Flashcards in Real Patient Deck (43):
What is charcot marie tooth sydrome?
Hereditary neuropathy affecting motor and sensory nerves of the PNS
Typical presentation of charcot marie tooth syndrome?
Foot drop, wasting of muscles in lower leg (inverted champagne bottle)
Weakness in hands and forearms
High arched or flat arched feet
How is charcot marie tooth syndrome diagnosed?
Nerve conduction studies
Diagnosis of restrictive lung disease?
FEV1 and FVC decrease
FEV1:FVC ratio >80% (FEV1 decreases less than FVC)
Diagnosis of obstructive lung disease?
FEV1 and FVC decrease
FEV1:FVC ratio <70%
What are the two main causes of restrictive lung disease?
Interstitial lung disease (fibrosis of the interstitium, thickening the barrier for gas exchange)
Chest wall abnormalities (obesity)
What are the common interstitial lung diseases?
Idiopathic pulmonary fibrosis
Features of IPF?
Progressive breathlessness, malaise, WL, decreased chest expansion, fine end inspiratory crackles
Investigations for IPF?
Spirometry, CXR (lower zone fibrosis), CT (honeycombing)
What are the most common pneumoonosies and offending particles?
Asbestosis: insulation material
Berylliosis: miners, aerospace workers
Silicosis: sand blasters
What are main symptoms of digoxin toxicity?
Vomiting, loss of appetite, blurry vision
Arrhythmias (commonly frequent premature beats)
Valve replacement on patient with midsternal scar and pacemaker implant on LHS?
Mechanical mitral valve
What is the INR target for mechanical heart valve?
What kind of hypersensitivity is MS?
What is the pathophysiology of MS?
Demyelinating disorder of the CNS
What are the main types of MS?
Progressive relapsing remitting
What can worsen the symptoms of MS?
heat: holidays, hot baths
What is internuclear ophthalmoplagia?
Difficulty adducting one eye and nystagmus in the abducting eye
What are some of the common symptoms of MS?
UMN signs (muscle weakness, increased tone, hyperreflexia, babinski positive)
Numbness and parasthesia
Bowel and bladder symptoms
What is ataxia?
Group of conditions affecting coordination, balance and speech
What is key for the diagnosis in MS?
Multiple neurological symptoms separated in time and space
Investigations for MS?
MRI (shows white plaques)
CSF (high levels of ABs)
How to treat MS?
OA knee with pain and sometimes giving way?
Degenerative meniscal injury
MRI, knee Xray
What autoantibodies are associated with RA?
Anti RF, Anti CCP (these are negative in psoriatic arthritis)
Xray findings in psoriatic arthritis?
Pencil in cup
Treatment of psoriatic arthritis?
DMARDs: methotrexate, sulfasalazine
Biologics (TNF inhibitors)
GALS screening questions?
Problems getting dressed
Problems walking up stairs
Pain or stiffness in muscles and joints
Inspect from side, front and back
Lateral flexion of neck
Hands behind head
Hand: inspect, power grip, thumb to finger, pincer grip, squeeze MCPJs
Knee flexion, internal rotation of the hip
Where is a transplanted kidney placed?
RIF (soft round palpable mass with hockey stick scar)
Findings in hand RA?
Ulnar deviation at MCPJs
Swan neck hyperextended PIP, flexed DIP
Boutonniere flexed PIP, hyperextended DIP
Z shaped thumb fixed flexion and subluxation of MCPJ, hyperextions of IPJ
RA hand exam?
Expose to elbow
Inspect for deformity (dorsum and palm)
Squeeze MCPs for tenderness
Bimanually palpate swollen joints
Bimanually palpate wrist
Run hand up forearm (plaques, nodules)
Prayer sign, upside down prayer sign
Thumb to each finger
Pick up small object
Pan systolic, best heard at apex
Radiates to the axilla
Diabetic foot exam?
Palpate: temp, cap refill, pulses (p.tibial, d.pedis)
Sensation: monofilament, 128hz fork
What is charcot foot?
Progressive degeneration of joint due to loss of sensation
NF1 vs NF2?
1: chromosome 17, multiple neurofibromatomas near skin (mobile lumps under skin and cafe au lait) lisch nodules in iris
2: chromosome 22, brain, spinal cord and CNs commonly affected (bilateral aucoustic neuromas), meningiomas (seizures, visual changes)
CT or MRI to detect fibromas
Why does thyroid eye disease occur?
TSH receptors near eyes
Features of graves eye disease?
Treatment of graves?
What is retinitis pigmentosa?
Genetic disorders that result in break down of retina
Tunnel vision, FH
Dark pigment deposits on ophthalmoscopy
Systolic cresendo decresendo
Radiates to carotid
Best heard in aortic area
Slow rising pulse
What is de musset sign?
Bobbing of the head seen in aortic regurge due to wide pulse pressure seen in aortic regurge