Kumar and Clark Flashcards
Where does rotator cuff tendonitis radiate to?
Upper arm
When is rotator cuff tendonitis worse?
At night
On abduction and elevation
(painful arc)
What may be associated with rotator cuff tendonitis?
Subacromial bursitis
When may isolated subacromial bursitis occur?
After direct trauma, falling onto outstretched arm or elbow
calcific tendonitis also causes bursitis
Calcific tendonitis and bursitis
Feels hot and swollen
Calcific tendonitis and bursitis: what does the bursitis look like on x-ray?
Diffuse opacity
Which muscle may waste in Carpal tunnel syndrome?
Abductor pollucis brevis
Nerves roots which make up brachial plexus?
C5, C6, C7, C8, T1
Which muscles keeps the scapula against the thoracic wall and retract the scapula?
The rhomboid major and minor
Dorsal scapula nerve innervates which muscles?
C3/C4
Innervates the rhomboid major and rhomboid minor
Cancers which could cause ectopic ACTH (cushings)
Thymus
Pancreas
Lung
Differentiating between pituitary, adrenal and ectopic cause of cushings? (ACTH)
ACTH if
Pituitary problem = 300
High dose dexamethasone suppression test will confirm which problem as the cause of cushings?
High dose dexamethasone will show if the problem is pituitary (if it is pituitary problem then high dose dexamethasone will suppress by 50%)
Name a somatostatin analogue that could be used in the treatment of cushings?
Pasireotide
Problems with which part of the pituitary could cause diabetes insipidus?
Posterior pituitary
Hormone replacement for hypopituitarism: TSH and hydrocortisone dosages?
TSH 100-150 mcg/day
Hydrocortisone: 10-25 mg/day
What does growth hormone do?
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
Risks of testosterone replacement
Prostate enlargement
Polycythaemia
Hepatitis
Causes of cranial diabetes insipidus?
Familial
Acquired (e.g. trauma)
Rare (tumour, sarcoid, irradiation, meningitis)
Treatment of DI
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
What kind of medication could you use to shrink a GH tumour before surgery?
Somatostatin analogue
Medication for prolactinoma?
Dopamine antagonist e.g. cabergoline
What is a TSHoma?
Pituitary tumour that secretes TSH
TSH level in primary hypothyroidism?
Elevated
TSH level in secondary hypothyroidism
Decreased or normal
Myxoedema
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)
Drugs which can cause iodine deficiency?
amiodarone, lithium, IL-2, IFN-α, iodides, aminosalicylic acid, aminoglutethimide, pheylbutazone, thalidomide, stavudine, bexarotene
Drugs I have heard of, that could cause iodine deficiency (–>hypothyroidism)
Amiodarone Lithium ASA IFN-alpha Iodides IL-2
Cancer which could cause secondary hypothroidism?
Craniopharyngioma
Characterized by
Presence of Thyroid Peroxidase Antibodies (in blood)
T-cell infiltrate and inflammation on microscopy
Hashimotos thyroiditis?
What characterises hashimotos thyroiditis?
Presence of Thyroid Peroxidase Antibodies (in blood)
T-cell infiltrate and inflammation on microscopy
Cardiac signs and symptoms of hypothyroidism?
Cardiac dilatation
Pericardial effusion
Reduced heart rate
WORSENING OF HEART FAILURE
Hypothyroidism and heart failure?
Worsening of heart failure!!!
Hypothyroidism metabolic effects?
Hyperlipidemia
Decreased appetite
Weight gain
Respiratory signs and symptoms of hypothyroidism?
Deep hoarse voice
Macroglossia
Obstructive sleep apnoea
Hypothyroidism and effects on prolactin?
Hyperprolatinaemia because of increased TRH (increases prolactin secretion)
Common causes of macrocytosis?
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
Hypothyroidism laboratory investigations?
High TSH, low T3/T4 Macrocytic anemia (this is typical, check no underlying vitamin B12 deficiency) Elevated creatinine kinase Elevated LDL, cholesterol Hyponatremia Hyperprolactinemia
When would you take T4?
Before breakfast
Hyperthyroidism and muscles?
Muscle weakness especially in upper arms and thighs
When does subacute thyroiditis usually occur?
Usually after an upper respiratory infection e.g. mumps, influenza, common cold
Treatment for opthalmopathy?
Decompression Lubricant Radiotherapy Corrective surgery Stop smoking
Hyperthyroidism - Toxic nodule (adenoma)
More insidious onset Usually older patients May feel nodular Antibody negative Assymetric goitre (e.g. on uptake scan!!)
T4 and TSH in subacute thyroiditis?
T4 high then low then normal
TSH low then high then normal
Scintigraphy scan and uptake in subacute thyroiditis
Low uptake!
Thyroid storm
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
Treatment for thyroid storm?
Lugols iodine Glucocorticoids Propyluracil Beta blockers Fluids Monitoring
Which thyroid medication is preferred in pregnancy?
Propythiouracil
Which autoimmune diseases are associated with Graves?
Primary autoimmune adrenal insufficiency Sjogrens SLE T1DM Vitiligo Myasthenia gravis PERNICIOUS ANEMIA RA
Main cause of non-goitrous hypothyroidism?
Atrophic thyroiditis
Main causes of goitrous thyroiditis?
Hashimotos thyroiditis
Iodine deficiency
