can only be diagnosed if psoriasis is present (F) also if fhx of psoriasis ref K&C
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AutoimmuneDrugs: e.g. methyldopa, isoniazid, ketoconazole, nitrofurantoin Hereditary: Wilson’s disease Others: IBD – UC, alcohol (rarely) e.Polyarthritis - FALSE 138The signs of hypopituitarism a.Hypotension – TRUE Hypoadrenalism causes mild hypotension b.Absent pubic and axillary hair – TRUE Gonadotrophin deficiencies → loss of libido, loss of 2° sexual hair, amenorrhoea and impotence c.Alopecia – TRUE Underactivity of the thyroid, pituitary or adrenals can cause diffuse alopecia, as may hyperthyroidism d.Extreme emaciation - ? FALSE Weight may increase (due to hypothyroidism) or decrease in severe combined deficiency (pituitary cachexia) Emaciation = wasting of the body, caused by such conditions as malnutrition, TB, cancer or parasitic worms Cachexia = a condition of abnormally low weight, weakness, and general bodily decline associated with chronic disease. It occurs in conditions such as cancer, pulmonary TB and malaria
a.Polyposis coli – TRUE Classification of colorectal polyps Type of Polyp Pathogenesis Polyposis Syndrome Adenoma Neoplastic FAP Juvenile Hamartoma Juvenile polyposis Peutz-Jeghers Hamartoma Peutz-Jeghers syndrome Metaplastic Unknown Metaplastic polyposis Lymphoid Hyperplasia Lymphoid polyposis Inflammatory Inflammation Inflammatory polyposis
Although patients with Crohn’s colitis are also at risk, this is lower than with UC c.Diverticular disease – FALSE Not associated with malignancy Complications of diverticular disease include:
d.Pernicious anaemia – TRUE There is a higher incidence of gastric carcinoma with PA than in the general population; the incidence in PA is 1-3% e.Hypertrophic pulmonary osteoarthropathy – TRUE Often associated with carcinoma of the bronchus 141A 75 year old male patient with gross painless haematuria a.Should have a rectal examination b.May have tuberculosis c.Should be reassured if JVP is normal d.Should be given vitamin K e.Is likely to have renal stones 142In fibrosis of the left upper lobe a.TB is the likely cause – TRUE
Tuberculosis – associated with calcified areas and pleural thickening Sarcoidosis – hilar lymphadenopathy may also be present Radiotherapy – usually following treatment for carcinoma of breast Ankylosing spondylitis – fibrosis usually occurs when severe Chronic extrinsic allergic alveolitis b.Trachea is deviated to the right – FALSE Trachea will be deviated towards the side of the upper lobe fibrosis c.Tactile vocal fremitus increased in the left apex – FALSE Increased in consolidation d.Apex usually displaced to left – TRUE Displaced towards the side of the lesion e.Hartman’s sign is diagnostic – ??? 143The clinical features of acute hepatitis include a.Dislike of cigarettes – TRUE b.Splenomegaly – TRUE The spleen is palpable in 10% of cases of hepatitis A Other causes of splenomegaly:
c.Glycosuria – TRUE There is a higher incidence of diabetes mellitus in hepatitis C d.Anorexia – TRUE e.Bilirubinuria – TRUE Cholestatic jaundice → pale stools and dark urine 144The following statements are true a.Carpal tunnel syndrome is commonest in middle aged females – TRUE
c.Cushing’s syndrome in females usually gives rise to amenorrhoea – ?TRUE Cushing’s syndrome can cause amenorrhoea or oligomenorrhoea in females but not sure if it usually does d.Acromegaly may give rise to hypertension - TRUE e.Calcified ascending aorta on x-ray suggests syphilis – TRUE Aortic-wall calcification occurs in syphilitic aortitis (ascending aorta) 145Diuretic therapy a.May precipitate hepatic Encephalopathy – TRUE In hepatic failure hypokalaemia caused by diuretics (thiazide and loop diuretics) can precipitate encephalopathy, particularly in alcoholic cirrhosis Diuretics may also increase the risk of hypomagnesaemia in alcoholic cirrhosis, leading to arrhythmias Spironolactone, a K+ sparing diuretic, is chosen for oedema arising from cirrhosis of the liver b.May cause secondary gout – TRUE Uric acid levels in the blood are often increased because thiazides are secreted by the organic acid secretory system in the tubules and compete for uric acid secretion. This may precipitate gout (also occurs with loop diuretics) c.May cause collapse in elderly patients – TRUE Loop diuretics may cause hypotension leading to collapse d.Should not be prescribed for patients with diabetes mellitus – FALSE Diabetes mellitus is not a contraindication to the prescription of diuretics 146Erythema multiforme a.May have associated oral lesions – TRUE Involvement of the oral, conjunctival and genital mucosae is not uncommon and, if extreme, is known as the Stevens-Johnson syndrome When there is severe mucosal involvement = Erythema multiforme major Without mucosal involvement = Erythema multiforme minor
Idiopathic 50% of cases (no cause found) Viral Herpes simplex, hepatitis B, orf, adenovirus, Mumps, mycoplasma Bacterial Streptococci Fungal Coccidoidomycosis, histoplasmosis Drugs Antibiotics, phenytoin, NSAIDs Other LE, pregnancy, malignancy c.May be very toxic and require steroid therapy – FALSE Systemic steroids are often prescribed to moderate the acute symptoms, although it is debatable whether they affect the outcome and may ↑ mortality d.Is frequently seen in amyloidosis – FALSE e.May be fatal – ? FALSE 147Acute myocarditis a.Is usually viral in origin – TRUE Viruses include coxsackie virus, adenovirus, CMV, echovirus, influenza, polio, hepatitis, HIV b.May be produced by steroid therapy – FALSE Drugs causing hypersensitivity reactions, e.g. methyldopa, penicillin, sulphonamides, antituberculous may cause acute myocarditis c.Produces T-wave abnormalities on ECG – TRUE ECG demonstrates ST and T wave abnormalities and arrhythmias d.May result in ventricular dysrhythmias – FALSE Atrial arrhythmias e.Frequently shows Bell’s sign – ??? 148Rheumatoid disease a.May lead to impotence – FALSE
d.Occasionally leads to hypersplenism – TRUE Hypersplenism can result from splenomegaly due to any cause. It is commonly seen with splenomegaly due to haematological disorders, portal hypertension, RA (Felty’s syndrome) and lymphoma. Hypersplenism produces:
1% of patients with RA have Felty’s syndrome e.May affect the lungs – TRUE
Fibrosing alveolitis Pleural nodules Pleuritis Serositis causing pleural effusions Obstructive bronchiolitis 149Acute nephritis is a recognised feature of the following disease a.Brucellosis – FALSE May cause:
b.Ankylosing spondylitis – FALSE c.Polyarteritis nodosa – FALSE Aneurysmal dilatation of medium-sized arteries may be seen on renal arteriography Associated with slowly progressing renal failure d.Polyposis coli – FALSE e.Bacterial endocarditis – TRUE Acute renal failure may occur from immune complex disease, haemodynamic upset (acute heart failure), damage during cardiac surgery and nephrotoxic antibiotics Yüklə 353,5 Kb. Dostları ilə paylaş:
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