Endocrine Flashcards
(144 cards)
1
Q
What are the values dx for DM?
A
HbA1c—> more than 6.5%
FBS: >126mg/dl
RBS: >200mg/dl with Sx of hyperglycemia
OGTT: >200mg/dl
2
Q
What are the values dx for Pre-diabetics or values which increase the risk for diabetes?
A
HbA1c: 5.7-6.4%
FBS: 100-125mg/dl
RBS: 140-199mg/dl
OGTT: 140-199mg/dl
3
Q
Important point for diabetes
A
If a patient is Asymp, a positive test should be reconfirmed with the same test on a d/f day for diabetes
4
Q
What will be effect of intensive glycemic controlon complications of type 2 DM?
A
Macrovascular—–> No change
Microvascular——> decrease
No change in mortality if HbA1c is 6-7% But mortality increases if it is less than 6%
5
Q
Name the test to assess the risk of diabetic foot ulcer
A
Monofilament test is used to document peripheral sensoryneuropathy
6
Q
What are the d/f in lab values of DKA and HONK?
A
DKA::
Glucose is 250-500mg/dl with increased Anion gap
low Bicarb with positiveserum ketones and decreased Serum osmolality
HONK::
Glucose is 600mg/dl with normal Anion gap
Normal Bicarb with normal serum ketones and increased Serum osmolality
7
Q
How to managed HONK?
A
Aggressive hydration with normal saline initially then with 0.45% saline
IV insulin
8
Q
When to switch insulin route in DKA? (from IV to S/C)
A
When patient able to eat
RBS less than 200mg/dl
anion gap less than 12
serum HCO3 more than 15
9
Q
Name the diabetic medications which can be used in renal insufficiency
A
Piogiltazone
DPP-IV inhibitors (Sitagliptin)
10
Q
Name the diabetic medications which decreased the body weight
A
GLP-1 receptor agonist (Exenatide)
11
Q
Name the diabetic medications which are weight neural
A
Metformin
DPP-IV inhibitors (Sitagliptin)
12
Q
Name the diabetic medication which increased the weight
A
Pioglitazone (TZDs)
Sulfonylureas
13
Q
Important point of diabetic medication
A
Add Sulfonylureas when metformin failed Add Pioglitazone (TZDs) when both metformin and Sulfonylureas not tolerate
14
Q
Why is serum sodium level high in central DI?
A
Thirst mechanism also disturbed in central DI result intake of water is low
whereas in nephrogenic DI, thirst mechanism is intact so serum sodium level is normal
15
Q
Important point of DI and primary polydipsia
A
DI—-> Euvolemic hypernatremia
Primary polydipsia——> Euvolemic hyponatremia
16
Q
Name the medications which can cause diabetes insipidus and other causes
A
Lithium Demeclocyline foscarnet Cidofovir amphotericin
Other cause hypercalcemia and receptor mutation
17
Q
Important point of testosterone deficiency
A
Normal size is: length 4-7cm with volume 20-25ml
18
Q
What are the absolute contraindications of COCPs?
A
Cirrhosis/liver cancer/Breast cancer
Hx of smoking Or IHD
Hx of venous thromboembolic disease
Stage 2 HTN
Currently smoker
Migraine with aura
Major surgery with immobilisation
Less than 3 wk postpartum
19
Q
Triad of Zollinger ELLISON SYNDROME
A
Multiple refractory ulcer in stomach and distal part of intestine
Gastrin level more than 1000pg/ml in presence of normal gastric pH
Secretin stimulation test
20
Q
How to approach Zollinger ELLISON SYNDROME ?
A
Check serum gastrin level off PPI therapy for 1 week
If less than <110 pg/ml——>no gastrinoma
If 110-1000pg/ml——>secretin stimulation test—> if positive—-> localise gastrinoma via imaging
If more than 1000pg/ml—->check gastric pH off PPI therapy for 1 week—->if less than 4—>localise gastrinoma via imaging
And if more than 4——> no gastrinoma
21
Q
Important point of Zollinger ELLISON SYNDROME
A
calcium infusion study is usually reserved for patients who have gastric acid hypersecretion and are strongly suspected of having gastrinoma despite a negative secretin test.
Calcium infusion can lead to an increase in serum gastrin levels in patients with gastrinoma
22
Q
Triad of GLUCAGONOMA
A
Diabetes mellitus
Necrolytic migratory erythema
GIT SxS like diarrhoea
23
Q
Triad of VIPOMA
A
Secretory Watery diarrhoea with increase sodium and osmalal gap <50mOsm/kg
Low Stomach acid
Low potassium with high calcium and glucose
24
Q
How to approach hyperprolactinemia in pre menopausal female?
A
Rule other causes and then MRI brain
If asymptomatic and size <1cm—>No treatment
If symptomatic and size >1cm—>dopamine agonist
Do surgery if size >3cm or refractory to meds
25
How to approach acromegaly?
First get IGF-1 level—> if elevated—->OGTT—->if inadequate suppression—->MRI of brain
26
What are the causes of hyper androgenism in females?
CIA PON
Cushing syndrome
Increase Prolactin
Acromegaly
P PCO
O ovarian / adrenal tumor
N non classic CAH
27
Triad of Idiopathic hirsuitism
Due to excessive conversion of testosterone to DHT in hair follicles.
Usually +ve family history and no virilization.
17 OH-progesterone and androgens usually normal
28
How to d/f hyperandrogenism due to adrenal and ovarian tumor?
If increases Testosterone and normal DHEAS—-> ovarian tumor
If relatively normal testosterone and increase DHEAS—-> adrenal tumor
29
Important point of hyper androgenisation
DHEAS is specific for adrenal glands and is sulfated form of DHEA.
DHEA is produced by both ovaries and testes
30
What does meant by secondary amenorrhea?
Amenorrhea for menses for more than 3 cycles Or more than 6 months
31
How to approach secondary amenorrhea?
Get BHCG and rule out pregnancy first And then find other causes
32
What are the causes of Hyperthyroidism in which thyroglobulin level is high?
TIE
```
T= thyroiditis
I = Iodide exposure
E = Extraglandular production
```
33
Name the cause of Hyperthyroidism in which thyroglobulin level is low?
Exogenous hormone
34
What are the causes of Hyperthyroidism in which RAIU is high?
```
Grave disease (diffuse uptake)
Toxic adenoma / multinodular goiter (nodular uptake)
```
35
What are the conditions present with this pattern of TFT; TSH low and FT4 normal ?
FT3 is high--->T3 toxicosis
| FT3 is normal--->subclinical Hyperthyroidism/Early pregnancy/non-thyroid illness
36
What are the causes of thyroiditis?
```
Hashimoto
Silent thyroiditis (painless)
Subacute thyroiditis (De Quervain thyroiditis) painful
```
37
Classified the causes of thyroiditis in term of Radioactive iodine uptake
Variable uptake ----> Hashimoto
| Low uptake ----> Silent and subacute thyroiditis
38
Triad of Subacute thyroiditis (De Quervain thyroiditis)
Occur after viral illness
Painful tender Goiter and SxS of hyperthyroid
Increase in ESR and CRP
39
Name the medication which decreases the absorption of levothyroxine
Bile acid binding reagents
Iron / Calcium and aluminium hydroxide
PPI / Sucralfate
40
Important point of thyroid medication
Oral estrogen or pregnancy (↑estrogen)--->↓ clearance of TBG--->↑TBG--->↓free T4--->↑dose of levothyroxine
Also by tamoxifen / raloxifene / Heroin / methadone
41
Name the medication which decreases TBG concentration
Anabolic steroid / Androgen / Steroid / slow release nicotinic acid
TBG conc decrease ---> T4 increase---> decrease dose of levothyroxine
42
Name the medications which increases thyroid hormone metabolism
Rifampin
Phenytoin
Carbamazepine
43
What are the test to dx the cause of thyroid nodule
TFT
U/S neck
FNAC
44
What to do if patient with thyroid nodule and with out risk factors of US finding of cancer?
((In case US finding or having risk factor of cancer stat FNAC))
1) TSH----> If low----> do RAIU
RAIU----> Hot nodule---->t/m Hyperthyroidism
And if cold nodule----> Do FNAC
2) If TFT is normal or increase—> FNA
45
To whom parathyroid surgery is beneficial?
Serum calcium >1mg/dl above upper limit of normal range
Young age <50 Primary
Bone marrow density T-score
46
Name the medication for hyperparathyroidism
Bisphosphonate can be used in those who refuse surgery and have prior history of osteopenia/osteoporosis
47
What are the causes of hypercalemia in which PTH level remain normal or low?
Malignant::
Malignancy
Non malignant::
Vit-D toxicity
Drug induced / milk alkali syndrome
Granulomatous disease
Thyrotoxicosis
ImMobilization
48
How lymphoma increases the calcium level?
By increasing the production of Vit-D3 result absorption of calcium from Gut
49
Name the cancer which increases the calcium level by producing PTHrP
MOA —-> PTH receptor activation and excessive bone resorption
Squamous cell carcinoma
Renal and bladder cancer
Ovarian and Endometrial cancer
Breast cancer
50
Why D3 level low in Humoral induced hypercalemia?
PTHrp does not induce conversion of 25-OH vitamin-D to 1,25-diOH vitamin D to the same extent as PTH and hence its levels will be low or low normal
51
How to t/m hypercalemia due to ImMobilization?
Hydration and Bisphosponates
52
Important point
Hypoalbuminemia--->may decrease total calcium level and not ionized calcium level
53
What are the findings of Osteomalacia on imaging?
Thining of cortex with reduced bone density and concave shaped vertebral bodies (codfish)
B/L and symmetrical pseudofracture (looser bones)
54
What are the lab findings of Paget disease?
Normal ions values along with PTH
Marker of bone resorption (c-telopeptide, n-telopeptide) and bone formation (alkaline phosphatase, osteocalcin)—significantly ↑.
55
What is the CBC finding in patient with adrenal insufficiency?
Increase level of eosinophils
56
Important point of adrenal insufficiency
Etomidate shouldn't be used as it inhibit steriod synthesis and acute adrenal crisis--->avoid in pts suspected of HPA suppression
57
How to treat Primary hyperaldosteronism?
If U/L adrenal adenoma--> surgery Or Potassium sparing diuretic if poor surgical candidate
If B/L----> Aldosterone antagonist
58
How alcohol causes hypogonadism?
Suppressing LH release from pituitary Or by directly inhibiting testosterone production from testes
59
Important point
Normal to have gynecomastia in boys during puberty
It will resolve in few months to 2 yes without intervention
60
If patient has localised gangrene in foot what is the stage?
Stage 5
61
If patient has extensive gangrene involved the whole foot what is the stage of foot ulcer?
5
62
If patient has deep ulcer penetrating to ligament or muscle but no bone involved or abscess formation what is the stage of foot ulcer?
2
63
Important point
Patient with anorexia have EUTHYROID hypothyroxinemia
Normal TSH
Normal to decrease T3 / T4
64
How d/f malignancy increase the serum calcium level?
By increasing production of Vit-D3
Increase PTHrP
Bony Mets
65
Important point
PTHrp doesn't involve in production of Vit-D3 so it's level will be low
66
How to d/f thyroid storm / pheochromocytoma / malignant hyperthermia?
No fever or rigidity in pheochromocytoma
Fever but no rigidity in thyroid storm
Fever plus rigidity in Malignant hyperthermia
67
How LDL and TAG level increase in hyperthyroidism?
By decreasing the activity of LPL
| And decreasing the activity of LDL receptor
68
Name the antiarrhythmic which QT interval
Class IA
Amidarone
Class 3
Sotalol
69
Name the antiarrhythmic which QRS duration
Class-1a (procainamide)
```
Class 1C (flecainde)
Amidarone
```
70
Name the antiarrhythmic which PR interval
Class 2
Amidarone / sotalol
Class 4
71
How to approach menopause treatment?
If mild Vasomotor sxs--->behavioural modification
If mod-severe----> SSRI (if contradiction of HRT)
If no CI Of HRT—->check Uterus-->if present give HRT and if absent give Progesterone
72
D/f b/w Simple and complex Breast cyst findings
Simple--->Thin wall fluid filled (anechoic) without solid or echogenic debri
Complex--->Thick wall sepated with solid and cystic component
73
How to manage Complex Breast cyst?
Bx
74
How to manage SIMPLE breast cyst?
If Asymptomatic---> Obs
If sxs FNA
75
How to manage Symptomatic SIMPLE breast cyst?
Do FNA
If bloody aspirate---> Bx and imaging
If non-bloody aspirate--->if cyst resolve--->no management further OR if persist or Recurrent---> bx and imaging
76
How to Approach asymptomatic Isolated proteinuria in kids ?
| Asymptomatic Isolated means just proteinuria without other findings
Check Pr/Cr ratio--->if increase renal disease
If normal--->check protein in next Urine D/R
If increase--->orthostatic
If negative---->Transient
77
How to Approach Primary hyperthyroidism?
Check Signs of Graves disease
If no signs —->RAIU
If high uptake---> Graves or Toxic/multi nodular goiter
If low uptake--->check thyroglobulin level
If low level ---> exogenous hormone
If high level—->thyroiditis Or Iodide exposure
78
Difference b/w lab report of DKA and HONK
DKA:::
Met-Acidosis with increase anion gap
Positive ketones with glucose 250-500mg/dl
Serum osmolality less than 320
HONK::
Normal anion gap without Met-Acidosis
Negative or small ketones with glucose ≥600
Serum osmolality more than 320
79
What are the cause of Erectile dysfunction?
| Remember PENIS
Psychological
E endocrine like DM , low testosterone
N Neurogenic
I insufficient blood flow
Substance like antiHTN/ antidepressants/ ethanol
80
How to d/f psychogenic and organic Erectile dysfunction?
Intact nocturnal and early morning penile erection seen in psychogenic
Whereas both these affected in organic causes
81
Which nerves involved in Erection?
Parasympathetic S2-S4
| Sympathetic T11-T12
82
Triad of Euthyroid sick syndrome
Seen in non thryoid illness
Normal T4 and TSH
Decrease total and Free T3
83
How thyroid hormone production increase to meet metabolic demand in pregnancy?
Estrogen increase TBG result increase only in bound hormones
B-HCG stimulates TSH receptor increase thryoid hormones
Both these suppress TSH
84
TFT Pattern in Pregnancy
Increase Total 4
Mild Increase or unchanged free T3
Deceased TSH
85
How to Approach PPROM from 34 wks till less than 37 wk?
Delivery
GBS ppx ABx like penicillin
± Steroid
86
How to approach uncomplicated PPROM before 34 wks?
| Remember FACE
F fetal surveillance
A Abx like azomax and ampicillin
C corticosteroids
E expectant management
87
How to approach complicated PPROM before 34 wks?
Complicated means infection or Fetal /maternal compromise
C-DAM
Corticosteroids
D immediate delivery
A Abx like ampicillin and Gentamicin
M magnesium if before 32 weeks
88
What are the indications of Anti thyroid medication in GRAVES diseases?
* Pregnancy
* Old age with limited life expectancy
Mild hyperthyroidism
Preparation for Radioactive iodine Or thyroidectomy
89
What are the indications of RADIOACTIVE IODINE in GRAVES diseases?
Mod-severe hyperthyroidism
| With or without mild ophthalmopathy
90
What are the indications of Thyoidectomy in GRAVES diseases?
1) Very large Goiter
2) Retrosternal Goiter with Obs SxS
3) Co existing primary hyper parathyroidism
4) thyroid cancer!!??
5) Pregnant who can’t tolerate Anti thyroid meds
6) severe ophthalmopathy
91
How Serum And urine calcium level increase in Hyperthyroid?
Increase osteoclasts activity result increased Sr. calcium level —-> -ve PTH—-> No absorption of calcium from kidney—-> loss of calcium in urine
92
Important point of thyrotoxic myopathy
Both in acute and chronic type, proximal weakness occur but in acute distal weakness also
There is no bulbar or respiratory muscle involvement
93
What are the S.E of anti thyroid medication?
Both cause agranulocytosis
* Prophylthiouracil—-> Hepatic failure and ANCA associated vasculitis
* Methiamzole—->1st trimester teratogen and cholestasis
94
How to manage thyroid storm?
1) BB like propanol
2) Steroid like hydrocortisone
3) PTU followed by iodine solution to decrease synthesis and release of hormones
4) find and treat the underlying cause
95
Triad of Painless (Or silent) thyroiditis
Non tender small Goiter
Positive TPO Ab with low radioactive uptake
Brief episode of hyperthyroid
96
How GENERALIZED RESISTANCE TO THYROID HORMONE present?
Autosomal dominant Occur due to peripheral resistance
SxS of hypothyroid with Increase T3 and T4
Normal or mild increase in TSH
97
How FHH occurs?
Defect in calcium sensor of PTH gland result loss of negative feedback on Gland by hyercalcemia
98
Triad of VIPOMA
Secretory water diarrhoea with osmolal gap less than 50
Low K, Chloride
increase Calcium and Glucose
99
How to dx and manage VIPOMA?
Serum VIP level
Image like CT or MRI to localise tumor
Rx is IV volume repletion
octreotide to ↓ diarrhea
possible hepatic resection with mets to liver
100
Name the condition causing a Vit-D induced hypercalcemia
ENDOGENOUS::
Lymphoma
Granulomatous diseases like sarcoidosis
EXOGENOUS::
Supplement
Calcidoil (Vit D2)
Calcitriol (Vit D3)
Calcipotirene (topical Vit-D derivative)
101
How bony mets increase Calcium level?
Release cytokines to stimulate bone resorption
Seen in breast cancer , multiple myeloma and lymphoma
102
How to approach Low serum calcium level?
Check Sr. magnesium
Drug induced
Due to citrate or increase volume
If not b/c of above —-> Check PTH
103
What are the causes hypocalcemia in which PTH is high?
Tumor lysis syndrome
Inflammation like pancreatitis or sepsis
Endocrine like CKD / Vit-D deficiency
PTH resistance
104
What are the causes hypocalcemia in which PTH is low?
Removal of gland via surgery
Autoimmune like polyglandular autoimmune syndrome
Infiltrative disorder like mets, Wilson diseases or hemochromatosis
105
Triad of Pseudohypoparathyroidism type 1A (Albright hereditary osteodystrophy)
Low calcium level despite Increase PTH
Obesity and Shortened 4th/5th digits
short stature and developmental delay
106
What is the cause of Pseudohypoparathyroidism 1A?
autosomal dominant
Due to inactive G-protein alpha subunit causing end-organ (kidney and bone) resistance to PTH
Defect must be inherited from mother due to imprinting.
107
Triad of Pseudopseudohypoparathyroidism
SxS same as of Albright hereditary osteodystrophy
No end organ resistance so PTH and calcium remain normal
Occurs when defective C, protein alpha subunit is inherited from father but Normal maternal allele maintains responsiveness of kidney to PTH.
108
Define Osteomalacia
due to defective mineralization of osteoid bone matrix
Low Phosphorus and calcium—> Increases PTH—> bone resorption—> increase ALP
109
What are the causes of PRIMARY adrenal insufficiency?
1) Autoimmune
2) Adrenal haemorrhage/infarction due to anticoagulant or N.meningitis
3) Infection like Tb, HIV or disseminated fungal
Mets like lung cancer
4) Acute illness, injury or surgery in patient with steroid used, CAH or chronic adrenal insufficiency
110
Approach to HTN and hyperkalemia
Plasma Aldo/renin ratio—>if normal find other cause
If increase—>adrenal suppression test —>if negative -> find other cause
If positive—>adrenal imaging
111
Evaluate HTN and hypokalaemia in adrenal imaging (CT scan)
If it shows discrete U/L adrenal adenoma and age less than 40—> surgery
If CT normal or age >40 with abnormal CT—>adrenal venous sampling
If sampling shows —-> B/l adrenal hyperplasia —-> medical t/m
If shows u/L —->surgery
112
What are the cause hypertension with low k, aldo and renin?
CAH
Cushing syndrome
Exogenous mineralocorticoids
Deoxycorticosterone producing adrenal tumor
Steroid resistance
Altered aldosterone metabolism
113
What are the cause hypertension with low k, renin but increase aldosterone?
Conn syndrome
| B/L adrenal hyperplasia
113
What are the cause hypertension with low k but increase in renin and aldosterone?
CHF
Cirrhosis
Co arctation of aorta
Reno-vascular HTN
Renin secreting Tumor
Diuretic abuse
Malignant HTN
113
What are the causes of Androgen deficient Gynecomastia?
Renal failure
Increase prolactin level
Male hypogonadism due to testicular damage or Klinefelter syndrome
114
What are the causes of gynecomastia due to increase level of oestrogen or peripheral conversion?
Remember ACT
Antiandrogenic Or herbal Drugs
Androgen use
Aromatase activity
Cirrhosis
Tumors producing estrogen
Thyrotoxicosis
115
Important point of DKA
Direct assay beta-hydroxybutyrate (BH), which is predominant ketone in DKA
116
Classified the anti DM meds in terms of decreasing HBA1c
Metformin , sulfonylureas> Giltazone>GLP 1 receptor agonist> DPP inhibitors
117
What are the S.e of different DM meds?
1) Lactic acidosis causes by metformin
| 2) CHF, Bone fracture, bladder cancer, Edema by Giltazone
118
Name the tumor which causes hypoglycaemia but shows low level of Insulin, C peptide and pro insulin
NON-BETA CELL TUMOR
Produce IGF II—->insulinomimetic effect when bind to insulin receptor—->hypoglycemia—->↓ insulin, c peptide and proinsulin
119
What are the major risk factors of OSTEOPOROSIS?
Non Modifiable::
Advanced age with Low body weight
Post menopausal
Modifiable::
Smoking
Sedentary life style
Excessive alcoholic
120
Triad of Milk alkali syndrome
PTH independent hypercalcemia due to excessive intake of Calcium
Metabolic alkalosis with low phosphate
Acute kidney injury
121
How to manage milk alkali syndrome?
Normal saline followed by lasix
Discontinued all causative agents
122
How Ophthalmolopathy in GRAVE disease worsen due to radioactive iodine?
It occurs due to effects of activated T cells and TSH receptor Ab (TRAB) on retro orbital fibroblast and adipocytes
Radioactive iodine increase the TRAB which worsen Ophthalmolopathy so give Steroid anti thyroid meds
123
What are the risk Factors of ELDERLY ABUSE?
Woman
Advance age >80 yrs
Cognitive impairment like dementia or depression
Physical disability due to hip fracture or stroke
124
How ELDERLY abuse present?
| Stat call adult protective services
1) Sexual abuse sxs like anogenital trauma
2) signs of neglect like malnourished or pressure ulcers
3) non osteoporotic fracture like spiral fracture of long bones
4) Injuries or bruising at atypical location like trunk or thigh
125
What are the Effects of AMIDARONE on thyroid gland? Both present as hypothyroidism
1) Iodine induced Inhibition of thyroid hormone synthesis (Wolff chaikoff effect)
Present like hypothyroidism(Up TSH and down T4) so give levothyroxine
2) Decrease T4-T3 conversion (down T3 ; up T4 and normal to increase TSH) which doesn't need treatment
126
What are the Effects of AMIDARONE on thyroid gland? Part 2 (both present as hyperthyroidism)
AMIDARONE induced thyrotoxicosis (AIT)
TYPE 1 AIT:
Due to iodine induced Increase hormones synthesis present as hyperthyroidism so give antithyroid drugs.
Type 2 AIT:
Due to destructive thyroiditis give Steroid as TX
127
How to d/f AIT 1 and 2 on TFT and RAIU?
Both have up T4 / T3 and Down TSH
AIT 1 has low RAIU and increase vascularity on U/S due to increase production of hormones
AIT 2 has undectable RAIU and low vascularity on U/S due to increase destruction which release hormones
128
What are the consequences of adding insulin in Refeeding syndrome?
Increase Sr.Na and water leads to CHF and pul edema
Low thiamine ---> wernicke encephalopathy
Low ions like K, Mg and Ph ---> fits and arrhythmia
129
How to approach Rabies PEP if bitten by PETS like dog, Cat or ferret?
Is animal available for Quarantine?
If no----> stat PEP
If yes----> 10 days observation and No PEP if animal is healthy
130
How to approach Rabies PEP if bitten by high risk wild animal like bat, racoons, shunk, fox and coyote?
Is animal available for testing?
If no ----> stat PEP
If yes----> Euthanize and test; if test positive give PEP
131
How to approach Rabies PEP if bitten by (1) low risk animal like rabit rat mouse chipmunk and Squirrel
or (2) livestock or unknown wild animal?
First case---> NO PEP
2nd case ----> contact public health department
132
Name the anti diabetic meds given for CVS patient
Metformin
GLP-1 Agnoist like Liraglutide
SGLT2 Inhibitor like Empagliflozin
133
How to treat Comedonal acne?
Located at nose, forehead and chin
Remember GAS
Topical retinoids like Glycolic acid, Azelaic, Salicylic
134
How to manage mild, mod and severe Inflammatory acne?
It shows inflammatory erythematous papules and pustules
If mild give---> Topical retinoids plus benzoyl peroxide
If moderate---> topical ABx like Clindamycin or erythromycin
If severe---> Oral Abx
135
How to manage moderate, severe and unresponsive Nodular (cystic) acne?
Moderate----> topical (ABx + benzoyl peroxide) + topical ABx
Severe ----> add oral Abx
Unresponsive----> Oral isotretinoin
136
What are the complications of PCO?
| MONE
M Metabolic syndrome LIKE DM or HTN
O OSA
N NASH
E Endometrial hyperplasia or cancer
137
Triad of Osler weber rendu syndrome
| Autosomal dominant
Recurrent nasal bleeding and clubbing
Ruby colored papules blanch with pressure (telangiectasia)
AV malformation with reactive polycythemia
138
What are the IMMEDIATE and Delayed cause of Post operative fever?
• IMMEDIATE (within 6hours after surgery)
Tissue trauma
Blood product
Malignant hyperthermia
• DELAYED (After 1month)
Viral Infections
SSI (indolent organism)
139
What are the Acute Infective and Non Infective cause of Post operative fever?
After 24 hour but before 1
• INFECTIVE::
Nosocomial Infection
SSI (due to Group A strep / C perfringen)
Catheter site Infection
• Non INFECTIVE:
MI
PE and DVT
140
What are the sub Acute Infective and Non Infective cause of Post operative fever
After 1 week but before 1 month
• INFECTIVE::
Catheter site Infection
Clostridium difficile
• NON INFECTIVE
DVT / PE
Drug fever
141
What are the typical features of Edward syndrome?
| Face--->Hands--->thorax---->Abdomen---->Lower limb
Face shows small jaw with prominent occiput and low set Ears
Clenched hands with Overlapping fingers
Heart and Renal defects
Limited hip abduction and Rocker bottom feet
142
What are the typical features of Patau syndrome?
| Face--->Hand-->thorax with abdomen--->lower limb
Face shows small eye with small head Or holoprosencephaly
Hands shows more than 5 fingers
Cardiac with Renal defects and Umbilical hernia / Omphalocele
Rocker bottom feet
