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Practice Exams > 25/9/21 > Flashcards

25/9/21 Flashcards

1
Q

True or False. Gynaecomastia occurs in <10% of adolescents during puberty.

A

False - enlargement of breast tissue occurring during puberty → 50% of male adolescents

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2
Q

How does an adolescent with gynaecomastia present?

A
  • usually present with a lump or mass behind the nipple → occurs gradually and should not exceed 4cm in diameter
  • breast may be tender for 6 months following onset but will gradually resolve
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3
Q

If left untreated, how long will it take for the gynaecomastia to resolve?

A
  • if left untreated → pubertal gynaecomastia regresses substantially or resolves in >70 percent of patients after 1 year
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4
Q

Features of pathological gynaecomastia? (5 points)

A
  • Occurrence outside the neonatal or pubertal age group
  • Occurrence in pre-pubertal boys who have no other secondary sexual characteristics → testicular enlargement, pubic or axillary hair, axillary odour
  • Rapid progression
  • Enlargement >4cm
  • Persistence for more than one year after the age of 17years
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5
Q

What is sarcoidosis? What are some of the other organs that are commonly affected (outside the lung) ?

A

Multi-system granulomatous disorder of unknown aetiology

  • scattered collections of mixed inflammatory cells affecting different parts of the body → non-caseating epithelioid granulomas

Commonly infects other organs outside the lungs

  • Skin 20-35%, Eye, Liver, Heart, MSK, Nervous System
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6
Q

Name 2 non-specific lesions associated with cutaneous sarcoidosis. (5 options)

A
  • Erythema Nodosum often accompanied by arthritis in the ankles, elbows, wrists and hands (Löfgren syndrome)
  • Erythema multiforme
  • nummucular eczema
  • calcinosis cutis
  • pruritis
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7
Q

Name 1 specific lesion associated with cutaneous sarcoidosis. (5 options)

A
  • Lupus pernio → large bluish-red and dusky purple infiltrated nodules and plaque-like lesions on the nose, cheeks, ears, fingers and toes
  • Skin plaques → purple-red or brown, thickened circular lesions
  • Maculopapular eruptions
  • Subcutaneous nodules
  • Infiltration of old scars
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8
Q

What are the MSK presentations of Sarcoidosis?

A
  • Arthritis, periarthritis (inflammation of surrounding tissues), arthralgia (painful joints)
  • Arthritis - most commonly acute and can result in swelling of the lower legs + tenderness of the ankles, knees and fingers
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9
Q

What is Löfgren’s Syndrome and how does it present? (4 points)

A

Acute form of sarcoidosis

Presents with a combinations of symptoms and findings below:

  • Erythema Nodosum
  • Bilateral Hilar Lymphadenopathy
  • Bilateral Ankle Arthritis or Painful Ankles
  • Fever and Malaise
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10
Q

3 elements for diagnosis of sarcoidosis.

A
  1. Compatible clinical and radiographic manifestations
  2. Exclusion of other diseases that may present similarly
  3. Histopathologic detection of noncaseating granulomas - via biopsy
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11
Q

When is there no need to biopsy in the diagnosis of sarcoidosis? (2 points + 1 bonus)

A
  • Presence of bilateral hilar lymphadenopathy in an asymptomatic patient
  • Presentation of Löfgren’s Syndrome
  • DO NOT biopsy erythema nodosum as it will be reported as panniculitis even is sarcoidosis exists.
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12
Q

What is the causative pathogen in Lyme Disease? How is Lyme Disease transmitted? When considering Lyme Disease we should be suspicious of travellers from _____.

A

Caused by Borrelia species - transmitted via tick bite

Not endemic to Australia - present in returned travellers from Europe and North America

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13
Q

How do you diagnose Lyme Disease?

A

Lyme Disease should be suspected in patients who are at risk of exposure to ticks carrying Lyme Disease AND have clinical manifestations that are consistent with Lyme Disease

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14
Q

What are the typical dermatological findings in Lyme Disease?

A

erythema migrans

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15
Q

What are the three stages of Lyme Disease? (Describe them)

A
  1. Early Localised Disease (erythema migrans)
    • diagnosis: clinical grounds alone when characteristic erythema migrans lesion is present + recently travelled to an endemic area
  2. Early Disseminated Disease
    • multiple erythema migrans lesions and or neurological or cardiac findings
    • occurs weeks to months after infection
  3. Late Lyme Disease
    • intermittent or persistent arthritis and/or certain rare neurologic problems, primary a subtle encephalopathy or polyneruopathy
    • can develop months to a few years after initial infection
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16
Q

How do you treat Lyme Disease?

A
  • for early Lyme Disease → doxycycline 100mg PO BD
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17
Q

What is Developmental Dysplasia of the Hip? What are the risk factors for DDH?

A

Underdeveloped femoral head → dislocated posteriorly and superiorly

Risk Factors (Five Fs)

  1. Female
  2. First Born
  3. Family History
  4. Foot Abnormalities
  5. Funny Delivery (breech or transverse)

as well as oligohydramnios and C-Section

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18
Q

On examination, what are the tests used to diagnose DDH? Describe them please.

A

Diagnosed early by Ortolani and Barlow Tests (abnormal thud or clunk) → test usually negative after 2 months

Barlow - flex and adduct the hips - femoral head dislocates posteriorly and dislocation is palpable

Ortalani - flex hip to 90 degrees and abduct the the thigh (bringing the dislocated femoral head from its posterior position) - femoral head reduces into the acetabulum and a palpable clunk is heard

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19
Q

Discuss the role of imaging in diagnosing DDH.

A
  • *Ultrasound**
  • excellent up to 6 months and more sensitive compared to clinical examination
  • best delayed until at least 3-4 weeks post-term → physiological immaturity evident on early U/S can lead to false positive
  • *X-Ray**
  • less reliable in first few months of life → femoral head is made of mostly cartilage
  • more reliable method of investigating for DDH in children aged between 4-6 months as the ossification centre of the femoral head appears
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20
Q

How do you treat DDH?

A

Pavlik Harness

  • allows contact between the thigh and hip bones
  • strengthen the muscles and ligaments while the hip is developing
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21
Q

What is the role of swaddling in DDH?

A

Pavlik Harness

  • allows contact between the thigh and hip bones
  • strengthen the muscles and ligaments while the hip is developing
22
Q

Breast/Nipple Thrush: Nipple and Areola Signs and Symptoms (3 points)

A
  • Burning, stinging nipple pain which continues during and after the feed
  • Very tender to touch nipple and even light clothing can cause pain
  • Nipple can appear pink and/or shiny and areola may be reddened, dry or slightly flaky
    • consider dermatitis if pruritic or rash
    • consider nipple vasospasm if nipple pain is exacerbated by cold and/or nipples blanch
23
Q

Breast/Nipple Thrush: Breast Signs and Symptoms (3 points + 2 bonus)

A
  • Shooting, stabbing or deep aching breast pain
  • Pain occurs after feeing or expressing
  • Let-down reflex may be more painful than normal
  • Can be localised to one nipple or breast but can also be bilateral
  • Breasts will appear normal
  • consider mastitis if breasts appear inflamed
24
Q

Breast/Nipple Thrush: Baby Signs and Symptoms (1 point)

A
  • Signs of thrush - white oral plaques in the mouth or red papular rash with satellite lesions around the anus and genitals
25
Q

Treatment of Nipple Thrush - Mother and Baby

A

Mother

  • Fluconazole 150mg every 2nd day for 3 doses THEN Nystatin 2 x 500,000 unit tablets TDS
  • Miconazole Oral Gel to nipples QID
  • if breast pain as well - 6 doses of fluconazole not just 3

Baby
- Miconazole Oral Gel QID for 1 week then Once Daily for 1 week

26
Q

Treatment of Nipple Thrush - other measures

A
  • Wash hands frequently - alcohol based hand gel may be used
  • Sterilise dummy daily and replace weekly
  • Keep nipples dry
27
Q

Wheeze + Sudden Onset of Symptoms + NO Coryzal Symptoms = _______

A

Inhaled Foreign Body -> refer to ED

28
Q

History Features of Inhaled Foreign Body

A
  • persistent wheeze, cough, fever, dyspnoea not otherwise explained
  • recurrent or persistent pneumonia may be the presenting feature
  • child may be asymptomatic after the precipitating event
29
Q

Examination Features of Inhaled Foreign Body

A
  • Asymmetrical chest movement
  • Tracheal deviation
  • Wheeze or decreased breath sounds
  • Respiratory Examination may be normal
30
Q

What to look for CXR in context of ?Inhaled Foreign Body

A
  • look for opaque foreign body
  • segmental lobar collapse
  • localised emphysema in expiration
31
Q

Patients with COPD who would benefit from Long Acting Bronchodilator Therapy.

A
  • have moderate of severe COPD
  • experience frequent breathlessness requiring short-acting therapy
  • have mild COPD → experience breathlessness that is not adequately relieved by short acting bronchodilator therapy
32
Q

Different types of Long Acting Bronchodilator Therapy and how do they work?

A
  • Long Acting Beta2 Agonists (LABA): bronchodilation by relaxing airway smooth muscle through stimulation of beta2-adrenergic receptors
  • Long Acting Muscarinic Antagonists (LAMA): prevent bronchoconstriction via acetylcholine by competitive antagonism of the muscarinic receptors
33
Q

Name the 4 types of LAMAs, brand names and frequency of dose.

A
  • Tiotropium
    • Spiriva - Respimat or Handihaler, Braltus, Zonda
    • Once Daily
  • Glyccopyronium
    • Seebri Breezhaler
    • Once Daily
  • Aclidinium
    • Bretaris Genuair
    • Twice Daily
  • Umeclidinium
    • Incruse Ellipta
34
Q

Name 2 subgroups of LABA with examples, brand names and frequency of dose.

A
  • Eformeterol or Salmeterol
    • Eformetrol - Foradile Aerolizer, Oxis Turbuhaler
    • Salmeterol - Serevent Accuhaler
    • Twice Daily in conjunction with SABA
    • Improve QOL, Decrease use of rescue medication + reduce frequencty of exacerbations
  • Indaceterol or Olodaterol or Vilanterol (Ultra LABA)
    • Indacaterol - Onbrez Breezhaler
    • Once Daily
35
Q

High Risk Stress Fracture Sites (10 points - give me 5)

A
  1. Pars Interarticularis of Lumbar Spine
  2. Femoral Head or Neck
  3. Patella
  4. Anterior Cortex of Tibia
  5. Medial Malleolus
  6. Talus
  7. Tarsal Navicular
  8. Proximal 4th or 5th Metatarsal
  9. Base of 2nd Metatarsal
  10. Great Toe Sesamoids
36
Q

History and Examination Findings for Stress Fracture (4 points)

A
  • Repeated or increase in stress to affected area
  • Focal pain of insidious onset
  • Pain increases with activity
  • Focal bony tenderness
37
Q

True or False. Stress Fractures will be seen immediately at time of onset of symptoms.

A
  • Plain radiographs → early stress fractures may not be apparent on radiographs, no earlier than 2-6 weeks following onset of symptoms
38
Q

Treatment of Stress Fracture (5 points)

A
  • Pain → Ice, Panadol, Activity Modification
    • Cessation of inciting activity for 4-8 weeks
  • Stiff soled orthotic shoe or walking boot can be used in patients who continue to have pain despite cessation of inciting activity
  • If pain persists with simple walking - period of unloading for 1-2 weeks, PWB or NWB with crutches
  • DO NOT require casting or immobilisation
  • Pts encouraged to complete NWB activity during the treatment phase → pool running, swimming and low resistance spinning on the bicycle
39
Q

NEXUS Criteria for Cervical Spine Pain. Explain what it is and also what are the 5 points.

A

Cervical Spine Injury cannot be excluded if any of the following criteria are present:

  • Midline cervical tenderness
  • Altered mental status
  • Focal neurological deficit
  • Evidence of drug or alcohol intoxication
  • Presence of other injury considered painful enough to distract from neck pain
40
Q

Definition and Mechanism of Whiplash Injury. What structures are impacted?

A

Defined as a neck injury → resulting from acceleration-deceleration mechanism which causes sudden extension and flexion of the neck
- commonly referred to as cervical strain or sprain

Extension-Flexion Mechanism can cause injury to intervertebral joints, discs and ligaments, cervical muscles and/or nerve roots.

  • Injury to the facet joint → most common cause of whiplash related upper neck pain and headaches
41
Q

Symptoms of Whiplash Injury (7 points)

A
  • Neck Pain + Stiffness → present immediately after the injury or can be delayed by several days
    • Persistent low-intensity pain
  • Headache
  • Shoulder or Back Pain
  • Dizziness + Nausea
  • Parasthesias - of the ulna border of the hand
  • Fatigue
  • Sleep Disturbances
42
Q

Initial Management of Whiplash Injury

A
  • Patient Education
  • Postural Modification
  • Early Mobilisation
  • Adjunctive Pharmacologic Therapy
43
Q

How do you manage patients that have severe neck pain secondary to Whiplash injury or have risk factors for chronic pain? What are the risk factors for developing chronic pain?

A
  • Risk Factors for Chronic Pain → severe functional component, mood disturbance related to pain, catastrophising
  • Earlier referral for adjunctive therapies → physical therapy, manipulation therapy, psychological therapies
    • Physical Therapy at 4 weeks
    • CBT at 6-8 weeks
44
Q

Who should be offered coeliac serology testing? (10 points)

A
  1. Persistent unexplained abdominal or gastrointestinal symptoms
  2. Faltering growth
  3. Prolonged fatigue
  4. Unexplained weight loss
  5. Severe or persistent mouth ulcers
  6. Unexplained Iron, Vitamin B12 or Folate Deficiency
  7. Type 1 Diabetes, at diagnosis
  8. Autoimmune Thyroid Disease, at diagnosis
  9. Irritable Bowel Syndrome (in adults)
  10. First Degree Relatives of people with coeliac disease
45
Q

Consider coeliac serology testing in these 7 groups of people.

A
  1. Metabolic Bone Disorder
  2. Unexplained neurological symptoms
  3. Unexplained subfertility or recurrent miscarriage
  4. Persistently deranged LFTs
  5. Dental enamel defects
  6. Down Syndrome
  7. Turner Syndrome
46
Q

What is the 2 serological tests for coeliac disease?

A

IgA Anti-Tissue Transglutaminase + Anti-Deamidated Gliadin Antibody tests

47
Q

Definitive diagnosis of coeliac disease. How and what is seen on histology?

A

The diagnosis of Coeliac Disease → Duodenal Biopsy

- Characteristic histology → intraepithelial lymphcytosis with blunting of villi

48
Q

Discuss HLA DQ2/8 genotyping in the context of coeliac disease. Pros and Cons. (2 each, 1 of the cons is really soft and not really a con…)

A

Pros

  1. Can exclude coeliac diagnosis if genotypes are absent - If absent genotype → patients will not have the disease or ever develop it
  2. Not adversely affected by gluten free diet

Cons

  1. COSTS 118 DOLLARS SO BE PRUDENT WITH ORDERING THIS
  2. a positive genotype does not diagnose coeliac disease → indicates that further testing is warranted (not really a con…)
49
Q

Investigations that should be conducted in newly diagnosed coeliac disease patients. (2 groups - 5 individual tests)

A

Investigate newly diagnosed patients for micronutrient deficiencies (Fe, B12, Folate, Vit D) + screen adults for osteopenia by measuring bone density (DEXA scan)

50
Q

Increase in risk of coeliac disease if family member has coeliac disease. What if multiple family members have coeliac disease?

A

Risk of patients with family members with coeliac disease is 10% → increases to 20% if multiple family members are affected

51
Q

If a patient is asymptomatic, do they need to be screened for coeliac disease and if so, why?

A
  • Many “asymptomatic” patients with coeliac disease will have nutritional deficiencies, reduced bone density → so ALL FAMILY MEMBERS irrespective of symptoms status should be considered for screening.
    • First degree relatives should be screening and if several affected family members - second degree relatives should also be tested.
    • Screen with HLA DQ2/8 rather than with serology alone.
  • Screening children with FHx of coeliac disease can be delayed to age of 4 if well and symptom free

Practice Exams (45 decks)

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