ICM

Question 1

List causes of Microcytic anaemia

Answer 1

Iron deficiency anaemia (most common); Thalassaemia; Sideroblastic (rare), aneamia of chronic disease (may be normocytic)

Question 2

List causes of Normocytic anaemia

Answer 2

Pregnancy; Acute blood loss; Haemolysis (can be macro); Hypothyroidism (can be macro); Bone marrow failure; Renal failure; Chronic disease

Question 3

List causes of Macrocytic anaemia

Answer 3

B12 or folate deficiency; Myelodysplastic sydromes; Alcohol excess; Reticulocytosis; Cytotoxic drugs (e.g. chemo, hydrocarbamide); Marrow infiltration; Antifolate drugs; Hypothyroidism

Question 4

Interpret these ABG resultspH: 7.29 (7.35-7.45) PaCO2: 25 mmHg (35-45 mmHg)HCO3-: 12 mEq/L (22-26 mEq/L)

Answer 4

Metabolic acidosis with partial respiratory alkalotic compensation

Question 5

Interpret these ABG resultspH: 7.45 (7.35-7.45) PaCO2: 63 mmHg (35-45 mmHg)HCO3-: 30 mEq/L (22-26 mEq/L)

Answer 5

Metabolic alkalosis will full respiratory compensation

Question 6

Interpret these ABG resultspH: 7.21 (7.35-7.45) PaCO2: 56 mmHg (35-45 mmHg)HCO3-: 22 mEq/L (22-26 mEq/L)

Answer 6

Respiratory acidosis without compensation

Question 7

Interpret these ABG resultspH: 7.35 (7.35-7.45) PaCO2: 41 mmHg (35-45 mmHg)HCO3-: 22 mEq/L (22-26 mEq/L)

Answer 7

Normal ABG

Question 8

Interpret these ABG resultspH: 7.52 (7.35-7.45) PaCO2: 16 mmHg (35-45 mmHg)HCO3-: 13 mEq/L (22-26 mEq/L)

Answer 8

Respiratory alkalosis with partial metabolic acidotic compensation

Question 9

Interpret these ABG resultspH: 7.22 (7.35-7.45) PaCO2: 58 mmHg (35-45 mmHg)HCO3-: 23 mEq/L (22-26 mEq/L)

Answer 9

uncompensated respiratory acidosis

Question 10

What is a melanocytic naevus?

Answer 10

A mole. Made from a collection of melanocytes - dark pigmentation which gives them their colour.

Question 11

What features distinguish a malignant melanoma from a mole (melanocytic naevus)?

Answer 11

Asymmetrical irregular border and colour with increasing size

Question 12

What are the features of a BCC?

Answer 12

Pearly lesion
Central ulceration on with rolled edges
Telengectasia (dilated spidery venules) (Bleed > ulcerate > heal again)
Almost never mets, commonest skin cancer, sunlight exposure

Question 13

What are the characteristics of a Squamous Cell Carcinoma?

Answer 13

Rapidly expanding
Painless (though often looks painful!)
Ulcerated nodule, rolled margin
Commonly ulcerate and bleed
Potential to metastasize!

Question 14

What does psoriasis look like?

Answer 14

Scaly, thickened, red patches with silvery-white accumulations Frequently appear around elbows and knees

Question 15

What does erythema multiforme look like?

Answer 15

Target lesions typically on arms and hands but anywhereHeals in 3 weeks

Question 16

What causes erythema multiforme?

Answer 16

Barbiturates, aspirin, sulphonamides, herpes simplex, TB, mycoplasma, typhoid, pregnancy, Vit C def, collagen vascular disease, IBD

Question 17

What features may help you diagnose a shingles rash?

Answer 17

Unilateral
Follows dermatome
Pustular

Question 18

How do you treat shingles and what causes it?

Answer 18

Caused by varicella zoster

Treated with aciclovir (800mg five times a day for 7 days)

Question 19

How do you diagnose a neck swelling as a thyroglossal cyst?

Answer 19

By asking the patient to stick their tongue out. If it is it will move up with the tongue.

Question 20

When would surgical resection be indicated for a thyroglossal cyst?

Answer 20

Dyspnoea
Dysphagia
Cyst infection
To prevent malignant change
Cosmesis

Question 21

How does the appearance of ringworm differ to erythema multiforme?

Answer 21

The lesions are not target-like although they are circular, tend to have a wider inner radius than EM and often isolated lesions rather than clusters of lesions

Question 22

How would you treat ringworm?

Answer 22

Topical anti fungal therapy Oral terbenfaine/itraconazole

Question 23

What does erythema nodosum look like?

Answer 23

Red bruise-like patches on the skin

Question 24

What is Erythema Nodosum and what causes it?

Answer 24

Reactive process of unknown pathogenesisStrept infectin, sarcoidosis, pregnancy, oral contraceptive pill, IBD, TB(In 50% of cases no cause identified)Do bloods and CXR

Question 25

What does pretibial myxoedema look like and what causes it?

Answer 25

Graves Disease (rare complication)
Sore, swollen, cracked skin down shins

Question 26

What is the ‘Butterfly Rash’ associated with?

Answer 26

SLE
Pellagra
Dermatomyositis

Question 27

What would you feel on palpation of an arteriovenous fistula?

Answer 27

A thrill (buzzing sensation)
Also audible bruit

Question 28

What does impetigo look like and what is the most common cause?

Answer 28

It has honey coloured scabs on an erythematous background
Staph aureus is the most common cause
It’s highly contagious!

Question 29

Where is eczema most common and what conditions is it commonly associated with?

Answer 29

Head, neck and creases (flexure areas)

Asthma and hayfever