__Cases for PACES Flashcards
Management Psoriasis
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)
Causes of nail pitting (x4)
Psoriasis
Lichen Planus
Aloperia areata
Fungal infections
Stigmata of venous hypertension in legs x5
Oedema Lipodermatosclerosis Varicose eczema Atrophie blanche Varicose veins
Which ulcers are painful?
Arterial
Venous and neuropathic are painless
Diabetic with well demarcated plaques with waxy-yellow center and red-brown edges
Necrobiosis lipoidica diabeticorum
Pearly nodule, rolled edges, superficial telangectasia
BCC
Malignant melanoma clinical signs x5
Asymmetrical Border irregular Colour - black with irregular pigmentation Diameter >6mm Enlarging
Staging of malignant melanoma
Stage with Breslow Thickness
Tuberous sclerosis signs x4
Facial adenoma sebaceum
Periungal fibromas
Shagreen patch (rough leathery patch over lumbar region)
Ash leaf macules (depigmented macules on trunk)
Assoc with Tuberous sclerosis (other than skin manifestations) x4
Cystic lung disease
PCKD and/or angiomyolipoma
Retinal phakomas (dense white patches)
Mental retardation, seizures
Investigations in Tuberous sclerosis
Skull radiograph - calcification
CT/MRI - tuberous masses in cerebral cortex
Abdo US - renal cysts, harmartomas
Neurofibromatosis main signs x4
x4 extra signs
≥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)
Neurofibromatosis associations x2
RAS, phaeochromocytoma
Describe joint positions of swan-neck deformity and Boutonniere’s
Swan-neck: hyperextension of PIP, flexion of DIP
Boutonnieres: flexion of PIP, hyperextension of DIP
Signs of active disease in rheumatoid
red, swollen, hot, painful hands
Systemic manifestations of RA (x5 systems)
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
Rheumatoid arthritis x-ray signs
Periarticular osteoporosis
Articular erosions
Loss of joint space
Soft tissues swelling
American College of Rheumatology criteria
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
SLE systems involved x8
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
Investigations in systemic sclerosis (x6 categories)
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
Ank spond specific test
Schobers test - two points marked 15cm apart on dorsal spine expand less than 5cm on max flexion forward
Complications of Ank Spond to look for
Anterior uveitis Apical lung fibrosis Aortic regurg Atrio-ventricular nodal Heart Block Arthritis
Tx of Ank Spond x3
Physio
Analgesia
Anti-TNF
Things to examine for in Marfans (x5)
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
