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MCQs – 5 Feb 2015

 Q.1

IDIOPATHIC THROMBOCYTOPENIC PURPURA

Underlying problem is failure of production of platelets.

May present with bruising.

Platelet count will typically be 150-250×109/litre.

In the majority of cases, runs a chronic refractory course.

May be precipitated by a viral infection.

Q.2

PERTHE’S DISEASE

Typical age at presentation is eight-to-15 years.

In 10 per cent of patients is bilateral.

Limits flexion and external rotation at the hip.

Prognosis is worse the younger the child at onset.

When suspected, patient should be referred urgently to a specialist.

Q.3

PORT WINE STAINS

Are normally present at birth.

Are always pale pink in colour.

Blanch on pressure.

Persist throughout life.

Are best treated by plastic surgery, whatever their size.

Q.4

IN PATIENTS WITH A NEUROPATHIC BLADDER, INTERMITTENT SELF-CATHETERISATION

Is only effective when the bladder contains a significant residual volume of urine.

Should take place once or twice daily.

Must be carried out with a full sterile technique.

Should be discontinued if any urethral bleeding occurs.

Catheters should be used for one-to-two days, only then should be discarded.

Q.5

RECOGNISED FEATURES OF POLYMYALGIA RHEUMATICA INCLUDE

Mild anaemia.

Night sweats.

Thigh pain.

Carpal tunnel syndrome.

Marked stiffness on movement.

A.1.

False. Immune mediated cause of thrombocytopenia from increased platelet destruction.

True. Usually large, from minimal trauma and in atypical sites.

False. Normal count is 150-400 x 109/litre.

False. Only 15 per cent of cases do this and may need immunosuppressive treatments.

True. Treatment of ITP required only if there are significant bleeding symptoms.

A. 2.

False. Five-to-nine year-old boys rather than girls.

True. Avascular necrosis of unknown aetiology.

False. Often no abnormality on examination but if there is, it will be limited internal rotation.

False. Worse prognosis with increasing age.

False. Managed by observation and avoidance of vigorous exercise so no need for urgent referral.

A. 3.

True. And affect both sexes equally.

False. Range from pale pink to deep purple.

True. Whereas flat melanocytic naevi don’t.

True. Do not involute, though some may fade slightly.

False. Small ones may be treated but for larger ones, best option is cosmetic cover or perhaps laser.

A. 4.

True. Those who learn often become dry and protect their kidneys from the effects of back pressure and infection.

False. At least four times daily to prevent bladder overfilling.

False. Sterility is not necessary — washing hands and skin round urethral orifice is sufficient.

False. 74 per cent get this initially and in 28 per cent, still occurring after three months. Warn patients of possibility beforehand.

False. Rinse in tap water and keep in Milton. Plastic catheter will last about a month.

A. 5.

True. And loss of weight.

True. And mild fever.

True. May make it difficult for the patient to sit on the lavatory seat or to drive for more than a few miles.

True. Shoulder pain and stiffness stopping arm movement may lead to swelling and oedema of the hands.

True. Especially on waking.

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