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Musculoskeletal > Kumar and Clark > Flashcards

Kumar and Clark Flashcards

1
Q

Where does rotator cuff tendonitis radiate to?

A

Upper arm

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2
Q

When is rotator cuff tendonitis worse?

A

At night
On abduction and elevation
(painful arc)

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3
Q

What may be associated with rotator cuff tendonitis?

A

Subacromial bursitis

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4
Q

When may isolated subacromial bursitis occur?

A

After direct trauma, falling onto outstretched arm or elbow

calcific tendonitis also causes bursitis

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5
Q

Calcific tendonitis and bursitis

A

Feels hot and swollen

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6
Q

Calcific tendonitis and bursitis: what does the bursitis look like on x-ray?

A

Diffuse opacity

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7
Q

Which muscle may waste in Carpal tunnel syndrome?

A

Abductor pollucis brevis

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8
Q

Nerves roots which make up brachial plexus?

A

C5, C6, C7, C8, T1

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9
Q

Which muscles keeps the scapula against the thoracic wall and retract the scapula?

A

The rhomboid major and minor

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10
Q

Dorsal scapula nerve innervates which muscles?

A

C3/C4

Innervates the rhomboid major and rhomboid minor

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11
Q

Cancers which could cause ectopic ACTH (cushings)

A

Thymus
Pancreas
Lung

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12
Q

Differentiating between pituitary, adrenal and ectopic cause of cushings? (ACTH)

A

ACTH if

Pituitary problem = 300

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13
Q

High dose dexamethasone suppression test will confirm which problem as the cause of cushings?

A

High dose dexamethasone will show if the problem is pituitary (if it is pituitary problem then high dose dexamethasone will suppress by 50%)

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14
Q

Name a somatostatin analogue that could be used in the treatment of cushings?

A

Pasireotide

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15
Q

Problems with which part of the pituitary could cause diabetes insipidus?

A

Posterior pituitary

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16
Q

Hormone replacement for hypopituitarism: TSH and hydrocortisone dosages?

A

TSH 100-150 mcg/day

Hydrocortisone: 10-25 mg/day

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17
Q

What does growth hormone do?

A 
Improves quality of life
Decreases abdominal obesity
Increases muscle mass, stamina and exercise tolerance
Decreases LDL, increases HDL
Increases bone density
Improves cardiac function
Given by daily SC injection
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18
Q

Risks of testosterone replacement

A

Prostate enlargement
Polycythaemia
Hepatitis

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19
Q

Causes of cranial diabetes insipidus?

A

Familial
Acquired (e.g. trauma)
Rare (tumour, sarcoid, irradiation, meningitis)

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20
Q

Treatment of DI

A 
Desmospray
nasally; 10- 60 mcg/day
Desmopressin oral tablets
100-1000mcg per day
Desmopressin sublingual tablets
	- 60 – 360 mcg per day
Desmopressin injection
1-2mcg IM per day
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21
Q

What kind of medication could you use to shrink a GH tumour before surgery?

A

Somatostatin analogue

22
Q

Medication for prolactinoma?

A

Dopamine antagonist e.g. cabergoline

23
Q

What is a TSHoma?

A

Pituitary tumour that secretes TSH

24
Q

TSH level in primary hypothyroidism?

A

Elevated

25
Q

TSH level in secondary hypothyroidism

A

Decreased or normal

26
Q

Myxoedema

A

Myxoedema - THIS IS CONFUSING!

  - Either refers to severe hypothyroidism e.g. Myxoedema coma
  - OR to accumulation of hydrophilic mucopolysaccharides  in the ground substance of the dermis and other tissues → doughy induration of the skin classical seen in the shins = PRETIBIAL MYXOEDEMA.  This is seen in GRAVES disease (i.e. thyrotoxicosis)
27
Q

Drugs which can cause iodine deficiency?

A

amiodarone, lithium, IL-2, IFN-α, iodides, aminosalicylic acid, aminoglutethimide, pheylbutazone, thalidomide, stavudine, bexarotene

28
Q

Drugs I have heard of, that could cause iodine deficiency (–>hypothyroidism)

A 
Amiodarone
Lithium
ASA
IFN-alpha
Iodides
IL-2
29
Q

Cancer which could cause secondary hypothroidism?

A

Craniopharyngioma

30
Q

Characterized by
Presence of Thyroid Peroxidase Antibodies (in blood)
T-cell infiltrate and inflammation on microscopy

A

Hashimotos thyroiditis?

31
Q

What characterises hashimotos thyroiditis?

A

Presence of Thyroid Peroxidase Antibodies (in blood)

T-cell infiltrate and inflammation on microscopy

32
Q

Cardiac signs and symptoms of hypothyroidism?

A

Cardiac dilatation
Pericardial effusion
Reduced heart rate
WORSENING OF HEART FAILURE

33
Q

Hypothyroidism and heart failure?

A

Worsening of heart failure!!!

34
Q

Hypothyroidism metabolic effects?

A

Hyperlipidemia
Decreased appetite
Weight gain

35
Q

Respiratory signs and symptoms of hypothyroidism?

A

Deep hoarse voice
Macroglossia
Obstructive sleep apnoea

36
Q

Hypothyroidism and effects on prolactin?

A

Hyperprolatinaemia because of increased TRH (increases prolactin secretion)

37
Q

Common causes of macrocytosis?

A

Vitamin B-12 deficiency
Folate deficiency
Liver disease
Alcoholism
Hypothyroidism
A side effect of certain medications, such as those used to treat cancer, seizures and autoimmune disorders
Increased red blood cell production by the bone marrow (regeneration) to correct anemia, for example, after blood loss

38
Q

Hypothyroidism laboratory investigations?

A 
High TSH, low T3/T4
Macrocytic anemia (this is typical, check no underlying vitamin B12 deficiency)
Elevated creatinine kinase
Elevated LDL, cholesterol
Hyponatremia
Hyperprolactinemia
39
Q

When would you take T4?

A

Before breakfast

40
Q

Hyperthyroidism and muscles?

A

Muscle weakness especially in upper arms and thighs

41
Q

When does subacute thyroiditis usually occur?

A

Usually after an upper respiratory infection e.g. mumps, influenza, common cold

42
Q

Treatment for opthalmopathy?

A 
Decompression
Lubricant
Radiotherapy
Corrective surgery
Stop smoking
43
Q

Hyperthyroidism - Toxic nodule (adenoma)

A 
More insidious onset
Usually older patients
May feel nodular
Antibody negative
Assymetric goitre (e.g. on uptake scan!!)
44
Q

T4 and TSH in subacute thyroiditis?

A

T4 high then low then normal

TSH low then high then normal

45
Q

Scintigraphy scan and uptake in subacute thyroiditis

A

Low uptake!

46
Q

Thyroid storm

A 
Medical Emergency    A,B,C
Severe Hyperthyroidism
Respiratory and Cardiac Collapse
Hyperthermia
Exaggerated reflexes
May require Ventilation
May be associated underlying  infection

Tx: Lugols Iodine, glucocorticoids, PTU, B-blockers, fluids, monitoring

47
Q

Treatment for thyroid storm?

A 
Lugols iodine
Glucocorticoids
Propyluracil
Beta blockers
Fluids
Monitoring
48
Q

Which thyroid medication is preferred in pregnancy?

A

Propythiouracil

49
Q

Which autoimmune diseases are associated with Graves?

A 
Primary autoimmune adrenal insufficiency
Sjogrens
SLE
T1DM
Vitiligo
Myasthenia gravis
PERNICIOUS ANEMIA
RA
50
Q

Main cause of non-goitrous hypothyroidism?

A

Atrophic thyroiditis

51
Q

Main causes of goitrous thyroiditis?

A

Hashimotos thyroiditis

Iodine deficiency

Musculoskeletal (44 decks)

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