passmed 28/12

Question 1

a low lying placenta is found at the 20 week anatomy scan. what happens next?

Answer 1

Rescan at 32 weeks, which allows for potential correction due to natural uterine growth upwards

Question 2

classical triad present in disseminated gonococcal infection

Answer 2

tenosynovitis
migratory polyarthritis
dermatitis

later complications can manifest as Fitz-Hugh-Curtis syndrome: perihepatitis, septic arthritis, endocarditis

Question 3

nephrotic syndrome triad

Answer 3

hypoalbuminaemia
oedema
proteinuria

children most common cause = minimal change disease, no renal complications seen on blood results. Responds well to steroids.

Question 4

Pre eclampsia

Answer 4

new onset hypertension >140 after 20 weeks + 1 or more of proteinuria ++/+++ or evidence of end organ involvement e.g. neurological, renal, etc.

If new reading >160, ADMIT for obstetric review.

Question 5

blood pressure targets for all patients under 80 years old

Answer 5

clinic <140/90

home <135/85

Question 6

why is the APTT raised in antiphospholipid syndrome?

Answer 6

APS is a prothrombotic condition. The platelets are all used up in clotting, so none are left and paradoxically raising the APTT,

Question 7

vwb disease causes more mucosal type bleeding, but haemophilia more haemarthroses.

Question 8

stereotypical PCOS biochemical results

Answer 8

FSH:LH ratio raised

testosterone normal or mildly elevated

SHBG normal to low

Question 9

PCOS can be diagnosed if 2/3 of the criteria are met:

Answer 9

Clinical features of hyperadrogenism e.g. acne, hirsutism

PCOS on TVUS

Biochemical features of hyperandrogenism e.g. raised FSH:LH, normal to slightly elevated testosterone, low SHBG.

Question 10

Management of latent TB

Answer 10

rifampicin and isoniazid (with pyridoxine)

latent TB = positive IGRA test, no CXR or symptoms

rifamycins are contraindicated in patients with HIV or have undergone organ transplantation

Question 11

Why is pyridoxine (vitamin B6) given in TB treatment?

Answer 11

To prevent the peripheral neuropathy that can be brought on by isoniazid

Question 12

pulmonary stenosis results in what type of heart failure?

Answer 12

right sided heart failure, with raised JVP, hepatomegaly and ankle oedema.

Question 13

maternal GD is a risk factor for neonatal hypoglycaemia. How do you manage neonatal hypoglycaemia?

Answer 13

If symptomatic OR very low blood glucose, admit to NICU and give IV 10% dextrose.

Symptoms would include jitteriness and irregular respirations.
IV dextrose is to prevent neurological complications such as seizures, coma or apnoea

Question 14

features of osteomalacia

Answer 14

bone pain, tenderness over long bones, proximal myopathy causing waddling gait

due to vitamin D deficiency