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3B > Odd bits > Flashcards

Odd bits Flashcards

1
Q

OA aetiology and presentation

A

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?

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2
Q

OA investigations and management

A 
XR - LOSS 
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

Management

  1. Lifestyle - Lose weight, etc.
  2. PT
  3. Paracetamol
  4. Topical NSAIDs
  5. Oral meds - NSAIDs and Opioids
  6. IA steroids
  7. Surgery - Washout or replacement
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3
Q

Wegener’s aetiology

A

Granulomatosis with polyangitis

AI
Necrotising granulomatous vasculitis

Respiratory tract + Kidneys

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4
Q

Wegener’s clinical features

A

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
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5
Q

Wegener’s investigations and management

A

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

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6
Q

Goodpasture’s aetiology and clinical features

A

Anti-GBM
Against T4 collagen
Small vessel vasculitis

Men 2:1
20-30
60-70
HLA-DR2

Pulmonary haemorrhage
Rapidly progressive glomerulonephritis
(Proteinuria + Haematuria)

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7
Q

Goodpasture’s investigations / management / complications

A

Anti-GBM

Renal biopsy - Linear IgG deposits along BM
Transfer factor ^

Management

  • Plasma exchange
  • Steroids
  • Cyclophosphamide

Complications = Pulmonary haemorrhage

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8
Q

Syphilis aetiology and clinical features

A

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
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9
Q

Congenital syphilis

A

Blunted upper incisor - Hutchinson teeth
Mulberry molars

Rhagades - Linear scars at angle of mouth
Keratitis
Saber shins
Saddle nose
Deafness
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10
Q

Syphilis investigations

A

Cardiolipin tests - VDRL / RPR

  • Negative after treatment
  • Insensitive in late syphilis

Treponemal specific antibody tests - TPHA
- Remains positive after treatment

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11
Q

Syphilis management

A

IM Benpen
Doxycycline

Jarisch-Herxheimer reaction

  • Fever, rash, tachycardia
  • No wheeze or HTN
  • Supportive treatment only
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12
Q

Steroids side effects

A

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
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13
Q

Toxic epidermal necrolysis aetiology and clinical features

A 
Phenytoin
Sulphonamides
Allopurinol
Penicillins
Carbamazepine
NSAIDs

Systemically unwell - Pyrexia and tachycardia
Nikolsky +ve

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14
Q

TENS management

A

Stop cause

Supportive care

IVIG

Immunosuppressant

  • Ciclosporin
  • Cyclophosphamide

Plasmapheresis

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15
Q

SJS aetiology

A 
Phenytoin
Sulphonamides
Allopurinol
Penicillins
Carbamazepine
NSAIDs

OCP!!

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16
Q

SJS clinical features and management

A

Maculopapular rash
Target lesions

Vesicles or bullae

Mucosal involvement

Systemic symptoms - Fever / Arthralgia

Admission!

17
Q

Diabetic retinopathy - NON-proliferative

A

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
18
Q

Diabetic retinopathy - Proliferative

A

Retinal neovascularisation - Vitreous haemorrhage
Fibrous tissue forming anterior to retinal disc

More common in DM1
50% blind in 5 years

19
Q

Transfusion reactions

A 
Non-haemolytic
Haemolytic
Allergic / Anaphylaxis
TRALI
TACO
Infective
20
Q

Acute haemolytic transfusion reaction

A

Wrong ABO

Intravascular haemolysis
RBC destruction by IgM

Fever
Abdo pain
Chest pain
Agitation
HYPOtension

STOP transfusion
Fluid resuscitation

21
Q

Allergic / anaphylaxis transfusion reaction

A

Hypersensitivity

Urticaria

  • Stop transfusion
  • Antihistamine
  • Continue afterwards
Anaphylaxis 
HYPOtension
Dyspnoea
Wheeze
Stridor
Angioedema

Severe

  • IM adrenaline
  • Supportive care - Anaphylaxis workup
22
Q

TRALI

A

Within 6 hours

Hypoxaemia - ARDS

  • Hypoxia
  • Fever
  • HYPOtension

CXR - Pulmonary infiltrates

23
Q

TACO

A

Fluid overload leading to pulmonary oedema

HYPERtension!!

24
Q

Acute fracture management

A

ABCDE

Reduction
Restriction - Immobilisation
Rehabilitation

25
Q

Hyperemesis gravidarum aetiology

A

8-12 weeks

Multiple pregnancies
Trophoblastic disease
Hyperthyroid
Nulliparity
Obesity

Protective factor - Smoking

26
Q

Hyperemesis clinical features and when to admit

A
  1. 5% weight loss
  2. Dehydration
  3. Electrolyte imbalance

Admit if…

  • Unable to tolerate fluids or PO antiemetics
  • Ketonuria
  • Weight loss > 5%
  • Comorbidity
27
Q

Hyperemesis investigations and management

A

Pregnancy-Unique-Quantification of Emesis (PUQE)

  1. Cyclizine
  2. Ondansetron
  3. Metoclopramide

IV fluids?

Ginger
Acupuncture

28
Q

Hyperemesis complications

A

Wernicke’s
MW tear
Central pontine myelinolysis
Acute tubular necrosis

Small for dates
Prematurity

29
Q

Burns classification

A

1st degree - Epidermis
2nd degree - Epidermis + Upper dermis
3rd degree - Epidermis + Full dermis
4th degree - Epidermis = Dermis + SC tissue, bones, tendon

30
Q

Burns diagnosis

A

Rule of 9s

Palm = 1%
Genitals = 1%
Arm = 9%
Head = 9%
Leg = 18%
Front = 18%
Back = 18%

Lund & Browder chart

31
Q

Burns management

A

> 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

3B (23 decks)

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