Consultation Flashcards
Acromegaly investigations
Baseline insulting like growth factor will be raised
Glucose tolerance test - failure or suppression of growth hormone
MRI - pituitary views
Which systems are affected in acromegaly?
Cardiac - cardiomyopathy, IHD
HTN
T2DM
Visual impairment
Carpal tunnel
Visual impairment in acromegaly
Bitemporal hemianopia
Compression of the adenoma on the optic chiasm
Treatment for acromegaly
Surgery which is transphenoidal and aims to be curative
Medical therapy is somatostatin analogis i.e. octreotide and second line agents is bromocriptine
Radiotherapy to pituitary
Risk of surgery for acromegaly
Risk of panhypopituitarism
Scoring system for OSA
Epworth
STOP bang questionnaire
Osteogenesis imperfecta inheritance
8 types
Most commonly dominant
Spontaneous is more severe
Ehlers Danlos heart murmur
MV prolapse or MR
For investigating lymphoma is a biopsy of a lymph node or FNA more appropriate
For lymphoma you need histology so biopsy needed as FNA does not provide enough information (FNA fine for cytology only)
Cholesterol target for stroke
Fasting LDL <1.8
Or 2.5 if non fasting
Treatment for anti phospholipid
Warfarin over doac
Differentials for the appearance of retinitis pigmentosa
Diabetic retinopathy
Laser treatment scars
Toxoplasmosis
Rubella
Inheritance of R pigmentosa
30% de novo
Can be dominant recessive or x linked
Why does R pigmentosa happen and how does it affect vision
Build up of pigment
Night time vision first affected then they get tunnel vision
What type of arthritis does gonococcal usually cause?
Septic arthritis
Reactive arthritis genetics
Associated with HLA B27 gene
Seronegative spondyloarthopathies
Reactive arthritis
Psoriatic arthritis
Enteric arthritis
Ank spond
Jaccouds arthropathy
Looks like RA hands ulnar deviation but is in SLE
Sarcoid stages
Stage zero normal chest x-ray
Stage one hilar lymphadenopathy
Stage two HL + pulmonary infiltrates
Stage three infiltrate only
Stage four pulmonary fibrosis
Inheritance of spherocytosis
Dominant
Rheumatoid extra articular features
Eyes; scleritis, scleromalacia, sicca
Lungs; fibrosis, nodules
Kidneys; nephrotic syndrome (GN)
Heart; constrictive pericarditis, effusion
Nerves; peripheral neuropathy, carpal tunnel from subluxation
Splenomegaly, neutropenia - feltys
XR findings RA
Soft tissue swelling
Subluxation
Loss of joint space
Periarticular osteopenia
Erosions
RA HLA
DR4
Treatments for Parkinson’s
Physio
OT
Mood
Levodopa and peripheral decarboxylase inhibitors, dopamine agonists
Hashimotos antibodies
Anti tpo and anti thyroglobulin
Hashimotos what is it
Most common cause of hypothyroidism
Autoimmune inflammation and goitre then thyroid gland atrophies
Meds causes of hypothyroidism
Lithium
Amiodarone (can also cause hyper)
Radio isotope scanning in Graves versus thyroiditis
Increased uptake in graves disease.
Reduced in thyroiditis
Treatment option if thyrotoxicosis returns
Radio iodine, but hypothyroidism is common afterwards
Subtotal thyroidectomy
Causes of hypoadrenalism
Autoimmune adrenalitis
TB or sarcoid
Amyloidosis
Haemochromatosis
metastatic infiltration
Congenital adrenal hyperplasia
Secondary is anterior pituitary failure
Investigations for Cushing’s syndrome
Overnight dexamethasone suppression test: give 1 mg of dexamethasone at midnight and check 9 am cortisol
If positive i.e. cortisol level above 50 then proceeded to identify the cause of Cushing syndrome with plasma ACTH level and high dose dexamethasone suppression test.
Give 2 mg dexamethasone six hourly for 48 hours and measure the cortisol which should fall by more than 50% in pituitary Cushing’s but not adrenal or ectopic
Gynaecomastia plus infertility plus tall man equals
Klinefelter’s syndrome
Need to confirm primary gonadal failure, i.e. high LH and FSH with low testosterone
Pupils in compressive third nerve palsy versus Horners
Dilated pupil and third nerve palsy.
Constricted pupil in Horners
Vitamin C surgical sieve
Vascular
Infection
Trauma
Autoimmune
Metabolic
Idiopathic or iatrogenic
Neoplastic
Congenital
Degenerative
Endocrine
