AKT Qustions

1. A 22-year-old male blood donor is noted to have the following blood results:

Bilirubin 41 µmol/L
ALP 84 U/L
ALT 23 U/L
Albumin 41 g/L

Dipstick urinalys is normal
He has recently complained of coryzal symptoms and a non-productive cough. What is the most likely diagnosis?

A. Gilbert's syndrome
B. Dubin-Johnson syndrome
C. Rotor syndrome
D. Hepatitis C infection
E. Infectious mononucleosis

Answer: A

An isolated hyperbilirubinaemia in a 22-year-old male is likely to be secondary to Gilbert's syndrome. The normal dipstix urinalysis excludes Dubin-Johnson and Rotor syndrome as these both produce a conjugated bilirubinaemia. Viral infections are common triggers for a rise in the bilirubin in patients with Gilbert's

Gilbert's syndrome

Gilbert's syndrome is an autosomal recessive* condition of defective bilirubin conjugation due to a deficiency of UDP glucuronyl transferase. The prevalence is approximately 1-2% in the general population
Features:
unconjugated hyperbilinaemia (i.e. not in urine)
jaundice may only be seen during an intercurrent illness
Investigation and management
investigation: rise in bilirubin following prolonged fasting or IV nicotinic acid
no treatment required
*the exact mode of inheritance is still a matter of debate

2. Which one of the following steroid creams is the most potent?ia

A. Propaderm
B. Eumovate
C. Betnovate RD
D. Betnovate
E. Dermovate

answer: E

Use weakest steroid cream which controls patients symptomsThe table below shows topical steroids by potency


Very potent
Clobetasone propionate 0.05% (Dermovate)

Potent
Betamethasone dipropionate 0.025% (Propaderm)Betamethasone valerate 0.1% (Betnovate)

Moderate
Betamethasone valerate 0.025% (Betnovate RD)Clobetasone butyrate 0.05% (Eumovate)
Mild
Hydrocortisone 0.5-2.5%

Finger tip rule
1 finger tip unit (FTU) = 0.5 g, sufficient to treat a skin area about twice that of the flat of an adult hand


Area of skin Fingertip units per dose

Hand and fingers (front and back) 1.0
A foot (all over) 2.0
Front of chest and abdomen 7.0
Back and buttocks 7.0
Face and neck 2.5
An entire arm and hand 4.0
An entire leg and foot 8.0