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Final MB Part II - Short Answer Questions > Ley Learning Points > Flashcards

Ley Learning Points Flashcards

1
Q

What is the most common cause of a congenital stridor?

A

Laryngomalacia

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2
Q

What is the most common cause of an exacerbation of laryngomalacia?

A

An intercurrent respiratory tract infection

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3
Q

Outline how the diagnosis of laryngomalacia may be confirmed?

A

Flexible laryngoscopy; demonstrates prolapse over the airway of an omega(Ω)-shaped epiglottis

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4
Q

What is meant by stridor?

A

Stridor is an inspiratory sound secondary to narrowing of the upper airway

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5
Q

Outline the main difference between stridor and a wheeze?

A

Stridor is caused by upper respiratory tract narrowing whereas a wheeze is caused by lower respiratory tract narrowing

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6
Q

What procedures need to be avoided in children with stridor?

A
  • Anything that may cause the child upset (blood tests, cannulas etc.) as it may cause deterioration<br></br>- The upper airway must not be examined either to prevent total obstruction
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7
Q

Outline the differential diagnoses that may cause acute stridor in a child? (5)

A
  • Laryngotracheobronchitis (croup)
  • Inhaled foreign bodies
  • Anaphylaxis
  • Epiglottitis
  • Rare causes; bacterial tracheatis, severe tonsilitis, inhalation of hot gasses, retropharyngeal abscess
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8
Q

What age group are particularly affected by croup?

A

Croup typically affects patients between the ages of 6 months and 5 years

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9
Q

Which oragnism is the most common cause of croup?

A

Parainfluenza virus

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10
Q

Which vaccination aims to prevent epiglottitis?

A

Haemophilus influenza tybe b (Hib)

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11
Q

What is the most common cause of an acute stridor?

A

Laryngotracheobronchitis (croup)

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12
Q

Which conditions are tested for in the Newborn Blood Spot test (a.k.a heel prick test/Guthrie card)? (9)

A
  • Congenital hypothyroidism
  • Sickle cell disease (SCD)
  • Cystic fibrosis (CF)
  • Metabolic disorders;
    • Phenylketonuria (PKU)
    • Medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
    • Maple syrup urine disease (MSUD)
    • Isovaleric acidaemia (IVA)
    • Glutaric aciduria type 1 (GA1)
    • Homocystinuria (HCU)
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13
Q

When is the newborn blood spot test carried out and why?

A

It is carried out between 5-8 days so as to give the baby enough time to latch and begin feeding normally, this will alow detection of metabolic disorders

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14
Q

What is the definition of precocious puberty in boys and girls?

A

<div>Premature sexual maturation is defined as puberty starting below the age of 8 years in girls and 9 years in boys.</div>

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15
Q

How isprecocious puberty treated? (2)

A
  • LHRH (GnRH) analogues

- Treat any underlying lesion/source

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16
Q

Which gene variant is commonly associated with ankylosing spondylitis?

A

HLA-B27

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17
Q

Which virus is responsible for causing hand, food and mouth disease (HFMD)?

A

Coxsackie virus A16

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18
Q

Outline the main differentials for a child presenting witha new-onset petechial or purpuric rash? (4)

A
  • Henoch-Schönlein Purpura (HSP)
  • Immune Thrombocytopaenic Purpura (ITP)
  • Haematological Malignancy
  • Meningococcal meningitis
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19
Q

Which scoring system is used to assess the severity of croup?

A

Westley Score

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20
Q

Which features make up the Westley score that is used in the assessment of croup severity? (5)

A

L-SCAR;

  • Level of consciousness
  • Stridor
  • Cyanosis
  • Air entry
  • Retractions
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21
Q

Which scoring system is used to assess clinical status in a newborn term infant?

A

APGAR Score

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22
Q

Outline how the APGAR score can be used to assess clinical status in a term neonate?

A
  • Score 0-3; high risk of neonatal mortality
  • Score 4-6; slightrisk of neonatal mortality
  • Score 7-10; normal healthy neonate
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23
Q

Which condition is a common complication of viral gastroenteritis in children?

A

Lactose intolerance; usually resolves following removal and slow reintroduction of lactose in the diet

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24
Q

At what time points is the APGAR commonly used to assess neonates? (3)

A
  • 1 minute
  • 5 minutes
  • 10 minutes
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25
Q

At what point does neonatal cyanosis and reduced oxygen saturations become concerning? (2)

A
  • Suboptimal SpO2 readings are concerning beyond the first 10 minutes of life
  • Peripheral cyanosis can be concerning beyond the first 24 hours of life
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26
Q

Outline the NICE Guidelines for when to refer a child with bronchiolitis to hospital? (3)

A
  • Respiratory rate of over 60 breaths/minute
  • Difficulty with breastfeeding or inadequate oral fluid intake (< 50% normal feeding)
  • Signs of clinical dehydration
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27
Q

Which congenital heart defects are most commonly associated with a congenital cyanosis? (3)

A
  • Tetralogy of Fallot (ToF)
  • Transposition of the great arteries (TGA)
  • Tricuspid atresia (TrA)
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28
Q

Which congenital heart conditions are acyanotic? (6)

A
  • Ventricular septal defect (VSD)
  • Atrial septal defect (ASD)
  • Patent ductus arteriosus (PDA)
  • Patent foramen ovale (PFO)
  • Coarctation of the aorta (CoA)
  • Aortic valve stenosis (AS)
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29
Q

What is the most common cause of pulmonary hypoplasia?

A

Congenital diaphragmatic hernia; not necessarily due to direct compression of the lung by the herniated viscera but rather part of a sequence a

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30
Q

Outline the tetrad of features associated with Tetralogy of Fallot? (4)

A
  • Ventricular septal defect (VSD)
  • Right ventricular hypertrophy
  • Right ventricular outflow obstruction (pulmonary stenosis)
  • Overriding aorta
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31
Q

Which type of murmur is most commonly associated with Tetralogy of Fallot?

A

An ejection systolic murmur heard over the left sternal edge indicative of pulmonary stenosis

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32
Q

Outline the main indications for neonatal unit admission in cases of neonatal hypoglycaemia? (2)

A
  • If the blood glucose drops below 1 mmol L-1

- If symptoms develop

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33
Q

Ouline the management of neonatal hypoglycaemia?

A

IV 10% dextrose

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34
Q

What is the investigation of choice to diagnose vesicoureteric reflux?

A

Micturating cystourethrogram; involves catheterisation of the patient with insertion of radiocontrast agent whilst using real-time fluoroscopy to image the flow during urination

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35
Q

At what age does a cow’s milk protein intolerance tend to present?

A

6+ months; around the point where weaning/formula top up feeds are introduced

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36
Q

Outline the features of cow’s milk protein intolerance? (5)

A
  • Poor weight gain
  • Erythematous blanching rash
  • Colicky abdominal pain
  • Regurgitation of feeds
  • Diarrhoea
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37
Q

Which specific fractures are most commonly associated with non-accidental injury (NAI)? (5)

A
  • Radial
  • Humeral
  • Femoral
  • Posterior rib
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38
Q

What commonly precedes the development of idiopathic thrombocytopaenic purpura (ITP)?

A

Viral illnesses such as glandular fever

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39
Q

Outline the criteria for admission to hospital for a febrile convulsion? (3)

A
  • First witnessed convulsion
  • Lasts longer than 5 minutes
  • Any features of complex seizure (focal and/or repeated)
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40
Q

Between what ages are febrile convulsions most commonly thought to occur?

A

Between 6 months and 5 years of age

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41
Q

Outline the main features of febrile convusions? (3)

A
  • Tonic-clonic in nature
  • Brief, lasting < 5 minutes
  • Associated with viral infections most often URTI
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42
Q

What is the most common lower respiratory tract infection (LRTI) in children under 2 years of age?

A

Bronchiolitis

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43
Q

In what age group is bronchiolitis most commonly found? (2)

A
  • Infants between 1-12 months account for 75% of cases

- Peak incidence is however between 3-6 months of age

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44
Q

Outline the typical features of bronchiolitis? (6)

A
  • Low-grade fever
  • Cough
  • Reduced feeding
  • Reduced wet nappies
  • Tachypnoea
  • Crackles/wheezing
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45
Q

Outline the common signs of respiratory distress in a child? (6)

A
  • Grunting
  • Nasal flaring
  • Head bobbing
  • Accessory muscle usage
  • Tracheal tug
  • Intercostal/subcostal/sternal recessions
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46
Q

Outline the most common differentials for a child presenting with respiratory distress? (6)

A
  • Croup
  • Viral URTI
  • Epiglottitis
  • Inhaled foreign body
  • Pneumonia
  • Caridac issues
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47
Q

What is the mainstay management used in bronchiolitis?

A

Supportive Management;

  • Monitor respiratory rate and saturations
  • Consider capillary blood gas
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48
Q

Outline the indications for an escalation of case in patients with bronchiolitis? (5)

A
  • SpO2 < 92% on room air
  • Persistent severe respiratory distress; grunting, severe recessions, RR > 70
  • Oral fluid intake < 50% of normal or clinical signs of dehydration
  • Apnoeic episodes
  • Known risk factors; < 3 months old, underlying lung disease
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49
Q

Which test can be used to investigate a baby born with neonatal jaundice?

A

Split Bilirubin Test (SBR);<br></br>- Predominant conjugated bilirubin elevation indicates post-hepatic cause<br></br>- Predominant unconjugated bilirubin elevation indicates pre-hepatic cause<br></br>- Equal conjugated and unconjugated bilirubin elevation indicates hepatic cause

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50
Q

Which acid-base disturbance is most commonly associated with pyloric stenosis?

A

Hypokalaemic hypochloraemic metabolic alkalosis

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51
Q

Between what ages does pyloric stenosis most commonly present?

A

Between 3 and 6 weeks

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52
Q

Outline the most common differentials for a child presenting with a limp? (8)

A
  • Juvenile Idopathic Arthritis (JIA)
  • Septic Arthritis
  • Reactive Arthritis
  • Transient Synovitis
  • Fracture
  • Perthe’s Disease
  • Congenital Hip Dysplasia (DDH)
  • Slipped upper femoral epiphysis (SUFE)
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53
Q

Which investigation is most useful in diagnosing intussusception?

A

Abdominal ultrasound

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54
Q

Which investigation is most useful in diagnosing necrotising enterocolitis?

A

Abdominal X-ray

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55
Q

Which investigation is most useful in diagnosing aslipped upper femoral epiphysis (SUFE)?

A

Plain X-ray of both hips in AP and frog-leg views

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56
Q

What is the most common presenting feature of Wilms tumour?

A

Abdominal mass

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57
Q

Which type of intracranial bleeding is most common in premature neonates?

A

Intraventricular haemorrhage (IVH);suggested to occur as a result of birth trauma combined with cellular hypoxia

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58
Q

Outline the triad of features associated with shaken baby syndrome? (3)

A
  • Retinal haemorrhages
  • Subdural haematoma
  • Encephalopathy
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59
Q

Outline the signs and symptoms of Kawasaki disease? (6)

A

CRASH & BURN

  • Conjunctivitis
  • Rash (non-vesicular)
  • Adenopathy (cervical)
  • Strawberry tongue (peeling, red lips)
  • Hand and foot erythema and desquamation
  • Burning up (fever)
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60
Q

Outline the cardinal management of Kawasaki disease?

A

High-dose aspirin

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61
Q

Outline the main investigations that can be carried out in patients with suspected bronchiolitis? (2)

A

Nasopharyngeal Aspirate (NPA)

  • Respiratory Syncytial Virus (RSV) Lateral Flow Test (LFT)
  • Viral Immunofluorescence/Polymerase Chain Reaction (PCR)
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62
Q

How can bronchiolitis be prevented in high-risk infants?

A

Palivizumab; amonoclonal anti respiratory syncytial virus (RSV) F protein antibody

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63
Q

Under what circumstances is the threshold for admission of babies suffering from bronchiolitis reduced? (2)

A
  • Any baby below 2 months of age

- Presenting to hospital within 1-2 days from onset of symptoms

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64
Q

Outline the management options for paediatric patients with severe bronchiolitis who are deteriorating despite supportive management? (4)

A
  • Headbox; humidified air
  • High flow humidified nasal oxygen (OptiFlow)
  • Non-invasive ventilation (NIV); continuous positive airway pressure (CPAP)
  • Invasive ventilation; sedation intubation and ventilation
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65
Q

What is the most common cause of clubbing in children?

A

Cystic fibrosis

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66
Q

What is the most common cause of acute exacerbations of asthma in children?

A

Poor adherence to treatment; poor inhaler technique or non-compliance with taking

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67
Q

Outline the most important tasks to be carried out before a patient can be discharged following an acute exacerbation of asthma? (4)

A
  • GP review within 48 hours of discharge
  • Follow-up outpatient review in 2-4 weeks
  • Review medications against SIGN/BTS or NICE guidelines
  • Explain steroid and salbutamol weaning plan to patient and prescribe in TTO
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68
Q

Outline the major side effects of salbutamol? (5)

A
  • Tremor
  • Palpitations/tachycardia
  • Lactic/metabolic acidosis
  • Hypokalaemia
  • Hyperglycaemia
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69
Q

How may we sub-classify non-asthmatic causes of wheeze in a child? (2)

A
  • Episodic viral induce wheeze (EVW); associated with urticaria
  • Multiple trigger wheeze (MTW); associated with allergens other than viruses such as dust mites, pets and pollen etc
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70
Q

Outline the acute management of an episodic virally induced wheeze (EVW)?

A

Identical to Acute Asthma Management;

  • High flow oxygen if desaturating
  • Salbutamol; inhaled if not needing oxygen, nebulised if supplemental oxygen
  • Ipratropium bromide; inhaled if not needing oxygen, nebulised if supplemental oxygen
  • Oral corticosteroids; only in severe cases requiring admission
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71
Q

Outline the prophylaxis that can be considered in preschool children with episodic viral induced (EVW) or multi-trigger wheezing (MTW)?

A
  • Prophylactic inhaled corticosteroids (ICS) or oral leukotriene receptor antagonists (LRTA) can be tried in severe or frequent wheezers
  • However these should be stopped if no clear benefit identified
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72
Q

Outline the main causes of jaundice within the first 24 hrs of life? (4)

A
  • Rhesus haemolytic disease (HDNB)
  • ABO haemolytic disease
  • Hereditary spherocytosis
  • Glucose-6-phosphate dehydrogenase deficiency (G6PD)
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73
Q

Outline the major risk factors for surfactant-deficient lung disease of the newborn? (4)

A
  • Prematurity
  • Maternal diabetes/gestational diabetes
  • Caesarean section
  • Second born of premature twins
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74
Q

Describe the classical finding on echocardiography that is consistent with a transposition of the great arteries (TGA)?

A

Parallel aorta and pulmonary trunk

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75
Q

Which medication is given to patients with transposition of the great arteries (TGA) to maintain the ductus arteriosus prior to corrective surgery?

A

Prostaglandin E1

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76
Q

Which chromosome is effected by a trisomy in Patau’s syndrome?

A

Chromosome 13

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77
Q

Outline the features of Patau’s syndrome? (4)

A
  • Microcephaly with small eyes
  • Cleft lip and/or palate
  • Polydactyly
  • Scalp lesions
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78
Q

What is the most common cause of headaches in children?

A

Migraine

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79
Q

Outline the first-line management of intussusception?

A

Pneumatic reduction; this utilises air to resolve the intussusception and is carried out under fluoroscopic guidance

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80
Q

What is the most common cardiac cause of cyanosis in a newborn?

A

Transposition of the great arteries (TGA)

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81
Q

Which investigations should be carried out in any baby suspected of being cyanotic at birth? (2)

A
  • Pulse oximetry

- Capillary blood gas

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82
Q

What age of gestation is considered the threshold for prematurity?

A

< 37 weeks (i.e. 36+6is still premature)

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83
Q

Which imaging modality is used to confirm a diagnosis of developmental dysplasia of the hip (DDH)? (2)

A
  • Aged ≤ 4.5 months; hip ultrasound

- Aged > 4.5 months; hip X-ray

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84
Q

What is Perthe’s disease?

A
  • Degenerative condition affecting the hip joints of children, typically between the ages of 4-8 years
  • It is due toavascular necrosis of the femoral head, specifically the femoral epiphysis.
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85
Q

Outline the management of Perthe’s disease?

A

Perthes’ disease presenting under the age of 6 years has a good prognosis requiring only observation/follow-up

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86
Q

Outline the school exclusion advice for children with chickenpox?

A

Child should be excluded from schooluntil all the lesions are dry and have crusted over (usually about 5 days after the onset of the rash)

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87
Q

What dose of oral dexamethasone is used in the treatment of croup?

A

0.15 mg kg-1

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88
Q

What is the first step in newborn resuscitation?

A

Dry the baby so as to stimulate ventilation

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89
Q

Which congenital cardiac lesions can present with neonatal collapse? (4)

A
  • Severe aortic coarctation
  • Aortic arch interruption
  • Hypoplastic left heart syndrome (HLHS)
  • Critical aortic stenosis
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90
Q

What is the most common pathological arrhythmia in a child?

A

Supraventricular tachycardia (SVT)

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91
Q

Which cardiac defects are commonly associated with Turner syndrome? (2)

A
  • Bicuspid aortic valve; causing anejection systolic murmur

- Coarctation of the aorta

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92
Q

What is the most common cause of painless massive GI bleeding requiring a transfusion in children between the ages of 1 and 2 years.

A

Meckels diverticulum

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93
Q

What is the firstline treatment for threadworm infections?

A

Mebendazole

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94
Q

At what age would the average child acquire the ability to crawl?

A

9 months

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95
Q

Outline the guidance on immunisation scheduling for babies born premature? (2)

A
  • Born < 28 weeks;receive their first set of immunisations in hospital due to risk of apnoea
  • Born ≥ 28 weeks; vaccinate at normal chronological age, do not adjust for gestational age
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96
Q

Which test is used to assess hearing in neonates?

A

Automated otoacoustic emissions

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97
Q

Outline the choice of antibiotics used in the treatment of bacterial meningitis in children? (2)

A
  • < 3 months; IV cefotaxime + IV amoxicillin

- ≥3 months; IV ceftriaxone

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98
Q

Which medications taken during pregnancy can increase the risk of orofacial clefts?

A

Anti-epileptics

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99
Q

How can one best differentiate a viral induced wheeze from bronchiolitis? (2)

A

Age of Child;

  • Bronchiolitis; usually between 0 - 12 months
  • Viral-induced wheeze; between ages of 1 - 7 years

Onset of Wheeze/Respiratory Distress;

  • Bronchiolitis; gradual onset, peaking around day 3
  • Viral-induced wheeze; variable prodrome with sudden deterioration
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100
Q

Outline the management of pyloric stenosis?

A

Ramstedt pyloromyotomy

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101
Q

Outline the features of a patent ductus arteriosus (PDA)? (5)

A
  • Left subclavicular thrill<br></br>- Continuous ‘machinery’ murmur<br></br>- Large volume, bounding and collapsing pulse<br></br>- Wide pulse pressure<br></br>- Heaving apex beat
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102
Q

Outline the test used to diagnose Hirschsprung’s disease?

A

Rectal suction biopsy; histology and microscopy will reveal absence of ganglionic cells

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103
Q

Which virus is responsible for causing Fith’s Disease (slapped-cheek)?

A

Parvovirus B19

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104
Q

How do you estimate gestational age of a baby?

A

The estimated age of the baby in weeks from imaging plus the number of days since the first day of the last menstrual period (as indicated by the first day of bleeding)

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105
Q

How do you calculate corrected age for a baby born prematurely?

A
  • Chronological age minus the number of weeks born before 40 weeks<br></br>- E.g. a baby born at 36+3that is now 6 weeks old will be 42+3or 2 weeks and 3 days old
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106
Q

Outline the components of the APGAR score?

A
  • Appearance
  • Pulse
  • Grimace/Reflex Irritability
  • Activity/Muscle Tone
  • Respiratory Rate
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107
Q

What is the most common presenting sign indicative of neonatal sepsis?

A

Grunting (respiratory distress)

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108
Q

Which imaging modality is preferred in the diagnosis of pyloric stenosis?

A

Abdominal ultrasound

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109
Q

Outline the criteria for a diagnosis of gestational diabetes?

A

Either;

  • Fasting plasma glucose level > 5.6 mmol/L
  • A 2-hour plasma glucose level ≥ 7.8 mmol/L
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110
Q

Outline the criteria for immediately commencing insulin therapy in gestational diabetes?

A

If the fasting glucose at the time of diagnosis is ≥ 7 mmol/L then insulin should be started immediately.

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111
Q

How often are routine cervical cancer screening (smear tests) carried out? (3)

A
  • 25-49; every 3 years<br></br>- 50-64; every 5 years<br></br>- 65+; only if 1 of the last 3 tests were abnormal
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112
Q

Outline the classification of perineal tearing severity during childbirth? (4)

A
  • 1st degree;superficial damage with no muscle involvement<br></br>- 2nd degree;injury to the perineal muscle, but not involving the anal sphincter<br></br>- 3rd degree; injury to perineum involving the anal sphincter complex (external and internal anal sphincter)<br></br>- 4th degree;injury to perineum involving the anal sphincter complex and the rectal mucosa
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113
Q

At what gestation should a referral to maternal and fetal medicine for lack of fetal movements?

A

If fetal movements have not yet been felt by 24 weeks gestation

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114
Q

Outline the methods that can be used to induce labor? (5)

A
  • Membrane sweep
  • Vaginal prostaglandin E2pessary
  • Maternal oxytocin infusion
  • Amniotomy/ARM
  • Cervical ripening balloon
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115
Q

Which scoring system can be used to help assess the need for induction of labour?

A

Bishop Score

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116
Q

Outline the indications for electroconvulsive therapy (ECT)? (4)

A
  • Treatment resistant severe depression
  • Prolonged or severe manic episodes
  • An episode of moderate depression known to have responded to ECT in the past
  • Life-threatening catatonia
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117
Q

Outline the main surgical options used in the management of an unruptured ectopic pregnancy? (2)

A
  • Salpingectomy; removal of the tube, used if contralateral tube is known to be functional<br></br>- Salpingectomy; higher risk of persistent trophoblast and recurrent ectopic pregnancy
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118
Q

What important monitoring is required in patients who have undergone salpingotomy for the surgical managment of an ectopic pregnancy?

A

Essential to monitor β-hCG levels until they return to the non-pregnant level (< 5 IU/L).

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119
Q

Outline the imaging modality used in the investigation of an ectopic pregnancy?

A

Transvaginal ultrasound scan

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120
Q

Outline the main underlying causes of a pregnancy of unknown location (PUL)? (3)

A
  • Early uterine pregnancy; too early to visualise
  • Failed pregnancy; complete miscarriage where no previous scan is available
  • Ectopic pregnancy; outside the uterine cavity and adnexa
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121
Q

Outline the normal pattern of hCG and progesterone levels in early pregnancy? (2)

A
  • hCG should increase by > 66% for each 48 hrs that pass<br></br>- Progesterone levels should remain high (40-60 nmol L-1)
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122
Q

What additional investigations can be carried out in patients with a suspected ectopic pregnancy where a TVUS has failed to identify any pregnancy? (2)

A
  • Repeat TVUS within a few days <br></br>- Laparoscopy if repeat TVUS is negative
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123
Q

What is the probability of giving birth to a live baby following preterm premature rupture of membranes (P-PROM)?

A

10-20%; the prognosis is extremely poor

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124
Q

Outline the management options for missed or incomplete miscarriages? (3)

A
  • Expectant management; first-line, trialled for 7-14 days
  • Medical management; vaginal or oral misoprostol
  • Surgical management; evacuation of retained production of conception (ERPC)
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125
Q

What is the most common cause of a missed miscarriage?

A

Sporadic fetal chromosomal abnormalities

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126
Q

Outline the pharmacological agents used in the management of gestational hypertension? (3)

A
  • First-line; labetalol unless contraindicated
  • Second-line; nifedipine
  • Third-line; methyldopa
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127
Q

Outline the initial steps in investigating potential reduced fetal movements after 28 weeks gestation? (2)

A
  • Handheld doppler<br></br>- USS with doppler
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128
Q

Outline the management of chickenpox exposure in pregnancy at ≤ 20 weeks if the mother is not vaccinated and has negative anti-varicella antibodies?

A

Give varicella-zoster virus (VSV) immunogloubin G

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129
Q

Which surgical procedure is used to treat vaginal prolapse following hysterectomy?

A

Sacrocolpopexy; this procedure suspends the vaginal apex to the sacral promontory to compensate for the role of the uterosacral ligaments which will have been removed/severed during hysterectomy

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130
Q

Outline the first-line treatment for primary dysmenorrhoea?

A

Mefenamic acid (NSAID)

131
Q

During routine antenatal care when is the initial booking visit carried out?

A

Between 8-12 weeks

132
Q

During routine antenatal care when is the dating scan carried out?

A

Between 10 - 14 weeks

133
Q

During routine antenatal care when can Down syndrome screening be carried out?

A

Between 11-14 weeks

134
Q

During routine antenatal care when is the anomaly scan carried out?

A

Between 18-21 weeks

135
Q

During routine antenatal care when is the presentation assessed and external cephalic version offered (if appropriate)?

A

Around 36 weeks gestation

136
Q

Outline the monitoring regimen for patients who are taking lithium? (2)

A
  • Serum lithium levels should be monitored weekly when treatment is initiated or when the dose is changed<br></br>- These levels should be checked 12-hours after the most recent dose of lithium
137
Q

What is the most reliable test used to confirm/detect ovulation?

A

Day 21 serum progesterone

138
Q

What medication can be used to treat moderate-to-severe tardive dyskinesia in patients taking antipsychotics?

A

Tetrabenazine

139
Q

What is the main contraindication for the use of the injectable progesterone contraceptive?

A

Current breast cancer

140
Q

Outline the criteria needed for a diagnosis of miscarriage?

A

A transvaginal ultrasound (TVUS) demonstrating a crown-rump length greater than 7mm with no cardiac activity

141
Q

Outline the features of HELLP syndrome?

A
  • Haemolysis<br></br>- Elevated liver enzymes<br></br>- Low platelets<br></br>- Pre-eclampsia
142
Q

Outline the initial management for a new presentation of Perthe’s disease in a child under the age of 6 years?

A

Observation;Perthes’ disease presenting under the age of 6 years has a good prognosis requiring only observation

143
Q

What is the most common cause of painless massive GI bleeding in children between the ages of 1 and 2 years?

A

Meckel’s diverticulum

144
Q

Where is the most common location of the urethral opening in patients with hypospadias?

A

Distal ventral surface of the penis

145
Q

Outline the first-line medication used in the treatment of ADHD?

A

Methylphenidate (Ritalin)

146
Q

Which complication are women with PCOS at particular risk of when undergoing IVF?

A

Ovarian hyperstimulation syndrome (OHSS); abdominal pain, nausea and vomiting, bloating, ascites, oliguria

147
Q

Outline the diagnostic criteria for hyperemesis gravidarum? (3)

A
  • Weight loss≥ 5% of pre-pregnant baseline<br></br>- Dehydration<br></br>- Electrolyte imbalance
148
Q

What is meant by the term primary post-partum haemorrhage?

A

Primary postpartum haemorrhage; the loss of ≥ 500mL from the genital tract within 24 hours of the birth of a baby

149
Q

Outline the subclassification of primary post-partum haemorrhage? (2)

A
  • Minor haemorrhage; 500-1000 mL blood loss<br></br>- Major haemorrhage; > 1000 mL blood loss
150
Q

Outline the main causes of primary post-partum haemorrhage (PPH)? (4)

A

The Four T’s;

  • Tone; uterine atony
  • Tissue; retained placenta
  • Trauma; birth trauma
  • Thrombin; coagulation abnormalities
151
Q

What is the most common cause of primary post-partum haemorrhage?

A

Uterine atony

152
Q

What is the most common cause of recurrent first trimester spontaneous miscarriage?

A

Antiphospholipid syndrome (APLS)

153
Q

What is the recommended dose of folic acid supplementation for pregnant women without risk factors for the fetus having a neural tube defect (NTD)?

A

400 μg/day

154
Q

Which virus is known to cause roseola infantum?

A

Human herpesvirus 6 (HHV-6)

155
Q

What kind of acid-base disturbance is commonly associated with bulimia nervosa?

A

Hypochloraemic hypokalaemic metabolic alkalosis

156
Q

Outline the fluid resuscitation regimen used in children?

A

20 mL kg-1bolus given over less than 10 minutes

157
Q

Outline the maintenance fluid regimen used in children?

A
  • 100 mL kg-1 for first 10 kg <br></br>- 50 mL kg-1 for next 10 kg<br></br>-20 mL kg-1 for every 1 kg thereafter
158
Q

Outline the replacement fluid regimen used in children?

A

100 mL kg-1over 24 hrs

159
Q

Which medication is used in the acute management of delerium tremens?

A

Chlordiazepoxide; a long acting benzodiazepine

160
Q

Outline the features of post-traumatic stress disorder (PTSD)? (3)

A
  • Re-experiencing; nightmares, flashbacks<br></br>- Avoidance; avoiding people or situations<br></br>- Hyperarousal; hypervigilance, sleep disturbance
161
Q

Which complication of pregnancy is the risk increased ofin singleton pregnancies conceived by assisted fertilisation (IVF)?

A

Placenta praevia; the risk of placenta praevia is 6-fold higher in these patients

162
Q

Outline the differences between primary and secondary dysmenorrhoea? (2)

A
  • Primary dysmenorrhoea; typically develops within 1-2 years of the menarche, pain starts just before or within a few hours of the menses
  • Secondary dysmenorrhoea; typically develops many years after the menarche, pain can start 3-4 days prior to the menses
163
Q

Outline the features needed for a diagnosis of pre-eclampsia? (2)

A
  • New-onset blood pressure ≥ 140/90 mmHg after 20 weeks <br></br><br></br>AND ≥ 1 OF;<br></br><br></br>- Proteinuria<br></br>- Organ dysfunction
164
Q

Outline the management of hand foot and mouth disease (HFMD)?

A

Conservative management; general advice about hydration and analgesia

165
Q

Outline the main options for emergency contraception and when they may be used? (3)

A
  • Levonorgestrel; within 72 hours of intercourse<br></br>- Ulipristal acetate;within 120 hours of intercourse<br></br>- Intrauterine device (IUD); within 120 hours of intercourse or upto 120 hours after likely ovulation
166
Q

What is the most common type of epithelial cell tumour found in the ovaries?

A

Serous cystadenoma

167
Q

Outline the management of whooping cough? (3)

A
  • Oral azithromycin
  • Inform Public Health England (PHE)
  • Isolate from school until 48hrs of antibiotics
168
Q

Outline the criteria needed for a diagnosis of whooping cough to be made? (2)

A
  • An acute cough lasting ≥14 days without another apparent cause

PLUS one or more of the following features;

  • Paroxysmal cough
  • Inspiratory whoop (loud harsh inspiratory noise)
  • Post-tussive vomiting
  • Undiagnosed apnoeic attacks in young infants.
169
Q

What pulse abnormality is most associated with a patent ductus arteriosis (PDA)?

A

Alarge volume, bounding, collapsing pulse

170
Q

Which scoring system can be used to assess the severity of alcohol withdrawal?

A

Clinical Institute Withdrawal Assessment for Alcohol (CIWA) Scale

171
Q

Which developmental abnormalities are associated with increased nuchal translucency? (3)

A
  • Down’s syndrome<br></br>- Congenital heart defects<br></br>- Abdominal wall defects
172
Q

Outline the main abnormalities seen in the results of the combined test for a fetus with Down’s syndrome? (3)

A
  • Elevated β-hCG<br></br>- Increased/thickened nuchal translucency<br></br>- Reduced pregnancy-associated plasma protien-A (PAPP-A)
173
Q

What is the most common identifiable cause of postcoital bleeding?

A

Cervical ectropion

174
Q

What is the main complication assocaited with induction of labour (IOL)?

A

Uterine hyperstimulation; too frequent or prolonged uterine contractions that can cause significant fetal distress

175
Q

Outline the main contraindications for a vaginal delivery after caesarian section (VBAC)? (3)

A
  • Vertical (classic) caesarian scar<br></br>- Previous uterine rupture<br></br>- Placenta praevia
176
Q

Outline the management options used in the treatment of vaginal candidiasis? (2)

A
  • Itraconazole (200 mg PO BD) OR Fluconazole (150 mg PO STAT)
  • Clotrimazole pessary (500 mg PV STAT); especially if pregnant
177
Q

Which conditions can be associated with an increased/thickened nuchal translucency, raised β-hCG and reduced PAPP-A? (3)

A
  • Trisomy 21 (Down’s syndrome)<br></br>- Trisomy 18 (Edward’s syndrome)<br></br>- Trisomy 13 (Patau’s syndrome)
178
Q

Outline the main indications for an induction of labour (IOL)? (5)

A
  • Prolonged pregnancy; 1-2 weeks after the EDD<br></br>- Prelabour premature rupture of membranes (before 37 weeks gestation)<br></br>- Diabetic mother < 38 weeks gestation<br></br>- Pre-eclampsia (PET)<br></br>- Rhesus incompatibility
179
Q

What is the definition of preterm premature rupture of membranes (P-PROM)?

A

Rupture of membranes that occurs before 37 weeks gestation

180
Q

What is the definition of premature rupture of membranes (PROM)?

A

This describes the normal prelabour rupture of membranes

181
Q

What is the definition of prolonged rupture of membranes (PROM)?

A

Rupture of membranes that occurs > 18hrs before the onsent of uterine contractions/labour

182
Q

Outline the management of endometrial hyperplasia in post-menopausal women? (2)

A
  • With atypia; hysterectomy with bilateral salpingo-oophorectomy
  • Without atypia; observation alone and/or Mirena coild (IUS) insertion
183
Q

When in the cycle should a serum progesterone be carried out for a woman undergoing infertility investigations?

A

7 days prior to the next expected period; for a typical 28-day cycle this should be around day 21

184
Q

How does the combined oral contraceptive pill (COCP) influence a women’s risk of cancer? (2)

A
  • Increased risk of breast and cervical cancer

- Reduced risk of ovarian and endometrial cancer

185
Q

Which test is used to diagnose pertussis infection (whooping cough)?

A

Per nasal swab

186
Q

Which supportive management approaches can be used in chickenpox? (2)

A
  • Topical calamine lotion; to soothe the itching

- Paracetamol; to reduce/control the fever

187
Q

For how long after childbirth can lochia be present for?

A

Lochia (passage ofblood, mucus and uterine tissue) can occur during the puerperium period which lasts from childbirth upto 6 weeks

188
Q

Which investigation is indicated if lochia persists beyond 6 weeks after childbirth?

A

Ultrasound scan

189
Q

Outline the thromboprophylaxis needed in a pregnant woman who has had one previous venous thromboembolic event (VTE)?

A

Low molecular weight heparin (LMWH) antenatally and for 6 weeks postpartum

190
Q

Outline the first-line choice of laxative used in the treatment of paediatric constipation?

A

Osmotic laxatives; macrogels such as Movicol combined with advice on diet/fluid intake

191
Q

What is the most common cause of transient episodes (< 40 minutes) of decreased CTG variability?

A

Fetus is sleeping

192
Q

Outline thefirst-line medical treatment for intrahepatic cholestasis of pregnancy?

A

Urosdeoxycholic acid

193
Q

Outline the key features of vulval carcinoma? (4)

A
  • Lump/ulcer on labia majora
  • Inguinal lymphadenopathy
  • Associated with itching/irritation
  • Aged > 65 years
194
Q

Outline the main absolute contraindication for hormonal contraception use in women with no history of breast cancer?

A

All methods of combined hormonal contraception are absolutely contraindicated in women over 35 smoking 15 cigarettes or more a day.

195
Q

Outline the main indication for taking high dose folic acid (5 mg) in pregnant women with no underlying health problems?

A

BMI >30 kg/m2

196
Q

At what age would the average child start to play alongside, but not interacting with, other children?

A

Parallel play starts to occur from around 2 years of age

197
Q

Outline the most common causes of antepartum haemorrhage? (4)

A
  • Placenta praevia<br></br>- Placental abruption<br></br>- Extra-placental bleeding (cervicovaginal lesions)<br></br>- Unexplained/indeterminate
198
Q

Outline the management strategies used in the treatment of postpartum haemorrhage? (2)

A
  • Pharmacological management; syntocinon, ergometrine, prostaglandins
  • Surgical management; tamponade/ligation/embolisation
199
Q

Outline the management of an unborn neonate with exomphalos? (2)

A
  • Caesarian section; elective if unruptured, emergency if ruptured<br></br>- Repair; staged if unruptured, immediate is ruptured
200
Q

Outline the main factors that increase the risk of completed suicide attempts? (5)

A
  • Efforts to avoid discovery<br></br>- Writing a note<br></br>- Making plans<br></br>- Sorting of affairs<br></br>- Use of violent methods
201
Q

Which abnormalities of the fetus are associated with raised α-fetoprotein (AFP)? (2)

A
  • Abdominal wall defects;omphalocele/exomphalos gastroschisis<br></br>- Neural tube defects;meningocele, myelomeningocele, anencephaly
202
Q

In obstetrics, what terminology is used to describe the head in relation to the ischial spine?

A

Fetal station; the station is ‘0’ when the head is directly at the level of the ischial spines, if the station was described as -2, it would be 2cm above the ischial spines, and it was +2 it would be 2cm below the ischial spine

203
Q

Which SSRIs can be used first-line in women who are breast feeding? (2)

A
  • Sertaline

- Paroxetine

204
Q

Which form of contraception would be considered safest to use in a patient with a family/personal history of breast cancer or a confirmed BRCA mutation?

A

Copper coil/interuterine device (IUD)

205
Q

Which organism is most commonly associated with early onset sepsis of the neonate?

A

Group B <i>Streptococcus</i>; a common commensal of the female genital tract

206
Q

Outline the main risk factors for development of generalised anxiety disorder? (4)

A
  • Aged between 35-54
  • Being divorced/separated
  • Living alone
  • Being a lone parent
207
Q

Outline the first-line treatment recommended for women without previous history of severe depression who have gone onto develop moderate to severe depression in pregnancy or the post-natal period?

A

Cognitive behavioural therapy (CBT)

208
Q

What is the most common causative organism seen in neonatal meningitis?

A

Group B <i>Streptococcus</i>

209
Q

Which type of ovarian tumour is most commonly associated with the development of endometrial hyperplasia?

A

Granulosa cell tumours; atypical hyperplasia of the endometrium is classified as a premalignant conditioncaused by overstimulation of the endometrium by oestrogen secreted from the granulosa cells

210
Q

Outline the preventative management of pre-eclampsia in women considered to be at moderate to high risk?

A

Aspirin (75-150 mg) OD from 12 weeks gestation up until the birth

211
Q

Outline the threshold for preventative management of pre-eclampsia? (2)

A
  • ≥ 1 high risk factor

AND/OR

  • ≥ 2 moderate risk factors
212
Q

Outline the drug of choice for reversing respiratory depression caused by magnesium sulphate in the treatment of eclamptic siezures?

A

Calcium gluconate

213
Q

Outline the features of a threatened miscarriage? (2)

A
  • PV bleeding +/- pain

- Closed cervical os

214
Q

When should lithium levels be checked post-dosing?

A

12 hours after the administration of the dose

215
Q

Outline the criteria for colposcopy referral in women taking part in cervical smear test screening? (3)

A
  • One positive hrHPV test result with cytological atypia
  • Three successive positive hrHPV test results without cytological atypia
  • Two sucessive inadequate samples
216
Q

Outline the diagnostic critera for polycystic ovarian syndrome (PCOS)? (3)

A

Must have ≥ 2 of the following<br></br>- Infrequent or no ovulation (oligomenorrhoea or amenorrhoea)<br></br>- Clinical or biochemical signs of hyperandrogenism or elevated levels of total or free testosterone<br></br>- Polycystic ovaries as seen on ultrasound or increased ovarian volume

217
Q

Outline the main risk factors associated with placenta accreta? (7)

A
  • Previous caesarian section
  • Previous pelvic inflammatory disease
  • Previous placenta accreta
  • Previous endometrial curettage procedures
  • Multigravida
  • Increased maternal age
  • Low-lying placenta or placenta praevia
218
Q

Outline the only definitive management option in cases of adelayed placental delivery with placenta accreta?

A

Hysterectomy with placenta in situ

219
Q

Outline the risk factors associated with and increased likelihood of a women having a child with a neural tube defect? (6)

A
  • Previous child with a neural tube defect
  • Diabetes mellitus
  • Taking an anti-epileptic medication
  • Obese (BMI > 30 kg/m2)
  • HIV positive taking co-trimoxazole
  • Sickle cell anaemia
220
Q

Outline the dosing regimen for folic acid supplementation in pregnancy? (2)

A
  • 0.4 mg taken prior to conception until 12 weeks if no increased riskof neural tube defects (NTDs)
  • 5 mg taken prior to conceptionuntil 12 weeks if increased risk of neural tube defects (NTDs)
221
Q

Outline the main markers that are raised in anorexia nervosa? (6)

A

G’s and C’s;

  • Growth hormone; raised
  • Glucose; raised
  • Glands (salivary); enlarged
  • Cortisol; raised
  • Cholesterol; raised
  • Carotin; raised
222
Q

Outline the medications used in the medical termination of pregnancy? (2)

A
  • Mifepristone (anti-progestogen and anti-glucocorticoid)

- At least one dose of misoprostol (prostaglandins)

223
Q

How long must the symptoms of PTSD be present for in order for the diagnosis to be made?

A

4 weeks

224
Q

Outline the triad of features associated with vasa praevia? (3)

A
  • Rupture of membranes
  • Painless vaginal bleeding
  • Fetal bradycardia
225
Q

Outline the threshold haemoglobin values for a diagnosis of anaemia in pregnancy? (3)

A
  • First trimester; Hb > 110 g L-1<br></br>- Second trimester; Hb > 105 g L-1<br></br>- Third trimester; Hb > 100 g L-1
226
Q

Outline when the combined oral contraceptive pill can be recommenced following pregnancy? (2)

A
  • Breastfeeding; ≥ 6 weeks postpartum<br></br>- Not breastfeeding; ≥ 3 weeks postpartum
227
Q

Outline the RCOG Guidance regarding indications for the use of continuous CTG monitoring in labour? (5)

A
  • Suspected chorioamnionitis or sepsis, or a temperature ≥38°C<br></br>- Severe hypertension ≥160/110 mmHg<br></br>- Oxytocin use<br></br>- Presence of significant meconium<br></br>- Fresh vaginal bleeding that develops in labour
228
Q

Which antibiotic is used as GBS prophylaxis in women with a pyrexia > 38°C during labour?

A

Benzylpenicillin

229
Q

Outline the triad of features associated with Meig’s syndrome? (3)

A
  • A benign ovarian tumour<br></br>- Ascites<br></br>- Pleural effusion
230
Q

How long after caesarian section must you wait before re-inserting an IUD or IUS?

A

4-6 weeks

231
Q

Where should you assess for a pulse in an infant (> 1 years of age)? (2)

A
  • Brachial

- Femoral

232
Q

Which organism is most commonly associated with causing pelvic inflammatory disease (PID)?

A

Chlamydia trachomatis

233
Q

Outline the main features that can be assessed in patients with a congenital diaphragmatic hernia that can give a prognostic indication? (2)

A
  • Liver position; liver in the thoracic cavity is a poor prognostic factor
  • Lung-to-head ratio; a ratio >1.0 reflects a better outcome
234
Q

Outline the tetrad of features associated with progressive supranuclear palsy (PSP)? (4)

A
  • Postural instability
  • Impaired vertical gaze
  • Parkinsonism
  • Frontal lobe dysfunction (disinhibition)
235
Q

Outline the differences between mania and hypomania?

A

-Mania is a persistently elevated mood state with psychotic symptoms such as delusions<br></br>- Hypomania describes manic symptoms lasting less than 7-10 days without the presence of psychotic symptoms

236
Q

Outline the primary indication for a referral to the midwife-lead breastfeeding clinic?

A

Breastfed baby that has lost ≥10% of its bodyweight within the first week of life

237
Q

Which specific organism is responsible forGroup B Streptococcal disease (GBS)?

A

<i>Streptococcus agalacticae</i>

238
Q

How common is a reoccurance of postpartum psychosis in subsequent pregnancies?

A

Between 25-50%

239
Q

Outline the peak incidence of acute lymphoblastic leukaemia (ALL)?

A

Aged 2-5

240
Q

What is the most common cardiac pathology associated with Duchene Muscular Dystrophy (DMD)?

A

Dilated cardiomyopathy

241
Q

Outline the main causes of an ataxic gait? (8)

A

PASTRIES;

  • Posterior fossa tumour
  • Alcohol
  • Multiple sclerosis
  • Trauma
  • Rare causes
  • Inherited ataxias (Friedreich’s, episodic ect.)
  • Epilepsy treatment
  • Stroke
242
Q

Which tool is recommended by NICE for the early recognition of stroke in A&E?

A

Rosier Score

  • Loss of consciousness or syncope = -1
  • Seizure activity = -1
  • New onset asymmetric facial weakness = +1
  • New onset asymmetric arm weakness = +1
  • New onset asymmetric leg weakness = +1
  • New onset speech disturbance = +1
  • New onset visual field defect = +1
243
Q

When should magnesium infusions be stopped following an eclamptic siezure?

A

Within 24 hours of delivery and/or the last seizure

244
Q

What is the most common complication of a surgical termination of pregnancy (TOP)?

A

Infection; occurs in around 10% of TOP

245
Q

Which anti-epileptic is most commonly associated with weight gain?

A

Sodium valproate

246
Q

Which spinal tracts are most commonly affected in subacute combined degeneration of the spinal cord? (2)

A
  • DC-ML system; loss of fine touch and proprioception

- Lateral corticospinal tracts; muscle weakness and hyperreflexia (UMN lesion)

247
Q

What is the recommended compression:ventilation ratio for the newborn?

A

3:1 (compressions:ventilations)

248
Q

Which antibiotic should be used in the treatment of children with pneumonia where the causitive organism is though to be <i>Mycoplasma pneumoniae?</i>

A

Erythromycin or other macrolide

249
Q

Which antiepileptic is commonly associated with causing folate deficiency?

A

Phenytoin;it is believed that it induces intestinal pH changes affecting the enterohepatic circulation of folate

250
Q

Outline the main indications for electroconvulsive therapy (ECT)? (3)

A
  • Catatonia
  • Prolonged or severe manic episode
  • Severe depression that is life-threatening
251
Q

Outline the most common side effect assocatied with clozapine?

A

Constipation/intestinal obstruction; thought to be mediated by its anticholinergic effects

252
Q

When does the moro reflex typically disappear?

A

Between 3-4 months of age

253
Q

Outline the main risk factors associated with placental abruption? (10)

A

ABRUPTION;

  • Abruption previously
  • Blood pressure; hypertension or pre-eclampsia
  • Ruptured membranes (P-PROM)
  • Uterine injury; usually abdominal trauma
  • Polyhydramnios
  • Twins; or other multiple gestation
  • Infection; especially chorioamnionitis
  • Older age; > 35 years
  • Narcotic usage; cocaine, amphetamines, smoking
254
Q

Outline the main indications for a surgical management of miscarriage (SMOM)? (4)

A
  • Maternal sepsis
  • Heavy vaginal bleeding
  • Haemodynamic instability
  • Trophoblastic disease
255
Q

How does ovarian cancer initially spread?

A

Via local invasion within the pelvic regions

256
Q

What the main risk factor associated with zopiclone use in the elderly?

A

Increased risk of falls

257
Q

Outline the first-rank symptoms of Schizophrenia? (4)

A

ABCD<br></br>- Auditory hallucinations; 2nd and 3rd person<br></br>- Broadcasting of thoughts; withdrawal, insertion<br></br>- Controlled emotions and actions; passive impulsivity phenomena<br></br>- Delusional perceptions

258
Q

Outline the first-line treatment offered to children and young people with anorexia nervosa?

A

Anorexia focused family therapy is the first-line treatment for children and young people with anorexia nervosa

259
Q

Outline the features associated with fetal alcohol syndrome? (6)

A

Fetal Alcohol Syndrome<br></br>- Microcephaly<br></br>- Short palpebral fissures<br></br>- Hypoplastic upper lip<br></br>- Absent philtrum<br></br>- Reduced IQ<br></br>- Variable cardiac abnormalities

260
Q

Outline the gold-standard investigation for a patient with suspected endometriosis?

A

Laparoscopy

261
Q

What are the two main causes of hypercalcaemia secondary to cancer? (2)

A
  • Bone metastases; raised phosphate and ALP along with Ca2+
  • Paraneoplastic syndrome; SCC can secrete PTH-like hormone
262
Q

What is the most common cause of primary postpartum haemorrhage (PPH)?

A

<div>Uterine atony is the most common cause of primary postpartum haemorrhage (PPH)</div>

<div><br></br></div>

263
Q

At what age should the average child start to smile?

A

6 weeks

264
Q

Outline the clinical signs that may be associated with chorioamnionitis? (3)

A
  • Fetal tachycardia
  • Maternal leukocytosis
  • Prulent cervical discharge
265
Q

Outline the features of complex regional pain syndrome (CRPS)? (5)

A

PORTS

  • Pain
  • Oedema
  • Restricted movement
  • Temperature/colour change
  • Stiffness
266
Q

Outline the treatment of choice for a <i>Phthirus pubis</i> (pubic lice) infestation?

A

Insecticides; either malathion (organophosphate) lotion or permethrin cream (synthetic pyrethroid)

267
Q

How many doses of tetanus vaccine generally confers life-long protection?

A

In the UK, 5 doses of the tetanus vaccine are given over the course of the routine immunisation schedule

268
Q

Outline the acid-base disturbance most commonly associated with ethylene glycol poisoning?

A

Metabolic acidosis with a high anion gap and high osmolar gap

269
Q

Why is it important to correct vitamin B12 deficiency before correcting folate deficiency in patients who have a dual deficiency?

A

Vitamin B12 is needed as part of folate metabolism and hence by increasing folate first in isolate, you will further deplete vitamin B12 levels which may lead to complications such assubacute combined degeneration of the spinal cord

270
Q

Outline the triad of features associated with normal pressure hydrocephalus (NPH)? (3)

A

NPH: Wet, Wacky & Wobbly<br></br>- Dementia<br></br>- Ataxia <br></br>- Urinary incontinence

271
Q

What is considered the threshold temperature for a fever in children?

A

> 37.5°C (99.5°F)

272
Q

Outline the key stages of ongoing advanced life support (ALS)? (3)

A
  • Rhythm check plus shock (if appropriate) every 2 minutes or after every 5 cycles of chest compressions and ventilations at 30:2
  • 1 mg of adrenaline (if appropriate) every 3-5 minutes or after every other rhythm check
  • 150 mg of amiodarone (if appropriate) after 5 shocks
273
Q

Which scoring systems can be used to differentiate bacterial causes of tonsilitis/pharyngitis? (2)

A
  • Centor criteria

- Fever PAIN criteria

274
Q

Outline the components of the Centor criteria for identifying bacterial causes of pharyngitis/tonsilitis? (4)

A
  • Presence of tonsillar exudate = +1
  • Tender cervical lymphadenopathy = +1
  • History of fever = +1
  • Absence of cough = +1

The higher the score the greater the likelihood of a bacterial infection

275
Q

Outline the components of the FeverPAIN criteria for identifying bacterial causes of pharyngitis/tonsilitis? (5)

A

<b><u>FeverPAIN;</u></b><br></br>- <b><u>F</u></b>ever over 38°C = 1<br></br>- <b><u>P</u></b>urulence (pharyngeal or tonsillar exudate) = 1<br></br>- <b><u>A</u></b>ttend rapidly (over 3 days or less) = 1<br></br>- <b><u>I</u></b>nflamed tonsils = 1<br></br>- <b><u>N</u></b>o cough or coryza = 1<br></br><br></br><br></br>The higher the score the greater the likelihood of a bacterial infection

276
Q

How can you differentiate placenta praevia from a threatened miscarriage?

A

Both cause painless PV bleeding however placenta praevia will present much later in pregnancy (> 20 weeks)

277
Q

Outline the thresholds for diagnosis of delayed third stage of labour? (2)

A
  • Physiological management; no delivery of placenta within 60 minutes of deliver of the fetus<br></br>- Active management; no delivery of placenta within 30 minutes of deliver of the fetus
278
Q

Outline the difference in terms of agents used for medical management of miscarriage and medical termination of pregnancy? (2)

A
  • MMOM; vaginal misoprostol only

- M-TOP; vaginal misoprostol plus vaginal mifepristone

279
Q

Outline the main differences between bipolar I and bipolar II?

A
  • Bipolar I is characterised by fluctuating episodes of depression and mania<br></br>- Bipolar II is charactersied by fluctuating episodes of depression and hypomania without progression to mania
280
Q

Outline the first-line choice of medication used to treat an acute manic episode?

A

Antipsychotic; olanzapine, haloperidol, quetiapine or resperidone

281
Q

Outline the main types of delusion seen in schizophrenia? (5)

A
  • Delusional jealousy; ‘my wife is cheating on me’<br></br>- Erotomanic delusions; ‘Justin Bieber is in love with me’<br></br>- Grandiose delusions; ‘I have cured cancer’<br></br>- Nihilistic delusions; ‘my body is rotting’<br></br>- Persecutary delusions; ‘my neighbours are plotting to harm me’
282
Q

Outline the main types of peripheral neuropathies? (3)

A
  • Mononeuropathies; single nerve palsies<br></br>- Radiculopathies; single nerve root palsies<br></br>- Polyneurophaties; multiple nerve palsies
283
Q

Outline how to carry out and interpret Hoover’s test? (4)

A
  • Patient asked to flex the hip of the unaffected lower limb
  • Functional hemiparesis will result in extension of the contralateral (affected) lower limb
  • This can be felt as downward pressure at the heel of the affected lower limb; this is Hoover sign positive
  • In an organic deficit, there will be no such pressure felt at the heel of the affected limb; this is Hoover sign negative
284
Q

Which organism is the most common cause of otitis externa (swimmers ear)?

A

<i>Pseudomonas aeruginosa</i>

285
Q

Outline the triad of features commonly associated with reactive arthritis? (3)

A

‘Can’t see, pee or climb a tree’

  • Uveitis
  • Urethritis
  • Polyarticular arthralgia
286
Q

Which scoring system can be used to assess the severity of symptoms seen in hypermesis gravidarum?

A

The Pregnancy-Unique Quantification of Emesis (PUQE) score

287
Q

Outline the Salter-Harris Classification of paediatric growth plate fractures? (5)

A
  • Class I; fracture through the physis/growth plate only (x-ray often normal)<br></br>- Class II; fracture through the physis and the metaphysis<br></br>- Class III; fracture through the physis and the epiphysis to include the joint<br></br>- Class IV; fracture through the physis, metaphysis and the epiphysis<br></br>- Class V; crush injury involving the physis (x-ray may be normal)
288
Q

What is the difference between circumstantiality and tangentiality?

A
  • Circumstantiality; a feature of anxiety and/or hypomania where a patient is unable to answer questions without giving excessive and unnecessary detail before returning to answer the original point<br></br>- Tangentiality; a feature of psychosis where patient will wander off on a tangent whilst answering the question never to return to answer the point without direction from the interviewer
289
Q

What is the difference between flight of ideas and Knight’s move?

A
  • Flight of ideas; a feature of mania, where there are leaps from one topic to another but with discernible links between them<br></br>- Knight’s move; a feature of scizophrenia where there are unexpected and illogical leaps from one idea to another with no discernible links between them
290
Q

Which endocrine disorder is most commonly known to develop as a result of chronic lithium toxicity?

A

Hypothyroidism

291
Q

Which drugs are used first line in the treatment of post-traumatic stress disorder (PTSD)? (2)

A
  • SSRIs; sertraline

- SNRIs; venlafaxine

292
Q

Outline the difference between an obsession and a compulsion?

A
  • An obsession is an intrusive, unpleasant and unwanted thought.
  • A compulsion is a senseless action taken to reduce the anxiety caused by the obsession
293
Q

Outline the features associated with congenital rubella syndrome? (2)

A
  • Sensorineural deafness; manifests during newborn hearing screen<br></br>- Congenital cataracts; manifests as absent fundal reflexes
294
Q

Which scoring system is used to assess the likelihood of septic arthritis in children?

A

Kocher’s criteria

295
Q

Outline the difference between rigidity and spasticity?

A
  • Velocity independant hypertonia (rigidity) is caused by an extrapyramidal lesions (rubrospinal or vestibulospinal tracts)
  • Velocity dependant hypertonia (spasticity) is caused by a pyramidal lesions (upper motor neurones of the corticospinal tract)
296
Q

Outline the main examples of first-generation (typical) and second generation (atypical) antipsychotics? (2)

A
  • First-generation (typical) antipsychotics; haloperidol, chlorpromazine
  • Second generation (atypical)antipsychotics; olanzapine, risperidone, clozapine, aripiprazole
297
Q

Outline the window of time in which chorionic villous sampling (CVS) and amniocentesis can be performed? (2)

A
  • Chorionic villous sampling (CVS); between the 11th and 13th week of gestation <br></br>- Amniocentesis; from 15 weeks gestation onwards
298
Q

Outline the most common complications of chickenpox (VZV)? (4)

A

PAED<br></br>- Pneumonia<br></br>- Arthritis, nephritis and pancreatitis<br></br>- Encephalitis; cerebellar involvement may be seen<br></br>- Disseminated haemorrhagic chickenpox

299
Q

What is the most sensitive ECG finding associated with a pulmonary embolism?

A

T wave invesion in leads V1-V3 and lead III

300
Q

Outline the main causes of menorrhagia? (7)

A

PERIODS;

  • Polyps (endometrial/cervical), pelvic inflammatory disease (PID)
  • Endometriosis, endometrial hyperplasia/carcinoma
  • Really severe hypothyroidism
  • Intrauterine contraceptive device (IUD)
  • Ovarian cysts (PCOS)
  • Dysfunctional uterine bleeding (idiopathic)
  • Submucosal fibroids
301
Q

When is the Newborn Blood Spot test (heel prick test/Guthrie card) carried out as part of routine neonatal screening and why is this?

A

Between day 5 and day 8 after birth; this allows the baby to have established feeding and hence for any metabolic abnormalities to have manifested in their bloods

302
Q

When in pre-eclampsia most common diagnosed during pregnancy?

A

Majority of cases (≥ 85%) occur after 34 weeks gestation

303
Q

Which two immunoglobulins are associated with antiphospholipid syndrome (APLS)? (2)

A
  • Anti-cardiolipin antibody (ACA)

- Lupus anticoagulant (LAC)

304
Q

Which other autoimmune condition is antiphospholipid syndrome (APLS) known to be associated with?

A

Systemic lupus erythematosus (SLE); hence ANA and anti-dsDNA testing should be carried out in all patients diagnosed with APLS

305
Q

Outline the management of antiphospholipid syndrome (APLS) in pregnancy?

A

Oral low-dose aspirin and low-molecular-weight subcutaneous heparin from the time of a positive pregnancy test

306
Q

Outline the triad of features associated with endometriosis? (3)

A
  • Dysmenorrhoea
  • Dyspareunia
  • Infertility
307
Q

At what age is the combined oral contraceptive pill (COCP) no longer suitable for the management of menorrhagia?

A

> 35 years the COCP is not licensed for the management of menorrhagia

308
Q

Why is that the activated thromboplastin time (APTT) is paradoxically prolonged in patients with antiphospholipid syndrome (APLS)?

A

The activated thromboplastin time (APTT) assay uses phospholipids as reagents. As lupus anticoagulants bind to phospholipids, the presence of these antibodies in the sample falsely prolongs this time and gives the appearance of anti-coagulation when in fact the condition is characterised by a pro-coagulable state

309
Q

Outline the management stages of urge incontinence/overactive bladder (UI/AOB)? (2)

A
  • Conservative management; minimise caffeine and alcohol, bladder drill retraining
  • Medical; tolterodine, oxybutynin, mirabegron
310
Q

What is the threshold level of body mass index (BMI) below which ovulation is unlikely to occur?

A

< 18 kg m-2

311
Q

Outline the management of anorexic amenorrhoea? (3)

A
  • Encourage normal eating and avoid overexercising
  • Refer to eating disorders unit
  • Prescribe oestrogen replacement to prevent osteoporosis
312
Q

What feature seen on fundoscopy is classically associated with papilloedema and signs of raised intracranial pressure (ICP)

A

Blurred optic disk margins

313
Q

Which organisms are most commonly associated with cerebral abscess formation secondary to parameningeal infections?

A
  • <i>Staphylococci</i>

- <i>Streptococci</i>

314
Q

What category of dysfunction results from lesions in the frontal lobe?

A

Impaired executive function; decision making, adaptable thinking, planning, self-monitoring, self-control, working memory, time management, and organisation

315
Q

Which special stain can be used to identify iron deposits in hereditary haemochromatosis?

A

Perl’s Prussian Blue

316
Q

What are the three most common causes of a persistent dry cough despite normal chest X-ray? (3)

A
  • Asthma
  • Sinusitis and postnasal drip
  • Reflux oesophagitis
317
Q

Which organism is most commonly associated with pericarditis?

A

Coxsackie B virus

318
Q

Outline the association between alcoholism and Cushing’s syndrome?

A

Excess alcohol ingestion triggers excess ACTH release from the anterior pituitary which triggers adrenal hypertrophy and thus features of Cushing’s syndrome

319
Q

Outline the imaging modality used in the diagnosis of end-stage renal failure?

A

Renal ultrasound; accurately size the kidneys
and identify obvious causes for renal failure, such as polycystic kidney disease or obstruction causing bilateral hydronephrosis

320
Q

Outline the symptoms of end-stage renal failure? (6)

A
  • Nausea
  • Anorexia
  • Weight loss
  • Fatigue
  • Pruritus
  • Cramps
321
Q

Which investigation should be carried out within 24 hours in all patients with suspected pyelonephritis?

A

Renal ultrasound; to exclude any evidence of obstruction

322
Q

Which antibiotics regimens are used in the treatment of pyelonephritis? (2)

A

2-week course with follow-up urine culture

  • Gentamicin and ampicillin
  • Ciprofloxacin
323
Q

Outline the associated between Cushing’s syndrome and hypokalaemia. What does this imply about the aetiology?

A

The finding of hypokalaemia on a background of features of Cushing’s syndrome suggests an ACTH-dependant adrenal excess. This could either be from a pituitary adenoma as in Cushing’s disease or from ectopic ACTH release by small cell lung cancers (SCLC)

Final MB Part II - Short Answer Questions (3 decks)

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