RECORDING 58

Question 1

which system you must review in ‘haemoptysis’?

Answer 1

Not only in prompt ‘haemoptysis’,you must always review renal in any respi prompts and vise versa. (PULMONORENAL SYNDROME)

Question 2

D/D: for fever with haemoptysis (infective causes)

Answer 2

Tuberculosis

Brucellosis (animal contact)

Question 3

D/D: for joint pain (other than CTD)

Answer 3

Infectiom

Saecoidosis

Question 4

D/D: for cough with normal CXR

Answer 4

ACEi
Asthma (early morning cough)
Postnasal drip
GERD (heart burn)

Question 5

Respiratory Cause of oedema?

Answer 5

COR PULMONALAE does not always mean COPD

• primary hypertension (especially young female)
• connective tissue disease
• recurrent thromboembolism
• obstructive sleep apnoea
• COPD

Question 6

D/D: for diabetes with dizziness +

Answer 6

Hypoglycemia (RBS check,relation to meal,nocturnal)
Addison disease (buccal pigmentation,postural drop)
Postural drop (other autonomic complications)

Question 7

D/D: for diabetes with visual impairment

Answer 7

Decreased visual acuity
-retinopathy causes
   maculopathy
   retinal detachment
   retinal haemorrhage
-non retinopathy causes
   osmotic changes
   catarct
   rubiosis iritis (glaucoma)

Field defect
-acromegaly (bitemporal hemianopia)
-posterior circulation stroke / occipital infarct
(bitmeporal hemianopia)

Diplopia

• MG
• 3rd nerve palsy (mononeuritis multiplex)

Question 8

What do you understand by visual impairment?

Answer 8

1. Decreased visual acuity
2. Field defect
3. Diplopia

Question 9

Important point to remember in approaching tingling numbness in diabetic patient?

Answer 9

In diabetic neuropathy,pattern is glove and stocking and start from lower limbs and accompanied by other microvascular compliations.
That’s why if the pattern says other wise,look for other causes.
-if uniltateral thigh pain,maybe myalgia parasthica (lateral cutaneous nerve of the thigh compression)
-if unilateral hand pain,maybe carpal tunnel syndrome

Question 10

D/D: for diabetic with headache

Answer 10

+ Acromeglay

- Other causes of headache

Question 11

D/D: for diabetic with multisystem involvement

Joint pain,heart failure,hypogonadism

Answer 11

Haemochromatosis
Cystic fibrosis (young patient)

Question 12

D/D: for diabetic with renal impairment

Answer 12

If renal impairment due to diabetic nephropathy,URE would be proteinuria with no cast or blood.
If cast,blood +, look for other glomerulonephropathy causes.

Question 13

What is the most important take home message for endocrine cases?

Answer 13

Whenever you suspect a gland etiology, look for its buddies.

whenever you see glandular problem,consider whether there maybe MAN or APS

Question 14

How will you approach goitre?

Answer 14

First,check whether it is thyroid or not.
If thyroid,hypo or hyper or cancer (LN,HOV)
Is there any complications?

Question 15

What will you do if you see suspicious features in patient with thyroid gland?

Answer 15

FNAC

Question 16

D/D: for diabetes with weight loss

Answer 16

+ if you want to say weight loss is due to diabetes,
there must be osmotic symptoms, uncontrolled status.
+ thyroid + diabetes
- if not,look for other causes

Question 17

What is the important take home message after getting a diagnosis ?

Answer 17

look for the etiology (step 2),assocaition,complication
if this is the case of hypothyroid,as next step,think what maybe causing it?
-?Hasimoto
-?Post thyroidectomy
-?drug induced
(lithium for pyschiatric prob, Amiodarone for heart prob)
Is there anyother MAN/APS?
Is there any pressure symptoms?

Question 18

What are the prompts for acromegaly?

Answer 18

• poorly controlled DM/ HT
• headache + DM/HT
• headache
• visual field defect

Question 19

D/D: for headache with visual field defect (bitemporal hemianopia)

Answer 19

Macroprolactionomas

• Acromegaly (features)
• Prolactinoma (nipple dc,hypogonadism)
• Nonfunctioning pituiatry adenoma)

Question 20

D/D: for polyuira

Answer 20

Hyperglycemic causes (DI,DM)
Hypercalcemic causes
Primary polydyspsia

Question 21

Dx : Cough + Joint pain + Polyuria

Answer 21

Sarcoidosis

Question 22

Prompts for pheochromocytoma

Answer 22

HT+ Headache

HT a must

Question 23

D/D: for HT+Headache

Answer 23

Acromegaly

Pheochromocytoma