Nephrology MCQ_Part03

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The most common complication of minimal change disease is:
 1.Infection
 2.Hemorrhage
 3.Side-effects of steroid therapy
 4.End-stage renal disease
 5.Renal vein thrombosis

Primary IgA nephropathy is believed to result from which immunopathogenetic mechanism?

1.Deposition of immune complexes containing IgA1 in mesangium with activation of alternative complement pathway
2.Defective hepatic clearance of immune complexes containing IgA
3.Increased mucosal synthesis of IgA that cross reacts with mesangial antigens
4.monoclonal B cell proliferation producing mesangiopathic IgA
5.planted viral antigens in mesangium inducing an autoimmune response

A 39year old man is complaining of the worst groin pain that he has ever experienced. He feels that he may have strained his groin playing football earlier in the week but notes that the pain seems to begin in the flank. It is affecting his left side and is colicky type and  the pain is worsening on urinating. Dipstick reveals microscopic haematuria. He has no past history of abdominal problems and has had no operations in the past. His observations reveal a heart rate of 120 beats/minute, respiratory rate 24 breaths/minute, sats 92%, blood pressure 157/91mmHg. What is the likely diagnosis?

A. Pyelonephritis
B. Renal calculus
C. Ureteric calculus
D. Renal cell carcinoma
E. Prostatism

MCQ 1 ANSWER

The Correct Answer is C - Minimal change disease


Is a commonest cause of nephrotic syndrome in children in whom this disease occur frequently. Despite massive proteinuria, the renal function remains normal. Over 90% of patients are corticosteroid sensitive while small numbers of patients are corticosteroid dependent or resistant. The later can be treated by immunosuppressive agents. The disease is characterized by normal appearing glomeruli on light and immunofluorescence microscopy and the only abnormality detected is effacement of epithelial cell foot processes which is identified on electron microscopy only. No immune-complexes are identified and so the disease is not an immune complex in origin but several associated features suggests immune mediation. The current hypothesis is that the cell-mediated immunity seems to play an important role where T-lymphocytes are said to produce vascular permeability factor which is responsible for massive proteinuria.

MCQ 2 ANSWER

The Correct Answer is A - IgA NEPHROPATHY


IgA NEPHROPATHY Causes: Nephrotic syndrome
Epidemiology/At risk individuals: Most common type of GN worldwide, occurs 1-2 days after URTI/GIT infections in patients


Clinical features: There is an acquired or genetic defect in regulating production of IgA antibodies. After URTI / GIT infection, too much IgA is produced a forms immune complexes and trapped in mesangium and activate alternate complement pathway a injury. Patient will develop Proteinuria + haematuria (Nephrotic syndrome). Progress to ESRF in 25-50% of patients.


Morphology: Light Microscope: mesangial proliferation, matrix deposition. Immunofluorecence: IgA in mesangium + C3.

MCQ 3 ANSWER

The Correct Answer is C - Ureteric calculus




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Surgery MCQ_Part 01

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Stones in the common bile duct
a. Are found in 30% of patients undergoing cholecystectomy (Without pre-op ERCP)
b. Can present with Charcot's Triad
c. Are suggested by an bile duct diameter more than 8mm on ultrasound
d. ERCP, sphincterotomy and balloon clearance is now the treatment of choice
e. If removed by exploration of the common bile duct the T-tube can be removed after 3 days

Regarding stones in the gallbladder
a. Cholesterol stones are the most common
b. Pigment stones are due increased excretion of polymerised conjugated bilirubin
c. Are not a risk factor for the development of gallbladder carcinoma
d. 90% of gallstones are radio-opaque
e. A mucocele of the gallbladder is caused by a stone impacted in Hartmann's pouch




Regarding appendicitis
a. The risk of developing the illness is greatest in childhood
b. Mortality increases with age and is greatest in the elderly
c. 20% of appendices are extraperitoneal in a retrocaecal position
d. Faecoliths are present in 75-80% of resected specimens
e. Appendicitis is a possible diagnosis in the absence of abdominal tenderness


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Nephrology MCQ_Part 02

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Which of the following does not complicate pyelonephritis:
A. pyonephrosis
B. papillary necrosis
C. renal stones
D. perinephric abscess
E. renal cell carcinoma

Fanconi syndrome, a tubular functional disorder characterized by abnormal proximal tubular function, has all of the following characteristics except:
A. aminoaciduria
B. polyuria and polydipsia
C. glucosuria
D. phosphaturia and hypophosphatemia
E. excess bicarbonate loss and hence metabolic acidosis

Renal tubular carcinoma has all of the following characteristics except:
A. a disease of middle-aged and elderly individuals
B. a transitional cell neoplasm
C. metastases may affect a wide variety of organs
D. associated with the von Hippel Lindau tumor suppressor gene on chromosome 3p
E. the likelihood of metastases is strongly linked to the size of the tumor

EXPLANATIONS



MCQ 01 ANSWER

The Correct answer is E
Pyelonephritis is an ascending urinary tract infection that has reached pelvis of thekidney.It primarily affects the interstitial area and the renal pelvis or, less often, the renal tubules. Chronic pyelonephritis is persistent kidney inflammation that can scar the kidneys and may lead to chronic renal failure.
Papillary necrosis is complication of pyelonephritis.
Kidney stones formation or urolithiasis is comprised of calcium carbonate crystals in the presence of hypercalciuria and a common complication is chronic pyelonephritis.

MCQ 02 ANSWER

Correct answer is B
Fanconi syndrome is a generalized disorder of the Proximal Tubules. The defect can lead to glycosuria, aminoaciduria, phosphaturia, bicarbonaturia and excessive urinary loss of K+, Na+, Ca++, Mg++, uric acid and other organic acids.It may be inherited, or caused by drugs or heavy metals.
  • Clinical features
  • Polyuria, polydipsia and dehydration
  • Hypophosphatemic rickets (in children) and osteomalacia (in adults)
  • Growth failure
  • Renal tubular Acidosis
  • Hypokalemia
  • Hyperchloremia
  • Hypophosphatemia/phosphaturia
  • Glycosuria
  • Proteinuria/aminoaciduria
  • Hyperuricosuria
Causes
  1. Cystinosis(most common)
  2. Wilson's disease
  3. Lowe syndrome
  4. Galactosemia
  5. Glycogen storage diseases

MCQ 03 ANSWER

The Correct answer is B
Renal Carcinoma( hypernephroma/Grawitz tumour) originates in the epithelium of the proximal
tubule.
Epidemiology
* 90% renal cancers
* Mean age 55 years, male: female is 2:1

Risk factors
Cigarette smoking
Obesity
Positive family history
Hypertension
Dialysis patients with acquired cystic disease of the kidney
Patients with certain inherited disorders such as von Hippel-Lindau disease

Clinical features
* 50% incidental findings during abdominal imaging for other symptoms
* Haematuria, loin pain, abdominal mass, anorexia, malaise, weigh loss and Pyrexia of unknown origin
* Polycythemia or Anaemia,Hypertension
* Rarely, invasion of left renal vein compresses testicular vein causing a left varicocele
*Stauffer syndrome - paraneoplastic, non-metastatic liver disease
* Spread may be direct, via lymph nodes, or haematogenous (bone, liver, brain)
If tumour is confined to the renal parenchyma, the 5-year survival rate is 60-70%

Classification of Classification
* Clear cell carcinoma (associated with the loss of von Hippel Lindau tumor suppressor gene on chromosome 3p)
* Papillary carcinoma
* Chromophobe renal carcinoma
* Collecting duct carcinoma

Investigations
* Bloods – FBC (polycythemia from epo secretion), ESR, U+E, alk phos (bony metastasis)
* Urine – RBC, cytology
* Imaging – USS, CT/MRI, IVU
* Renal angiography if partial nephrectomy or palliation are being considered
* CXR – cannon ball metastasis


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Neurology MCQ_PART 04

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Causes of dilated pupil:
a. Children.
b. Topical cycloplegic agents.
c. Cataract surgery.
d. 3rd cranial nerve palsy.
e. Cocaine abuse.

Subacute combined degeneration of the cord:
a. Anemia is absent in 20% of cases.
b. Can result in a sensory level on the trunk.
c. A family history of pernicious anemia can be obtained.
d. There are upgoing planters.
e.  MRI of the cord is diagnostic.

Chronic subdural hematoma:
a. Usually bilateral.
b. A history of head trauma is seen in 90% of cases.
c. Epilepsy is a risk factor.
d. Small ones may resolve spontaneously.
e. Papilloedema is seen in 90% of cases.

EXPLANATIONS



MCQ 01 ANSWER

Correct Answer - T T T T T


Causes
  • In dark Environment
  • Strong sexual arousal
  • Oxytocin
  • Oculomotor nerve palsy
  • Head injury or orbit trauma (eye injury),or any iris trauma including Surgery
  • Anticholinergics such as atropine
  • Cycloplegics(agents that paralysis of the ciliary muscle of the eye) are also mydriatic(an agent that induces dilation of the pupil)- cyclopentolate,tropicamide
  • Cocaine - inhibits the normal reuptake of norepinephrine into presynaptic nerve terminals resulting in an increased level of extracellular norepinephrine. The released norepinephrine then proceeds to bind to adrenergic receptors,and the end result is dilation of the pupil
  • Drugs that increase serotonin levels - fenfluramine, antidepressants such as the SSRIs and MAOIs
  • Adie's pupil - benign condition affecting the young women
  • Migraine

MCQ 02 ANSWER

Correct Answer - T F T T F
Subacute combined degeneration of spinal cord,refers to patchy degeneration of myelin of
the posterior and lateral columns of the spinal cord as a result of vitamin B12 deficiency.


Causes
Inadequate diet
Increased requirments - Pregnancy
Defective absorption - Pernicious anaemia,malabsorption(coeliac disease,pancreatitis,gastric
surgery,tapeworm infestation)


Clinical Features
  • Weakness of legs,arms and trunk
  • Tingling and numbness that progressively worsens (never get a sensory "level")
  • Bilateral spastic paresis
  • Pressure, vibration and touch sense are diminished
  • A positive Babinski sign may be seen
  • Ataxic gait with positive Romberg's sign
  • Optic Atrophy
  • Cerebral demyelination with enchephalopathy and dementia


Investigations
Pheripheral Blood film - megalloblastic anaemia but Anemia And macrocytosis may be absent in 20% of cases ; but hyper segmented neutrophils are still usually seen in these cases.
Serum B12/folate levels
MRI - may show spinal and cerebral white matter hyperintensity on T2 images.But not diagnostic

MCQ 03 ANSWER

Correct Answer - F F T T F


A chronic subdural hematoma (SDH) is an old clot of blood on the surface of the brain beneath its outer covering. It predominantly occursin infancy and in the elderly. 1/6th of cases are bilateral.
Predisposing factors
Less than 50% might have a traumatic event
Other risk factors include alcohol abuse, seizures, shunts that drain excess cerebrospinal
fluid from the brain,brain atrophy,blood thinning medications such as Coumadin and coagulation disorders


Symptoms
The symptoms of a chronic subdural haematoma do not usually appear until about 2-3 weeks
after the initial head injury (in some people it may be months)
The symptoms tend to progress gradually
The most common complaint is headache, seen in up to 80 percent of patients. Other symptoms
include lethargy, memory impairment, confusion, weakness, nausea, vomiting, impaired vision
and seizures
Patients with large hematomas may develop varying degrees of paralysis and coma
Papilloedema is uncommon


Management
If there is a small,subdural haematoma that is not producing any symptoms,it can sometimes be treated just by careful monitoring and observation. The blood clot is left to re-absorb by itself
Surgery - Burr Hole or Craniotomy




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Obstetrics MCQ_Part 03

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In pregnancy Which of the following statements are correct
a.Renal blood flow increases by more than 20 %     
b.GFR increases    
c.Serum urea levels fall    
d.Serum creatinine levels fall    
e.Tubular reabsorption of glucose declines, causing glycosuria in the presence of normal blood glucose levels

Shoulder dystocia   
a.associated with high maternal weight    
b.associated with diabetes         
c.associated with mid-cavity forceps delivery    
d.associated with premature labour    
e.has been successfully managed by Caesarean section

Secondary amenorrhoea
a.is defined as cessation of menstruation for more than 12 months   
b.should be not be investigated unless persisting for more than 12 months
c.may be due to Asherman’s syndrome
d.is commonly due to stress
e.may be due to hyperprolactinaemia

ANSWER

MCQ 01 Correct Answer - T T T T F
Physiology of pregnacy psecentation


Renal blood flow increases by about 25 % from 1.2 to 1.5 litres perminute.This occurs early in pregnancy. Changes in renal functionroughly parallel those in cardiac function. GFR increases 30 to 50%,peaks between 16 and 24 wk gestation, and remains at that level until
nearly term, when it may decrease slightly because uterine pressure onthe vena cava often causes venous stasis in the lower extremities.Renal plasma flow increases in proportion to GFR. As a result, BUNdecreases, usually to less than 10 mg/dL (less than 3.6 mmol urea/L), and creatinine levels decrease proportionally to 0.5 to 0.7 mg/dL (44 to 62 ╬╝mol/L). Marked dilation of the ureters (hydroureter) is caused by hormonal influences (predominantly progesterone) and by backup due to pressure from the enlarged uterus on the ureters, which can also cause hydronephrosis. Postpartum, the urinary collecting system may take as long as 12 wk to return to normal. Glucose transfers in bulk through the glomerulus and is then reabsorbed by the proximal tubule.With the increased GFR, much more sugar is dumped on the tubule and may swamp its reabsorptive capacity. The result is the common pregnancy finding of glycosuria in the presence of normal blood glucose levels.

MCQ 02 Correct Answer - T T T F T
Shoulder dystocia presentation

Shoulder dystocia occurs in approximately 1% of vaginal births.There are well-recognised risk factors, such as diabetes, fetal macrosomia, and maternal obesity. Premature labour means small babies and a reduced risk. Mid-cavity forceps suggests some difficulty in descent of the head. Zavanelli's maneuver, which involves pushing the fetal head back in with performing a cesarean section is one way of managing Shoulder Dystocia. MCQ 03 

Correct Answer -F F T F T 
Secondary amenorrhea presentation

It is defined as the absence of menses for three months in a woman with previously normal menstruation or nine months for women with a history of oligomenorrhea. 

Causes
  1. Intrauterine adhesions (Asherman's Syndrome) 
  2. Pregnancy (most common cause) 
  3. Anovulation 
  4. Premature menopause 
  5. Menopause
  6. Polycystic ovary syndrome (PCOS)
  7. Hypothalamic: Exercise amenorrhoea, related to physical exercise, Stress amenorrhoea, Eating disorders and weight loss (obesity, anorexia nervosa, or bulimia 
  8. Pituitary: Sheehan syndrome, Hyperprolactinemia, Hemochromatosis 
  9. Other central regulatory: hypothyroidism, hyperthyroidism




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Cardiology MCQ_PART 05

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Sudden chest pain and acute aortic insufficiency in a 67 year old hypertensive Afro-American male
A. Takayasu arteritis
B. Giant cell arteritis
C. Aortic dissection
D. Polyarteritis nodosa
E. Wegener's granulomatosis

Hemoptysis, hematuria and recent Epistaxis in a 43 year old man may be found to have
A. Takayasu arteritis
B. Giant cell arteritis
C. Aortic dissection
D. Polyarteritis nodosa
E. Wegener's granulomatosis

What is the most likely cause of Constrictive pericarditis:
A. Uremia
B. Congestive heart failure
C. Rheumatic fever
D. Myocardial infarction
E. Tuberculosis





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Medicine MCQ_part 02

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Regarding Bronchiectasis
A. Characterized by the production of large amount of sputum
B.Haemoptysis is a feature
C.Cystic Fibrosis is a known cause
D.Ring Shadows and Tram like Shadows seen in the Chest Xray

What of the folowing are features of Small Cell Carcinoma of the Lung
A.ACTH production
B.Clubbing
C.Eaton Lambert Myasthenic Syndrome 
D.Hypercalcaemia

True or False regarding the Iron Metabolism
A.Absorbed in the terminal Ileum
B.Absorption is increased when there is a defieciency 
C.Ferrratin and Haemosiderin are transporters
D.Albumin is the Transporter








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Paediatrics MCQ_Part 08

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 Which of the following are recognised causes of clubbing:
A. Cystic fibrosis.
B. Familial.
C. Bacterial endocarditis.
D. Fallot's tetralogy.
E. Ulcerative colitis.
 
Autosomal dominant conditions are
A. Gilbert syndrome.
B. Becker muscular dystrophy.
C. Turner syndrome.
D. Tuberous sclerosis.
E. Cystic fibrosis.

Cystic fibrosis:
A. It is most common in sub-Saharan Africa.
B. The most common mutation is called delta-F508.
C. The responsible gene is located on chromosome 14.
D. Can present in neonates with intestinal obstruction.
E. Can be investigated by measuring sweat electrolytes. 






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Paediatrics MCQ_Part 07(Antral Gastritis and Epilepsy)

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A 15-year-old boy presents with melena and anemia. Endoscopy demonstrates a nodular
gastritis of the antrum  and an ulcer. Biopsies of the antrum demonstrate spiralshaped
organisms consistent with Helicobacter pylori. You prescribe amoxicillin,
clarithromycin, and lansoprazole for 2 weeks. At a follow-up visit, the family asks whether the
treatment has been successful in eradicating the organism.
Of the following, the PREFERRED noninvasive test to evaluate whether the pathogen has been
eradicated is
A. fecal Campylobacter-like organisms (CLO) test
B. fecal H pylori antigen
C. salivary H pylori antibody concentrations
D. serum H pylori immunoglobulin G serology
E. serum H pylori urease concentrations


Concerning epilepsy in children:
A. There is an association with cerebral palsy.
B. Most forms of childhood epilepsy require lifelong treatment.
C. Infantile spasms may respond to corticosteroid treatment.
D. Consciousness is usually impaired in absence seizures.
E. A post-ictal hemi-paresis may occur.







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Paediatrics MCQ_Part 06

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Concerning asthma:
A. Inhaled steroids are useful in the treatment.
B. Wheeze on auscultation is pathognomonic.
C. It is seldom a cause of hospital admission.
D. Exacerbation of symptoms can occur with exercise.
E. Sufferers should be excluded from sport at school.


Concerning systemic lupus erythematosus (SLE):
A. It causes a characteristic "butterfly rash".
B. Is more common in males.
C. Arthralgia is a rare feature.
D. Maternal SLE can cause heart block in the neonate.
E. Anti-nuclear antibodies are usually present.

Compared with cow's milk, human breastmilk contains:
A. Less sodium.
B. Less calcium.
C. Less protein.
D. Less fat.
E. Less carbohydrate








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Hematology MCQ_Part 01

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Both the aPTT and PT would be expected to be prolonged with:
A. Deficiency of factors X, V, II or I
B. Deficiency of factors X, V, II or XIII
C. Deficiency of factors XII, XI, IX, VIII, or IV
D. Deficiency of factors III or VII
E. Deficiency of HWMK (High molecular weight kininogen) or Prekallikrein

In the clotting process, as the hemostatic plug develops, fibrin polymerizes into monomeric threads which are held together by noncovalent bonds. Which clotting protein increases the strength of the clot by crosslinking the newly formed fibrin threads?
A. Factor XIII
B. High molecular weight kininogen (HMWK)
C. Plasminogen
D. Thrombin
E. von Willebrand Factor (vWF)


A 60 year old patient with pernicious anemia. the stomach would exhibit one of the following characteristicically:  
A. Increased number of argentaffin cells
B. Hyperacidity
C. Mucosal atrophy
D. H. pylori infection






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Obstetrics MCQ_Part 02 (Neural Tube Defect,Hyperprolactinaemia and Normal Labour)

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01. Neural Tube Defect
A.Occurs in one pregnancy in 200         
B.Is more common after maternal consumption of sodium valproate    
C.Is more common in the white than the black population    
DIs prevented by pre and early pregnancy folic acid    
E.Is suggested by the pineapple sign

02. Hyperprolactinaemia
A.May cause male infertility
B.Is associated with elevated levels of LH-RH
C.May be associated with phenothiazine therapy
D.Always causes galactorrhoea
E.Adenomas should be sought with a lateral skull x-ray to examine the  pituitary fossa


03. Normal Labour
A.The latent phase may last for more than four hours     
B.The active phase should be associated with cervical dilatation at a rate of at least 1 cm. per hour    
C.The active phase starts when the cervix is effaced and 2 cm. dilated         
D.Is best charted using a partogram    
E.Epidural anaesthesia has an adverse effect on the rate of progress in the 1st. stage of labour    






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Paediatrics MCQ_Part 05(Hirschsprung's disease,Testicular torsion,Oesophageal atresia and Tracheo-oesophageal fistula

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Regarding Hirschsprung's disease
    (a) Often presents with neonatal large bowel obstruction
    (b) Results from absence of ganglion cells in both the Meissner's and Auberbach's plexus
    (c) A contrast-study will show dilatation of the aganglionic segment
    (d) The diagnosis can be confirmed by histological evdience of reduced acetylcholinesterase in the aganglionic segment
    (e) Early treatment may involve rectal irrigation or an emergency colostomy 



Regarding testicular torsion
    (a) The highest incidence is in the neonatal and peripubertal periods
    (b) May present with abdominal pain and vomiting and few testicular symptoms
    (c) Radiological investigation with doppler ultrasound or isotope scanning is invariably indicated
    (d) Testicular viability is reduced if surgery is delayed more than 6 hours
    (e) Contralateral orchidopexy should also be performed if a torsion is confirmed 



Regarding oesophageal atresia and tracheo-oesophageal fistula (TOF)
    (a) Most cases of oesophageal atresia are associated with a proximal TOF to the lower oesophagus
    (b) Often present prenatally with oligohydramnios
    (c) Postnatally present with difficulty swallowing and aspiration
    (d) The diagnosis my be confirmed by the inability to pass a nasogastric catheter
    (e) Radiological evidence of gas in the stomach confirms the presence of distal TOF








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Dermatology MCQ_Part 01

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True or False  Regarding IMPETIGO
A.Commoner in children
B.Can be caused by Staphylococci
C.Heals without permanent Scarring
D.Acute Glomerulonephritis is  a known complication
E.Does not cause Blistering

True or False  Regarding  Herpes Zoster
A.Pain precedes papules
B.It is an sexual Transmitted disease
C.Meningitis is a common complication
D.Recurrent attacks are common
E.Can involve many dermatomes in an immunocompromised patient

Atopic Eczema
A.a family history of atopy
B.If occurs early and defined has bad prognosis
C.In children it is common on cheeks
D.In adults more common on flexor area
E.Pruritis is absent






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