Y3 Exam 2 Flashcards

Question 1

Q

List some complications of shoulder dystocia: (4)

Answer

A

Brachial plexus injury (commonly Erb’s palsy (waiter’s tip))
Perineal tears
Fetal hypoxia (→ cerebral palsy if prolonged)
Postpartum haemorrhage (T = trauma!)

Question 2

Q

List some common causes of bilious vomiting: (4)

What is the 1st line investigation to identify a cause of bilious vomiting?

Answer

A

Intestinal obstruction:
• Malrotation
• Intusussecption
• Ileus
• Duodenal atresia

Abdominal Xray

Question 3

Q

What are the 5 commonest in-utero causes of infection? (TORCH)

Answer

A

T - toxoplasmosis

O - other (syphilis & chickenpox (varicella-zooster virus))

R - rubella

C - cytomegalovirus

H - herpes simplex virus (HSV)

Question 4

Q

What results of an OGTT are normal and thus above would qualify as gestational diabetes? (5,6,7,8!)

What is the initial management if fasting glucose is less than 7mmol/l?

What is the initial management if fasting glucose is more than 7mmol/l?

Answer

A

Results:
Fasting glucose: < 5.6 mmol/l
2h glucose: < 7.8 mmol/l

< 7 mmol/l: 2 week trial of diet & exercise → metformin

> 7 mmol/l: insulin +/- metformin

Question 5

Q

What is the medical management of a miscarriage? - how does it work?

What is the surgical management of a miscarriage?

Answer

A

*Misoprostol
** prostaglandin analogue (softens the cervix & stimulates uterine contractions to expel the miscarriage)
*Surgical management:**
*-** vacuum aspiration & curettage (products are sucked & scooped out) → misoprostol is given before procedure to soften the cervix

Question 6

Q

What is the 1^st line investigation of endometrial cancer? - what is this used to look for/ what is normal?

What investigation is done if the above is abnormal?

What is the management of stage 1 & 2 endometrial cancer? (cancer confined to cervix/ invaded cervix only)

Answer

A

*Investigations:**
1^st line:* Transvaginal US to look at endometrial thickness (should be <4mm)
If ^ abnormal:* Endometrial biopsy (pipelle biopsy)

Management:
TAH & BSO
(total abdominal hysterectomy with bilateral salpingo-oophorectomy = removal of uterus, cervix & ovaries)

Question 7

Q

What is Hirschprung’s Disease?

What is a common presentation of it?

What investigation is done? - what is used to confirm the diagnosis?

What is the definitive management?

Answer

A

Congenital condition in which nerves of the distal bowel & rectum are absent (myenteric plexus)

24h neonate hasnt passed meconium, distended abdomen and vomiting!

Rectal exam (forecful evacuation of stool will occur!!!) - confirmation is made by suction rectal biopsy

Definitive management: surgical removal of aganglionic bowel

Question 8

Q

What is the difference between an STI & an STD?

Answer

A

STI: a sexually transmitted infection that is only an infection (it hasnt caused any disease yet)

STD: a sexually transmitted infection that has caused a disease (aka, it is causing harm, eg PID)

Question 9

Q

What age group is classed as adolescence?

Which area of the brain changes the most during this period?
~ what 3 things is this brain area involved in?

Answer

A

11-25y

Prefrontal cortex
~ planning
~ social interaction & self-awareness
~ risk taking

Question 10

Q

Name the 3 types of emergency contraception available and:

a) state the timeframe in which they are effective after UPSI
b) state their mechanism of action against pregnancy

List 2 contraindictations of EllaOne

Answer

A

*EllaOne**
a) effective up to 5 days after UPSI
b) delays ovulation
c) asthma, breastfeeding should be avoided for 1 week
*IUD (copper coil)**
a) effective up to 5 days after UPSI
b) copper is spermicidal + prevents implantation
c) insertion may cause PID
*Levonorgestrel**
a) effective up to 3 days after UPSI
b) delays ovulation

Question 11

Q

What are the 4 abnormalities seen in Tetralogy of Fallot?

What xray finding is seen in this condition?

What clinical sign may be seen on examination? - Why does this happen?

What is the definitive treatment and when does it occur?

Answer

A

1) Pulmonary valve stenosis
2) R ventricle hypertrophy
3) Ventricularseptal defect
4) Overriding aorta (L & R ventricle drain into aorta)

Boot shaped heart seen on xray

Central cyanosis - high pressure in R ventricle due to hypertrophy causes R→L shunt through ventricularseptal defect - less oxygenated blood enters systemic circulation

Surgical correction: performed when baby is 5kg (~ 6 months)

Question 12

Q

State the diagnosis & commonest causative organism of a-e:

a) Child presents with rapdly-developing non-blanching purpuric skin rash, lethargy, headache, fever, vomting.

b) Child presents with mild fever, runny nose, lethargy and an itchy lace like rash on the body, which is bright red over the cheeks.

c) Unvaccinated child with a 4day history of cough, fever, lethargy has now developed a rash all over his body with a few grey spots inside his cheeks.

d) Child presents with a course red rash on his trunk that has a sandpaper texture, as well as a fever, sore throat and bright red tongue.

e) Child presents with an itchy, widespread, erythematous, vasicular rash that started on their face/ trunk & has quickly spread to their whole body. Child also has a fever and Mum noticed that the rash has started to crust over.

f) Child presents with lethargy, fever, cough & sore throat with new ulcers around their mouth and blistering red spots on their hands & feet.

Answer

A

a) Meningitis - Neisseria meningitidis
b) Slapped cheek - Parvovirus B19
c) Measles - Measles virus
d) Scarlet fever - Group A STREP
e) Chickenpox - Varicella Zooster virus
f) Hand, foot & mouth disease - Coxsackie A virus

Question 13

Q

Match the congenital defect with genetic condition:

Ventricular septal defect
Aortic arch defect
Coarctation of the aorta
Pulmonary valve stenosis
Tetralogy of Fallot
Supravalvular aortic stenosis

Williams syndrome
Down’s syndrome
DiGeorge syndrome
Noonan syndrome
Turner’s syndrome

Answer

A

Downs syndrome: Ventricular septal defect, tetralogy of Fallot

DiGeorge syndrome: Aortic arch defect

Turner syndrome: Coarctation of the aorta

Noonan syndrome: Pulmonary valve stenosis

Williams syndrome: Supravalvular aortic stenosis

Question 14

Q

Who is notified about a palliative patient and their wishes?

Answer

A

GP practice (Palliative care register)
OOH will have a record too

Question 15

Q

What changes occur at birth regarding the foetal circulation? (6)

Answer

A

1) foramen ovale closes
2) ductus arteriosus closes
3) ductus venosus closes (blood vessel connecting umbilical vein→IVC)
4) Pulmonary vascular resistance falls
5) Pulmonary blood flow increases
6) Systemic vascular resistance increases

Question 16

Q

What skills would you expect to see from each developmental domain in an 18m toddler?

Gross motor (2)
Fine motor (2)
Language (1)
Social (2)
Self help (1)

Answer

A

*Gross motor:** 1) walks up/down stairs unsupported
2) kicks a ball
*Fine motor:** 1) scribbles with crayon
2) builds towers with 4+ bricks

Language: 1) starts to join words into sentences

*Social**: 1) early pretend play
2) says no when interfered with

Self help: 1) eats with fork

Question 17

Q

What part of the GIT does coeliacs disease affect & what is the main histological finding seen?

List some clinical features seen in coeliac disease: (6)

What condition is closely associated with coeliac disease?

Answer

A

Small bowel (esp jejenum) - villous atrophy

Failure to thrive (in children)
Diarrhoea
Weight loss
Fatigue
Dermatitis herpetiformis (itchy rash, usually on abdomen)
Malabsorption

Type 1 diabetes (as well as other autoimmune conditions)

Question 18

Q

Erb’s palsy results in damage to what nerves of the brachial plexus?

What obstetric emergency can result in Erb’s palsy?

Answer

A

C5 & C6

Shoulder dystocia

Question 19

Q

What skills would you expect to see from each developmental domain in an 24m toddler?

Gross motor (1)
Fine motor (1)
Language (1)
Social (1)
Self help (1)

Answer

A

Gross motor: climbs on play equipment (eg, slides)

Fine motor: scribbles with circular motion

Language: vocabulary of 30-50 words

Social: helps with simple household tasks

Self help: opens door by turning knob

Question 20

Q

Paget’s disease of the breast is commonly mistaken for what condition?

What severe condition does Paget’s disease of the breast overlie?

What part of the breast is involved first in Paget’s disease of the breast?
~ List some presenting features (4)

Answer

A

Eczema !!

An underlying breast cancer

Nipple:
• Nipple discharge +/- blood
• Eczema like rash on/ around the nipple
• Burning/ pain of the nipple
• Nipple inversion

Question 21

Q

TRUE or FALSE

Grief is an individual experience.
Grief only lasts for a few months.
Bereavement is associated with increased mortality & morbidity.

Answer

A

True
False - grief can last for years
True!

Question 22

Q

What skills would you expect to see from each developmental domain in a 6m infant?

Gross motor (2)
Fine motor (2)
Language (2)
Social (2)
Self help (1)

Answer

A

*Gross motor:** 1) rolls over
2) starts to sit without support
*Fine motor:** 1) uses 2 hands to pick up large objects
2) transfers toy from 1 hand to another
*Language**: 1) responds to name
2) 2 syllable babble
*Social**: 1) reaches for familiar people
2) pushes things they don’t want away

Self help: 1) feeds self small food

Question 23

Q

Someone with autism may have defecits in what 3 things?

What does the management of autism involve?

What congenital condition is autism commonly seen in?

Answer

A

*1)** Social interaction
*2)** Communiation
*3)** Behaviour

Management: MDT team, no medications

Down syndrome

Question 24

Q

A 48y old woman presents with intense ithcing in the perineal area, associated with pain on micturation and dyspareunia.

O/E you notcie white polygonal papules on the labia majora, coalescing into a patch affecting the labia minora. There is one fissuring area, which bleeds on contact. The skin is white, thin & shiny. Mild scarring is noted. There is no vaginal discharge.

What is the likely diagnosis:

a) Lichen Planus
b) Lichen Sclerosus

What is the 1^st line treatment for this condition?

Answer

A

LICHEN SCLEROSUS

3 month trial of topical steroids

Question 25

Q

A diagnosis of pre-eclampsia requires what? (1 + 3)

What is the prophylaxis used in high risk women for pre-eclampsia?

Answer

A

BP 140/90 +

PLUS any of:
Proteinuria
Organ dysfunction (raised creatinine / elevated LFTs / seizures)
Placental dysfunction (eg, foetal growth restriction)

Aspirin from 12 weeks gestation

Question 26

Q

What are the 5 things that a CTG measures?

What is the normal HR of a fetus?
~ what is the range of normal variability within this?

Answer

A

Contractions (num. of uterine contractions in 10 mins)
Baseline fetal HR (the average HR)
Variability (of fetal HR)
Accelerations (increase in HR of 15bpm for 15 secs)
Decelerations (decrease in HR by 15bpm for 15 secs) - concerning

Foetal HR = 110 - 160bpm
~ normal variability = 5 - 25bpm

Question 27

Q

List some of the criteria mentioned in Wilson’s criteria for screening programmes:

Answer

A

Knowledge of the disease:
~ the disease to be screened for has to be well understood
~ the disease should be an important public health concern (eg affect the majority of the population)
~ there has to be a recognisible early stage of the disease

Testing for the disease:
~ there has to be a sensitive test for the disease that is accepted by the public

Treatment of the disease:
~ there has to be available treatment for the disease that is accepted by the public
~ the treatment has to be cost effective
~ outcome of treatment should be better if disease is detected early

Question 28

Q

What do the 3 stages of labour consist of?

Answer

A

First stage - from the onset of labour (contractions) until 10cm cervical dilatation

Second stage - from 10cm dilatation until the baby is delivered

Third stage - from delivery of the baby to delivery of the placenta

Question 29

Q

Describe the discharge associated with each condition below:

1) Bacterial vaginosis
2) Candidiasis
3) Chlamydia
4) Gonorrhoea
5) Trichomoniasis

Answer

A

1) Watery, FISHY discharge
2) Thick, white discharge (cottage cheese)
3) Watery, odourless discharge
4) Yellow discharge
5) Frothy, green discharge

Question 30

Q

What is placenta praevia?

When would placenta praevia be diagnosed in a pregnancy if it’s present?

What is the common presentation of placenta praevia?

If someone is identified as having placenta praevia, when would they be given repeat US’s?

What is the management of placenta praevia regarding the delivery?

Answer

A

Placenta praevia: when the placenta is attached in the lower portion of the uterus - often covering the cervical os.

At the 20 week anomaly scan

Painless bleeding (antepartum haemorhage)

32 & 36 weeks gestation (if present on the 32 week scan to guide decisions about delivery)

C-section should be planned for 36-37 weeks (to avoid spontaneous labour as vaginal delivery is contraindicted)

Question 31

Q

What is anticipatory care planning (ACP)?

What might be discussed in an anticipatory care plan?

Once a patient is ‘palliative’ & ACP has been discussed, what happens in regards to their records in the GP practice?
~ who is informed about this?
~ is the patient frequently reviewed? - who is involved in this?

Answer

A

This is a discussion with a palliative patient & their carers regarding their wishes for their future care.

Do they want a DNACPR?
Where do they want to die?
Would they want treatment for a simple infection?

Once palliative & have had the ACP discussion, the patient is placed on a Palliative Care Register in the practice.
~ patients plan is sent to OOH & anyone who is invovled with their care
~ GP practice has regular palliative care meetings with an MDT to discuss all palliative patients

Question 32

Q

What is Kawasaki disease?

What are the 6 common features of Kawasaki disease? CREAM

What is the main complication of Kawasaki disease? - What investigation is done to screen for this?

What is the treatment of Kawasaki disease?

Answer

A

A systemic medium vessel vasculitis

*Fever for 5+ days** PLUS
*C** - conjunctivitis (red eyes)
*R** - rash
*E** - oedema/ erythema of hands & feet
*A** - adenopathy (usually cervical)
*M** - mucosal invovlement (strawberry tongue, cracked lips)

Coronary artery aneurysm - ECHO

Treatment: aspirin (to reduce risk of thrombosis) & IV immunoglobulins IVIg) (to reduce risk of coronary artery aneurysms)

Question 33

Q

What is health promotion?

What are the 3 areas of health promotion that can be targetted?

What types of things are done to target these areas in order to promote good health?

Answer

A

Health promotion: any activity designed to enhance health/ reduce disease.

• Educational
~ Provides people with the knowledge of diseases so they can mae informed choices regarding health
~ eg, smoking, diet

• Socioeconomic
~ Makes healthy choices the easy/ cheaper choice
~ eg, sugar tax, more cycle paths

• Psychological
~ Helps people with the psychological aspect of good health
~ Eg, is the individual ready to give up alcohol

Question 34

Q

Where do most people choose to die?

The Gold Standards Framework provide tools to GP’s to help them with what?

Answer

A

Most people choose to die in their own home.

To help them look after palliative patients in their own home.

Question 35

Q

What are the 2 commonest causes of death in the UK now?

What is the commonest cause of death in men aged 15-34y?

Answer

A

Cancer & IHD

Suicide

Question 36

Q

What skills would you expect to see from each developmental domain in a 12m toddler?

Gross motor (2)
Fine motor (2)
Language (2)
Social (1)
Self help (2)

Answer

A

*Gross motor:** 1) stands without support
2) starts to walk without help (by 18m)
*Fine motor:** 1) stacks 2+ blocks
2) picks up 2+ toys in 1 hand
*Language**: 1) know’s the meaning of 1 or 2 words
2) uses mama / dada specifically for parents

Social: 1) points to things of interest

*Self help:** 1) feeds themself with spoon
2) lifts cup to mouth and drinks

Question 37

Q

What condition is indicated by a woody, tender uterus?

Answer

A

Placental abruption

Question 38

Q

The results of a womans cervical smear screening identifies the presence of high-risk human papillomavirus (hrHPV). What should happen next?

If the next step is positive, what should be done?

If the step was negative, what should be done?

Answer

A

The sample should be sent for cytology.

Cytology positive (dyskaryosis): Woman should be sent for colposcopy

Cytology negative: Woman should have another smear in 12 months

Question 39

Q

Failure to progress in labour is when the labour isn’t developing at a satisfactory rate. Name the 3 things that progress in labour is influenced by: (3 P’s)

What is considered as a delayed 2^nd stage of labour in:

a) nulliparous women
b) multiparous women

What is considered as a delayed 3^rd stage of labour in:

*a) active management**
~ what does active management of the 3^rd stage of labour involve?*
b) physiological management

Answer

A

Power (of uterine contractions)
Passenger (size/ presentation/ position of baby!)
Passage (shape & size of mothers pelvis)
*Nulliparous**: 2^nd stage taking 2 hours
*Multiparous**: 2^nd stage taking 1 hour
*Active**: 3^rd stage taking longer than 30 mins
~ IM oxytocin & controlled cord traction*
*Physiological**: 3^rd stage taking longer than 60 mins

Question 40

Q

List 3 functions of oxytocin:

List 2 uses of nifedipine throughout pregnancy:

Answer

A

Oxytocin
• Ripening of cervix
• Stimulates contractions of uterus
• Squeezes mammary ducts to aid in breastfeeding

Nifedipine
• 2^nd line Pre-eclampsia treatment (to control hypertension)
• Tocolysis (in premature labour)

Question 41

Q

What is the most likely diagnosis of the following:

Unvaccinated child presents with a fever, sore throat & difficulty swallowing. The child is sitting forward and drooling.

What is the management of this?

Answer

A

Epiglottitis

1) Secure airway!!!!!
2) IV antibiotics (ceftriaxone) + Steroids (dexamethasone)

Question 42

Q

In regards to multiple pregnancy, what do the following terms mean:

Monoamniotic
Diamniotic
Monochorionic
Dichorionic

If you see the lambda sign on an US, what type of twins does that indicate?

Answer

A

1. Monoamniotic: Single amniotic sack (shared between babies)

2. Diamniotic: 2 separate amniotic sacs (each baby has their own)

3. Monochorionic: Single placenta (shared between babies)

4. Dichorionic: 2 separate placenta’s (each baby has their own)

Lambda sign = dichorionic, diamniotic (2 sacs & 2 placenta’s)

Question 43

Q

What is the commonest presenting symptom of endometrial cancer?
List 2 other common symptoms:

Name 2 protective factors against endometrial cancer:

Answer

A

POST-MENOPAUSAL BLEEDING !
~ Intermenstrual bleeding
~ Unusually heavy menstrual bleeding

• Smoking
• COCP

Question 44

Q

Between which ages is jaundice more likely to be pathological?

What causes physiological jaundice? - what type of bilirubin will be elevated?

What type of bilirubin will be elevated in breast-milk jaundice?

Answer

A

Before 24h, after 2 weeks (3 weeks if pre-term)

Physiological jaundice:
• HbF has shorter life span & liver function is immature so cannot conjugate as quick as is needed with the excess haemolysis
• Bilirubin = unconjugated

Breast-milk jaundice: unconjugated bilirubin

Question 45

Q

What is the difference between an STI & an STD?

Answer

A

STI: a sexually transmitted infection that is only an infection (it hasnt caused any disease yet)

STD: a sexually transmitted infection that has caused a disease (aka, it is causing harm, eg PID)

Question 46

Q

What type of formula is used to treat CMPA?

If the child still can’t tolerate this formula, what would they be swapped to?

Answer

A

Hydrolysed formula

An amino acid formula

Question 47

Q

What would you hear when ascultating someone with an atrial septal defect? (2)

Explain why you would hear these things!

Answer

A

Fixed, split 2nd heart sound → as blood is being shunted from L→R atria, there is more blood to flow through the pulmonary valve. This causes a delay in the valve closing compared to closing of aortic valve = split 2nd heart sound

Pulmonary flow murmur (ejection systolic murmur) → due to increased blood flowing through the valve

Question 48

Q

What is the medical management of an abortion? - Between which weeks can this be done?

What is the surgical management of abortion? - Between which weeks can this be done?

Answer

A

Medical management: 5-23⁺⁵ weeks

1) Mifepristone (progesterone antagonist → degeneration of endometirum & increases uterine sensitivity to prostaglandins)
2) 36-48h later, give Misoprostol (prostagland analogue → contraction of myometrium & expulsion of uterine contents)

Surgical management: 5-12 weeks

Misoprostol given to woman before procedure to ‘prime’ the uterus → transcervical suction of uterin contents!

Question 49

Q

A 14-year-old presents to her GP with her mother who is concerned that she is tired all the time and failing to meet deadlines for school projects. She is slightly overweight, but examination is otherwise normal. Urinalysis, FBC, U&Es, LFTs, TFTs and blood glucose are all normal. What would be the most appropriate next step?

Advise her that everything is normal and to seek further review if new symptoms develop
Advise her that the tests are normal and suggest seeking additional educational support
Discuss her lifestyle including sleep patterns and diet
Refer her to paediatrics for further investigation
Repeat the blood tests in case something has changed

Answer

A

Discuss her lifestyle including sleep patterns and diet

Repeating normal tests after a very short time scale is unlikely to provide new information. The history and initial examination/investigation suggest that lifestyle factors are likely to be the cause, so this needs to be explored and advice given accordingly.

Question 50

Q

What is the commonest causative organism of bronchiolitis?
~ what is the treatment?

What is the commonest causative organism of viral induced wheeze?
~ what is the treatment?

What is the commonest causative organism of bacterial/ viral pneumonia?
~ what is the treatment for each?

What is the commonest causative organism of croup?
~ what is the treatment?

What is the commonest causative organism of epiglottitis?
~ what is the treatment?

What is the commonest causative organism of whooping cough?
~ what is the treatment?

Answer

A

Bronchiolitis: RSV
~ supportive treatment (viral infection - self resolves)

Viral induced wheeze: RSV
~ 10 puffs of salbutamol +/- O2 if needed

*Bacterial pneumonia:** Strep pneumonia - amoxicillin
*Viral pneumonia:** RSV (supportive treatment)

Croup: parainfluenza virus
~ dexamethasone

Epiglottitis: H.influenza B
~ secure airways, ceftriaxone & dexamethasone

Whooping cough: Bordetella pertussis
~ supportive management

Question 51

Q

If a whirlpool sign is seen on a transvaginal US, what condition does this suggest?

What is the definitive investigation to diagnose this condition?

What are the 2 management options?

Answer

A

Ovarian torsion

Laparoscopic surgery

*Management**: done whilst doing the laparoscopic surgery!
1) Detorsion of the ovary
2) Oophorectomy (removal of the affected ovary)

Question 52

Q

What skills would you expect to see from each developmental domain in a 12m toddler?

Gross motor (2)
Fine motor (2)
Language (2)
Social (1)
Self help (2)

Answer

A

*Gross motor:** 1) stands without support
2) starts to walk without help (by 18m)
*Fine motor:** 1) stacks 2+ blocks
2) picks up 2+ toys in 1 hand
*Language**: 1) know’s the meaning of 1 or 2 words
2) uses mama / dada specifically for parents

Social: 1) points to things of interest

*Self help:** 1) feeds themself with spoon
2) lifts cup to mouth and drinks

Question 53

Q

Describe what coarctation of the aorta is:

List the clinical signs/ symptoms of coarctation of aorta: (3)

How would a child with coarctation of aorta usually present?

What congenital condition is associated with coarctation of the aorta?

Answer

A

Narrowing of the descending aorta

1) Weak/ absent femoral pulse
2) Radio-femoral delay
3) Systolic murmur that’s loudest at the back

Presentation: sudden deterioration & collapse

Turner’s syndrome

Question 54

Q

What is the commonest causative organism of bronchiolitis?
~ what is the treatment?

What is the commonest causative organism of viral induced wheeze?
~ what is the treatment?

What is the commonest causative organism of bacterial/ viral pneumonia?
~ what is the treatment for each?

What is the commonest causative organism of croup?
~ what is the treatment?

What is the commonest causative organism of epiglottitis?
~ what is the treatment?

What is the commonest causative organism of whooping cough?
~ what is the treatment?

Answer

A

Bronchiolitis: RSV
~ supportive treatment (viral infection - self resolves)

Viral induced wheeze: RSV
~ 10 puffs of salbutamol +/- O2 if needed

*Bacterial pneumonia:** Strep pneumonia - amoxicillin
*Viral pneumonia:** RSV (supportive treatment)

Croup: parainfluenza virus
~ dexamethasone

Epiglottitis: H.influenza B
~ secure airways, ceftriaxone & dexamethasone

Whooping cough: Bordetella pertussis
~ supportive management

Question 55

Q

Premature menopause occurs before what age?

What is the cause of premature menopause?

The symptoms of menopause are caused by a lack of what hormone?

What test can be done to investigate menopause/ peri-menopause?

Answer

A

Beofre 40y

Cause: premature ovarian insufficiency

Oestrogen!

FSH levels! - they will be high near menopause

Question 56

Q

You are asked to see a 29-year-old woman in clinic who has recently found out she is pregnant. She has a history of type 1 bipolar affective disorder, for which she takes lithium. Despite treatment she suffered an episode of mania 9 months previously. How should this patient’s psychiatric medication be managed during the antenatal period?

Answer

A

Gradually switch the lithium to an atypical antipsychotic

Question 57

Q

What antibodies are present in coeliac disease?

What type of Ig are these antibodies?

When testing for these antibodies, what do you also need to test for to avoid a false negative result?

Answer

A

Anti-tissue transglutaminase (anti-TTG) & anti-endomysial (anti-EMA)

IgA antibodies

Total IgA levels - some people are IgA deficient so their total IgA will be low, even if they have coeliacs

Question 58

Q

A one-year old girl presents to the Emergency department with intermittent abdominal pain. Her father explains that during these episodes the child becomes irritable, pale, and draws her legs up towards her abdomen. There has been no vomiting, but the child has refused feeds for two days. The abdomen is soft, but there is a palpable, sausage shaped mass in the right flank.

What is the likely diagnosis?

What other buzz word would indicate this diagnosis? (common in later presentations)

What is the 1st line investigation & management of this conditon?

If the child had been vomiting & there was abdominal distension, what does this suggest?

Answer

A

Intussusception

Redcurrent jelly stool

Investigation: abdominal US
Management: Enema (commonly air enema)

Obstruction!

Question 59

Q

Anaphylaxis is what type of hypersensitivity reaction?

This type of reaction is mediated by what?

Answer

A

Type 1 hypersensitivity reaction

IgE mediated mast cell degranulation

Question 60

Q

What is the management of a baby with symptomatic patent ductus arteriosus? - what is the mechanism behind this?

When would this management not be used and why?

In these babies, what would the management be? - what is the timeframe for this?

Answer

A

Indomethacin (an NSAID) - it is a prostagland inhibitor so causes closure of ductus arteriosus

Not used in term babies as their patent ductus arteriosus isnt prostaglandin sensitive!

Watch & wait - most will close spontaneously within 1y. IF symptomatic, can be surgically ligated

Question 61

Q

An 18m boy presents with a 4h history of barking cough (seal) and noisy breathing having been well the day before.
Examination shows a runny nose, loud stridor, tracheal tug, sub-costal recession, well perfused peripheries and temp of 37.8c

What is the likely diagnosis?

What is the commonest causative organism?

What age group is it most common in?

How long does it usually last for?

What is the management?

Answer

A

Croup

Parainfluenza

Commonest in 6m - 2y

Lasts for up to 48h

Management: steroids! (dexamethasone)

Question 62

Q

What skills would you expect to see from each developmental domain in a 3y?

Gross motor (1)
Fine motor (1)
Language (2)
Social (1)
Self help (1)

Answer

A

Gross motor: 1) Rides a tricycle

Fine motor: 1) Draws/ copies a complete circle

*Language**: 1) Identifies 4+ colours
2) Asks questions: ‘why’ ‘how’

Social: 1) Gives directions to other children

Self help: 1) Toilet trained (may still need help with wiping)

Question 63

Q

The Fit note replaced the sick note in 2010. State whether the following are true or false.

A fit note can be completed by a DR & an advanced nurse practitioner.
It is an assessment as to whether the patient is able to work in their job specifically?
A fit note includes items of considerations to employers when signing a patients return to work.
A fit note is required if a patient has been off work for more than 7 days.

Answer

A

FALSE: fit note can only be completed by a DR
FALSE: it is an assessment of whether the patient is fit to work in general.
TRUE: items of considerations may include: phased return to work/ adjusted hours of work/ adaptations to the workplace
TRUE

Question 64

Q

List the distinguishing features that differentiate IgA nephropathy from post-streptococcal glomerulonephritis: (2)

Answer

A

IgA Nephropathy:
~ 1-2 days post URTI
~ Renal biopsy: IgA immune complex deposits in the glomerulus

Post-strep GN:
~ 1-3 weeks post URTI (usually strep throat)
~ Renal biopsy: IgG immune complex deposits in the glomerulus

Answer 65

A

1) Give O2 if sats are below 94%

2) Take blood cultures

3) Give IV antibiotics

4) Fluid challenge (give IV fluids)

5) Measure blood lactate

6) Measure urine output

Answer 66

A

• Weight gain
• Osteoporosis
~ over 45y

Answer 67

A

Providing pain & symptom relief
Spiritual support
Psychosocial support

Neither. Palliative care just makes the patient & family comfortable.

Answer 68

A

Bacterial Tracheitis

Always consider bacterial tracheitis in a barking cough with continuous stridor that does not resolve.

Answer 69

A

Vasa praevia: occurs when the fetal blood vessels cover the internal cervical OS.

Painless vaginal bleeding
Rupture of membranes
Fetal bradycardia → death

*Planned management:** elective C-section 34-36 weeks (before membranes rupture spontaneously)
*Unplanned management:** emergency C-section!

Answer 70

A

1) No social smile by 2 months
2) Not sitting unsupported by 9 months
3) Not walking unsupported by 18 months
4) No words by 2 years

Answer 71

A

ECHO

Give prostaglandin E - this reopens the ductus arteriosis which increases cardiac ouput & relieves the strain on the L ventricle

Surgical repair (narrowed part is resected and the 2 ends are anastamosed together) or stent insertion

Answer 72

A

Atrophic vaginitis

After menopause, the vaginal mucosa becomes drier and thinner - more likely to bleed, especially after sexual intercourse

Answer 73

A

Exomphalus = herniation of abdominal contents at birth which ARE COVERED by the peritoneal membrane

Gastroschisis = herniation of abdominal contents at birth which AREN’T COVERED by the peritoneal membrane!

Answer 74

A

Ventouse suction cup
Suction cup is put on babies head and is slowly pulled to help pull baby out of vagina

Forceps
Forceps are placed either side of babies head and babies head is slowly pulled out of vagina

Perineal tears
Episiotomy
Postpartum haemorrhage
(stress) Incontinence of bladder/ bowel

Answer 75

A

1) Gross motor skills
2) Fine motor skills
3) Speech & language skills
4) Social & self help skills
5) Hearing & vision

Answer 76

A

HUS occurs when there is thrombosis in small blood vessels throughout the body

Gastroenteritis

E.coli - stool sample will identify it

1) Haemolytic anaemia → FBC, blood film
2) AKI → U&E’s to measure serum urea
3) Thrombocytopenia → FBC

Answer 77

A

Pulmonary stenosis

Aortic stenosis

Answer 78

A

Baby blues: Within 2 weeks of delivery

Postnatal depression: several weeks after delivery up to 1y

Answer 79

A

Slapped cheek
Hand, foot & mouth
Scarlet fever
Bronchiolitis, viral induced wheeze
Croup

Answer 80

A

Premature separation of the placenta from uterus during pregnancy
~ Concealed & revealed

Woody, hard uterus
Sudden onset, severe abdominal pain
Vaginal bleeding (may be disproportionate to observations though)
Fetal distress on CTG (bradycardia/ reduced foetal movements)
1. Emergency C-section*
2. Conservative management with CTG & maternal monitoring

Answer 81

A

Gastroenteritis - E.coli

Haemolytic uraemic syndrome:
• haemolytic anaemia (causing jaundice)
• AKI (causing high urea levels)
• thrombocytopenia

Conservative: encourage fluids

Answer 82

A

Ovulation = 14d
~ Stimulated by spike in LH

a) follicular phase = days 0 - 14
b) luteal phase = days 14 - 28

Follicular phase:
• Under FSH stimulation, follicles mature → ovulation
• Mature follicles secrete oestrogen which negatively feedbacks on A.pituitary to decrease release of FSH & LH

Luteal phase:
• Follicle that released the ovum changes into corpus luteum which secretes progesteron to maintain endometrium
• If no fertilisation occurs, corpus luteum degenerates → low progesterone → menstruation

Answer 83

A

When the placenta implants deeper than the endometrium…*
*Placenta accreta:** into the surface of myometrium ONLY
*Placenta increta:** into the myometrium but not through it
*Placenta percreta:** into AND through the myometrium (commonly onto pelvic organs!)
Previous placenta accreta
Previous C-section
Previous endometrial courettage procedures (eg, for abortion)

Difficulty delivering placenta & significant postpartum bleeding as a result!

Answer 84

A

• Fully breastfeeding
• Amenorrhoeic (no periods)
~ effective up to 6 months postpartum

21 days

*Postpartum contraception:**
Progesterone only pill / implant* - can be started anytime after birth
COCP* - should be avoided with breastfeeding, can only be started 6 weeks after birth
IUD/ IUS* - can either be inserted within first 48h after birth OR 4 weeks after delivery

Answer 85

A

Burnout

All the others would have symptoms which impact the patient more severely across all settings. There are no pointers to substance misuse in the stem.

Answer 86

A

→ Continuous inflammation
→ Limited to colon & rectum
→ Only superficial mucosa affected
→ Smoking is protective
→ Excrete blood & mucus
→ Use aminosalicylates (1st line treatment)
→ Primary scleorising cholangitis

Answer 87

A

When the placenta implants deeper than the endometrium…*
*Placenta accreta:** into the surface of myometrium ONLY
*Placenta increta:** into the myometrium but not through it
*Placenta percreta:** into AND through the myometrium (commonly onto pelvic organs!)
Previous placenta accreta
Previous C-section
Previous endometrial courettage procedures (eg, for abortion)

Difficulty delivering placenta & significant postpartum bleeding as a result!

Answer 88

A

Lifestyle modification: weight loss, exercise, diet

2nd line: Clomiphene

3rd line: Laparoscopic ovarian drilling

Assisted conception

Answer 89

A

Ductal carcinoma - cancer of the ductal cells

Ductal carcinoma in situ!

Medullary carcinoma

BRCA1

Answer 90

A

1) Engagement: foetus head is fully engaged with pelvis
2) Descent: foestus starts to descend along birth canal
3) Flexion: foetus head flexes towards chest
4) Internal rotation: foetus internally rotates to face mothers back
5) Extension: foetal head extends & is delivered
6) Restitution: foetus externally rotates to face anteriorly
7) Expulsion: anterior shoulder is delivered, followed by the rest of body

Answer 91

A

Cord prolapse: occurs when the umbilical cord exits the cervix before the presenting part of the foetus does

EMERGENCY: the foetus can compress the cord → fetal hypoxia!!!!

Cord prolapse should be suspected if there are signs of foetal distress on the CTG
~ vaginal/ speculum examination can confirm it.

Women should lie in left lateral position/ knee-chest position until emergency C-section can be done

Answer 92

A

Between 41 - 42 weeks

Answer 93

A

Machinery

Machinery is categorised as a mechanical hazard.

Answer 94

A

Bacterial Tracheitis

Always consider bacterial tracheitis in a barking cough with continuous stridor that does not resolve.

Answer 95

A

Antiphospholipid syndrome

Aspirin & LMWH

Answer 96

A

Increased risk of instrumental delivery
Prolonged 2^nd stage of labour
Hypotension
Motor weakness in legs (cannot walk around after)
Headache (after insertion - uncommon)

Paracetemol & codeine
~ NSAIDs are avoided!!

Answer 97

A

Systematic reviews

Systematic reviews combine evidence from multiple studies, including RCTs, and therefore provide the strongest evidence.

Answer 98

A

Health education: involves communication with people aimed at changing their knowledge/ attitudes in regards to health so that they make better decisions regarding their health

Health protection: targets factors that are beyond the control of individuals in order to achieve better health in the population.
~ eg sugar tax!

Answer 99

A

Wheeze
Cough (worse at night)
SOB

Answer 100

A

Take a fetal blood sample

Speculum is inserted and babies head is ‘scratched’ to obtain a blood sample ⇒ ONLY shows if baby is hypoxic

Answer 101

A

→ Position of the cervix (anterior)
→ Effacement of the cervix (length - shorter = better)
→ Consistency of the cervix (soft)
→ Dilatation of the cervix (bigger = better)
→ Station of the presenting part (distance in cm in relation to the ischial spines)

Bishops score is used to assess whether induction of labour would be successful
~ score of 8 indicates successful induction

Answer 102

A

Contemplation

He has just started thinking about reducing his alcohol intake. At the precontemplation stage, he has given it no thought. He has not started to reduce alcohol yet or given an indication of a plan, so preparation and action are also incorrect. Maintenance occurs once the reduction in alcohol is established.

Answer 103

A

Tonic-clonic seizure: Muscles stiffen (go rigid = tonic) before generalised jerking of limbs (clonic)

Myoclonic seizure: Sudden jerking of one limb - patient may be conscious!

Absence seizure: Patient ‘pauses’ for a few seconds before restarting activity - patient often has no recollection

Atonic seizure: Muscles suddenly loose all tone - patient falls over

Answer 104

A

Contemplation

He has just started thinking about reducing his alcohol intake. At the precontemplation stage, he has given it no thought. He has not started to reduce alcohol yet or given an indication of a plan, so preparation and action are also incorrect. Maintenance occurs once the reduction in alcohol is established.

Answer 105

A

Live attenuated:
• MMR
• Rotavirus
• Nasal flu vaccine

Answer 106

A

Molar pregnancy (hydatiform mole)

Complete mole: 2 sperm fertilise 1 egg that contains no genertic material (empty egg)
~ no fetal material will form

Partial mole: 2 sperm fertilise 1 normal egg, resulting in a cell that has 3 sets of chromosomes!
~ some fetal material may be seen

hCG is abnormally high for gestational dates - can cause hyperthyroidism as hCG mimics TSH & overstimulates the thyroid gland

Treatment: evacuation of the uterus to remove it - the products of conception are sent to histology to confirm the molar pregnancy

Answer 107

A

a) Tranexamic acid (anti-fibrinolytic)
b) Mefenamic acid (reduced bleeding & pain)
3) Mirena coil

Answer 108

A

Blood volume increases during pregnancy, but plasma volume > RBC = anaemia (as RBC’s are diluted!)

Answer 109

A

CENTOR & feverPAIN

Answer 110

A

Just in case box: Given to patients at end of life. It includes medicines that can be quickly administered if the patient has any distress.

Opioid for pain/breathlessness (morphine)
Sedative for anxiety/agitation/breathlessness (midazolam)
Anti-secretory for resp secretions (Hyoscine butylbromide injection)
Anti-emetic for nausea and vomiting (levomepromazine injection)

Answer 111

A

Joint replacement in severe osteoarthritis of the hip

Tertiary prevention attempts to reduce the impact of an established disease or disability. Joint replacement in osteoarthritis is the only option which corresponds to this. The others are examples of primary and secondary prevention.

Answer 112

A

Placental abruption

Maternal/ foetal compromise: emergency C section

No compromise: induction of labour

Answer 113

A

Show (mucus plug from the cervix)
Rupture of membranes
Regular, painful contractions
Dilation of cervix (seen on examination)

Nifedipine (orally)
~ the use of medications to stop uterine contractions

Answer 114

A

Encourage him to discuss it further and explore the reasons for his request

Enabling discussion will allow the GP to find out details about the main concerns of the patient and address symptom control better.

Answer 115

A

Power (of uterine contractions)
Passenger (size/ presentation/ position of baby!)
Passage (shape & size of mothers pelvis)
*Nulliparous**: 2^nd stage taking 2 hours
*Multiparous**: 2^nd stage taking 1 hour
*Active**: 3^rd stage taking longer than 30 mins
~ IM oxytocin & controlled cord traction*
*Physiological**: 3^rd stage taking longer than 60 mins

Answer 116

A

Coeliac’s disease - dermatitis herpetiformis

*Antibodies:**
1) Anti-TTG plus total IgA
2) Anti-EMA (if anti-TTG were positive)

Duodenal biopsy (via endoscopy)

Answer 117

A

First degree: Tear limited to the superficial perineal skin or vaginal mucosa only
~ Don’t require treatment

Second degree: Tear extends to perineal muscles and fascia, but the anal sphincter is intact
~ Requires a simple stitch (midwife can do this)

*Third degree:** tear involves the external anal sphincter
*3A** - less than 50% thickeness of sphincter is torn
*3B** - more than 50% thickeness of sphincter is torn
*3C** - External & internal anal sphincters torn
~ Requires surgical correction*
*Fourth degree:** tear extends to the rectal mucosa
~ Requires surgical correction*

Answer 118

A

Bacterial vaginosis: Metronidazole

Candidiasis: Antifungal cream/ pessary (clotrimazole)/ oral tablet

Chlamydia: doxycycline 100mg 2x daily for 7 days

Gonorrhoea: IM ceftriaxone (if sensitivities are known) / oral ciprofloxacin (if sensitivities aren’t known)

Trichomoniasis: Metronidazole

Herpes: Aciclovir

Answer 119

A

*Gross motor:** 1) walks up/down stairs unsupported
2) kicks a ball
*Fine motor:** 1) scribbles with crayon
2) builds towers with 4+ bricks

Language: 1) starts to join words into sentences

*Social**: 1) early pretend play
2) says no when interfered with

Self help: 1) eats with fork

Answer 120

A

ASSIGN score

Answer 121

A

Haemangioma - a vascular birth mark that isnt present at birth but appears from 6 weeks onwards. It will proliferate & grow up until 8m and then self resolve.

Treatment if asymptomatic: nothing - they will self resolve (involute)

Treatment if problematic: Oral propanolol

Answer 122

A

Risk factors of uterine rupture:
• VBAC (vaginal birth after C-section - C-section scar is a weak point in the uterus!)
• The use of oxytocin to stimulate contractions
• High BMI

Clinical features:
• Sudden abdominal pain
• Vaginal bleeding
• Maternal shock (hypotension, tachycardia, collapse)
• Ceasing of uterine contractions
• ABNORMAL CTG

Management: EMERGENCY C-SECTION

Answer 123

A

Mutual Participation

Authoritarian and paternalistic approaches do not allow for patient input. Guidance-cooperation allows for some patient input, but not full discussion and rarely a final decision from the patient about the treatment they wish to opt for. Perceptual skills are a form of consultation skill on the part of the doctor, not a doctor-patient consultation style.

Answer 124

A

Xray of hip

Surgery: correction of femoral head positon PLUS screw fixation
~ Prophylactic fixation of contralateral hip may be done

Answer 125

A

Show (mucus plug from the cervix)
Rupture of membranes
Regular, painful contractions
Dilation of cervix (seen on examination)

Nifedipine
~ the use of medications to stop uterine contractions

Answer 126

A

OGTT - 24-28 weeks
~ Patient fasts throughout night, BM measured in morning before patient takes sugary drink (75g glucose) → BM measured 2h later

Results:
Fasting glucose: < 5.6 mmol/l
2h glucose: < 7.8 mmol/l

Answer 127

A

SPICT (supportive & palliative care indicators tool)

PPS (palliative performance scale)
~ lower % on the scale indicates poorer prognosis

Answer 128

A

*Gross motor:** 1) rolls over
2) starts to sit without support
*Fine motor:** 1) uses 2 hands to pick up large objects
2) transfers toy from 1 hand to another
*Language**: 1) responds to name
2) 2 syllable babble
*Social**: 1) reaches for familiar people
2) pushes things they don’t want away

Self help: 1) feeds self small food

Answer 129

A

Lumbar puncture
~ signs of raised ICP

Answer 130

A

Fetal station (this is how far down into the pelvis the babies head is palpated in relation to the ischial spines)

Cervical position (as the cervix ripens, it moves more anteirorly)

Cervical dilatation (as the cervix ripens, it dilates)

Cervical effacement (as the cervix ripens, it becomes shorter)

Cervical consistency (as the cervix ripens, it becomes softer)

Answer 131

A

MCUG (micturicting urogram)

DMSA

US KUB

Answer 132

A

Abdominal bloating
Early satiety
Loss of appetite
Weight loss
Ascites
Pelvic pain

CA125 & Transvaginal US

Answer 133

A

2500g (2.5kg)

4.5kg

Answer 134

A

Voluntary euthanasia: patient with capacity requests euthanasia

Non-voluntary euthanasia: patient without capacity has their death hastened

Involuntary euthanasia: patient is killed against their wishes (more murder…)

Physician assisted suicide: the DR provides the advice/ drugs needed for suicide
~ ILLEGAL!!!!

Answer 135

A

a) 50 - 70y
b) every 3 years
c) mammogram (xray of breasts)

Answer 136

A

Membrane sweep
Vaginal prostaglandins (pessary)

Uterine hyperstimulation
~ fetal distress & hypoxia!
~ management: removing vaginal prostaglandins +/- giving tocolysis (using terbutaline)

Answer 137

A

Contractions (num. of uterine contractions in 10 mins)
Baseline fetal HR (the average HR)
Variability (of fetal HR)
Accelerations (increase in HR of 15bpm for 15 secs)
Decelerations (decrease in HR by 15bpm for 15 secs) - concerning

Foetal HR = 110 - 160bpm
~ normal variability = 5 - 25bpm

Answer 138

A

Gross motor: climbs on play equipment (eg, slides)

Fine motor: scribbles with circular motion

Language: vocabulary of 30-50 words

Social: helps with simple household tasks

Self help: opens door by turning knob

Answer 139

A

CENTOR & feverPAIN

Answer 140

A

Biliary tree obstruction (bile is unable to be transported to the bowel)

Congenital condition in which there is absent / stenoised bile duct - prevents bile (and conjugated bilirubin) being transported to bowel
~ abdominal US

1) Jaundice
2) Pale, chalky white stools
3) Hepatosplenomegaly

Surgery - kasai portoenterostomy (small intestine is attached directly to the liver)

Answer 141

A

Pregnancy-induced hypertension occurring after 20 weeks gestation with proteinuria.

Labetelol
~ Nifedipine

Answer 142

A

More than 4 weeks

Answer 143

A

Premature separation of the placenta from uterus during pregnancy
~ Concealed & revealed

Woody, hard uterus
Sudden onset, severe abdominal pain
Vaginal bleeding (may be disproportionate to observations though)
Fetal distress on CTG (bradycardia/ reduced foetal movements)
1. Emergency C-section*
2. Conservative management with CTG & maternal monitoring

Answer 144

A

Pyloric stenosis

Abdominal US

Management: surgery (laparoscopic pyloromyotomy)

Answer 145

A

Vasa praevia: occurs when the fetal blood vessels cover the internal cervical OS.

Painless vaginal bleeding
Rupture of membranes
Fetal bradycardia → death

*Planned management:** elective C-section 34-36 weeks (before membranes rupture spontaneously)
*Unplanned management:** emergency C-section!

Answer 146

A

Discuss her lifestyle including sleep patterns and diet

Repeating normal tests after a very short time scale is unlikely to provide new information. The history and initial examination/investigation suggest that lifestyle factors are likely to be the cause, so this needs to be explored and advice given accordingly.

Answer 147

A

Oxytocin
• Ripening of cervix
• Stimulates contractions of uterus
• Squeezes mammary ducts to aid in breastfeeding

Nifedipine
• 2^nd line Pre-eclampsia treatment (to control hypertension)
• Tocolysis (in premature labour)

Answer 148

A

An URTI causing oedema & swelling of the larynx.

Parainfluenza virus

~ Increased work of breathing
~ Barking cough (sounds like a seal)
~ cold symptoms
~ hoarse voice
~ +/- stridor
~ +/- mild fever

1 - 2 days

Oral dexamethasone

Answer 149

A

Loss of normal function in right arm

Nerves in the arm are not affected by the stroke. Some cerebral neurons will have died but this is pathology not activity limitation. The other options would be described as participation restrictions resulting from the activity limitation.

Answer 150

A

Shock
Anger
Denial
Bargaining
Relief
Sadness
Fear
Guilt
Anxiety
Distress

Answer 151

A

1) Testosterone - high (insulin promotes release of androgens)
2) Sex hormone binding globulin - low (insulin decreases SHBG production)
3) LH - high
4) FSH - low (low FSH results in follicles not maturing and turning into cysts)
5) Insulin - high (insulin resistance is a feature of PCOS)
6) LH:FSH ratio - high (High LH & low FSH)

Answer 152

A

*3 mins:** call for help
*6 mins:** move to theatre
*9 mins:** prepare for delivery of the baby
*12 mins:** deliver the baby (by 15 mins!)

Answer 153

A

*3 mins:** call for help
*6 mins:** move to theatre
*9 mins:** prepare for delivery of the baby
*12 mins:** deliver the baby (by 15 mins!)

Answer 154

A

Entonox = gas & air (NO)
~ breathe it in at the start of a contraction
~ takes about 30s to work

Answer 155

A

Type 1 hypersensitivity reaction

IgE mediated mast cell degranulation

Answer 156

A

1. Pre-contemplation
~ does activity

2. Contemplation
~ considers stopping activity

3. Action
~ stops activity

4. Regression
~ restarts activity

Answer 157

A

Nephrotic syndrome:
• proteinuria (+++)
• oedema
• hypoalbuminaemia
• hyperlipidaemia

Nephritic syndrome:
• haematuria
• hypertension
• proteinuira (+)

Answer 158

A

Maternal diabetes (eg, gestational diabetes)

Shoulder dystocia
Pernieal tears
Instrumental delivery/ C-section
Clavicle fracture of baby
Erbs palsy (brachial plexus injury - common from shoulder dystocia)

Answer 159

A

*Primary**: within the first 24h
*Secondary**: between 24h - 12 weeks after delivery
*Minor** PPH: under 1000mls
*Major/ moderate** PPH: 1000 - 2000mls
*Severe** PPH: 2000mls +
Tissue (retained placenta)
Tone (of uterus = uterine antony is commonest cause)
Trauma (eg, perineal tear)
Thombin (bleeding disorder)

Answer 160

A

Type 1 resp failure: low O2, normal CO2

Type 2 resp failure: low O2, high CO2 - respiraoty acidosis

Answer 161

A

10⁵

Answer 162

A

*Anterior fontanelle:** diamond
*Posterior fontanelle:** triangle

Answer 163

A

1) No social smile by 2 months
2) Not sitting unsupported by 9 months
3) Not walking unsupported by 18 months
4) No words by 2 years

Answer 164

A

Systematic reviews

Systematic reviews combine evidence from multiple studies, including RCTs, and therefore provide the strongest evidence.

Answer 165

A

Avascular necrosis of the femoral head in children which is caused by disruption to the blood flow of the femoral head

Ages 4-10y

• Gradual* onset limb & hip pain
• Referred pain to the knee
• Pain persists for >4 weeks
* Gradual due to the femoral head becoming increasingly ischaemic

Answer 166

A

*Primary nocturnal enuresis**
- Secondary* notcurnal enuresis

Diurenal enuresis

Management: identify underlying cause & treat!
~ eg, reduce fluid intake in evenings
~ eg, check for UTI

Answer 167

A

Gross motor: 1) Rides a tricycle

Fine motor: 1) Draws/ copies a complete circle

*Language**: 1) Identifies 4+ colours
2) Asks questions: ‘why’ ‘how’

Social: 1) Gives directions to other children

Self help: 1) Toilet trained (may still need help with wiping)

Answer 168

A

Mutual Participation

Authoritarian and paternalistic approaches do not allow for patient input. Guidance-cooperation allows for some patient input, but not full discussion and rarely a final decision from the patient about the treatment they wish to opt for. Perceptual skills are a form of consultation skill on the part of the doctor, not a doctor-patient consultation style.

Answer 169

A

Headache
Changes in vision (commonly blurred vision)
Nausea / vomiting
Ankle oedema
Upper abdominal pain

Eeclampsia: IV magnesium sulphate

Answer 170

A

The women will start developing anti-D antibodies after any sensitising event (commonly giving birth)

If someone is rhesus negative, they don’t have the D antigen on their RBC’s so if their blood comes into contact with someone that is rhesus positive then their blood will start producing antibodies against the foreign antigens.

Rh status of mother & baby is checked at the booking appointment (week 10)

If mother is negative & baby is positive, prophylaxis = anti D injection at 28 weeks gestation PLUS immediately after any sensitising events

Answer 171

A

Vaginal progesterone pessary/gel - this prevents cervical ripening & decreases activity of the myometrium

Cervical cerclage - a stitch is put into the cervix to keep it closed until nearer term date

Answer 172

A

It’s when the head of femur is displaced along the growth plate (it looks like it has slipped off)

Teenage boys

Obesity

~ Hip/ groin/ knee pain with insidious onset
~ Restricted ROM of hip
~ Painful limp

Answer 173

A

Irregular/ absent menstrual periods
Hyperandrogenism (eg acne/ hirsutism)
polycystic ovaries on US (>12) (or ovarian volume 10cm³ plus)

2 out of the 3 criteria

Transvaginal US: follicular arrangement within the ovary has a string of pearls appearance

Answer 174

A

→ Position of the cervix (anterior)
→ Effacement of the cervix (length - shorter = better)
→ Consistency of the cervix (soft)
→ Dilatation of the cervix (bigger = better)
→ Station of the presenting part (distance in cm in relation to the ischial spines)

Bishops score is used to assess whether induction of labour would be successful
~ score of 8 indicates successful induction

Answer 175

A

Membrane sweep
Vaginal prostaglandins (pessary)

Uterine hyperstimulation
~ fetal distress & hypoxia!
~ management: removing vaginal prostaglandins +/- giving tocolysis (using terbutaline)

Answer 176

A

TENS machine
Birthing ball
Birthing pool
Entenox (gas & air = NO)
IM diamorphine
Remifentanil (administered as patient controlled anaesthesia - patient has a button to press when needing a dose)
Epidural

Answer 177

A

Burnout

All the others would have symptoms which impact the patient more severely across all settings. There are no pointers to substance misuse in the stem.

Answer 178

A

Small bowel (esp jejenum) - villous atrophy

Failure to thrive (in children)
Diarrhoea
Weight loss
Fatigue
Dermatitis herpetiformis (itchy rash, usually on abdomen)
Malabsorption

Type 1 diabetes (as well as other autoimmune conditions)

Answer 179

A

Placenta praevia: when the placenta is attached in the lower portion of the uterus - often covering the cervical os.

At the 20 week anomaly scan

Painless bleeding (antepartum haemorhage)

32 & 36 weeks gestation (if present on the 32 week scan to guide decisions about delivery)

C-section should be planned for 36-37 weeks (to avoid spontaneous labour as vaginal delivery is contraindicted)

Answer 180

A

Vaginal delivery: ONLY if her viral load is undetectable (< 50 copies/ ml) - otherwise C-section recommended

Breastfeeding: NO. Even if viral load is undetectable, HIV can be transmitted to baby through the breast milk!

Prophylaxis:
• Viral load is undetectable (< 50 copies/ ml) = 1x antiviral for 4 weeks
• Viral load is detectable (> 50 copies/ ml) = 3x antiviral for 4 weeks

Answer 181

A

Endometriosis

Answer 182

A

Henoch-Schonlein Purpura - A type of IgA vasculitis

Purpura (rash on legs → buttocks)
Joint pain (commonly knee’s & ankles)
Abdominal pain
Renal impairment

Management: supportive (analgesia, rest, hydration)
~ most usually resolve within 4-6 weeks.

Monitoring: needed whilst the disease is still active:
• urine dipstick (to monitor renal impairment)
• blood pressure (to monitor for hypertension)

Answer 183

A

Nuchal translucency (**increased** in downs)
PAPP-A hormone (**decreased** in downs)
Beta-hCG hormone (**increased** in downs)

Answer 184

A

The pulmonary artery arises from the left ventricle & the aorta arises from the right ventricle (they’ve swapped)

There needs to be a shunt between R & L ventricles so that oxygenated blood goes to systemic circulation

1) patent ductus arteriosus (connection between pulmonary trunk & aorta)
2) atrioseptal defect
3) ventriculoseptal defect

Prostaglandin E is given - prevents the ductus arteriosus from closing

Answer 185

A

Kallmann’s syndrome

Hypogonadotropic hypogonadism: hypothalamus doesn’t secrete enough GnRH to stimulate anterior pituitary to secrete LH & FSH → little testosterone/ oestrogen secreted

Answer 186

A

Loss of normal function in right arm

Nerves in the arm are not affected by the stroke. Some cerebral neurons will have died but this is pathology not activity limitation. The other options would be described as participation restrictions resulting from the activity limitation.

Answer 187

A

GORD

Immaturity of the lower oesophageal sphincter - age 1y

*Management:**
No effect on growth:* conservative advice
Effect on growth:* gaviscon mixed with feeds/ omeprazole!

Answer 188

A

Mastitis

Causes:
• blocked milk duct
• infection (usually staph aureus)

Answer 189

A

Osteogenesis imperfecta (brittle bone disease)

Answer 190

A

1) Testosterone - high (insulin promotes release of androgens)
2) Sex hormone binding globulin - low (insulin decreases SHBG production)
3) LH - high
4) FSH - low (low FSH results in follicles not maturing and turning into cysts)
5) Insulin - high (insulin resistance is a feature of PCOS)
6) LH:FSH ratio - high (High LH & low FSH)

Answer 191

A

2 months old

Up to 4 months:
• Diphtheria, tetanus, polio, pertussis, HepB, H.influenza B
• Pneumococcal disease
• Meningococcal B
• Rotavirus

12 months:
• Meningococcal C
• Measles, mumps & rubella

13-14y:
• HPV vaccine (cervical cancer)

14y:
• Meningococcal ACWY

Answer 192

A

Primary prevention: Preventing the onset of an illness

Secondary prevention: Detection of a disease at an early stage in order to cure it/ lessen the symptoms

Tertiary prevention: Measures to prevent disability caused by the disease

Answer 193

A

Viral induced wheeze

Commonest under 5s (especially under 3y)

Management: salbutamol (10 puffs!)

Answer 194

A

Pubic symphysis

Turtle-neck sign

*Episiotomy** (cutting the perineum to make the vaginal opening larger)
*McRoberts Manoeuvre** (mothers knee’s to abdomen - this provides posterior tilt to pelvis, lifting pubic symphysis out of way)

Answer 195

A

1) Intellectual impairment (IQ < 70)

2) Social/ adaptive dysfunction
(eg deficits in communication/ self-care, social skills etc)

3) Onset before 18y (whilst brain is still developing)

1) Head injury
2) Chromosomal abnormalities (eg Downs)
3) Congenital abnormalities (eg infection/ abnormal brain development)

Answer 196

A

Machinery

Machinery is categorised as a mechanical hazard.

Answer 197

A

Blocked milk duct: conservative - analgesia & continuation of breastfeeding

Infection: antibiotics: flucloxacillin is 1^st line + continuation of breast feeding

Milk sample is sent to lab for culture & sensitivities

Breast abscess (requires surgical inscision & drainage!)

Answer 198

A

L→R ventricle

Increased blood in R ventricle → increased blood (and thus pressure) in pulmonary circulation → pulmonary hypertension

Pulmonary hypertension causes Eisenmenger syndrome: pressure in R ventricle is higher than L which causes blood to be shunted from R→L

Central cyanosis (more blood is bypassing the lungs)

Answer 199

A

Prolactin

Oxytocin

Answer 200

A

→ NO blood/ mucus (uncommon)
→ Entire GI tract
→ Skip lesions on endoscopy
→ Terminal ileum most affected & Transmural thickness of inflammation
→ Smoking = risk factor
→ Weight loss
→ Structures/ fistulas

Answer 201

A

3 pregnancies of which only 1 has been delivered past 24 weeks gestation

Answer 202

A

*Medical:**
Methotrexate IM* - avoid pregnancy for 3 months due to teratogenic effects!

Surgical:
1^st line:Laparoscopic salpingEctomy
~ removal of whole affected fallopian tube

2^nd line: Laparoscopic salpingOtomy
~ removal of only ectopic, fallopian tube is left

Answer 203

A

Episiotomy: a cut is made in the perineum to avoid perineal tears during labour

Answer 204

A

Joint replacement in severe osteoarthritis of the hip

Tertiary prevention attempts to reduce the impact of an established disease or disability. Joint replacement in osteoarthritis is the only option which corresponds to this. The others are examples of primary and secondary prevention.

Answer 205

A

Encourage him to discuss it further and explore the reasons for his request

Enabling discussion will allow the GP to find out details about the main concerns of the patient and address symptom control better.

Answer 206

A

Conjugated bilirubin!!

Split bilirubin

Pale, chalky white stools

Answer 207

A

Kernicterus

Unconjugated bilirubin - it’s fat soluble so can cross the BBB whereas conjugated bilirubin is water soluble so cannot cross the BBB

Phototherapy (babies are placed under blue light)

Encephaloptahy (seizures)/ cerebral palsy

Answer 208

A

a) Threatened miscarriage:
Mild bleeding, mild/ no pain, cervical os is closed, foetus present intrauterine - Miscarriage may or may not occurr

b) Inevitable miscarriage:
Heavy bleeding, pain, cevical os is open, foetus currently present intrauterine - Miscarriage is inevitable

c) Complete miscarriage
+/- bleeding/ pain, cevical os closed, NO products of conception intrauterine anymore (all have been expelled) - Miscarriage has already occurred

d) Missed miscarriage
Asymptomatic, cevical os closed, foetus currently present intrauterine but is dead

Answer 209

A

HPV vaccine to 12-14y olds

Smear tests - every 5 years between 25-64y

Strains 16, 18

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Y3 Exam 2 Flashcards

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