General Points 8

Question 1

Osteopetrosis

Answer 1

Bones become harder and more dense.
Autosomal recessive condition.
It is commonest in young adults.
Radiology reveals a lack of differentiation between the cortex and the medulla described as marble bone.

Question 2

Infected sebaceous cyst

Answer 2

Incision and drainage with excision of the cyst wall and packing of the defect

Question 3

Abdominal aortic aneurysm

Answer 3

0.06 per 1000 people
Commonest in elderly men
Abdominal aortic ultrasound measurement in all men aged 65 years
Causes - arterial disease, connective tissue disorders
Most are incidental findings
Symptoms are duee to rupture or impending rupture
20% rupture anteriorly into the peritoneal cavity - very poor prognosis
80% rupture posteriorly into the retroperitoneal space
Risk of rupture is related to aneurysm size - only 2% of aneurysms measuring less than 4cm in diameter will rupture over a 5 year period, 75% of aneurysms measuring over 7cm in diameter will rupture over a 5 year period

Management
Aneurysm size of less than 5cm - USS abdo in 6 months
Aneurysm size of 5cm or greater - CT chest, abdomen and pelvis with the aim of delineating anatomy and planning treatment
Depending upon co-morbidities, surgery is generally offered once the aneurysm is between 5.5cm and 6cm

Question 4

True vs false aneurysm

Answer 4

True - all 3 layers of the arterial wall are involved

False - only a single layer of fibrous tissue forms the aneurysm wall

Question 5

Inferior myocardial infarction and aortic regurgitation murmur

Answer 5

Ascending aorta dissection

Question 6

Differentials for high amylase

Answer 6

Acute pancreatitis, pancreatic pseudocyst, mesenteric infarct, perforated viscus, acute cholecystitis, DKA

Question 7

Infusion with which of the following blood products is most likely to result in an urticarial reaction?

Answer 7

Fresh frozen plasma

Question 8

Infusion with which of the following blood products is most likely to result in a pyrexial reaction?

Answer 8

Packed red blood cells

Question 9

Causes of avascular necrosis

Answer 9

Plastic rags

Pancreatitis
Lupus
Alcohol
Steroids
Trauma
Idiopathic, infection
Caisson disease, collagen vascular disease
Radiation, rheumatoid arthritis
Amyloid
Gaucher's disease
Sickle cell disease

Question 10

IVDU with back pain and pyrexia

Answer 10

Osteomyelitis
The most likely organism is staph aureus and the cervical spine is the most common region affected
TB tends to affect the thoracic spine and in other causes of osteomyelitis the lumbar spine is affected