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Sheff 3a > GP RA/OA, Thyroid, IBD/IBS, Skin > Flashcards

GP RA/OA, Thyroid, IBD/IBS, Skin Flashcards

1
Q

OA risk factors

A

Age, female
Obesity
Previous Fractures / joint damage

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2
Q

Pathology of OA

A

Loss of articulation cartilage

-> cartillangeous growths which calcify -> osteophytes

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3
Q

Features of OA

A

Worse on movement, relieved by rest
Mostly hands, feet and weight bearing (hips, knees, spine)
Crepitus
Bouchard . Herberdens nodes

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4
Q

Ix in OA

A 
FBC and ESR -> normal 
RF negative 
ACPA 
X-ray - Loss of joint space, Osteophytes, Subchondral sclerosis and Cyst formation 
MRI - early cartilage changes
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5
Q

Management of OA

A

Patient education
Weight loss -> especially if weight bearing joints
Strengthening exercises
Bracing devices / joint support / walking stick
Good footwear

Medication
Paracetamol / NSAIDs
Intraarticular corticosteroid injections

Surgical
Hip / knee replacement

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6
Q

RA RF?

A

Smoking
Female
Family Hx
HLA -DR4

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7
Q

Pathology of RA

A

Autoimmune symetical inflammation of joints

  • > synovium grows forming mass called ‘Pannus’
  • > pannus damages articulate cartilage and subchondral bone -> bony erosions
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8
Q

Features of RA

A

Insidious onset pain
Early morning stiffness which eases
Proximal joints of hands and feet (progresses to wrists, elbow, shoulder, spine, knees…)

Swelling of joints
Z shaped thumb
Boutonnière deformity / swan neck

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9
Q

Non articular manifestations of RA (Name 4)

A

Systemic - fever, fatigue, weight loss

Eyes - sjogrens

Neuro - carpal tunnel, cord compression, mononeuritis multiplex

Haem - Lymphadenopathy, thrombocytosis, anaemia, Fetty syndrome

Pulm - pleural effusion, fibrosis, rheumatoid nodules

Vessels - raynauds, pericardial effusion

Vasculitis - ulcers

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10
Q

R.A Ix?

A

Peripheral symmetrical polyarthritis worse in morning

Bloods - Raised CRP/ESR, normochromic normocytic anaemia, thrombocytosis

Autoantibodies - ACPA [key], RF (less specific)

X-ray - soft tissue swelling
-later joint narrowing, erosions of joint margins, cysts, porous is of bone

Synovial fluid - sterile

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11
Q

Mx of RA

A

NSAIDs

Corticosteroids - oral / injection

Disease modifying antirheumatic drugs - Methotrexate / sulfasalazine

Biological DMARD - TNFa inhibitors (entanercept/infliximab)
-IL-1 receptor blocker ….

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12
Q

Side effects of methotrexate

A

Kills babies - stop 3months prior to conception
Mouth ulcers, diarrhoea
Liver/pulmonary fibrosis
Renal impairment

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13
Q

Causes of hypothyroidism

A

Autoimmune thyroiditits - antibodies to TSH receptor -> goitre (hashimotos) / atrophy

Post partum thyroiditis

Iatrogenic - Thyroidectomy, radioactive iodine

Drug induced - carbimazole, lithium, amiodarone, interferon

Iodine deficiency

Congenital hypothyroidism

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14
Q

Sx / signs of hypothyroid

A

Sx
Tiredness, weight gain, cold intolerance, goitre
Depression, poor memory
Dry skin/hair
Arthralgia, weakness, reduced libido, constipation

Signs 
Mental slowness 
Dry thin hair 
Bradycardia 
Dry skin 
Slow-relaxing reflexes
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15
Q

Ix in hypothyroid

A

Serum free t4 - low
Thyroid autoantibodies
Anaemia, hyponatraemia

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16
Q

Mx of hypothyroid

A

Levothyroxine - assessed after 6 weeks

Annual measurement of TSH

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17
Q

What is a myoedema coma? Ix? Mx?

A

Severe hypothyroidism -> coma and confusion
-hypothermia, cardiac failure, hypoglycaemia, hyponatraemia

Ix
TSH, T4 and cortisol
FBC,U+E, glucose, cultures
ECG monitoring

Mx 
T3
Oxygen 
Gradual rewamrmig 
Hydrocortisone 
Glucose 
Supportive
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18
Q

Causes of hyperthyroidism

A

Graves - IgG antibodies -> stimulate TSH receptor

Toxic multinodular goitre

Post partum thyroiditis

De Quervain -> transient due to inflammation of gland with infection

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19
Q

Sx and signs of hyperthyroid

A 
Sx 
Weight loss 
Irritability, sweating, palpitations 
Heat intolerance 
Tremor 
Oligomenorrhea 
Eye complaints 
Loss of libido 
Signs 
Tremor 
Hyperkinesis 
Tachycardia / AF 
Warm vasodilator peripheries 
Exopthalmos (only graves) 
Lid lag 
Goitre 
Bruit
20
Q

Ix in hyperthyroid ? How to differentiate graves from toxic multinodular goitre?

A

Serum TSH - low
Serum free t3/4 - raised
TSH receptor autoantibodies

Ultrasound - differentiate graves and toxic multinodular goitre
[±exopthalmos]

21
Q

Mx of hyperthyroid

A

Drugs - carbimazole [risk of agranulocytosis]

Radioactive iodine

Surgery

22
Q

What happens thyroid crisis? Cause? Mx?

A

Hyperpyrexia, tachycardia, extreme restlessness
-> delirium, coma and death

Infection, stress, surgery/radioactive iodine treatment

Large doses of carbimazole, propranolol, and potassium iodide
Hydrocortisone - blocks conversion of t4->t3

23
Q

Graves eye features

A

Lid retraction, lid lag
Exophthalmos - protruding eyeball
Opthalmoplegia - limited movements

24
Q

HLA in coeliac? What causes it?

Typical histology?

A

HLA-DQ2 , DQ8
Gliardin (gluten)
Villous atrophy and crypt hyperplasia

25
Q

Features of coeliac

A

Presents in infancy - diet change
Or adults in 5th decade

Anaemia, nutritional deficiency,

26
Q

Ix in coeliac

A

Serum antibodies - IgA tTG (tissue transglutaminase), IgA EMA

Distal duodenal biopsy - crypt hyperplasia and villous atrophy

Blood count - anaemia

DEXA scan - increased risk of osteoporosis in older

Small bowel radiology - if complication such as lymphoma suspected

27
Q

Mx in coeliac? Complications?

A

Lifelong gluten free diet
Correct vitamin deficiency

Increased risk of T cell lymphoma, small bowel / oesophageal ca

28
Q

HLA in IBD

A

HLA B27

29
Q

Some differences between UC and Crohns

A

Crohns
Any part of GI
Discontinuous involvement (skip lesions)
Deep ulcers
Microscopic - Transmural inflammation, granulomas in 50%

UC
Only colon 
Begins in rectum and spreads proximally 
Continuous involvement 
Bleeds easily 
Microscopic - no granuloma, goblet cell depletion, crypt abscesses
30
Q

Clinical feaures of Crohns

A

Abdo pain
Weight loss
Terminal ileum -> right iliac fossa and mimic appendicitis
Diarrhoea, bleeding, pain

31
Q

Clinical features of UC

A

Diarrhoea with blood and mucus

Often relapses and remissions

32
Q

Extra GI manifestations of IBD

A

Eyes - conjunctivitis

Joints - arthralgia

Skin - erythema nodosum, ulcers

Hepatobiliary - fatty liver, hepatitis, gall stones, cirrhosis

Renal - stones

Venous thrombosis

33
Q

Ix in IBD

A

Bloods - anaemia

Imaging - colonoscopy, abdo X-ray, USS, small bowel imaging

34
Q

Mx of Crohns

A

Oral 5-ASA (aminosalicylic acid)

Steroids - Prednisolone
->methotrexate if resistant

Azathioprine

Metronidazole - antibacterial and immunosuppressive

Anti TNFa - infliximab

35
Q

When would you offer surgery in IBD

A 
Failure of medical therapy 
Stricture 
Abscess 
Cancer 
Fissures
36
Q

Mx of UC

A

Mild - aminosalicylic acid -> prednisolone

Severe - prednisolone

Systemic features - hydrocortisone, infliximab, cyclosporin

Maintain remission - aminosalicylic acid, azathioprine

37
Q

Ix/ Mx of acute severe UC ? Monitor?

A

Admit

FBC,CRP, liver, U+E
Blood cultures
Abdo X-ray -> look for dilation and mucosal islands
Stool cultures

IV hydrocortisone
Correct U+E / fluid
LMW heparin -> VTE risk
If no response ->. Cyclosporin and infliximab

Monitor
Stool chart
Vital signs
Bloods / abdo X-ray if needed

38
Q

Ix / features in CKD

A

EGFR
Proteinuria / haematuria

Anaemia -> Reduced erythropoetin by kidney
-blood loss, dietary deficiencies

Bone disease - eg osteoporosis

Neuro [almost all] - Peripheral neuropathy / weakness / parathesia
-autonomic dysfunction

Cardiovascular - MI, HF, stroke

39
Q

Mx of CKD

A

Renoprotection - Blood pressure - ACE, CCB, diuretic

CV risk - Statins, smoking, diabetic control

Complication mx

Hyperkalaemia - dietary restriction

Ca/phosphate- dietary, calcium carbonate
-Vit D for calcium

Anaemia - iron

Acidosis / infections

40
Q

Renal replacement therapy in CKD

A

Dialysis
Haemo -
Peritoneal

Transplant

41
Q

Anne Mx

A

Washing with acne soaps, discourage picking

1- topical benzoyl peroxide / retinoids

2- oral antibiotics

3-oral retinoids

42
Q

Psoriasis features

A

Plaques over extensor surfaces - elbows, knees

43
Q

What is guttate psoriasis ?

A

Often in children / young adults

Eruption of small oval plaques on trunk 2 weeks after strep throat

44
Q

Mx of psoriaiss

A

Topical

  • Emollients
  • Vit D analogues - calcitrol
  • Corticosteroids

Phototherapy

Systemic

  • Retinoic acid
  • immunosuppression - methotrexate / cyclosporin
  • TNFa blockers - infliximab
45
Q

Rheumatoid X-ray

A

Symmetrical in small joints of hands and feet
SOLES

Subluxation 
Osteopenia (periarticular) 
Loss of joint space 
Bony Erosions 
Soft tissue Swelling
46
Q

Joint spared in RA

A

Distal phalange

Sheff 3a (30 decks)

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