Capsule cases with Karim Flashcards
Which neuro condition does not affect lower limbs?
MS
endo 124 case
What is produced by cancers, leading to hypercalcemia of malignancy?
PTHrp (related peptide)
What is the phosphate level in hypercalcemia of malignancy vs primary hypercalcemia
Phosphate rises in hypercalcemia of malignancy, but not in primary hypercalcemia
Why does dehydration worsen hypercalcemia?
Calcium is an osmotic diuretic, so you pee more and dehydrated
That means the kidneys don’t clear the PTHrp, so the calcium shoots up
When do you give bisphosphonates in hypercalcemia?
If you don’t know cause of hypercalcemia, do not give bisphosphonates, give fluids and measure PTH
If you know they have cancer, give bisphosphonates to prevent boney mets, otherwise the bisphosphates with mask the phosphate levels?
Secondary hypertension causes
Hypothyroidism Aortic coarctation Conns Phaeo Apparently lots, look back at DPD?
When do you do plasma electrophoresis?
Myeloma
Renin/aldosterone ratio is used for
Conns
Cushings disease vs syndrome
Disease - pituitary
What is a viscus?
Viscus - any hollow organ with gas in it
What is Plummers?
Toxic multinodular goitre causing hyperthyroidism
What is De Quervains thryoiditis?
Post viral, self resolving hyperthryoidism
Can you give IV fluids in thyroid storm?
Yeah
Why might you give hydrocortisone for someone with thyrotoxic crisis?
Hydrocortisone blocks T4 to T3 conversion
What might you do to check for acromegaly?
Oral glucose tolerance test to check for paradoxical rise in glucose
MRI of pituitary
What test do you do a
Low dose dexamethasone suppression test
How do you identify acromegaly on the face?
Wide nose (cartilage growth) Skin is thick
Treatment for acromegaly
Cabergoline
Ocreotide
steroids if pituitary failure????
What dose do you start with for hyperthryoidism
Start with high dose of PTU / carbimazole then taper down
Which thyroid drug might cause neutropenia
Carbimazole
If you get a rash from carbimazole, what do you do?
Switch to PTU
If you get neutropenia from carbimazole, what do you do?
DO NOT switch to PTU, try surgery or radioiodine
What is carcinoid tumour/ syndrome? Explain why it usually goes unnoticed / when it does get noticed
Neuroendocrine tumour in gut that releases serotonin
This is normally removed by the liver so people die without even knowing they have this tumour
If there are liver mets, it prevents the liver clearing it so it builds up and causes the problems
Name a heart and lung complication from carcinoid tumours
Tricuspid valve damage by serotonin via IVC travel
Pulmonary fibrosis/stenosis
What do you measure to diagnose carcinoid tumour?
5HIAA (serotonin)
Symptoms of carcinoid tumour
Diarrhoea
Hot flushes worsened by alcohol
Chest pain
Wheeze
Facts about carcinoid tumour - where do they arise from? What percentage metastasise? What syndrome can develop?
Derive from argentaffin cells
Arise in appendix and distal ileum - common sites
3% metastasise
Can release ACTH and cause Cushing’s syndrome
50% cardiac involvement?
What do you call it when the carcinoid tumours develop arms and legs to surrounding areas?
Desmoplastic tumours (often in mesentery)
Explain why you get pollagra from carcinoid tumours
Nicotinamide/niacin (vit B3) - precursor to 5HIAA
Carcinoid tumour therefore consumes B3, resulting in deficiency. This causes pollagra.
Symptoms of pollagra
Dermatitis
Diarrhoea
Dementia
