Sunday 16/6/19

Question 1

What are the causes of peripheral oedema

Answer 1

Low albumin
- intake : malnutrition
- loss: enteropathies, nephrotic syndrome
- synthesis: liver disease
Hydrostatic pressure
- cardiac failure, renal failure, portal hypertension
Other
- lymphoedema
- myxoedema
- drugs: pregabalin, amlodipine
- deep venous thrombosis

Question 2

What are the pulmonary causes of clubbing?

Answer 2

suppurative lung disease
interstitial lung disease
lung cancer

Question 3

What are other (non pulm) causes of clubbing? 7

Answer 3

cirrhosis
inflammatory bowel disease
coeliac disease
thyroid acropachy
familial or congenital clubbing
thymoma/ lymphoma / carcinoma
congenital heart disease

Question 4

What are the causes of adrenal insufficiency?

Answer 4

primary
idiopathic
waterhouse friderichsen
endocrinopathy/polyglandular - autoimmune adrenalitis (Addison’s)
congenital adrenal hyperplasia or tumor: (met or primary)
infection: tb, histo, coccidio
infiltration: amyloid

secondary
pit adenoma
Sheehan’s syndrome

tertiary
iatrogenic steroids

Question 5

What are the adventitious sounds you would hear in

a) heart failure
b) chronic obstructive pulmonary disease
c) interstitial lung disease

Answer 5

a) medium mid/late expiratory crackles
b) early inspiratory medium/coarse crackles
c) late inspiratory/ end inspiratory fine crackles

Question 6

What are the causes of hypothyroidism?

Answer 6

without goitre
thyroidectomy

with a goitre
drugs: amiodarone, carbimazole, PTU, CTLA4 (ipi), PD-1 antibody (pembro)
riedel’s thyroiditis (igG4)
congenital - cretinism

transient
subacute thyroiditis
postpartum thyroiditis

Question 7

What are the causes of hypopituitarism?

Answer 7

apoplexy
adenoma
radiation
trauma - base of skull injury
drugs: CTLA4, pembro
autoimmune hypophysitis
idiopathic
empty sella syndrome

Question 8

How would you investigate suspected hypercortisolism?

Answer 8

24 hr urinary cortisol
salivary cortisol
low dose dexamethasone suppression test

if 2/3 are elevated proceed to confirmatory testing:
high dose DST and check ACTH
if ACTH elevated: MRI pituitary looking for adenoma
If one not seen (microadenoma) then petrosal sampling to localise
can also use petrosal sampling post op to assess for microrecurrence/effectiveness of surgery

if ACTH suppressed look for adrenal adenoma, or ectopic
with CT chest

Question 9

What occupations put one at risk of ILD

Answer 9

electricians, plumbers - asbestos
stone mason, minors - silicosis
farmers, joiners - mould
painters 
miners, coal workers - pneumoconiosis
bird fanciers
cheese workers
air con - legionella
air space manufacturing, electronics, light bulbs - beryliosis

Question 10

what makes a spleen a spleen?

Answer 10

it is notched
can have a rub
can get above it
not ballotable
doesn't descend with breathing
is dull to percussion on traube's space

Question 11

what are the causes of massive splenomegaly?

Answer 11

1. myelofibrosis
2. CML
3. malaria, hepatosplenic t cell lymphoma: particularly boys given Aza and infliximab

Question 12

What are causes of moderate splenomegaly?

Answer 12

1. portal hypertension
2. lymphoma/leukaemia
3. thalassaemia
4. gaucher’s disease
5. felty’s

Question 13

what are causes of mild splenomegaly?

Answer 13

polycythaemia
haemolytic anaemias: TTP
EBV/ hepatitis/IE
PAN/SLE
infiltrative: amyloid, sarcoid

Question 14

what are causes of cerebellar disease?

Answer 14

ischaemia
demyelination
toxic/met/drugs: alcohol, phenytoin, lithium, cytarabine, 5FU
space occupying lesions
congenital: SCA, friedrich's ataxia
infections: meningitis
paraneoplastic: ovarian, breast, NHL
traumatic bleeds