3. BAMS Haem/Derm/Neuro/Ophth

Question 1

Anaemia

1. Define
2. 3 causes
3. 3 systemic features
4. 4 types and definitions/causes
5. Mx
6. 3 causes for reduced Fe
7. 3 causes for reduced B12
8. 3 causes for reduced folate
9. 3 IO features of iron deficiency

Answer 1

1. Reduction of Hb in blood
2. Reduced production, increased loss, increased demand
3. Fatigue, pallor, brittle nails, koiconychia, heart failure, SoB, tachycardia
4. Microcytic - iron deficiency
   Microcytic - folate/B12 deficiency
   Normocytic - increased loss, renal disease, rheum diseases
   Pernicious - lack of intrinsic factor
5. Replace haematinics
6. Gastic ulcers/erosions, IBDs, coeliac disease
7. Lack of intake, lack of intrinsic factor, Crohn’s
8. Lack of intake, absorption failure
9. Glossitis (beefy tongue), oral dysaesthesia, pale gingivae/mucosa, RAS (OU), glossitis, angular cheilits

Question 2

Haem Malignancies

1. Define 2 main types
2. 3 signs of leukaemia
3. 4 types of leukaemia
4. 2 types of lymphoma
5. Common neck features

Answer 2

1. Leukaemia - neoplastic proliferation of WBCs, usually dissemianted
   Lymphoma - neoplastic proliferation of white cells, usually solid tumour
2. Anaemia, lymphadenopathy, SoB, neutropenia, bone pain, tiredness, fatigue, chest pain, pallor
3. ALL, AML, CLL, CML
4. HL, NHL
5. Firm (rubbery), painless, moveable

Question 3

Blood Disorders

1. 2 types of haemophilia
2. Dental relevance and Mx
3. 3 types of VWD
4. Describe coagulation cascade
5. 2 causes of platelet abnormlaities
6. Dental Mx
7. Describe action of 4 antiplatelets
8. Describe action of 4 anticoagulants
9. SDCEP guidelines

Answer 3

1. A - FVIII deficiency
   B - FIX deficiency. Christmas disease
2. Increased bleeding risk. Liaise with haem
3. Type 1, type 2, type 3
4. Bleeding and vasoconstriction, platelet plug formation (platelet aggregation activated by vWF), coagulation (fibrin scaffold reinforces platelet plug and clotting factors activated)
5. Alcohol, drugs, bone marrow suppression
6. > 100x10^9 - fine. >50x10^9 for secondary care
7. Aspirin - irreversible COX inhibitor (inhibits platelet aggregation)
   Clopidogrel - ADP receptor inhibitor. Prevents platelet activation and fibrin cross-linking
   Prasugrel - ADP receptor inhibitor. Reduces platelet aggregation
   Ticagrelor - reversible ADP receptor antagonist
   Dipyramidole - blocks platelet aggregation by inhibiting phosphodiesterase enzymes
8. Warfarin - inhibits coagulation factors I, II, V, VII, X. Vit K-dependent
   Heparin - as warfarin
   Dabigatran - dTi (prevents fibrin formation)
   Apixaban - FXa inhibitor (prevents fibrin formation)
   Rivaroxiban - FXa inhibitor (prevents fibrin formation)
9. Low-risk - no problems
   High-risk - >3 extractions, surgical (flap-raising, implants, gingival recontouring, biopsies) - miss/delay morning dose. Pack, suture, ensure bleeding stops

Question 4

Derm

1. Eczema what surfaces affected
2. Psoriasis what surfaces affected

Answer 4

1. Flexor

2. Extensor