Kumar and Clark

Question 1

Where does rotator cuff tendonitis radiate to?

Answer 1

Upper arm

Question 2

When is rotator cuff tendonitis worse?

Answer 2

At night
On abduction and elevation
(painful arc)

Question 3

What may be associated with rotator cuff tendonitis?

Answer 3

Subacromial bursitis

Question 4

When may isolated subacromial bursitis occur?

Answer 4

After direct trauma, falling onto outstretched arm or elbow

calcific tendonitis also causes bursitis

Question 5

Calcific tendonitis and bursitis

Answer 5

Feels hot and swollen

Question 6

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

Answer 6

Diffuse opacity

Question 7

Which muscle may waste in Carpal tunnel syndrome?

Answer 7

Abductor pollucis brevis

Question 8

Nerves roots which make up brachial plexus?

Answer 8

C5, C6, C7, C8, T1

Question 9

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

Answer 9

The rhomboid major and minor

Question 10

Dorsal scapula nerve innervates which muscles?

Answer 10

C3/C4

Innervates the rhomboid major and rhomboid minor

Question 11

Cancers which could cause ectopic ACTH (cushings)

Answer 11

Thymus
Pancreas
Lung

Question 12

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

Answer 12

ACTH if

Pituitary problem = 300

Question 13

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

Answer 13

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

Question 14

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

Answer 14

Pasireotide

Question 15

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

Answer 15

Posterior pituitary

Question 16

Hormone replacement for hypopituitarism: TSH and hydrocortisone dosages?

Answer 16

TSH 100-150 mcg/day

Hydrocortisone: 10-25 mg/day

Question 17

What does growth hormone do?

Answer 17

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

Question 18

Risks of testosterone replacement

Answer 18

Prostate enlargement
Polycythaemia
Hepatitis

Question 19

Causes of cranial diabetes insipidus?

Answer 19

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

Question 20

Treatment of DI

Answer 20

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

Question 21

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

Answer 21

Somatostatin analogue

Question 22

Medication for prolactinoma?

Answer 22

Dopamine antagonist e.g. cabergoline

Question 23

What is a TSHoma?

Answer 23

Pituitary tumour that secretes TSH

Question 24

TSH level in primary hypothyroidism?

Answer 24

Elevated

Question 25

TSH level in secondary hypothyroidism

Answer 25

Decreased or normal

Question 26

Myxoedema

Answer 26

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)

Question 27

Drugs which can cause iodine deficiency?

Answer 27

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

Question 28

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

Answer 28

``` Amiodarone Lithium ASA IFN-alpha Iodides IL-2 ```

Question 29

Cancer which could cause secondary hypothroidism?

Answer 29

Craniopharyngioma

Question 30

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

Answer 30

Hashimotos thyroiditis?

Question 31

What characterises hashimotos thyroiditis?

Answer 31

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

Question 32

Cardiac signs and symptoms of hypothyroidism?

Answer 32

Cardiac dilatation Pericardial effusion Reduced heart rate WORSENING OF HEART FAILURE

Question 33

Hypothyroidism and heart failure?

Answer 33

Worsening of heart failure!!!

Question 34

Hypothyroidism metabolic effects?

Answer 34

Hyperlipidemia Decreased appetite Weight gain

Question 35

Respiratory signs and symptoms of hypothyroidism?

Answer 35

Deep hoarse voice Macroglossia Obstructive sleep apnoea

Question 36

Hypothyroidism and effects on prolactin?

Answer 36

Hyperprolatinaemia because of increased TRH (increases prolactin secretion)

Question 37

Common causes of macrocytosis?

Answer 37

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

Question 38

Hypothyroidism laboratory investigations?

Answer 38

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

Question 39

When would you take T4?

Answer 39

Before breakfast

Question 40

Hyperthyroidism and muscles?

Answer 40

Muscle weakness especially in upper arms and thighs

Question 41

When does subacute thyroiditis usually occur?

Answer 41

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

Question 42

Treatment for opthalmopathy?

Answer 42

``` Decompression Lubricant Radiotherapy Corrective surgery Stop smoking ```

Question 43

Hyperthyroidism - Toxic nodule (adenoma)

Answer 43

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

Question 44

T4 and TSH in subacute thyroiditis?

Answer 44

T4 high then low then normal | TSH low then high then normal

Question 45

Scintigraphy scan and uptake in subacute thyroiditis

Answer 45

Low uptake!

Question 46

Thyroid storm

Answer 46

``` 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

Question 47

Treatment for thyroid storm?

Answer 47

``` Lugols iodine Glucocorticoids Propyluracil Beta blockers Fluids Monitoring ```

Question 48

Which thyroid medication is preferred in pregnancy?

Answer 48

Propythiouracil

Question 49

Which autoimmune diseases are associated with Graves?

Answer 49

``` Primary autoimmune adrenal insufficiency Sjogrens SLE T1DM Vitiligo Myasthenia gravis PERNICIOUS ANEMIA RA ```

Question 50

Main cause of non-goitrous hypothyroidism?

Answer 50

Atrophic thyroiditis

Question 51

Main causes of goitrous thyroiditis?

Answer 51

Hashimotos thyroiditis | Iodine deficiency