Endo - symptoms + signs Flashcards
Symptoms of DI
- Chronic thirst
- Polyuria (3L/24h)
- Nocturia
- Signs of hypernatraemia
Lethargy, restlessness, irritability, hyper-reflexia, spasticity, muscle twitching
Severe: delirium, seizures, coma - Incontinence (if damage to the bladder through over-distention)
Signs of DI
- Hypernatraemia
- Hypotonic urine
- Distended and palpable bladder
- 24h urine collection - urine volume >3L
- Signs of volume depletion - dry mucous membranes, reduced skin turgor, tachycardia, hypotension, narrow pulse pressure
Symptoms and signs of hypocalcaemia
CATs go numb
Convulsions
Arrhythmias (prolonged QT)
Tetany
Paraesthesia (hands, mouth, feet, lips)
Trousseau’s sign
Chvostek’s sign
Prolonged QT
Hyperreflexia
Stridor
Hypocalcaemia is a result of pancreatitis, renal failure
Sympotms and signs of hypercalcaemia
Stones, throans, bones, groanes, psychiatric overtones
Renal stones Bone pain/damage Polyuria Abdo upset (constipation, nausea, pain) Psychiatric conditions (depression, anxiety)
Hypercalcaemia can also cause pancreatitis
Symptoms and signs of primary hyperparathyroidism
Symptoms of hypercalcaemia
• Excess calcium makes neurones less excitable
o Slower muscle contractions
o Diminished neuro firing in the CNS
• Hypercalciuria – can lead to dehydration
Stones, thrones, bones, abdo groans, psychic overtones
• Stones – renal colic, kidney stones, gallstones
- Thrones – refers to the toilet – polyuria, polydypsia dehydration
- Bones – bone pain, osteopenia, osteoporosis, pathological fractures
- Groans – constipation, muscle weakness, proximal myopathy, fatigue
- Psychic overtones – depression, dementia, confusion, inability to concentrate, memory problems
Symptoms and signs of secondary hyperparathyroidism
- Signs + symptoms of CKD
- Fractures/bone pain
- Renal osteodystrophy – bone resorption
- Rickets (bone bossing, rachitic rosary, bowed legs, knock knees)
- Proximal myopathy
- Fatigue
- Hypocalcaemia – CATs go numb
• Calcification in blood vessels and soft tissues (high levels of phosphate cause it to find and stick to any available calcium, which forms bone-like crystals in places that thy shouldn’t be)
Secondary hyperparathyroidism is basically
• Vitamin D deficiecy
• Osteomalacia
• Rickets
Paget’s disease symptoms + signs
• Misshapen bones can cause nerve impingement
o Pain
o Hearing loss (impingement of the auditory nerve)
o Vision loss (impingement of the optic nerve)
o Lower limb muscle weakness (misshapen vertebrae compress the spinal cord)
o Sciatica
o Spinal stenosis
• Bony deformities o Leontiasis (bitemporal skull enlargement with frontal bossing) o Increasing skull size o Bone bossing (skull, femur, tibia) o Paget’s sarcoma (osteosarcoma) o Kyphosis o Pelvic asymmetry o Bowing of femur, tibia, forearm o Prognathism o Osteoarthritis o Pathological fractures
- Bone pain aggravated by movement (femur, pelvis, skull)
- Increased local temperature (skin over involved bone may be warm) – due to increased vascularity + metabolic activity
Symptoms + signs of osteoporosis
• Asymptomatic until fracture occurs
• Signs of vertebral fractures (most common fractures in osteoporosis) o Back pain o Loss of height o Kyphosis o Tenderness on percussion
• Sign of femoral neck fracture (commonly after minimal trauma)
o Severe pain with leg shortened and externally rotated
• Colles’ fracture of the distal radius after fall onto outstretched hand
Symptoms and signs of tertiary hyperparathyroidism
• Stones, thrones, bones, groans, psychic overtones
• Excess calcium makes neurones less excitable
o Slower muscle contractions
o Diminished neuro firing in the CNS
• Hypercalciuria – can lead to dehydration
Stones, thrones, bones, abdo groans, psychic overtones
• Stones – renal colic, kidney stones, gallstones
- Thrones – refers to the toilet – polyuria, polydypsia dehydration
- Bones – bone pain, osteopenia, osteoporosis, pathological fractures
- Groans – constipation, muscle weakness, proximal myopathy, fatigue
- Psychic overtones – depression, dementia, confusion, inability to concentrate, memory problems
• Calcification in blood vessels and soft tissues (high levels of phosphate cause it to find and stick to any available calcium, which forms bone-like crystals in places that thy shouldn’t be)
if tertiary hyperparathyroidism due to CKD - high phosphate
if tertiary hyperparathyroidism due to chronic vitamin D deficiency or if renal transplant - low phosphate
Signs of hypothyroidism on physical examnation
Hands
Bradycardia
Cold
Head/Neck/Skin Goitre Puffy face Oedema Hair loss Dry skin Vitiligo
Chest
Pericardial or pleural effusions
Abdomen
Ascites
Neuro
Delayed relaxation of reflexes
Carpal tunnel syndrome
Features specific to Grave’s disease (graves triad)
Ophthalmopathy (exophthlamos, periorbital oedema, increased tear production, blurred vision, ophthalmoplegia, double vision due to extraocular muscle weakness) Pretibial myxoedema (non pitting) Thyroid acropathy (resembles clubbing)
Other Proximal myopathy (thyrotoxic myopathy, hyperthyroid myopathy) Hyperreflexia Lid retraction + lid lag Tachycardia + AF Thyroid gland - audible bruit Presence of bruit
Thyroid crisis symptoms and signs
> 2 feature - at risk of death, need aggressive treatment
- Hyperpyrexia (>41)
- Severe Tachycardia (>170)
- Cardiac failure
- Hepatocellular dysfunction
- Jaundice
- Psyciatric symptoms (anxiety, delirium, psychosis)
Coma
What is myxoedema coma?
Sympotms + signs
mx
Severe form of hypothyroidism that happens in the elderly
- Heart failure
- Hypotension
- Hypothermia
- Hyponatraemia
- Hypoxia
- Hypercapnia
- Confusion
- Coma
Mx
- IV hydrocortisone (if secondary hypothyroidism due to hypopituitarism) **
- IV T3
- Supportive measures - oxygen, rewarming, IVF
- Treatment of underlying cause (e.g. infection)
- Replace T3 with T4 after 2-3 days if there is clinical improvement
- always give hydrocortisone before thyroid hormone, always assume that hypothyrodidism is due to hypopituitarism until TFTs arrive, because hydrocortisone deficiency can kill
In very general terms, how does DM present?
Polyuria
Polydipsia
Triad of signs in SIADH
Triad of
- Hypotonic hyponatraemia
- Concentrated urine
- Euvolaemic state (therefore BP normal!)
