PAssmed qs i forget

Question 1

Ankylosing spondylitis - x-ray findings?

Answer 1

Ankylosing spondylitis - x-ray findings: subchondral erosions, sclerosis
and squaring of lumbar vertebrae

Question 2

Marfans: heart complications?

Answer 2

heart: dilation of the aortic sinuses (seen in 90%) which may lead to aortic aneurysm, aortic dissection, aortic regurgitation, mitral valve prolapse (75%),
lungs: repeated pneumothoraces

Question 3

marfans: eye complications?

Answer 3

eyes: upwards lens dislocation (superotemporal ectopia lentis), blue sclera, myopia

Question 4

Ehler-Danlos syndrome : complications?

Answer 4

elastic, fragile skin
joint hypermobility: recurrent joint dislocation
easy bruising
aortic regurgitation (mostly), mitral valve prolapse and aortic dissection
subarachnoid haemorrhage
angioid retinal streaks
Beighton score used to assess hypermobility

Question 5

osteoporosis in a man?

Answer 5

check testosterone levels
hypergonadotropic (primary gonadal failure) or hypogonadotropic (secondary to a defect in the hypothalamic-pituitary axis) hypogonadism. The role of androgens on male bone metabolism is twofold. First, androgens stimulate bone formation during puberty. Second, androgens prevent bone resorption during and after puberty.

Question 6

Patients who are allergic to aspirin may also react to?

Answer 6

sulfasalazine.

Cautions
G6PD deficiency

Question 7

Sulfasalazine: adverse affects

Answer 7

Adverse effects
oligospermia
Stevens-Johnson syndrome
pneumonitis / lung fibrosis
myelosuppression, Heinz body anaemia, megaloblastic anaemia
may colour tears → stained contact lenses

Question 8

Bone pain, tenderness and proximal myopathy (→ waddling gait) what do you sus?

Answer 8

osteopenia

Question 9

SLE drug causes?

antibodies?

Answer 9

most common drug causes include procainamide and hydralazine.
others:Less common causes
isoniazid
minocycline
phenytoin

antibodies?:
skin (e.g. malar rash) and pulmonary involvement (e.g. pleurisy) are common
ANA positive in 100%, dsDNA negative
anti-histone antibodies are found in 80-90%

Question 10

ANk spond As?

Answer 10

Apical fibrosis
Anterior uveitis
Aortic regurgitation
Achilles tendonitis
AV node block
Amyloidosis

Question 11

bloods:
low vitamin D levels
low calcium, phosphate (in around 30%)
raised alkaline phosphatase (in 95-100% of patients)
x-ray
translucent bands (Looser’s zones or pseudofractures)

Answer 11

osteomalacia

Question 12

lytic lesion in the diaphysis of the right femur with an ‘onion skin’ appearance in a 15YO?

Answer 12

ewing’s sarcoma - pelvis and long bones

Question 13

benign ‘overgrowth’ of bone, most typically occuring on the skull
associated with Gardner’s syndrome (a variant of familial adenomatous polyposis, FAP)

Answer 13

osteoma (begin)

Question 14

20-40Y/O, occurs most frequently in the epiphyses of long bones
X-ray shows a ‘double bubble’ or ‘soap bubble’ appearance

Answer 14

giant cell tumour

Question 15

where does osteocarcoma commonly occur?

what are the features of the X-ray?

Answer 15

metaphyseal region of long bones prior to epiphyseal closure, with 40% occuring in the femur, 20% in the tibia, and 10% in the humerus
x-ray shows Codman triangle (from periosteal elevation) and ‘sunburst’ pattern
AF: retinablastoma
RF: pagets, radiotherapy

Question 16

X Ray findings of Rheumatoid arthriis

Answer 16

Early x-ray findings
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling

Late x-ray findings
periarticular erosions
subluxation

Question 17

Drugs that worsen psoriasis?

Answer 17

trauma
alcohol
drugs: beta blockers, lithium, antimalarials (chloroquine and hydroxychloroquine), NSAIDs and ACE inhibitors, infliximab
withdrawal of systemic steroids

Question 18

criteria for hereditary haemohragic telangectasia

Answer 18

epistaxis : spontaneous, recurrent nosebleeds
telangiectases: multiple at characteristic sites (lips, oral cavity, fingers, nose)
visceral lesions: for example gastrointestinal telangiectasia (with or without bleeding), pulmonary arteriovenous malformations (AVM), hepatic AVM, cerebral AVM, spinal AVM
family history: a first-degree relative with HHT

Question 19

Secontion 2?

Answer 19

28 days, not renewable
an Approved Mental Health Professional (AMHP) or rarely the nearest relative (NR) makes the application on the recommendation of 2 doctors
one of the doctors should be ‘approved’ under Section 12(2) of the Mental Health Act (usually a consultant psychiatrist)
treatment can be given against a patient’s wishes

Question 20

Section 3?

Answer 20

6 months, can be renewed
AMHP along with 2 doctors, both of which must have seen the patient within the past 24 hours
treatment can be given against a patient’s wishes

Question 21

Section 4?

Answer 21

72 hour assessment order
used as an emergency, when a section 2 would involve an unacceptable delay
a GP and an AMHP or NR
often changed to a section 2 upon arrival at hospital

Question 22

Section 5/4

Answer 22

similar to section 5(2), allows a nurse to detain a patient who is voluntarily in hospital for 6 hours

Question 23

Section 5/2

Answer 23

a patient who is a voluntary patient in hospital can be legally detained by a doctor for 72 hours

Question 24

local anaesthetic tox SX?

Answer 24

agitation, confusion, dizziness, drowsiness, dysphoria, auditory changes, tinnitus, perioral numbness, metallic taste, and dysarthria. If not promptly recognised and treated, these signs and symptoms can progress to seizures, respiratory arrest, and/or coma.