Causes of Type 1 Distal Renal Tubular Acidosis?
Autoimmune: Sjogren’s, Rheumatoid Arthritis
Drugs: lithium, NSAIDs, anti-fungals
WIlson’s disease
Familial
Ix of Type 1 Distal Renal Tubular acidosis?
Renal panel: Low K, Bicarbonate
Urine K, Cr
Urine pH: pH > 5.5
Urine Calcium: high
Investigate underlying cause:
Autoimmune workup: Anti-Ro, La, ESR
Schirmer’s test for Sjogrens, Salivary gland biopsy
Management of Type 1 Distal Renal Tubular acidosis 2’ Sjogrens?
Sodium bicarbonate
K replacement
Treat underlying cause:
Eye drops for dry eyes
Immunosuppression
What are the highest risk drugs implicated in drug induced lupus?
procainamide, hydralazine, penicillamine
medications causing drug induced lupus?
procainamide, hydralazine, penicillamine
+
isoniazid
anti-TNF alpha therapy (esp infliximab, etarnercept)
methyldopa
diltiazem
minocycline
what common medications may trigger / worsen psoriasis/ psoriatic arthropathy?
beta blockers
enalapril
what to examine for in patient with psoriatic arthropathy?
examine skin for plaques
nail changes
dactylitis
joints
enthesitis
eyes
Suspecting haemochromatosis, what to examine?
Skin for hyperpigmentation
Venesection marks over antecubital fossa
Abdomen: liver exam
Cardio: for congestive cardiac failure
Joint: pseudogout
if hypothyroid symptoms: thyroid exam
Offer to examine for testicular atrophy (hypogonadism)
which autoantibody is associated with highest risk of scleroderma renal crisis?
anti RNA polymerase III
Dermatomyositis, what to examine?
Skin for dermatomyositis signs: hands, face, shawl sign
power: neck flexion/ extension, proximal UL and LL
Respi: ILD
Cardio: pHTN
KIV further examination depending on whether you suspect underlying malignancy
Takayasu arteritis, what to examine?
check radial, brachial, carotid, femoral pulses.
Check for R-R, R-F delay.
Auscultate for carotid, subclavian, abdominal bruit.
Feel for AAA.
Pronator drift.
Ask for differential BP.
Offer Fundoscopy.
Giant cell arteritis, what to examine?
Temporal artery tenderness,
palpable temporal artery
pronator drift
relevant neurological exam
offer fundoscopy
check radial, brachial, carotid, femoral pulses.
Check for R-R, R-F delay.
Auscultate for carotid, subclavian, abdominal bruit.
indications for treatment of sarcoidosis with steroids?
- Symptomatic pulmonary sarcoidosis
- Critical organ involvement
- Granulomatous vasculitis
- Systemic metabolic effects, e.g. hypercalcaemia, fever
- Local pressure effects
management of acute sarcoidosis?
Acute sarcoidosis usually tends to resolve spontaneously over weeks and do not require treatment
steroids may be indicated if:
* Symptomatic pulmonary sarcoidosis
* Critical organ involvement
* Granulomatous vasculitis
* Systemic metabolic effects, e.g. hypercalcaemia, fever
* Local pressure effects
skin features of sarcoidosis?
lupus pernio
erythema nodosum
examination of a patient with hereditary haemorrhagic telangiectasia?
telangiectasia (look at mouth/ tongue as well)
conjunctival pallor if anaemic
offer postural BP and DRE
what is Gitelman’s syndrome?
- AR, Tubular defect in NaCl reabsorption in distal tubule
- Cramps, fatigue, polyuria/nocturia, chondrocalcinosis
-> HyperK metabolic alkalosis, low Mg, normal BP
management of Gitelman’s syndrome?
Liberal NaCl intake with KCl supplements
DCT Na/K channel blockers: Spironolactone/eplerenone/amiloride
indomethacin (blocks PGE2 production, raises K)
Lofgren’s syndrome?
acute presentation of sarcoidosis
classic triad of fever, erythema nodosum, and bilateral hilar adenopathy
what medications may worsen raynauds?
drugs that cause vasoconstriction
- beta blockers, caffeine, chemotherapy agents (bleomycin), decongestants, nicotine, stimulants, and cocaine
- triptans, ergotamine used in migraines
Anti-phospholipase A2 receptor (PLA2R) antibodies?
primary membranous nephropathy
physical examination of patient suspected of atypical femoral fracture?
- identify limb length discrepancy
- lower limb examination: hip ROM, neurovascular status of lower limb
- no blue sclera
ix of atypical femoral fracture 2’ bisphosphonates?
X-ray hip pelvis
Vit D, Ca, PO4, PTH, Cr
TFTs
examination in patient with gynaecomastia?
examine breast lump
look for cervical and axillary lymphadenopathy
presence of axillary hair
offer to examine testes
