23 December #2

Question 1

What are causes of erythema nodosum?

Answer 1

Infection - strep, TB, brucellosis
Sarcoidosis
IBD
Behcet
Malignancy
Pregnancy
COCP
Penicillin
Sulphonamides

Question 2

What are features of pemphigus vulgaris?

Answer 2

Flaccid blisters and mucosal ulceration
Blisters rupture when touched

Treat with steroids and immunosuppressants

Question 3

What are features of Lichen planus?

Answer 3

Purple
Pruritic
Papular
Wickham Striae
Commonly found on wrists, lower back, ankles and genitals

Treat with- topical steroids

Question 4

What are common causes of erythema multiforme?

Answer 4

HSV
Idiopathich
Bacteria- Mycoplasma
Drugs= penicillins, sulphonamides, carbamazepine, NSAIDS
SLT
Sarcoidosis
Malignancy

Question 5

What formula is used to calculate fluid resus post burns?

Answer 5

Parkland

Question 6

What is the management of psoriasis on face/flexures/ genital areas?

Answer 6

Mild to moderate steroid for max 2 weeks

Question 7

What is the management of acne rosacea?

Answer 7

Predominant erythema
- Brimonidine gel

Mild to moderate papules/pustules
- topical ivermectin
- topical metronidazole or azelaic acid

Moderate to severe papules/pustules
- topical ivermectin and oral doxycycline

Question 8

What is Bechets disease?

Answer 8

Triad of
-oral ulcers
-genital ulcers
-anterior uveitis

Affects people from middle east

Question 9

What are features of Men 2b?

Answer 9

Phaeochromocytoma
Medullary thyroid ca
Marfanoid

Question 10

What are features of autoimmune polyendocrine syndrome?

Answer 10

Oral candidiasis
Addison disease
hashimotos
Vitiligo
T1DM

Question 11

What are features of androgen insensitivity syndrome?

Answer 11

46XY
Primary amenorrhoea
Bilateral groin swellings- undescended testes
Raise as female
Remove testes as increased risk of Ca

Question 12

What are features of chronic pancreatitis?

Answer 12

Due to alcohol excess
Epigastric pain- worse 15-30mins post meal
N&V
Steatorrhea
Diabetes

Low faecal elastase
Amylase normal
CT-pancreatic atrophy, calcification, pseudocysts

Question 13

What is the management of VT with a pulse?

Answer 13

Amiodarone 300mg IV
If ineffective then synchronised DC cardioversion

Question 14

What are features of Cryptococcus meningitis?

Answer 14

HIV/immunocompromise
India ink +ve

Question 15

What investigations are done in myasthenia gravis?

Answer 15

1) Serum anti-acetylecholine receptor antibody testing
If negative 40% positive for anti muscle specific kinase antibodies
Repetitive nerve stimulation
CT thorax

Question 16

What are features of familial mediterranean fever?

Answer 16

Autosomal recessive disorder
Seen in turkish/arabic descent

Attacks lasting 1-3 days
- fever
-pleurisy
- peritonitis
- arthritis
-pericarditis
-erysipleoid rash

Treat with colchicine

Question 17

What are features of narcolepsy?

Answer 17

Daytime sleepiness
Disrupted normal sleep
Can be associated with caraplexy- brief muscle weakness, paralysis
Sleep paralysis

Investigation
- Sleep EEG

Treatment
- Modafinil
-Methylphenidate

Question 18

What is the management of T2DM?

Answer 18

1) Metformin
- consider SGLT2 inhibitor (dapagliflozin) as well if CVD, CHF, high QRISK, CKD

2) HbA1c rises to 58mmol despite metformin
- add either DPP4 (sitagliptin), Thiazolidinediones (pioglitazone), Sulfonylureas (glicazide), SGLT2 inhibitors if not on

3) HbA1c 58 then triple therapy

4) Triple therapy ineffective consider GLP-1 mimetic (liraglutide) BMI>35 or BMI <35 but insulin therapy would have occupational implications or weight loss would benefit co-morbidities

Question 19

What are features of Brugada Syndrome?

Answer 19

Autosomal dominant

Present as sudden cardiac death
More common in SE asia

ECG
- convex ST elevation followed by egative T wave

Diagnose by Flecainide or Ajmaline provocation test- ECG changes are more obvious

Manage with ICDo

Question 20

How can you differentiate between pericarditis and Dressler syndrome post MI?

Answer 20

Dressler syndrome takes 4-6 weeks to onset

Question 21

What are features of Sharps syndrome?

Answer 21

Combination of SLE, sclerosis and myositis

Myalgia
SoB- pulmonary hypertension
Polyarthralgia
Raynaud
Dactylitis
Rash
Oesophageal dysfunction
Renal/CNS disease unlikely

Anti-U1 ribonucleoprotein antibodies