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

1. 
   Psoriatic arthritis
   
   1. 
      does not affect the axial skeleton (F)
      
   2. 
      can only be diagnosed if psoriasis is present (F) also if FHx of psoriasis ref K&C
      
   3. 
      is associated with nail pitting (T)
      
   4. 
      rarely occurs before 40 (F) common age of onset is 15-50 y/o
      
   5. 
      often responds to weekly methotrexate therapy (T) it may take up to six months for the drug to have maximum effect. Effects can include decreased inflammation and pain & improved flexibility
      

Similar to R.A. that complicates psoriasis. Joint involvement is assymetrical, involves terminal interphalangesl joints, pitting in nails, sacroiliits, tests for rheumatoid factor are negative

2. 
   Primary Osteoarthritis
   
   1. 
      is commoner in women than in men (T)
      
   2. 
      usually spares the distal pharyngeal joints (F) this is the hallmark
      
   3. 
      is associated with osteoporosis (F) Osteoperosis is a/w a decreased risk of OA
      
   4. 
      usually requires disease modifying treatment (F)
      
   5. 
      typically causes symptoms which are worse after use (T) pain worse with movement & towards end of day
      

Degenerative disease of synovial joints, damage to hyaline cartilage, with sclerosis,cysts, osteophyte formation, obesity increases risk, genetic component, common after age of 55, IPJ’s thumb,knee, hip cervical & lumbar spine most commonly affected, Tx: exercise weight loss analgaesia NSAIDs

3. 
   In patients who present with sore throat:
   
   1. 
      70% are caused by beta-hemolytic streptococcal infection (F) 25%
      
   2. 
      Penicillin V is effective in reducing non-suppurative complications (F) ref BMJ penicillin did not shorten symptoms
      
   3. 
      More severe clinical features are indicative of bacterial infection (T?) bacterial can lead to epiglottitis but viral can lead to infectious mononucleosis
      
   4. 
      Influenzae vaccination appears to reduce incidence (T) 70-90% reduction in incidence, ref BMJ (it’s not a live vaccine)
      
   5. 
      Ibuprofen is of proven benefit (T) more effective than paracetemol in decreasing pain & swelling of sore throat
      

4. 
   A 41 year old male with poorly controlled type 1 diabetes for 17 years and recently treated hypertension complains of swollen feet and ankles. Possible causes are:
   
   1. 
      diabetic nephropathy (T)
      
   2. 
      autonomic neuropathy (T)
      
   3. 
      recurrent hypoglycemia (?)
      
   4. 
      insulin allergy (?)
      
   5. 
      treatment with calcium channel antagonists (T) cause oedema
      

5. 
   In acute poisoning, the following are appropriate specific reversal agents:
   
   1. 
      lead- Fuller’s earth (F) used to treat paraquat (herbicide) OD. To treat lead OD: dimercaprol, EDTA, penicillamine
      
   2. 
      Opiates-naloxone (T)
      
   3. 
      Benzodiazepines-flumazenil (T)
      
   4. 
      Warfarrin-red cell concentrate (F) give VitK, prothrombin complex concentrate 2,7,9,10 or fresh frozen plasma 15ml/kg
      
   5. 
      Digoxin-digoxin specific antibody fragments (T) tradename = digibind
      

6. 
   The following are recognized causes of decompensation in patients with chronic liver disease:
   
   1. 
      Hypoglycemia (T) hypoglycemia is a manifestation of (especially fulminant) hepatic failure because of failure of gluconeogenesis and depletion of glycogen stores. BUT hyperglycemia can occur as well, it’s a common manifestation of chronic liver disease because of insulin resistance.
      
   2. 
      Cefotaxime (T) S/E’s include disturbances in liver enzymes, hepatitis & cholestatic jaundice, ref: BNF
      
   3. 
      Constipation (T) lactulose is given to improve encephalopathy on the basis the you’re excreting out the toxins so I presume constipation has opposite effect-retention of toxins
      
   4. 
      pethidine (T) may precipitate coma in hepatic impairment ref: BNF
      
   5. 
      lactulose (F) this is given to improve encephalopathy
      

7. 
   A 25 year old man presents with sore throat which had been present 4-5 days. On examination his temperature was 38 degrees. His tonsils were enlarged and inflamed. He had bilateral axillary, supraclavicular and inguinal lymphadenopathy. His lymph nodes were tender. The following should be included in the differential diagnosis:
   
   1. 
      CML (F) non tender lymph nodes
      
   2. 
      Infectious mononucleosis (T)
      
   3. 
      Acute taxoplasmosis (T)
      
   4. 
      Chickenpox (F)
      
   5. 
      HIV infection (F)
      

8. 
   The following are features of pernicious anemia
   
   1. 
      gastric atrophy (T)
      
   2. 
      malabsorption syndrome (T) decreased intrinsic factor which is needed to absorb B12
      
   3. 
      mild icterus (T) in chronic severe B12- deficiency,lemon yellew tint
      
   4. 
      paresthesia with impaired vibration and position sense (T) subacute combined combined degeneration of the cord due to B12 deficiency
      
   5. 
      decreased MCV on routine hematological testing (F) increased MCV
      

Macrocytic anaemia, usually due to B12 def. Auto antibodies against intrinsic factor in stomach which is needed for B12 absorption. Gastrectomy, Crohns are other causes. Middle aged & elderly women, silver hair, blue eyes, lemon yellow tint, vitilgo, fatigue, lethargy, SOB, Tx: vit B12 injections (hydroxycobalamin) 5 times at 2 day intervals and then every 3 months for life.

9. 
   In hereditary hemachromatosis
   
   1. 
      inheritance is autosomal dominant (F) AutRecessive chromosome 6
      
   2. 
      chondrocalcinosis is a recognized feature (T) occurs in 40%
      
   3. 
      bronze skin pigmentation is due to iron deposition (F) due to melanin rather than iron
      
   4. 
      cardiac failure may be a presenting feature (T) occurs in 15%
      
   5. 
      hepatoma is an important complication (T) primary hepatic CA occurs in ~20% whether treated or not, screen alpha feto protein
      

Autosomal recessive, chr 6, increased iron absorption & deposition esp in liver pancreas & heart, Occurs most commonly in men over 30 y/o. A/w: DM, skin pigmentation, hepatomegaly, arrhythmias, osteoarthritis, polyarthropathy. Dx: increased iron & ferritin, saturated iron binding capacity, liver biopsy shows iron staining. Tx:weekly venesection until iron levels normal, maintenance venesection every 3 months

10. 
    The following statements about atopic dermatitis are true
    
    1. 
       At some time in their lives, approximately 15% of children develop it (T)
       
    2. 
       UVB is a relatively safe second line treatment (T)
       
    3. 
       Antecubital and popliteal fossae are typical sites (T)
       
    4. 
       Methotrexate may be useful in severe cases
       
    5. 
       Restriction diets are of little proven value in most patients (T)
       

11. 
    Which of the following treatments are appropriate for the condition listed?
    
    1. 
       Tar for psoriasis (T) also good for chronic atopic eczema
       
    2. 
       Topical steroids for atopic dermatitis (T)
       
    3. 
       Oral steroids for rosacea (?) topical steroids precipitate it as well as hot drinks,C2H5OH & sunlight, give oxytetracycline
       
    4. 
       Cyclosporine for atopic dermatitis (T)
       
    5. 
       Systemic steroids for psoriasis (F) topical steroids
       

12. 
    Patients with antibody deficiency syndromes typically present with:
    
    1. 
       disseminated viral infections
       
    2. 
       pyogenic bacterial infections
       
    3. 
       bronchiectasis
       
    4. 
       pneumocystis carinii
       

(e) hearing deficit

13. 
    Patients who have undergone splenectomy or who are hyposplenic:
    
    1. 
       are particulary predisposed to viral infections and therefore have influenza immunization annually (?)
       
    2. 
       are particulary predisposed to overwhelming infections caused by pyogenic encapsulated bacteria (T)
       
    3. 
       can withhold antibiotic prophylaxis provided their immunizations are uptodate
       
    4. 
       are predisposed to malaria infections (T)
       
    5. 
       often have a low white cell count (F) usually normal or raised
       

14. 
    In malignant spinal cord compression
    
    1. 
       pain is the initial symptom in more than 90% patients (?) P/C: spastic paresis, tetraparesis, pain @ level of compression & sensory loss below level of compression
       
    2. 
       cervical spine is most commonly affected (F) thoracic 70%, cervical 20%
       
    3. 
       nerve root irritation produced unilateral or bilateral radicular pain (T)
       
    4. 
       normal plain xrays of the spine will outrule a diagnosis of spinal cord compression (F) spinal MRI is best, also must do CXR, etc to identify primary neoplasm or infection
       
    5. 
       initial management should ordinarily include high dose corticosteroids (T)
       

15. 
    In pagets disease of bone
    
    1. 
       hypercalcemia is a frequent finding (F) serum Ca++ is usually normal,only get increased Ca++ in severe Paget’s where there is uncoupled resorption
       
    2. 
       both increased osteoblastic and osteoclastic activity occur (T) the disease is basically increased remodeling so there is increased resorption & production
       
    3. 
       sarcoma of long bones is a complication (T) <1% get osteogenic sarcoma, most common sites are femur and pelvis
       
    4. 
       bone pain responds to bisphosphonates (F) only decreases bone turnover, give analgaesics & NSAIDs for bone pain
       
    5. 
       renal calculi are a recognized problem (?) couldn’t find it listed as a complication anywhere but Paget’s can lead to hypercalcaemia in severe cases which would predispose to renal calculi so T?
       

Pagets is a disease that involves increased bone remodeling, generally a disease of the elderly, Causes: FHx & viral infection of osteoclasts, Complications: fracture, spinal compression, deafness, osteogenic sarcoma,high output heart failure. Tx: analgaesia, NSAIDs, bisphosphonates