Multi-system Flashcards
What spinal issue can be see in duchenne
Scoliosis
Dx and Tx for Duchenne
Dx with either biopsy of muscle or genetic test. Tx with steroids
What can eventually occur in the joints of a DMD patient
Joint contractures
Why does CK drop in the progression of duchenne
As the muscle is replaced by fibrofatty infiltration… the CK will drop a bit
List so,e complications of Prada Willi syndrome
All relates to obesity. Sleep apnoea, DM, choking, gastric rupture. So make sure to limit food for these little chubby kids. Also can give GH, to increase vertical growth
Protruding Metopic suture, seen where
Seen in cris du chat
Name some of the less obvious edwards signs
Low set ears, small jaw, limited hip abduction
Screening recommendations for gon chlam infx
Annual NAAT test, for sexually active under 25 (or has RFs)
What is congenital contractural arachnodactylyl
A fibrilin II defect, causing Mariah features, except no CV or ocular signs
AL Amyloidosis main manifestations
Nephrotic syndrome, Hmeg, periorbital purpurin, waxy skin, restrictive cardiomyopathy
Why is lymphoedema not pitting
Because the protein concentration is high
Two reasons we need estrogen therapy in turners syndrome
For sexual development, but also to decrease risk of osteoporosis
The gene test we have to do for CHARGE syndrome
CHD7
Contrast manifestions of CREST and diffuse SS
CREST:
• Scleroderma on head & distal UE
Prominent vascular manifestations
• Raynaud phenomenon
• Cutaneous telangiectasia
• Pulmonary arterial hypertension
• CREST syndrome
Diffuse SS:
• Scleroderma on trunk & UE
• Prominent internal organ involvement
• Scleroderma renal crisis
• Myocardial ischemia & fibrosis
• Interstitial lung disease
Joint fluid:
> 10,000 wbc
> 75% PMN
culture it… likely septic
WBC numbers in joint fluid to remember for step
<2000 is normal
2,000-10,000 is inflam
> 10,000 is septic
Join fluid with blood and fat droplet
Maybe fracture
Foot puncture wound and osteoM… cover which bac
Pseudomonas
Adults vs kids. Osteomyelitis. Which is more from seeding and which from contiguous spread
Adults from spread, kids more seedinh
If patient had allergic rash on penicillin, can we give ceph? What about anaphylaxis or angioedema
Yes, and No
Are OA patients at higher risk of osteoporosis after Sx
Yes
Viscosity of joint fluid in inflam
Lower!
Retina bulls eyes appearance
Chloroquine tox
Don’t forget carpal tunnel from RA
Other than AR… what other cardiac issue in ank spond
Heart block
Mixed connective tissue disease AB
U1 RNP Ab
Other than our tigger and target zones… what else do we see in myofascial pain and not fibromyalogia
Myofascial pain can be seen in muscle tissue only. Whereas fibro also in other CT
Anti RNA polymerase III in SS a risk for what?
Scle renal crisis
CS can be given for SS flare…. But what is the main risk
Increased risk for renal crisis
CREST mainstay Tx
Methotrexate usually
Is lupus arthritis deforming
No
Aortic complications of GCA
Aneurysm
Most common artery affected in AION in GCA
Posterior ciliary artery. From the ophthalmic. From the ICA
Commonest cause of mortality in Behcets
Thrombosis
Preventing recurrence in Behcets?
Colchicine (sounds Turkish too)
Some other random causes of adhesive capsulitis
DM, hypothyroid, contractures, stroke, shoulder injury
Rotator cuff impingement Dx test
X-ray! Not MRI (if tear)
Compartment syndrome delta pressure cut off
30
Open fractures usually need what intervention (medically)
Abx and Tet prophylx
Within how many hours to prevent long term complications of compartment syndrome
6 hours to do fasciotmy. Main Px factor
Durkan test (carpal compression): positive in what?
Carpal tunnel
Carpal tunnel worse when
At night
Carpal tunnel risks
Preg, DM, hypothyroidism, acromegaly, RA, amyloidosis, overuse
Are ganglion cysts mobile
Not usually
Dupytrens contracture…. High recurrence after Tx?
Yes?
Alarm signs of hand bite and invx to do
Crepitus and skin discolouration. Do X-ray and usual labs
Osteochondritis dissecans Signs
Antalgic gait patient, usually adol boy, how does a lot of activity. Almost OA like signs. Often has history of ankle inversions
Patellofemoral pain syndrome overview of signs
Anterior knee pain. Overuse injury. Worse when walking up and downstairs. Worse when squatting. Squeeze test positive. Just rest and give nsaid, quad training
Morton neuroma signs
Click sensation when palpating area, numbness and pain and paraesthesia. Symptoms worse than squeezing metatarsal
Postmenopausal women is a risk factor for gout.
Salicylates. High-dose or low-dose can cause hyperuricaemia
Low-dose
Acute attacks for gout first line is NSAID. Name me a couple of circumstances where the contra indicated.
Heart failure, chronic kidney disease, peptic ulcer disease, anticoagulant patient
Colchicine is only useful in gout and Sudo gout after how long after disease Flair onset
24 hours
Xanthine oxidase inhibitor is an increase the risk of what in gout
Nephrolithiasis
Uricosuricsh drugs are contraindicated in what circumstances in gout
Toffee, nephrolithiasis, CKD
What’s the issue with giving a. XOI, In patients were taking Azathioprine or six mercaptopurine
Remember these therapeutics require xanthine oxidase as degradation
Hypothyroidism is linked to go out or pseudogout
Pseudogout
A couple of ways to distinguish between L2 to L4, and L5
First one will have lots of hip flexion, need extension, foot dorsi flexion. Patella reflex gone. Anterior thigh and medial aspect of lower leg is gone.
L5 you will lose big toe dorsi flexion and foot aversion. Lateral aspect of the leg and dorsum of the foot tend to go
 Is active ROM, but with limited impact on passive ROM, is characteristic of which specific problem. Could be more than one,
Bursitis
Post op fever timing.
any time:
One to 3 days:
4 to 5 days:
More than a week:
Drug reactions
Atelectasis or pneumonia
UTI
DVT/PE
Surgical site infection
If fever of unknown origin work up is negative, what is the prognosis for the patient
Usually very good
What is the malaria prophylaxis a GP should give
Before patient travels to endemic region give atovaquone proguanil, mefloquine. They should be given two weeks before travel and continued for four weeks after return
CI to give the following:
Primaquine
Mefloquine
Arovaquone
Chloroquine:
G6PD (test prior)
Seizure, psych, cardiac condition issue
Preg or breastfeed, or CKD
Psoriasis
Malaria fever patters
Chikungunya
Join pain (mozzy bite)
We all know Zeca can cause micro carefully. What can I do neurologically to the patient directly
Guillain barré
What is the diagnosis steps for Lymes disease initially
Do no serology. Since usually negative until weeks after. So just clinical
Diagnostic steps for disseminated or late limes
Must do ELIZA. Then if positive to Western blot
If someone has a tick bite, what are the criteria to give prophylactic doxycycline
The Tick is ixodes.
The tick was in for more than 36 hours. Prophylaxis can be started less than 72 hours of removal. They have no contra indications to doxy.
Local rate of infection in the tics for Borrelia is more than 20%
If patient gets limes disease. You usually treat this early disease with doxycycline. How do you treat pregnant patient? How do we treat young patients? How do we treat more advanced disease, CNS involvement, cardiac involvement, arthritic involvement.
Amoxicillin for pregnant patients. Young patients can be given doxy. Advance cases you can give Foxy
Dengue virus
Phone pain, thrombocytopenia, shock, hi LFT. Just give fluids and blood products as needed
Banesiosis
Also by same tick as limes disease. Coinfection common. Causes intravascular homolysis and the Maltese cross in blood Smith. Give oral azithromycin
Rocky mountain spotted fever. How to manage
Clinical diagnosis at 1st to empiric treatment. Give doxycycline. If patient is pregnant in first two trimesters, tried to give chloramphenicol. Confirmed diagnosis with biopsy and immunofluorescence
Name some states that rocky mountain spotted fever can be seen
North Carolina, Virginia, Missouri, Arkansas
Name a few complications of infectious mononucleosis
Nasopharyngeal carcinoma, haemolytic anaemia, hepatic necrosis, bacterial superinfection, upper airway obstruction, spleen rupture, CNS infection
If a patient with infectious mononucleosis gets upper airway obstruction (swollen tonsils), or haemolytic anaemia what do we do
Give corticoster
If a patient has infectious mononucleosis presentation, Monospot is negative. What two steps do you have to do in your head
Test the EBV antibody. As the Monospot can be negative.
If the antibody test is negative then it maybe is CMV, toxo, HIV
What is the caveat with B cells and T cells in EBV infection
The bee cells cause the lymphocytosis, but the T cells are the atypical cells
Why is a concurrent STI a risk for HIV
Because there’s lots of macrophages in the area, and that means that more HIV can infect the macrophages
Recall my three structural genes in HIV
Env (GP120 and GP41) gag (P24 and P17) pol (Reverse transcriptase, integrates, protease
Recall the receptor on macrophages, and the receptor on T cells that allow HIV to enter
CCR five on macrophages, CXCR4 On T cells. CCR five mutations can cause immunity if homozygous, or slower course if heterozygous
HIV patient, cd4 less than 50. Fever, night sweats, focal lymphadenitis
MAC
List the opportunistic infections that can occur at a CD less than 500
Oral thrush, hairy leukoplakia, Kaposia, HPV and TB
List the opportunistic infections that can occur at a CD less than 200
Histoplasmosis, HIV Dementia, junkie cerebrum, pneumocystitis