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PACES 2024 > High Yield > Flashcards

High Yield Flashcards

1
Q

Causes of Type 1 Distal Renal Tubular Acidosis?

A

Autoimmune: Sjogren’s, Rheumatoid Arthritis

Drugs: lithium, NSAIDs, anti-fungals

WIlson’s disease

Familial

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2
Q

Ix of Type 1 Distal Renal Tubular acidosis?

A

Renal panel: Low K, Bicarbonate

Urine K, Cr
Urine pH: pH > 5.5
Urine Calcium: high

Investigate underlying cause:
Autoimmune workup: Anti-Ro, La, ESR
Schirmer’s test for Sjogrens, Salivary gland biopsy

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3
Q

Management of Type 1 Distal Renal Tubular acidosis 2’ Sjogrens?

A

Sodium bicarbonate
K replacement

Treat underlying cause:
Eye drops for dry eyes
Immunosuppression

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4
Q

What are the highest risk drugs implicated in drug induced lupus?

A

procainamide, hydralazine, penicillamine

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5
Q

medications causing drug induced lupus?

A

procainamide, hydralazine, penicillamine
+
isoniazid
anti-TNF alpha therapy (esp infliximab, etarnercept)
methyldopa
diltiazem
minocycline

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6
Q

what common medications may trigger / worsen psoriasis/ psoriatic arthropathy?

A

beta blockers
enalapril

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7
Q

what to examine for in patient with psoriatic arthropathy?

A

examine skin for plaques
nail changes
dactylitis
joints
enthesitis
eyes

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8
Q

Suspecting haemochromatosis, what to examine?

A

Skin for hyperpigmentation
Venesection marks over antecubital fossa

Abdomen: liver exam
Cardio: for congestive cardiac failure
Joint: pseudogout
if hypothyroid symptoms: thyroid exam

Offer to examine for testicular atrophy (hypogonadism)

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9
Q

which autoantibody is associated with highest risk of scleroderma renal crisis?

A

anti RNA polymerase III

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10
Q

Dermatomyositis, what to examine?

A

Skin for dermatomyositis signs: hands, face, shawl sign

power: neck flexion/ extension, proximal UL and LL

Respi: ILD
Cardio: pHTN

KIV further examination depending on whether you suspect underlying malignancy

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11
Q

Takayasu arteritis, what to examine?

A

check radial, brachial, carotid, femoral pulses.
Check for R-R, R-F delay.

Auscultate for carotid, subclavian, abdominal bruit.

Feel for AAA.

Pronator drift.
Ask for differential BP.
Offer Fundoscopy.

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12
Q

Giant cell arteritis, what to examine?

A

Temporal artery tenderness,
palpable temporal artery

pronator drift
relevant neurological exam
offer fundoscopy

check radial, brachial, carotid, femoral pulses.
Check for R-R, R-F delay.

Auscultate for carotid, subclavian, abdominal bruit.

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13
Q

indications for treatment of sarcoidosis with steroids?

A
  • Symptomatic pulmonary sarcoidosis
  • Critical organ involvement
  • Granulomatous vasculitis
  • Systemic metabolic effects, e.g. hypercalcaemia, fever
  • Local pressure effects
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14
Q

management of acute sarcoidosis?

A

Acute sarcoidosis usually tends to resolve spontaneously over weeks and do not require treatment

steroids may be indicated if:
* Symptomatic pulmonary sarcoidosis
* Critical organ involvement
* Granulomatous vasculitis
* Systemic metabolic effects, e.g. hypercalcaemia, fever
* Local pressure effects

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15
Q

skin features of sarcoidosis?

A

lupus pernio
erythema nodosum

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16
Q

examination of a patient with hereditary haemorrhagic telangiectasia?

A

telangiectasia (look at mouth/ tongue as well)
conjunctival pallor if anaemic
offer postural BP and DRE

17
Q

what is Gitelman’s syndrome?

A
  • AR, Tubular defect in NaCl reabsorption in distal tubule
  • Cramps, fatigue, polyuria/nocturia, chondrocalcinosis

-> HyperK metabolic alkalosis, low Mg, normal BP

18
Q

management of Gitelman’s syndrome?

A

Liberal NaCl intake with KCl supplements
DCT Na/K channel blockers: Spironolactone/eplerenone/amiloride
indomethacin (blocks PGE2 production, raises K)

19
Q

Lofgren’s syndrome?

A

acute presentation of sarcoidosis

classic triad of fever, erythema nodosum, and bilateral hilar adenopathy

20
Q

what medications may worsen raynauds?

A

drugs that cause vasoconstriction

  • beta blockers, caffeine, chemotherapy agents (bleomycin), decongestants, nicotine, stimulants, and cocaine
  • triptans, ergotamine used in migraines
21
Q

Anti-phospholipase A2 receptor (PLA2R) antibodies?

A

primary membranous nephropathy

22
Q

physical examination of patient suspected of atypical femoral fracture?

A
  • identify limb length discrepancy
  • lower limb examination: hip ROM, neurovascular status of lower limb
  • no blue sclera
23
Q

ix of atypical femoral fracture 2’ bisphosphonates?

A

X-ray hip pelvis
Vit D, Ca, PO4, PTH, Cr
TFTs

24
Q

examination in patient with gynaecomastia?

A

examine breast lump
look for cervical and axillary lymphadenopathy
presence of axillary hair
offer to examine testes

25
Q

ix of gynaecomastia?

A

testosterone, prolactin, LH, FSH
US breast

26
Q

secondary causes of hyperlipidaemia?

A

hypothyroidism
nephrotic syndrome
liver disease

medication: atypical antipsychotics, TCMs

27
Q

physical examination of patient with hyperlipidaemia?

A

xanthomas
xanthelasma
corneal arcus
CABG scar

pulses, bruits

28
Q

physical examination in patient with hypocalcaemia?

A

chvostek’s
offer trousseau

examine for features of albrights’ hereditary osteodystrophy:
short stature
obesity
round face
short 4th/5th metacarpals +/- metatarsals

29
Q

what is pseudohypoparathyroidism?

A

kidney/ bone unresponsive to PTH
-> low ca, high PO4, high PTH

30
Q

treatment in albright hereditary osteodystrophy with pseudohypoparathyroidism?

A

elemental calcium
low phosphate diet
activated vitamin D

31
Q

Drugs that may interact to cause digoxin toxicity?

A

Clarithromycin
Verapamil
Amiodarone
Quinine
Cyclosporin
Itraconazole/ Ketoconazole
Diltiazem

32
Q

features of Digoxin toxicity?

A

GI: anorexia, N/v, abdo pain
Bradycardia
Color vision, confusion, weakness, lethargy, fatigue

33
Q

ecg changes of digoxin toxicity?

A

short QT
T wave inversions
sloped ST depression

34
Q

ix of digoxin toxicity

A

digoxin level
K
Renal panel

exclude other differentials

35
Q

mx of digoxin toxicity?

A

A->E approach
telemetry
mx arrhythmias as per ACLS
digoxin antibody
atropine
IV fluids

PACES 2024 (14 decks)

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