Additional Stuff Missed

Question 1

Which layer of the skin is reduced in psoriasis?

Answer 1

Stratum granulosum

Question 2

Define Osteomalacia and give some causative reasons for it:

Answer 2

Softening of the bone secondary to decreased mineralization of the bone matrix

Causes:
- Low Vit D = Low Ca2+

Question 3

Outline pathogenesis behind Non- radiographic axial spondyloarthritis:

Answer 3

Gut flora + HLA B27 + Abnormal biomechanics
= IL-23

this promotes:

• IL17 = inflammation and bone loss
• IL- 22 = Osteoproliferation

Question 4

List some places that are at risk of avascular necrosis:

Answer 4

Femoral head
Scaphoid
Tarsal navicular

Question 5

Outline the stages of OA on radiograph:

Answer 5

Stage 0 = nothing seen

stage 1 = minor joint space narrowing +/- small osteophytes

Stage 2 = Definitive Osteophytes + joint space narrowing

Stage 3 = Multiple Osteophytes + Definitive joint space narrowing
+/- Deformity

Stage 4 = Large osteophytes, marked reduction in joint space + deformity + scloerosis

Question 6

Who get’s urine cultures done when there is a UTI:

Answer 6

3< children

Question 7

What is the diagnostic criteria for RA?

Answer 7

Number of joints: Max 5 points

Serology:

Synovitis

ESR or CRP

Question 8

List some complications of AKI:

Answer 8

Hyperkalamia

Pulmonary edema

Acidosis

Toxin build up

Question 9

Define Pyuria and if it present without bacteria in the urine, what are some likely diagnoses?

Answer 9

Pyuria: Pus in the urine

If without bacteria consider:

• TB
• Chlamydia

Question 10

What is the most common type of prostate cancer and how is it graded?

Answer 10

Adenocarcinoma

Gleason’s grading

Question 11

What is the staging of prostate cancer and where does it often spread to?

Answer 11

T1 - local involvement

T2 - Diffuse throughout Prostate

T3 - eroded out of prostate

T4 - invading neighbouring structures

*levi rectal muscle often involved

Question 12

Things that can raise PSA:

Answer 12

Size of prostate

Acute illness

Age - increases with age

Question 13

List some causes of Down’s syndrome with some features you expect to see and how is down’s diagnosed?

Answer 13

Nondisjunction
Robertsonian translocation
Mosaicism

Phenotype features:

• epicanthal folds
• flat facial profile
• tetralogy of fallot
• one palmar crease
• macroglossus
• Chorionic villus sampling
• Amniocentesis
• use karyotyping

Question 14

List several things that go wrong with valves and the apparatus:

Answer 14

Valves:

• Calcification
• Thickening
• Degeneration
• Prolapse

Annular: 
- Dilation 
- Calcification 
- tethering/ rupture 
-

Question 15

Systemic diseases associated with aortic regurgitation:

Answer 15

Marfan’s syndrome

SLE

Ankylosing spondylitis

Question 16

Valve replacement: compare and contrast mechanical valves and tissue valves:

Answer 16

Mechanical:

• life long durability
• anti-coagulation is needed
• increased risk of infection
• haemolytic anaemia

Tissue:

• limited life expectancy
• free from anticoagulation

Question 17

List some complications of mitral stenosis:

Answer 17

AF

Pulmonary hypertension with right sided heart failure

Dysphagia as it compresses on the esophagus

Stroke formation - due to the AF

Question 18

There are two types of mitral regurgitation - what are they?

Answer 18

Mitral valve prolapse
- pansystolic

Mitral regurgitation
- mid systolic click followed by pansystolic

Question 19

Which murmur is associated with IVDUs?

Answer 19

Tricuspid regurgitation

Question 20

Whats the most important diagnostic factor for leukaemia which will guide treatment:

Answer 20

Cytogenetics of the cancer

Question 21

What is the treatment for ALL?

and what is an extremeley bad prognostic for ALL?

Answer 21

Young:

• High dose Chemo
• Clinical Trials
• Supportive management
• Stem cell transplant - if relapse, refractory, Good performance

Bad prognostic:
- t9;22

Question 22

What is the treatment for AML?

Answer 22

<60: High dose chemo + Stem Cell Transplant

> 60: Low dose Chemo

Comorbidities or very old: Supportive measures

Question 23

What may have hypercellularity but present with pancytopenia?

Answer 23

Myelodysplastic syndrome
May progress to AML

*Refractory Anaemia with blast cell = most at risk of doing this

Question 24

Symptoms of GvHD:

Answer 24

Jaundice
Diarrhea - bloody
Rash
Hepatosplenomegaly

Question 25

What can cause Cold type haemolytic syndrome?

Answer 25

Mycoplasma infections

EBV infection

Question 26

Common drug used for haemophilic disorders:

Answer 26

Desmopressin

Question 27

Management of Immune thrombocytopenia purpura?

Answer 27

Intravenous immunoglobulins

Question 28

Name the drug used to mimic mineralocorticosteroids and when is it used?

Answer 28

Fludrocortisone

In adrenal insufficiency

Question 29

Outline how Adenosine works and list some side effects:

Answer 29

MOA:
Causes transient heart block across the AVN:
A1 receptors activation which reduces cAMP. This stimulates efflux of K+ - causing hyperpolarization of the node, blocking Ca2+ from entering and depolarising.

this causes a break in the re-entry circuit of the AVN. Allowing the SA node to resume sinus rhythm over the heart.

Side effects:

• transient heart block
• breathlessness
• sense of impeding doom as the heart stops

*should not be used in coronary heart disease due to the coronary steal syndrome