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MRCP 2 > Derm/ Endo / Gastro > Flashcards

Derm/ Endo / Gastro Flashcards

1
Q

Ulcerative colitis
Now hepatosplenmegaly and ALP 600 = ? Ix?

A

Primary sclerosing cholangitiss
ERCP/MRCP
[pANCA often positive]

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2
Q

Anti-mictochondrial antibodies in ? Which subtype

A

Primary billiary cirrhosis
M2 subtype most specific

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3
Q
A

Primary sclerosing cholangitis
[stricturing of bile ducts or ‘beading’

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4
Q

HRT and
colon Ca?
Diabetes?
osteoperosis?
Gallbladder disease?
Dementia?
CAD?

A

colon Ca - decreased risk [but more advanced disease hen found]

Diabetes - decreases risk

osteoporosis - decreases risk

Gallbladder disease - increases risk

Dementia - no change

CAD - no change

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5
Q

PCOS and hirtuism rx? Ovulation?

A

co-cyprindiol

Clomifine for ovulation

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6
Q

Thyrotoxicosis in preg rx?

A

Propylthiouracil in first trimester
Carbamazepine 2-3rd

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7
Q

Bacillus cereus onset of Sx?

A

1-4hrs

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8
Q

Chest tightness, palpitations, SOB and HTN?

A

Phaeo

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9
Q

Swan neck of oesopahagus =? rx? if medical ineffective?

A

Achalasia
CCB or nitrates

Botox/balloon dilation

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10
Q

Sore throat / cough. Now oedematous papules some with vesicles in middle forming a target lesion =?

A

HSV-1 most likely

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11
Q

Regurgitation of undigested food + halitosis = ? key Ix? Rx?

A

Zenckers diverticulum
Barium swallow
Surgical

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12
Q

Diffuse symmetrical triphasic sharp waves on EEG = ?

A

Hepatic encephalopathy

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13
Q

Can you get eye signs in post partium thyroiditis?

A

No

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14
Q

DKA - given fluids and insulin what is next most important

A

LMWH - high risk of thrombosis

IV sodiumbicarb if severe acidosis + circulatory collapse

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15
Q

Girl - rasied testosterone/progesterone, hirtuism, irregular periods and

A

non classical CAH
[as raised progesterone not in PCOS]

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16
Q

Diagnosis of haemochromatosis

A

Genetic testing
[then liver biopsy to determine cirrhosis level]

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17
Q

Best drug for long term rx of portal HTN

A

propanolol

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18
Q

Which laxative causes melanosis coli

A

Senna

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19
Q

Small hyperpigmented macules on wrists, arms, neck

A

Lichen plannus

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20
Q

Keloid scar Rx if causing issues Eg depression

A

triamcinolone

2nd line 5-FU

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21
Q

Describe this

A

Annular rash

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22
Q

Derm what does it mean?
Annular
serpiginous
Nummular
reticulated

A

Annular - Ring shaped erythema with central clearing

serpiginous - Curved

Nummular - circular without central clearing

reticulated - Lace or network pattern

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23
Q

dyspepsia with no red flags rx?

A

PPI
-> if sx persist stop for 2 weeks then H pylori
-> If ongoing endoscopy

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24
Q

Viral infection then tender thyroiditis

A

De Quiervans

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25
Q

Fibrosis of thyroid sometimes leading to tracheal compression?

A

Riedel’s thyroiditis

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26
Q

Cranial DI presents with

A

Hypernatraemia and hypotension

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27
Q

Bleeding DU what medication has positive impact on prognosis?
Variceal?

A

Omeprazole

Terlipressin for variceal

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28
Q

Delayed puberty with low FSH/LH ix?

A

GnRH testing

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29
Q

Pigmented oral lesions

A

peutz-jeghers syndrome

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30
Q

Hx of nose bleeds + fam Hx

A

Heredatory haemorrhagic telangectasia
[olser weber rendu]

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31
Q

middle eastern - repeated abdo pain, fever and arthralgia

A

familial Mediterranean fever

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32
Q

Daily fevers, arthritis, Salmon coloured rash raised ferritin and splenomegaly

A

Adult onset stills

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33
Q

Acute abdo symptoms and neuropsych? Common triggers?

A

Acute intermittent porphyria
Alcohol, oestrogen

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34
Q

Low BMI with urinary K <1 =

A

Laxative abuse - as lose lots through bowels, kidneys try to conserve

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35
Q

SAAG for portal HTN

A

> 11g/L

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36
Q

given vanc - > red man sydrome rx?

A

Chlorphenamine
-then add steroids topical/PO if needed

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37
Q

diarrhoea, wheeze abdo pain weight loss? ix?

A

carcinoid
urinary 5-haii

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38
Q

phaeo initial Ix 2 options

A

urinary metanephrines
urinary vanillylmandelic acid

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39
Q

Small undescended testis and gynecomastia often learning difficulties ? genetics? rx?

A

Kleinfelter
XXY
Androgen replacement

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40
Q

Diabetes, diarrhoea, gallstones

A

Somatostatinoma

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41
Q

CAH caused by

A

21-hydroxylase deficiency 95%
17-hydroxylase deficiency in others

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42
Q

best Ix for charcots vs infective

A

indium-labelled white cell scan

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43
Q

middle ages woman with itching fatigue and raised ALP key ix?

A

PBC = Anti-mitochondrial Abs

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44
Q

Lesions in armpit and neck pictured = ? What would be seen on opthalmology?

A

Pseudoxanthoma elastum
angioid streaks in iris

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45
Q

risk of transmisstion / When test baby for hep c with a positive mum ? breast feeding risk?

A

2% risk

test after 2 months

No risk breastfeeding

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46
Q

coeliac disease malignany

A

enteropathic associated T cell lymphoma

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47
Q

Uncontrolled bleeding DU with poor lung function rx

A

Angiography and embolisation

unfit for surg

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48
Q

Name 3 causes of carpal tunnel

A

Hypothyroid
Cushing
Obesity
Raised oestrogen

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49
Q

Best drugs for maintaining remission in corhns

A

Thiopurines
- azathioprine or 6-mercaptopurine

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50
Q

1st line Ix visceral leish

A

Direct agglutination testing + rk39 antigen test

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51
Q

AIDs + ++ALP key Ix

A

MRCP
- likely strictures due to infection eg cryptosporridium or CMV or microsporidium

-> Stenting

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52
Q

general flu like sx with oral ulcers and a patch of alopecia

A

Secondary syphilis

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53
Q

Surgery for BCC vs melanoma

A

BCC - mohs micrographic surgery

melanoma - wide excision 2 cm

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54
Q

psoriasis + what -> erythroderma

A

propranolol

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55
Q

2 main causes of erythroderma

A

eczema - 40%
psoriasis - 25%

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56
Q

Barrets with low grade dysplasia Rx

A

High dose PPI

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57
Q

pemphigoid of preg rx

A

Topical corticosteroids
=> oral if not improving

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58
Q

Watery diarrhoea, weight loss
Colonoscopy - normal macroscopic, but cellular infiltrate in lamina propria?
rx?

A

Microscopic colitis
Stop NSAID / PPI

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59
Q

Serum osmolality after deprivation?
Urine osmolality after deprivation?
Urine osmolality after desmopressin?

A

Serum osmolality after deprivation - 278-300
Urine osmolality after deprivation - >300
Urine osmolality after desmopressin- >750

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60
Q

Most common cause of acute dysentry in UK

A

Campylobacter
[then salmonella]

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61
Q

Chronic history abdo pain, loose stool and depression
Eye movement disorder with jaw twitching on eye movement? ix?

A

Whipple
Jejunal biopsy -> PAS positive macrophages

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62
Q

Lesion on achillies ix?

A

Xanthomata
Needs fasting lipids

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63
Q

Why not start thyroxine with other concurrent autoimmune disease eg vitiligo?

A

Need to rule out autoimmune adrenitis
-> otherwise thyroxine can precipitate an adrenal crisis

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64
Q

Examine nutritional status in anorexia

A

Mid arm circumference and skin-fold thickness

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65
Q

Test for chronic pancreatic insufficiency?
bile acid malabsorbtion?

A

Pancreatic - fecal lipase

Bile acid - seHCAT test

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66
Q
A

Lupus vulgaris

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67
Q

HHS K5.5 Na146, glucose 35
Which fluid

A

0.9% saline

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68
Q

36 weeks preg
deranged LFTs + jaundice
When would you think cholestasis of preg and when acute fatty liver

A

Cholestasis - more common
-less Sx

Acute fatty liver - vomiting
-abnormalities of synthetic function eg low albumin

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69
Q

Chronic alcohol, obese, buffalo hump, raised 0900 cortisol
midnight cortisol <50% dx?

A

Pseudo Cushings

Cushings would not have significant drop in cortisol

70
Q

Pain in cheeks and gums ? rx?

A

Lichen plannus (wickhams straiae)

Topical corticosteroids

71
Q

Thyrotoxicosis in pregnancy with smooth small goitre =

A

Graves (85% thyrotoxicosis of preg)

72
Q

symmetrical dark pink lesions on shins + new AF = ? finding on hand exam?

A

Graves
Lesions are pretibial myxoedema

Acropachy - soft-tissue swelling of the hands and clubbing of the fingers.

73
Q

hypertension, HypoK, Alkalosis

A

Conns

74
Q

Differentiate liddle and conns

A

Both HTN, hypoK and alkalosis

Conns - raised aldosterone
Liddle - low

75
Q

Previous acne now these itch red lesions? Rx?

A

Keloid scars secondary to acne

Intralesional steroids

76
Q

Ectopic gastric mucosa in diverticulum? Key Ix? rx?

A

Meckles
Tc-99m pertechnetate scintigraphy
Surgery if bleeds

77
Q

itchy rash on the elbows? on biopsy?

A

Dermatitis herpetiformis
IgA deposits on biopsy

78
Q

Raised prolactin in CKD due to?

A

Uraemia -> hypothalamus -> reduces dopamine

Also impaired metabolism of prolactin by kidney

79
Q

insulinoma vs insulin abuse

A

C -peptide high in insulinoma
[also raised pro-insulin]

80
Q

How does test for pernicious anaemia work?

A

Schilling - check labled b12 in urine

Then add intrinsic factor -> if positive the % of b12 in urine will significantly increase

81
Q

Weight loss, foul smelling stool
Macrocytic anaemia with raised folate and low B12

A

Small bowel bacterial overgrowth

82
Q

Memory loss, ataxia, weight loss, loose stools

A

Whipples

83
Q

CKD what does K need to be before surgery

A

<5.5

84
Q
A

dextrocardia

85
Q

What electrolyte abnormality

A

HypoK
Prominent U wave (small deflection following t wave)

86
Q

Which vit deficiency

A

naicin b3

87
Q

What is needed for synthesis of naicin?

A

Pyridoxine (B6)
-> B6 deficiency may also cause pellagra

88
Q

microcytic anaemia , epistaxis =? ix?

A

Telangiectasia of lips + above =
olser weber rendu (HHT)

CT angiogram bowel

89
Q

phaeo, hyperPTH =

A

MEN2a

90
Q

Rash on scalp ? cause?
rx?

A

Seborrheic dermatitis - likely malassezia
Ketoconaozole

91
Q

kantor string sign on barium meal

A

crohns

92
Q

Subacute thyroiditis rx?

A

propranolol

93
Q

Kid with cold

A

impetigo

94
Q

CKD5
Tightening of skin and joint contractures
indurated woody plaques on trunk and limbs

A

nephrogenic systemic fibrosis

95
Q

pregnant with this striae caused by?

A

cortisol

96
Q

IBD rx options in order

A

topical pred
topical tacrolimus
oral pred

97
Q
A

nail pitting psoriasis

98
Q

primary HyperPTH surgical indications
Cr
T score
Age
Ca
urinary ca

A

Cr >30% increase
T score >-2.5
Age <50
Ca >2.85
urinary ca >10mmol/24hrs

99
Q

Hx of coeliac with negative endomysial antibodies why?

A

IgA deficiency -> causes false negative
Need to do immunoglobulin electrophoresis

100
Q

Non bowel parts of FAP

A

Hypertrophy of retinal epithelium
dental issues
osteomas

101
Q

Itchy = ? rx?

A

malassezia - ptyriasis versiculor

Ketoconazole

102
Q

Travellers diarrhoea when Abx

A

> 3 days
6 episodes per day
bloody

103
Q

How much pred in breast feeding is safe

A

<40mg/day

104
Q

Long standing T1DM not great control
now joint pains in wrist and ankle and these lesions on the shins
Cause of joint pains?

A

raised red plaques - necrobiosis lipoidca diabeticorium

Rheum A - HLADR4 associated with above lesions and joint pains

105
Q

Epilepsiy now pancreatitis = which med

A

valproate

106
Q

How to calculate plasma osmolarity? value for HHS

A

2(Na + K) + urea + glucose
>320 for HHS

(Glucose likely >30)

107
Q
A

Hosepipe appearnce of UC

108
Q

RX of pain in thyroiditis

A

NSAIDs

109
Q

Rectal bleeding, mum has it too
multiple polyps ? how often endocopy

A

peutz jehger
endoscopy 3 yearly

110
Q

Long distance run now this rash

A

capilliritis

111
Q

Cafe au lait skin
precocious puberty
Hyper thyroid

A

mcune albright syndrome

112
Q

1st line Rx PCOS

A

weight loss if raised BMI

113
Q

65F with hairloss and itching in patch on scalp

A

Cicatricial Alopecia

114
Q

Hairloss 2-3months after stressfull times

A

telegen effluvium

115
Q

Psychogenic pulling out of own hair

A

trichotilomania
[MANIA]

116
Q

Ulcerative colitis with colon diameter 5.5 on IV hydrocortisone next step

A

IV cyclosporin
[not infliximab]

Surg ref if colon >6cm after 72hrs therapy

117
Q

Polyglandular syndrome type 1 and 2 features

A

Type 1
2 of:
HypoPTH 90%
Adrenal insufficiency
chronic mucocutaenous candida
gonadal failure
hypothyroid

type 2
Adrenal insufficiency and T1DM
[vitiligo, gonadal failure and pernicious anaemia]

118
Q

Normal TSH and free t4
low total t4 (and mebe t3) =?

A

Thryroid binding globulin deficiency

119
Q

Alcoholic hepatitis Igs

A

++ IgA
+IgG / M

120
Q

How long washout for aldosterone levels if on ACE/ARB etc

A

2 weeks

121
Q

Melanoma biopsy margin

A

1cm

122
Q

toxic epidermal necrolysis mediated by

A

Cytotoxic T cells

123
Q

Recently started antihypertenive now acute abdo

A

ACEi -> angiodema of bowel

124
Q

IBD then on sertraline now colitits what type?

A

Lyphocytic colitis

125
Q

What transferrin saturation in Haemochromatosis

A

> 55%
Venesection to aim <50%

126
Q

Cholangiocarcinoma secondary to PSC rx

A

Liver transplant
If invasion of lymph then stenting and palliative

127
Q

Amiodarone thyrotoxicosis rx

A

Stop ami
steroids

128
Q

bleeding varicies -> banding but still ooze what next

A

TIPS
Balloon tamponade only for catatrophic bleeding

129
Q

Tall, small testis and no pubic hair =

A

Klinefelters 47XXY

130
Q

Blue-black skin pigmentation seen with

A

Minocycline

131
Q

Really itchy rash following a stress trigger

A

Lichen simplex et chronicus

132
Q

Anaemia

A

HHT

133
Q

Low Na in boozer with normal CT chest

A

Beer potomania

134
Q

Groin perianal and axilla lesions with discharge. Not STI

A

Hidradenitis suppurativa

Doxy / tetracyclines

135
Q

Slow growing painless

A

Subungual fibromas

136
Q

Prev TB

A

Discoid lupus

[Lupus vulgaris is a single slow growing plaque]

137
Q

24
Altered bowel habit and passing air bubbles in urine

A

Crohns with fistula

138
Q

Thyroidectomy
Hyper PTH
Impaired glucose tolerance

A

Men2a

[Impaired glucose tolerance due to phaeo]

139
Q

Which drug for deranged LFTs if cholestatic?
If ALT higher than ALP

A

Co-amox

Statins

140
Q

Young, Abdo pain, weight loss, postural hypotension

A

Addison’s
[often low glucose]

141
Q

Amiodarone thyrotoxicosis most commonly treated with antithyroid drugs incombnation with what ?

A

potassium percholrate

142
Q

No prev issues

A

Tinea corporis (ring worm

topical antifungal

143
Q

Weight loss raised glucose

A

glucagonoma

144
Q

Alcoholic with low Ca - what needs replaced 1st

A

Mg

145
Q

Glargline insulin as changes in?

A

Glycine and Arginine

[GlArginine]

146
Q

Itchy rash after running - some areas of blistering where he’s rubbed it

A

mastocytosis
[Dariers sign is the blistering where rubbed]

147
Q

Crohns on azathioprine wants to get preg plan?

A

Continue same dose
Start folic acid

148
Q

Kallman best rx

A

Pulsed GnRH

149
Q

Pancreatitis LDL 4.5, triglycer 11.2 rx?

A

Statin + fibrate

150
Q

Diarrhoea

A

UC - continuous thickening of bowel

151
Q

Primary amenorrhoea raised FSH/LH
small and fat
No breast development

A

turner

152
Q

UC and PSC how often colonoscopy if asymptomatic

A

every year

153
Q

palpable red nodules on penis and scrotum

A

scabies

154
Q

erythema nodosum HLA

A

HLA B27

155
Q

Actual thyroid adenoma in preg rx?

A

Antithyroid drugs til delivery

156
Q

ASCA antibodies in

A

cROHNS

157
Q

Dysphagia

A

Pharyngeal pouch

158
Q

65M IDA with no change in bowel habit 1st line ix

A

Urineanaysis

159
Q

Which glutide is best

A

Liraglutide

160
Q

Recurrent pneumonia caused by

A

bronchiectasis
[yellow nail syndrome]

161
Q

Alcoholic with multiple episodes of pancreatitis. How to manage diabetes?

A

Likely type 3 diabetes -> lack of insulin

Insulin replacement

162
Q

Addisons and Thyroid disease

A

Polyglandular type 2

163
Q

74 widespread itch rash

A

Scabies

164
Q

Itchy - biopsy shows cuffing in coat sleeve

A

Erythema annular centrifugum

165
Q

Liver failure related hydrothorax definitive management

A

Transplant

166
Q

Perductal concentric onion skin fibrosis =

A

PSC

167
Q

Growth next to nose

A

BCC

168
Q

Itchy, comes and goes

A

Lichen plannus

169
Q

Severe psoriasis not responding to rx rx?

A

Anti-TNFa
Ustekinumab - ant IL-12/23

170
Q

Area of skin that becomes waxy and hyper/hypo pigmented
Trigger of trauma or infection?

A

Morphoea

171
Q

History of funny turns whcih improve after sugary tea and raised Ca on bloods

A

MEN1

[insulinoma -> funny turns]

172
Q

Peristomal pyoderma gangrenosum not responding to oral steroids

A

Infliximab

MRCP 2 (5 decks)

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