Year 4 PassMed Incorrect Qs

Question 1

In Kawasaki Disease, What investigation should be used to screen for long-term complications and what are they looking for?

Answer 1

Coronary artery aneurysms are a complication of Kawasaki disease and this should be screened for with an echocardiogram

Question 2

Paeds- William’s syndrome features? (6)

What chromosome and what mutation?

Diagnosis made by what study?

Answer 2

• elfin-like facies
• characteristic like affect - very friendly and social
• learning difficulties
• short stature
• transient neonatal hypercalcaemia
• supravalvular aortic stenosis

Chromosome 7
- micro-deletion

Diagnosis- FISH studies

Question 3

If the smear test is found to be high risk HPV (hrHPV) positive, what test will be performed next?

Answer 3

Cytology

Question 4

HELLP Syndrome Stands for?

Answer 4

Haemolysis, Elevated Liver enzymes, Low Platelets

Question 5

ENT Talk through the Webbers and Rinne’s Test and its pathologies

Answer 5

Normal-
Air conduction > bone conduction bilaterally
Midline

R ear Conductive hearing loss (Blockage) -
Rinnes Negative - Bone conduction > air conduction in affected ear
Air conduction > bone conduction in unaffected ear
Web Lateralises to affected ear

R ear Sensorineural hearing loss (CN VIII affected)-
Rinnes Positivre - Air conduction > bone conduction bilaterally (Hear from good ear)
Web Lateralises to unaffected ear

Question 6

The most common organism causing infective exacerbations of COPD and 2 extra less common?

Answer 6

Haemophilus influenzae

• Streptococcus pneumoniae and
  -Moraxella catarrhalis.

Question 7

Neonate swelling on head. Born four hours ago, using forceps. On examination, there is a swelling in the parietal region which does not cross the suture lines. Which type of head injury is this likely to be?

Answer 7

Cephalohaematoma: Several hours after birth, doesn’t cross suture lines, can take months to resolve

Question 8

Site of access for intraosseous access?

Answer 8

Most commonly obtained at the proximal tibia

Question 9

Age and who offered abdominal aortic aneurysm (AAA) screening?

Answer 9

All Men aged 65yo

Question 10

How many years of taking feminising hormones are transwomen (male at birth) offered breast cancer screening?

Answer 10

After 2 years of feminising hormones

Question 11

Intrahepatic cholestasis of pregnancy when do you induce labour?

Answer 11

37 weeks

Question 12

where are the most common sites for ectopic preg to implant? (3)

Answer 12

ampullary ectopic: most common ~70% of tubal ectopics and ~65% of all ectopics

isthmal ectopic: ~12% of tubal ectopics and ~11% of all ectopics

fimbrial ectopic: ~11% of tubal ectopics and ~10% of all ectopics

Question 13

Antibiotic used in acute bronchitis?

Answer 13

oral doxycycline first-line.

Question 14

Asthma- what does ABPA stand for, what is it

Management?

Answer 14

• allergic bronchopulmonary aspergillosis (ABPA)
• a fungal infection of the lung secondary to a (TYPE I eosinophilic) hypersensitivity reaction to antigens of Aspergillus fumigatus
  -Oral glucocorticoids- prednisolone

Question 15

Paeds- Intussusception
- Boys or girls affect more?
- Most common anatomical site?
- STEM in stool?
- STEM AXR finding
- STEM ABdo USS finding

• Management (2)

Answer 15

• Boys twice as likely
• Ileo-caecal junction
• ‘red-currant jelly’ stool
• AXR ‘sausage-shaped’ in the left upper quadrant.
• USS target sign

Management
1) first-line insufflation under radiological control

2) second line- if this fails, or the child has signs of peritonitis, surgery is performed

Question 16

What is the manoeuvre in shoulder distocia and what does it entail?

Answer 16

McRoberts’ manoeuvre- flexion and abduction of the maternal hips, bringing the mother’s thighs towards her abdomen

Question 17

Management of Cord Prolapse step by step

Answer 17

1) The presenting part of the fetus may be pushed back into the uterus to avoid compression

2) If the cord is past the level of the introitus, there should be minimal handling and it should be kept warm and moist to avoid vasospasm

3) go on ‘all fours’ until preparations for…
4) Immediate caesarian section have been carried out
the left lateral position is an alternative

ADIITIONAL
4) tocolytics may be used to reduce uterine contractions
5) retrofilling the bladder with 500-700ml of saline may be helpful as it gently elevates the presenting part
6) although caesarian section is the usual first-line method of delivery, an instrumental vaginal delivery is possible if the cervix is fully dilated and the head is low.

Question 18

Paeds- The 3 investigations for a child with recurrant UTI and what do they look for?

Answer 18

USS- Anatomical abnormalities and hydronephrosis
DMSA- Scarring of the kidney
MCUG- Checking for reflux

Question 19

Surgery- What is duct elecectasia and what would you see?

Answer 19

Women around the menopause and occurs due to a dilation of the milk duct as a result of ageing

+/- associated with a small lump right under the nipple

Brown-green nipple discharge is most commonly associated with duct ectasia.

Question 20

GDM management options

Also alternative to metformin if cannot tolerate it or fail metformin targets but decline insulin?

Answer 20

1) Fasting <7mmol/l trial diet and exercise- if not met within 1-2 weeks START metformin, if still not met then short acting inulin
2) If at the time of diagnosis the fasting glucose level is >= 7 mmol/l insulin should be started
3) plasma glucose level is between 6-6.9 mmol/l, and there is evidence of complications such as macrosomia or hydramnios, insulin should be offered

glibenclamide (sulphonylureas)

Question 21

Resp- The different % of PEFR and what category they correspond to

Answer 21

Mild is not a category
50-75% Moderate
33-50% Severe
< 33% Life threatening

Question 22

Ectopic Pregnancies Management

Expectant criteria (5) + management

Medical criteria (5) + management

Surgical criteria (5) + management

Answer 22

Expectant management
- NO FETAL HR/ RUPTURE
- < 35mm
- No symptoms
- hCG <1000
- If another compatible intrauterine preg

Mx = Monitor over 48hrs, if hCG inc. or symp then intervine

Medical Management
- NO FETAL HR/ RUPTURE
- < 35mm
- No symptoms
- hCG <1500
- Not compatible with another intrauterine preg

Mx = Methotrexate IM but need follow up

Surgical Management
- FETAL HR/ RUPTURE
- > 35mm
- Symptoms ie. pain
- hCG >5000
- Compatible with another intrauterine preg

Mx = Unilateral salpingectomy if healthy on contra-lateral, if not then salpingotomy

Question 23

A very rare but deadly complication of the varicella-zoster virus?

Answer 23

Necrotising fasciitis- invasive group A streptococcal soft tissue infections. Causing painful lesions of the skin and underlying muscles.
Diagnosed clinically by passing a probe or gloved finger below the affected skin, which causes the skin to separate from the underlying tissue.

Question 24

What is the most common cause of stridor in infants?

Answer 24

Laryngomalacia (Floppy epiglottis)

Question 25

Paediatric constipation Maintenance therapy stepwise management

Answer 25

1. first-line: Movicol Paediatric Plain (polyethylene glycol 3350 + electrolytes)
2. add a stimulant laxative if no response
3. substitute a stimulant laxative if Movicol Paediatric Plain is not tolerated. Add another laxative such as lactulose or docusate if stools are hard
4. continue medication at maintenance dose for several weeks after regular bowel habit is established, then reduce the dose gradually

Question 26

O+G: SE of GnRH agonist used for medical Mx of fibroids TO SHRINK THE FIBROID, which you must warn the patient about before starting

Answer 26

GnRH agonists should be used for a short period in patients with uterine fibroids due to side-effects such as loss of bone mineral density

Question 27

Paeds- Indication for tonsillectomy (need ALL 4 to be met)

Answer 27

• Sore throats are due to tonsillitis (i.e. not recurrent URTI)
• Has five or more episodes of sore throat per year
• symptoms have been occurring for at least a year
• the episodes of sore throat are disabling and prevent normal functioning

Question 28

Roseola infantum is caused by Herpes virus?

Rash?

Answer 28

HSV 6

3-5 day high fever followed by 2 day maculopapular rash which starts on the chest and spreads to the limbs

Question 29

ENT - BPPV

Name of:
Diagnosis manoeuvre?
Management manoeuvre?
Exercises if decline Management manoeuvre?

Answer 29

Diagnosis- Dix-Hallpike
Management - Epley manoeuvre
Exercises - Brandt-Daroff exercises

Question 30

Paeds- Management of hypoglycaemia in newborn

Answer 30

Asymptomatic:
- encourage normal feeding (breast or bottle)
- monitor blood glucose

Symptomatic or very low (< <1mmol/L or < 2.6??) blood glucose:
- admit to the neonatal unit
for intravenous infusion of 10% dextrose

Question 31

Symptoms of magnesium sulfate toxicity (3)
Also what is seen first out of the three?
Antidote?

Answer 31

• Loss of deep tendon reflexes (seen first)
• Respiratory depression
• Cardiac arrest.
  Loss of deep tendon reflexes is the first sign of magnesium toxicity.

Calcium gluconate is the first-line treatment for magnesium sulphate induced respiratory depression