extra passmed questions 5 Flashcards
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
what is the threshold for starting immediate insulin in a patient with a diagnosis of gestational diabetes:
fasting glucose level is >= 7 mmol/l
first line treatment for stress incontinence
pelvic floor muscle training
first line for urge incontinence
bladder retraining
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
most appropriate choice for menorrhagia (first line)
mirena coil (IUS)
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
investigation of placental praevia:
transvaginal ultrasound
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
most common site of ectopic pregnancy:
ampulla of fallopian tube
three causes of increased nuchal translucency:
- downs syndrome
- congenital heart defects
- abdominal wall defects
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
what is oligohydraminos and possible cause:
deficiency in amniotic fluid.
renal agenesis can cause this, as amniotic fluid mainly derived from foetal urine.
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
Cervical cancer screening: if smear inadequate:
then repeat within 3 months
patient presents with breast cancer. what form of contraception if most appropriate:
Copper IUD
- breast cancer CONTAINDICATION to all hormonal forms of contraception
what is advisable for all postmenopausal women with atypical endometrial hyperplasia:
due to risk of malignant progression
total hysterectomy w/ bilateral salpino-oophorectomy
Bladder still palpable after urination:
retention with urinary overflow incontinence
Women who have been treated for CIN II should be offered cervical screening at :
6 months
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
haemophilia mode of inheritance
x-linked
mothers –> sons
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
management of acute epiglottis
- senior involvement (anaesthetics, ENT)
- endotracheal intubation - do not examine throat
- oxygen
- IV ABX
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
