PassMed Questions Flashcards
1
Q
Why and when are irradiated blood products given?
A
To prevent graft versus host disease following a bone marrow or stem cell transplant
2
Q
How may the following present?
Missed miscarriage
Threatened miscarriage
Inevitable miscarriage
Incomplete miscarriage
A
Missed miscarriage - sac with no foetal part seen (closed cervical os)
Threatened miscarriage - painless bleeding with a closed cervical os
Inevitable miscarriage - heavy bleeding with clots, pain and open cervical os
Incomplete miscarriage - not all products of conception have been expelled with heavy bleeding and open cervical os
3
Q
cause of genital warts?
A
HPV
4
Q
Treatment of genital warts?
A
multiple, non-keratinised warts: topical podophyllum
solitary, keratinised warts: cryotherapy
5
Q
What is a common consequence of sub-arachnoid haemorrhage?
A
Syndrome of inappropriate anti-diuretic hormone secretion (SIADH)
6
Q
What two antidepressants should never be combined and why?
A
SSRIs and MAOIs should never be combined as risk of serotonin syndrome
7
Q
What is a major feature of sepsis?
A
Decreased systemic vascular resistance
8
Q
What is often high in cardiogenic shock?
A
Pulmonary artery occlusion
9
Q
Why is cardiac output low in hypovolaemia?
A
decrease preload
10
Q
Signs of Cor Pulmonale/ right sided heart failure?
A
- Raised JVP
- Oedema
- Hepatomegaly
11
Q
Most common cause of infective exacerbation of COPD?
A
1) haemophilus influenza
12
Q
What is known to be a protective factor for endometrial cancer?
A
COCP and smoking
13
Q
treatment of Adenomyosis?
A
Hysterectomy
14
Q
Endometrial Hyperplasia presentation and treatment?
A
Abnormal bleeding (post, inter menstrual/ menopausal)
Tx - high dose progestogens/ intra-uterine system
15
Q
Most common cause of Ambiguous genitalia?
A
Congenital Adrenal Hyperplasia
16
Q
Anorexia biochemical signs?
A
Most things low
Gs and Cs HIGH (cortisol, GH, glucose, salivary glands, cholesterol)
17
Q
Poor prognosis factors of ALL?
A
age < 2 years or > 10 years WBC > 20 * 109/l at diagnosis T or B cell surface markers non-Caucasian male sex
18
Q
What is Palivizumab?
A
Monoclonal antibody used to prevent RSV for those at risk
Immunocompromised, CHD, prematurity
19
Q
What is the difference between AML and ALL on blood film sample?
A
AML - Auer rods, fine chromatin, large cells
ALL - glycogen granules, coarse chromatin, smaller cells
20
Q
Neuroblastoma symptoms?
A
Lump in abdomen
lump in chest
Back pain
bruising round eyes
21
Q
Investigations of Neuroblastoma?
A
Bone marrow aspiration and biospy
normally from pelvic bones
22
Q
Emergency treatment for serious Croup?
A
High flow O2 and nebuliser Adrenaline
23
Q
Treatment of PPH?
A
1st - IM Oxytocin
signs of hypovolaemia? = RESUS
1) bimanual uterine compression to manually stimulate contraction
2) IV oxytocin and/or ergometrine
3) IM carboprost
4) intramyometrial carboprost
5) rectal misoprostol
6) surgical intervention such as balloon tamponade
24
Q
What is a mild/moderate/severe PPH?
A
Mild = 500-1000ml Moderate = 1000-2000ml Severe = Over 2000ml
25
Most common cause of PPH?
Uterine Atony
26
What is Ergometrine contraindicated in?
Hypertension
27
What is Carboprost contraindicated in?
Asthma
28
Placenta Abruption vs Placental Praevia?
```
Pain?
blood colour?
Uterus tender?
General condition?
Lie and presentation?
Foetal heart/ distress?
Coagulation problems?
placenta position?
Associated history?
```
ABRUPTION VS PRAEVIA
```
Pain vs painless
Dark red vs bright red
Tender vs relaxed
Inconsistent with external loss vs consistent with external loss
No malpresentation vs malpresentation
Distressed vs normally okay
Coagulation problems in abruption
Normal position vs low position
Pre-eclampsia/HTN/ trauma vs none
```
29
hereditary non-polyposis colorectal carcinoma disposes you high risk to what cancers?
Colo-rectal 1st
Endometrial 2nd
30
What is cervical excitation seen in?
PID
| Ectopic Pregnancy
31
What is associated with Coarctation of the aorta?
Turner's Syndrome
Bicuspid aortic valve
Berry aneurysms
Neurofibromatosis
32
causes of raised serum alpha-feto-protein (AFP) in pregnancy?
Neural tube defects
Abdominal wall defects
Multiple pregnancy
33
causes of low serum alpha-feto-protein (AFP) in pregnancy?
Maternal DM
Maternal Obesity
Down's Syndrome
Edward's Syndrome
34
Pneumonia treatment in kids?
If the cause is Mycoplasma or chlamydia?
If the cause is associated with influenza?
IV Amoxicillin
Macrolides
Co-amoxiclav
35
what syndromes are associated with:
Bronchiectasis?
Mitral valve prolapse?
supravalvular aortic stenosis?
Bronchiectasis - Kartagener's Syndrome
Mitral valve prolapse - Fragile X Syndrome
supravalvular aortic stenosis - William's Syndrome
36
When do the following reflexes typically disappear?
Moro
Grasp
Rooting
Stepping
Moro - 3/4 months
Grasp - 4/5 months
Rooting - 4 months
Stepping - 2 months
37
SCHOOL EXCLUSION
When should a kid with the following return to school?
glandular fever
No exclusion
38
SCHOOL EXCLUSION
When should a kid with the following return to school?
Coxsackies (hand, foot,mouth)
No exclusion
39
SCHOOL EXCLUSION
When should a kid with the following return to school?
Measles/ Rubella
4 days after onset of rash
40
SCHOOL EXCLUSION
When should a kid with the following return to school?
Mumps
5 days from onset of swollen glands
41
SCHOOL EXCLUSION
When should a kid with the following return to school?
Chickenpox
After all lesions have crusted over
42
SCHOOL EXCLUSION
When should a kid with the following return to school?
Whooping cough (Pertussis)
48hrs after Antibiotics start or 21 days after onset of symptoms / cough
43
SCHOOL EXCLUSION
When should a kid with the following return to school?
Fifth disease (slapped cheek)
No exclusion
44
SCHOOL EXCLUSION
When should a kid with the following return to school?
Impetigo
When all lesions have crusted over or 48hrs after antibiotic commencement
45
SCHOOL EXCLUSION
When should a kid with the following return to school?
Scarlet fever
24hrs after Abx commencement
46
What may Roseola infantum cause?
Febrile convulsions
47
What is Roseola infantum caused by?
human herpes virus 6 (HHV6)
| SIXTH disease!
48
Treatment of threadworm?
Mebendazole single dose
May need another 2 weeks later
49
How does Sheehans Syndrome present?
common complication of PPH (pituitary gland = necrosis manifests as hypopituitarism)
- presents with lack of milk production and amenorrhoea
50
Management of dysmenorrhoea already on long term contraception?
Mefenamic Acid
51
Associations with Hyperemesis Gravidarum?
Nulliparity
Obesity
Trophoblastic disease
Hyperthyroidism
Increased beta hCG
Multiple pregnancies
52
What is associated with a decreased incidence of hyperemesis?
Smoking
53
What is a rare adverse effect of Lamotrigine?
Stevens-Johnson syndrome
(flu like prodrome 2 months after starting anti-convulsant)
(after this, rapid onset red, blistering rash, starting on the trunk extending to face/limbs)
54
Name some localising features of a focal temporal seizure
HEAD
Hallucinations
Emotional
Automatisms (lip smacking, grabbing)
Deja Vu, Dysphasia post-ictal
55
Name some localising features of a focal frontal seizure
Jacksonian march,
post-ictal weakness
head and leg movements
56
Name some localising features of a focal parietal seizure
Paraesthesia
57
Name some localising features of a focal occipital seizure
Floaters, flashes
58
Long term prophylaxis of cluster headaches?
Verapamil
59
Side effects of Rifampicin?
Orange bodily fluids,
rash,
hepatotoxicity (induces PY450)
drug interactions
60
Side effects to Isonaizid?
Peripheral neuropathy,
psychosis,
hepatotoxicity (inhibits PY450)
61
Side effects of Pyrazinamide?
Arthralgia,
gout,
hepatotoxicity,
nausea
62
Side effects of Ethambutol?
Rash and Optic Neuritis
63
ADENOMYOSIS
Features?
Ix?
Treatment
- Dysmenorrhoea
- Menorrhagia
- Enlarged boggy uterus
Ix - MRI
Tx- GnRH agonists/ Hysterectomy
64
Triad of Vasa Praevia
- Rupture of membranes
- Followed by painless bleeding
- Fetal bradycardia
65
Rhyme to remember Reactive Arthritis?
Cant:
See (conjunctivitis)
Pee (Urethritis)
Or climb a tree (Arthritis of lower Limbs)
```
circinate balanitis (painless vesicles on the coronal margin of the prepuce)
keratoderma blenorrhagica (waxy yellow/brown papules on palms and soles)
```
66
Management of Myasthenic Crisis
IV Immunoglobulins
Plasmopheresis (removes circulating antibodies- those responsible for MG too)
67
What is first line treatment for neuropathic pain?
- Amitriptyline
- Duloxetine
- Gabapentin
Pregabalin
2nd line rescue therapy - Tramadol
68
Drugs associated with Stevens Johnson Syndrome?
```
Lamotrigine
Carbamazepine
Sulfonamide
Salicylates
Allopurinol
Phenytoin
Sertraline
```
69
Management of candida nappy rash?
topical imidazole
70
Whats the most common cause of nappy rash?
Irritant dermatitis - typically creases are SPARING
71
Metabolic signs of Molar pregnancy?
Extremely high beta hCG
Low TSH
High Thyroxine
(beta hCG is similar shape to LH, FSH and TSH so can mimic these hormones)
72
What layers do you cut through in a LSCS?
1) Superficial fascia
2) Deep fascia
3) Anterior rectus sheath
4) Rectus Abdominis
5) Transversalis fascia
6) Extraperitoneal connective tissue
7) Peritoneum
8) Uterus
73
Medication to suppress lactation?
Cabergoline
74
when should you suspect chorioamnionitis?
Triad of:
1) Maternal Tachycardia
2) Foetal Tachycardia
3) Maternal Pyrexia
+ Preterm PROM
75
Classical history of Vestibular Schwannomas? (acoustic neuromas)
combination of vertigo, hearing loss, tinnitus and an absent corneal reflex (CN, V, VII, VIII)
CN V = Absent corneal reflex
CN VII = Facial palsy
CN VIII = Vertigo, hearing loss, tinnitus
76
Investigation of Vestibular Schwannomas?
MRI of cerebellopontine angle + Audiometry
77
Typical features of Normal pressure Hydrocephalus?
urinary incontinence
gait abnormality (may be similar to Parkinson's disease)
Dementia
(WET, WOBBLY, WHACKY)
78
Triad of Shaken Baby syndrome?
Retinal haemorrhages, subdural haemotoma and encephalopathy
79
Metabolic signs in Congenital Adrenal Hyperplasia?
Hyponatraemia Hyperkalaemia ( SALT LOSERS!)
80
What is the double bubble sign?
Sign seen in duodenal atresia (common in Downs Syndrome
81
What may chlamydia infection at birth cause?
Neonatal Conjunctivitis, Pneumonia
Chorioamnionitis
preterm PROM
82
What should everyone who has an MI be given?
Aspirin
P2Y12 receptor antagonist (Clopidogrel/ Ticagrelor)
Unfractioned Heparin / LMWH
83
CSF findings for MS patient?
Oligoclonal bands
| IgG antibodies
84
Best anti-emetic for Parkinson's?
Domperidone
85
Treatment of Restless Leg Syndrome?
Dopamine agonists (ropinirole)
86
What do you do if low grade CIN I is found on colposcopy?
Discharge and repeat in 12 months
87
Cervical cancer features?
Postcoital bleeding
Purulent discharge
Red brown discharge!
+ Risk factors!!!
88
Most common type of vaginal cancer?
Most common type of primary vaginal cancer?
80% Metastases (cervix or endometrium)
Primary = Squamous cell carcinoma (85%)
89
Blood test results in PCOS?
```
Testosterone
SHBG
LH
FSH
Progesterone
```
```
Testosterone - HIGH
SHBG - LOW
LH - HIGH
FSH - NORMAL
Progesterone - LOW
```
90
Faecal impaction treatment?
1st - Macrogol (Movicol Paediatric Plain)
2nd - Stimulant laxative (Senna)
3rd - Osmotic laxative (Lactulose)
91
When do the following rashes normally present?
Naevus Flammeus (port-wine stain)
strawberry naevus (cavernous haemangioma)
Erythema toxicum (neonatal urticaria)
Naevus Flammeus (port-wine stain) - BIRTH
strawberry naevus (cavernous haemangioma) - FIRST MONTH
Erythema toxicum (neonatal urticaria) - 2/3 DAYS
92
Causes of Non Immune Hydrops Fetalis?
● Severe anaemia – congenital parvovirus B19 infection, alpha thalassaemia major, massive materno-feto haemorrhage
● Cardiac abnormalities
● Chromosomal – Trisomy 13, 18, 21, or Turners
● Infection – toxoplasmosis, rubella, CMV, varicella
● Twin- Twin transfusion syndrome (in the recipient twin)
● Chorioangioma
93
Test to ensure enough anti D given?
Kleinhauer Test = test amount of foetal Hb in mothers blood
94
Diagnosis of haemolytic disease of newborn?
Direct Coombs test
95
When should ECV be offered in
Nulliparous women?
Multiparous women?
Nulliparous = 36 weeks
Multiparous = 37 weeks
96
Risk factors for Obstetric Cholestasis?
Hepatitis C
Multiple Pregnancy
Obstetric cholestasis in a previous pregnancy
Presence of gallstones
97
How would a breast fibroadenoma feel?
painless Small rubbery mass that moves and is larger/ tender when menstruating
98
When would fat necrosis of the breast occur?
After trauma
99
Ductal papilloma symptoms?
Bloody/ clear discharge and mass felt around the nipple
100
How may alveolar oedema be described on X-ray?
Bat wing opacities
101
What is the leading cause of sudden cardiac death in the young?
Hypertrophic Cardiomyopathy
102
If a patient has primary adrenal insufficiency, what should be done to their medication if they have a febrile illness?
In what other circumstances would you do the same?
Double their Hydrocortisone
Breaking a bone// other body stressor diarrhoea/cold
103
Risk factors of SAH?
- Ehlers Danlos Syndrome
- Alcohol, Cocaine, Smoking
- Polycystic kidney disease
- coarctation of the aorta
104
Most common causative agents of infective COPD exacerbation?
Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae
105
What do the following liver function tests suggest?
A. ↑AST+↑ALT with an AST/ALT ratio of 2:1
B. ↑AST+↑ALT with an AST/ALT ratio of 1:2
C. Predominant ↑ALP
D. Isolated ↑ALP
E. Isolated ↑Bilirubin
A. ↑AST+↑ALT with an AST/ALT ratio of 2:1 = Alcoholic Liver Disease
B. ↑AST+↑ALT with an AST/ALT ratio of 1:2 = viral hepatitis or possibly non-alcoholic fatty liver disease
C. Predominant ↑ALP = cholestatic picture of LFTs
D. Isolated ↑ALP = breakdown of bone e.g bony metastases
E. Isolated ↑Bilirubin = gilberts syndrome
