Corrections Flashcards
How can spider naevi be differentiated from telangiectasia?
By pressing on them and watching them fill.
Spider naevi –> fill from centre
Telangiectasia –> fill from edge
What 4 paraneoplastic features are associated with squanous cell lung cancer?
1) PTH-rp secretion causing hypercalcaemia
2) clubbing
3) hypertrophic pulmonary osteoarthropathy (HPOA)
4) hypertrophic pulmonary osteoarthropathy (HPOA)
What 4 paraneoplastic features are associated with small cell lung cancer?
1) SIADH
2) ACTH
3) Lambert-Eaton syndrome
What type of pneumonia can cause a pleural empyema?
Klebsiella
What GI symptoms can be seen in Addison’s?
Diarrhoea & nausea
Name 2 corticosteroids that has very high glucocorticoid activity but minimal mineralocorticoid activity
Dexamethasone
Betamethasone
What is the treatment of choice in a toxic multinodular goitre?
Radioactive iodine
Gonadotrophin & testosterone levels in Klinefelter’s?
elevated gonadotrophin levels but low testosterone
Most common cause of acromegaly?
Excess GH 2ary to pituitary adenoma
Features of acromegaly?
1) coarse facial appearance, spade-like hands, increase in shoe size
2) large tongue, prognathism, interdental spaces
3) excessive sweating and oily skin: caused by sweat gland hypertrophy
4) features of pituitary tumour: hypopituitarism, headaches, bitemporal hemianopia
5) raised prolactin in 1/3 of cases → galactorrhoea
6) 6% of patients have MEN-1
Complications of acromegaly?
1) HTN
2) diabetes
3) cardiomyopathy
4) colorectal cancer
What is the purpose of checking TPO antibodies in patients who have subclinical hypothyroidism?
This can indicate patients who are more likely to progress to overt hypothyroidism.
In TNM, what does a nuclear scintigraphy reveal?
Patchy uptake
Features of Klinefelter’s?
- often taller than average
- lack of secondary sexual characteristics
- small, firm testes
- infertile
- gynaecomastia - increased incidence of breast cancer
- elevated gonadotrophin levels but low testosterone
Karyotype of Klinefelter’s?
47, XXY
In the mx of DKA, how much should treatment aim to reduce blood ketones by & glucose by/hour?
Ketones –> around 1mmol/hr
Glucose –> around 3mmol/hr.
Kallman’s vs Klinefelter’s?
Kallmans –> hypogonadotrophic hypogonadism
Klinefelter’s –> hypergonadotrophic hypogonadism
What mx of Grave’s disease may lead to the development / worsening of thyroid eye disease?
Radioiodine treatment
What is a normal rise in urine osmolality following water deprivation test?
Urine osmolality >600mOsm/kg excludes diabetes insipidus.
Urine osmolality <400mOsm/kg and raised serum osmolality indicates an inability to concentrate urine & indicates diabetes insipidus.
1st line mx of a prolactinoma (micro & macro)?
Dopamine agonist e.g. cabergoline
Glucose gel vs tablets in hypoglycaemia?
Glucose tablets > gel if patient alert enough to chew and swallow.
1st line mx of hypoglycaemia in those with reduced consciousness?
75ml of 20% glucose infusion by IV injection (if no venous access then consider IM glucagon)
Clinical features of an adrenal crisis?
- weight loss
- lethargy
- shock
- collapse
- reduced consciousness
- hypotension
- hypoglycaemia
- hyponatraemia
- hyperkalaemia
Mx of an adrenal crisis?
1) ABCDE
2) IM or IV hydrocortisone
3) IV fluids
4) Correct hypoglycaemia e.g. IV dextrose
5) Careful monitoring of electrolytes and fluid balance
