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Pass Med finals pack > extra passmed questions 5 > Flashcards

extra passmed questions 5 Flashcards

1
Q

36 y/o female

30 weeks pregnant

pc: severe lower abdo pain.
oe: uterus is tender and hard, fetal lie normal

indicative of:

A

woody uterus

placental abruption

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2
Q

what is the threshold for starting immediate insulin in a patient with a diagnosis of gestational diabetes:

A

fasting glucose level is >= 7 mmol/l

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3
Q

first line treatment for stress incontinence

A

pelvic floor muscle training

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4
Q

first line for urge incontinence

A

bladder retraining

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5
Q

which of the following is associated with endometrial hyperplasia:

a) tamoxifen
b) >30 years
c) alcohol
d) COCP
e) late menarch

A

a) tamoxifen

endometrial hyperplasia caused by oestrogen which is unopposed by progesterone.

other risk factors

  • obesity
  • late menopausea
  • early menarche
  • aged over 35
  • nulliparity
  • smoking
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6
Q

most appropriate choice for menorrhagia (first line)

A

mirena coil (IUS)

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7
Q

what might be given to a patient who suffered pre-eclampsia, in future pregnancies, to reduce risk of developing pre-eclampsia again?

A

low dose aspirin

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8
Q

investigation of placental praevia:

A

transvaginal ultrasound

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9
Q

midwife takes blood to screen for HIV, rubella and syphillis. MSUS also sent for culture to screen for asymptomatic bacteria.

what other infectious disease is also screened for:

A

hep B

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10
Q

most common site of ectopic pregnancy:

A

ampulla of fallopian tube

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11
Q

three causes of increased nuchal translucency:

A
  1. downs syndrome
  2. congenital heart defects
  3. abdominal wall defects
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12
Q

32 y/o female 34 weeks gestation first pregnany.

pc: seizure following a 1 day period of severe abdominal pain, nausea, vomiting, and visual disturbance.
fh: epilsepsy
oe: hyperreflexia noted

likely diagnosis

A

eclampsia

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13
Q

what is oligohydraminos and possible cause:

A

deficiency in amniotic fluid.

renal agenesis can cause this, as amniotic fluid mainly derived from foetal urine.

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14
Q

27 y/o female

pc: 6 month hx spasmodic pains in LIF. sometimes radiate to back, bloated particularly around period. stubbprn bowels recently.
oe: abdo and vaginal examination normal.

diagnosis:

A

IRRITABLE BOWEL SYNDROME

classic ABC features

A-abdo pain

B-bloating

C-change in bowel habit

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15
Q

Cervical cancer screening: if smear inadequate:

A

then repeat within 3 months

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16
Q

patient presents with breast cancer. what form of contraception if most appropriate:

A

Copper IUD

  • breast cancer CONTAINDICATION to all hormonal forms of contraception
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17
Q

what is advisable for all postmenopausal women with atypical endometrial hyperplasia:

A

due to risk of malignant progression

total hysterectomy w/ bilateral salpino-oophorectomy

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18
Q

Bladder still palpable after urination:

A

retention with urinary overflow incontinence

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19
Q

Women who have been treated for CIN II should be offered cervical screening at :

A

6 months

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20
Q

The combination of menorrhagia, subfertility and an abdominal mass in this patient points towards:

A

fibroids = benign tumours of the myometrium

  1. menorrhagia
  2. pain with torsion
  3. subfertility
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21
Q

haemophilia mode of inheritance

A

x-linked

mothers –> sons

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22
Q

6 y/o girl

pc: fever , lethargy

no vaccinations

oe: not talking, leaning forward with hands on knees, breathing loudly, drooling. febrile.

likely diagnosis:

A

acute epiglottis

haemophilus influenza type b

Acute epiglottitis is characterised by rapid onset fever, stridor and drooling

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23
Q

management of acute epiglottis

A
  1. senior involvement (anaesthetics, ENT)
    - endotracheal intubation
  2. do not examine throat
  3. oxygen
  4. IV ABX
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24
Q

A baby is born with microcephaly, small eyes, low-set ears, cleft lip and polydactyly:

Which chromosome likely to be affected?

A

patau syndrome (trisomy 13)

Many children die before within a year of birth but those who survive will often go on to show intellectual and motor disability.

25
Q

what is given to neonate with patent ductus arteriosus in the post natal period?

A

indomethacin OR ibpuprogen

ibuprogen given, reduces prostaglandins which maintain the patency of PDA.

26
Q

what should be given to maintain a patent ductus arteriosus in cyanotic congenital heart diseases:

A

prostaglandin E1

until surgical correction can be carried out

27
Q

All breech babies at or after 36 weeks gestation require:

A

USS for DDH screening at 6 weeks regardless of mode of delivery

28
Q

management for unilateral undescended testis?

A

referral considered from 3 months of age

orchidopexy at 1 year: a surgery to move a testicle that has not descended or moved down to its proper place in the scrotum.

29
Q

managment of bilateral undescended testes?

A

urgent review within 24hrs by senior paediatrician

30
Q

what kind of disorder is fragile X?

A
  • trinucleotide repeat disorder
  • CGG
  • chin protruding, giant gonads

dx
- chronic villous sampling or amniocentesis

most common cause of inherited neurodevelopmental delay

31
Q

appropriate treatment for meningitis if over 3 months of age:

A

cetriaxone

IV 3rd generation cephalosporin

if under 3 months
- IV amoxicillin + IV cefotaxime

32
Q

investigation for necrotizing enterocolitis

A

abdominal x-ray

will reveal gas cysts in bowel wall

33
Q

signs of intussception

A

vomiting

abdo distention

red currant jelly stools

common between 3-12 months

34
Q

when is hirschsprungs disease usually noticed?

A
  • usually within first 24-48hrs

- when meconium fails to pass

35
Q

4 year old with painless haematuria, non tender mass, reduction in appetite and distended abdomen:

likely diagnosis

A

Wilms tumour

36
Q

New borns undergo a heel prick test. what might indicate cystic fibrosis?

A
  • elevated immunoreactive trypsinogen (IRT)
  • baby should then undergo the sweat test, if this is raised then confirms dx of CF

NOTES
IRT (pancreatic enzyme) released when damage due to CF as pancreatic duct blocked by mucus plugs.

37
Q

High fever lasting >5 days, red palms with desquamation and strawberry tongue are indicative of:

A

Kawasaki disease

Differential diagnosis:
- scarlet fever also causes skin desquamation and strawberry tongue, but not prolonged fever

38
Q

innocent murmurs:

Due to the turbulent blood flow in the great veins returning to the heart. Heard as a continuous blowing noise heard just below the clavicles

A

venous hum

39
Q

investigation of choice for intussusception:

A

abdo uss

40
Q

main cause of croup

A

parainfluenza viruses

41
Q

A baby is born with micrognathia, low-set ears, rocker bottom feet and overlapping of fingers :

A

Edwards syndrome (18)

I was rock bottom when I hit 18.

average life expectancy: 5-12 days

42
Q

what should be considered in infants with vague signs such as poor feeding, grunting, lethargy:

A

neontatal sepsis

43
Q

most common causes of neonatal sepsis are:

A
  • group B strep

- E.Coli

44
Q

management of neonatal sepsis according to NICE

A

IV benzylpenicillin + gentamicin

45
Q

The most common heart lesion associated with Duchenne muscular dystrophy :

A

dilated cardiomyopathy

46
Q

what is mesenteric adenitis?

A

inflamed lymph nodes within the mesentery.

often follows recent viral infection.

needs no tx

47
Q

child presenting with cough and wheeze on a background of viral illness, raises suspicion of:

A

bronchiolitis
- RSV

supportive if patients obs are only mild fever. admission if sats below 92%

48
Q

The initial management in Hirschprung’s disease is:

A

rectal washout

anorectal pull is definitive management, not initial.

49
Q

investigation for hirschsprungs:

A

full thickness rectal biopsy

50
Q

which antibiotic is given first line in children suspected of mycoplasma pneumonia?

A

erythromycin

otherwise: amoxicillin is first line, with co-amoxiclav is child presents with pneumonia associated with influenza

51
Q

neonate born at 38+6 weeks

pc: signs of resp distress
oe: heart sounds absent on LHS, tinkling sounds heard, infant cyanosed

indicative of:

A

diaphragmatic hernia

best initial management
- intubation and ventilation

52
Q

causes of neonatal meningitis:

A

SADBELL

Sad situation

B- group B strep

E - e coli

L - listeria monocytogenes

53
Q

A 48 hour old neonate develops increasing abdominal distension. He had a normal delivery but has yet to pass any meconium. Following digital rectal examination liquid stool is released.

A

Hirschsprungs may present either with features of bowel obstruction in the neonatal period or more insidiously during childhood. After the PR there may be an improvement in symptoms. Diagnosis is by full thickness rectal biopsy.

54
Q

A 7 month old girl presents with vomiting and diarrhoea. She is crying and drawing her legs up. There is a a sausage shaped mass in the abdomen.

A

Sausage shaped mass (colon shaped) is common in intussusception. The other common sign is red jelly stool.

55
Q

THIS is characterised by sore vesicular lesions on the palms, soles and buccal mucosa.

A

hand, foot and mouth disease

clinical features

  • mild systemic upset, sore throat, fever
  • oral ulcers
56
Q

main cause of hand foot and mouth disease?

A

coxsackie A6 virus

57
Q

A 13-year-old girl presents to clinic with right knee pain. She is a keen hockey player but has had no recent injuries. On examination there is a painful swelling over the tibial tubercle. What is the most likely diagnosis?

A

osgood schlaTTer disease

Tibial Tubercle

58
Q

management of hand, foot and mouth disease?

A

symptomatic tx

  • hydration advice and analgesia
  • don’t need to be excluded from school
59
Q

1 y/o bilious vomiting, abdo distention, constipated since birth, did not pass meconium until he was 3 days old.

OE: abdomen distended, PR showed stool ejection

likely diagnosis:

A

HIRSCHSPRUNGS

5X more likely in boys

Colon biopsy: aganglionic segment of bowel

Pass Med finals pack (40 decks)

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