past paper questions 2 Flashcards
32 y/o female EPAU
pc: 6 weeks amennorrhoea, positive pregnancy test, LIF pain, small vaginal bleed 1 day ago.
possible gynae causes?
- ectopic pregnancy
- ovarian cyst
- miscarriage
onset of pain 1 week prior to bleeding classically suggests ecotpic pregnancy
complications of copper coil
- pain
- irregular bleding
- infection
psuedomonas aureginosa gram stain and shape
- gram negative
- rod
non-invasive method to confirm diagnosis of MS
MRI of brain
- high signal lesions (plaques) on white matter tract
36 y/o female
pc: 3 week hx of sensory symptoms in left arm, started with tingling in her hand, spread over 3 days up her arm.
pmh: 7 years ago painful loss of vision in left eye which resolved in 2 weeks
OE: loss of light touch and pinprick sensation in left upper limb, otherwise normal
most likely diagnosis?
Multiple sclerosis
36 y/o patient with diagnosis of MS confirmed by MRI.
symptoms resolve, but one year later she presents with numbness, ascending to umbilicus and weakness in both limbs.
what treatment could be offered?
- relapse
- IV Methyl prednisolone
- high dose oral steroids
49 y/o patient
pmh: diagnosed with MS aged 36
has had progressive deterioration.
main symptoms now are:
- painful spasms in legs
- urinary frequency
- urgency
- occasional incontinence
what treatments may help her symptoms?
Pharmacological
- anti-cholingeric drugs
Non-pharmacological
- self-catheterisation / intermittent catheterisation
57 y/o
pc: 9 month hx shaking in right hand, writing getting smaller as he writes
OE: resting remor, R hand abolished on purposeful movements, mild cogwheel rigidity at right wrist , slowness in snapping
gait normal, but right arm significantly flexed at elbow, doesn’t swing properly as he walks
most likely diagnosis?
Parkinsons
pathophysiology of Parkinsons?
- loss of dopaminergic neurones from this substantia nigra
most appropriate management for:
31 y/o female, 15cm fundal fibroid, pelvic adhesions and severe menorrhagia.
has completed family
options:
a) anterior repair (colporrhaphy)
b) bilateral oophorectomy
c) bilateral tubal ligation
d) left ovarian cystectomy
e) left oophorectomy
f) total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy
g) total abdominal hysterectomy with ovarian conservation
h) transvaginal tape (TVT) urethral sling
i) vaginal hysterectomy
j) Wertheim’s (radical) hysterectomy
total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy
most appropriate intervention for 65 y/o female with bilateral mixed solid/cystic ovarian masses, ascites and raised Ca 125.
a) anterior repair (colporrhaphy)
b) bilateral oophorectomy
c) bilateral tubal ligation
d) left ovarian cystectomy
e) left oophorectomy
f) total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy
g) total abdominal hysterectomy with ovarian conservation
h) transvaginal tape (TVT) urethral sling
i) vaginal hysterectomy
j) Wertheim’s (radical) hysterectomy
f) total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy
28 y/o nulliparous woman with infertility
- marked cyclical pain
- occurs ten days preceding onset of heavy periods
- negative pregnancy test
- US shows 4cm echogenic ovarian cyst
endometriosis
a 42 yr old woman presents to her GP with severe right iliac fossa pain, feeling faint, and shoulder tip pain. She has no vaginal bleeding, but she has a positive pregnancy test. There is no pregnancy seen on transvaginal ultrasound.
ectopic pregnancy
45 y/o
- regular heavy periods
- haemoglobin level of 8g/dl
Abdo examination
- irregular, hard mass arising from pelvis
- size of 20 week pregnancy
most likely
uterine fibroids
a 58 year old woman with type 2 diabetes. She has had no periods for 9 years, but presents with a sudden heavy painless bleed.
most likely:
a) appendicitis
b) constipation
c) dysmenorrhoea
d) ectopic pregnancy
e) endometrial carcinoma
f) endometriosis
g) follicular cyst
h) incomplete miscarriage
endometrial carcinoma
a 35 year old woman who finds that she has been unable to pass urine normally since the forceps delivery of her 4.2 kg baby a week ago. She now loses a dribble of urine intermittently throughout the day, and feels constantly as if she wants to pass urine. She also has lower abdominal discomfort and a central pelvic mass.
overflow incontinence
a 48 year old multiparous woman who has noticed that she loses a dribble of urine when she coughs. She feels a fullness in the vagina. On examination, there is a ‘lump’ protruding from the anterior aspect of the vagina.
cystocele
A cystocele is when the wall between the bladder and the vagina weakens. This can cause the bladder to drop or sag into the vagina. It may be caused by things that increase pressure on the pelvic muscles.
a 38 year old woman who needs to dash to the toilet when she has the urge to pass urine. Sometimes she leaks when she is unable to reach the toilet in time. She now has stopped going out unless she knows there is a toilet nearby.
detrusor instability
a woman who presents to antenatal clinic feeling uncomfortable at 34 weeks. Her uterus measures ‘large for dates’ and it is difficult to palpate fetal parts.
most appropriate test to help make diagnosis?
ultrasound assessment of liquor volume
is produced by the ovary in the first trimester, but by the placenta in the second and third trimesters. Synthetic forms of it are given in the ‘mini-pill’.
progesterone
is produced in large amounts by the growing follicle in the ovary
oestradiol
is produced by the posterior lobe of the pituitary gland. A synthetic form of it may be given to women to treat slow progress in labour.
oxytocin
what is nephrotic syndrome?
- condition that causes kidneys
- to leak large amounts of protein into urine
- may cause sweling of body tissues, greater chance of catching infection
what should be looked for in a blood result for nephrotic syndrome?
serum albumin
what should be looked for in a blood result for acute renal failure?
serum urea
what should be looked at in a blood result for gilbert’s syndrome?
serum bilirubin
gilberts syndrome:
In a newborn infant, this is associated with:
1. pitting oedema of the lower limbs and a short neck.
Turner’s syndrome (genotype XO)
In a newborn infant, this is associated with:
an increased respiratory rate for 24 hours in an otherwise well infant
transient tachypnoea of the newborn
