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Yr 6 PACES knowledge > Medical and Surgical shorts > Flashcards

Medical and Surgical shorts Flashcards

1
Q

Sign of active inflammation in rheumatoid arthritis?

A

Hot swollen painful joints

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2
Q

Presentation of rheumatoid hands

A

Symmetrical polyarthritis

+/- signs of active synovitis

+/- signs of cause (nodules, psoriatic plaques)

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3
Q

Findings on systemic examination in rheumatoid arthritis

A

Skin - steroid use

BP/pulse - increased CVD risk

Eyes - anaemia, scleritis

Heart - pericardial rub

Lungs - pulmonary fibrosis, pleural rub

Abdomen - splenomegaly (Felty’s)

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4
Q

X-ray features of rheumatoid arthritis

A

Loss of joint space
Periarticular erosions
Deformity
Periarticular osteopenia

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5
Q

Mx of rheumatoid arthritis

A

Conservative:
PT
OT - aids + splints

Medical:

  • Analgesia
  • Steroids: IM, PO, periarticular
  • DMARDS: Methotrexate
  • Biologics
  • -> treat CVD risk!!

Surgical:

  • Carpal tunnel decompression
  • Joint replacement
  • Tendon repairs
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6
Q

Extra-articular features of rheumatoid arthritis

A 
Nodules
Carpal tunnel 
Scleritis
Pericarditis
Pulmonary fibrosis
Splenomegaly (Felty's)
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7
Q

What should be monitored in pts receiving methotrexate?

A

FBC (BM suppression)
LFTs (hepatotoxicity)
CXR (fibrosis)

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8
Q

Name some biologics used to treat Rheumatoid arthritis? what needs to be done for patients first?

A

Require tuberculin skin test + CXR

Anti-TNF + rituximab
anti-CD20

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9
Q

What is Rheumatoid factor? what is its significance

A

anti-IgG IgM

Higher titres assoc. w more severe disease + extra-articular manifestations

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10
Q

C-spine problem seen in RA?

A

Atlanto-axial subluxation: occurs due to weak ligaments

  • Can cause progressive spastic paresis due to cord compression
  • Pre-op: main risk is during intubation
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11
Q

Facial features of scleroderma

A

Microstomia
Beaked nose
Telangiectasia

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12
Q

Diffuse vs limited scleroderma

A

Limited: distribution in limbs + face. progresses over years.

Diffuse; early visceral involvement. Progresses over months

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13
Q

Ix in scleroderma

A
  • Urine dip: haematuria, proteinuria
  • ECG: RV strain (st depression + t wave inversion)
  • Bloods: FBC, U+Es, !!antibodies!!
  • Imaging: CXR, HRCT, echo (pulm HTN)
  • Lung function
  • Barium swallow
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14
Q

Mx of scleroderma

A

Raynaud’s: Gloves + hand warmers +/-nifedipine

Oesophageal dysmotility: SALT review + PPI for reflux

Renal: aggressive BP control

pulmonary HTN: sildenafil

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15
Q

Mixed CTD?

A 
RA
SLE
Scleroderma
polymyositis
Sjogrens
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16
Q

Mx of chronic limb iscehmia

A 
Conservative:
RF optimisation (= HTN/DM control, smoking cessation, diet + exercise)

Medical:
RF control: statin, clopidogrel
Analgesia

Surgical:
Stenting
Bypass surgery
Amputation :(

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17
Q

Critical limb ischemia features

A 
Pain
Pallor
Pulseless
Parasthesia
Perishingly cold
Paralysis
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18
Q

Causes of medical 3rd nerve palsy

A
  • DM
  • MS
  • Midbrain infarction: Contralateral hemiplegia
  • Migraine
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19
Q

Ddx for surgical 3rd nerve palsy

A

***PCA aneurysm!!!!
Cavernous sinus thrombosis
Trauma
Raised ICP: transtentorial herniation

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20
Q

initial mx of hip fracture

A

ABC: resus
Analgesia
Assess neurovascular status of limb
IMAGING - orthogonal views

Prep for theatre:
Anaesthetist - inform + book for theatre
Bloods - FBC, clotting, G+S, Xmatch, U+E
CXR
DVT prophylaxis
ECG
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21
Q

Indications for amputation

A 
Dead: PVD
Sepsis
Trauma
Burns
Frostbite
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22
Q

Complications of amputation

A

Early:
Bleeding, infection (cellulitis, gangrene, osteomyelitis), DVT
specific: MI/stroke/angina

Late:
Phantom limb pain
Contractures

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23
Q

Definition of varicose veins

A

Dilated + tortuous superficial veins

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24
Q

Causes of varicose veins

A

Prolonged standing
Obesity
OCP
Pregnancy

secondary: DVT, pelvic mass, AVM

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25
Q

Sx of varicose veins

A 
Heaviness
Tingling
Cramping
Pain
Bleeding
Oedema
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26
Q

NICE guidelines re management of varicose veins

A

Conservative: Compression stockings
Compression bandages for ulcers
Reduce time spent standing
Weight loss

Surgical: Laser ablation of superficial veins
(refer if CEAP4a or more)

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27
Q

NICE guidelines re management of varicose veins

A 
Conservative: 
Reduce time spent standing
Weight loss
Grade 2 Compression stockings
Compression bandages for ulcers

Medical: analgesia + piriton (pruritus)

Surgical: 1) Laser ablation 2) sclerotherapy 3) ligation + stripping
(refer if CEAP4a or more)

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28
Q

Complications of varicose veins

A

Chronic venous insufficiency
Ulcers
Thrombophlebitis –> infected thrombophlebitis
DVT

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29
Q

investigations in suspected testicular tumour

A

Markers: AFP, LDH, hCG
Scrotal USS
CT TAP

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30
Q

Mx of testicular cancer

A

inguinal orchidectomy
histology of biopsy
chemo/radiotherapy
- Bleomycin, etoposide, cisplatin

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31
Q

staging of testicular tumours

A

1) confined to testes
2) LNs below the diaphragm
3) LNs above and below the diaphragm
4) extra-lymphatic spread (lungs, liver)

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32
Q

Common skin rash in Coeliac disease - what does it look like? Fx? name?

A

Dermatitis herpetiformis

Blistering + itchy on EXTENSOR surfaces

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33
Q

Commonest cause of erythema multiforme

A

HSV

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34
Q

Causes of erythema multiforme

A 
HSV
Mycoplasma
SLE
Drugs: allopurinol, penicillin, NSAIDs
Sarcoid
Malignancy
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35
Q

causes of acanthosis nigricans

A

Endo–> increased weight:
DM, Cushings PCOS acromegaly

OCP
GI cancer

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36
Q

Pemphigus vs pemphigoid

A

Blisters are superficial in pemphigus(flaccid), deep in pemphigoid (tense)

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37
Q

Features of hypocalcemia

A

SPASMODIC

Spasms: Trousseau's sign (BP cuff)
Paraesthesia
Anxious
Seizures
Muscle tone increased = Hypertonia
Orientation impaired = Confusion 
Dermatitis (atopic)
Impetigo
Chovstek's sign (tapping CN7), Cardiomyopathy
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38
Q

CAUSES of hypocalcemia

A

Commonest = CKD!!

Raised PO4: CKD, hypoPTH
Low PO4: active pancreatitis, osteomalacia

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39
Q

Mx of mild hypocalcemia

A

oral Ca QDS PO

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40
Q

Fx of hypercalcemia

A

Bones, Stones, Moans, Groans

Bone pain + pathological #s
Renal stones + nephrogenic DI
Depression
Abdominal pain + constipation

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41
Q

Causes of hypercalcemia

A

HyperPTH (or PTHrP in paraneoplastic)

Normal PTH:
Myeloma(normal ALP), bone mets (high ALP) or sarcoid

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42
Q

Ix in hypercalcemia

A

PTH
phosphate
FBC, CXR, protein electrophoresis, bone scan

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43
Q

Mx of hypercalcemia

A

FLUIDS 0.9% saline

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44
Q

Special mx of hypercalcemia of malignancy

A

Bisophosphonates

45
Q

Psoriasis - describe the skin leasions

A

well defined salmon-pink plaques

On extensor surfaces + behind ears + scalp + sites of trauma (Koebner phenomenon)

46
Q

Nail changes in psoriasis

A

Pitting
Onycholysis
Sublingual hyperkeratosis

47
Q

Why might some psoriatic plaques be brown

A

Application of coal tar treatment

48
Q

Causes of onycholysis

A

Psoriasis
Fungal infection
Trauma
HypERthyroidism

49
Q

Causes of nail pitting

A

Psoriasis
Fungal infection
Lichen planus

50
Q

Psoriasis - Sx? triggers?

A

Itch + arthritis

Triggers: stress, SMOKING, EtOH, b-blockers, injury

51
Q

Subtypes of psoriasis

A

Guttate = drop-like lesions on trunk, commoner in children after strep infection
Pustular
Psoriatic arthritis: asymmetric olygoarthritis (mimics RA)

52
Q

Mx of psoriasis

A

MDT: GP, dermatologist

Conservative: avoid triggers (EtOH, stress, smoking)

Topical:
Emollients (epaderm, diprobase)
Steroid cream
Coal tar

Phototherapy:
Narrow band UVB

Systemic:
Ciclosporin, retnoids, methotrexate

53
Q

3 Skin features of dermatitis

A

LIchenification
Excoriations
Painful fissures

54
Q

Differential for dermatitis

A

Atopic eczema
Contact dermatitis - just hands
Discoid
Seborrhoea dermatitis

55
Q

Diff btw seborrheic dermatitis and psoriasis

A

Scales!!
Psoriasis = thick and silvery
seborrheic dermatitis = thin + white

56
Q

proper name for dandruff

A

seborrheic dermatitis

Dandruff is a milder form, without associated inflammation (red skin)

57
Q

Mx of dermatitis

A

MDT + avoid triggers

Topical steroids + emollients + soap subs

+ antihistamines
+ Abx for secondary infection

Phototherapy

If severe –> systemic steroids or cyclosporin

58
Q

Cutaneous manifestations of DM - on hands?
on abdomen?
on shins?
on feet?

A

Hands:

  • Cheiroarthropathy (prayer sign)
  • Granuloma Annulare

Abdomen:
- Lipodystrophy (injection site)

Shins:
- Necrobiosis lipoidica

Feet:

  • Charcot joint
  • Ulcers
59
Q

What are charcot joints? what does it look like?

A

Neuropathic osteoarthropathy

Progressive damage to weight bearing joint + bone due to lack of sensation

Loss of medial arch +
Rocker bottom deformity

60
Q

Skin - SqCC

Appearance?
Pre-malignant forms?

A

Ulcerated + everted edge
Sun-exposed sites

Actinic keratoses: crusty lesion
Bowens: red/brown scaly plaque

61
Q

Evolution of SqCC

A

Actinic keratoses –> bowens –> SqCC

62
Q

Warty stuck-on appearance

A

Seborrheic keratoses

63
Q

RFs for SqCC

A

Sun exposure

immunosuppression

64
Q

RFs for malignant melanoma

A 
Sun exposure
Low Fitzpatrick skin type
High # of common moles
FH
Age
Immunosuppression
65
Q

Staging of malignant melanoma

A

Breslow thickness

66
Q

Neurofibromatosis - features on examination

A

Skin:

  • Neurofibromas - gelatinous nodules
  • Cafe au last spots >=6
  • Axillary freckling

Neuro:

  • Lisch nodules = posts on iris
  • Peripheral neuropathy
67
Q

Neurofibromatosis - complications? Types?

A

NF1 and NF2.
Both are autosomal dominant. NF1 is more common.

Complications: 
Epilepsy
Learning difficulty
Scoliosis
Sarcomatous change of neurofibromas
68
Q

Differential for cafe au lait spots

A

NF
TS
McCune Albright syndrome - precocious puberty

69
Q

Cutaneous features of Tuberous Sclerosis

A

Ash leaf macule

Shagreen patch = leathery skin over sacrum

Facial adenoma sebaceum = pink/yellow papules on face (oil producing glands)

70
Q

Tuberous sclerosis - noncutaneous problems

A

Neuro: epilepsy, LD

Cystic kidneys –> Renal transplant

Dense white patches on retina

71
Q

Hereditary Haemorrhagic telangiectasia - what is it?

A

Autosomal dominant condition
Multiple telangiectasia due to AVMs
- in lungs, liver, brain, skin

72
Q

HHT - on examination?

Differentials?

A

O/E: telangiectasia on face, lips, buccal mucosa
–> cyanosis from pulmonary AVMs
Ddx: CREST, CLD

73
Q

Complications of HHT

A

HAEMORRHAGE
- epistaxis, GI bleed, haemoptysis, SAH

High output cardiac failure

74
Q

Peutz Jeghers - features?

A

Hyper pigmented macules on face/oral mucosa/palms + soles!!

GI hamartamous polyps

75
Q

Complications of Peutz Jeghers

A
  • CRC
  • Bleeding from polyps
  • Pancreatic endocrine tumours
76
Q

Ddx for erythema multiforme

A

Tinea
Discoid eczema
Erythema marginatum
Erythema migrans (Lyme, trunk distribution)

77
Q

Causes of erythema multiforme

give 4 drugs

A

HSV
Mycoplasma

Drugs: trimethoprim, NSAIDs, penicillin, phenytoin

78
Q

Severe erythema multiform? Mx?

A

Steven Johnsons syndrome

Mx: dexamethasone, IVIG

79
Q

Causes of erythema nodosum - give 7

A

Systemic disease:
IBD, Sarcoid, Behcets

Infection:
TB
STREP

Drugs:
OCP
trimethoprim

80
Q

Skin manifestations of sarcoid

A

Erythema nodosum
Lupus pernio = brown plaques, esp on nose
Red/brown nodules and papule

81
Q

Key points to present in ?rheumatoid hands

A

Symmetrical deforming polyarthropathy

  • signs of active synovitis (hot, swollen painful joints)
  • signs of a cause: rheumatoid nodules, psoriatic plaques
82
Q

Systemic features of RA

A 
Rheumatoid nodules
Carpal tunnel
Episcleritis/scleritis
pericarditis (rub)
Pulmonary fibrosis
Splenomegaly
83
Q

Mx of RA

A

Conservative:
PT, OT, splints

Medical:
DMARDs - methotrexate
Analgesia
Steroids
Gastric protection + bone protection
Surgical:
Carpal tunnel decompression
Tendon repair and transfers
Ulna sylectmy
Arthroplasty
84
Q

4 Diff DMARDs used to treat RA + their side effects

A

Methotrexate
- BM suppression + pulmonary fibrosis + hepatotoxic

Sulfasalazine
- BM suppression + skin rashes + hepatotoxic + SPERM count

Hydroxychloroquine
- RETINOPATHY

Penicillamine
- LUPUS, nephrotic syndrome

85
Q

Significance of seronegative RA?

A

Less severe disease

Less likely to have extra-articular features

86
Q

If DMARDs fail in treating RA, what is used next?

And what are the cautions taken when treating in this way?

A

Biologics - anti-TNF (Infliximab, etanercept) and B-cell depleters (rituximab)

Risk of opportunistic TB infection (do tuberculin skin test)
Risk of viral reactivation (HepB, PML)

87
Q

Apart from RA, other diseases where RhF is common

A

Sjogrens = 100%

SLE

88
Q

American College of RHeu Criteria for RA

A

4/7 of:

  • Morning stiffness >1h
  • 3+ joints involved
  • Hand involvement
  • Rheumatoid nodules
  • +ve RhF
  • SYMETRICAL
  • XR changes
89
Q

Abs in SLE

A

ANA (100%)
Anti-dsDNA
anticardiolipin and lupus anticoagulatn

90
Q

Mx of SLE

A

MILD disease: topical steroids + sun cream + hydroxycloroquine

MODERATE disease(organ involvement)
- Pred + AZT

Severe (AIHA/CNS/pericarditis)

  • Cyclophosphamide
  • High dose methylpred
91
Q

Specific examination test for ANk SPon

A

Schooner’s test <5 cm

92
Q

Ank spon - findings on back examination

A

Inspection:

  • Thoracic kyphosis
  • Neck hyperextension

Mvmt:
Reduced ROM throughout spine

Test:
Schober’s test <5cm (from PSIS to 10cm above)

93
Q

Tests for sacroilitis

A

Pain on palpation

Pain on adduction of the hip, with the knee and hip flexed

94
Q

Extra-articular features of Ankylosing Spondylitis

A

Anterior Uveitis (small pupil –> irregular)
Apical pulmonary fibrosis
Aortic regurgitation
Achilles tendonitis

Psoriatic plaques

95
Q

Sx of Ank Spon?

Ix?

A

Morning stiffness
Back pain relieved by movement
Eye pain
SOB

Ix:
ECG - AV block is common!

Bloods: FBC, ESR, CRP, HLAB27

Imaging: spine XR - sacroileitis, bamboo spine
CXR - fibrosis
DEXA scan

96
Q

Mx of Ank Spon

A

Conservative:
Physio, exercise

Medical:
NSAIDs
Steroid injection
Anti-TNF if severe

Surgery: ?hip replacement

97
Q

Findings O/E of Marfan’s

A

Tall + long arm span

Hands: long fingers, hyper extensible

PULSE: radioradial delay (coarctation), collapsing pulse (AR)

Face: High arched palate, Lens dislocation

Chest: Deformity, AR

98
Q

Cause of Marfans syndrome

A

Autosomal dominant inheritance

Fibrillin protein

99
Q

Goitre + hypothyroidism

A

Hashimoto’s thyroiditis

100
Q

Hands in Acromegaly

A

Spade like
Tight rings
Increased skin fold thickness

?thenar wasting if carpal tunnel

101
Q

Features of acromegaly

A

Hands: spade like, rings are tight

Face: prognathism, prominent supraorbital ridges, large ears + nose, widely spaced teeth

HTN

Bitemporal hemianopia + headaches
Acanthosis Nigerians
Organomegaly
Carpal Tunnel syndrome
OSA
102
Q

Ix in ?Acromegaly

A

OGTT

Urine dip: glucose
BP: raised
ECG: LVH
CXR: cardiomegaly
AbdoUSS: organomegaly
Bloods: raised IGF, other pit hormones (bitemp hemianopia) - prolactin, TFTs, glucose
103
Q

Mx of acromegaly

1st line? 2nd line?

A

1st line: SURGICAL - transphenoidal excision of pituitary

2nd line: Medical: OCTREOTIDE - ss analogue

104
Q

F/U in acromegaly

A

Bloods: GH
Visual fields
ECG
MRI head

105
Q

Side effects of steroids

A

Hands: thin skin, bruising
Arms: Proximal myopathy, HTN
Face: cataracts, glaucoma, psychosis
Trunk: DM, central adiposity, osteoporosis, DM

Infections
Suppression of ACTH –> need steroids for surgery and infection

106
Q

Considerations in patients taking steroids

A
  • Do not suddenly stop or reduce steroid dose
  • Use lowest possible dose
  • Increase dose if infection/surgery
  • Consider bone and gastro protection
  • Carry alert bracelet
107
Q

MOA of CBZ and PTU?

of radio iodine?

A

CBZ + PTU - block T4 synthesis

Radioiodine - blocks T4 –> T3

108
Q

Technetium scan of thyroid :
low uptake?
high uptake?

A

Low uptake = hashimoto’s
high uptake = graves
multiple hot and cold nodule = TMN

109
Q

Sarcoidosis: features

A

Erythema nodosum + arthralgia = acute sarcoidosis

  • Lupus pernio (raised, hard purpley skin on face)
  • LNopathy
  • Hepatosplenomegaly
  • Enlarged parotids
  • Cardiomyopathy
  • Hypercalcemia
  • BHL + pulmonary fibrosis

Yr 6 PACES knowledge (14 decks)

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