HASH - big iron lungs and neck
Haemachromatosis
Acromegaly
Sarcoidosis
Hyperparathyroidism
Haemachromatosis
Acromegaly
Sarcoidosis
Hyperparathyroidism
HASH - big iron lungs and neck
Haemachromatosis Acromegaly Sarcoidosis Hyperparathyroidism
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True leg length - ASIS to medial malleolus Apparent leg length - Umbilicus to medial malleolus true length leg discrepancy - hip disease on shorter side apparent leg length discrepancy - tilting of hip 'SHAFT' 'DEATH'
Instrumental Shopping Housekeeping Accounting Food prep Transportation Basic Dressing Eating Ambulating Toileting Hygiene TUUNA FISH at Night and in the Morning, or all the time?
Trauma Weight loss Neurological symptoms / signs Age <20, >55 Fever IV drug use Steroids / immunosuppression Hx of cancer Worse at Night, worse on lying down Morning stiffness Acute onset / Constant / progressively worse 4 or more of 11
'AN ARTH RRR ITIS 4 U' ANA Arthritis + 3 characteristic Rashes + '2 itis' + 4 disorders + oral Ulcers 1. ANA antibodies (+ve in >95%) - one of big things about SLE 2. Arthritis (it's a rheumatological condition, of course!) 3. Photosensitive rash 4. Malar 'butterfly' rash 5. Discoid rash (Erythema -> pigmented hyperkeratotic oedematous plaques -> atrophic depressed lesions) 6. Oral ulcers 7. Serositis (Pleuritis and pericarditis) 8. Haematological disorder (anaemia, thrombocytopenia, leucopenia) 9. Immunological disorder (Anti-dsDNA, Anti-Sm, Antiphospholipid) 10. Renal disorder (GN) 11. Neurological disorder (seizures, psychosis) In 2012, SLICC introduced a new criteria which is similar, but splits the above into 11 clinical and 6 lab crteria: Changes to clinical criteria: 1. Photosensitive rash, malar 'butterfly' rash, discoid rash -> alopecia, acute cutaneous, chronic cutaneous 2. Haematological disorder -> split into 3 major criteria (hemolytic anaemia, leukopenia, thrombocytopenia) Lab criteria: 3. Immunological disorder + ANA -> split into 6 criteria (ANA, anti-DNA, anti-Sm, anti-phospholipid Ab, [complement C3, C4, CH50], Direct Coombs' test Think Cardio + Abdo examination; start with general appearance then hands
1. Systemic (Fever, weight loss) 2. Bones (Osteoporosis) 3. Hands (Carpal tunnel syndrome, Raynaud's, peripheral neuropathy, de Quervain's syndrome) 4. Elbows (Rheumatoid nodules) 5. Eyes (Episcleritis, scleritis, scleromalacia, keratoconjunctivitis sicca) 6. Heart (Aortic regurgitation, pericardial effusion) 7. Lungs (Pulmonary fibrosis, obliterative bronchiolitis, pleural effusion) 8. Liver and kidneys (Amyloidosis, which can then lead to nephrotic syndrome, hepatosplenomegaly) 9. Spleen (Splenomegaly. With neutropenia it is known as Felty's syndrome) Diagnostic criteria = 4 of 7 of 2. Morning stiffness (>1 hour lasting 6 weeks) 3. Involvement of joints of hand (wrist, MCP, DIP) and feet (MTP) - Boutonniere and swan neck deformities of fingers at PIP and DIP, z-deformity of thumb, ulnar deviation of fingers at MCP, dorsal wrist subluxation. 4. Characteristic radiological findings (Joint space narrowing, juxta-articular osteopenia, soft tissue swelling) 5. Rheumatoid nodules 6. Rheumatoid factor +ve 7. Extra-articular manifestations |
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