Practice Questions Flashcards
29 year old female No known PMHx Nil regular medications New relationship Wants to go back on COCP Up to date with CST
What are the 5 most important questions in hx to explore before prescribing her COCP?
FHx of thromboembolic event
Could she be pregnant/last menstrual period
Does she smoke
Current breast feeding
New pattern of headache to suggest migraine
Previous compliance issue with pill
29 year old female No known PMHx Nil regular medications New relationship Wants to go back on COCP Up to date with CST
What are 2 important findings in physical exam that you would need to document in her medical record?
BMI/Weight
Blood pressure
What are 3 management options for tinea/pityriasis veriscolor?
Topical ketoconazol/clotrimazole/selenim suffice/terbinafine (shampoo/cream) for 2/52
Advise that moistre is the usual underlying cause of this yeast-infection
Explain that the discolouration will take long time to resolve
Oral fluconazole/itraconazole
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
In assessing this patient, what further information do you need to ask (List 6)
Family hx of Prostate Ca
Haematuria
Rapid deterioration of symptoms
Impact on quality of life
Dysuria
Constipation
Incomplete emptying sensation
Polyuria/Polydipsia
Weight loss
Bone pain
Possibility of STI
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
Apart from BPH, give 5 more likely differential diagnoses for this presentaiton
Prostate cancer
Urethral stricture
Overactive bladder
Infections: Urinary tract infection
Interstitial cystitis
Bladder stone
Diabetes
Polydipsia /Excessive fluid intake
Constipation
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
Give the main 4 relevant features of physical exam to identify the cause of his presentation
Abdominal examination for bladder size
External genitals examination
DRE
Neurological examination of perineum/lower limb
Vital signs
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
In addition to urinary tract US, what investigations would you order to assess a man with moderate to severe LUTS (List 4)
Urinanalysis & MSU for MCS if UA positive
Fasting glucose
UEC
PSA
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
What are the main findings in urinary tract US that will assist you in your management of this patient? (List 4)
Estimate prostate size (normal is <25cc)
Estimate residual volume (>100ml may require further ix)
Exclude bilateral hydronephrosis 2nd to chronic retention
Exclude bladder stones and larger bladder tumours
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
Examination and Ix are consistent with a diagnosis of moderate BPH. What are the 2 pharmacological treatment options you may consider
Alpha blockers - tamsulosin, prazosin
5-alpha reductase inhibitors - finasteride, dutasteride
Combination therapy - tamsulosin/dutasteride
Anticholinergic - oxygbutynin, solifenacin
75 year old male 2 year hx of LUTS - slow stream, hesitancy, nocturia (3x/night), daytime frequency and urgency Nil PMHx Nil regular meds FHx: Father TURP @ 70 years
What are 4 possible long-term complication of BPH if left untreated?
Acute urinary retention
Recurrent UTIs
Macroscopic haematuria
Chronic urinary retnetion
Bladder stones
Bilateral hydronephrosis with renal impairment
19 year old female Ground crew for Qantas Attends for pre-employment health assessment PMHx: long-standing mild-moderate asthma Meds: Salbutamol - OTC Non-smoker
In order to assess asthma control level - what are 4 important questions you need to ask?
Frequency of daytime sx
Frequency of reliever use
Frequency of night time sx
Limitation on exercise tolerance
19 year old female Ground crew for Qantas Attends for pre-employment health assessment PMHx: long-standing mild-moderate asthma Meds: Salbutamol - OTC Non-smoker
Based on further hx and assessment you decide to start this patient on a preventer
What are 7 main features of asthma management?
Education about chronic nature of asthma requiring lifelong treatment
Preparing an asthma action plan
Immunisation for common respiratory infections including influenza
Educaiton on proper use of asthma devices
Annual spirometry
Regular review to assess control level
Identify and avoid asthma triggers
Keeping diary of PEFR
Regular daily exercise 30min/day
Maintaining the optimal body weight
19 year old female Ground crew for Qantas Attends for pre-employment health assessment PMHx: long-standing mild-moderate asthma Meds: Salbutamol - OTC Non-smoker
Based on further hx and assessment you decide to start this patient on a preventer.
Patient re-presents in 4 weeks for planned review. Sx are consistent with sbuoptimal asthma control
What are 6 possible cause of her poor response to treatment?
Poor technique with use of asthma devices
Poor compliance with medication
Prescribed preventer not sufficient/inappropriate
Ongoing exposure to triggers (stress/allergens)
Underlying pathology other than asthma
Wrong diagnosis
Occupational exposure to triggers at the airport
6/52 old female baby attends 6-week check with Mum
Uncomplicated pregnancy.
Born at term
NVD
O/E: Mild jaundice in sclera, face and upper trunk
No jaundice at birth or in early newborn period
Mum not sure when jaundice started
What further hx will you ask (6)?
Stool colour(2)
Urine colour (2)
Has been unwell/fever (2)
Is she breastfed (2)
Feeding frequency/wet nappies (1)
FHx of haemolytic disease/G6PD, spherocytosis (1)
FHx of Gilbert Sx (1)
Weight gain since birth (1)
Hx of maternal hepatitis (1)
Has she had the heel prick test at birth (1)
6/52 old female baby attends 6-week check with Mum
Uncomplicated pregnancy.
Born at term
NVD
O/E: Mild jaundice in sclera, face and upper trunk
No jaundice at birth or in early newborn period
Mum not sure when jaundice started
Bloods show: FBC/EUC - normal
Total serum bilirubin 180 (NR<200), conjugated fraction 68 (NR <34)
What is the single most likely diagnosis?
Neonatal cholestasis
Biliary atresia
6/52 old female baby attends 6-week check with Mum
Uncomplicated pregnancy.
Born at term
NVD
O/E: Mild jaundice in sclera, face and upper trunk
No jaundice at birth or in early newborn period
Mum not sure when jaundice started
Bloods show: FBC/EUC - normal
Total serum bilirubin 180 (NR<200), conjugated fraction 68 (NR <34)
What is your next single management step?
Urgent referral to Paediatric team
78 year old female, aged care facility
PMHx:
Controlled HTN
Mild dementia
Ongoing oedema and erythema over both lower legs for a few months.
Failed to respond to oral antibiotics.
Systemically well, normal vital signs, no fever
Photo: bilateral lower limb erythema with occasional vesicles
What are the 2 most likely differential diagnoses that can explain this presentation?
Stasis (venous) dermatitis (2)
Contact dermatitis (1)
Lipodermatosclereosis (1)
Pretibial myxedema (1)
78 year old female, aged care facility
PMHx:
Controlled HTN
Mild dementia
Ongoing oedema and erythema over both lower legs for a few months.
Failed to respond to oral antibiotics.
Systemically well, normal vital signs, no fever
Photo: bilateral lower limb erythema with occasional vesicles
What are 4 features of management based on provisional diagnosis
Measure ABPI to assess arterial suplly (1)
Graduated compression stockings (2)
Elevate feet when sitting/in bed (2)
Apply a potent topical steroid (Bethametasone Diproprionate 0.05%) (2)
Take regular walks /exercise (1)
Use a moisturising cream (1)
Vascular surgeon opionion re: vascular veins (1)
Soap free wash (1)
Frusemide 40mg/daily (1)
78 year old female, aged care facility
PMHx:
Controlled HTN
Mild dementia
Ongoing oedema and erythema over both lower legs for a few months.
Failed to respond to oral antibiotics.
Systemically well, normal vital signs, no fever
Photo: bilateral lower limb erythema with occasional vesicles
What are 5 possible iatrogenic complications that this patient may face should they go to hospital?
Hospitla acquired infections - UTI, pneumonia, cannula site (2)
Falls in an unaccustomed environment (2)
Delirium/confusion (2)
Medication errors (2)
Pressure sores (2)
Thromboembolism/DVT (1)
Mental health issues - depression (1)
Constipation (1)
Deconditioning (1)
Insomnia (1)
Malnutrition (1)
21 year old male, migrant from PNG 'cannot shake this cold' 8/52 of productive cough with blood Nil regular meds Nil PMHx
Give 4 most likely diagnoses for this presentation
Pulmonary tuberculosis (4)
Pertussis (3)
Bronchiectasis (3)
Bronchitis/Post-infective cough (3)
Asthma flare due to exposure in new environment (2)
Post-nasal drip/Rhinosinusitis (2)
Pneumonia (1)
GORD (1)
21 year old male, migrant from PNG 'cannot shake this cold' 8/52 of productive cough with blood Nil regular meds Nil PMHx
Give 3 initial investigations you would order to clarify the diagnosis:
Chest High-Resolution CT Sputum for acid fast bacilli Urine MSU FNA RBC morphology of sputum Sputum for cell cytology Bronchoscopy and biopsy under direct vision LFT Spirometry CT chest with contrast ABG Oesophgeal manometry & 24 hr pH Sinus CT Methacholine Challenge Test CXR Sputum for MCS Sputum for mycoplasma PCR Nasopharyngeal swab for influenza PCR
Sputum for acid fast bacilli (2)
CXR (2)
Sputum for MCS (2)
35 year old female New pt, accompanied by friend Lying down with lights dimmed as she has had a headache for 12/24 Feels like vomiting Letter from another GP stating: PMHx: Migraine - pethidine injections
Give the 4 most important steps in assessing the situtation further
Check drug/doctor shopper hotline (2)
Take full history of headache (2)
Attempt to contact treating doctor (2)
Examine the patient - including assessing for evidence of drug abuse (2)
Examine for other causes of headache (2)
Explore past treatment hx (2)
35 year old female New pt, accompanied by friend Lying down with lights dimmed as she has had a headache for 12/24 Feels like vomiting Letter from another GP stating: PMHx: Migraine - pethidine injections
Give 3 management steps
Confirm practice policy not to give pethidine for migraines (2)
Appropriate alternative analgesia such as NSAIDs (2)
Antiemetics i.e. metoclopramide (2)
Triptan medication i.e. sumatriptan (2)
55 year old female
New pt, recently relocated
Previous GP has found abnormal tests that she would like to discuss with you
Marocytic anaemia with low vitamin B12. Normal folate
Other than pernicious anaemia, give the 4 most likely causes of B12 deficiency
Strict vegiterian diet (2.5)
(Atrophic) Gastritis (2.5)
Crohn’s (2.5)
Medications - Omeprazole, metformin (2.5)
Malabsorption disease - coeliac (2.5)
Previous gastrectomy/bariatric surgery (2.5)
Chronic alcoholism (2.5)
55 year old female
New pt, recently relocated
Previous GP has found abnormal tests that she would like to discuss with you
Marocytic anaemia with low vitamin B12. Normal folate
Findings are suggestive of pernicious anaemia. What are the 2 tests you would order to make a definitive diagnosis?
Anti parietal cell antibody (2)
Anti intrinsic factor antibody (2)
36 year old male Nil PMHx Training for a marathon Has noticed blood in urine Blood on urine dipstick
What are the 5 most likely differential diagnoses of his haematuria?
Exercise-induced haematuria (3)
Urinary Tract Infection/Cystitis (2)
Polycystic Kidney Disease (1)
Trauma - renal or urethral (1)
Glomerulonephritis/IGA nephropathy (1)
Nephrolithiasis/Stone (1)
Benign renal mass - angiomyolipoma (1)
Urogenital carcinoma/Bladder carcinoma/renal cell carcinoma (1)
36 year old male Nil PMHx Training for a marathon Has noticed blood in urine Blood on urine dipstick
What are the 3 most important investigations/examination findings from the list below: Urine osmolality Urine sodium concentration Urine for crystal assessment CT KUB PSA Abdominal Xray RBC morphology Spiral CT/CT Urogram Urine MCS Urea and Electrolytes Uric Acid ECG CXR Cystourethrogram
RBC morphology (2)
Spiral CT/CT Urogram (2)
Urine MCS (2)
Urea and Electrolyte (2)
68 year old male 2-3 days of one-sided persistent throbbing headache over left temple Never had similar headache in the past PMHx: Hypercholesterolaemia, Heartburn Meds: Simvastatin, Omeprazole Tender over area of headache
What is the single most likely cause of this presentation
Left side temporal arteritis/Giant cell arteritis (2)
68 year old male 2-3 days of one-sided persistent throbbing headache over left temple Never had similar headache in the past PMHx: Hypercholesterolaemia, Heartburn Meds: Simvastatin, Omeprazole Tender over area of headache
Which 1 of the following investigations would be more helpful in confirming your clinical diagnosis? Anti CCP FBE LFT U&E Brain CT Ultrasound of the carotid ESR ANA Anti CCP Troponin
ESR (2)
68 year old male
2-3 days of one-sided persistent throbbing headache over left temple
Never had similar headache in the past
PMHx: Hypercholesterolaemia, Heartburn
Meds: Simvastatin, Omeprazole
Tender over area of headache
A diagnosis of giant cell arteritis has been confirmed
What are 5 key features of management
Long term prednisolone rx starting at 60mg/day (2)
Low dose aspirin 100mg/day (2)
Explanation of autoimmune nature of the condition (2)
Warn about possible impact on vision as a result of poor treatment (2)
Regular review of inflammatory markers (2)
Rheumatologist/Neurologist involvement (2)
Explain side effects of long term corticosteroid treatment - weight gain (2)
Fracture prevention plan (1)
Risk assessment of cardiovascular disease (1)
Advise to take regular PPI considering on aspirin + prednisolone (2)
75 year old female PMHx: Hiatus hernia, GORD Meds: Esomeprazole Presents for annual influenza vaccine Found to have irregularity in pulse ECG = AF
Which 4 of the following investigations will assist you to identify a possible underlying cause for her ECG findings High resolution chest CT ESR CRP Bone scan CXR CT abdomen FOBT Fasting BSL Ferritin FBE Lipid profile LFT Mammogram Serum Protein Electrophoresis Pelvic US TFTs Vitamin B6 Creatinine/Urea/Electrolytes Cortisol CTPA D-Dimer
CXR
FBE
TFTs
Creatinine/Urea/Electrolytes
75 year old female PMHx: Hiatus hernia, GORD Meds: Esomeprazole Presents for annual influenza vaccine Found to have irregularity in pulse ECG = AF
What are 3 main goals in management of this new cardiac problem (There is no need to name medications)
Rate control (2)
Rhythm control (2)
Prevention of thromboembolic event (2)
42 year old female Lump outer aspect of right breast 2cm size lump PMHx: Obesity Meds: COCP BMI 33 Ex-smoker Never been pregnant
What are 7 specific relevant questions you need to ask when taking a focused hx about this new lump?
Recent trauma to this breast (fat necrosis) (1)
Pain/tenderness over the lump (1)
Any nipple discharge/inversion (1)
Any Axillary lump (1)
Any previous breast lumps (1)
Eczema over the areola (1)
FHx: Breasth Ca/Ovarian Ca (1)
Age of menarche (1)
Relation with menstrual cycle / Last menstruation (1)
42 year old female Lump outer aspect of right breast 2cm size lump PMHx: Obesity Meds: COCP BMI 33 Ex-smoker Never been pregnant
What are 6 important steps in breast physical examination?
Inspection of skin for changes - dimpling/inversion/tethering (1)
systemic palpation of all quadrants of both breasts (1)
Identify the exact location of the lump (1)
Examination of relevant lymph nodes - axillary, supraclavicular (1)
Palpation for lump specific features - size, mobility/adherence, consistency, shape, margin, tenderness (1)
Adequate exposure of both breasts (1)
Assess for nipple discharge (1)
Inspection of nipples for changes (1)
42 year old female Lump outer aspect of right breast 2cm size lump PMHx: Obesity Meds: COCP BMI 33 Ex-smoker Never been pregnant
What are the 5 specific characteristics of the lump that you would like to explore during the examination?
Consistency (0.5)
Shape (0.5)
Margins (0.5)
Mobility (0.5)
Depth (0.5)
Tenderness (0.5)
Skin tethering caused by lump (0.5)
48 year old male
Attends with wife
PMHx: Marfan’s syndrome, HTN, T2DM, Aortic metallic valve, COPD
Meds: Perindopril, Metformin, Warfarin, Spiriva
You suspect non-compliance as BP and Diabetes are not controlled properly.
Unstable INR
In order to gather more info about compliance what steps can you take? List 4
- Ask about compliance/side effects of medications (1)
Opportunistically ask wife about medication compliance (1)
Check prescription requests/issuing intervals on the records (1)
Check with pharmacist about prescription dispensing intervals (1)
Organise home medication review (1)
48 year old male
PMHx: Marfan’s syndrome, HTN, T2DM, Aortic metallic valve, COPD
Meds: Perindopril, Metformin, Warfarin, Spiriva
You suspect non-compliance as BP and Diabetes are not controlled properly.
Unstable INR
What are the 6 patient characteristics that may impact their compliance with the prescribed medications?
Literacy (0.5)
Age (0.5)
Ethnic background (0.5)
Mental Health Issues (depression/memory loss) (0.5)
Physical disabilities (Visual impairment) (0.5)
Socioeconomic level (0.5)
Drug/Alcohol issues (0.5)
Language (0.5)
Belief about the medication (0.5)
48 year old male
PMHx: Marfan’s syndrome, HTN, T2DM, Aortic metallic valve, COPD
Meds: Perindopril, Metformin, Warfarin, Spiriva
You suspect non-compliance as BP and Diabetes are not controlled properly.
Unstable INR
What are the 7 possible indications for which you can claim a HMR under current medicare regulations?
5 or more regular medications (2)
> 12 doses of medication per day (1)
Recent significant changes made to medications (1)
Medication with a narrow therapeutic index/requiring therapeutic monitoring (1)
Sx suggestive of an ADR (1)
Sub-optimal response to rx (1)
Suspected non-compliance (1)
Difficulty managing own medicines because of literacy/language (1)
Problems or impaired sight, confusion/dementia or other cognitive difficulties (1)
Patients attending a number of different doctors (1)
Recent discharge from a facility/hospital (1)
68 year old male Truck driver Progressive dyspnoea for 3/12 PMHx: Myocardial infarction (15 years ago) - stented Ex-smoker HTN Meds: Aspirin 100mg mane Perindopril 5mg mane Atenolol 50mg mane Atorvastatin 40mg OD
Apart from cardiac failure, what are 5 most likely causes of dyspnoea?
Coronary artery disease (1)
Aortic stenosis (1)
Atrial fibrillation (1)
COPD (1)
Pulmonary fibrosis/Interstitial Lung Disease (1)
Lung cancer (1)
Obesity (1)
Lack of fitness (1)
Anaemia (1)
68 year old male Truck driver Progressive dyspnoea for 3/12 PMHx: Myocardial infarction (15 years ago) - stented Ex-smoker HTN Meds: Aspirin 100mg mane Perindopril 5mg mane Atenolol 50mg mane Atorvastatin 40mg OD
What are 5 specific questions in hx that will assist you to reach a diagnosis?
Orthopnea (1)
Chest pain (1)
Recent weight change (1)
Cough (1)
Palpitation (1)
Exact level of exercise tolerance (1)
Paroxysmal nocturnal dyspnoea (1)
Peripheral oedema (1)
Known recent bleeding (1)
68 year old male Truck driver Progressive dyspnoea for 3/12 PMHx: Myocardial infarction (15 years ago) - stented Ex-smoker HTN Meds: Aspirin 100mg mane Perindopril 5mg mane Atenolol 50mg mane Atorvastatin 40mg OD
O/E: HR 90bpm regular
BP 150/90mmHg
JVP ?slightly elevated
Chest is clear
Ix confirm diagnosis of congestive cardiac failure
What are the 6 important features of your management?
Explanation of the chronic nature of heart failure (1)
Salt intake restriction (<2gram/day) (1)
Fluid intake limit to <1.5L (1)
Change atenolol to cardiac failure specific beta blocker - carvedilol (1)
Gradually increase dose of perindopril to maximum (1)
Daily weight diary (1)
Assure immunisation - influenza/pneumonia (1)
Lifestyle modification with regular exercise/reduce caffeine/reduce alcohol (1)
Involve cardiologist (1)
Add diuretic - Frusemide 40mg/day (1)
Cardiac rehabilitation (1)
Address safety of driving/adverse informing road safety authorities (1)
52 year old male Truck driver Snoring Wife reports loud snoring and pauses during the night Non-smoker Nil regular meds Nil PMHx You suspect OSA
Considering the provisional diagnosis of OSA, what are 5 specific questions you need to ask to further explore this complaint
Recent weight gain (1)
Hx of gasping/chocking typical of OSA (1)
Nasal patency/obstruction/issues/trauma/rhinitis (1)
Alcohol intake before bedtime (1)
Daytime sleepiness (1)
Impact on driving / recent accidents (1)
Morning headaches (1)
Decreased concentration (1)
Irritability/lowered mood (1)
Sexual dysfunction (1)
52 year old male Truck driver Snoring Wife reports loud snoring and pauses during the night Non-smoker Nil regular meds Nil PMHx You suspect OSA
What are 4 relevant feature of your physical exam to assess for OSA
BMI (1)
Neck circumference (1)
Assess mandible for retrognathia (1)
Check nasal patency (1)
Assess mallampati score / Tonsillar hypertrophy (1)
Blood pressure (1)
Heart auscultation /Cardiovascular examination (1)
52 year old male Truck driver Snoring Wife reports loud snoring and pauses during the night Non-smoker Nil regular meds Nil PMHx You suspect OSA
BMI = 26
BP 130/82mmHg
Sleep study reveals moderate to severe OSA
What are 5 main features of management?
- Not to drive until the sleep problem has been dealt with
- Use mouth splint
- Reduce alcohol intake late at night
- Avoid spicy food
- Regular exercise at least 30mins most days
- CPAP treatment under sleep physician supervision
- Magnesium supplementation at night
- Offer medical certificate for work
- Recommend afternoon nap
- Allocate enough time for adequate sleep at night
- Reduce salt in diet
- Provide work cover certificate
- Organise ABPM
- Offer holter ECG
- Refer for stress ECHO
- ENT review
- Provide carer certificate for wife
- Recommend annual influenza immunisation
- Advise to have annual blood test to monitor for LFT
- Organise non-urgent carotid doppler US
Not to drive until the sleep problem has been dealt with (1)
Reduce alcohol intake at night (1)
Regular exercise at least 30mins most days (1)
CPAP treatment under sleep physician’s supervision (1)
Offer medical certificate for work (1)
Allocate enough time for adequate sleep at night (1)
4 year old female Attends with Mum Vomiting since 0300 Not interested in eating Sipping on water - brings everything straight up BNO No urinary sx Perfectly well yesterday No signs of significant dehydration
What is the most likely cause of Jade’s presentation?
Viral gastroenteritis/gastritis (3)
4 year old female Attends with Mum Vomiting since 0300 Not interested in eating Sipping on water - brings everything straight up BNO No urinary sx Perfectly well yesterday No signs of significant dehydration
What are the 4 most important causes of this presentation that should not be missed?
- Metabolic conditions - DKA (2)
- Poisoning (1)
- Head injury - concussion (1)
- Sepsis - pneumonia (1)
- Gastrointestinal obstruction (1)
4 year old female Attends with Mum Vomiting since 0300 Not interested in eating Sipping on water - brings everything straight up BNO No urinary sx Perfectly well yesterday No signs of significant dehydration
You confirm gastroenteritis as the dx
What are the 5 key features of your management?
Explain self-resolving nature of viral infection (1)
Plan proper oral hydration at home (2)
Exclude from child care until 48hour after last vomit/diarrhoea (1)
Warn about alarming signs which need review (safety net) (1)
Proper hand wash advice (1)
Antiemetic - Ondansetron 4mg wafer BD (1)
Advise that diarrhoea may follow (1)
38 year old female Nurse Palpitation, lethargy and weight loss Nil PMHx Nil regular medications Etonogestrel contraceptive implant 2/12
TSH <0.01mIU/L (normal range 0.5-4)
T4: 27pmol (normal 10-25)
T3: 6.8pmol/L (normal range 3.1-5.4)
What are the 4 likely causes of her thyroxicosis apart from Graves disease?
Toxic multi-nodular goitre (1.5)
Toxic adenoma (1.5)
Exogenous thyroid hormone (1.5)
Subacute thyroiditis (1.5)
38 year old female Nurse Palpitation, lethargy and weight loss Nil PMHx Nil regular medications Etonogestrel contraceptive implant 2/12
TSH <0.01mIU/L (normal range 0.5-4)
T4: 27pmol (normal 10-25)
T3: 6.8pmol/L (normal range 3.1-5.4)
What 2 Ix will be most helpful to confirm clinical suspicion of Graves Disease?
- Thyroid US
- Thyroid CT Angiogram
- CXR
- ECG
- Thyroid peroxidase
- Thyroid MRI
- Radionuclide thyroid scan
- TSH receptor antibodies
- FNA
- CTPA
- Radioactive iodine scan
- Thyroglobulin autoantibodies
- FBE
- EUC
- LFT
- PTH level
- ESR
- Anti SM antibody
- Anti ds-antibody
- ANA
Radionuclide uptake thyroid scan
TSH receptor antibodies
38 year old female Nurse Palpitation, lethargy and weight loss Nil PMHx Nil regular medications Etonogestrel contraceptive implant 2/12
TSH <0.01mIU/L (normal range 0.5-4)
T4: 27pmol (normal 10-25)
T3: 6.8pmol/L (normal range 3.1-5.4)
Investigations are consistent with Graves. You start the patient on carbimazole 10mg/TDS in consultation with endocrine.
Pt returns to see you in 6/52 with fever, mouth ulcers and sx of gastroenteritis
What is the most important cause of her new sx that you need to consider first?
Agranulocytosis or Neutropenia (4)
