Other Flashcards
Leriche syndrome
Thigh/buttock claudication
Absent femoral pulses
Male impotence
Distal aorta or proximal common iliac artery occulsion
Arterial leg ulcers
Are smaller than venous ulcers
Are deeper than venous ulcers
Have well defined borders
Have a “punched-out” appearance
Occur peripherally (e.g., on the toes)
Have reduced bleeding
Are painful
Venous leg ulcers
Occur after a minor injury to the leg larger & superficial than arterial ulcers
irregular, gently sloping borders
gaiter area of the leg (from the mid-calf down to the ankle)
Are less painful than arterial ulcers
Occur with other signs of chronic venous insufficiency (e.g., haemosiderin staining and venous eczema)
Starting on long term steroids
DONT Stop
Don’t – steroid dependence after 3 weeks of treatment - abruptly stopping risks adrenal crisis
S – Sick day rules
T – Treatment card
O – Osteoporosis prevention (e.g., bisphosphonates and calcium and vitamin D)
P – PPI
Bechet’s disease
Oral ulcers: 3 times per year
Genital ulcers
Erythema nodosum
Anterior/ posterior uveitis
Pathergy test
Gout
monosodium urate crystals
needle-shaped
negatively birefringent
NSAID/ colcichine
Allopurinol
Side effect of colcichine:
diarrhoea
Psudeogout
calcium pyrophosphate crystals
rhomboid
positively birefringent
Chondrocalcinosis
Nephritic syndrome
PHAROH
Proteinuria (protein in the urine), < 3g per 24 hours
Haematuria: micro/ macroscopic
Azootemia - high urea and creatinine
Red Cell Casts
Oliguria
Hypertension
Fluid retention
Nephrotic Syndrome
Proteinuria (more than 3g per 24 hours)
Low serum albumin (less than 25g per litre)
Peripheral oedema
Hypercholesterolaemia
Thrombosis
HTN
Nephrotic Syndrome Causes
Children: minimal change disease - steroids
Adults: Membranous nephropathy
Focal segmental glomerulosclerosis
IgA nephropathy
(or Berger’s disease) is the most common cause of primary glomerulonephritis.
20s presenting with haematuria. Histology: IgA deposits and mesangial proliferation.
The mesangial cells are found in the centre of the glomerulus and help support the capillaries (as well as performing other functions).
Membranous nephropathy
deposits of immune complexes in the GBM causing thickening and malfunctioning of the membrane and proteinuria.
Histology shows IgG and complement deposits on the basement membrane.
It is a key cause of nephrotic syndrome in adults.
The majority (around 70%) are idiopathic.
can be secondary to malignancy, systemic lupus erythematosus or drugs (e.g. NSAIDs).
Membranoproliferative glomerulonephritis (or mesangiocapillary glomerulonephritis)
typically affects patients under 30. It involves immune complex deposits and mesangial proliferation.
Post-streptococcal glomerulonephritis
tends to affect patients under 30. It presents 1-3 weeks after a streptococcal infection (e.g., tonsillitis or impetigo). Patients usually make a full recovery.
Rapidly progressive glomerulonephritis (or crescentic glomerulonephritis)
presents with an acute severe illness but tends to respond well to treatment. Histology shows glomerular crescents.
Goodpasture syndrome
anti-glomerular basement membrane (anti-GBM) disease.
antibodies attack the glomerulus and pulmonary basement membranes.
glomerulonephritis and pulmonary haemorrhage.
20s or 60s with acute kidney failure and haemoptysis
Systemic diseases that can cause glomerulonephritis include?
Henoch-Schönlein purpura (HSP)
Vasculitis (e.g., microscopic polyangiitis or granulomatosis with polyangiitis)
p-ANCA (or MPO antibodies) – microscopic polyangiitis
c-ANCA (or PR3 antibodies) – granulomatosis with polyangiitis
Lupus nephritis (associated with systemic lupus erythematosus)
Henoch-Schonlein Purpura
IgA vasculitis, in children, purpuric rash affecting the lower limbs and buttocks.
IgA deposits in the blood vessels.
URTI/ GI usually triggers
Purpura (100%),
Joint pain (75%),
Abdominal pain (50%)
Renal involvement (IgA nephritis) (50%)
Polyarteritis Nodosa
medium-vessel vasculitis
idiopathic or secondary to infections, particularly hepatitis B
Renal impairment
Hypertension
Tender, erythematous skin nodules (similar to erythema nodosum)
Myocardial infarction
Stroke
Mesenteric arteritis causing intestinal symptoms
Kawasaki Disease
medium-vessel vasculitis.
young children, typically under 5 years of age.
Persistent high fever for > 5 days
Widespread erythematous maculopapular rash
Desquamation (skin peeling) of palms & soles
Bilateral conjunctivitis
Strawberry tongue
Takayasu’s Arteritis
large vessel vasculitis- aorta and its branches. can also affect the pulmonary arteries.
swell and form aneurysms or become narrowed and blocked.
Stenosis or occlusion can reduce the pulses and blood pressure - “pulseless disease”.
presents before age 40, with non-specific systemic sx , such as fever, malaise and muscle aches.
claudication symptoms particularly in arm
CT or MRI angiography.
