PT 34

Question 1

Allopurinol is what?

Answer 1

First line (secondary) gout prevention

Uric acid conc <0.36 mmol/L
- Will never get gout again if under this level

Question 2

What’s Pseudogout?

Answer 2

CPPD
Calcium pyrophosphate deposition
A disease

Question 3

CPPD
- Stand for?
- Location? (3)
- Name of the differential on imaging: what does it mean?

Answer 3

Calcium pyrophosphate depositions

Knee, wrist, shoulders

Chondrocalcinosis: calcium deposits in the articular hyaline cartilage of joint eg knee joint

Question 4

Hyperthyroidism TSH, T4 and T3: what do they stand for and where do they deviate in hyperthyroidism from the normal? Which hormone is more abdunant in our bodies?

Answer 4

TSH = thyroid stimulating hormone = lower than normal range

T4 = free thyroxine (negative feedback loop on TSH) T4 is more abdundant 80-90%, but less active = higher than normal range

T3 = Triidothyronine which is more active but less abdundant (T3 wasn’t on passmed bc levothyroxine was T4 replacement so yeah T3 wasn’t that relevant in there so not really there)

Question 5

Overreplacement of thyroxine consequences: on bones and why?

What do you see on Thyroid Function Tests with overreplacement?

What do thyroid hormones do to metabolism?

Too high? (4)
1 endocrine fluids
1 muscloskeletal
1 weight change
1 bowel motions

Too low? (5)
1 general wellbeing
1 mood
1 heart
1 weight change
1 bowel motions

Answer 5

Hyperthyroidism —> osteoporosis: activity of osteoclasts are higher than osteoblasts

In overreplacement of T4 due to levothyroxine, low TSH and normal T3 levels can be seen

Thyroid hormones increases catabolism metabolism,
- Metabolites:
1. Breakdown of lipids (which lowers lipids in blood could be good)
2. Breakdown of glucose - like glucagon breaks glycogen
- Systemic:
1. Raises temperature
2. Increases O2 consumption

Too high: Sweating, tremours, weight loss, diarrhoea

Too slow: Tired, depression, bradycardia, weight gain, constipation

Question 6

4 conditions associated with HYPOthyroidism

Answer 6

First degree heart block from bradycardia bc HYPOthyroidism slows metabolism and slows everything down

Hyperlipidaemia bc thyroid hormones are required for metabolism if lipids

Can lead to Insulin resistance; as thyroid hormones involved in glucose metabolism, low levels means glucose in blood, and overtime can gain insulin resistance like in diabetes mellitus

Weight gain due to slow metabolism due to low levels of thyroid hormones in hypothyroidism

Question 7

Can opoids be used in migraines?

Answer 7

No, bc they just don’t relieve the pain very well

Question 8

What is TSH also known as?

Answer 8

Thyroid stimulating hormone aka Thyrotropin

Question 9

What can confirm diagnosis of hyperthyroidism?

Answer 9

Thyroid function test = low serum TSH and high serum T4 and T3

Question 10

What is positive Trendelenburg gait:

• What is the saying?
• What is the name of the group of muscles that are weak on the weak side: what are the individual muscles called?
• What happens to the opposite hip when the patient is standing with the leg that is on the weak side?
• What is compensated gait?
• What is the gait on two sides?

Answer 10

“Sound side sags”

Hip ABductors: gluteus medius, gluteus minimus, and tensor fasciae latae

When patient stand with the leg pn the weak side, the hip on the opposite side sags,

Compensate tredenlenburg on one side can look like upper torso leaning towards the side of the standing leg

Bilateral Trendelenburg = waddling gait