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3 FoCP > Urology and Endocrine > Flashcards

Urology and Endocrine Flashcards

1
Q

core urinary symptoms

A 
frequency
nocturia
urgency
incontinence
incomplete voiding
visceral pain
haematuria
dysuria
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2
Q

what is phimosis

A

foreskin cannot be pulled back

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3
Q

what is paraphimosis

A

when foreskin cannot be reduced

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4
Q

what are some obstructive symptoms that can occur in LUT

A 
poor flow
hesitancy
intermittency
post micturition dribbling
incomplete voiding
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5
Q

what hormone fuels BPH?

A

testosterone

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6
Q

what does early, terminal and continuous haematuria indicate about the source

A

early - urethral/piping
terminal - prostate
continuous - bladder

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7
Q

what are some possible causes of haemturia

A 
BPH
cancer
infection
stones
trauma
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8
Q

what is enuresis?

A

unconscious voiding

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9
Q

what is the typical age for testicular torsion presentation

A

10-11

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10
Q

what could a scrotal mass be

A 
hernia
torsion
tumour
trauma
varicocele
cyst
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11
Q

what endocrine dysfunction manifests in CKD?

A

RAAS - heart/BP
EPO - anaemia
Vit D - bone

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12
Q

what is usually included in a U n E panel

A 
sodium
potassium
eGFR
creatinine
urea
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13
Q

low urea is a cause of concern - true or false

A

false

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14
Q

what can high urea suggest?

A

acute or chronic kidney failure
or shock
or dehydration

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15
Q

how should creatinine be interpreted?

A

against the patients demographic’s baseline.

big muscular patients have high creatinine baseline.

oppo is true

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16
Q

what two markers are best for indicating kidney function

A

creatinine and eGFR

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17
Q

symptoms of hypernatraemia

A

lethargy, weakness
confusion
coma/seizures

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18
Q

what can cause hypernatraemia

A

dehydration
diabetes insipidus
iatrogenic (too much IVT)

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19
Q

symptoms of hyponatraemia

A 
nausea
malaise
headache
irritability
confusion
muscle weakness
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20
Q

what ECG changes can be seen with hyperkalaemia

A

tented T wave
flattening of P waves
progressive lengthening of PR intervals/QRS

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21
Q

common causes of hyperkalaemia

A

acute/chronic kidney failure
drugs (ACEI/ARBs)
Diabetic ketoacidosis (T1DM)
addision’s disease

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22
Q

common causes of hypokalaemia

A

diuretics
V and D
cushings/steroid use

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23
Q

symptoms of hypokalaemia

A 
muscle weakness
hypotonia
hyporeflexia
cramps
palpitations
constipations
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24
Q

what kind of antibiotics can cause acute kidney injury

A

aminoglycosides e.g. gentamicin

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25
Q

what are some pre-renal, renal and post renal causes of acute kidney injury

A

absolute or relative loss of fluid

renal disease
drugs

urinary tract obstruction

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26
Q

symptoms of acute kidney injury

A 
fatigue
nausea
confusion
dehydration
reduced urine output
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27
Q

causes of chronic kidney disease

A 
hypertension
diabetes
polycystic kidney disease
chronic urinary tract obstruction
primary or secondary glomerular disease
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28
Q

what factors should be considered in management of CKD

A

BP control
anaemia
vitamin D
modify risk factors

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29
Q

describe fibroadenosis,

A

Fibroadenosis is fibrocystic disease
Rubbery and bilateral.
Pain and lumpiness Fluctuates with period cycle

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30
Q

describe a fibroadenoma

A

Hyperplasia of terminal duct lobules
Firm, non-tender and highly mobile lump (untethered)
usually <30 YO

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31
Q

fibroadenomas have no increase in breast cancer link - true or false?

A

true

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32
Q

describe a breast cyst

A

fluid filled sacs in breast tissue
smooth firm lumps
soft and fluctuant or hard and painful
common 30-60 YO

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33
Q

2 types of breast abscess

A

lactational abscess

non-lactational abscess

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34
Q

describe a non-lactational breast abscess

A

usually under areola, nipple inversion associated. common in young female smokers

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35
Q

symptoms of breast abscess

A

erythema, pain, swelling

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36
Q

symptoms of breast cancer

A 
breast/axilla lump
discharge
skin changes
thickened tissue
change in size
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37
Q

modifiable risk factors of breast cancer

A 
OCP
obesity
breast feeding 
alcohol
HRT
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38
Q

how to conduct a breast exam?

A

intro - chaperone
look - 4 hand positions
palpation - hand behind head, check axillary and supraclavicular lymph nodes

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39
Q

what does a patients HbA1C tell u?

A

three month average plasma glucose concentration

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40
Q

what should a normal HbA1C reading be?

A

<42 mmol/mol

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41
Q

what is a diabetic HbA1C reading?

A

48+ mmol/mol

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42
Q

what are 3 possible diagnostic criteria for DM?

A

random glucose >11.1 w/ symptoms

2x random glucose >11.2 w/o symptoms

HbA1C >48 or 6.5%

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43
Q

what are some possible secondary causes of diabetes

A

acromegaly
cushing’s
haemochromatosis
pancreatitis

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44
Q

macrovascular effects of diabetes

A

CVS - angina, MI, CHF

CBVS - stroke, TIA

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45
Q

microvascular effects of stroke

A

eyes - retinopathy, glaucoma, cataracts

kidneys- nephropathy

PNS - peripheral neuropathy

PVD - absent foot pulse, ischaemic skin changes, gangrene

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46
Q

what is the normal range for blood glucose

A

<7.8

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47
Q

stages of diabetic retinopathy

A

background retinopathy - micro aneurysm

pre-proliferative retinopathy - hard exudates, soft exudates

proliferative retinopathy - neovascularisation and possible hemorrhage

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48
Q

what is the surgical sieve

A

VITAMIN C D E F

vascular
inflammatory/infection
trauma
autoimmune
Metabolic
Iatrogenic
Neoplastic

Congenital
Degenerative
Endocrine/environment
Functional

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49
Q

1 unique feature of quinsy

A

Difficulty opening mouth

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50
Q

Describe the partitions of the neck 1 - 6

A 
1 - under the mandible
2 - top of SCM (angle of jaw)
3 - middle of SCM
4 - bottom of SCM to clavicle
5 - posterior triangle
6 - tracheal region
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51
Q

What are some dysfunctions one can have in ENT?

A

Breathing
Swallowing
Voice
Endocrine

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52
Q

How to tell if a lump is a thyroglossal cyst

A

Will move when tongue is protruded

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53
Q

Why does a thyroglossal cyst move with protrusion of the tongue

A

Cyst attached to hyoid bone, tongue attached to hyoid bone.

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54
Q

Describe the features of a branchial cyst

A

Well defined anterior border, but undefined posterior and superior borders because its under SCM and jaw

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55
Q

Features of a thyroglossal cyst? Signs and site?

A

Midline neck lump
Painless
Smooth
Cystic

Moves on swallowing and protrusion of tongue

Around the region of the hyoid bone

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56
Q

Features of a branchial cyst

A

Smooth
Slowly enlarging mass

+/- fistula

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57
Q

What can cause swelling of the parotid gland?

A

Mumps

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58
Q

Where would a parapharyngeal abscess be located?

A

Behind the jaw

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59
Q

Symptoms of a parapharyngeal abscess?

A

Fever
Sore throat
Odynophagia
Neck swelling

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60
Q

Features of a malignant lymphadenopathy

A

Hard

Tethered to skin

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61
Q

What should not be forgotten when presenting with ear pain?

A

The throat!

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62
Q

How does candidiasis of the throat look like

A

Yellowy white reddish patches of the pharynx

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63
Q

indications for a PR exam

A 
constipation
cauda equina syndrome
hemorrhoids
prostatic conditions
rectal cancer
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64
Q

symptoms of BPH

A 
>storage
increased frequency
urgency
nocturia
incontinence
>voiding
hesitency 
intermittency
incomplete voiding
weak flow
dribbling

> post-micturition
dysuria
urinary retention
bladder pain

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65
Q

a urinary catheter is the first line for incontinence - true or false

A

false - used a “condom” type tube

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66
Q

indications for urinary catheter

A

relieve urinary retention
monitor urine output
collect urine sample
bladder irrigation

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67
Q

what factors are used to diagnose acute kidney injury?

A

serum creatinine and urine output

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68
Q

what are the risk factors for acute kidney injury

A 
age >75
CKD
cardiac failure
PVD
chronic liver disease
diabetes
sepsis
drugs
fluid imbalance
hx of urinary symptoms
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69
Q

what is the criteria for stage 3 AKI

A

> 3x serum creatinine baseline increase

<0.3 mL/kg/hr for 24hr OR anuria for 12 hr

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70
Q

signs and symptoms of CKD

A 
anaemia
GI disturbance (anorexia, NVD)
polyneuropathy
CNS dysfx
CVS dysfx
oedema
bone dysfx
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71
Q

how to differentiate acute and chronic kidney failure

A

previous sCr to determine pattern
duration of symptoms
small kidney on U/S

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72
Q

what factors are used in the staging of CKD

A

eGFR and albumine-creatinine ratio

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73
Q

what is the duration criteria for CKD

A

3 months

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74
Q

which benign breast lumps are not associated with pain

A

fibroadenoma

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75
Q

common age for fibroadenoma

A

<30

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76
Q

benign breast lumps associated with period cycle

A

fibrocystic disease
fibroadenoma
breast cyst

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77
Q

common ages for fibrocystic disease

A

20-50 (premenopausal)

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78
Q

fibrocystic disease is associated with a discharge true or fals

A

true

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79
Q

common locationfor fibrocystic disease

A

bilateral, multiple lumps

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80
Q

texture of fibroadenoma lump

A

firm/ rubbery

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81
Q

which breast lump is the most mobile

A

fibroadenoma

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82
Q

how does fat necrosis in the breast arise

A

trauma

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83
Q

what associated symptoms come with breast abscess

A

inflammatory, infection - redness, swelling, pain

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84
Q

what causes diabetic ketoacidosis

A

lack of insulin leads to rise in blood glucose and metabolism of fatty acids yielding high ketone bodies.

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85
Q

signs and symptoms of DKA

A 
Nausea and vomiting
thirst
polyuria
abdominal pain
tachycardia and hypotension
kussmaul respiration
pear drops scent
reduced GCS
dehydration
hyperglycaemia
cerebral edema
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86
Q

Main aims on how should a patient with DKA be treated

A

rehydrate
give insulin
potassium

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87
Q

What is hyper osmolar hyperglycaemic state

A

Happens in uncontrolled type 2 DM

High blood glucose, dehydration, high blood osmolality.

Little to no ketones

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88
Q

Signs of hyper osmolar hyperglycaemic state

A

Dehydration

Reduced GCS

89
Q

Insulin levels in HHS

A

Low, but sufficient to prevent ketogenesis. But no enough to prevent hyperglycaemia

90
Q

What often precipitates HHS

A

Infection - pneumonia

91
Q

Blood biochemical differences between DKA and HHS

A

HHS has higher bicarb, urea and blood glucose.

High pH also cos lower ketones.

92
Q

Main aims of treatment for HHS

A

Rehydrate.
Some insulin
Replace lost electrolytes

93
Q

Complications of insulin therapy

A

Hypoglycaemia
Lipohypertrophy at injection sites
Insulin resistance
Weight gain

94
Q

2 classifications of symptoms in hypoglycaemia

A

Adrenergic

Neruglycopaenic

95
Q

Adrenergic symptoms in hypoglycaemia

A 
Sweating
Shaking
Pallor
Anxiety
Hunger
Abdominal discomfort
Dilated pupils
N&amp;V
Palpitations
96
Q

Neuroglycopenic symptoms in hypoglycaemia

A 
Reduced GCS
Confusion
Impaired judgement
Seizures
Memory loss
Lethargy
Blurred vision
Slurred speech
Ataxia
Paraesthesia and paralysis
Coma
97
Q

What can be found in a typical hypobox

A

Sugary drinks
Dextrose tablets
IV glucose
Dextrose gel

98
Q

What can cause secondary diabetes

A

Acromegaly
Cushing’s syndrome
Haemochromatosis
Pancreatitis

99
Q

What is the most common cause of blindness in people under 65?

A

Diabetes

100
Q

What causes diabetic retinopathy

A

High blood glucose causing damage to retinal vessels

101
Q

Stages of diabetic retinopathy

A

Non-proliferative
Pre-proliferative
Proliferative
Advanced retinopathy

102
Q

Features of non-proliferative diabetic retinopathy

A

Microaneurysms (dot haemorrhages)

Blot haemorrhages

Hard exudates (protein + lipid)

103
Q

What causes hard exudates in non-proliferative retinopathy

A

Breakdown of blood-retina barrier causing lipid and proteins to leak into the retina

104
Q

Description of hard exudates in diabetic retinopathy

A

Bright yellowish color
Irregular outline
Sharply defined margin

105
Q

Features in pre-proliferative diabetic retinopathy

A

Cotton wool spots
Venous loops and beading
Intraretinal microvascular remodelling

106
Q

What causes cotton wool spots in diabetic retinopathy

A

Edema from retinal infarcts

107
Q

Description of cotton wool spots in diabetic retinopathy

A

Greyish white
Indistinct margins
Dull matte surface

108
Q

Difference in appearance between cotton cool spots and hard exudates in diabetic retinopathy

A

Hard exudates are bright yellow and shiny

Cotton wool spots are greyish white and dull

109
Q

What causes venous loops and beading in diabetic retinopathy

A

Retinal ischaemia

110
Q

Where do you find intraretinal microvacular remodelling in diabetic retinopathy

A

Borders of non-perfused retina

111
Q

Features of proliferative diabetic retinopathy

A

Pre-retinal neovascularisation

Haemorrhages of neovessels

Vitreous haemorrhage

112
Q

Features of advanced diabetic retinopathy

A

Retinal fibrosis

Retinal detachment

113
Q

Features of maculopathy in diabetic retinopathy

A

Maculo edema

Perimacular hard exudates

114
Q

What causes diabetic nephropathy?

A

Persistent glycosaemia causes reactive oxygen species and glycation products. Damaging glomeruli and proteinuria. Eventually kidney failure occurs as damage spreads.

115
Q

How to diagnose diabetic nephropathy?

A

Urine albumin

Starts off as microalbuminuria

Then more albumin leaks through eventually leading to proteinuria detectable by dipsticks.

116
Q

What causes diabetic neuropathy

A

Occlusion of blood supply to peripheral nerves and/or accumulation of glucose products disrupting nervous function

117
Q

What is the first stage of diabetic neuropathy

A

Symmetrical sensory neuropathy

118
Q

Describe the progression of diabetic sensory neuropathy

A

Starting in feet, loss of vibration sense, pain, temperature. Followed by proprioception and balance.

119
Q

Complications of diabetic sensory neuropathy

A

Loss of pain sensation leads to unrecognised trauma, ulceration and neuropathic arthropathy like Charcot’s joint

120
Q

What causes charcots joint

A

Loss of pain sensation leads to abnormal mechanical stress on the joints, accumulation of which leads to joint deformities like large bony swellings

121
Q

What does motor nerve neuropathy in diabetics lead to

A

Muscle wasting

Distortion of feet with high arches and clawed toes

122
Q

Describe acute painful neuropathy in diabetes

A

Burning crawling pain in lower limbs, worst at night and exacerbated by pressure

123
Q

What is mononeuritis and mononeuritis multiplex in diabetics?

A

Radiculopathy involving one or more nerve roots causing pain along a dermatome/myotome.

124
Q

What is a common diabetic mononeuritis?

A

Carpal tunnel

125
Q

What is the most common cranial mononeuritis in diabetes

A

3rd and 6th nerve palsy

126
Q

Describe 3rd and 6th nerve mononeuritis multiplex in diabetics

A

Unilateral pain, ptosis and diplopia - no change in pupillary function.

127
Q

What is it called when a diabetic has marked quadriceps muscles wasting with pain and diminished or absent knee reflexes?

A

Diabetic amyotrophy

128
Q

What systems are commonly affected in diabetic autonomic neuropathy

A

Cardiovascular
GI
Bladder
Penile

129
Q

What is the effect of diabetic autonomic neuropathy on the CVS

A 
Resting tachycardia
Loss of sinus arrhythmia
Postural hypotension
Peripheral vasodilation - warmth in feet
Bounding pulse
130
Q

What is sinus arrhythmia

A

Physiological response to the respiratory cycle causing increase or decrease vagal tone leading to change in heart rate

131
Q

What can prolonged diarrhea in a diabetic indicate?

A

Autonomic neuropathy in the GI system

132
Q

What will autonomic neuropathy in diabetes do to a patient’s sex life

A

Males will get erectile dysfunction

133
Q

What signs are indicative of someone at risk to diabetic feet

A

Neuropathic signs

Vascular disease signs

134
Q

What vascular disease signs can be found on someone at risk to diabetic feet

A 
Thin skin
Hair loss
Bluish discoloration of skin
Reduced skin temperature
Absent foot pulses
135
Q

What should be considered in someone at risk to diabetic feet

A

Regular chiropody checks
Special shoes
Daily feet inspection
Avoid heat sources

136
Q

Why should regular subcutaenous insulin injection sites be rotated

A

Prone to lipohypertrophy at injection site

137
Q

What is the biggest risk to the patient when having insulin infusions

A

Hypoglycaemia

138
Q

Having a goitre is indicative of thyroid pathology - T or F?

A

False.

139
Q

What types of goitres are there

A

Diffuse
Multinodular
Singular nodule

140
Q

What does a goitre associated with lymphadenopathy indicate?

A

Malignancy

141
Q

What can cause a diffuse goitre

A 
Overactive or underactive thyroid
Iodine deficiency
Graves disease
Hashimoto’s disease
Acute viral thyroiditis
142
Q

What investigations should be done on a patient with a goitre

A

Bloods - thyroid function tests

Imaging - U/S

FNA

143
Q

Which is the biologically active hormone, T3 or T4

A

T3

144
Q

In a hyperthyroid patient, what symptoms only occur in Graves disease

A

Exophthalmos and opthalmoplegia (restricted eye movement)

Thyroid acropachy

145
Q

What is seen in thyroid acropachy

A

Hand swelling
Clubbing
Perioesteal new bone formation

146
Q

3 most common causes of hyperthyroidism

A

Graves
Toxic multinodular goitre
Toxic adenoma

147
Q

Biochemical picture of hyperthyroidism

A

Low TSH

High T4 and T3

148
Q

Symptoms of hyperthyroidism

A 
Weight loss
Increased appetite
Irritability
Tremor
Heat intolerance
Diarrhea
Eye symptoms
Period disturbance
Sweating
Palpitations
149
Q

Signs of hyperthyroidism

A 
Tachycardia
Lid lag
Warm vasodilated peripheries
Tremor
Hyperkinesis
Exopthalmos
Goitre bruit
Weight loss
Pretibial myxoedema
Palmar erythema
150
Q

Common causes of hypothyroidism

A

Autoimmune (hasimotos or thyroid atrophy)
Iatrogenic
Drug induced
Iodine deficiency (endemic)

151
Q

Some medication that can cause hypothyroidism

A

Carbimazole
Lithium
Amiodarone
Interferon

152
Q

What to look for in suspected autoimmune hypothyroidism

A

Antibodies

153
Q

Biochemical markers of hypothyroidism

A

High TSH

Low T3, T4

154
Q

Symptoms of hypothyroidism

A 
Weight gain
Lethargy
Cold intolerance
Poor appetite
Goitre
Dry brittle hair
Dry skin
Constipation
Period disturbance
Low moods
155
Q

Signs of hypothyroidism

A

Dry thin hair
Bradycardia
Dri skin
Slow relaxing reflexes

156
Q

How do reflexes change in hypothyroidism

A

Slow relaxing reflexes.

Initial reflex is normal, but muscle will be slow to relax.

157
Q

What kind of goiter would someone with hasimotos classically present with

A

Hard non-tender

158
Q

What is addison’s disease

A

Primary hypoadrenalism -> loss of adrenal gland function

159
Q

What is the difference between primary, secondary and tertiary hypoadrenalism

A

Primary = adrenal gland problem

Secondary = pituitary gland problem

Tertiary = hypothalamus problem

160
Q

What is the HPA axis?

A

Hypothalamus makes CRH which stimulates anterior pituitary to make ACTH which stimulates adrenal glands to make cortisol.

161
Q

Clinical features of addison’s disease

A 
Lethargy
Depression
Anorexia
Weight loss
Postural hypotension 
Hyperpigmentation
In women, vitiligo and body hair loss
162
Q

Why is hyperpigmentation seen in addison’s diseaser

A

Stimulation of melanocytes by excess ACTH

163
Q

Where is hyperpigmentation often seen in addison’s disease

A

Buccal mucosa
Skin creases
Pressure points
Recent scars

164
Q

What causes postural hypotension in addison’s disease

A

Dehydration and low electrolytes (low aldosterone)

165
Q

What can precipitate an addison’s crisis

A

Infection, illness

166
Q

Symptoms of an addison’s crisis

A 
Vomiting 
Abdominal pain
Weakness
Hypoglycaemia
Hypovolaemic shock
167
Q

What are some investigations that can be done for suspected addison’s disease

A

Cortisol measurement
ACTH level
ACTH stimulation test

168
Q

What is the hptm, pituitary, thyroid axis

A

Hypothalamus makes TRH which stimulates anterior pituitary to make TSH which stimulates thyroid gland to make T4/T3

169
Q

Difference between cushing’s disease and cushing’s syndrome

A

Cushing’s disease is specifically caused by ACTH over production by the pituitary gland causing excess glucocorticoid production.

Cushing’s syndrome can be caused by anything that causes excess glucocorticoids

170
Q

Symptoms of cushings syndrome

A

Weight gain - central, trunk, abdomen

“Buffalo hump”

Moon face

Thin easily bruised skin

Purple striate on abdomen, breasts and thigh

Pigmentation in ACTH overproduction causes

171
Q

Causes of cushings syndrome

A

ACTH dependent

Pituitary-dependent
Ectopic ACTH producing tumours
ACTH administration

ACTH independent

Adrenal gland malignancy
Glucocorticoid administration

172
Q

What are some common ectopic ACTH producing tumours

A

Small cell lung cancer

Carcinoid tumours

173
Q

what is the most common cause of lumps in the neck

A

reactive lymph node from infection (bacterial, viral or others)

174
Q

how would a thyroglossal cyst be identified

A

midline lump

moves with swallowing and tongue protrusion

175
Q

which age group is more likely to get inflammatory and congenital neck lumps

A

children and teens.

176
Q

what is the onset pattern of

  1. inflammatory lump
  2. malignant lump
  3. salivary gland blockage
A

inflammatory lumps come and ago within 2-6 weeks.

malignant lumps enlarge progressively in a short time

transient swelling with associations with eating suggest salivary gland blockage

177
Q

how to malignant lump necks tend to feel?

A

hard

178
Q

what lumps move with swallowing?

A

thyroid gland swallowing and thyroglossal cysts

179
Q

what does a tender lump indicate?

A

infection over the lump

180
Q

what do midline lumps tend to be?

A

thyroid swelling
thyroglossal
dermoid cysts

181
Q

what does a a bilateral tender swelling across the mandibular angle suggest

A

parotid infection (mumps)

182
Q

where is virchows node and what does it suggest

A

left supraclavicular fossa

metastatic malignancy

183
Q

signs and symptoms of bells palsy

A 
unilateral facial muscle weakness
facial tingling
phonophobia
some pain around ear
loss of taste in anterior 2/3 of tongue on affected side
184
Q

how to diagnose bells palsy?

A

by excluding other possible causes of unilateral facial weakness

185
Q

4 side effects of med-long term steroid use

A

weight gain
skin thinning
hyperglycaemia -> Diabetes
brittle bones

186
Q

what TSH, T4 and T3 pattern can suggest someone who is ‘sick euthyroid’

A

normal TSH
normal T4
low T3

(with ongoing illness)

187
Q

what is a toxic adenoma (in hyperthyroidism)

A

solitary overactive nodule producing excess thyroid hormones

188
Q

what is de Quervain’s thyroiditis

A

associated with viral infection or post-partum

patients experience period of hyperthyroid, then hypothyroidism before resolving back to euthyroidism.

189
Q

what is carbimazole sometimes given for?

A

hyperthyroidism - Graves disease

190
Q

what are the symptoms and signs of a ‘thyroid storm’ or thyroid crisis

A

hyperpyrexia
tachycardia
extreme restlessness

with more progression, it can lead to delirium, coma and death

191
Q

what can precipitate a thyroid storm or thyroid crisis

A

infection
stress
surgery
radioactive iodine therapy

192
Q

what causes addison’s disease?

A

autoimmune antibodies

193
Q

why does vitiligo and loss of body hair happen in women with addison’s disease?

A

hair growth is dependent on adrenal androgens

194
Q

what is the most common history of someone presenting in addison’s crisis?

A

someone who is on long term corticosteroid therapy, sudden withdrawal causing addison’s crisis

195
Q

what does the short-ACTH test involve and show?

A

exogenous introduction of a small amount of ACTH, if cortisol does not go up, then it demonstrates primary adrenal insufficiency (problem is due to adrenal glands)

196
Q

what further test can be done to determine secondary or tertiary hypoadrenalism?

A

CRH test.

197
Q

symptoms of HHS

A

lethargy, confusion, focal neurological deficits, seizures,

leg weakness, cramps, visual impairment.

198
Q

risk factors of HHS

A

type 2 diabetics, old, dementia, immunosuppressed

199
Q

signs of HHS

A

signs of dehydration
tachycardia, hypotension, tachypnea
signs of cause of HHS - infection? thyroid? acute abdomen?

200
Q

how to differentiate DKA from HHS?

A

level of ketones in bloods, “pear drops breath”, history (DKA is faster)

201
Q

how to differentiate BPH from prostate cancer?

A

BPH is smooth on PR exam, prostate cancer is hard/irregular

202
Q

how to diagnose prostate cancer?

A

transrectal ultrasound of prostate, elevated PSA, and biopsy

203
Q

symptoms of prostate cancer

A

urgency, increased frequency, nocturia, dribbling, retention, or retention with overflow incontinence.

204
Q

3 most common organisms causing UTI

A

E coli
proteus
staph saprotiphycius/epidermis

205
Q

in an uncomplicated pyelonephritis, what is the likely cause of persistent illness despite 2-3 days of antibiotics? what should be done ti investigate?

A

do a imaging of utrinary tract to check for abscesses

206
Q

what is the first investigation done for someone presenting with UTI symptoms?

A

urine dipstick - look for nitrites and luekocytes

207
Q

definition of nephrotic syndrome?

A

proteinuria and hypoalbuminaemia

208
Q

most common cause of nephrotic syndrome in children?

A

minimal change glomerular disease

209
Q

symptoms of nephrotic syndrome?

A

facial swelling, wide spread edema

systemic fatigue, anorexia

210
Q

which age group is more common in pharyngeal pouch?

A

> 70s

211
Q

symptoms of pharyngeal pouch

A 
chronic cough
aspiration
halitosis
dysphagia
regurgitation
212
Q

what can an enlarged left supraclavicular lymph node suggest?

A

cancer of the internal organs

213
Q

a new born baby is found to have several large lumpbs on the side of the neck, they are soft and appear fluid filled. what is an important thing to check in the newborn for fear of further complications?

A

ACBDE assessment and then chromsomal abnormalities

214
Q

common age group for bells palsy

A

15-60

215
Q

causes of bells palsy

A

can be after viral infection or idiopathic

216
Q

how long does bells palsy usually last

A

about 3 weeks

217
Q

investigations of a goitre?

A

blood tests - TFTs
imaging - US/Xray
Fine needle aspirate

218
Q

a 10 year old with background of JIA, presents to the A&E with vomiting, abdominal pain, fatigue, muscle pains, cramps, and dehydration. what differentials have to be considered?

A

infection - gastroenteritis, sepsis
DKA
addison’s crisis

3 FoCP (11 decks)

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