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Finals Revision Progress > Medical Shorts > Flashcards

Medical Shorts Flashcards

1
Q

Types of vasculitis

A

Large vessel:
temporal arteritis
Takayasu’s arteritis

Medium vessel:
polyarteritis nodosa
Kawasaki disease

Small vessel:
ANCA-associated vasculitides (Wegener’s, Churg-Strauss, microscopic polyangiitis)
Henoch-Schonlein purpura
cryoglobulinaemic vasculitis

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2
Q

Features of RA on XRAY?

A 
LESS
Loss of joint space
Erosions
Soft tissue swelling
Soft bones (Periarticular osteopenia)
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3
Q

Extra articular features of RA

A

aNTI CCP OR RF

Nodules
Tenosynovitis
Immune: vasculitis, amyloidosis
Carditis
Carpal tunnel
Pulmonary fibrosis
Ophthalmic: episcleritis, sjogren's
Raynaud's
Felty's
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4
Q

Blood tests for RA, what is the autoimmune process?

A

FBC: Low Hb and PMN
High ESR and CRP
RF, anti-CCP, ANA, HLA DR3/DR4

RF is IgM against Fc portion of own IgG. Higher titres associated with worse prognosis

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5
Q

Xray features of RA

A 
SOLE 
Soft tissue swelling
Osteopenia
Loss of joint space
Erosions
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6
Q

Dx criteria and Tx of RA

A

Dx: American College of Rheumatology Criteria, 4/7 features

MDT; conservative medical surgical

Medical
Analgesia
Steroids
DMARDs
Biologicals
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7
Q

DMARDs and biologicals used in RA

A

DMARDs:
Methotrexate
Sulfasalazine
Hydroxychloroquine

Biologicals
Anti-TNF; infliximab, etanercerpt
B-cell depletion: rituximab

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8
Q

What is tuberous sclerosis?

A

Tuberous sclerosis is a rare, multi-system genetic disease that causes benign tumours to grow in the brain and on other vital organs

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9
Q

Features of tuberous sclerosis

A 
ASHLEAF
Ashleaf spots
Shagreen patches
Heart rhabdomyosarcomas
Lung hamartomas
Epilepsy
Angiomyolipomas in kidney
Face angiofibromas
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10
Q

Ix for tuberous sclerosis?

A

Skull films: railroad track calcification
CT/MRI brain: tuberous masses in cortex
Abdo US: renal cysts
Echo: cardiomyopathy

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11
Q

Features and complications of NFT?

A

Skin: neurofibromas, cafe au lait spots, axillary freckling, lisch nodules in iris

Complications: Hypertension, epilepsy, learning difficulties, scoliosis

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12
Q

Differentials for neurofibromatosis?

A

McCune Albright

Tuberous sclerosis

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13
Q

Features of scleroderma

A 
CREST MFHH
Calcinosis
Raynaud's
Esophogeal dysmotility
Sclerodactyly
Telangectasia
Microstomia
Fibrosis of lungs
Pulmonary HTN
HTN
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14
Q

Classification of scleroderma

A

Localised
Systemic:
- Diffuse
- Limited (including CREST, is below elbows knees and face)

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15
Q

Ix for scleroderma

A

Bedside:

  • urine show proteinuria and haematuria
  • ECG: RV strain

Bloods:

  • ANA
  • Anti centromere (limited)
  • Anti Scl-70 (diffuse)

Imaging:
CXR/HRCT: fibrosis
Echo: pulmonary HTN

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16
Q

Mx of scleroderma

A

Manage different features; MDT approach with GP, rheumatologist, pulmonologist, cardiologist

Specific: immunosuppression for organ involvement or progressive skin disease

Raynauds: gloves, CCBs and prostacyclin infusion if severe

Renal: aggressive BP control

Reflux: PPIs

Pulmonary hypertension: sildenafil

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17
Q

Features of SLE

A

SOAP BRAIN MD

Serositis
Oral ulcers
Arthritis
Photosensitivity

Blood anaemia
Renal proteinuria
ANA +ve
Neurology (chorea + focal)

Malar rash
Discoid rash

18
Q

What is SLE? Mainstay of mx?

A

SLE is a multisystem inflammatory disease characterised by a T3 hypersensitivity reaction against circulating immune complexes

Mx: MDT with steroids +/- azathioprine

19
Q

Key investigations in SLE

A

Raised ESR, low C3 and C4 in disease activity

Antibodies:
ANA
dsDNA
Anti cardiolipin and lupus anticoagulant

20
Q

Features of ankylosing spondylitis?

A

Morning stiffness
Back pain relieved by exercise
Thoracic kyphosis and neck hyperextension; question mark posture
Reduced ROM through spine

21
Q

Findings on examination of ank spond

A

Increased occiput to wall distance >5cm
Schober’s test <5cm
Reduced chest expansion

22
Q

Extra articular features of ankylosing spondylitis

A 
Anterior uveitis
Apical pulmonary fibrosis
Aortic regurgitation
Achilles tendonitis
Atlanta axial subluxation
23
Q

What are the seronegative arthropathies?

A 
PEAR
Psoriatic arthropathy
Enteropathic arthritis
Ank spond
Reactive arthritis
24
Q

Ix for ank spond?

A

Bloods: ESR, CRP, HLA-B27

Imaging
Spine XRAY: Bamboo spine, sacroileitus
CXR: fibrosis

DEXA scan: osteoporosis

25
Q

What is gout?

A

Asymmetrical oligoarthritis of small joints of hands and feet, caused by the deposition of urate crystals in the synovium. It is caused by chronic hyperuricaemia

26
Q

Gout vs pseudogout

A

Gout: negatively bifringent needle shaped crystals, urate crystals

Pseudogout: positively bifringent, calcium pyrophosphate crystals

27
Q

Causes of gout

A 
Urate excess:
Drugs
Drinking
Diet: purine rich foods
Decreased excretion: CRF
Death of cells; leukaemia, lymphoma, psoriasis
28
Q

Gout mx

A

Acute: pred, indomethacin, diclofenac, colchicine

Chronic: allopurinol

29
Q

Acromegaly features

A

Hands: spade like, tight rings, sweaty and boggy if active

Arms: HTN

Face: coarse facial features, prominent supra orbital ridges, macroglossia, prognathism, widely spaced teeth

Extras: acanthosis nigerians, goitre, organomegaly, bitemporal hemianopia

30
Q

acromegaly Ix

A

Bedside: urine dip for glycosuria

Bloods: IGF-1, OGTT (fails to suppress GH), pituitary hormones (test, TFT)

Imaging: CXR showing cardiomegaly
MRI showing pituitary adenoma

31
Q

management of acromegaly

A

1st line: trans sphenoidal excision, complications include meningitis, diabetes insipidus, panhypopituitarism

2nd line: medical therapy:
somatostatin analogues (octerotide)
GH antagonists (pegvisomant)
Da agonists (cabergoline)

3rd line: radiotherapy

32
Q

Osler Weber Rendu features

A

Autosomal dominant disease

Multiple telangiectasia
AVMs in lungs, liver and brain

Complications: haemorrhage

33
Q

Peutz Jeghers features

A

Small pigmented macule on lips, oral mucosa, palms and soles

Autosomal dominant mutation causing mucocutaneous macules and GI hamartomatous polyps and pancreatic endocrine tumours

Complications: high cancer risk

34
Q

Cushing’s syndrome investigations

A

Bedside;
- Urine dip; glycosuria

Imaging:
- MRI pituitary fossa

Special tests:

  • 24 hour urinary free cortisol (loss of diurnal variation)
  • High dose dexamethasone suppression test
  • ACTH levels
35
Q

Mx of Cushing’s disease

A

Treat cause, i.e. adrenalectomy or tumour excision

BP control
DM control
Biphosphonates

36
Q

Causes of Cushing’s syndrome

A

ACTH independent

  • Iatrogenic steroids
  • Adrenal adenoma/carcinoma/hyperplasia

ACTH dependent

  • Cushing’s disease
  • SCLC
37
Q

Addison’s disease features

What Sx might they complain of?

A

Hyperpigmentation
Postural hypotension
Signs of AI disease +/- TB

Dizziness, faints, lethargy, wt loss and anorexia

38
Q

Causes of Addison’s

A

Other AI disease; DM

Tuberculosis

39
Q

Ix for Addison’s

A

Bloods

  • Low Na and glucose
  • Anti 21 hydroxylase abs
  • SynACTHen test; no increase in cortisol
40
Q

Mx of acute addisonian crisis

A

0.9% normal saline rehydration
100mg IV hydrocortisone
Rx cause

41
Q

Indications for steroids in sarcoidosis?

A
  • patients with chest x-ray stage 2 or 3 disease who have moderate to severe or progressive symptoms
  • hypercalcaemia
  • eye, heart or neuro involvement

Finals Revision Progress (16 decks)

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