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PACES Station 5 Flashcards

1
Q

Clinical Features of Acromegaly

A 
Large, sweaty hands
Thickened skin
Prominent supraorbital ridges, enlarged nose and lips
Prognathism
Interdental separation
Macroglossia
Hypertrichosifs
Gynaecomastia
Bitemporal hemianopia (10%)
Carpel tunnel
HTN
Cardiomegaly
Diabetes
Arthropathy
Skin tags and colonic polyps
Headaches, change in ring size/show size
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2
Q

Pathophysiology of Acromegaly

A

Most commonly caused by a growth hormone secreting adenoma of the anterior pituitary. 75% are macro adenomas

Rarer causes include ectopic GH release from carcinoid or small cell tumours

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3
Q

Complications of Acromegaly

A 
HTN
Cardiomegaly
Arthritis
IGGT/DM
Visual field defects
Cranial nerve palsies
Tumours: fibroids and colonic polyps with risk of developing into malignancy
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4
Q

Investigating possible Acromegaly

A

Oral glucose tolerance test - should suppress GH
Serum insulin-like growth factor 1
MRI pituitary

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5
Q

Management of Acromegaly

A

Surgical - transphenoidal hypophysectomy with attempt to leave remaining pituitary intact to preserve function

Medical - somatostatin analogues (ocreotide) inhibit GH release. Cause gallstones.
Bromocriptin (Dopamine)agonist

Radiotherapy if surgery contraindicated is an option but also effects other pituitary hormones and visual loss

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6
Q

Differential Diagnosis for lump in Neck

A

Congenital - thyroglossal cyst, branchial anomalies
LNs - bacterial, viral, granulomatous, malignancy
Vascular - aneurysm
Salivary - tumour
Neurogenic - schwannoma, neurofibroma
Thyroid…

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7
Q

Management of Thyroid Nodule

A
  1. Functioning or not?
    - serum TSH, if low suggests need scintigraphy to delineate hot nodule or not
    - if TSH normal or high then FNA

Histology may be indeterminate but generally still remove

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8
Q

Types of Thyroid Cancer

A

Papillary carcinoma - most common and most favourable prognosis. Radio iodine /surgical management

Follicular carcinoma

Anaplastic carcinoma - highly aggressive undifferentiated

Medullary thyroid carcinoma - associated with MEN2a (phaeo and primaryPTH), MEN2b (phaeo + marfanoid)

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9
Q

Complications of Large Goitre

A 
Dyspnoea and airway obstruction
Dysphagia
Recurrent laryngeal nerve palsy
Horners
Jugular vein compression
Cerebrovascular steal syndrome
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10
Q

Clinical Features of Thyrotoxicosis

A

Goitre (usually non-tender), smooth diffuse in graves
Heat intolerance, sweating, agitation, stress
Weight loss, palpitations
AF
Brisk reflexes
Eyes - proptosis, ophthalmoplegia, lid lag
Specific to graves - proptosis, thyroid acropachy, pretibial myxoedema

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11
Q

Investigations of Thyrotoxicosis

A

TSH/T4
Thyroid autoantibodies
Radioisotope scanning

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12
Q

Management of Graves Thyrotoxicosis

A

Beta blocker - propranolol
Carbiomazole or propylthiouracil
Titrate dose
Stop at 18months (1/3 will remain euthyroid)

IF returns consider:

  • repeat course
  • radioiodine
  • subtotal thyroidectomy

High dose steroids/surgical decompression for severe ophthalmoplegia

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13
Q

Progression of Eye Signs in Graves

A 
NOSPECS
No signs
Only lid lag
Soft tissue involvement
Proptosis
Extraoccular muscle involvement
Chemosis
Sight loss due to optic nerve compression/atrophy
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14
Q

Common causes of Hyperthyroidism

A 
Graves
Hashimotos (thyrotoxicosis before hypothyroid)
Toxic adenoma
Iodine induced
TSH secreting tumour (rare)
Infective thyroiditis
Post-partum thyroiditis
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15
Q

Causes of Hypothyroidism

A

Primary

  • autoimmune (hashimotos)
  • iodpathic atrophy
  • previous radio iodine
  • antithyroid drugs
  • infiltrative: sarcoid, systemic sclerosis

Secondary
-hypothalamic, pituitary disease

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16
Q

Drugs causing Hypothyroidism

A

Iodine contrast
Lithium
Sunitinib (tyrosine kinase inhib) used in renal cell carcinoma

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17
Q

Features of Cushings

A 
Cushingoid facies
Centripetal obesity
Inter scapular fat pad
Acne vulgaris
Purpuric and petechial rashes
Bruising
Violaceous striae
Proximal myopathy
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18
Q

Pathophysiology of Cushings Disease

A

Hyper secretion of ACTH from pituitary adenoma

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19
Q

Causes of Cushings Syndrome

A

ACTH dependent:

  • Cushings disease (pituitary adenoma)
  • Ectopic ACTH from SCLC or carcinoid

ACTH independent

  • exogenous steroid administration
  • adrenocortical adenoma/carcinoma
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20
Q

Investigations for cortisol excess

A

24hr urinary free cortisol (x3)
Midnight salivary/serum cortisol
Dexamethasone suppression test (no ACTH suppression)

Low dose dexamethasone suppression test can help distinguish between bushings and pseudocushings

Consider inferiors petrosal sinus sampling in ACTH dependent Cushings with no clear pituitary source

Check Calcium - hyperPTH in MEN1

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21
Q

Complications of Cushings

A

Diabetes
Osteoporosis
HTN
Cataracts

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22
Q

Management of Cushings Syndrome

A

If adenoma - surgical transphenoidal/adrenalectomy

If adjunct needed then ketoconazole used to inhibit steroid genesis

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23
Q

Nelsons Syndrome

A

Enlargement of a pituitary corticotroph adenoma due to absence of negative feedback from adrenal cortisol following removal of both adrenals.

Also get hyper pigmentation as high ACTM stimulated melanocyte stimulating hormone

May get bitemporal hemianopia

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24
Q

What is MEN1?

A

Autosomal dominant

  • Pituitary adenoma (cushings)
  • hyperparathyroidism
  • pancreatic gastrinoma
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25
Q

Clinical Features of Addisons Disease

A

Widespread pigmentation - buccal mucosa, skin creases and pressure areas
Calcification of auricular cartilage
No adrenelectomy scars (would be present in Nelsons)
Postural hypotension

Other autoimmune conditions: vitiligo, T1DM, Pernicious anaemia, RA, SLE, Sj

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26
Q

Causes of Primary Adrenal Failure

A 
Autoimmune (Addisons)
TB
Bilateral adrenelectomy
Amyloidosis
Haemochromatosis
HIV
Haemorrhagic infarcts - meningococcal
Adrenal Mets
Congenital Adrenal Hyperplasia
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27
Q

Diagnostic Tests for Adrenal Insufficiency

A

9 am serum cortisol

Synacthen test

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28
Q

Management of Adrenal Failure

A

Adrenal crisis - rapid steroid, fluid replacement and reversal of electrolyte abnormalities (low Na, high K)

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29
Q

Causes of Pituitary Failure

A 
Pituitary mass
Previous pituitary surgery/radiotherapy
Infiltrative disease
Pituitary infarct (Sheehans)
Pituitary apoplexy
Trauma/ SAH
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30
Q

Causes of Gynaecomastia

A 
Hypogonadism
Testicular tumour
Chronic Liver Disease
CKD
Klinefelters
Thyrotoxicosis
Carcinoma of lung
Drugs: digoxin, spironolactone
Puberty
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31
Q

Klinefelters Syndrome

A 
Tall
Gynaecomastia
Other features of hypogonadism including small, firm testes
Autoimmune disease
Mitral valve prolapse
Varicose veins

Genetics: XXY or mosaicism XXY:XY

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32
Q

Turners Syndrome

A

XO

Short stature, square chest
Widely spaced nipples
Webbed neck
Nail dysplasia
High arch palate
Short fourth metacarpals
Numerous naevi
Wide carrying angle

Associated: Coarctation, DM, renal malformations, cataracts, ptosis

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33
Q

Physiological Actions of Parathyroid Hormone

A

Stimulated by low Calcium

Bone: increase bone resorption
Kidneys: stimulates calcium reabsorption and inhibits phosphate (unlike vitD which promotes uptake of both)
Stimulates vitD synthesis

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34
Q

Clinical Features of RA

A 
Symmetrical deforming polyarthropathy
Involves PIPs and MCPs
Palmar subluxation and ulnar deviation
Swan neck, boutonnieres and Z deformity
Rheumatoid nodules (firm, non-tender)
May be vasculitic nail fold infarcts/pupura
Risk of nerve entrapments

Then: MSK, ears, eyes, c-spine, lungs, heart, spleen, kidneys

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35
Q

Diagnostic Criteria for RA

A 
ACR - at least 4 of the following:
-morning stiffness >1hr
-symmetrical joint involvement
-arthritis in >3 joints
involves small joints of hand
-postive RF
-rheumatoid nodules
-radiographic evidence
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36
Q

Rheumatoid Factor

A

IgM against Fc of IgG. Present in 75% of RA and occurs in other autoimmune connective tissue disease e.g. SLE.

Suggests more aggressive joint disease than seronegative disease and extra-articular manifestations more common

AntiCCP also a poor prognostic marker

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37
Q

Possible causes of anaemia in RA

A 
Anaemia of chronic disease
Iron deficiency -GI loss due to NSAIDs
Folate deficiency - methotrexate
Pernicious anaemia
BM suppression - gold, methotrexate, sulphasalazine
Feltys
Anaemia of renal disease
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38
Q

Eye involvement in RA

A 
Episcleritis (painless)
Scleritis (painful)
Cataracts - steroids
Sjogrens
Extraoccular muscle tenosynovitis
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39
Q

Renal disease in RA

A

Membranous glomerulonephritis - gold
Mesangioproliferative glomerulonephritis
Acute tubulointerstitial nephritis - NSAIDs
Renal amyloidosis

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40
Q

Principles of Management of RA

A

MDT
General: education, physio, OT, bone protection, pneumovax
Analgesia
DMARDS
Biologicals - antiTNF (infliximab/adaluminab)
Corticosteroids

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41
Q

DMARDS in RA

A

Sulphasalazine - risk of nausea, rash neutropenia - 3 monthly FBC, LFT

Methotrexate - need baseline CXR and monitor LFT, FBC

Leflunomide- risk of HTN, neutropenia

Azathioprine - check TPMT prior to starting (predicts BM toxicity)

Ciclosporin - causes HTN and renal impairment

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42
Q

Clinical Features of Psoriatic Arthropathy

A

Nails - pitting, onycholysis, transverse ridging
Psoriatic plaques
Koebners phenomenon - plaques over sites of trauma

Other things to examine:

  • MSK association with gout
  • CVS: Aortitis and AR
  • Resp: apical lung fibrosis
  • Eyes: conjunctivitis, uveitis
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43
Q

Patterns of Psoriative Arthropathy

A

Asymmetrical, oligoarthritis involving DIP

Symmetrical polyarthritis involving PIP and MCP (rheumatoid pattern)

DIP arthritis

Arthritis mutilans - aggressive deforming disease with bone resorption leading to telescoping

Spondylitis/sacroilitis - asymmetrical unlike AnkSpond

44
Q

Enthesitis

A

Inflammation of tendon insertion

45
Q

Dactylitis

A

Inflammation of tendon sheath leading to sausage like swollen fingers

46
Q

Management of Psoriatic arthropathy

A

MDT…
Analgesia
Corticosteroids
DMARDs - methotrexate, sulfasalazine, cyclosporin

47
Q

Adverse effects of antiTNF alpha

A 
Serious infection e.g. TB
Haematological malignancy
Nausea
Hypersensitivity
Worsens heart failure
48
Q

Contraindications for antiTNF alpha

A 
Pregnancy/breastfeeding
Active bacterial infection
Active TB (need 2 month therapy before initiating)
Septic arthritis
CCF
Demyelinating disease
49
Q

Clinical Features of Ankylosing Spondylitis

A 
Severe kyphosis with protuberant abdomen
Decreased cervical movement
Decreased spinal movement
Reduced chest expansion
Schobers test positive - 10 above, 5 below dimples of venus should increase by 5cm

Extra bits: anterior uveitis, aortic regard, apical fibrosis, AV block (check pacemaker)

50
Q

Definition of Ankylosing Spondylitis

A

Symptomatic sacroilitis for > 3 months with morning stiffness and improvement with exercise, worsening with rest

51
Q

Systemic Manifestations of Ankylosing Spondylitis

A 
Eyes: anterior uveitis
Aortic regurg
AV block
Apical fibrosis
Atlantoaxial subluxation
Achilles tendonitis
Amyloidosis
52
Q

Diagnosing Ank Spond

A

Clinical hx
Raised inflammatory markers
evidence of sacroilitis on XR/MRI

53
Q

Management of Ank Spond

A 
MDT...
Education
Physio/OT
Analgesia
Corticosteroids
DMARDs - gold, penicillamine (methotrexate and sulphasalazine help peripheral disease but not spine)
Biologicals such as adalimumab
54
Q

Clinical Features of Gout

A

Asymmetrical joint deformity and swelling
Tophi, hands, feet, ears
Olecranon bursa

55
Q

Differential Diagnosis for single inflamed joint

A 
Gout/pseudogout
Septic arthritis
Spondyloarthritis
OA
Lyme disease/stills disease
56
Q

Pathophysiology of Gout

A

Uric acid produced by breakdown of purines in liver by enzyme xanthine oxidase - eliminated by kidneys and GI tract

Causes:

  • reduced excretion: HTN, CKD, drugs (ACEi, aspirin, thiazides)
  • Increased purine production: diet, lymphoproliferative disorders, secondary polycythaemia, glycogen storage disease
57
Q

Management of Gout

A

Acute: rest, rehydrate, NSAIDs, colchicine

Recurrent: lifestyle advise, allopurinol

58
Q

What is pseudogout

A

Crystal arthropathy of calcium pyrophosphate deposition - postivitely bifringent crystals in polarised light

Chondrocalcinosis on radiograph

Occurs in haemochromatosis, hypothyroidism and CKD

59
Q

Classification of Systemic Sclerosis

A

Diffuse: involvement of skin, trunk and extremities, early involvement of lung, kidney, gut and heart

Limited: skin only at extremities and face, late lung involvement including pHTN, renal crisis is rare

60
Q

Diagnostic Criteria for Systemic Sclerosis

A

1 major or 2+ minor
Major - skin involvement
Minor - sclerodactyl, finger pulp atrophy, bilateral pulmonary fibrosis

61
Q

Organ involvement in systemic sclerosis

A

Skin - raynauds, sclerodactyly, pulp atrophy, calcinosis, nail dystrophy, ulceration, telangiectasia, vitiligo
MSK - arthritis, myositis, myopathy, intraairticular calcification
GI - dysphagia, GORD, intestinal hypo motility leading to bacterial overgrowth and malabsorption
Renal - malignant HTN, glomerulonephritis, renal crises
Resp - ILD, pleural effusions
CVS - restrictive cardiomyopathy, pericarditis, pulmonary HTN

62
Q

Antibodies in Systemic Sclerosis

A

Limited - ANA, RF, antiCentromere

Diffuse - anti Scl 70, anti RNA pol

63
Q

Management of Systemic Sclerosis

A

General: education, PT/OT, analgesia, MDT

Raynauds: smoking cessation, hand warmers, vasodilators (calcium antagonists, ACEi, prostacyclin), sympathectomy

GI: low residue diet, nutritional supplements, Abx, PPI for reflux, pro kinetics

Renal: ACEi

Rs: vasodilator therapy for pHTN, antifibrotis therapy - D penicillamine, interferon gamma

64
Q

Clinical features of psoriasis

A

Erythematous plaques with silvery white scales on extensor surfaces, behind ears and scalp
Asymmetric arthropathy and nail changes
Koebner phenomenon
Auspitz sign - visible bleeding points over plaques from enlarged dermal capillaries and intense scratching
CVS - aortic regard
Rs - apical lung fibrosis
Eye - uveitis

65
Q

Pathophysiology of Psoriasis

A

Inflammatory skin condition
Receive abnormal epidermal proliferation
T cell mediated

Associated with HLA-B13, B17 and Cw6, also susceptibility gene on chr 6

Genetics and environmental factors involved

66
Q

Exacerbating factors in Psoriasis

A 
Trauma
Sunburn
Stress
Alcohol
Smoking
Beta haemolytic strep - guttate psoriasis
Drugs - lithium, beta blockers, Acei, antimalarials
Withdrawal of steroids
HIV
67
Q

Cardinal histopathological features of psoriasis

A 
Acanthuses (skin thickening)
Parakeraotisis
Absence of granular cell layer
Polymorphonuclear abscess of munro
Dilated capillary loops in upper epidermis
68
Q

Variants of Psorias

A 
Chronic plaque psoriasis
Pustular psoriasis
Guttate psoriasis 
Palmoplantal psoriasis
Erythrodermic psoriasis
69
Q

What skin conditions demonstrate Koebners phenomenon?

A 
Psoriasis
Lichen planus
Vitiligo
Viral warts
Pemphigus
Pemphigoid
Molloscum contagiosum
70
Q

Management of psoriasis

A

General: patient education, avoid exacerbating factors
Topical: emollients, steroids, UVB, tar, dithranol
Systemic: methotrexate, azathioprine, cyclosporin, tacrolimus, retinoids

71
Q

Clinical Features of Neurofibromatosis

A

Neurofibromas along course of peripheral nerves > 6
Axillary freckling
Cafe au last spots >6
HTN - secondary to renal artery stenosis
Acoustic neuroma ? hearing aid
Eyes - cataracts, optic glioma, lisch nodules (hamartomata on iris) on slit lamp
Pulmonary fibrosis, pneumothorax
Heart - cardiomyopathy
MSK: Kyphoscoliosis, bowing of legs, rib notching, charcot joints
Kidney - RAS
Phaeochromocytomas

72
Q

Genetics of Neurofibromatosis

A

NF1 (peripheral) - AD, chr 17, tumour suppressor gene (neurofibromin normally binds and inhibits Ras)

NF2 (central) AD chr 22 also tumour suppressor gene

73
Q

Clinical features of HHT

A

Telangiectasis of face, mouth, lips, tongue, buccal mucosa
NO features of Systemic sclerosis
Conjunctival pallor (iron deficiency anaemia)

Resp: AVMs, may be clubbed as a result
CVS: high output cardiac failure
GI: iron def anaemia, hepatosplenomegaly, portal HTN
Eyes - retinal haemorrhage
Neuro: SAH, central vascular lesions, ischaemic stroke - paradoxical emboli from pulmonary AVM

74
Q

What are telangiectasia?

A

Enduring dilation of small blood vessels, capillary or venules (venules in HHT)

75
Q

What is HHT

A

Autosomal dominant condition, multiple genes associated on different chromosomes

Telangiectasia effect multiple organs

76
Q

Management of HHT

A 
Anaemia - iron sups, transfusion
Skin - cosmetic/laser ablation
Epistaxis - cauterise, laser ablation
PAVM - embolisation, surgical resection/ligation
GI - photocoag therapy,
77
Q

Clinical Features of Dermatomyositis

A

Heliotrope rash around eyes
Violaceous scaly papule over knuckles, elbows, knees - Gottron papule
Erythema + Poikiloderma in photosensitive distribution
Proximal muscle weakness and tenderness

Associated ILD, dysphagia, arthritis

78
Q

Drugs causing dermatomyositis like skin changes

A

Hydroxyurea
Penicillamine
Statin
Quinidine

79
Q

Investigations in Dermatomyositis

A

raised CK
EMG - spontaneous fibrillation
Muscle biopsy - necrosis, phagocytosis of muscle fibres

80
Q

Causes of Purpura

A

Platelet defect - idiopathic, CLD
Capillary defect - age, steroids, vasculitis, ehlers-danlos, HHT, scurvy
Coag defect - warfarin, vWF, DIC, amyloidosis

81
Q

Lichen Planus

A

Flat topped, violaceous polygonal papule on fleecers surfaces
Fine white striae - wickhams - on surface of lesions
Koebners phenomenon
Scalp involvement with scarring alopecia
Lace like white lines on buccal mucosa
Dystrophic nails

Associated drugs - ACEi, beta blockers, NSAIDs, antimalarials
Hep C association

82
Q

Underlying causes of Erythema nodosum

A 
Streptococcal throat infection
TB
Sarcoidosis
IBD
Behcets
Drugs - OCP, penicillin, tetracyclines, sulphonamides
83
Q

Clinical Features of SLE

A

Erythematous, maculopapular rash in butterfly distribution, sparing nasolabial folds with scaling and follicular plugging
May have vasculitis lesions, livedo, photosensitivity, alopecia
Symmetrical non-erosive polyarthritis

Hands - palmar erythema, arthritis, raynauds, dermatomyositis
Nails - splinter haemorrhages, nail-fold capillaries, periungal infarcts
Mouth - ulcers
Scalp - scarring alopecia
Rs - ILD, pleural effusions,
CVS - pericarditis, pHTN
CNS - hemiparesis, mononeuritis multiplex
Renal - HTN, oedema,
Haem - splenomegaly, lymphadenopathy
Eyes - sjogrens, retinal infarcts

84
Q

Diagnostic Criteria for SLE

A 
4 of the following:
-malar rash
-discoid rash
-photosensitivity
-oral ulcers
-arthritis
-serositis
-renal involvement
-neurological involvement
-haematologial involvement
ANA positive
85
Q

Causes of Drug Induced Lupus

A 
Procainamide
Hydralazine
Quinidine
Chlorpromazine
Methyldoxpa
Phenytoin
Carbamazepine
OCP
86
Q

Differentiating SLE with drug induced lupus

A

SLE - more females, renal and CNS involvement more common, positive antidsDNA

Drug induced - equal male to female, rare renal and CNS involvement, positive anti-histone

87
Q

Autoantibodies of SLE

A 
ANA in 95%
antihistone in drug induced
antidsDNA - high specificity for SLE
Anti-ro, antiLa
antiphospholipid
88
Q

Management of SLE

A

Non-pharm

  • avoid over exposure
  • avoid high dose OCP
  • remove offending drugs
  • smoking cessation

Pharm

  • NSAIDs
  • antimalarials - hydroxychloroquine
  • corticosteroids
  • cytotoxics: azathioprine, mycophenalate, cyclosporin
89
Q

Clinical Features of Tuberous Sclerosis

A

Salmon papule and nodules over face in butterfly distribution - adenoma sebaceous

Periungal fibroma - smooth, firm nodules adjacent to nails

Shagreen patches - irregular, green-brown patches over lumbosacral region

Ash leaf macules - hypopigmented areas over trunk and buttocks

Cafe au last spots

Eyes - angiofibromata of eye lid, retinal hamartomata
Oral - bifid uvula, high arch palate
Resp - pneumothorax, cysts
Abdo - hepatic and renal hamartoma
Neural - focal deficit depending on location of tubers

90
Q

Genetics of Tuberous sclerosis

A

Autosomal dominante - 2 loci identified
Chr 9 and Chr 16 (hamertin and tuberin tumour suppressor genes)

65% spontaneous

91
Q

Pemphigus vulgaris

A 
Flaccid blisters with clear fluid
Fragile
Involved buccal mucosa\
Blisters just above basal cell layer
IgG autoantibodies against desmogleins

Drugs implicated: penicillamine, benzylpenicillin, ACEi

Treat with barrier nursing, corticosteroids, avoid dehydration

92
Q

Pemphigoid

A

Tense blisters
IgG against hemidesmosomes in basement membrane
Mucosal involvement rare

Treat with steroids/steroid sparing agents

93
Q

Pseudoxanthoma elasticum

A

folds of loose skin in neck, popliteal fossa, axilla and groin
Plucked chicken appearance

Due to abnormal mineralisation and calcification of elastic fibres

Associated with:

  • aortic regurg
  • mitral regurgitation
  • mitral valve prolapse
  • peripheral vascular disease
  • restrictive cardiomyopathy
  • renovascular disease
  • HTN
  • angioid streaks
94
Q

Causes of Angioid Streaks

A

Irregular red-brown lines radiating from optic disc

Ehlers danlos
Pseudoxanthoma elasticum
marfans
sickle cell disease
lead poisoning
95
Q

Ehlers Danlos Syndrome

A

11 different forms, some AD some AR
Collage defect

Features:
skin - broad nasal bridge, wide eyes, thin hyper extensible skin, impaired wound healing
MSK -kyphoscoliosis, hyper extensible joints, hallus valgus, pes planes
GI: diverticula, diaphragmatic hernia, megacolon
CVS - MVP, AR, aneurysms, dissections

96
Q

Causes of Blue sclerae

A 
Pseudoxanthoma
Marfans
OI
Ehlers Danlos
Alkaptonuria
97
Q

Causes of Acanthosis Nigricans

A 
Obesity
Diabetes/insulin resistance
Cushings
Acromegaly
Thyroid disease
PCOS
Familial 
Malignancy - adenocarcinoma of GI tract
98
Q

Pretibila myxodema

A

Firm, non pitting pink/purply brown plaques on anterolateral aspect of lower legs

peau d’orange texture

99
Q

Diabetic Retinopathy

A

Background: blot haemorrhages, hard exudate

Preprolifeative: large blot haemorrhages, cotton wool spots, venous dilatations/beading

Proliferative: leashes of new vessels with evidence of photocoag scars

100
Q

Eye problems in Diabetes

A 
Cataracts
Glaucoma
Mononeuritis multiplex
Infections
Diabetic retinopathy (25%)
101
Q

Pathophysiology of Diabetic Retinopathy

A

Hyperglycaemia’s structural and physiological effect on retinal capillaries
Increased sorbitol results in increased vessel permeability and weakness

Retinal ischaemia (small vessel disease) triggers VEGF

Production of vasoprolierative factors e.g. VEGF leads to new vessel formation

102
Q

Indications to refer to Opthalmology

A

Non-proliferative with macular involvement
Pre-proliferative
Proliferative - urgent

103
Q

Complications of laser photocoag

A

Vitreous haemorrhage
Visual field constriction
Headaches
Retinal vein occlusions

104
Q

Hypertensive retinopathy

A

1 - Arteriolar narrowing
2 - AV nipping
3 - micro aneurysms, blot haemorrhages, flame haemorrhage, exudates
4 - papilloedema

105
Q

Retinitis Pigmentosa

A

Black-brown pigmentation resembling bone spicules
Constricted visual fields
Night blindness
Photopsia - flashes of light

Associated with alports syndrome, bardett-biedel (polydactyly)

PACES (3 decks)

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