past paper questions 1 Flashcards
factors increasing risk of pre-term labour
- past obstetric history
- low social class
- smoking
- FH
- bacterial vaginosis
- Vaginal infection
drug given to reduce risk of another pre-term birth
- progesterone
what is tocolysis?
- obstetric procedure
- involving various medications
- to delay delivery of fetus
- in female presenting with pre-term contractions
drugs used for tocolysis?
- atosiban
- nifedipine
- magnesium sulphate
- ritodrine
- NSAIDs (indomethacin)
drug given to prevent respiratory distress syndrome in newborn?
- dexamethasone
- or betamethasone
common complications of babies born at 28 weeks?
- respiratory distress syndrome
- hypothermia
- jaundice
- hypoglycaemia
- sepsis
- poor feeding
- retinopathy
- necrotising enterocolitis
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?
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)
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?
- IgE mediated response
- to inhaled allergen (pollen)
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?
- inhaled corticosteroid (e.g. beclometasone or fluticasone)
- long term anti-inflammatory treatment
- delivered directly to the airways
name signs of peripheral vascular disease
- pallor
- cyanosis
- hairless or shiny skin
- arterial ulcers
- gangrene
what two signs on palption may support diagnosis of peripheral vascular disease?
- coldness or numbness of leg
- weak or absent peripheral pulses
- positive buergers test
what is buergers test?
- with patient supine
- colour of soles changes from pink to white
- on elevation of legs to 45 degrees for more than 1 minute
common underlying pathology of peripheral artery disease?
- atherosclerosis
- resulting in stenosis / occlusion of arteries
- supplying lower limb
modifiable risk factors for peripheral arterial disease?
- blood pressure
- fasting glucose
- lipid profile
- BMI
- smoking
non-invasive diagnostic method for determining severity of arterial occlusion?
- ankle brachial pressure index
a decision is made to put a patient on an anti-hyperglycaemic drug.
there are no co-morbid conditions.
what drug will you use?
- metformin
which group of patients is at particular risk of toxicity from metformin?
- renal failure
- or elderly
common side effects of metformin to warn patient in advance?
- GI disturbance: anorexia, nausea, vomiting, abdominal pain, diarrhoea
- weight loss, lactic acidosis, metallic taste
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
hep C not usually performed
treatment of urinary tract infection in pregnancy reduces risk of:
pre-term labour
which test is diagnostic for Down’s syndrome?
amniocentesis
what is mifepristone?
- anti-progestogenic steroid
- sensitises the myometrium to prostaglandin induced contractions
- and ripens the cervix
- often used in combination with misopristol to bring about abortion
all but one are suggestive of pre-eclampsia?
a) proteinuria
b) hypertension
c) abnormal platelet count
d) intrauterine growth restriction
e) polyhydraminos
polyhydraminos
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?
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
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?
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
what complication can arise from a child taking long-term oral steroids over a several months?
- short stature
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
Duchenne muscular dystrophy (DMD)
three key consequences of cystic fibroiss?
- thick pancreatic and biliary secretions (blockage of ducts), lack of lipase
- low volume thick airway secretions (bacterial colonisation, infections)
- congenital bilateral absence of vas deferens in males
three key method for establishing a diagnosis of CF?
- newborn blood spot testing
- sweat test is gold standard
- genetic testing for CFTR gene (amniocentesis or chronic villious sampling)
what is the cervical screening schedule in England?
routine 3 yearly recall between ages 25-49, then 5 yearly until aged 65
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?
glyceryl trinitrate
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?
hes aged 55 or over
thus
- calcium channel blocker
- e.g. amlodipine
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?
- under 55
- however of afro-Caribbean descent
- thus first line is CCB
- e.g. amlodipine
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
furosemide
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?
ARB
- losartan
main side-effects of anti-hypertensives?
ACEi: dry cough, postural hypotension, renal failure, hyperkalaemia
main side effects of calcium channel blockers?
ankle oedema
headache
flushing
bradycardia
main side effects of beta blockers?
- diabetes
- impotence
- brady cardia
- cold hands and feet
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
bradycardia and bronchospasm
blood tests routinely performed at booking:
- FBC
- rubella antibodies
- Hep B antibodies
- Syphillis screen
- HIV test
mother is having di-zygotic twins, what will the placental type be with reference to the chorion and amnion?
- dichorionic, diamniotic
High blood pressure + proteinuria
pre-eclampsia
symptoms associated with pre-eclampsia
- headache
- visual disturbances
- epigastric pain / abdo
- swelling
patient with pre-eclampsia is admitted to hospital.
what tests should be conducted?
- FBC
- CTG
- US
- LFT
- Uric acid
- 24 hr protein
what drug is most effective for preventing seizures during pregnancy?
iv magnesium sulphate
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
Gynae
- pelvic inflammatory disease
- miscarriage
- ovarian cyst
Non gynae
- UTI
- constipation
- IBS
- appendicitis
- trauma
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?
meningococcal septicaemia
what is the pathophysiology behind the non-blanching rash seen in meningococcal septicaemia?
- septicaemia
- causes capillary fragility
- resulting in petechial haemorrhages
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?
benzyl penicilli
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?
- FBC (WCC)
- CRP
- blood culture
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?
viral meningitis
some causative agents of viral meningitis?
- echovirus
- coxsackie virus
- polio virus
spread through saliva or stool
common causative agents of bacterial meningitis (3)
- streptococcus pneumonia
- neisseria meningitides
- haemophillus influenza
baby born at 34 weeks gestation, small head circumference, weighs 1.1kg, transferred to SCBU
- What two immediate non-respiratory complications is this infant susceptible to?
- HYPOTHERMIA
- HYPOGLYCAEMIA
baby born at 34 weeks gestation, small head circumference, weighs 1.1kg, transferred to SCBU
- Name three maternal behaviours that may have resulted in the severe intrauterine growth retardation of this baby?
Malnutrition,
alcohol,
cocaine (drug abuse),
smoking
if a baby has difficult sucking bottle what method of feeding could be employed?
NG tube
what is Rhinnes test?
- 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
four phenotypical features of downs syndrome?
- epicanthric folds
- single palmar crease
- sandal toes
- small ears
- hypotonia
4 symptoms classically associated with hypothyroidism?
- cold intolerance
- weight gain
- coarse hair
- fatigue
- menorrhagia
- constipation
- low mood
what non-invasive test would help you exclude deep venous thrombosis in 35 y/o female patient presenting with acutely painful swollen leg?
- venous doppler
3 potential complications of dalteparin use?
- LMWH
- should be given sub cut
complications
- bleeding
- osteoporosis
- thrombocytopenia
