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Internal Medicine > OHCEPS - The Endocrine System > Flashcards

OHCEPS - The Endocrine System Flashcards

1
Q

Lethargy or fatigue may be a symptom of what?

A
  1. Undiagnosed DM
  2. Cushing’s
  3. Hypoadrenalism
  4. Hypothyroidism
  5. Hypercalcemia
    ALSO consider:
  6. Depression
  7. Chronic disease of any other kind (e.g., anemia, chronic liver and renal problems, chronic infection, and malignancy).
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2
Q

Constipation is a common feature of what?

A

Hypercalcemia + Hypothyroidism.

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3
Q

Diarrhea is a symptom of what?

A

Hyperthyroidism + Addison’s

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4
Q

Urinary frequency and polyuria may be a result of what?

A
  1. DM
  2. Diabetes insipidus
  3. Hyperglycemia by Cushing’s –> can give polyuria.
  4. Hypercalcemia –> may also give polyuria
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5
Q

Thirst and polydipsia?

A
  1. DM
  2. Diabetes insipidus
  3. Hypercalcemia
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6
Q

Sweating may be seen in what?

A
  1. Episodes of hypoglycemia
  2. Hyperthyroidism
  3. Acromegaly
  4. Pheochromocytoma
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7
Q

Vitiligo is associated with what?

A
  1. Hypo/Hyperthyroidism
  2. Addison’s
  3. Hashimoto
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8
Q

Incr. pigmentation is seen in what?

A

Addison/Cushing

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9
Q

Decr. pigmentation is seen in what?

A

Hypopituitarism, if generalized.

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10
Q

Hirsutism may be a sign of what?

A
  1. PCOS
  2. Cushing
  3. Congenital adrenal hyperplasia
  4. Acromegaly
  5. Virilizing tumors
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11
Q

Loss of axillary + pubic hair in both sexes may be a sign of what?

A
  1. Hypogonadism

2. Adrenal insufficiency –> DOWN androgen production

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12
Q

Skin and soft tissue changes seen in hypothyroidism?

A
  1. Dry, coarse, pale skin with xanthelasma formation.

2. Classically, loss of the outer 1/3 of the eyebrows.

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13
Q

Skin and soft tissue changes in hyperthyroidism?

A
  1. Thyroid achropachy (only Graves) –> Finger clubbing + new bone formation at the fingers.
  2. Also pretibial myxedema - reddened edematous lesions on the shins (often the lateral aspects).
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14
Q

Skin and soft tissue changes in hypoparathyroidism?

A

Generally, dry, scaly skin.

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15
Q

Skin and soft tissue changes in DM?

A
  1. Xanthelasma
  2. Ulceration
  3. Repeated skin infections
  4. Necrobiosis lipoidica diabeticorum - shin, yellowed lesions on the shins.
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16
Q

Skin and soft tissue changes in acromegaly?

A
  1. Soft tissue overgrowth with skin tags at axillae and anus.
  2. “Doughy” hands and fingers
  3. Acanthosis nigricans - Velvety black skin changes at the axilla
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17
Q

Where else may acanthosis nigricans be seen?

A
  1. Cushing
  2. PCOS
  3. Insulin resistance
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18
Q

What do pituitary tumors classically cause?

A

Bitemporal hemianopia by impinging on the optic chiasm.

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19
Q

Short stature may be caused by what?

A
  1. Hypopituitarism
  2. Hypothyroidism
  3. GH deficiency
  4. Steroid excess
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20
Q

Tall stature may be a sign of what?

A
  1. GH excess

2. Gonadotrophin deficiency

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21
Q

Mention 3 non-endocrine causes of erectile dysfunction.

A
  1. Alcoholism
  2. Spinal cord disease
  3. Psychological illness
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22
Q

Flushing may be a symptom of what?

A
  1. Carcinoid

2. Menopause

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23
Q

What should be asked about flushing?

A
  1. Any aggravating/relieving factors.

2. Other symptoms: palpitations, diarrhea, dizziness.

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24
Q

During history-taking, what should be especially asked during the DHx?

A
  1. OTC medicines
  2. Hormonal treatments - OCPs, local or systemic steroids.
  3. Amiodarone
  4. Lithium
  5. Herbal or other remedies
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25
Q

What should be asked during the PMH?

A
  1. Previous thyroid/parathyroid surgery.
  2. Previous radio-iodine or antithyroid drugs.
  3. Gestational diabetes
  4. HTN
  5. Previous pituitary or adrenal surgery.
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26
Q

What should be specifically asked during the FHx?

A
  1. Type II DM
  2. Related autoimmunes –> Pernicious anemia, celiac disease, vitiligo, Addison, thyroid disease, type I DM.
  3. Many patients will only have heard of these if they have a family member who suffers from them.
  4. Congenital adrenal hyperplasia
  5. MEN
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27
Q

Incr. appetite + Decr. weight is a sign of?

A
  1. Thyrotoxicosis

2. Uncontrolled DM

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28
Q

Incr. appetite + Incr. weight is a sign of?

A
  1. Cushing
  2. Hypoglycemia
  3. Hypothalamic disease
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29
Q

Decr. appetite + Decr. weight is a sign of?

A
  1. GI disease
  2. Malignancy
  3. Anorexia
  4. Addison
  5. DM
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30
Q

Decr. appetite + Incr. weight is a sign of?

A

Hypothyroidism

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31
Q

Mention some questions that should be asked during the diabetic history.

A
  1. When was it first diagnosed?
  2. How was it first diagnosed?
  3. How was it first managed?
  4. How is it managed now?
  5. If on insulin - when was that first started?
  6. Are they compliant with a diabetic diet?
  7. Are they compliant with their diabetic medication?
  8. How often do they check their blood sugar?
  9. What readings do they normally get?
  10. What is their latest HbA1C (many will know this)?
  11. Have they ever been admitted to hospital with DKA?
  12. Do they go to a podiatrist or chiropodist?
  13. Have they experienced problems with their feet?
  14. Do they attend a retinal screening program?
  15. Have they needed to be referred to an ophthalmologist?
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32
Q

What should be asked in the newly diagnosed diabetic?

A

Ask about history of weight loss (will differentiate between type I and II).

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33
Q

What is the inheritance pattern in MEN?

A

AD

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34
Q

What are the features of MEN1?

A

The 3”Ps”

  1. Parathyroid hyperplasia (100%)
  2. Pancreatic endocrine tumors (40-70%)
  3. Pituitary adenomas (30-50%)
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35
Q

What are the features of MEN2?

A
  1. Medullary cell thyroid carcinoma (100%)
  2. Pheochromocytoma (50%)
  3. MEN2a –> Parathyroid hyperplasia (80%)
  4. MEN2b –> Mucosal and bowel neuromas - Marfanoid habitus.
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36
Q

What should be examined in the hands/skin regarding the endocrine system?

A
  1. Size
  2. Subcutaneous tissue
  3. Length of the metacarpals
  4. Nails
  5. Palmar erythema
  6. Sweating
  7. Tremor
  8. Thickness –> Thin in Cushing, Thick in acromegaly
  9. Signs of easy bruising.
  10. Pulse + BP - Lying and standing.
  11. Proximal muscle weakness.
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37
Q

What should be examined in the axillae?

A
  1. Skin tags
  2. Loss of hair
  3. Abnormal pigmentation
  4. Acanthosis nigricans
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38
Q

What should be looked during examination of the face and mouth?

A
  1. Hirsutism
  2. Acne
  3. Plethora or skin greasiness
  4. Look soft tissues for prominent glabellas (above the eyes)
  5. Enlargement of chin (macrognathism)
  6. In the mouth –> Look at the spacing of teeth, and if any have fallen out.
  7. Buccal pigmentation + tongue enlargement (macroglossia).
  8. Normally the upper teeth close in front of the lower set - reversal is termed “prognathism”.
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39
Q

What should be looked for in the neck?

A
  1. Note any swellings or lymphadenopathy
  2. Examine thyroid
  3. Palpate the supraclavicular regions
  4. Note excessive soft tissue
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40
Q

What should be examined in the chest?

A
  1. Any hair excess or loss
  2. Breast size in females
  3. Gynecomastia in men
  4. Nipple color/pigmentation/galactorrhoea
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41
Q

What should be examined in the abdomen?

A
  1. Central adiposity/obesity
  2. Purple striae
  3. Hirsutism
  4. Palpate for organomegaly
  5. Look external genitalia to exclude any testicular atrophy in males or virilization (e.g., clitoromegaly) in women.
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42
Q

What should be examined in the legs?

A

Test for proximal muscle weakness - make note of any diabetes-related changes.

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43
Q

What is the Trousseau’s sign?

A
  1. Inflate a blood pressure cuff above the systolic pressure for 3 minutes.
  2. When HYPOCALCEMIA has caused muscular irritability, the hand will develop flexor spasm.
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44
Q

What is the Chvostek’s sign?

A
  1. Gently tap over the facial nerve (in front of the tragus of the ear).
  2. The sign is positive if there is a contraction of the lip + facial muscles on the same side.
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45
Q

What are the 2 signs of tetany?

A
  1. Trousseau

2. Chvostek

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46
Q

What should be the position of the patient during thyroid examination?

A

The patient should be sitting upright on a chair or the edge of a bed.

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47
Q

What does inspection of the thyroid gland involve?

A
  1. Look at the thyroid region.
  2. If the gland is quit enlarged (goitre) –> may notice it protruding as a swelling just below the thyroid cartilage.
  3. Normal thyroid gland is usually neither visible nor palpable.
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48
Q

What is the location of thyroid gland?

A

Lies 2-3cm below the thyroid cartilage and has 2 equal lobes connected by a narrow isthmus.

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49
Q

What should be asked if the a localized or generalized swelling is visible on the thyroid?

A

Ask the patient to take a mouthful of water then shallow - watch the neck swelling carefully.
ALSO, ask the patient to protrude their tongue and watch the neck swelling.

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50
Q

Will enlarged lymph nodes move during shallowing?

A

NO - Hardly move.

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51
Q

Will thyroglossal cysts move with shallowing?

A

Yes - will move upwards with protrusion of the tongue.

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52
Q

What should be examined regarding the rest of the neck?

A
  1. Carefully inspect the neck for any obvious scars - thyroidectomy scars are often hidden below a necklace and are easily missed.
  2. Look for the JVP and make note of dilated veins which may indicate retrosternal extension of a goitre.
  3. Redness or erythema –> suppurative thyroiditis.
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53
Q

Palpation of the thyroid should be done from behind?

A

YES - Stand behind the patient and place a hand either side of their neck.
Patient’s neck should be slightly flexed to relax the sternomastoids.

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54
Q

What are the steps during thyroid examination?

A
  1. Ask if there is any tenderness.
  2. Place the 3 middle fingers of either hand along the midline of the neck, just below the chin.
  3. Gently “walk” your fingers down until you reach the thyroid gland.
  4. If enlarged - determine if symmetrical.
  5. Are there any discrete nodules?
  6. Assess size, shape, mobility of any swelling.
  7. Repeat examination while the patient shallows.
  8. Ask them to hold a small amount of water in their mouth - then ask them to shallow once your hands are in position.
  9. Consider consistency of any palpable thyroid tissue.
  10. Feel for a palpable thrill which may be present in metabolically active thyrotoxicosis.
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55
Q

What may be the consistency of thyroid gland?

A
  1. Soft - normal.
  2. Firm - simple goitre.
  3. Rubbery hard - Hashimoto’s
  4. Stony hard - cancer, cystic calcification, fibrosis, Riedel’s.
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56
Q

Is the central isthmus of the thyroid palpable?

A

Almost never palpable.

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57
Q

What other structures of the neck should be palpated?

A
  1. Cervical lymph nodes
  2. Carotid arteries - check for patency, can be compressed by a large thyroid.
  3. Trachea for deviation.
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58
Q

What does percussion of the thyroid gland involve?

A
  1. Percuss downwards from the sternal notch.

2. In retrosternal enlargement the percussion note over the manubrosternum is dull as opposed to the normal resonance.

59
Q

What does auscaltation of the thyroid involve?

A
  1. Apply the diaphragm of the stethoscope over each lobe of the thyroid gland + auscultate for a bruit.
  2. Soft bruit is indicative of incr. blood flow which is characteristic of the hyperthyroid goitre seen in Graves.
  3. You may beed to occlude venous return within the IVJ to rule out a venous hum
  4. Listen over the aortic area to ensure that the thyroid bruit is not, in fact, an outflow obstruction murmur conducted to the root of the neck.
60
Q

What is the Pemberton’s sign?

A

Test for thoracic inlet obstruction (e.g., retrosternal goitre).

61
Q

How to we look for the Pemberton’s sign?

A
  1. Ask the patient to raise both arms above the head.
  2. Patients with inlet obstruction may develop signs of venous compression (facial plethora, cyanosis, dizziness, syncope).
  3. Look at the neck veins for congestion and listen for stridor.
62
Q

How do we examine the thyroid functional status?

A
  1. Observe the patient’s composure (relaxed, agitated, fidgety).
  2. Measure the HR and note if the patient is in atrial fibrillation.
  3. Inspect the hands –> Erythema, warmth, thyroid acropachy –> Phalangeal bone overgrowth similar to pulmonary osteopathy.
  4. Feel the palms - sweat/dry?
  5. Look for peripheral tremor - Ask patient to stretch out their arms.
  6. Inspect the face - Exophthalmos, proptosis, hypothyroid features.
  7. Examine the eyes.
  8. Examine the thyroid and neck.
  9. Test tendon reflexes at the biceps and ankle.
  10. Test for proximal myopathy by asking the patient to stand from a sitting position.
  11. Look for pretibial myxedema.
63
Q

What should be checked during inspection of the eyes in thyroid disease?

A
  1. Look at the patient’s eyes from the front, side, and from above.
  2. Note whether the sclera is visible above or below the iris and whether the eyeball appears to sit forward.
  3. Note the health of the conjunctiva and sclera –> especially for any ulceration or conjunctivitis.
  4. Ensure both eyes can close!
64
Q

What is termed “proptosis”?

A

The eyeball appears to sit forward - best seen from above.

65
Q

Is it a problem if the eyes of the patient can’t close?

A

It is a medical emergency.

66
Q

What is the von Graefe’s sign?

A

Lid lag.

  1. Hold your finger high and ask the patient to look at it and follow it with their eyes as it moves (keeping their head still).
  2. Quickly move your hand downwards - in this way the patient is made to look upwards and then quickly downwards.
  3. Watch the eyes and the eyelids - do they move smoothly and together?
67
Q

How can proptosis be formally assessed?

A

Using Hertel’s exophthalmometer.

68
Q

What is the difference between proptosis and exophthalmos?

A

Exophthalmos is a severe form of proptosis.

69
Q

What happens in severe exophthalmos, in which patient can’t close his eyes?

A
  1. Corneal ulceration
  2. Chemosis - edema of the conjunctiva and sclera caused by obstruction of the normal venous and lymphatic drainage.
  3. Conjunctivitis
70
Q

What is termed “lid retraction”?

A

Upper eyelid is retracted such that you are able to see white sclera above the iris when the patient looks forwards.

71
Q

What causes lid retraction?

A

Caused by incr. tone and spasm of levator palpebrae superioris as a result of thyroid hormone excess.

72
Q

How do we call the sign of incr. tone and spasm of levator palpebrae superioris as a result of thyroid hormone excess?

A

Dalrymple’s sign.

73
Q

To sum up, what does the examination of the eyes in thyroid disease involve?

A
  1. Inspection
  2. Visual fields
  3. Eye movements
  4. Lid lag
74
Q

What are the common findings when examining the eyes in thyroid disease?

A
  1. Proptosis
  2. Exophthalmos
  3. Lid retraction
  4. Lid lag
75
Q

Thyrotoxicosis leads to proptosis and exophthalmos?

A

NO - Proptosis/exophthalmos may be seen in 50% of patients with Graves - HOWEVER, proptosis may persist once thyroid hormone levels have been normalized.

76
Q

What are the eye signs of thyrotoxicosis?

A
  1. Lid retraction

2. Lid lag

77
Q

What are the eye signs of Graves disease (Graves ophthalmopathy)?

A
  1. Periorbital edema and chemosis
  2. Proptosis/exophthalmos
  3. Ophthalmoplegias (particularly upward gaze)
  4. Lid retraction and lid lag ONLY when thyrotoxicosis is present
78
Q

What does visual blurring may indicate?

A

Optic neuropathy - Fundoscopy should be performed.

79
Q

In diabetes clinics, a quick screening examination is performed looking for major complications. What is particularly checked?

80
Q

In general, during examination of a diabetic, what should be checked?

A
  1. CVS disease
  2. Renal disease
  3. Retinal disease
  4. Peripheral neuropathy –> Sensory, health of insulin injection sites, the diabetic foot, secondary diabetes (acromegaly, Cushing’s, hemochromatosis) + associated hyperlipidemia.
81
Q

During thorough diabetic examination, what should be checked during inspection?

A
  1. Hydration
  2. Weight
  3. Facies associated with known endocrine disease
  4. Pigmentation (hyperpigmentation or patchy loss)
82
Q

During thorough diabetic examination, what should be checked regarding the legs?

A
  1. Muscle wasting
  2. Hair loss
  3. Skin atrophy
  4. Skin pigmentation
  5. Leg ulceration (especially around pressure points and toes)
  6. Skin infections
83
Q

During thorough diabetic examination, what should be checked regarding injection sites?

A

Inspect and palpate for:

  1. Fat atrophy
  2. Fat hypertrophy
  3. Local infection
84
Q

During thorough diabetic examination, what should be checked regarding associated skin lesions?

A
  1. Necrobiosis lipoidica diabeticorum - Look on the shins, arms, and back.
  2. Sharply demarcated oval plaques with a shiny surface, yellow waxy atrophic centers + brownish margins with surrounding telangiectasia.
  3. Also look for granuloma annulare.
85
Q

During thorough diabetic examination, what should be checked regarding hyperlipidemia?

A
  1. Eruptive xanthoma
  2. Tendon xanthoma
  3. Xanthelasma
86
Q

During thorough diabetic examination, what should be checked during neurological examination?

A
  1. Visual acuity
  2. Fundoscopy
  3. Peripheral sensory neuropathy –> Evidence of injury, ulcer, Charcot joint formation.
  4. Test muscle strength and examine feet.
87
Q

During thorough diabetic examination, what should be checked during cardiovascular examination?

A

Ideally a full cardiovascular examination including lying and standing BP measurements.

88
Q

What happens with the diabetic foot?

A

Combination of peripheral vascular disease + peripheral neuropathy can lead to repeated minor trauma to the feet –> Ulceration and infection which are very slow to heal.

89
Q

What is the framework for the diabetic foot examination?

A
  1. Inspection
  2. Neurology
  3. Circulation
90
Q

What do we examine during inspection of the diabetic foot?

A
  1. Colour
  2. Ulceration
  3. Dryness
  4. Callous formation
  5. Infection
  6. Evidence of injury - Shoes rubbing?
  7. Charcot’s joints - grossly abnormal and dysfunctional joint due to repeated minor trauma and poor healing due to loss of pain sensation.
91
Q

What do we examine during neurological diabetic foot examination?

A
  1. 10g monofilament test

2. Light touch sensation, pain sensation, vibration sense, proprioception (joint position sense)

92
Q

What should be checked during the circulatory diabetic foot examination?

A
  1. Peripheral pulses (dorsalis pedis and posterior tibialis)
  2. Temperature
  3. Capillary filling time
93
Q

Why do we call it “10g monofilament”?

A

Because it is designed to bend under approximately 10g of pressure.

94
Q

What are the steps for the 10g monofilament test/

A
  1. Apply the filament to the patient’s skin at the appropriate spots.
  2. Press firmly so that the filament bends.
  3. Hold the filament against the skin for 1.5sec and ask the patient if they can feel it.
  4. The filament should NOT slide, stroke, or scratch the skin.
  5. DO NOT PRESS on ulcers, callous, scars, or necrotic tissue.
  6. The feet are “at risk” if they cannot feel the monofilament at ANY of the sites.
95
Q

What is the MCC of blind registration between ages 30-65?

96
Q

The changes seen in the fundus of diabetic patients arise due to common microvascular lesions. These include?

A
  1. Microaneurysms
  2. Hemorrhages - Dot and blot
  3. Hard exudates - Lipid precipitated out of the plasma.
  4. Cotton wool spots - Represent ischemia and occur due to interruption of axoplasmic flow in the nerve fiber layer.
  5. Intraretinal microvascular abnormalities (IRMA)
  6. Venous beading
  7. Neovascularization
97
Q

What involves the classification off diabetic retinopathy?

A
  1. Background diabetic retinopathy
  2. Pre-proliferative retinopathy
  3. Proliferative
  4. Maculopathy
98
Q

What happens in background diabetic retinopathy?

A
  1. Microaneurysms
  2. Hard exudates
  3. Hemorrhages
  4. May be extensive and widespread in severe disease.
99
Q

What happens in pre-proliferative retinopathy?

A

Ischemia is evinced by cotton wool spots - venous beading may also be present.

100
Q

What happens in proliferative retinopathy?

A

New vessel formation - This may progress to vitreous bleeding, traction, retinal detachment and blindness.

101
Q

What happens in maculopathy?

A

Pathology affecting the macula causes catastrophic visual loss:

  1. Exudates and hemorrhages in the macular area.
  2. Patient may have reduced visual acuity with no abnormality seen on fundoscopy.
102
Q

Besides retinal problems, mention 4 other ocular manifestations of diabetes.

A
  1. Glaucoma
  2. Cataract
  3. Optic neuropathy
  4. Cranial nerve palsy
103
Q

What type of glaucoma do we see in diabetes?

A
  1. Open angle

2. Neovascular secondary to rubeosis iridis - new vessel formation on the iris and interruption of the drainage angle.

104
Q

Treatment of cataract in diabetes is an easy case?

A

Not at all.

105
Q

What optic neuropathy do we see in diabetics?

A
  1. Acute ischemic optic neuritis

2. Diabetic optic neuropathy

106
Q

How do we classify hypertensive retinopathy?

A 
Into:
1. Mild
2. Moderate
3. Severe
forms to better correlate with the duration of systemic HTN and associated risk of CAD and cerebrovascular disease.
107
Q

What is the appearance in mild hypertensive retinopathy?

A
  1. Generalized or focal arteriolar narrowing of the retinal arterioles.
  2. Opacity of the retinal artery walls - so called silver/copper wiring.
  3. A-V nipping - the retinal arteries cross the veins at a more perpendicular angle and impinge upon the surface of the vein.
108
Q

What is the appearance of moderate hypertensive retinopathy?

A
  1. Retinal hemorrhage
  2. Cotton wool spots - small areas of ischemia with resulting disruption of axoplasmic flow in the nerve fiber layer of the retina.
  3. Hard exudates - lipid exudates.
  4. Microaneurysms.
109
Q

What is the appearance of severe hypertensive retinopathy?

A

All of mild/moderate + optic disc swelling.

110
Q

Mention some causes of hypothyroidism.

A
  1. Dietary iodine deficiency
  2. Autoimmune thyroiditis (Hashimoto)
  3. Lymphocytic thyroiditis (10% of post-partum women)
  4. Drugs (amiodarone, lithium, IFN-α, thalidomide, dopamine)
  5. Radioactive iodine treatment
  6. Surgical thyroid injury
  7. External irradiation
  8. Pituitary adenoma
111
Q

Mention some symptoms of hypothyroidism.

A
  1. Tiredness
  2. Weight gain
  3. Anorexia
  4. Cold intolerance
  5. Poor memory
  6. Depression
  7. Decr. libido
  8. Goiter
  9. Puffy eyes
  10. Brittle hair
  11. Dry skin
  12. Arthralgia/Myalgia
  13. Muscle weakness
  14. Constipation
  15. Menorrhagia
112
Q

Mention some signs of hypothyroidism.

A
  1. Croaking voice
  2. Mental and physical sluggishness
  3. Pseudodementia - “myxedema madness”
113
Q

What should be checked during inspection of a patient with hypothyroidism?

A
  1. Coarse cool dry skin (look for yellowish tint of carotenaemia “peaches and cream” complexion).
  2. Palmar crease pallor
  3. Peripheral cyanosis
  4. Puffy lower eyelids
  5. Loss of outer 1/3 of eyebrows
  6. Thinning of scalp hair
  7. Tongue swelling
  8. Xanthelasma
114
Q

What should be checked in a patient with hypothyroidism, regarding the cardiovascular and chest diseases?

A
  1. Mild HTN
  2. Pericarditis
  3. Pleural effusion
  4. Low cardiac output
  5. HF
  6. Bradycardia
  7. Small volume pulse
115
Q

What should be checked in a patient with hypothyroidism regarding neurological function?

A
  1. Carpal tunnel syndrome
  2. Peripheral neuropathy
  3. Cerebellar syndrome
  4. Proximal muscle weakness
  5. Myotonia
  6. Muscular hypertrophy
  7. Delayed ankle jerks
  8. Bilateral neural deafness (seen in CONGENITAL hypothyroidism)
116
Q

Mention some causes of hyperthyroidism.

A
  1. Graves disease
  2. Chronic thyroiditis (Hashimoto)
  3. Subacute thyroiditis (de Quervain thyroiditis)
  4. Postpartum thyroiditis
  5. Drugs - Iodine-induced, amiodarone
  6. Bacterial thyroiditis
  7. Post viral thyroiditis
  8. Idiopathic
  9. Toxic multinodular goiter
  10. Malignancy (toxic adenoma, TSH-producing pituitary tumors)
117
Q

Mention some symptoms of hyperthyroidism.

A
  1. Weight loss
  2. Incr. appetite
  3. Irritability
  4. Restlessness
  5. Muscle weakness
  6. Tremor
  7. Breathlessness
  8. Palpitations
  9. Sweating
  10. Heat intolerance
  11. Itching
  12. Thirst
  13. Vomiting
  14. Diarrhea
  15. Eye problems (Graves’ ophthalmopathy)
  16. Oligomenorrhea
  17. Loss of libido
  18. Gynecomastia
118
Q

Mention some signs of hyperthyroidism.

A
  1. Irritability

2. Weight loss

119
Q

What signs should be checked during inspection of a thyroid patient?

A
  1. Onycholysis
  2. Palmar erythema
  3. Tremor
  4. Sweaty palms
  5. Thyroid acropathy
  6. Hyperkinesis
  7. Gynecomastia
  8. Pretibial myxedema
  9. Graves’ ophthalmopathy
120
Q

Mention some cardiovascular and chest sign seen in hyperthyroidism.

A
  1. Resting tachycardia
  2. High cardiac output
  3. Systolic flow murmurs
121
Q

What signs should be checked during neurological examination in a patient with hyperthyroidism?

A
  1. Proximal myopathy
  2. Muscle wasting
  3. Hyper-reflexia in legs
122
Q

What happens in PCOS?

A

Abnormal metabolism of androgens and estrogens with abnormal control of androgen production.

123
Q

Mention some PCOS symptoms.

A
  1. Oligomenorrhea with anovulation and erratic periods.
  2. Infertility
  3. In some patients - hirsutism is the presenting complaint.
124
Q

Mention some signs of PCOS.

A
  1. Obesity (50%)
  2. Male-pattern hair growth
  3. Male-pattern baldness
  4. Incr. muscle mass
  5. Deep voice
  6. Clitoromegaly
  7. Acanthosis nigricans
125
Q

Mention 2 rare causes of Cushing.

A
  1. Depression

2. Alcohol-induced

126
Q

Mention some main symptoms of Cushing.

A
  1. Weight gain (central/upper body)
  2. Change in appearance
  3. Menstrual disturbance
  4. Thin skin with easy bruising
  5. Acne
  6. Excessive hair growth
  7. Muscle weakness
  8. DOWN libido
  9. Depression
  10. Insomnia
127
Q

Mention some signs of Cushing.

A
  1. Supraclavicular fat pads
  2. “Moon face”
  3. Thoracocervical fat pads (buffalo hump)
  4. Centripetal obesity
  5. Hirsutism
  6. Thinning of skin
  7. Easy brusing
  8. Purple striae
  9. Poor wound healing
  10. Skin infections
  11. Proximal muscle weakness (shoulders, hip)
  12. Ankle edema
  13. HTN
  14. Fractures due to osteoporosis
  15. Hyperpigmentation (if raised ACTH)
  16. Glycosuria
128
Q

Mention some causes of hypoadrenalism (Addison’s).

A
  1. Autoimmune adrenalitis (>80% in UK).
  2. TB
  3. Metastatic malignancy
  4. Amyloidosis
  5. Hemorrhage
  6. Infarction
  7. Bilateral adrenalectomy
  8. HIV
129
Q

Mention some symptoms of hypoadrenalism.

A
  1. Anorexia
  2. Weight loss
  3. Tiredness
  4. Nausea/Vomiting/Diarrhea
  5. Constipation
  6. Abdominal pain
  7. Confusion
  8. Erectile dysfunction
  9. Amenorrhea
  10. Dizziness
  11. Syncope
  12. Myalgia
  13. Arthralgia
130
Q

Mention some signs of hypoadrenalism.

A
  1. Skin pigmentation - especially in sun-exposed areas, mucosal surfaces, axillae, palmar creases and in recent scars.
  2. Cachexia
  3. Loss of body hair
  4. Postural hypotension
  5. Low grade fever
  6. Dehydration
131
Q

Mention some causes of GH excess.

A
  1. Pituitary tumor (95%)
  2. Hyperplasia due to GHRH excess (very rare)
  3. Tumors in hypothalamus, adrenals, or pancreas.
132
Q

Mention some symptoms of GH excess.

A
  1. Headache
  2. Diplopia
  3. Change in appearance
  4. Enlarged extremities
  5. Deepening of voice
  6. Sweating
  7. Tiredness
  8. Weight gain
  9. Erectile dysfunction
  10. Dysmenorrhea
  11. Galactorrhea
  12. Snoring
  13. Arthralgia
  14. Weakness
  15. Numbness
  16. Paresthesia
  17. Polyuria
  18. Polydipsia
133
Q

Mention some signs of GH excess.

A
  1. Prominent supraorbital ridges.
  2. Large nose/lips
  3. Protrusion of lower jaw (prognathism)
  4. Interdental separation
  5. Macroglossia
  6. “Spade-like” hands
  7. “Doughy” soft tissues
  8. Thick oily skin
  9. Carpal tunnel syndrome
  10. Hirsutism
  11. Bitemporal hemianopia –> If tumor impinging on optic chiasm.
  12. Cranial nerve palsies (III, IV, VI)
  13. HTN
134
Q

Mention the symptoms of prolactinoma in males.

A
  1. DOWN libido
  2. Erectile dysfunction
  3. Infertility
  4. Galactorrhea
135
Q

Mention the symptoms of prolactinoma in a female.

A
  1. Oligomenorrhagia
  2. Vaginal dryness
  3. Dyspareunia
  4. Galactorrhoea
136
Q

If a prolactinoma occur in a male before puberty, what are the symptoms?

A

Female body habitus and small testicles.

137
Q

Mention the main signs of a prolactinoma.

A
  1. Visual field defects (bitemporal hemianopia)
  2. Cranial nerve palsies (III, IV, VI)
  3. Galactorrhoea
    In MALES:
  4. Small testicles
  5. Female pattern of hair growth
138
Q

Mention some causes of hypercalcemia.

A
  1. Hyperparathyroidism
  2. Malignancy
    Less common:
  3. VitD intoxication
  4. Granulomatous disease
  5. Familial hypocalciuric hypercalcemia
    Rare:
  6. Drugs –> Bendofluazide
  7. Hyperthyroidism
  8. Addison’s disease
139
Q

Mention some symptoms of hypercalcemia.

A
  1. Depend largely on the underlying cause.
  2. Mild hypercalcemia is asymptomatic.
  3. Higher levels may cause nausea, vomiting, drowsiness, confusion, abdominal pain, constipation, depression, muscle weakness, myalgia, polyuria, headache, and coma.
140
Q

Mention some signs of hypercalcemia.

A

Often there are signs of the underlying cause. There are NO SPECIFIC signs of hypercalcemia.

141
Q

Mention some causes of hypocalcemia.

A
  1. Hypoalbuminemia
  2. Hypomagnesemia
  3. Hyperphosphatemia
  4. Surgery to the thyroid and parathyroid glands.
  5. PTH deficiency or resistance.
  6. VitD deficiency
142
Q

Mention some symptoms of hypocalcemia.

A
  1. Depression
  2. Paresthesia around the mouth
  3. Muscle spasms
143
Q

Mention some signs of hypocalcemia.

A
  1. Carpopedal spasm (flexion at the wrist and the fingers) when blood supply to the hand is reduced by inflating a sphygmomanometer cuff on the arm (Trousseau’s)
  2. Nervous excitability - Tapping a nerve cause the supply muscle to twitch (Chvostek’s sign).
144
Q

Mention some important presenting symptoms in endocrinology to keep in mind.

A
  1. Appetite + weight changes
  2. Lethargy
  3. Bowel habit
  4. Urinary frequency + polyuria
  5. Thirst + Polydipsia
  6. Sweating
  7. Pigmentation
  8. Hair distribution
  9. Skin and soft tissue changes
  10. Headache and visual disturbance
  11. Alteration in growth
  12. Changes in sexual function
  13. Flushing

Internal Medicine (107 decks)

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