Difficult Topics 2

Question 1

Non-healing ulcer, with hard, raised everted edges

Answer 1

Squamous Cell Carcinoma

Question 2

Which metastasizes - Squamous Cell or Basal Cell?

Answer 2

Squamous Cell Carcinoma

Question 3

Pearly nodule with rolled telangiectactic edge

Answer 3

Basal Cell Carcinoma

Question 4

Strep throat infection –> tear-drop salmon-pink papules with fine scale, on trunk/limbs

Answer 4

Guttate Psoriasis

Question 5

Psoriasis treatment

Answer 5

Dermol 500 cream –> Dovobet (calcipotriol + betamethasone)

Also: UV phototherapy, methotrexate

Question 6

Seborrheic drematitis treatment

Answer 6

Ketoconazole 2% shampoo + olive oil

Question 7

Single red lesion, with central clearing – what is best investigation?

Answer 7

KOH microscopy (tinea caused by dermatophytes)

Question 8

Several itchy, hypopigmented lesions

Answer 8

Pityriasis Versicolor

Question 9

Sharply-defined skin infections

Answer 9

Erysipelas (strep pyogenes)

Question 10

Differentiate with herpes zoster ophthalmicus and Ramsay-Hunt?

Answer 10

Face paralysis in Ramsay-Hunt (shingles affecting facial nerve)

Question 11

One red lesion with central clearing –> lots more across body

Answer 11

Pityriasis Rosea (HHV6/7)
One red lesion is Herald Patch

Question 12

Rosacea treatment

Answer 12

Topical metronidazole

Question 13

How to remember TB side effects

Answer 13

RifamPEEcin
IsoNERVEzid
PyraLIVERmide
EYEthambutol

Question 14

HIV diagnosis

Answer 14

Combined HIV antibody and p24 antigen

Question 15

Haemolytic Uraemic Syndrome triad

Answer 15

MAHA
AKI
Thrombocytopaenia

Question 16

Cause of diarrhoea in a traveller

Answer 16

E. coli (ETEC)

Question 17

Chlamydia treatment

Answer 17

Doxycycline (or azithromycin)

Question 18

Gonorrhoeae treatment

Answer 18

IM ceftriaxone

Question 19

Haemantics in sideroblastic anaemia

Answer 19

Raised iron, raised ferritin

Question 20

Syphilis treatment

Answer 20

IM penicillin

Question 21

Pallor, jaundice, hepatosplenomegaly, overgrowth of maxillary bone

Answer 21

Beta thalassaemia (increased EPO = increased bone expansion)

Question 22

Where is B12 absorbed?

Answer 22

Terminal ileum (so affected by Crohn’s)

Question 23

Thrombotic Thrombocytopenia Purpura pentad

Answer 23

HUS + fever + CNS signs

Question 24

Thrombotic Thrombocytopenia Purpura

Answer 24

Plasmapheresis and steroids

Question 25

Genetics of sickle cell anaemia

Answer 25

Mutation in codon 6 of β-globin gene = glutamate to valine

Question 26

APTT = intrinsic or extrinsic pathway?

Answer 26

Intrinsic
 Haemophilia A or B
 vWD (carries factor 8)
 Unfractionated heparin

Question 27

PT = intrinsic or extrinsic pathway

Answer 27

Extrinsic
 Warfarin
 Hepatic failure

Question 28

Difference between warfarin compliance and overdose re. APTT and PT

Answer 28

Warfarin compliance = ↑PT, normal APTT

Warfarin overdose = ↑PT and ↑APTT

Question 29

Platelet transfusion indication

Answer 29

Normal: <10
Surgery: <50
Surgery in critical site: <100

Question 30

FFP vs cryoprecipitate

Answer 30

FFP = clotting factors 
Cryoprecipitate = fibrinogen – use when fibrinogen <1g/L (give 10 units)

Question 31

CML treatment

Answer 31

Imatinib (TKI)

Question 32

CLL treatment

Answer 32

Watch and wait… unless lymphos double every 6 months, B symptoms, bone marrow failure

Question 33

Auer rods

Answer 33

AML

Question 34

Sigmoid vs caecal volvulus treatment

Answer 34

Sigmoid: flatus tube insertion
Caecal: right hemicolectomy