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Peer teaching (mix of all) Flashcards

1
Q 
What is the structure that gives rise to the uterus?
A  Paramesonephric ducts
B   Mesonephric ducts
C   Primitive streak
D   Metanephros
E   Cloaca
F   Mesoderm
G  Ectoderm
H  Endoderm
A

A Paramesonephric ducts

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2
Q 
What is the structure that gives rise to the GI tract?
A  Paramesonephric ducts
B   Mesonephric ducts
C   Primitive streak
D   Metanephros
E   Cloaca
F   Mesoderm
G  Ectoderm
H  Endoderm
A

H Endoderm

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3
Q 
What is the structure from which the lower part of the vagina is formed?
A  Paramesonephric ducts
B   Mesonephric ducts
C   Primitive streak
D   Metanephros
E   Cloaca
F   Mesoderm
G  Ectoderm
H  Endoderm
A

E Cloaca

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4
Q 
What is the structure that gives rise to the kidneys?
A  Paramesonephric ducts
B   Mesonephric ducts
C   Primitive streak
D   Metanephros
E   Cloaca
F   Mesoderm
G  Ectoderm
H  Endoderm
A

D Metanephros

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5
Q

True or false?

During development of the ovarian follicles the primary oocyte arrests at Metaphase of the first meiotic division

A

False: Prophase of the first meiotic division

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6
Q

True or false?

The first polar body is extruded prior to ovulation

A

True: the polar body is produced at the completion of the first stage of meiosis together with a haploid gamete

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7
Q

True or false?

Cardiac activity is evident from day 18

A

False: day 22

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8
Q

True or false?

hCG is produced by the corpus luteum

A

False: the corpus lute produces progesterone

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9
Q

True or false?

the blastocyst begins to form from day 7

A

False: day 5

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10
Q

True or false?

Implantation occurs on around day 9

A

True

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11
Q 
Which of these shunts the blood from the right to left atrium?
A Ductus venous
B  Ductus arteriosus
C  Foramen ovale
D  Mitral valve
E  Umbilical vein
F  Umbilical artery 
G Intraventricular septum
A

C Foramen ovale

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12
Q 
Which of these carries oxygenated blood from the placenta to the foetus?
A Ductus venous
B  Ductus arteriosus
C  Foramen ovale
D  Mitral valve
E  Umbilical vein
F  Umbilical artery 
G Intraventricular septum
A

E Umbilical vein

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13
Q 
Which of these allows blood from the right ventricle to bypass the lungs?
A Ductus venous
B  Ductus arteriosus
C  Foramen ovale
D  Mitral valve
E  Umbilical vein
F  Umbilical artery 
G Intraventricular septum
A

B Ductus arteriosus

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14
Q 
Which of these, if fails to close at birth leads to pulmonary HTN?
A Ductus venous
B  Ductus arteriosus
C  Foramen ovale
D  Mitral valve
E  Umbilical vein
F  Umbilical artery 
G Intraventricular septum
A

C Foramen ovale

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15
Q 
Which of these allows oxygenated blood to bypass the fetal liver?
A Ductus venous
B  Ductus arteriosus
C  Foramen ovale
D  Mitral valve
E  Umbilical vein
F  Umbilical artery 
G Intraventricular septum
A

A Ductus venous

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16
Q 
Which of these suppresses secretion of FSH?
A  Oxytocin
B  Cortisol 
C  hCG
D  Prolactin
E  Progesterone
F  Inhibin
G  TSH
A

F Inhibin

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17
Q 
hCG shares a common alpha subunit with this hormone?
A  Oxytocin
B  Cortisol 
C  hCG
D  Prolactin
E  Progesterone
F  Inhibin
G  TSH
A

G TSH

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18
Q 
Which of these is secreted by lactotrophs?
A  Oxytocin
B  Cortisol 
C  hCG
D  Prolactin
E  Progesterone
F  Inhibin
G  TSH
A

D Prolactin

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19
Q 
Which of these inhibits myometrial cell contractility?
A  Oxytocin
B  Cortisol 
C  hCG
D  Prolactin
E  Progesterone
F  Inhibin
G  TSH
A

E Progesterone

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20
Q 
Which of these is the hormone required for milk ejection?
A  Oxytocin
B  Cortisol 
C  hCG
D  Prolactin
E  Progesterone
F  Inhibin
G  TSH
A

A Oxytocin

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21
Q 
Which of these together with the decidua basilis and amnion forms part of the placenta?
Cytotrophoblast
Cotelydon
Amnion
Chorion
Decidua basilis
Syncytotrophoblast
Trophoblast
Yolk sac
A

Chorion

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22
Q 
Which of these is the covering of the fetal side of the placenta?
Cytotrophoblast
Cotelydon
Amnion
Chorion
Decidua basilis
Syncytotrophoblast
Trophoblast
Yolk sac
A

Amnion

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23
Q 
The double layer of epithelium of the villi comprises of syncytotrophoblast and \_\_\_\_\_\_\_?
Cytotrophoblast
Cotelydon
Amnion
Chorion
Decidua basilis
Syncytotrophoblast
Trophoblast
Yolk sac
A

Cytotrophoblast

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24
Q 
The functional unit of the placenta ?
Cytotrophoblast
Cotelydon
Amnion
Chorion
Decidua basilis
Syncytotrophoblast
Trophoblast
Yolk sac
A

Cotelydon

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25
True or false? | The oxyhaemoglobin dissociation curve for the fetus is situated to the left of the mother’s
True
26
True or false? | Fetal haemoglobin has a lower affinity for oxygen
False
27
True or false? | Alveoli are present in the fetal lungs from 15 weeks
False
28
True or false? | Surfactant is produced by Type 1 alveolar cells
False
29
True or false? | Oral corticosteroids are given to women in preterm labour to promote fetal lung maturation
False
30
True or false? Transient tachypnoea of the newborn is more common in babies born by elective caesarean section before 38 completed weeks
True
31
``` Deficiency of this vitamin is associated with neural tube defects? Vitamin D 20 – 22 weeks Vitamin C Folic acid Biparietal Diameter 10 – 14+1 weeks Spina bifida Crown rump length Downs Syndrome ```
Folic acid
32
``` A vitamin deficiency common in women born from outside of the UK who live here and obese women? Vitamin D 20 – 22 weeks Vitamin C Folic acid Biparietal Diameter 10 – 14+1 weeks Spina bifida Crown rump length Downs Syndrome ```
Vitamin D
33
``` The Combined test screens for which condition? Vitamin D 20 – 22 weeks Vitamin C Folic acid Biparietal Diameter 10 – 14+1 weeks Spina bifida Crown rump length Downs Syndrome ```
Downs Syndrome
34
``` The Combined test is performed between _______ weeks? Vitamin D 20 – 22 weeks Vitamin C Folic acid Biparietal Diameter 10 – 14+1 weeks Spina bifida Crown rump length Downs Syndrome ```
10 – 14+1 weeks
35
``` The fetal anatomy scan is usually performed between ________ weeks? Vitamin D 20 – 22 weeks Vitamin C Folic acid Biparietal Diameter 10 – 14+1 weeks Spina bifida Crown rump length Downs Syndrome ```
20 – 22 weeks
36
``` Ultrasound dating of a pregnancy between 8-12 weeks is done by measuring the _______ ? Vitamin D 20 – 22 weeks Vitamin C Folic acid Biparietal Diameter 10 – 14+1 weeks Spina bifida Crown rump length Downs Syndrome ```
Crown rump length
37
What do the results in the combined test mean?
In Downs: PAPP-A tends to be low and hCG and NT high
38
When do the diagnostic tests take place?
Amniocentesis – 15 weeks+ | CVS – 11 to 15 weeks
39
``` May cause deafness if mother in contact with this virus after 13 weeks? Parvovirus Lithium Downs syndrome Azothioprine Rubella Group B Streptococcus Folic acid Patau syndrome Sodium valproate Chicken pox CMV Edwards syndrome ```
Rubella
40
``` Condition caused by a trisomy of chromosome 13? Parvovirus Lithium Downs syndrome Azothioprine Rubella Group B Streptococcus Folic acid Patau syndrome Sodium valproate Chicken pox CMV Edwards syndrome ```
Patau syndrome
41
``` This drug increases the risk of ancephaly? Parvovirus Lithium Downs syndrome Azothioprine Rubella Group B Streptococcus Folic acid Patau syndrome Sodium valproate Chicken pox CMV Edwards syndrome ```
Sodium valproate
42
``` Most likely to cause a problem to the baby if delivered within 7 days of a non-immune mother becoming infected? Parvovirus Lithium Downs syndrome Azothioprine Rubella Group B Streptococcus Folic acid Patau syndrome Sodium valproate Chicken pox CMV Edwards syndrome ```
Chicken pox
43
``` Colloquial name – slapped cheek virus? Parvovirus Lithium Downs syndrome Azothioprine Rubella Group B Streptococcus Folic acid Patau syndrome Sodium valproate Chicken pox CMV Edwards syndrome ```
Parvovirus
44
``` Associated with early onset Alzheimers? Parvovirus Lithium Downs syndrome Azothioprine Rubella Group B Streptococcus Folic acid Patau syndrome Sodium valproate Chicken pox CMV Edwards syndrome ```
Downs syndrome
45
``` This drug is associated with Ebsteins anomaly ? Parvovirus Lithium Downs syndrome Azothioprine Rubella Group B Streptococcus Folic acid Patau syndrome Sodium valproate Chicken pox CMV Edwards syndrome ```
Lithium
46
``` An important cause of neonatal meningitis? Parvovirus Lithium Downs syndrome Azothioprine Rubella Group B Streptococcus Folic acid Patau syndrome Sodium valproate Chicken pox CMV Edwards syndrome ```
Group B Streptococcus
47
``` A condition screened for at 26-28 weeks in women with a BMI > 30? Eclampsia Diabetes Asthma Cholestasis Genital Herpes Antiphospho-lipid syndrome Pre-eclampsia Rhesus incompatability Hypothyroidism ```
Diabetes
48
``` A condition more common in primips ? Eclampsia Diabetes Asthma Cholestasis Genital Herpes Antiphospho-lipid syndrome Pre-eclampsia Rhesus incompatability Hypothyroidism ```
Pre-eclampsia
49
``` A condition characterised by intense itching? Eclampsia Diabetes Asthma Cholestasis Genital Herpes Antiphospho-lipid syndrome Pre-eclampsia Rhesus incompatability Hypothyroidism ```
Cholestasis
50
``` If first presentation of this condition is in late pregnancy caesarean section is recommended? Eclampsia Diabetes Asthma Cholestasis Genital Herpes Antiphospholipid syndrome Pre-eclampsia Rhesus incompatability Hypothyroidism ```
Genital Herpes
51
``` Associated with macrosomic infants? Eclampsia Diabetes Asthma Cholestasis Genital Herpes Antiphospho-lipid syndrome Pre-eclampsia Rhesus incompatability Hypothyroidism ```
Diabetes
52
``` A seizure after 20 weeks pregnant is assumed to be this condition until proven otherwise? Eclampsia Diabetes Asthma Cholestasis Genital Herpes Antiphospho-lipid syndrome Pre-eclampsia Rhesus incompatability Hypothyroidism ```
Eclampsia
53
``` A condition associated with very preterm deliveries and venous thromboembolism? Eclampsia Diabetes Asthma Cholestasis Genital Herpes Antiphospho-lipid syndrome Pre-eclampsia Rhesus incompatability Hypothyroidism ```
Antiphospho-lipid syndrome
54
``` A maternal disease associated with neural tube defects? Eclampsia Diabetes Asthma Cholestasis Genital Herpes Antiphospho-lipid syndrome Pre-eclampsia Rhesus incompatability Hypothyroidism ```
Diabetes
55
``` More common in women with pre-pregnancy renal disease? Pre-eclampsia Hyperemesis Eclampsia Pulmonary embolism Haemorrhagic stroke Pulmonary oedema HELLP syndrome Rhesus incompatability Choriocarcinoma ```
Pre-eclampsia
56
``` Risk of recurrence is reduced by an infusion of magnesium sulphate? Pre-eclampsia Hyperemesis Eclampsia Pulmonary embolism Haemorrhagic stroke Pulmonary oedema HELLP syndrome Rhesus incompatability Choriocarcinoma ```
Eclampsia
57
``` Likely to occur in a woman with severe pre-eclampsia who is given large amounts of IV fluids? Pre-eclampsia Hyperemesis Eclampsia Pulmonary embolism Haemorrhagic stroke Pulmonary oedema HELLP syndrome Rhesus incompatability Choriocarcinoma ```
Pulmonary oedema
58
``` Condition specific to pregnancy characterised by deranged AST and ALT, low platelets and anaemia? Pre-eclampsia Hyperemesis Eclampsia Pulmonary embolism Haemorrhagic stroke Pulmonary oedema HELLP syndrome Rhesus incompatability Choriocarcinoma ```
HELLP syndrome
59
True or false? | Women found to have Group B Streptococcus on an HVS in pregnancy should receive antenatal antibiotics
False
60
True or false? | The presence of raised bile acids indicates obstetric cholestasis
True
61
True or false? | Fetal anaemia may be due to rhesus isoimmunisation
True
62
True or false? | Urinary tract infections are very rare in pregnancy
False
63
True or false? | Pain due to appendicitis in the third trimester occurs in the RUQ
True
64
True or false? | Urinary tract infections can increase the risk of preterm labour
True
65
``` An essential component of the ultrasound at 20 weeks? Fetal sex determination Placental abruption Minor Placental localisation Placenta praevia Major Cervical ectropion Vasa praevia ```
Placental localisation
66
``` A painful, hard woody uterus without vaginal bleeding suggests ______ ? Fetal sex determination Placental abruption Minor Placental localisation Placenta praevia Major Cervical ectropion Vasa praevia ```
Placental abruption
67
``` A ______ placenta praevia completely covers the cervical os? Fetal sex determination Placental abruption Minor Placental localisation Placenta praevia Major Cervical ectropion Vasa praevia ```
Major
68
``` This cause of bleeding is associated with pre-eclampsia? Fetal sex determination Placental abruption Minor Placental localisation Placenta praevia Major Cervical ectropion Vasa praevia ```
Placental abruption
69
``` Painless heavy vaginal bleeding can occur with this condition? Fetal sex determination Placental abruption Minor Placental localisation Placenta praevia Major Cervical ectropion Vasa praevia ```
Placenta praevia
70
``` Bleeding after rupture of membranes may be due to this rare condition? Fetal sex determination Placental abruption Minor Placental localisation Placenta praevia Major Cervical ectropion Vasa praevia ```
Vasa praevia
71
``` This finding is very common in pregnancy due to the high oestrogen levels, it causes postcoital bleeding? Fetal sex determination Placental abruption Minor Placental localisation Placenta praevia Major Cervical ectropion Vasa praevia ```
Cervical ectropion
72
``` This technique used in IVF aims to reduce the risk of multiple pregnancy? Blastocyst transfer Gestational diabetes Single embryo transfer Monochorionic monoamniotic twins Pre-eclampsia Diachorionic diamniotic twins Twin to twin transfusion syndrome Rhesus isoimmunisation ```
Single embryo transfer
73
``` The lambda sign on an early pregnancy scan indicates this type of multiple pregnancy? Blastocyst transfer Gestational diabetes Single embryo transfer Monochorionic monoamniotic twins Pre-eclampsia Diachorionic diamniotic twins Twin to twin transfusion syndrome Rhesus isoimmunisation ```
Diachorionic diamniotic twins
74
``` This condition occurs when there are placental vascular anastomoses between the two fetoplacental circulations? Blastocyst transfer Gestational diabetes Single embryo transfer Monochorionic monoamniotic twins Pre-eclampsia Diachorionic diamniotic twins Twin to twin transfusion syndrome Rhesus isoimmunisation ```
Twin to twin transfusion syndrome
75
``` Various fetal abnormalities are more common with this type of twins? Blastocyst transfer Gestational diabetes Single embryo transfer Monochorionic monoamniotic twins Pre-eclampsia Diachorionic diamniotic twins Twin to twin transfusion syndrome Rhesus isoimmunisation ```
Monochorionic monoamniotic twins
76
``` One of the twins can become hydropic with this condition? Blastocyst transfer Gestational diabetes Single embryo transfer Monochorionic monoamniotic twins Pre-eclampsia Diachorionic diamniotic twins Twin to twin transfusion syndrome Rhesus isoimmunisation ```
Twin to twin transfusion syndrome
77
``` This pregnancy related condition is increased in a twin pregnancy ? Blastocyst transfer Gestational diabetes Single embryo transfer Monochorionic monoamniotic twins Pre-eclampsia Diachorionic diamniotic twins Twin to twin transfusion syndrome Rhesus isoimmunisation ```
Pre-eclampsia
78
``` Vaginal infection associated with preterm, prelabour rupture of membranes (PROM)? Augmentin Erythromycin UTI Cryocautery to cervix Bacterial vaginosus Loop excision of cervix Gestational diabetes 24 weeks Cervical suture 28 weeks Corticosteroids Chorioamnionitis Surfactant ```
Bacterial vaginosus
79
``` Gestation of ‘viability’ in the UK? Augmentin Erythromycin UTI Cryocautery to cervix Bacterial vaginosus Loop excision of cervix Gestational diabetes 24 weeks Cervical suture 28 weeks Corticosteroids Chorioamnionitis Surfactant ```
24 weeks
80
``` Given to women in preterm labour to improve fetal lung maturation? Augmentin Erythromycin UTI Cryocautery to cervix Bacterial vaginosus Loop excision of cervix Gestational diabetes 24 weeks Cervical suture 28 weeks Corticosteroids Chorioamnionitis Surfactant ```
Corticosteroids
81
``` Intrauterine condition associated with preterm labour? Augmentin Erythromycin UTI Cryocautery to cervix Bacterial vaginosus Loop excision of cervix Gestational diabetes 24 weeks Cervical suture 28 weeks Corticosteroids Chorioamnionitis Surfactant ```
Chorioamnionitis
82
``` Antibiotics used in the management of premature PROM? Augmentin Erythromycin UTI Cryocautery to cervix Bacterial vaginosus Loop excision of cervix Gestational diabetes 24 weeks Cervical suture 28 weeks Corticosteroids Chorioamnionitis Surfactant ```
Erythromycin
83
``` Previous treatment associated with pre-term delivery? Augmentin Erythromycin UTI Cryocautery to cervix Bacterial vaginosus Loop excision of cervix Gestational diabetes 24 weeks Cervical suture 28 weeks Corticosteroids Chorioamnionitis Surfactant ```
Loop excision of cervix
84
``` Management aimed at reducing the risk of preterm delivery? Augmentin Erythromycin UTI Cryocautery to cervix Bacterial vaginosus Loop excision of cervix Gestational diabetes 24 weeks Cervical suture 28 weeks Corticosteroids Chorioamnionitis Surfactant ```
Cervical suture
85
``` Pregnancy specific condition that causes fetal growth restriction? Parvovirus Pre-eclampsia Head circumference Excess caffeine intake Gestational diabetes Polyhydraminos Chromosomal Anhydraminos Smoking Abdominal circumference Oligohydraminos ```
Pre-eclampsia
86
``` Condition that increases the chances of the fetus having a large abdominal circumference in comparison to their head circumference? Parvovirus Pre-eclampsia Head circumference Excess caffeine intake Gestational diabetes Polyhydraminos Chromosomal Anhydraminos Smoking Abdominal circumference Oligohydraminos ```
Gestational diabetes
87
``` Symmetrical fetal growth restriction is often associated with these abnormalities? Parvovirus Pre-eclampsia Head circumference Excess caffeine intake Gestational diabetes Polyhydraminos Chromosomal Anhydraminos Smoking Abdominal circumference Oligohydraminos ```
Chromosomal
88
``` An oedematous fetus may be due to this condition ? Parvovirus Pre-eclampsia Head circumference Excess caffeine intake Gestational diabetes Polyhydraminos Chromosomal Anhydraminos Smoking Abdominal circumference Oligohydraminos ```
Parvovirus
89
``` In asymmetric growth restriction the ______ measurement is the most severe effected ? Parvovirus Pre-eclampsia Head circumference Excess caffeine intake Gestational diabetes Polyhydraminos Chromosomal Anhydraminos Smoking Abdominal circumference Oligohydraminos ```
Abdominal circumference
90
``` Often the first indication of fetal growth restriction? Parvovirus Pre-eclampsia Head circumference Excess caffeine intake Gestational diabetes Polyhydraminos Chromosomal Anhydraminos Smoking Abdominal circumference Oligohydraminos ```
Oligohydraminos
91
``` Will occur if there is renal agenesis? Parvovirus Pre-eclampsia Head circumference Excess caffeine intake Gestational diabetes Polyhydraminos Chromosomal Anhydraminos Smoking Abdominal circumference Oligohydraminos ```
Anhydraminos
92
``` Probably the commonest cause of fetal growth restriction? Parvovirus Pre-eclampsia Head circumference Excess caffeine intake Gestational diabetes Polyhydraminos Chromosomal Anhydraminos Smoking Abdominal circumference Oligohydraminos ```
Smoking
93
Can occur at the time of membranes rupturing ? Postpartum haemorrhage due to vaginal trauma Cord prolapse Placenta abruption Epileptic seizure Second degree tear Amniotic fluid embolism Postpartum haemorrhage due to poor uterine tone Eclampsia Third degree tear Cord presentation
Cord prolapse
94
Severe back pain, uterus firm and tender, small amount of bleeding in a women with pre-eclampsia? Postpartum haemorrhage due to vaginal trauma Cord prolapse Placenta abruption Epileptic seizure Second degree tear Amniotic fluid embolism Postpartum haemorrhage due to poor uterine tone Eclampsia Third degree tear Cord presentation
Placenta abruption
95
A seizure in a woman previously fit and well? Postpartum haemorrhage due to vaginal trauma Cord prolapse Placenta abruption Epileptic seizure Second degree tear Amniotic fluid embolism Postpartum haemorrhage due to poor uterine tone Eclampsia Third degree tear Cord presentation
Eclampsia
96
Bleeding very heavily just after a twin delivery? Postpartum haemorrhage due to vaginal trauma Cord prolapse Placenta abruption Epileptic seizure Second degree tear Amniotic fluid embolism Postpartum haemorrhage due to poor uterine tone Eclampsia Third degree tear Cord presentation
Postpartum haemorrhage due to poor uterine tone
97
Bleeding heavily following a difficult forceps delivery? Postpartum haemorrhage due to vaginal trauma Cord prolapse Placenta abruption Epileptic seizure Second degree tear Amniotic fluid embolism Postpartum haemorrhage due to poor uterine tone Eclampsia Third degree tear Cord presentation
Postpartum haemorrhage due to vaginal trauma
98
``` Tear involving the anal sphincter ? Postpartum haemorrhage due to vaginal trauma Cord prolapse Placenta abruption Epileptic seizure Second degree tear Amniotic fluid embolism Postpartum haemorrhage due to poor uterine tone Eclampsia Third degree tear Cord presentation ```
Third degree tear
99
True or false? | Obturator internus is part of the levator ani
False
100
True or false? | The pouch of Douglas lies posterior to the uterus
True
101
True or false? | The ovary is attached to the uterus by the round ligament
False
102
True or false? | Lymphatic drainage of the ovary is to the superfical inguinal and femoral nodes
False
103
True or false? | The principle supports of the uterus include the uterosacral ligaments
True
104
``` Cells that line the cervical canal? Squamous cells Glandular neoplasia Columnar cells Transformation zone Squamous metaplasia Squamous dysplasia Squamous neoplasia Zona pellucida ```
Columnar cells
105
How does the prodrome differ between the different types of seizures?
NEA: none Epileptic: Aura (auditory, smell, premonition, déjà vu) Syncope: Light headed, nausea sudden, palpitations,
106
How does the onset differ between the different types of seizures?
NEA: Not much Epileptic: Twitching, Syncope: Pale, sweating, look like going to faint,
107
How does the actual seizure differ between the different types?
NEA: Long duration, wild movements, NOT rhythmical, eye closed/ resisting eye opening, respond, pelvic thrusting Epileptic: Short duration, anatomical/repetitive/ rhythmical, pelvis thrusting (less), eyes open Syncope: Short/variable, anoxic seizure, sustained if stood up, eyes open
108
How does the recovery differ between the different types of seizures?
NEA: Quicker to recover, cry/speak Epileptic: Tired, drowsy, slow recovery, confused Syncope: Fast
109
What is purpura?
Purpura is the appearance of red or purple discolorations on the skin that do not blanch on applying pressure. They are caused by bleeding underneath the skin. Purpura measure 0.3-1 cm .
110
What causes purpura?
(D)isseminated (I)ntravascular (C)oagulation Consumptive coagulopathy Bacteraemia > widespread Thrombosis in microvassaculature Platelets used up and Clotting factors not produced by liver > Bleeding Tendency
111
What are the non-infective causes of fever?
Kawasaki's Disease – Diagnostic Criteria Rheumatic Fever – Diagnostic Criteria Reactive Arthritis Malignancy (Leukaemia, Lymphoma, Neuroblastoma) Connective Tissue Disorders (SLE, PAN, JIA) Inflammatory Bowel Disease
112
Jirou, a three year old boy presents with a seven day history of high fevers. He has now developed red eyes, a rash and is complaining of a sore mouth and throat. On examination he appears miserable and unwell with a diffuse maculopapular rash mainly on his torso. He has bilateral injected conjunctiva, red cracked lips and a strawberry tongue. He has a unilateral 3cm x 2cm cervical swelling, and swollen reddened palms. What are the differential diagnosis?
``` Staphylococcus Scalded Skin Infection Juvenile Rheumatoid Arthritis Streptococcal Infection, Grp A (scarlet fever) Toxic Shock Syndrome Measles Rheumatic Fever Rheumatic Heart Disease Steven Johnson’s syndrome Kawasaki’s Disease ```
113
How can you remember the symptoms of Kawasaki's?
``` M(y) = Mucosal involvement like dry chapped lips and strawberry tongue H= Hands and feet with oedema and desquamation (late in the disease) E= Eyes non-purulent bilateral conjunctivitis A= Adenopathy often cervical unilateral > 1.5 cm lymph nodes enlargement R= Rash usually truncal and pleomorphic T= Temperature non remitting fever for at least five days ```
114
How would you reduce the fluids in paediatric DKA?
Weight < than 10 kg, give 2 ml/kg/hour ​ Weight between 10 and 40 kg, give 1 ml/kg/hour​ Weight more than 40 kg, give a fixed volume of 40 ml/hour.​
115
What would you get on examination of congenital hypothyroidism?
``` Myxedematous facies Large fontanelles Macroglossia Distended abdomen with umbilical hernia Hypotonia Persistent jaundice Hypothermic/ mottled skin Bradycardia ```
116
How do you treat congenital hypothyroidism?
Act promptly Urgent assessment Check TFTs Levothyroxine - 10-15 micrograms/kg/day Aim to normalize T4 within 2 weeks and TSH within 1 month Ensure growth and neurodevelopmental outcomes close to genetic potential
117
What can happen if congenital hypothyroidism isn't treated?
``` Progressive intellectual deterioration occurs with each passing week Irreversible Severe developmental delay by 6 months Dwarfism Delayed sexual maturations Coarse dry skin ```
118
10 days old Collapsed and shocked Differential diagnosis unwell neonate?
``` Sepsis, sepsis, sepsis In any neonate Cardiac Non accidental injury/trauma Metabolic ```
119
A newborn is seen by the paediatric SHO for a routine baby check. O/E a heart murmur is noted. Further investigation is under taken and the baby is found to have a congenital heart disease. Which prenatal Ix can be used to detect congenital heart conditions?
Echo
120
A newborn is seen by the paediatric SHO for a routine baby check. O/E a heart murmur is noted. Further investigation is under taken and the baby is found to have a congenital heart disease. Which direction does blood flow in acyanotic congenital heart disease? Give 2 causes
Left to right: ASD, VSD, PDA
121
A newborn is seen by the paediatric SHO for a routine baby check. O/E a heart murmur is noted. Further investigation is under taken and the baby is found to have a congenital heart disease. In which direction does blood flow in a cyanotic congenital heart disease? Give 2 causes
Right to left: ToF, ToGA
122
A newborn is seen by the paediatric SHO for a routine baby check. O/E a heart murmur is noted. Further investigation is under taken and the baby is found to have a congenital heart disease. What are the 4 features of ToF? What syndrome arises if left untreated?
Pulmonary stenosis, VSD, overriding aorta, RVH. Eisenmenger’s syndrome – long standing R to L shunt increases Pul pressure over time, leading to thickening of pulmonary arteries, which causes RVH and increases pressure in RV, reversing the shunt L to R (cyanotic).
123
A 4 year old girl attends A&E following 5 day hx of coughing and worsening difficulty in breathing – both get worse at night. She is normally fit & well apart from a short episode of coryzal symptoms. What is the most likely diagnosis?
Croup
124
A 4 year old girl attends A&E following 5 day hx of coughing and worsening difficulty in breathing – both get worse at night. She is normally fit & well apart from a short episode of coryzal symptoms. How is the cough associated with Croup normally described?
Barking
125
A 4 year old girl attends A&E following 5 day hx of coughing and worsening difficulty in breathing – both get worse at night. She is normally fit & well apart from a short episode of coryzal symptoms Give two symptoms not mentioned associated with Croup?
Stridor, Hoarseness
126
A 4 year old girl attends A&E following 5 day hx of coughing and worsening difficulty in breathing – both get worse at night. She is normally fit & well apart from a short episode of coryzal symptoms. Give two other causes other than croup of developing stridor in this age group?
Epiglottitis, Foreign body, anaphylaxis
127
A 4 year old girl attends A&E following 5 day hx of coughing and worsening difficulty in breathing – both get worse at night. She is normally fit & well apart from a short episode of coryzal symptoms Name the virus commonly associated with causing Croup? What treatment is typically prescribed? In severe disease, what else can be given before escalation to ICU?
Parainfluenza virus. Dexamethasone oral 0.15mg/kg Adrenaline
128
What are the causes of bile stained vomiting?
Intestinal obstruction (distal to ampulla of vater) – malrotation, duodenal atresia, meconium ileus, necrotizing enterocolitis
129
What are the causes of haematemesis?
Oesophagitis, peptic ulceration, oral/nasal bleeding
130
What does projective vomiting in the first few weeks of life point towards?
Pyloric stenosis
131
What does vomiting at the end of a paroxysmal cough point towards?
Whooping cough
132
What does abdo tenderness/ pain on movement point towards?
Surgical abdomen
133
What are the causes of abdo distention?
Intestinal obstruction, incl strangulated inguinal hernia
134
What are the paediatric causes of hepatosplenomegaly?
Chronic liver ds, neonatal hepatitis, biliary atresia, primary sclerosing cholangitis
135
What are the causes of blood in stool?
Intussusception, gastroenteritis (salmonella/campylobacter)
136
What are the causes of severe dehydration/shock?
Severe gastroenteritis, systemic infection (UTI, meningitis), DKA
137
What are the causes of failure to thrive?
GOR, coeliac ds, CMP allergy & other chronic GI conditions
138
A young child attends A&E. His father is very concerned that he has started vomiting after feeds. The vomiting is getting worse after successive feeds. He is still trying to feed and seems to be hungry. What is the most likely diagnosis? What is the surgery to treat it?
Pyloric stenosis. | Ramstedt’s pyloromyotomy
139
A young child attends A&E. His father is very concerned that he has started vomiting after feeds. The vomiting is getting worse after successive feeds. He is still trying to feed and seems to be hungry. At what age does pyloric stenosis usually present?
2-8 weeks
140
A young child attends A&E. His father is very concerned that he has started vomiting after feeds. The vomiting is getting worse after successive feeds. He is still trying to feed and seems to be hungry. Can bile be present as the pyloric stenosis progresses? & why?
No, above the ampulla of vater
141
A young child attends A&E. His father is very concerned that he has started vomiting after feeds. The vomiting is getting worse after successive feeds. He is still trying to feed and seems to be hungry. What acid-base disturbance would you expect to find? & what electrolyte imbalances?
Metabolic alkalosis, low K, low Cl
142
A 20 year old lady presents to A&E with a new PV bleed and crampy abdominal pains. Her LMP was 9 weeks ago. On examination: Suprapubic tenderness and cervical excitation +ve. You perform a pregnancy test which is positive What is your differential diagnosis?
Ectopic Miscarriage Molar
143
A 20 year old lady presents to A&E with a new PV bleed and crampy abdominal pains. Her LMP was 9 weeks ago. On examination: Suprapubic tenderness and cervical excitation +ve. You perform a pregnancy test which is positive. What 3 investigations would help you to establish the diagnosis?
PV examination Cervical excitation/motion tenderness - Ectopic or PID Os open or closed? USS Intrauterine pregnancy? Tubal pregnancy? - Ectopic Uterus large for dates? - Molar Serum bHCG Extremely high - Molar Serial measurements show an increase over time?
144
A 20 year old lady presents to A&E with a new PV bleed and crampy abdominal pains. Her LMP was 9 weeks ago. On examination: Suprapubic tenderness and cervical excitation +ve. You perform a pregnancy test which is positive. PV examination shows cervical motion tenderness USS shows a pregnancy in the fallopian tube bHCG is raised Mx of this ectopic pregnancy?
ABCDE Salpingectomy (take tube out) Salpingotomy (If she needs the tube) Methotrexate - if bHCG low and systemically well. Requires follow up
145
A 20 year old lady presents to A&E with a new PV bleed and crampy abdominal pains. Her LMP was 9 weeks ago. On examination: Suprapubic tenderness and cervical excitation +ve. You perform a pregnancy test which is positive. USS shows bulky uterus with a ‘snow storm’ appearance bHCG is v v raised What is this and how would you manage it?
Molar pregnancy. | Suction Curettage
146
A 31 year old lady who is 34 weeks pregnant presents to A&E with a bright red PV bleed. Differential diagnosis?
Placenta praevia Placental abruption (Other: Vasa praevia, uterine rupture, domestic violence)
147
A 31 year old lady who is 34 weeks pregnant presents to A&E with a bright red PV bleed. On examination, the uterus is non-tender, and the baby is in an abnormal lie. What diagnosis would this support?
Praevia is painless, Abruption is painful Praevia, the baby is often in an abnormal lie If this were an abruption, you would see a ‘tender, woody uterus’
148
If there is a praevia, what must you NOT do?
PV exam
149
A 31 year old lady who is 34 weeks pregnant presents to A&E with a bright red PV bleed. On examination, the uterus is non-tender, and the baby is in an abnormal lie. What one investigation would you order to establish the diagnosis?
TV USS - would show praevia | Abruption is a clinical diagnosis of exclusion - would present in hypovolemic shock
150
What is the initial management for abruption/praevia?
``` ABCDE Admit CTG Plan for delivery: If fetal distress (often abruption): Coag screen, crossmatch Steroids if gestation <34 weeks Anti D (if Rhesus -ve mother) If no fetal distress (often praevia): elective C-section at 39 weeks (if placenta remains low lying) ```
151
A 65 year old lady presents to her GP with spotting, she went through the menopause aged 50. What one condition must be ruled out?
PMB is endometrial cancer until proven otherwise
152
A 65 year old lady presents to her GP with spotting, she went through the menopause aged 50. What risk factors may this lady have for endometrial cancer?
``` Unopposed oestrogen Early menarche Late menopause Obesity +PCOS Nullparity T2DM HRT Tamoxifen for breast cancer ```
153
What are protective factors against endometrial cancer?
Breaks in oestrogen e.g. COCP and pregnancy
154
A 65 year old lady presents to her GP with spotting, she went through the menopause aged 50. What 3 investigations would you do?
PV exam - Normal (+/- atrophic vaginitis) TVUS - Endometrial thickening Hysteroscopy + biopsy - staging
155
A 65 year old lady presents to her GP with spotting, she went through the menopause aged 50. A hysteroscopy and biopsy is diagnostic for endometrial adenocarcinoma. How will you proceed?
TAH + BSO = Total Abdominal Hysterectomy and Bilateral Salpingo-oophorectomy for treatment and staging
156
What are the FIGO endometrial staging stages?
Stage 1 - confined to uterus Stage 2 - Uterus + cervix Stage 3 - Through wall of uterus Stage 4 - Spread - bladder/bowel. Distant metastases
157
27 year old lady presents to her GP with post-coital bleeding. On questioning she does not think she had the HPV vaccine at school. What one condition must be ruled out?
Cervical carcinoma
158
27 year old lady presents to her GP with post-coital bleeding. On questioning she does not think she had the HPV vaccine at school. What risk factors may this lady have for cervical carcinoma?
``` HPV 16/18/33 Smoking Early first intercourse Many sexual partners Low socioeconomic group ```
159
27 year old lady presents to her GP with post-coital bleeding. On questioning she does not think she had the HPV vaccine at school. How would you investigate?
Colposcopy | Biopsy abnormal areas
160
27 year old lady presents to her GP with post-coital bleeding. On questioning she does not think she had the HPV vaccine at school. How would you manage a small lesion on colposcopy?
Simultaneous treatment at colposcopy with LLETZ, Cone biopsy
161
27 year old lady presents to her GP with post-coital bleeding. On questioning she does not think she had the HPV vaccine at school. How would you manage invasive cervical carcinoma?
Stage 0 = Carcinoma in situ (LLETZ/cone biopsy) Stage 1A1 = Confined to cervix, <3mm depth = Cervical conization, or hysterectomy Stage 1A2= Confined to cervix, >3mm depth = Total hysterectomy or radiotherapy Stage 2-4 = Beyond cervix = Chemoradiotherapy
162
When does cervical screening take place and how often?
25-64 year olds 25-49 = 3 yearly 50-64 = 5 yearly Should be taken mid-cycle
163
A 40 year old lady presents to your GP surgery complaining of heavy periods which soak her with the passage of clots. What are the potential causes of her menorrhagia?
``` Dysfunctional uterine bleeding Fibroids Endometriosis Adenomyosis IUD Copper coil Clotting disorders vWD Hypothyroidism ```
164
A 40 year old lady presents to your GP surgery complaining of heavy periods which soak her with the passage of clots. What are the management options available to the GP?
IUS (Mirena) - If finished family NSAIDS (Mefenamic acid) - Better if pain Tranexamic acid (Antifibrinolytic)
165
A 40 year old lady presents to your GP surgery complaining of heavy periods which soak her with the passage of clots. On further questioning you discover that these treatments have not previously worked for her, and you refer to secondary care. A transvaginal ultrasound was then performed which revealed numerous fibroids. What other symptoms may she have presented with?
Infertility Irregular abdominal mass Pressure effects on bowel/bladder
166
Summary of progesterone contraception?
Systemic : POP (mini pill), implant, injection Local: IUS thickens cervical mucus to prevent sperm reaching egg; thins lining of womb to prevent egg implanting; +/- stops ovulation local s/e: irregular bleeding patterns. systemic s/e: +/- acne, +/- mood changes Can be used by women who smoke & over 35; after stopping normal levels of fertility return. 3 hour window to take pill.
167
A 25 year old lady comes to hr GP complaining of pain which begins a few days before her period, and stops at the end of her period. She also tells you that she experiences some pain whilst having sex with her partner. What is the most likely cause of her cyclical pain?
Endometriosis | (Cyclical pelvic pain + Deep dyspareunia + Infertility)
168
A 25 year old lady comes to hr GP complaining of pain which begins a few days before her period, and stops at the end of her period. She also tells you that she experiences some pain whilst having sex with her partner. You believe she may have endometriosis and refer to secondary care. What is the gold standard investigation for endometriosis?
Diagnostic laparoscopy
169
A 25 year old lady comes to hr GP complaining of pain which begins a few days before her period, and stops at the end of her period. She also tells you that she experiences some pain whilst having sex with her partner. You believe she may have endometriosis and refer to secondary care. What management options may the gynaecology team offer for endometriosis?
Management is primarily symptomatic control: 1st line: Paracetamol/NSAIDs 2nd line: Hormones such as COCP 3rd line: (Secondary care) GnRH analogues Surgical management: Lap excision and laser treatment of lesions - may improve fertility
170
A 20 year old lady presents to you GP clinic with PV discharge. You suspect she may have an infection and want to ask a few more questions... She returns the following day with worsening pelvic pain and fever. You conduct a PV exam and find cervical excitation. What is the most likely diagnosis?
PID
171
A 20 year old lady presents to you GP clinic with PV discharge. You suspect she may have an infection and want to ask a few more questions... She returns the following day with worsening pelvic pain and fever. You conduct a PV exam and find cervical excitation. What is your management?
Analgesia High vaginal swabs Triple therapy: IM ceftriaxone + PO Doxycycline + PO Metronidazole
172
An 56 year old P4 (vaginal deliveries) with a BMI of 30 comes to see you complaining of involuntary leakage of urine with coughing/sneezing. 1: diagnosis? 2: investigations 3: 3 pillars of management?
1. Stress incontinence 2. Urinalysis 3. Conservative: Physio, lose weight, vaginal sponges, incontinence pads Medical: Duloxetine Surgical: midurethral sling, trans-obturator tape
173
An 82-year-old lady presents with urinary straining, poor flow, incomplete emptying of the bladder, and urinary incontinence. Urodynamics demonstrates a voiding detrusor pressure of 90 cm H20 (normal value < 70 cm H2O) and peak flow rate of 5 mL/second (normal value > 15 mL/second). What is the most likely diagnosis?
Overflow incontinence
174
An 82-year-old lady presents with urinary straining, poor flow, incomplete emptying of the bladder, and urinary incontinence. Urodynamics demonstrates a voiding detrusor pressure of 90 cm H20 (normal value < 70 cm H2O) and peak flow rate of 5 mL/second (normal value > 15 mL/second). Other investigations?
Urinary flow rate | Post void residual volume
175
A 51 year-old woman presents to her GP with a nine month history of urinary incontinence, passing large volumes of urine involuntarily. Examination of her abdomen is normal. Urinalysis is normal. Diagnosis?
Overactive bladder
176
A 51 year-old woman presents to her GP with a nine month history of urinary incontinence, passing large volumes of urine involuntarily. Examination of her abdomen is normal. Urinalysis is normal. Management?
Conservative: lower fluid intake, timed voiding, bladder re-training 6/52 Medical: Oxybutanin (CI = frail → tolteradine) Surgical: Neuromodulation - S3 nerve root stimulation
177
A 55-year-old woman attends the GP surgery as she is worried about her risk of developing ovarian cancer, especially because of the amount of exposure ovarian cancer has received in the news. Which of the following is most associated with the development of ovarian cancer? ``` Early menarche Early menopause COCP use Multiple pregnancies Low BMI ```
Early menarche Other risk factors: Late menopause, nulliparity, HRT, high BMI, BRCA 1/BRCA 2
178
A 65-year-old post-menopausal lady presents with bloating, unintentional weight loss, dyspareunia, and a raised CA-125. Given the likely diagnosis, which of the following terms best describes how this cancer spreads initially? ``` local spread in pelvic region spread to abdominal organs haematological spread lymphatic spread seeding ```
local spread in pelvic region
179
What are the general causes of sexual health disorders?
Physical, psychosocial, or iatrogenic
180
What are the physical causes of sexual health disorders?
Chronic disease – cardiovascular disease, diabetes, obesity, neurological disease Hormone disorders – androgen deficiency, oestrogen deficiency, hyperprolactinaemia, thyroid dysfunction Local problems – infections (STIs, prostatitis), irritation (thrush), insufficient lube, congenital defects, endometriosis, tumours, cysts FGM
181
What are the psychological causes of sexual health disorders?
``` Stress, depression, anxiety Low self-esteem and body image issues Eating disorders – hormones and body image Past trauma or abuse Relationship problems (‘sexual script’) Lack of sex ed (“women have 3 holes????!”) FGM Alcohol abuse – “whiskey dick” Illicit drugs – e.g. cocaine, heroin ```
182
What are the iatrogenic causes of sexual health disorders?
SSRIs Anti-hypertensives: Beta-blockers are associated with erectile dysfunction Alpha-blockers can cause retrograde ejaculation (a cause of male infertility) Local damage from surgery: Especially prostate surgery and erectile dysfunction
183
What is sexual aversion disorder?
Complete distaste or fear of sex Discussing sex is intolerable and distressing Generally psychological, treated with psychosexual therapy
184
What is hypoactive sexual desire disorder?
Lack of libido/sex drive Causes include chronic disease, hormone disorders, psychological and relationship problems Treat by cause
185
Summary of erectile dysfunction?
Difficulty obtaining or maintaining erection Causes – CVD, DM, neurological disease, low testosterone, SSRIs, anti-hypertensives, prostate surgery, relationship problems, psychological problems Non-medical treatment – vacuum device, penile rings, Kegels Medical treatment – sildenafil tablets or injectable alprostadil (remember need stimulation to work, and take 45-60 minutes to become effective): Vasodilators
186
What are the six features of female sexual arousal disorder?
``` Little interest in sex Few thoughts about sex Decreased initiation of sex Little pleasure during sex Decreased interest in sex when exposed to erotic stimuli Little physical response to sex ```
187
Summary of female sexual arousal disorder?
Persistent or recurrent inability to maintain sexual arousal (until adequate completion of sexual activity) Causes – CVD, DM, neurological disease, oestrogen deficiency, SSRIs, local irritation, psychological problems, relationship problems Non-medical treatment – psychosexual therapy, Eros therapy device, sexual aids Medical treatment – correct any hormone issues
188
Summary of rapid ejaculation?
Inability to control ejaculation in order for both partners to enjoy sexual intercourse Physical causes - hyperthyroidism, prostatitis, ED Psychological/social causes – lack of experience, time-pressure, anxiety, relationship problems Treatments – topical LAs, psychosexual therapy, behavioural techniques (stop-start)
189
Summary of delayed ejaculation?
Delayed length of time/inability to ejaculate Causes – neuropathy, spinal injury, alcohol, SSRIs, sexual script issues, anxiety, pressure Treatments – of physical causes, psychosexual therapy
190
Summary of female dyspareunia?
Pain on intercourse – superficial or deep Physical causes – infection, injury, insufficient lube, FGM (superficial); endometriosis, tumours/cysts, congenital defect (deep) Psychological causes – trauma, abuse, education, relationship issues, FGM Treatment – by underlying cause
191
Summary of vaginismus?
Involuntary contraction of lower 1/3 of vaginal muscle, leading to difficult/painful penetration Causes broadly the same as dysparenunia Management – must do physical exam  psychosexual therapy, behavioural therapies (guided self-exploration, vaginal dilators)
192
What are the 5 key features of couples therapy?
``` Improve communication Modify dysfunctional behaviour Decrease emotional avoidance Change view of relationships Promote strengths ```
193
What are the public health aspects of STI prevention?
``` Primary prevention = reduce risk of acquiring STIs: Education, awareness, free condoms, hep B vaccination Secondary prevention = earlier identification of asymptomatic disease: Targeted screening (Goodwin!), partner notification/contact tracing Tertiary prevention = reduce morbidity and morality: Treat the disease ```
194
Summary of chlamydia?
Caused by chlamydia trachomatis bacteria 2 week incubation period – may need to re-test Asymptomatic – can cause discharge and dysuria (especially in men) Diagnosis = first void urine NAAT Treatment = week of azithromycin
195
Summary of gonorrhoea?
Caused by Neisseria gonorrhoea bacteria (is a Gram-neg diplococci!) 2 week incubation period – may need to re-test Asymptomatic – can cause discharge and dysuria (especially in men) Diagnosis = first void urine NAAT Treatment = single-dose ceftriaxone
196
Summary of syphilis?
Caused by Treponema pallidum bacteria Prevalence is increasing – very transmissible horizontally and vertically Presentations: Primary (days-weeks) – CHANCRE = painless genital sores! (any genital sore is syphilis until proven otherwise) Secondary (months) – gum lesions, rash, lymphadenopathy Tertiary (years) –gummatous, neuro, cardio Diagnosis = serology Treatment = IM penicillin
197
Summary of trichomonas?
``` Sexually-transmitted protozoal infection GREEN FROTHY SMELLY DISCHARGE Strawberry cervix Diagnosis = high vaginal swab Treatment = metronidazole ```
198
Summary of BV?
NOT an STI Caused by anaerobes overgrowing normal vaginal flora Grey/white discharge with distinctive fishy odour Diagnosis = high vaginal swab (has high pH) Treatment = metronidazole
199
Summary of candidiasis?
Yeast infection with candida albicans Can be STI (especially in men) – but usually due to overgrowth of normal vaginal flora due to pH imbalance (soaps, Abx) Itching, local inflammation, superficial dyspareunia, odourless white discharge Diagnosis = high vaginal/urethral swabs (has low pH) Treatment = antifungals (clotrimazole pessary/cream, fluclonazole tablets)
200
Summary of genital warts?
Caused by HPV Highly contagious and spread by skin-to skin contact Many people have the causative virus – but immune system keeps it under control, and the warts manifest when immunosuppressed: Steroids, immunosuppressants, pregnancy, age, diabetes Treatment = OTC creams, cryotherapy
201
``` 14yo girl comes in Having unprotected sex with her boyfriend Wants contraception Doesn’t want her mother to know How do you manage this patient? ```
Pregnany test STI Test Explore concerns and discuss options Go for Long acting contraception if she is interested Don’t tell her mother because of fraser/gillick competence
202
``` 43 yo BMI 32 Female, presents feeling tired all the time Trying to lose weight but can’t Heavy periods and irregular Has noticed “brittle hair” Feeling low in mood How would you investigate this? ```
``` FBC: ESR/CRP: WCC: LFT and U&E: IgA, TTG: Thyroid function: Random or fasting blood sugar/ Hba1c: PHQ9: If history suggests: Lymes (outdoors), chronic hepatitis (IVDU), autoantibodies (inflammatory signs), sleep studies (snoring), EBV (young person), Vitamin D (housebound), HIV (IVDU/sex) ```
203
What are some drugs to be wary of in CKD?
Diuretics, ace, arbs, metformin, nsaids
204
You are performing the Postnatal check on a 3 day old girl. She has swollen hands and feet, and you find it difficult to palpate her femoral pulses. Select the most likely karyotype. ``` 45XO 47 XY (21) Fragile X syndrome 47 XY (18) 47 XY (13) 47 XXY ```
Turner’s Syndrome = 45 XO (missing X chromosome) swollen hands and feet = Lymphodema – due to malfunctions of the lymphatic system
205
You are performing the Postnatal check on a 3 day old girl. She has swollen hands and feet, and you find it difficult to palpate her femoral pulses. which heart defect?
Aortic stenosis
206
You are performing the Postnatal check on a 3 day old girl. She has swollen hands and feet, and you find it difficult to palpate her femoral pulses. Name 5 features of Turners syndrome?
``` Short stature Webbed neck (due to cystic hygroma) Lymphoedema of hands and feet in neonate Wide-carrying angle (cubitus valgus) Widely spaced nipples, shield chest Spoon shaped nails Low set ears Low posterior hair-line Short metacarpal IV Pigmented moles Normal Intellect Non-verbal learning disabilities (maths, spatial orientation) Primary Amenorrhoea (due to ovarian dysgenesis) – infertility Delayed puberty Congenital heart defects:- coarctation of the aorta- aortic stenosis- bicuspid aortic valve Renal anomolies (horse-shoe kidney) Hypothyroidism Diabetes ADHD Recurrent Otitis Media / hearing loss Visual impairments ```
207
You are performing the Postnatal check on a 3 day old girl. She has swollen hands and feet, and you find it difficult to palpate her femoral pulses. Name 3 Signs of Turner’s Syndrome at Antenatal Fetal ultrasound Scans?
Fetal oedema of the neck, hands and feet Cystic hygroma - a form of benign lymphangioma – most common in the posterior triangle of the neck Structural defects of the heart, kidneys
208
``` An 18 month-old girl presents with recurrent cough, which is occasionally productive. She is small for her age. Her mother reports that the girl also has episodes of pale, greasy stools. What's the most likely diagnosis? Pneumonia Bronchiolitis Croup Cystic Fibrosis Asthma ```
Cystic Fibrosis
209
``` A 6 week old, bottle-fed infant presents with vomiting. This has been steadily getting worse over the last 5 days. He is now eager for feeds and shortly after taking milk will forcefully vomit up the milk. There are no signs of dehydration, but he has lost weight. Diagnosis out of the following? Gastro-oesophageal reflux disease Pyloric stenosis Intussusception Duodenal atresia Overfeeding ```
Pyloric stenosis
210
Name 5 signs of dehydration?
``` Reduced level of consciousness ↓ Sunken fontanelle Sunken eyes Dry mucous membranes Reduced urine output ↓ Reduced skin turgor ↓ Tachycardia ↑ Tachypnoea ↑ Low blood pressure ↓ Increased capillary refill time ↑ Cool peripheries Faint / impalpable pulse ```
211
A 14 year old boy presents with a limp and left knee pain for 24 hours. He is systemically well and afebrile. On examination his left leg is externally rotated and shorter than the right. Diagnosis?
Slipped upper femoral epiphysis (SUFE)
212
A 3 week-old male infant presents with severe vomiting. He is shocked and hypotensive. Bloods reveal a normal pH, raised K+, low Na+ and low glucose levels. Diagnosis?
Congenital adrenal hyperplasia (CAH)
213
A 4 year old boy presents with oedema. He is clinically unwell with severe abdominal pain, fever and guarding. Urine is positive for protein and his serum albumin is low. Diagnosis?
Nephrotic syndrome
214
What are the 6 features of the dependence syndrome?
``` 1 - Craving 2 – Difficulty controlling use 3 – Physical withdrawal 4 – Tolerance 5 – Neglect of other activities 6 – Persistent use despite consequences ```
215
How many of the 6 features need to be present for dependence syndrome?
3
216
Which 2 drugs are used to reduce off opiates?
Methadone and Buprenorphine
217
What is Naltrexone used for?
Opioid antagonist – blocks euphoria, prevents relapse
218
What is delerium tremens?
Alcohol withdrawal – tachycardia, hypotensive, tremor, fits, hallucinations e.g. insects crawling under skin
219
Name as many personality disorders as you can
``` Paranoid Schizoid Schizotypal Antisocial (psychopathic) Borderline Histrionic Narcissistic Avoidant Dependent Obsessive-compulsive ```
220
What suggests anxiety in a child?
Thumb-sucking Nail-biting Bed-wetting Foodfads
221
What is the management of anxiety?
``` Symptom control Regular exercise Meditation CBT Relaxation Behavioural therapy (e.g graded exposure) Medication (Benzodiazepines, SSRIs, Azapirones, older antihistamines, beta blockers) Hypnosis ```
222
What are the diagnostic criteria for anorexia?
1 – Weight <85% predicted 2 – Fear of weight gain 3 – Disproportionate idea of body 4 – Amenorrhoea in women or decreased libido in men
223
A nurse informs you of a 28-year-old woman who is 24 weeks pregnant. He says that she has a blood pressure reading of 155/90 mmHg. Her previous blood pressure 2 days ago was 152/85 mmHg. Her urine dip shows +++ protein. She was previously healthy prior to becoming pregnant. ``` What is the first line management in this situation? Oral labetalol IV hydralazine Aspirin 300mg Nifedipine Urgent delivery of foetus ```
Oral labetalol
224
``` A neonate is born at 32 weeks gestation after prolonged premature rupture of membranes (PROM). Approximately 12 hours after birth the neonate presents with temperature instability, respiratory distress and lethargy. Sepsis is confirmed by blood cultures. What is the most likely infectious agent? Staph. aureus Staph. epidermidis Group B streptococcus E. coli Listeria monocytogenes ```
Group B streptococcus
225
A 32-year-old woman who is 30+2 weeks pregnant, para 2+0, presents to the maternity triage unit. Her past deliveries were both elective Caesarean sections. Her pregnancy has been uneventful up to this point but she presents to the maternity triage unit this morning with an episode of painless vaginal bleeding. She describes the amount as about a tablespoon. What should be done next to determine the diagnosis? Digital vaginal exam to assess for cervical dilatation Induction of labour USS abdomen FBC to assess for anaemia Nothing as blood loss insignificant
USS abdomen
226
A 30-year-old primigravida lady is 41 weeks pregnant. At her 41 week antenatal visit, she was offered a vaginal examination and a membrane sweeping hoping that she would go into labour. However, she does not go into labour even after 6 hours. Her Bishop Score is 4. ``` What is the next step? Oral prostaglandins Vaginal prostaglandin gel C-section Syntocinon Amniotomy ```
Vaginal prostaglandin gel
227
A 28-year-old G1P0 lady has been in labour for eleven hours; she progressed through the first stage without any issues. However, the midwife has noted CTG abnormalities, and was able to palpate the umbilical cord. She immediately calls the obstetric registrar who checks the CTG, which shows variable decelerations. What is the initial definitive management for the cause of these decelerations? IV oxytocin O’Sullivan’s manoeuvre SC terbutaline Woods’ Screw Manoeuvre Place hand into vagina to elevate presenting part
Place hand into vagina to elevate presenting part
228
``` A 33-year-old lady has developed a massive obstetric haemorrhage. A diagnosis of uterine atony is made. After initial stabilisation and general measures, what is the first-line medical management? Ergometrine Syntocinon Carboprost Misoprostol Mifepristone ```
Syntocinon | then Ergometrine
229
``` A woman who gave birth 6 weeks ago presents to her local GP surgery with her husband. She describes 'crying all the time' and 'not bonding' with her baby. Which one of the following screening tools is it most appropriate to detect postnatal depression? Hamilton Depression Rating Scale PHQ-9 Edinburgh Scale Beck Depression Inventory PHQ-2 ```
Edinburgh scale
230
A 30-year-old primigravida lady is 41 weeks pregnant. At her 41 week antenatal visit, she was offered a vaginal examination and a membrane sweeping hoping that she would go into labour. However, she does not go into labour even after 6 hours. Her Bishop Score is 4. What does the bishop score mean?
a score of < 5 indicates that labour is unlikely to start without induction a score of > 9 indicates that labour will most likely commence spontaneously
231
``` A 71 year old woman presents to the GP with a 12-month history of progressive decline in her memory function. She has no other symptoms. Her husband says she now gets lost trying to find the toilet at home. She has previously been fit and well, and physical examination is unremarkable. She scores 23/30 on a mini-mental state examination (MMSE). Select the most appropriate cause of the dementia? Lewy body dementia Vascular dementia Alzheimer’s disease Picks disease Normal pressure hydrocephalus ```
Alzheimer’s disease
232
What makes up a Comprehensive Geriatric Assessment for discharge planning?
Medical Assessment – Problem list (diagnosis and treatment), co-morbid conditions & disease severity, Medication review- doctor / consultant Functional Assessment – ADL, gait, balance- occupational therapist, physiotherapist Psychological Assessment – cognition, mood- nurse, psychiatrist Social assessment – care resources, finances- social worker Environmental assessment – home safety
233
What is the supportive management in delirium?
``` Clocks and calendars Side room Sleep hygiene – discourage napping Adequate lighting Continuity of care Access to hearing aids / glasses ```
234
A 70-year-old woman with a history of vertebral crush fractures presents to the osteoporosis outpatient clinic. Which of the following investigations is most useful to assess the extent of her osteoporosis? Spinal X-rays MRI scan Full blood count, bone and liver biochemistry blood tests Vitamin D levels DEXA scan
DEXA scan
235
What are the risk factors for osteoporosis?
``` Steroids (>5mg/day) Hyperthyroidism, hyperparathyroidism, hypocalcaemia Alcohol / tobacco Thin (BMI < 22) Testosterone ↓ (antiandrogens) Early menopause – oestrogen deficiency Renal or liver failure Erosive / Inflammatory bowel disease Dietary intake (↓Ca2+, malabsorption, diabetes type I) ```
236
A 22 year old woman attends A&E with lower abdominal pain, her last period was 7 weeks ago. The nurse is concerned as her observations are “off”, she is hypotensive, has a HR 110. On examination she has rebound tenderness, cervical excitation, a closed cervical os and no discharge. Her pregnancy test was +ve. You suspect this is due to an ectopic pregnancy. Name 2 features you might see on TVUSS that indicate this diagnosis(2)
Empty uterus | Free fluid in adnexae/pouch of Douglas
237
A 22 year old woman attends A&E with lower abdominal pain, her last period was 7 weeks ago. The nurse is concerned as her observations are “off”, she is hypotensive, has a HR 110. On examination she has rebound tenderness, cervical excitation, a closed cervical os and no discharge. Her pregnancy test was +ve. You suspect this is due to an ectopic pregnancy. What medical management could be used if she was haemodynamically stable?(1)
Methotrexate
238
A 22 year old woman attends A&E with lower abdominal pain, her last period was 7 weeks ago. The nurse is concerned as her observations are “off”, she is hypotensive, has a HR 110. On examination she has rebound tenderness, cervical excitation, a closed cervical os and no discharge. Her pregnancy test was +ve. You suspect this is due to an ectopic pregnancy. You take her to theatre for laparoscopic surgery, her other fallopian tube appears to be covered in adhesions. What surgical procedure would you perform to remove the ectopic in hope of preserving her future fertility? (1)
Salpingotomy

1 - Phase 3a revision AE (2 decks)

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