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Approaches Flashcards

1
Q

Autonomic neuropathy

-> what to assess for next

A
  • Peripheral neuropathy
  • Parkinonism/ ataxia
  • No associated features (no parkinonism/ataxia/PN)
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2
Q

Autonomic neuropathy + Parkinonism/ Ataxia?

A

Multi system atrophy: Parkinonism predominant, Cerebellar predominant

Lewy body disorders: Parkinson’s disease, Dementia with Lewy body

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3
Q

autonomic neuropathy + distal painful peripheral neuropathy?

A

think of
- Vasculitis
- HIV
- Fabry Disease
- Diabetes
- Amyloidosis
- Hereditary

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4
Q

Autonomic neuropathy + distal sensorimotor peripheral neuropathy?

A

Diabetes, Amyloidosis

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5
Q

Autonomic neuropathy + subacute sensory peripheral neuropathy?

A

Sjogren’s syndrome
Paraneoplastic

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6
Q

Erythema nodosum: different groups of causes?

A

Infections
Malignancy
Autoimmune disease
Granulomatous disease
IBD
Drugs
Pregnancy

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7
Q

Erythema nodosum: malignancy causes?

A

Lymphoma
Leukaemia
Internal carcinomas
Sweet’s Syndrome

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8
Q

Erythema nodosum: infective causes

A

Bacterial: streptococcal, TB, leprosy, GE (Salmonella, campylobacter, Yersinia), Leptospirosis, Chlamydia trachomatis, Lymphogranuloma venereum, Whipple’s disease

Fungal: Coccidiomycosis, Histoplasmosis, Blastomycosis

Viral: Infectious mononucleosis, Hepatitis B

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9
Q

Erythema nodosum: Autoimmune disease cause

A

Behcet’s disease

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10
Q

Erythema nodosum: Granulomatous disease cause

A

Sarcoidosis

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11
Q

Erythema nodosum: IBD causes

A

Crohns, UC

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12
Q

Drug causes of erythema nodosum?

A

COCP
Penicillins
Sulfonamides (e.g bactrim)
Bromides and iodides
TNFa inhibitors (rare)

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13
Q

Causes of Gout?

A

Obesity

Drug/Dietary:
- Ethanol
- excessive purine ingestion
- B12 deficiency
- Cytotoxic drugs

Malignancies with high cell turnover

Skin disorders: psoriasis, eczema

Haematological disorders:
myeloproliferative
lymphoproliferative disorders
haemolytic anaemia

renal failure with reduced excretion

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14
Q

Hypertension: main groups of causes

A

Renal cause
Endocrine cause
Neurological
Vascular
Drugs
Pregnancy

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15
Q

Renal causes of hypertension? what features may be suggestive

A

jump in Cr after ACEi/ARB
Flash pulmonary oedema
Renal bruit
haematuria

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16
Q

Renal causes of hypertension? causes

A

Renal artery stenosis: assoc Takayasu’s arteritis, Neurofibromatosis

Polycystic Kidney disase: assoc Berry aneurysms, Regurgitant murmurs

Glomerulonephritis: Recurrent UTI, Hep B/C/HIV, Autoimmune, myeloma

Renal cell carcinoma (EPO producing): assoc polycythaemia

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17
Q

Endocrine causes of Hypertension?
features

A

may have clear physical signs associated with underlying disorder
electrolyte abnormalities
episodic HTN

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18
Q

endocrine causes of hypertension?
causes

A

Conn’s syndrome: hypokalaemic (may be normoK) metabolic alkalosis

Cushing’s syndrome: Lung ca, ectopic, glucocorticoid/TCM use

Acromegaly: DM, CTS, Acanthosis nigricans, osteoporosis, hemianopia, GI bleed

Phaeochromocytoma: MEN, Paroxysmal

Hyper/hypothyroidism

Hyperparathyroidism: MEN syndrome, hyperCa, osteoporosis

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19
Q

pregnancy related cause of hypertension

A

pre eclampsia
- frothy urine, blurring of vision, HTN, seizures

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20
Q

drug causes of hypertension

A

OCPs
steroids
recreational drugs

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21
Q

neurological causes of hypertension?

A

Raised ICP
obstructive sleep apnoea: hypoxia, polycythaemia, metabolic disorders

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22
Q

vascular causes of hypertension

A

Coarctation of aorta: asymmetrical clubbing, differential clubbing, pulse delays

Arteritis: Takayasu’s arteritis- vascular claudication, Scleroderma

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23
Q

generic groups of causes of mononeuritis multiplex

A

infections
rheumatological
chronic disease
haematologic
malignancy
metabolic

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24
Q

malignancy related causes of mononeuritis multiplex

A

paraneoplastic
carcinoid
tumour invasion

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25
haematologic causes of mononeuritis multiplex
hypereosinophilia cryoglobulinaemia hypereosinophilia idiopathic thrombocytopenic purpura
26
endocrine cause of mononeuritis multiplex
B12 deficiency
27
chronic diseases causing mononeuritis multiplex
diabetes mellitus hypertension acromegaly amyloidosis sarcoidosis
28
infectious causes of mononeuritis multiplex
leprosy lyme disease hep B/C/ HIV
29
rheumatological causes of mononeuritis multiplex
vasculitis: GPA, eGPA, polyarteritis nodosa, Behcet's disease, giant cell arteritis, HSP connective tissue diseases: sjogrens, SLE, RA, systemic sclerosis
30
congenital causes of primary hypogonadism?
Klinefelter's syndrome XXY Mutation in LH/FSH receptor genes Cryptorchidism Disorders of androgen synthesis Myotonic dystrophy
31
Acquired causes of primary hypogonadism?
infections- mumps radiation drugs: ketoconazole, suramin, alkylating agents toxins trauma torsion autoimmune systemic illnesses: cirrhosis, chronic renal failure, AIDS
32
causes of pseudogout
haemochromatosis hyperPTH hypoMg hypophosphatasia: rare genetic mutation in ALP -> development of osteomalacia and periodontal disease
33
causes of hypomagnasaemia?
**GI loss** diarrhoea malabsorption small bowel bypass surgery medications: PPIs **Renal Loss** volume expansion uncontrolled DM Alcohol hyperCa acquired tubular dysfunction: recovery from ATN, post obstructive diuresis, post kidney transplantation Genetic disorders: Bartter, Gitelmans, HNF1b mutation medications: diuretics, antibiotics (e.g. aminoglycosides), calcineurin inhibitors, cisplatin, EGFR antibodies
34
what are some secondary causes of haemochromatosis?
increased intake: transfusion overload iron loaded diet Hemin infusions (used to treat porphyric attacks) increased absorption: thalassaemia major/intermedia sideroblastic anaemia- congenital or acquired chronic liver disease: alcoholic, chronic hepatitis, NAFLD
35
Causes of sideroblastic anaemia?
Congenital Acquired: - Clonal/neoplastic: myelodysplasia - Metabolic: Zinc toxicity, Cu deficiency, Alcohol, Drugs e.g. isoniazid, chloramphenicol, linezolid
36
Causes of group 1 hypertension ie. Pulmonary arterial hypertension?
- Idiopathic - Hereditary variant - Drug and toxin induced: e.g. appetite suppressants, amphetamines, cocaine, interferon - Connective tissue disease - Congenital heart disease - HIV - Schistosomiasis - portopulmonary hypertension
37
Causes of group 2 pulmonary hypertension?
secondary to left heart disease: HFpEF, HFrEF Valvular heart disease Congenital/ acquired cardiac conditions
38
Causes of group 3 pulmonary hypertension?
due to lung diseaase and or hypoxia: obstructive lung disease restrictive lung disease mixed disease hypoxia without lung disease developmental lung disorders
39
causes of group 4 pulmonary hypertension?
due to pulmonary artery obstruction: chronic thromboembolic pulmonary hypertension pulmonary artery obstructions
40
causes of group 5 pulmonary hypertension?
unclear/ multifactorial: -haematological disorders - systemic and metabolic disorders - complex congenital heart disease
41
Causes of pyoderma gangrenosum?
inflammatory bowel disease inflammatory arthritis: e.g. RA solid organ malignant neoplasms DM haematological disorders Sarcoidosis Autoimmune/ viral hepatitis
42
inflammatory arthritis causing pyoderma gangrenosum?
RA Ank Spond SLE
43
haematological disorders that can cause pyoderma gangrenosum?
MGUS Myelodysplastic syndrome Polycythaemia vera Haematological Malignancy
44
Causes of secondary osteoarthritis
Mechanical Inflammatory Metabolic
45
Inflammatory causes of secondary osteoarthritis?
Crystal arthropathy RA post septic arthritis Spondyloarthropathies
46
Causes of thrombosis?
Inherited Acquired: immobility, prothrombotic state, endothelial dysfunction
47
Inherited causes of thrombosis?
Factor V Leiden mutation Protein C/S deficiency Anti thrombin III deficiency Prothrombin mutation
48
Acquired causes of thrombosis?
Immobility: post surgery, pregnancy Endothelial dysfunction: recent surgery, trauma, venous catheter Prothrombotic state: Malignancy, Myeloproliferative neoplasm Antiphospholipid syndrome Nephrotic syndrome IBD Congenital heart disease Paroxysmal nocturnal haemoglobinuria Medications: COCP, hormone replacement therapy; antifibrinolytic, anabolic
49
Causes of intention tremor?
Cerebellar disease Multiple sclerosis Midbrain stroke/ trauma
50
Causes of resting tremors?
Parkinson’s disease Parkinsonian syndromes Rubral tremors: midbrain, thalamic, cerebellar or pontine injury Wilson’s disease Severe essential tremors
51
Causes of postural- action tremors?
Physiological tremors Essential tremors Task- specific tremors Extrapyramidal disorders: PD, wilsons, dystonia Cerebellar disease Neuropathic tremors (muscle weakness and loss of proprioception): CIDP, hereditary neuropathies
52
Focal lesions causing splenomegaly?
Haematoma Cyst Primary vascular tumour Haemangiomas Hamartomas
53
Infiltrative causes of splenomegaly?
Sarcoidosis Amyloidosis Gaucher’s disease Tumour metastasis SLE HLH
54
Autoimmune cytopenias causing splenomegaly?
AIHA ITP Immune neutropenia Feltys syndrome
55
Haematological malignancy causing splenomegaly ?
Lymphoma Leukaemia Myelofibrosis PCV
56
Infections causing splenomegaly?
Malaria Visceral leishmaniasis TB EBV, HIV Leptospirosis, Schistosomiasis
57
Liver disease causing splenomegaly?
Liver cirrhosis with portal hypertension
58
Extramedullary haemopoiesis causing splenomegaly?
Transfusion dependent thalassaemia Primary / secondary myelofibrosis
59
Causes of secondary myelofibrosis?
Neoplasia Infection: TB, fungal infections, HIV Metabolic: Gaucher disease Haematological malignancies: CML, Myeloma, lymphoma, AML Radiation Sarcoidosis
60
Causes of raised CK?
Inflammatory myopathy Infectious myopathy Dystrophinopathies Rhabdomyolysis Drugs Metabolic myopathies: carbohydrate/ lipid/ purine metabolism Endocrine myopathies Malignant hyperthermia Motor neuron disease: ALS, spinal muscular atrophy Periodic paralysis
61
Inflammatory myopathies causing raised CK?
Dermatomyositis Polymyositis Inclusion body myositis Behcets Sarcoidosis
62
Dystrophinopathies causing raised CK?
Beckers Duchennes Fascio scapulo humeral Limb girdle Myotonic dystrophy
63
Drug causes of raised CK?
Colchicine Statin Anti malarials Alcohol Penicillamine
64
Endocrine myopathies causing raised CK?
Acromegaly Hypothyroidism
65
Causes of palpitations?
Cardiac High output states Metabolic and endocrine Catecholamine excess: stress, exercise Substance use: cocaine, amphetamines, caffeine, alcohol, nicotine Drugs Psychiatric disorders
66
Cardiac causes of palpitations
Arrhythmias Valvular heart disease Shunt
67
High output states causing palpitations?
Anaemia Pregnancy Fever Pagets disease of the bone
68
Metabolic/ endocrine causes of palpitations?
Hypoglycaemia Hyperthyroid Phaeochromocytoma
69
Psychiatric disorders causing palpitations?
Generalised anxiety Panic disorder Somatization disorder
70
Drug causes of palpitations
Vasodilators Anticholinergics Sympathomimetic agents Beta blocker withdrawal
71
Causes of hyperpigmentation on examination?
Iron overload: haemochromatosis, haemosiderosis Endocrine: addisons, cushings Metabolic: renal failure, porphyria Liver: PBC Drugs: amiodarone, minocycline Physiological- sun tanning
72
Causes of macrocytosis?
B12/ folate deficiency Drugs: methotrexate, azathioprine, hydroxyurea Shift to immature red cells: Reticulocytosis Primary bone marrow disorders: Myelodysplastic syndrome Lipid abnormalities: Liver disease, hypothyroidism Alcohol abuse Multiple myeloma
73
Causes of microcytic anaemia?
Hereditary: thalassaemia Acquired: Iron deficiency Anaemia of chronic disease Anaemia of inflammation Myelodysplastic syndrome with acquired thalassaemia Zinc toxicity Cu deficiency Sideroblastic anaemia
74
Causes of sideroblastic anaemia?
Toxins: lead, alcohol Drugs: isoniazid, chloramphenicol, linezolid
75
Causes of polyuria?
Primary polydipsia Solute diuresis: diuretics, hyperglycaemia, mannitol, SGLT2i Diabetes insipidus
76
Causes of cranial Diabetes insipidus?
Idiopathic Post neurosurgery Traumatic Tumour Hypoxic injury Infiltrative diseases
77
Causes of nephrogenic diabetes insipidus?
Hereditary Lithium HyperCa HypoK Renal causes: ADPKD, amyloidosis, medullary cystic kidney disease, post obstructive/ ATN diuresis
78
Malignant causes of monoarthritis?
Tenosynovial giant cell tumour Chondrosarcoma Osteoid osteoma Metastatic disease
79
Causes of weight gain?
- Fat - Big tumour - Fetus - Fluid: cardiac, renal, liver, low albumin (malnutrition, chronic disease, protein losing enteropathy), capillary leak syndromes
80
Cause of weight gain from fat ?
Neuroendocrine causes Cushings PCOS Hypothyroid Hypothalamic dysfunction Hypogonadism GH deficiency Iatrogenic Drugs: corticosteroids, antipsychotics, antidepressants, insulin, AEDs Hypothalamic surgery Physiological: Sedentary lifestyles Social and behavioural
81
Infectious / post infectious causes of polyarthritis?
Viral infection Bacterial infection: Lyme disease, bacterial endocarditis Rheumatic fever Reactive arthritis
82
Metabolic causes of secondary osteoarthritis
Haemochromatosis Acromegaly Ochronosis: alkaptonuria, quinine/ hydroquinone use
83
Mechanical causes of secondary osteoarthritis
Previous trauma Valgus/ varus deformity Occupation related Developmental Meniscectomy Leg length discrepancy Hyper mobility syndrome Neuropathic arthropathy
84
Causes of painless haematuria?
Renal: dystrophic RBCs GN, PCKD Urological cause: isomorphic Exercise Trauma Post radiation: radiation cystitis Bladder cancer Drugs: cyclophosphamide, anti platelets/ anticoag

PACES 2024 (14 decks)

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