Other Flashcards
(110 cards)
What is the definition of hyperlactataemia and lactic acidosis?
Hyperlactatataemia = serum lactate >2
Lactic acidosis = serum lactate >4; even in the absence of overt acidemia
How do you differentiate Type A from Type B Lactic Acidosis?
Type A Lactic Acidosis = caused by impaired tissue oxygenation
Type B Lactic acidosis = not caused by impaired tissue oxygenation
Therefore Type A usually has manifestations of hypoperfusion/shock incl reduced urine output, hypotension, cool or clammy extremities, altered mental status
What are the main causes of Type B Lactic Acidosis?
1) Diabetes - secondary to ketoacidosis or metformin toxicity
2) Malignancy - incl lеukеmia, lymрhoma, and solid malignancies
3) Alcoholism - esp chronic, severe alcoholism
4) Methanol and ethylene glycol poisoning
5) HIV antiretroviral medication-induced mitochondrial dysfunction
6) Beta-adrenergic therapy - eg salbutamol
7) Inherited mitochondrial disorders eg MELAS (Mitochondrial Encephalopathy with Lactic Acidosis and Stroke-like episodes syndrome
8) Thiamine deficiency
9) Propofol therapy
10) Linezolid therapy
What is Yellow Nail syndrome?
An uncommon disorder characterized by the triad of chronic lung disease; lymphedema; and slow-growing, yellow nails without a cuticle or lunula
Nails progressively thicken, becoming opaque and curved with loss of the lunula and cuticle
What is Yellow Nail syndrome typically related to?
Chronic respiratory illness (esp pleural effusions and chronic bronchitis) and lymphoedema
Rarely assoc with RA, internal malignancy and immunodeficiency
How do you treat Yellow Nail syndrome?
Treat underlying condition
Oral Vitamin E
Oral Zinc
Oral itraconazole
Most treatments disappointing
What percentage of patients with pulmonary sarcoidosis have skin involvement?
20-30%
What percentage of patients with cutaneous sarcoidosis have other organ involvement?
70%
How do you treat cutaneous sarcoidosis?
Topical steroids
Consider MTx if severe
What is cutaneous T cell lymphoma?
A diverse group of neoplasms of skin-homing T cells with great variation in appearance, histology, immunophenotype and prognosis
What is the most common type of T cell lymphoma?
Mycosis fungoides - represents half of cases
What is the classical presentation of mycosis fungoides?
Poikilodermatous patches and plaques typically in bathing-suit distribution
What is the 5 year survival in Mycosis fungoides?
88%
What are Neutrophilic Dermatoses?
A heterogenous group of disorders with overlapping clinical and histologic findings that are often assoc with internal diseases eg haem malignancy, dyscrasias, monoclonal gammopathy, IBD, RA
What is the classic appearance of neutrophilic dermatoses?
Infiltrated papules, nodules, pustules +/- infiltrates affecting eyes, joints, bones, lung, liver, brain and lymph nodes
Key includes violaceous and undermined edges and display pathergy (trauma worsens extent of problem, so do not debride)
What is Sweet Syndrome?
Acute febrile neutrophilic dermatosis
Infiltrated erythematous plaques and bullae favouring head/neck + constitutional symptoms
Most commonly secondary to AML, IBD, autoimmune disorders, drugs (azathioprine), pregnancy, infections (strep, GI yersiniosis)
What is the treatment and prognosis of Sweet Syndrome?
Treat underlying condition
High dose steroids
Supportive tx of fever
Resoles in 5-12 weeks but may recur
What is pyoderma gangrenosum?
The most common form of Neutrophilic Dermatosis
What is Anetoderma?
Reactive phenomenon commonly assoc with autoimmune disorders (Graves, Lupus, Sjogren’s), HIV, leprosy, chickenpox, cutaneous B-cell lymphoma, infantile haemoangioma
Presents with focal atrophic plaques - buttonhole sign (on pinching)
Hard to treat
What is Vitiligo?
Loss of melanocytes
Affects 0.5-1% of population
Assoc with autoimmune thyroid disease, T1DM, pernicious anaemia, Addison disease, SLE, RA, psoriasis, alopecia areata
How do you treat Vitiligo?
Topical steroids or calcineurin inhibitors
Narrowband UVB
Sometimes in recalcitrant issues requires systemic steroids, surgical grafting, depigmentation therapy
Camouflage make-up
However not treating at all is also an option
How does Cryoglobulinaemia present?
Acral cyanosis
Severe Raynaud’s with ulceration
Purpura
Livedo
Arterial thrombosis
Ulcers
Arthralgias/arthritis
May have systemic manifestations incl
membranoproliferative GN
Interstitial lung infiltrates
Sensory neuropathy
Abdominal pain
What conditions is Cryoglobulinaemia assoc with?
Haematological malignancies incl multiple myeloma, CLL, Waldenstrom’s
Autoimmune incl RA, SLE, systemic sclerosis, vasculitis, glomerulonephritis
Infection - hep A/B/C
How do you treat Cryoglobulinaemia?
Treat underlying condition
Keep warm
Rituximab for Hep-C assoc disease
Plasmapharesis + cytotoxic agent if life threatening complication