H2023 MED9
Oppgaver og bilder er hentet fra eksamensoppgaver fra Det Medisinske Fakultet ved UiB
1.
A 2 year old girl is arriving at the pediatric department late at night. She has a history of 1 day with fever, reduced general condition and refuses to move the left hip or walk. CRP is 90 mg/L. You order an ultrasound of the hip and there is increased amount of fluid in the hip joint. You suspect this is a septic arthritis of the left hip. What is the most important treatment option to save the hips joint?
2.
A boy of 7 years of age with cough, high fever and a CRP of 99, is referred for imaging. What is the first imaging modality of choice in this setting? One correct answer.
3.
A 2 year old with a history of severe headache for the last 3 weeks and episodic vomiting, is referred for imaging. What are the preferred imaging modality in this setting?
4.
A boy of 2 months is admitted to hospital with seizures. Parents inform that the father dropped the baby on the floor, by accident, 3 days ago. Examination reveals no external damage on the head. What are the initial imaging modalities of choice in this setting?
5.
Below, you will find some general statements to consider before you decide to prescribe a drug to a pregnant woman. Which of the following statements is correct? Choose one right answer.
6.
Your patient has been treated for hypertension during pregnancy with the calcium antagonist nifedipin. Nifedipin has been considered safe during pregnancy. She has now given birth to a healthy little boy who was born at term. Your patient wishes to breastfeed her child and she wonders whether Nifedipin is compatible with breastfeeding. What do you have to consider? Choose one right answer.
7.
A 4 year old girl comes to yor office with her mother. Healthy girl that plays around. The mother has some concerns about the girls feet. They have recognized that she has flatfeet and sometimes she stumbles. What do you do?
8.
WHat is true about remodelling in pediatric fractures?
9.
A 14 year old boy has had 6 months with activity related pain in his lower back. Sometimes a tingling sensation on the posterolateral part of his ties. He plays football every day, but he now has to skip some of the training because of pain. He got better during summer holiday, but is now worse again. What is the most likely diagnosis?
10.
A 9 year old boy has an accident when playing at school. He has a swelling in his ancle, and the x-rays shows that he has a Salter-Harries type 2 fracture in the distal tibia. What do you think is correct about the treatment and follow up?
11.
When treating children. with drugs there are different aspects to take into account. What is not correct?
12.
MRI: What are the white (1) and blue (2) arrows demarcating?
13.
CT of patient with ovarian cancer: What is demarcated with yellow (1) and green (2) arrows?
14.
What is correct about PET-CT in gynecologic cancer?
15.
A 13-year-old boy, diagnosed with Type 1 diabetes, is brought to the emergency room experiencing confusion, rapid breathing, and fruity smell on the breath. Considering these symptoms, which condition is the boy most likely suffering from?
16.
A 6-month-old girl is brought to the emergency room where you are the attending intern. She presents with fever, refusal to drink, and irritability which is exacerbated by the sharp light in the room. During the examination, she vomits, and you observe a bulging anterior fontanelle, red and partially bulging eardrums on both sides, as well as a high-pitched cry. What do you do?
17.
Where would you place an intraosseous needle in an infant?
18.
James is an almost 15-year-old high-school student with sickle-cell anemia. James and his parents came to Norway from Tanzania 10 years ago, and two years ago his spleen was removed. The last year his pulmonary function has deteriorated, and last month several small silent cerebral infarcts were discovered. What is the most probable mechanism for James’ cerebral infarcts?
19.
A nine-year-old boy presents with a runny nose, cough and shortness of breath. He has a history of asthma and is currently taking an inhaled corticosteroid. On examination, he has no fever, a respiratory rate of 28 breaths per minute, and his oxygen saturation is 96% on room air. On auscultation, his chest is clear. What is the most likely diagnosis?
20.
A 5-year-old child is brought to the emergency room by his parents due to a limp and refusing to bear weight on the right leg, with symptoms building up over the previous 2-3 days. There is no history of trauma and no fever. On examination the right leg is slightly flexed, abducted and rotated. The boy strongly resists to change the position of his right leg but is otherwise in good condition with no abnormal findings. What is the most likely diagnosis?
21.
A 3-year-old girl was brought to the clinic with a three-day history of cough, runny nose, fatigue, and mild fever. On examination, there is rhinorrhea and normal breath sounds with no stridor or wheezing. Considering her age and the symptoms presented, which of the following is the most likely diagnosis?
22.
What is the typical age of onset for Duchenne muscular dystrophy?
23.
A 16-year-old girl with a history of atopic eczema presents with sudden-onset difficulty breathing, wheezing, and distress during a football match. She is brought to the side-line where she calms down and improves after approximately 10 minutes. You are the physician at the event. What is the most likely diagnosis?
24.
A 2-year-old girl arrives just after midnight with her father at the emergency room, where you are the new intern. She has been experiencing fever for the past 2-3 days, and at the same time, signs of irritability, pain, and a reluctance to bear weight or move her right leg. Upon examination, you find her somewhat lethargic and there is a lack of alertness in her eyes. You observe no spontaneous movement of the right leg, and extensive pain when you try to extend and rotate it. What is the first thing you do?
25.
A mother brings her 6-month-old daughter to your GP office because the girl has dry itchy skin, with a red scaly rash that started in her face. Her two elder siblings, age 8 and 10 years, had similar skin lesions in infancy. What is the most likely diagnosis?
26.
Metabolic screening of newborns in Norway includes analyses for two endocrine disorders; which?
27.
A five-week-old girl is admitted to hospital because of vomiting. What is the most common presenting symptom of hypertrophic pyloric stenosis?
28.
A young father is worried that his daughter’s development is not normal. She has recently begun to sit without support. While sitting on her father’s lap, she reaches for objects, but when catching the object, she has not started to use a pincer-grasp (norsk: pinsettgrep). On the floor, she rolls over and tries to crawl. She loves peek-a-boo games, babbles and imitates, but has no own words. Which developmental age in months corresponds to the description?
29.
A single mother brings her 12-year-old healthy daughter Kari to your GP office. Since the mother is short (154 cm) and Kari had her menarche two months ago, the mother is worried that Kari’s adult height will end up very low. You measure Kari, and she is 148 cm. What do you say to Kari and her mother?
30.
Which of these symptoms are usually NOT found in Henoch-Schönlein purpura?
31.
You get a telephone call informing you that a 3-year-old boy will be admitted to your hospital department because the parents suspect that he has drunk a whole bottle of paracetamol mixture. You prepare for his arrival. What is the antidote for paracetamol toxicity?
32.
A 14-year-old boy is referred to you because of gynecomastia. At examination, you find him slim, in mid-puberty and with moderate gynecomastia. Your general examination is normal. How do you judge these findings?
33.
In a 10-year-old girl with diarrhea and weight loss, what is the best blood test to rule out celiac disease?
34.
A 4-year-old boy presents with a history of moderate fever (38.4 C) and constant, progressively worsening abdominal pain that started around the umbilical region yesterday and today is most pronounced in the right lower quadrant with additional vomiting. On examination, he does not like to move in bed, and you notice tenderness and guarding in the right lower quadrant. What is the most likely diagnosis?
35.
A 2-year-old girl is examined at your office after having coughed for some days. She has no fever, and you find that the pulse rate is 130 per minute and the respiratory rate is 28 per minute. What is the normal reference range for pulse and respiration rate in a 2-year-old child?
36.
You are in the outpatient clinic, seeing a 5-year-old boy with Spinal Muscular Atrophy type II. The child is treated with Spinraza, but is still wheelchair bound, and has had two prolonged airway infections the last three months, with cough and secretions. His SpO2 is 96%, his capillary pCO2 at daytime is 7.2 kPa (4,5 - 6,0 kPa). How do you proceed with treating this child?
37.
A 2-year-old girl with grade III vesicoureteral reflux is seen by you at the hospital because of fever for the last 12 hours and a positive urinary dip stick. Examination of catheter urine obtained after admission shows 3+ for leukocytes and proteins, as well as 2+ for blood. Urine is sent for culture and blood tests taken. In half an hour you get the result of the CRP analysis which is 21 mg/L. What do you do then?
38.
You are the new GP intern in a rural community. You are on call and asked to attend to a one- year-old boy after an attack characterized by central cyanosis, tachypnoea, irritability and agitation (your own interpretation of what the parents tell you). Upon examination, the general condition is OK, but he seems somewhat dystrophic and small for age. On auscultation you hear a loud and harsh systolic ejection murmur, and the second heart sound is clearly single. What is the most likely diagnosis?
39.
The Moro reflex is a primitive reflex which is elicited by a sudden controlled extension of an infant’s head (NB: the head should be supported in the examinator's hand) or by pulling up on the infant's arms while in a supine position and letting go of the arms, causing the sensation of falling. The normal Moro reflex starts with symmetrical abduction and extension of the arms, followed by flexion and adduction, before the arms return to the infant’s side. At what age does the Moro reflex normally disappear?
40.
A 2-year-old child presents with a barking cough and stridor. Which of the following is the most likely causative organism?
41.
The Norwegian childhood vaccination program does NOT include a vaccine against:
42.
What is the most important risk factor for necrotizing enterocolitis in newborn infants?
43.
A father brings his 3-year-old boy to your office for examination. After three days of fever around 390C, slight cough and malaise, the fever is now gone, but a maculopapular rash has spread from the neck and trunk to the face and extremities. You suspect exanthema subitem (fourth disease). What microorganism is causing this disease?
44.
A 2-day-old baby born three months early develops respiratory distress, tachypnoea, and cyanosis. A chest X-ray reveals a ground-glass appearance. What is the most likely diagnosis?
45.
Two weeks after completing oral penicillium for acute tonsillitis, a 7-year-old boy presents with joint pain and swelling of his right knee. On examination, you note a low-grade fever and a faint, pink rash on the trunk that does not itch. What is the most likely diagnosis?
46.
Neonatal hyperbilirubinemia is a common condition that in severe cases can cause brain damage. Which of the following statements is true?
47.
A 14-month-old boy has serious breathing problems after having swallowed a small toy. If he is conscious, what is the first thing you should do?
48.
Which of the following statements is true?
49.
Child abuse is serious and requires immediate attention. What should alert you about possible physical abuse when taking medical history or examining a child?
50.
As GP, an increasing number of children are brought to you for examination because the parents suspect that their child is suffering from food intolerance. What is true for lactose intolerance?
51.
A 2-month-old boy presents at your GP office with his agitated single mum and two siblings aged 3 and 5 years. The boy seems respiratory distressed, has a bad cough, intercostal retractions, and nasal flaring. On auscultation, you hear fine crackles and wheezing. What do you do?
52.
A 14-year-old girl presents with primary amenorrhea. On examination, she has a no breast development, sparse pubic and axillary hair, short stature, webbed neck, and a shield-shaped chest. What is the most likely diagnosis?
53.
A 15-year-old girl has been suffering from headaches for many years. Which of the following is NOT a common symptom of migraine in adolescents?
54.
A 3-week-old newborn presents with persistent jaundice and dark yellow urine. Laboratory investigations reveal an elevated conjugated bilirubin. What is the most likely cause?
55.
Which one of the following statements about ICP (intrahepatic cholestasis of pregnancy) is true?
56.
A 34-year-old woman; Gravida 3 and Para 2 presents in gestational week 32 with preterm prelabour rupture of membranes. She has abdominal pain, purulent vaginal discharge. Her temperature is 38.8 and she complains of chills. What is the most likely diagnosis?
57.
Mary Kvidal is pregnant with her first child. She has read on the website of a well-known influencer that vaginal delivery is dangerous for the child and ruins the mother sexually, and therefore Mary wants to be delivered by cesarean section. She presents this request to you as her general practitioner, you refer her to the hospital for counselling. What is the goal of the counselling?
58.
Kirsti Kolle Grøndahl is pregnant with her third child. She is an accountant, she is 32 yeras old and you have just diagnosed her with gestational diabetes. What is the main objective of the treatment for gestational diabetes?
59.
Vesla Vetlesen is pregnant in week 8 with her first child, she suffers from asthma and depression, and she is very worried that she will do something wrong to harm the baby. She asks you, as her general practitioner, what medicine she can use in pregnancy. What are your most important sources on safe medication in pregnancy?
60.
A pregnant woman in her first pregnancy has her blood pressure taken in week 32 at 156/100 mm Hg. Her family has hypertensive problems, and she has previously used an antihypertensive medication called Adalat before pregnancy. Today she presents with light headache and the urinary test shown proteins 3+, blood- and nitritt negative. What is the most likely diagnosis?
61.
Sissel Rønbeck had her first child three days ago. She bled 1200 ml during delivery, bimanual compression of the uterus was necessary to control the bleeding. She was dicharged from the hospital just this morning, but now presents at your office with lower adbominal pain, a general feeling of being ill, and she has measured her temperature at 39,6 C. What is the most likely diagnosis?
62.
What is the most common presentation at term?
63.
Gro is pregnant with her third child, she is 39 years old and wants a prenatal diagnostic ultrasound and a NIPT-test. Which of the following statements regarding this form of diagnosis is correct?
64.
Oddrunn Pettersen had her third child by c-section eleven days ago. She now presents with pain and swelling of the left calf. What do you suspect and how do you proceed?
65.
Gunhild Øyangen is 10 weeks pregnant with her first child. She does not remember if she has been vaccinated against rubella. You check her immunologcal status and find that she indeed has no immunity against rubella. What are you going to do?
66.
How will you best assess progress in labor?
67.
What is an important ethical argument against abortion?
68.
Tove Strand is 24 pregnant with her second child. She suffers from ankylosing spondylitis, she has blood type B negative, she has a BMI of 31 and she has a new partner in the current pregnancy. What is important to keep in mind at this control?
69.
Cervix cancer treatment: What is the most important factor for the individual treatment recommendations?
70.
A 34 years old woman delivered her second child 8 months ago. She is currently still breastfeeding (not fully). Her periods have returned and she has started work as a nurse (her husband has the paternity leave). Her problem is massive urinary leakage. She needs to use protective pads continuously. She has a BMI of 36.What treatment should you recommend?
71.
Einfrid Halvorsen presents at your office with headache and visual disturbances. She is 34 weeks pregnant with her first child, she has a BMI of 29, and she is an air hostess. She was 39 when she met Knut Frydenlund, the man of her dreams, she married him after two months, at which time she was already pregnant. What is the most likely cause of Einfrid ́s symptoms?
72.
What is the best biochemical marker for intrahepatic cholestasis of pregnancy (ICP)
73.
Helen Marie Bøsterud takes an oral glucose tolerance test at 27 weeks of pregnancy, her 0-value is 5,5 and her 2-h value is 8,4. What is the most likely diagnosis?
74.
During the second stage of labor, fetal cardinal movements occur. What is the second cardinal movement?
75.
What would be your most important task to remember as a doctor after a transport delivery?
76.
Anne-Lise Bakken is a first-time mother of 29, now 26 weeks pregnant. She is a dentist, happily married to Hallvard Bakken and she has a BMI of 26. She asks you if she really needs to take an oral glucose test.
77.
A woman presents with bleeding and menstrual pain in week 9 of pregnancy. What are the most likely diagnoses and how do you proceed?
78.
A woman of 38 years has during last months had intermenstrual bleeding, especially in relation to sexual intercourse. She has delivered 3 children, has a copper IUD. By GE you find an “ulcer” on the portio, 10mm diameter, easily bleeding. What will you do?
79.
What is the most common histologic type of endometrial cancer?
80.
Name the most important risk factor for ovarian cancer
81.
Postmenopausal bleeding: What is the overall risk of malignancy in women exhibiting this symptom?
82.
HPV infections and CIN. What genotype is most common in the precursor lesions of the cervix.
83.
The progesterone level varies during the menstrual cycle. When is it at the highest?
84.
Name the most important risk factor for ovarian cancer?
85.
You are a general practitioner (GP). Your patient is a 68-year-old woman. She has a feeling of bulging in the vagina and urge incontinence. At the gynecological examination, you notice prolapse of the anterior vaginal wall. What kind of information do you give her?
86.
HPV infection and anogenital warts: What genotypes are most common?
87.
What is considered a primary risk factor for developing cervical cancer?
88.
A 38-year-old woman, identified as a BRCA1 carrier (BRCA1 positive), is in good health and has given birth to two children, with the most recent delivery occurring a year ago. Having completed her childbearing, she now seeks a risk-reducing surgery involving the removal of her ovaries and fallopian tubes. What recommendation should be given regarding hormonal replacement therapy following this surgery?
89.
A 32 year old woman pregnant after IVF was admitted to the gynecology department due to hyperemesis gravidarum when she was 8 weeks pregnant. She was treated with antiemetics and i.v fluid for three days. At discharge, she was advised to have an appointment with her GP (You) after one week. Which of the following findings would indicate that she needs readmission for further hydration/ treatment?
90.
You are junior doctor at the gynecological/obstetric outpatient clinic. Your patient is 15 years old and has severe dysmenorrhea. She had her first menstrual period 2 years ago and has had a regular cycle for one year. She has not yet had sexual intercourse. She is otherwise healthy with normal sexual development corresponding to her age. Her mother and 18-year-old sister are both healthy. Oral nonsteroidal anti-inflammatory drugs (NSAID) combined with paracetamol have been ineffective. What do you do?
91.
The cervix screening programs: What coverage rate is the target?
92.
Termination of pregnancies - What method is used the most in Norway today
93.
The two most common subtypes of long QT syndrome, LQTS1 and LQTS2, are both caused by pathogenic variants in genes (KCNQ1 and KCNH2, respectively) that encode potassium channels in the heart. What is the most important trigger of LQTS1 episodes?
94.
A 4-year old boy is referred to clinical assessment due to moderate intellectual disability and some dysmorphic features, including elongated face and large, protruding ears. Targeted gene testing demonstrates a pathogenic triplet expansion in the FMR1 gene, in agreement with X- linked fragile X syndrome. Both parents are apparently healthy, and there are no other known cases of similar phenotype in the family. What is the most likely explanation for both parents being healthy?
95.
Multiple endocrine neoplasia type 2 (MEN2) is a rare autosomal dominant cancer syndrome, caused by pathogenic variants in the RET gene. It is associated with a high risk of medullary thyroid cancer, often with onset in childhood. In a family with MEN2 syndrome, an affected woman has recently given birth to her first child. Which statement is most correct about genetic testing for MEN2 in this situation?
96.
Lynch syndrome is a hereditary cancer syndrome with high risk of developing certain types of cancer. Which biological function is impaired by pathogenic variants in the Lynch-associated genes?
97.
A 55-year old woman has been diagnosed with ovarian cancer. She is not aware of any other cancer cases among her closest relatives (i.e. her parents, two younger sisters (48 and 51 yrs., respectively) and her 23-year old son). Which clinical advise will be most correct is this situation?
98.
In 2017, 70 children were born with Down syndrome in Norway (i.e. about 12 per 10,000 live born children). There are different risk factors and genetic causes for Down syndrome. Which consideration is most correct for the average child that was born with Down syndrome?
99.
A couple (male, 34 years; female, 32 years) is seeking medical advice due to fertility-related problems. They have no children, and the female has experienced several miscarriages (spontaneous abortions) before week 10. Both are apparently otherwise healthy. As part of the diagnostic evaluation, they undergo some laboratory tests. Which of the following genetic laboratory tests is most relevant in this situation?
100.
Several different terms can be used in a laboratory report to describe genetic variation. Which statement is the most correct description of such terms?
101.
A disorder with X-linked recessive inheritance with full penetrance affects about one in 16.900 males in a certain population. What is the frequency of disease-causing variants in the same population?
102.
Many disorders and syndromes can be inherited from one generation to the next. The pedigree figure shows a family with individuals that are affected by the same disorder with monogenic inheritance. Which pattern of inheritance is most likely in this family?
103.
B. What would you specifically focus at during the gynecologic examinations and what supplementary investigations could you initiate to investigate this as a GP? Describe briefly.
C. What would be Your first –line suggestion of therapy for this woman?
104.
A. Before you refer the patient to the nearest gynecological department for further examination what examinations or tests will you perform? What findings do you expect (both tests/examinations that you expect to be pathologic and normal should be mentioned)
B. What is the most likely diagnose her?
C. Mention at least three differential diagnoses.
D. What determines the treatment strategies used? What possible treatment options are available?
105.
106.
107.
(a) Is it a predictive or diagnostic test?
(b) Which clinical information should be provided to the laboratory when requesting genetic testing of the affected woman?
The medical genetics laboratory performs an NGS-based renal gene panel analysis, and reports back that the woman is heterozygous for a pathogenic, protein-truncating variant in the PKD1 gene that may explain the polycystic kidneys. Around 10 % of such variants are de novo.
(c) What should be done to follow-up this finding, with respect to the medical genetic consequences?
The affected woman and her husband (51 years old; healthy) have a 13-year old daughter. She is apparently healthy. Still, her parents are very worried about her risk of getting polycystic kidneys and renal failure.
(d) What is the risk that the daughter has inherited the pathogenic PKD1 variant?
(e) Should the daughter be referred to an ultrasound examination of her kidneys and/or be genetically tested for the pathogenic PKD1 variant in the current situation? Give reason(s) for your answer, with reference to the Biotechnology Act («Bioteknologiloven»), if relevant.
Fill in your answer here
108.
a) List common causes of convulsions in newborns.
b) Describe how seizures may present in a newborn baby.
c) How would you discriminate convulsions from jitteriness?
109.
a) What additional information do you immediately ask the team leader for?
When you arrive five minutes later, the girl is awake and in good general condition. Your general examination reveals normal findings, apart from a systolic heart murmur, grade III with punctum maximum to the right of her sternum.
b) What is your primary diagnosis?
c) Describe a clinical sign that may strengthen your primary diagnosis.
As you are doing your examination, the girl’s mother arrives. She feels that the whole situation has escalated and is out of proportion. “I fainted all the time when I was my daughter’s age”, she states, “let Anne finish the game, and we can come and see you tomorrow at your office”.
d) In this context, what is your response to her opinion?
Anne’s mother is right as to the fact that most adolescents who faint do not need hospitalization. As GP, what do you have to do at your office to be able to conclude that a syncope is most probably not caused by a heart condition?
110.
a) What is your primary diagnosis?
b) How would you expect that the rash will develop? What are the characteristics of the rash of this condition?
c) What are your two most likely differential diagnoses, and how do they differ from the actual infection?
You decide that Kari does not need hospitalization.
d) What are your main arguments for that decision?
e) What information do you give to the father?
Three days later, the father contacts you again. He tells you that Kari has had an increasing fever, up to 40,50C, with much less effect of paracetamol. The last four hours, she has also complained of intense pain from her left calf, with no relief after an extra dose of paracetamol.
f) What do you do now?
111.
a) What do the blood tests tell you?
b) What is your primary diagnosis?
c) What is the most plausible explanation for Arne’s systolic heart murmur?
d) What is the normal testicular volume in a 5 year old boy, and why do you think his testicles are enlarged?
You admit Arne to hospital the same afternoon.
e) What examinations should be done after admission to establish the diagnosis and prepare for the start of treatment?
