Clinical Consultation Flashcards

1
Q

Causes of breathlessness in ankylosing spondylitis

A

Anaemia
Apical pulmonary fibrosis
Aortic regurgitation
Mechanical restriction

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2
Q

Treatment in ankylosing spondylitis

A

Patient education
PT/OT
Hydrotherapy
Smoking cessation
NSAIDS - naproxen/meloxicam
Anti-TNF agents eg adalimumab
Anti-Il-17 - secukinumab
Jak inhibitors - upadacitinib

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3
Q

Pretreatment considerations with Anti-TNF treatment

A

Immunisations
Screen for latent/active Tb

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4
Q

Ix in ankylosing spondylitis

A

FBC - Anaemia
CRP and ESR
U&Es and LFTS
HLA-B27
CXR if chest symptoms
XR of spine and pelvis - syndesmophytes and sacroilitis, fusion of spine
MRI spine can consider
AS symptom index - out of ten- >4 - active disease

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5
Q

Management of acute IBD

A

FBC
CRP
U&Es and LFTs
Stool culture
Faecal calprotectin
AXR
Analgesia
IV hydrocortisone
IVF
pLMWH

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6
Q

Complications of IBD

A

Dilatation of bowel loops
Fistulating disease
Perforation
Abscess formation
Refractory to medical management

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7
Q

Tx following acute flare of IBD

A

Tapering course of steroids
Escalation of DMARDs eg anti-TNF agent
IBD nurse
Dietician
Flexi Sig

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8
Q

Differences between Crohns and UC on sigmoidoscopy

A

Crohns- aphthous ulcers, skip lesions, cobblestone appearances, transmural inflammation, normal rectum

UC - superficial inflammation restricted to mucosa/submucosa, crypt abscesses

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9
Q

Malignancy risk in IBD

A

Increased risk of colon cancer, have a colonoscopy 10 years post diagnosis, and further scopes as per risk category

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10
Q

Steroid sparing agents in IBD

A

Methotrexate
Azathioprine
Ciclosporin
Anti-TNF for refractory Crohns
Rectal steroids

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11
Q

Lhermitte’s Phenomenom

A

Electric shock sensation on flexion of the neck often going down the back

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12
Q

Hoffmans sign

A

Hold the PIPs of the middle finger, flick the tip of the middle finger - positive if the index or thumb extend signifying an UMN lesion in keeping with cervical myelopathy

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13
Q

Causes of myelopathy

A

Trauma
Neoplastic
MS
Vascular
Hereditary spastic neuropathy

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14
Q

Ix of myelopathy

A

FBC
ESR
Autoimmune screen
U&Es and LFTs
B12
Copper studies
Urgent MRI

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15
Q

Management of degenerative cervical myelopathy

A

Referral to neurosurgery
Analgesia
PT with neurorehab
OT

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16
Q

Findings in spastic paraparesis

A

Muscle weakness and spasticity
Urinary retention

17
Q

Pyramidal signs

A

Hyperreflexia
Weakness especially in extensors
Spasticity
Babinski positive

18
Q

Management of suspected meningitis

A

A-E approach
FBC - WCC
CRP
U&Es and LFTS
Coag
Broad spectrum abs
Dexamethasone
IVF
CT head - if signs of raised ICP, papilloedema, seizures or focal neurology
LP - CSF protein, glucose (and paired serum) viral PCR, cultures

19
Q

Differences between LP results in viral vs bacterial

A

Turbid appearance in bacterial, can be clear in viral
High protein in bacterial, may be normal in viral
Low Glucose in bacterial, may be normal in viral
Positive gram stain in bacterial
Neutrophil predominant high WCC in bacterial, lymphocyte predominant in viral

20
Q

Complications of bacterial meningitis

A

Death
Deafness
Blindness
Cognitive issues
Amputation as a result of sepsis

21
Q

Treatment of migraine

A

Simple analgesia - paracetamol and NSAIDS
Triptan
Antiemetic

Prophylaxis can be given dependent on p

22
Q

Investigations in acromegaly

A

ECG
FBC
U&Es and LFTs
Random IGF1
OGTT with serial GH measurements
MRI brainn with pituitary views

23
Q

Complications of acromegaly

A

Bilateral carpal tunnel syndrome
Cardiomyopathy
IHD
HTN
T2DM
Visual impairment

24
Q

Treatments in acromegaly

A

Trans-sphenoidal resection
Dopamine receptor agonists - bromocriptine and cabergoline
Somatostatin analogues - octreotide
Radiotherapy

25
Q

Complications of pituitary resection in acromegaly

A

Pan hypopituitarism

26
Q

Epworth score

A

Score >11 signifies presence of OSA

27
Q

Treatment of OSA

A

If confirmed on polysomnography can trial CPAP overnight

28
Q

Scar present in renal transplant

A

Rutherford-Morrison

29
Q

Secondary issues in Osteogenesis Imperfecta

A

Bicuspid aortic valve
Aortic degneration
Poor hearing
Small stature
Barrel chested
Scoliosis
Translucent teeth
Bowing of long bones
Joint hypermobility
Skin hyper laxity
Retinal detachment and haemorrhages

30
Q

Genetic basis ofbsteogenesis imperfecta

A

Usually AD
Can be de novo

31
Q

Side effects of bisphosphonates

A

Oesophagitis/gastritis
Osteonecrosis of the jaw

32
Q

Findings in Ehlers-Danlos

A

Fragile skin - ecchymoses and fish mouth scars
Hyperextensible skin
Joint hyper mobility

Mitral valve prolapse
Aortic dilatation - risk of dissection/rupture

Aneurysm rupture and dissection
Bowel perforation and bleeding

33
Q
A