OLSCOIL NA hEIREANN
THE NATIONAL UNIVERSITY OF IRELAND
NATIONAL UNIVERSITY OF IRELAND, GALWAY
SUMMER EXAMINATION 2008.
M.B., BCh, B.A.O. WRITTEN
MEDICINE
PAPER 2
Dr. J. J. Gilmartin
Dr. P. Marren
Dr. D. Reddan
Dr. R. Coughlan
Dr. T. Counihan
Dr. C. Fleming
Time allowed : 3 hours
EACH QUESTION (1,2,3,4,5 & 6) MUST BE ANSWERED ON A SEPARATE ANSWER BOOK
1.
You are asked to see Mr. Sean Cathal Laurence Carter, a 63 year old smoker of 50 pack years
with a 3 day history of increasing confusion and drowsiness. He has been taking no
medications. Clinically he appears unwell and cannot provide a history. There are several
large lymph nodes in the right supraclavicular fossa and 5 fingers of hepatic enlargement but
no other clinical signs. His biochemistry (in mmols/l) shows :
Na
+
117 (135-145); Cl-81(98-106); K
+
3.5 (3.3-5.1); glucose 3.7(3.9-7.8); Urea 2.8 (3.2-7.5)
(a) What abnormality does his chemistry show?
(b) What immediate treatment will you institute?
(c) What other urgent investigations will you perform?
(d) What unifying pathology can explain the presentation?
2. A 26 year old professional woman develops a red scaly rash on her elbows, knees, forearms
and scalp. This gradually extends over a number of months to affect her face, lower back and
lower limbs. It is very unsightly but not very itchy. She also has some pain and stiffness in her
hands and knees. She previously experienced a red scaly rash following a sore throat as a
teenager but this resolved spontaneously within a few weeks.
Her father has a history of a similar rash on his scalp.
(a) What is the likely diagnosis of the skin disease and why?
(b) This skin disease can present in different forms. Describe these clinical variants
(c) Describe the treatment options available to this woman and the advantages /
disadvantages of each option.
(d) Discuss the overall impact this skin disease may have on this woman’s quality of life.
3. Discuss Chronic Kidney disease with specific reference to:
(a) eGFR
(b) Staging of CKD
(c) Complications of CKD
(d) Preparation for renal replacement therapy
