GENERAL PRACTITIONER EXAM
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A 29-year-old female with Typhoid fever wishes to continue to breast feed her 1 month old infant. Which of the following antibiotics is suitable?
Typhoid fever is best treated with quinolones, chloramphenicol or cotrimoxazole. However, with breast feeding chloramphenicol is relatively contra-indicated as are quinolones due to potential risk even if small. Also cotrimoxazole is safe in breastfeeding except with infants less than 2 months due to possible risk of increased bilirubin. In pregnancy or children, the drug of choice is parenteral ceftriaxone.
A 20-year-old with epilepsy is well controlled on sodium valproate 600mg twice daily and is on OCPs for three years. She presented to her general practitioner 12 weeks pregnant.
which of the following is correct?
There is an increased risk of neural tube defects associated with anticonvulsants during pregnancy.
However, the risks associated with treatment are outweighed by the benefits in preventing seizures, so the drug should be continued.
The risks may be minimized through use of folate supplements.
Sodium valproate is not an enzyme inducer and would not speed up metabolism of the pill.
A 31-year-old pregnant lady has a blood pressure of 151/89 mmHg. There are no other abnormalities. BMI is 32.9 kg/m2 and urinalysis is normal. ECG reveals left ventricular hypertrophy. What is the most likely etiology?
This woman has hypertension which is discovered in her pregnancy but has evidence of LVH on her ECG suggesting that this is longstanding.
Often, it takes at least two years of sustained hypertension to develop LVH, and although her pregnancy may have contributed to any deterioration, the LVH suggests may have contributed to any deterioration, the LVH suggests that it was pre-existent.
The cause for her hypertension may be secondary but her high BMT is suggestive of it being essential.
A 14 year old female reports a 6 month history of intermittent abdominal cramping, with each episode becoming progressively worse. According to her there is no obvious relationship to eating, voiding, or defecating. She report that she has not yet begun menstruating and is not sexually active. No history of weight loss is present. She appears to be in mild emotional distress about being the “last girl in her class to have a period”. She is in no physical discomfort and her vital signs are normal. Secondary sexual characteristics appear to be developing normally. She is in the 57th percentile for weight and the 65th percentile for weight. Your presumptive diagnosis is confirmed by a complete physical examination. The therapeutic procedure of choice would be
The key to making a diagnosis of imperforate hymen, aside from the obvious finding on physical examination, lies in the systematic drawing of inferences. One can speculate that this patient´s recurrent crescendo abdominal cramping represents six menstrual sheddings, with no egress from the body. Her delay in menarche, despite normal growth parameters, offers another clue that the structural amenorrhea is present. Amounts of retained blood vary among patients; up to 3000 mL have been reported. A large volume can accumulate without causing any permanent damage, and subsequent fertility is usually normal. Hymenotomy will relieve the pressure, and normal menses should ensure
A patient of yours unfortunately goes into premature labor at 23 weeks. The fetus is not viable. She wishes to have the fetal remains cremated. Regarding the legal aspects of this case which of the following is true?
Cremation of fetal remains less than 24 weeks is not subject to the Cremation Act.
As such, forms 4 and 5 should not be completed. In spite of this most crematoria are happy to make arrangements to cremate fetal remains. Where body parts are removed at post mortem, arrangements for cremation of these are normally made by the pathology service
A 36 week pregnant woman comes for routine prenatal visit. You do not feel the presenting part. The most accurate method to determine this is
The figure demonstrates the different types of presenting parts of a baby. The method for determining this is with a manual exam, but in this question since the doctor has already done that and was unable to determine the presenting part, the next step would be to obtain an ultrasound.
A 24 year old female is diagnosed as having deep venous thrombosis in her right lower extremity in her first trimester of pregnancy. The most appropriate therapy is
Deep venous thrombosis (DVT) is clotting of blood in a deep vein of an extremity (usually calf or thigh) or the pelvis. DVT is the primary cause of pulmonary embolism. DVT results from conditions that impair venous return, lead to endothelial injury or dysfunction, or cause hypercoagulability. DVT may be asymptomatic or cause pain and swelling in an extremity.
Diagnosis is by history, physical examination, and duplex ultrasonography, with d-dimer or other testing ax necessary. Treatment is with anticoagulants. In pregnancy, heparin is safe to give.
A 20 year old college student presents with lower abdominal pain and fever. On Physical examination bilateral lower abdominal tenderness is present. Her vaginal exam shows tenderness with cervical mobilization. Her pregnant test is negative. The most likely diagnosis is
Pelvic inflammatory disease is infection of the upper female genital tract: the cervix, uterus, fallopian tubes and ovaries; abscesses may occur. Common symptoms and signs include lower abdominal pain, cervical discharge, and irregular vaginal bleeding. Long-term complications include infertility, chronic pelvic pain, and ectopic pregnancy.
Pelvic inflammatory disease (PID) results from microorganisms ascending from the vagina and cervix into the endometrium and fallopian tubes.
Infection of the cervix (cervicitis) causes mucopurulent discharge.
Infection of the fallopian tubes (salpingitis) and uterus (endometritis) tend to occur together. If severe, infection can spread to the ovaries (oophoritis) and then the peritoneum (peritonitis).
These infections are called salpingitis even though they involve other structures.
Diagnosis includes PCR of cervical specimens for Neisseria gonorrhoeae and chlamydiae, microscopic examination of cervical discharge (usually), and ultrasonography or laparoscopy (occasionally). Treatment is with antibiotics.
A 23-year-old woman is admitted in labour. She is in her second pregnancy, after her first previous elective having been an elective caesarean section for breech presentation. What is the risk of scar rupture?
This answer is D. The risk of scar rupture in women undergoing a trial of labour after a previous elective caesarean section is 0.7 percent.
If both the mother and her partner are carriers of cystic fibrosis, what is the risk of an affected baby?
This answer is B. The risk of inheriting an autosomal recessive disorder when both patients are carriers is 1:4.
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