaly, macro-orchidism

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140
Q

Name 3 causes of hypoxic-ischaemic encephalopathy

A

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)

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141
Q

Give 3 examples of soft tissue birth injuries

A

Caput succedaneum, cephalhaematoma, chignon, bruising to the face, forcep marks

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142
Q

What is the underlying mechanism of respiratory distress syndrome and how might this be managed if a preterm delivery is anticipated?

A

Surfactant deficiency leading to widespread alveolar collapse and impaired gas exchange. Dexamethosone given antenatally to mother stimulate fetal surfactant production

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143
Q

What signs might you find on examination of a infant with RDS?

A

Tachypnoea (>60/min), laboured breathing with chest wall recession (espsternal and subcostalindrawing) and nasal flaring, expiratory grunting, cyanosis

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144
Q

What CXR appearance is characteristic of RDS?

A

Diffuse granular or “ground glass”. Heart border becomes indistinct in severe disease. Pneumothoraces may be present

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145
Q

What would you give an infant with RDS?

A

Surfactant therapy via tracheal tube, raised ambient O2

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146
Q

Where do brain haemorrhages in preterm infants typically occur?

A

Germinal matrix above caudate nucleus

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147
Q

What complication might be caused by a large intraventicular haemorrhage?

A

Hydrocephalus (ventriculoperitoneal shunt may be required)

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148
Q

What are the XR features of NEC?

A

Distended loops of bowel and thickening of the bowel wall with intramural gas

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149
Q

What is bronchopulmonary dyplasia?

A

Infants who still have an O2 requirement at 36 weeks. CXR shows wide areas of opacification, sometimes with cystic changes

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150
Q

What is the term given to encephalopathy resulting from the deposition of unconjugatedbilirubin in the basal ganglia and brainstem nuclei?

A

Kernicterus

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151
Q

Give 2 treatments available for treating jaundice

A

Phototherapy, exchange transfusion

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152
Q

Give 3 risk factors for neonatal infection in mothers colonised by group B streptococcus

A

Preterm baby, PROM, maternal fever during labour, maternal choramnionitis or prev infected infant

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153
Q

How might gonococcal conjunctivitis present?

A

Conjunctival injection and swelling of eyelids within first 48h

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154
Q

How might chlamydia conjunctivitis present?

A

Purulent discharge and swelling of eyelids at 1-2w

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155
Q

Name 3 factors that increase the risk of neonatal hypoglycaemia

A

IUGR, preterm, maternal DM, large for dates, hypothermic, polycythaemia

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156
Q

Name 3 symptoms of neonatal hypoglycaemia

A

Jitteriness, irritability, apnoea, lethargy, drowsiness, seizures

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157
Q

Give 3 broad causes of delayed puberty

A

Constitutional|Hypogonadotrophic gonadism - e.g. systemic disease (CF, Crohn’s), hypothalamo-pituitary disorders (Kallmann, intracranial tumours)|Hypergonadotrophic hypogonadism e.g. 45 XO

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158
Q

Which enzyme deficiency causes over 90% of cases of congenital adrenal hyperplasia? How does this result in the overproduction of adrenal androgens?

A

21-hydroxylase - needed for cortiosol biosynthesis. Cortisol deficiency stimulates the pituitary to produce ACTH which drives the overproduction of adrenal androgens

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159
Q

How is the diagnosis of CAH made?

A

Raised serum 17-alpha hydroxyprogesterone

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160
Q

How might CAH present?

A

Virilization in females, salt losing adrenal crisis in 80% of males, tall stature in 20% of male non-salt losers

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161
Q

How is CAH managed?

A

Lifelong glucocorticoids (suppress ACTH), mineralocorticoids also if salt loser

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162
Q

What may be given prenatally to reduce ACTH drive and therefore virilisation in a female infant?

A

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

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163
Q

Name 5 non-modifiable risk factors for cardiovascular disease

A

Age|Ethnicity|Sex|Socio-economic status|Personal history of CVD|FH of CVD

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164
Q

Name 5 modifiable risk factors for cardiovascular disease

A

Smoking|Hyperlipidaemia|Hypertension|Diet|High BMI|DM|Physical inactivity|Alcohol intake|Coronary-prone behaviour

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165
Q

How can you score risk of cardiovascular disease?

A

QRISK2

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166
Q

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?

A

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

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167
Q

An African lady has just been diagnosed with hypertension. What is the first line treatment?

A

CCB e.g. amlodipine, diltiazem. Or thiazide like diuretic if not tolerated

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168
Q

A 50 y/o white man has just been diagnosed with hypertension. What is the first line treatment?

A

ACE inhibitor e.g. ramipril. Or CCB e.g. amlodipine if not tolerated

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169
Q

Which cholesterol is “good”, which “bad”?

A

LDL = bad|HDL = good

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170
Q

How could someone modify their lifestyle to manage hyperlipidaemia?

A

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

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171
Q

What are some side effects of statins?

A

Fatigue|Headache|Nausea|Indigestion|Myopathy (myalgia, myositis, rhabdomyolysis), measure CK

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172
Q

What factors can precipitate an episode of angina?

A

Emotion|Cold weather |Heavy meal

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173
Q

What are the different types of angina?

A

Stable (at rest)|Unstable (at rest or on minimal exertion)|Variant/Prinzmetal (coronary artery spasm during rest)

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174
Q

What are the symptoms of angina?

A

Central chest tightness|Exacerbated by exercise, relieved by rest|Radiates to arm/neck/jaw/teeth

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175
Q

What investigations would you perform in someone with symptoms of angina?

A

ECG (may show ST depression from old infarct)|Exercise ECG|Stress Echo, coronary angiography, cardiac CT

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176
Q

How would you manage angina in GP?

A

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

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177
Q

What are some risk factors for heart failure?

A

IHD, smoking, HTN, valvular disease, obesity, cardiomyopathy

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178
Q

Name 4 symptoms of left sided cardiac failure

A

SOB|PND/orthopnoea|Nocturnal cough (pink frothy sputum)|Poor exercise tolerance|Cold peripheries|Weight loss

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179
Q

Name 4 symptoms of right sided heart failure

A

Peripheral oedema/ascites|Hepatomegaly|Raised JVP|Nausea|Anorexia|Facial engorgement

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180
Q

What are the Framingham criteria for?

A

Diagnosing congestive heart failure

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181
Q

How would you diagnose heart failure using the Framingham criteria?

A

Need 2x major or 1x major and 2x minor

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182
Q

How do you classify the severity of heart failure?

A

Using the New York Heart Association criteria

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183
Q

What investigations would you do in suspected heart failure?

A

Bloods - FBC, U+E, BNP|CXR|ECG (Ischaemia/MI/ventricular hypertrophy)|Echo

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184
Q

What are the signs of congestive heart failure on CXR?

A

ABCDE|Alveolar oedema|Kerley B lines|Cardiomegaly|Dilated upper lobe vessels|Plural effusion

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185
Q

What drugs improve mortality in heart failure?

A

ACEi|Spironolactone|Beta blockers|Hydralazine and nitrates

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186
Q

What supportive therapies can you give to people with heart failure?

A

Flu jab annually|One-off pneumococcal vaccine|RF management|Cardiac rehab

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187
Q

What are the ECG signs of AF?

A

Absent P waves, irregularly irregular rhythm

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188
Q

Name 4 causes of AF

A

Heart failure/ischaemia|Hypertension|MI|PE|Hyperthyroidism|Caffeine|Alcohol|Electrolyte abnormality

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189
Q

What are the symptoms of AF?

A

May be asymptomatic|Chest pain|Palpitations|Dyspnoea, faintness

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190
Q

How would you investigate AF?

A

ECG|U+E|Cardiac enzymes|TFTs|Echo

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191
Q

What are the main goals of AF treatment?

A

Anticoagulation and rate control

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192
Q

What drugs are used to treat AF?

A

Rate control - propanolol/diltiazem. If fails add digoxin then consider amiodarone|Anticoagulation - acute=heparin, chronic=warfarin

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193
Q

CHA2DS2Vasc

A

Calculates stroke risk for patients with AF. 1=consider, 2=anticoagualte

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194
Q

HAS-BLED

A

Calculates risk of major bleeding in patients on anticoagulation for AF

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195
Q

What are the signs of asthma in an adult?

A

Wheeze (expiratory, polyphonic)|Sputum|Hyperinflated chest with hyperresonant percussion

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196
Q

What is the RCP 3 questions screening tool for asthma control?

A

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

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197
Q

How would you treat asthma in an adult?

A

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

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198
Q

What is COPD and how is it diagnosed?

A

Progressive disorder characterised by airway obstruction with little or no reversibility|FEV1<80% predicted, FEV1/FVC ratio <0.7

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199
Q

What are the 2 types of COPD?

A

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

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200
Q

COPD drug treatment

A

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

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201
Q

How would you diagnose diabetes in an adult?

A

Abnormal random/OGTT BG>11.1mmol|Abnormal fasting>7mmol|Abnormal HbA1c >48mmol/mol

202
Q

What are the presenting complaints you may get with diabetes?

A

Polyuria, polydipsia, weight loss, lethargy, recurrent/prolonged infections, pruritus vulvae, acute complications (DKA/hypo)

203
Q

How would you treat T2DM?

A

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
Q

Name 4 complications of uncontrolled DM

A

CV ischamia (ACS, CVA, PVD)|Nephropathy|Retinopathy|Neuropathy|Diabetic foot

205
Q

Name 3 causes of hyperthyroidism

A

Grave’s disease|De Quervain’s thyroiditis|Phaeochromocytoma|Drugs (amiodarone, lithium, thyroxine)|Toxic nodular goitre

206
Q

Name 5 symptoms of hyperthyroidism

A

Weight loss and increased appetite|Diarrhoea|Sweating, tremor|Irritability|Heat intolerance|Emotional lability|Oligo/amenorrhoea|Proximal myopathy

207
Q

Name 5 signs of hyperthyroidism

A

Palmar erythema|Sweaty/warm hands|Fine tremor|Tachycardia|Hair thinning|Lid lag|Hyperreflexia|Goitre|Thyroid eye disease

208
Q

What investigations would you do and what would you find in hyperthyroidism?

A

TFTs (low TSH, high free T3 and T4)|Antibodies (Anti-TPO antibodies, antithyroglobulin)|CRP/ESR|Thyroid USS

209
Q

How would you manage hyperthyroidism?

A

Carbimazole (propylthiouracil if pregnant)|Beta blocker/CCB for tachycardia|Eye drops for eye disease|Radio-iodine or thyroidectomy

210
Q

Give 2 signs and 2 symptoms of thyroid eye disease

A

Ocular irritation|Red eyes|Diplopia|Proptosis|Lid lag|Conjunctival injection|Chemosis

211
Q

Name 4 causes of hypothyroidism

A

Iodine deficiency|Autoimmune (Hashimoto’s)|Drugs (amiodarone, lithium, carbimazole)|Iatrogenic (radio-iodine, surgery)|Postpartum thyroiditis

212
Q

Name 4 symptoms of hypothyroidism (adults)

A

Lethargy|Weight gain and increased appetite|Intolerance to cold|Dry skin, hair loss|Slowing of intellectual ability|Constipation|Menorrhagia

213
Q

Name 4 signs of hypothyroidism (adults)

A

Dry coarse skin|Cold peripheries|Myxoedema|Reflexes relax slowly|Bradycardia

214
Q

What investigations would you do for an adult with symptoms of hypothyroidism?

A

TFTs (high TSH, low T3/T4)|Antibodies (anti-TPO antibodies, anti-thyroglobulin)|Raised CK, cholesterol|USS thyroid

215
Q

How would you treat hypothyroidism?

A

Levothyroxine (T4)

216
Q

What are some RFs for CKD?

A

Increasing age|CVD|DM|Obesity|Smoking|AKI|Proteinuria

217
Q

How would you diagnose CKD?

A

Kidney damage (albuminaemia) or GFR<60ml/min)

218
Q

Name 4 causes of CKD

A

HTN|Glomerulonephritis|DM|Vasculitis (SLE)|Myeloma|Malignancy

219
Q

How might CKD present?

A

Many asymptomatic|Severe CKD presents with anorexia, nausea and vomiting, peripheral neuropathy, pruritus, peripheral oedema, SOB|Very severe - pericarditis, seizures, coma

220
Q

What type of anaemia might you get with CKD?

A

Normochromic normocytic anaemia

221
Q

What U+Es might you expect with CKD?

A

Hyperkalaemia|Low bicarb|High phosphate|Hyperparathyroid hormone|High alk phos

222
Q

How would you manage CKD?

A

Avoid nephrotoxic drugs|Exercise, stop smoking, weight loss|GFR monitoring|CVD prevention, BP control|Manage anaemia|RRT when severe

223
Q

Name 3 complications of CKD

A

Anaemia|Coagulopathy|HTN|Peripheral neuropathy|Fluid overload|Malnutrition

224
Q

Describe the risk factors for TB

A

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
Q

What health issues may be important in a migrant population?

A

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
Q

What measurement made on CXR would tell you that a heart is enlarged?

A

Cardiothoracic ratio of over 0.5

227
Q

On CXR you can see a double cardiac shadow on the R side of the heart. What is this?

A

Enlarged L atrium

228
Q

State the ECG features that would raise your suspicion of LVH

A

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
Q

State two long-term complications of untreated aortic stenosis

A

Sudden death|AF or VT|Left heart failure|ANgina|R heart failure|Cerebral embolus

230
Q

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?

A

Blockade of the re-uptake of serotonin (5-HT)|Downregulate the number of 5-HT receptors|Pre-frontal cortex

231
Q

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?

A

Continue for at least 6m|Relapse is high before this time

232
Q

What receptors do TCAs effect and what do TCAs do to them?

A

Blocks muscarinic receptors

233
Q

What findings on clinical examination would make you suspect overdose of TCA?

A

Tachycardia|Dilated pupils|Enlarged bladder

234
Q

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?

A

15%|Autosomal dominant

235
Q

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?

A

Reinforcement

236
Q

What is the most common malignant neoplasm to affect the breast?

A

Adenocarcinoma

237
Q

State the names of 2 genes responsible for familial causes of breast cancer

A

BRCA1, BRCA2

238
Q

State 5 common tumours that typically metastasise to bone

A

Breast|Bronchus|Thyroid|Prostate|Kidney

239
Q

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

A

Typhoid|Glandular fever|Toxoplasmosis|CMV|Hepatitis|Schistosomiasis|Malaria

240
Q

Name one example of an antibiotic which is a DNA gyrase inhibitor

A

Ciprofloxacin

241
Q

A patient is found to have high concentrations of serum transaminases. State the cell origin of these enzymes

A

Hepatocyte

242
Q

What blood test diagnoses glandular fever?

A

EBV IgM (Monospot)

243
Q

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%.

A

TGA

244
Q

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?

A

Russell Silver syndrome

245
Q

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?

A

Viral induced wheeze

246
Q

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?

A

Gluten free diet

247
Q

Baby comes in with prolonged jaundice, what is the first most important investigation to do?

A

Unconjugated and conjugated bilirubin

248
Q

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?

A

Perthes disease

249
Q

Boy recently treated for severe strep throat, and now has developed nodules on his shin which are tender. What are these called?

A

Erythema nodosum

250
Q

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?

A

Spironolactone

251
Q

Woman develops pruritus vulva, PMHx includes PCOS, DHx currently on metformin and clomifene. What additional test do you do?

A

OGTT

252
Q

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?

A

Carotid artery dissection

253
Q

Pregnant lady with bilateral wrist pain and tingling, worst at night. What is this?

A

Carpal tunnel syndrome

254
Q

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?

A

C7

255
Q

Guy goes into dementia clinic and has a few tests done: verbal fluency, Luria’s motor tests… what are they testing him for?

A

FTD

256
Q

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?

A

GAD and agorophobia

257
Q

Lady arrives at A&E having taken an overdose of tricyclics. What is one important investigation you must do?

A

ECG

258
Q

Elderly lady found confused and wandering around the estates, police finds her. What can they use to bring her to be assessed?

A

Section 136

259
Q

What is the treatment for acute alcohol withdrawal?

A

Chlordiazepoxide

260
Q

What is the treatment for overdose of diazepam?

A

Flumenazil

261
Q

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?

A

Section 135

262
Q

Where does GnRH pulses originate?

A

Hypothalamus

263
Q

Where are FSH and LH released from?

A

Anterior pituitary

264
Q

Oestrogen produced by the follicle has a negative feedback effect on FSH production. Why is this?

A

So only one egg matures

265
Q

Which hormone stimulates the LH surge which causes ovulation?

A

Oestrogen

266
Q

What produces progesterone?

A

Corpus luteum

267
Q

What does progesterone do?

A

Maintains lining of uterus

268
Q

What are the benefits of HRT?

A

Symptom management|Osteoporosis prevention|Colorectal cancer prevention

269
Q

What are the risks of HRT?

A

Breast cancer if combined|Endometrial cancer if oestrogen only|Gallbladder disease

270
Q

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?

A

Start folic acid, female stop drinking, man stop smoking, lose weight

271
Q

What 3 things are you looking for in a sperm sample?

A

Count|Morphology|Motility

272
Q

What things may reduce a man’s sperm quality?

A

Smoking, obesity, Klinefelter’s, varicocoele, prolactin, hypothalamic hypogonadism

273
Q

What are ovulatory factors for infertility?

A

PCOS, hypothalamic hypogonadism, hyperprolactin, premature ovarian failure, adrenal tumour, thyroid

274
Q

What are the tubal factors that could cause infertility?

A

PID, surgical adhesions, endometriosis

275
Q

How could you investigate tubal patency?

A

Laparoscopy and methylene blue dye, Hysterosalpingogram (less risky)

276
Q

How many cycles of IVF can a 30 y/o infertile couple have on the NHS? What risks are associated?

A

3 as aged under 40. Multiple pregnancy, ectopic, infection from egg collection, ovarian hyperstimulation syndrome, miscarriage

277
Q

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?

A

B-hCG|Miscarriage|Molar pregnancy|Ectopic

278
Q

What are the risk factors for miscarriage?

A

Age, previous, obesity, smoking, BV, uterine anatomy, medical condition (e.g. antiphospholipid)

279
Q

What would you class as recurrent miscarriages?

A

3 or more in succession

280
Q

What is the management of molar pregnancy?

A

Suction curettage, monitor HCG

281
Q

What is the difference between complete and incomplete molar pregnancy?

A

Complete = sperm plus empty egg|Incomplete = 2 sperm plus 1 egg

282
Q

What is the most common location for an ectopic pregancy?

A

Ampulla of fallopian tube

283
Q

What are the risk factors for an ectopic pregnancy?

A

PID, IUD, pelvic surgery, smoking, previous ectopic

284
Q

Why might someone get shoulder tip pain with an ectopic pregnancy?

A

This means it has ruptured and the blood is causing diaphragmatic irritation

285
Q

What is the characteristic signs on pelvic examination of an ectopic?

A

Cervical excitation

286
Q

What happens to the hCG level in ectopic?

A

Doesn’t increase by 2/3 in 24h

287
Q

What is your initial management of someone with a ruptured ectopic?

A

ABCDE|NBM|FBC and crossmatch|Anti-D if Rh-ve

288
Q

What is the surgical treatment of an ectopic?

A

Laparoscopy and salpingectomy, or salpingotomy

289
Q

What can you use for medical management of an ectopic and when is this appropriate?

A

Methotrexate injection if HCG<3000, stable, no foetal cardiac activity, unruptured

290
Q

What are the RFs for fibroids?

A

Perimenopausal women, FHx, Afro-Caribbean

291
Q

What are the protective factors for fibroids?

A

COCP, injectable progesterones, parity

292
Q

What is the classic appearance of a fibroid if cut transversely?

A

Whorled

293
Q

What are the complications of fibroids?

A

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
Q

What is the most common type of ovarian tumour?

A

Epithelial

295
Q

Where might ovarian secondary tumours originate from?

A

Breast, bowel|10% of ovarian malignancy

296
Q

What are “chocolate cysts”?

A

Endometriomas

297
Q

What is a cervical ectropion?

A

Columnar epithelium of endocervix visible as erythema around external os

298
Q

What are the RFs for cervical ectropion?

A

Increased oestrogens e.g. ovulation, pregnancy, COCP

299
Q

How might cervical ectropion present?

A

Asymptomatic|PV discharge|PCB

300
Q

How would you manage a suspected cervical ectropion?

A

Exclude carcinoma by doing a colposcopy|Ablate if symptomatic

301
Q

Who is screened for cervical cancer and how often?

A

25-64 y/o women|25-49 = every 3y|50-65 = every 5y|Best time is mid cycle|80% uptake

302
Q

What is the most common type of cervical cancer?

A

Squamous cell carcinoma

303
Q

What is the most common type of endometrial cancer?

A

Adenocarcinoma

304
Q

What are some risk factors for endometrial cancer?

A

PCOS, obesity, nulliparity, early menarche, late menopause|Unopposed HRT, tamoxifen

305
Q

What are some risk factors for ovarian cancer?

A

Nulliparity, early menarche, late menopause|Ovarian cyst may undergo malignant change|BRCA, HNPCC

306
Q

Ovarian cancer Ix

A

Serum CA125|USS (solid areas, ascites, multilocular cysts, bilateral changes, mets), CT|Symptoms and age

307
Q

Vulval cancer RFs

A

VIN, oncogenic HPV|Lichen sclerosis, immunosuppression, smoking

308
Q

Vulval cancer presentation

A

Vulval pain/pruritus, lump, bleeding, discharge, dysuria, dyspareunia

309
Q

Urethrocoele

A

Prolapse of lower vaginal anterior wall, involving urethra only

310
Q

Cystocoele

A

Prolapse of upper vaginal anterior wall, involving bladder +/- urethra

311
Q

Apical prolapse

A

Prolapse of uterus (or vault if hysterectomy), cervix and upper vagina

312
Q

Rectocoele

A

Prolapse of lower vaginal posterior wall, involving anterior wall of rectum

313
Q

Enterocoele

A

Prolapse of upper vaginal posterior wall, involving bowel loops into pouch of douglas

314
Q

Genital prolapse risk factors

A

Multiparity|Pelvic surgery|Pelvic mass|Menopause|Vaginal delivery|Obesity

315
Q

How would you examine someone with a genital prolapse?

A

Bimanual and sims speculum

316
Q

Genital prolapse management

A

Lose weight, pelvic floor exercises|Cone, ring, shelf pessary|Surgery: hysteroplexy/hysterectomy, sacrospinous fixation

317
Q

PID management

A

Multiple ABx to cover all potential causative organisms e.g. ceftriaxone, azithromycin, doxycycline, metronidazole

318
Q

What is the most important risk factor for stroke?

A

Hypertension

319
Q

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?

A

Absent sensation to temperature in L hand (Brown-Sequard syndrome)

320
Q

What is the treatment for an acute relapse of MS?

A

Course of oral steroids e.g. prednisolone

321
Q

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?

A

Left cortical infarct

322
Q

PD histological findings

A

Lew bodies - eosinophilic cytoplasmic inclusion consisting of alpha-synuclein

323
Q

PD pathophysiology

A

Degeneration of dopaminergic neurones in the substantia nigra

324
Q

PD treatment

A

Dopamine receptor agonists: ropinirole, cabergoline|Levodopa and dopa-decarboxylase inhibitors|MAO-B inhibitors|COMT inhibitors

325
Q

PSP

A

Progressive supranuclear palsy (eyes)|Postural instability, vertical gaze palsy, trunk rigidity, symmetrical, speech and swallow problems

326
Q

MSA

A

Multiple system atrophy|Autonomic: impotence/incontinence, postural hypotension, cerebellar signs

327
Q

HD pathology

A

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
Q

LMN signs

A

Limb weakness|Muscle wasting|Fasciculations

329
Q

UMN signs

A

Hypertonia|Brisk reflexes|Upgoing plantars|Spasticity

330
Q

MND Ix

A

NCS - exclude peripheral neuropathy/myopathy|EMG - reduced number of action potentials with increased amplitude|MRI - exclude cervical cord compression, MS, myelopathy

331
Q

MND conservative management

A

Feeding and resp support - overnight NIV|MDT approach - OT, SALT, physio, dieticians, MND specialist nurses

332
Q

MND pharmacological management

A

Riluzole|Hyoscine|Baclofen|Antidepressants

333
Q

GBS treatment

A

IV Ig

334
Q

MG pathophysiology

A

Autoimmune - ABs to post-synaptic nicotinic acetylcholine receptors|Interferes with muscular transmission|Fatigability due to fewer available AChRs at NMJ

335
Q

MG typical patient

A

Woman, 30-50, other AI diseases

336
Q

MG presentation

A

Increasing muscular fatigue extra-ocular (ptosis, diplopia), bulbar (swallowing, chewing, dysphonia), face, neck, limbs (proximal), girdle, trunk.

337
Q

MG Ix

A

Antibodies - Anti-AChR, MuSK|CT Thorax - thymus|Ice test|Tensilon (edrophonium) Test

338
Q

MG Rx

A

Acetylcholinesterase inhibitors (pyridostigmine). Immunosuppressants for relapses - pred|Thymectomy

339
Q

Myasthenic crisis

A

Weakness of respiratory muscles, may need intubation and ventilation, treat with plasmaphereis/IV Ig, treat trigger - infection, medications, post-op

340
Q

Erectile dysfunction

A

Difficulty in developing or maintaining an erection suitable for satisfactory intercourse

341
Q

ED causes

A

DM|Vascular disease|Radical surgery e.g. TURP|Spinal cord injury|MS|Endocrine disorders

342
Q

ED RFs

A

Sedentary lifestyle|Obesity and diet|Smoking and alcohol|DM|Hypertension|Hyperlipidaemia|Depression|Drugs

343
Q

Factors suggestive of organic contribution to ED

A

Loss of erections in all situations|Gradual onset|Ejaculatory problems|Decrease in flaccid penile size|Other organic RFs - alcohol, tobacco, DM etc

344
Q

Factors suggestive of psychogenic contribution to ED

A

Morning erections|Nocturnal erections|Situational erections|Fully rigid erections several times a week|Abrupt onset (weeks)

345
Q

What may cause psychogenic ED?

A

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
Q

ED treatment options

A

Sildenafil|Injectable or intraurethral alprostadil|Vacuum device|Penile/scrotal rings|New stimulating routines e.g. enhancing lubricants, vibrators|Kegel exercises

347
Q

What is FSAD?

A

Female sexual arousal disorder|Failure of genital response - the principal problem is vaginal dryness or failure of lubrication

348
Q

FSAD causes

A

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
Q

FSAD treatment

A

New sexual routines -| lubricants, vibrators, Eros device|Couples psychosexual therapy|Sensate focus

350
Q

Sensate focus

A

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
Q

What bloods would you do for someone presenting with sexual dysfunction?

A

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
Q

Female orgasmic disorder

A

Orgasm does not occur or is markedly delayed

353
Q

Female orgasmic disorder cause

A

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
Q

Female orgasmic disorder treatment

A

Individual psychotherapy|Sex therapy focus|Behavioural - education, personal sexual growth programme, guided masturbation, lubricants and vibrators, Kegel exercises

355
Q

How might the menopause affect sexual function?

A

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
Q

Rapid ejaculation

A

The inability to control ejaculation sufficiently for both partners to enjoy sexual interaction

357
Q

Rapid ejaculation causes

A

Genetic susceptibility|Penile hypersensitivity|Hyperthyroidism|Prostatitis|ED|Anxiety states|Early learned experiences|Lack of experience/infrequent sexual activity|Psychosocial, relationship factors

358
Q

Rapid ejaculation treatment options

A

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
Q

Vaginismus

A

Genito-pelvic pain/penetration disorder|Spasm of the pelvic floor muscles that surround the vagina, causing occlusion of the vaginal opening

360
Q

Vaginismus causes

A

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
Q

Vaginismus treatment

A

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
Q

Dyspareunia

A

Pain during intercourse, can be due to local pathology or psychological

363
Q

Dyspareunia physiological causes

A

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
Q

Dyspareunia psychological causes

A

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
Q

Dyspareunia treatment options

A

Steroid creams and moisturising|Testosterone replacement|Couple therapy - is there depression, change negative communication|Personal sexual growth |Sensate focus

366
Q

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?

A

Macrocytosis|B12 deficiency

367
Q

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

A

Mallory Weiss tear|Bleeding varices|Gastritis|Peptic ulcer disease

368
Q

State 2 abnormalities you may find on examination of the abdomen of an alcoholic’s abdomen

A

Abdo distention|Ascites|Hepatomegaly|Splenomegaly|Caput medusa

369
Q

State two neurological sites that can account for tremor, blood pressure findings and incontinence.

A

Basal ganglia|Corpus striatum|Nigrostriatal tract|Sympathetic autonomic nervous system

370
Q

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?

A

Guttate psoriasis

371
Q

A boy aged 3 presents with an itchy eruption affecting the antecubital and popliteal fossae present for 6 months. What diagnosis is most likely?

A

Atopic eczema

372
Q

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?

A

Strep pyogenes

373
Q

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?

A

Influenza A

374
Q

A four year old boy has abdominal distension and a large mass in the left flank with hypertension and haematuria. Cause?

A

Nephroblastoma

375
Q

A 6 month old infant has been passing pale stools since birth and is now deeply jaundiced with ascites and is vomiting blood. Cause?

A

Portal hypertension

376
Q

A 13 year old girl presents with lower abdominal discomfort and a plain abdominal X-ray reveals teeth.

A

Dermoid cyst of ovary

377
Q

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.

A

High flow oxygen

378
Q

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.

A

SABA via nebuliser

379
Q

A 10 year old with a history of severe head injury 24 hours previously has nausea and vomiting. What electrolyte abnormality may they have?

A

Low plasma sodium

380
Q

A baby boy with recurrent projectile vomiting. What electrolyte abnormality may he have?

A

Lowered plasma chloride and raised plasma bicarbonate

381
Q

Severe abdominal pain in a child with mumps. What electrolyte abnormality may they have?

A

Raised plasma amylase

382
Q

One week after surgery, a baby undergoing prosthetic correction of a Fallot’s tetralogy develops a Gram-positive endocarditis. Organism?

A

Staph epidermis

383
Q

Three days after her first sexual intercourse, an 18 year old woman notices painful and frequent micturition. Organism?

A

E coli

384
Q

A 7 year old who attends school in Sheffield develops fever and sore throat that is severe enough to warrant admission to hospital. Organism?

A

Strep pyogenes

385
Q

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?

A

Breast abscess

386
Q

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?

A

Fibrocystic change

387
Q

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?

A

Fat necrosis

388
Q

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?

A

Influenza

389
Q

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?

A

Postictal confusion

390
Q

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.

A

Meningoencephalitis

391
Q

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?

A

Constipation

392
Q

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?

A

Sub-dural haemorrhage

393
Q

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?

A

X linked recessive

394
Q

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?

A

Autosomal recessive

395
Q

A 20 year old develops conjunctivitis and painful joints 3 weeks after he|attended the genitourinary clinic for dysuria.

A

HLA-associated

396
Q

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?

A

Left temporal lobe

397
Q

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?

A

Right temporal lobe

398
Q

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?

A

Maternity blues

399
Q

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?

A

Left MCA infarct

400
Q

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?

A

Subdural haematoma

401
Q

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?

A

Intracerebral haemorrhage

402
Q

What would you find on investigation in BV?

A

Vaginal pH>4.5, clue cells, positive whiff test

403
Q

Gonorrhoea Rx

A

IM ceftriaxone plus oral azithromycin to cover for chlamydia

404
Q

A 45 y/o lady comes to see you with symptoms of HSDD. Name 4 investigations you would do (endocrine/metabolic)

A

Testosterone, oestrogen, TSH, prolactin

405
Q

Name 2 non metabolic causes of HSDD

A

DM, CVD|Psychological - prev abuse|Iatrogenic - SSRI, OCP

406
Q

Name 2 treatment options for HSDD

A

Psychosexual treatment - CBT, psychodynamic, cognitive, integrative, behavioural|Flibanserin

407
Q

Extrinsic compression of SC symptoms

A

Sensory loss in saddle distribution

408
Q

Intrinsic compression of SC symptoms

A

Sacral sparing sensory loss

409
Q

Syringomyelia

A

Where a fluid-filled cavity develops in the CSF producing characteristic sensory and motor effects. Assoc w/ Arnold-Chiari malformations

410
Q

Syringomyelia signs

A

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
Q

Brown-Sequard syndrome

A

Cord hemisection produces characteristic signs|Ipsilateral UMN weakness, position and vibration sense loss|Contralateral spinothalamic sensory loss

412
Q

What is the commonest site for intussusception? What is the most serious complication?

A

Ileum passing into the caecum throught ileocaecal valve|Bowel perf, peritonitis, gut necrosis

413
Q

What is Meckel’s diverticulum a remnant of and how might it present?

A

Vitello-intestinal duct|Generally asymptomatic, bleeding, intussusception, volvulus or diverticulitis

414
Q

How would you investigate and treat a suspected malrotation?

A

Upper GI contrast study|Surgical correction

415
Q

What is the most common cause of gastroenteritis in children in the UK?

A

Rotavirus

416
Q

What should you be cautious of when treating a child with hypernatraemic dehydration?

A

Not reducing plasma sodium too rapidly - shift of water into cerebral cells may result in cerebral oedema and seizures

417
Q

What is the commonest cause of persistent loose stools in preschool children?

A

Toddler’s diarrhoea - stools of varying consistency, sometimes with undigested vegetables

418
Q

What is the classical presentation of Crohn’s in children?

A

25% have abdo pain, diarrhoea, weight loss

419
Q

How is Crohn’s diagnosed?

A

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
Q

How is remission induced in Crohn’s?

A

Nutritional therapy - whole protein modular feeds for 6-8w|Systemic steroids if ineffective

421
Q

How is remission maintained in Crohn’s?

A

Azathioprine, MTX, anti TNF alpha agents

422
Q

How does UC classically present in a child?

A

Rectal bleed, diarrhoea, colicky pain|Erythema nodosum and arthritis

423
Q

What would be seen in UC on endoscopy (upper and ileocolonoscopy) and biopsy?

A

Confluent colitis extending from rectum|Mucosal inflammation, crypt damage, ulceration

424
Q

What therapies might you use to induce remission in UC?

A

Aminosalicylates e.g. mesalazine, topical steroids for rectal disease, systemic steroids for aggressive disease

425
Q

What medical emergency might result from UC and how would you treat it?

A

Severe fulminating disease|IV fluids and steroids (ciclosporin if this fails to induce remission)

426
Q

What kind of laxative is used first line to treat constipation?

A

Macrogol laxative (e.g. polyethene glycol + electrolytes a.k.a. Movicol) (+stool softener

427
Q

What is the pathophysiology of Hirschprung disease?

A

Absence of myenteric and submucosalplexus ganglion cells narrow contracted segment and dilated colon where normal innervation starts |Most commonly rectosigmoid

428
Q

How might Hirschprung’s present?

A

Failure to pass meconium|Abdo distension|Bile stained vomit

429
Q

How is Hirschprung’s diagnosed? What might the test show?

A

Suction rectal biopsy|Absence of ganglion cells|Presence of large, acetylcholinesterase-positive nerve trunks

430
Q

How is Hirschprung’s managed?

A

Initial colostomy followed by anastamosing normally innervated bowel to anus

431
Q

Give 4 red flag features of a febrile child

A

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
Q

Give 2 causes of non-infectious meningitis

A

Malignancy, autoimmune disease

433
Q

What are some symptoms of meningitis/encephalitis in children?

A

Lethargy, drowsiness, seizures, poor feeding/vomiting, irritability, hypotonia, fever, photophobia, headache

434
Q

What is Cushing’s triad?

A

Bradycardia, hypertension, abnormal pattern of breathing

435
Q

Give 5 things you might find on examination of a child with meningitis

A

Fever, purpuric rash, neck stiffness, bulging fontanelle, Kernig signs, altered consciousnees, papilloedema

436
Q

Give 3 complications of meningitis

A

Hearing loss, local vasculitis, local cerebral infarction (may lead to epilepsy), subdural effusion, hydrocephalus, cerebral abscess

437
Q

Give 3 contraindications of lumbar puncture

A

Cardioresp instability|Focal neuro signs|Signs of raised ICP|Coagulopathy|Thrombocytopenia|Local infection at site of LP

438
Q

What are the most common causative organisms for encephalitis?

A

Enteroviruses|Resp viruses|Herpes viruses e.g. HSV, varicella, HHV6

439
Q

Where in the brain are focal changes especially seen with HSV encephalitis?

A

Temporal lobes

440
Q

What group of children are particularly susceptible to pneumococcal infection?

A

Children with hyposplenism e.g. sickle cell, nephrotic syndrome - give prophylactic penicillin V

441
Q

Give 3 serious complications that can|occur from chicken pox infection (primary|VZV infection)

A

Secondary bacterial infection|Encephalitis|Purpural fulminans|Disseminated disease in immunocompromised

442
Q

How would yo treat adolescents and adults with chickenpox?

A

Valaciclovir

443
Q

Give 5 signs/symptoms of infectious mononucleosis

A

Fever, malaise, tonsillopharyngitis,|lymphadenopathy, petechiae on the soft palate, splenomegaly, hepatomegaly,|maculopapular rash, jaundice

444
Q

What drug should you avoid in children|with EBV infection and why?

A

Amoxicillin/ampicillin - can cause a florid maculopapular rash

445
Q

Give 2 serious complications of mumps

A

Encephalitis, subacute sclerosing panencephalitis

446
Q

Give 3 symptoms of mumps

A

Fever, malaise, parotitis

447
Q

Name a complication of mumps in boys

A

Orchitis (usually unilateral, rarely causes infertility)

448
Q

Give 3 signs/symptoms of rubella infection

A

Fever, maculopapular rash (initially on face), lymphadenopathy

449
Q

Name 2 complications of rubella infection

A

Arthritis, encephalitis, thrombocytopenia, myocarditis

450
Q

Name 3 non-infective causes of prolonged fever

A

Systemic JIA|Malignancy|SLE|Vasculitis|IBD|Fabricated illness

451
Q

What age group is Kawasaki disease most likely to affect?

A

6mo-4y

452
Q

How is Kawasaki disease diagnosed?

A

Clinically, fever >5d and 4/5 from:|Conjunctival injection|Strawberry tongue, cracked lips|Cervical lymphadenopathy|Rash|Red and oedematous palms and soles

453
Q

Name 2 things you would find on investigation of a child with Kawasaki disease

A

Increased WCC, plts, ESR, CRP

454
Q

How do you obtain samples for culture for TB in children?

A

Gastric washings on 3 consecutive mornings

455
Q

At what age can you diagnose HIV infection by anti-HIV antibodies?

A

18m

456
Q

What signs/symptoms would warrant HIV testing in children?

A

Persistent lymphadenopathy,|hepatosplenomegaly, recurrent fever, parotid swelling, thrombocytopeneia or SPUR (serious, persistent, unsual,|recurrent) infections

457
Q

What would you give a HIV+ve child as pneumocystis jiroveci prophylaxis?

A

Co-trimoxazole

458
Q

Name 5 viruses that are an important cause of respiratory infections in children

A

RSV, rhinovirus, parainfluenza, influenza, adenoviruses

459
Q

What would you find O/E of a child with acute OM?

A

Tympanic membrane bright red and bulging with loss of normal light reflection|May have fever

460
Q

Name 2 bacterial causes of acute OM

A

H influenzae|Moraxella catarrhalis

461
Q

Give 2 serious but uncommon complications of acute OM

A

Mastoiditis and meningitis

462
Q

What is a common complication of recurrent otitis media and what age range is it commonly seen in? Management?

A

OME. 2-7y. Grommet insertion, adenoidectomy

463
Q

What is the usual age range for croup, and peak incidence?

A

6mo-6y|Peak 2y|Commonest in Autumn

464
Q

How does bacterial tracheitis (pseudomembranous croup) differ from croup? What organism usually causes it and how is it managed?

A

Child has high fever, appears toxic and has rapidly progressive airways|obstruction with copious thick airways|secretion |Staph aureus|IV ABx

465
Q

Which organism is responsible for causing acute epiglottitis?

A

HiB

466
Q

How does whooping cough present and how long does it normally last?

A

1 week of coryza, then paroxysmal cough followed by inspiratory whoop develops which lasts 3-6w

467
Q

What age range does bronchiolitis usually|affect?

A

1-9mo, rare after 1y

468
Q

Name a serious complication of bronchiolitis

A

Recurrent apnoea

469
Q

What would a CXR typically show in bronchiolitis?

A

Hyperinflation of the lungs due to small airways obstruction, air trapping and often focal atelectasis

470
Q

Name the 2 general patterns of wheeze in preschool children

A

Transient early wheezing|Persistent and recurrent wheezing (atopic asthma)

471
Q

Briefly describe the pathophysiology of asthma

A

Bronchial inflammation|Bronchial hyperresponsiveness|Airway narrowing

472
Q

What additional therapy might be used in a specialist asthma clinic for children with severe persistent asthma?

A

Anti-IgE therapy (omalizumab)

473
Q

Which protein is defective in CF and on which Cr is it located?

A

CTFR|Cr 7

474
Q

Which organisms typically tend to result in chronic infection in people with CF?

A

Pseudomonas aeruginosa, Burkholderia,|Staph aureus (initially) and H influenzae|(initially)

475
Q

When does the ductus arteriosus close?

A

1-2d after birth

476
Q

Name 7 signs/symptoms of heart failure|in children

A

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
Q

What are the 2 main types of atrial septal defect?

A

Secundum (80%, involving centre of atrial septum involving foramen ovale)|Partial/primum ASD

478
Q

What kind of murmur would you hear with an ASD?

A

ULSE ejection systolic|Fixed split 2nd heart sound

479
Q

How would you treat AVSD?

A

Surgical correction at 3-5y

480
Q

How are VSDs classified into small and large?

A

Small = smaller than aortic valve in diameter|Large = same size or bigger

481
Q

What symptoms might be present with aortic stenosis?

A

Asymptomatic murmur. Severe: reduced exercise tolerance, chest pain on exertion or syncope

482
Q

What signs might be present with aortic stenosis?

A

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
Q

What is the most common childhood arrhythmia?

A

SVT

484
Q

What bacteria is responsible for rheumatic fever?

A

Beta-haemolytic strep

485
Q

Give 6 signs/symptoms of infective endocarditis

A

Fever, anaemia, splinter haemorrhages,|clubbing, necrotic skin lesions, changing|cardiac signs, splenomegaly, neurological|signs from cerebral infarction, retinal|infarcts, arthritis/arthralgia, microscopic haematuria

486
Q

What is the most common causative organism for IE?

A

Alpha-haemolytic strep (e.g. strep viridans)

487
Q

What are the clinical signs of nephrotic syndrome?

A

Periorbital oedema (esp on waking),|scrotal/vulval, leg and ankle oedema,|ascites, breathlessness (pleural effusions|and abdo distension)

488
Q

Give 3 complications of nephrotic syndrome

A

Hypovolaemia, thrombosis, infection (esp|Pneumococcus), hypercholesterolaemia

489
Q

Name a steroid-resistant nephrotic syndrome. How should these children be managed?

A

Focal segmental glomerulosclerosis,|mesangiocapillary glomerulonephritis,|membranous nephropathy. Diuretic therapy, salt restriction, ACEi, sometimes NSAIDs

490
Q

Give 3 glomerular and 3 non-glomerular causes of haematuria

A

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
Q

Give 2 causes of acute nephritis

A

Post-infectious (including strep),|vasculitis, IgA nephropathy and|mesangiocapillary glomerulonephritis, anti-glomerular basement membrane|disease

492
Q

Name 3 signs/symptoms of HSP

A

Characteristic skin rash, arthralgia,|periarticular oedema, abdominal pain,|glomerulonephritis, fever

493
Q

What is the clinical triad seen in HUS? What infection normally precedes?

A

Acute renal failure, haemolytic anaemia, thrombocytopenia|E.coli O157

494
Q

Give 4 features of hydrocele

A

Asymptomatic scrotal swellings, often bilateral,|sometimes with bluish discolouration, non-tender,|transilluminate, may resolve spontaneously

495
Q

How is an undescended testicle classified?

A

Retractile, palpable, impalpable

496
Q

What are the reasons for surgical management of an undescended testicle?

A

If not treated - fertility reduction, increased risk of malignancy, cosmetic and psychological reasons

497
Q

How would you manage testicular torsion?

A

Surgery within 6-12h for good chance of testicular viability|Fixation of contralateral testicle

498
Q

What is hypospadias?

A

Urethral opening proximal to the normal meatus on the glans

499
Q

What is the pathophysiology of biliary atresia and how would you treat?

A

Progressive destruction of extrahepatic biliary tree and intrahepatic biliary ducts. Surgical bypass of the fibrotic ducts (hepatoportoenterostomy)

500
Q

Name 4 causes of unconjugated|hyperbilirubinaemia in prolonged neonatal jaundice

A

Breast milk jaundice, infection,|haemolytic anaemia, hypothyroidism,|high GI obstruction, Crigler-Najjar|syndrome

finals (8 decks)

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