extra passmed questions 2 Flashcards
likely cause of ambiguous genitalia in a neonate
congenital adrenal hyperplasia
gross dilatation of the ureter, pelvis and calyces with ureteral tortuosity
this indicates:
vesicouretic refux
- abnormal backflow of urine from bladder into ureter and kidney
1st line for Constipation in children:
movicol
this is a simple fracture to the bottom part of the fibula (bone on the outer part of your leg).
Weber A fracture
may weight bear as tolerated in a CAM boot
An 8-year-old boy presents to the emergency department severely short of breath and wheezy. He is extremely short of breath and cannot complete sentences fully. His peak expiratory flow rate is 300 l/min (40% of normal). His oxygen saturations are 93%. His pCO2 is 4.9 kPa.
normal pco2 (4.5-6kpa)
which feature is most concerning?
normal CO2
- indicative of reduced respiratory effort
specific indicators of life threatening asthma
- cyanosis
- poor resp effort
- peak exp flow rate < 33%
- silent chest
- altered level of consciousness
A 4-year-old boy presents to the emergency department with a suspected fractured femur. He has had several visits over the past few months. On examination, his teeth appear abnormal and he is very skinny. His father is also concerned about the boys hearing.
What is the most likely diagnosis?
Osteogenesis imperfecta
characteristically presents in childhood with features such as bone fractures and deformities, blue sclera and hearing/visual problems
The most common form is type 1, which is a mild form. Presenting features include fractures following minor trauma, blue sclera, deafness secondary to otosclerosis and dental imperfection.
difference between nephrogenic diabetes insipidus and diabetes insipidus?
- kidneys inabiltiy to respond to vasopressin
- thus can’t give vasopression as will be infective
- need to give a thiazide like diuretic instead
A 60-year-old man presents with visible haematuria for the past three weeks. He has an ache in the left loin but examination is unremarkable other than a left varicocele. He also notes to feeling intermittently hot and sweaty.
likely diagnosis :
renal cell carcinoma
classical triad:
- haematuria
- loin pain
- abdominal mass
- pyrexia of unknown origin
- left varicocele due to occlusion of left testictular vein
A 14 year-old boy develops visible haematuria following an upper respiratory tract infection
most likely
IgA nephropathy
what is perthe’s disease?
- avascular necrosis of femoral head
- typically 4-8 y/o
- 5x more common in boys
4 y/o male
pc: urine dark reddish colour, eating less over past couple weeks
OE: afebrile , distended abdomen soft and non-tender. palpable mass in right flank.
FHx: father and grandfather both had kidney trouble
likely diagnosis?
Wilms tumour
- given boys age, haematuria with no pain and reduction in appetite.
describe the combined test for down’s syndrome in pregnancy?
- occurs at 10-14 weeks gestation
- USS for nuchal translucency
- and blood test for beta-HCG & pregnancy associated plasma protein A (PAPP-A)
- In pregnancies with Down Syndrome, PAPP-A is low and beta-hCG raised.
A 65-year-old woman presents to her GP complaining of 2 weeks of fatigue and lethargy. She has also been experiencing difficulty with dressing herself in the morning due to stiffness in her shoulders.
Routine blood tests are normal. ESR raised.
indicative of:
polymyalgia rheumatica
- symmetrical aching and stiffness of shoulders, hip girdle, neck and torso
baby girl born 4 weeks ago has had persistent jaundice since 48hrs post birth.
reluctant to breastfeed, has dark urine.
OE: jaundiced, notice firm, enlarged liver.
blood show conjugated hyperbilirubinemia.
serum A1A levels and electrophoresis normal. neonatal heal prick normal.
likely condition?
Biliary atresia
- obliteration or discontinuity within extrahepatic biliary system
- obstruction in flow of bile
early surgical treatment required
24 y/o male
pc: 3 month hx lower back pain radiating to buttocks, symptoms worst in morning. improve with exercise. occasionally wake him up from sleep.
diagnosis?
ankylosing spondylitis
- HLA-B27
IX - Plain XRay
- sacroilitis (subcondral erosions, sclerosis)
- syndesophytes (ossification of outer fibers of annulus fibrosis)
- squaring of lumbar vertebrae
Hashimoto’s thyroiditis is associated with what lymphoma
MALT
- mucosa assocaited lymphoid tissue
hashimoto’s
- autoimmune disorder of thyroid
- antiTPO, antiTTg
Seen in sporty teenagers
Pain, tenderness and swelling over the tibial tubercle
Osgood-Schlatter disease
Bronchiectasis: most common organism
Haemophilus influenzae
what is given in the prophylaxis of oesophageal bleeding
propanolol
the normal age when a child should show a responsive smile:
14 - 16 weeks
Metabolic ketoacidosis with normal or low glucose cause:
alcoholic ketoacidosis
70 y/o female
pmh: T2DM, alchohol abuse , non smoker
pc: productive cough and fever
OE: crackles in right upper lobe
CXR: consolidation which is cavitating in right upper lobe
diagnosis:
pneumonia
- klebsiella pneumonia is common cause of cavitating pneumonia in upper lobe
Klebsiella – KlebSTELLA (common in alcoholics)
57 y/o female presents with the following symptoms:
These include bilateral swelling of her metacarpophalangeal joints
early morning stiffness of around an hour’s duration
raised nodule on the extensor surface of her left forearm
likely to be:
rheumatoid arthritis
what test should be done in all women with recurrent episodes of vaginal candidiasis?
blood glucose
Recurrent thrush is likely due to some form of immunosuppression. The most common form of immunosuppression seen in recurrent thrush is diabetes, and this is the most likely in this woman as she is not sexually active and has no significant past medical history. Therefore, it would be appropriate for her GP to perform a random blood glucose test.
What is the most common cause of hepatocellular carcinoma in the United Kingdom?
hep C (europe)
hep B (worldwide)
likely constitents of stone in patient with renal stag horn calculus?
struvite (ammonium magnesium phosphate)
primary hyperparathyroidism cause:
tumour
causes high calcium
secondary hyperparathyroidism cause:
low vitamin D or CKD
can’t absorb calcium
then decreases or normal calcium
tertiary hyperparathyroidism cause:
due to low calcium
there is hyperplasia of gland to try and compensate –> increased calcium
A 34-year-old woman presents with palpitations and feeling hot all the time. On examination she has a non-tender goitre. Bloods show the following:
TSH: < 0.05 (0.5-5.5)
Free T4: 22 (70-140)
likely answer:
Grave’s disease
more likely than De Quervain’s thyroiditis which is associated with tender goitre and raised ESR.
cardiac complication of Ehler-Danlos syndrome?
aortic regurgitation
Ehler-danlos
- autosomal dominant
- type 3 collagen
first line management for back pain
oral NSAID
fracture at growth plates classification
salter-harris
Salter-Harris grading = SALTR
I = S = SLIPPED II = A = Above III = L = Lower IV = T = Through (all) Three V = R = Rammed
popping sensation in her right knee during the match, and upon clinical examination the knee is swollen, and the patient is unable to fully extend her knee.
indicative of:
meniscal tears
most appropriate imaging for diagnosing meniscal tears:
MRI
triad of fat embolism;
coming from bone marrow
triad:
- hypoxemia
- neurological abnormalities
- petechial rash
Bone remodeling / fragmentation involving the midfoot.
In combination with the presence of a swollen, red, warm joint in a patient with a history of poorly controlled diabetes is highly suggestive of a :
Charcot’s foot
5Ds - deformity, debris, density change, destruction, dislocation
unlike septic arthritis: charcot joint swollen, normal temperature without elevated inflammatory markers, painless
Myotomes of the foot just read.
Big Toe; Largest of 5 = L5, Little Toe; Smallest 1 = S1.
presents with isolated lateral hip/thigh pain with tenderness over the greater trochanter
trochanteric bursitis
lateral knee = iliotibial band syndrome
lateral hip = trochanteric bursitis
McMurrays tests for:
meniscal tears
occur through twisting
rotate foot internally, pain and clicking feeling –> McMurrays test positive –> meniscal tear
initial management of scaphoid fracture:
Immobilise with futuro splint
or standard below elbow backslab
before specialist review
pc: pain and tenderness in the anatomical snuffbox, FOOSH
Slipped upper femoral epiphysis vs Perthes ?
Secondary school age = SUFE, obese, knee, hip problems
Primary school age = Perthes
Golfer’s vs Tennis Elbow
Golfers
- aka medial epicondylitis
- pain on resisted wrist pronation
Tennis
- lateral epicondylitis
- pain on resisted wrist extension
which fracture is characterised by bulging of the cortex (XR)
typically in children 5-10 years
Buckle fracture
- incomplete fracture
MX
- splinting and immobilisation rather than a cast
IVDU + back pain + pyrexia
highly suspicious of:
osteomyelitis
staph aureua
loss of pain and temperature sensation of the upper limbs:
affected area:
spinothalamic tract
Syringomyelia
- cystic cavity forms within spinal cord
7 y/o boy
pc: unwell, pain in R hip, walk with limp
oe: flexion, extension and rotation of hip is painful and limited
temperature: 38.2 degrees
likely diagnosis:
septic arthritis
manouver for dislocated shoulders
stimson manoeuver
management of grade 1-2 acromioclavicular joint:
conservative, resting + sling
Grade IV, V and VI are rare and require surgical intervention.
A 22-year-old drunk man is involved in a fight. He hurts his thumb when he punches his opponent.
fracture type;
bennets
A 14-year-old boy jumps off a 10 foot wall and lands on both feet. An x-ray shows a bimalleolar fracture of the right ankle.
fracture type:
potts
75 y/o female
pc: FOOSH
oe: dorsal displacement and angulation, transverse fracture of radius around 2cm proximal to radio carpal joint
Colle’s
The most common site of metatarsal stress fractures
2nd metatasal
- longest bone
- thin and vulnerable to stress fractures
60 y/o female likes going on long walks
pc: tripped, got a undisplaced, intracapsular neck of femur fracture
management:
internal fixation
patient got pre-morbid status
Hemiarthroplasty is reserved for patients with poor pre-morbid functioning.
Total hip replacements are used for displaced intracapsular fractures.
risk factors for adhesive capsulitis
female
> 40
HLA-B27 +
stroke
diabetes
35 y/o runner
pc: heel pain, aggravated by walking on tip toes.
oe: diffuse tenderness worse on medial aspect of heel bed
classic plantar fasciitis
example of gram negative infections:
klebsiella
pseudomonas aeruginosa
E-coli
82 y/o
pc: tripped, shoulder pain
oe: pain to 90 degrees on abduction
supraspinatus tear
most common rotator cuff tear
22-year-old man falls over and presents to casualty.
A shoulder x-ray: Hill-Sachs lesion is present.
indicative of:
glenohumeral dislocation
75 y/o male
pc: head on car crash
oe: severe pain L knee, tibia displaces posteriorly on application of force
describes:
positive posterior drawer test
indicative of PCL damage
mechanism of injury also suggestive of PCL rupture
- bilateral buttock pain
- radiating through thighes and calves
- worse on standing
- unable to walk for more than 10 minutes without pain
- relieved by forward flexion of spine.
- no hx bladder or bowel dysfunction
likely diagnosis:
lumbar spinal stenosis
Spinal stenosis is a key differential in a patient who presents with claudication
burning thigh pain –> meralgia paresthetica .
what nerve affected?
lateral cutaneous nerve of thigh
painful arc of abductoin injury
likely diagnosis
subacrominal impingement
- 60-120 degrees
rotator cuff
- in first 60 degrees
which test used to assess carpal tunnel:
carpal tunnel
- wasting thenar eminence
- tinels (paraesthesia)
- weakness of thumb abduction
Phalens test
- patient cocks wrist in reverse prayer sign
- positive if numbness over medial nerve distrubation
wrist drop and loss of sensation from 1st dorsal web-space.
diagnosis:
radial nerve palsy
What causes wasting of the hypothenar eminence?
ulnar nerve palsy
risk factors of congenital hip dislocation include:
- female
- breech
- FH
- oligohydraminos
Signs of systemic sepsis with changing lower limb neurology =
possible epidural abscess
discitis
- backpain
- pyrexia 2. rigors 3. sepsis
can lead to –> epidural abscess –> changing lower limb neurology
staph aureus
a shoulder locked in an internally rotated position is highly suggestive of:
posterior shoulder discloation
anterior : FOOSH
posterior: seizures and electric shock
64 y/o female with RA
pc: pain in ring finger on flexion, one time it got ‘stuck’
oe: nodule at base of finger
diangosis:
trigger finger
dislocation of the distal radioulnar joint with an associated fracture of the radius is what type of fracture?
dislocation of the distal radioulnar joint with an associated fracture of the radius
Imaging for any ligament tear in the knee?
MRI
Twisting knee injury =
Meniscal tear
Treatment for a displaced hip fracture?
Hemiarthroplasty
