Last minute random Flashcards
TOM TIP: If you are going to remember one thing about polycystic ovarian syndrome, remember the triad of [3]
TOM TIP: If you are going to remember one thing about polycystic ovarian syndrome, remember the triad of the Rotterdam criteria:
* anovulation
* hyperandrogenism (characterised by hirsutism and acne)
* polycystic ovaries on ultrasound.
An important feature of polycystic ovarian syndrome is hirsutism. Hirsutism can also be caused by: [4]
An important feature of polycystic ovarian syndrome is hirsutism. Hirsutism can also be caused by:
- Medications, such as phenytoin, ciclosporin, corticosteroids, testosterone and anabolic steroids
- Ovarian or adrenal tumours that secrete androgens
- Cushing’s syndrome
- Congenital adrenal hyperplasia
Which hormone is raised in PCOS? [1]
Explain how this contributes to the pathogenesis of PCOS [+]
Insulin resistance is a crucial part of PCOS.
Hyperandrogenism:
- When someone is resistant to insulin, their pancreas has to produce more insulin to get a response from the cells of the body.
- Insulin promotes the release of androgens from the ovaries and adrenal glands.
- -Therefore, higher levels of insulin result in higher levels of androgens (such as testosterone).
- Insulin also suppresses sex hormone-binding globulin (SHBG) production by the liver.
- SHBG normally binds to androgens and suppresses their function
Anovulation:
- The high insulin levels contribute to halting the development of the follicles in the ovaries, leading to anovulation and multiple partially developed follicles (seen as polycystic ovaries on the scan).
What hormonal blood tests would indicate PCOS? [1]
TOM TIP: The key thing to remember for your exams is the raised LH, and the raised LH:FSH ratio.
What is the investigation of choice for PCOS? [1]
What is the classical appearance of ^? [1]
Pelvic ultrasound is required when suspecting PCOS. A transvaginal ultrasound is the gold standard for visualising the ovaries.
String of pearls
TOM TIP: It is worth remembering the “string of pearls” description for your exams. It may come up in MCQs. It is also worth remembering that an [] indicate polycystic ovarian syndrome, even without the presence of cysts.
TOM TIP: It is worth remembering the “string of pearls” description for your exams.It may come up in MCQs. It is also worth remembering that an ovarian volume of more than 10cm3 can indicate polycystic ovarian syndrome, even without the presence of cysts.
The screening test of choice for diabetes in patients with PCOS is a []
The screening test of choice for diabetes in patients with PCOS is a 2-hour 75g oral glucose tolerance test (OGTT).
Women with polycystic ovarian syndrome have several risk factors for [] cancer:
Ovarian
Breast
Liver
Endometrial
Anal
Women with polycystic ovarian syndrome have several risk factors for [] cancer:
Ovarian
Breast
Liver
Endometrial
Anal
In CF: positive heel prick for CF:
- [] (a pancreatic enzyme) is released by the pancreas when there is damage due to CF as the pancreatic duct is blocked with mucus plugs
positive heel prick for CF:
- Immunoreactive trypsinogen (a pancreatic enzyme) is released by the pancreas when there is damage due to CF as the pancreatic duct is blocked with mucus plugs
A 17-year-old male with a history of cystic fibrosis presents to clinic for annual review. What is the most appropriate advice regarding his diet?
High calorie and low fat with pancreatic enzyme supplementation for every meal
High calorie and low fat with pancreatic enzyme supplementation for evening meal
Normal calorie and low fat with pancreatic enzyme supplementation for every meal
High calorie and high fat with pancreatic enzyme supplementation for evening meal
High calorie and high fat with pancreatic enzyme supplementation for every meal
High calorie and high fat with pancreatic enzyme supplementation for every meal
- Patients with cystic fibrosis (CF) have an increased energy requirement due to the chronic inflammation and infection associated with their disease
The parents of a 3-year-old boy with cystic fibrosis ask for advice. They are considering having more children. Neither of the parents have cystic fibrosis. What is the chance that their next child will be a carrier of the cystic fibrosis gene?
50%
100%
1 in 25
25%
66.6%
As cystic fibrosis is an autosomal recessive condition there is a 50% chance that their next child will be a carrier of cystic fibrosis (i.e. be heterozygous for the genetic defect) and a 25% chance that the child will actually have the disease (be homozygous).
Rheumatic fever is which type of hypersensitivty reaction
Type 1
Type 2
Type 3
Type 4
Type 5
Rheumatic fever is which type of hypersensitivty reaction
Type 1
Type 2
Type 3
Type 4
Type 5
Which heart murmur would this heart histological change most likely cause? [1]
Aschoff body - mitral stenosis - diastolic murmur
Describe the initial presentation of rheumatic fever
Typically causes:
- tonsillitis
- migratory arthritis
- pericarditis / myocarditis / endocarditis
- subcut. nodules & erythema nodosum
- Sydenham chorea
How do you dx rheumatic fever?
Diagnosis is based on evidence of recent streptococcal infection accompanied by:
* 2 major criteria
* 1 major with 2 minor criteria
Evidence of recent streptococcal infection
* raised or rising streptococci antibodies,
* positive throat swab
* positive rapid group A streptococcal antigen test
Major criteria
* erythema marginatum
* Sydenham’s chorea: this is often a late feature
* polyarthritis
* carditis and valvulitis (eg, pancarditis)
* The latest iteration of the Jones criteria (published in 2015) state that rheumatic carditis cannot be based on pericarditis or myocarditis alone and that there must be evidence of endocarditis (the clinical correlate of which is valvulitis which manifests as a regurgitant murmur)
* subcutaneous nodules
Minor criteria
* raised ESR or CRP
* pyrexia
* arthralgia (not if arthritis a major criteria)
* prolonged PR interval
Describe how you treat rheumatic fever - specifically the GAS infection? [1]
Penicillin is the drug of choice for treating GAS infection.
After a stat dose of antibiotic, which antibiotic should be continued for ten days in patients with rheumatic fever? [1]
Phenoxymethylpenicillin
Which neurological disorder is associated with rheumatic fever?
Sydenham’s chorea
What are the major criteria for rheumatic fever?
JONES (J< 3NES) criteria:
- Joint pain (migratory arthralgias)
- < 3 (carditis, including endocarditis, myocarditis and/or pericarditis)
- Nodules (subcutaneous nodules over the extensor surfaces)
- Erythema marginatum (pink rash with cleared centres over trunk and limbs)
- Sydenham’s chorea (develops months later, characterised by involuntary movements).
Which rash is classically seen in rheumatic fever?
Erythema marginatum
Single chamber pacemakers have a lead in which chambers [can be in one of two] [2]
Single-chamber pacemakers have leads in a single chamber, either the right atrium (SAN issue) or the right ventricle (AVN issue)
Biventricular pacemakers have leads in the []
Biventricular pacemakers have leads in the right atrium, right ventricle and left ventricle.
Pacemakers:
A line before either the P wave or QRS complex but not the other indicates a [] pacemaker
A line before either the P wave or QRS complex but not the other indicates a single-chamber pacemaker
Pacemakers:
A line before both the P wave and QRS complex indicates a [] pacemaker
A line before both the P wave and QRS complex indicates a dual-chamber pacemaker
A 36-year-old woman presents to A&E with a sudden onset severe headache, associated with nausea and blurred vision. When asked about family history she reports that her father needed dialysis for end-stage renal failure. On examination, she is photophobic and Kernig’s sign is positive. There are palpable masses in the flanks bilaterally.
Which of the following describes a possible complication of the underlying diagnosis?
Pericarditis
Anterior uveitis
Liver fibrosis
Polyarthritis
Irregular menstrual periods
Liver fibrosis
