passmed

Question 1

splenectomy + HbA1C

Answer 1

Splenectomy can give a falsely high HbA1c level due to the increased lifespan of RBCs

Question 2

Peptic ulceration, galactorrhoea, hypercalcaemi

Answer 2

MEN 1
3 Ps
Parathyroid hyperplasia –> hypercalcaemia (most comm pres)
Pituitary adenoma –> galactorrhoea
Pancreatic disease –> insulinoma, gastrinoma –> PU

Question 3

nephrogenic DI - water deprivation test findings

Answer 3

urine osmolality - after fluid deprivation LOW

urine osmolality -after desmopressin LOW

Question 4

EBV virus effect on FBC

Answer 4

neutropaenia

Question 5

CML novel tx

Answer 5

imatinib - TK inhibitor

Question 6

most common thyroid c + progn

Answer 6

papillary thyroid C - excellent prognosis despite early spread to cervical LNs

Question 7

ITP 1st line tx

Answer 7

oral pred

Question 8

causes of raised prolactin - p’s

Answer 8

pregnancy
prolactinoma
physiological
polycystic ovarian syndrome
primary hypothyroidism
Phenothiazines, metocloPramide, domPeridone

Question 9

most common cause of inherited THROMBOPHILIA –> tendency to develop clots

Answer 9

Factor V Leiden mutation (5% prevalence) results in activated protein C resistance –> 4x risk of VTE

Question 10

ovaries drain to where

Answer 10

para-aortic LNs

Question 11

SGLT-2 rare skin SE

Answer 11

nec fasc of genitalia or perineum (Fourniers)

Question 12

std HbA1c target in T2DM

Answer 12

48mmol/mol

Question 13

how to change drugs in addisons when intercurrent illnesss

Answer 13

DOUBLE GC + same fludrocortisone

Question 14

platelet transfusion: active bleeding cut off

Answer 14

• Offer platelet transfusions to patients with a platelet count of <30 x 10 9 with clinically significant bleeding
  e. g. WHO bleeding grade 2= haematemesis, melaena, prolonged epistaxis
• higher threshold higher (maximum < 100 x 10 9) for patients with severe bleeding (WHO bleeding grades 3&4), or bleeding at critical sites, such as the CNS
• platelet transfusions have highest risk of BACTERIAL CONTAMINATION vs other blood products

Question 15

platelet transfusions cut off as prophylaxis before surgery

Answer 15

Platelet transfusion for thrombocytopenia before surgery/ an invasive procedure. Aim for plt levels of:
> 50×10 9/L for MOST PTS
50-75×10 9/L if HIGH RISK OF BLEEDING
>100×109/L if surgery at CRITICAL SITE

Question 16

Platelet transfusion threshold if no active bleeding or planned procedures

Answer 16

A threshold of 10 x 10 9 except where platelet transfusion is CI or there are alternative treatments for their condition

• EG, do not perform platelet transfusion for any of the following conditions:
• ->Chronic bone marrow failure
• ->AI thrombocytopenia
• ->HIT or TTP

Question 17

antiplatelets for ACS (medically treated)

Answer 17

1st: Aspirin (lifelong) + ticagrelor (12m)
2nd: if aspirin CI, clopi (lifelong)

Question 18

antiplatelets for PCI

Answer 18

1st: Aspirin (lifelong) + prasurgrel or ticagrelor (12m)
2nd: if aspirin CI, clopi (lifelong)

Question 19

antiplatelets for TIA

Answer 19

1st: Clopi (lifelong)
2nd: aspirin (lifelong) + dipyridamole (lifelong)

Question 20

antiplatelets for Ischaemic stroke

Answer 20

1st: Clopi (lifelong)
2nd: aspirin (lifelong) + dipyridamole (lifelong)

Question 21

antiplatelets for PAD

Answer 21

1st: Clopi (lifelong)
2nd: aspirin (lifelong)

Question 22

neuroblastoma

Answer 22

tumour arising from NEURAL CREST TISSUE of ADRENAL MEDULLA (most common site) + SYMP NERVOUS SYSTEM

• median age of onset = 20m
• feat: abdo mass, pallor, weight loss, bone pain, limp, hepatomegaly, paraplegia, proptosis
• Ix: raised urinary VMA + HVA levels, calcification on abdo XR, biopsy

Question 23

venous ulceration iX + MX

Answer 23

IX: 1. ABPI is imp in non-healing ulcers to assess for poor arterial flow which could impair healing

• a ‘normal’ ABPI may be regarded as between 0.9 - 1.2
• Values < 0.9 indicate ARTERIAL disease
• Interestingly, values > 1.3 may also indicate arterial disease, in the form of false-negative results secondary to arterial calcification (e.g. In diabetics)

MX:

1. COMPRESSION BANDAGING, usu 4 layer (only tx shown to be of real benefit)
2. oral PENTOXIFYLLINE, a peripheral VD, impr healing rate
3. small evidence base supporting use of FLAVINOIDS

Question 24

Interpretation of ABPI

Answer 24

> 1.2: may indicate calcified, stiff arteries. This may be seen with advanced age or PAD
1.0 - 1.2: NORMAL
< 0.9: likely PAD.
Values < 0.5 indicate severe disease which should be REFER URGENTLY

Question 25

what ABPI is compression bandaging acceptable for

Answer 25

Compression bandaging is generally considered acceptable if the ABPI >= 0.8

Question 26

arterial ulcers

Answer 26

Occur on the toes and heel
Painful
There may be areas of gangrene
Cold with no palpable pulses
Low ABPI measurements

Question 27

Marjolins ulcers

Answer 27

=Squamous cell carcinoma
Occurring at sites of chronic inflammation e.g; burns, osteomyelitis after 10-20 years
Mainly occur on the lower limb

Question 28

Venous ulcers features + cause

Answer 28

-Most due to venous hypertension, secondary to chronic venous insufficiency (other causes include calf pump dysfunction or neuromuscular disorders)
-Ulcers form due to capillary fibrin cuff or leucocyte sequestration
-Features of venous insufficiency include oedema, brown pigmentation, lipodermatosclerosis, eczema
-Location above the ankle, painless
-Deep venous insufficiency is related to previous DVT and superficial venous insufficiency is associated with varicose veins
-Doppler ultrasound looks for presence of reflux and duplex ultrasound looks at the anatomy/ flow of the vein
-Management: 4 layer compression banding after exclusion of arterial disease or surgery
If fail to heal after 12 weeks or >10cm2 skin grafting may be needed

Question 29

Neuropathic ulcers

Answer 29

Neuropathic ulcers

• Commonly over plantar surface of metatarsal head and plantar surface of hallux
• The plantar neuropathic ulcer is the condition that most commonly leads to amputation in diabetic patients
• Due to pressure
• Mx: includes CUSHIONED SHOES to reduce callous formation + DIABETIC FOOT CHECKS

Question 30

Pyoderma Gangrenosum

Answer 30

• Associated with IBD/RA
• Can occur at STOMA sites
• Erythematous nodules or pustules which ulcerate