Benha University Faculty of Medicine
Master degree of Dermatology Int. med. Course exam. 19-6-2012
Time allowed 3 hour Number of papers: 2
Answer
(Total marks 50)
1– Pericardial effusion in systemic disorders ( 10 causes ): ( 5marks)
i- collagen diseases ( RA , SLE ,SS )
ii- FMF
iii- Infections as lyme disease, TB
iv- sarcoidosis
v- hypothyroidism
vi- IBD
vii- wagner's granulomatosus
viii- uremia ( R.F )
ix- malignancies ( leukemia , lymphoma , lung cancer )
x- Amyloidosis
2 - proteinuria ( def. , 5 causes, 5 sequale ): ( 5marks)
Proteinuria is defined as urinary protein excretion of more tha 150 mg/day 5 types:
i- glomerular proteinuria
due to increased glomerular permeability
as - minimal change disease , MPGN , Ig A nephropathy , DM , amyloidosis,
ii- tubular proteinuria
due to decreased proximal tubular reabsorption of normally filtered ptns , usually less than 2 gm/day
as hypertensive nephrosclerosis , acute tubular necrosis , tubulo-interstitial diseases ( interstitial nephritis, urate nephropathy, NSAIDS,sickle cell, fanconi ) iii- overflow proteinuria
due to increased production of low molecular weight proteins
as Bence-Jones proteinuria in MM, hemoglobinuria in intravascular hemolysis , myoglobinuria in rhabdomyolysis iv- orthostatic (postural) proteinuria as in pregnancy v- functional as in fever , CHF, stress, anaemia, exercise vi- false proteinuria , due to loss of protein from lining of UT as infections , hematuria
5 sequale i- increased incidence of infections ii- anaemia iii- atherosclerosis d.t hyperlipidemia iv- hypercoagulable states d.t loss of antithrombin iii, hypovolemia and increased coagulating factors v- attacks of abdominal pain ( nephritic crisis ) vi- PT dysfunction vii- renal failure ( acute or chronic )
3 – 5 Diabetic emergencies : ( 5marks)
i- hypoglycemic coma affects Type 1 & 2 Diabetic
Secondary to Insulin or Oral Hypoglycemic Medication
Serum Glucose Levels Fall Below Normal Levels
Chch by neuroglycopenic and neurogenic manifestations
Ttt by glucose supplementation , glucagon ii- DKA ( Diabetic ketoacidosis )
common in type I DM ( IDDM )
In an attempt to save the Heart and Brain, the body produces Ketone Bodies from fatty acids( Acetoacetate, Beta-hydroxybutyrate, And Acetone)
Excessive Ketones lead to Acidosis
Chch by nauses,vomiting,abdominal pain,polyuria,kaussmul breathing , acetone odour of breath and hypovolemia
Ttt by fluids , insulin , correction of electrolytes and acidosis iii-hyperglycemic hyperosmolar non-ketotic coma ( HHNK )
Effects Type 2 Diabetics ,rare in type I
Prominent later in life
Elevated Blood Glucose lead to increases serum osmolarity
This results in Diuresis and Fluid Shift.
Increased Urination causes body wide depletion of Water and Electrolytes
No acidosis
Ttt by fluids and insulin iv- lactic acidosis
ppt. by tissue hypoxia , biguanides( metformin ) , alcoholism
there is anerobic glycolysis with production of lactic acid leading to sever acidosis this leads to kussmaul's breathing , disturbed consciousness , coma
ttt by I.V fluids , correction of precipitating agents , bicarbonate , even dialysis v- Cerebro-Vascular Stroke
Death or injury of brain tissue that is deprived of oxygen
Caused by a blockage (ischemic) or bleeding (hemorrhagic) of a blood vessel in the brain
Chch by Intoxicated appearance, slurred speech, unconsciousness
Severe headache, vision changes, One-sided weakness on body, Confusion Loss of bladder/bowel control ,Unequal pupils , High blood pressure
4 - Diagnostic tests to assess patient who bleeds ( 5 tests ): ( 5marks)
i- platelets count
low in thrombocytopenia
ii- bleeding time , PFA-100
increased BT or increased PFA-100in platelet dysfunction
normal BT or normal PFA-100 in vascular disorders, dysfibrinoginemia , factor VIII deficiency
iii- PT( Prothrombin time )
decrease VII, decresed V in liver disease
decreased VII, normal V in vit.K def. , warfarin, F VII def.
iv- PTT( Partial thromboplastin time )
corrects with mixing study in FVIII,IX,XI def.( hemophilia ABC)
not correct with mixing study in circulating anticoagulant ( lupus anticoagulant , heparin )
v- thrombine time : increased in dysfibrinoginemia
5 – hepatic involvement in dermatological disorders ( 5 ): ( 5marks)
6- polyneuropathy with nutritional disorders ( 5 causes ) : ( 5marks)
i- thiamine deficiency (dry beri beri )
chch by peripheral sensory neuropathy
ttt by thiamine 100 mg/day and vit. B complex ,diet rich in vitamins
ii- pellagra ( niacin ) deficiency
chch by sensory PN , dermatitis , diarrhea , dementia ttt by Nicotinic acid, 50 mg PO tid or25 mg IV tid; nicotinamide
50-100 mg IM or PO tid
iii- Vit. B12 deficiency ( SCD )
there is combined degeneration of
PN leading to sensory PN
Pyramidal tract leading to paraparesis
Post.column leading to sensory ataxia
Ttt by IM B12, 1000 μg daily for 1 week,
then weekly for 1 month, then monthly or oral B12, 1000 μg daily,
iv- pyridoxine deficiency ( vit B6 )
chch by Neuropathy, sensory ataxia, depression ,Infantile pyridoxine deficient epilepsy
ttt by 50-100 mg PO daily for neuropathy (preventive use if taking B6 antagonist)
v- copper deficiency
chch by Myelopathy, neuropathy
ttt by elemental cu
7- 5 risk factors for pulmonary embolism: ( 5marks)
Aquired
Advanced age Obesity Previous thromboembolism Prolonged immobility Hypercoagulable state Congestive heart failure Primary pulmonary hypertension Chronic obstructive pulmonary disease (COPD) Malignancy Stroke Inflammatory bowel disease Varicose veins Pregnancy and postpartum period Estrogen therapy such as oral contraceptives or hormone replacement therapy Indwelling vascular devices Surgery/postoperative Trauma (especially spinal injuries and long bone fractures) Severe burns
Inherited
Protein C, protein S, and antithrombin III deficiencies Activated protein C resistance (factor V Leiden) Hyperhomocysteinemia Prothrombin gene mutation Antiphospholipid antibody syndrome Lupus anticoagulant
8 – 5 Systemic causes of GIT Bleeding : ( 5marks)
i- hemorrhagic blood diseases ( thrombocytopenia , coagulopathy )
ii- vasculitis ( e.g PAN , Henoch Schonlein purpura )
iii- uremia
iv- anticoagulant therapy
v- hereditary hemorrhagic telangiectasia
vi- DKA MCQ (10 marks):
All questions answered by (false) or (true):
1-The pain of myocardial ischemia: a) Is typically induced by exercise and relieved by rest. b) Radiates to the neck and jaw but not teeth. c) Rarely lasts longer than 10 seconds after resting. d) Is easily distinguished from esophageal pain.
2-In Infective endocarditis a) Streptococci and staphylococci account for over 80% of cases b) left heart valves are more frequently involved than right heart valves c) normal cardiac valves are not affected d) glomerulonephritis usually occurs due to immune complex disease
3-Finger clubbing is atypical finding in: a) Chronic bronchitis b) Bronchiectasis c) Primary biliary cirrhosis d) Crypto genie fibrosing alveolitis
4 The following statements about thyrotoxicosis are true a) most cases are due to Graves' disease b) muttinodular goitre is more common than uninodular goitre c) amiodarone treatment is occasionally responsible d) the thyroid gland is diffusely hyperactive in Graves' disease
5-Causes of dysphagia include a) Cancer b) Cervical spondylosis c) Achalasia d) Post-corrosive
6-The following may be a cause of constipation a) Ignoring urge b) Antispasmodics c) Irritable bowel syndrome d) Thyrotoxicosis
7- Pernicious Anemia is characterized by: a. Macrocytic anemia b. Pyramidal lesions c. Splenomegaly d. Deep sensory loss
8- Rheumatoid arthritis may be associated with e. Subcutaneous nodules f. Radial deviation of the hands g. o) Swan.neck deformity of the hands h. Thickening of the u1nar nerve 9-Secondary diabetes is associated with: a) Thiazide diuretic therapy b) Haemochromatosis c) Primary hyperaldosteronism d) Pancreatic carcimona
10-Microscopic heamaturia would be an expected finding in: a) Urinary tract infection. b) Renal papillary necrosis. c) Membranous glomerulonephritis. d) Infective endocarditis.