NSS End of Block Exam Flashcards
What is the standard excision margin for a BCC?
4mm
What is the standard excision margin for the first excision of a melanoma (before you have a Breslow depth to help decide)?
2mm
- don’t want huge margins because fibrosis around the surrounding area changes the way the lesion drains and makes it harder to do a lymph node biopsy
What are the excision margins for melanoma based on its Breslow depth?
What tests should you do before prescribing methotrexate?
FBC, LFTs, U&Es
Infectious diseases screen - hepatitis B, hepatitis C, and TB (methotrexate is an immunosuppressant so may cause reactivation of latent disease)
Folate levels
Pregnancy testing
A man presents to the dermatologist with a 22mm pyogenic granuloma on his forearm that bleeds on contact.
How should you manage?
A. leave and monitor
B. cryotherapy
C. curettage and cautery
D. surgical excision
D. Surgical excision due to size and bleeding tendency
How should you manage a tympanic perforation with visible bleeding on otoscopy and hearing loss of 55dB?
A. Prescribe steroid and antibiotic ear drops to prevent infection
B. Leave it alone, it will heal itself over a few weeks
C. Offer a myringoplasty to resolve the hearing loss
C. Myringoplasty - a surgical procedure aimed at repairing the tympanic membrane
indicated for larger perforations or cases where the perforation fails to heal spontaneously
A 22 year old surfer presents saying that water is becoming increasingly trapped in his right ear when he goes out surfing. He has previously had a few episodes of otitis externa which were managed by the GP. On examination you can see a lesion that fills the bulk of his ear canal.
What is the most likely diagnosis?
A. otitis externa with sclerosis of the external acoustic meatus
B. osteoma in the ear canal
C. build up of keratin and wax
D. foreign body in the ear
Osteoma in the ear canal - associated with chronic cold water exposure
Parkinson’s disease is associated with > 50% dopamine reduction in the nigrostriatal pathway in the brain. True or false?
True
Guillain Barre Syndrome predominantly affects motor function : is it characterised by UMN or LMN signs?
What is the pattern of sensory loss?
LMN signs
symmetrical and ascending pattern of sensory loss
What is the sensitivity of CT scans in picking up subarachnoid haemorrhage within 24 hours?
A. 30%
B. 50%
C. 70%
D. 90%
D. 90% (potentially even higher)
REVIEW
How should you investigate a patient who has presented with a new abducens nerve palsy?
A. MRI of the orbits
B. Optical coherence tomography
C. blood pressure, blood glucose and other observations
D. fluorescein angiography
C. blood pressure and blood glucose
need to assess for underlying cause of the nerve palsy
How do you remember the innervation of lateral rectus and superior oblique?
LR6 SO4
Lateral rectus is innervated by CN6 (abducens) - abducens nerve plasy causes difficulty moving eye laterally
Superior oblique is innervated by CN4 (trochlear), so a trochlear nerve palsy causes difficulty with vertical gaze
What is the most common cause of opthalmia neonatorum?
Chlamydia Trachomatis
What is the management of suspected retrobulbar haemorrhage?
Immediate decompression with lateral canthotomy and cantholysis to release pressure
should be performed at the bedside / in ED ASAP if retrobulbar hemorrhage is suspected based on clinical signs and symptoms, such as severe eye pain, proptosis (bulging of the eye), reduced visual acuity, or an afferent pupillary defect
CT/ MRI can be done to confirm the diagnosis AFTER the pressure has been reduced
