14/10/21

Question 1

Clinical Diagnosis of COPD (3 points)

Answer 1

1. Symptoms of exertional breathlessness, cough and sputum
2. History of smoking, or exposure to other noxious agents
3. Post-Bronchodilator FEV1/FVC <0.7

Question 2

What constitutes a positive bronchodilator response?

Answer 2

Adults: 12% or 200ml change
Children: 12% change

Question 3

Causes of Obstructive Lung Disease (6 points)

Answer 3

• COPD
• Asthma
• Bronchiectasis
• Cystic Fibrosis
• Bronchiolitis
• Alpha1-Antitrypsin Deficiency

Question 4

Causes of Restrictive Lung Disease (8 points)

Answer 4

• Pulmonary Fibrosis
• Neuromuscular Disorders
• Congestive Cardiac Failure
• Sarcoidosis
• Obesity
• Interstitial Lung Disease (ILD)
• Pneumonia
• Pleural Disease → pleural effusion or diffuse pleural thickening

Question 5

What stage of COPD do you use ICS?

Answer 5

Moderate

Question 6

Examples of LAMA and LABA. 1 each

Answer 6

LAMA - tioptropium

LABA - salmeterol

Question 7

Ranges for overt and subclinical hypothyroidism in pregnancy?

Answer 7

Overt -> TSH >2.5 with increased T4 or TSH >10 irrespective of T4
Subclinical -> TSH 2.5-10 with normal T4

Question 8

Investigations in hypothyroidism in pregnancy. Why are these two tests important?

Answer 8

TSH and T4 -> all the risk associated with hypothyroidism (prematurity, low birth weight and miscarriage)
TPO Antibodies -> thyroid peroxidase antibody → may increase the risk of pregnancy complications INCLUDING IN WOMEN WITH A TSH IN THE NORMAL RANGE.

Question 9

Management steps for overt hypothyroidism diagnosed in pregnancy?

Answer 9

1. commence thyroixine 50-100microg/day
2. refer to endocrinologist
3. consider TPO Antibody testing
4. repeat TFTs in 4 weeks

Question 10

What is a keratoacanthoma? What are the clinical features?

Answer 10

Benign squamoproliferative lesion → can appear suddenly and grow rapidly

• same sites as SCC
• presents over weeks to a few months → enlarging nodule with a central keratotic core

Question 11

Differential Diagnoses for Keratoacanthoma

Answer 11

• Squamous Cell Carcinoma
• Nodular Basal Cell Carcinoma
• Merkel Cell Carcinoma
• Prurigo Nodule
• Giant Molluscum Contagiosum
• Deep Fungal Infection
• Nodular Kaposi’s Sarcoma
• Cutaneous Metastases

Question 12

Treatment for Keratoacanthoma. What is the significance of this?

Answer 12

• Surgical Excision → 3-5mm margin

- difficult to distinguish between a keratoacanthoma and an SCC on clinical diagnosis or partial biopsies

Question 13

Differential Diagnosis for 2nd and 3rd Trimester PV bleeding in pregnancy (9 points)

Answer 13

1. Bloody Show associated with labour
2. Placenta Previa
3. Placental Abruption
4. Uterine Rupture (rare)
5. Vasa Previa (rare)
6. Cervical Pathology - cervicitis
7. Vaginal Pathology
8. Uterine Pathology - polyps, infection/inflammation, trophoblastic disease
9. Non-Tubal Ectopic Pregnancy

Question 14

Investigations in 2nd or 3rd trimester PV bleeding (5 points)

Answer 14

• FBE
  
  • RhesusD negative → need anti-D immune globulin → protects against RhD alloimmunisation
• Obstetric U/S
• Group and Hold
• Coagulation Studies
• Fetal Fibronectin (fFN)

Question 15

Discuss the fetal fibronectin test. What is it and what are the associated benefits?

Answer 15

• glycoprotein found at boundary between the amniotic sac and the uterus
• performed in women with suspected premature labour
• Cervical or Vaginal fluid sample → sample collected to be analysed for fFN
• Positive fFN → can be related to causes other than risk of pre-term delivery
• Negative fFN → highly predictive that preterm delivery will not occur within in the next 7-14 days
  
  • therefore can reduce unnecessary hospitalisations and drug therapies

Question 16

What is a infantile haemangioma? How common is it?

Answer 16

aka Strawberry Naevus

Common benign vascular tumour → affects 10% of neonates

• more common in girls and in premature babies

Question 17

Timeline of an infantile haemangioma?

Answer 17

1. Not usually present at birth
2. Appears within the first month
3. Proliferates until the child is 5-9 months old
4. Enters a slow involution phase which can take several years
   
   1. after involution → larger lesions often leave excess skin, telangiectasia and textural change

Question 18

Treatment of infantile haemangioma? Criteria for referral (4 points)

Answer 18

• most small, non-facial haemangiomas DO NOT need treatment

Consider referral to dermatologist or paediatrician:

• rapidly proliferating facial haemangiomas
• segmental facial haemangiomas → can be associated with intracranial, ocular or CV problems)
• ulcerated lesions
• large number of haemangiomas