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Yr 6 PACES knowledge COPY RJ Challenger > 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

//////////////////////////////////////////

all tumours produce LDH

Seminoma produce PLAP (Placental ALP)

Teratoma produce AFP.

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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

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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

110
Q

Causes of glomerulonephritis?

A
  • Clue: “VALID MD”
  • Vasculitis (Eg Wegener’s granulomatosis)
  • Amyloidosis
  • Lupus
  • Infection (Hep B, strep, malaria)
  • Diabetes
  • Malignancy
  • Drug toxicity

Yr 6 PACES knowledge COPY RJ Challenger (16 decks)

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