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__Y6 Finals Revision > __Cases for PACES > Flashcards

__Cases for PACES Flashcards

1
Q

Management Psoriasis

A

Conservative - avoid precipitants (stress, alcohol, BB, smoking)

Topical - emmolients, calcipotriol (vit D analogue), steroids
Consider coal tar, dithranol
Phototherapy (UVB, psoralen + UVA)

Systemic - cytotoxics (methotrexate), anti-TNF (adalimumab)

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2
Q

Causes of nail pitting (x4)

A

Psoriasis
Lichen Planus
Aloperia areata
Fungal infections

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3
Q

Stigmata of venous hypertension in legs x5

A 
Oedema
Lipodermatosclerosis
Varicose eczema
Atrophie blanche
Varicose veins
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4
Q

Which ulcers are painful?

A

Arterial

Venous and neuropathic are painless

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5
Q

Diabetic with well demarcated plaques with waxy-yellow center and red-brown edges

A

Necrobiosis lipoidica diabeticorum

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6
Q

Pearly nodule, rolled edges, superficial telangectasia

A

BCC

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7
Q

Malignant melanoma clinical signs x5

A 
Asymmetrical
Border irregular
Colour - black with irregular pigmentation
Diameter >6mm
Enlarging
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8
Q

Staging of malignant melanoma

A

Stage with Breslow Thickness

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9
Q

Tuberous sclerosis signs x4

A

Facial adenoma sebaceum
Periungal fibromas
Shagreen patch (rough leathery patch over lumbar region)
Ash leaf macules (depigmented macules on trunk)

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10
Q

Assoc with Tuberous sclerosis (other than skin manifestations) x4

A

Cystic lung disease
PCKD and/or angiomyolipoma
Retinal phakomas (dense white patches)
Mental retardation, seizures

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11
Q

Investigations in Tuberous sclerosis

A

Skull radiograph - calcification
CT/MRI - tuberous masses in cerebral cortex
Abdo US - renal cysts, harmartomas

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12
Q

Neurofibromatosis main signs x4

x4 extra signs

A

≥2 cutaneous neurofibromas
≥6 Cafe au lait patches (≥15mm)
Axillary freckling
Lisch nodules (melanocytic harmartomas of iris)

HTN (RAS and phaeo)
Crackles (fibrosis)
Neuropathy (large, palpable nerves)
Loss in visual acuity (optic glioma)

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13
Q

Neurofibromatosis associations x2

A

RAS, phaeochromocytoma

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14
Q

Describe joint positions of swan-neck deformity and Boutonniere’s

A

Swan-neck: hyperextension of PIP, flexion of DIP

Boutonnieres: flexion of PIP, hyperextension of DIP

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15
Q

Signs of active disease in rheumatoid

A

red, swollen, hot, painful hands

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16
Q

Systemic manifestations of RA (x5 systems)

A

Pulmonary - fibrosis, pleural effusions, caplans nodules
Eyes - scleritis
Neuro - carpal tunnel, atlanto-axial subluxation, peripheral neuropathy
Haem - Felty’s (RA, splenomeg, neutopaenia), anaemia
Cardiac - pericarditis

17
Q

Rheumatoid arthritis x-ray signs

A

Periarticular osteoporosis
Articular erosions
Loss of joint space
Soft tissues swelling

18
Q

American College of Rheumatology criteria

A

MA PEARS (need 4/7)

Morning stiffness
Arthritis in ≥3 joint areas

Positive Rheumatoid factor
Erosions on joint radiographs
Arthritis of hands 
Rheumatoid nodules
Symmetrical arthritis
19
Q

SLE systems involved x8

A

Skin - butterfly malar rash, photosensitivity, discoid rash, oral ulcers, livido reticularis, reynaud’s phenomenon

Hands - Jaccoud’s arthopathy

Resp - plural effusion, fibrosis
Renal - HTN, nephrotic synd
Neuro - focal neurology, ataxia
Eyes - Sjogrens
Haem - AI haemolytic anaemia
Immune - positive anti-dsDNA, anti-Sm
20
Q

Investigations in systemic sclerosis (x6 categories)

A

Autoantibodies - anti-centromere, anti-Scl70

Hand radiograph - calcinosis

CXR, spirometry, HRCT - lower lobe fibrosis, asp pneumonia

FBC, B12/folate, Ba swallow - dysmotility and malabsorption

U&E, urinalysis, urine MC&S - glomerulonephritis (consider biopsy)

ECG, Echo - myocardial fibrosis and arrythmia

21
Q

Ank spond specific test

A

Schobers test - two points marked 15cm apart on dorsal spine expand less than 5cm on max flexion forward

22
Q

Complications of Ank Spond to look for

A 
Anterior uveitis
Apical lung fibrosis
Aortic regurg
Atrio-ventricular nodal Heart Block
Arthritis
23
Q

Tx of Ank Spond x3

A

Physio
Analgesia
Anti-TNF

24
Q

Things to examine for in Marfans (x5)

A

General - tall, arm span > height

Hands - arachnodactyl (encircle wrist thumb and little finger), hyperextensible (thumb can touch down to wrist)

Face - high arched palate

Chest - pectus carinatum, scoliosis, scars from cardiac surgery/chest drains with pneumothx

Cardiac - aortic regurg (collapsing pulse), MV prolapse, coarctation

25
Q

Marfans main mangement

A

Concern re aorta

Monitor aortic root size annual TTE
BB and ARB to slow aortic root dilatation
Preemptive surgery when indicated to prevent dissection/AAA rupture

screen family members

26
Q

Pagets signs (x5)

A

Bony enlargement (skull, long bones)
Conductive deafness (hearing aid)
Pathological fractures - look for scars
+- cardiac failure (high output), carpal tunnel

27
Q

Background diabetic retinopathy

A

Hard exudates
Blot haemorrahages
Microaneurysms (dots)

Routine referal to eye clinic, discuss DM control

28
Q

Pre-proliferative diabetic retinopathy

A

Soft exudates (cotton wool spots)
Flame haemorrhages
Venous beading

Urgent referral to opthal

29
Q

Proliferative diabetic retinopathy

A

Neovascularisation

Urgent referral to opthal

30
Q

Diabetic maculopathy

A

Macular odema or hard exudates within one disc space of fovea

31
Q

Hypertensive retinopathy

Grade 1

A

Silver wiring (increased reflectance from thickened arterioles)

32
Q

Hypertensive retinopathy

Grade 2

A

AV nipping (narrowing of veins as arteries cross them)

33
Q

Hypertensive retinopathy

Grade 3

A

cotton wool spots and flame haemorrhages

34
Q

Hypertensive retinopathy

Grade 4

A

plus papilloedema

35
Q

Causes of papilloedema

A

Raised ICP - SOL, benign intercranial HTN, cavernous sinus thrombosis

Malignant HTN (>180/120)

Central retinal vein occlusion

__Y6 Finals Revision (14 decks)

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