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Effects of cocaine use?
- MI, HTN, tachy/brady, QRS widening and QT prolongation, aortic dissection.
- seizures, hypertonia, hyperreflexia, agitation, seizures.
- hyperthermia, metabolic acidosis and rhabdomyolysis.
Investigation and Management of hypocalcaemia?
PTH levels. IV calcium gluconate 10ml in 10% over 10 minutes. IV calcium chloride is more likely to give local irritation. ECG monitor recommended.
Autoantibody highly specific for systemic sclerosis?
- Anti-centromere. ANA is present in 95%. RF in 25%. Anti-Ro and La are associated with SSc presenting with sjogrens.
- anticardiolipin are specific to SLE, and AMA to PBC.
Eye condition commonly occuring in Behcet's disease?
- Iritis. Commonly presents with oral and genital ulcers. also, fever, abdo pain, diarrhoea, episcleritis, polyarteritis, pericarditis and DVT. Its a multisystem vasculitis.
- Mx with steroids or colchicine.
Rash in secondary syphilis?
keratoderma blenorrhagica - maculopapular rash on torso, palms and soles. Pt likely had a painless penile ulcer a few weeks back.
CHANCROID: Pathophysiology? Presentation? management?
- Haemophilus Ducreyi. Commonly presents with other STI e.g. herpes/syphilis.
- presents with fever, anorexia, malaise and extremely painful genital ulcers. 1/3rd have inguinal lymphadenopathy.
- Mx: azithromycin, certriaxone, ciprofloxacin.
- auto recessive lysozymal strorage disease. def glucocerebrosidase which metabolises glycolipids leading to fatty accumulation in cells and tissues. There are three types:
- 1. adult non-neuropathic
- 2. infantile neuropathic
- 3. juvenile sub-acute neuropathic.
- All patients have hepatosplenomegally, and 'gaucher cells' infilatrating bone marrow (stuffed with glucocerebroside).
- pathological bone fractures.
- avascular necrosis of femoral head.
- bone marrow replacement and hyperslenism result in anaemia and thrombocytopenia.
- disease may be confined to distal ends of femur with characteristic 'erlenmeyer flask' cysts.
- cornea's may have a yellow brown deposit/colour. can also be present on skin.
Causes of raised ALP?
- 1.hepatobiliary disease e.g. cholestasis, hepatocyte disease e.g. hepatitis.
- 2. bone disease: reflected inc. osteoblastic activity e.g. pagets, cancer, mets, osteomalacia, rickets, renal dystrophy, recent fracture, growing child, pregnancy, malignancies that produce an ALP like gene e,g. seminoma,
Management of acute chest syndrome in sickle cell anaemia?
- oxygen, analgesia, antibiotics, transfusion.
- hydroxycarbamide in severe cases.
- BMT can be curative of condition in children.
tell me about neurofibromatosis?
- Autosomal dominant inheritence.
- Caused by default in neural crest differentiation.
- 2 types
- 1: Cafe au lait spots, iris lisch nodules, axillary and inguinal freckles, optic glioma, neurofibromas (rubbery and purple on skin), bone abnormalities e.g. scoliosis.
2: bilateral acoustic neuromas, gliomas, meningiomas, can have neurofibromas on skin but more rare than in type 1. Posterior subcapsular lenticular opacity.
Tell me about MEN?
- Type 1:
- familial primary hyperparathyroidism
- pituitary adenoma
- pancreatic islet tumour
- Zollinger-Ellison syndrome (ulcers)
- REMEMBER USING PPP (parathyroid, pituitary, pancreatic islets)
- Type 2:
- Familial hyperparathyroidism
- medullary thyroid carcinoma.
- REMEMBER USING PPT (parathyroid, phaeo, thyroid)
Tell me about basal cell carcinoma using DEPSIM?
(description, epidemiology, pathophysiology, symptoms, investigation, management).
- skin cancer
- most common
- effects deepest cell layer of the epidermis.
- 90% present on the head and neck. 'pearly' papule with overlying telangiectasia. central ulceration, raised border. non-healing lesion that bleeds easily.
- shave or punch biopsy or full excision if ulcerated to investigate.
- Managed with surgical excision.
prognosis: these rarely metastase and invasion is local. carcinoma on nose more likely to spread.
Tell me about squamous cell ca using DEPSIM?
- D: Skin cancer
- E: less common than basal cell.
- P: arises from keratinocytes of superficial layers. precursors are actinic keratoses. N/B keratoacanthoma is now thought to be a benign epithelial lesion not associated with squamous cancer. linked with light exposure and HPV. grossly and histologically similar to squamous cell ca so watch out! often regresses spontaneously.
- S: sun exposed areas. nodule, plaque or patch. ulcerates to give 'rodent ulcer'. may form keratin horn and crusting. I: shave or punch biopsy.
- M: excise. more rapid growth than basal cell. locally destructive. 3-4% metastasize.
What is the skin rash appearance in Dermatomyositis?
- Gottrons papules (50%) are violaceous flat topped papules on MCPs and DIPS, knees, elbows and medial malleoli.
- systemic erythematous or violaceous plaques. smooth and non-scaling.
- facial photosensitivity and dusky erythema on face.
- lilac heliotrope rash.
ALSO: proximal muscle weakness, dysphonia, dysphagia. Associated with gastric and ovarian cancer and lyphoma.
Causes of blue sclerae?
osteogenesis imperfecta, Marfans, Ehler-Danlos, pseudoxanthoma elasticum.
Causes/Associations of duputren's contracture?
Peyronnies, epilepsy, alcoholism, DM, being male.
Signs of lead poisoning?
- anorexia, nausea vomiting, lead line of gums, ocular palsy, foot and wrist drop, slurred speech, confusion, children show thick epiphyseal lines of XR.
- peripheral smear shows stippled erythrocytes. microcytic anaemia (iron def), leukocytosis.
Diagnosis of rheumatic fever?
Evidence of strep infection and 2 major or 1 major and 2 minor:
- Major: arthritis, carditis, nodules, erythema marginatum, chorea.
- Minor: fever, arthralgia, raised acute phase proteins e.g. ESR, CRP, prolonged PR interval.
Aetiology of Horner's?
- Horners is interruption to the sympathetic chain leading to ptosis, enopthalmous, anhidrosis and pupillary constriction on the affected side.
- CAUSES: pancoasts tumour, cervical rib, syringomyelia, lateral medullary syndrome, trauma.
Associations with acanthosis nigricans?
- Endocrine disease: T2DM, acromegaly, Cushings.
- Cancer: gastric adenocarcinoma
Tell me about HSP using DEPSIM.
- D: acute immune-complex mediated vasculitis
- E: occurs in children and young adults. Peak incidence age 5. most cases 2-11. M:F 2:1
- P: URTI precedes 70%. IgA immune complexes deposit in skin, intestine and renal small vessel walls leading to purpura, abdo pain and cresentic GN.
- S: pupuric rash (non blanching) on lower extremities, abdo pain, arthritis. stools may show occult or gross blood. haematuria most common presenting sign of GN.
- I: palpable purpura in absence of thrombocytopenia (low platelets suggest ITP). FBC, urinalysis, occult blood test, renal function, coagulation studies, consider ASO titer.
- M: supportive. NSAIDS for pain. if renal involvement biopsy and for mild-moderate give steroids, if severe give azathioprine, ciclophosphamide, IV ig, plasmapheresis.
- duration 4-6 weeks. recurrence in 50%.
Tell me about Fluoroquinolones using CIMS?
- C: fluoroquinolone. antibiotics. examples: ciclosporin,
- I: CF, complicated UTI, enteric fever, multi-drug resistent infection. contraindicated under age 18.
- M: MOA - inhibits DNA production - inhibits DNA gyrase.
- S: tendon rupture and tendinopathy e.g. achilles rupture.
What is the diagnosis in 50% of status epileticus cases with no PMHx?
- Frontal lobe tumour.
- Other features of front lobe syndrome: apathy, behavioural change, urinary and faecal incontinence, anosmia, expressive dyphasia (if on dominent side).
- can mimic dementia!
Presentation and management of TCA overdose?
- PC: early features are antimuscarinic therefore dry mouth, restlessness, dilated pupils, sinus tachy, blurred vision. Then later there are broad complex arrhythmias, seizures, metabolic acidosis, sinus tachy, widened QRS, and prolonged QT.
- Mx: Most antiarrhythmic drugs are contrainidicated as they prolonge the QT interval further. IV bicarbonate reduces risk of seizures and arrhythmias. dialysis is ineffective.
Tell me about Peutz-Jegher's using DEPSIM?
How does it differ from familial Adenomatous Polyposis?
- D: familial polypomatous condition
- E: Autosomal dominent. 50% die from cancer by age 60.
- P: numerous hamartomatous polyps in the GI tract. Effects mainly small bowel. high malignant potential.
- S: pigmented freckles on lips, palms, soles and face. intestinal obstruction e.g. intussussception. GI bleeding (therefore microcytic anaemia).
- M: conservative unless complications develop.
FAP occurs mostly in large bowel. (therefore obstruction not a feature). there are thousands of adenomatous polyps in the LI. Other features are bone cysts (benign) particularly jaw cysts. fibromas, osteomas, polyposis and sebaceous cysts combined is termed Gardner's syndrome. Dx with colonscopy. Has different inheritence patterns. Mx depends on the genotype. if there is an APC mutation the majority have colon cancer by age 40, and prophylactic surgery by 25 is recommended.