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Clinical consultations Flashcards

1
Q

Endocrine symptom screen

A
  • ALWAYS ADDISONS! Nausea, vomiting, abdo pain, dizziness, pigmentation
  • Thyroid symptoms
  • Sexual dysfunction e.g. amenorrhea
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2
Q

Pituitary profile: initial bloods

A

think FLAT PEG

  • FSH and LH
  • Cortisol (9am)
  • Thyroid profile
  • Prolactin
  • IGF-1
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3
Q

Which hormones are secreted from the pituitary gland?

A

Anterior: FLAT PEG
- FSH, LH
- ACTH
- TSH
- Prolactin
- Endorphins
- GH

Posterior:
- ADH
- Oxytocin

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4
Q

Acromegaly - symptoms

A
  1. Secondary to excess GH:
    - Larger hands and feet
    - Facial features changing
    - Sweating
  2. Secondary to pituitary adenoma:
    - Headaches
    - Bitemporal hemianopia - ask about not seeing vehicles overtaking for example, when driving
    - Diplopia
  3. Secondary to complications:
    - Carpal tunnel - tingling in hands
    - Diabetes - polyuria, polydipsia
    - Colonic polyps - change in bowel habit, bleeding
    - OSA - daytime somnolence
  4. General endocrine screen
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5
Q

Acromegaly examination

A

Hands: large, spade shaped, Phalens test for carpal tunnel

Face: look from side for prominent supraorbital ridge and jaw

Mouth: Widened interdental gap

Eyes: visual fields and eye movements

Neck: goitre

Axilla: skin tags

Heart: apex beat and heart sounds

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6
Q

Bisphosphonates adverse effects

A

Oesophagitis - sit upright when swallowing

Osteonecrosis of jaw - needs regular dental checks

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7
Q

Crohn’s disease - extra-GI manifestations

A

Mouth ulcers
Uveritis
Rashes - erythema nodosum, pyoderma gangrenosum
Arthralgia (HLA B27 associated eg ank spond)

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8
Q

Initial investigations in IBD

A

Bedside:
Stool MCS, virology, OCP if recent travel
Faecal calprotectin

Bloods: FBC, U+Es, CRP, LFTs
Coeliac screen (anti-TTG and total IgA)

Imaging:
AXR to r/o toxic megacolon
Consider CTAP if peritonitic
Consider MRI small bowel if worried about enteritis

Flexi sig

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9
Q

Initial management IBD

A

Admit
IV fluids
Crohn’s - exclusive enteral nutrition
(nutritional supplements, water and black tea/coffee only)
UC - IV hydrocortisone

Flexible sigmoidoscopy

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10
Q

Indications for surgery in Crohn’s disease

A

Toxic megacolon
Intra-abdominal abscess
Fistulating disease
Refractory to medical treatment

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11
Q

Maintenance therapy in Crohn’s

A
  • Tapering steroids with vitamin D and PPI cover
    -Azathioprine/mercaptopurine/methotrexate
  • Anti-TNF e.g. infliximab
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12
Q

Sigmoidoscopy features in Crohn’s versus UC

A

Crohn’s
- Apthous ulcers
- cobblestone mucosa
- patchy inflammation
- transmural

Ulcerative colitis:
- Pancolitis starting at rectum and moving distally
- Superficial inflammation

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13
Q

Complications of IBD

A

Malnutrition - vitamin deficiency

Infections
- perianal abscess
- intra-abdominal abscess

Fistulating disease in Crohns

Skin - erythema nodosum, pyoderma gangrenosum
Joint pain

Chronic pain

Malignancy
10 years of symptoms -> index surveillance colonoscopy

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14
Q

Smoking in IBD

A

Smokers 2x as likely to develop Crohn’s

Smoking is often protective in UC!

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15
Q

Management of ulcerative colitis

A

Acute flare
- Admit
- IV fluids
- IV hydrocortisone

Maintenance
- Rectal ASA (mesalazine) or budesonide
- Severe: oral mesalazine or azathioprine

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16
Q

Ankylosing spondylitis - examination

A

Palpate down spine

Neck:
- Flexion and extension
- Lateral flexion
- Rotation

Lower back:
- Flexion and extension
- Lateral flexion
- Rotation

Tragus to wall distance

Modified Schober test:
- Mark the midpoint of dimples of venus
- Mark 5cm below and 10cm above

Heart - aortic regurg
Lung - fibrosis (typically apical)

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17
Q

Ankylosing spondylitis - complications

A

Interstitial lung disease
Uveitis

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18
Q

Ankylosing spondylitis - investigations

A

Bloods
- fbc, inflammatory markers, renal and liver function
- HLA-B27

Imaging
XR spine and pelvis - sacroilitis, syndesmophytes, spinal fusion
Echo - assess for AR
CXR - fibrosis and consider HRCT
Lung function tests and transfer factor

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19
Q

Ankylosing spondylitis Mx

A

Pharmacological:
Anti-inflammatories - NSAIDs
Intra-articular steroids may be used
DMARDs generally not used
Biologics e.g. adalimumab (anti TNF)

MDT approach including PT, OT
Smoking cessation

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20
Q

Checks before anti-TNF treatment

A

Check for latent or active TB
BBV screen
Up to date immunisation

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21
Q

Back pain red flags

A

Acute onset
Bladder/bowel dysfunction
Loss of perianal sensation
Focal weakness or sensory loss

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22
Q

Scoring system in ankylosing spondylitis

A

Bath Ankylosing Spondylitis score
measure of disease activity

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23
Q

Complications of Ehlers Danlos Syndrome

A

Hypermobility of joints -> pain and deformity

Cardiovascular
- Mitral valve prolapse/regurgitation
- Aortic regurgitation
- Conduction abnormalities

Vascular complications (worst prognosis)
- Aneurysms
- Haemorrhage

GI
- Oesophageal dysmotility
- Diverticular disease

Eyes
- Glaucoma
- Retinal disease

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24
Q

Management of Ehlers Danlos Syndrome

A

Supportive:
MDT approach
PT/OT
Analgesia
Management of specific complications

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25
Q

Ehlers Danlos inheritance

A

Several different subtypes - some AD, some AR, some de novo

Defective collagen synthesis

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26
Q

Ehlers Danlos examination

A

Joints:
- Thumb back to wrist
- Elbow hyperextension

Skin:
- Pull skin - elasticity

Cardiac:
- Apex beat
- Heart sounds (AR/MR)
- AF

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27
Q

Thyroid examination

A

Inspection:
- Clothing
- Eyes
- Hair loss
- Anxious/depressed

Hands:
- Tremor
- Sweating
- Dry skin

Neck:
- Goitre?
- Swallow water
- Stick tongue out (cyst would move up)

Eyes:
- Eye movements
- Lid lag

From behind:
- Palpate the thyroids
- Again ask patient to swallow and stick tongue out
- Lymphadenopathy

Sit back down opposite patient:
- Percuss retrosternally and to the sides
- Auscultate for bruits on both sides

Extra:
- Biceps/ankles reflexes
- Proximal myopathy
- Legs (pretibial myxoedema)

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28
Q

Hypothyroidism causes

A

Primary:
- Hashimoto’s (autoimmune) - most common
- Iodine deficiency
- Riedel’s thyroiditis (fibrosis of gland) (reduced TRH release)

Secondary:
- Reduced TSH release from pituitary

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29
Q

Hyperthyroidism DDx

A

Primary hyperthyroidism
- Graves disease = most common
- Toxic adenoma
- Toxic multinodular goitre
- De Quervains thyroiditis
- Amiodarone thyrotoxicosis
- Exogenous levothyroxine

Secondary hyperthyroidism (excess TSH release)

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30
Q

De Quervains thyroiditis disease course

A

hyper -> eu -> hypothyroid -> euthyroid

PAINFUL GOITRE

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31
Q

Management of hypothyroidism

A

Levothyroxine

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32
Q

Complications of hypothyroidism

A

Most concerning: myxoedema coma
(Hypothermia, bradycardia, hypoglycaemia, reduced GCS)

Metabolic:
- Hypercholesterolaemia
- Weight gain

Cardiac:
- Ischaemic heart disease
- Bradycardia
- Heart failure

Neuro
- Depression
- Peripheral neuropathy
- Cerebellar syndrome

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33
Q

Investigations in thyroid disease

A
  • TFTs
  • Anti-TSH receptor antibodies (Graves)
  • Anti-TPO antibodies (Hashimotos)
  • Screen for other autoimmune disease e.g. coeliac, hypoparathyroidism, etc

US neck - assess goitre
Consider iodine uptake scan

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34
Q

Iodine uptake scan - interpretation of results

A

Diffuse increased uptake = Graves

Hot spots of increased uptake = toxic multinodular goitre

Single hot spot = toxic adenoma

Diffuse reduced uptake = de Quervains

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35
Q

Management of Graves

A

Symptomatic: Propranolol

For the thyroid:
1) Carbimazole - risk of agranulocytosis.
- can ‘block and replace’

2) Propylthiouracil - better in Pregnancy and Pancreatitis

If any agranulocytosis develops…
STOP THYROID DRUGS
Offer radioiodine treatment

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36
Q

Management of toxic multinodular goitre hyperthyroidism

A

First line = radioiodine

Second line:
- Anti-thyroid drugs (carbimazole, propylthiouracil)
- Offer thyroidectomy

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37
Q

Management of toxic adenoma hyperthyroidism

A

First line = hemithyroidectomy or radioiodine

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38
Q

Cushing’s syndrome causes

A

Pituitary adenoma -> excess release of ACTH (Cushing’s disease)

Adrenal adenoma -> excess release of cortisol

Ectopic ACTH secretion e.g. lung Ca

Exogenous steroids

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39
Q

Cushing’s disease examination

A

General inspection:
- Central adiposity
- Hirsutism
- Fat re-distribution: Central adiposity, Moon face, bufallo hump
- Striae
- Buffalo hump
- Check for evidence of diabetes (CBG)

Check cardiac, respiratory and abdominal systems

Proximal myopathy

Blood pressure

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40
Q

Cushing’s investigations

A

Low dose dexamethasone suppression test - see if cortisol remains elevated

High dose dexamethasone suppression test
- Dexamethasone suppresses ACTH production, not cortisol
- Cushing’s syndrome: Low ACTH and low cortisol
- Adrenal adenoma: Low ACTH and high cortisol
- Ectopic tumour: High ACTH and high cortisol

Also
- HbA1c, renal profile
- Pituitary profile
- Blood gas would show hypokalaemic metabolic alkalosis
- MRI pituitary +/- CT chest (Ectopic) / abdomen (adrenal adenoma)

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41
Q

Cushing’s management

A

Disease: transsphenoidal resection of pituitary tumour

Syndrome: Treat underlying cause
- Wean exogenous steroids
- Adrenal tumour resection
- Ectopic tumour resection
- meds include metyrapone or ketoconazole to reduce cortisol production

Management of complications:
Hypertension
Hyperglycaemia

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42
Q

Osteoporosis definition

A

bone density if more than 2.5 standard deviations below the mean value for an adult of the same gender and race

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43
Q

Main modifiable risk factor for thyroid eye disease

A

SMOKING

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44
Q

Causes of clubbing

A

Cardiac:
- Cyanotic congenital heart disease
- Subacute endocarditis

Respiratory:
- Suppurative lung disease: CF, bronchiectasis
- Interstitial lung disease
- TB

Abdominal:
- Chronic liver disease
- IBD

Other:
- Idiopathic

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45
Q

DVLA rules for stroke/TIA

A

Group 1 license: no driving 1 month

Group 2 licence: no driving 1 year

46
Q

Insulin DVLA rules

A

Group 1 license: Must inform DVLA

Group 2 license: stop driving until DVLA review

47
Q

Angina DVLA rules

A

Group 1 license: no requirements

Group 2 license: need to inform DVLA

48
Q

MI DVLA rules

A

Group 1 license:
- No need to tell DVLA
- 1 week off driving if successful and completed angioplasty
- Otherwise, 4 weeks off driving (i.e. if incomplete, unsuccessful or medical mx)

Group 2 license: Inform DVLA, 6 weeks off driving

49
Q

Cardiac device DVLA rules

A

Must inform DVLA for all licenses, but can continue driving

50
Q

Rheumatoid arthritis Ix

A

Bloods:
- RF and anti-CCP
- Anaemia
- CRP/ESR

XR hands:
- Joint deformities
- Narrowed joint space
- Subluxation

CXR - fibrosis

Baseline echo, lung function test

51
Q

Rheumatoid arthritis/Psoriatic arthritis mx

A

Analgesia
MDT approach

1) Methotrexate with folate
(acute flare - steroids as well)

2) Sulfasalazine

3) Anti-TNF e.g. etanercept

52
Q

Psoriatic arthritis XR findings

A

Pencil in cup appearance
Fluffy periosteitis

53
Q

Psoriatic arthritis serology

A

RF and anti-CCP negative
HLAB27 +ve

54
Q

Examination in small joint arthropathies

A

Hands: Look Feel Move
- check for active synovitis
- Functioning eg buttons

Elbows - nodules, psoriasis

Eyes - episcleritis

Ears/scalp - psoriasis

Neck - atlanto-axial instability

Chest - fibrosis

55
Q

Migraine mx

A

Acute management - abortive
1) Paracetamol, NSAIDs, anti-emetics +/- Sumatriptan

Prevention
1) Propranolol
2) Topiramate (CI in pregnancy)

Headache clinic
Avoidance of triggers

56
Q

Migraine and COCP

A

COCP contra-indicated in migraine with aura

57
Q

Triptans are contra-indicated in

A

Ischaemic heart disease
CVA
SSRI use

58
Q

Rheumatology questioning approach

A

1) Joints
- Swelling, pain, stiffness, symmetry
- Nodules

2) Skin
- Rashs
- Sun sensitivity, scaling, scalp involvement
- Hair loss
- Mucosal involvement

3) Systemic
- Fevers, fatigue, appetite, weight loss
- Pleuritis

4) Vascular
- Raynauds
- Scleritis/episcleritis

5) Other autoimmune conditions

59
Q

General rheumatology investigations

A

Bedside: ECG and urine dip

Bloods: FBC, U+Es, CRP, ESR, LFTs
Connective tissue disease screen

Imaging:
- CXR
- XR of affected joints
- Baseline echo

Other:
- Baseline lung function tests

60
Q

Systemic sclerosis: history

A

1) Joints: swelling/pain
- may have tightness restricting movement of hands

2) Skin
- Tightening, sclerodactyly
- Change to face shape (beaked nose, microstomia)
- Telangiectasia

3) Systemic
- Fevers, weight loss, fatigue
- Swallowing difficulties
- Sicca

4) Vascular
- Raynauds
- Digital ulceration
- Scleritis/episcleritis

5) Other autoimmune conditions

61
Q

Systemic sclerosis: examination

A

General appearance: facial features (beaked nose, microstoma, telangiectasia)

Hands:
- Calcinosis
- Sclerodactyly
- Scars of digital ulceration
- Check elbows for any calcinosis/nodules

Face:
- Beaked nose
- Microstoma
- Telangiectasia

Cardiac:
- Check JVP, RVH, loud P2, heart sounds
- Could have a functional TR

Resp:
- fibrosis

62
Q

Management of scleroderma

A

Avoid steroids where possible

Non-steroid immunomodulators e.g. methotrexate

Patient education + smoking cessation

Treatment of complications
- Vasodilators e.g. CCB for ulcers
- Tx pulmonary htn e.g. iloprost
- Scleroderma renal crisis: ACEi

Steroids can make scleroderma renal crisis worse

63
Q

SLE history

A

1) Joints
- Symmetrical small join arthropathy
- Jaccouds arthropathy: reversible deforming arthropathy, no erosions

2) Skin
- Photosensitive rash
- Butterfly rash
- Hair loss
- Mucosal involvement

3) Systemic
- Fevers, weight loss, fatigue
- Pleurisy e.g. chest pain
- Breathing difficulty

4) Vascular
- Raynaud’s
- Scleritis/episcleritis

5) Any other autoimmune disease

  • Drug history - triggering drugs include beta blockers, lithium
64
Q

SLE examination

A

Hands: any arthropathy, skin changes

Face: butterfly rash, check for mouth ulcers, behind scalp

Lungs: auscultate, percuss for pleural effusion

Cardiac: check for pulm HTN

Legs: rashes or swelling

65
Q

SLE management

A

Acute flare: steroids

Maintenance: AZT or MTX

Symptom control

Smoking cessation

66
Q

SLE investigations

A

Bedside: ECG, urine dip

Bloods: anti-dsDNA, anti-histone Abs, complement (C3 and C4)

Imaging:
- CXR
- XR hands, if arthropathy (no erosions)
- Echo

Other:
Lung function tests

67
Q

Polymyositis and dermatomyositis: history

A

1) *Muscle weakness
- Difficulty getting up from a chair/going up stairs
- Difficulty reaching into a cupboard above you
- Muscle tenderness

2) Skin
- Red scales on hands, no itchy
- Purple rash across face
- Hair loss, mucosal involvement

3) Systemic
- Weight loss, fevers, fatigue
- Ask about malignancy symptoms: haemoptysis, PR bleeding, breast lumps, bloating

4) Vascular
- Ask about GCA sx (DDx: PMR)

5) Any other autoimmune conditions

  • Drug history - statin, steroids
68
Q

Difference between polymyositis and dermatomyositis

A

Polymyositis: Muscle involvement without skin features

Dermatomyositis: Muscle involvement with skin features (often paraneoplastic)

69
Q

Polymyositis DDx

A

Other causes of proximal myopathy:
- Cushing’s
- Osteomalacia
- Polymyalgia rheumatica
- Hypothyroidism
- Statin induced myopathy
- Myasthenia gravis (fatiguability)

70
Q

Poly/dermatomyositis Ix

A

Bedside: ECG, urine dip

Bloods: Raised CK, anti-Jo Abs, anti-Mi Abs

Imaging: CT abdomen pelvis for malignancy screening

Other:
- EMG
- Muscle biopsy

71
Q

Poly/dermatomyositis treatment

A

1) Steroids for acute flare

2) Steroid-sparing immunomodulators: methotrexate, azathioprine

3) Treat symptoms, PT/OT

4) Treat complications

72
Q

Causes of young hypertension

A

Essential hypertension

Secondary causes:
- Renal: renal artery stenosis
- Endocrine: CHAP
Cushing’s, Hypothyroidism, Acromegaly, Phaeochromocytoma
- Cardiac: coarctation of aorta

73
Q

Young hypertension investigations

A

Bedside: ECG, urine dip, offer fundoscopy

Bloods: FBC, U+Es, inflammatory markers, HbA1c, pituitary profile

Imaging: CXR, echo
If deranged renal function: US KUB, consider MRA kidneys

74
Q

Young hypertension: examination

A

General appearance - Cushingoid?

Hands: Pulse, radio-radial delay

Face:
- Moon face? Hair loss? Acromegaly?
- Offer fundoscopy

Heart: auscultation

Resp: auscultation

Abdomen: ballot kidneys, renal bruits

Check for proximal myopathy
Examine thyroid

75
Q

Headache red flags/key questions

A

Reduced GCS
Seizures
Vomiting
Amnesia
Focal neurology
Photophobia
Worse on waking

76
Q

Headache examination

A

Hands: pulse

Face: Pupils, cranial nerves

Neck: CAROTID BRUITS!

UL and LL neuro

KERNIG’S SIGN!

Cardiac - murmurs or arrhythmias

Calves - DVT

77
Q

Subarachnoid haemorrhage investigations

A

CT Head

If CT head negative, but high suspicion, do LP for xanthrochomia

78
Q

Meningitis CSF interpretation

A

Bacterial: high WCC (neutrophils), low glucose, high protein

Viral: High WCC (lymphocytes), normal glucose, high protein

79
Q

Cluster headache treatment

A

Abortive: High fow O2 and subcutaneous sumatriptan

Preventative: Verapamil

80
Q

Sudden onset headache DDx:

A

Subarachnoid haemorrhage

Cavernous sinus venous thrombosis

Cervical artery dissection
- This can be carotid or vertebral artery dissection
- Think about sudden head movements, whiplash, head held back in any position

81
Q

Optic atrophy - history

A

Reduction in colour vision

MS
- ask if worse after hot bath
- Other neurology - time and space

Drugs history - isoniazid

Cardiovascular risk factors

82
Q

Optic atrophy DDx

A

1) Demyelination: MS

2) Inflammatory: vasculitis

3) Compressive: SOL

4) Metabolic: B12 deficiency, diabetes

5) Toxins: Isoniazid

83
Q

Argyll Robertson pupil

A

Affected eye is dilated
Does not accommodate or react to light

Associated with absent ankle jerks

Reassurance

84
Q

Holme’s Adie pupil

A

Affected eye is dilated
Accomodates, but does not react to light
Associated with syphilis

85
Q

3rd nerve palsy presentation and cause

A

Down and out pupil with ptosis

Causes: 3 Ms, 2 Cs

  • Mononeuritis multiplex
  • deMyelination (MS)
  • Midbrain infarct
  • posterior Communicating artery aneurysm
  • Cavernous sinus pathology
86
Q

6th nerve palsy presentation and cause

A

Failure of abduction in affected eye

Causes
- Diabetic retinopathy
- Mononeuritis multiplex e.g. SLE
- Compressive e.g. SOL, raised ICP, aneurysm
- Denyelination e.g. MS

87
Q

Causes of facial nerve palsy

A

Inflammatory:
- Bell’s Palsy
- SLE
- Vasculitis
- Sarcoidosis (can be bilateral)

Compressive:
- SOL (cerebello-pontine angle tumour - ask about hearing changes)

Demyelinating: MS, GBS (miller-fisher)

Infective: HIV, Lyme disease

88
Q

Symptoms to ask about in facial nerve palsy

A
  • Timing, onset
  • Neuropathic pain
  • Hyperacuisis
  • Hearing changes
  • Rash (herpes zoster)
  • Vision changes

Features of SOL
- Headache, personality/memory change
- Hearing loss!

Features of demyelination
- Neurology time/space

Previous surgery - parotid scars

89
Q

Facial nerve palsy - examination

A

Inspection
- Ptosis
- Vesicular rash
- Check behind ears for parotid scars

Facial movements: Eyebrows involved in LMN

Eye movements

Cerebellar exam

Gait
UL/LL if time

90
Q

Internuclear ophthalmoplegia - pathophysiology, examination and causes

A

Lesion in the medial longitudinal fasciculus

Examination:
- Failure of adduction of eye on the affected side
- Nystagmus in the contralateral eye

Causes
- Demyelination (MS) is most common
- Cerebrovascular e.g. midbrain stroke
- Inflammatory/vasculitis
- SOL

91
Q

Relative afferent pupillary defect - examination, causes

A

Examination: Swinging light test
- When light shone on unaffected eye, normal consensual constriction
- When light shone on affected eye, both eyes appear to dilate

Causes
- In over 50s: GCA until proven otherwise (tx steroids)
- Optic neuritis e.g. MS
- Optic atrophy e.g. diabetic neuropathy, B12 def
- Vascular e.g. CRAO or CRVO

92
Q

Hereditary haemorrhagic telangiectasia - inheritance

A

Autosomal dominant

93
Q

Hereditary haemorrhagic telangiectasia - history

A

Abnormal bleeding:
- Epistaxis
- Haemoptysis
- GI bleeding
- Menorrhagia
- Previous strokes or intracranial bleeds

Anaemia sx: angina, dizziness, palpitations, SOB

Family history of similar

94
Q

Hereditary haemorrhagic telangiectasia - investigations

A

Bloods: FBC, haematinics, U+Es, LFTs, clotting profile

Imaging: CXR, MRI brain, TTE

Genetic testing

95
Q

Hereditary haemorrhagic telangiectasia - complications

A

Anaemia

Epistaxis
Pulmonary haemorrhage

AV malformations (brain, hepatic etc)
Can lead to ICH, stroke

Portal HTN from vascular disease -> hepatomegaly and splenomegaly

96
Q

Hot swollen joint DDX

A

Crystal arthropathy
Septic joint
Psoriatic arthropathy
Reactive arthritis
Haemarthrosis

97
Q

Risk factors for crystal arthropathy

A

Obesity

Dehydration/Diuretics/CKD

Diet: red meat, shellfish, port/red wine

High turnover states: myeloproliferative disease

98
Q

Risk factors for septic arthritis

A

Prosthetic joint
IVDU
Immunosuppression esp. diabetes

99
Q

Investigations for acute hot swollen joint

A

Bloods: FBC, U+Es, CRP/ESR, LFTs
HLA B-27
Urate is low in acute gout

May consider XR of affected joint

Joint aspiration - fluid microscopy, culture, gram-staining and crystals

Prosthetic joints must be aspirated in theatres!

100
Q

Management of crystal arthropathy

A

Acute: NSAIDs, colchicine

Maintenance: allopurinol
Lifestyle modification

101
Q

Management of septic arthritis

A

IV Abx ideally after joint aspiration
Joint washout by orthopaedics

102
Q

Reactive arthritis risk factors

A

STI - gonorrhea, chlamydia

Gastroenteritis

103
Q

Sarcoidosis - history

A

Joints: may have joint swelling

Skin: lupus pernio, erythema nodosum

Systemic: Weight loss, fatigue,
- Hypercalcaemia sx: bones, stone, moans and groans
- Breathlessness
- Bilateral facial nerve palsy
- Uveitis

104
Q

Sarcoidosis: examination

A

Hands: skin changes

Face: lupus pernio, bilateral facial nerve palsy

Chest: apical fibrosis

Heart sounds: ?pulm HTN

Abdomen: Splenomegaly

105
Q

Sarcoidosis: investigations

A

Bloods: FBC, U+Es, CRP/ESR, LFTs, BONE PROFILE, Serum ACE, Myeloma screen

Urine: Bence jones proteins

CXR: BHL, apical fibrosis

Baseline echo

Biopsy (peripheral ideally) -> non-caseating granuloma

106
Q

Sarcoidosis: management

A

Supportive

Steroid indications:
- Parenchymal lung disease
- Uveitis
- Neuro involvement
- Cardiac involvement
- HyperCa

Steroid-sparing agents can be used

107
Q

Facioscapulohumeral muscular dystrophy
Inheritance

A

Autosomal dominant

108
Q

Facioscapulohumeral muscular dystrophy examination

A

Screening: winged scapula, ask patient to whistle

Inspection: facial/proximal muscle wasting, may have hearing aids

Tone: flaccid

Power: Proximal weakness, winged scapula

Coordination: intact

Sensation: intact

109
Q

Facioscapulohumeral muscular dystrophy complications

A

Sensorineural hearing loss

Restrictive lung disease (mechanical)

Functional limitations

110
Q

Hyperviscosity syndrome - causes

A

Increased immunoglobulins:
- Multiple myeloma
- Waldenstroms macroglobulinaemia

Cell hyperproliferation:
- Essential thrombocytosis
- Polycythaemia
- Myeloproliferative disorders / leukaemia

Reduced RBC deformability
- Sickle cell disease
- hereditary spherocytosis

111
Q

Seizure DVLA rules

A

Group 1 licence: License revoked until 6 months seizure free (including changes to medications)

Group 2:
- One off seizure: License revoked until 5 years seizure-free and off medications
- Multiple seizures: License revoked until 10 years seizure-free and off medications

112
Q

OSA DVLA rules

A

No driving until symptoms under control

MUST TELL DVLA

PACES (5 decks)

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