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Shorts Flashcards

1
Q

Lupus Pernio

A

Purple-red or violaceaous plaques and nodules - hard and indurated
Nose cheeks ears lips

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2
Q

Systemic manifestasions of sarcoidosis

A

Cutaneous - lupus pernio and erythema nodosum
Ocular - anterior uveitism glaucoma cataracts optic neuritis, conjunctival nodules
Parotid gland swelling
Interstitial lung disease
Restrictive cardiomyopathy abd pulmonary HTN
Hepatosplenomegaly and portal HTN
Lymphadenopathy
VII palsy and mononeuritis multiplex
Arthropathy

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3
Q

Sarcoidosis pathophysiology

A

Infiltrative - non caseating epithelioid granulmomas

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4
Q

Sarcoidosis - lungs

A

BHL, ILD, Bronchiectasis, restrictive lung defect, concurrent obstructive lung defect

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5
Q

Sarcoidosis - Abdomen

A

Elevated ALT / ALP, hepatic granulomas, cholestasis, hepatosplenomegaly

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6
Q

Sarcoidosis - heart

A

Restrictive cardiomyopathy, cardiac granuloma, pulmonary hypertension

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7
Q

Sarcoid - nervous system

A

CN palsies (VII most common)
Aseptic meningitis, ataxia, hypothalamic/pituitary involement
Mononeuritis multiplex
Psychosis

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8
Q

Sarcoid - lymphadenopathy

A

1/3 pts lymphadenopathy, R paratracheal LN most common, then cervical LN

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9
Q

Sarcoid - metabolic

A

Hypercalcaemia hypercalcuira

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10
Q

Sarcoid - MSK

A

Arthropathy

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11
Q

Sarcoid - investigations

A

FBC, U&E, ESR, LFTs, Ca, ACE, CXR, ECG, Echo, Slit lamp (opthal), BAL / tissue biopsy

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12
Q

Sarcoid - treatment

A

Topical - steroids

Systemic - oral steroids, methotrexate, hydroxychloroquine, azathioprine, thalidomide, allopurinol

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13
Q

Causes of raised serum ACE

A 
Sarcoid 
Berylliosis
Lymphoma
TB
Asbestosis
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14
Q

Lupus vulgaris

A

Enlarging re-brown papule coalesce to form slow growing plaque with thick hyperkeratotic margins and central atrophy
Cutaneous TB

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15
Q

Pretibial myxodema

A

Thyroid dermopathy
Bilateral asymmetrical firm non pitting plaques or nodules with pink/purple or brown appearance
Anterolateral aspect lower legs, tender +/- pruritic
Prominent hair folliceswith shiny skin orange peel appearane
Graves disease - determine thyroid status ?surgery ?radio-I
5% graves pts

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16
Q

Acanthosis nigricans

A 
Obesity 
Insulin resistance / DM
Cushings
Acromegaly 
Hypo/per thyroidism 
PCOS
Malignancy - AC GIT
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17
Q

Cushing’s

A 
Moon face
Centripedal obesity 
Buffalo hump
Purpura
Striae and thin skin 
Easy bruising
Proximal myopathy
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18
Q

Acromegaly

A

Facies - prominent supraorbital ridge, prognathism, bitemporal hemianopia, carpal tunnel, thick skin

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19
Q

Ehlers-Danlos sydrome

A

Skin - thin, hyperelastic, fragile, impaired wound healing with cigarette paper scars, fish mouth wounds over sites of minor injury
Hyperextensible joints - apposition of thumb to forearm, hyperextension of elbow and knee >10%, flat foot
Eyes - myopia, blue sclerae, retinal haemorrhage / detatchment
CV - mitral prolapse, regurgitations, aneurysms
GI - GI blood loss
MSK - OA, kyphoscoliosis

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20
Q

Ehlers Danlos - GI

A

GIB
Diverticulae
Megacolon +/- rupture

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21
Q

Ehlers Danlos - CV

A

MV prolapse
MR/AR
Arterial aneurysms
Aortic dissection

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22
Q

DDx blue sclerae

A

Ehler Danlos
Marfans syndrome
Osteogenesis imperfecta

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23
Q

Joint hypermobility

A 
Ehler Danlos
Marfans
Turners
Noonans 
Fragile X 
Downs
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24
Q

Peutz - Jeghers

A

Brown-black pigmented macules on the peri-oral areas
Look into mouth as well!
Multiple hamartomas GI tracts (polyps)
Pallor/koilonychia, abdominal pain, obstruction/intussuseption
AD condition - germline mutation Chr 19
Malignancies associated - pancreas, GIT, breast. Cancer predisposing condition!
Genetic councessling / endoscopic surveillance

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25
Q

Necrobiosis lipoidica diabeticorum

A

Wll circumscribed coalescing oval plaques anterior surface of lower legs
Shiny with wazy atrophic centres and red/brown margins with telangectasia
Diabetes

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26
Q

Pemphigus

A

Fragile superficial blisters with clear fluid
Mucous membranes - tender
Drug Hx
Associated with myaesthenia gravis
Heal with scarring
IgG agains desmogleins
Penicillamine / benpen / cephalosporin / ACEi / NSAIDs

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27
Q

Pemphigoid

A

Deeper blisters, unlikely to rupture
More elderly
No mucosal involement
Preilation for flexural areas

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28
Q

Dermatitis herpetiformis

A

Erythematous vesicles/papules - intense pruritus
Extensor surfaces
Coeliac disease

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29
Q

DDx bullous skin eruption

A

Burns/ contact dermatitis

Impetigo / chicken pox

30
Q

Treating dermatitis herpetiformis

A

Gluten free diet

Dapsone

31
Q

Clubbing - respiratory

A 
Bronchogenic Ca
Mesothelioma
ILD
Bronchiectasis
CF
Empyema
TN 
Asbestosis
32
Q

Clubbing - CV

A

CCHD
Subacute endocarditis
Atrial myxoma

33
Q

Clubbing - GI

A 
CLD
IBD
GI lymphoma
Coeliac and tropical sprue
Whipples Disease
34
Q

DDx unilateral clubbing

A

idiopathic
Bronchial AV fistula
Axillary / SC / ulnar aneurysm
Brachial plexus injury

35
Q

Tuberous sclerosis (physical examination)

A

Salmon coloured papules and nodules onface in butterfly distribution esp nasolabial folds
Periungal fibromas - smooth firm nodular lesions adjacent to nails (more common in toes)
Shagreen Patch - ireegular uneven thickened plaques in cobble stone appearance lumboscaral
Ash leaf macules - areas of hypopigmentation
Cafe-au-laif spots

36
Q

Tuberous sclerosis - genetics

A

AD, 2 loci, Chr 9 and 16, 65% spont mutation

37
Q

Tuberous sclerosis - pathophysiology

A

Mutation in hamartin or tuberin (both tumour supressing)

Chr 9 and 16

38
Q

Tuberous sclerosis - organ involements

A

Eye - retinal hamartoma, retinal hypopigmentation, angiofibromas of eyelid
Heart - cardiac rhabdomyoma
Brain - tubes, mental retardation, seizures
Lungs - cysts, PTX
Kidneys - hamartoma / angiomyolipoma, renal cysts
Mouth - gingival hamartoma, dental pits, high arched palate
Bone - cysts, sclerotic lesions
Abdomen - hamartoma, polyposis
Vascular - aneurysm aorta / carotid / renal / intracranial

39
Q

Alopecia

A

Patches of hair loss, well circumscribed with a distinctive border (nail involement 40%)
Autoimmune condition, associations with vitiligo, hashimotos, graves, addisons, hypoparathyroid, DM, pernicious anaemia, MG, SLE, IPF, PBC

40
Q

Treating alopecia accreta

A 
Non pharmacological (cosmetic camouflage)
Steroids, anthralin, minoxidil
41
Q

Diagnostic criteria for SLE

A 
4 of 11 from: 
Malar rash
Discoid rash
Photosensitivity 
Oral ulcer
Arthritis
Serositis
Renal involement
Neurological involement
Haematological involement
Immunological involement
ANA +ve
42
Q

Causes of drug induced lupus

A 
Isoniazid 
Methyldopa
Phenytoin 
Carbamazepine 
Sulphonamides
COCP 
Tetracycline
43
Q

Shorts station: SLE

A

Skin: Rash - sun exposed photosenstive incl malar rash with sparing nasolabial folds. Macular / papular or maculopapular. Scaling.
Scarring alopecia. Palmar erythema, vasculitis lesions, purpura, urtricaria, livedo reticularis, telangectasia, alopecia, Raynauds, S/C nodules
Joint: Hands - symmetrical non erosive polyarthritis PIP, MCP, wrist, knee
Lung: ILD, effusion, pleurisy
CV: Pericarditis
Neuro: hemiparesis, CN lesion, MN multiplex, polyneuropathy
Renal: HTN, oedema, proteinuria/haematuria
Eyes: Sjorgen
Skin only = discoid lupus
Skin + = SLE
SLE + RA or SS or dermatomyositis = mixed CTD

44
Q

Autoantibiodies in lupus

A 
ANA (95%)
Anti-DsDNA (60%, specific) 
Anti-Sm Ab (20%, specific) 
Anti Ro & La (ANA -ve cutaneous lupus) 
Antiphosphlipid 40%
45
Q

Classification of lupus nephritis

A

I - Normal
II - Mesangeal GN. Degree of proteinuria, low C3. Steroids
III - Focal proliferative GN. Cyclophosphamide, azathiprine, MMF
IV - Diffuse proliferative
V - Membranous - steroids
VI - Sclerosing. Unlikely to respond to therapy

46
Q

Managing SLE

A

Non pharm - avoid overexposure to sunlight, avoid high dose oestrogen COP, stop smoking and prevent CV disease
Steroids
NSAIDS
DMARDS - hydroxychloroquine
Cytotoxic - azathioprine, cyclophosphamide, MMF,

47
Q

Livedo Reticularis - DDx

A

Physiological

Anti phosphlipid, SLE, cryoglubulinaemia, cold agglutinins, vasculitis, cholesterol or septic emboli

48
Q

Erythema multiforme

A

Symmetrical distribution of target lesions (favouring palms and soles)
Note mucosal involement!!
Idiopathic 50%
TB, strep throat - group A, HSV, EBV, CMV, HIV, VZV, HAV, HBC, HCV
Enteritis - salmonella, campylobacter, yersinia
Sarcoid (lupus pernio, ILD), SLE, vasculitis, drugs
Drugs - penicillins, solphonamides, sulphonylureas, phenytoin, carbamazepine, NSAIDs, Aspirin, COCP

49
Q

SJS

A

Variant of EM with mucosal membrane involement and severity
Vesibullous lesions with haemorrhage and necrosis
Conservative treatment - similar to burns

50
Q

Thyroid examination - focussed

A

Examine from front - diffieculty breathing, goitre
Examine from side - exophthalmos, goitre, movement on swallowing and tongue protrusion
Examine from back - palpate swelling, ?movement on swallowing or tongue protrusion
Examine additional - temperature, pulse, thyroid acropatchy, myxoedema

51
Q

Examining - acromegaly

A

Enlarged hands and feet. Sweatiness of palms.
Skin tags
Hyperpigmentation - acanthosis nigricans in 40% (neck and axillae)
Nails can be thick and hard
Prognathism
Macroglossia
Gynaecomastia
Other –> Bitemporal hemianopia, optic atrophy, carpal tunnel, HTN, cardiomegaly, diabetes, arthropathy, goitre, proximal myopathy

52
Q

Acromegaly - causes and complications

A

Causes - pituitary adenoma (GH secreting). Rare: GHRH hypothalamic tumours / paraneoplastic carcinoid or SCLC
HTN, cardiomegaly, arthritis, diabetes, visual field defects, CN palsies

53
Q

Acromegaly - investigation and management

A

GH excess - IGF (insulin like growth factor 1) in serum, OGTT (75mg glucose load, measure at 2h)
MRI to confirm
Transphenoidal resection can be curative
Medical - somatostatin analogues (like octreotide) inhibit GH release or dopamin agonists (bromocriptine, cabergoline) inhibit GH secretion

54
Q

DDx painful thyroid

A

Thyroiditis - infectious, traumatic, radiation, subacute granulomatous

55
Q

Goitre

A

MN diffuse - iodine deficiency, grave’s, hashimoto’s, de quervain’s
Solitary - adenoma, toxic adenoma, cysts, cancer, single palpable node in multinodular disease

56
Q

DDx neck mass

A

Congenital - thyroglossal cyst (midline, moves on tongue protrusion)
Lymphadenopathy
Vascular - aneurysms, carotid body tumour
Salivary - salivary gland tumour, sialadenitis
Neurogenic - schwanomma, neurofibroma, nerve sheath tumours

57
Q

Investigating thyroid tumours

A

TFTs to determine if functioning or non functioning
If TSH low - radioiodine uptake to deliniate the functioning nodule
If TSH normal/high - FNA + USS + cytology

58
Q

Thyroid cancers

A 
P apilary (most common, favourable prognosis, Rx or surgery)
F ollicular (Rx or surgery
M edullary (MEN 2a and b, calcitonin producing)
A naplastic (bad)
59
Q

Definition of myxoedema

A

Non pitting oedema

60
Q

Causes of hyperthyroidism

A 
Graves
Toxic adenoma
`Toxic Multinodular Goitre
Iodine induced - amiodarone, contrast agents
deQuervains (coxackie virus)
Postpartum thyroiditis
61
Q

Causes of hypothyroidism

A

AI (hashimotos) thyroiditis
Idiopathic
Previous Rx or thyroidectomy
Hypothalamic / pituitary disease

62
Q

Autoantibodies in thyroid

A

Graves - thyrotropin receptor antibody (TRAb)

Hashimotos - anti TPO anti thyroglobulin

63
Q

Pathophysiology of graves disease

A

AI disease - thyroid stimulating Ab which activate TSH receptors.

64
Q

DDx proptosis

A

Graves
Cavernous sinus thrombosis
Retroorbital tumour

65
Q

Managing graves disease

A
  1. Symptoms - B blocker, lubricant for eye, tape eyes at night
  2. Thionamides - carbimazole or PTU (aganulocytosis in 0.5%)
  3. Rx ablation - tissue destruction in 6-18 weeks. NOTE: may worsen exopthalmos and so can be avoided
  4. Surgery - thyroidectomy if large goitre or co existing nodule
66
Q

AI in SS

A

Limited systemic - anti centromere Ab, ANA, RF

Diffuse systemic - Anti ScL 70 (topoisomerase 1); anti RNA polymerase 1, 2, and 3

67
Q

Horner’s syndrome - on examination

A

Ptosis (partial, as upper eyelid innervated by III and Muller muscle - synpathetic), miosis, anhydrosis (dependant on site of lesion, none/face/arm/upper trunk.
Interruption of the sympathetic pathways starting at the hypothalamus and ending in the muller muscle/pupil/sweat glands

Post ganglionic lesions do not affect sweating

68
Q

Horner’s syndrome - anatomy and DDx

A

1st order - hypothalamus –> brainstem –> cervical cord –> T1 nerve root ganglion. (demyelination, tumour, syringomyelia, infarct)
2nd order - T1 root ganglion –> cervical sympathetic chain –> superior cervical ganglion. (pancoast tumour, cervical rib, NF, CVC, anaeurysm/dissection, birth lower cervical plexus trauma)
3rd order - superior cervical ganglion –> Muller muscle, pupil and sweat glands. (herpes zoster, carotico-cavernous fistula, internal CA disseciton

69
Q

Vitiligo

A

Well demarcated areas of depigmentation

Any area of skin and mucous membrane can be involved.
Associations with: Allopecia accreta, hashimotos, graves, addisons, hypoparathyroid, diabetes, IPF, PBC, pernicious anaemia, atrophic gastritis.
Management:
1. Arrest depigmentation - steroids (topical/systemic), topical tacrolimus, phototherapy
2. Cosmetic - sunscreen, camouflage, tattooing

70
Q

SLE mnemonic

A 
DOPAMINE RASH
Discoid rash
Oral ulcers
Photosensitivity 
ANA
Malar rash
Immunological - dsDNA
Neurological - seizures, psychosis
Renal (lupus nephritis)
Arthritis
Serositis
Haematological
71
Q

Lupus nephritis classification

A 
1 - normal
2 - mesangeal
3 - focal proliferative
4 - diffuse proliferative
5 - membranous
6 - sclerosing
72
Q

Chorea vs hemibalismus vs dystonia

A

Chorea is a flowing movement
Hemibalismum is a flinging movement, usually 1/2 body, ususally post stroke
Dystonia is involuntary sustained muscle contracture
Torticollis - fixed or dynamic tilt, rotation, with flexion or extension of the head and/or neck

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