SAQ book Flashcards
Why would a person with ?acromegaly start tripping over things?
Bitemporal hemianopia from pituitary tumour compressing optic chiasm.
Why do acromegaly patients get DM?
Increase blood glucose to try and suppress growth hormone secretion but in acromegaly there is no suppression.
What do most acromegaly patients die of?
Cardiovascular disease
Why do you not use growth hormone levels to diagnose acromegaly
Short half-life and secreted in pulsatile manner so not accurate.
- What drug to help tremor in hyperthyroidism?
2. What 3 drugs to ‘block’ hyperthryoidism?
- beta-blocker e.g. propranolol.
2. Propythiouracil or carbimazole
25 year old female complains of thirst, weight loss and polyuria.
- Likely diagnosis?
- Where is ADH secreted from?
- Expected urine and serum osmolality?
- Diabetes insipidus.
- Posterior pituitary
- Low urine osmolality in conjunction with high serum osmolality
Explain the difference of cranial and nephrogenic DI and how to differentiate?
Nephrogenic = kidneys not responsive to ADH. Cranial = insufficiency of ADH.
Desmopressin stimualtion test: Patients are given desmopressin subcutaneously. Serum osmolality, urine osmolality, and urine volumes are measured hourly over the next 4 hours.
- Central DI: >50% increase in urine osmolality following desmopressin (more concentrated).
= Nephrogenic DI: no or <50% increase in urine osmolality following desmopressin and still high urine output.
If she has diabetes insipidus and recently given birth…?
Sheehan’s syndrome from pituitary infarction.
3 macrovascular and 3 microvascular DM complications
- Stroke, MI, peripheral vascular disease.
- Nephropathy, retinopathy, neuropathy.
Describe the pathophysiology of DKA
Insulin deficiency leads to glucose production in liver - gluconeogenesis.
Lipolysis occurs.
Fatty acids are broken down to form ketone bodies.
Ketone bodies produce metabolic acidosis.
Symptoms of prolactinoma
Galactorrhea (nipple discharge), low libido, low fertility, amenorrhoea, headache and visual field defect.
2 non-surgical Rx for a prolactinoma
Dopamine agonist e.g. Bromocriptine.
Radiotherapy.
Phosphate level in hyperparathyroidism.
Low
2 compilations of parathyroid gland surgery
Hypoparathyroidism
Laryngeal nerve palsy
1st sense to smith in DM neuropathy
Vibration
Signs in the foot apart from blunted sensation in a diabetic?
Charcot’s joint, painless ulcers, clawing toes, low reflexes.
Name 2 types of neuropathy that can occur in DM patients
Mononeuritis multiplex, autonomic neuropathy, autonomic gastroparesis.
What is the pathogen which could cause symptoms of conjunctivitis in a neonate?
Chlamydia trachomatis
Important differential diagnosis in a kid with conjunctivitis and ABSENT RED REFLEX
Retinoblastoma
64year old man with long-standing T2DM. Annual ophthalmology review. Retina has = Cotton-wool spots and small new vessels in optic disc area.
- What stage of DM retinopathy is he at?
- What are cotton wool spots?
- What other possible findings on retina for this man?
- Treatment?
- 2 other eye conditions DM is a risk factor for?
- Proliferative by the presence of the new vessels around optic disc.
- Ischaemic nerve fibres
- Flame haemorrhages, hard exudates, tortuous veins.
- Photocoagulation.
- Cataracts, retinal detachment, glaucoma.
Name 4 extra-articular features of rheumatoid arthritis
Scleritis Anaemia Splenomegaly with Felty's syndrome Rheumatoid nodules on elbow Pleural effusion Carpel tunnel syndrome
4 precipitants for an acute gout attack
Trauma
Surgery
Alcohol
Starvation and dehydration
X-ray features of gout
Occur in chronic disease rather than in an acute attack.
- ‘punched-out’ erosions.
- preservation of joint space.
- over-handing edges (‘rat-bute’ erosions)
What is this x-feature called and when is it seen?
‘ Calcification within the joint/articular cartilage’
Chondrocalcinosis
Pseudogout, gout, hyperparathyroidism, Wilsons disease, haemochromatosis.
Name 3 common places for pseudogout
Knee, hip and wrist.
4 signs O/E of knee osteoarthritis
Crepitus, reduced range of movement, pain on movement, antalgic gait.
39 year old lady comes to clinic with weight loss, malaise and proximal muscle weakness, mainly affecting her shoulders.
O/E: proximal muscle weakness, purple discolouration of her eyelids and rough, red papules over her knuckles.
- What is the purple discolouration on eyelids?
- What are the red papules on her knuckles?
- What is the diagnosis?
- Name 2 antibodies for the condition?
- Helitropes
- Gottron papules
- Dermatomyositis
- anti-Jo-1, ANA or Anti-Mi-2
Name 2 features on an xray of ankylosing spondylitis
Syndesmophytes causing bamboo spine.
Calcification of intervertebral ligaments.
If you hear a heart murmur in a patient with ank spondylitis, what murmur and what pathology?
Aortic regurgitation causing a early diastolic murmur
3 features of Reiter’s syndrome
Arthritis, conjunctivitis, urethritis.
4 causes of mono neuritis multiplex
Granulomatosis with polyangiitis, diabetes mellitus, polyarteritis nodosa, rheumatoid arthritis, leprosy.
5 causes of CKD
Diabetes Hypertension Polycystic kidney disease Minimal change disease Amyloidosis
4 blood tests to monitor in CKD
U+E for eGFR
HbA1c
Calcium, phosphate, vitamin d and parathyroid hormone.
3 signs of CKD on examination
Pallor Ascites Uraemic tinge/frost Purpura Bruising
2 complications of peritoneal dialysis
Failure
Peritonitis
sclerosis peritonitis
When is a transplant rejection considered acute or chronic
acute <6months
Why would a renal transplant pt see a dermatologist
Increased risk of skin cancer from immunosuppression.
Name for renal bone disease and how to manage it
Renal osteodystrophy.
Limit dietary phosphate
Calciferol.
An 83-year-old man is admitted to A+E.
- Found by his son on the floor in his kitchen. Confused and unable to give any history to indicate how he fell and how long he had been on the floor.
- He has a past medical history of HTN, T2DM, BPH and osteoarthritis. His regular medications are: lisinopril 20 mg OD, amlodipine 5mg OD, metformin 1g BD, gliclazide 80mg OD.
Admission bloods are as follows: Hb 12.6, WCC 8.75, Neut 6.98, Na 135, K 5.3, urea 19.6, creatinine 352. The nurse in A+E said his urine was brown, and tested positive for blood.
1. What is most likely cause of AKI?
2. How does it lead to AKI?
3. What blood test would you expect to be high?
4. What urine test would you do?
5. What would you see in urine microscopy?
6. Other causes of the condition in 1.?
- Rhabdomyolysis
- Acute tubular necrosis
- Creatinine kinase
- Urinary myoglobin
- Muddy brown granular casts
- Excessive exercise, seizures, neuroleptic malignant syndrome.
75year old lady comes to A+E with daughter after found slumped in seat.
Left side facial droop, left arm and leg weakness.
PMHx = CABG, HTN, smoker.
1. 4 RF (not mentioned) for a stroke?
2. Difference in TIA and stroke?
3. Term for this patient’s left sided weakness?
4. 2 signs on cerebral hemisphere infarction?
5. Commonest cause for cerebral infarction and surgical Mx?
6. 3 parts to the general management plan?
- Diabetes mellitus, AF, hyperlipidaemia, alcohol, COCP, PVD.
- Stroke >24hrs or lead within 24hrs.
- Hemiplegia
- Homonymous hemianopia, left sided sensory loss, dysphasia.
- Carotid artery atherosclerosis so do carotid endarterectomy.
- Swallow assessment, physio, pressure ulcer prevention/tissue viability nurse review, control BP, OT.
Damage to what 2 visual structures can lead to homonymous hemianopia?
Optic radiation
Visual cortex
Dorsal column function. where does it decussate
Fine touch, vibration and proprioception.
Decussates in medulla oblongata.
Spinothalamic tract function
Pain and temperature.
Describe the distribution of signs in a pt with left-sided Brown-Sequard syndrome at lumbar region
Left-sided (ipsilateral) spastic paralysis and loss of vibration + proprioception below level.
Right-sided (contralateral) loss of pain and temperature sensation below level.
What is a positive Kernig’s sign
Pain and resistance on knee extension when hip fully flexed due to meningeal irritation.
3 RFx for carpel tunnel syndrome and 2 management options
Acromegaly, pregnancy, hypothyroidism.
Split, surgical decompression, local steroid injection
3 drug classes used in Parkinson’s disease and 2 side effects for each
- Leovdopa + dopa decarboxylase inhibitor to reduce SE. SE = gambling, weaning of effectiveness, dyskinesia.
- Monoamine oxidase B inhibitors e.g. Selegiline. SE = headache, n+v, depression.
- Dopamine agonists e.g. Ropinirole. SE = gambling, impulsive behaviours, sleep disorder, anxiety.
Medical name for pain on swallowing
Odynophagia
2 differentials for tonsillitis
Infectious mononucleosis
Scarlet fever
Which lymph nodes are commonly enlarged in tonsillitis
Jugulodigastric lymph nodes
What is the significance of swallowing fluid being normal but swallowing solids being difficult?
If fluid and solids ?motility cause rather than stricture/obstruction
Which side is recurrent laryngeal nerve palsy commoner on and why?
Left as longer than right
3 complications of bells palsy
keratitis
altered taste
psychological distress
2 parts to the tympanic membrane
pars flaccid and pars tensa
Differential for acoustic neuroma
Meningioma
Epithelium of sinuses
Ciliated, pseudostratified columnar epithelium.
3 salivary gland names
Parotid, submandibular, sublingual
CN to examine in ?parotid adenoma
CN7 / facial.
