can only be diagnosed if psoriasis is present (F) also if fhx of psoriasis ref K&C
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- Bu səhifədəki naviqasiya:
- False
- Rose spots constitute a subtle, extremely sparse (often
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Contact Dermatitis is treated the same as atopic dermatitis except there is the additional avoidance of the precipitant. Topical steroids and emollients are appropriate.
Rosacea: Steroids are contra-indicated. Use metronidazole or tetracyclines. Acne: Treatment options: TOPICAL (benzoyl peroxide, retinoids, astringents, antibiotics) or SYSTEMIC (antibiotics, cyproterone acetate, isotretinoin, steroids). Lichen Planus: Potent topical steroids usually suppress irritation. Eczema Herpeticum: Widespread herpes simplex infection which occurs in atopic eczema. Lymphadenopathy and constitutional symptoms may occur. Steroids (used for atopic eczema) should be stopped until the eczema herpeticum has resolved. Treatment is with iv acyclovir.
TTTTF Lymphangitis carcinomatosa: LC occurs as a result of the initial hematogenous spread of tumor to the lungs, with subsequent malignant invasion through the vessel wall into the pulmonary interstitium and lymphatics. Tumor then proliferates and easily spreads through these low-resistance channels. Less commonly, direct infiltration occurs as a result of contiguous mediastinal or hilar lymphadenopathy or an adjacent primary bronchogenic carcinoma. The usual presenting complaint is of breathlessness in a patient with known malignancy. Occasionally, patients may have a dry cough or hemoptysis. Symptoms often precede the development of any radiographic abnormality. Pericardial Effusion: Causes – Bacteria, Fungi, MI, Dressler’s, Uraemia, RA, Myxoedema, Trauma, Surgery, MALIGNANCY, Radiotherapy, Procainamide, Hydralazine. Clinical Features – Dyspnoea, raised JVP.
FTFFF Gilbert’s: Asymptomatic isolated hyperbilirubinaemia which can be precipitated by fasting. Hepatitis C: Probably the most likely given the occupation that was given in the stem. Drug induced haemolysis: Would not raise AST and ALT, although it may be associated with gallstones. Primary Biliary Cirrhosis: Increased Alk Phos and GGT, mildly increased AST and ALT. Late disease will have and increased bili and PT with a decreased PT. Lethargy and pruritis may precede jaundice by months to years. 9 times more common in women, but I guess women can also be dentists. Alk Phos only being marginally increased make this unlikely. Biliary Cholelithiasis: Increased Alk Phos and GGT.
FTTTF PTH increases Ca reabsorption and PO4 excretion. MEN1: Parathyroid hyperplasia, Pituitary adenoma, Pancreatic tumours MEN2a: Medullary Thyroid Ca, Pheochromocytoma, Parathyroid hyperplasia MEN2b: Men2a + neurocutaneous signs –parathyroid hyperplasia.
Chronic Renal failure is associated with anaemia and causes secondary (not tertiary, although may eventually) hyperparathyroidism.
TTFTF Alport’s syndrome is X-linked dominant, aut dom, or rarely aut rec. Genes code for type IV collagen. Signs include progressive haematuric nephritis, sensorineural deafness and lenticonus (bulging of the lens capsule). Renal transplantation is the treatment of choice for ESRD in individuals with Alport syndrome. The results of renal transplantation for patients with Alport syndrome compare favorably with results in persons with other diagnoses.
TFTTF Palpation of the precordium reveals a quiet apical impulse. In pulmonary hypertension and RV hypertrophy, a RV parasternal lift may be encountered. On auscultation, a loud S1 is present because the transmitral gradient holds the mitral valve open throughout diastole until ventricular systole closes the fully opened valve with a loud closing sound (S1). In advanced mitral stenosis, as the mitral leaflets become so damaged that they neither open nor close well, S1 eventually quiets. S2 is physiologically split with a loud pulmonic component (P2) in the presence of pulmonary hypertension. S2 is usually followed by another early diastolic sound, called the opening snap (OS). The interval between S2 and the OS provides a good estimate of LA pressure and thus the severity of the mitral stenosis. When LA pressure is high, the OS closely follows S2 (0.06 s), but when it is normal, the OS occurs later (0.12 s), and it may mimic the S3 gallop. As mitral stenosis worsens, the S2-OS interval shortens. The OS is followed by the characteristic low-pitched early-diastolic murmur. This murmur can be soft in patients with low cardiac output. In such patients, modest exercise, such as isometric handgrip, may increase the intensity of the murmur. A presystolic accentuation of the mitral stenosis murmur is also heard coincident with the atrial contraction. In the presence of pulmonary arterial hypertension, another diastolic murmur of blowing quality due to resultant pulmonary regurgitation (Graham Steell murmur) often becomes audible.
TFFFT (b) This is all that I could find on potential differences: Potential difference (PD) (voltage) measured from nasal mucosa and the reading obtained by a reference electrode inserted into the forearm correlates with the movement of sodium across cell membranes, which is a physiologic function rendered abnormal by a CFTR mutation. The nasal potential difference (NPD) is a sensitive test of electrolyte transport that can be used to support or refute a diagnosis of CF. A normal mean value standard error (SE) is 0.9-24.7 mV; an abnormal value is 1.8-53 mV. When measurements are repeated after mucosal perfusion with amiloride to block an epithelial sodium channel, the drop in PD is greater in patients with CF (73%) than in control subjects (53%). Normally, subsequent perfusion with chloride-free solution and isoproterenol produces a sharp increase in the PD but has little effect when CFTR function is abnormal. As a result of the lack of commercially available equipment and the practical difficulties with NPD measurement, this test is performed in only a few research centers to diagnose CF in patients in whom making a diagnosis is difficult or a sweat test is not technically possible because of skin problems.
(d) Premature death is primarily from respiratory complications. (e) Nebulised anti-pseudomonal antibiotics are thought to prevent recurrent exacerbations, reduce antibiotic usage and maintain lung function. (http://www.cysticfibrosismedicine.com/htmldocs/CFText/tobi.htm)
FFFTF (a) No sex predominance (b) UC is generally considered to always affect the rectum, with contiguous involvement that can include the entire large intestine. (c) Pyoderma gangrenosum occurs in 1% of patients with UC. An indolent chronic ulcer may occur even when disease is in remission. Intralesional therapy with steroids is useful, and colectomy results in healing in approximately one half of patients. (d) UC is assoc with Primary Sclerosing Cholangitis, which has an increased risk of biliary carcinoma. UC also has a significant risk of bowel ca. 46. Renal artery stenosis: (a) False: Not sure, couldn’t find any literature to support either way, however, I would imagine that a relatively high percentage of those going for a peripheral angiography would have renal artery stenosis(arteriopathy), but not 50%. (b) True: The affected kidney often atrophies (c)False: Non cardiogenic flash pulmonary oedema is generally associated with severe B/L renal artery stenosis. Flash pulmonary oedema is acute onset pulmonary oedema of any cause. The treatment consist of management of the underlying condition(revascularisation of the kidneys) and direct treatment of the pulmonary oedema(O2, loop diuretic, nitrates, morphine) (d)True: The renin –angiotensin system is activated in the underperfused kidney which in turn leads to increased aldosterone. The aldosterone is responsible for decreased serum potassium. (e) False: Similar to coronary arteries – A stenosed coronary artery does not “always” progress to complete occlusion. 47. Heart sounds:
48. Ulcerative Colitis:
49. Chronic Liver Disease:
50. The following drugs are paired with common indications for their use:
51. The following may cause falls in the elderly
52. On examination of the chest
53. Immediately following an ischaemic stroke
54. The following associations are correct
55. Ulcerative Colitis
56. Breast carcinoma
57. Abdominal pain may be caused by
58. Groin Lymphadenopathy
59. Pulsus alternans
This is characterized by regular alternate beats that are both weak and strong. It is seen in severe myocardial failure and is due to prolonged recovery time of the myocardium. It also occurs with abnormal tachycardia – in this case it is a compensatory mechanism 60. Pericardial rub
A pericardial friction rub is a scratching sound which may be heard in both diastole and systole. It’s intensity is altered by the posture of the patient, eg, it is often heard loudest when the patient is sitting up and breathing out. Cause: usually idiopathic(query viral infection?). Less common causes of pericarditis are a heart attack, a bacterial infection, an injury to the chest, radiation treatments for cancer, kidney failure, HIV infection, tuberculosis, autoimmune diseases such as lupus, or certain drugs. 61. (a) F-exam may be normal in pulmonary TB even if radiological abnormalities are present. Primary pulmonary TB infection is classically silent. (b) F-clubbing occurs due to complications of TB,e.g. bronchiectasis,not primarily due to the disease itself. (c) ?T-I can’t find a reference for this anywhere but TB is an inflammatory process so I assume it would be raised (d) T-Pulmonary TB, especially postprimary disease, nearly always causes abnormalities on the chest radiograph. Typically, the disease is parenchymal without nodal enlargement, and it manifests as cavitary lesions. Upper-lobe involvement with cavitation and the absence of lymphadenopathy are helpful in distinguishing postprimary from primary TB. Anterior or basal segments may be involved in as many as 75% of cases, in addition to the usually involved pulmonary segments, namely, the apical or posterior segments of the upper lobe or the superior segment of a lower lobe. (e) Pneumothorax may occur as a complication of TB infection. However, I can’t find any percentages for this 62(a) ? (b) ?
(c) ? (d) ?
(e) T 63(a) T- decreased production of gastric intrinsic factor,needed to bind B12 to facilitate absorbtion (b) T- causes decreased absorbtion of B12 in terminal ileum due to atrophy of intestinal mucosa (c) T- B12 deficiency causes a macrocytic anaemia with an increased MCV (usually >100fl) (d) T-similar mechanism to celiac disease (e) F-proximal small bowel resection should not affect B12 absobtion,terminal ileal resection, however, will greatly decrease the amount of B12 absorbed.
64(a) F-pupil is dilated due to failure of parasympathetic innervation. Pupil constriction occurs with ptosis as part of horner’s syndrome (partial ptosis ,miosis, anhidrosis & enopthalmos) due to failure of sympathetic innervation (b) T-due to the failure of the medial rectus muscle and the unopposed action of the lateral rectus muscle (c) T-ipsilateral ptosis due to damaged innervation to levator palpebrae (d) F-corneal reflx is mediated by CN5 (sensory/afferent) and CN7 (motor/efferent) (e)F-obviously 65(a) F- this occurs in subarachnoid haemorrhage (b) T-also alcoholics & patients on anticaogulants (c) T- very slight injury may precipitate a subdural haemorrhage (d) F-usually a venous bleed so HTN has little or no aetiological role (e) F-evacuation via a burr hole usually leads to full recovery (OHCM pp.366)
(b) T (pp.629 K&C) (c) F- there are elevated urea & creatinine levels (d) T
(e) F 67 (a) F-sweating is common in hypoglycemia and the patient is usually warm & clammy (b) T
(c) F (d) F-deep,irregular respiration (Kussmaul’s breathing) occurs in DKA (e) T
(b) ?
(c) ? (d) T-sedatives & antidepressants may be causative factors in hypothermia (e) T- arrythmias & cardiac arrest in particular
(b) T
(c) F- the neutrophil count is decreased in brucella infection (d) T
(e) T 70(a) T- pain may be referred and/or radiate from hip to knee and vice versa (b) ? T
(c) ? (d) F-patellar tap is used to demonstrate the presence of a join effusion. A patello-femoral lesion can be examined for by sliding the patella sideways over the underlying femoral condyles. (e) F-usually worsens or first becomes symptomatic during pregnancy
(b) F- Most patients are moderately anemic, have an elevated erythrocyte sedimentation rate, thrombocytopenia, and relative lymphopenia. (c) T- At approximately the end of the first week of illness, about a third of patients develop bacterial emboli to the skin known as rose spots. These are considered a classic symptom in typhoid fever, but they occasionally appear in shigellosis and nontyphoidal salmonellosis. Rose spots constitute a subtle, extremely sparse (often <5 spots), salmon-colored, blanching, truncal, maculopapular rash with 1- to 4-cm lesions that generally resolve within 2-5 days. Relative bradycardia and a dicrotic pulse are also common during this stage of illness. (d) F- Constipation often develops early and is likely due to obstruction at the ileocecal valve by swollen Peyer patches. It may last for the entire duration of illness. In the third week, the patient commonly has pronounced abdominal distension & some individuals may produce liquid, foul, green-yellow diarrhea (pea soup diarrhea). During the incubation period, 10-20% of patients have transient diarrhea (enterocolitis) that usually resolves before the onset of the full-fledged disease. Young children and individuals with AIDS are more likely to have diarrhea that is probably due to blunted secondary immunity. The incidence of constipation versus diarrhea varies geographically, perhaps because of local differences in diet or S typhi strains or genetic variation. (e) T- Produces rapid improvement in patient's general condition, followed by defervescence in 3-5 d. Cures approximately 90% of patients. By the 1970s, widespread resistance to the drug developed. Ampicillin and co-trimoxazole became treatments of choice. However, in the late 1980s, some S typhi strains developed simultaneous plasmid-mediated resistance to all 3 drugs. Fluoroquinolones and third-generation cephalosporins have filled the breach, but some resistance exists to both.
(b) F
(c) T (d) T
(e) ? BNF says KCl supplements can cause oesophageal or small bowel ulceration,but I don’t know if this applies to enteric coated preparations. I assume not but I can’t find a reference anywhere. 73(a) T-exposure may cause asbestosis and/or mesothelioma (b) F-I’ve never heard of painter&decorator’s lung! (c) T-exposure may cause berylliosis (d) ?T-Strongyloidiasis: Patients may report skin contact with sand or soil, abdominal pain or distension, and/or diarrhea, with or without immunocompromise. Marked wheezing and/or respiratory distress may occur (e) ?T- dust is a risk factor for occupational asthma but I can’t find a specific reference to cotton dust 74(a) T-low fibre diet and disordered colonic peristalsis are implicated in diverticular disease (b) F-pathophysiology of IBD is unknown,believed to be genetic or immunological in nature (c) F-I can’t find a link between these. (d) T- a high fat,low fibre diet is implicated in the development of colorectal ca. (e) F-contributing factors include exposure to nitrosamines in the environment or food, chronic ingestion of hot liquids or foods,cigarette smoking and chronic alcohol exposure, Plummer-Vinson syndrome, caustic injury to the esophagus, vitamin or nutritional deficiencies
(b) T-Nonimmune hemolytic transfusion reactions occur when RBCs are damaged prior to transfusion, resulting in hemoglobinemia and hemoglobinuria without significant clinical symptoms. (c) F (d) ? T -ARF is a rare complication of hemolysis and hemoglobinuria. Most often, it is associated with transfusion reactions (e) 76FTTFT Infectious mononucleosis=Glandular fever Yüklə 353,5 Kb. Dostları ilə paylaş:
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