28/1 Flashcards
hyperthyroid
- define
- cause
- age/ sex
- symptoms
- signs
- Ix
- Mx
define
- high thyroid hormone
cause
- grave’s
- toxic multinodular
- solitary nodule
- thyrotoxicosis - de-quervains, drug-induced (anuidaribem excess levothyroxine), post-partum, storm
age/ sex
- toxic multinodular - older women
symptoms
- sweating, menorrhagia, diarrhoea, increased appetite, tremor, heat intolerance, palpitations
- toxic multi - out of control TSH
- solitary nod - firm, painless, mobile on swallow, hot nodules produce hormones
- dequervains - fever, neck pain, malaise, tachycardia
signs
- grave’s - proptosis, thyroid acropachy, pretibial myxoedema, goitre
- storm - excessive sweat, severe tachycardia, confusion
Ix
- thyroid exam
- FBC - microcytic anaemia in menorrhagia
- primary - IN T4, normal TSH
- secondary - IN T4, IN TSH
- anti-TSH-R antibodies
- technitium uptake scan, radioactive scans
- CT/ MRI - orbit
Mx
- carbimazole
- propylthiouracil
- propanolol - symptoms
- dequervain’s - acute phase treatment - steroids and aspirin
- radioactive iodine
- surgery
hypothyroid
- define
- age/ sex
- cause
- symptoms
- signs
- Ix
- Mx
define
- low thyroid levels
cause
- hashimotos
- iodine insuficiency
- secondary - dug-induced (amiodarone, lithium), radioactive iodine, thyroid sx, anti-thyroid meds
symptoms
- fatigue, low mood/ depression, amenorrhoea, constipation, wt gain, hair loss, fluid retention (BRADYCARDIC acronym)
Ix
- thyroid exam
- FBC, ESR, TSH, free T4
- CT neck/ chest
- USS, FNAC
- anti-TPO
- IN CK
Mx
- levothyroxine
gout
- define
- age/ sex
- cause
- symptoms
- signs
- Ix
- Mx
define
- inflammation of synovial joint due to monosaturate urine monohydrate (MSUM) crystals
age/ sex
- male (10:1)
cause
- high purine diet (meat, seafood)
- beer, alcohol
- obesity
- secondary - hypoparathyroidism, hypothyroidism, thiazides, apsirin, TB meds, chemo
- CKD, cardio disease
- FHx
symptoms
- extreme pain, sudden
- worse within 6-24/24H
- worse in early morning/ late eve
- swelling, erythema
- no systemic sx
signs
- 1st MTPJ (wrist, CMCJ, olecranon bursae)
Ix
- joint exam - toe
- NVSc, sensation
- bloods - Hb, serum uric acid (4 weeks later), UE, CRP, ESR, TFT
- joint aspirate - needle shaped crystals, negatively charged crystals
- xray - punched out lesions away from joint line, overhanging edges, lytic lesions
Mx
- lifestyle
- acute - NSAIDs»_space; colchinine if renal/ cvd disease»_space; steroids if ESRF
- chronic - allopurinol and NSAIDs, started together with overlap for 3M
pseudogout
- define
- age/ sex
- cause
- symptoms
- signs
- Ix
- Mx
define
- inflammation of synovial joint by calcium pyrophosphate crystals
age/ sex
- male
symptoms
- same as gout
signs
- same as gout
Ix
- joint exam - toe
- NVSc, sensation
- bloods - Hb, serum uric acid (4 weeks later), UE, CRP, ESR, TFT
- joint aspirate - rod shaped crystals, positively charged crystals
- xray - asymptomatic
tophi
- define
- age/ sex
- cause
- symptoms
- signs
- Ix
- Mx
define
- chronic presentation of inflammation of synovial joints due to crystals
symptoms
- polyarticular
- joint stiffness due to erosions
- renal damge - urate crystal deposition
- ulceration and discharge of tophie
- tophi - ear, elbow, DIPJ
Mx
- same as above
acute calcific peri-arthritis
- define
- age/ sex
- cause
- symptoms
- signs
- Ix
- Mx
define
- hydroxyapatite depositions in periarticular tissues (mm, cartialges)
Mx
- spont in 1-3W
fractures
- colle’s
- smith’s
- galezzi
- monteggia’s
colle’s
- define - FOOSH
- present - dinner fork deformity, dorsal angulation of radius, transverse radial fracture, 1 inch prox to radio-carpal joint
- Mx - good position conservative, manipulated with traction and moulded plaster, scan week 1 and week 2, unstable/ comminuted then ORIF
- comp - median nn trauma, post-traumatic carpal tunnel
smith’s
- fall onto flexed wrist
- present - garden spade deformity, volar angulation of radius
- mx - orif
MUGR - monteggia ulnar, galezzi radius
monteggia’
- proximal ulnar fracture, radial head dislocation
galezzi
- distal radius, dislocation of radio-ulnar J
- radial nn injury, extensor tendon injury
fractures - lower limb
- define
- age/ sex
- cause
- symptoms
- signs
- Ix
- Mx
femoral fracture - Mx
- intracap - Gardener 1/2 - ORIF, gardener 3/4 hemiarthroplasty, young screw
- intertroch - DHS
- subtroch - IMD and hip screw
goitre
- diffuse
- multinodular
- solitary nodule
diffuse
- hashimoto’s, grave’s
- iodine deficiency
- post-puberty
- pregnancy
- dequervains
multi
- eu/hyperthyroid
solitary
- benign adenoma, follicular adenoma
