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Pass Med finals pack > extra passmed questions 2 > Flashcards

extra passmed questions 2 Flashcards

1
Q

likely cause of ambiguous genitalia in a neonate

A

congenital adrenal hyperplasia

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2
Q

gross dilatation of the ureter, pelvis and calyces with ureteral tortuosity

this indicates:

A

vesicouretic refux

- abnormal backflow of urine from bladder into ureter and kidney

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3
Q

1st line for Constipation in children:

A

movicol

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4
Q

this is a simple fracture to the bottom part of the fibula (bone on the outer part of your leg).

A

Weber A fracture

may weight bear as tolerated in a CAM boot

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5
Q

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?

A

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
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6
Q

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?

A

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.

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7
Q

difference between nephrogenic diabetes insipidus and diabetes insipidus?

A
  • kidneys inabiltiy to respond to vasopressin
  • thus can’t give vasopression as will be infective
  • need to give a thiazide like diuretic instead
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8
Q

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 :

A

renal cell carcinoma

classical triad:

  1. haematuria
  2. loin pain
  3. abdominal mass
  • pyrexia of unknown origin
  • left varicocele due to occlusion of left testictular vein
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9
Q

A 14 year-old boy develops visible haematuria following an upper respiratory tract infection

most likely

A

IgA nephropathy

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10
Q

what is perthe’s disease?

A
  • avascular necrosis of femoral head
  • typically 4-8 y/o
  • 5x more common in boys
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11
Q

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?

A

Wilms tumour

- given boys age, haematuria with no pain and reduction in appetite.

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12
Q

describe the combined test for down’s syndrome in pregnancy?

A
  • 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.
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13
Q

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:

A

polymyalgia rheumatica

- symmetrical aching and stiffness of shoulders, hip girdle, neck and torso

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14
Q

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?

A

Biliary atresia

  • obliteration or discontinuity within extrahepatic biliary system
  • obstruction in flow of bile

early surgical treatment required

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15
Q

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?

A

ankylosing spondylitis
- HLA-B27

IX - Plain XRay

  1. sacroilitis (subcondral erosions, sclerosis)
  2. syndesophytes (ossification of outer fibers of annulus fibrosis)
  3. squaring of lumbar vertebrae
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16
Q

Hashimoto’s thyroiditis is associated with what lymphoma

A

MALT
- mucosa assocaited lymphoid tissue

hashimoto’s

  • autoimmune disorder of thyroid
  • antiTPO, antiTTg
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17
Q

Seen in sporty teenagers

Pain, tenderness and swelling over the tibial tubercle

A

Osgood-Schlatter disease

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18
Q

Bronchiectasis: most common organism

A

Haemophilus influenzae

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19
Q

what is given in the prophylaxis of oesophageal bleeding

A

propanolol

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20
Q

the normal age when a child should show a responsive smile:

A

14 - 16 weeks

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21
Q

Metabolic ketoacidosis with normal or low glucose cause:

A

alcoholic ketoacidosis

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22
Q

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:

A

pneumonia
- klebsiella pneumonia is common cause of cavitating pneumonia in upper lobe

Klebsiella – KlebSTELLA (common in alcoholics)

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23
Q

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:

A

rheumatoid arthritis

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24
Q

what test should be done in all women with recurrent episodes of vaginal candidiasis?

A

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.

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25
Q

What is the most common cause of hepatocellular carcinoma in the United Kingdom?

A

hep C (europe)

hep B (worldwide)

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26
Q

likely constitents of stone in patient with renal stag horn calculus?

A

struvite (ammonium magnesium phosphate)

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27
Q

primary hyperparathyroidism cause:

A

tumour

causes high calcium

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28
Q

secondary hyperparathyroidism cause:

A

low vitamin D or CKD

can’t absorb calcium

then decreases or normal calcium

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29
Q

tertiary hyperparathyroidism cause:

A

due to low calcium

there is hyperplasia of gland to try and compensate –> increased calcium

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30
Q

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:

A

Grave’s disease

more likely than De Quervain’s thyroiditis which is associated with tender goitre and raised ESR.

31
Q

cardiac complication of Ehler-Danlos syndrome?

A

aortic regurgitation

Ehler-danlos

  • autosomal dominant
  • type 3 collagen
32
Q

first line management for back pain

A

oral NSAID

33
Q

fracture at growth plates classification

A

salter-harris

Salter-Harris grading = SALTR

I = S = SLIPPED
II = A = Above
III = L = Lower
IV = T = Through (all) Three
V = R = Rammed
34
Q

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:

A

meniscal tears

35
Q

most appropriate imaging for diagnosing meniscal tears:

A

MRI

36
Q

triad of fat embolism;

A

coming from bone marrow

triad:

  1. hypoxemia
  2. neurological abnormalities
  3. petechial rash
37
Q

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 :

A

Charcot’s foot

5Ds - deformity, debris, density change, destruction, dislocation

unlike septic arthritis: charcot joint swollen, normal temperature without elevated inflammatory markers, painless

38
Q

Myotomes of the foot just read.

A

Big Toe; Largest of 5 = L5, Little Toe; Smallest 1 = S1.

39
Q

presents with isolated lateral hip/thigh pain with tenderness over the greater trochanter

A

trochanteric bursitis

lateral knee = iliotibial band syndrome

lateral hip = trochanteric bursitis

40
Q

McMurrays tests for:

A

meniscal tears

occur through twisting

rotate foot internally, pain and clicking feeling –> McMurrays test positive –> meniscal tear

41
Q

initial management of scaphoid fracture:

A

Immobilise with futuro splint

or standard below elbow backslab

before specialist review

pc: pain and tenderness in the anatomical snuffbox, FOOSH

42
Q

Slipped upper femoral epiphysis vs Perthes ?

A

Secondary school age = SUFE, obese, knee, hip problems

Primary school age = Perthes

43
Q

Golfer’s vs Tennis Elbow

A

Golfers

  • aka medial epicondylitis
  • pain on resisted wrist pronation

Tennis

  • lateral epicondylitis
  • pain on resisted wrist extension
44
Q

which fracture is characterised by bulging of the cortex (XR)

typically in children 5-10 years

A

Buckle fracture
- incomplete fracture

MX
- splinting and immobilisation rather than a cast

45
Q

IVDU + back pain + pyrexia

highly suspicious of:

A

osteomyelitis

staph aureua

46
Q

loss of pain and temperature sensation of the upper limbs:

affected area:

A

spinothalamic tract

Syringomyelia
- cystic cavity forms within spinal cord

47
Q

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:

A

septic arthritis

48
Q

manouver for dislocated shoulders

A

stimson manoeuver

49
Q

management of grade 1-2 acromioclavicular joint:

A

conservative, resting + sling

Grade IV, V and VI are rare and require surgical intervention.

50
Q

A 22-year-old drunk man is involved in a fight. He hurts his thumb when he punches his opponent.

fracture type;

A

bennets

51
Q

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:

A

potts

52
Q

75 y/o female

pc: FOOSH
oe: dorsal displacement and angulation, transverse fracture of radius around 2cm proximal to radio carpal joint

A

Colle’s

53
Q

The most common site of metatarsal stress fractures

A

2nd metatasal

  • longest bone
  • thin and vulnerable to stress fractures
54
Q

60 y/o female likes going on long walks

pc: tripped, got a undisplaced, intracapsular neck of femur fracture

management:

A

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.

55
Q

risk factors for adhesive capsulitis

A

female

> 40

HLA-B27 +

stroke

diabetes

56
Q

35 y/o runner

pc: heel pain, aggravated by walking on tip toes.
oe: diffuse tenderness worse on medial aspect of heel bed

A

classic plantar fasciitis

57
Q

example of gram negative infections:

A

klebsiella

pseudomonas aeruginosa

E-coli

58
Q

82 y/o

pc: tripped, shoulder pain
oe: pain to 90 degrees on abduction

A

supraspinatus tear

most common rotator cuff tear

59
Q

22-year-old man falls over and presents to casualty.

A shoulder x-ray: Hill-Sachs lesion is present.

indicative of:

A

glenohumeral dislocation

60
Q

75 y/o male

pc: head on car crash
oe: severe pain L knee, tibia displaces posteriorly on application of force

describes:

A

positive posterior drawer test

indicative of PCL damage

mechanism of injury also suggestive of PCL rupture

61
Q
  • 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:

A

lumbar spinal stenosis

Spinal stenosis is a key differential in a patient who presents with claudication

62
Q

burning thigh pain –> meralgia paresthetica .

what nerve affected?

A

lateral cutaneous nerve of thigh

63
Q

painful arc of abductoin injury

likely diagnosis

A

subacrominal impingement
- 60-120 degrees

rotator cuff
- in first 60 degrees

64
Q

which test used to assess carpal tunnel:

carpal tunnel

  • wasting thenar eminence
  • tinels (paraesthesia)
  • weakness of thumb abduction
A

Phalens test

  • patient cocks wrist in reverse prayer sign
  • positive if numbness over medial nerve distrubation
65
Q

wrist drop and loss of sensation from 1st dorsal web-space.

diagnosis:

A

radial nerve palsy

66
Q

What causes wasting of the hypothenar eminence?

A

ulnar nerve palsy

67
Q

risk factors of congenital hip dislocation include:

A
  • female
  • breech
  • FH
  • oligohydraminos
68
Q

Signs of systemic sepsis with changing lower limb neurology =

A

possible epidural abscess

discitis

  • backpain
    1. pyrexia 2. rigors 3. sepsis

can lead to –> epidural abscess –> changing lower limb neurology

staph aureus

69
Q

a shoulder locked in an internally rotated position is highly suggestive of:

A

posterior shoulder discloation

anterior : FOOSH
posterior: seizures and electric shock

70
Q

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:

A

trigger finger

71
Q

dislocation of the distal radioulnar joint with an associated fracture of the radius is what type of fracture?

A

dislocation of the distal radioulnar joint with an associated fracture of the radius

72
Q

Imaging for any ligament tear in the knee?

A

MRI

73
Q

Twisting knee injury =

A

Meniscal tear

74
Q

Treatment for a displaced hip fracture?

A

Hemiarthroplasty

Pass Med finals pack (40 decks)

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