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Misc 2 Flashcards

1
Q

What complications are associated with Takayasu’s arteritis?

A

Renal artery stenosis

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2
Q

What is phlegmasia cerulean dolens?

A

Rare complication of DVT
Presents suddenly with complete venous occlusion
Triad of lower extremity oedema, cyanosis + severe pain after 24hrs of blanching + edema

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3
Q

Management of phlegmasia cerulean dolens

A

Catheter directed thrombolysis

2nd line = thrombectomy

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4
Q

What is an ape hand deformity?

A

Occurs in median nerve damage

Inability to abduct + oppose thumb due to paralysis of thenar muscle

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5
Q

Describe the presentation of GPA

A

URT: epistaxis, sinusitis, nasal crusting
LRT: SOB, haemoptysis
Glomerulonephritis
Saddle shaped nose

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6
Q

Describe the 2 types of scleroderma

A 
Limited = skin involvement limited to face + hands/ elbows only. CREST symptoms 
Diffuse = limited + full body skin involvement + renal damage + pulmonary fibrosis
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7
Q

What antibody is linked to diffuse + limited scleroderma?

A 
Limited = anti-centromere
Diffuse = Scl70
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8
Q

How do you manage scleroderma?

A

DMARDS, cyclophosphamide, biologics

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9
Q

What diseases are associated with ANCA?

A

Vasculitis

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10
Q

What disease is associated with anti-Ro?

A

Sjogrens syndrome

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11
Q

Describe rheumatic fever

A 
Caused by strep pyogenes (sore throat) 
Erythema marginatum 
Sydenham’s chorea 
Polyarthritis 
Carditis 
Subcutaneous nodules
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12
Q

How do you treat myositis?

A

Steroids, DMARDS, biologics, IVIG

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13
Q

What other conditions is PMR related to?

A

GCA + temporal arteritis

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14
Q

Where does PMR usually affect?

A

Shoulders + thighs

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15
Q

What is pseudogout?

A

Acute CPP crystal arthritis (CPP = calcium pyrophosphate)

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16
Q

Presentation of acute CPP crystal arthritis

A

Sudden pain + stiffness (commonly knee)
Swelling, red, inflamed skin over joint
Fever

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17
Q

Presentation of acute calcific tendonitis

A

Painful swelling around joint, usually shoulder
Redness + tenderness
Settles in 2-4 weeks

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18
Q

Systemic sclerosis presentation

A

Stiffening, hardening or tightening of skin
Dysphagia + heartburn
Raynauds
Joint/ muscle pain/ stiffness

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19
Q

Investigation results for osteomalacia

A

Low Vit D, rasied ALP, low calcium, low phosphate

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20
Q

Blood results for osteoporosis

A

Normal bloods

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21
Q

Investigation results + presentation for Paget’s disease

A

Rise in ALP
Characteristic x ray changes; thickened skull vault, bowing of tibia + bossing of skull
Bone pain

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22
Q

Management of Pagets

A

Bisphosphonate

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23
Q

What do you need to check before starting azathioprine?

A

Check thiopurine methyltransferase deficiency (TPMT) before treatment

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24
Q

What score is used to measure RA impact?

A

DAS28

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25
What are the associated features of ankylosing spondylitis?
``` Apical fibrosis Anterior uveitis Aortic regurgitation Achilles tendonitis AV node block Amyloidosis ```
26
What is the most specific test for systemic sclerosis?
Anti-centromere antibodies
27
What antibodies are associated with RA?
Anti-CCP
28
What is a serious complication of dermatomyositis?
Ovarian, breast and lung tumours
29
What is Felty’s syndrome?
Splenomegaly Neutropenia Occurs in a pt with RA
30
What disease are cANCA + pANCA associated with?
``` cANCA = granulomatosis with polyangiitis pANCA = EGPA + others ```
31
What disease is associated with anti-Scl-70 ab?
Diffuse scleroderma (systemic sclerosis)
32
What disease is associated with anti-dsDNA ab?
SLE
33
What disease is associated with anti-CCP ab?
RA
34
What disease is associated with AMA?
Primary biliary sclerosis
35
Causes of drug induced SLE
``` Procainamide Hydralazine Isoniazid Minocycline Phenytoin ```
36
What ab are positive in SLE?
99% are ANA positive 20% are rheumatoid factor positive anti-dsDNA: highly specific (> 99%), but less sensitive (70%) anti-Smith: most specific (> 99%), sensitivity (30%) also: anti-U1 RNP, SS-A (anti-Ro) and SS-B (anti-La)
37
Management of AS
NSAIDs then TNF inhibitors
38
Presentation of Sjogrens syndrome
``` dry eyes: keratoconjunctivitis sicca dry mouth vaginal dryness arthralgia Raynaud's, myalgia sensory polyneuropathy recurrent episodes of parotitis renal tubular acidosis (usually subclinical) ```
39
What is blue sclera associated with?
Osteogenesis imperfecta
40
What is the presentation of antiphospholipid syndrome?
Arterial/ venous thrombosis Miscarriage Livedo reticularis
41
What is Takayasu’s arteritis + what is the presentation?
Inflammatory arteritis of aorta Upper limb claudication Absent pulses
42
What is polyarteritis nodosu + what is the presentation?
Systemic necrotizing vasculitis of small + medium vessels | Common with hep B
43
What is wegeners granulomatosis + what is the presentation?
Small + medium sized necrotizing vasculitis | Cutaneous vascular lesions seen
44
What is a posterior femoral nerve stretch indicative of?
Referred lumbar spine pain as a cause of hip pain
45
What is Marfans caused by?
Autosomal dominant connective tissue disorder Defect in FBN1 gene on chromosome 15 Defect in fibrillin
46
What are plantar spur and pencil + cup deformities typical of?
X ray features of psoriatic arthritis
47
What DMARD is safe in pregnancy?
Hydroxychloroquine
48
What does joint aspiration show in gout?
Needle shaped negatively birefringent crystals
49
What is a Z score on a DEXA scan adjusted for?
Age, gender + ethnicity
50
What antibody is positive in myositis?
Anti-Jo1
51
If someone is positive for Anti-Jo1 ab predispose you to?
Lung fibrosis (antisynthetase syndrome)
52
Describe the presentation of adult onset Stills
Joint pain, spiking fevers and pink bumpy rash | High serum ferritin and leukocytosis
53
RF for osteoporosis
``` Steroid use RA Alcohol excess Hx of parental hip fracture Low bmi Current smoking ```
54
What structure is divided in surgical management of carpal tunnel?
Flexor retinaculum
55
Burning thigh pain is indicative of what?
Meralgia paraesthetica – lateral cutaneous nerve compression
56
What is the most common cause of compartment syndrome?
Tibial fracture + supracondylar fracture
57
What are the complications of compartment syndrome in the kidneys?
Rhabdomyolysis caused myoglobin release in the blod Deposits in renal tubules causing AKI Results in dark brown urine, + for blood
58
Treatment of intracapsular fractures, based on mobility + displacement
``` Undisplaced = internal fixation Undisplaced + significant comorbidities = hemiarthroplasty Displaced <70 = internal fixation Displaced >70 = total hip replacement Displaced + immobile = hemiarthroplasty ```
59
Treatment of reverse oblique, transverse or subtrochanteric fracture
Intramedullary nail
60
Treatment of intertrochanteric fracture
Dynamic hip screw
61
What imaging is best for ?Achilles tendon rupture?
US
62
What is cubital tunnel syndrome?
Compression of ulnar nerve | Causes pins + needles in 4th + 5th finger
63
How does subacromial impingement present?
Painful arc of abduction (worse between 90 + 120 degrees)
64
What is adhesive capsulitis?
Frozen shoulder | Common in middle aged females, associated with DM
65
Describe the features of L3 nerve root compression
Sensory loss over anterior thigh Weak quads Reduced knee reflex Positive femoral stretch test
66
Describe the features of L4 nerve root compression
Sensory loss over anterior aspect of knee Weak quads Reduced knee reflex Positive femoral stretch test
67
Describe the features of L5 nerve root compression
Sensory loss over dorsum of foot Weak in foot + big toe dorsiflexion Reflexes intact Positive sciatic nerve stretch test
68
Describe the features of S1 nerve root compression
Sensory loss over posterolateral aspect of leg + lateral aspect of foot Weak in plantar flexion of foot Reduced ankle reflex Positive sciatic nerve stretch test
69
Describe plantar fasciitis
Most common cause of heel pain Pain in medial calcaneal tuberosity Worse when walking on toes
70
When should a DEXA scan be done?
FRAX score >10%
71
What is Morton’s neuroma?
Benign neuroma affecting intermetatarsal plantar nerve, commonly 3rd MTP space Causes forefoot pain, worse on walking Mulder’s click if pressed
72
What is the motor, sensory nerve + typical injury that occurs to C5-C7?
Musculocutaneous nerve Motor = elbow flexion + supination Sensory = lateral part of forearm Injured in brachial plexus injury
73
What is the motor, sensory nerve + typical injury that occurs to C5, C6?
Axillary nerve Motor = shoulder abduction (deltoid) Sensory = inferior region of deltoid Injured in humeral neck fracture, results in flattened deltoid
74
What is the motor, sensory nerve + typical injury that occurs to C5-C8?
Radial nerve Motor = Extension of forearm, wrist, fingers, thumb Sensory = small area between dorsal aspect of 1st + 2nd metacarpals Injured in humeral midshaft fracture, palsy results in wrist drop
75
What is the motor, sensory nerve + typical injury that occurs to C6, C8, T1?
Median nerve Motor = LOAF muscles Sensory = palmar aspect of lateral 3.5 figners Causes carpal tunnel syndrome when compressed at wrist Loss of pronation + weak wrist flexion when damaged
76
What is the motor, sensory nerve + typical injury that occurs to C8, T1?
``` Ulnar nerve Motor = intrinsic hand muscles, wrist flexion Sensory = medial 1.5 fingers Injured in medial epicondyle fracture Damage results in a ‘claw hand’ ```
77
What are the LOAF muscles?
Lateral 2 lumbricals Opponens pollis Abductor pollis brevis Flexor polis brevis
78
What is a Klumpke injury?
Damage of lower trunk of brachial plexus (C8, T1) May be due to shoulder dystocia or sudden upward jerk of hand Associated with Horner’s syndrome
79
What is an Erb-Duchenne palsy?
Damage of upper trunk of brachial plexus (C5, C6) May be due to shoulder dystocia Arm hangs by side + is internally rotated
80
Describe a fat embolism
``` Occurs after trauma Triad of symptoms: respiratory, neuro, petechial rash Tachycardia, fever, SOB, hypoxia Confusion, retinal hemorrhages Petechial rash ```
81
What is a Galeazzi fracture?
Dislocation of distal radioulnar joint with associated fracture of radius
82
What is a Monteggia fracture?
Fracture of proximal ulna with associated dislocation of proximal radioulnar joint
83
What is a Bennett’s fracture?
Fracture of base of 1st MCP that extends into CMP joint What is a Pott’s fracture? Bimalleolar ankle fracture Due to forced foot eversion
84
How does spinal stenosis present?
Gradual onset, leg pain, numbness, weakness, worse on walking Resolves when sitting down or leaning forward
85
What is syringomyelia?
Cystic cavity forms within spinal cord
86
What is Brown-Sequard syndrome?
Hemisection of spinal cord due to stabbing or lateral vertebral fracture Causes ipsilateral paralysis + loss of proprioception Pain + temp sensation lost on contralateral side
87
Leg shortening and externally rotated is indicative of what?
Hip fracture
88
Leg shortening and internally rotated is indicative of what?
Hip dislocation
89
What is De Quervain;s tenosynovitis?
Pain over radial styloid process on forced abduction or flexion of thumb (+ve Finkelstein test)
90
What does a positive straight leg raise show?
Sciatic nerve pain
91
What is a greenstick fracture?
Unilateral cortical breach only
92
What is a toddler’s fracture?
Oblique tibial fracture in infants
93
What is a buckle fracture?
Incomplete cortical disruption resulting in periosteal haematoma only
94
What are Oslers nodes?
Tender, purple raised lesions | Due to immune complex deposition = SLE, gonorrhea, typhoid
95
What is trigger finger?
Stiffness + snapping of finger when extending | Nodule may be felt at base of digit
96
What is the Salter-Harris system used for?
Classifying fractures about the growth plate in children
97
What is Leriche syndrome?
Claudication of buttocks + thighs Atrophy of musculature of legs Impotence (due to paralysis of L1 nerve)
98
What is the weber classification used for?
Related to level of fibular fracture Type A = below syndesmosis Type B = start at level of tibial plafond, may extend to involve syndesmosis Type C = above syndesmosis
99
What is a Maisonneuve fracture?
May occur with spiral fibular fracture, leading to disruption of syndesmosis with windening of ankle joint
100
Management of ankle fractures
Young patients with unstable/ high velocity/ proximal injuries = surgery Elderly = conservative (below knee cast)
101
What drug can cause Dupeytrens contracture
Phenytoin
102
What is Thessaly’s test?
Used to test for meniscal tear
103
Difference between Cushings disease + syndrome
``` Syndrome = collection of S+S due to prolonged exposure to cortisol Disease = prolonged exposure due to increased ACTH production due to pituitary adenoma ```
104
What are the differentials for HTN with hypokalaemia?
Conn’s Cushings Renal artery stenosis Liddle’s
105
How to differentiate between Cushings, Conns, renal artery stenosis + Liddle’s?
Conn’s = high aldosterone, low renin Cushings = high aldosterone, low renin Renal artery stenosis = high aldosterone + renin Liddle’s = low aldosterone + renin
106
Describe Conn’s syndrome
Hypokalaemia (paraesthesia, muscle weakness, polyuria) | HTN
107
What test is diagnostic for Conn’s?
Aldosterone to renin ratio
108
Which antibody is Hashimoto’s associated with?
Anti-thyroid peroxidase ab (anti-TPO) Which pneumonia bacteria is associated with erythema multiforme? Mycoplasma pneumonia
109
What is the commonest cause of Addisons?
Autoimmunity
110
What can long term PPI therapy cause?
Hypomagnesaemia leading to muscle aches
111
What are the live attenuated vaccines?
``` BCG MMR Oral polio Yellow fever Oral typhoid ```
112
Describe a type 1 hypersensitivity reaction
Antigen reacts with IgE bound to mast cells | Eg atopy + anaphylaxis
113
Describe a type 2 hypersensitivity reaction
IgG or IgM | Eg ITP, Goodpasture’s, pernicious anemia, acute hemolytic transfusion reaction
114
Describe a type 3 hypersensitivity reaction
IgA + IgG combine | Eg SLE, post strep glomerulonephritis
115
Describe a type 4 hypersensitivity reaction
``` Delayed hypersensitivity (T cell mediated) Eg TB, allergic dermatitis, MS, GBS ```
116
Where does a prolactinoma usually reside?
Anterior pituitary gland
117
What is apraxia?
Inability to perform skilled movements
118
What is agnosia?
Inability to recognise previously familiar sensory input ie inability to recognise objects
119
What is astereognosis?
Ability to recognise objects by palpation in one hand but not the other
120
Where does a bleed usually occur in subdural haemorrhage?
Bridging veins between cortex + venous sinus
121
What is corticobasal degeneration?
Pts have a rigid limb (alien limb – moves on its own) | Develop frontal type dementia; behavior + personality changes
122
How does progressive supranuclear palsy present?
Build up of protein Tau Backward falls, early speech and swallowing problems Lose voluntary gaze; can’t move eyes up and down
123
What investigations can be used to assess multi system atrophy vs Parkinsons?
Tilt test = shows postural hypo (MSA) Hot cross bun sign on MRI = multi system atrophy MSA is symmetrical
124
What medications can cause Parkinsonian symptoms?
Anti-emetics = metoclopramide | Anti-psychotics
125
What are the differentials for HTN with hypokalaemia?
Conn’s Cushings Renal artery stenosis Liddle’s
126
How to differentiate between Cushings, Conns, renal artery stenosis + Liddle’s?
Conn’s = high aldosterone, low renin Cushings = high aldosterone, low renin Renal artery stenosis = high aldosterone + renin Liddle’s = low aldosterone + renin
127
Describe Conn’s syndrome
Hypokalaemia (paraesthesia, muscle weakness, polyuria) | HTN
128
What test is diagnostic for Conn’s?
Aldosterone to renin ratio
129
Which antibody is Hashimoto’s associated with?
Anti-thyroid peroxidase ab (anti-TPO) Which pneumonia bacteria is associated with erythema multiforme? Mycoplasma pneumonia
130
What is the commonest cause of Addisons?
Autoimmunity
131
What can long term PPI therapy cause?
Hypomagnesaemia leading to muscle aches
132
What are the live attenuated vaccines?
``` BCG MMR Oral polio Yellow fever Oral typhoid ```
133
Describe a type 1 hypersensitivity reaction
Antigen reacts with IgE bound to mast cells | Eg atopy + anaphylaxis
134
Describe a type 2 hypersensitivity reaction
IgG or IgM | Eg ITP, Goodpasture’s, pernicious anemia, acute hemolytic transfusion reaction
135
Describe a type 3 hypersensitivity reaction
IgA + IgG combine | Eg SLE, post strep glomerulonephritis
136
Describe a type 4 hypersensitivity reaction
``` Delayed hypersensitivity (T cell mediated) Eg TB, allergic dermatitis, MS, GBS ```
137
Where does a prolactinoma usually reside?
Anterior pituitary gland
138
What is apraxia?
Inability to perform skilled movements
139
What is agnosia?
Inability to recognise previously familiar sensory input ie inability to recognise objects
140
What is astereognosis?
Ability to recognise objects by palpation in one hand but not the other
141
Where does a bleed usually occur in subdural haemorrhage?
Bridging veins between cortex + venous sinus
142
What is corticobasal degeneration?
Pts have a rigid limb (alien limb – moves on its own) | Develop frontal type dementia; behavior + personality changes
143
How does progressive supranuclear palsy present?
Build up of protein Tau Backward falls, early speech and swallowing problems Lose voluntary gaze; can’t move eyes up and down
144
What investigations can be used to assess multi system atrophy vs Parkinsons?
Tilt test = shows postural hypo (MSA) Hot cross bun sign on MRI = multi system atrophy MSA is symmetrical
145
Are Parkinsons symptoms symmetrical?
No – asymmetrical if idiopathic | Drug induced = symmetrical
146
When to start Levodopa in Parkinsons?
When symptoms become intolerable
147
What can be used to enhance the effect of Levodopa?
COMPT inhibitors – prevent breakdown of dopamine peripherally
148
What are the SE of dopamine agonists?
Hallucinations and confusion
149
Tx for trigeminal neuralgia
Carbamazapine
150
What is Lhermitte’s sign?
MS disease near dorsal column of cervical cord | Tingling in hands on neck flexion
151
What is Uhthoff’s phenomenon?
Worsening of vision following a rise in temp
152
What is used for prophylaxis against migraines?
Topiramate or propranolol
153
How soon must a thrombectomy be done after an ischaemic stroke?
6 hours following onset of symptoms
154
How do you treat neutropenia of chemo
Filgrastim = granulocyte stimulating factor
155
What is the most common presentation of MS?
Optic neuritis
156
What are axillary freckles a sign of?
Neurofibromatosis 1
157
What type of seizures do you typically get weakness after, and why?
Focal seizures = Todd’s palsy
158
What is the ROSIER score used for?
Recognition of stroke in ER
159
Where is the lesion in Wernicke’s aphasia?
Superior temporal gyrus
160
Management of hepatic encephalopathy
Lactulose (PO or PR) | Rifaxamin 2nd line
161
How do you differentiate between a true and pseudo seizure?
Raised prolactin = true seizure | Pelvic thrusting, crying afterwards + gradual onset = pseudo
162
Describe progressive supranuclear palsy
Impaired balance + falls Vertical gaze palsy Symmetrical onset
163
Describe the types of multi system atrophy
MSA-P – predominantly Parkinson | MSA-C – predominantly cerebellar
164
What is Shy-Drager syndrome?
Type of multi system atrophy
165
What are the symptoms of multi system atrophy?
Parkinsonism symptoms Autonomic disturbance; erectile dysfunction, postural hypotension, atonic bladder Cerebellar signs
166
Lesions in the cerebellum causing ataxia; where does gait ataxia come from, and where does finger-nose ataxia come from?
Finger nose = cerebellar hemisphere | Gait ataxia = cerebellar vermis
167
Describe the S+S of a stroke in the anterior cerebral artery
Contralateral hemiparesis + sensory loss | Lower extremity > upper extremity
168
Describe the S+S of a stroke in the middle cerebral artery
Contralateral hemiparesis + sensory loss Upper extremity > lower extremity Contralateral homonymous hemianopia Aphasia
169
Describe the S+S of a stroke in the posterior cerebral artery
Contralateral homonymous hemianopia with macular sparing | Visual agnosia
170
Describe the S+S of Weber’s syndrome
Ipsilateral CN3 palsy | Contralateral weakness of upper + lower extremity
171
What is Weber’s syndrome?
Stroke in branches of posterior cerebral artery that supply midbrain
172
Describe the S+S of a stroke in the posterior inferior cerebellar artery
``` Wallenberg syndrome Ipsilateral: face pain + temp loss Contralateral: limb/ torsa pain + temp loss Ataxia Nystagmus ```
173
Describe the S+S of a stroke in the anterior inferior cerebellar artery
Ipsilateral: facial paralysis + deafness Contralateral: limb/ torsa pain + temp loss Ataxia Nystagmus
174
Describe the S+S of a stroke in the retinal/ ophthalmic artery
Amaurosis fugax
175
What is Hoffman’s sign?
Exaggerated flexion of terminal phalaynx of thumb | Associated with upper motor neurone disease
176
What is a Jacksonian movement
Clonic movements travelling proximally | Frontal lobe epilepsy
177
What is cataplexy?
Sudden + transient loss of muscle tone due to strong emotion
178
What is Parsonage-Turner syndrome?
Peripheral neuropathy that may complicate viral illnesses, resolves spontaneously
179
What is palinopsia?
Seeing an image after the stimulus is removed
180
What is Gerstmann’s syndrome?
Dyscalcula, inability to tell L from R, dysgraphia, finger agnosia
181
Describe a hemiplegic gait
Asymmetrical, affected limb held in extension with feet inverted. Affected leg circumducts Due to unilateral UMN lesion (CVA, tumour, trauma, MS)
182
Describe a diplegic gait
Bilateral stiff limbs held in extension | Due to spinal cord lesions: tumour, transverse myelitis, spondylosis, cerebral palsy, MS
183
Describe a parkinsonian gait
Short stepping, shuffling, minimal arm swing, difficulty turning Associated with cogwheel rigidity, pin-rolling tremor
184
Describe an ataxic gait
Broad based, unsteady, foot stamping | Cerebellar, vestibular or sensory impairment: MS, B12 def, CVA, tumour
185
Describe a neuropathic gait
Foot drop = high stepping gait, feet stamping Due to common peroneal nerve palsy, L5 radiculopathy or generalized polyneuropathy (diabetic, Charcot-Marie Tooth, Guillain-Barre)
186
Describe a sensory gait
Foot slamming, may be ataxic Romberg’s positive Due to B12 def, syphilis, diabetes, vasculitis, CMT or GBS
187
Describe a myopathic gait (waddling or Trendelendburg)
Weak hip abductors so pelvis tips down; compensates by flexing torso away from bad leg or circumducts the leg Due to proximal myopathy (thyroid issues, Cushings, myositis, muscular dystrophy)
188
Describe a choreiform gait
Normal gait with involuntary choreic movements | Due to Huntingdons, cerebral palsy, Wilson’s disease, Parkinson’s meds
189
Describe a antalgic gait
Painful gait, shortened length of time on affected leg | Due to pain: OA, inflammatory joint disease, fracture, sciatica

Family Medicine (10 decks)

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