Past SAQs

Question 1

A 10-year-old girl is the shortest in her class. What would you look for in her past medical history? (3)

Answer 1

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

Question 2

A 10-year-old girl is the shortest in her class. What would you look for in her family history? (2)

Answer 2

Parents’ height => Mid parental height

Any medical conditions or genetic disorders of the parents which may have been inherited

Question 3

A 10-year-old girl is the shortest in her class. What would you look for on examining her? (3)

Answer 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

Question 4

A 10-year-old girl is the shortest in her class. What features would indicate she needed further investigation? (2)

Answer 4

She has fallen off her growth curve for height, weight, BMI etc.
Abnormal physiological findings of skin, genitals, hearing and vision, abnormal tenderness

Question 5

What are three clinical features of PCOS

Answer 5

• Androgen excess
• Polycystic ovaries on US scan
• Oligo ovulation or anovulation

Question 6

What biochemical findings you might expect in PCOS

Answer 6

• Androgen high
• Low oestradiol
• FSH low
• LH higher
• Sex hormone binding globulin low
• Insulin high

Question 7

Name and describe 2 presenting symptoms of PCOS

Answer 7

• 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)

Question 8

What is the oestrogen status of PCOS patients? How would you demonstrate this?

Answer 8

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.

Question 9

What is pre-eclampsia?

Answer 9

Pre-eclampsia = A multisystem condition arising de novo at 20 weeks’ gestation and finishing by 6 weeks’ post-partum, characterised by hypertension and proteinuria.

Question 10

What are the risk factors of pre-eclampsia?

Answer 10

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

Question 11

What are the clinical features of pre-eclampsia?

Answer 11

Hypertension, proteinuria and oedema

Question 12

How do you treat pre-eclampsia?

Answer 12

Monitor foetus, try aim to deliver after 28 weeks, unless there is a risk to the foetus, corticosteroids to help with surfactant release

Question 13

Describe the current theory for the pathogenesis of pre-eclampsia

Answer 13

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.

Question 14

What are the consequences of Pre-eclampsia?

Answer 14

Can cause IUGR, preterm delivery and still-birth

Question 15

What are two symptoms of pre-eclampsia? [2]

Answer 15

• Headache
• Dizziness
• Blurred vision
• Swelling of feet/hands (oedema)

Question 16

What are two key features that would allow you to diagnose pre-eclampsia? [2]

Answer 16

• Hypertension - >140/90 on 2 separate occassions

* Proteinurea - >300mg in a 24hours urine collection

Question 17

What is a possible long-term maternal consequence of pre-eclampsia?

Answer 17

Stroke

Cardiovascular Disease

Question 18

What are the advantages of a mini-mental state exam (MMSE)? Some disadvantages?

Answer 18

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

Question 19

What are the advantages of a Montreal cognitive assessment (MoCA)? Some disadvantages?

Answer 19

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

Question 20

4 problems when administering the MoCA test to elderly patients

Answer 20

• 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

Question 21

Describe how the neural tube is formed and say when each part of the formation occurs

Answer 21

• 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

Question 22

Give two conditions in which the neural tube fails to close properly and describe the most common condition

Answer 22

• Spina bifida – more common
Spina bifida is a failure of caudal fusion.
• Anencephaly

Question 23

What substance prevents this from occurring? How do you combat deficiency in that substance?

Answer 23

Folate. Take folate supplements from 3 months before trying to conceive and continue taking them in the first trimester of pregnancy.

Question 24

Name the 3 requirements essential to a successful first trimester of a human pregnancy

Answer 24

• Adequate nutrition, e.g. folic acids
• Formation of the placenta
• Closure of the neural tube

Question 25

Name and describe the 3 stages of birth (6 marks)

Answer 25

• 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

Question 26

Where do contractions start from and to where do they spread? (2 marks)

Answer 26

• Fundally dominant, starting from the fundus and ending at the cervix

Question 27

What is meant by the term “effacement”? (1 mark)

Answer 27

• Thinning of the cervix

Question 28

what circumstance would “syntometrine” be administered? (1 mark) Extra Oxytocin given to stimulate contractions to stimulate Placental delivery.

Answer 28

• Stimulate delivery of the placenta and closure of the spiral arteries to prevent post-partum haemorrhage