Revision for MCQ's

Question 1

What is the most common skin cancer in nz? What are the risk factors?

Answer 1

BCC: Fair skin, age and sun exposed places.

Question 2

What is the most important prognostic factor in melanoma? What is second?

Answer 2

Depth. Lymph node involvement.

Question 3

What is 1% of body equal to?

Answer 3

The palm of the hand and fingers of the patient.

Question 4

What is the fluid requirement for a burn?

Answer 4

3-4mls/kg/% burn over 24 hours of heartmans. Give half in the first 8 hours.

Question 5

What is a flap vs a graft?

Answer 5

A flap has its own blood supply. A graft needs a blood supply (and cant be put on avascular tissue such as cortical bone or tendons).

Question 6

What are the two types of flaps? Explain the difference.

Answer 6

Split thickness (SSG) and full thickness graft (FFSG).
SSG doesn’t contain the underlying deep dermis therefore doesn’t contain sweat glands etc, but a large chunk can be taken as it leaves the skin on top for the donor to epithelialise. FFSG need to be closed fully and only a small amount can be taken - but it does contain sweat glands and doesn’t look shiny.

Question 7

What is a compound graft/flap.

Answer 7

A flap/graft with lots of different tissue types e.g. skin fat and cartilage.

Question 8

What is a microvascular flap/free flap?

Answer 8

A flap which has been disconnected from blood supply but then reconnected using microsurgical techniques.

Question 9

Does a craniosynostosis need an xray?

Answer 9

No

Question 10

What are some issues with craniosynostosis?

Answer 10

Question 11

How are most craniosynostosis treated?

Answer 11

With springs.

Question 12

What joints are effected in RA?

Answer 12

preferentially the wrist, MCP and PIP joints.

Question 13

What blood tests are specific and sensitive for RA?

Answer 13

Blood tests: CRP and ESR are increased.
RF is increased - but not specific.
AntiCCP is much more specific (90%).

Question 14

What genetic marker is altered in RA?

Answer 14

HLA - DR4 (found in 70% of patients and is associated with bad outcomes). HLA - DR1 is also a good marker.
PTPN22 and PAD14.

Question 15

What increases risk of RA?

Answer 15

Smoking (lots of citrullinated proteins) increases risk for rheumatoid +vs RA patients.

Question 16

What is the key pathophysiological feature of RA?

Answer 16

Thickend, inflammed, hypervascular and hypercellular synovium creating a pannus of lymphocytes.

Question 17

Drugs to treat RA?

Answer 17

NSAIDS for symptoms. Prednisone to get inflammation down early. Methotrexate or sulphasalazine as a DMARD.
Methotrexate is a teratogen so don’t use if pregnant or planning to get pregnant - maybe put on adequate contraceptive. Hydroxychloroquine can be given in this case.
Can go onto biologics such as infliximab (anti-TNF)

Question 18

What is the goal serum urate level to get down to

Answer 18

0.36mmol/L.

Question 19

Treatment of gout?

Answer 19

1. NSAIDS but they are often contraindicated.
2. Cholchine but contraindicated in eGFR <50
3. Corticosteroids if anything else doesn’t work 20-40mg of pred stat, then daily and wean over 2 weeks to prevent another attack.

Question 20

What are the guidelines for giving urate lowering drugs?

Answer 20

1) at least 2 flares every year.
2) a tophus present (extra-articular collections of cells and urate crystals in soft tissue).
3) x-ray evidence of damage from gout.
4) renal impairment or very high urate.

Question 21

How does allopurinol work?
Are there side effects?

Answer 21

Xanthine oxidase inhibitor.
Lots of side effects - severe hypersensitivity reaction.
Need to do blood tests to look for kidney function before giving as oxypurinol may cause this hypersensitivity reaction.

Question 22

Symptoms of PMR?

Answer 22

Pain in shoulder and pelvic girdle.

Question 23

What test is normally high in PMR?

Answer 23

ESR and CRP.

Question 24

What are some differentials for PMR

Answer 24

Fibromyalgia, rheumatoid arthritis, malignancy and hypothyroidism.

Question 25

How do you treat PMR?

Answer 25

Low dose steroid: 15mg of prednisone daily for 1mth then slowly taper off till you find the perfect dose. Most patients will require low dose prednisone for 3 years.

Question 26

What do you need to look out for with PMR?

Answer 26

Temporal arteritis: red flags are fever, loss of vision, new headaches in temporal region. superficial temporal arteries may be tender/pulseless.
Need to treat with steroids (80mg pred) to prevent permanent blindness.
Always do a temporal artery biopsy.

Question 27

What is the main gene indicated in spondyloarthropathies?

Answer 27

HLAB27

Question 28

What things make spondyloarthropaties feel better?
What makes spondyloarthropaties worse?

Answer 28

1) improvement with movement/exercise
2) Improvement with NSAID treatment.

1) Pain with rest/going to bed.

Question 29

What is enthesis? What is normally affected in ankspond?

Answer 29

Pain at the insertion site of a tendon into the periosteum. The archillies tendon and plantar fascia.

Question 30

What are the extraarticular features of spondyloarthropathies?

Answer 30

Anterior uveitis in 25%
IBD in 7%
Lung fibrosis or pneumonitis.
Cardiac conduction defecits.