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197 Cards in this Set
- Front
- Back
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PFT findings in asthma?
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decrease of FEV1 with methacholine challenge, increase flow with beta-2 agonist
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PFT findings in COPD?
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decrease FEV1/FVC and increase TLC
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PFT findings in ILD?
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decrease in Dco and lung volumes
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management of COPD exacerbation?
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supplemental O2 (target O2sat 88-92% for CO2 retainers)
bronchodilators (B-2 agonist and antACh puffers) systemic corticosteroids +/-ABX |
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management of asthma?
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step-wise approach:
1. environmental control and bronchodilator PRN 2. regular dosing bronchodilator +/- inhaled steroids 3. long-acting B-2 agonist or leukotriene antagonists +/- systemic steroids |
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treatment of PE?
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low molecular weight heparin followed by warfarin with thrombolytics and IVC filters in special patient groups
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Define: Shock
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inadequate tissue perfusion potentially resulting in end organ injury
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causes of transudative pleural effusions?
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altered capillary hydrostatic or plasma oncotic pressure
ex. CHF, nephrotic syndrome, liver failure/cirrhosis, PE, peritoneal dialysis, hypothyroidism, CF, urinothroax |
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causes of exudative pleural effusions?
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increased permeability of pleural capillaries or lymphatic dysfunction
-infection: pneumonia, lung abscess, TB pleuritis, viral infection, empyema -malignancy: lung ca, lymphoma, mets, mesothelioma -vascular/cardiac: vasculitis, PE, post CABG -intra-abdominal: subphrenic abscess, esophageal perforation, pancreatic disease (incr amylase), Meigs' syndrome (ovarian fibroma/pelvic tumour) |
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waht are the criteria for an exudative pleural effusion?
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exudative is one is met:
1. LDH > 200 (>2/3 upper limit of normal serurm LDH) 2. pleural:serum LDH >0.6 3. pleural:serum protein >0.5 |
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common presentation of obstructive sleep apnea?
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obese male with history of severe snoring and excessive daytime somnolence
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gold standard for diagnosis of obstructive sleep apnea?
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polysomnography
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treatment of obstructive sleep apnea?
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weight loss, postural therapy, CPAP
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what percentage of lung neoplasms are benign?
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<5%
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what are the common etiologies for ILD?
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occupation-related, drug-related, rheumatic diseases and vasculitis, idiopathic
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True or False: malignant lung neoplasms are the most common cancer and cause the most cancer-related deaths in both men and women?
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True
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what percentage of malignant lung neoplasms are bronchogenic?
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90%
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what are the types of bronchogenic lung cancers?
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SCLC, adenocarcinoma, squamous cell carcinoma, large cell lung cancer
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paraneoplastic syndromes that are most often associated with which lung cancer?
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SCLC
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how do you calculate the A-aDO2 gradient?
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{150-1.25(PaCO2)}-PaCO2
normal is <15mmHg at sea level |
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what treatment modalities prolong survival for patients with COPD?
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smoking cessation, vaccination (pneumovax, influenza), home oxygen
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what are the characteristics of ARDS?
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severe respiratory distress, hypoxemia, noncardiogenic pulmonary edema (bilateral infiltrates on CXR)
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what is your ddx for a microcytic anemia?
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Thalassemia
Anemia of chronic disease Iron deficiency Lead poisoning Sideroblastic anemia |
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what must be ruled out in iron deficiency anemia in males and post-menopausal women?
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GI bleed
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what nail change is seen in severe iron deficiency?
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Koilonychia (spoon-shaped nails)
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what are the iron indices in iron deficiency anemia?
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decreased serum ferritin, decreased serum iron, increased TIBC, decreased transferrin saturation
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what are the 2 major categories of a macrocytic anemia?
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megaloblastic and non-megaloblastic
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what are the 5 non-megaloblastic causes for a macrocytic anemia?
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liver disease
myelodysplastic syndrome reticulocytosis alcoholism hypothyroidism |
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what is the approach to an elevated red cell mass?
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rule out secondary causes of erythrocytosis: pulmonary disease, high altitude, CO poisoning, Epo-secreting tumours
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What is the hemolytic anemia screen? What would the results be?
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increased: reticulocytes, LDH, unconjugated bilirubin, urobilinogen
decreased: haptoglobin |
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What 3 major categories are in your differential for a generalized lymphadenopathy?
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infectious
inflammatory neoplastic |
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what is your ddx for splenomegaly?
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increased demand for splenic function (hematological diseases, infections and autoimmune diseases)
spleen congestion (CHF, portal HTN) infiltration (malignant vs non-malignant) |
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what clinical features characterize disorders of primary hemostasis?
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superficial bleeding (mucosal, skin)
petechiae ecchymoses |
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what are some causes of vitamin K deficiency?
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anticoagulants, antibiotics, diet, chronic liver disease, biliary obstruction, malabsorption
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name 5 important etiologies of DIC
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1. trauma
2. shock 3. infection 4. malignancy 5. obstetrical complication |
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which triad describes the pathophysiology of venous thrombosis?
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Virchow's Triad
1. endothelial damage 2. hemostasis 3. hypercoagulability |
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what are the heritable causes of hypercoagulability?
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Factor V Leiden/APC resistance
Prothrombin G20210A gene mutation Antiphospholipid Antibody Syndrome deficiencies: Protein C, Protein S and antithrombin hyperhomocysteinemia |
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what is the most common cause of isolated thrombocytopenia in adults?
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ITP
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what is erythromelalgia and with which conditions is it associated?
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burning pain of toes and fingers accompanied by erythema, pallor or cyanosis in presence of palpable pulses
caused by platelet activation and subsequent arterial microvascular thrombosis in PRV and Essential Thrombocytopenia; associated usually with platelet counts > 400 x 10'9/L |
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What is the Philadelphia chromosome?
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Present in >90% of individuals with CML, formed by reciprocal translocation between chromosomes 9 and 22, resulting in bcr-abl fusion gene, an active tyrosine kinase
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What is the pentad seen in multiple myeloma?
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1. increased calcium
2. anemia 3. renal failure 4. lytic bone lesions 5. infections |
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What distinguishes Hodgkin's lymphoma from non-Hodgkin's lymphoma?
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Reed-Sternberg cells, arising from germinal center B-cells
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In a patient who is actively bleeding, what Hb level would you want to maintain?
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Hb >70 g/L
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What coagulation factors are dependent on Vitamin K from synthesis?
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II, VII, IX, X, protein C and S
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What is the pentad of symptoms seen in TTP?
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1. thrombocytopenia
2. MAHA (microangiopathic hemolytic anemia) 3. renal failure 4. neurological symptoms 5. fever |
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What are the 2 most common clinical conditions encountered in cardiology?
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ischemic heart disease and heart failure
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What are some clinical conditions in cardiology that require urgent diagnosis and treatment?
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MI, unstable arrhythmias, sudden cardiac death, infective endocarditis, cardiac tamponade, acute arterial occlusion, aortic dissection, ruptured aortic aneurysm
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What initial investigations should be performed in a patient with suspected cardiac disease?
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ECG, CXR and cardiac enzymes
F/U: ambulatory ECG, echo, myocardial perfusion imaging, exercise stress testing, coronary angiography |
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What are components of the long-term management of stable coronary artery disease?
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ASA, ACEI
B-blocker and BP control Cigarette cessation and Cholesterol lowering Diet and Diabetes Exercise and Education |
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What is the treatment of acute NSTEMI?
STEMI? |
B-blockers
Enoxaparin, Clopidogrel Morphine Oxygen ASA 625 mg chewed Nitrates STEMI - receive thrombolysis or primary PCI |
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What is the long-term management of heart failure?
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Lifestyle
ACEI B-blockers Aldosterone antagonists Diuretics possibly Digoxin |
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What is the acute management of pulmonary edema?
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Lasix
Morphine Nitrates Oxygen PEEP and Positioning |
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What are 3 common non-cardiac causes of chest pain?
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1. GERD
2. pneumonia 3. costochondritis |
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What are 3 classic findings of severe aortic stenosis?
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1. crescendo-decrescendo SEM loudest over right 2nd intercostal space radiating to carotid
2. pulsus parvus et tardus 3. sustained apical impulse |
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What is the predisposing factor for teh development of Torsades de Pointes?
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prolonged QT interval
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How can ischemia lead to transient congestive heart failure?
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cardiac relaxation is an active process that requires ATP and therefore O2
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What is the role for digoxin in the treatment of CHF?
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decreases sx, reduces hospitalizations
it has no mortality benefit |
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Name 3 classes of meds that have shown to reduce mortality in CHF?
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B-blockers
ACEI Spironolactone |
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What is the difference in the pathophysiology of chronic stable angina, and the acute coronary syndromes?
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Chronic stable angina is due to a stable stenosis
ACS is due to a dynamic stenosis (i.e. plaque rupture) |
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Both NSAIDs and ASA inhibit the same enzyme (COX-1), What is only ASA used for long-term anti-platelet therapy?
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ASA irreversibly inhibits COX-1 which permanently shuts off thromboxane (pro-platelet aggregation activity) synthesis as thromboxane is made within platelets
Platelets have no nuclei (no DNA) to regenerate the COX-1 enzyme |
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Name 4 contraindications to the use of B-blockers
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1. significant bradycardia
2. significant pulmonary edema 3. severe asthma 4. 2nd or 3rd degree heart block |
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Which cardiac enzyme peaks most rapidly?
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CK-myocardial band
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Patient presents with macroglossia; liver enlarged, unexplained nephrotic syndrome, SOB
rales bilaterally What do you predict his ejection fraction will be and why? |
Clinical presentation of amyloidosis
This can result in CHF due to restricitive cardiomyopathy. In this situation, the EF is usually maintained |
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Which infectious agent is the most common cause of infectious myocarditis?
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Coxackie
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What is the treatment for varicose veins?
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Elevation and stockings, ligation and stripping veins, sclerotherapy and endovenous laser therapy
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Thrombolysis is preferred in which clinical scenarios?
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In an early presentation of STEMI, when there are contraindications to PCI, when PCI is not available
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A recent immigrant from the tropics presents with pulmonary infiltrates, eosinophilia and unilateral leg edema.
What is the likely diagnosis? |
Filariasis
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What is the most common cause of PU?
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H. pylori
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How is diarrhea classified?
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Secretory, osmotic, inflammatory, steatorrheal or altered motility
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What is the most common cause of dyspepsia?
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Functional
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What is the most common cause of upper GI bleed?
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Peptic Ulcer Disease
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What serological test is used to diagnose celiac disease?
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Anti-tissue transflutaminase (TTG)
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Which type of inflammatory bowel disease is more associated with rectal bleeding and increased colon cancer risk?
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Ulcerative colitis
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What causes of hepatitis are associated with AST, ALT >1000?
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Common bile duct stone, virus, durgs, ischemia, autoimmune hepatitis
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What is the serological profile for a patient who has recovered from hepatitis B infeciton?
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Negative = HBsAg, HBeAg
Positive = anti-HBs |
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What are the 3 most common causes of acute pancreatitis?
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Gallstones, ethanol, idiopathic
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What is the Paynaud's Pentad?
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1. RUQ abdominal pain
2. jaundice 3. fevers, chills 4. altered LOC 5. hypotension |
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What is the most common cause of elevated ALT in North America?
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Non-alcoholic steatohepatitis (NASH)
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What is the genetic mutation in hemochromatosis and how is it treated?
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C282Y or H63D in the HFE gene
treated by phlebotomy or deferoxamine if phelbotomy contraindicated |
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What bacteria cannot be seen on Gram stain?
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Mycobacterium, Treponema, Chlamydia, Rickettsia
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What electrolyte disturbance can occur in meningitis?
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Hyponatremia secondary to SIADH
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What tests would you order for a CSF sample if you suspected meningitis?
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cell count, glucose, protein, C&S, Gram stain, PCR and/or serology (viral)
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List the most common causes of community acquired pneumonia
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S. pneumoniae, Mycoplasma, Chlamydia, H. influenza, viral
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In which situations is the initiation of antiretroviral therapy strongly recommended in HIV-positive individuals?
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AIDS-defining illness, severe symptoms of HIV or CD4 <200
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What is the recommended prophylactic treatment for PCP in HIV-positive individuals and when is it initiated?
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TMP-SMX; initiated if CD4 count <200 or history of oral candidiasis
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What are the three major systemic mycoses?
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Histoplasma, Blastomyces, Coccidiodes
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Which organisms are most commonly responsible for infection in febrile neutropenia today?
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Gram positive organisms
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What are the major classes of etiologic causes for fever of unknown origin?
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Infectious, neoplastic, collegen vascular, drugs
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Which infectious disease presentations are considered medical emergencies?
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septic arthritis, emphysematous pyelonephritis, toxic shock syndrome, septic shock, meningitis, febrile neutropenia, infective endocarditis
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How would a chest x-ray help with the diagnosis of active tuberculosis?
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CXR: look for signs of active vs past infections, evidence of miliary TB and pleural effusion
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What infectious disease can you get from mosquito bites? Tick bites?
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Mosquitos - malaria, Dengue, Yellow Fever, West Nile, Japanese Encephalitis, filariasis
Ticks - Lyme disease, Rock Mountain Spotted Fever |
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Which parasitic infections can cause acute diarrhea?
Which cause opportunistic infectious? |
Diarrhea - Entamoeba histolytica, Giardia lamblia, Cryptosporidium, Entamoeba dispar
Opportunistic Infections - Cryptosporidium, toxoplasmosis |
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What cells make up the the filtration barrier in the nephron?
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Capillary endothelium, glomerular basement membrane, podocytes
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What are the 5 major functions of the kidney?
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Waste excretion, electrolyte balance, BP regulation, hormonal synthesis, glucose homeostasis
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What are the 3 main categories of pathologic proteinuria?
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tubulointerstitial, glomerular, overflow
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What are the ways to calculate GFR?
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Cr clearance = urine [Cr] x urine volume/plasma [Cr] x duration of urine collection (min)
Cockcroft Gault formula = (140-age)(body mass)/(plasma [Cr] x 72) MDRD equation = urea:[Cr] in serum = 1:20 normally 120 ml/min in a healthy adult = 173 L/day -- 98% reabsorbed; daily urine output = 1.0-1.5 L |
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What are some causes of an increased BUN?
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volume depletion, GI bleed, increased protein diet, sepsis, catabolic state with tissue breakdown, corticosteroid or cytotoxic agents
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At what blood glucose level do you start seeing glucose in the urine?
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9-11 mmol/L
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Dysmorphic RBC's + casts suggest the source of blood is?
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Glomerular
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Isomorphic RBC's and no casts suggest that the source of blood is?
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Extraglomerular
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Name 4 types of casts and the conditions in which you will find them?
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Hyaline - normal
RBC - GMN, vasculitis WBC - pyelonephritis, interstitial nephritis Pigmented granular - ATN, GN, interstitial nephritis |
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What are the causes of hypo-osmolar hyponatremia?
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Hypervolemic: CHF, cirrhosis/ascites, pregnancy, ARF/CRF
Euvolemic - SIADH, adrenal insuffiency, hypothyroid, psychogenic polydipsia Hypovolemic - diuretics, salt wasting nephropathy, diarrhea, sweating, 3rd spacing |
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Major complication of rapid correction of nyponatremia?
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Central pontine myelinolysis
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If you give DDAVP in the setting of hypernatremia and urine volume decreases and urine osmolality increases, the diagnosis is?
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Central Diabetes insipidus
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What are the characteristics on ECG that indicate hyperkalemia?
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Peaked and narrow T waves, loss of P waves, prolonged PR interval, widening of QRS with merging of T wave (sinus wave pattern)
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What is the order of drugs given in the setting of hyperkalemia?
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Ca gluconate, glucose and insulin R, furosemide, kayexelate, ventolin
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What is the treatment for a comatose patient with an anion-gap osmolar gap metabolic acidosis?
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ethanol or fomepizole and dialysis for methanol or ethylene glycol poisoning
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In a patient with bulimia nervosa, what lab value differentiates vomiting from diuretic abuse as a cause of metabolic alkalosis
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urine chloride will be high (>20 mEq/L) in diuretic use and will be low in vomiting
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What are 3 causes of metabolic acidosis with concomitant respiratory alkalosis?
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cirrhosis, sepsis, ASA overdose
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What is the most common cause of glomerulonephritis in adults?
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IgA nephropathy
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What are the 4 commonest causes of the pulmonary-renal syndrome?
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ANCA-associated vasculitides, Goodpasture's disease, post-infectious GN, SLE
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What would be a reasonable set of investigations for a young patient with acute nephrotic syndrome?
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Blood work: CBC, lytes, BUN, Cr, albumin, lipids, complements, ANA, ANCA, HBV, HCV, ASOT, VDRL, HIV
Urine: R&M, 24-hour protein and Cr CXR, Renal Biopsy |
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What needs to be done in all patients started on an ACEI or ARB?
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check K and Cr within 2 weeks after initiating therapy, since blockage of angiotension II in pateints with bilateral renal artery stenosis will cause acute renal failure and hypokalemia
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What would be the most important aspect of the history in a patient with acute renal failure and urine WBC casts?
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drug history: likely allergic interstitial nephritis caused commonly by antibiotics, NSAIDs, or allopurinol
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What are 3 ways to differentiate ATN from acute pre-renal failure?
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1. Prerenal failure = improve with fluid challenge
2. presence of pigmented granular casts on microscopy = ATN 3. FE(Na) will be <1% in prerenal, >2% in ATN |
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What would you suspect as the cause of acute renal failure and HTN 2 days after coronary angiography?
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Atheroembolic renal disease
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What are the 2 most common causes of ARF in hospitalized patients
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pre-renal azotemia, ATN
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What fractional excretion of sodium (FE.Na) do you expect with pre-renal ARF?
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<1% usually
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What renal etiology do the following cast types suggest in ARF - pigmented granular casts, WBC casts, RBC casts?
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pigmented granular casts - acute tubular necrosis
WBC casts - acute interstitial nephritis RBC casts - glomerulonephritis |
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What findings are expeted in chronic renal failure (CRF) in terms of GFR and U/S?
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GFR < 60 ml/min for >3months, decreased kidney size
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What are the three most common causes of chronic renal failure?
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Diabetes, HTN, glomerulonephritis
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What effect does angiotensin II have on renal arterioles and GFR?
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vasoconstriction of efferent renal arterioles = increased GFR
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What are the four basic types of renal complications secondary to diabetes?
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Progressive glomerulosclerosis, accelerated atherosclerosis, autonomic neuropathy, papillary necrosis
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What is the characteristic protein type found in urine with multiple myeloma
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Bence-Jones protein (monoclonal light chains)
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What is the prevalence of simple cysts of the kidney?
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very common 50% > 50 years of age
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What form of renal replacement therapy improves patient survival?
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Renal transplantation
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What are some common drugs used in renal transplantation?
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cyclosporine, tacrolimus, MMF, sirolimus, prednisone
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What are the clinical features of Tic Douloureux?
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aka trigeminal neuralgia
sharp pain in V3 +/- V1 and V2, pain lasts few seconds to minutes, may cause wincing (tic), may be brought on by triggers, lasts for days to weeks followed by remission of weeks/months |
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What are a few examples of Hereditary Ataxias?
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Friedrich's Ataxia, Ataxia-Telangiectasia, Olivopontocerebellar Ataxia, Spinocerebellar Ataxia
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How does Cranial Nerve III palsy present?
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Ptosis, eye down and out, pupil dilated +/- unreactive pupil (midriasis)/extraocular muscle paresis
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What is the management of Bell's Palsy?
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education, reassurance, eye protection (artificial tears/lubricating ointment/patching) +/- steroids/acyclovir
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What is the presentation of Ataxia-Telangiectasia?
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progressive cerebellar ataxia in infancy, followed by telangiectasias of conjunctivae, nose and ears at a later stage
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Describe a Parkinsonian gait
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shuffling with bradykinesia (difficulty initiating and terminating steps), stooped posture
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Describe a gait due to spastic hemiparesis i.e. Cerebral Palsy
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Scissoring gait, spastic extended legs and flexed arms, adventitial movements
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What are two types of Complex Regional Pain Syndrome?
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Type I - reflex sympathetic dystrophy
Type II - causalgia |
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What are oral pharmacological treatment options for neuropathic pain?
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First line - tricyclic antidepressants, gabapentin
Second line - SSRI, opioids |
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What is a TIA?
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Stroke syndrome with neurological symptoms lasting from a few minutes to 24 hours, followed by complete functional recovery
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What are risk factors for stroke?
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Age, HTN, smoking, DM, hypercholesterolemia, AFib, obesity, hyperhomocysteinemia, drugs, cardiac pathology
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What is the inital antiplatelet of choice for secondary stroke prevention?
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ASA
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What are the hallmark S/Sx of Parkinson's Disease?
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classic 4: tremor, rigidity, akinesia, postural instability
shuffling gait, stooped posture bradykinesia, resting tremor mask facies, depression, fronal lobe sx cogwheeling, lead piping, micrgraphia |
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What is the pathophysiology of Wilson's Disease?
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abnormality of copper metabolism
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What is the inheritance pattern of Huntington's Disease?
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autosomal dominant with anticipation
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What is the most common tic disorder?
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Gilles de la Tourette's Syndrome
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What is the biggest worry about Guillain-Barre syndrome?
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risk of imminent respiratory failure
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What types of neuropathies are seen in diabetes mellitus
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distal symmetric polyneuropathies - glove and stocking distribution
cranial nerve neuropathies focal mononeuropathies polyradiculopathies autonomic neuropathies |
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What is the commonly associated tumour with myasthenia gravis?
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Thymoma
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What is the hallmark of Myasthenia Gravis
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fatiguable muscle weakness
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What disease is Lambert Eaton myasthenic syndrome associated with?
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small cell lung cancer
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How can Lambert-Eaton syndrome be differentiated from myasthenia gravis?
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their answer: post-exercise facilitation
MG - worse with extended contraction, ?improves with tensilon test LB - improves with extended contraction, ?improves with cholinesterase inhibitors |
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In vertigo, if nystagmus is seen in more than one direction, what does that tell you?
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The etiology must be central
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What causes of headache are serious and must be ruled out?
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subarachnoid hemorrhage
meningitis increased intracranial pressure temporal arteritis |
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What classes of drugs can be used for migraine prophylaxis?
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anticonvulsants, tricyclic antidepressants, beta-blockers, 5-HT antagonists, riboflavin (vitamin B2)
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Where can CNS lesions be located and result in coma?
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bilateral coronary cortex, RAS (brainstem), focal brain lesions causing herniation or diffuse axonal injury
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What makes a partial seizure complex vs simple?
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involve altered level of awareness
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What is the most common cause of late-onset epilepsy (>50 yrs)?
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Stroke
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What investigations can help differentiate an epileptic seizure from a pseudoseizure?
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EEG, serum prolactin
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In delirium, what are the most common types of hallucinations experienced?
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visual and tactile hallucinations
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In dementia, what are indications for ordering a CT head?
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<65 years old, acute change in LOC/cognition (rapid progression), hx of TIA/CVA, focal neurological deficits, hx of neoplasm that can metastasize to brain, immunocompromised, anticoag use
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List the main dementia syndromes?
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Alzheimer's
multi-infarct dementia Lewy body disease frontotemporal dementia |
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What are the cardinal features of Horner's syndrome?
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meiosis, anhydrosis, ptosis
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How does hydroxyamphetamine help localize the lesion in Horner's syndrome?
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hydroxyamphetamine can only cause dilatation if the lesion is preganglion ic of central
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Left upper quadrantopsia - where is the lesion?
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Right temporal lobe - Meyer's loop
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What are common presentations in MS?
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optic neuritis, transverse myelitis, diplopia, vertigo
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What imaging modality should be used to support a clinical diagnosis of MS?
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MRI
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List 6 signs of osteoarthritis on physical exam
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Heberden's and Bouchard's nodes
squaring of CMC joint line tenderness, bony enlargement at affected joints, malalignment/joint deformity, limited ROM, periarticular muscle atrophy, creptius on ROM |
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What are 4 radiological hallmarks of OA?
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joint space narrowing, subchondral sclerosis, intraosseous cyst formation, osteophytes
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List the diagnostic criteria for RA; How many criteria are required for a diagnosis?
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1. morning stiffness >1hour
2. arthritis of >3 joints 3. arthritis of hand joints 4. symmetric arthritis 5. rheumatoid nodules 6. serum RF 7. radiographic changes: erosions, periarticular osteopenia need 4+ for >6weeks |
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What percentage of patients with RA are rheumatoid factor positive?
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60-80%
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Name 5 poor prognostic features of RA
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young age of onset, high RF titres, elevated ESR, >20 active joints, extra-articular features
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List the diagnostic criteria for SLE. How many are required for diagnosis?
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1. malar rash
2. discoid rash 3. photosensitivity 4. oral/nasal ulcers 5. arthritis 6. serositis (pleuritis/pericarditis) 7. neurologic disorder (seizures or psychosis) 8. renal disorders (proteinuria or cellular casts) 9. hematological disorder (hemolytic anemia) 10. immunological disorder (anti-dsDNA Ab, anti-Sm AB) 11. ANA+ |
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What antibody is most sensitive for the dx of SLE?
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ANA (98% sensitive)
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List five major pharmacologic agents that are associated with drug-induced lupus
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hydralazine, isoniazid, procainamide, chlorpromazine, methyldopa
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List the three commonest manifestations of APS
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thromboembolic events, recurrent spontaneous abortions, thrombocytopenia
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What are the features of scleroderma renal crisis and what percentage of patients with scleroderma are at risk of developing renal crisis?
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malignant arterial hypertension (>150/90 mmHg), incr Cr, oliguria, and microangiopathic hemolytic anemia
10-15% of scleroderma patients are at risk of developing scleroderma renal crisis |
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List the 5 diagnostic criteria for polymyositis/dermatomyositis
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1. progressive symmetric proximal muscle weakness
2. elevated muscle enzymes (CK, aldolase, LDH, AST, ALT) 3. EMG changes 4. muscle biopsy 5. DM - discoid rash definite if 4+ criteria, probable if 3, possible if 2 |
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List the features of the classic triad of Sjogren's disease
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1. dry eyes
2. dry mouth 3. inflammatory arthritis |
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What type of malignancy are patients with Sjogren's at freatest risk of developing?
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Non-Hodgkin's lymphoma
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List the diagnostic criteria for Wegener's granulomatosis.
How may of these criteria are required for the diagnosis of Wegener's granulomatosis? |
1. nasal or oral inflammation, ulcers, epistaxis
2. abnormal CXR findings including nodules, cavitations 3. urinary sediment (protein, RBC casts) 4. biopsy of involved tissue: lung tissue shows granulomas, renal tissue shows necrotizing segmental granulomatosis - minimum of 2 criteria for dx |
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List the dx criteria for polyarteritis nodosa
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3/10:
1. weight loss >4 kg 2. myalgias, weakness, leg tenderness 3. livedo reticularis 4. neuropathy 5. testicular pain or tenderness 6. diastolic BP >90 mmHg 7. abnormal renal function tests 8. hepatitis B virus 9. arteriographic abnormality 10. biopsy or artery showing presence of granulocytes or mononuclear leukocytes in the arterial wall |
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List the features for the dx of Giant Cell arteritis
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1. temporal artery tenderness/decrease pulse/bruit
2. age >50 yrs 3. ESR >50 4. abnormal artery on biopsy (giant cells present) |
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List the ddx of an elevated ESR
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RA, PMR, GCA, hypoalbuminemia, anemia, multiple myeloma, bacterial infections, malignancy
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What are the common joints involved in ankylosing spondylitis?
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axial - SI, hip, shoulder
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What percentage of patients with ankylosing spondylitis are HLA-B27 positive? What is the prevalence of HLA-B27 in the general population?
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95% of AS pts are HLA-B27 positive
9% of general pop'n are positive |
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What GI and GU infections precede the development of Reactive Arthritis?
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GI - shigella, salmonella, campylobacter, yersinia
GU - chlamydia, mycoplasma |
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List the 5 general MSK patterns of psoriatic arthritis
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1. asymmetric oligoarthritis
2. arthritis of DIP joints with nail changes 3. destructive (mutilans) arthritis 4. symmetric polyarthritis 5. sacroilitis and spondylitis |
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What are the common sites of involvment in gout and what is the pattern of joint involvement?
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1st MTP, ankle, knee
pattern of joint involvement is asymmetrical |
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What are the common precipitants of gout attacks?
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alcohol, dietary excess, dehydration, thiazide and loop diuretics, trauma, illness, surgery
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List the risk factors for the development of pseudogout
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advanced OA, hypercalcaemia (hyperparathyroidism), hypomagnesemia, hypophosphatemia, haemacromatosis,
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What are the common sites of involvement in pseudogout?
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MCPs, knee, polyarticular wrist, 1st MTP
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What is the ddx of acute monoarthritis?
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Septic Arthritis, Gout, pseudogout, trauma, hemarthrosis, osteonecrosis, OA, tumour, systemic inflammatory disease, polyarthritis presenting with monoarticular symptoms
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What are the tender point sites in fibromyalgia?
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occiput, trapezius, supraspinatus, low cervical, second rib, lateral epicondyle, gluteal, greater trochanter, medial fat pad of knee
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What are the features for the diagnosis of polymyalgia rheumatica?
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age >50, bilateral aching/morning stiffness for 1 month, usually affects shoulder and hips, 50% get temporal arteritis (sudden visual changes, pain)
ESR >40, prompt response to low-dose corticosteroids |
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What is the intial management of BPH?
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watchful waiting if mild sx and not bothersome to patient
alph-adrenergic antagonists and 5alpha-reductase inhibitors if medical management fails, then TURP |
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What important dx must be ruled out in patient >40 yrs of age with hematuria?
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investigate hematuria with cytoscopy to rule out bladder carcinoma (TCC)
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which imaging modality is best for detecting uric acid stones?
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CT, uric acid stones are not visible on AXR
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Is elevated PSA specific for prostate cancer?
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no - also elevated in BPH, post DRE, trauma, prostate cancer
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Mnemonic for aetiologies of pleural effusions
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CAPTAIN CHEM
Exudative: collagen vascular disease ascites (or other abdominal pathology) pneumonia TB asbestos infarcted PE neoplasm (lung, breast) Transudative: cardiac failure hypoabuminaemia (liver disease) embolism (PE - non infarcted) Meig syndrome (ovarian tumour causing ascites) |
