passmed Flashcards
Hereditary Haemorrhagic Telangiectasis (Osler-Weber-Rendu syndrome)
ADom
- multiple telangiectasis over skin + mucous membranes
- 4x dx criteria (2+ = possible, 3+ definite)
1. epistaxis (spont, recurrent nosebleeds)
2. telangiectasias (multiple at characteristic sites - lips, oral cavity, fingers, nose)
3. visceral lesions eg GI telang, pulmonary AVM, heaptic AVM, cerebral AVM, spinal AVM
4. FHx eg 1st degree relative with HHT
Bowens disease
RED, SCALY PATCHES - precancerous dermatosis = precursor to SCC- more comm in elderly
- often 10-15 mm in size
- slow-growing
- often occur on sun-exposed areas such as the head (e.g. temples) and neck, lower limbs
Mx of Bowens disease
- may sometimes be dx and mx in 1’ care if clear dx or repeat episode
- topical 5-fluorouracil
- -typically used 2x/d for 4 w
- -often results in significant inflammation/erythema. Topical steroids are often given to control this
- cryotherapy
- excision
Pompholyx define
= type of eczema which affects both the hands (cheiropompholyx) and the feet (pedopompholyx). It is also known as dyshidrotic eczema.
-may be precipitated by HUMIDITY (e.g. sweating) and HIGH TEMPS
Pompholyx Features
- small blisters on the palms and soles
- pruritic -often intensely itchy, sometimes burning
- once blisters burst skin may become dry and crack
Pompholyx Mx
cool compresses
emollients
topical steroids
Malignant melanoma 4 subtypes
superficial spreading
nodular
lentigo maligna
acral lentiginous
bullous pemphigoid vs pemphigus vulgaris
bullous pemphigoid = DEEP - no mucosal involvement
pemphigus vulgaris = SUPERFICIAL = mucosal invovlement
lichen planus
immune mediated
- features: itchy, papular rash most common on the palms, soles, genitalia and flexor surfaces of arms
- rash often polygonal in shape, with a ‘white-lines’ pattern on the surface (Wickham’s striae)
- Koebner phenomenon may be seen (new skin lesions appearing at the site of trauma)
- oral involvement in around 50% of patients: typically a white-lace pattern on the buccal mucosa
- nails: thinning of nail plate, longitudinal ridging
lichen planus mx
- potent topical steroids are the mainstay of treatment
- benzydamine mouthwash or spray is recommended for oral lichen planus
- extensive lichen planus may require oral steroids or immunosuppression
causes of a raised TLCO
asthma pulmonary haemorrhage (Wegener's, Goodpasture's) left-to-right cardiac shunts polycythaemia hyperkinetic states male gender, exercise
causes of a lower TLCO
pulmonary fibrosis pneumonia pulmonary emboli pulmonary oedema emphysema anaemia low cardiac output
TLCO / transfer factor
= rate at which a gas will diffuse from alveoli into blood
- CO is used to test the rate of diffusion
- results = total TLCO or that corrected for lung volume (transfer coefficient, KCO)
SEVERE ACUTE ASTHMA features
Inability to complete sentences in one breath
PEF 33–50% best or predicted
Respiratory rate ≥25/min
Heart rate ≥110/min
lung cancer - non small cell- only 20% suitable for surgery what are the CI to surgery
stage IIIb or IV (i.e. metastases present)
FEV1 < 1.5 L is considered a general cut-off point*
malignant pleural effusion
tumour near hilum
vocal cord paralysis
SVC obstruction
- However if FEV1 < 1.5 for lobectomy or < 2.0 for pneumonectomy then some authorities advocate further lung function tests as operations may still go ahead based on the results
