passmed Flashcards
(13 cards)
a patient presents with sudden loss of vision in his right eye. The loss of vision started in the edges and moved towards the centre and had preceding flashes and floaters. What is this and name a risk factor of it?
- retinal detachment
- T2DM
what exam can be used to distinguish between vestibular neuronitis from a posterior circulation stroke
HiNTs exam
- VN = peripheral cause of vertigo and PCS is a central cause of vertigo
- this exam involves the head impulse test, the test of skew and assessing nystagmus
A 37-year-old woman who is 15 weeks pregnant presents with abdominal pain. The pain came on gradually and has been getting progressively worse for 3 days. She is nauseated and has vomited twice this morning. She has a temperature of 38.4ºC, blood pressure is 116/82 mmHg and heart rate is 104 beats per minute. The uterus is palpable just above the umbilicus and a fetal heart beat is heard via hand-held Doppler. On speculum examination the cervix is closed and there is no blood. She has a history of menorrhagia due to uterine fibroids. This is her first pregnancy. What is the most likely diagnosis?
fibroid degeneration
A 45-year-old woman presents to the outpatient gynaecology clinic with complaints of nausea, severe menstrual cramps and heavy menstrual bleeding that have been worsening over the past few months. On further questioning, she reports pain mostly in the lower abdomen radiating to her back. She has a past medical history of acne for which she takes lymecycline. She is sexually active with a regular partner and uses barrier contraception. She has one child who is sixteen years old. On examination, the gynaecologist notes an enlarged, boggy uterus.
adenomyosis
A 35-year-old woman presents with heavy menstrual bleeding that has worsened over the past year. Her periods last 7-8 days, and she uses multiple sanitary pads daily. She also complains of pelvic pressure and frequent urination. A recent pelvic ultrasound reveals multiple uterine fibroids, one of which distorts the uterine cavity. She is sexually active and desires contraception.
COCP
- not the mirena/IUS because uterine distortion is a contraindication to LNG-IUS use.
- Distortion of the uterine cavity due to fibroids can impair the device’s ability to stay in place and evenly distribute its hormone release, leading to continued heavy bleeding and an increased risk of expulsion
- and difficulty with insertion
At her booking visit, a woman mentions to her midwife that she has been previously diagnosed with immune thrombocytopenic purpura (ITP). Which procedure carries the greatest risk of haemorrhage in the newborn?
Prolonged ventouse delivery
A 28-year-old woman discusses contraception options with her healthcare provider, following a surgical termination of pregnancy at 16 weeks. The doctor suggests intrauterine contraception as being the most effective for her.
immediately after the procedure
A 28-year-old woman at 20 weeks gestation was admitted to the hospital after she had painful vaginal bleeding. On examination her cervical os is open and she has partial expulsion of her products of conception. Expectant management was unsuccessful.
What medical management is given to the woman in this case?
single dose vaginal misoprostol alone for incomplete miscarriage
(for missed, oral mifepristone and misoprostol 48 hours later)
A 30-year-old woman attends maternity bereavement services after delivering a stillborn foetus. She reports spontaneous lactation and seeks medication to suppress it. She has no significant past medical history and is not currently taking any medications.
What is the most appropriate medication to prescribe?
cabergolie (dopamine agonist)
A 28-year-old patient who is currently 25 weeks pregnant attends your GP surgery with an itchy rash on her abdomen and torso, which started the previous night. She had recently been babysitting her niece who was then diagnosed with chickenpox. She does not know for sure if she has had chickenpox in the past. One examination, there are red spots vesicles on her arms, torso and abdomen. She is otherwise well and all vital signs within normal range.
What should your next step be?
commence oral aciclovir
- more than 20 weeks gestation and presented within 24 hours of the rash developing
what are the symptoms of magnesium toxicity and management?
Deep tendon reflexes, respiratory depression and cardiac arrest
Calcium gluconate is the first-line treatment for magnesium sulphate induced respiratory depression.
A 23-year-old patient with a history of well-controlled epilepsy presents to general practice with her partner. They have been trying to conceive with regular sexual intercourse for the past 11 months. Her current medications include omeprazole, levetiracetam, folic acid 400 micrograms and paracetamol as required.
What medication changes are most appropriate?
Women on antiepileptics, who try to conceive, should receive folic acid 5mg instead of 400mcg OD
