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PACES - Final Week Revision > Station 5 > Flashcards

Station 5 Flashcards

(94 cards)

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1
Q

Rheumatoid arthritis antibodies (2)

A

Anti-cyclic citrullinated peptide (CCP)
Rheumatoid factor

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2
Q

Criteria to diagnose Psoriatic arthropathy

A

CASPAR criteria:
Axial or peripheral arthritis
Enthesitis
Psoriasis
Nail dystrophy
Dactylitis

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3
Q

CN 7 palsy symptoms

A

Slurred speech
Dribble/Dry eye/mouth
Taste
Tinnitus
Pain in face/ear

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4
Q

Bell’s Palsy management

A

Resolves in up to 6 months
Weaning steroids for 10 days starting at 50mg OD
Eye protection patch + drops
Facial massage leaflet
10% it might happen again

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5
Q

CREST Syndrome

A

Calcinosis
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactily
Telangiectasia

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6
Q

Difference between Homocysteinuria and Marfan’s?

A

Autosomal recessive
No aortic disease
Recurrent DVTs and PEs
Upwards lens dislocation

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7
Q

Causes of Addison’s disease

A

Autoimmune (with vitiligo, IDDM)
Tuberculosis
HIV/AIDS
Secondary hypoadrenalism - pituitary tumours
Tertiary hypoadrenalism - Steroid medication

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8
Q

Autoimmune adrenalitis antibody

A

Anti 21-hydroxylase

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9
Q

Causes of hypertension in young patient

A

1) Cushing – acromegaly – Obesity (metabolic syndrome)
2) Medications induced (STEROIDS)
3) Renal : ADCKD – RAS – GN
4) Suprarenal: Conns – Liddles – pheochromocytoma (remember MEN-2 or neurofibromatosis)
5) Essential HTN

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10
Q

Polycythaemia Rubra Vera exam

A

Hepatomegaly/hepatosplenomegaly
Venepunctures
Goût

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11
Q

Behçet’s disease

A
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12
Q

Sheehan syndrome

A
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13
Q

Addison’s disease - hx and exam

A

Nausea, vomiting
Salty food craving
Postural symptoms
Tanned skin (due to high ACTH)
Weight loss, fatigue, Impact on life
Autoimmune diseases inc family hx

Hand palmar creases
Postural BP

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14
Q

Addison’s disease

A
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15
Q

Myasthenia Gravis history and exam

A
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16
Q

Pseudoxanthoma Elasticum - features mnemonic

A
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17
Q

Symptoms of Carcinoid Syndrome

A
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18
Q

Antibodies in Myasthenia Gravis

A

Anti-acetylcholine receptor (AChR)
Anti-muscle-specific tyrosine kinase (MuSK) antibodies.

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19
Q

Hereditary Haemorrhagic Telangiectasia

A

Telangiectasia on the lips/tongue/limbs
Bruits from AVMs in lower lungs and liver
BG of anaemia, epistaxis, GI bleed, haematemesis, headaches

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20
Q

Osteogenesis imperfecta

A

Blue sclerae
Hearing aids
Joint hyper mobility
Scoliosis
Aortic regurgitation

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21
Q

Neurofibromatosis type 1 mnemonic

A

Café au lait patches
Axillary
Freckles
Eye nodules (Lisch)
Scoliosis & Seizures
Phaemochromocytoma
Optic nerve tumours
Tumour of the kidney (nephroblastoma)
Short stature

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22
Q

Neurofibromatosis type 2 features (5)

A

Bilateral vestibular schwanomas
Méningiomas
Cataracts
Retinal hamartomas
<6 café au lait spots

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23
Q

Tuberous Sclerosis examination (3) and four associated conditions

A

Ash-leaf macule
Shagreen patches
Adenoma sebaceum

Epilepsy, learning disability
Benign tumours in brain and kidneys
Cysts on liver/kidney/pancreas
Sporadic or Autosomal dominant TSC1 and TSC2

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24
Q

Polymyositis and Dermatomyositis antibody

A

Anti-Jo1

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25
Dermatomyositis antibody
Anti-Mi2
26
MEN 1a syndrome
Parathyroidism Pituitary adenoma Pancreatic islet cell tumours
27
MEN 2a syndrome
Medullary thyroid cancer Hyperparathyroidism Phaeochromocytoma
28
Allport syndrome
Sensorineural deafness AAA Haematuria & renal cysts X-linked dominant disease
29
Polyarteritis Nodosa
Associated with hepatitis B Testicular pain Joint pain Livedo reticularis Mononeuritis multiplex
30
Hypercoagulable state
(Risk factors for PEs) Drugs (COCP) Antiphospholipid syndrome Malignancy Nephrotic syndrome Pregnancy Lymphoproliferative disorders Polycythaemia rubra vera
31
Erythema Nodosum
Sarcoidosis (Lofgren syndrome) Idiopathic / Inflam bowel disease Group A haemolytic strep HIV Tuberculosis Pregnancy Drugs (COCOP, abx)
32
Lofgren syndrome
Sarcoidosis Bilateral hilar lymphadenopathy Uveitis Erythema Nodosum Fever
33
Livedo Reticularis
Anti-phospholipid syndrome SLE Hepatitis C
34
Systemic Sclerosis
Calcinosis Raynaud’s phenomenon Esophageal dysmotility Sclerodactyly Telangiectasia Arthritis with myopathy Interstitial lung disease or pulmonary artery hypertension
35
Seronegative spondarthritides
‘PEAR’: - Psoriatic arthritis - Enteropathic arthritis - Ankylosing spondylitis - Reactive arthritis
36
Autoimmune questions
- morning joint stiffness - back/pelvic pain - rash, photosensitivity, nodules, oral ulcers - dry eyes, dry mouth - Raynaud’s phenomenon - dysphagia, heartburn - lung involvement - haematuria, bowel habits
37
Acromegaly symptoms
Headaches Bitemporal hemianopia Galactorrhoea, menstrual changes Increase in hand & shoe size Change of appearance Diabetes/polyuria/polydipsia Excessive sweating Carpal tunnel syndrome
38
Acromegaly examination findings
Prognathism Prominent supraorbital ridge, Large tongue Bitemporal Hemianopia, CN3 palsy Tinel & Phallen’s signs for carpal tunnel
39
Causes of Acromegaly
Pituitary adenoma secreting growth hormone (can be part of MEN1) Ectopic growth hormone secretion from tumour
40
Investigations for Acromegaly
IGF1 level Oral glucose tolerance test for GH supp Hormone profile MRI brain +/- body
41
Management of acromegaly
Transphenoidal surgery May consider radiotherapy and octreotide Treatment of complications (OSA, DM, carpal tunnel) Colonoscopy every three years
42
Complications of Acromegaly (4)
Hypertension Diabetes Sleep apnoea Heart failure
43
Causes of hyperthyroidism
Grave’s disease (TSH receptor Ig) Multinodular goitre Thyroiditis
44
Causes of hypothyroidism (3)
Hashimoto’s thyroiditis Iatrogenic (post-surgery, lithium) Iodine deficiency
45
Addison’s disease investigations
Short Synacthen test - synacthen causes rise in ACTH level Hyponatraema, hyperkalaemia Renin-aldosterone ratio
46
Extra-articular manifestations of Rheumatoid arthritis
Scleritis, episcleritis Pleural effusions / pulm effusion Pericarditis Splenomegaly (Felty’s syndrome) Glomerulonephritis
47
Methotrexate (3 facts)
Inhibits purine metabolism Always prescribe folate supplements Risk of myelosuppression and liver impairment
48
Ehler-Danlos disease types
Hyper mobile joints type Velvety skin type Vascular type Defect in collagen genes
49
Polycythaemia rubra Vera symptoms and blood results
Hypertension DVTs, strokes High WCC and platelets Haematocrit >55% JAK2 mutation
50
Thyroid exam
Sweaty hands with thyroid acropachy Irregular pulse Exophthalmos, peri-orbital swelling Visual acuity and ocular movements Neck - observe, goitre, swallowing, percussion sternum, feel lymphadenopathy Proximal myopathy Pretibial myxoedema
51
Symptoms of hyperthyroidism
Sweaty hands & tremor Tachycardia Anxiety Palpitations Weight loss
52
Side-effects of Carbimazole
Rash Agranulocytosis Hepatitis Teratogenic
53
Issues around radio-iodine therapy
4 weeks can’t be around pregnant women or kids Worsening of eye disease Avoid pregnancy four months
54
Eye signs in Grave’s eye disease
Asymptomatic Lif retraction Proptosis Ocular muscle involvement Corneal involvement Optic nerve damage Treat with high dose steroids & ophthalmology & eye drops & stop smoking
55
Causes of goitre
Idiopathic Graves’ disease Iodine deficiency Pregnancy
56
Causes of hypothyroidism
Iodine deficiency Autoimmune thyroiditis Pituitary failure Lithium / Amiodarone
57
Symptoms of hypothyroidism
Depression Weight gain Constipation
58
Differentials loss of peripheral vision
Glaucoma Retinitis pigmentosa Retinal artery occlusion (vein is central) CVA Chiasmal lesion
59
Intranuclear ophthalmoplegia
Medial longitudinal fasciculus lesion Affected eye can’t adduct Other eye nystagmus on looking that way
60
Horizontal Diplopia
CN6 palsy
61
Vertical diplopia
CN 3 or 4 palsy
62
Ocular exam
Acuity Fields + extinction Reflex - accommodation + light Ophthalmoscopy Ocular movements inc diplopia
63
Ankylosing spondylitis symptoms
Pain worse in mornings Affecting pelvis Plantar fasciitis, tendinitis, dactyliitis Red eyes Scored in Bath
64
Ank spondylitis exam
ROM neck and spinous processes Schobers test (5cm above dimples of Venus, 10cm below) —> positive if <5cm expansion Red eyes AR murmur Power/sensation in legs
65
Extra-articulate features of Ankylosing spondylitis
Atlantoxial dislocation causing cord compression Anterior uveitis Aortic regurgitation, arrhythmias Fibrosis IgA nephropathy
66
Ankylosing spondylitis tests
Renal function HLA-B27 XR lumbar spine and pelvic joints ECG for cardiac problem CXR for fibrosis
67
Acromegaly complications
Diabetes Hypertension Carpal tunnel syndrome Hypogonadism OSA Recital bleeding from polyps or kidney stones
68
Acromegaly examination
Visual fields Face - prom supraorbital ridge, prognathism, macroglossia Carpal tunnel syndrome Proximal myopathy Neck circumference if OSA
69
Acromegaly investigations
IGF-1 level Oral glucose tolerance test (paradoxical rise) MRI pituitary fossa Formal visual fields Hormone screen (ACTH, cortisol, TSH, LH, FSH, prolactin) + calcium for MEN1
70
Cushing’s examination
Fingerprick glucose marks Carpals tunnel Facial plethora with hirsutism Buffalo hump Proximal myopathy
71
Cushing syndrome causes
Steroid use Pituitary adenoma secreting ACTH Small cell lung cancer secreting ACTH Adrenal adenoma/carcinoma
72
Treatment of Cushing syndrome
Surgery Octreotide, somatostatin Optimise lifestyle
73
Definition of osteoporosis
Bone density more than 2.5 standard deviation below the mean value for an adult the same gender and race
74
Investigations that confirm Cushing syndrome
24h urinary cortisol Low dose dex supp test
75
Investigations that identify cause of Cushing syndrome
9am ACTH level High dose dex supp —> of low urinary cortisol then pituitary adenoma MRI pituitary fossa or CT CAP
76
Pyoderma gangrenosum
Painful red/black ulcers IBD Autoimmune Haematological malignancy Hep C
77
limited systemic sclerosis antibody
Anti centromère antibody
78
Diffuse systemic sclerosis antibody and features
Anti-Scl70 Renal crisis Interstitial lung disease Pulmonary artery hypertension Right heart failure
79
Dermatomyositis exam
Gottron’s papules Heliotropic rash on face ILD, pulm hypertension Reflux Cardiac arrhythmias & myositis Cancer association Anti-Jo1
80
Headache examination
Visual fields Fundoscopy Cranial nerves 3-4-6 and CN 7 Temporal tenderness Nuchal rigidity Power in arms/legs
81
Reactive arthritis
Associated with salmonella, campylobacter, chlamydia Triad: conjunctivitis + arthritis + urethritis Can cause dactylitis
82
AIDS-defining illnesses:
CD4 <200 PCP or mycobacterium avium Oesophageal candidiasis Chronic diarrhoea (from CMV) Kaposi syndrome
83
Marfan syndrome cause & manifestations
Autosomal dominant from fibrillin gene mutation (chrom 15) Hugh arched palate Longer arm span than tall height Upward lens dislocation, blue sclera Aortic root dilatation/regurgitation/MVP Hypermobility with arachnodactily Spontaneous pneumothorax, emphysema, Bronchiectasis
84
Raynaud’s phenomenon associations (esp if has a digital ulcer)
Scleroderma SLE Rheumatoid arthritis Dermatomyositis Polymyositis
85
Everything autosomal dominent except for:
Recessive: Wilson’s disease (ATP7B gene) Friedrich’s ataxia (frataxin gene) Hereditary Haemochromatosis (HFE gene)
86
Symptoms of Haemochromatosis
Arthralgia with synovitis Diabetes Cardiomyopathy Bronze skin Raised ferritin and transferrin Screening of relatives
87
Extra-articulas features of Ankylosing spondylitis
Anterior uveitis Aortitis Aortic regurgitation Apical pulmonary fibrosis Amyloidosis causing glomerulonephritis Achilles tendon enthesitis
88
Cause of Marfan syndrome
Autosomal dominant mutation causing a defect in Fibrillin-1
89
Differential diagnoses acromegaly
Craniopharyngeoma Hypothyroidism
90
Pituitary function tests
9am cortisol LH, FSH, testostérone, oestradiol Thyroid function tests Prolactin Plasma and urinary sodium
91
Characteristics of Raynaud’s phenomenon not seen in Raynaud’s disease (3)
- Asymmetrical - dilated nail fold capillaries due to co-existing autoimmune disorder - digital ulcers
92
Exacerbating factors for Raynaud’s phenomenon (3)
Cold Drugs (bisoprolol, COCP) Vibrating tools
93
Drugs that cause drug-induced lupus (4)
Phenytoin Isoniazid Procainamide Infliximab
94
Differentials for vitiligo (2)
Pityriasis versicolor Albinism

PACES - Final Week Revision (7 decks)

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