Year 3 Flashcards
Chronic multi-system disease with unknown aetiology.
- Lymphadenopathy - enlarged, non-tender (typically cervical and submandibular)
- CXR: bilateral hilar lymphadenopathy
- Elevated calcium and serum ACE
- Erythema Nodosum, lupus pernio
- Weight loss, low grade fever
- Treatment: corticosteroids if severe
Sarcoidosis
Cholestatic liver disease
- Bile duct destruction, cirrhosis, end stage liver disease
- Predominantly young, middle aged men
- Obstructive jaundice, priuritis
- Link to IBD (UC>CD)
- No specific auto-antibodies, but ANCA often present
- Tx: Liver transplant
- Leading cause of dead is liver failure and cholangiocarcinoma
Primary Sclerosing Cholangitis
Constant aching pain around eye, radiating to forehead
- Reduced vision, N&V, haloes
- Red congested eye
- Cloudy cornea
- Dilated non-responsive pupil
- Attacks precipitated by sitting in the dark, dilating eye drops or emotional upset
- Tx: acetazolamide
Acute Glaucoma
Tight band around head - Dull pulsatile constricting bilateral pain - Related to stress, commonest headache - Worsens as day progresses - F>M, lower SES Tx: rest and simple analgesia
Tension headache
Headache lasting a few weeks
- Tender thickened pulseless temporal artery
- Jaw claudication, especially on chewing
- Associated with PMR
- Can -> blindness
- Ix: raised ESR and CRP
- Tx: Steroids
Giant cell (temporal) arteritis
Rapid onset, severe headache
- Same time each time 15mins-3hours
- Often begins around eye, occurs in cluster periods
- Eye redness, rhinorrhea
- Due to hypothalamic activation with secondary autonomic and trigeminal activation
- Lacrimation, rhinorrhoea, nasal congestion, partial Horner’s
- Tx: 100% O2 (acute)
- Preventers: verapamil, lithium, steroids,
Cluster Headache
Idiopathic disorder
- Paroxysms of intense sharp stabbing pain in CNV distribution
- Triggered by touching affected area (eating, chewing, hair brushing, shaving)
- Causes: Aneurysm, tumour, chronic meningeal inflammation, MS, zoster
- Ix: MRI to rule out secondary cause
- Tx: carbamezapine, lamotrigine, phenytoin
Trigeminal Neuralgia
LOC due to transient arrhythmia (decreased CO)
- Often post MI
- Palpitations
- Pale before, flushed after
- Recovery in seconds
- Tx: pacemaker
Stokes-Adams Attack
Hereditary Neuropathy beginning in puberty with weak legs and foot drop, with variable loss of sensation and reflexes
- Pes Cavus, high foot arches
- Areflexia, hammer toes
- Distal atrophy hands and legs, champagne bottle appearance
- May need to excessively lift legs to clear the toes
- Tx: Rehab and orthototics
Charcot-Marie-Tooth Disease
- CMT1A: atrophy hand and arm muscles - mutation PMP22 myelin gene
TRIAD: Opthalmoplegia, mental change, gait dyfunction
Wernicke’s Encephalopathy: due to acute thiamine deficiency
RFs: alcoholics, malnutrition, GIT surgery, AIDS, Cancer, Chemotherapy
Demyelinating CNS condition, Characterised by:
- 2 or more episodes of neurological dysfunction distinct in both time and space
MS: white woman, 20-40years
- Temporary visual/sensory loss usually
- MRI sensitive, but not as specific as spinal MRI
Frontotemporal denegeneration
- Disruption personality and social conduct
- Primary language disorders
- Components of dys-executive syndrome
- Many display Parkinsonism and subset also have MND
Pick’s Disease
Loss of vision in a normal eye due to damage to visual area of occipital cortex = Cortical blindness
Often lack of insight into condition and confabulate sight
Pupillary light reflex intact as doesn’t involve cortex
Normal fundoscopy
Anton’s Syndrome
Insidious onset gait apraxia (falls).
- Cognitive impairment, urinary problems
- Dilated ventricles on CT
- Periventricular leukomalacia
- Cerebral infarction
Normal pressure hydrocephalus
AD defect in haem synthesis
- Abdo pain, vomiting, tachycardia, confusion, motor neuropathy
- Precipitated by alcohol and OCP
Porphyria
Mixed neuropathy and CCF (SOB, peripheral oedema, motor and sensory)
- Vitamin B1 (thiamine deficiency)
Beri-Beri
Raccoons sign: periorbital bruising
Battle’s sign: Mastoid bruising
Bloody otorrhoea, CSF otorrhoea/rhinorrhoea
Hearing impairment (sensorineural due to CN VIII damage or conductive due to haemotympanium)
Base of skull fracture
Streptococcus
Staphylococcus
Enterococcus
Gram positive cocci
Clostridium
Listeria
Gram positive bacilli
Neisseria
Haemophilis
Gram negative cocci
Salmonella Shigella Pseudomonas Legionella Vibrio ESBL Proteus
Gram negative bacilli
Tick borne infection caused by spirochete Borrelia burgdorferi
- Erythema migrans, arthritis
- Tick bite -> Bull’s Eye appearance
Lyme disease
Popliteal cyst: synovial fluid from a knee effusion escapes in a subgastrocneumius bursa.
- Usually in response to injury/inflammation (arthritis)
- Sudden onset pain behind knee
Baker’s Cyst
- Tx: Rest, Ice, Compression, elevation, gentle mobilisation, analgesia.
- If severe corticosteroid (intra-articular) injections/surgery
- Frank haematuria post URTI/gastroenteritis
- IgA nephropathy: commonest glomerulonephritis causing renal failure
- Increased IgA titre
Berger’s Disease
Dx: renal biopsy - focal/diffuse mesangial proliferation and extracellular expansion. IF: diffuse mesangial IgA
Tx: ACEI to decrease proteinuria, early corticosteroids can delay renal failure
