Medical Shorts Flashcards
Types of vasculitis
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
Features of RA on XRAY?
LESS Loss of joint space Erosions Soft tissue swelling Soft bones (Periarticular osteopenia)
Extra articular features of RA
aNTI CCP OR RF
Nodules Tenosynovitis Immune: vasculitis, amyloidosis Carditis Carpal tunnel Pulmonary fibrosis Ophthalmic: episcleritis, sjogren's Raynaud's Felty's
Blood tests for RA, what is the autoimmune process?
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
Xray features of RA
SOLE Soft tissue swelling Osteopenia Loss of joint space Erosions
Dx criteria and Tx of RA
Dx: American College of Rheumatology Criteria, 4/7 features
MDT; conservative medical surgical
Medical Analgesia Steroids DMARDs Biologicals
DMARDs and biologicals used in RA
DMARDs:
Methotrexate
Sulfasalazine
Hydroxychloroquine
Biologicals
Anti-TNF; infliximab, etanercerpt
B-cell depletion: rituximab
What is tuberous sclerosis?
Tuberous sclerosis is a rare, multi-system genetic disease that causes benign tumours to grow in the brain and on other vital organs
Features of tuberous sclerosis
ASHLEAF Ashleaf spots Shagreen patches Heart rhabdomyosarcomas Lung hamartomas Epilepsy Angiomyolipomas in kidney Face angiofibromas
Ix for tuberous sclerosis?
Skull films: railroad track calcification
CT/MRI brain: tuberous masses in cortex
Abdo US: renal cysts
Echo: cardiomyopathy
Features and complications of NFT?
Skin: neurofibromas, cafe au lait spots, axillary freckling, lisch nodules in iris
Complications: Hypertension, epilepsy, learning difficulties, scoliosis
Differentials for neurofibromatosis?
McCune Albright
Tuberous sclerosis
Features of scleroderma
CREST MFHH Calcinosis Raynaud's Esophogeal dysmotility Sclerodactyly Telangectasia Microstomia Fibrosis of lungs Pulmonary HTN HTN
Classification of scleroderma
Localised
Systemic:
- Diffuse
- Limited (including CREST, is below elbows knees and face)
Ix for scleroderma
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
Mx of scleroderma
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
Features of SLE
SOAP BRAIN MD
Serositis
Oral ulcers
Arthritis
Photosensitivity
Blood anaemia
Renal proteinuria
ANA +ve
Neurology (chorea + focal)
Malar rash
Discoid rash
What is SLE? Mainstay of mx?
SLE is a multisystem inflammatory disease characterised by a T3 hypersensitivity reaction against circulating immune complexes
Mx: MDT with steroids +/- azathioprine
Key investigations in SLE
Raised ESR, low C3 and C4 in disease activity
Antibodies:
ANA
dsDNA
Anti cardiolipin and lupus anticoagulant
Features of ankylosing spondylitis?
Morning stiffness
Back pain relieved by exercise
Thoracic kyphosis and neck hyperextension; question mark posture
Reduced ROM through spine
Findings on examination of ank spond
Increased occiput to wall distance >5cm
Schober’s test <5cm
Reduced chest expansion
Extra articular features of ankylosing spondylitis
Anterior uveitis Apical pulmonary fibrosis Aortic regurgitation Achilles tendonitis Atlanta axial subluxation
What are the seronegative arthropathies?
PEAR Psoriatic arthropathy Enteropathic arthritis Ank spond Reactive arthritis
Ix for ank spond?
Bloods: ESR, CRP, HLA-B27
Imaging
Spine XRAY: Bamboo spine, sacroileitus
CXR: fibrosis
DEXA scan: osteoporosis
What is gout?
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
Gout vs pseudogout
Gout: negatively bifringent needle shaped crystals, urate crystals
Pseudogout: positively bifringent, calcium pyrophosphate crystals
Causes of gout
Urate excess: Drugs Drinking Diet: purine rich foods Decreased excretion: CRF Death of cells; leukaemia, lymphoma, psoriasis
Gout mx
Acute: pred, indomethacin, diclofenac, colchicine
Chronic: allopurinol
Acromegaly features
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
acromegaly Ix
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
management of acromegaly
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
Osler Weber Rendu features
Autosomal dominant disease
Multiple telangiectasia
AVMs in lungs, liver and brain
Complications: haemorrhage
Peutz Jeghers features
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
Cushing’s syndrome investigations
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
Mx of Cushing’s disease
Treat cause, i.e. adrenalectomy or tumour excision
BP control
DM control
Biphosphonates
Causes of Cushing’s syndrome
ACTH independent
- Iatrogenic steroids
- Adrenal adenoma/carcinoma/hyperplasia
ACTH dependent
- Cushing’s disease
- SCLC
Addison’s disease features
What Sx might they complain of?
Hyperpigmentation
Postural hypotension
Signs of AI disease +/- TB
Dizziness, faints, lethargy, wt loss and anorexia
Causes of Addison’s
Other AI disease; DM
Tuberculosis
Ix for Addison’s
Bloods
- Low Na and glucose
- Anti 21 hydroxylase abs
- SynACTHen test; no increase in cortisol
Mx of acute addisonian crisis
0.9% normal saline rehydration
100mg IV hydrocortisone
Rx cause
Indications for steroids in sarcoidosis?
- patients with chest x-ray stage 2 or 3 disease who have moderate to severe or progressive symptoms
- hypercalcaemia
- eye, heart or neuro involvement
