Revision for MCQ's Flashcards
(30 cards)
What is the most common skin cancer in nz? What are the risk factors?
BCC: Fair skin, age and sun exposed places.
What is the most important prognostic factor in melanoma? What is second?
Depth. Lymph node involvement.
What is 1% of body equal to?
The palm of the hand and fingers of the patient.
What is the fluid requirement for a burn?
3-4mls/kg/% burn over 24 hours of heartmans. Give half in the first 8 hours.
What is a flap vs a graft?
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).
What are the two types of flaps? Explain the difference.
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.
What is a compound graft/flap.
A flap/graft with lots of different tissue types e.g. skin fat and cartilage.
What is a microvascular flap/free flap?
A flap which has been disconnected from blood supply but then reconnected using microsurgical techniques.
Does a craniosynostosis need an xray?
No
What are some issues with craniosynostosis?
How are most craniosynostosis treated?
With springs.
What joints are effected in RA?
preferentially the wrist, MCP and PIP joints.
What blood tests are specific and sensitive for RA?
Blood tests: CRP and ESR are increased.
RF is increased - but not specific.
AntiCCP is much more specific (90%).
What genetic marker is altered in RA?
HLA - DR4 (found in 70% of patients and is associated with bad outcomes). HLA - DR1 is also a good marker.
PTPN22 and PAD14.
What increases risk of RA?
Smoking (lots of citrullinated proteins) increases risk for rheumatoid +vs RA patients.
What is the key pathophysiological feature of RA?
Thickend, inflammed, hypervascular and hypercellular synovium creating a pannus of lymphocytes.
Drugs to treat RA?
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)
What is the goal serum urate level to get down to
0.36mmol/L.
Treatment of gout?
- NSAIDS but they are often contraindicated.
- Cholchine but contraindicated in eGFR <50
- Corticosteroids if anything else doesn’t work 20-40mg of pred stat, then daily and wean over 2 weeks to prevent another attack.
What are the guidelines for giving urate lowering drugs?
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.
How does allopurinol work?
Are there side effects?
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.
Symptoms of PMR?
Pain in shoulder and pelvic girdle.
What test is normally high in PMR?
ESR and CRP.
What are some differentials for PMR
Fibromyalgia, rheumatoid arthritis, malignancy and hypothyroidism.
