Exam QNA

Question 1

How much margin does melanoma excision require?

Answer 1

In situ: 0.5cm

Breslow<2mm: 1CM

Breslow>2mm: 2cm

Question 2

Gene responsible for melanoma

Answer 2

CDKN2A, CKD4
Retinoblastoma 1 (RB1)

Question 3

Poor prognostic factors for melanoma

Answer 3

Male
Old age
Nodular
Thicker breslow thickness

Question 4

What skin condition associated with melanoma?

Answer 4

Xeroderma pigmentosum

Question 5

What is xeroderma pigmentosum

Answer 5

Autosomal recessive
DNA repair disorder
Damaged skin cells post UV exposure cannot be repaired

Question 6

How to ensure margins are included in a re-excision of melanoma

Answer 6

Mohs microscopic surgery (takes longer, 100% of margins are examined under microscope)

Frozen section

Question 7

DVT mx

Answer 7

1. Rx dose enox + 6mo of anticoagulation
2. Catheter directed thrombolysis
3. tPA (plasminogen activator)
4. SVC filter

Question 8

Indications for catheter-directed thrombolysis for DVT

Answer 8

Clots less than 14 days old

Acute phegmasia cerulea dolens with no contraindications

Question 9

Indications for IVC/SVC filter

Answer 9

Failure of treatment of DVT
CI to anticoagulation
Presurgical prophylaxis for pt with high risk of VTE

Question 10

Treatment options for BCC

Answer 10

Curettage and cautery
Excision with margin of 4 mm (or Mohs micrographic)
Topical fluorouracil 5%

Question 11

Treatment of MRSA

Answer 11

Outpatient: Clindamycin

Inpatient: IV vancomycin 7-14 days

Question 12

Treatment of MRSA

Answer 12

Outpatient: Clindamycin

Inpatient: IV vancomycin 7-14 days

Question 13

Reedstenberg cells

Answer 13

Hogdkin lymphoma

Question 14

Sx of Aortic stenosis

Answer 14

Syncope
Dyspnoea
Angina

Heart failure later on

Question 15

Commonest bacterial cause of infective endocarditis

Answer 15

Staph aurus
sterp viridans

Question 16

Janeway lesions vs Osler nodes

Answer 16

Janeway = palm, painless

Oslers = painful, pulp of fingers

Question 17

Pathophysiology of Janeway lesion and Osler nodes

Answer 17

Janeway: immunocomplex deposition

Osler: septic microemboli (painless)

Both signs of infective endocarditis

Question 18

How does bicuspid valve cause aortic stenosis

Answer 18

Doesnt cause narrowing of flow in itself

Causes turbulent flow which lead to continuous trauma leading to fibrosis, rigidity and calcification

Question 19

Why bicuspid aortic valve could lead to sudden death

Answer 19

Increased risk of

MI
Aortic dissection

Question 20

Surgical options for aortic stenosis

Answer 20

TAVI (transcatheter AV implant)

Open operation

Question 21

Why metalic valves increase risk of clotting

Answer 21

Risk of clot formation even when blood not flowing through the valve (eg around the hinges, etc) as it captures the blood and keeps it

Question 22

Branching hyphae seen on the valve in histology. What does it indicate?

Answer 22

Fungal infection eg candida

Question 23

What is a vegetation on heart valve usually made off

Answer 23

Fibrin-platelet thrombus with bacteria deep inside it

Question 24

Why antibiotics might not be effective against valvular vegetation

Answer 24

Avascular area
Deep position of bacteria within the fibrin-platelet complex
Fibrin network stops the leucocyte migration

Question 25

Why prosthetic valves more prone to infective endocarditis

Answer 25

Organisms attach themselves and form a biofilm

Question 26

How do steroids cause immunosuppression

Answer 26

Sequestration (removal) of CD4 T cells

Question 27

Mech of action of immunosuppressants

Answer 27

Question 28

Complication of immunosupprassants

Answer 28

Infection Hepato-renal toxicity Anaphylaxis Cancer (biologics)

Question 29

Treatment of infective endocarditis

Answer 29

1. abx 2. valve replacement 3. heart transplant

Question 30

Consequence of long term steroid use

Answer 30

Malignancy: leukaemia lymphoma

Question 31

Features of temporal artery biopsy

Answer 31

Intimal thickening Luminal stenosis Tunica media changes: - Giant cells - necrosis

Question 32

Why get visual disturbance in giant cell arteritis

Answer 32

Ophthalmic artery affected

Question 33

Risk factors for oesteoprosis

Answer 33

Female Post-menupause Age >60 Steroids

Question 34

Blood test for giant cell arteritis

Answer 34

ESR

Question 35

Blood test for rheumatic heart disease monitoring

Answer 35

ESR

Question 36

Pathophysiology of osteoprosis

Answer 36

Metabolic bone disease: a. low bone mass b. microarchitecutural

Question 37

Osteomalacia vs osteoprosis

Answer 37

M: reduced bone mineral to matrix ratio P: reduced bone mass. normal ratio

Question 38

Why tumours cause hypercoaguable state

Answer 38

Produce procoagualnts and inflammatory cytokines Activate coagulation cascade Stimulate tissue factor production

Question 39

Which enzyme converts fibringoen to fibrin

Answer 39

Thrombin

Question 40

Which enzyme converts fibringoen to fibrin

Answer 40

Thrombin

Question 41

Complications of cryptorchidism

Answer 41

Infertility Cancer Torsion

Question 42

Type of testicular cancer in elderly

Answer 42

lymphoma

Question 43

TNM staging of colorectal ca

Answer 43

Tis- in situ T1- submucosa T2- muscularis propria T3- Subserosa T4- Directly invading other organs or structures

Question 44

Giant cells def

Answer 44

fusion of multiple cells especially macrophages form giant cells of langerhans sign of chronic inflammation

Question 45

Pathophysiology of IBD

Answer 45

unknown/idiopathic

Question 46

IBD extra-intestinal manifestations

Answer 46

Shared: - Uveitis - Episcleritis - Arthritis Crohns specific: - erythema nodosum - perianal disease (fistula/abscess) UC specific: - PSC

Question 47

Crons vs UC histological findings

Answer 47

Crohns: - transmural inflammaition - granulomas UC: - Crypt abscess - Inflammatory cells in lamina propria

Question 48

Endoscopic appearance of crohns vs UC

Answer 48

Crohns: - skip lesion - strictures - copplestoning UC: - continues inflammation of rectum +colon - contact bleeding