extra passmed questions 4 Flashcards
18 month baby boy
pc: nappy filled with dark red blood. haemodynamically unstable, requires blood transfusion.
most likely cause:
meckel’s diverticulum
differentials
- polyps
- necrotizing enterocolitis (seen in first few weeks of life)
An itchy rash affecting the face and scalp distribution is commonly caused by
seborrhoeic dermatitis
differential:
- acne rosacea (telangiectasia and pustules)
what is given for induction of labour?
vaginal prostaglandin E2
cervical ripening
what is used first line for possibility of pulmonary embolism?
when might this not be used?
Computed tomographic pulmonary angiography (CTPA)
HOWEVER
- patients with renal impairment should be have V/Q scans
- contrast media is nephrotoxic
if angina not controlled with beta blocker add…
calcium channel blocker
nifedipine!
23 y/o ED w/ fluttering and feeling faint. no chest pain or SOB.
ECG: irregular tachycardia, 166bpm with QRS duration of 110MS .
BP: 102/68mmHg, 99% oxygen
likely diagnosis and management?
SUPRAVENTRICULAR TACHYCARDIA
1st line = carotid massage
if these fail then adenosine given
What should be done in patients with Addisons during illness?
Addisons patients have little to no steroid production.
during illness body usually increases cortisol production as a stress response.
therefore patients steroid replacement therapy is doubled.
a radiograph showing valvulae conniventes extending all the way across the bowel are consistent with
small bowel obstruction
earlier vomitting also sign of SBC
treatment of choice for all patients with a displaced hip fracture
hemiarthroplasty / total hip replacement
a patient on the COCP is about to undergo a laparoscopic cholecystectomy.
what might be advised?
stop COCP 28 days before surgery
low calcium, phosphate and vitamin D levels combined with a raised alkaline phosphatase and parathyroid hormone level is entirely consistent with
OSTEOMALACIA
- vitamin D deficiency
- thus vitamin D3 supplementation given
first line therapy for prolactinomas
- dopamine agonists
- inhibit prolactin release from pituitary
- e.g. bromocriptine
- transphenoidal approach surgery is then done if patients don’t tolerate the dopamine agonist
what is ocretoide?
- somatostatin analogue
- used in tx of acromegaly
treatment of choice for gonorrhoea?
- IM ceftriaxone stat dose
what should be done in a a patient with a Wells score of 2?
- arrange proximal leg vein USS within 4 hrs.
- or LMWH if USS cannot be arranged in 4hrs
unilateral blood stained discharge is likely to be associated with…
duct papilloma
small harmless growth in one of the breast ducts
doesn’t have malignant potential so often removed
THIS will often present with green-brown discharge and an abscess with puss discharging from the nipple. The latter will also be associated with red, swollen, warm skin of the breast.
duct ectasia
what are good measures to represent liver function in patients with alcoholic liver cirrhosis?
prothrombin time (PT) - surrogate measure of synthetic function of liver to produce clotting factors
patients with suspected PE hsould initially be managed with a …
direct oral anticoagulant
- rivaroxoban
Isolated fever in well patient in first 24 hours following surgery?
physiological response to surgery
key differentials
- infection
- thrombosis
A baby born at 37 weeks breech position.
NIPE unremarkable.
what further DDH screening may be required?
If a baby is born >36 weeks gestation with breech presentation, then s/he requires a bilateral hip USS at 6 weeks regardless of method of delivery.
t presents as pain at rest for greater than 2 weeks, often at night, not helped by analgesia. He initially had intermittent claudication, but this has developed and become more serious as the pain is also at rest.
critical limb ischaemia
acute limb ishcaemia
- if exhibiting 6Ps
- thus unlikely to be ALI
what long term medication would a patient with spontaneous bacterial peritonitis be put on?
ciprofloxacin
antibiotic prophylaxis
what is recommended after a woman has a wide local excision of a ductal carcinoma?
arrange radiotherapy
preffered antiplatelet for secondary prevention of stroke?
- clopidogrel
what is a risk factor for ectopic pregnancy?
history of endometriosis
how are acute flares of rheumatoid arthritis managed?
methylprednisolone IM
SEVERE LIFE THREATENING ASTHMA
Which of the following groups of medications should be given to this patient as an initial treatment?
- nebulised salbutamol
- nebulised ipratropium bromide
- oral prednisolone
presence of a painless penile ulcer and his history of unprotected sex with multiple partners;
syphillis
contrasted to herpes simplex characterised by
- ulceration
- mild fever
- painful ulceration
what should be given as prophylaxis for contacts of patients with meningococcal meningitis
ciprofloxacin
most common mechanism of ankle sprain
inversion
Patients with obstructive urinary calculi and signs of infection require:
- urgent renal decompression
- IV antibiotics
- due to risk of sepsis
THIS is a rare-fibro-inflammatory disease of the intrahepatic and/ or extrahepatic bile ducts, obstructing the flow of bile from the liver to the intestines.
primary sclerosing cholangitis
strong association with ulcerative colitis
Vision worse going down stairs…
trochlear nerve palsy
management of primary dysmenorrhoea?
NSAIDS e.g. mefanamic acid and ibuprogen
inhibit prostaglandin production
2nd line: COCP
State some causes of secondary dysmenhorroea?
occurs many years after menarche and is a result of underlying pathology
- endometriosis
- adenomyosis
- pelvic inflammatory disease
- intraurertine devices
- fibroids
what should be done for all patiens with secondary dysmenorrhoea?
refer to gynae for investigation
+ve pregnancy test + mild suprapubic gain management:
refer urgently to EPAU
need to rule out ectopic pregnancy.
COCP protective against
Increases the risk of cancers we screen
- breast
- cervical
protective against those we don’t
- endometrial
- ovarian
Lynch syndrome increases risk of what chancers
LYNCH syndrome is the CEO of cancers
C- colon
E- endometrial
O-ovarian
which contraceptive associated with delayed return to fertility?
Depo-provera
is recommended to be stopped after 50 years. increased risk of osteoporosis.
so continuing it in a post-menopausal woman would increase her risk of a fragility fracture
how does IUS work?
thickening cervical mucous
contraindication for depo-provera?
breast cancer
which is associated with development of ovarian cancer?
- early menarch
- early menopause
- COCP
- multiple pregnancy
- low BMI
EARLY MENARCHE
risk is greater is ovulation is no suppressed.
investigation for ovarian cancer
- CA125
2. USS
can oral anticoagulants be continued in pregnancy?
NO
contraindicated
so women on NOACs
should be switched to LMWH
why?
- placental haemorrhage, fetal prematurity and fetal loss
how can galactocele’s be clinically differentiated from breast abscesses?
Galactocele
- painless
- non-tender
- no localised erythema
- afebrile
next appropriate step in investigation of galactocele?
no further investigation needed
can be differentiated from breast abscess through clinical HX + OE findings
in gestational diabetes, if blood lgucose targets are not met with diet/ metformin what is the next step in management?
commence insulin
inital step in induction of labour?
Membrane sweep
separating chorionic membrane from decidua to trigger labour.
if this fails then vaginal prostaglandins are recommended.
options
- membrane sweep
- vaginal prostaglandin e2
- maternal oxytocin infusion
- amniotomy ‘breaking of waters’
- cervical ripening balloon
What bishop score would indicate spontaneous labour is likely?
score above 8
risk factor of prostaglandins in labour
uterine hyperstimulation
CTG - baby having decelerations
stop p.glandins and start tocolysis: terbutalnine
example of tocolytic used in preterm labour
nifedipine
relax uterus
half contractions and labour
high ALP indicates
- either bone problem
- or cholestatic picture
markers of inflammation in liver
ALT
AST
liver enzymes
which is bad, early or late decelerations on CTG?
MX
- LATE decelerations
- require fetal blood sampling
- to assess for fetal hypoxia + acidosis
management of ovarian caners:
primary
- if stage 2-4 –> surgical excision of tumour
- then chemotherapy
risk factors of ovarian cancer?
- family history: BRCA1 or BRCA2
- many ovulations: early menarche, late menopause, nulliparity
initial investigations of ammenohorea?
- bHCG
- FBC, U&Es, coeliac, TFTs
- gonadotrophins
- low levels –> hypothalamic cause
- raised –> ovarian (premature ovarian failure) - prolactin
- androgen
- raised –> PCOS - oestrogen
management of preterm labour:
early stage
- tocolytics + steroids
- steroid pre-emptively help foetal lngs mature if delivery required
define premature ovarian failure:
onset of menopaual symptoms
elevated Gonadotrophin
before 40
most appropriate initial treatment for menorrhagia?
36 y/o female
pc: 1.5cm uterine fibroid not distorting uterine cavity. wants ongoing contraception.
IUS
if uterine fibroid less than 3 cm
how does the implantable contraceptive work?
slowly released progestogen hormone etonogestrel.
preventing ovulatoin.
thickening cervical mucus.
best imaging technique for diagnosing adenomyosis is
MRI
not CT, because CT lacks ability to differentiate between different tissue types.
adenoymosis is:
presence of endometrial tissue in myometrium
what is used in endometriosis diagnosis?
laparoscopy
first line treatment for magnesium sulphate induced respiratory depression:
calcium gluconate
what is eclampsia:
development of seizures in association with pre-eclampsia
pre-eclampsia
- 20 weeks post gestation <
- pregnancy induced HTN
- proteinuria
management of thrush
- clotrimazole pessary
- oral: fluconazole
glucose test to exclude diabetes.
DDs: licen sclerosis
26 y/o 5 week hx worsening dull pelvic pain + smelly dishcarge
has IUDi in situ. does not menstruate.
has had HPV but not smart test.
likely diagnosis:
pelvic inflammatory disease
- smelly discharge sign of sexually transmitted infection
PID
- infection + inflammation of uterus, fallopian tubes and ovaries and surrounding peritoneum
main causative organisms of pelvic inflammmaotry disease:
chlamydia trachomatis
common cause
- neisseria gonorrhoea
- mycoplasma genitalium
- mycoplasma hominis
features of pelvic inflammatory disease:
- lower abdo pain
- fever
- deep dyspareunia
- dysuria + menstrual irregulatiries
- vaginal or cervical dishcarge
- cervical excitation
investigation for sus pelvic inflammatory disease
- pregnancy test , exclude ectopic
- high vaginal swab
- screen for chlamydia and gonorrhoea
management of placental abruption when fetus is alive, < 36 weeks and not showing signs of distress:
admit
administer steroids
placental abruption management:
fetus < 36 weeks
foetal distress
immediate caesarean
placental abruption management:
fetus > 36 weeks
fetal distress
immediate ceasarean
placental abruption management:
fetus > 36 weeks
no fetal distress
deliver vaginally
