Odd bits Flashcards
OA aetiology and presentation
Destruction of bone and cartilage
- Female
- Family Hx
- Overweight
- High impact sports
Large joints - Knees, hips, thumb base
Joint pain - Worse on movement, relieved by rest
Limited ROM
Crepitus
Warmth
Square thumbs
Osteophytes - Painless
- Bouchard’s - PIP
- Heberden’s - DIP
Nerve compression?
OA investigations and management
XR - LOSS Loss of joint space Osteophytes Subchondral cysts Subchondral sclerosis
Management
- Lifestyle - Lose weight, etc.
- PT
- Paracetamol
- Topical NSAIDs
- Oral meds - NSAIDs and Opioids
- IA steroids
- Surgery - Washout or replacement
Wegener’s aetiology
Granulomatosis with polyangitis
AI
Necrotising granulomatous vasculitis
Respiratory tract + Kidneys
Wegener’s clinical features
URT - Epistaxis, sinusitis, nasal crusting
LRT - Dyspnoea, haemoptysis
Rapidly progressive glomerulonephritis - Haematuria
Saddle-shaped nose
B-symptoms
Cutaneous - Vasculitic rash
- Ocular - Redness, pain, proptosis, diplopia, blurring
- MSK - Myalgia, arthralgia, swelling
- Neuro symptoms
- VTE
Wegener’s investigations and management
Urinalysis - Haematuria
cANCA
pANCA
CXR/CT - Cavitating lesions
FBC - Anaemia
Creatinine ^
ESR ^
Renal biopsy - Epithelial cells in Bowman’s capsule
Prednisolone
Cyclophosphamide
Plasma exchange
Prognosis - 8-9 years
Goodpasture’s aetiology and clinical features
Anti-GBM
Against T4 collagen
Small vessel vasculitis
Men 2:1
20-30
60-70
HLA-DR2
Pulmonary haemorrhage
Rapidly progressive glomerulonephritis
(Proteinuria + Haematuria)
Goodpasture’s investigations / management / complications
Anti-GBM
Renal biopsy - Linear IgG deposits along BM
Transfer factor ^
Management
- Plasma exchange
- Steroids
- Cyclophosphamide
Complications = Pulmonary haemorrhage
Syphilis aetiology and clinical features
STI - Treponema Pallidum
9-90 days incubation
Primary
- Chancre - Painless ulcer
- Local non-tender lymphadenopathy
Secondary - 6-10 weeks after
- Systemic symptoms - Fevers, lymphadenopathy
- Rash on trunk, palms, soles
- Buccal ‘snail track’ ulcers
- Condylomata lata
Tertiary
- Gummas
- Ascending aortic aneurysms
- Paralysis
- Tabes dorsalis
- Argyll-Robertson pupil
Congenital syphilis
Blunted upper incisor - Hutchinson teeth
Mulberry molars
Rhagades - Linear scars at angle of mouth Keratitis Saber shins Saddle nose Deafness
Syphilis investigations
Cardiolipin tests - VDRL / RPR
- Negative after treatment
- Insensitive in late syphilis
Treponemal specific antibody tests - TPHA
- Remains positive after treatment
Syphilis management
IM Benpen
Doxycycline
Jarisch-Herxheimer reaction
- Fever, rash, tachycardia
- No wheeze or HTN
- Supportive treatment only
Steroids side effects
CORTICOSTEROIDS
Cushing's Osteoporosis Retardation of growth Thin skin, easy bruising Immunosuppression Cataracts and glaucoma Oedema Suppression of HPA axis Teratogenic Emotional disturbance Rise in BP Obesity - Truncal Increased hair growth - Hirsutism DM Striae
Toxic epidermal necrolysis aetiology and clinical features
Phenytoin Sulphonamides Allopurinol Penicillins Carbamazepine NSAIDs
Systemically unwell - Pyrexia and tachycardia
Nikolsky +ve
TENS management
Stop cause
Supportive care
IVIG
Immunosuppressant
- Ciclosporin
- Cyclophosphamide
Plasmapheresis
SJS aetiology
Phenytoin Sulphonamides Allopurinol Penicillins Carbamazepine NSAIDs
OCP!!
SJS clinical features and management
Maculopapular rash
Target lesions
Vesicles or bullae
Mucosal involvement
Systemic symptoms - Fever / Arthralgia
Admission!
Diabetic retinopathy - NON-proliferative
Mild = 1 or more microaneurysm
Moderate
- Microaneurysms
- Blot haemorrhages
- Cotton wool spots
- Venous bleeding / looping
- Intraretinal microvascular abnormalities (IRMA)
Severe
- Blot haemorrhages and microaneurysms in 4 quadrants
- Venous bleeding in 2 quadrants
- IMRA in 1 quadrant
Diabetic retinopathy - Proliferative
Retinal neovascularisation - Vitreous haemorrhage
Fibrous tissue forming anterior to retinal disc
More common in DM1
50% blind in 5 years
Transfusion reactions
Non-haemolytic Haemolytic Allergic / Anaphylaxis TRALI TACO Infective
Acute haemolytic transfusion reaction
Wrong ABO
Intravascular haemolysis
RBC destruction by IgM
Fever Abdo pain Chest pain Agitation HYPOtension
STOP transfusion
Fluid resuscitation
Allergic / anaphylaxis transfusion reaction
Hypersensitivity
Urticaria
- Stop transfusion
- Antihistamine
- Continue afterwards
Anaphylaxis HYPOtension Dyspnoea Wheeze Stridor Angioedema
Severe
- IM adrenaline
- Supportive care - Anaphylaxis workup
TRALI
Within 6 hours
Hypoxaemia - ARDS
- Hypoxia
- Fever
- HYPOtension
CXR - Pulmonary infiltrates
TACO
Fluid overload leading to pulmonary oedema
HYPERtension!!
Acute fracture management
ABCDE
Reduction
Restriction - Immobilisation
Rehabilitation
Hyperemesis gravidarum aetiology
8-12 weeks
Multiple pregnancies Trophoblastic disease Hyperthyroid Nulliparity Obesity
Protective factor - Smoking
Hyperemesis clinical features and when to admit
- 5% weight loss
- Dehydration
- Electrolyte imbalance
Admit if…
- Unable to tolerate fluids or PO antiemetics
- Ketonuria
- Weight loss > 5%
- Comorbidity
Hyperemesis investigations and management
Pregnancy-Unique-Quantification of Emesis (PUQE)
- Cyclizine
- Ondansetron
- Metoclopramide
IV fluids?
Ginger
Acupuncture
Hyperemesis complications
Wernicke’s
MW tear
Central pontine myelinolysis
Acute tubular necrosis
Small for dates
Prematurity
Burns classification
1st degree - Epidermis
2nd degree - Epidermis + Upper dermis
3rd degree - Epidermis + Full dermis
4th degree - Epidermis = Dermis + SC tissue, bones, tendon
Burns diagnosis
Rule of 9s
Palm = 1% Genitals = 1%
Arm = 9% Head = 9%
Leg = 18% Front = 18% Back = 18%
Lund & Browder chart
Burns management
> 15% in adults
10% in children
Irrigate with cool saline - 10 minutes
Cover with cling film
Cool burn + Warm patient
IV fluids - Hartmann’s
Parklands formula
(Percentage x 4 x body weight)
50% given in 8 hours
50% given in 16 hours
Wound cleaning - Topical silver sulfadiazine
Abx - Cefadroxil
Tetanus
3rd degree - Skin grafting
