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PACES 2024 > Approaches > Flashcards

Approaches Flashcards

1
Q

Autonomic neuropathy

-> what to assess for next

A
  • Peripheral neuropathy
  • Parkinonism/ ataxia
  • No associated features (no parkinonism/ataxia/PN)
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2
Q

Autonomic neuropathy + Parkinonism/ Ataxia?

A

Multi system atrophy: Parkinonism predominant, Cerebellar predominant

Lewy body disorders: Parkinson’s disease, Dementia with Lewy body

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3
Q

autonomic neuropathy + distal painful peripheral neuropathy?

A

think of
- Vasculitis
- HIV
- Fabry Disease
- Diabetes
- Amyloidosis
- Hereditary

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4
Q

Autonomic neuropathy + distal sensorimotor peripheral neuropathy?

A

Diabetes, Amyloidosis

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5
Q

Autonomic neuropathy + subacute sensory peripheral neuropathy?

A

Sjogren’s syndrome
Paraneoplastic

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6
Q

Erythema nodosum: different groups of causes?

A

Infections
Malignancy
Autoimmune disease
Granulomatous disease
IBD
Drugs
Pregnancy

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7
Q

Erythema nodosum: malignancy causes?

A

Lymphoma
Leukaemia
Internal carcinomas
Sweet’s Syndrome

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8
Q

Erythema nodosum: infective causes

A

Bacterial: streptococcal, TB, leprosy, GE (Salmonella, campylobacter, Yersinia), Leptospirosis, Chlamydia trachomatis, Lymphogranuloma venereum, Whipple’s disease

Fungal: Coccidiomycosis, Histoplasmosis, Blastomycosis

Viral: Infectious mononucleosis, Hepatitis B

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9
Q

Erythema nodosum: Autoimmune disease cause

A

Behcet’s disease

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10
Q

Erythema nodosum: Granulomatous disease cause

A

Sarcoidosis

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11
Q

Erythema nodosum: IBD causes

A

Crohns, UC

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12
Q

Drug causes of erythema nodosum?

A

COCP
Penicillins
Sulfonamides (e.g bactrim)
Bromides and iodides
TNFa inhibitors (rare)

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13
Q

Causes of Gout?

A

Obesity

Drug/Dietary:
- Ethanol
- excessive purine ingestion
- B12 deficiency
- Cytotoxic drugs

Malignancies with high cell turnover

Skin disorders: psoriasis, eczema

Haematological disorders:
myeloproliferative
lymphoproliferative disorders
haemolytic anaemia

renal failure with reduced excretion

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14
Q

Hypertension: main groups of causes

A

Renal cause
Endocrine cause
Neurological
Vascular
Drugs
Pregnancy

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15
Q

Renal causes of hypertension? what features may be suggestive

A

jump in Cr after ACEi/ARB
Flash pulmonary oedema
Renal bruit
haematuria

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16
Q

Renal causes of hypertension? causes

A

Renal artery stenosis: assoc Takayasu’s arteritis, Neurofibromatosis

Polycystic Kidney disase: assoc Berry aneurysms, Regurgitant murmurs

Glomerulonephritis: Recurrent UTI, Hep B/C/HIV, Autoimmune, myeloma

Renal cell carcinoma (EPO producing): assoc polycythaemia

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17
Q

Endocrine causes of Hypertension?
features

A

may have clear physical signs associated with underlying disorder
electrolyte abnormalities
episodic HTN

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18
Q

endocrine causes of hypertension?
causes

A

Conn’s syndrome: hypokalaemic (may be normoK) metabolic alkalosis

Cushing’s syndrome: Lung ca, ectopic, glucocorticoid/TCM use

Acromegaly: DM, CTS, Acanthosis nigricans, osteoporosis, hemianopia, GI bleed

Phaeochromocytoma: MEN, Paroxysmal

Hyper/hypothyroidism

Hyperparathyroidism: MEN syndrome, hyperCa, osteoporosis

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19
Q

pregnancy related cause of hypertension

A

pre eclampsia
- frothy urine, blurring of vision, HTN, seizures

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20
Q

drug causes of hypertension

A

OCPs
steroids
recreational drugs

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21
Q

neurological causes of hypertension?

A

Raised ICP
obstructive sleep apnoea: hypoxia, polycythaemia, metabolic disorders

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22
Q

vascular causes of hypertension

A

Coarctation of aorta: asymmetrical clubbing, differential clubbing, pulse delays

Arteritis: Takayasu’s arteritis- vascular claudication, Scleroderma

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23
Q

generic groups of causes of mononeuritis multiplex

A

infections
rheumatological
chronic disease
haematologic
malignancy
metabolic

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24
Q

malignancy related causes of mononeuritis multiplex

A

paraneoplastic
carcinoid
tumour invasion

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25
Q

haematologic causes of mononeuritis multiplex

A

hypereosinophilia
cryoglobulinaemia
hypereosinophilia
idiopathic thrombocytopenic purpura

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26
Q

endocrine cause of mononeuritis multiplex

A

B12 deficiency

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27
Q

chronic diseases causing mononeuritis multiplex

A

diabetes mellitus
hypertension
acromegaly
amyloidosis
sarcoidosis

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28
Q

infectious causes of mononeuritis multiplex

A

leprosy
lyme disease
hep B/C/ HIV

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29
Q

rheumatological causes of mononeuritis multiplex

A

vasculitis:
GPA, eGPA, polyarteritis nodosa, Behcet’s disease, giant cell arteritis, HSP

connective tissue diseases:
sjogrens, SLE, RA, systemic sclerosis

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30
Q

congenital causes of primary hypogonadism?

A

Klinefelter’s syndrome XXY
Mutation in LH/FSH receptor genes
Cryptorchidism
Disorders of androgen synthesis
Myotonic dystrophy

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31
Q

Acquired causes of primary hypogonadism?

A

infections- mumps
radiation
drugs: ketoconazole, suramin, alkylating agents
toxins
trauma
torsion
autoimmune

systemic illnesses: cirrhosis, chronic renal failure, AIDS

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32
Q

causes of pseudogout

A

haemochromatosis
hyperPTH
hypoMg
hypophosphatasia: rare genetic mutation in ALP -> development of osteomalacia and periodontal disease

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33
Q

causes of hypomagnasaemia?

A

GI loss
diarrhoea
malabsorption
small bowel bypass surgery
medications: PPIs

Renal Loss
volume expansion
uncontrolled DM
Alcohol
hyperCa
acquired tubular dysfunction: recovery from ATN, post obstructive diuresis, post kidney transplantation
Genetic disorders: Bartter, Gitelmans, HNF1b mutation

medications: diuretics, antibiotics (e.g. aminoglycosides), calcineurin inhibitors, cisplatin, EGFR antibodies

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34
Q

what are some secondary causes of haemochromatosis?

A

increased intake:
transfusion overload
iron loaded diet
Hemin infusions (used to treat porphyric attacks)

increased absorption:
thalassaemia major/intermedia
sideroblastic anaemia- congenital or acquired
chronic liver disease: alcoholic, chronic hepatitis, NAFLD

35
Q

Causes of sideroblastic anaemia?

A

Congenital

Acquired:
- Clonal/neoplastic: myelodysplasia
- Metabolic: Zinc toxicity, Cu deficiency, Alcohol, Drugs e.g. isoniazid, chloramphenicol, linezolid

36
Q

Causes of group 1 hypertension ie. Pulmonary arterial hypertension?

A
  • Idiopathic
  • Hereditary variant
  • Drug and toxin induced: e.g. appetite suppressants, amphetamines, cocaine, interferon
  • Connective tissue disease
  • Congenital heart disease
  • HIV
  • Schistosomiasis
  • portopulmonary hypertension
37
Q

Causes of group 2 pulmonary hypertension?

A

secondary to left heart disease:

HFpEF, HFrEF
Valvular heart disease
Congenital/ acquired cardiac conditions

38
Q

Causes of group 3 pulmonary hypertension?

A

due to lung diseaase and or hypoxia:

obstructive lung disease
restrictive lung disease
mixed disease
hypoxia without lung disease
developmental lung disorders

39
Q

causes of group 4 pulmonary hypertension?

A

due to pulmonary artery obstruction:

chronic thromboembolic pulmonary hypertension
pulmonary artery obstructions

40
Q

causes of group 5 pulmonary hypertension?

A

unclear/ multifactorial:

-haematological disorders
- systemic and metabolic disorders
- complex congenital heart disease

41
Q

Causes of pyoderma gangrenosum?

A

inflammatory bowel disease
inflammatory arthritis: e.g. RA
solid organ malignant neoplasms
DM
haematological disorders
Sarcoidosis
Autoimmune/ viral hepatitis

42
Q

inflammatory arthritis causing pyoderma gangrenosum?

A

RA
Ank Spond
SLE

43
Q

haematological disorders that can cause pyoderma gangrenosum?

A

MGUS
Myelodysplastic syndrome
Polycythaemia vera
Haematological Malignancy

44
Q

Causes of secondary osteoarthritis

A

Mechanical
Inflammatory
Metabolic

45
Q

Inflammatory causes of secondary osteoarthritis?

A

Crystal arthropathy
RA
post septic arthritis
Spondyloarthropathies

46
Q

Causes of thrombosis?

A

Inherited
Acquired: immobility, prothrombotic state, endothelial dysfunction

47
Q

Inherited causes of thrombosis?

A

Factor V Leiden mutation
Protein C/S deficiency
Anti thrombin III deficiency
Prothrombin mutation

48
Q

Acquired causes of thrombosis?

A

Immobility: post surgery, pregnancy

Endothelial dysfunction: recent surgery, trauma, venous catheter

Prothrombotic state:
Malignancy, Myeloproliferative neoplasm
Antiphospholipid syndrome
Nephrotic syndrome
IBD
Congenital heart disease
Paroxysmal nocturnal haemoglobinuria
Medications: COCP, hormone replacement therapy; antifibrinolytic, anabolic

49
Q

Causes of intention tremor?

A

Cerebellar disease
Multiple sclerosis
Midbrain stroke/ trauma

50
Q

Causes of resting tremors?

A

Parkinson’s disease
Parkinsonian syndromes
Rubral tremors: midbrain, thalamic, cerebellar or pontine injury
Wilson’s disease
Severe essential tremors

51
Q

Causes of postural- action tremors?

A

Physiological tremors
Essential tremors
Task- specific tremors
Extrapyramidal disorders: PD, wilsons, dystonia
Cerebellar disease
Neuropathic tremors (muscle weakness and loss of proprioception): CIDP, hereditary neuropathies

52
Q

Focal lesions causing splenomegaly?

A

Haematoma
Cyst
Primary vascular tumour
Haemangiomas
Hamartomas

53
Q

Infiltrative causes of splenomegaly?

A

Sarcoidosis
Amyloidosis
Gaucher’s disease
Tumour metastasis
SLE
HLH

54
Q

Autoimmune cytopenias causing splenomegaly?

A

AIHA
ITP
Immune neutropenia
Feltys syndrome

55
Q

Haematological malignancy causing splenomegaly ?

A

Lymphoma
Leukaemia
Myelofibrosis
PCV

56
Q

Infections causing splenomegaly?

A

Malaria
Visceral leishmaniasis
TB
EBV, HIV
Leptospirosis, Schistosomiasis

57
Q

Liver disease causing splenomegaly?

A

Liver cirrhosis with portal hypertension

58
Q

Extramedullary haemopoiesis causing splenomegaly?

A

Transfusion dependent thalassaemia
Primary / secondary myelofibrosis

59
Q

Causes of secondary myelofibrosis?

A

Neoplasia
Infection: TB, fungal infections, HIV
Metabolic: Gaucher disease
Haematological malignancies: CML, Myeloma, lymphoma, AML
Radiation
Sarcoidosis

60
Q

Causes of raised CK?

A

Inflammatory myopathy
Infectious myopathy
Dystrophinopathies
Rhabdomyolysis
Drugs
Metabolic myopathies: carbohydrate/ lipid/ purine metabolism
Endocrine myopathies
Malignant hyperthermia
Motor neuron disease: ALS, spinal muscular atrophy
Periodic paralysis

61
Q

Inflammatory myopathies causing raised CK?

A

Dermatomyositis
Polymyositis
Inclusion body myositis
Behcets
Sarcoidosis

62
Q

Dystrophinopathies causing raised CK?

A

Beckers
Duchennes
Fascio scapulo humeral
Limb girdle
Myotonic dystrophy

63
Q

Drug causes of raised CK?

A

Colchicine
Statin
Anti malarials
Alcohol
Penicillamine

64
Q

Endocrine myopathies causing raised CK?

A

Acromegaly
Hypothyroidism

65
Q

Causes of palpitations?

A

Cardiac
High output states
Metabolic and endocrine
Catecholamine excess: stress, exercise
Substance use: cocaine, amphetamines, caffeine, alcohol, nicotine
Drugs
Psychiatric disorders

66
Q

Cardiac causes of palpitations

A

Arrhythmias
Valvular heart disease
Shunt

67
Q

High output states causing palpitations?

A

Anaemia
Pregnancy
Fever
Pagets disease of the bone

68
Q

Metabolic/ endocrine causes of palpitations?

A

Hypoglycaemia
Hyperthyroid
Phaeochromocytoma

69
Q

Psychiatric disorders causing palpitations?

A

Generalised anxiety
Panic disorder
Somatization disorder

70
Q

Drug causes of palpitations

A

Vasodilators
Anticholinergics
Sympathomimetic agents
Beta blocker withdrawal

71
Q

Causes of hyperpigmentation on examination?

A

Iron overload: haemochromatosis, haemosiderosis

Endocrine: addisons, cushings

Metabolic: renal failure, porphyria

Liver: PBC

Drugs: amiodarone, minocycline

Physiological- sun tanning

72
Q

Causes of macrocytosis?

A

B12/ folate deficiency
Drugs: methotrexate, azathioprine, hydroxyurea

Shift to immature red cells:
Reticulocytosis

Primary bone marrow disorders:
Myelodysplastic syndrome

Lipid abnormalities:
Liver disease, hypothyroidism

Alcohol abuse
Multiple myeloma

73
Q

Causes of microcytic anaemia?

A

Hereditary: thalassaemia

Acquired:
Iron deficiency
Anaemia of chronic disease
Anaemia of inflammation
Myelodysplastic syndrome with acquired thalassaemia
Zinc toxicity
Cu deficiency
Sideroblastic anaemia

74
Q

Causes of sideroblastic anaemia?

A

Toxins: lead, alcohol
Drugs: isoniazid, chloramphenicol, linezolid

75
Q

Causes of polyuria?

A

Primary polydipsia
Solute diuresis: diuretics, hyperglycaemia, mannitol, SGLT2i
Diabetes insipidus

76
Q

Causes of cranial Diabetes insipidus?

A

Idiopathic
Post neurosurgery
Traumatic
Tumour
Hypoxic injury
Infiltrative diseases

77
Q

Causes of nephrogenic diabetes insipidus?

A

Hereditary
Lithium
HyperCa
HypoK

Renal causes: ADPKD, amyloidosis, medullary cystic kidney disease, post obstructive/ ATN diuresis

78
Q

Malignant causes of monoarthritis?

A

Tenosynovial giant cell tumour
Chondrosarcoma
Osteoid osteoma
Metastatic disease

79
Q

Causes of weight gain?

A
  • Fat
  • Big tumour
  • Fetus
  • Fluid: cardiac, renal, liver, low albumin (malnutrition, chronic disease, protein losing enteropathy), capillary leak syndromes
80
Q

Cause of weight gain from fat ?

A

Neuroendocrine causes
Cushings
PCOS
Hypothyroid
Hypothalamic dysfunction
Hypogonadism
GH deficiency

Iatrogenic
Drugs: corticosteroids, antipsychotics, antidepressants, insulin, AEDs
Hypothalamic surgery

Physiological:
Sedentary lifestyles
Social and behavioural

81
Q

Infectious / post infectious causes of polyarthritis?

A

Viral infection
Bacterial infection: Lyme disease, bacterial endocarditis

Rheumatic fever
Reactive arthritis

82
Q

Metabolic causes of secondary osteoarthritis

A

Haemochromatosis
Acromegaly
Ochronosis: alkaptonuria, quinine/ hydroquinone use

83
Q

Mechanical causes of secondary osteoarthritis

A

Previous trauma
Valgus/ varus deformity
Occupation related
Developmental
Meniscectomy
Leg length discrepancy
Hyper mobility syndrome
Neuropathic arthropathy

84
Q

Causes of painless haematuria?

A

Renal: dystrophic RBCs
GN, PCKD

Urological cause: isomorphic
Exercise
Trauma
Post radiation: radiation cystitis
Bladder cancer
Drugs: cyclophosphamide, anti platelets/ anticoag

PACES 2024 (14 decks)

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