Passmedicine Flashcards
What diagnosis would be suggested by raised T4, raised ESR and a tender goitre?
Sub-acute thyroiditis (de Quervain’s thyroiditis)
Under what circumstances should subclinical hypothyroidism (TSH high, T3/T4 normal) be treated?
TSH > 10
Other autoimmune disease
Previous treatment for Graves disease
Thyroid auto-antibodies present
What are the three main strategies for management of Grave’s disease?
Anti-thyroid drugs (e.g. carbimazole)
Block and replace (carbimazole, levothyroxine)
Radio-ablation
What is the therapeutic goal of treatment in Hashimoto’s thyroiditis?
Normalisation of TSH level
In acute ST-elevation myocardial infarction, what are the recommendations for management of blood glucose?
Dose-adjusted insulin infusion with regular monitoring of blood glucose levels to <11mmol/l
What is first-line for treatment of hypertension in diabetics?
ACE inhibitors
Which drugs are first line for diabetic neuropathic pain? When would amitriptyilline be avoided?
Amitriptyilline, gabapentin, pregabalin
In cases where there might be a risk of urinary retention
When should glitazones be avoided?
Heart failure
Which anti-arrythmic medication is associated with thyroid dysfunction?
Amiodarone (hypothyroidism and thyrotoxicosis)
Which medication/supplement might cause absorption of thyroxine to be reduced?
Iron
What are the “sick day rules” for patients with Addisons?
Double the glucocorticoids
Which derangement in acid-base balance are a) Addisons and b) Cushings associated with?
a) Addisons- metabolic acidosis
b) Cushings- metabolic alkalosis
Which steroid would you use in a situation where you wanted to minimise fluid retention?
Dexamethasone or betmethasone- have mimimal mineralocorticoid activity
What is important about the PTH level in hyperparathyroidism?
It may be raised, or it may be inappropriately normal
