- somatostatin analogue - used in tx of acromegaly

extra passmed questions 4 Flashcards by Andrea Jayawardena

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)

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An itchy rash affecting the face and scalp distribution is commonly caused by

seborrhoeic dermatitis

differential:
- acne rosacea (telangiectasia and pustules)

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what is given for induction of labour?

vaginal prostaglandin E2

cervical ripening

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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

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if angina not controlled with beta blocker add…

calcium channel blocker

nifedipine!

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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

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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.

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a radiograph showing valvulae conniventes extending all the way across the bowel are consistent with

small bowel obstruction

earlier vomitting also sign of SBC

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treatment of choice for all patients with a displaced hip fracture

hemiarthroplasty / total hip replacement

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a patient on the COCP is about to undergo a laparoscopic cholecystectomy.

what might be advised?

stop COCP 28 days before surgery

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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

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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

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what is ocretoide?

somatostatin analogue

- used in tx of acromegaly

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treatment of choice for gonorrhoea?

IM ceftriaxone stat dose

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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

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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

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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

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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

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patients with suspected PE hsould initially be managed with a …

direct oral anticoagulant

rivaroxoban

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Isolated fever in well patient in first 24 hours following surgery?

physiological response to surgery

key differentials

infection
thrombosis

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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.

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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

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what long term medication would a patient with spontaneous bacterial peritonitis be put on?

ciprofloxacin

antibiotic prophylaxis

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what is recommended after a woman has a wide local excision of a ductal carcinoma?

arrange radiotherapy

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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?

1. nebulised salbutamol 2. nebulised ipratropium bromide 3. 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

1. endometriosis 2. adenomyosis 3. pelvic inflammatory disease 4. intraurertine devices 5. 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

1. 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 1. membrane sweep 2. vaginal prostaglandin e2 3. maternal oxytocin infusion 4. amniotomy 'breaking of waters' 5. 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?

1. bHCG 2. FBC, U&Es, coeliac, TFTs 3. gonadotrophins - low levels --> hypothalamic cause - raised --> ovarian (premature ovarian failure) 4. prolactin 5. androgen - raised --> PCOS 5. 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