Derm + Surg Flashcards

Question 1

Q

KeratoConjunctivitis - eye
GingivoStomatitis - tongue
Herpes labial - COLD SORE - lips
Finger herpetic whitlow - finger

Severe: TEMP lobe encephalitis, esophagitis,
erythema multiforme.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Genital warts - painful
\_\_\_\_
\_\_\_\_

Fever initially - Mild Systemic upset
Itchy rash:
head/trunk –> spread
Mac –> Pap –> VESICLES

oval-VESICLES @palms/soles/oral mucosa
-SORE throat unlike chicken pox
-HIGH-temp
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
-Fever, 
-SORE throat - pharyngitis - 
-PALATAL PETECHIAE
-C. Lymphadenopathy 
-HSM - Burkitt / Nasoph cancer / Spl. rupt

(AVOID contact sport for how long?)

__________________

IC - HIV/transplant pt:
Fever, 
Rash/petechiae at day 4 to 6:
trunk --> forearms / face; 
 commonly present, lymphadenopathy C. -Lymphadenopathy 
-HSM

PRCE: pneumonitis, retinitis, conjunctivitis, encephalitis
____
____

HIGHHHHHHH fever = few days

thennnnnnnnn —–>

-MacPap RASH - all over body

-NAGAYAMU papular spots:
@uvula and soft palate

Answer

A

HSV 1
\_\_\_\_
HSV 2
\_\_\_\_
\_\_\_\_

HHV 3 - Chicken pox
-Hand Foot Mouth Coxsackie #vesicles too!!
-BUT NOT a herpesvirus (only added here to compare vesicle business)
\_\_\_\_
HHV 4 - EBV monospot pos+
-avoid contact sport for 8 weeks
\_\_\_\_
HHV 5 - CMV monospot neg-
\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_

Roseola SIXTH disease
HHV6 URTI
#RSH

Question 2

Q

Nagayamu PAPPPPPPP spots @UVULA/Soft palate

Palatal petechiae

Koplik white spots - ‘like salt’ buccal

Forscheimer RED spots/MACCCCCULES @soft-palate
- ?nationality = Forscheimer sound like?!
_________

3. 
Brain CALCification/ SMALL
SENSORI-neural deafness
-ChorioRetinitis (white + RED)
-TCP -iuGR

Seizures -HSM
Blueberry muffin rash

________________

Brain CALCification,
-HYDROcephalus
-Chorioretinitis (white, overlying VIT inflamm)

-Seizures -HSM
-Blueberry muffin rash
?erythema multiforme

Tx?
__________

Ear, Eye, Heart dx

a-EARRR: Sensorineural DEAF,

b-EYEEE: Smaaaall-Eyes
CATARACT/ ACAG
——‘SALT-pepp’ CHORIOret

c-HEARTTT: CongenHeartDx - ?WHICH one?

NOOOO Seizures -HSM
Blueberry muffin rash

Answer

A

Rosela 6th HHV6
-Nagayamu NagPap

EBV hhv4

Measles

Rubella (back+forth...MAC+Forsch...)
GERMAN MEASLES aka Rubella!!! 
-FORSCHEIMER WAS GERMAN!!!
-Forschiemer also seen in Rubella/Measles/Scarlet Fever
\_\_\_\_\_\_\_\_\_

CMV

SEEEE-MV
Sensorineural
SMALL brain / plts

sensorineural = cmv + rubella

ganciclovir
________________

Toxo
-spiramycin
_______
Rubella
- ears, eyes, heart - PDA

Question 3

Q

‘Slapped-cheek’ rash - - >

PROX arms
EXTensor surfaces
Nasolabial SPARING

Kids: 4 - 10 years

Lethargy, fever, headache

_____________

HIGHHHHHHH fever = few days

thennnnnnnnn —–>

-MacPap RASH - all over body

-NAGAYAMU papular spots:
@uvula and soft palate

Febrile SEIZURES 10-15%,
Aseptic MENINGITIS;
COUGH and Diarrhoea - common
ENCEPHALOpathy

Answer

A

PFI: PARVO Fifth Infectiosum

infection @pregnancy –>

Anaemia, fetal hydrops, and fetal death
Sickle-cell Hemolysis Aplastic Crisis

__________

Roseola SIXTH disease
HHV6 URTI
#RSH

Question 4

Q

DON’T apply POTENT csted for more than ??????? weeks at any one site.

Advise(?? -> ??)
How many weeks break?
worsened by?

PRESENT?

Chronic plaque psoriasis - trunk/limbs

Scalp psoriasis

Delicates: Face/Flexural/Genital psoriasis

W1-4: mild/mod potent csted 2w only
W4+: check CDT, csted tx break/4w, repeat/refer

Answer

A

DON'T apply POTENT csted for more than EIGHT!!!! weeks at any one site.
-Advise(8w csted max->
- 4w break)
-worsened by LITHIUM + BetaBlockers!!
\_\_\_\_\_\_\_\_

-PAPAA leaflet
-Rv CDT / 4 weeks -> annually
(CDT: Compliance, CI, Decline, Tol)
-EMOLLIENT
-Smoking Alcohol WL
-EMOLLIENT
-Not infectious
-Top: POTENT csted/VitD/Coal-Tar/Dithranol
_______________

Chronic plaque psoriasis - trunk/limbs: 
W1 - 8 Emollient
-CSTED <4-8w OD
and
-VIT-D OD
-@w4: check CDT+Advise(8w csted max->4w break)

W8 - 12 Emollient = ?4w steroid BREAK
-VIT-D BBBD

W12 - 16: Emollient
-CSTED <4w BBBD
OR
-COAL TAR O/BD

W16+ Emollient

CSTED+VIT-D 4 weeks OD
Dithranol

Refer for:
Tacrolimus, 
NBUVB>PUVA
MTX Ciclosporin Retinoid
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Scalp psoriasis:

W1-4:

CSTED OD
VIT-D OD @csted CDT
COAL TAR Shampoo @mild/mod
COAL TAR Shampoo + csted/vit-d @severe

W4-8:

Check CDT+Advise(8w csted max->4w break)
Diff csted formulation - mousse/shampoo
Thick scale: warm MOSC: mineral/olive/salicylate/coconut oil

W8+:
-CSTED+VIT-D 4w OD
-CSTED vPotent 2w
-VIT-D OD @csted CDT + mild/mod
-COAL TAR Shampoo + csted/vit-d
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Delicates: Face/Flexural/Genital psoriasis

W1-4: mild/mod potent csted 2w only
W4+: check CDT, csted tx break/4w, repeat/refer

Question 5

Q

-steroid cream till ? HOURs after flare-control
-steroid cream @delicate face/fex for ? days
___________

fever/malaise + Weep, Crust, Pustules
-Dx? Tx - local / ext / refer when?
______________

-WIDESPREAD lesions
-BLEEDing, ?COALESCE, DENUDED, Extend over body
-2ndary infection w/ Staph/Strep
___________

DIRT: mnemonic?

Dry + Itch = …
-Mild: Itch INFREQ +/- Red

-Mod: Itch FREQ + Red +/- Thick+Excor

-Severe: Itch INCESS + RED +/-
Thick+Excor + Bleed/Crack/Ooze/Pigmented

Tx?

Answer

A

Eczema - Atopic dermatitis

steroid cream till 48 HOURs after flare-control
steroid cream @delicate face/fex for 5 days

Infected eczema
-Local = Top ABx +/- csted <2w
-Ext = PO ABx Fluclox/Erythro + SwabC+S, 
-Refer = 2ww @not-respond
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Eczema herpeticum - HSV 11111111 !!!!!!
__________

DIRT: Dry Itch Red (mod) Thick/Exco (severe):

Emollient 10:1
Hydrocort 1%
BetaMeth 0.025% / Clobet 0.05%
BetaMeth 0.1% / PredPO 30mg @ psych distress

AntiHist = non-sed / sedating
Bandage - dry/occlusive
C.sted maintinance
Ci - tacrolimus

Refer: SURSI
Suspect dermatitis, 
Uncontrolled, Uncertain ddx
Recurrent 2ndary infection, 
Sig psych/social issue
Infected = 2ww @I.E. not respond/ ASAP @E.Herpeticum
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Question 6

Q

typically <2 months of age, non-pruritic

thick SCALE in scalp

?nappy area, periNASAL area, eyebrows, glabella

Answer

A

Seborrhoeic dermatitis - cradle cap

Baby oil / shampoo
Top hydrocort MILD

Question 7

Q

a morbilliform (measles-like) drug eruption, acutely unwell patient with fever, abdominal pain, and facial swelling

recent use of sulfonamides, anticonvulsants, allopurinol, and minocycline; also associated with use of carbamazepine; medicine intake may be 2 to 6 weeks prior to symptom development

diagnosis is clinical, and tests are not routinely recommended \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

maculopapular rash; 
pharyngitis common, oral erosions
petechiae, 
conjunctival haemorrhage; 
 (encephalitis/meningitis) (myocarditis) rare

eosinophilia, atypical lymphocytosis

Answer

A

Drug reaction with eosinophilia and systemic symptoms

_____________

Entero/Echovirus

Question 8

Q

painful skin lesions, dusky with early erosion and mucous membrane involvement

-Viral: HSV
Bact: Mycoplasma/Strep
Coccidio/Toxo

-Haem cancers

-Sulfonamides, 
OCP
Allopurinol/Aspirin NSAID
Penicillin, possible herpetic infection
-carbemazapine carbemazapine  carbemazapine carbemazapine  carbemazapine carbemazapine

Answer

A

Erythema multiforme
-SJS / TEN

AntiHist
Csteds
Emollients

IVF + Mouthwash antiseptic

Question 9

Q

fine morbilliform-MEASLES-LIKE
eruption trunk and upper arms, occasionally palms and soles; lasts for 4 to 5 days, resolves spontaneously
_____________

rash may be maculopapular;
RUQ/jaundice? random AF mate
_________

malnourished person 
grey stools/diarrhoea 
intolerant to bread 
papules and vesicles 
rash @bum/extensors

Answer

A

HIV-seroconversion exanthema
_____________
Acute hepatitis B/c virus infection
_______

Dermatitis Herpetiformis
-Top Dapsone

Question 10

Q

(Forscheimer Petechial MACules @soft palate)

prodrome of fever, headache

Rash: pink MacPap @face –> whole body

Usually fades by the 3-5 day

Lymphadenopathy: SUBOCCIPITAL and postauricular
__________

Eye: cataract - small eyes - Salt-Pep ChorioRetinitis

Ear - SENSORI-neural

Heart - PDA

Answer

A

Rubella

Congen Rubella

Question 11

Q

Prodrome: irritable, CONJUNCTIVITIS, fever

WHITE spots (‘grain of salt’) @buccal mucosa

MacPap Rash: behind EARS/HAIRline –> body

blotchy + CONFLUENT

-what are those spots called?

Answer

A

Measles

White spots = Koplik

Question 12

Q

Rxn to erythrogenic toxins produced by GAS

Fever, malaise,

SPARING Rash AROUND mouth
-Circumoral palloooor

SANDPAPER Rash #fine-punctate-erythema

‘Strawberry’ Tongue
-Tonsillitis #palatal petechiae

Dx? Organism? Tx?
_________

Joint - polyarthiritis
O-Carditis 
Nodules - subcut
Erythema ?
Sydenham Chorea

Dx? Organism? The rash???
________

Target lesion (which one?)
Bit my tic
-Went in fields/abroad
-Heart-Block

Rash? Dx? Organism? Tx? Ix?

Answer

A

Scarlet fever

GAS-pyogenes
PMP-V

-Sandpaper rash, Strawb tongue
________

Rheumatic fever
-GAS-pyogenes
-Erythema Marginatum
_______

Erythema Migrans

LYME Dx - Borrelia Borgdorfei
Doxy
ELISA

Question 13

Q

echo: may show dilated coronary vessels

C - CONJUNCTIVITIS b/l and bulbar without discharge and sparing of the limbus
R - RASH polymorphous generalized ?perineal desquam
A - Adenopathy-CERVICAL>=1.5cm
S - STRAWB tongue /dryness and lips fissuring/oral mucosa erythema
H - Hand and feet DESQUAM of fingers/toes, erythema @ palms and soles

Dx? Tx? Large / Med / Small vessel dx?

Answer

A

Kawasaki disease

Aspirin,
Echo
IVIG

Large: GCA / Takayasu

Med: Kawasaki / Buerger / PAN

Small: The rest vasculidities are small

Question 14

Q

lesions at SITE of

jewelry/belt buckle/button/watch (nickel),
eyelid (nail polish allergy),
forehead and both eyelids (shampoo allergy)

WEEPING eczema

Dx? Tx? What test What mediated?

Used for food allergies / inhaled allergens
-Skin Prick -> RAST

Used for contact dermatitis - allergic?
-PATCH

Cement = contact dermatitis allergic + irritant due to:

alkaline - ?
dichromates - ?

Answer

A

AAAllergic contact dermatitis -
pAAAtch testing

Avoid stimulus (AHist not recommended)
Csted
Emollient
SOAP sub

HSR4 Delayed Th1 Cell-mediated

GvH/GBS
Allergic dermatitis
TB
EAAlveolitis chronic
Scabies

*T3HSR=S-LIT-E
SLE
SickSerumSinusNTSE
StrepGN, 
EAAlvelotisAcute AKA HSR-pneumonitis
\_\_\_\_\_\_\_\_\_

Cement = contact dermatitis allergic + irritant due to:

alkaline - irritant
dichromates - allergic

Question 15

Q

eczematous/lichenified/scaly - patterns suggestive of exposures

hands [detergents / cleaners]
buttocks [nappy rash - flexural sparing!!]

Dx? What test? What mediated?

Cement = contact dermatitis allergic + irritant due to:

alkaline - ?
dichromates - ?

Answer

A

Irritant contact dermatitis -
skin prIIIIIIIck
IgE mediated

Cement = contact dermatitis allergic + irritant due to:

alkaline - irritant
dichromates - allergic

Question 16

Q

Eczematous lesions on the sebum-rich areas:

Scalp (may cause dandruff),
Periorbital,
Auricular and
NASOLABIAL folds

Otitis EXT + Blepharitis
Assoc w/ HIV / Parkinson’s

Scalp beard Tx? KISS
Face body Tx??

Answer

A

Seborrhoeic dermatitis in adults

Scalp and beard:

1a. Ketocon 4w/Selenium sulphide2w Shampoo
1b. Zn pyrithione H+S / Coal Tar T-Gel

Itch @SCALP only:
Potent top csted BetaMeth/Mometasone 0.1%
<4 weeks
Scales - Warm MOSC* hrs B4 shampooing
*Mineral/Olive oil/Salicylic acid /Coconut oil
__________________
Face and Body:
Ketocon @adults/teens - 4w
Clomit v Micon @ kids - 4w
+/- Hydrocort MILD top <1-2w
Eyelids: cotton bud baby shampoo

Question 17

Q

FLAT pink and blotchy #vascular
Since BIRTH -> disappears by 2yr
-forehead/eyelids/neck nape
BLANCHES - 
\_\_\_\_\_\_\_\_\_\_\_\_\_

small BRIGHT Red LUMP 
NOT present @birth -->
develops @1st MONTH of life -->
Inc SIZE / VASC till 9 months
\_\_\_\_\_\_\_\_\_\_

Purple flat
Face as a purplish/red macule with irregular contours.
NOTTTTT resolve!!!!!

Assoc with intracranial vascular abnormalities like Sturge-Weber-Syndrome.
__________

bluish discolouration
@lower back and buttock
-disappear by 1 year of age.

Answer

A

Salmon Stork Patch - NAEVUS simplex
-Marks on the neck may persist.
______________

Strawberry Infantile Naevus Capillary haemangioma
SINC hemangioma
______________

Port wine stains AKA naevus flammeus
-need cosmetics / laser therapy.
FLAT BASTARD FLAT FLAT FLAT

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwjFvZiiuN_uAhUxonEKHV5wBbkQFjABegQIBhAC&url=https%3A%2F%2Fwww.gosh.nhs.uk%2Fconditions-and-treatments%2Fconditions-we-treat%2Fport-wine-stains%2F&usg=AOvVaw3wRAHI5vJTrs2C0dC2OPnL
_______________

Mongolian Blue Spot

Question 18

Q

Near Menopause
Dilatation of the large breast ducts

GREEN nipple discharge
_________

Local areas of epithelial proliferation in large mammary ducts –>

Blood stained discharge

Answer

A

Mammary duct ectasia
_________

Duct papilloma PRoflieration

bloody paps!!

Question 19

Q

small, crusty, scaly, lesions

yellow pink, red, brown
irregular, kind of like covering loads of patches

-SUN-exposed areas e.g. temples of head
_________

localised, demarcated really WELL
-Unlike acinitic keratoses

Answer

A

Actinic keratoses premalignant skin lesion consequence of chronic sun exposure
5FU, Imiquod, Cryo, Surg Moh

Bowens = localised, demarcated really WELL

Question 20

Q

large variation in colour from flesh to light-brown to black

have a ‘stuck-on’ appearance

Sudden on set Seb keratoses sign of?
____________

@birth
> 1cm diameter

Increased risk of MALIGNANT TRANSFORMATION (increased risk greatest for large lesions)
____________

CIRCULAR macules 
HETERGENEOUS colour  
palms, soles and mucous membranes
-Can develop into..?
\_\_\_\_\_\_\_\_\_\_\_

DOMED pigmented nodules < 1cm
-Arise from JUNCT naevi uniform colour
-HOMOGENOUS colour
__________

develop few months
in KIDS @face / legs
-pink or red <1cm

Answer

A

Seborrhoeic keratoses

Lesar Trelat - GI/Visceral malignancy
___________

Congenital melanocytic naevi
\_\_\_\_\_\_\_\_\_
Junctional melanocytic naevi
-can develop into Compound naevi
-Circular HETEROgeneous 
\_\_\_\_\_\_\_\_\_\_

cOmpOund naevi
-domed hOmOgeneous
__________

sPPPitz naevus
-PPPink red

Question 21

Q

Erythema w/ Papule/Pustules
@Forehead, Nose, Cheeks

1-Mild-Mod: ltd pap/pust ?-?w
2-Mod-Severe pap/pust +/- PLAQUES ?-?w
3-Fail?
______________

Flushing - ???
Ocular blepharitis/conjunc/keratitis - ???
Rhinophyma - ???
Telangiectasia - ?? / ?? / ??
Exacerbated by ???

Clinically Inflamed Phymatous Acne Rosacea tx?

Answer

A

Acne rosacea

8-12w
1-Top IVERMECTIN antihelminth >
Top Metro/Azelaic @ Unavail/Preg/BFeed

2 … AND
-PO DOXY MR / Erythro @Preg/BFeed

Cont 12-16weeks –> Refer
_____________

Flushing/Erythema - Brimonidine alpha-ag
Ocular blepharitis/conjunc/keratitis - WMDa ALI
Rhinophyma - Plastics
Telangiectasia - EDessic/IPL/YAG
Exacerbated by: CCB/Cted/Sun

CIPAR: Doxy MR
_____________

WMDa ALI:
warm comp/rmassage @post-bleph, debris removal/Ax tx - ?ABx, Artificail tear/lube#hypromellose, Lens reduce/change, Incr humidity-lower comp screen = lower lid aperture

Question 22

Q

HBC SHLD

painful genital ulcers - HBC
-painFUL Unilat Ing NODE sharply defined, ragged, undermined border - ddx? organism?

______________

painless gential ulcers - SHLD

warts: plantar , common , anal
–Tx @single wart @multiple wart?
painLESS ulcer, painFUL Ing nodes, ProctoColitis- ALTERED bowel habits - ddx? organism?
painLESS ulcer, “beefy-red ulcer” + characteristic ROLLED edge of granulation tissue - ddx? organism?

CHD, LGC, DGIK

Answer

A

PAINFUL ulcers
-Herpes painful nodes
-Behcet - uveitis VTE and painful ulcer
-Chancroid-HDucreyi=
painFUL Unilat Ing NODE sharply defined, ragged, undermined border. 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

PAINLESS ulcers
-Syphilis=painLESS Ing node

HPV 1+2=plantar, 4=common, 6+11-anus;
solitary-cryo, multiple-podophyllum

-LGC: LymphoGranulomaChlamydia=
painFUL Ing nodes, ProctoColitis B/C/D

DGiK: Donovanosis Granuloma Inguinale Klebsiella
Azith Cipro Gent

Question 23

Q

Rapidly developing

WIDEspread erythema, –>

white, sterile non-follicular PUSTULES = coalesce to form large LAKES of pus

Fever, malaise, tachycardia,
WL/arthralgia.

Usually presents in people with existing or previous chronic plaque psoriasis
_____________

Diffuse, widespread severe psoriasis =
90% BSA

Pptd by infection irritants -
Coal-tar/Ciclosporin/CstedSTOP/Phototherapy

Fever, malaise, tachycardia,
LNopathy, and peripheral oedema

Answer

A

GPP: Pustular Psoriasis - 999 ADMIT
-Generalized

_____________

Erythrodermic psoriasis - 999 ADMIT
-care of dehydration /infection /CCF-high output

Question 24

Q

Night blindness nyclatopia
__________

Acanthosis nigricans, which cancer?
_______

Acquired icythosis , which cancer?
-ErythroDerma, which cancer?
_________

Acquired hypertrichosis languinosa, which cancer?
__________
Dermatomyositis , which cancer?
__________
Erythema gyratum repens , which cancer?
____________
Necrolytic migratory erythema , which cancer?
_________

Pyoderma ganngrenosum
___________

Sweet syndrome
______

Tylosis

Answer

A

(1.)Vit A def (2.) Ret pigmentosa
__________

Gastric cancer
________

Lymphoma
_______

GI and Lung
_________
Ovarian and lung cancer
__________
Lung cancer
__________
Glucogonoma
________

RA AML IBD Myeloprolif
______

Haem cancers, myelodysplasia
________

Oesophageal cancer

Question 25

Q

PolyNeuropathy, CCF
Wernicke-Korsakoff syndrome

Alcoholic hepatitis = ?
Alcohol DKA = ? + ?

Confusion, Lillepution, Tremor
NOAC
nystagmus, ophthalmoplegia, ataxia, confusion
- PolyNeuropathy
Konfabulaton, Amnesia, Memory
DT syx + autonomic HYPERactivity
- high GGT, high MCV-megalo, CDT

Syx < 12 hrs
Seizures < 36hrs
DT < 72 hrs

Ix:
Low red cell tranSKETOLase
MRI = petechial haemorrhages @mamillary bodies and ventricle-walls.

Answer

A

Thaimine

Vit B1111111111 Ber1 Ber1
-B1T

Alcoholic hepatitis = steroids
Alcohol DKA = IVF + Thiamine

Delirium Tremens
Wernicke
Korsakoff
Alco withdrawal

Question 26

Q

dermatitis
diarrhoea
dementia
-Assoc with FLUSHING + hypoTN... Dx? 
-Takes Isoniazid ..... for TB

__________

reactive arthritis -> thickening of the skin of the palms and soles
___________

sweat excess
damp and excessively smelly feet
-clusters of PUNCHED-OUT PITS
-organism? 
\_\_\_\_\_\_\_\_

pustules @palms and soles
skin = thickened + red
#smokers
________

children = eczema

soles = SHINY and hard
Worse @summer

tiny BLISTERS #eczema
develop across
fingers, palms, soles
-summer time only

Answer

A

Pellagra Niacin B3 def
-B3NP
-Assoc with mets carcinoid!!!
________

Keratoderma blennorrhagica
________

Corynebacterium Pitted keratolysis
___________

Palmo-Plantar Pustulosis
________

Juvenile plantar dermatosis
SHINY, Sweaty feet syndrome
(Sweaty feet = IVA remember!!!)

PomPholyx Dyshidrotic Eczema
-BLISTERS

Question 27

Q

Anaemia, irritability, seizures

Dermatitis, seborrhoea
____________

MEGALO-anaemia, deficiency @preg -> NTDs
-AFP -> USS -> Amniocentesis w16-20

MEGALO-anaemia, peripheral neuropathy
____________

Haemolytic anaemia @newborn
-ataxia, peripheral neuropathy

HAEMORRHAGIC anaemia @newborn
_________

Bloodshot Itchy eyes,
angular stomatitis,
cracked lips

Anabolic steds
Buserelin
Cimetidine/Cannabis-WEED
Digoxin
Estrogens
Finasteride 
Goserelin
HyperT/Hcg-seminoma
Isoniazid
Jaundice-LF
KleinFeltHerTits
K-sparing-SPIRO
Ketoconazole

Answer

A

Pyridoxine B6

Biotin 7/8
_________

Folic acid

B12 CyanoCobalamin
_________

Tocopherol - Vit E

Vit K
-Breast-fed babies @risk
_______

Riboflavin - B2

Anabolic steds
Buserelin
Cimetidine/Cannabis-WEED
Digoxin
Estrogens
Finasteride 
Goserelin
HyperT/Hcg-seminoma
Isoniazid
Jaundice-LF
KleinFeltHerTits
K-sparing-SPIRO
Ketoconazole

Question 28

Q

Earache/TUGGING/rubbing/crying/restlessness
ear reveals a BULGING tympanic membrane.
speech and language SALT delay,
Behavioural / Balance problems
@otoscope =
Effusion and AIR / FLUID levels/BUBBLESw/
normal/RETRACTEDDDDDDD tympanic membrane landmarks
#conductive hearing loss.
2 WEEKS!!!! persistent inflammation and
PERF of the tympanic membrane with discharge
@otoscopy = erythema/injection of tympanic membrane

Answer

A

AOM: earache/TUGGING/rubbing/crying/restlessness
ear reveals a BULGING tympanic membrane.
OME (glue ear) —
@otoscope =
effusion and air fluid levels/bubbles w/
normal/RETRACTED tympanic membrane landmarks
#conductive hearing loss.
speech and language delay, behavioural or balance problems
CSOM — 2 WEEKS!!!! persistent inflammation and PERF of the tympanic membrane with discharge
Myringitis — @otoscopy = erythema/injection of tympanic membrane

Question 29

Q

Recent holiday
HypoPigmented
Flaky/Rough

Ix?
Preg/BFeed CI??
Tx?

Relapse prevention/Prophylax?
_____________
Ill-defined, scaly, mildly ERYTHEMATOUS patches of uncertain cause,
@faces of children + young adults.
ERYTHEMATOUS Patches -> leave areas of HYPOPIGmentation
__________

recent VIRAL infection - malaise
Herald patch
MACCCCCular rash - usually on back/TRUNK) –>
Ooooval, Scaaaaly fir-tree

resolve: <3 months
________________

recent Tonsillitis - GAS-PPPyogenes
PAPPPPPules
SCALE
face, ears, and scalp

Answer

A

Pityriasis versicolor
Ix: skin scraping MCS
Preg/BFeed CI: Selenium / Flucon/Itracon

Tx:

Advise - recurrence @hot temp
Selenium sulfide shampoo @EXT
Ketocon shampoo @EXT / Preg/Bfeed
Imidazole @SMALLarea=MICE
Flucon/Itracon PO @tx fail –> Refer

RelapsePrev/Proph: Repeat ASKIF or Ketocon
______

Pityriasis ALBA 
Erythematous patch -> HypoPigmented  
--resolving 1 month to 1 year.
\_\_\_\_\_\_\_
Pit ROSACEA - self limiting MACCCC
-resolve in 6-12 weeks
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Guttate - self limiting PAPPPP Scale

GGGuttate-GAS
PPPyogenes-PAP

Question 30

Q

T3 preggers

Pruritic ABDO Striae –> spread
____________________

Pruritic
Umb –> Spread-2-trunk
BLISTERINGGGG
_______

pemphig? = no mucous
@OLD person
membranes
-Anti-?

pemphi? - nikolsy sign
-Anti-?
(anti-?)
**GUS GUIL(ein)-FOY ** LOL

Answer

A

Polymorphic Eruption of Preg
-AHist, Csteds top/po, Emollients

-Pruritic
-3rd trimester
-ABDO Striae –> spread
-ACE
___________

PemphigOOOOOid gestation - POOOOO steds

O looks like fkn belly-button!!! and blisters too!!!
______

pemphigOLD = no mucous membranes
-Anti-HEMI-DESmosome

pemphiGUS - nikolsy sign
-Anti-desmoGLEIN
(anti-desmosome)
**GUS GUIL(ein)-FOY ** LOL

Question 31

Q

FACE/TRUNK
- PUNCTUM ?sebum/discharge

Cyst lining = normal epidermis (??? cyst)

OR

Outer root sheath of hair follicle (??? cyst)
____________

most commonly develop in LIGAMENTS / TENDONS
-Aggressive fibromatosis
-fibroblast dense lesions (resembling scar tissue).
________

Rubbery subcut swelling
-lat aspect of eyebrow
-Following excision it was found to be lined by SQUAMOUS epithelium and HAIR Follicles
____________

PAINLESS areas of YELLOW skin over - waxy
SHIN
abundant telangiectasia
________________

ABx? - Erythrasma Tx
________

smooth
mobile
painless - Dx?

Size >5cm
Increasing size
Pain
Deep anatomical location - Dx?
\_\_\_\_\_\_\_\_\_\_\_

Benign lesion.
-Firm ELEVATED nodules
-Hx of trauma
-Females + Lower legs 
-often LARGER than they APPEAR
\_\_\_\_\_\_\_\_\_\_\_

Swelling tendon sheath
-near a joint/wrist hand
-remember the case with Osborne SCF Reg?
___________

red-blue papules #haemorrhagic
-sheep and goats
___________

superficial infection of the HAIR follicles –>
papules / pustules
_________

E.Nodosum Ax
-Mx?

Answer

A

Epidermoid = cyst lining
Pilar = Outer-root sheath HAIR-FOLLICLE

#BOTH SEBACEOUS
\_\_\_\_\_\_\_\_

Dermoid cyst
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Desmoid tumours 
-should be managed in a similar manner to soft tissue sarcomas. 
\_\_\_\_\_\_\_\_\_

Necrobiosis lipoidica diabeticorum
___________________

Erythromycin - Erythrasma Tx
____________

Lipoma - Ultrasound @ > 5cm

Liposarcoma
________

Dermatofibroma
_____

Ganglion Cyst
______

Orf - PoxVirus
________

Folliculitis
-@shave = pseudoFolliculitis #Barbae
________

E.Nodosum = PAIN
No Cause - idiopathic
Occult cancer
Drugs - -Sulf,OCP,Allop,Penicillins
Other = Pregnancy/GAStrepPyog
Sarcoid
UC/Crohns
Myobact

erythema nodosum Mx

No active treatment
Arrange routine FOLLOW-UP

Question 32

Q

Heavy 
Dermatitis Eczema 
Pigmentation brown
LipoDermatoSclerosis 
Ulcer @MED-MALLEOLUS
Gangrene
-Location ABOVE the ankle, painLESSSSS

Venous ulceration
above MED or LAT malleolus???

Superficial venous insuff = ??
Deep venous insuff = ???

venous insufficiency –> Venous ??–>

capillary ?? cuff
WCC sequestration

Doppler USS looks for ??? and
Duplex USS looks at the ???

Tx: 
Exclude ?? --> ? or ? --> ?? @:
- Fail to heal after ?? wks or 
- >??cm^2 skin 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Occur on the TOES / heel
There may be areas of gangrene
Cold with NO palpable pulses
Pain???
Low ABPI measurements
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Pulses FINE
AND 
Warm foot
Charcot/Claws/Cavus Pes: Plantar surface of metatarsal HEAD and plantar surface of hallux
Due to pressure
Management includes ??
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

FRIABLE growing lesion = initially appeared as
RED papule –> CRATER filled CENTRALly w/ yellow/brown material
_________

Have some kind of 
LONG-STANDING issue
e.g. Ulcer/Burn for YEEEEEEARS
thennnnn get some ulceration...
What is it???

Answer

A

Venous ulceration
-above MED malleolus

Superficial venous insuff = varicose veins
Deep venous insuff = prev DVT and

venous insufficiency –> Venous HTN –>

capillary FIBRIN cuff /
?? sequestration

DoppleRRR USS = for RRReflux and
Duplex USS = for Anatomy/ Flow

Tx: 
Exclude ART dx --> 
Pentoxifylline OR
4 layer compression banding --> 
Grafting @:
- Fail to heal after 12 wks or 
- >10cm^2 skin

Prev: Grad Comp Stocking @healed
_____________________

ART ulcers - LOW ABPIs
Occur on the toes and heel
PainFUL-punched out
?gangrene
Cold with NO palpable pulses
Low ABPI measurements
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Neuropathic ulcers
Commonly over PLANTAR surface of:
-metatarsal head / hallux
Due to PRESSURE
Management includes CUSHIONED shoes to reduce callous formation
-CHARCOT joints
\_\_\_\_\_\_\_\_\_\_\_\_\_

Keratoacanthoma
_______

Marjolin ULCER

Question 33

Q

Hyperhidrosis tx AiBS
_____________________
First-line treatment on his psoriatic plaques?
________
Actinic keratoses tx?
________________

melanoma:

Back, Arms, Chest, Legs @YOUNG
Chronically sun-exposed skin, OLDer people
Red or black lump, oozes or bleeds, sun-exposed skin
Nails/palms/soles BAME - Subungual pigmentation sign???
______________

Morphoeic BCC - ??? microgaphic surgery

Answer

A

1. 
Aluminium
iontophoresis - palmar/plantar/pits
Botox
Surgery-Sympathectomy
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
2.
Top csted + Top Vit D3 calcipotriol
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
3.
sun cream
imiquimod
cryo/curettage
5FU+hydrocort/diclofenac top @mild

similar to BCC
__________________

Melanoma:

Superficial
LentigOLD
Nodular AGGRESSIVE melanoma: Red or black lump, oozes or bleeds, sun-exposed skin
Acral - Subungual pigmentation (Hutchinson’s sign)

Hutchinson

HZO - corneal dx @nosetip V1
Pupil = uncal / TTentorial herniation
acral melanoma

___________________

Morphoeic BCC - MOH microgaphic surgery

Question 34

Q

Impetigo tx - something changed… WHAT??!

NON-bullous localised?
NON-bullous widespread?
Bullous / systemically unwell

School / work exclusion?

Scarlet fever 1d after ABx
Pertussis 2d after ABx Azith-Clari/21d after no ABx
Impetigo 2d after ABx
Measles/rubella = 4 rash onset after
Mumps = 5 days Parotitis onset
Chicken pox = all scabbed over
Scabies = all healed
Flu = all healed

_________________

Obese RECURRENT boils 
@intertriginous area - AXILLA
large red lumps
scarring/sinus tracts - rope-like
little hole with pus discharging

Answer

A

Hydrogen peroxide
Fusidic acid
Mupirocin
Fusidic acid
Mupirocin
Fluclox/Erythro
Fluclox/Erythro

Stay away from school/work till
-crusted/dry/healed
-48hr after ABx
_________________

Hidradenitis suppurativa:

Smoke
Alco
WL/ Hygiene

Csteds: intra-lesional/ PO

Acute: Fluclox I+D
Chronic: Top Clinda/ PO lymecycline

Question 35

Q

SUDDEN, patchy patchy patchy patchy patchy patchy patchy patchy hair loss

NON-SCARRING

Exclamation mark sign

?Ai assoc/dx

Tx:
No hair regrowth - <50% = ?
No hair regrowth - >50% =
? For how long? –> ?

Refer ?
____________

Male pattern baldness - FAMILIAL

distributions?
Dx?

Chemo/ISup/RT -> rapid hair-loss
-Dx?

Infection/hormonal #RECENT BRITH stress ->
hair move to tologen/dormant phase #loss
-Dx?

XS pulling on hair shafts

Indo-pak / Black
Dx?

Answer

A

Alopecia Areata

Hair regrowth – short/fine/depigmented = No tx

Tx?
No hair regrowth - <50% = WW
No hair regrowth - >50% =
-potent / v.potent 3m csted –> refer CiP

Refer = C i P A

Csteds: intralesional/po
immunotherapy/supp,
PUVA
TAPD screen #Ai dx: thyroid addisons pernicious dm

_____________

Male pattern baldness - FAMILIAL

Alopecia AndrogenETIC
bitemporal
central

Chemo/ISup/RT -> rapid hair-loss
-Anagen Effluvium

Infection/hormonal #RECENT BRITH stress ->
hair move to tologen/dormant phase #loss
-Telogen Effluvium

XS pulling on hair shafts
-TRACTIONAL Alopecia #Sidra

Question 36

Q

Vitiligo tx
_________________

pRuritic, pOlygonal, pApular, puRple
Wickham lacy striae
Oral mucosa involvement
Nail stuff
SquamousCC

-ACEi/Thiazides/Methyldopa
-NSAID/Chloroquine/DM drugs
____________
____________

White Itchy Spots @
OLD vulvas (VIN) /
Dicks (phimosis/zoon balanitis)

Answer

A

Vitiligo:
Top csted + ci-tacrolimus
NB-UVB

Lichen planus:
Top csted + ci-tacrolimus
____________
____________

Lichen Sclerosis:
Top csted + emollient

Question 37

Q

For all fungal - captia/corpora/cruris/pedis - Ix????

Tinea capitis tx
Urban Tricophytan - ?? - LFTs
Rural Microsporum - ? / ? 
Transmission reduce: ?? / ?? 
Refer @??

Painful, PUSTULAR boggy masses = 
THICK crust (???) - tx?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Inappropriate top csted use --> ext spread + change in lesion morphology ???
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Tinea Corporis/Cruris
Annular, erythematous pap/pustules

Tinea Pedis
________________

Fungal nail infection

Answer

A

For all fungal - captia/corpora/cruris/pedis - Ix???? Scraping MCS + contacts

Capitis - ScrapingCS pt + contacts:
Urban Tricophytan - TERBINAF PO - LFTs
Rural Microsp RUBRUM - GRISEO/Itracon PO
Transmission reduce: selenium sulf/ketocon 
Refer @CDTFail

Painful, PUSTULAR boggy masses =
THICK crust (KERION) - REFER
_________________

Tinea INCOGNITO — inappropriate top csted use –> ext spread + change in lesion morphology
__________________

mild: MICE/TopTerb +/-
csted mild potent 7d @itch/inflame –>
severe/ext: PO Terbinafine>Griseoful/Itracon

mild: MICE/TopTerb/UndeCenoic/Tolnaftate +/-
csted mild potent 7d @itch/inflame –>
severe/ext: PO Terbinafine>Griseoful/Itracon __________________

Self-care: SAAdc
Amorolfine: 6m finger / 9+m toe
-even on area of paronychiaaaaa
Antifungal PO - Terbin / Itra (TI-IT) > Griseo
-Dermatophyte:
1. PO Terbinaf <3m finger/<6m toes 
2. Itracon x2 finger/ x3 PULSED toes
-Candia:
1. Itracon x2 finger/ x3 PULSED toes
2. PO Terbinaf <3m finger/<6m toes 
Monitor nail growth 3-6m after tx

Question 38

Q

Acne vulgaris - SCAR

s=RAC
c=DC
a-i
r=CAP

Answer

A

SINGLE - Mild-mod: RAC 8-12wks
Top Retinoid Adapalene +/- BPO
Top Azelaic acid
Top Clinda + BPO = prevent bac resist

COMBO - Mod: 8-12wks

Doxy/Lyme 3m > Erytho
COCP @women

ABx x2 fail / Scar - ?Isotret refer

Refer @ CAP
-conglomata/fulminans/
-ABx x2 fail / Scar - ?Isotret refer
-psych dx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Isotret - dry skin/terato/depression

Question 39

Q

ROLLED Raised PEARLY edge; 
SLOW growing
TELANGIECTASIAS @lesion;
-Nodule on the skin
- Tx?

Actinitc keratoses tx?

Sun PUVA
IC - hiv/transplant
Cigarettes
Keratoses
-?Dx (on any sun-exposed area eg forehead, feet, arms, back, ears)
-sq in situ - ?Dx = WELL-DEMARCATED + isolated
-keratoacanthoma

Have some kind of 
LONG-STANDING issue
e.g. Ulcer/Burn for YEEEEEEARS
thennnnn get some ulceration...
What is it???

Answer

A

Surgery/RT 
imiquimod
curettage/cryo
5-FU
similar to actinitc keratoses tx

Squamous CC
Keratoses
-acitinic (on any sun-exposed area eg forehead, feet, arms, back, ears)
-sq in situ - Bowen = WELL-DEMARCATED + isolated
-keratoacanthoma

MARJOLIN!!! Type of SqCC

Question 40

Q

Hirsutism vs Hypertrichosis
___________

What % of FOBT is positive? I.E.What’s the PPV?

What’s % of FOBT is an adenoma?
______________

MUCINOUS RIGHT-sided Colonic tumours
FEWWWWWW Polyps @colon

-POLYPS @Gastric + Duodenal
-ADENOMAS @colon
—-OSTEOMAS in WHAT?!?!
____________

Pigmented lesions @MOUTH (~HHT)
HAMARTOMAS @intestine #BENIGN
INTUSSUSCEPTION/ Obstruction EPISODIC

___________

Trichilemmomas*
MACROcephaly
Intestinal HAMARTOMAS

*benign follicular neoplasms @outer root sheath of the PiloSeb glands
____________

Answer

A

Hirsutism:
PCOS
CAH
Obesity
Syndrome CUSHING

Hypertrichosis:
Porph cut tardis
Anorexia nervosa - lanugo
Congen Languinosa
Congen Terminalis
\_\_\_\_\_\_\_\_\_\_\_\_\_

5-15%

30-45%
______________

HNPCC Lynch

MSH2 gene = DNA mismatch
Gastric/SBowel
ENDOMET/Bladder

FAP - Dom = APC gene
-Gardener Syndrome get OSTEOMAS!!!
_________

Peutz -Jeghers - Dom
-STK11 (LKB1) 
-Breast/Panc/Ovarian cancers
-Gynae cancer (except Endomet)
-Testicular cancers
\_\_\_\_\_\_\_\_\_\_

Cowden dx - Dom £10-bet

P-TEN
Breast, Endomet, Thyroid

_________

Question 41

Q

Nagayamu PAPPPPPPP spots @UVULA/Soft palate

Palatal petechiae

Koplik white spots - ‘like salt’ buccal

Forscheimer MACCCCCULES @ mouth

Answer

A

Rosela 6th HHV6
-Nagayamu NagPap

EBV

Measles

Rubella (back+forth…MAC+Forsch…)
GERMAN MEASLES aka Rubella!!!
-FORSCHEIMER WAS GERMAN!!!

Question 42

Q

Intermittent tingling, numbness or altered sensation and burning or pain in the distribution of the median nerve (the thumb, index finger, middle finger, and radial half of the ring finger).

WORSE @NIGHT and can disrupt sleep.
Symptoms may affect one or both hands.
Pain in the hand may radiate up the arm into the wrist or as far as the shoulder.

Loss of grip strength, clumsiness and reduced manual dexterity for example when doing up buttons.

Assoc w/ carpal tunnel syndrome such as osteoarthritis or inflammatory arthritis.

Exacerbating factors such as sleep, sustained hand or arm positions, and repetitive movements of the hand or wrist.

Relieving factors such as changing hand posture or shaking/flicking the wrist.
Effect on function and activities of daily living (ADLs) including work.

Examine the person looking for:
Signs of CTS (in both hands) including:
Sensory loss in the distribution of the median nerve.
ATROPHY of the muscles of the THENAR eminence.
Reduced strength of thumb ABDuction.

Dry skin on the thumb, index, and middle fingers – trophic ulcers at the tips of the digits may be present.

Phalen’s test is positive = flexing the wrist for 60 seconds causes pain and paraesthesia in the median nerve distribution.

Tinel’s/Durkan’s comp test = positive

Avoid ??

Answer

A

Optimise:

Bone: Ortho/ Rheum
Endocrine: HYPOthyroid/ Acromeg

Avoid REPETITIVE move / SLEEP on arm

BREAK from gardening @Syx onset

Splinting @neutral position

Ortho/Rheum referral - ?csted injection
-Avoid NSAD/diuretics

Question 43

Q

Vascular disease Ix? PAD
? –>
? –>
? –> ?

ABPI range - ??
1.3 or mooooore = ??-->??
0.9 or less = ??
0.6 or less = ??
0.3 or less = ??
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

What vessels mainly affected?

How can iliac be split up?
___________

MOST IMPORTANT RF 4 PAD?

Acute Limb Isc = ?path process

Syx?

Causes? Syx based on cause?
_________________

Answer

A

Vascular disease Ix?
Pulses –>
ABPI –>
Duplex USS –>MR/CT angio

ABPI range? 0.9-1.3

3 or mooooore = DM/RF–>Art Stiff
9 or less = IC
6 or less = CLI Rest-pain/Mix Art-Ven dx
3 or less = ulcer/gangrene/ARTERIAL!!!!!!

_______________

What vessels mainly affected?

Iliac
Fem=Calf

How can iliac be split up?
Int - (Bum=gluteal, ED=pudendal) - LERICHE
Ext - Thigh
________________

MOST IMPORTANT RF 4 PAD?
-SMOOOOOKING

Atheroscl -> Stenosis -> PAD
——————–|–> Stenosis -> Embolus/Thrombus

Acute Limb Isc =
RAPID decr
@limb perfusion

pAin, pAllor, pAraesthesia
pErishing, pOwer, pUlseless

Ax: Embolus V Thrombus

Embolus due to Surg/AF -> CLAPS
- CLaudication NONE
- Acute,
- Profound isch cos not collats formed,
- Skin marbling mottling
Thrombolysis -> Thrombus = opposite…
________________

Question 44

Q

Types of chronic limb ischemia?

??:
@Walk - ? - pedis ?
@Rest - ? - pedis ?
@Walk - ? - pedis ?

??:
@rest = ? > ? weeks
@elevate = ?
@wound HUG = ?

Answer

A

IC and Critical LI

IC:
@Walk - cramp - pedis X
@Rest - relief - pedis felt
@Walk - cramp - pedis X

CLI:
@rest = Pain > 2weeks!!!!!
@elevate = PAllor --> @flat = Red
@wound HUG = PUlseless 
-heal/ulcer/gangrene

Question 45

Q

ALI tx?
__________

What happens as a result of
Revasc of irreversible ischaemic/necrotic limb?

Answer

A

ALI tx: OHAP PEAR SCOLD

Oxygen, Hydration, ACs-lmwh, Paracetamol etc

PCI thrombolysis
Embolectomy
Amputation @UNsalvageable
Revasc = Ix-Duplex USS -->MR/CT angio:
-Endo: Viable limb
-Surg: NON-viable limb

SmokeStop
Clopi 75mg
Obesity tx
Lipids 80mg Atorva
DM tx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Revasc of irrevers isch/necrotic limb -->
Inflamm mediator release --> 
Reperfusion Syndrome - multiorgan dx/death

Question 46

Q

IC Tx? RED padma aban
___________________________

Crit LI TX? PUDI
-wound HUG -> death:
dry = ?
wet = ? + ?
gas = ?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

When Primary Stent Placement okay?

When Primary Stent Placement NOT okay?
Crit LI limb caused by:
-? dx (?)
-? dx

in summary:
Chronic Limb Isch Tx:
IC=RED Crit LI=PUDI

Answer

A

REDs PUDI

REvasc = Duplex USS–>MR/CT angio–>ABAN*
Ex=supervised/unsupervised - push past pain!!!
DVLA - bus/lorry inform -> SCOLD + RF decr

*ABAN: Angioplasty/Bypass/Amputate/NaftiDrofUryl
___________________________
Pain tx = Paracetmol opiods etc - pain team
Urgent vasc referral
DVLA - bus/lorry…
INFORM

-wound HUG -> death:
dry = necrosis = Revasc ± amputate
wet = necrosis + infection = debride ± amputate
gas = c.perfringens = Amputate/BenPen/O2 hyperbaric
___________________________

When Primary Stent Placement okay?
- CritLI=Aorto-Iliac COMPlete dx

Do not offer PRIM STENT PLACEMENT for
Crit LI limb caused by:
-aorto-iliac dx (partial)
-fem-pop dx

Question 47

Q

What descent of ppl risk of AAA?

AAA SCREEN
@Men and women
AGES and RFs?
____________

@abdo palpation = ?Asyx AAA –> ?Ix

Refer people with Asyx AAA that is

3 - 5.4 cm < ?w
5.5/+ cm < ?w

What tests for:
1. ElectiveAAA surgical repair?

-Prevention=reduce rupture risk=?
-Monitoring - ?
____________

@UNNNruptured/Asyx AAA –>
Aneurysm repair @ ?

UNNNruptured AAA Repair options?

EVAR when?

Answer

A

European

Stop smoking/SCOLD
SCREEN = Aortic USS self-refer @:
-Men 66/+ Women 70/+ :
PMH: COPD / CAD PAD Stroke / HTN/lipids
DHx: Smoke / Ex-smoker
FHx of AAA
____________

@abdo palpation = ?Asyx AAA –>
Aortic USS

Refer people with Asyx AAA that is

3 - 5.4 cm < 12w
5.5/+ cm 2ww

What tests for:

ElectiveAAA surgical repair?
- CardioPul Ex Test
- CT-Angio CETSAP*

*Contrast-Enhance Thin-Slice Art-Phase CT Angio

-Prevention=reduce rupture risk=SCOLD
-Monitoring - Aortic USS
____________
@UNNNruptured/Asyx AAA –>
Aneurysm repair @SAAg
-Syx
-Asyx >5.5/+ cm
-Asyx >4cm + GGGGrown >1cm/yr

UNNNruptured AAA Repair options?
Open Surgical Repair > EVAR

EVAR @Abdo dx HASH: 
-hostile abdo/
-anaesthetic risk/comorbidities
-stoma
-horshoe kidney/
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Question 48

Q

?Syx/Rupt AAA:
> 60 a/w abdo pain=radiating to BACK 
then collapsed... 
PMH: Smoker + HTN + AAA 
-Ix? 
-what about volume resus?
-Ix @?Assx 4 SURG REPAIR?!?

-AAAs = more likely to rupture in women or men?
____________

Repairing RUPPtured aneurysms:
- Men <70 - ?
- Old Men >70 - ?
- Women all ages - ?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Cx of Open Surgical Repair?

Cx of EVAR?
-Prev of above cx: ?

-Suspect above cx: ? -->
Type 1 - ?/?/?
Type 2+EVAR -> expansion - ?
Type 3 -  ?/?/?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer

A

?Syx/Rupt AAA: ARC

Aortic USS –>
Refer ASAP (RESTRICTIVE vol resus) ->
CT-Angio CETSAP @ ?surg-repair*

-AAAs = more likely to rupture in WOMEN
____________

Repairing rupppptured aneurysms:
- Men <70 - Open Surg Repair
- Old Men >70 - EVAR
- Women all ages - EVAR
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Cx of Open Surgical Repair?
-TrashFoot Chol Emboli

Cx of EVAR = ENDOLEAK
-Prev ENDOLEAK:
Duplex / CT-Angio-CE #SurveillanceImaging

-Suspect ENDOLEAK: (CT-Angio/USS)=CE –>

-Type 1 - Open-Repair / EVAR/PCI
-Type 2+EVAR -> expansion - ? - intervention…
-Type 3 - Open-Repair / EVAR/PCI
_______________

Question 49

Q

Chest pain=radiates to back
‘Tearing’

1) to neck/jaw?
2) to intraScapular area
PMH:
-?CTDiseases
-?STD/Preggers
-HTN/ ?aortic valve type

Other features:
?? → angina,
?? → paraplegia,
?? → limb ischaemia

Tx:

Stanford/DeBakey
A / 1+2) Asc = ?

B / 3) Desc i.e. distal to ? = Tx?

Answer

A

Thoracic Dissection

1) to neck/jaw - Aortic arch
2) to intraScapular area - Desc aorta

PMH:

Marfan/EhlerDanlos-Noonan/Turner
Syphillis/Preggers
HTN/Bicussssspid aortic valve

Other features:
coronary arteries → angina,
spinal arteries → paraplegia,
distal aorta → limb ischaemia

Tx:

Stanford/DeBakey
A / 1+2) Asc = SURG + Labetall

B)/3 Desc i.e. distal to L Subcl =
TLC = Labetalol + BP 100-110 maintain

Question 50

Q

Refer for Varicose vein tx @??

SALSA @varicose
FP-BDISH @haemorrhoid

If decline referral/NOOO HDPLUGS?

Check what b4 giving stockings?

Answer

A

SALSA GEW

Refer for Varicose vein tx 
@HDPLUGS=SALSA
-Sclerotherapy
-Ablation RF/Laser
-Ligation 
-Strip @saph ANT-MED calf 
-Ablation RF/Laser

Decline referral / NOOO HDPLUGS? GEW

GCS** class 2>1
Ex+WL

b4 giving stockings
-CHECK ABPI excl. Art Insuff

*Heavy 
Dermatitis Eczema 
Pigmentation brown
LipoDermatoSclerosis 
Ulcer 
Gangrene

**GradCompStocking

Question 51

Q

Fissure:FPG /
Haemorrhoid:FP-BDISH
-JL-SMN

Anal fissure tx?

F?
Pain= ? @PooPain
G? < ? m @Adults

R/v:
kids @ ?w --failed-tx--> ? 
adults @< ? m --failed-tx--> UNHEALED +... 
--@Syx improve -> ? 
--@SyxNOTimprove/CDT - ?  
--GenSurg ?

_________________

Haemorrhoid
-classiciation / tx?

Answer

A

Fibre/Fluids / StoolWitholdingXX/Hygiene!!!!
Pain=Paracet/Nsaid/Top Lidocaine @PooPain
GTN <2m @adults

R/v:
kids @2w --failed-tx--> Paeds
adults @<2m --failed-tx--> UNHEALED +... 
--@Syx improve -> Repeat GTN 
--@SyxNOTimprove/CDT - Top Dilit?  
--GenSurg ?sphincterotomy
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

JL-SMN proJECT->proLAPSE/Trude

ProJect
ProLapse/TRUDE + reduce SPONT
ProLapse/TRUDE + reduce MANUAL
ProLapse/TRUDE + reduce NOT POSS
FP
- Fibre/Fluids/ StoolWitholding+HygieneALLOW!!!!
- Pain=Paracetacmol/Nsaid/Top CALL* @PooPain

Grades 1 +2 = B-DISH
Band Ligate/Botox
Diathermy electrotx
InfraRed/Photo Coag
ScleroTherapy
Haemorrhoidectomy LEASt
-Lords strerch/Excisional/ArtLigat/STapled

*Csted/Astringent/Lidocaine/Lube

Question 52

Q

SEVERE SUDDEN abdo-pain
OUT-of-keeping with phys-exam findings
–Bleeding/Diarrhoea/Fever

PMH: AF
SHx: IVDU / Chemo pt..

High WCC/Lactate

Ix? Tx?
____________________

Acute but TRANSIENT
LUQ/LLQ pain (WATERSHED area e.g. Spl. flex.)
BF compromise @ LARGEbowel

?COCAINE-user

AXR = ?

Mucosal Oed/HAEMORRH –> Tx?

Answer

A

Acute Mesenteric Ischaemia
-emboli @Endocard/Cancer –>
block SMA

LACTATE FIRST
CT –> URGENT Surg
____________________

Isch. Colitis
-cocaine

mucosal OED/HAEMORRH –>
- AXR = THUMBPRINTING –> SUPPORTIVE Tx

Question 53

Q

Heavy 
Dermatitis Eczema 
Pigmentation brown
LipoDermatoSclerosis 
Ulcer @MED-MALLEOLUS
Gangrene
-Location ABOVE the ankle, painLESSSSS

Venous ulceration
-above the MED/LAT malleolus???

venous insufficiency –>
Venous ??–>
-capillary ?? cuff
-WCC sequestration

HDPLUG
-Location ?? the ankle, pain???

Deep venous insuff = ???
Superficial venous insuff = ??

Doppler USS looks for ??? and
Duplex USS looks at the ???

Tx: 
Exclude ? --> 
? Or ? --> 
? @:
- Fail to heal after 12 wks or 
- >10cm^2 skin 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TOES / heel
Ulcer/Gangrene
Cold, NO pulses
-PainFULLLLLL
Low ABPI measurements
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Pulses FINE
AND
Warm foot

-Charcot/Claws/Cavus Pes: Plantar surface of metatarsal HEAD and plantar surface of hallux
-Due to pressure
Management includes ?
_______

Have some kind of 
LONG-STANDING issue
e.g. Ulcer/Burn for YEEEEEEARS
thennnnn get some ulceration...
What is it???
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

FRIABLE growing lesion = initially appeared as
RED papule –> CRATER filled CENTRALly w/ yellow/brown material

Answer

A

Venous ulceration
-above MED malleolus

venous insufficiency –> Venous HTN –>

capillary FIBRIN cuff /
?? sequestration

Deep venous insuff = prev DVT and
Superficial venous insuff = varicose veins

DoppleR USS looks for REFLUX and
Duplex USS looks at ANATOMY/FLOW

Tx: 
Exclude ART dx --> 
Pentoxifylline OR
4 layer compression banding --> 
Grafting @:
- Fail to heal after 12 wks or 
- >10cm^2 skin

Prev: Grad Comp Stocking @healed
_____________

ART ulcers
Occur on the toes and heel
PainFUL-punched out
?gangrene
Cold with NO palpable pulses
Low ABPI measurements
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Neuropathic ulcers
-Commonly over plantar surface of metatarsal head and plantar surface of hallux
-Due to pressure
-Tx = CUSHIONED shoes = reduce callous formation
_________

MARJOLIN ULCER
_____________________

Keratoacanthoma

Question 54

Q

Lump in INGUINAL groin area
Reducible disappears when laying flat scrotum fine

<6w - surg < ?
<6m - surg < ?
<6y - surg < ?

probability of strangulation = ?%

Direct V Indirect Ing Hernia
-Direct = ?
-Indirect = ?
______________

BLACK kid
symmetrical bulge
@UMBILICUS

Tx? Resolve by?
-Syx and large = 2-3yrs
-Asyx and small = 4-5yrs
_______________

epidural analgesia helps
to accelerate WHAT
after abdo SURGERY?

2y/o RECTAL BLEED
cherry red lesion @anal verge

Constipation ACUTE, PainPoo,
Blood on paper
6/12 o’clock skin TAG
-?PMH: crohns

FEVER and severe pain
@anus, skin looks legit
i.e. No skin tag…

Constipation CHRONIC, strain, PainPoo,
Blood on paper
O/E Inside=iNDURATED area PROX to anal verge

Constipation, BLOOD in PAN,
3, 7, 11 o’clock
No pain - unless..?

OBSTRucted POO + childbirth = May be internal/external

> 6/52: triad:
Ulcer,
Sentinel pile,
Enlarged anal papillae

PainPoo -> O/E red-purple pea-size lump

Proctitis Causes:
Crohn’s, UC and…?

Ano-rectal abscess –> ?Cx
? rule determines location
_______________

Ann Arbor 1234
Duke ABCD - mwnd

Low Rectal tumours/ Anal tumours - No mets

Rectal tumour @mid-rectum/sigmoid

Acute abdominal pain
Erect CXR = free air
At laparotomy = PERF sigmoid cancer
-what operation?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Trauma, got abdo BRUISING
-?Fluid in abdomen - which scan?

Diverticula most commonly where?

Indications for thoracotomy?

Ginkgo leaf where can pec muscles?

Old/Psych dx/Parkinson/CHAGAS - which volvulus?

Parklands formula
Alco units

Which type of stoma needs spouting? Why?

Firm mass @abdo-wall. Overlying skin = dusky
Signs of ischaemia + necrosis.
Met Acidosis.
NOOOO sign of obstruction.

-Lower lateral ventral hernia - tense/red/irreducible??

TPN derranges what bloods?

ABDO pain, HTN, hydronephrosis, displaced ureters

cancer/Ai dx BG
high CRP/ESR, Uraemia + Anaemia

Gastric MALT lymphoma - tx??

colovesical fistula Ix?
Anorectal fistula Ix?

Bowel obstruction Ix - definitive?

organise an Ix in 2w time to
ensure anastomosis is not leaking,
prior to reversing the ileostomy

Answer

A

Congenital inguinal hernia – paediatric surgery ASAP incarceration risk
<6w - surg <2d
<6m - surg <2w
<6y - surg <2m

probability of strangulation = 3%

Direct V Indirect Ing Hernia
-Direct = weakness @posterior wall of the inguinal canal
-Indirect = persistent PVaginalis
_____________

Infanta UMBILICAL hernia
No tx - resolve <3yrs
-Syx and large = 2-3yrs 
-Asyx and small = 4-5yrs 
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

epidural analgesia helps
to accelerate the
return of NORMAL bowel function
after abdominal surgery

Juvenile polyp hamartomas

Fissure FPG - -?PMH: crohns

fever + severe pain = Intersphincteric Abscess > fissure

Solitary Rectal Ulcer - excl cancer #biopsy

Haemorrhoids FP BDISH
-No pain - unless thrombosed

Rectal prolapse/intususception

Chronic fissure > 6/52: triad

Perinanal Hematoma

Proctitis Causes:
Crohn’s, UC,
C.difficile - LGVChlamydia

Ano-rectal abscess –> Fistuale
Goodsall rule determines location
___________

______________

1 node, 2 node, b/l diaphragm, extranodal
MWND: Mucosa, Wall, Node met, Distant mets

A-P resection @low-rectun/anus

Anterior Resection @mid-rectum + above
High Ant Resection @sigmoid

Hartmanns at @Perf
______________

FAST SCAN

Diverticula most commonly at SIGMOID

Thoracotomy: in haemothorax include
>1.5L blood initially, OR
>200ml/hr >2hr loss

Subcut emphysema!! Not fkn Perf 🤦🏽‍♂️😶

SIGMOID at oldie, psychos, Parkinsons, Chagas

4-BSA-kg 8+16hrs
mls.% / 1000

Spout SMALL Bowel stoma cos of enzymes!!!

Richters hernia = Strang Syx w/out Obst
SPIGELIAN HERNIA!! LLVH tense red

TPN derranges LFTs!!!!!
HypoMAGnesia

-retroperitoneal FIBROSIS

Gastric MALT lymphoma - eradicate H. pylori!!!

colovesical fistula - CT!!!!
Anorectal fistula = MRI

Bowel obstruction Ix - definitive = CT!!!!!
-Abdo = initial

GASTROGRAFIN

Question 55

Q

HD Stable
Small SUBCAPsular haematoma
MINIMAL intra-abdo blood
NOOOOO hilar disruption
?HD Unstable
Lacerations affecting <50%/!!!!!!
INCR amounts of intra-abdo blood
MODerate HD instability compromise

3. HD UNstable  
Hilar injuries
Maajor haemorrhage
Maajor associated injuries
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Which of the following is the best option for long term feeding?
________

Liver USS = 7cm cystic lesion 
-Eosinophilia
-DAUGHTER cysts present
-Echinococcus
Dx - organism? Ix? 
Tx --> Tx? 
What's CI?

Liver USS hyperechoic,

Bloods+LFTs NOOOOORMAL
Constant RUQ pain

Liver USS hyperechoic

Fluid filled structure
FEVER, RUQ pain, Jaundice - Dx?

Liver USS hyperechoic 
- Fluid filled structure 
- FEVER, RUQ pain, Jaundice
Fluid filled structure + 
POORLY DEFINED boundaries +
Aspiration = odourless ANCHOVY paste
Colon biopsy: Aask shaped ulcers 
-Dx? Tx?

OCP use, 30-50 y/o
USS = sharply demarcated
heterogeneous mix echoity

-Gastrectomy–>years later–>
Ataxia, HYPOreflexia, vibration/pinprick gone

Carcinoid Investigation?

Assoc w/ Pellagra Niacin B3 def 3D’s
H.pyloyi + Carcinoid relation to heart…?
which heart murmurs?

Epithelial defects
2cm superiorly @midline coccyx.
-HIRSUTE
_______________

Boas sign - dx?

Cullen @?dx = where?; Grey-Turner = ?

?@appendicits = rebound tenderness
?@appendicitis = touch LIF = pain RIF

heart/breath sound @abdo = PERF

SBO Ax -?
LBO Ax -?
_______________

Fever, RUQ pain
-Dx? Tx?

what to do @syx gallstones?

commonest site of GS?
does Asyx need op?
what if NOT well for lap chole?
what med can be used?
what to do @CBD stones?
what to do if ERCP fails for above?

cholecystectomy 6 months ago ->
since the operation = experienced
-chronic diarrhoea #float in the toilet
Tx?

Isolated hyperbilirubibemia Ix?

Lidocaine max dose? With Adren?
\_\_\_\_\_\_
-Location + Blood supply?
Foregut, Midgut, Hindgut
-Ligament of ? = upper GI v lower GI #D-J jct

Answer

A

Conservative
Laparotomy with conservation
Resection
______________

PEG BEST LONG TERM!!!
____________

Hyatid Echinococcus Cysts #Eosino #Daughter

CT abdomen!!!!
MEBENDAZOLE -> ?Resection + HyperTonic swabs
Perc Asp is contraindicated

Liver hemangioma

Liver abscess

AMOEBIC cyst = Asp anchovy paste + poorly defined boundary = METRONIDAZOLE

Liver cell adenoma
-OCP 30-50 y/o

B12 def
-Subacute Combined Degen of Spinal Cord cos #NO INTRINSIC FACTOR

Urinary 5HiAA
-H.pylori + Carcinoid –> Coronary-itis

Spine epithelial defect + HIRSUTISM = pilonidal sinus
______________

Boas = shoulder/scapula excitation @cholecystitis

Cullen @panc = umbilicus; Grey-Turner = flank

Blumberg@appendicits = rebound tenderness
Rovsing @appendicitis = touch LIF = pain RIF

Claybrook@PERF
-heart/breath sound @abdo = PERF

SBO Ax - ACHI: adhesions/cancer/hernia/ibd-crohns
LBO Ax - cancer
_______________

ACUTE Cholecystitis
-AUSS, AMG+Lap Chole <1wk

lap chole @syx gallstones #day-case #elective
CYSTIC DUCT!!!
Asyx NOT need op
not well for lap chole = Cholecystostomy
USDA @radio-lucent <1.5cm + funct GB @cystography

-CBD stones = lap chole + CBD clearance via:
ERCP or @lap chole
-if ERCP fail = temporary stenting

cholecystectomy 6 months ago -> 
since the operation = experienced 
-chronic diarrhoea #float in the toilet
Tx = CHOLESYTRAMINE - help absorb bile salts

Isolated hyperbilirubibemia Ix? = FBC check for Hemolysis

Lidocaine max dose? With Adren?
3mg/kg, 7mg/kg w/ adrenaline
__________

Foregut: esophagus to upper duodenum

Midgut:
lower duodenum to proximal
2/3 of transverse colon.

Hindgut:
distal 1/3 of transverse colon
to anal canal above pectinate line.

Question 56

Q

Painful skin dx = NODULAR @
FACIAL areas #sharp-demarcated
due to:
-V=Haem/Lymph spread
-I=TB foci ext through skin
-D=BCG
-Iatro=Pri Inoc

Breakdown of skin OVERLYING TB foci @:
-Node
-Skin over infected bone/joint
_________

MIDDLE-AGED woman
Dry coarse hair, Dry skin, Menorrhagia
#HypoT Ax #rare:

dense fibrous tissue
REPLACING normal thyroid parenchyma

O/E: a HARD, fixed, painLESS goitre = NOTED. Assoc with retroperitoneal fibrosis.
__________

WOMAN > Man gets standard
Hyperthyroid Syx (Palp, SOB, Fatigue, Oligomenorrhoea) +
PainLESS goitre:

1-Proptosis/Exophthalmos - lid retraction lag, Pretibial Myxoedema, SMOKER, Young<60

2-BIG lump in neck
-PMH: BEFORE was asyx… NOW turned rogue…
O/E NOOO exophthalmos/ lid lag/ PreTib Myx
-Older >60
-Scanty uptake on RadioIod Uptake Scan

Enlarging, painless, midline neck swelling
- TFTs normal, NO hyperthyroid Syx
- O/E moves on swallowing NOT with tongue protrusion
- -i.e. not thyroglossal cyst

Which Ax of hyperthyroidism are these?

sweating, palpitations, diarrhoea.
-WL = >3 kilograms
PMH: AF

MOST likely cardiac sequeale?
_________

Graves:
TSHrAB
stim ? –?75%–> ?
? = ?

Toxic:
1. ?
2. Nodular 
#BenignFollicular?
--> XS ? = suppress ?

Goitre:

Painful Ax? #ESR
Painless Ax?

Amiod Induced Thyroiditis
PathPhys/goitre?/tx?
1. Goitre
2. NO Goitre

Talk about causes of low TSH, high/norm/low T4/4 i.e. that damn table
_______
Thyrotox crisis?
_______

How to differentiate between HypoT+HyperT:

Answer

A

Lupus Vulgaris
-face lesions + hx of TB inoculation

Scro-Fulo-Derma
-Skin Overlying TB foci = fucked
______

Riedel Thyroiditis
______

Graves
- Eye shit, PreTib Myxoed
- EYE SHIT ABSENT 30%!!!!!! FFS
- SMOKER !!!!!
Toxic Multinodular
- Plummer Dx
- B4 Asyx -> now Syx
- NO eye syx, NO pretib myxoed
Non-Toxic Goitre
Thyrotoxicosis -> HIGH-OUTPUT Cardiac Failure
_________

Graves <60
TSHrAB
stim TSH receptor -anti-TPO75%-> 
Thyroid HYPERplasia
XS T4/3 = suppress TSH

Toxic >60
1. Multinodular
Iod def areas
DENMARK

2. Nodular 
#BenignFollicularAdenoma 
--> XS T4/3 synth = suppress TSH

Goitre:

Painful Ax? #ESR
a. SadQT 1. HyperT <6w 2. Euthyroid <3w 3. HypoT
b. Acute Thyroiditis #bacteria @pyriformSinus
c. Preg PPT
Painless Ax= graves, toxic

Amiod Induced Thyroiditis
PathPhys/goitre?/tx?
1. XS iod induced T4/3 synth -> Goitre #AT drugs/K-percolate
2. Destructive Thyroiditis -> No goitre #csteds

_______________

ABCDE
Paracetamol Propranolol
PTU /Lugol
Dexamethasone
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

HypoT:
Dry hair-coarse/skin
Menorrhagia

HyperT:
Pretib myxoed
Oligomenorrhoea
Lat malleoli oed lesions

Question 57

Q

PainLESS nodue @Thyroid
-cervical LNopathy
-YOUNG
____________

Solitary thyroid nodule
-Encapsulated

Invades vascular
___________

Calcitonin raised
-diarrhoea+flushing
-hard upper lobe
____________

OOOOLD woman
-dysphagia, hoarseness, SOBOE
-hard mass @unilateral lobe
-cervical LNopathy
\_\_\_\_\_\_\_\_\_\_

Parathyroid/Pit/Panc
-insulinoma gastrinoma

Parathyroid/pheochromocytoma
MED THYROID CANC

Pheochromocytoma
-Marfanoid - Neuroma
MED THRYOID CANC

Answer

A

Papillary cancer

–papillary projections
–pale empty nuclei
–NOT encapsulated

LN mets common
________

follicular adenoma

Follicular carcinoma
________

Medullary carcinoma
-Lymphatic and haematogenous metastasis
-Poor prognosis
_______

Anaplastic - ANNA the old woman

________

MEN 1

MEN 2a RET

Men 2b RET

Question 58

Q

1-inch prox to RadioCarp joint

What fractures are compartment syndrome associated with?
________

FOOSH
- Distal-Radius# - Transverse
- Dorsal displacement + angulation

—DINNER fork dx
_________

FOOSH
- Distal-Radius #
- Volar-Palmer displacement

-fall back onto the palm OR
-fall with wrists flexed (wtf?)
-Garden-Spade deformity
_______

FOOSH
-Distal-Radius #
-RadioCarpal dislocation
_________
FOOSH
-Radius #
-RadioUlnar dislocation
Rotational force
__________
_________
FOOSH+FORCEDPronation
-Ulnar #
-RadioUlnar joint dislocation
_________

6. 
Fistfight –> flexed metacarpal impact
1st Carpo-MCP joint
-Triangular fragment @ MCP-Ulnar base
\_\_\_\_\_\_\_\_\_\_

FOOSH
- fracture NOT initially seen
- after casting THEN fracture seen..

Pain @ snuffbox – poss AVN necrosis
_________

8. FOOSH
sharp lateral elbow pain
Tender radial head, 
impaired elbow movement (inc sup and pron)
\_\_\_\_\_\_\_

Bimalleolar ankle fracture
- Forced foot eversion

Answer

A

What fractures are compartment syndrome associated with?
-Supracondylar + Tibial shaft
_________

Colles - R-D dx
-DINNER fork deformity
____
Smith (reverse colles) - R-VP dx
-GARDEN-spade deformity
____
Barton - R-RC
_____
Galleazzi - R-RU
________
________
Monteggia - U-RU
______
Bennet - 1st MCP
___
Scaphoid fracture
____
Radial head fracture @elbow
_____
Pott’s fracture

Question 59

Q

Painful wrist

Pain @ resisted thumb ABduction

pain @ radial wrist @ FINKelstein

What’s dx? And finkelstein? Which tendons?
_________

Kanavel’s sign:
FIXED flexion, 
Fusiform swelling, 
Pain @ passive extension
\_\_\_\_\_\_\_\_\_

AR Bone harder denser
Cant differentiate between cortex and medulla @ x-ray #marblebone
_________

Poor collagen formation -> shit osteoid
Translucent, multiple fractures
Blue sclera
_________

VitD def -> osteoid ossify fail = Small, F2T
LARGE head,
CW deformity –
thick costochonJunc; Transverse(Harrison’s) sulcus in chest=pull of diaphragm
Bowing femur+tibia,

Answer

A

De Quervain’s tenosynovitis – finkelstein to diagnose

Pain @:
Flex thumb THEN
Ulnar deviate and flex wrist

Extensor pollicis brevis
Adductor pollicis longus
__________

Infective flexor tenosynovitis
AB’s, RICE, debridement
________

Osteopetrosis
________

Osteogenesis imperfecta
___________

Rickets osteomalacia

Question 60

Q

1 in 10million @young males 
Long bone DIAPHYSIS = small round tumour 
ONION skin appearance 
Aggressive 
\_\_\_\_\_\_\_

LONG bone METAPHYSIS
Assoc with Pagets, Radiation, Retinoblastoma
______

2 in 1 million @>40yr
________

Tumour with loads of histiocytes
Most common in adults
Undifferentiated pleomorphic sarcoma i.e. cell origin unknown
_______

Trapped flexor tendon
Digit Locked in flexion
Have to passively release it
-Flexor tendon sheath thickened + narrowed

PMH: DM rheumatoid gout
_______

Patient has diabetes/cirrhosis/phenytoin user

Patients got flexion contracture of the fingers
(mainly RING)
Nodular thickening of palmer fascia

Hueston table top test?
________

Pain and swelling
Large radiolucent and head of numerous extending to subchondral plate

SOAP bubble on X-ray

Can present as path fract

Answer

A

Ewing
____

Osteosarcoma
______

Liposarcoma
- >5cm , deep
______

Malignant Fibrous Histiocytoma
________

Stenosing Tino synovitis
A.k.a. trigger finger

-Analgesias/steds
_________

Dupuytrens contracture
-Peyeonie/Ledderhose

__________

Giant cell tumour

Question 61

Q

Chronic pain + tingling of BUM
-worsened by sitting on toilet/chair for aaaages

O/E: elicit pain @INT rotation
__________

Test integrity of structures?
ACL - ?
PCL - ?
Meniscal tear - ?
Thomas - ?
Trendelenburg - ?
\_\_\_\_\_\_\_\_\_

Picked up on newborn exam
POSITIVE ortalini and barlow
Unequal skin folds
\_\_\_\_\_\_\_
4. 
Viral infection -> hip pain 2-10yrs
\_\_\_\_\_\_\_
5.

Degen -> AVN fem head 
Progressive hip pain + Limp
Stiffness + RedROM
widening of the right hip joint space 
with flattening of the femoral head

most common organism?
_______
6.

Kid = Joint pain, swelling >3m
Knees, ankles, elbows
Limp, ANA+, Ant Uveitis
________

a. Pyrexia + Acute Hip Pain #?Flexed

b.
SickleCell dx, IVDU, DM, Endocarditis
-most common pathogen?
- @sickle-cell anaemia = ?pathogen

Ix ? Tx?
______

Obese and boys
Knee/Distal thigh pain
Can’t int. rotate in flexion
_____

PMH: Alcohol XS, LT Csted use,

Hip pain, reduced ROM of hip
x-ray = subchondral #, segmental FLAT Femoral head + osteopaenia.

Answer

A

Piriformis Sydrome
-sciatic come out of foramen BELOW piriformis -> liable to comp
_______

ACL - Lachman
PCL - Post drawer
Meniscal tear - McMurray
Thomas - FFD hip
Trendelenburg - hip abduction
\_\_\_\_\_\_\_

Hip dysplasia
_______

4. 
Transient synovitis
\_\_\_\_\_\_
5 
Perthes dx
\_\_\_\_\_\_\_
6.

JIA – PauciArticular most common 
\_\_\_\_\_
a.
Septic arthritis -> Washout 
-S.Aureus

b.
Osteoyelitis:
-Staph. aureus
- @sickle-cell anaemia = Salmonella

Ix: MRI

Tx: Fluclox/Clinda
____

Slipped Upper Femoral Epiphysis
_____

Avascular necrosis

Question 62

Q

Worse on the ‘outside’ of hip
-Bad @ night when lies on right side.

O/E:

full ROM in the hip
Deep palpation @LATERAL hip joint recreates the pain.

-Due to repeated movement of the fibroelastic iliotibial band
_______

T3 of pregnancy
Groin pain + limited hip ROM 
-Non Weight-Bear
-ESR high
\_\_\_\_\_\_\_\_

3. 
Common @PREG #waddling
-Preg -> hormone -> Ligament laxity
-Pain @pubic symphysis
-Radiatie to groin + medial thighs.

_______
_______

Shortened
Int. Rotated
Flexed, Adducted
-Sciatic nerve injury 
\_\_\_\_\_

Shortened,
Ext. Rotated 
-AVN risk (fem circumflex + lig teres artery)
-Low-energy impacts in elderly patients
\_\_\_\_\_\_

Abducted, Ext. rotated,
-PALPABLE BULGE of the femoral head
_____

Pain @ walking or palpation,
Instability,
Neurovascular deficits
Signs of damage to pelvic organs e.g. haematuria or PR bleeding.

Answer

A

Greater trochanteric pain syndrome
AKA Trochanteric bursitis.
______

Transient idiopathic osteoporosis
______

Pubic symphysis dysfunction
_______
_______

Posterior hip dislocation
_____

NOF #
_____

Anterior hip dislocation
_____

Pelvic fractures

Question 63

Q

Knee EXT weak 
? reflex loss 
Thigh numb 
\_\_\_\_
Foot stuff:

Ankle DORSIflex
Calf and foot numb

1st Web sensory + Eversion dx ?

Lateral foot sensory + Eversion = ?

Eversion AND inversion +
- hip abduction dx
- pain and sensory loss 
@lat side thigh, lower leg, foot-dorsum and toes 1-3 
- Common peroneal fucked too (as above)
# Peroneal AKA Fibular nerve ffs

Cant plantar flex + lateral aspect sensory dx ?
____

Knee FLEXION weak
Foot movements weak

Gluteal -> ankle = pain and numbness
_____

Weak hip ADduction

–Medial thigh NUMB
________

Weak hip ABduction
-positive trendelenburg
?Left/right? gluteals fucked -> RIGHT pelvic drop
_______

Inverted + 
Supinated
plantar flexed
Not passively corrected
\_\_\_\_\_\_\_

Claw toes
pain @ walk
Assoc: CMTooth, SpinaBifida, CPalsy

Answer

A

Femoral nerve
-Patellar reflex loss
___

Lumbosacral trunk

1st Web + Eversion dx = deep C.peroneal

Lateral foot sensory + Eversion = superficial C.peroneal

L5 nerve root –> sciatic –> CPeron = S/D
Eversion AND inversion +
- hip abduction (gluteal muscles - superior gluteal nerve) -
- pain and sensory loss
@lat thigh, lower leg, foot-dorsum and toes 1-3
- Common peroneal fucked too (as above)

Cant plantar flex + lateral aspect sensory dx= S1
____

Sciatic nerve
____

Obturator
-adduction + medial thigh shit
-Adductor + gracilis + obt internus
______

Sup>Inf Gluteal Nerve:
Weak hip ABduction
-positive trendelenburg
Ipsi gluteals fucked -> contralat pelvic drop
Eg. Left gleuts fucked -> RIGHT pelvic drop
______

Talipes EquinoVarus (CLUB foot)
-Manipulation + Casting STRAIGHT

_____

Pes Cavus - high arched foot!!!!

Question 64

Q

Salter-harris; 1, 2, 3, 4, 5 classes @ paeds
_______

TWISTING - Lock + Give way 
(passive ext = imposs
active ext = poss cos pt figured out a way to unlock!!)
Tender joint line (med/lat)
GRADUAL Swelling, 
Pain ROM dec
Pos McMurray

How to investigate?!

O’Donoghue Triad??
\_\_\_\_\_\_
3. 
Athletic males = unilateral 
X-ray – enlarged + tender tib tub

What affects inferior pole of patella similar to above condition? 
\_\_\_\_
4. 
Lock + Give way 
Swelling + Pain worse with exercise
\_\_\_\_\_
5. 
Lock + Give way 
Sliding moving patella
Pain @ sitting; worse @ move
\_\_\_\_\_\_
6. 
Teen girl injured her knee
Now gets pain when going downstairs
Evidence of quads wasting
\_\_\_\_\_
7. 
Trauma OR
Quads contract @ knee stretched in valgus + ext rot
Swollen+Tense = haemoarthrosis
\_\_\_\_\_\_\_\_
8.
Old person
Knee fractures before the ligaments rupture
-Fall from a height
-Car-bumper fracture

Valgus – ?  
Varus – ?
\_\_\_\_\_\_\_\_
9.
Forefoot pain @ 3rd/4th 
Inter MTP space
Shoot/Burn/Electric pain
'Pebble' in shoe
Click @ squeezing metatarsals = mulder’s click
\_\_\_\_\_\_
10.
Simmonds test 
Pop in heel 
Assoc with quinolones cipro!!!

Image??

Answer

A

P/PM/PE/PME/Crush
P=Physis, M=Metaphysis, E=Epiphysis
__________

Meniscal Tear
Medial > Lateral
MedMen attached to MCL+jointcaps

MRI!!!

ODonnaghue triad=Torn(MedMen+MCL+ACL)
\_\_\_\_\_\_\_\_
3. 
OsgoodSchlatter 
osteochondrosis + traction apophysitis = can’t extend

Sinding Larson syndrome 
\_\_\_\_\_
4. 
Subchondral AVN -> bone/cart detach -> microracture BUT no remodelling
\_\_\_\_\_
5. 
Patellar SubLux Syndrome
\_\_\_\_
6. 
Chondromalacia Patellae
\_\_\_\_\_\_
7. 
Patella dislocation
\_\_\_\_\_\_
7. 
Tib Plateau Fracture -Schatzker Classification system
-VaLLLgus – LLLat plateau 
-Varus – med plateau
\_\_\_\_\_\_
8.
Morton's neuroma
\_\_\_\_\_
9.
Achilles rupture 
-USS!!!!

Answer 65

A

Facet joint
____

Spinal stenosis
____

Ankylosing spondylitis
_______

Peripheral arterial disease
_____

Cervical spondylosis

Lhermitte sign
Physio, analgesias, brace, surgery

General theme for prolapsed disc type shit is PHYSIO and analgesia
______

Cervical spondylo LisThesis

Cervical vertebrae DISPLACED anteriorly and deformity and narrow vertebral canal

Answer 66

A

Radial tunnel syndrome –
post interosseous

Similar to lateral epicondylitis
______

Cubital tunnel syndrome -
Ulnar nerve compression

Dx @ wrist = 2 medial lubicrals fucked so
can’t flex MCP and ext D/PIP so there will be lots of clawing

Dx @ elbow = medial aspect of FDProfundus only fucked so there’ll be less clawing cos it’s still got its lateral (median nerve) supply
_______

Adhesive Capsulitis
__________

Parsonage – Turner syndrome
______

Supraspin-ABd, infraspin-ER, teres Minor-ER= GREATER tubercle

Supscapularis-IR = less tubercle
_____

Supraspinatus= suprascap nerve

Subscap = subscap nerve

Teres minor = axillary nerve
______

0-15 = supraspin - suprascap nerve

15-100 = deltoid - axillary nerve

> 90 = trapezius - accessory

> 100 = serratus anterior - long thoracic

Answer 67

A

(1.)Vit A def (2.) Ret pigmentosa
__________

Gastric cancer
________

Lymphoma
__________

Glucogonoma
________

5.
RA AML IBD Myeloprolif
______

Haem cancers, myelodysplasia
________

Oesophageal cancer
_______

GI and Lung
_________
Ovarian and lung cancer
__________
Lung cancer

Answer 68

A

Gram-negative diplococci

-GONORRHOEA

Answer 69

A

Codeine to PO morphine

PO morphine = to…

SC moprhine /?
OXYCOD PO /?

SC diamorphine /?
IV moprhine /?

OXYCOD SC /?

Alcohol units?

Answer 70

A

Monoplegia - 1 limb
Hemiplegia - Unilat 2 limbs
Quadriplegic - 4 limbs
-Paraplegia - Bilat LOWER limbs

ACA MCA PCA*
L>UL ; UL>L

< – HemiParesis
……..Aphasia – > Agnosia
……..Sensory
….HomoHAnopia – > Mac-Sparing

*PCA - Weber Midbrain
-Same CN3, opp HemiParesis
-Agnosia
-Macular sparing HomoHNopia
________________

Amaurosis fugax - Retinal/Ophthalmic Artery
Locked in syndrome - Basilar Artery
____________

Pontine bleed

Absent < – > horizontal eye-move
Miosis
Paralysis=Quadriplegia

AICA: Lat Pont

Same FACE: PD/PT (paralysis/deaf // pain/temp)
Opp limb
Nystagmus
Ataxia

PICA: Lat Med Wallenburg

same as above EXCEPT
paralysis and deafness

______________

Anterior Circulation Stroke:

3=TotalACS
2=PartialACS

Unilat sensory/motor FAL
Cog dx - VisuoSpatial/Dysphasia
HomoHNopia

LacACS Assoc w/ HTN 
1 of:
-Sensory
-AtaxicHemiParesis
-Motor
PURELY
\_\_\_\_\_\_\_\_\_

4-6-4 H:
CN4 vertical nystagmus
CN3 Ptosis, Dilated, Vertical nystagmus
CN6 horizontal nystagmus

Nystagmus: Central v Periph:
central is:

B/L
Assoc sens/motor dx
Direction = multi / purely uni or rotatory

Brainstem Death:
Coma unknown Ax
Reversible ax excluded
Sedation X
Electrolytes fine

Bronchial stim -> no cough
Response to sound/Supra-Orb Pressure
Occ-Vestib Reflex absent
Corneal Reflex absent
Disconnect ventilator 5-mins -> no resp support

Answer 71

A

-Bodily sensation CONTROLLED by ext influence = passivity phenomenon

-Object is perceived –>
Sudden Intense Delusional Insight into the objects meaning
——-Delusional perception

wakes up and less often when he is falling asleep he is ‘PARALYSED’ and UNABLE 2 MOVE.
‘hallucinations’ such as seeing another person in the room
-Dx = Sleep paralysis

Clozapine = OPPOSITE of SLUDs
-reduces SEIZURE threshold
-Smoking CESSATION can cause a rise in clozapine blood levels
-CONSTIPATION /intestinal OBSTRUCTION
-If clozapine doses are missed > 48 hours
the dose will need to be restarted
AGAIN SLOWLY

Li = causes both:
HypoT i.e. CONSTIPATION
+
HyperCalc i.e. CONSTIPATION

Paroxtene = Discont Synd
-PURSM + GI dx DIARRHOEA

Stopping of voluntary movement or staying still in an unusual position = catatonia

narcissistic personality disorder have a heightened impression of self-importanceunlimited abilities to succeed, become powerful lack empathy and will happily take advantage of others to achieve their own need.
-NARCISITIC PD

Chronic insomnia may be diagnosed after 3 months

Tetra-benazine = tardive dyskinesia
Propranolol = akathisia
Procyclidine benztropine = acute dystonia
Lorazepam = calm psychotic episode

Which of the following features is needed to make a diagnosis of a personality disorder?
Over 18 years of age

CT head scan should be considered in elderly patients with new sudden onset psychosis to rule out an organic cause for their presentation

EUBPD = dialectical behaviour therapy (DBT)

Clinical Institute Withdrawal Assessment for Alcohol (CIWA) = alcohol withdrawal severity

Chlordiazepoxide is used in the treatment of delirium tremens

Pseudohallucinations are more common after bereavement and do not imply psychosis
–HAS INSIGHT

OCD = marked/severe functional impairment e.g. loses job etc
= refer + iapt/CBT + ssri-clomi

GAD: Persistent, ‘free-floating’ anxiety, with associated features.
Treatment with SSRIs + CBT is key.

Panic disorder: a panic disorder is more associated with RANDOM panic attacks, on a background of no anxiety usually.

lower back pain, constipation, headaches, low mood, and difficulty concentrating.
i.e. bones stones moans psychic groans #hypercalcemia = Lithium

Circadian rhythm disturbance is a feature of schizophrenia
#INSOMNIA

wife died WITHIN LAST < 6 months.
reports being tearful ‘picking fights’ he has on occasion described HEAR HIS WIFE talking to him and on one occasion he prepared a meal for her.
-NORMAL grief reaction

People can hear voices it’s perfectly normal.
Train of thought = voice in your head.
CONFUSION about source of voice = what makes it a hallucination

wife died >6m ago SUDDENLY…. i.e. fkn ages ago bro
reports being tearful ‘picking fights’ he has on occasion described hearing his wife talking to him and on one occasion he prepared a meal for her.
-ATYPICAL grief reaction #delayed/prolonged

M1 O2D2 G3 S4 (PTSD also 4 too!!) D24

Answer 72

A

Lithium = NEPHROgenic DInsipidus ; HypoT, Ebstein
Check levels
-12 hours after the last dose - ->
-7 days after dose change

Cotard syndrome is associated with severe depression

patient is in a public place and threatening violent behaviour. The police should be contacted to be brought in + assessed

hypomania = Delusions of grandeur
- 4d + no Hosp/Funct dx/Psych dx

Copro-praxia = involuntary performing
of obscene or forbidden gestures
e.g. inappropriate touching
‘‘Coppring a feel… he he he “

Echopraxia = imitation of the movements of OTHERS

Pali-lalia automatic repetition of one’s OWN words

Folie à deux - shared hallucinations/delusions between individuals

De Clerambault AKA Erotomania Delusional disorder
presence of delusion
(of a FAMOUS person being in love with them)
with ABSENCE of other psychotic symptoms
—like that girl in love with joey #Drake Ramoray

Melanosis Coli = Purging behaviours in bulimia are not only vomiting, can be use of
LAXATIVES or Diuretics or Exercising

SSRI: TIC
Cont 6m after remission -> reduce dose over 4 week period

Mania = Refer urgent @DMSA !!!
danger mania severe-depression adv st8ments

Illness anxiety disorder AKA CHONDRIASIS=CANCER !!!

A 14-year-old patient presents to her GP complaining of unexpected weight gain and tiredness.
She has been in contact with mental health services recently for treatment of anorexia nervosa.
-Dx = HypoThyroidism
Anorexia can cause HypoThyroidism in some individuals

Antisocial personality disorders more often affects men
-steal ‘because they can’
-do not see why they should obey the rules of society
-enjoyed hurting their younger siblings
-killed the family pet
ANTISOCIAL PD – ?DialecticalBT

Patients with 
poor oral compliance 
to antipsychotics 
should be considered for 
once MONTHLY 
IM antipsychotic depot injections

Paroxtene = Discont Synd
-PURSM + GI dx diarrhoea

GRADUAL onset schizophrenia is a poor prognostic indicator

fluoxetine when used in the T3
-Persistent pulmonary hypertension

hypomania describes
decreased / increased function for
4 days or MORE ffs !!!!
but NO FHP !!!!!

Answer 73

A

TCA
-Opp of SLUDS: Blurred vision + dry mouth
These antimuscarinic side-effects are more common with IMIPRAMINE than other types of
-OVERFLOW incontinence !!!!!!!!

Selective serotonin reuptake inhibitor = Sertraline/Citalopram

SNRI = Venlafaxine
Serotonin and Noradrenaline reuptake inhibitor

    clozapine
    olanzapine: higher risk of dyslipidemia and obesity
    risperidone
    quetiapine
    amisulpride
    aripiprazole

Clozapine
-reduces SEIZURE threshold
-Smoking CESSATION can cause a rise in clozapine blood levels
-constipation/intestinal obstruction
-If clozapine doses are missed > 48 hours
the dose will need to be restarted
AGAIN SLOWLY

Li = causes both:
HypoT i.e. CONSTIPATION
+
HyperCalc i.e. CONSTIPATION

Paroxtene = Discont Synd
-PURSM + GI dx DIARRHOEA

ECT –
-cardiac arrhythmias are a short term side effect
-AntiDEPRESSANT medication should be
REDUCED
NOT STOPPED when pt =
about to commence ECT treatment
-ECT = Retrograde amnesia #memory impairment

Aripiprazole has the MOST TOLERABLE side effect profile of the atypical antispsychotics, particularly for prolactin elevation

Mirtazapine =
Specific Serotonergic + NorAdr
antidepressant which increases release of neurotramsitters by blocking alpha2 adrenoreceptors
-useful side effects (sedation + increased appetite)
-i.e. useful for those who can’t sleep + low BMI

Antipsychotics in the elderly
- increased risk of STROKE + VTE

Zopiclone increases the risk of falls in elderly patients

Avoid TCA/MAOi
in people using
brimonidine alpha ag @ACAG
-FOVL / iNFLAMM-Itch / TCA-MAOi

SSRIs and MAOis (phenelzine)
should never be combined
as there is a risk of serotonin syndrome

Triptans/MAOi/Ecstasy should be avoided in patients taking a SSRI

Citaloproam = the most likely SSRI
to lead to long-QT + Torsades de pointes

SSRI @preg = Sertaline/Fluox-parox
–still cause CONGEN Heart dx

TCA = antimusc = opposite of SLUDS
-OVERFLOW incontinence !!!!!!!!

Pt on Long-term atypical ANTIPSYCHOTICS
-gets polyuria, polydipsia etc
can lead to the development of
Glucose dysregulation and DIABETES

Schizophrenia = Cognitive behavioural therapy

Alcohol withdrawal

symptoms: <12 hours
seizures: 36 hours
delirium tremens: 72 hours

Answer 74

A

IV fluids should be given in
2nd degree aka Partial thickness Superficial or more
that cover 15% BSA

Superficial dermal burns
covering >3% TBSA in ADULTS
must be referred to secondary care

In KIDS, IVF are recommended
when burns cover 10% body surface area.

Pityriasis rosea often follows a VIRAL infection.
Streptococcal throat infection tends to trigger GUTTATE psoriasis

Pompholyx eczema may be precipitated by humidity
(e.g. sweating) and high temperatures

Horner’s syndrome – (ptosis miosis ±anhydrosis)
ANHYDROSIS determines site of lesion:
•head, arm, trunk = central lesion: stroke, syringomyelia

•JUST face = pre-ganglionic lesion: Pancoast’s, cervical rib

•ABSENT = post-ganglionic lesion: carotid artery
_________

patient reports NO new findings on history including normal vision.
Fundoscopy = abnormality in both eyes.
-What abnormality is most likely in this patient:
Cotton wool spots / Retinal neovascularisation?
Cotton wool spots = NORMAL vision

patient reports NEW VISUAL LOSS findings.
Fundoscopy = abnormality in both eyes.
-What abnormality is most likely in this patient?
Cotton wool spots / Retinal neovascularisation
Retinal neovascularisation = FUCKED vision
_________

POAG = Disc Haemorrhages/Pallor = Atrophy

Optic disc = SWOLLEN = CRVO / Papilloedema

Paton’s Concentric Radial RETinal lines = CASCADE from optic disc = Papilledema

Papilloedema = BLURRED Optic disc margin =
LOSS of optic CUP + LOSS of venous PULSATION

Increased ARTERIAL REFLEX = feature of
HTN retinopathy.

The use of antivirals for shingles may 
reduce the incidence of 
POST HERPETIC NEURALGIA
particularly in older people
Antivirals will NOT affect the virulence of the patient,

Those with a 
POS FHx of 
glaucoma should be 
screened ANNUALLY 
from aged 40 years

Answer 75

A

LONG-sighted #HyperMetropia = ACAG
Short-sighted #Myopia = POAG

Afro-Caribbean origin = skin type VI Fitzpatrick
–never burns/tans

In diabetic retinopathy,
cotton wool spots represent
areas of retinal INFARCTION
- Pre-capillary arteriolar occlusion

Erysipelas is a bacterial infection 
caused by Streptococcus PYOGENES - GAS
FLUCLOXACILLIN
---It is differentiated from cellulitis due to its 
raised and well defined BORDER.
# s.aureus=cellulitis

Bilateral gritty eye
1. -WORSE @MORNING
BLEPHARITIS

-WORSEN @THROUGHOUT day = Dry eyes

Lund and Browder chart is the most accurate way to asses the burns area
Lund > Wallace 9

Cataracts are not an acute problem so carry no urgency.
Cataract removal operations
should NEVER be rationed on the basis of visual acuity
I.E. SEND THAT DAMN referral ROUTINELY

The most common dermatosis in pregnancy is atopic eruption of pregnancy

SUP-VL:
1. -CANNOT SEE see retina @fundoscope = Vitreous haemorrhage #vitreous is full of blood.

- severe retinal haemorrhages @fundoscope = CRVO

HZO = ADMIT -> PO Aciclovir
HZO -> Ant Uveitis #CORNEAL involvement

pemphigOLD = no mucous membranes
-Anti-HEMI-DESmosome

pemphiGUS - nikolsy sign
-Anti-desmoGLEIN
(anti-desmosome)
**GUS GUIL(ein)-FOY ** LOL

Answer 76

A

Lipomas = >5cm = USS ?sarcoma
MACROprolactinomas >1cm = TS surg
B/L adrenal hyperplasia = Spiro @Hyperldosternosim

centre, spider naevi
• liver disease
• pregnancy
• cocp

skin rash under her new wrist watch. An allergy to nickel is suspected.
- PATCH test = HSR 4

builder presents with sore and itchy skin on his hands and wrists. He has noticed it gets better when he is not in work and wonders if it is something he is coming into contact with at work causing the irritation
-Skin Patch - Type 4 hypersensitivity (Delayed Th1 Cell-mediated)
This history suggests a delayed reaction to an irritant at work (Allergic contact dermatitis) so is likely to require a longer period of exposure to elicit a reaction, so needs patch testing

female who has JUST started work as a cleaner presents with a rash on her hands. On examination there is a generalised erythematous rash on the dorsum of both hands. There is no evidence of scaling or vesicles. What is the most likely diagnosis?

Irritant contact dermatitis
1. Cataract
halos in cataract + ACAG ffs

Actinic keratoses may develop on ANY sun-exposed area
-Bowen’s isolated and well demarcated.

Answer 77

A

alopecia areata = screen for other Ai dx
TAPD: thyroid addisons pernicious dm

Blunt ocular trauma + hyphema (blood @ant chamber) -->
high-risk of raised IOP
#intraocular pressure-Glaucoma

erythema nodosum Mx
-No active treatment, arrange routine follow-up

Anterior uveitis
TOP steroid + TOP cycloplegic (mydriatic)
drops

ARMD Ix = Fluorescein angiography

Inpatient treatment for erythroderma
must be monitored for complications like
dehydration, infection and high-output CCF

P.Ganrenosum = PPU Dx Unrelated =
-RAIM: RA AML IBD MyeloProflif

Dry Eye WMD ALI
If pt use > 6 drops/day –>
consider PRESERVATIVE-free drops
-cos preservatives = FURTHER damage cornea/conjunctiva-epith

@mod-severe, PRESERVATIVE TOXICITYpotential = is higher due to
MORE frequent dosing and
REDUCED tear secretion.

-@severe:
PUNCTAL plugs @tear ducts –>
increase tear film

8-year-old girl
noticed a small growth on the sole of her foot
for the last 3 months that has become painful.
O/E small, firm, hyperkeratotic growth + tiny overlying black dots.
-Salicylic acid

Wallace 9 rule

Whole UPPER limbs FRONT+BACK = 9
Chest/abdo/lower limb FRONT = 9

Pyoderma gangrenosum =
-RA AML IBD MyeloProflif

Hyphaema = Red

-Blunt ocular trauma + Hyphema -->
high-risk of raised IOP
#intraocular pressure-Glaucoma

Hypopyon = pus
_______

Ramus MAXILLARY fracture
______

Comminuted MAXillary fracture
—Blowout
______

Depressed zygomatic fracture

–CHEEK
–BINOCULAR vision

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