Past SAQs Flashcards
A 10-year-old girl is the shortest in her class. What would you look for in her past medical history? (3)
Any significant illness in their past
Previous growth measurements and growth charts
Birth history - was she SGA or suffered from IUGR?
Chronic Paediatric disease, e.g. CF or coeliac disease
Any signs of psychosocial deprivation
Endocrine conditions
Chromosomal abnormalities like Turners having previously been diagnosed
Any skeletal conditions, like achondroplasia
A 10-year-old girl is the shortest in her class. What would you look for in her family history? (2)
Parents’ height => Mid parental height
Any medical conditions or genetic disorders of the parents which may have been inherited
A 10-year-old girl is the shortest in her class. What would you look for on examining her? (3)
Leg length (short extremities but normal torso can be indicative of skeletal dysplasia) Total height BMI Weight Skin Genitals Hearing and vision Any signs of endocrine disorders
A 10-year-old girl is the shortest in her class. What features would indicate she needed further investigation? (2)
She has fallen off her growth curve for height, weight, BMI etc.
Abnormal physiological findings of skin, genitals, hearing and vision, abnormal tenderness
What are three clinical features of PCOS
- Androgen excess
- Polycystic ovaries on US scan
- Oligo ovulation or anovulation
What biochemical findings you might expect in PCOS
- Androgen high
- Low oestradiol
- FSH low
- LH higher
- Sex hormone binding globulin low
- Insulin high
Name and describe 2 presenting symptoms of PCOS
• Oligomenorrhoea or amenorrhoea – abnormal bleeding, abnormal pain
• Clinical or biochemical androgen excess – may present as hirsutism and virilisation
(Basically same as clinical features but not polycystic ovaries on ultrasound scan as that is a sign not a presenting complaint)
What is the oestrogen status of PCOS patients? How would you demonstrate this?
Oestrogen would be low.
Genital examination and find reduced vaginal lubrication or vaginal dryness. Can also take a history and find out if sexual intercourse is painful and menstrual cycles are irregular or absent.
What is pre-eclampsia?
Pre-eclampsia = A multisystem condition arising de novo at 20 weeks’ gestation and finishing by 6 weeks’ post-partum, characterised by hypertension and proteinuria.
What are the risk factors of pre-eclampsia?
Previous history of pre-eclampsia, multiple gestations, first pregnancy, maternal obesity, maternal conditions like hypertension, diabetes or kidney disease, over 35 or 16, family history, polycystic ovarian syndrome, sickle cell
What are the clinical features of pre-eclampsia?
Hypertension, proteinuria and oedema
How do you treat pre-eclampsia?
Monitor foetus, try aim to deliver after 28 weeks, unless there is a risk to the foetus, corticosteroids to help with surfactant release
Describe the current theory for the pathogenesis of pre-eclampsia
Ineffective opening of the spiral arteries leads to failed remodelling of the spiral arteries by cytotrophoblast, which causes decreased blood flow and hence decreased nutrient supply to the placenta and fetus.
What are the consequences of Pre-eclampsia?
Can cause IUGR, preterm delivery and still-birth
What are two symptoms of pre-eclampsia? [2]
- Headache
- Dizziness
- Blurred vision
- Swelling of feet/hands (oedema)
What are two key features that would allow you to diagnose pre-eclampsia? [2]
- Hypertension - >140/90 on 2 separate occassions
* Proteinurea - >300mg in a 24hours urine collection
What is a possible long-term maternal consequence of pre-eclampsia?
Stroke
Cardiovascular Disease
What are the advantages of a mini-mental state exam (MMSE)? Some disadvantages?
Advantages:
• Quick to administer
• Can provide monitoring method for deteriation
• No additional equipment
Disadvantages:
- Inappropriate if patient has learning, linguistic/communication or other disabilities (as education, cultural and socioeconomic backgrounds really impact this)
Difficulty to identify mild cognitive impairment
What are the advantages of a Montreal cognitive assessment (MoCA)? Some disadvantages?
Advantages:
- Different areas of cognition assessed at the same time
- Quick
- Has translations
Disadvantages: Depends on education level, Depends on linguistic ability ‘ceiling and floor’ effects, practice/repeat effects, coaching effects before or during test
4 problems when administering the MoCA test to elderly patients
- Depression can masquerade as dementia => misdiagnosis common
- Ageing = slower reactive time and slower processing, which would impact administration and results of the MoCA
- Slower speech and impaired hearing therefore may impact administration of the test
- Functional decline may impact motor components of the examination
Describe how the neural tube is formed and say when each part of the formation occurs
- Thickening of the ectoderm in the dorsal midline of the embryo to form the neural plate – 18 days post fertilisation
- Expansion of the ectoderm with it folding out to from the neural folds
- Two neural folds fuse dorsally – at 23 days
- Some of the cells specialise to form neural crest cells and detach from the neural folds
Give two conditions in which the neural tube fails to close properly and describe the most common condition
• Spina bifida – more common
Spina bifida is a failure of caudal fusion.
• Anencephaly
What substance prevents this from occurring? How do you combat deficiency in that substance?
Folate. Take folate supplements from 3 months before trying to conceive and continue taking them in the first trimester of pregnancy.
Name the 3 requirements essential to a successful first trimester of a human pregnancy
- Adequate nutrition, e.g. folic acids
- Formation of the placenta
- Closure of the neural tube
Name and describe the 3 stages of birth (6 marks)
- Dilation Phase – cervix undergoes effacement and widening with fundally dominant contractions of the myometrium. The rate of contractions increases
- Expulsion Phase – Delivery of the child
- Placental phase – where placenta is delivered within 30min of the expulsion phase - this is important to happen as it causes uterine spiral arteries to be contracted and prevent potentially fatal blood loss
Where do contractions start from and to where do they spread? (2 marks)
• Fundally dominant, starting from the fundus and ending at the cervix
What is meant by the term “effacement”? (1 mark)
• Thinning of the cervix
what circumstance would “syntometrine” be administered? (1 mark) Extra Oxytocin given to stimulate contractions to stimulate Placental delivery.
• Stimulate delivery of the placenta and closure of the spiral arteries to prevent post-partum haemorrhage
