Medicine III Flashcards
management of cushings disease
Surgery
- Adrenal tumour will need a laprascopic adrenalectomy
- If cushings disease e.g. pit tumour-→ transsphenoidal removal of adenoma indicated
Medical treatment
- metyrapone and ketoconazole
A 38-year-old woman is reviewed in the Endocrinology clinic, having been referred by her GP for refractory hypertension. Her ambulatory blood pressure readings have consistently been over 170/95 mmHg, in spite of gradual uptitration of amlodipine, enalapril and indapamide. She has no significant past medical history or family history, and examination of the chest and abdomen is normal.
Her blood test results are shown below:
Na+144 mmol/L(135 - 145)K+3.1 mmol/L(3.5 - 5.0)Bicarbonate32 mmol/L(22 - 29)Urea5.4 mmol/L(2.0 - 7.0)Creatinine75 µmol/L(55 - 120)
Which of the following is the most likely underlying cause of her hypertension?
Bilateral idiopathic adrenal hyperplasia is the most common cause of primary hyperaldosteronism
Conns - Aldosterone-producing adenomas accounts for ⅓
A 47-year-old woman is admitted to the emergency department with a left upper lobe pneumonia. She has a routine set of bloods taken for a review of systems which show the following:
what is the caused of deranged thyroid tests
In the context of an acute illness, a normal TSH and low T3 and T4 levels are diagnostic of sick euthyroid syndrome.
The TSH would be raised if the cause was De Quervain’s or Hashimoto’s thyroiditis as the fall in thyroid hormone levels in both these conditions occurs slowly over time.
A 55-year-old man presents for his diabetes check-up. He is currently taking metformin 1g twice daily.
His HbA1c on review is 61mmol/mol.
His BMI is 36 kg/m² and he requests that any new medications started will not cause him any further weight gain.
What medication should be avoided?
glicazide
→ inhibit ATP-sensitive K-channels in the beta-cell plasma membrane → in insulin release.
difference between Osteoporosis, Osteopenia and Osteomalacia?
Osteoporosis is defined as a T score of Osteopenia is -1
Osteomalacia is poor mineralisation of the bone, vitamin D deficiency is often the cause
diagnose
This patient has subclinical hypothyroidism (very mildly raised TSH but normal T3 and T4)
if no symptoms- watch and wait
You are conducting the annual review of a 44-year-old woman who has type 1 diabetes mellitus. You want to assess for diabetic neuropathy affecting the feet.
What is the most appropriate screening test to use?
A 10 g monofilament should be used to assess for diabetic neuropathy in the feet
2 ways of calculating HR
n. of R waves x 6
or
300/ number of big square between R-R
What is the most common cause of left axis deviation?
Left axis deviation is rarely the result of left ventricular hypertrophy and more often due to defects in the conduction system of the heart.
A patient is noted to have an abnormally shortened PR-interval on their ECG. Which of the following is the most likely cause?
WPW
A short PR-interval indicates abnormally short conduction time between the atria and ventricles. This is typically caused by the presence of an accessory pathway between the atria and ventricles. WPW syndrome is an example of this kind of disorder. In WPW syndrome, an accessory pathway known as the bundle of Kent is present. Most individuals are asymptomatic, however, there is a risk of sudden death without treatment.
Which of the following is a common cause of right axis deviation?
In right ventricular hypertrophy, the increased muscle mass of the right ventricle causes an increased signal on the ECG. As a result, the axis of the heart is shifted to the right with lead III becoming more positive and lead I and II becoming less positive.
What is the normal duration of a QRS complex?
0.12s or 120ms
What is the normal duration of a QRS complex?
0.12s or 120ms
What is the duration of a normal PR-interval?
0.12-0.2s
or 120-200ms
A 68-year-old woman presents to the two-week wait clinic with a three-month history of a dry cough, shortness of breath, weight loss, fatigue, and painful wrist swelling. There is no past medical history or family history of note and she has never smoked.
On examination, she is cachexic and has finger clubbing. Her chest X-ray reveals a peripherally located nodule with minimal pleural involvement.
Which of the following is the most likely diagnosis?
lung adenocarcinoma- found more peripherally
- associated with non smokers
- clubbing
- Hypertrophic pulmonary osteoarthropathy
A 62-year old female presents with a 1-hour history of central crushing chest pain. She is an ex-smoker with a 20-year pack history. She has no significant past medical history. Her ECG is shown below:
Her admission and 1hr troponin are found to be raised.
Which of the following accurately describes the pathology underlying her ECG?
incomplete blockage by a thrombus in one of the main coronary arteries- NSTEMI
A 63-year-old gentleman, a current heavy smoker with hypertension and hyperlipidaemia, is diagnosed as having stable angina. He is currently still symptomatic on his current treatment regime. The Cardiologist at the local hospital decides to start him on both a beta-blocker and calcium-channel blocker simultaneously, together with a glyceryl trinitrate spray when required.
Which of the following is the single best beta-blocker and calcium-channel combinations for this gentleman?
REMEMBER THIS
dihydropyridine vs nondihydropyridine CCB
