Symptoms of SIADH
SIADH Spasms Isn't any pitting oedema (key for differential ) Anorexia Disorientation (and other psychoses) Hyponatremia
(Urine concentrated, plasma diluted)
Causes of SIADH
SIADH
Surgery
Intracranial (infection , head injury, CVA)
Alveolar (ca, pus)
Drugs (opiates, anti epileptics, cytotoxics, anti-psychotics
Hormonal (hypothyroid, low corticosteroid level)
Test for carpal tunnel syndrome in hypo or hyperthyroidism
Hypo (as carpal tunnel thickened by myxoedema)
Causes of hypothyroidism with an enlarged gland
Iodine deficiency, hashimotos throiditis, or drugs eg amidarone
Reflexes in hypothyroidism
Normal contraction with slow relaxation
What is onycholysis ? Feature of what
Separation of nail from bed
Graves
Causes of goitre in thyrotoxic patients
Graves, toxic multinodular goitre, toxic adenoma
Sizing of a goitre
0 - not visible or palpable 1a- only on palpating 1b- only visible when neck extended 2 visible with neck in normal position 3 visible from a distance
Charcots foot?
Degeneration of joint due to neuropathy –> walking strange -> bony deformation and flattened foot
Symptoms of acromegaly
ABCDEF Arthritis Blood pressure raised Carpal tunnel syndrome Diabetes Enlarged organs Field defect
What is diabetic dermopathy
Brown macules over shins
Dry shiny hair loss skin indicates
Peripheral vascular disease
Eczema / haemosiderin staining indicates
Venous disease
Venous ulcers vs
Arterial ulcers
Moderate / no pain - larger/shallow - associated with venous insufficiency / varicose veins
Very painful - deep punched out appearance - associated with diabetes / peripheral vascular disease
Causes of bilateral pitting oedema
Venous insufficiency / heart failure
3 signs of charcots foot
High arch
Clawed toes
Prominent metatarsal heads
Absent peripheral pulses suggests
Peripheral vascular disease
Things to complete diabetic foot exam
Full neuro vascular assessment of limbs
Check capillary blood glucose
Give advice on glycemic control and foot care
What is thyroid acropachy ?
Seen in?
Phalangeal bone overgrowth
Graves
What is palmar erythema ?
Seen in ?
Reddening of palms at thenar / hyper thenar
Hyperthyroidism
Irregular heart rate seen in ?
AF (hyperthyroidism)
What causes the exophthalmos in graves
Abnormal connective tissue deposition in the orbit and extra ocular muscles
When might eye movements be restricted
Graves due to the abnormal connective tissue deposition in orbit and extra ocular muscles
What is lid lag ?
Due to ?
Upper eyelid observed laggin behind eyes in downward movement (sclera visible)
Due to anterior protrusion of eye (exophthalmos )
Which masses move with swallowing
Thyroid and thryroglossal
What would lymphadenopathy with thyroid mass suggest
Metastatic spread
Thyroid Bruis suggest
Suggests increased vascularity - Graves’ disease
Hyporeflexia in which thyroid
Hypothyroid
What would you do to complete thyroid exam
If indicated take blood samples to assess function (TSH /T4)
Dry shiny hair loss skin indicates
Peripheral vascular disease
Eczema / haemosiderin staining indicates
Venous disease
Venous ulcers vs
Arterial ulcers
Moderate / no pain - larger/shallow - associated with venous insufficiency / varicose veins
Very painful - deep punched out appearance - associated with diabetes / peripheral vascular disease
Causes of bilateral pitting oedema
Venous insufficiency / heart failure
3 signs of charcots foot
High arch
Clawed toes
Prominent metatarsal heads
Absent peripheral pulses suggests
Peripheral vascular disease
Things to complete diabetic foot exam
Full neuro vascular assessment of limbs
Check capillary blood glucose
Give advice on glycemic control and foot care
What is thyroid acropachy ?
Seen in?
Phalangeal bone overgrowth
Graves
What is palmar erythema ?
Seen in ?
Reddening of palms at thenar / hyper thenar
Hyperthyroidism
Irregular heart rate seen in ?
AF (hyperthyroidism)
What causes the exophthalmos in graves
Abnormal connective tissue deposition in the orbit and extra ocular muscles
When might eye movements be restricted
Graves due to the abnormal connective tissue deposition in orbit and extra ocular muscles
What is lid lag ?
Due to ?
Upper eyelid observed laggin behind eyes in downward movement (sclera visible)
Due to anterior protrusion of eye (exophthalmos )
Which masses move with swallowing
Thyroid and thryroglossal
What would lymphadenopathy with thyroid mass suggest
Metastatic spread
Thyroid Bruis suggest
Suggests increased vascularity - Graves’ disease
Hyporeflexia in which thyroid
Hypothyroid
What would you do to complete thyroid exam
If indicated take blood samples to assess function (TSH /T4)
