AS PACES Shorts Flashcards
Locations of psoriasis
Extensors, behind ears, scalp, umbilicus, trauma (Koebner phenomenon)
Nails - pitting, discolouration, onycholysis, subungal hyperkeratosis
DDx Keobner phenomenon
Psoriasis, lichen planus, viral warts, vitiligo, sarcoid
Pathogenesis of psoriasis
Type IV T cell driven
Hyperkeratosis
Parakeratosis (nuclei in stratum corneum)
Intra-epidermal micro abscesses of Munro
Subtypes of psoriasis
Guttate (drop like lesions, children often post Strep)
Pustular
Erythrodema
Flexural
Psoriasis Mx
Conservative –> avoid precipitants, MDT
Medical –> Emollients (diprobase), Steroids, Vit D analogues, Phototherapy (PUVA, narrow band UVB), Systemic retinoids, methotrexate, ciclosporin, anti TNF
Malignant melanoma features
ABCDE Asymmetry Boarder Colour Diameter <6mm Evolution
MM classification
Superficial spreading 80% Lentigo maligna melanoma: elderly Acral lentiginousL blacks, soles, palms Nodular: younger Amelanotic: delayed Dx
Signs of NF
Cafe au Lait spots >6 >15 mm
Axillary freckling
Neurofibromatomas - gelatinous, violaceous nodules
Eyes –> Lich nodules (melanocytic hamartomas of the iris
BP - phaeo / RAS
Back - scoliosis
Acuity - optic glioma
Tuberous sclerosis - O/E
Facial adenoma sebaceum (perinasal angiofibroma)
Periungal fibromas - hands and feet
Shagreen patch (sacrum)
Ash leaf macules
Cafe au laid spots
Cystic lung disease, cystic renal disease,
Gingival hypertrophy and hirsuitism 2* to phenytoin (majority epileptic)
AD chr 16
OWR syndrome (HHT) O/E
Telangectasia on face, lips, buccal mucosa; cyanosis if large AVMs, no signs of CREST
DDx CREST, CLD
AD, AVM in lungs, brain, liver
Epistaxis, GI haemorrhage, haemoptysis, SAH, HOCF,
Peutz Jeghers
Small pigmented macules on lips, oral mucosa, palms and soles
DDx PJ, simple freckles
AD STK11 chr 19
GI hamartomas (bleeding, intussusception) and mucocutaneous macules
CRC 20% lifetime risk; + pancreatic endocrine tumours
Erythema multiforme - O/E
Symmetrical target lesions esp extensor surfaces
Ddx EM, discoid eczema,
2* to infections (HSV 70%, mycoplasma) or drugs (NSAIDS, allopurinol, penicillin, phenytoin, sulfonamides)
If V severe SJS/TEN
Erythema nodosum - O/E + causes
Tender blue/red smooth shiny nodules on shins
Systemic (sarcoid, IBD, Behcet’s), Infection (strep, TB), Drugs (sulphonamides, OCP)
Lupus pernio - appearance
Blown plaques on nose, skin manifestation of sarcoidosis
Extra-articular features
Nodules Tenosynovitis (de Quervains and atlanto-axial subluxation) Immune (vasculitis, amyloidosis, Sjogren's, AIHA) Cardiac (pericarditis ± effusion) Carpal tunnel Pulmonary fibrosis ± effusions Opthalmic: episcleriis, scleritits Renal: 2* to amyloid deposition Felty's
SE Methotrexate
BM supression, hepatotoxicity, pulmonary fibrosis
Monitor FBC, LFTs, CXR
SE sulfasalazine
BM suppression, skin rashes, hepatitis, lowered sperm count
SE hydroxychloroquine
Retinopathy
SE penicillamine and gold
Nephrotic syndrome
Atlanto-axial subluxation in RA patients
Rheumatoid tenosynovitis leads to weakening of ligaments supporting the top of the C spine
Posterior subluxation of odontoid peg can compress spinal cord leading to progressive spastic paraparesis or if v acute cardiac arrest.
Pre op XR C spine in gentle flexion
Mx Raynauds
Gloves and hand warmers
CCB (e.g. nifedipine)
If severe prostacyclin infusion
SLE medical management
Mild - cutaneous and joints. Topical roids, hydroxychloroquine
Moderate - organ involvement. Pred + Azathioprine
Severe - AIHA, serositis, CNS disease. High dose methylprednisolone, cyclophosphamide
Ank Spond - O/E
Thoracic kyphosis + neck hyperextended - question mark movement
Occiput to wall distance >5cm; Schober’s >5cm; reduced chest expansion <5cm
Sacroilitis - pain on hip adduction of hip, direct pressure
Extra: anterior uveitis, apical lung fibrosis, aortic regurg, achilles tendonitis, psoriatic plaque
ECG - AV block 10%
Dipstick - protein if amyloidosis
Ix ECG, FBC, ESR, HLAB27, XR spine, CXR, DEXA
Ank spond - bamboo spine
Syndesmophytes, ligamental calcification, periosteal bone formation
Sx - spinal osteotomy
Marfan’s syndrome - O/E
Arm-span:height ratio >1.05 Arachnodactyly Hyperextension of joints RR delay - coarctation, collapsing High arched palate + lens dislocation (upwards) Pectus carinatum/excavatum AR / MVP Thyroid mass AD chr 15 fibrillin gene Echo - aortic root dilatation (monitor annually)
Mx Gout
Conservative: Remove cause, good hydration
Medial: Indomethacin / diclofenac; 2nd line colchicine; 3rd line steroids
Chronic: Allopurinol (XO inhibitor)
Mx Thyrotoxicosis
Medical: Propranolol; Carbimazole (block and replace)
Radio I: CI pregnancy and around children
Surgical: thyroidectomy (SE haematoma, RLN injury, hypo PTH, hypothyroid)
DDx hypothyroid
AI (Hashimoto’s, 1* atrophic)
Iatrogenic (drugs, surgery, RI)
Iodine deficiency
DDx Macroglossia
Acromegaly
Amyloidosis
Hypothyroidism
Down’s syndrome
Acromegaly: Hx
Headaches, vision problems, Change in appearance - hat and ring size Carpal tunnel OSA Chest pain, SoB, palpitations, change in bowel habit Polyuria and polydipsia
Acromegaly Ix
Bloods - increased IGF1, OGGT (will not suppress GH), glucose
CXR - cardiomegaly
MRI - pituitary adenoma
Acromegaly Mx
MDT, CV risk factors
Medical: Somatostatin analogues (octreotide); Da agonists (cabergoline); GH antagonists
Surgery: trans-sphenoidal excision
Cushing’s Ix
Urine dip - glycosuria
24h urinary free corotisol, dexamethasone suppression test (low and high dose)
MRI pituitary ± while body CT
