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Obstetrics, Gynaecology And Paediatrics > Passmed > Flashcards

Passmed Flashcards

1
Q

Patient in labour with pyrexia, suspected Group B strep infection. Give?

A

Benzylpenicillin as prophylaxis. Vancomycin if pen allergy

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2
Q

Symptoms of intussuseption and investigations?

A

Intermittent severe crampy abdo pain, drawing up of knees, bilious vomiting, red currant jelly blood stained stools

Can present in young or infants

Inv: ultrasound

Rx: air insufflation or surgery

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3
Q

Labial lump, pruritus, inguinal lymphadenopathy. Older female. Diagnosis?

A

Vulval carcinoma. May be bleeding secondary to ulceration

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4
Q

What is a Bartholin’s cyst?

A

Occlusion to Bartholin’s gland causing unilateral labial swelling. Can cause pain when walking and dyspareunia. Women of childbearing age.

UNLIKELY vulval itching which is more Lichen or vulval carcinoma

Bartholin’s glands secrete fluid that acts as a lubricant during sex

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5
Q

Presentation of an infected Bartholin’s cyst?

A

Bartholin’s or labial abscess. Acutely painful labial swelling with overlying erythema and systemic symptoms including fever. Inguinal lymphadenopathy
So fever, pain and erythema

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6
Q

Respiratory distress syndrome - presentation and risk factors?

A

Tachypnoea, intercostal recession, expiratory grunt, cyanosis. Ground glass opacification on CXR.
RFs: male, GDM, CS
Rx: prevention by corticosteroids, assisted ventilation, exogenous surfactant via ETT

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7
Q

7y/o presents with vulval/anal itching. Area erythematous from itching. Dx?

A

Threadworm - highly transmissible so ALL members of household should be treated.
Rx: single dose of mebendazole for the household and give hygiene advice

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8
Q

Treatment for GDM? Thresholds?

A

Do OGTT
If levels are >7 at time of diagnosis commence SHORT-ACTING insulin (for GDM it’s short acting)
If <7 then trial diet and exercise but if symptoms don’t improve in 1-2 weeks then metformin

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9
Q

Management of pre-existing DM in pregnant women?

A

Weight loss
Stop oral hypoglycaemics except metformin
Folic acid 5mg/day from pre-conception to 12 weeks gestation

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10
Q

When is VBAC appropriate?

A

For pregnant women >37 weeks with a SINGLE previous CS by low transverse incision

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11
Q

Presentation of Rickets?

A

Bow legs (younger children) and knock knees in older children. Kyphoscoliosis. Aching horned and joints. Bossing of forehead. Waddling gait.

Rickets describes inadequately mineralised bone in developing and growing bones, resulting in soft and easily deformed bones.

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12
Q

Paediatric BLS

A

Unresponsive
Open airway
5 rescue breaths then check for signs of circulation with brachial or femoral pulse
15:2 compressions

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13
Q

Causes of ambiguous genitalia neonates

A

Most common is congenital adrenal hyperplasia
Kallman’s - phenotypically male but have hypog hypog. No ambiguous genitalia
Androgen insensitivity syndrome - phenotypically female but no ambiguous genitalia

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14
Q

Rx of patent ductus arteriosus?

A

Indomethacin given to neonate in postnatal period, NOT TO MOTHER ANTENATALLY

Signs: L subclavicular thrill, MACHINERY MURMUR, collapsing pulse, heaving apex beat

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15
Q

Efficacy of emergency contraception?

A

Levonorgestrel - 72 hours after UPSI
Ulipristal - 96 hours after UPSI but CId with asthma
IUD - within 5 days of UPSI. If more than 5 days, then IUD can be fitted up to 5 days after the likely ovulation date

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16
Q

Symptoms of placental abruption with dilated pupils and brisk reflexes. Dx?

A

Cocaine abuse

DDx
HELLP syndrome - anaemia, low platelets
Heroin/opioid abuse - pinpoint pupils; not associated with abruption
Pre-eclampsia
DIC - rule out if clotting panel normal

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17
Q

Post-menopausal bleeding. What are you thinking?

A

Endometrial cancer. Other RFs for increased oesterogen: HRT, nulliparity, late menopause, early menses. We do not want unopposed oestrogen so addition of progestogen is important. Tamoxifen is an RF.

Inv: TVUS for endometrial thickness. If thickened, then hysteroscopy with endometrial biopsy

All women >55 with post-menopausal bleeding should be referred on 2WW for TVUS +- hysteroscopy with endometrial biopsy

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18
Q

Whooping cough presentation?

A

Paroxysmal cough, inspiratory whoop, post-tussive vomiting, apnoeic episodes
Dx: PCR and serology
Rx: infants <6 months admission with supportive care. Otherwise, macrolides eg erythromycin and household contacts given abx prophylactically.
School exclusion: 48 hours after abx or 21 days after onset if not given abx

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19
Q

Management of bacterial meningitis in paediatrics?

A

<3 months - IV amoxicillin & IV cefotaxime
>3 months - just IV cefotaxime. Consider dexamethasone if lumbar puncture reveals purulent CSF, high white cell count or bacteria on gram stain

Bacterial vs viral - petechial non-blanching rash indicates meningococcal meningitis

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20
Q

Child with fever and limp, complaining of hip pain after recent viral illness? Diagnosis?

A

Transient synovitis. Must refer a child with hip pain for same-day assessment to exclude septic joint.
Transient synovitis is self-limiting

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21
Q

Low birth weight is a risk factor for…?

A

Neonatal sepsis

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22
Q

Recurrent febrile seizures in children. Rx?

A

Buccal midazolam (benzodiazepine)
If that fails, then anticonvulsant like PO lamotrigine, phenytoin, PR carbamazepine

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23
Q

Palmar grasp milestone

A

6 months

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24
Q

Draws a circle milestone

A

3 years

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25
Q

Tower of 3-4 blocks milestone

A

18 months

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26
Q

Causes of neonatal sepsis?

A

Group B strep
Transmission of pathogens from environment post-delivery

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27
Q

Investigations for neonatal sepsis and management

A

Blood culture to establish diagnosis
FBC
Blood gases
Urine MC&S

Rx: Benpen with gentamicin
(this is different o meningitis which is amoxicillin and cefotaxime for <6 months and just cefotaxime for >6 months)

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28
Q

CIs to COCP

A

> 35
BMI>35
More than 15 cigarettes per day
Family history of VTE
Breastfeeding <6 weeks postpartum

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29
Q

Presentation of ovarian hyper stimulation syndrome?

A

Women undergoing ovulation induction
Ascites, vomiting, diarrhoea

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30
Q

Patient has tubal ectopic pregnancy. Started on methotrexate but hCG titres fail to fall. Surgery is indicated. Which surgery?

A

NICE guidelines recommend that a salpingectomy is offered to women who have tubal ectopics unless they have other RFs for infertility like contralateral tube damage in which case they do salpingotomy.

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31
Q

Haemophilia, previous right-sided haemarthrosis, swollen knee, 14y/o female. Dx?

A

Turner’s. Haemophilia is an X-linked recessive disorder and would only be expected in males. But as patients with Turner’s have only one X, they may develop X-linked recessive conditions

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32
Q

Part of fallopian tube most associated with risk of rupture?

A

Isthmus

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33
Q

Define pre-eclampsia

A

After 20 weeks gestation
Pregnancy induced HTN
Proteinuria

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34
Q

What is used to prevent seizures in patient s with pre-eclampsia and treat seizures once they develop?

A

MgSO4. Monitor RESP RATE AND REFLEXES with this treatment. If respiratory depression occurs, need calcium gluconate

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35
Q

Causes of bleeding in the first trimester

A

Miscarriage
Ectopic
Implantation bleeding
Cervical ectropion
Vaginitis
Polyps

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36
Q

Common intolerance after viral gastroenteritis

A

Lactose

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37
Q

Correct position for cord prolapse

A

On all fours, knees and elbows

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38
Q

First investigation for pyloric stenosis

A

Abdominal US

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39
Q

Child with cough and weeks presents to ED on background of viral illness. Dx and Rx?

A

Bronchiolitis. Supportive care.

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40
Q

Woman with previous Group B strep. Worried about this pregnancy now. Do we give abx?

A

Maternal IV abx prophylaxis should be offered to women with previous babies with GBS

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41
Q

What is Ebstein’s anomaly?

A

Causes by use of lithium in pregnancy. Causes pansystolic and middiastolic murmur. Enlargement of the right atrium

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42
Q

Levonorgestrel is taken within how long of UPSI?

A

72 Hours

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43
Q

Neonate. Respiratory distress and tinkling sounds heard on auscultation of precordium. Dx and rx?

A

Diaphragmatic hernia - gut has penetrated through hence tinkling sounds in chest. Manage with NG tube to keep the air out of the gut so INTUBATE AND VENTILATE. Definitive rx is surgical repair of hernia

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44
Q

Features of acute epiglottitis

A

Acute onset, relatively normal respiratory try rate, forward lean, stridor.
Contact on call paediatrician, arrange same day review and admission to hospital

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45
Q

Scale used for postpartum mental health problems?

A

Edinburgh postnatal depression scale.
Baby blues go within 3 days so anything beyond is likely postnatal depression

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46
Q

Causes of hypothyroidism

A

Hashimoto’s
Iodine deficiency
Lithium
de Quervain’s thyroiditis
Postpartum thyroiditis

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47
Q

What is postpartum thyroiditis?

A

Autoimmune condition which presents as body transitions back from immunosuppressed state of pregnancy to normal immunity. First they get thyrotoxic phase (hyperthyroid) which is treated with propranolol. Then hypothyroid phase treated with levothyrox

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48
Q

Congenital heart diseases: cyanotic vs acyanotic?

A

Cyanotic
ToF
TGA

Acyanotic
VSD
ASD
PDA
Coarctation of aorta

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49
Q

Infantile colic?

A

Infants less than 3 months: bouts of excessive crying, pulling up of legs, often worse in evening. Reassure and support.
Intussuception is 3m- 3 years and would have diarrhoea and vomiting

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50
Q

First line for vaginal candiadasis (thrush)?

A

Oral fluconazole. Intravaginal pessary for those who can’t have PO with unsafe swallow

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51
Q

Differentiate CAH and androgen insensitivity syndrome

A

Androgen insensitivity - genetically XY but phenotypically female due to reduced/absent TST receptors in target tissue. X-linked. Masses in adnexa due to undescended testes.

CAH - excess androgen production causing precocious puberty and early onset of pubic hair. Females have ambiguous genitalia and vitalisation but males have normal genitalia at birth.

52
Q

Threadworm rx?

A

Single dose of mebendazole for entire household and hygiene advice

53
Q

Harsh cough in infant. DDx?

A

Cough in bouts that turns them red and vomiting - pertussis

Bronchiolitis - wheeze

Fever and chest pain - TB, pneumonia

54
Q

Eclampsia post natal treatment

A

MgSO4 should continue for 24 hours after delivery or after last seizure

55
Q

Limping child under 3?

A

Bloods to rule out septic arthritis
XR to rule out fracture
Always have specialist referral under 3 to rule out septic arthritis

56
Q

Sheehan’s?

A

Reduced function of the pituitary gland due to ischaemic necrosis due to hypovolaemic shock when giving birth to their child. Therefore amenorrhoea, problems with milk production and hypothyroidism

57
Q

Infantile colic vs infantile spasms?

A

In infantile spasms the child gets distressed between spasms. In colic the child becomes distressed during the spasms. Do an EEG

58
Q

Henoch Schonlein purpura distribution?

A

Buttocks, extensor surfaces, arms and legs.

59
Q

Investigation of choice in adenomyosis (presence of endometrial tissue in myometrium)?

A

MRI pelvis

60
Q

Reduced foetal movements past 28 weeks. What to do?

A

Handheld Doppler. If no foetal heartbeat detected then immediate USS

61
Q

How many days does a patient wait to resume hormonal contraception after ulipristal emergency contraception?

A

5 days

62
Q

POI FSH/LH?

A

High FSH and LH

63
Q

DVT or PE in pregnancy. Inv and Rx?

A

Suspected DVT - duplex USS
Suspected PE - duplex USS. If confirmed no further treatment. Otherwise do VQ next. If PE is suspected, then even before VQ give LMWH.

Note DOACs, warfarin and thrombolysis are all CId in pregnancy

64
Q

Heel prick test for?

A

CF, congenital hypothyroidism, sickle cell disease. If immunoreactige trypsingen is raised then may indicate CF. so then we do wear test

65
Q

Pericarditis ECG finding besides saddle-shaped ST elevation?

A

PR depression

66
Q

Investigation of choice for ?aortic dissection

A

CT CAP

67
Q

Child presents with round rash with pale pink Centre. Preceding symptoms are cough and sore throat. Now become lethargic and developed aches and pains. Dx?

A

Rheumatic fever due to Group A strep. Treat with Penicillin V

Rheumatic fever: sore throat, rash, arthritis, murmur.

68
Q

Secondary prevention of ACS meds?

A

ACEi, beta-blocker, statin, aspirin, ticagrelor

69
Q

Investigations for acute angle closure glaucoma?

A

Gonioscopy and tonometry

70
Q

Hypercalcaemia presentation?

A

Bones, stones, moans, psychiatric overtones. Might be prone to renal calculi. Low mood. Abdo pain, chnage in bowel habit.
You’re less of a cutie (QT) when you’re grumpy so shortened QT interval.

Hypokalaemia is prolonged QT (I’m 0-K with that tall QT). 0 K as in no potassium and tall QT as in prolonged QT

71
Q

Suspected aortic dissection. Can’t do CT angiogram of chest, abdo and pelvis as pt clinically unstable. Next?

A

TOE

note patients with Ehlers Danlos often get aortic dissection so hyper motility of joints, translucent looking skin, colon perforation are all signs the dissection is secondary to Ehlers

72
Q

In angina do not use a beta blocker with…?

A

Verapamil - risk of complete heart block

73
Q

First line angina

A

CCB or beta blocker
If CCB - verapamil or diltiazem
If CCB needed in combo with a beta blocker, then use use amlodipine instead of verap or diltiaz with the beta blocker

Do not prescribe verapamil with a beta blocker as risk of complete heart block

74
Q

Patient with CKD prescribed new medication. Already on statins. Develops muscle aches and dark urine. What medication?

A

Clarithromycin - this is an inhibitor of the P450 system and interacts with statins

Leads to increased levels of atorvastatin by reduced metabolism= more likely to develop rhabdomyolysis. Risk esp high for CKD pt

75
Q

SEs ACEi?

A

Cough, hyperkalaemia, angioedema

76
Q

Causes of prolonged QTc?

A

TCAs
SSRIs esp citalopram
Haloperidol
Ondansetron
Hypocalcaemia, hypokalaemia, hypoMg2+

77
Q

Suspected dry AMD. Test?

A

Amsler grid

78
Q

Side effects of amiodarone

A

Grey skin, bradycardia

79
Q

SVT Rx? Stable pt.

A

Vagal maneouevres then 6mg IV adenosine

80
Q

Thiazides can cause which electrolyte abnormalities?

A

Hypokalaemia.

Citalopram: QT prolongation

81
Q

NSTEMI management?

A

Aspirin 300mg and fondaparinux
If they’re going straight for PCI then give unfractionated heparin

How to decide to go for PCI straight away?
GRACE score
Unstable patients go for PCI straight a way as do pts with GRACE score >3%

82
Q

Eyelid margins sore. Dx?

A

Blepharitis - remove debris from eyelid margins and hit compresses

83
Q

Pts of Afro-Caribbean origin what to give after CCB?

A

ARB rather than ACEi

84
Q

ST elevation in V5 and V6 is what territory and which artery?

A

Lateral leads and left circumflex

85
Q

In ALS if IV access cannot be obtained then what route should be used?

A

Interosseous line insertion in proximal tibia or proximal humerus

Why not:
IM - drug absorption too slow
Rectally - absorption too slow and rectal preparations need to be made
ETT - absorption through alveoli; OS better
Central line - if central line already present then this can be used. If not, then intraosseous

86
Q

Hirschprung’s investigation and Rx?

A

Inv: AXR and rectal biopsy
Rx: rectal washouts/bowel irrigation. Definitive management is surgery to affected part of colon (anorectal pullthrough)

87
Q

How does Meckel’s diverticulum present?

A

Like appendicitis but with bleeding

88
Q

What age do febrile convulsions stop?

A

5 years

89
Q

How long before upper GI endoscopy should PPIs be stopped?

A

2 weeks - so that the pathology can be recognised

90
Q

Prophylaxis of cluster headaches versus migraines?

A

Cluster use verapamil
Migraines use propanolo

91
Q

What to do in a patient with an upper GI bleed eg oesophageal varies secondary to liver disease?

A

ABCDE
Correct clotting: FFP, vit K, platelets
Terlipressin and prophylactic abx before endoscopy
Band ligation
Sengstaken-Blakemore tube
TIPSS

Prophylaxis
Propanolol
Band ligation
TIPSS

92
Q

DVLA regs after first seizure clinic?

A

6 months

93
Q

First unprovoked seizure but there ARE structural abnormalities/epileptiform activity on neuroimaging. DVLA?

A

First seizure without any abnormalities is 6 months
But if there is abnormalities then 12 months

94
Q

Pt with dysphasia and halitosis. Coughing at night. Dx?

A

Pharyngeal pouch.
Hiatus hernia would have reflux symptoms esp after eating

95
Q

Oesophageal candiadasis. Common exam Q causes?

A

HIV, steroid inhalers

96
Q

Pt with migraines who is already on an SSRI for depression. Now has been prescribed sumatriptan. Why worry?

A

Serotonin syndrome
Agitation, HTN, twitching muscles, dilated pupils

97
Q

CRVO symptoms?

A

Sudden painless loss of vision, retinal haemorrhage. Swollen optic disc

98
Q

After how long is the COCP effective?

A

After 7 days. Only if taken in first 5 days of cycle then no need for additional contraception. At any other point, need to use condoms for 7 days.

POP effective after 2 days
IUD effective instantly

99
Q

Patient who had an MI then develops syncope and low BP when lying flat. ECG shows Mobitz I. How does this look and Rx?

A

Wenkeback - PR prolongation and then drop a QRS, regularly. Rx - pacing if symptomatic like this pt but nothing if asymptomatic

100
Q

NSTEMI management with and without PCI availability?

A

Angiography not available immediately eg DGH = aspirin and fondaparinux

Angiography available = unfractionated heparin (NOT LMWH) and aspirin. Unfractionated heparin preferred due to easy reversibility with protamine sulfate

Use GRACE score to determine severity

101
Q

GDM - when to start insulin immediately?

A

At the time of diagnosis if the glucose level is >=7 then start insulin immediately
Otherwise it’s diet then metformin then your short acting insulin

102
Q

Breeches presentation increases risk of developmental dysplasia of hip. True or false? Inv?

A

True. Do USS hip

103
Q

Unilateral red eye, pain, epiphora (excessive lacrimation), photophobia, burning around eye. Fluoroscein staining shows linear, branching epithelial defect. Not a contact lens wearer. Dx, Rx?

A

Herpes simplex keratitis
It’s a virus so topical aciclovir

104
Q

Symptoms of dry AMD?

A

Progressive, subacute vision loss, loss of central vision, difficulty seeing in dark or when lights changes from light to dark. Distorted line perception on Amsler. Fundoscopy shows drusen (lipids)

105
Q

AV nicking on fundoscopy?

A

Hypertensive retinopathy
Arteriole crosses venule causing compression of small veins with slight bulge on either side of crossing. Not likely to have change in vision

106
Q

Cotton wool spots on fundoscopy?

A

Hypertensive and diabetic retinopathy. Due to retinal arteriole obstruction causing ischaemia. No changes in vision

107
Q

Cupping of optic disc on fundoscopy?

A

Glaucoma. Happens due to optic nerve damage. Glaucoma presents with blurred vision in peripheries, haloes round lights, poor vision in dark.

108
Q

Vision loss and pain on moving eye. Dx?

A

Optic neuritis
MS, CMV, Lyme disease, herpes

109
Q

Causes of raised ICP?

A

Localised mass eg extradural, subdural, intracerebral
Neoplasms like meningioma, glioma
Abscess
Focal oedema secondary to trauma/infarction/tumour
Disturbance of CSF circulation: obstructive hydrocephalus
Obstruction to major venous sinuses: cerebral venous thrombosis , depressed fractures
Brain oedema: encephalitis, meningitis

110
Q

HSP purpura how does it present?

A

Non-blanching rash affecting legs and buttock, arthralgia and abdo pain

111
Q

IgA nephropathy or PSGN?

A

PSGN is several weeks after initial infection eg tonsillitis (Group A strep). Immune complexes like abs, complement get stuck in glomeruli—> AKI

IgA nephropathy is shorter latency/same time as virus. IgA deposits in nephrons

112
Q

Young boy, webbed neck, pulmonary stenosis, short statute. Dx

A

Noonan syndrome

113
Q

Heart failure. First line is ACEi and beta. Then aldosterone antagonist like spironolactone. Then?

A

SGLT 2 inhibitors like dapagliflozin

Then?
Ivabradine and sacubatril/valsartan
Digoxin

Annual influenza and one-off pneumococcal

114
Q

Management of pericarditis?

A

NSAIDs and colchicine

115
Q

Scleritis associated with which two immunological conditions?

A

RA and SLE

116
Q

Anterior uveitis vs scleritis?

A

Both: red painful eye, watering, photophobia, decreased vision

Ant uveitis has small, irregular pupil, hypopyon

117
Q

CAH presentation?

A

CAHnfused about genitalia

118
Q

Whooping cough in adults present? Rx?

A

Clarithromycin; presents like croup in adults

119
Q

How to define PPH? Rx?

A

> 500ml of blood loss following delivery

Causes of PPH - 4Ts
Trauma
Tone (uterine atony)
Tissue (retained placenta)
Thrombin (clotting/bleeding disorder)

Rx
IV oxytocin, ergometrine, carboprost (CI asthma)
If medical fails then surgical intrauterine balloon tamponade

120
Q

First line for hyperemesis gravidarum?

A

Promethazine and cyclizine

Metoclopramide not recommended for more than 5 days due to extra pyramidal SEs

121
Q

GORD symptoms in 6-week child?

A

Tummy ache, vomiting, crying, milky vomits after feeds, infants less than 8 weeks, often worse after being laid flat

122
Q

Pt with symptoms of PE but has CKD (thus creatinine and urea out of whack). Investigation?

A

VQ as cannot use contrast in patient with CKD

123
Q

Patient with BP greater than 180/120 and new signs of heart failure. Next?

A

Refer for acute medical admission

124
Q

Ectopic pregnancy should be greater than how many mm for consideration of surgical management?

A

35mm

125
Q

Miscarriage management versus ectopic management? Stop getting these confused

A

Miscarriage misoprostol
Ectopic methotrexate

126
Q

Why is dysuria a worrying
symptom in pregnancy?

A

Indicates UTI and this is associated with premature birth/preterm labour

127
Q

Facial lesions and burning pain on forehead. Hutchinson’s sign positive. Dx?

A

Herpes zoster ophthalmicus. Hutchinson’s sign is vesicles go tip of nose which is strongly associated with ocular involvement and warrants urgent Ophthalmological assessment.

HZO is reactivation of herpes zoster affecting ophthalmic branch of trigeminal nerve.

Rx: urgent review by ophthalm and PO antiviral

Obstetrics, Gynaecology And Paediatrics (2 decks)

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