Clinical Consultation Flashcards
Causes of breathlessness in ankylosing spondylitis
Anaemia
Apical pulmonary fibrosis
Aortic regurgitation
Mechanical restriction
Treatment in ankylosing spondylitis
Patient education
PT/OT
Hydrotherapy
Smoking cessation
NSAIDS - naproxen/meloxicam
Anti-TNF agents eg adalimumab
Anti-Il-17 - secukinumab
Jak inhibitors - upadacitinib
Pretreatment considerations with Anti-TNF treatment
Immunisations
Screen for latent/active Tb
Ix in ankylosing spondylitis
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
Management of acute IBD
FBC
CRP
U&Es and LFTs
Stool culture
Faecal calprotectin
AXR
Analgesia
IV hydrocortisone
IVF
pLMWH
Complications of IBD
Dilatation of bowel loops
Fistulating disease
Perforation
Abscess formation
Refractory to medical management
Tx following acute flare of IBD
Tapering course of steroids
Escalation of DMARDs eg anti-TNF agent
IBD nurse
Dietician
Flexi Sig
Differences between Crohns and UC on sigmoidoscopy
Crohns- aphthous ulcers, skip lesions, cobblestone appearances, transmural inflammation, normal rectum
UC - superficial inflammation restricted to mucosa/submucosa, crypt abscesses
Malignancy risk in IBD
Increased risk of colon cancer, have a colonoscopy 10 years post diagnosis, and further scopes as per risk category
Steroid sparing agents in IBD
Methotrexate
Azathioprine
Ciclosporin
Anti-TNF for refractory Crohns
Rectal steroids
Lhermitte’s Phenomenom
Electric shock sensation on flexion of the neck often going down the back
Hoffmans sign
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
Causes of myelopathy
Trauma
Neoplastic
MS
Vascular
Hereditary spastic neuropathy
Ix of myelopathy
FBC
ESR
Autoimmune screen
U&Es and LFTs
B12
Copper studies
Urgent MRI
Management of degenerative cervical myelopathy
Referral to neurosurgery
Analgesia
PT with neurorehab
OT