Revision notes for Medical Finals, for all modules: Cardiology, Respiratory, Neurology, GI, Haematology, Rheumatology, Dermatology, Infectious Disease, Renal
POLYMYOSITIS + DERMATOMYOSITIS
Investigations: EMG, muscle biopsy, skin manifestations; inc se CK + aldolase; inc ALT + AST; anaemia, RF +ve, Normal ESR and CRP; anti-
nuclear autoantibodies (Anti-Jo-1 AB, Anti-Mi-2, Anti-SRP)
Polymyositis: LL, neck muscles, spares face + ocular muscles, muscle pain + tendernessin 25%; late: muscle atrophy, myocarditis, resp failure
Dermatomyositis: myositis features, purple malar rash; Shawl sign; peri-orbital oedema; Gottron sign; periungal erythema, psoriatic like
lesions over scalp
Rx: rest, corticosteorids (prednisolone), 2nd: methotrexate, azathioprine, IV Ig, mycophenolate mofetil
RAYNAUDS
Exaggerated digital arteriolar vasospasm; primary: 60% adults; Hands change colour in cold: white blue red
Rx: avoid exposure to cold/ injuries/ skin cuts; lubricating lotions, stop smoking, ischaemia: CCBs nifedopine/ amlodipine; 2nd lines: ACEIs,
sildenafil. Severe/ resistance: sympathectomy
Prognosis: primary: benign; secondary: ulceration + gangrene
FIBROMYALGIA
3-10% gen pop; F>M; ‘central pain sensitisation’, hypersensitivity of pain fibres
Investigations: Trigger points x18, no lab/ imaging abnormalities; ESR + CRP NORMAL; do not investigate; dg of exclusion
Rx: education, exercise, painkillers ineffective, amitryptiline/ fluoxetine/ gabapentin
POLYMYALGIA RHEUMATICA
Investigations: anaemia, inc ESR + CRP (ESR > 40mm/h); CK normal; Inc Alkphosph
Rx: prednisolone (10-20mg/d + taper); maintenance for 1y; methotrexate reduces RR; OP prophylaxis
GIANT CELL A RTERITIS (TEMPORAL ARTERITIS )
Think if >65y + PUO; high CRP; leukocyte count=N; Systemic pan-arteritis of medium & large vessels; assoc in PR in 25%.
Complications: blindness
Tests: ESR > 100mm/h; Inc ESR + CRP, Alk phosph, plt, low Hb, normocytic normochromic anaemia, thrombocytosis; temporal A bx: inflamm
infiltrate in media + adventitia with cellular infiltrates
Rx: prednisolone (40-60mg/d & taper) + low-dose aspirin; visual loss: IV pulse methylprednisolone
GRANULOMATOSIS WITH POLYANGITIS = WEGENER’S
AI; necrotizing granulomatosis inflammation & pauci-immune vasculitis of small + medium sized vessels (Wegener’s granulomatosis); M=F;
12/milion/yr; peaks 4th + 5th decades
Sites inv: pulm (100%; ALL pt), sinus/ nasopharynx (90%), renal (88%), arthralgia arthritis (60%), neuro cutaneous (50%), ophthalmic (40%)
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