papaer 2

Question 1

what is the commonest cause of respiratory distress in the newborn period? and the biggest risk factor

Answer 1

Transient tachypnoea of the newborn.

It is caused by delayed resorption of fluid in the lungs

more common following c-sections (lung fluid not ‘squeezed out’ during labour)

Chest x-ray may show hyperinflation of the lungs and fluid in the horizontal fissure.

Management
observation, supportive care
supplementary oxygen maybe

settles within 1-2 days

Question 2

imaging for osteomyelitis

Answer 2

mri

Question 3

how to calculate absolute risk reduction

Answer 3

(Number who had particular outcome with the control)/ (Total number who had the control) - (MINUS) -
(Number who had particular outcome with the intervention) / (Total number who had the intervention)

Question 4

how to calculate The positive predictive value (PPV)

Answer 4

dividing the number of true positives by the total number of individuals who tested positive

Question 5

how to calculate the sensitivity?

Answer 5

Sensitivity is determined by dividing the number of true positives (78) by the sum of true positives and false negatives

Question 6

Typically starts with a high grade fever which resolves before the onset of the rash. starts on the trunk before spreading to the limbs. Maculopapular rash
not itchy. - diagnosis

Answer 6

Roseola infantum

Question 7

femoral vs inguinal hernia

Answer 7

a femoral hernia will pass below and lateral to the pubic tubercle, whereas an inguinal hernia will be seen above and medial to it.

Question 8

strangulated hernia - open or laparoscopic repair?

Answer 8

open

Question 9

Chlamidyma vs Gonorrhea cell type and management

Answer 9

gonorrhea- gram negative diplicocci
Chlamidya- gram negative eukaryotic cells

clammy dogs - chlamydia/doxycycline
‘the Gunner was accused of Ceft’ - gonnorhoea/ceftriaxone (or cefixime)

Question 10

when to monitor a blood tranfusion?

Answer 10

-

Question 11

spinal cord compression give what before starting tranfusion

Answer 11

dexamethasone

Question 12

inactivated vaccines

Answer 12

rabies
hepatitis A
influenza (intramuscular)

Question 13

category of c sections and timings

Answer 13

Category 1
an immediate threat to the life of the mother or baby
examples indications include: suspected uterine rupture, major placental abruption, cord prolapse, fetal hypoxia or persistent fetal bradycardia
delivery of the baby should occur within 30 minutes of making the decision

Category 2
maternal or fetal compromise which is not immediately life-threatening
delivery of the baby should occur within 75 minutes of making the decision

Category 3
delivery is required, but mother and baby are stable

Category 4
elective caesarean

Question 14

when is a platelet transfusion appropriate

Answer 14

Platelet transfusion is appropriate for patients with a platelet count < 30 x 109 and clinically significant bleeding

Question 15

treatment of neutapenic sepsis after chemo

Answer 15

Piperacillin with tazobactam (Tazocin)

Question 16

hints test: abnormal head impulse and unilateral nystagmus

Answer 16

peripheral cause (Vestibular neuronitis)/

Question 17

when not to fly in pregnancy

Answer 17

37 weeks plus singleton
32 weeks plus twins +

Question 18

most common headache in children

Answer 18

migraine without aura

Question 19

most common cause of puerperal pyrexia

Answer 19

puerperal pyrexia

Question 20

seretonin syndrome vs malignant …

Question 21

how many weeks can you diagnose pre eclampsia by

Answer 21

20 weeks

Question 22

rheumatoid arthirits x ray findings

Answer 22

Early x-ray findings
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
periarticular erosions
subluxation

Question 23

osteoarthritis hand changes

Answer 23

Heberden’s nodes (in the DIP joints)
Bouchard’s nodes (in the PIP joints)
Squaring at the base of the thumb (CMC joint)

Question 24

swan neck deformity vs Boutonniere deformity

Answer 24

Swan neck deformity (hyperextended PIP and flexed DIP)
Boutonniere deformity (hyperextended DIP and flexed PIP)

Question 25

1st and second line treatment for osteoarthritis

Answer 25

topical nsaids oral nsaid w ppi cover

Question 26

ankylosing spondylitis pelvic x ray finding

Answer 26

sacro-ilitis

Question 27

A 9-year-old boy is diagnosed as having Attention Deficit Hyperactivity Disorder and started on methylphenidate. Which one of the following should be monitored during treatment?

Answer 27

Growth due to appetite suppression

Question 28

gout vs pseudogout

Question 29

accelerations decelerations

Question 30

Why should NSAIDS not be given to kids w chicken pox

Answer 30

NSAIDs can increase the risk of necrotising fasciitis in patients with chicken pox

Question 31

Turner's syndrome is associated with which heart condition

Answer 31

Turner's syndrome is associated with aortic

Question 32

what is the normal folic acid intake vs high risk intake and who is high risk?

Answer 32

all women should take 400mcg of folic acid until the 12th week of pregnancy women at higher risk of conceiving a child with a NTD should take 5mg of folic acid from before conception until the 12th week of pregnancy either partner has a NTD, they have had a previous pregnancy affected by a NTD, or they have a family history of a NTD the woman is taking antiepileptic drugs or has coeliac disease, diabetes, or thalassaemia trait. the woman is obese (defined as a body mass index [BMI] of 30 kg/m2 or more).

Question 33

when should pregnant women take folic acid till

Answer 33

12 weeks

Question 34

ds 4 test 3 test

Question 35

Inflammatory arthritis involving DIP swelling and dactylitis points to a diagnosis of

Answer 35

psoriatic arthritis

Question 36

Adjuvant hormonal therapy is offered if tumours are positive for hormone receptors. which are used for who?

Answer 36

Tamoxifen is still used in pre- and peri-menopausal women. In post-menopausal women, aromatase inhibitors such as anastrozole

Question 37

how do you decide about whether to revmove lymph nodes in breast cancer surgery?

Answer 37

women with no palpable axillary lymphadenopathy at presentation should have a pre-operative axillary ultrasound before their primary surgery if negative then they should have a sentinel node biopsy to assess the nodal burden in patients with breast cancer who present with clinically palpable lymphadenopathy, axillary node clearance is indicated at primary surgery this may lead to arm lymphedema and functional arm impairment

Question 38

who mastectomy vs wide local excision breast cancer

Answer 38

Mastectomy Wide Local Excision Multifocal tumour Solitary lesion Central tumour Peripheral tumour Large lesion in small breast Small lesion in large breast DCIS > 4cm DCIS < 4cm

Question 39

when is radiotherapy used in breast cancer?

Answer 39

Whole breast radiotherapy is recommended after a woman has had a wide-local excision as this may reduce the risk of recurrence by around two-thirds. For women who've had a mastectomy radiotherapy is offered for T3-T4 tumours and for those with four or more positive axillary nodes

Question 40

when is biological theraphy used for breast cancer?

Answer 40

The most common type of biological therapy used for breast cancer is trastuzumab (Herceptin). It is only useful in the 20-25% of tumours that are HER2 positive. Trastuzumab cannot be used in patients with a history of heart disorders.

Question 41

when is chemo used fore breast cancer

Answer 41

Cytotoxic therapy may be used either prior to surgery ('neoadjuvanant' chemotherapy) to downstage a primary lesion or after surgery depending on the stage of the tumour, for example, if there is axillary node disease - FEC-D is used in this situation.

Question 42

case control studies are always...

Answer 42

retrospective

Question 43

what do these tumour markers relate to? CA 125 CA 19-9 CA 15-3 Alpha-feto protein (AFP) Carcinoembryonic antigen (CEA)

Answer 43

what do these tumour markers relate to? CA 125 CA 19-9 CA 15-3 Alpha-feto protein (AFP) Carcinoembryonic antigen (CEA)

Question 44

what treatments can be offered for endometriosis before establishing a definitive diagnosis with laparoscopy?

Answer 44

Cyclical pain can be treated with hormonal medications that stop ovulation and reduce endometrial thickening. This can be achieved using the combined oral contraceptive pill, oral progesterone-only pill, the progestin depot injection, the progestin implant (Nexplanon) and the Mirena coil. GnRH agonists- to induce menopause but you also get menopause sympotoms e.g. hot flushes and risk of osteoperosis

Question 45

investigation for adenomyosis?

Answer 45

Transvaginal ultrasound of the pelvis is the first-line investigation for suspected adenomyosis. MRI and transabdominal ultrasound are alternative investigations where transvaginal ultrasound is not suitable. The gold standard is to perform a histological examination of the uterus after a hysterectomy. However, this is not usually a suitable way of establishing the diagnosis for obvious reasons.

Question 46

what is the treatment for adenomyosis?

Answer 46

NICE recommend the same treatment for adenomyosis as for heavy menstrual bleeding. When the woman does not want contraception; treatment can be used during menstruation for symptomatic relief, with: * Tranexamic acid when there is no associated pain (antifibrinolytic – reduces bleeding) * Mefenamic acid when there is associated pain (NSAID – reduces bleeding and pain)

Question 47

Management when contraception is wanted or acceptable:

Answer 47

Mirena coil (first line) COCP Cyclical oral progestogens Progesterone only medications such as the pill, implant or depot injection may also be helpful. Other options are that may be considered by a specialist include: GnRH analogues to induce a menopause-like state Endometrial ablation Uterine artery embolisation Hysterectomy

Question 48

what is the most accurate marker of ovarian reserve?

Answer 48

Anti-Mullerian hormone can be measured at any time during the cycle and is the most accurate marker of ovarian reserve. It is released by the granulosa cells in the follicles and falls as the eggs are depleted. A high level indicates a good ovarian reserve.

Question 49

Testosterone is necessary for sperm creation. The hypothalamo-pituitary-gonadal axis controls testosterone. Hypogonadotrophic hypogonadism (low LH and FSH resulting in low testosterone), can be due to:

Answer 49

pathology of the pituitary gland or hypothalamus Suppression due to stress, chronic conditions or hyperprolactinaemia Kallman syndrome which is a condition characterized by delayed or absent puberty and an impaired sense of smell. (genetic condition)

Question 50

what are some causes of Hypergonadotropic Hypogonadism?

Answer 50

Hypergonadotrophic hypogonadism is the result of abnormal functioning of the gonads. This could be due to: * Previous damage to the gonads (e.g. testicular torsion, cancer or infections, such as mumps) * Congenital absence of the testes or ovaries -Kleinfelter’s Syndrome (XXY) -Turner’s Syndrome (XO)

Question 51

how often are women offered a cervical smear test?

Answer 51

Every three years aged 25 – 49 Every five years aged 50 – 64 There are some notable exceptions to the program: -Women with HIV are screened annually -Women over 65 may request a smear if they have not had one since aged 50 -Women with previous CIN may require additional tests (e.g. test of cure after treatment) -Certain groups of immunocompromised women may have additional screening (e.g. women on dialysis, cytotoxic drugs or undergoing an organ transplant) -Pregnant women due a routine smear should wait until 12 weeks post-partum

Question 52

What is the management based on these smear results? -Inadequate sample -HPV negative -HPV positive with normal cytology -HPV positive with abnormal cytology

Answer 52

Inadequate sample – repeat the smear after at least three months HPV negative – continue routine screening HPV positive with normal cytology – repeat the HPV test after 12 months HPV positive with abnormal cytology – refer for colposcopy

Question 53

what are the typical examination findings for someone with pelvic inflammatory disease?

Answer 53

Examination findings may reveal: Pelvic tenderness Cervical motion tenderness (cervical excitation) Inflamed cervix (cervicitis) Purulent discharge Patients may have a fever and other signs of sepsis.

Question 54

how does bacterial vaginosis change the pH of the vagina?

Answer 54

increases pH Above 4.5

Question 55

what is the most common bacteria causing BV? Mycoplasma hominis Prevotella species Prevotella Peptostreptococcus Bacteroides spp. Gardnerella vaginalis

Answer 55

Gardnerella vaginalis

Question 56

what age does menopause become purely a clinical diagnosis and for those under this age which blood test is used to make a diagnosis?

Answer 56

over 45 and FSH

Question 57

what age do women need to use contraception until?

Answer 57

Two years after the last menstrual period in women under 50 One year after the last menstrual period in women over 50

Question 58

what are the two main side effects of the pogesterone depot injection and who is it unsuitable for?

Answer 58

weight gain and reduced bone mineral density (osteoporosis).- only in depot Reduced bone mineral density makes the depot unsuitable for women over 45 years.

Question 59

What to co-prescrige in non-hodgkins lymphoma for better outcomes?

Answer 59

Rituximab

Question 60

What type of cells are characteristic for hodgkins lymphoma?

Answer 60

Reed-sternberg cells

Question 61

Pain in lymph nodes after drinking alcohol? diagnosis

Answer 61

Hodgkin’s lymphoma

Question 62

Risk factor for MALT lymphoma?

Answer 62

H pylori

Question 63

What to give if vacomycin didn’t work first time in C.diff?

Answer 63

ORAL vancomycin and IV metronidazole

Question 64

what malignancy is linked to mysthethenia gravis linked to?

Answer 64

Thymoma

Question 65

Prevention of motion sickness

Answer 65

Hycosine>cyclizine

Question 66

Test for autoimmune haemolytic anemia

Answer 66

Coombs test

Question 67

Management of neonatal hypoglycaemia:

Answer 67

Asymptomatic: * encourage normal feeding (breast or bottle) * monitor blood glucose symptomatic or very low blood glucose: * admit to the neonatal unit * intravenous infusion of 10% dextrose

Question 68

what histological finding would you find in lung cancer causing hypercalcemia?

Answer 68

squamous cell carinoma

Question 69

how does Recurrent laryngeal nerve palsy present and what is it caused by?

Answer 69

horse voice a tumour pressing on or affecting the recurrent laryngeal nerve as it passes through the mediastinum.

Question 70

Limbic encephalitis is a paraneoplastic syndrome where the immune system makes antibodies to tissues in the brain, specifically the limbic system, causing inflammation in these areas. This causes symptoms such as hallucinations, confusion and seizures. short-term memory impairment- this is caused by which type of lung cancer

Answer 70

Limbic encephalitis is a paraneoplastic syndrome where the immune system makes antibodies to tissues in the brain, specifically the limbic system, causing inflammation in these areas. This causes symptoms such as hallucinations, confusion and seizures. short-term memory impairment- this is caused by which type of lung cancer

Question 71

2 things that cause hypotension in blood transfusion

Answer 71

anaphylaxis, abo incompatibitlty

Question 72

if only fever and chills in bloo dtransfusion

Answer 72

Slow or stop the transfusion Paracetamol Monitor

Question 73

Transfusion-associated circulatory overload (TACO) vs Transfusion-related acute lung injury (TRALI)

Answer 73

taco Pulmonary oedema, hypertension - stop transfusion and diuretic TRALI Hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension - stop tranfusion and maybe oxygen

Question 74

Downs syndrome tripple test vs quadruple test

Answer 74

The triple test is performed between 14 and 20 weeks gestation. It only involves maternal blood tests: Beta-HCG – a higher result indicates greater risk Alpha-fetoprotein (AFP) – a lower result indicates a greater risk Serum oestriol (female sex hormone) – a lower result indicates a greater risk

Question 75

antenatal downs test

Answer 75

Combined Test The combined test is the first line and the most accurate screening test. It is performed between 11 and 14 weeks gestation and involves combining results from ultrasound and maternal blood tests. Ultrasound measures nuchal translucency, which is the thickness of the back of the neck of the fetus. Down’s syndrome is one cause of a nuchal thickness greater than 6mm. Maternal blood tests: Beta‑human chorionic gonadotrophin (beta-HCG) – a higher result indicates a greater risk Pregnancy‑associated plasma protein‑A (PAPPA) – a lower result indicates a greater risk Triple Test The triple test is performed between 14 and 20 weeks gestation. It only involves maternal blood tests: Beta-HCG – a higher result indicates greater risk Alpha-fetoprotein (AFP) – a lower result indicates a greater risk Serum oestriol (female sex hormone) – a lower result indicates a greater risk Quadruple Test The quadruple test is performed between 14 and 20 weeks gestation. It is identical to the triple test, but also includes maternal blood testing for inhibin-A. A higher inhibin-A indicates a greater risk.