can only be diagnosed if psoriasis is present (F) also if fhx of psoriasis ref K&C
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Partial villous atrophy Can’t find reference to this assuming its false 103Pneumothorax a.Causes fever F b.Causes chest pain T c.Causes blood stained sputum F d.May be of sudden onset T e.May cause cyanosis T
B) Sudden onset unilateral C) Can’t find a reason why it would D) Virtually always E) Tension pneumothorax with a mediastinal shift
a.Causes shoulder girdle pain T b.Is associated with raised ESR T c.Steroids are often helpful T d.Patients rarely die of the disease T e.Can only be diagnosed on muscle biopsy F
105The following are typical presentations a.Toxoplasmosis Choroiditis T b.Q-fever endocarditis T c.Leptospirosis Renal failure T d.Paget’s disease heart failure T A) Retinochoroiditis. Mainly due to congenital but can arise in de-novo infection B) Q fever Fever, Myalgia, sweats, headaches, cough, hepatitis. If chronic suspect endocarditis. Not sure if endocarditis is therefore typical presentation.
106Third nerve palsy a.Is associated with small pupil b.May be viral c.Is characterized by inability to look down and out d.May be caused by a lesion of posterior cerebral artery e.Is associated with diabetes
Causes of third nerve palsy are diabetes, giant cell ateritis, syphilis, posterior communicating artery aneurysm, ‘coning’ of temporal lobe, midbrain tumor and infarction Signs of Complete Third Nerve Palsy, 1. Unilateral complete ptosis 2. The eye facing down and out 3. A fixed and dilated pupil Sparing of the pupil means that the pupil is of normal size and reacts normally. This is because the parasympathetic fibres that cause the pupil to constrict run in a discrete bundle on the surface of the Third Nerve and remains undamaged (unless they get squashed by tumor or aneurysm) . (a) False, associated with a large pupil if “Surgical” i.e. posterior communicating artery aneurysm, tumor, otherwise normal (b) False (c) False, the person can look down and out (d) False, associated with posterior COMMUNICATING artery aneurysm (e) True, any nerve in the body can be involved in diabetic mononeuritis. Isolated palsies of nerves to the external eye muscles esp. 3rd and Sixth are more common in diabetes 107The following are associated with their possible complications/associations a.Bronchial carcinoma cerebellar ataxia b.Brucellosis allergic alveolitis c.Bronchiectasis proteinuria and hepatomegaly d.Bullous emphysema jaundice+abnormal serum electrophoresis e.Fibrosiing alveolitis prominent a-wave on JVP Answers (a) True, non-metaplastic neurological complication . Other such complications are confusion, fits, cerebellar syndrome, proximal myopathy, peripheral neuropathy, polymyositis (symmetrical proximal muscle weakness from muscle inflammation), Eaton-Lambert syndrome (Myasthenia like syndrome that occurs with small cell lung cancer) (b) False, Allergic alveolitis think Farmers Lung, Bird Fanciers Lung etc (c) False, Bronchiectasis is used to describe abnormal and permanently dilated airways signs:- finger clubbing, coarse inspiratory crackles (d) True, Caused by α1-Antitrypsin Deficiency. α 1- Antitrypsin is anti protease enzyme that inhibits neutophil elastase (nasty stuff made by white cells which destroy alveolar wall connective tissue leading to emphysema). Deficiency also leads to cirrhosis (hence jaundice), mechanism unknown. Genetic Variants are characterized by their electrophoretic mobilities as medium, slow or very slow. (e) True, Fibrosing Alveolitis is characterized by inflammatory cell infiltrate and pulmonary fibrosis, of unknown cause. It leads to pulmonary hypertension and Cor pulmonale. A- wave on JVP due to atrial systole, Giant a waves occur when right atrial pressures are raised because of raised pressure in pulmonary circulation. 108Features of brucellosis include a.Phylectenular conjunctivitis b.Allergic alveolitis c.Lymphadenopathy
Brucellosis is a gram negative bacterial infection, a zoonosis ( carried by your friendly domestic animal, vet and Kerry Farmer). Symptoms can be indolent and last for years- fever, sweats, malaise, anorexia, vomiting, weight loss, hepatosplenomegaly, constipation, diarrhea, myalgia, backache etc. Complications- Osteomyelitis, Infective Endocarditis, Abscesses, Meningoencephalitis. Diagnose with blood culture. Stuff them with Doxycycline and Streptomycin. (a) False, Consists of multiple small yellow grey nodules near the limbus, this is associated with Tuberculosis (b) False, caused by inhalation of allergens, trying to confuse us with Berylliosis (lung fibrosis due to exposure to beryillium) the sneaky physicians. (c) True 109Hypothermia (accidental) in the elderly a.Is frequently associated with shivering b.T3 should be used c.Rectal thermometer should be used d.Rapid rewarming is advised e.Is associated with bradycardia Answers (a)False, generally the elderly do not notice anything wrong, so do not try to warm themselves up, younger people do shiver (b)False, only if hypothyroid, which can cause hypothermia, hence do thyroid function tests (c) True, less than 35 Deg Cel. is definition of hypothermia, need to monitor rectal temperature during treatment (delegate to unfortunate junior staff member) (d) False, rapid rewarming leads to peripheral vasodilatation and shock and death (e)True 110The following abolish paroxysmal atrial tachycardia a.Valsalva manoevre b.Carotid massage c.Eyeball pressure d.Digoxin e.Beta blocker Paroxysmal Atrial Tachycardia often comes on suddenly (paroxysmal) and causes a rapid heartbeat (tachycardia) from abnormal atrial electrical signals. The atria are above the ventricles, their position is often referred to as supraventricular; therefore, this condition may be called paroxysmal supraventricular tachycardia (PSVT). About half of patients with PSVT have no heart disease and simply generate abnormal signals because of other conditions, such as thyroid disease. Nicotine from smoking, caffeine, or stress may cause this condition. Adenosine used for diagnosis and treatment. (a) True (b) True, caution if possible digoxin toxicity, acute ischaemia or carotid bruit (c) False, facial immersion in cold water can be attempted to abolish rhythm, both used by the Bush administration to torture terror suspects (d) True, however may be caused by digoxin toxicity hence do digoxin levels (e)True, Calcium Channel blockers like Verapamil and Diltiazem can be used but never with beta-blockers 111A patient on an open ward demonstrates tubercle bacilli on several sputa. The following should be done a.Transfer patient to single room b.Incinerate all personal clothes c.Tell family it is unlikely they are infected d.Arrange skin tests and CXR for family contact e.Commence drug therapy before TB culture results available Answers British Thoracic Society Guidelines (a) True, as the patient is infectious via the aerosol route. Patients whose bronchial washings (Bronchoalevolar lavage, Dr Bredin’s Favourite & only hobby) are smear positive should be managed as if non-infectious unless (1) the sputum is also smear positive or becomes so after bronchoscopy, (2) they are on a ward with immunocompromised patients, or (3) they are known or suspected of having MDR-TB (Multi-drug resistant T.B.) (b) False, not unless you own shares in your neighborhood incinerator. Marked crockery And separate washing up facilities are unnecessary, and no special precautions are needed for bed linen, books, etc. Sputum and other specimens should be incinerated along with whoever dreamed up this MCQ (c)False, studies show one percent of close contacts get infected
a.Acute gout b.Budd-chiari syndrome c.Stroke
d.Hypercapnia e.Uveitis Answers Ploycythemia Rubra Vera is a neoplasia of a clone from 1 multipotent cell which produces erythriod progenitor cells.
113The following have hematuria (microscopic/macroscopic) a.Steroid-sensitive but recurrent minimal change GN b.IgA nephropathy c.Nephropathy associated with diabetes d.Infective endocarditis e.Acute papillary necrosis
(b) True, (c) False (d) True, due to immune complex deposition, hence do urinalysis for work up of infective endocarditis (e) True
a.History of alcoholism would support the diagnosis b.History of thyrotoxicosis would support the diagnosis c.AP and lateral X-rays of spine are a sensitive indicator of disease progression d.Bone loss is mainly cortical rather than trabecular e.Vitamin D replacement is mandatory Answers (a) True, other risk factors include Low BMI, family history of osteoporosis, early menopause, smoker, steroid usage, Cushing’s disease, hyperparathyroidism, hypogonadism (b) True (c) False, Plain X-rays only used for fractures due to osteoporosis, rubbish as an indicator of osteoporosis (d) False, bone loss is trabecular in post menopausal osteoporosis, however cortical bone loss occurs as well in older patients (are we really expected to know this?) (e) False, give where appropriate. (Note: - Calcium levels normal in osteoporosis) 115Psoriasis may cause a.Thimble pitting of nails b.Arthritis of distal interphalangeal joints c.Permanent scarring alopecia d.Cataracts e.Steatorrhea and malabsorption Answers (a)True, also show onycholysis (separation of the nail bed from the nail plate (b)True, less commonly causes seronegative rheumatoid-like joint changes, large joint mono or polyarthropathy and spondylitis(Inflammation of one or more of the vertebrae of the spine). (c)False (d)False
(e)False, think dermatitis herpetiformis associated with celiac disease 116Endogenous eczema of the atopic type a.Itches in the majority of patients b.May cause weeping of the skin c.Often responds to topical corticosteroids d.Is often associated with hay fever and/or asthma e.Often involves limb flexures Answers
(b) False, skin is dry (c) True (d) True, ‘atopy’ implies a genetic predisposition to develop eczema, asthma and hay fever. (e) True, tends to involve wrists, antecubital fossae, popliteal fossa and dorsa of feet
a.Scalp
b.Elbows and knees c.Sacrum
d.Sternum and between scapulae e.Face
Answers Seborrhoeic eczema is caused by the yeast Pityrosporum ovale (also called Malassezia) and the cutaneous immune response to it produces its characteristic inflammation and scaling i.e. itchy, diffuse scaling on an erythamtous background. No Cure, Topical Hydrocortisone used to treat. Ketoconazole shampoo and cream helpful. (a)True, ‘cradle cap’ in babies (b)False, tends to affect flexures, more common in psoriasis (extensor surfaces) (c)False (d)True
(e)True 118Griseofulvin is indicated in the treatment of: a.Candida infection of the nails b.Dermatophyte infection (trichophyton rubrum nail infection, tinea capitis/scalp ringworm) c.Paronychia d.Tinea versicolor e.Porphyria Answers
a.More often affects the lower lip than the upper lip b.Metastasizes early to the internal jugular lymph nodes c.Affects men more often than women d.Has a poor prognosis if it occurs at the angle of the mouth e.Is best treated by surgical excision Answers (a) True, tends to be squamous cell carcinoma with sun exposure the main aetiological factor, hence occurs on the lower lip in more than 90% of cases (b)False, tends to metasistis primarily to the submandibular group of lymph nodes. To a lesser extent, drainage may go to submental, intraparotid, or internal jugular lymph nodes. Cervical lymphadenopathy detected clinically does not indicate lymph node metastasis. Any lymphadenopathy present is more likely to be inflammatory than metastatic. Only 60% with palpable lymphadenopathy will have metastasis. (c) True, 6:1 male to female ratio (d) True, lesions of the angle of the mouth are not biologically more aggressive, but it has been found that 82% recurred in the primary site. This is often because angle involvement results either from a large primary tumor or the clinician performs inadequate resection due to reconstructive considerations. (e)True, treatment surgical with full thickness excision 120Malignant disease of a.The tonsil most commonly arises in lymphoid tissue b.The tongue can cause pain radiating to ear c.Nasopharynx may present with deafness d.The floor of the mouth is most commonly an ulcerating squamous carcinoma e.The buccal mucosa can arise in a patch of leukoplakia Answers (a)False, most cancers arise from squamous cells, Lymphoma’s are the second most common. (b) True, due to referred pain (c)True, due to middle ear effusion (d)True, squamous cell carcinoma accounts for 90 percent of tumors (e)True, premalignant lesion, around 3% develop cancerous change 121.
a.T b F
c T in advanced cases paradoxical aciduria may develop d.F
e F Plasma Cl is low due to loss of NaCl in vomit Pyloric stenosis leads to a hypochloraemic hypokalaemic metabolic alkalosis. Because of the alkalosis H+ ions are moved out of cells in exchange for K+ ions and the renal excretion of H+ ions is decreased at the expense of increased renal excretion of K+ ions. Eventually hypokalaemia develops such that K+ needs to be conserved and this is done at the expense of excreting H+ ions, thus a paradoxical aciduria may occur in advanced cases. 122. a. F PTH increases Ca reabsorption in the kidney b. F PTH decreases PO reabsorption in the kidney c.T
d.? e.?
a F this tests hypoglossal nerve function: deviates to side of lesion b F light reflex tests optic and occulomotor nerves c F d F trigeminal supplies sensation e T ask patient to wrinkle forehead, raise eyebrows, puff out cheeks, show teeth 124. a. T pinna is pushed down and forward b. T increasing deafness is a sign c ? F if perceptive deafness=sensorineural deafness d.T moving pinna is painful e.? it usually occurs in young children but I’m not sure about always This is a complication of middle ear infection. Acute mastoiditis is the result of extension of acute otitis media into the mastoid air cells with suppuration and bone necrosis. Symptoms are: continuous and throbbing pain, otorrhoea and increasing deafness. Signs include pyrexia, general malaise, tenderness over the mastoid antrum and swelling in the postauricular area with the pinna pushed down and forward. The treatment involves general supportive treatment, antibiotics according to sensitivity and cortical mastoidectomy if not improving. 125. a F
b F the frontal sinuses are not developed in early childhood thus frontal sinusitis is uncommon in the first decade of life c T usually occurs infants and small children d F e F
a F it is usually a fluctuant mass b T
c ? Some books say it may move on swallowing but characteristically moves on protruding tongue d T thyroglossal cyst may develop anywhere along migration path of thyroid gland from base of tongue e F it is usually in the midline
a F
b T patient complains of pain and there is tenderness over hernia c F
d T this is a feature of intestinal obstruction e F patient may be anxious anyway for any reason An irreducible hernia is one in which the contents cannot be manipulated back into the abdominal cavity. A strangulated hernia is one where the blood supply becomes compromised-firstly venous congestion, then arterial compromise eventually leading to gangrene and local peritonitis. The patient complains of pain and has features of intestinal obstruction. The hernia is tender, cough impulse is lost and there may be evidence of circulatory collapse and sepsis. 128. a F
b F c T
d T e T
129. a F There may be wasting of the THENAR eminence b T c F There may be paraesthesia in the median nerve distribution d F e T Phalen’s sign involves flexing the wrist and is positive if this results in paraesthesia or numbness within 1 minute, as can occur in carpal tunnel syndrome 130.Galeazzi’s fracture involves:
Galeazzi’s fracture is a fracture of the shaft of the radius with distal ulna subluxation 131??? No answer given… 132.
133.
a. T Initial signs of an MI include distress, anxiety, pallor, sweatiness, tachycardia, hypotension 4th heart sound and signs of heart failure or a pansystolic murmur. Later a pericardial friction rub or peripheral oedema may occur b. T ventricular extrasystoles are the commonest post MI arrythmias c. T d. F this would increase the risk of thromboembolism e. F 134. a T
b F Fluoroquinolones are considered the best treatment for typhoid eg ciprofloxacin c T penicillin by injection followed by oral treatment remains the treatment of choice for acute tonsillitis. It is recommended that treatment be continued for 10 days. But beware differential diagnosis includes infectious mononucleosis which if treated with ampicillin may provoke widespread rash d F Flucloxacillin is treatment of choice e T Amoxicillin 3g PO is recommended 1hour before dental procedures with no or local anaesthetic. If penicillin allergy alternative=clindamycin. 135. a F
b T c T
d T atpical TB e F
136Hypercalcaemia
Polyuria due to the effect of hypercalcaemia on renal tubules, ↓ing the concentrating ability – a form of mild nephrogenic diabetes insipidus
Systemic prednisolone should be given to patients with involvement of the eyes or persistent hypercalcaemia
Clinicopathological features of myeloma: Bone destruction – often causing #s of long bones or vertebral collapse (which can cause spinal cord compression) & hypercalcaemia Bone marrow infiltration – with plasma cells, resulting in anaemia, neutropenia, thrombocytopenia, together with production of paraprotein, which may (rarely) result in symptoms of hyperviscosity Renal impairment – owing to deposition of light chains in the renal tubules, hypercalcaemia, use of NSAIDs and (rarely) in patients who have had the disease for some time, deposition of amyloid
Hypocalcaemia causes QT interval prolongation
Could only find the drug MITOMYCIN: Given IV to treat upper GI and breast cancers and bladder instillation for superficial bladder tumours
a.Silent myocardial infarction – TRUE b.Acute abdomen – TRUE Medical causes of acute abdomen include: Referred pain – pneumonia, MI Yüklə 353,5 Kb. Dostları ilə paylaş:
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