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Medicine and Surgery Mushkies > Medical Shorts Mushkies > Flashcards

Medical Shorts Mushkies Flashcards

1
Q

Psoriasis examination?

A
  1. Skin
  2. Nails
  3. Joints
  4. Completion
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2
Q

Psoriasis skin findings?

A
  1. Symmetrical well defined salmon-pink plaques with a silvery, micaceous scale
  2. Location = extensors, behind ears, scalp, umbilicus, Koebner
  3. Skin staining from Rx = coal tar (brown), dithranol (purple)
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3
Q

Psoriasis nail findings?

A
  1. Discoloration
  2. Pitting
  3. Onycholysis
  4. Subungual hyperkeratosis
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4
Q

Psoriasis joints findings?

A

Inflammatory arthropathy

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5
Q

Psoriasis exam completion?

A
  1. Inspect common areas and assess joints

2. Auspitz’ sign = pinpoint bleeding on scraping scale

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6
Q

Psoriasis Ddx?

A
  1. Bowen’s disease
  2. Lichen planus
  3. Dermatitis
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7
Q

Onycholysis Ddx?

A
  1. Psoriasis
  2. Fungal infection
  3. Trauma
  4. Thyrotoxicosis
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8
Q

Nail pitting causes?

A
  1. Psoriasis
  2. Fungal infection
  3. Lichen planus
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9
Q

Koebner phenomenon causes?

A
  1. Psoriasis
  2. Lichen planus
  3. Viral warts
  4. Vitiligo
  5. Sarcoid
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10
Q

4 Psoriasis triggers?

A
  1. Smoking
  2. Stress
  3. Injury
  4. Drugs = BB, EtOH
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11
Q

Pathophysiology of psoriasis?

A
  1. T4 driven hypersensitivity reaction

2. Hyperkeratosis, parakeratosis, and intra-epidermal microabscesses of Munro

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12
Q

What is parakeratosis?

A

Nuclei in the stratum corneum

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13
Q

Psoriasis subtypes?

A
  1. Plaque
  2. Guttate
  3. Pustular = generalised or palmoplantar
  4. Flexural = not scaly
  5. Erythroderma
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14
Q

Psoriatic arthritis features?

A

A Seronegative arthritis that develops in 10-40%, can be:

  1. Asymmetric oligoarthritis
  2. Symmetric polyarthritis
  3. Distal arthritis
  4. Spondylitis
  5. Arthritis mutilans
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15
Q

Psoriasis Mx?

A
  1. General = MDT (GP, dermatologist), avoid precipitants
  2. Topical
  3. Phototherapy
  4. Systemic
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16
Q

Topical psoriasis Mx?

A
  1. Emollients
  2. Steroids = betamethasone
  3. Vit D analogues = Calcipotriol
  4. Coal tar
  5. Dithranol
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17
Q

Phototherapy psoriasis Mx?

A
  1. PUVA

2. Narrow-band UVB

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18
Q

Systemic psoriasis Mx?

A
  1. Cytotoxics = ciclosporin, methotrexate
  2. Retinoids = acetretin
  3. Biologics = anti-TNF
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19
Q

Dermatitis description?

A

Erythematous lichenified patches, predominantly on the flexors, with excoriations and painful fissures

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20
Q

Mx of dermatitis?

A
  1. General = MDT, avoid precipitants
  2. Adjuvants = antihistamins, antibiotics
  3. Topical = emollients, soap substitutes, steroids, tacrolimus
  4. Systemic = steroids, ciclosporin
  5. Phototherapy
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21
Q

Cutaneous manifestations of DM?

A
  1. Hands = cheiroarthropathy, granuloma annulare, skin pricks
  2. Injection sites = lipodystrophy
  3. Shins = necrobiosis lipoidica diabeticorum
  4. Feet = Charcot’s joints, ulcers
  5. Other = infections, eruptive tendon xanthomas secondary to hyperlipidaemia
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22
Q

Cheiroarthropathy?

A

Tight waxy skin that limits finger extension (prayer sign)

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23
Q

Granuloma annulare?

A

Flesh coloured papules in annular configuration, usually on dorsum of hand, 10% associated with DM

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24
Q

BCC description?

A

Pearly nodule with rolled, telangiectatic edge, on the face and sun exposed areas

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25
Q

Most common skin cancer?

A

BCC

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26
Q

Do BCCs metastasise?

A

No

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27
Q

Mx of BCC?

A
  1. Superficial = curettage

2. Deep = surgical excision +/- radiotherapy

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28
Q

SCC description?

A

Ulcerated lesion with everted edge found in sun exposed areas, alongside Actinic Keratoses and Bowen’s lesions

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29
Q

Actinic keratosis description?

A

Irregular, crusty, warty lesions

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30
Q

Bowen’s disease description?

A

Red/brown, scaly plaques

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31
Q

Evolution of SCC?

A

Actinic keratosis –> Bowen’s disease –> SCC

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32
Q

RFs for SCC?

A
  1. Sun exposure
  2. Immunosuppression
  3. Genetic = xerodermapigmentosum
  4. Chronic trauma = Marjolin’s ulcer
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33
Q

Dx of SCC?

A

Excisional biopsy

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34
Q

Mx of SCC/

A

Surgery +/- radiotherapy

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35
Q

Malignant melanoma pt characteristics?

A
  1. Fair skin with freckles
  2. Blue eyes
  3. Light hair
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36
Q

Malignant melanoma desciprtion?

A

ABCDE

  1. Asymmetry
  2. Irregular border
  3. Non-uniform colour
  4. Diameter > 6mm
  5. Evolving/elevation
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37
Q

Additional parts of skin exam?

A
  1. Regional lymph nodes
  2. Rest of skin
  3. Fundoscopy
  4. Liver
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38
Q

Glass eye + ascites?

A

Ocular melanoma

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39
Q

RFs for malignant melanoma?

A
  1. Sun exposure, esp. when young
  2. Low Fitzpatrick skin type
  3. Lots of common moles
  4. Age
  5. FHx
  6. Immunosuppression
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40
Q

5 types of malignant melanoma?

A

SLANA

  1. Superficial spreading = 80%
  2. Lentigo maligna melanoma = elderly
  3. Acral lentiginous = blacks, soles, palms
  4. Nodular = younger, new lesion
  5. Amelanotic = Delayed Dx
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41
Q

Staging of malignant melanoma?

A

Breslow Thickness

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42
Q

Malignant melanoma Mx?

A
  1. Excision biopsy for staging
  2. Secondary excision margin depends on stage
  3. +/- lymphadenectomy
  4. +/- adjuvant chemotherapy
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43
Q

Neurofibromatosis features?

A
  1. Skin
  2. Eyes
  3. Extras
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44
Q

Skin fx of NF?

A
  1. Cafe au lait spots (>=6, >=15mm diameter)
  2. Axillary freckling
  3. Neurofibromas
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45
Q

Neurofibromas description?

A

Gelatinous violaceous nodules

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46
Q

Eye fx of NF?

A
  1. Lisch nodules

2. Optic glioma –> altered acuity

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47
Q

What is a Lisch nodule?

A

Melanocytic hamartomatas of the iris

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48
Q

Extra fx of NF?

A
  1. Back = scoliosis
  2. Abdomen = RAS + phaeochromocytoma
  3. Palpable nerves + lymphadenopathy
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49
Q

NF inheritance?

A

AD

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50
Q

NF1 Chr and prevalence?

A

Chr17, 1/2500

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51
Q

NF2 Chr and prevalence?

A

Chr22, 1/35,000

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52
Q

4 complications of NF?

A
  1. Sarcomatous change = 5%
  2. Scoliosis
  3. Epidemiology
  4. Learning difficulty = 10%
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53
Q

NF Mx?

A
  1. MDT = GP and neurologist
  2. Excise some neurofibromas
  3. Genetic complications
  4. Complications = yearly BP review and cutaneous review, epilepsy rx
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54
Q

DDx of Cafe au Lait Spots?

A
  1. NF
  2. Tuberous Sclerosis
  3. McCune Albright syndrome
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55
Q

McCune Albright Syndrome?

A
  1. Cafe au lait spots
  2. Polyostotic fibrous dysplasia
  3. Precocious puberty
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56
Q

How can you classify the features of tuberous sclerosis?

A
  1. Cutaneous
  2. Neurological
  3. Other
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57
Q

What are the cutaneous features of tuberous sclerosis?

A 
1. Ash leaf spots under UV 
2 .Shagreen patch
3. Nose angiofibromas
4. Subungual fibromata
5. Cafe au lait spots
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58
Q

What are the neurological features of tuberous sclerosis?

A
  1. Developmental delay
  2. Epilepsy
  3. Intellectual impairment
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59
Q

What are the ‘other’ features of tuberous sclerosis? x5

A
  1. Retinal hamartomas
  2. Rhabdomyomas of the heart
  3. Gliomatous changes in the brain
  4. Polycystic kidneys
  5. Lymphoangioleiomyomatosis
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60
Q

Tuberous sclerosis Chr and inheritance?

A

Chr16, AD

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61
Q

Tuberous sclerosis Ix?

A
  1. Skull films = railroad track calcification
  2. CT/MRI brain = tuberous mass in cortex
  3. Abdo US = renal cysts
  4. Eccho = cardiomyopathies
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62
Q

HHT aka?

A

Osler-Weber Rendu syndrome

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63
Q

HHT examination?

A
  1. Multiple telangiectasia on face, lips and buccal mucosa
  2. Cyanosis = large pulmonary AVMs
  3. No signs of CREST
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64
Q

DDx for multiple telangiectasias?

A
  1. HHT
  2. CREST
  3. Chronic liver disease
  4. Ataxia telangiectasia
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65
Q

3 sites of AVMS in HHT?

A

Lungs, liver, brain

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66
Q

3 complications of HHT?

A
  1. Haemorrhage = epistaxis, GI haemorrhage, haemoptysis, SAH
  2. High output HF
  3. Colorectal cancer if SMAD4 mutation
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67
Q

Peutz-Jeghers examination?

A

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

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68
Q

Macules around lips and mouth DDx?

A
  1. Peutz-Jeghers
  2. Carney complex
  3. McCune-Albright
  4. Simple freckles
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69
Q

Peutz Jeghers?

A

AD mutation of STK11 gene on Chr19 characterised by mucocutaneous macules and multiple hamartomatous GI polyps

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70
Q

3 complications of Peutz Jeghers?

A
  1. GI hamartomas = intussusception, haemorrhage
  2. Pancreatic endocrine tumours
  3. Colorectal cancer
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71
Q

Erythema multiforme description?

A

Multiple symmetrical targetoid lesions, especially on extensor surfaces of the peripheries

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72
Q

Ddx of lesions with central clearing?

A
  1. Erthema multiforme
  2. Discoid eczema
  3. Tinea
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73
Q

Causes of erythema multiforme?

A
  1. Infections

2. Drugs

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74
Q

Infections that cause erythema multiforme?

A
  1. HSV (70%)

2. Mycoplasma

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75
Q

Drugs that cause erythema multiforme?

A
  1. NSAIDs
  2. Phenytoin
  3. Penicillin
  4. Sulfonamides
  5. Allopurinol
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76
Q

Mx of SJS and TEN?

A

Dexamethasone, IVIG

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77
Q

Erythema nodosum examination?

A

Tender, blue/red, smooth shiny nodules commonly found on shins

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78
Q

Causes of erythema nodosum?

A
  1. Systemic disease = Sarcoidosis, IBD, Behcets
  2. Infection = Strep, TB
  3. Drugs = sulphonamides, OCP
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79
Q

Rheumatoid hand examination?

A
  1. Look
  2. Feel = active synovitis (hot swollen painful joints)
  3. Move = fixed flexion in prayer position, decreased ROM
  4. Function = precision, power, aids
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80
Q

What causes fibromyalgia?

A

Theta waves

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81
Q

What to look for in rheumatoid hand examination?

A
  1. Skin = joint erythema, palmar erythema
    a. Swelling = MCPs and PIPs
    b. Muscle wasting = interossei, thenar eminence
    c. Deformity
    2 .Surgical scars = carpal tunnel release
  2. Wrist
  3. Elbow = nodules
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82
Q

Rheumatoid hand description?

A

Symmetrical deforming polyarthropathy

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83
Q

DDx for rheumatoid hands?

A
  1. Psoriatic Arthritis

2. Jacoud’s Arthropathy

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84
Q

Jacoud’s arthropathy?

A
  1. A chronic non-erosive reversible joint disorder that may occur after repeated bouts of arthritis.
  2. It is caused by inflammation of the joint capsule and subsequent fibrotic retraction, causing ulnar deviation of the fingers, through MCP subluxation ,
  3. Joints in the feet, knees and shoulders may also get affected.
  4. It is commonly associated with SLE and occurs in roughly 5% of all cases
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85
Q

Rheumatoid examination?

A
  1. Hands
  2. Skin = steroid use
  3. BP and pulse = AF, CVD
  4. Eye = epi/scleritis, keratoconjunctivitis sicca, anaeima
  5. Neck = atlantoaxial subluxation
  6. Heart = Pericardial rub
  7. Lungs = fibrosis, effusions, rub
  8. Abdomen = splenomegaly
  9. Urine dip = nephrotic syndrome/amyloid
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86
Q

3 symptoms of rheumatoid?

A
  1. Early morning stiffness
  2. Pain
  3. Swelling
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87
Q

RhA DLA?

A

HLA DR 3/4

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88
Q

RhA Ab?

A

anti-CCP = 98% specific, 75% sensitive

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89
Q

RhA X ray?

A

LESD

  1. Loss of joint space
  2. Periarticular erosions and osteopenia
  3. Soft tissue swelling
  4. Deformity
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90
Q

RhA Mx?

A
  1. MDT = GP, physio, OT, rheum, orthopod
  2. Conservative = physio, OT (aids and splints)
  3. Medical = Analgesia, Steroids (IM/PO/intra-articular), DMARDS, biologics
  4. Surgical = carpal tunnel decompression, tendon repairs and transfers, ulna stylectomy, arthroplasty
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91
Q

Extra-articular features of RhA?

A

aNTI CCP OR RF

  1. Nodules
  2. Tenosynovitis e.g. de Quervains
  3. Immune = vasculitis, amyloidosis, AIHA, Sjogrens
  4. Cardiac = pericarditis +/- effusion
  5. Carpal tunnel
  6. Pulmonary = fibrosis, effusions
  7. Ophthalmic = episcleritis, scleritis, Sjogrens
  8. Renal = nephrosis secondary to amyloidosis
  9. Raynaud’s
  10. Felty’s
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92
Q

Boutonniere’s deformity?

A

Rupture of central slip of extensor expansion –> PIPJ prolapse through ‘button-hole’ created by 2 lateral slips

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93
Q

Swan-neck deformity?

A

Rupture of lateral slips –> PIPJ hyperextension

94
Q

DMARDS for RhA?

A
  1. Methotrexate
  2. Sulfasalazine
  3. Hydroxychloroquine
  4. Penicillamine
  5. Gold
95
Q

2 s/e of penicillamine?

A
  1. Drug induced lupus

2. Nephrotic syndrome

96
Q

S/e of gold?

A

Nephrotic syndrome

97
Q

4 s/e of sulfasalazine?

A
  1. BM suppression
  2. Skin rashes
  3. Hepatitis
  4. Reduced sperm count
98
Q

Indication for Mx of RhA with biologics?

A

Severe RhA not responding to DMARDS

99
Q

3 Anti-TNFa agents?

A
  1. Infliximab
  2. Etanercept
  3. Adalimumab
100
Q

B cell depletion agent for RhA?

A

Rituximab (anti CD20 mAb)

101
Q

Rheumatoid Factor quick facts?

A
  1. Anti-IgG IgM
  2. Present in 70% with RhA
  3. Also present in 10% normal people
102
Q

Sjogrens RhF prevalence?

103
Q

SLE RhF prevalence?

104
Q

Higher titres of RhA associated with?

A
  1. More severe disease
  2. Erosions
  3. Extra-articular manifestations
105
Q

What is seronegative RhA?

A

RhA in the absence of RhF

106
Q

What % of RhA are seronegative?

107
Q

Seronegative RhA features?

A

Less severe disease and much less likely to have extra-articular features

108
Q

Cause of atlanto-axial subluxation in RhA?

A

Rheumatoid tenosynovitis –> weakening of ligaments supporting the top of the cervical spine

109
Q

Systemic Sclerosis examination?

A
  1. Hands = calcinosis, Raynauds (ulceration), sclerodactyly
  2. Face = beaked nose (nasal skin tethering), microstomia, telangiectasia, coup de sabre
  3. BP
  4. Lungs = pulmonary fibrosis
  5. Heart = pulmonary HTN, heave, raised JVP, loud P2
  6. Morphea = patches of sclerotic skin
110
Q

En coup de sabre?

A

Scar down central forehead found in systemic sclerosis

111
Q

Morphea?

A

Form of systemic sclerosis that involves isolated patches of hardened skin on the face, hands, and feet, or anywhere else on the body, with no internal organ involvement

112
Q

Classification of systemic sclerosis?

A
  1. Localised = morphea

2. Systemic = Diffuse (30%) or Limites (70%, incl. CREST)

113
Q

Limited systemic sclerosis Fx?

A
  1. Distribution limited to below elbow, knees and face
  2. Slow progression = years
  3. Pulmonary HTN in 15%
  4. CREST = calcinosis, raynaud’s, oesophageal dysmotility, sclerodactyly, telangiectasia
114
Q

Diffuse systemic sclerosis?

A
  1. Widespread cutaneous and early visceral involvement

2. Rapid progression = months

115
Q

Limited SS Ab?

A

Anti-centromere

116
Q

Diffuse SS Ab?

A

Anti-scl70 (topoisomerase)

117
Q

Systemic sclerosis prognosis?

A

50% 5 year survival

118
Q

SLE features?

A

4/11 of SOAP BRAIN MD:

  1. Serositis (pleuritis, pericarditis)
  2. Oral Ulcers
  3. Arthritis
  4. Photosensitivity
  5. Blood = pancytopenia
  6. Renal = proteinuria
  7. ANA
  8. Immunologic = dsDNA
  9. Neuro = psych, seizures
  10. Malar rash
  11. Discoid rash
119
Q

SLE examination?

A
  1. Hands = vasculitic lesions (nail fold infarcts), Raynaud’s (digital ulceration), Jacoud’s arthropathy
  2. Skin = purpura, livedo reticularis
  3. Face = malar rash, discoid rash, oral ulceration, anaemia
  4. Eyes = keratoconjunctivitis sicca
  5. Lungs = pleural rub, effusion, fibrosis
  6. Cardio = pulmonary HN
  7. Renal = HTN, dipstick
  8. Neuro = focal neurology, chorea
120
Q

Malar rash spares?

A

Nasolabial folds

121
Q

Discoid lupus description?

A

Hyperkeratotic papules

122
Q

SLE defn?

A

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

123
Q

SLE M:F?

124
Q

Races more affected by SLE?

A

Afro-Caribbeans and Asians

125
Q

SLE ANA prevalence?

126
Q

SLE most specific Ab?

A

dsDNA, although 60% sensitive

127
Q

SLE Abs?

A
  1. ANA
  2. dsDNA
  3. anti-cardiolipin
  4. lupus anticoagulant
128
Q

SLE activity monitoring?

A
  1. Raised ESR
  2. Low C3, C4
  3. Raised dsDNA titre
129
Q

SLE Mx?

A
  1. MDT = GP, rheum in specialist SLE clinics
  2. Mild disease = cutaneous and joints only
  3. Moderate disease = organ involvement
  4. Severe disease = AIHA, nephritis, pericarditis, CNS
130
Q

Mild SLE Mx?

A
  1. Topical corticosteroids
  2. HCQ
  3. Suncream
131
Q

Moderate SLE Mx?

A
  1. Prednisolone

2. Azathioprine

132
Q

Severe SLE Mx?

A
  1. High dose methylprednisolone

2. Cyclophosphamide

133
Q

Ankylosing spondylitis defn?

A

A chronic seronegative spondylarthropathy leading to inflammatory arthritis of the axial skeleton and associated extra-articular features

134
Q

Extra-articular features of ankylosing spondylitis?

A
  1. Anterior uveitis
  2. Apical lung fibrosis
  3. Aortitis
  4. Aortic regurgitation
  5. AVN block
  6. Amyloidosis –> glomerulonephritis
  7. Achilles tendon enthesitis (+other tendons)
135
Q

Ankylosing spondylitis examination?

A
  1. Back
  2. Movement
  3. Sacroiliitis
  4. Extra = ECG, dipstick
136
Q

Ank spond back exam?

A
  1. Question mark posture = thoracic kyphosis and neck hyperextension
  2. ROM throughout spine
  3. Protuberant abdomen = diaphragmatic breathing
137
Q

Ank spond movement?

A
  1. Schobers test = <5cm

2. .Chest expansion <5cm (@nipples)

138
Q

Ank spond sacroiliitis test?

A
  1. Direct pressure

2. Sacroiliac stretch = pain on adduction of hip with hip and knee flexed

139
Q

Ankylosing spondylitis bloods?

A
  1. FBC = anaemia
  2. Raised ESR
  3. Raised CRP
  4. HLA B27 +ive in 95%
140
Q

Ank spond spine imaging features?

A
  1. Sacroiliitis = sclerosis, erosions

2. Bamboo spine = vertebral body fusion by marginal syndesmophytes

141
Q

Ank spond Mx?

A
  1. Conservative = exercise and physio
  2. Medical = NSAIDs, local steroid injections, anti-TNF, bisphosphonates
  3. Surgery = hip replacement, spinal osteotomy
142
Q

Marfans syndrome triad?

A
  1. Skeletal features
  2. CVS features
  3. Eye features
143
Q

Marfans defn?

A

Genetic disorder of the connective tissue primarily affecting the eyes, skeleton and cardiovascular system

144
Q

Marfans examination?

A
  1. General = tall and thin, scoliosis
  2. Hands and arms= arachnodactyly (encircle wrist with hands), wide arm span, flexible joints, pulse (radio-radio delay, collapsing)
  3. Face = long thin face, upwards lens dislocation, myopia, high arched palate
  4. Chest and abdomen = pectus excavatum/carinatum, scars from cardiothoracic surgery, stretch mars
  5. Legs and feet = long legs, flat feet
145
Q

Marfans DDx?

A
  1. MEN2B

2. Homocystinuria

146
Q

Homocystinuria fx?

A
  1. Low IQ

2. Downward lens dislocation

147
Q

Marfans syndrome cause?

A

AD mutation in fibrillin-1 gene, a major protein of elastin in connective tissues

148
Q

Marfans Ix?

A
  1. Genetic testing
  2. Eye exam
  3. Echo = aortic root dilatation
149
Q

Marfan’s Mx?

A
  1. Screen family members
  2. Surveillance for complications = MDT regular check ups
  3. Medical = BB and ACEi can slow aortic root dilatation, pre-emptive aortic root surgery to prevent dissection/rupture
150
Q

Gout definition?

A

A mono/oligoarthropathy caused by deposition of monosodium urate crystals in the joints

151
Q

Hyperuricaemia RFs?

A
  1. Male
  2. Obese
  3. CKD
  4. Diuretics
  5. Purine rich diet = alcohol, meat, seafood
  6. Increased turnover = leukaemia, lymphoma, psoriasis
152
Q

Main gout goint?

153
Q

Gout DDx?

A
  1. Pseudogout
  2. Septic arthritis
  3. Calcinosis from CREST
154
Q

Gout Ix?

A
  1. Bloods = uric acid, lipids, glucose
  2. Joint aspiration with polarised microscopy = negatively birefringent needle-shaped crystals
  3. X-ray = punched out peri-articular erosion
155
Q

Gout Mx?

A
  1. Conservative = weight loss, keep hydrated, diet, avoid fasting, stop offending drugs
  2. Acute = indomethacin/diclofenac, colchicine, steroids
  3. Chronic = Allopurinol
156
Q

Why wait 2 weeks after an acute gout attack to prescribe allopurinol?

A

Can paradoxically trigger a bout of gout when initiated, so offer NSAID and colchicine cover for 1-3 months initially

157
Q

Osteoarthritis defn?

A

Mechanical joint degradation with degeneration of articular cartilage, peri-articular bone remodelling and inflammation

158
Q

Osteoarthritis RFs?

A
  1. Primary = Age, obesity, FHx, female

2. Secondary = pre-existing joint damage, metabolic disease, systemic disease

159
Q

Pre-existing joint damage that can cause secondary osteoarthritis?

A
  1. Trauma
  2. RA
  3. Gout
  4. Pagets
  5. AVN
  6. Septic arthritis
  7. Spondylarthropathy
160
Q

Metabolic disease that can causes secondary osteoarthritis?

A
  1. Chondrocalcinosis
  2. Haemochromatosis
  3. Acromegaly
161
Q

Systemic disease that can cause secondary osteoarthritis?

A
  1. Haemophilia (haemarthrosis)
  2. Neuropathy
  3. Haemoglobinopathy
162
Q

Osteoarthritis hand examination?

A
  1. Heberden’s
  2. Bouchard’s
  3. Squaring of carpometacarpal joint of thumb
  4. Reduced function
  5. Disuse atrophy
  6. Fixed flexion
163
Q

Osteoarthritic joint description?

A
  1. Crepitus
  2. Pain on movement
  3. Reduced range of movement
  4. Bony swellings (osteophytes)
  5. Joint instability
  6. Joint effusion
164
Q

Commonly affected OA joints?

A
  1. IP joints of fingers
  2. CMC joint of thumb
  3. Knees
  4. Hips
165
Q

OA joint pain features w/ regards to pt?

A
  1. Worse on exercise and relieved on rest

2. Morning pain <30mins

166
Q

Radiographic features of OA?

A
  1. Loss of joint space
  2. Osteophytes
  3. Subchondral cysts
  4. Subchondral sclerosis
  5. Deformity
167
Q

OA Ix?

A
  1. X-Ray

2. FBC, CRP/ESR (only useful for ruling out inflammatory and infective causes)

168
Q

OA Mx?

A
  1. Conservative = exercise, physio, weight loss, walking waids
  2. Analgesia = Paracetamol +/- NSAIDs, codeine, oral NSAIDs for flare ups
  3. Intra-articular joint injection
  4. Surgery = joint replacement
169
Q

Thyrotoxicosis examination?

A
  1. General = thin, anxious
  2. Hands = thyroid acropachy, erythema, sweaty palms, tachycardia, AF
  3. Arms = proximal myopathy
  4. Neck = smooth, diffuse goitre +/- bruit
  5. Eyes = non specific vs. Graves
  6. Legs = pretibiial myxoedema, proximal myopathy
170
Q

Non-specific thyrotoxicosis eye signs?

A
  1. Lid-lag

2. Lid retraction (increased tone of superior tarsal muscle)

171
Q

Graves’ eye signs?

A
  1. Exophthalmos
  2. Ophthalmoplegia
  3. Chemosis
172
Q

Chemosis defn?

A

Conjunctival oedema

173
Q

3 triggers of thyrotoxicosis?

A
  1. Child birth
  2. Stress
  3. Infection
174
Q

Goitre defn?

A

Enlargement and swelling of the thyroid gland

175
Q

Most common causes of goitre in UK?

A
  1. Graves
  2. Multinodular goitre (actually feels smooth, nodules are an USS Dx)
  3. Physiological = pregnancy/puberty
176
Q

Classification of causes of goitre?

A
  1. Diffuse

2. Nodular

177
Q

Causes of diffuse goitre?

A
  1. Simple = physiological, iodine deficiency, iatrogenic (e.g. lithium)
  2. AI = Graves, Hashimoto’s, Riedel’s
  3. Infective = acute viral thyroiditis
178
Q

Causes of nodular goitre?

A
  1. Multinodular goitre = euthryoid
  2. Toxic multinodular goitre = hyperthyroid
  3. Solitary nodule = Cancer, Plummer’s solitary nodule
  4. Multiple adenomas
179
Q

Thyrotoxicosis Ix?

A
  1. Bloods = FBC, TFTs, Abs (TSH, TPO), Ca, ESR
  2. Imaging = US, CT, CXR, radionuclide uptake scane
  3. Needle aspiration
  4. Biopsy
180
Q

Graves FBC effect?

A

May be mild anaemia and neutropenia

181
Q

Why CXR/CT in goitre?

A

To check for retrosternal goitre

182
Q

Goitre complications?

A
  1. Of hyper/hypothyoidism
  2. Compression of surrounding structures
  3. Cosmetic
183
Q

Goitre compression complications?

A
  1. Trachea = SOB
  2. RLN = dysphonia
  3. Oesophagus = dysphagia
  4. SVC = SVCS
184
Q

Thyrotoxicosis Mx?

A
  1. Medical
  2. Radioiodine
  3. Thyroidectomy
  4. Thyroid eye disease
185
Q

Medical Mx of thyrotoxicosis?

A
  1. Propranolol

2. Carbimazole (titrate OR block & replace)

186
Q

How long to tx with carbimazole for?

A

12-18 months

187
Q

Radioiodine s/e?

A
  1. May worsen thyroid eye disease
  2. Most pts become hypothyroid
  3. C/I in pregnancy and those around children
188
Q

Thyroidectomy s/e?

A
  1. Early = haematoma. RLNP, thyroid storm, hypocalcaemia

2. Late = hypothyroidism, hypoparathyroidism, keloid scar

189
Q

Thyroid eye disease Mx?

A
  1. Stop smoking
  2. Symptomatic = artificial tears, dark glasses, elevate bed
  3. Severe = high dose steroids, surgical decompression
190
Q

Hypothyroidism exam?

A
  1. General = overweight, depressed, gruff voice
  2. Hands = dry skin, bradycardia, cool, slow reflexes, proximal myopathy
  3. Face = coarse, puffy, peaches and cream complexion, loss of lateral eyebrows, xanthelasma, thin hair
  4. Neck = goitre, thyroidectomy scar
191
Q

3 AI diseases associated with thyroid disease?

A
  1. Addisons
  2. T1DM
  3. Vitiligo
192
Q

Hypothyroidism Mx?

193
Q

Hypothyroidism Ddx?

A
  1. Primary

2. Secondary = hypopituitarism (v. rare)

194
Q

Primary causes of hypothyroidism?

A
  1. AI = primary atrophic thyroiditis, Hashimoto’s thyroiditis
  2. Iatrogenic = drugs, radioiodine, surgery
  3. Iodine deficiency = e.g. derbyshire neck
  4. Genetic = thyroid agenesis
195
Q

Hyperthyroidism Ddx?

A
  1. High uptake

2. Low uptake

196
Q

High uptake causes of hyperthyroidism?

A
  1. Graves’
  2. Toxic adenoma
  3. Toxic multinodular goitre
197
Q

Low uptake causes of hyperthyroidism?

A
  1. Subacute thyroiditis
  2. Postpartum thyroiditis
  3. Ectopic/exogenous
198
Q

Acromegaly definition?

A

Disorder resulting from excess release of growth hormone after the growth plates have fused, >99% due to a GH secreting pituitary macroadenoma

199
Q

Clinical features of acromegaly?

A
  1. Pituitary enlargement symptoms = hypopituitarism, bitemporal hemianopia, headache
  2. Active acromegaly signs = excessive sweating, HTN
  3. Excessive soft tissue growth
200
Q

Excessive soft tissue growth in acromegaly?

A
  1. Hands = spade like, tight rings, sweaty, carpal tunnel syndrome (thenar wasting and loss of sensation)
  2. Arms = HTN
  3. Face = coarsening of features, prominent supra-orbital ridge, large nose, big ears, macroglossia, widely spaced teeth, prognathism
  4. Eyes = bitemporal hemianopia
  5. Neck = goitre and JVP
  6. Armpits = acanthosis nigricans
  7. Abdomen = organomegaly
  8. Proximal myopathy = stand up
  9. Previous photographs
201
Q

Causes of macroglossia?

A
  1. Acromegaly
  2. Amyloidosis
  3. Hypothyroidism
  4. Down’s syndrome
202
Q

Causes of acanthosis nigricans?

A
  1. Endo = metabolic syndrome, DM, Cushings, Acromegaly

2. Malignancy = gastric, pancreatic

203
Q

Acromegaly Ix?

A
  1. Bedside = glycosuria, LVH
  2. Bloods = raised IGF1, OGTT, PFTs and serum prolactin
  3. CXR = cardiomegaly
  4. MRI = pituitary adenoma
  5. Other = visual perimetry
204
Q

Acromegaly complications?

A
  1. Impaired GT and DM
  2. Cardiomyopathy and CVD (leading cause of death)
  3. Colorectal cancer (colonoscopy at 50 years)
205
Q

Acromegaly Mx?

A
  1. General = MDT, CV risk
  2. 1st line = trans-sphenoidal resection
  3. 2nd line = medical = SS analogues (octreotide), GH antagonist (pegvisomant), Da agonist (cabergoline)
  4. 3rd line = radiotherapy
206
Q

Acromegaly follow up?

A

Yearly

  1. Bloods = GH, PRL
  2. Visual fields
  3. ECG
  4. MRI head
207
Q

Cushings syndrome defn?

A

A metabolic disorder characterised by typical signs and symptoms caused by chronic glucocorticoid excess

208
Q

Cushings disease defn/

A

ACTH-producing pituitary tumour causing Cushings Syndrome

209
Q

Nelsons syndrome?

A

Symptoms resulting from rapid enlargement of a pre-existing pituitary tumour after a bilateral adrenelectomy

210
Q

Causes of Cushing’s syndrome classification?

A
  1. ACTH-dependent

2. ACTH-independent

211
Q

ACTH dependent causes of Cushing’s syndrome?

A
  1. Cushing’s disease

2. Ectopic ACTH (SCLC most common)

212
Q

ACTH independent causes of Cushing’s syndrome?

A
  1. Iatrogenic = most common
  2. Adrenal adenoma/carcinoma
  3. Adrenal hyperplasia
  4. Carney complex
213
Q

Cushing’s examination?

A
  1. Hands = thin skin, RA
  2. Arms = BP
  3. Face = moon face, acne, hirsutism
  4. Eyes = bitemporal hemianopia
  5. Shoulders and back = buffalo hump, kyphosis, crush fracture –> back pain
  6. Abdomen = central obesity, purple striae
  7. Stand = proximal myopathy
214
Q

4 Cushings symptoms for pts?

A
  1. Weight gain
  2. Bruising
  3. Headached
  4. Visual disturbance
215
Q

Cushings Ix classification?

A
  1. Confirm syndrome

2. Localise lesion

216
Q

Cushings confirm syndrome Ix?

A
  1. 24-hour urinary cortisol

2. Low dose dexamethasone suppression test

217
Q

Cushings localise lesion Ix?

A
  1. Plasma ACTH
  2. Low ACTH –> CT adrenals
  3. High ACTH –> High dose dexamethasone suppression test
  4. Inferior petrosal sinus sampling
  5. MRI pituitary fossa
218
Q

Cushings Mx?

A
  1. Complications = BP, DM, bisphosphonates

2. Cause

219
Q

Ectopic ACTH Mx?

A
  1. Tumour excision

2. Metyrapone (inhibits cortisol synthesis)

220
Q

Addisons disease signs?

A
  1. Medic alert bracelet
  2. Hyperpigmentation = palmar creases, scars, buccal mucosa
  3. Postural hypotension
221
Q

Addisons disease Ab?

A

21-hydroxylase (+ive in 80% with AI disease)

222
Q

Addisons disease Dx?

A
  1. 8am cortisol = low
  2. 8am ACTH = high
  3. SynACTHen test = no increase in cortisol
223
Q

Addisons acute Mx?

A
  1. 0.9% NS IV
  2. 100mg hydrocortisone IV
  3. Rx cause e.g. infection
224
Q

Addisons chronic Mx?

A
  1. Replace = hydrocortisone and fludrocortisone

2. Education and advice = dont stop steroids suddenly, increase dose during illness/stress, bracelet, carry steroid card

225
Q

Steroids s/e?

A

MEM ICE

  1. MSK = proximal myopathy, osteoporosis
  2. Endocrine = HPA suppression, obesity, DM
  3. Metabolic = Na and fluid retention, HTN, hypokalaemia
  4. Immune = infection
  5. CNA = depression, psychosis
  6. Cataracts, glaucoma
226
Q

Steroids advice to pt?

A
  1. Dont stop suddenly
  2. Consult doctor when unwell
  3. Carry steroid card/alert bracelet
  4. Avoid OTC s.g. NSAIDs
227
Q

What is hemiballismus?

A
  1. Involuntary flinging motions of the extremities
  2. Continuous and random
  3. Isolated to one side of the body
228
Q

Cause of hemiballismus?

A

Damage to the subthalamic nucleus

  1. Usually a small infarct in diabetics
  2. MS
  3. Any CNS pathology essentially
229
Q

Mx of hemiballismus?

A
  1. Often resolves spontaneously

2. Haloperidol

230
Q

Benign essential tremor features?

A
  1. Action/postural tremor = worse with movement
  2. Exacerbating factors = anxiety/caffeine
  3. Relieving factors = alcohol/sleep
231
Q

Mx of BET?

A
  1. Alcohol
  2. Propranolol
  3. Primidone = anti-epileptic
232
Q

DDx of solitary thyroid nodule?

A
  1. Dominant nodule of multinodular goitre
  2. Adenoma
  3. Malignancy = PFMA
  4. Cyst

Medicine and Surgery Mushkies (52 decks)

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