Shorts Flashcards
Feature of marfans
Hands - archnodactyly - hyperextensible joint - long arms General - tall Face - high arched palate - retroganthia - recessed lower mandible - flat malar prominence - microganthia - small chin - long narrow skull - doliocephaly Eyes - upwards dislocation of ocular lens - hypo plastic iris - myopia - visual field loss - retinal detachment, glaucoma, cataracts Chest - pectus carinatum or excavatum Cardiovascular - coartication - radial- radial delay - aortic regurgitation - mitral valve prolapse - aortic root anneyeursm
Genetic basis of marfans
Chr 15
Fibrillin 1 - FBN1
ABCDE of malignant melanoma
Asymmetry Border - irregular Colour- not uniform Diameter - >6mm Evolving/elevation
Features of tuberous sclerosis
Skin: facial adenoma sebaceous, periungual fibroma, shargreen patches, ash-leaf macula, cafe au lait spots Eyes: retinal phakomas Lungs: cystic lung disease Abdo - renal cysts Neuro: tuberous masses in cortex
Differential of cafe au lait spots
Neurofibromatosis
McCune Albright
Tuberous sclerosis
Features of McCune Albright
Cafe au lait spots
Polyostotic fibrous dysplasia
Endocrinopathy - precocious puberty
Features of peutz-Jeghers
Mucocutaneous Macules
GI hamartomatous polyps
Complication of peutz jeghers
GI hamartomas - Intussusception - GI bleeding Pacreatic endocrine tumours Increased risk of cancer - paticualry colorectal cancer
Cause of erythema multiforme
Infection: HSV, Mycoplasma
Drugs: sulfonamides, NSAID, Allopurinol, penecillin, phenytoin
Idiopathic
Causes of erythema nodusum
Systemic disease: sarcoidosis, bechets, IBD
Infection: EBV, mycoplasma, histoplasmosis, TB, Strep
Drugs: sulphonamide, OCP, salicylates
Pregnancy
Causes or secondary Raynauds
Connective tissue disease e.g. Sceleroderma
Vascular disease: thromboembolic disease, atherosclerosis
Drugs: amphetamine, b-blockers, ergot alkaloids, cytotoxic
Heam: cryoglobulinemia, hyperviscosity syndrome, coagulopathies
Frostbite
Cervical rib
Define swan neck deformity
Hyperextension of PIP with flexion of DIP
Define boutonaire derformity
Flexion at PIP joint with extension at DIP
Extra-articular manifestation of rheumatoid arthritis
Resp: pleurisy, fibrosing alveoltitis, pleural effusion
CVS: pericarditis, valvular heart disease, increased risk of IHD, pericardial effusion
Occular: episclerritis, scleritis, sjogrens
Immune: autoimmune haemolytic anaemia, anaemia of chronic disease, vasculitis, Amylodidosis
Abdo: spleenomegaly - felty syndrome
Tenosynovitis: de querverian and Atlanto-axial sublaxation
Msk: osteoporosis, carpal tunnel syndrome
X-Ray changes of RA
Soft tissue swelling Periarticular osteopenia Loss of joint space Periarticular erosion Defromity
American college of rheumatology criteria for the diagnosis of RA
4/7 of
- Morning stiffness - greater than 1hr
- Arthritis in 3+ joint areas
- Arthritis of the hands
- Symmetrical
- Rheumatoid nodules
- Positive RF
- Radiographic changes of RA
Diagnosis of SLE
Need 4/11 of American college of rheumatology criteria and serological evidence to diagnosis
Serositis - pleuritis or pericarditis
Oral ulcers
Athritis - non erosive peripheral joints
Photosensitivity
Blood dyscrasias e.g. AIHA, low WCC
Renal involvement - high BP and proitienuria
ANA positive
Immune phenomena: DS-DNA, anti-sm
Neurological: seizures, psychosis
Malar rash: facial erythema sparing naslab folds
Discoid rash
Definition of SLE
Multi system inflammatory disease characterised by a T3 hypersensitivity reaction against circulating immune complexes
Radiological feature of gout
Punched out peri-articular lesions
Radiological features of OA
Loss of joint space Osteophytes Subchondral sclerosis Subchondral cyst Deformity
Causes of macroglossia
Acromegaly
Amyloidosis
Hypothyroidism
Down’s syndrome.
Cause of Acanthosis Nigrcians
Endocrine - obesity and metabolic syndrome - diabetes melitus - cushings - acromegaly Malignancy - gastric cancer - pancreatic cancer
Complications of acromegaly
Impaired glucose tolerance and diabetes melitus
CVS: high BP, LVH, cardiomyopathy, arrthythmias, increases stroke and IHD risk
Increase risk of colorectal cancer
Sleep apnea
OA
Cause of swan neck deformity
Due to rupture of the lateral slips - leads to PIP hype extension
Cause of boutoinaries deformity
Rupture of central slip of extensor tendon lead to PIPJ prolapse through button hole created by the lateral slips
Felty syndrome
RA spleenomegaly neutropenia
Risk factors for pseudogout
Increased age OA Diabetes melitus Hypothyroidism Hyperparathyroidism Herditary heamachromatosis Wilson
Preciptiants for gout
Surgery
Infection
Fasting
Diuretics
Cause of gout
Hereditary
Drugs - diuretics, NSAIDS, Cytotoxics, Pyrazinamide
Decreased excretion - renal impairment
Increased cell turnover - lymphoma, leukemia, psoarasis, tumour lysis syndrome
Purine rich food - beef, pork
X-Ray change in gout
Punched out erosion in juxt-articular bone
Decreased joint space
Defenition of seronegative spondyloathropathies
Group of inflammatory athridities affecting the spine and peripheral joints without production of rheumatoid factor and assoicated with HLA - B27
Definition of ankylosining sponylitis
Chronic Disease of unknown aetiology characterised by stiffening and inflammation of the spine and sacroiliac joints
Complications of ankylosing spondylitis
Apical fibrosis Anterior uveitis Aortic reggurgitation Achilles tendonitis AV node block Amyloidosis
Enteropathic athritis
Occur in 15% of patient with UC or chrons
Asymmetrical large joint oligoathrtis mainly affecting the lower limbs
May have sacroillitis
Bechets disease
Systemic vasculitis of unknown cause leading to triad of oral aphthous ulcers, gential ulcers and uveitis
Cause of sjogrens
Primary - idiopathic
Secondary: RA, SLE, Systemic sclerosis
Signs of dermatomyositis
Heliotrope rash on eyelids and odema
Macular rash - shawl sign positive
Nail fold erythema
Gottrons papules
Mechanic hands - painfull rough skin cracking of finger tips
Retinopathy, hemaorrhages and cotton wool spot
Subcutaneous calcification
Cause of drug induced lupus
Procinamide
Phenytoin
Hydralazine
Isoniazid
Feature of antiphospholipd syndrome
CLOTS coagulation defect - increased APTT Livido reticularis Obstetric complications e.g. Recuurent 1st trimester miscarriages Thrombocytopenia
Definition of polymyalgia rheumatica
Inflammatory rheumatological syndrome that manifest as pain and morning stiffness involving the neck, shoulder girdle and pelvic girdle in an individual over 50
Classification of diabetic retinopathy
- Background retinopathy: microanneysursm, blot heamorrhages, hard exudates - yellow lipid patches
- Pre-proliferative retinopathy: heamorrhages in all 4 quadrants, venous abnormalities in more than 2 quadrants, cotton wool spots
- Proliferative retinopathy: new vessel formation, pre-retinal or vitreous haemorrhage, retinal dettachment
- Maculopathy: hard exudates within one disc width of the macula, macula odema, decreased visual acuity
Esotropia
Convergent squint - eye turns inward
Hypermetropia is a risk factor
Exotropia
Divergent squint - eye turns outward
Manifest squint
Normally visible
Latent squint
Eye only turns when when unaffected eye is closed
Myopia
Short sightedness - distant object appeared blurred
Hypermetropia
Long sightedness - close objects appeared blurred
Cataracts
Opacifaication of the crystalline lens which affects how the lens refracts light and its clarity therefore decreasing visual acuity
Cause of cataracts
Increased age
Diabetes
Steroids
Congenital: idiopathic, rubella, Wilson, galactosemia, myotonic dystrophy
Indication for cataract surgery
Cataracts is causing other Occular disease
Cause functional impairment of vision despite correction with glasses
Opacification prevents visuluisation of the fundus if active posterior segment disease
Age related macular degeneration
Dry: Drusen- fluffy white spots around the macula, Degeneration of macula, slow visual decline
Wet: subretinal neovascularisation - rapid visual decline with distortion
Features of optic neuritis
Decreased acuity Decreased colour vision Enlarged blind spot Optic disc may be normal, swollen or blurred RAPD
Cause of onycholysis
Psoarasis
Fungal infection
Trauma
Thyrotoxicosis
Cause of pitting in the nails
Psoarasis
Fungal infection
Lichen planus
Cause of Kobers phenomena
Psoarasis Lichen planus Viral warts Vitiligo Sarcoid
Histopatholgical features of psoarasis
Hyperkeratosis
Parakeratosis
Intra-epidermal microabcess of Munro
Features of pappilodema
Elevation of the optic disc Venous engorgement Loss of venous pulsation Blurring of the optic disc margin Paton lines: concentric radial retinal line cascading from the optic disc Loss of the optic cup
Rheumatoid factor high titre assoicated with
More severe disease
Erosions
Extra-articualar manifestation.
