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Migraine
Somatosensory: paraesthesiae
Speech: dysphasia
DDx: TIA
Ix: nil
Cluster headaches daily clusters for 4-6 wks then nothing for months
Neuro-muscular Disorders
MG (Myasthenia Gravis)
Edrophonium test
NO EYE INVOLVEMENT
Myotonic dystrophy
NO SENSORY LOSS
walking on air
Ophthalmoplegia
Ataxia
Areflexia
Meningitis
Disease
CSF
Pressure
Glucose
Protein
Cells
Bacterial
Raised
DOWN
UP
UP
NEUTROPHILS
TB
May be
normal
DOWN
UP
UP
LYMPHOCYTES
Viral
Normal
NORMAL
NORMAL
LYMPHOCYTES
M Tb
(Cryptococcus) - HIV
Treatment
TB 12 months
Meningococcus ceftriaxone
+ Dexamethasone in children w/S.pneumoniae
Multiple Sclerosis
F>M
Relapsing remitting
Optic neuritis
Transient blindness
Blurred vision
MRI demyelination
Contralateral signs;
-decreased pain and temperature sensation of the body
Stroke
Over 24 hours!
Collapse
Either Cardiovascular or Neurological!
Risk factors (age, PMH)
Neurological: (causes)
Meningitis:
Pyrexia infection!
iv benzylpenicillin
Subcortical dementia
Subarachnoid haemorrhage:
Syb-hyloid haemorrhage
Postural Hypotension:
DM Autonomic Neuropathy
Antihypertensive medication
Seizures: (causes)
Aetiology:
SIADH
Management hyponatraemia:
Hypocalcaemia
Presentation:
Causes:
Hypoparathyroidism
Vit D deficiency
Delirium Tremens
Must assume as a possibility in all patients within the first 4 days of admission
with new onset seizures.
Hypomagnaesaemia
S/e of frusemide
Hepatic encephalopathy
Hypoglycaemia
Gliclazide
Oral hypoglycaemic
sulfonylurea
Epilepsy
= tendency to recurrent unprovoked seizures.
Classification
Partial/focal:
-
st
1 line Tx
Focal/Partial seizures
Carbamazepine or Lamotrigine
Generalised tonic clonic (GTC)
Sodium valproate (note teratogenecity)
or Lamotrigine
Absence seizures
Ethosuximide or sodium valproate
Myoclonic
Sodium valproate
Tonic/Atonic seizures
Sodium valproate
So if in doubt, sodium valproate is a good guess, apart from females of
reproductive age, as due to teratogenicity of valproate, lamotrigine is a better
choice.
Status epilepticus
= >30 mins seizure, or without full conscious recovery between several seizures)
Management:
Airway: open and maintain airway
Breathing: 100% 02 + suction as required
Circulation: IV access and take bloods (routine, toxicology, blood
glucose, anticonvulsant levels)
Anti-convulsants:
Community/No IV access: Buccal midazolam/rectal diazepam
in community or no IV access
Hospital: IV lorazepam bolus.
Administer max 2 doses of 1st line Tx (inc pre-hospital tx).
If seizures continue administer IV phenytoin infusion.
If still refractory, call for senior anaesthetic help.
Dementia (causes)
Vascular dementia:
Alzheimers Disease:
Folstein test:
Hypothyroidism:
Alcoholic dementia
Depressive pseudo-dementia
Alcohol related:
Wernickes encephalopathy nystagmus/ opthalmoplegia/ ataxia. Thiamine
def.
Reversible.
Untreated - Korakoffs
- Korsakoffs syndrome gross defect in memory of recent events.
Confabulation.
Irreversible
Gait disturbances
Scissoring gait: most common in pts with spastic cerebal palsy, Legs
flexed slightly at the hips and knees, giving the appearance of crouching,
with the knees and thighs hitting or crossing in a scissors-like movement.
Often mixed with or accompanied by spastic gait, a stiff, foot-dragging
walk caused by one-sided, long-term muscle contraction.
Waddling gait: pt has been on long term steroids, which has caused
secondary Cushings and proximal myopathy as evidencedby the
weakness of the upper limbs in abduction and being unable to stand from
a sitting position, proximal myopathy produces a waddling gait
Optic;
Superior quadrantopia = temporal lobe lesion
Inferior quadrantopia = parietal lobe lesion
Homonomous hemianopia = optic radiation, visual cortex injury
Central scotoma = macula (degeneration or oedema)
Bitemporal hemianopia = chiasma lesions
Cerebral venous thrombosis
Preggers, thrombophiliacs
Presents as raised ICP
Cushings reflex!
SACD
Haematuria
Causes:
Bladder cancer:
Presentation bladder cancer: M:F 4:1, peak 60-70.
o Painless haematuria (bladder cancer until proven otherwise,
can be intermittent), Recurrent UTIs, Voiding irritability
Two types:
o Transitional cell carcinoma 90% - common in west
o Squamous cell carcinoma 7% - associated with
shistosomiasis
Risk factors
o TCC: 90% transitional cell carcinoma (cells line kidney ->
urethra). Smoking, aromatic amines (rubber), alanine dyes,
dry cleaning, pesticides. Cyclophosphamide, pelvic irradiation
o SCC: 10%. From chronic inflammation/irritation.
Developed: Stones, infection, LT catheters,
Developing: Shistosomiasis (fluke worm trematode),
inflammatory reaction to eggs
Pyelonephritis
Ascending UTI that has reached the pyelum (pelvis) of the kidney
In this case will get the UTI symptoms haematuria, painful
micturition;
Then if have loin pain, fevers/rigors, confusion think of
pyelonephritis
Common cause is a renal stone!
Others:
o Sex
o Pregnancy
o Female
o Diabetes
o Incomplete bladder emptying
Renal Tumours
Presentation: TRIAD: Haematuria; loin pain and loin mass. Can get
general malaise; fever; wt loss
Polycythaemia; hypertension; hypercalcaemia
Cannon ball mets!
Cystitis
UTI but in this case, no fever/rigors
Just local symptoms
Therefore think of cystitis in this instance.
Most common cause is E coli
Others include:
Proteus Mirabilis, strep faecalis
Treat with a 3-5 day course of oral amoxicillin, nitrofurantoin or
trimethoprim
Shistosomiasis
o Fluke worm (trematode)
o Disease is caused by inflammatory response to eggs or adult worms
o The earliest symptom is painless terminal haematuria (for
haematobium)
o As bladder inflammation progresses increased urinary frequency and
groin pain
o Strong association with chronic shistosomiasis and squamous cell
carcinoma of the bladder.
More on UTI;
o E coli commonest
o proteus (can cause urate stones)
o Trimethoprim, nitrofurantoin
o Dipstick nitrites and leucocytes
o MCS of MSU if no bacteria but positive white cells sterile pyuria - TB
Glomerulonephritis
Inflammation of the glomeruli
Can present in different ways; Nephrotic syndrome, Nephritic
syndrome and Acute/chronic renal failure
Nephrotic Syndrome
Massive proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia/hyperlipiduria
o E.g. Minimal change GN, Membranous GN
o Non proliferative
Nephritic Syndrome
Hematuria
Oliguria
Uremia
Hypertension
o E.g. IgA nephropathy, Post-streptococal.
o Proliferative
Membranous Glomerulonephritis
Again nephrOtic syndrome
BUT this is an adult.most common cause of nephrotic syndrome in
adults is membranous GN
Mainly idiopathic, but can be induced by a number of disease processes;
SLE
HBV
Drugs
Cf
Post-streptococcal glomerulonephritis
Usually seen 1-2 weeks after an infection caused by a group A haemolytic streptococcus e.g. tonsilitis or cellulitis
Nephritic syndrome and pepsi urine
Investigations reveal an elevated anti-steptolysin O titres.
Goodpastures Syndrome
Auto-antibodies formed against glomerular basement membrane, (anti
glomerular basement membrane antibody).
Renal failure, pulmonary haemorrhage and haemoptysis.
Rapidly progressive glomerulonephritis
Wegners granulomatosis and polyarteritis (ANCA antibody)
Renal failure
Complications of Renal Failure
Renal failure can arise from numerous causes
The effect of Renal failure is extensive and can manifest in a variety of
ways
Need to understand complication and appropriate treatment
AnaemiaLethargicpale conjunctivae
ejection systolic murmur = murmur created by high output state
no valve pathology
Reduced secretion of erythropoietin by kidneys
Recognise treatment
Iron stores are normal so not corrected by iron supplementation
Recognise treatment
High BP
Renal disease causes high BP and uncontrolled high BP can induce renal
disease
Recognise treatment
o
So give alternativeCCB
Uremiabuild up of urea
Lethargy, irritability
Pericarditis
GI
Neurological
Prostate Cancer
Aetiology: Begins in its outer part and so NO false capsule and so can
easily spread in the floor of the pelvis. Are adenocarcinomas, 80%
arise from peripheral zone.
Epidemiology: >50
Commonly quite advanced before symtpoms
Presentation: Commonest symptoms prostatism (poor stream,
urgency, frequency). Also can present with weight loss + bone pain
+ raised AlkP (metastasis).
o Rectal exam - prostate is asymmetrically enlarged or distorted,
irregular texture craggy, nodular, loss of midline sulcus.
Diagnosis:
o Transrectal USS and biopsy. Then staging: TNM and Gleason
grading.
PSA (NR < 4ng/ml) A PSA alone does NOT give enough information to
distinguish between benign and cancer.
o N in 30% of cancers, elevated in BPH so cannot distinguish
benign and malignant disease. But once cancer is diagnosed, it
is a very good marker of disease progression/recurrence
following treatment.
Renal Stones can cause urinary obstruction amongst other things (like
haematuria)
Inadequate volume
Stagnant urine
UTI generally produces phosphate stones. Can get a large staghorn calculus deposited within a pyonephros (infection of renal
collecting system)
Ix:
Adv: No contrast, safe iodine allergy. ALL stones radioopaque pick up 99%. May see ureter dilatation or
hydronephrosis.
IVU: plain abdo film, then iodine contrast, serial xrays. 90%
stones radio-opaque.
Management:
o
Nephrostomy or JJ stent
Stone types
Content
Calcium
Frequency
75-85%
Xray
Radiopaque
Magnesium
ammonium
phosphate
(Struvite)
15%
Radiopaque
Uric acid
5%
Radiolucent
Cystine
1%
Radiopque
Notes
Calcium
oxalate/calcium
phosphate.
Increased
conditions cause
hypercalcaemia
Infection urease
+ve: Proteus,
Staph, Klebsiella.
Can form
staghorn calculi
Hyperuricaemia
e.g. gout,
leukaemia
(metabolism)
2* cystinuria
High ESR
Neurogenic Bladder
automatic bladder
UTI
Very very common
Elderly women
Frequency, urgency and fever
Can also present insidiously, NO URINARY SYMPTOMS.sepsis
UTI is an example of urge incontinence
Stress Incontinence
Leak of urine when intra-abdominal pressure rises.
Event in the past has weakened the pelvic muscles
Child birth
Pelvic surgery
Summary of Incontinence
Overflow BPH and Spinal Cord Compression
Urge Often Idiopathic in Women. Treat with anticholinergics
Stress Increase in abdominal pressure. Treat with pelvic floor exercises/bladder
retraining
Functional dementia, poor mobility
Scrotal Swellings
4 questions
1. Can you get above the swelling
2. Can you identify the testis and epididymis
3. Is the swelling translucent
4. Is the swelling painful
Tender:
Acute epididymo-orchitis
Translucent:
Cyst of epididymis usually contains clear fluid
Indirect inguinal hernia may be aware of the lump, and may be able
to reduce it. impossible to get above the swelling. May become painful and
irreducible
o
o
Mumps orchitis: 1/5 males get orchitis with mumps. Testicular swelling
usually 4-8d after parotitis. Acute onset testicular swelling, erythema,
tenderness.
Cf bacterial infection; usually orchitis + epididymitis.
- Management: No anti-virals for mumps, so symptomatic relief; bed rest,
analgesia, fluids, scrotal elevation, cold compress etc.
Varicocele
= abnormal dilatation & tortuosity of pampiniform venous plexus in scrotum
o Epidemiology: 15-20% all males, 40%infertile males.
o Presentation: Dragging/aching pain, heaviness, atrophy. More
common L.
O/E: visible or palpable enlarged veins, particularly standing.
Classically bag of worms in EMQs (cf to tuberculous
epididymis where the vas deferens feels like a string of
beads!)
o Ix: USS
o Aetiology:
Valvular incompetence: Valves of veins within spermatic
cord incompetent. 98% L
Compression of venous drainage: Pelvic/abdominal
malignancy e.g. RCC, concern if new onset >40, nutcracker
syndrome
o Management: Varicocelectomy my improve fertility.
o Complications:? Arterial blood supply/ ? Thermoregulation ->
infertility. Commonest cause poor sperm production and
decreased semen quality
Acute Haematocele
o A haematocele is a collection of blood within the tunica vaginalis
o Acute haematocele is a common accompaniment of scrota trauma.
o The testis cannot be felt!
o Also does not transilluminate!
o It will be very tense and tender
o Ix: Both clinically and sonographically difficult to distinguish from a
neoplasm. So surgical exploration may be warranted.
Tuberculous Epididymis
o
o
o
Testicaular cancer
o Teratoma are germ cell tumours which usually occur in 20-30
o
Seminoma (30-40)
o Tx:
Seminoma; ORchidectomy.
Seminoma
%
40
Ages
>30
Teratoma
10
20-30
Origin
Germ cell,
Epithelium
seminiferous
tubules
Germ cell
Bloods
B-hCG
(AlkP)
B-hCG, aFP
Features
Low grade
tumour,
homogenous
USS
More
aggressive,
hetergenous
USS
-Non germ cell (5%): Leydig cell & Sertoli cell tumours: Rare, can produce
steroid hormones.
-Lymphomas: Can occur in 50-60s, most common testicular cancer of older
men
Pneumonia:
Staph Aureus
Post viral-infection
Cavities on CXR
Bordetella Purtussis
Whooping cough (100 days cough)
Starts with cold-like symptoms
1-12 days later develops paroxysmal violent cough with whoop
noise
Coughing spells may lead to vomitting and LOC
In UK: vaccination programme
Cytomegalovirus
Immunocompromised patients develop infection, which can be life
threatening.
Commonly:
AIDS
Post-transplant (BMT, solid organ)
Infections:
CMV pneumonia
CMV retinitis
CMV gastroenteritis
CMV oesophagitis
Diarrhoea:
Self-limiting
Bloody Diarrhoea
Shigella (G-ve)
Person-to-person spread
Campylobacter (G-ve)
E.coli (G-ve)
Travellers diarrhoea
Salmonella enteritidis
Salmonella typhi (Typhoid eneteric fever) Think when has headache and GI
symptoms
Faecal/ oral spread, high fever, malaise and diarrhoea, CNS and delirium;
Gram ve bacilli
Shistosomiasis
Malaria Plasmodium Falciparum - flu like illness followed by fever and chills,
classic periodic fever and rigors; Signs: anaemia, jaundice and
hepatosplenomegaly, no rash or lymphadenopathy
Cholera toxin causes massive secretion of isotonic fluid into the intestinal
lumen
Effective rehydration is key mainly oral but in severe cases IV fluids can
be given
Giardiasis
Toxoplasmosis
During first few weeks, infection causes a mild flu like illness
Complications include;
Encephalits; Chorioretinitis;
Trypanosomiasis
The Human African form is transmitted by the Tsetse fly - gives sleeping
sickness
o
Leishmaniasis Kala-Azar
Cutaneous leishmaniasis can give you a skin sore which can progress to
an ulcer which takes ages to heal
Swallowing difficult
Viral Infections
Cytomegalovirus
Treat - ganciclovir
The rash bright red petechiae usually appears first on lower limbs and
chest
Two types:
After primary infection (chicken pox) the virus is not eliminated from the
body but becomes latent in nerve cell bodies.
It can then several years later travel down nerve axons to cause a viral
infection of the skin in the region of the nerve
Hepatitis A
10% of CMV
Measles
Henoch-Schonlein purpura
o Systemic vasculitis (IgA complex deposition)
o Purpura, abdo pain and arthritis (Triad)
o Kidney involvement common (haematuria)
o Common post infection, esp resp tract
o Symptom control, spont resolution within 4/52
Pancoasts syndrome
o Horners (Ptosis, Miosis, Anhydrosis)
o HPOA (Clubbing, IM wasting, wrist pain)
o Arm pain/paraesthesia
o Vocal change
o Apical lung CA (Often Sq.cell) invades sympathetic chain
VwD
o Most common coag defect (Plt affected)
o Bleeding tendency
o Menstrual, gums, nose bleeds, PPH, easy bruising (not
haemophilia!)
o Blood plasma Ix
Kaposis sarcoma
o Tumour, Herpesvirus 8
o AIDS associated
o Papular lesions (lower limbs and intra oral)
o Airway and GI involvement
Peutz-Jeghers syndrome
o Benign GI polyps
o AD
o Hyperpig lips and oral mucosal macules
Barrets Oesophagus
o Sq to Col epith
o Chronic reflux
o M 50-70
o Inc risk dysphagia + (CA)
Gardners
o Colonic polyps + extracolonic tumours (e.g. osteomas and thyroid)
o AD
o FAP similarity
Alports
o Glomerulonephritis (Haematuria) + RF + Hearing loss (bilateral
sensorineural)
o X Linked
o Collagen synthesis
o Occular lesions
Tabes Dorsalis
o Slow degen nerve cells DC
o = neuro craziness
o Unteated syphilis (HIV)
o Paralysis, dementia, blindness
Chrug-strauss
o Asthma + Eosinophilia + vasculitis
Dresslers syndrome
o Pericardial effusion post MI
Feltys syndrome
o Rheumatoid, splenomegaly and neutropenia
Charcot-Marie-Tooth
o inverted champagne bottle appearance of legs; get foot drop
Osler-Weber-Rendu
o telangiectasia on the skin and the mucous membranes, which may
cause epistaxis, or chronic GI bleeds, with IDA
Von-Hippel-Lindau syndrome
o Bilateral renal carcinoma and cerebllar haemangioblastoma and
phaeochromocytoma.
o It may present with visual impairment and cerebellar signs.
Bergers Disease
o IgA nephropathy
o Most common form of primary glomerular disease
o Serum IgA increased in 50%
o Haematuria appears quickly after infections (mostly respiratory
o 25% will develop ESRF in around 25 years
Sjgrens Syndrome
o Autoimmune (anti-La, anti-Ro)
o Chronic inflammatory infiltrate in both lacrimal (dry eyes) and
salivary glands (dry mouth)
o Schirmers test
Meigs Syndrome
o Triad of ovarian fibroma or tumour, ascites and pleural effusion
o The removal of the ovarian lesion results in resolution of ascites and
pleural effusion
Zollinger-Ellison Syndrome
o Gastrin-secreting tumour
o Large amounts of hydrochloric acid production in gastric antrum
leads to recurrent peptic ulceration (often duodenal).
De Quervains thyroiditis
Beta-blockers
Hypothyroidism
Iatrogenic (thyroidectomy)
Iodine deficiency
Myxoedema Coma
o
SEVERE hypothyroidism
Treat:
Fluids
Gentle rewarming
IV thyroid hormones
Thyroid Cancer
Diabetes Treatment
T1DM:
Insulin
T2DM:
Diet
HbA1c >7%:
Note:
When choosing sulphonylureaglibenclamide is most popularbut
must be avoided in elderly due to its long duration of actionso use
Tolbutamide, (potential hypoglyceamia)
Metformin contraindicated in renal failure, liver disease and severe heart
failure due to risk for lactic acidosis.
Make sure you learn the diagnostic criteria
(potassium replacement)
Diagnostic Pitfalls
BM may be normal
Elevated WCC (NOT infection)
Amylase Inc (NOT pancreatitis)
Inc ketones & norm BM ?ETOH
Low potassium
Cause of hypertension
Phaeochromocytoma
Failure:
Short SynACTHen test if cortisol rises then the problem is probably in the
pituitary
Cushings
High dose will suppress only Cushings disease, not SCC of the lung
Prolactinoma
Galactorrhoea
Infertility in women
Growth Hormone
Acne
Arthritis
Diabetes Insipidus
Dilute urine
MEN syndromes
Steroid
Oxygen
heparin
synchronised DC shock
Anti-coagulant (warfarin)
Dialysis
Hypocalcaemia
Poisoning + antidotes
Poison / drug
Aspirin
Antidote
<500mg/L supportive
>500 mg/L alkaline diuresis with
i.v sodium bicarbonate
>700 mg/L - haemodialysis
Diazepam
Flumazenil
TCA
Lorazepam
Opiates
Naloxone
Paracetamol
N-Acetylcysteine
Heparin
Protamine sulphate
Warfarin
Vit K
Methanol
Ethanol
B-blockers
Atropine, Glucagon
Organophosphorous poisoning
Pralidoxime mesilate
Cyanide
Dicobalt Edetate
Haemachromatosis
Desferrioxamine
Penicillamine
Arsenic
Dimercaprol
Paraquat / CCB
Activated Charcoal
Lithium
Dialysis
Cocaine / extasy
Diazepam
Toxicity / SE
Macrocytic anaemia,
hypocalcaemia, nystagmus,
confusion, lethargy, cerebellar
signs
Cimetidine
Gynaecomastia
Digoxin
Gynaecomastia
Spironolactone
Gynaecomastia
Bendrofluazide
Gout
Minoxidil
Hirsuitism
Isoniazid
Ethambutol
Retrobulbar palsy
Pyrazinamide
Gout
Neuroleptics
Tardive dyskinesia
Aspirin
* These are not the most important or all the side effects of the drugs.
For full side effects please see BNF.
Warfarin
Table of what to when INR is raised.
Target INR should be between 2-3 or higher (3-4.5 with a metallic heart valve, or
recurrent systemic thromboses).
INR
Action
4.5 6
68
MISCELLANEOUS
Nutrition
RDAs:
- Sodium: 2.4g, Salt 6g (Salt = sodium x2.5)
- Protein (0.8-1.8g/kg)
- potassium (3.5kg)
Haematological malignancies
Multiple myeloma
60-70 yo.
Vasculitis
= Inflammation of vessels leading to occlusion (ischaemia and gangrene) and
end organ dysfunction and necrosis.
EFFECTS: ANY ORGAN!
SYSTEMIC: fever, malaise, weight loss, arthralgia, myalgia, lethargy, loss
of appetite
SKIN: purpura, ulcers, livedo reticularis, nail bed infarcts, digital
gangrene
PULMONARY: haemoptysis and dyspnoea
Cardiac: Angina or MI (coronary arteritis), heart failure and pericarditis
So presents as a mutli-system disease.
SIZE
LARGE
NAME
Giant cell
Presentation
Elderly, temporal
Ix
ESR, CRP,
Tx
High dose pred
arteritis
Takayasus
arteritis
MEDIU
M
Polyarteritis
nodosa
Kawasakis
disease
SMALL
Wegeners
granulomatosi
s
Microscopic
polyangitis
Churg-Strauss
headache, scalp
tenderness, jaw
claud
Young, Asian, PUO,
chest pain, poor
distal pulses O/E
Unwell, skin, renal
aneurysms
Child, Fever +
lymphadenopathy,
mucocutaneous
erythema,
conjunctivitis
URT + LRT +
glomerulonephritis
Glomerulonephritis
, purpura,
haemoptysis
Allergic rhinitis,
asthma, sinusitis,
eosinophilia
biopsy
Inflammed
aorta,
vessels
aortic arch
Renal
angiography
Steroids in
inflammatory
phase/surgery in
occlusive phase
Immunosuppresio
n
IV
immunoglobulin
cANCA 90%
Immunosuppsn.
pANCA 90%
Eosinophilia,
c/pANCA
40%
More detail:
Wegeners granulomatosis
Presentation: Rare.
Systemic: Tired, lethargic, fever, purpuric rash, arthralgia.
Triad:
URT symptoms: Epistaxis, nasal septum destruction,
rhinorrhoea, laryngeal damage.
LRT symptoms: Haemoptysis, cough, fibrosis, SOB.
Glomerulonephritis: Haematuria, proteinuria, HTn.
Ix: cANCA positive in 90%.
Tx: High dose immunosuppressants e.g. corticosteroids, cyclophosphamide.
Churg-Strauss. Allergic granulomatosis.
Presentation: Middle aged:
Allergic rhinitis, asthma.
Eosinophilic disease: eosinophilic pneumonia, gastrenteritis,
Eosinophilia >10% peripheral blood.
Systemic vasculitis: nerves, GIT.
Ix: p and cANCA +ve in 40%
Tx: High dose prednisolone
Acanthosis nigricans
Presentation: symmetrical, pigmented, velvety thickened skin on neck and
flexures eg. Axillae, groin.
Aetiology: Insulin resistance (DM, obesity, Cushings), acromegaly, thyroid, GI
cancer/malignancy.
Dermatological conditions DIABETES MELLITUS:
Necrobiosis lipoidica: shiny atropic yellow brown patches, can
ulcerate. Due to necrosis collagen fibres.
Acanthosis nigricans
Infections e.g. candidiasis, folliculitis
Granuloma annulare: erythematous ring shaped lesions.
Gottrons papules
Diagnosis: Dermatomyositis (Polymyositis + skin involvement)
Presentation:
Skin: Heliotrope rash, Gottrons papules (violet flat papules)
Muscle: proximal, symmetrical muscle weakness
Importance: Associated with malignancy +/-1 year in 30%.
Dermatitis herpetiformis
Presentation: Itchy blisters on elbows, scalp, shoulders, ankles. Found in
Coeliac disease
Aetiology: Gluten enteropathy -> circulatinG IgA complexes containing
transglutaminase, lodge in skin And cause inflammation
Ix: Coeliac antibodies +ve e.g. antiendomysial
Tx: Gluten free diet life long. Dapsone.
Erythema nodosum. Nodular, red, raised, tender, not itchy, ill-defined, typically
shin. Due to panniculitis = fat inflammation.
Associations:
Infections: TB, post-streptococcus
Drugs: OCP, antibiotics.
Systemic: SLE, sarcoidosis, IBD
Pregnancy & idiopathic