17/4/22 Flashcards
Hypermetropia vs myopia?
Hypermetropia = longsighted Myopia = shortsighted
Antibiotic management of
- sinusitis
- otitis media
- prostatitis
Sinusitis
- penicillin V
- Doxycycline
Otitis media
- Amoxicillin
- Clarithomycin
Prostatitis
- Ofloxacin
- Ciprofloxacin
What is the name for when a patient purposefully causes symtpoms e.g. diabetic taking too much insulin to intentionally cause hypos?
Munchausen’s syndrome
What bacteria is most likely to be responsible for a chronic ulcer?
Pseudomonas aerguinosa
What treatment is recommended in breast cancer patients post wide-local exicison?
Whole breast radio
Give a basic overview on how thyroid hormones work
TSH produced in anterior pituitary gland causes thyroid to produce T3 and T4 (T3 is more potent than T4)
Needs iodine to be produced as well as the action of thyroid peroxidase (TPO)
Travels around the blood bound to serum proteins
It causes an increase in BMR (basal metabolic rate)
Broken down by de-iodinase hormones
What lifestyle advice is important to give patients with any form of eye disease?
STOP SMOKING - causes progression of the disease
What kind of rare derm condition do you get in Grave’s?
Pretibial myoxedema
What is your management for hype/hypothyroid?
Hyper (high T3 + T4)
- Carbimazole - agranulocytosis, nausea and rash
- Radioiodine (not for preggers)
- stop antithyroid meds
- worsen eye disease - Surgery - will require levothyroxine for life
Where is a DEXA scan done?
Neck of femur
What is the advice for alendronate acid again?
DAILY tablet take every morning 30 mins before breakfast with big glass of water and don’t lie down for 2 hours after to avoid oeshageal ulcers
Make sure advise on risk of jaw necrosis -> regular dental checkups
Atypical femoral fractures
Take with vitD and calcium
What drug can cause hyperthyroidism?
Amiodarone
Go through what cancers you get with each type of MEN
What types are associated with thyroid cancer? What kind of thyroid cancer?
MEN1 = 3Ps
- Parathyroid
- Pituitary
- Pancreatic
MEN2a = 2Ps
- Parathyroid hyperplasia
- Phaemocromocytoma
MEN2b = 1P
- Phaemocromocytoma
2a + 2b -> medullary thyroid cancer - increase in calcitonin -> decrease in Ca2+
How do you diagnose and manage pheochromocytoma?
- Urine metanephirines
MIBG
MRI scan
Alpha blockade - PHenoxybenzamine
Beta blockade - propranolol
Give an overview of how parathyroid hormone works and what results you would see in different causes of hyperparathyroidism?
PTH is secreted from parathyroid glands found behind the thyroid. It is released in response to low calcium levels.
PTH causes:
- increase in osteoclast activity - increase Ca release from bone
- increased Ca2+ absorption in the kidneys and increased PO4- secretion
- vit D activation -> increase Ca2+ absorption
Primary (most commonly adenoma)
- high Ca2+
- high PTH
Secondary (caused by lack of calcitriol - activated vit D - due to renal problem or reduced levels of vit D)
- low Ca2+
- high PTH
Teritary (caused by years of secondary - PT hyperplasia and PTH now produced independately)
- high Ca2+
- high PTH
What is the relationship between Ca and PO4?
PO4 binds to Ca2+ and makes it unavalible for cells
What is more common parathyroid adenoma or carcinoma?
Carcinoma very rare
What is the MOA of bisphosphonates?
Reduce osteoclast activity
decreases Ca2+ release
Sheenan syndrome vs pituitary apoplexy?
Management of apoplexy?
Sheenan - reduced blood flow to pituitary post birth
Apoplexy - burst pituitary gland
Full hormone profile
- Steroids to replace ACTH
- Levothyroxine
MRI for extra imaging
What tablet can react with levothyroxine?
Iron
- make sure tell patient to take it 2 hrs after levothyroxine
Counsel a patient on levothyroxine
Explain hypothyrodism
- thyroid sits at the base of the neck and produces thyroxine - thyroxine helps keep cells metabolism up without enough of it we get - weight gain, hair loss, low mood, constipation and feeling colder than usual
Levothyroxine tops up levels of thyroxine to help minimise these symptoms
Is a lifelong drug and you must speak to a doctor before changing dose or stopping it
Take the tablet in the morning - 30 mins before breakfast (avoid taking alongside or too close to Fe tablet)
Should reduce symptoms
Need regular monitoring to work out what the correct dose is and once we have that it becomes annual check ups
Too much can cause hyperthyroid, too little causes hypothyroidism - when dose correct very little symptoms
More information on hypothyroidism and levothyroxine can be found in these leaflets or on the patient.info/NHS website
What antibody is found in hypothyroidism?
Anti-TPO
What is osteomalacia?
Softening of the bones due to low Vit D, phosphate and calcium -> bending bone -> diffuse joint and bone pain waddling gait
