Surg Soc Pub Quiz Flashcards by Anna White

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)

i. Empty uterus

ii. Free fluid in adnexae/pouch of Douglas

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Ectopic Pregnancy

What medical management could be used if she was haemodynamically stable?

i. MTX

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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)

i. Salpingotomy

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A 33 year-old woman presents to EPAU with PV bleeding & abdominal pain. She is 10 weeks pregnant.
a. List 3 causes of miscarriage. (3)

i. Chromosomal abnormalities (usually spontaneous miscarriage in 1st trimester)
ii. Thrombophilic abnormalities (e.g. Factor V Leiden, antiphospholipid etc.)
iii. Anatomical abnormalities (bicornuate/arcuate uterus, cervical incompetence)
iv. Endocrinal causes (PCOS, hyperprolactinaemia, uncontrolled DM)
v. Infective causes (BV cause late miscarriage)

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Miscarriage

b. What are the different types of miscarriage?

i. Threatened
ii. Inevitable
iii. Incomplete
iv. Complete
v. Septic
vi. Missed

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Miscarriage

On examination, her cervical os is closed. What type of miscarriage is this? (1)

Threatened

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Miscarriage

If her cervical os was open, what type of miscarriage would this be? (1)

Inevitable

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List 3 risk factors associated with miscarriages?

i. Maternal age (risk increases as maternal age increases)
ii. Previous miscarriages
iii. Occupational hazards
iv. Advanced paternal age
v. Maternal factors – low pre-pregnancy BMI, connective tissue disease, uttering surgery, fertility problems, stress/anxiety, uncontrolled DM vi. Lifestyle – smoking, alcohol, illicit drug use

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Threatened Miscarriage:

What is the best management option for this patient?

Watchful waiting (only 10% of threatened miscarriages go on to miscarry)

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A G2P2 female delivers a healthy baby boy, Chris. Shortly after delivery, she experiences a large PV bleed. a. What are the 4T’s of a primary postpartum haemorrhage? (4)

i. Tone – uterine atony
ii. Tissue – retained placenta
iii. Trauma – genital tract trauma
iv. Thrombin – clotting problems

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Define primary PPH. (1)

Severe blood loss <24 hours of birth (>0.5L in delivery OR >1L in CS)

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What is the initial management of her PPH? – list 3

i. ABCDE
ii. Bloods – FBC, clotting screen, group & save, cross match
iii. IV access + IV fluids

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Which drugs can you give for the management of primary PPH? (1)

i. IV oxytocin 5 units
ii. IM/slow IV ergometrine 0.5mg
iii. IM/intramyometrial carboprost 0.25mg (can give up to 8 times)
iv. PR misoprostol 1000mg

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How can primary PPH be prevented?

Active management of 3rd stage of labour with prophylactic oxytocics

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A couple that have been trying for a baby for over a year have yet to conceive. Semen analysis was normal, however results showed there was a problem with ovulation, her test showed she was anovulatory. Which parameter is used in to determine ovulation? (1)

Mid luteal (day 21) progesterone

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What is the 1st-line treatment for urge incontinence?

Bladder drill/training

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A 33 year-old woman (G3P2) is 34 weeks pregnant. She is being investigated following a PV bleed. She is found to have placenta accrete. Which one of the following is the most important risk factor for this condition? (1)

a. Smoking
b. Obesity
c. Previous C-sections
d. Twin pregnancies e. Endometriosis

Answer= C

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A 29-year-old female is 6 weeks postpartum and presents to her GP with a 12-hour history of a painful, erythematous breast. She is breastfeeding her baby. Her vital signs are normal. On examination, her right breast is tender, erythematous and warm to touch; there is no palpable lump or fissure. What is the most appropriate first line management? (1)

Advise to continue breastfeeding and use simple analgesia and warm compresses

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A child presents with heave proteinuria, low plasma albumin and oedema.
a. What is the most likely diagnosis? (1)

Nephrotic syndrome

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Nephrotic Syndrome

How is this managed? (1)

Prednisolone 60mg/m2 daily

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Nephrotic Syndrome

This child is resistant to treatment. The diagnosis was confirmed as minimal change disease. What histological finding would have confirmed this?

Fused podocytes

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Name 2 complications of minimal change disease. (2)

i. Hypovolaemia
ii. Thrombosis
iii. Infection
iv. Hypercholesterolaemia
v. Pericardial effusion

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A 6 month-old boy presents in AMU with increasing respiratory difficulty and tachypnoea. Coryzal and fever symptoms are also present. Symptoms and signs have increased from the second day when coryzal symptoms began. After examination the child is diagnosed with bronchiolitis.
a. What is the main organism causing bronchiolitis? (1)

RSV

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At what age does bronchiolitis usually occur?

<2 years old

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What is the best investigation to get a definite diagnosis of bronchiolitis?

Nasopharyngeal aspirate (NPA)

What management should be given if a child seems to have impending respiratory failure?

Continuous positive airway pressure (CPAP) – after initial resus, i.e. O2, IV fluids etc.

What test could you do to rule out possible pneumonia?

CXR (but you would not normally XR a child if you suspect bronchiolitis)

A 2 year-old child is admitted into A&E for a chest infection. Medics realize that this is their third serious chest infection in a month. With further discussion with parents, they find that the child is also failing to thrive. After investigating, the child is diagnosed with cystic fibrosis and they initiate management. a. What chromosome is affected in CF? (1)

Chromosome 7

What are the 3 most common organisms causing chest infections in CF?

i. S. aureus ii. H. influenzae iii. P. aeruginosa

What does the newborn screening test (Guthrie’s test) measure in regards to CF?

Immunoreactive trypsinogen

Name 4 pathological features of Tetrallogy of Fallot. (4)

a. Large VSD b. Overriding aorta c. Pulmonary outflow tract stenosis d. R ventricular hypertrophy

What is the recommended age at which solid foods should be introduced into an infants diet?

6 months

Which one of the following is a recognized risk factor for Sudden Infant Death Syndrome (SIDS)?

a. Male gender b. Large-for-dates at birth c. Supine sleeping position d. Breastfeeding e. Age 2-4 weeks Male Gender

At what age should a child learn to hop on 1 leg?

4 years

Which vitamin deficiency is associated with an increased risk of severe measles infection?

A 3 year-old child has presented with a 6-day fever, red eyes, red tongue, fissured lips, cervical lymphadenopathy, erythematous skin with blanching macules on his trunk and is irritable. What is the most likely diagnosis?

Kawasaki Disease

What is the most common congenital male reproductive disorder? (1)

Cryptorchidism (undescended testes)

At what age should a child be referred to a paediatrician if they have not started walking?

12 months

A 5 year-old boy has presented with a limp, pain in his right hip/knee. His hip is swollen but not red or hot. There is no previous history of a fall or trauma. On examination, he has an antalgic gait, limited hip abduction, flexion, extension and internal rotation. What is the most likely diagnosis? (1)

Perthe's disease

What is the main organism causing acute epiglottitis? (1)

Haemophilus influenzae type B (Hib)

What noise would you expect to hear with acute epiglottitis?

Stridor

What chromosome is affected in Angelman’s syndrome? (1)

What type of inheritance is Noonan syndrome?

. A 19-year-old student is brought to the clinic by her roommate because she has been acting strangely during the past six months. During the past month, the patient has been describing how another person's thoughts have been entering into her mind. The patient's grades have been slipping, and she does not talk as much as she did previously. The roommate says that when the patient does talk, she strays from the topic and is hard to follow. During the interview, the patient says a television reporter told her that the government had a special message for her and she should listen to the radio for further instructions. a. What 3 psychiatric symptoms does this patient show? (3)

i. Thought insertion ii. Loosening of association | iii. Delusional perception

Name 3 negative symptoms of schizophrenia (3)

i. Apathy ii. Poverty of speech iii. Blunted/incongruous affect iv. Loss of motivation v. Anhedonia

You decide to start this patient on anti-psychotic medication and prescribe olanzapine. List 2 investigations that should be done regularly to monitor for side effects?

I. BMI ii. ECG iii. Bloods (FBC, U&E, LFT, lipids, glucose, HbA1c, prolactin)

Name the 4 dopamine pathways (4)

i. Mesolimbic (D2 activated – cause +ve symptoms) ii. Mesocortical (D1 activated – cause –ve symptoms) iii. Nigrostriatial (movement associated – D2 blockade causes EPSE) iv. Tuberoinfundibular (affects prolactin – dopamine blockade cause hyperprolactinaemia)

A 35 year-old alcoholic has been admitted onto your ward for detox. Your consultant asks you to prescribe the medications he will need to manage his withdrawal. What do you prescribe?

Chlordiazepoxide and Pabrinex to prevent seizures and Wernickes

You’re working in a GP surgery doing a new baby clinic. One of your patients presents with her baby, 20 minutes late for her appointment, looking very disheveled with baby sick on her clothes, and has left her red baby book at home. The baby check is normal and you tell the mother that everything seems to be going well. She promptly burst into tears saying she’s struggling to cope and feels like she’s a terrible mother. Do you: (1) a. Admit her to the mother and baby unit for psychiatric treatment b. Prescribe her sertraline to help lift her mood c. Assess her using the Edinburgh Score (a postnatal depression scale) d. Tell her you’re sure she’s a great mother and she’ll get the hang of it soon e. Report her to Social Services with safeguarding issues

Mr Stevens, a 68 year-old male, comes in for review of his blood pressure. He is currently taking Ramipril and Amlodipine. His BP in clinic is 161/102. (5) a. List 1 common side effect of ACE inhibitors

Dry cough

What effect do ACE inhibitors have on renal vasculature?

Efferent arterial vasodilation

BP- Ramipril plus Amlodipine What would be the next line of therapy for Mr Stevens?

Thiazide diuretic (or equivalent)

List 2 examples of end-organ damage that can result from sustained hypertension.

i. Stroke ii. Retinopathy iii. CVD (MI, HF) iv. Atherosclerotic changes v. Renal (failure, proteinuria)

Which of these organisms is the most common cause of bacterial chest infections in patients with COPD? (1) a. H. influenzae b. P. aueruginosa c. C. jejuni d. Influenza A e. S. pneumoniae

H. influenzae

List 5 common causes of delirium. (5)

a. Systemic infection – pneumonia, UTI, wounds, IV lines, malaria b. Intracranial infection – encephalitis, meningitis c. Drugs – opiates, anticonvulsants, levodopa, sedatives, recreational, post GA d. Metabolic – uraemia, liver failure, anaemia, malnutrition, glucose or Na+ imbalance e. Hypoxia – resp or cardiac failure f. Vascular – stroke, MI g. Head injury – intracranial haemorrhage, space-occupying lesion h. Epilepsy i. Drug or alcohol withdrawal

In an elderly patient with a high risk of falls, name 1 drug that should be avoided.

Anti-hypertensives – ACEI, B-blockers, CCB, Diuretics Others – nitrates, PD meds, antipsychotics, antianxiolytics, TCA, erectile dysfunction meds

Name a medication used to relieve discomfort caused by excessive respiratory secretions in palliative care (use generic name). (1)

a. Hyoscine hydrobromide b. Hyoscine butylbromide c. Glycopyronium bromide

What is the definition of a 'close contact'?

i. Prolonged close contact in last 7 days (e.g. same residence, school etc.) ii. Transient close contacts exposed to droplets

Woman with SAH and left posterior communicating aneurysm. What is the most appropriate treatment for this patient? (1)

Endovascular coiling

What is the definition of domestic abuse?

Any incident or pattern of incidents of controlling, coerceive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality.

List 5 types of abuse encompassed under the umbrella term of domestic abuse

i. Psychological ii. Physical iii. Sexual iv. Financial v. Emotional

Give 3 ways in which domestic abuse impacts on health. Give examples of each

i. Traumatic injuries – fractures, puncture wounds ii. Chronic illness – chronic pain iii. Psychological/psychosocial – PTSD, depression, anxiety, eating disorder

What is your role as a doctor in the management of domestic abuse?

i. Signposting – display helpline posters ii. Focus on safety of patient and any dependents iii. Work with other agencies & professionals

What is equality and equity?

Equity – what is fair & just | Equality – equal shares for all

What are the 2 types of equity? Give examples of each

Horizontal – equal treatment for equal need (all individuals with pneumonia should be treated equally) Vertical – unequal treatment for unequal need (deprived areas need higher expenditure for health services)

Bob, of no fixed abode, presents to A&E following a fight. He is slurring his words, but you manage to understand that he is homeless. (7) a. List some possible reasons for homelessness.

i. Mental illness/breakdown ii. Domestic abuse iii. Disputes in family home iv. Bereavement

List 4 health problems faced by homeless adults

i. Infectious diseases ii. Sexual health problems iii. Substance misuse iv. Injuries following violence v. Mental illness vi. Poor nutrition vii. Poor dental health

He confesses that he ‘likes a drink’ most days. He knows he drinks about 1L of 7.5% lager a day. Calculate the number of units he consumes per week.

7. 5x1000 divided by 1000= 7.5 units/day. | 7. 5 x 7= 52.2 units/week

What public health measures can be used to reduce alcohol usage?

i. Increase minimum price per unit of alcohol ii. Change licensing laws iii. Reduce ‘passive drinking effects’ iv. Poster campaigns

Name 2 screening questionnaires used for suspected excessive alcohol consumption.

i. CAGE | ii. AUDIT

A 15 year-old female comes to clinic and she tells you that she is sexually active and requests for contraception. (6) a. Name the guidelines used in this situation to determine if she is Gillick competent.

Fraser Guidelines (only relates to contraception & sexual health)

What are the guideline’s 5 criteria that must be satisfied?

i. Sufficient maturity & intelligence to understand the advice given ii. Cannot be persuaded to inform parents or allow professional to tell parents about them seeking advice iii. Likely to begin/continue having sexual intercourse with/without contraception iv. Mental health likely to suffer unless they receive advice/treatment v. In their best interest

Name an example of a never event

Misinterpretation of a patient’s insulin dose resulting in an overdose of insulin

Define paraphilia and name 3 types.

Sexual arousal by inappropriate stimuli that does not conform to social and cultural norms, and is physically or emotionally harmful to the person.

List 2 organic causes of hypersexuality.

a. Dementia | b. Parkinson’s

What class of drug is sildenafil?

Phosphodiesterase inhibitor

Define transfemale. List 3 sex-reassignment procedures that they might ask for

Born male – transition to female Orchidectomy, penectomy, vaginoplasty, mammoplasty

List 4 causes of erectile dysfunction (4)

a. DM b. Neurogenic disorder c. Hormonal cause (hypogonadism) d. Peripheral vascular disease e. Advanced age f. Veno-occlusive disease g. Kidney failure h.Hyperprolactinaemia i. Drugs (SSRI, nicotine) j. Psychological (performance anxiety, stress)

Name 2 drugs that can cause delayed ejaculation.

SSRI, Antipsychotics, B-blockers, Muscle relaxants (baclofen), Opiates

Define vaginismus.

Spasm of vaginal muscles due to anticipation of pain or excessive anxiety causing penile entry impossible or painful.

1 organic and 1 psychological cause of vaginismus.

Organic – FGM, congenital abnormality, thrush, trauma Psychological – misinformation, mistaken beliefs, sexual abuse, religious/cultural issues, fear/dislike of partner

Outline treatment of vaginismus.

Individual psychosexual therapy Integrated CBT Behavioural intervention (kegels, self-exploration, examination in mirror, vaginal trainer)