Small conditions Flashcards
1
Q
functional obstruction of the LOS
Presentation + management
A
Achalasia
Presentation = progressive dysphagia, chest pain and regurgitation
Treatment = pneumatic balloon dilatation, surgical myotomy
2
Q
failure of LOS mechanism
presentation
A
Oesophageal hypomotility
Presentation = reflux symptoms
3
Q
overactive oesophageal muscles
presentation + management
A
Oesophageal hypermotility
Presentation = dysphagia + chest pain
Management = smooth muscle relaxants
4
Q
allergen mediated infiltration of the oesophageal epithelium
presentation + management
A
Eosinophilic oesophagitis
Presentation = dysphagia
Management = prednisolone, dietary elimination, endoscopic dilatation
5
Q
decreased blood supply to GI tract causing injury/ infarction
(presentation)
A
Ischaemic colitis/ enteritis
Presentation = IBD symptoms
6
Q
bowel inflammation caused by exposure to ionising radiation
presentation
A
Radiation colitis/ enteritis
Presentation = IBD symptoms
7
Q
excessive bacterial growth in the small intestine
diagnosis + management
A
Small bowel overgrowth
Diagnosis = H2 breath test Management = rotating antibiotics
8
Q
protrusion of the inner mucosal lining through the outer muscular layer of bowel forming a pouch
A
Diverticulosis
called diverticulitis when inflamed - causes rectal bleeding
9
Q
enlarged vascular cushions around the anal canal
A
Haemorrhoids
can be removed by elective surgery
10
Q
autoimmune driven liver inflammation
management
A
Autoimmune hepatitis
management = prednisolone
11
Q
autoimmune granulomatous inflammation of intrahepatic bile ducts
A
Primary biliary cholangitis
12
Q
autoimmune chronic inflammation of intra and extrahepatic bile ducts
A
Primary sclerosing cholangitis
13
Q
inflammation of the gallbladder
A
Cholecystitis
can lead to peritonitis
14
Q
Pre-malignant condition to oesophageal adenocarcinoma
pathophysiology + management
A
Barrett’s oesophagus
Pathophysiology = metaplasia of squamous to glandular epithelium
Management = endoscopic mucosal resection, radiofrequency ablation, oesophagectomy
15
Q
stomach lining inflammation due to altered gastric acid production
(Bacterial pathophysiology)
A
Gastritis A, B & C
Bacterial: H. pylori produces urease (splits ammonia to form urea) –> alkaline environment –> increased acid production
16
Q
bile duct cancer
presentation + management
A
Cholangiocarcinoma
Presentation = obstructive jaundice
Curative treatment= surgery
Palliation = stenting, bypass surgery, radio/chemo
17
Q
localised/ generalised inflammation of the peritoneum
A
Peritonitis
a cause of ascites
18
Q
Gastric outlet obstruction
bloods + management
A
Bloods: low Cl, Na, K
Management: endoscopic balloon dilatation, surgery
19
Q
Perforation of the tympanic membrane
presentation + management
A
Presentation = recurrent infections, hearing loss
Management = myringoplasty (surgical closure), water precautions
20
Q
inflammation of the external auditory meatus
management
A
Otitis externa
Management = antibiotic/ steroid ear drops
21
Q
osteomyelitis (bone infection) of the temporal bone
presentation
A
Malignant otitis externa
Presentation = extreme pain, cranial nerve palsies
(common in elderly, diabetic patients)
22
Q
calcification of the tympanic membrane/ middle ear
A
Tympanosclerosis
usually asymptomatic and requires no management
23
Q
Sterile fluid in middle ear
presentation + management
A
Otitis media with effusion (glue ear)
Presentation = hearing loss
Management = observation for 3 months, otovent (blow up balloon with nose to open eustacian tube), grommet
24
Q
Pus in middle ear
presentation + management
A
Acute suppurative otitis media
Presentation = otalgia (pain) and otorrhoea (discharge)
Management = observation, amoxycillin
25
persistent discharge of pus through a perforated tympanic membrane
complications
Chronic suppurative otitis media
Complications = dead ear, facial palsy, meningitis, brain abscess
26
Skin in the middle ear +/- mastoid air cells
presentation and management
Cholesteatoma
Presentation = persistent offensive otorrhoea
Management = mastoidectomy (surgical removal of skin cells)
27
fixation of the stapes due to abnormal growth of bone in the middle ear
Presentation and management
Osteosclerosis
Presentation = conductive hearing loss
Management = hearing aid, stapedectomy (artificial replacement of part of stapes)
28
vertigo caused by otoconia in the semi-circular canals
Presentation, diagnosis and management
Benign paroxysmal positional vertigo
Presentation = positional, rotatory nystagmus, no associated symptoms, precipitated by head movements
Diagnosis = Dix-Hallpike test
Management = Epley manoevure
29
vertigo due to reactivation of HSV infection of the vestibular ganglion
(presentation + management)
Vestibular neuritis/labyrinthitis (VIII nerve palsy)
Presentation = spontaneous, horizontal nystagmus towards affected ear, unilateral hearing loss
Management = benzodiazepines (vestibular sedatives), vestibular rehab
30
vertigo due to excessive build-up of endolymph in the inner ear
presentation + management
Meniere’s disease
Presentation = spontaneous, unilateral hearing loss
Management = Bendroflumethiazide, intratympanic dexamethasone, intratympanic gentamicin
31
a collection of blood between perichondrium and cartilage in ear caused by trauma
Management
Auricular haematoma
Management = incision + drainage, pressure dressing, prophylactic antibiotics
32
a collection of blood between the cartilage and perichondrium of the nasal septum caused by trauma
Management
Septal haematoma
Management = drainage
33
Nasal fracture
| Management
Manipulation under general anaesthetic
| immediate if bones broken, later if cartilage broken
34
inherited weakness of blood vessels in the nose
| presentation + management
Hereditary haemorrhagic telangiectasia (HHT)
Presentation = recurrent epistaxis, telangiectasias in lips and nose
Management = laser coagulation, septodermoplasty
35
highly vascular benign tumours
Presentation, diagnosis and management
Angiofibroma
```
Presentation = unilateral epistaxis
Diagnosis = nasal endoscopy
Management = surgery
```
(common in young males)
36
cancer of the nasal cavity
| presentation + management
Nasal malignancy
Presentation = unilateral mild epistaxis, unilateral hearing loss (blocked eustacian tube)
Management = radiotherapy, surgery
37
frontal sinusitis causing forehead swelling
| presentation + management
Pott’s puffy tumour
Presentation = frontal headache + sinusitis symptoms
Management = endoscopic sinus surgery
38
dilatation of the thyroglossal duct
| presentation + management
Thyroglossal cyst
```
Presentation = moves on tongue protrusion
Management = surgical removal
```
(may become infected)
39
neck swelling due to failure of branchial arch fusion
| presentation + management
Branchial cyst
Presentation when infected = solid painless mass, anterior to sternocleidomastoid (asymptomatic until infected)
Management = conservative, excision
40
herniation of the pharyngeal mucosa between the inferior pharyngeal constrictors
Pharyngeal pouch
Presentation = hoarseness, dysphagia, regurgitation, weight loss
Management = excised if large
(food can lodge there and become infected)
41
surface of the eye has different curvatures so close and distant objects are blurry
management
Astigmatism
Management = cylindrical glasses (curved in one axis), toric lenses (weighted), laser eye surgery
42
inflammatory process on the cornea
Causes
Corneal ulcers
Causes: infection, trauma, corneal degenerations/ dystrophies
43
Corneal abrasion
presentation + management
Presentation = sharp pain, watering, blurred vision
| Management = topical antibiotics, oral analgesia
topical anaesthetics delay healing
44
a group diseases affecting the cornea causing decreased vision
presentation
Corneal dystrophies and degenerations
Presentation = decreased vision
45
inflammation of the sclera
| presentation + management
Scleritis
Presentation = pain, tenderness, redness, engorged + inflamed scleral vessels
Management = high dose systemic steroids
46
inflammation of the ciliary body
diagnosis + presentation
Intermediate uveitis
diagnosis = slit light examination
Presentation = floaters, hazy vision
47
Inflammation of the choroid
diagnosis + presentation
Posterior uveitis
diagnosis = slit light examination
Presentation = blurred vision (spreads to retina)
48
allergic inflammation of the conjunctiva
| presentation + management
Allergic conjunctivitis
Presentation = itchy red eyes, watery discharge, chemosis (conjunctival oedema)
Management = topical antihistamine, mast cell stabilisers (preventative)
49
blocked sebaceous/ meibomian gland
| cause
Stye/hordeolum
```
External = blocked sebaceous gland of an eyelash
Internal = blocked meibomian gland
```
50
common, mild primary headache
| presentation + management
Tension-type headache
Presentation: mild, bilateral tightening
Abortive: aspirin, paracetamol, NSAIDs
Preventative: tricyclic antidepressants (e.g. amitriptyline) - rarely required
51
Headache on >15 days/ month which has developed/ worsened while taking regular medication
Medication overuse headache
52
inflammation of large arteries
| presentation + management
Giant cell arteritis
Presentation: diffuse, persistent headache, prominent, beaded temporal artery, malaise
Prophylactic management: antiepileptics (e.g. lamotrigine, carbamazepine)
53
headache caused by dural CSF leak
| presentation + management
Intracranial hypotension
Presentation: worsens on sitting/ standing
Management: fluid, analgesia, (IV) caffeine
54
total paralysis below level of 3rd nerve nuclei
Locked in syndrome
55
bacterial infection spread by ticks
| agent, presentation + management
Lyme disease
agent: borrelia burgdorferi
acute presentation: erythema migrans (expanding rash at bite site), flu-like symptoms
chronic: encephalopathy, encephalomyelitis
Management: prolonged antibiotics
56
viral infection of anterior horn cells of lower motor neurons
(presentation + management)
Poliomyelitis
Presentation: (99% asymptomatic), asymmetric flaccid paralysis
Management: polio vaccine
57
acute viral infection of the CNS transmitted through contaminated saliva
(presentation + management)
Rabies
Presentation = paraesthesia at bite, ascending paralysis, encephalitis
Management = active/ passive immunisation, sedation
58
blocked inhibition of motor neurons at the NMJ by bacterial toxins
(agent, presentation + management)
Tetanus
Agent: clostridium tetani
Presentation: rigidity + spasm
Management: immunisation, penicillin
59
Blocked Ach release at NMJ and autonomic nerve junctions by bacterial toxins
(agent, presentation + management)
Botulism
agent: clostridium botulinum
(usually spread by injecting blood users)
presentation: descending symmetrical flaccid paralysis
Management: anti-toxin, prolonged antibiotics, radical wound debridlement
60
failure of closure of cranial neural tube meaning skull fails to form
Exencephaly
| incompatible with life, no treatment
61
failure of closure of cranial neural tube causing herniation of cerebral tissue
Presentation
Encephalocele
Presentation = neurological deficits (depends on region of herniation, usually occipital)
62
gyri and sulci fail to develop
Lissencephaly (smooth brain)
63
congenital excess of small gyri
Polymicrogyria
64
failure of corpus callosum development
Agenesis corpus callosum
65
congenitally small head
Microcephaly
| can be caused by zika virus
66
CSF filled cysts/ cavities in the brain of a neonate
cause
Porencephaly
Cause = postnatal stroke/ infection
67
large congenital clefts/ slits in the brain
cause
Schizencephaly
Cause = genetic, in utero stroke/infection
68
longitudinally split spinal cord due to vertebral bone defect
presentation
Diastematomyelia
Presentation: scoliosis, motor/ sensory deficit of lower limbs, hair tuft on lower back
69
progressive degenerative loss of the basal ganglia (loss of inhibitory effects)
presentation
Huntington’s disease
Presentation: characteristic chorea, dementia
(hereditary)
70
generalised epilepsy presenting in adolescence
Presentation
Juvenile myoclonic epilepsy
Presentation: absence/ tonic-clonic seizures, early morning myoclonus (drop things, brief limb jerks)
(often provoked by alcohol/ sleep deprivation)
71
prolonged/ recurrent tonic-clonic seizures for >30 minutes
Status epilepticus
72
chronic inability to obtain the necessary amount of sleep
management
Insomnia
Management: lifestyle changes, hypnotic drugs (all have side-effects)
73
partial waking in a terrified state with no recall on waking
Night terrors
| occur in deep sleep, usually in 3-8yr olds
74
sleep walking
Somnambulism
occur in non-REM sleep (usually stage 4)
75
direct entry into REM sleep with little warning
Narcolepsy
| linked to dysfunctional release of orexin
76
Spinal cord tumours
types, presentation, management
extradural, intradural and intramedullary
Presentation = pain, weakness, sphincter disturbance
Management = surgical decompression, radiotherapy
77
degenerative change in the cervical spine --> cord and root compression
(presentation + management)
Cervical spondylosis
Presentation = myelopathy/radiculopathy
Management = conservative/ surgery
78
spinal cord/root compression due to degenerative change in the lumbar spine
(presentation + management)
Lumbar spinal stenosis
Presentation = spinal claudication (pain down both legs, worse on standing, walking)
Management = lumbar laminectomy
79
infection in the epidural space
| presentation + management
Epidural abscess
Presentation = back pain, pyrexia, focal neurology
Management = urgent surgical decompression, long term IV antibiotics
80
intravertebral disc infection
Discitis
81
infection within the vertebral body
| presentation + management
Osteomyelitis
Presentation = fever, pain
Management = antibiotics, surgery if neuro signs
82
temporary paralysis/weakness of the face
| presentation + management
Bells (VII nerve) palsy
Presentation = LMN unilateral face weakness
Management = steroids, eyedrops (eye closure affected)
**The forehead is also affected
83
LMN lesion in the medulla oblongata
presentation
Bulbar (IX, X, XI, XII nerve) palsy
Presentation = dysarthria (disordered articulation + slurring), dysphonia, dysphagia
84
UMN lesion of the corticobulbar tract
presentation
Pseudobulbar palsy
presentation = spastic immobile tongue, brisk jaw jerk and gag reflex
85
high risk of diabetes
Intermediate hyperglycaemia (IGT)
Fasting glucose: 6-7 mmol/l
OGTT: 7.8 - 11 mmol/l
HbA1c: 42 - 47 mmol/mol
86
autosomal dominant gene defect impairing pancreatic beta cell function
Maturity onset diabetes in the young (MODY)
87
increasing insulin resistance in the 2nd/3rd trimester of pregnancy
Gestational diabetes
88
Hypoglycaemia management
15-20g simple CHO (if able)
If unable to take oral CHO:
- 1mg i/m glucagon
- glucogel/ dextrogel
- IV glucose/ dextrose
Then follow up with long acting CHO
89
retinal ischaemia due to diabetes, can stimulate growth of abnormal leaky vessels
(presentation + management)
Diabetic retinopathy
Presentation:
proliferative = black floaters in vision
non-proliferative = loss of vision
Management = intravitreal anti-vegf, pan-retinal photocoagulation
90
kidney failure due to diabetic hypertension and ischaemia
diagnosis + management
Diabetic nephropathy
Diagnosis = urinalysis (increasing proteinuria), biopsy
Management = RAAS blockade (ACEIs, ARBs), RRT
91
sensory/ autonomic loss (particularly in feet and lower limbs) in diabetes
(presentation + management)
Diabetic neuropathy
Presentation = sensory loss, paraesthesia, Charcot's foot, autonomic neuropathy
Management = foot care
92
ketones >3.0mmol/l
Diabetic ketoacidosis
Presentation = thirst, nausea + vomiting, abdominal pain, ketoic breath, drowsiness, rapid, sighing respiration, tachycardia, hypotension, coma
Management (risk of DKA) = oral fluids, insulin
Management (DKA) = IV saline with potassium, IV insulin
93
benign pituitary tumour producing prolactin
| presentation + management
Micro/macroprolactinoma
Presentation = galactorrhoea (milky secretions), amenorrhoea, infertility
Treatment = dopamine agonists (very effective)
94
excessive GH due to pituitary tumour occurring BEFORE epiphysial growth plate fusion
(presentation + management)
Gigantism
presentation = may be >210cm but in proportion
Management = surgery, somatostatin analogues
95
pubertal changes at an early age
management
Central precocious puberty
boys <9 - usually underlying cause e.g. tumour
girls <8 - usually idiopathic
management = GnRH agonists
96
gonadotrophin independent abnormal sex steroid secretion
Precocious pseudopuberty
97
Puberty commencing >14 (boys) / >13 (girls)
Constitutional delay of growth and puberty
98
adrenal hyposecretion, usually due to 21-hydroxylase deficiency
neonatal presentation
Congenital adrenal hyperplasia
presentation: neonatal salt-losing crisis, ambiguous genitalia, precocious pseudo-puberty in boys, hirsutism in girls
99
target organ (kidney and bone) unresponsiveness to PTH
Pseudohypoparathyroidism
100
non-functioning thyroid tumour
Follicular (thyroid) adenoma
101
virally triggered thyrotoxicosis followed by hypothyroidism
presentation + management
Subacute (de Quervain’s) thyroiditis
Presentation = painful goitre, fever, myalgia
3-6 months thyrotoxicosis --> 3-6 months hypothyroidism
Management = short term steroids, NSAIDs
102
a group of conditions characterised by autoimmune activity against more than one endocrine gland
Autoimmune polyendocrine syndromes
APS-1: onset in childhood
APS-2: usually occurs in young adulthood
103
hypersensitivity reaction of the skin triggered by infection or medication
presentation + management
Erythema multiforme
Presentation = target lesions common on palms, soles and mucosal surfaces
Management = symptomatic, treat cause
104
Thyroid carcinoma
Diagnosis + management
Diagnosis: USS, FNA, TFTs
Management: total/ near-total thyroidectomy, high dose radioiodine
105
Hypersecretion of aldosterone
Cause + diagnosis
Conn's syndrome
Cause: adenoma, hyperplasia
Diagnosis: high plasma aldosterone + K, 24hr urine aldosterone, adrenal CT
106
autosomal dominant condition causing growth of tumours/ hyperplasia in endocrine glands
Multiple endocrine neoplasia (MEN)
107
Obesity management (4 tiers)
Tier 1: population-wide health improvement work
Tier 2: Primary care
- healthy helpings/ football fans in training
- Orlistat (lipase inhibitor)
Tier 3: specialist weight management
- weigh forward
Tier 4: specialist surgical service
108
rash caused by staph infection
Presentation + management
Staphylococcal scalded skin syndrome
Presentation = diffuse erythematous rash (common in flexures), skin tenderness, blistering, fever
Management = admission, IV antibiotics
109
rash caused by mild drug reactions
presentation
Morbilliform exanthem
Presentation = measles-like rash
110
autoimmune skin disorder causing blistering between keratinocyte layers
Presentation + management
Pemphigus
Presentation = flaccid blisters (rarely intact), systemically unwell
Management = systemic steroids, dress erosions
111
autoimmune skin disorder causing blistering at the dermo-epidermal junction
Presentation + management
Pemphigoid
Presentation = intact blisters, systemically well
Management = topical steroids (systemic if diffuse)
112
type IV hypersensitivity reaction to allergens causing dermatitis
Investigation
Allergic contact dermatitis
Investigation = patch testing
113
dermatitis caused by chemical and physical irritants
Causes
Irritant contact dermatitis
Causes = friction (e.g. nappy rash), environmental factors (e.g. hairdressers)
114
contagious bacterial skin infection, common in children
agent, presentation + management
Impetigo
agent = staph aureus/ step. pyogenes
Presentation: macule --> vesicle --> pustule --> erosion with honey coloured crust
Management = local care, topical antibiotics
115
bacterial infection of hair follicles
agent and management
Folliculitis
agent = staph aureus
Management = antibacterial washes/ ointments
116
sexually transmitted bacterial infection
agent, presentation + management
Syphilis
agent = treponema pallidum
presentation:
primary = painless, red, papule at site of infection
secondary = widespread skin rash (no itch)
tertiary = asymptomatic/ neurosyphilis (infectious)
Management = high dose IV penicillin
117
bacterial infection of the deep dermis and subcutaneous tissue
agent, presentation + management
Cellulitis
agent = strep pyogenes/ staph aureus
Presentation = ill-defined non-palpable inflammatory lesion (rubor, calor, tumor, dolor)
Management = antibiotics
118
bacterial infection of the dermis and lymphatics
agent, presentation + management
Erysipelas
agent = group A streptococci
Presentation = well-defined, hardened inflammatory lesion (rubor, calor)
Management = penicillin
119
viral infection of the orolabial and genital areas
presentation + management
Herpes simplex virus
Presentation = erythema multiforme
Management = topical/ systemic antiviral therapy
120
rough papules/ plaques caused by HPV infection
presentation + management
Viral warts
Presentation = rough, painful, hyperkeratotic papules/ plaques
management = salicylic acid, wart paints, cryotherapy, curette (if severe)
(usually resolve spontaneously)
121
firm, umbilicated papules caused by poxvirus infection
presentation + management
Molluscum contagiosum
Presentation = pearly + waxy, found in skin folds + genital region
Management = curettage, cryotherapy, chemovesicants (cause tissue necrosis)
122
fungal infection of keratinised tissue
Presentation
Dermatophytoses (ringworm)
Presentation = red, itchy, scaly, circular rash
123
opportunistic* fungal skin infection
*occur in immunosuppressed patients/ if broad spectrum antibiotics used/ DM etc
agent, presentation + management
Mucocutaneous candida infection
agent = candida albicans
presentation = erythematous patches +/- satellite pustules, found in flexures
management = topical/ oral antifungals
124
non-inflammatory superficial fungal skin infection - common on oily, sweaty skin
agent + presentation
Pityriasis versicolor
Agent = malassezia sp
Presentation = oval/ round patches with mild scale
125
benign warty "stuck-on" growths
management
Seborrhoeic keratoses
Management = (generally left untreated), cryotherapy, curettage
126
encapsulated lesion containing fluid/ semi-fluid material
presentation + management
Cyst
Presentation = firm and fluctuant, dimples when squeezed
Management = (usually none), excision
If inflamed/ infected = drainage, antibiotics, topical steroid
127
benign fibrous nodules formed by fibroblast proliferation
presentation + management
Dermatofibroma
Presentation = tethered to skin but mobile over fat, dimples when squeezed
Management = excision if concern/ symptomatic
128
benign tumour of fat cells
Lipoma
129
asymptomatic, benign tumours derived from overgrowth of vascular cells in the skin
examples
Angioma
E.g. cherry angioma, spider naevi, venous lakes
130
rapidly enlarging vascular growth, often at site of trauma
presentation + management
Pyogenic granuloma
Presentation = red, raw, bleeds easily
management = curettage
131
pre-malignant rough scaly patches on sun damaged skin
management
Acitinic keratoses
management = curettage, cryotherapy, diclofenac gel, imiquimod cream
132
melanoma cells entirely confined to the epidermis
management
Melanoma in situ
management = excision
133
variant of squamous cell carcinoma erupting from hair follicles in sun damaged skin
management
Keratoacanthoma
management = surgical excision
134
malignant metastases to the skin
management
Cutaneous metastases
management = treatment of underlying malignancy, excision, localised radiotherapy, symptomatic treatment
135
tender red nodules found on the shins in IBD
Erythema nodosum
136
Deep ulcers, typically on the legs due to immune dysfunction
Pyoderma gangrenosum
137
soft tissue swelling of the hands and finger clubbing seen in Grave's disease
(thyroid) acropachy
138
orange peel appearance and non-pitting oedema of lower legs occurring in thyroid disease
Pre-tibial myxoedema
139
autoimmune connective tissue disorder affecting the skin
presentation
Cutaneous lupus
presentation = butterfly rash on face, plaques with clear margins, photosensitivity
140
autoimmune rejection of hair
Alopecia
141
autoimmune destruction of melanocytes
Vitiligo
142
episodic flushing (without sweating) and facial telangiectasia linked to carcinoid tumours
Carcinoid syndrome
143
Hyperpigmentation cause
increased ACTH
144
eczematous plaque of the nipple, indicative of breast cancer
Paget’s disease
145
eczematous plaques (often in the axilla/ anogenital areas) indicative of intraepithelial adenocarcinoma
Extramammary Paget’s
146
autoimmune driven blistering of the skin due to underlying cancer
Paraneoplastic pemphigus
147
acute onset of lanugo hairs due to underlying cancer
Acquired hypertrichosis lanuginosa
| commonly colorectal, lung, breast
148
concentric erythematous lesions due to underlying cancer
Erythema gyratum repens
| commonly lung, oesophageal, breast
149
symmetrical hyperkeratosis of extremities (resembling psoriasis) due to underlying adenocarcinoma
Basex syndrome
150
acute onset of seborrhoeic keratosis due to underlying GI adenocarcinoma
Leser-Trelat syndrome
| be suspicious in younger patients
151
velvety brown/ black markings in flexures due to underlying diabetes/ gastric adenocarcinoma
Acanthosis nigricans
152
inflammatory myopathy and rash due to underlying cancer
presentation
Dermatomyositis
presentation = periorbital pink/purple rash, red maculo-papules over bony prominences and upper back (shawl sign)
153
Genetic disorder causing tumours to grow on nerve tissue and a predisposition to certain cancers (e.g. phaeochromocytoma, leukaemia)
Neurofibromatosis
presentation = neurofibromas (small rubbery tumours along nerves under skin), café au lait spots, freckles in axillae
154
planto-palmar keratoderma (thickening of skin) and increased risk of oesophageal cancer
Howel-Evans syndrome
155
Hypothermia
definition
management
Fall in core body temperature <35⁰C
Insulate to prevent further heat loss
Slow re-warming with blankets
Internal re-warming with hot drinks
Fast re-warming by immersion in water
156
vascular and cellular response to extreme cold
Frostbite
157
Heat exhaustion
definition + presentation
core body temperature 37.5 - 40⁰C
```
Profuse sweating (causing drop in circulating volume)
Headache
confusion
nausea
tachycardia
weak pulse
hypotension, syncope, collapse
```
158
Heat stroke
definition + presentation
core body temperature >40⁰C
Hot, dry skin (sweating ceased)
circulatory collapse
159
any inflammatory disease affecting >90% of total skin surface
management
Erythroderma
Management:
treat cause
fluid balance, nutrition, temperature regulation50:50 emollient (liquid paraffin:white soft paraffin)
manage itch
160
neurological deficit related to the spinal cord
presentation
Myelopathy
Presentation: UMN signs at affected lever + below, sensory deficits, bowel/bladder involvement + sexual dysfunction
161
compression of a nerve root leading to dermatomal and myotomal deficit
presentation
Radiculopathy “pinched nerve”
presentation: LMN signs in corresponding myotome, sensory loss/pain in corresponding dermatome
162
muscle weakness caused by inflammation
presentation + management
Inflammatory muscle diseases - e.g. polymyositis
presentation = painful weak muscles
management = high dose steroids + immunoglobulins
163
genetic structural abnormalities of the contractile apparatus
Muscular dystrophies (e.g. Duchenne's = absence of dystrophin)
(no treatments)
164
irreversible kidney damage requiring renal replacement therapy (RRT)
indications for RRT and additional management of patients on dialysis
End-stage renal disease
Indications = severe/ treatment resistant...
- uraemia, acidosis, hyperkalaemia, fluid overload
management: fluid + dietary restrictions, heparin
165
chronic kidney infection
(scarring + clubbing of calyces)
diagnosis
Chronic pyelonephritis
diagnosis = radiology
166
kidney damage due to reflux of urine
diagnosis + management
Reflex nephropathy
diagnosis = micturating cystogram
Management = surgery
(a common cause of UTIs in children)
167
reflux of urine into ureters due to ureters inserting into the bladder at an abnormally decreased angle
Vesicoureteric reflux
| causes hydroureter + a common cause of UTIs in children
168
cancer of plasma cells in bone marrow causing renal failure
Multiple myeloma
169
vasculitis of small vessels in multiple systems (inc. kidneys causing focal necrotising glomerulonephritis)
presentation (in other systems)
Granulomatosis with polyangiitis (formerly Wegner's granulomatosis)
Presentation = granulomatous inflammation in respiratory tract, arthralgia, myalgia, scleritis, fever, weight loss, vasculitic rash
170
Lower urinary tract symptoms
Voiding/ obstructive:
- hesitancy + poor stream
- incomplete emptying + terminal dribbling
Storage/ irritative:
- frequency
- nocturia
- urgency + urge incontinence
171
cancer of transitional epithelium of the urinary tract
Urothelial cancer
172
painful inability to void with a palpable and percussible bladder
management
Acute urinary retention
management = immediate urethral/ suprapubic catheterisation
173
decreased ADH secretion (central) or sensitivity to ADH (peripheral)
presentation + management
Diabetes insipidus
Presentation = polydipsia, polyuria
Management:
central = ADH supplementation
peripheral = underlying cause (hypercalcaemia/ hypokalaemia)
174
Management of hyperkalaemia
Calcium gluconate (stabilises myocardium)
Anion exchange resins (e.g. calcium resonium)
Salbutamol, insulin-dextrose (shift K intracellularly)
Diuresis
Dialysis
175
Benign inflammatory growths in the nasal cavity
presentation, diagnosis + management
Nasal polyps
Presentation = pale
Diagnosis = Coronal CT, nasoendoscopy
Management = steroidal nasal sprays, polypectomy (gives nasal spray better access)
(strong association with asthma)
176
management of epistaxis
anterior/ posterior nasal packing
Surgical management:
- artery ligation
- septodermoplasty (septal mucous membrane replaced)
- embolization (material injected to block blood supply)
177
Long/far sightedness
| can't see close objects well
Hyperopia
(eyeball to short/refractive power too weak - presbyopia)
presentation: convergent squint, eye strain after reading
management: biconvex (+ve power) lenses, laser eye surgery
178
Inflammation of iris +/- ciliary body
presentation, diagnosis + management
Acute anterior uveitis
Presentation = pain, photophobia, red eye, small irregular pupil
diagnosis = slit light examination
management = topical steroids, dilating drops, oral analgesia
179
Infection of orbital tissues
presentation, diagnosis, management + complications
Orbital cellulitis
presentation = pain, reduced eye movement, pyrexia, proptosis
diagnosis = CT
management = admit urgently, IV antibiotics
complications = cavernous sinus thrombosis/ orbital abscess
180
self-limiting (bacterial/viral) infection + inflammation of the conjunctivae
presentation + management)
Infective conjunctivitis
presentation: red eyes, discharge (sticky=viral, gritty=bacterial)
management: antibiotic eye-drops (usually resolves spontaneously)
181
central retinal artery occlusion
| cause, diagnosis + presentation
(ischaemia --> loss of photoreceptor function)
cause: embolus (most commonly)
diagnosis: fluorescein angiography
presentation: complete, sudden loss of vision in affected eye
182
central retinal vein occlusion
presentation, diagnosis + management
(blood seeps out into retina --> damages photoreceptors)
presentation: complete, sudden loss of vision
diagnosis: fluorescein angiography
management: intravitreal anti-vegf
183
damage to the optic nerve as a result of insufficient blood supply due to atheroma
presentation + diagnosis
non-arteritic anterior ischaemic optic neuropathy
presentation: painless, visual field defect
diagnosis: fluorescein angiography
184
damage to the optic nerve as a result of insufficient blood supply due to giant cell arteritis
(presentation, diagnosis + management)
arteritic anterior ischaemic optic neuropathy
presentation: complete sudden loss of vision, (+ other giant cell arteritis symptoms e.g. headache, pain on chewing, tenderness over superficial temporal arteries)
diagnosis: inflammatory markers, fluorescein angiography
management: high dose IV steroids
185
stabbing face pain caused by the trigeminal nerve (mostly V2 + V3)
triggers, presentation + prophylaxis
Trigeminal neuralgia
triggers: wind, cold, touch, chewing
presentation: 3-200 attacks of 5-10 seconds per day, autonomic features uncommon
prophylaxis: carbamazepine (no abortive treatment)
186
stabbing face pain caused by the trigeminal nerve (mostly V1)
triggers, presentation + prophylaxis
SUNCT (Short-lasting Unilateral Neuralgiform-headache w/ Conjunctival-injection + Tearing)
triggers: wind, cold, touch, chewing
presentation: 3-200 attacks of 10secs-4mins per day, autonomic features: eye-redness, lacrimation
prophylaxis: carbamazepine (no abortive treatment)
187
high intensity headache peaking instantaneously (in < 1 minute)
Thunderclap headache
| often due to SAH
188
neither communicating or non-communicating hydrocephalus
presentation, diagnosis, management
Normal pressure hydrocephalus
presentation: urinary incontinence, gait disturbance, rapidly progressive dementia
diagnosis: LP = normal opening pressure
management: ventriculo-peritoneal shunt placement (symptoms improve w/ CSF removal)
189
insufficient blood supply to the spinal cord
presentation
Spinal stroke/infarction
presentation: back pain, paraparesis(partial paralysis of lower limbs), numbness/paraesthesia, chronic urinary retention
190
acute herniation of an IV disc causing spinal cord/root compression
presentation + management
Disc prolapse
presentation: pain, myelopathy/ radiculopathy/ cauda equina syndrome
management: rehab, corticosteroid nerve-root-block-injection, discectomy
191
compression of all nerve roots in the lumbar spine (often due to lumbar disc prolapse)
presentation + management
Cauda equina syndrome
presentation: bilateral sciatica, saddle anaesthesia, urinary dysfunction
management: emergency lumbar discectomy
192
progressive disorder of the anterior horn cell
presentation, diagnosis, management
Motor neuron disease
presentation: combination of UMN and LMN signs: weakness, wasting, fasciculations, brisk reflexes
no sensory involvement
diagnosis: electromyography (EMG)
management: supportive (PEG, ventilation, PT, OT, SALT), Riluzole
193
skin condition consisting of itchy weals
causes, presentation, management
Urticaria
causes: idiopathic, infection, (rarely IgE mediated - drugs/food)
presentation: weals (central swelling surrounded by erythema), itching/burning
management: avoid triggers, oral anti-histamine, oral steroid
194
a cutaneous T-cell lymphoma (abnormal neoplastic proliferation of lymphocytes in the skin) affecting skin of the entire body
presentation + diagnosis + management
Sezary syndrome
presentation: thickened scaly red skin, itch++, lymph node involvement
diagnosis: sezary cells in blood
management: topical steroids, photochemotherapy, radiotherapy, chemotherapy, extracorporeal photopheresis, bone marrow transplantation (same as mycosis fungoides)
195
lens opacification
presentation + management
Cataract
presentation = gradual loss of vision, dazzle/glare by bright lights
management = cataract surgery (lens is removed by phacoemulsification and replaced with a plastic lens)
196
Short/near sightedness
(can't see distant objects well)
presentation + management
Myopia
(eyeball too long/ refractive power to strong)
Presentation: divergent squint, headaches
Management: biconcave (-ve power) lenses, laser eye surgery (to flatten cornea)
