can only be diagnosed if psoriasis is present (F) also if fhx of psoriasis ref K&C



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Functional GI disorders


Renal causes – pelviureteric colic, acute pyelonephritis

Metabolic causes – DM, acute intermittent prophyria, lead poisoning

Haematological causes – haemophilia & other bleeding disorders, HSP, sickle cell crisis, polycythaemia vera

Vasculitis – embolic

c.Renal papillary necrosis – TRUE


Common causes: reflux nephropathy, NSAIDs, DM, sickle cell disease or trait, cadmium or lead intoxication

Uncommon causes: Alport’s syndrome, Balkan nephropathy & herbal nephropathy, irradiation, Sjogren’s syndrome, Hyperuricaemic nephropathy
d.Chronic hepatitis – FALSE
Causes of chronic hepatitis:

Viral: Hep B +/- Hep D, Hep C

Autoimmune


Drugs: 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
e.Small stature – TRUE
GH deficiency hay be relatively ‘silent’ except in children, but may cause marked impaired well-being in some adults

139Coronary artery disease may result from

a.Syphilis

b.Excessive iron therapy

c.Temporal arteritis

d.Pancreatic insufficiency

e.Diphteria
140In the following circumstances, the physician should be aware of the possible presence of malignancy

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
b.Ulcerative colitis – TRUE
Patients with extensive UC of more that 10 years’ duration are at an increased risk of developing colorectal cancer.

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:



  • Perforation

  • Fistula formation

  • Intestinal obstruction

  • Haemorrhage

  • Mucosal inflammation

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
Causes of upper zone fibrosis include:

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:



  • Infections esp. infectious mononucleosis, septicaemia, bacterial endocarditis and malaria

  • Blood dyscrasis e.g. leukaemia (esp. CML), haemolytic anaemia, myelosclerosis, polycythaemia vera

  • Malignant lymphoma

  • Portal hypertension

  • Lipoid storage disease

  • Occasionally rheumatoid disease & SLE

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
More common in women but middle aged?
b.Pretibial myxoedema is seen in thyrotoxicosis – TRUE
This is a feature of thyrotoxicosis due to Graves’ thyroiditis

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
b.Is a vasculitic eruption seen in rheumatic fever – FALSE
The dermatological manifestations of rheumatic fever include:

Subcutaneous nodules: small, mobile painless nodules on extensor surfaces of joints and spine

Erythema marginatum: geographical-type rash with red, raised edges and clear centre; occurs mainly on trunk, thighs, arms
Causes of erythema multiforme:

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
b.Usually requires steroid therapy – FALSE
They are powerful disease-controlling drugs, but are best avoided in the long term because side effects are inevitable
c.May involve temperomandibular joints – TRUE
25% of cases of rheumatoid arthritis involve the TMJ

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:



  • Pancytopaenia

  • Haemolysis due to sequestration and destruction of red cells in the spleen

  • ↑ed plasma volume

1% of patients with RA have Felty’s syndrome

e.May affect the lungs – TRUE
Pulmonary manifestations of RA:

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:

  • Bone and joint infection: esp. sacroilitis and spondylitis

  • Respiratory infection: bronchitis, abscesses

  • Acute or chronic meningitis

  • Rarely endocarditis, genitourinary infection (?)

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
Kataloq: archive -> pub -> medstud
archive -> SIĞorta sġNFĠ
archive -> • Rəsmi Salamlama
archive -> MÜNDƏRĠcat
archive -> Сборник статей по материалам XXVI международной научно-практической конференции №12 (26)
archive -> Cilt: 3, Sayı: 3-4/Ağustos-Eylül 1995
archive -> Голосование за аборты есть одновременно голосование за эвтаназию, убийство пожилых людей, калек и больных, за генетические эксперименты – это первый шаг по наклонной, внизу которой находится полная дегуманизация жизни, долина смерти
archive -> Empire State College
medstud -> Objectives Describe basic intracranial physiology
medstud -> Is there a rectal lesion? Is prostate benign or malignant?

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