extra passmed questions 5 Flashcards by Andrea Jayawardena

36 y/o female

30 weeks pregnant

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

indicative of:

woody uterus

placental abruption

How well did you know this?

Not at all

Perfectly

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

fasting glucose level is >= 7 mmol/l

How well did you know this?

Not at all

Perfectly

first line treatment for stress incontinence

pelvic floor muscle training

How well did you know this?

Not at all

Perfectly

first line for urge incontinence

bladder retraining

How well did you know this?

Not at all

Perfectly

which of the following is associated with endometrial hyperplasia:

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

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

How well did you know this?

Not at all

Perfectly

most appropriate choice for menorrhagia (first line)

mirena coil (IUS)

How well did you know this?

Not at all

Perfectly

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

low dose aspirin

How well did you know this?

Not at all

Perfectly

investigation of placental praevia:

transvaginal ultrasound

How well did you know this?

Not at all

Perfectly

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:

hep B

How well did you know this?

Not at all

Perfectly

most common site of ectopic pregnancy:

ampulla of fallopian tube

How well did you know this?

Not at all

Perfectly

three causes of increased nuchal translucency:

downs syndrome
congenital heart defects
abdominal wall defects

How well did you know this?

Not at all

Perfectly

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

eclampsia

How well did you know this?

Not at all

Perfectly

what is oligohydraminos and possible cause:

deficiency in amniotic fluid.

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

How well did you know this?

Not at all

Perfectly

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:

IRRITABLE BOWEL SYNDROME

classic ABC features

A-abdo pain

B-bloating

C-change in bowel habit

How well did you know this?

Not at all

Perfectly

Cervical cancer screening: if smear inadequate:

then repeat within 3 months

How well did you know this?

Not at all

Perfectly

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

Copper IUD

breast cancer CONTAINDICATION to all hormonal forms of contraception

How well did you know this?

Not at all

Perfectly

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

due to risk of malignant progression

total hysterectomy w/ bilateral salpino-oophorectomy

How well did you know this?

Not at all

Perfectly

Bladder still palpable after urination:

retention with urinary overflow incontinence

How well did you know this?

Not at all

Perfectly

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

6 months

How well did you know this?

Not at all

Perfectly

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

fibroids = benign tumours of the myometrium

menorrhagia
pain with torsion
subfertility

How well did you know this?

Not at all

Perfectly

haemophilia mode of inheritance

x-linked

mothers –> sons

How well did you know this?

Not at all

Perfectly

6 y/o girl

pc: fever , lethargy

no vaccinations

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

likely diagnosis:

acute epiglottis

haemophilus influenza type b

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

How well did you know this?

Not at all

Perfectly

management of acute epiglottis

senior involvement (anaesthetics, ENT)
- endotracheal intubation
do not examine throat
oxygen
IV ABX

How well did you know this?

Not at all

Perfectly

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

Which chromosome likely to be affected?

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.

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

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

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

prostaglandin E1 until surgical correction can be carried out

All breech babies at or after 36 weeks gestation require:

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

management for unilateral undescended testis?

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.

managment of bilateral undescended testes?

urgent review within 24hrs by senior paediatrician

what kind of disorder is fragile X?

- trinucleotide repeat disorder - CGG - chin protruding, giant gonads dx - chronic villous sampling or amniocentesis most common cause of inherited neurodevelopmental delay

appropriate treatment for meningitis if over 3 months of age:

cetriaxone IV 3rd generation cephalosporin if under 3 months - IV amoxicillin + IV cefotaxime

investigation for necrotizing enterocolitis

abdominal x-ray will reveal gas cysts in bowel wall

signs of intussception

vomiting abdo distention red currant jelly stools common between 3-12 months

when is hirschsprungs disease usually noticed?

- usually within first 24-48hrs | - when meconium fails to pass

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

Wilms tumour

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

- 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.

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

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

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

venous hum

investigation of choice for intussusception:

abdo uss

main cause of croup

parainfluenza viruses

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

Edwards syndrome (18) I was rock bottom when I hit 18. average life expectancy: 5-12 days

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

neontatal sepsis

most common causes of neonatal sepsis are:

- group B strep | - E.Coli

management of neonatal sepsis according to NICE

IV benzylpenicillin + gentamicin

The most common heart lesion associated with Duchenne muscular dystrophy :

dilated cardiomyopathy

what is mesenteric adenitis?

inflamed lymph nodes within the mesentery. often follows recent viral infection. needs no tx

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

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

The initial management in Hirschprung's disease is:

rectal washout anorectal pull is definitive management, not initial.

investigation for hirschsprungs:

full thickness rectal biopsy

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

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

neonate born at 38+6 weeks pc: signs of resp distress oe: heart sounds absent on LHS, tinkling sounds heard, infant cyanosed indicative of:

diaphragmatic hernia best initial management - intubation and ventilation

causes of neonatal meningitis:

SADBELL Sad situation B- group B strep E - e coli L - listeria monocytogenes

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.

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.

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.

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

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

hand, foot and mouth disease clinical features - mild systemic upset, sore throat, fever - oral ulcers

main cause of hand foot and mouth disease?

coxsackie A6 virus

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?

osgood schlaTTer disease Tibial Tubercle

management of hand, foot and mouth disease?

symptomatic tx - hydration advice and analgesia - don't need to be excluded from school

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:

HIRSCHSPRUNGS 5X more likely in boys Colon biopsy: aganglionic segment of bowel