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Pass Med finals pack > past paper questions 1 > Flashcards

past paper questions 1 Flashcards

1
Q

factors increasing risk of pre-term labour

A
  • past obstetric history
  • low social class
  • smoking
  • FH
  • bacterial vaginosis
  • Vaginal infection
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2
Q

drug given to reduce risk of another pre-term birth

A
  • progesterone
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3
Q

what is tocolysis?

A
  • obstetric procedure
  • involving various medications
  • to delay delivery of fetus
  • in female presenting with pre-term contractions
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4
Q

drugs used for tocolysis?

A
  • atosiban
  • nifedipine
  • magnesium sulphate
  • ritodrine
  • NSAIDs (indomethacin)
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5
Q

drug given to prevent respiratory distress syndrome in newborn?

A
  • dexamethasone

- or betamethasone

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6
Q

common complications of babies born at 28 weeks?

A
  • respiratory distress syndrome
  • hypothermia
  • jaundice
  • hypoglycaemia
  • sepsis
  • poor feeding
  • retinopathy
  • necrotising enterocolitis
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7
Q

13 y/o female

pc: acute SOB and Wheeze following sports, struggling to speak, cyanosed, 87% O2 sats
pmh: 6 year hx hay fever

what treatments would you give immediately?

A

OH SHITE ME

O - oxygen
S - salbutamol nebulised
H - hydrocortisone
I - ipatropium NEB

if needed
T - theophylline
M- magnesium sulphate
E - escalate (intubation and ventilation)

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8
Q

13 y/o female

pc: acute SOB and Wheeze following sports day, struggling to speak, cyanosed, 87% O2 sats
pmh: 6 year hx hay fever

two key features of pathophys of this acute asthma attack?

A
  • IgE mediated response

- to inhaled allergen (pollen)

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9
Q

13 y/o female

pc: acute SOB and Wheeze following sports day, struggling to speak, cyanosed, 87% O2 sats
pmh: 6 year hx hay fever

already on blue inhaler for 6 months for recurrent wheeze.

doctors decide to start her on some long-term preventative treatment for her asthma, what would they give?

A
  • inhaled corticosteroid (e.g. beclometasone or fluticasone)
  • long term anti-inflammatory treatment
  • delivered directly to the airways
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10
Q

name signs of peripheral vascular disease

A
  • pallor
  • cyanosis
  • hairless or shiny skin
  • arterial ulcers
  • gangrene
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11
Q

what two signs on palption may support diagnosis of peripheral vascular disease?

A
  • coldness or numbness of leg
  • weak or absent peripheral pulses
  • positive buergers test
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12
Q

what is buergers test?

A
  • with patient supine
  • colour of soles changes from pink to white
  • on elevation of legs to 45 degrees for more than 1 minute
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13
Q

common underlying pathology of peripheral artery disease?

A
  • atherosclerosis
  • resulting in stenosis / occlusion of arteries
  • supplying lower limb
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14
Q

modifiable risk factors for peripheral arterial disease?

A
  • blood pressure
  • fasting glucose
  • lipid profile
  • BMI
  • smoking
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15
Q

non-invasive diagnostic method for determining severity of arterial occlusion?

A
  • ankle brachial pressure index
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16
Q

a decision is made to put a patient on an anti-hyperglycaemic drug.

there are no co-morbid conditions.

what drug will you use?

A
  • metformin
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17
Q

which group of patients is at particular risk of toxicity from metformin?

A
  • renal failure

- or elderly

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18
Q

common side effects of metformin to warn patient in advance?

A
  • GI disturbance: anorexia, nausea, vomiting, abdominal pain, diarrhoea
  • weight loss, lactic acidosis, metallic taste
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19
Q

which of the following is not routinely followed at booking visit in the UK?

a) rubella serology
b) hep c screening
c) syphillis serology
d) HIV testing
e) Rhesus D status determination

A

hep C not usually performed

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20
Q

treatment of urinary tract infection in pregnancy reduces risk of:

A

pre-term labour

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21
Q

which test is diagnostic for Down’s syndrome?

A

amniocentesis

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22
Q

what is mifepristone?

A
  • anti-progestogenic steroid
  • sensitises the myometrium to prostaglandin induced contractions
  • and ripens the cervix
  • often used in combination with misopristol to bring about abortion
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23
Q

all but one are suggestive of pre-eclampsia?

a) proteinuria
b) hypertension
c) abnormal platelet count
d) intrauterine growth restriction
e) polyhydraminos

A

polyhydraminos

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24
Q

4 y/o boy

pc: aching sore joints, lower abdo pain, reluctant to walk
pmh: n/a , tonsilitis 2 weeks ago

OE: multiple red spots around buttocks, elbows and knees, non-blanching, afebrile, looks miserable but not ill

what is the most helpful investigation the GP will arrange first?

A

urine dipstick testing for blood and protein

classic presentation of HSP

  • rash
  • arthritis
  • abdo pain
  • kidney impairment

kidney involvement seen in 50% of cases

thus important to do blood and urine test to check for kidney involvement

Henoch-schonlein purpura - IgA vasculitis that presents with a purpuric rash. Inflammation due to IgA deposits in blood vessels

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25
Q

4 y/o boy

pc: aching sore joints, lower abdo pain, reluctant to walk
pmh: n/a , tonsilitis 2 weeks ago

OE: multiple red spots around buttocks, elbows and knees, non-blanching, afebrile, looks miserable but not ill

most likely diagnosis?

A

henoch-scholein purpura

  • HSP form of small vessel vasculitis
  • reuslts from inflammation of small blood vessels in skin and various other tissues
  • most common symptoms: vasculitis rash, joint pain, abdo pain
26
Q

what complication can arise from a child taking long-term oral steroids over a several months?

A
  • short stature
27
Q

which of the following is not part of the neonatal screening programme in England?

a) sickle cell disease
b) medium chain acyl-CoA dehydrogenase deficiency
c) duchenne muscular dystrophy
d) phenylketonuria
e) hypothyroidism

A

Duchenne muscular dystrophy (DMD)

28
Q

three key consequences of cystic fibroiss?

A
  1. thick pancreatic and biliary secretions (blockage of ducts), lack of lipase
  2. low volume thick airway secretions (bacterial colonisation, infections)
  3. congenital bilateral absence of vas deferens in males
29
Q

three key method for establishing a diagnosis of CF?

A
  1. newborn blood spot testing
  2. sweat test is gold standard
  3. genetic testing for CFTR gene (amniocentesis or chronic villious sampling)
30
Q

what is the cervical screening schedule in England?

A

routine 3 yearly recall between ages 25-49, then 5 yearly until aged 65

31
Q

55 y/o

pc: chest pain while gardening, he’s having an angina attack

what is the most appropriate drug for him tot take at this time?

A

glyceryl trinitrate

32
Q

55 y/o

pc: chest pain while gardening, he’s having an angina attack

he’s also consequently found to have a BP of 150/95

what is the most appropriate first line therapy for this patient?

A

hes aged 55 or over

thus

  • calcium channel blocker
  • e.g. amlodipine
33
Q

Obiora Adichie, a 45 year old man originally from Nigeria, has newly diagnosed Stage 2 hypertension.

he doesn’t have heart failure.

whats appropriate first line therapy for this patient?

A
  • under 55
  • however of afro-Caribbean descent
  • thus first line is CCB
  • e.g. amlodipine
34
Q

88 y/o female with chronic heart failure.

now SOB at rest, used to only get SOB when walking upstairs

most appropriate drug for symptomatic relief of shortness of breath:

a) digoxin
b) furosemide
c) rampiril
d) spironolactone
e) theophylline

A

furosemide

35
Q

53 y/o with previously moderate HTN with lisinopril.

now developed persistent dry cough, GP thought it was side effect of anti-hypertensive therapy.

what is an appropriate drug to use to replace the ACEi?

A

ARB

- losartan

36
Q

main side-effects of anti-hypertensives?

A

ACEi: dry cough, postural hypotension, renal failure, hyperkalaemia

37
Q

main side effects of calcium channel blockers?

A

ankle oedema

headache

flushing

bradycardia

38
Q

main side effects of beta blockers?

A
  • diabetes
  • impotence
  • brady cardia
  • cold hands and feet
39
Q

What side effects are commonly observed in patients taking
propranolol?

a) anorexia and insomnia
b) bradycardia and bronchospasm
c) headache and dizziness
d) irregular heart beat
e) tremor and restlessness

A

bradycardia and bronchospasm

40
Q

blood tests routinely performed at booking:

A
  • FBC
  • rubella antibodies
  • Hep B antibodies
  • Syphillis screen
  • HIV test
41
Q

mother is having di-zygotic twins, what will the placental type be with reference to the chorion and amnion?

A
  • dichorionic, diamniotic
42
Q

High blood pressure + proteinuria

A

pre-eclampsia

43
Q

symptoms associated with pre-eclampsia

A
  • headache
  • visual disturbances
  • epigastric pain / abdo
  • swelling
44
Q

patient with pre-eclampsia is admitted to hospital.

what tests should be conducted?

A
  1. FBC
  2. CTG
  3. US
  4. LFT
  5. Uric acid
  6. 24 hr protein
45
Q

what drug is most effective for preventing seizures during pregnancy?

A

iv magnesium sulphate

46
Q

18 y/o 2 day hx lower abdominal pain.

  • sexually active, multiple partners, previous episode of chlamydia 2 years ago. termination 6 months ago.

Give some gynae and non-gynae differentials

A

Gynae

  • pelvic inflammatory disease
  • miscarriage
  • ovarian cyst

Non gynae

  • UTI
  • constipation
  • IBS
  • appendicitis
  • trauma
47
Q

9 month old baby boy

pc: miserable, vomited two bottle feeds overnight, 39 degrees temp, cold in peripheries, non-blanching rash.

what life threatening diagnosis could this be?

A

meningococcal septicaemia

48
Q

what is the pathophysiology behind the non-blanching rash seen in meningococcal septicaemia?

A
  • septicaemia
  • causes capillary fragility
  • resulting in petechial haemorrhages
49
Q

9 month old baby boy

pc: miserable, vomited two bottle feeds overnight, 39 degrees temp, cold in peripheries, non-blanching rash.
diagnosis: meningococcal septicaemia

what drug should be given IM?

A

benzyl penicilli

50
Q

9 month old baby boy

pc: miserable, vomited two bottle feeds overnight, 39 degrees temp, cold in peripheries, non-blanching rash.
diagnosis: meningococcal septicaemia

what there blood tests were ordered in A&E?

A
  • FBC (WCC)
  • CRP
  • blood culture
51
Q

9 month old baby boy

pc: miserable, vomited two bottle feeds overnight, 39 degrees temp, cold in peripheries, non-blanching rash.

lumbar puncture shows: raised lymphocyte count in CSF with normal CSF glucose

what do these results suggest?

A

viral meningitis

52
Q

some causative agents of viral meningitis?

A
  • echovirus
  • coxsackie virus
  • polio virus

spread through saliva or stool

53
Q

common causative agents of bacterial meningitis (3)

A
  • streptococcus pneumonia
  • neisseria meningitides
  • haemophillus influenza
54
Q

baby born at 34 weeks gestation, small head circumference, weighs 1.1kg, transferred to SCBU

  1. What two immediate non-respiratory complications is this infant susceptible to?
A
  • HYPOTHERMIA

- HYPOGLYCAEMIA

55
Q

baby born at 34 weeks gestation, small head circumference, weighs 1.1kg, transferred to SCBU

  1. Name three maternal behaviours that may have resulted in the severe intrauterine growth retardation of this baby?
A

Malnutrition,

alcohol,

cocaine (drug abuse),

smoking

56
Q

if a baby has difficult sucking bottle what method of feeding could be employed?

A

NG tube

57
Q

what is Rhinnes test?

A
  • press 512 hz tuning fork against mastoid bone
  • then hold 1 cm away from ear
  • which is louder behind the ear or in front
  • positive if air conduction is louder
  • air conduction is reduced in patients with ear wax
58
Q

four phenotypical features of downs syndrome?

A
  • epicanthric folds
  • single palmar crease
  • sandal toes
  • small ears
  • hypotonia
59
Q

4 symptoms classically associated with hypothyroidism?

A
  • cold intolerance
  • weight gain
  • coarse hair
  • fatigue
  • menorrhagia
  • constipation
  • low mood
60
Q

what non-invasive test would help you exclude deep venous thrombosis in 35 y/o female patient presenting with acutely painful swollen leg?

A
  • venous doppler
61
Q

3 potential complications of dalteparin use?

A
  • LMWH
  • should be given sub cut

complications

  • bleeding
  • osteoporosis
  • thrombocytopenia

Pass Med finals pack (40 decks)

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