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paces - final week revision > Station 5 > Flashcards

Station 5 Flashcards

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
Q

Dermatomyositis antibody

A

Anti-Mi2

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26
Q

MEN 1a syndrome

A

Parathyroidism
Pituitary adenoma
Pancreatic islet cell tumours

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27
Q

MEN 2a syndrome

A

Medullary thyroid cancer
Hyperparathyroidism
Phaeochromocytoma

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28
Q

Allport syndrome

A

Sensorineural deafness
AAA
Haematuria & renal cysts
X-linked dominant disease

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29
Q

Polyarteritis Nodosa

A

Associated with hepatitis B
Testicular pain
Joint pain
Livedo reticularis
Mononeuritis multiplex

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30
Q

Hypercoagulable state

A

(Risk factors for PEs)
Drugs (COCP)
Antiphospholipid syndrome
Malignancy
Nephrotic syndrome
Pregnancy
Lymphoproliferative disorders
Polycythaemia rubra vera

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31
Q

Erythema Nodosum

A

Sarcoidosis (Lofgren syndrome)
Idiopathic / Inflam bowel disease
Group A haemolytic strep
HIV
Tuberculosis
Pregnancy
Drugs (COCOP, abx)

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32
Q

Lofgren syndrome

A

Sarcoidosis
Bilateral hilar lymphadenopathy
Uveitis
Erythema Nodosum
Fever

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33
Q

Livedo Reticularis

A

Anti-phospholipid syndrome
SLE
Hepatitis C

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34
Q

Systemic Sclerosis

A

Calcinosis
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasia
Arthritis with myopathy
Interstitial lung disease or pulmonary artery hypertension

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35
Q

Seronegative spondarthritides

A

‘PEAR’:
- Psoriatic arthritis
- Enteropathic arthritis
- Ankylosing spondylitis
- Reactive arthritis

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36
Q

Autoimmune questions

A
  • 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
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37
Q

Acromegaly symptoms

A

Headaches
Bitemporal hemianopia
Galactorrhoea, menstrual changes
Increase in hand & shoe size
Change of appearance
Diabetes/polyuria/polydipsia
Excessive sweating
Carpal tunnel syndrome

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38
Q

Acromegaly examination findings

A

Prognathism
Prominent supraorbital ridge, Large tongue
Bitemporal Hemianopia, CN3 palsy
Tinel & Phallen’s signs for carpal tunnel

39
Q

Causes of Acromegaly

A

Pituitary adenoma secreting growth hormone (can be part of MEN1)
Ectopic growth hormone secretion from tumour

40
Q

Investigations for Acromegaly

A

IGF1 level
Oral glucose tolerance test for GH supp
Hormone profile
MRI brain +/- body

41
Q

Management of acromegaly

A

Transphenoidal surgery
May consider radiotherapy and octreotide
Treatment of complications (OSA, DM, carpal tunnel)
Colonoscopy every three years

42
Q

Complications of Acromegaly (4)

A

Hypertension
Diabetes
Sleep apnoea
Heart failure

43
Q

Causes of hyperthyroidism

A

Grave’s disease (TSH receptor Ig)
Multinodular goitre
Thyroiditis

44
Q

Causes of hypothyroidism (3)

A

Hashimoto’s thyroiditis
Iatrogenic (post-surgery, lithium)
Iodine deficiency

45
Q

Addison’s disease investigations

A

Short Synacthen test - synacthen causes rise in ACTH level
Hyponatraema, hyperkalaemia
Renin-aldosterone ratio

46
Q

Extra-articular manifestations of Rheumatoid arthritis

A

Scleritis, episcleritis
Pleural effusions / pulm effusion
Pericarditis
Splenomegaly (Felty’s syndrome)
Glomerulonephritis

47
Q

Methotrexate (3 facts)

A

Inhibits purine metabolism
Always prescribe folate supplements
Risk of myelosuppression and liver impairment

48
Q

Ehler-Danlos disease types

A

Hyper mobile joints type
Velvety skin type
Vascular type

Defect in collagen genes

49
Q

Polycythaemia rubra Vera symptoms and blood results

A

Hypertension
DVTs, strokes
High WCC and platelets
Haematocrit >55%
JAK2 mutation

50
Q

Thyroid exam

A

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
Q

Symptoms of hyperthyroidism

A

Sweaty hands & tremor
Tachycardia
Anxiety
Palpitations
Weight loss

52
Q

Side-effects of Carbimazole

A

Rash
Agranulocytosis
Hepatitis
Teratogenic

53
Q

Issues around radio-iodine therapy

A

4 weeks can’t be around pregnant women or kids
Worsening of eye disease
Avoid pregnancy four months

54
Q

Eye signs in Grave’s eye disease

A

Asymptomatic
Lif retraction
Proptosis
Ocular muscle involvement
Corneal involvement
Optic nerve damage
Treat with high dose steroids & ophthalmology & eye drops & stop smoking

55
Q

Causes of goitre

A

Idiopathic
Graves’ disease
Iodine deficiency
Pregnancy

56
Q

Causes of hypothyroidism

A

Iodine deficiency
Autoimmune thyroiditis
Pituitary failure
Lithium / Amiodarone

57
Q

Symptoms of hypothyroidism

A

Depression
Weight gain
Constipation

58
Q

Differentials loss of peripheral vision

A

Glaucoma
Retinitis pigmentosa
Retinal artery occlusion (vein is central)
CVA
Chiasmal lesion

59
Q

Intranuclear ophthalmoplegia

A

Medial longitudinal fasciculus lesion
Affected eye can’t adduct
Other eye nystagmus on looking that way

60
Q

Horizontal Diplopia

A

CN6 palsy

61
Q

Vertical diplopia

A

CN 3 or 4 palsy

62
Q

Ocular exam

A

Acuity
Fields + extinction
Reflex - accommodation + light
Ophthalmoscopy
Ocular movements inc diplopia

63
Q

Ankylosing spondylitis symptoms

A

Pain worse in mornings
Affecting pelvis
Plantar fasciitis, tendinitis, dactyliitis
Red eyes

Scored in Bath

64
Q

Ank spondylitis exam

A

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
Q

Extra-articulate features of Ankylosing spondylitis

A

Atlantoxial dislocation causing cord compression
Anterior uveitis
Aortic regurgitation, arrhythmias
Fibrosis
IgA nephropathy

66
Q

Ankylosing spondylitis tests

A

Renal function
HLA-B27
XR lumbar spine and pelvic joints
ECG for cardiac problem
CXR for fibrosis

67
Q

Acromegaly complications

A

Diabetes
Hypertension
Carpal tunnel syndrome
Hypogonadism
OSA
Recital bleeding from polyps or kidney stones

68
Q

Acromegaly examination

A

Visual fields
Face - prom supraorbital ridge, prognathism, macroglossia
Carpal tunnel syndrome
Proximal myopathy
Neck circumference if OSA

69
Q

Acromegaly investigations

A

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
Q

Cushing’s examination

A

Fingerprick glucose marks
Carpals tunnel
Facial plethora with hirsutism
Buffalo hump
Proximal myopathy

71
Q

Cushing syndrome causes

A

Steroid use
Pituitary adenoma secreting ACTH
Small cell lung cancer secreting ACTH
Adrenal adenoma/carcinoma

72
Q

Treatment of Cushing syndrome

A

Surgery
Octreotide, somatostatin
Optimise lifestyle

73
Q

Definition of osteoporosis

A

Bone density more than 2.5 standard deviation below the mean value for an adult the same gender and race

74
Q

Investigations that confirm Cushing syndrome

A

24h urinary cortisol
Low dose dex supp test

75
Q

Investigations that identify cause of Cushing syndrome

A

9am ACTH level
High dose dex supp —> of low urinary cortisol then pituitary adenoma

MRI pituitary fossa or CT CAP

76
Q

Pyoderma gangrenosum

A

Painful red/black ulcers

IBD
Autoimmune
Haematological malignancy
Hep C

77
Q

limited systemic sclerosis antibody

A

Anti centromère antibody

78
Q

Diffuse systemic sclerosis antibody and features

A

Anti-Scl70
Renal crisis
Interstitial lung disease
Pulmonary artery hypertension
Right heart failure

79
Q

Dermatomyositis exam

A

Gottron’s papules
Heliotropic rash on face
ILD, pulm hypertension
Reflux
Cardiac arrhythmias & myositis
Cancer association
Anti-Jo1

80
Q

Headache examination

A

Visual fields
Fundoscopy
Cranial nerves 3-4-6 and CN 7
Temporal tenderness
Nuchal rigidity
Power in arms/legs

81
Q

Reactive arthritis

A

Associated with salmonella, campylobacter, chlamydia

Triad: conjunctivitis + arthritis + urethritis
Can cause dactylitis

82
Q

AIDS-defining illnesses:

A

CD4 <200
PCP or mycobacterium avium
Oesophageal candidiasis
Chronic diarrhoea (from CMV)
Kaposi syndrome

83
Q

Marfan syndrome cause & manifestations

A

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
Q

Raynaud’s phenomenon associations (esp if has a digital ulcer)

A

Scleroderma
SLE
Rheumatoid arthritis
Dermatomyositis
Polymyositis

85
Q

Everything autosomal dominent except for:

A

Recessive:
Wilson’s disease (ATP7B gene)
Friedrich’s ataxia (frataxin gene)
Hereditary Haemochromatosis (HFE gene)

86
Q

Symptoms of Haemochromatosis

A

Arthralgia with synovitis
Diabetes
Cardiomyopathy
Bronze skin
Raised ferritin and transferrin
Screening of relatives

87
Q

Extra-articulas features of Ankylosing spondylitis

A

Anterior uveitis
Aortitis
Aortic regurgitation
Apical pulmonary fibrosis
Amyloidosis causing glomerulonephritis
Achilles tendon enthesitis

88
Q

Cause of Marfan syndrome

A

Autosomal dominant mutation causing a defect in Fibrillin-1

89
Q

Differential diagnoses acromegaly

A

Craniopharyngeoma
Hypothyroidism

90
Q

Pituitary function tests

A

9am cortisol
LH, FSH, testostérone, oestradiol
Thyroid function tests
Prolactin
Plasma and urinary sodium

91
Q

Characteristics of Raynaud’s phenomenon not seen in Raynaud’s disease (3)

A
  • Asymmetrical
  • dilated nail fold capillaries due to co-existing autoimmune disorder
  • digital ulcers
92
Q

Exacerbating factors for Raynaud’s phenomenon (3)

A

Cold
Drugs (bisoprolol, COCP)
Vibrating tools

93
Q

Drugs that cause drug-induced lupus (4)

A

Phenytoin
Isoniazid
Procainamide
Infliximab

94
Q

Differentials for vitiligo (2)

A

Pityriasis versicolor
Albinism

paces - final week revision (7 decks)

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