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Flashcards in Kumar and Clark Deck (51):
1

Where does rotator cuff tendonitis radiate to?

Upper arm

2

When is rotator cuff tendonitis worse?

At night
On abduction and elevation
(painful arc)

3

What may be associated with rotator cuff tendonitis?

Subacromial bursitis

4

When may isolated subacromial bursitis occur?

After direct trauma, falling onto outstretched arm or elbow
(calcific tendonitis also causes bursitis)

5

Calcific tendonitis and bursitis

Feels hot and swollen

6

Calcific tendonitis and bursitis: what does the bursitis look like on x-ray?

Diffuse opacity

7

Which muscle may waste in Carpal tunnel syndrome?

Abductor pollucis brevis

8

Nerves roots which make up brachial plexus?

C5, C6, C7, C8, T1

9

Which muscles keeps the scapula against the thoracic wall and retract the scapula?

The rhomboid major and minor

10

Dorsal scapula nerve innervates which muscles?

C3/C4
Innervates the rhomboid major and rhomboid minor

11

Cancers which could cause ectopic ACTH (cushings)

Thymus
Pancreas
Lung

12

Differentiating between pituitary, adrenal and ectopic cause of cushings? (ACTH)

ACTH if
Pituitary problem = 300

13

High dose dexamethasone suppression test will confirm which problem as the cause of cushings?

High dose dexamethasone will show if the problem is pituitary (if it is pituitary problem then high dose dexamethasone will suppress by 50%)

14

Name a somatostatin analogue that could be used in the treatment of cushings?

Pasireotide

15

Problems with which part of the pituitary could cause diabetes insipidus?

Posterior pituitary

16

Hormone replacement for hypopituitarism: TSH and hydrocortisone dosages?

TSH 100-150 mcg/day
Hydrocortisone: 10-25 mg/day

17

What does growth hormone do?

Improves quality of life
Decreases abdominal obesity
Increases muscle mass, stamina and exercise tolerance
Decreases LDL, increases HDL
Increases bone density
Improves cardiac function
Given by daily SC injection

18

Risks of testosterone replacement

Prostate enlargement
Polycythaemia
Hepatitis

19

Causes of cranial diabetes insipidus?

Familial
Acquired (e.g. trauma)
Rare (tumour, sarcoid, irradiation, meningitis)

20

Treatment of DI

Desmospray
nasally; 10- 60 mcg/day
Desmopressin oral tablets
100-1000mcg per day
Desmopressin sublingual tablets
- 60 – 360 mcg per day
Desmopressin injection
1-2mcg IM per day

21

What kind of medication could you use to shrink a GH tumour before surgery?

Somatostatin analogue

22

Medication for prolactinoma?

Dopamine antagonist e.g. cabergoline

23

What is a TSHoma?

Pituitary tumour that secretes TSH

24

TSH level in primary hypothyroidism?

Elevated

25

TSH level in secondary hypothyroidism

Decreased or normal

26

Myxoedema

Myxoedema - THIS IS CONFUSING!
- Either refers to severe hypothyroidism e.g. Myxoedema coma
- OR to accumulation of hydrophilic mucopolysaccharides in the ground substance of the dermis and other tissues → doughy induration of the skin classical seen in the shins = PRETIBIAL MYXOEDEMA. This is seen in GRAVES disease (i.e. thyrotoxicosis)

27

Drugs which can cause iodine deficiency?

amiodarone, lithium, IL-2, IFN-α, iodides, aminosalicylic acid, aminoglutethimide, pheylbutazone, thalidomide, stavudine, bexarotene

28

Drugs I have heard of, that could cause iodine deficiency (-->hypothyroidism)

Amiodarone
Lithium
ASA
IFN-alpha
Iodides
IL-2

29

Cancer which could cause secondary hypothroidism?

Craniopharyngioma

30

Characterized by
Presence of Thyroid Peroxidase Antibodies (in blood)
T-cell infiltrate and inflammation on microscopy

Hashimotos thyroiditis?

31

What characterises hashimotos thyroiditis?

Presence of Thyroid Peroxidase Antibodies (in blood)
T-cell infiltrate and inflammation on microscopy

32

Cardiac signs and symptoms of hypothyroidism?

Cardiac dilatation
Pericardial effusion
Reduced heart rate
WORSENING OF HEART FAILURE

33

Hypothyroidism and heart failure?

Worsening of heart failure!!!

34

Hypothyroidism metabolic effects?

Hyperlipidemia
Decreased appetite
Weight gain

35

Respiratory signs and symptoms of hypothyroidism?

Deep hoarse voice
Macroglossia
Obstructive sleep apnoea

36

Hypothyroidism and effects on prolactin?

Hyperprolatinaemia because of increased TRH (increases prolactin secretion)

37

Common causes of macrocytosis?

Vitamin B-12 deficiency
Folate deficiency
Liver disease
Alcoholism
Hypothyroidism
A side effect of certain medications, such as those used to treat cancer, seizures and autoimmune disorders
Increased red blood cell production by the bone marrow (regeneration) to correct anemia, for example, after blood loss

38

Hypothyroidism laboratory investigations?

High TSH, low T3/T4
Macrocytic anemia (this is typical, check no underlying vitamin B12 deficiency)
Elevated creatinine kinase
Elevated LDL, cholesterol
Hyponatremia
Hyperprolactinemia

39

When would you take T4?

Before breakfast

40

Hyperthyroidism and muscles?

Muscle weakness especially in upper arms and thighs

41

When does subacute thyroiditis usually occur?

Usually after an upper respiratory infection e.g. mumps, influenza, common cold

42

Treatment for opthalmopathy?

Decompression
Lubricant
Radiotherapy
Corrective surgery
Stop smoking

43

Hyperthyroidism - Toxic nodule (adenoma)

More insidious onset
Usually older patients
May feel nodular
Antibody negative
Assymetric goitre (e.g. on uptake scan!!)

44

T4 and TSH in subacute thyroiditis?

T4 high then low then normal
TSH low then high then normal

45

Scintigraphy scan and uptake in subacute thyroiditis

Low uptake!

46

Thyroid storm

Medical Emergency A,B,C
Severe Hyperthyroidism
Respiratory and Cardiac Collapse
Hyperthermia
Exaggerated reflexes
May require Ventilation
May be associated underlying infection

Tx: Lugols Iodine, glucocorticoids, PTU, B-blockers, fluids, monitoring

47

Treatment for thyroid storm?

Lugols iodine
Glucocorticoids
Propyluracil
Beta blockers
Fluids
Monitoring

48

Which thyroid medication is preferred in pregnancy?

Propythiouracil

49

Which autoimmune diseases are associated with Graves?

Primary autoimmune adrenal insufficiency
Sjogrens
SLE
T1DM
Vitiligo
Myasthenia gravis
PERNICIOUS ANEMIA
RA

50

Main cause of non-goitrous hypothyroidism?

Atrophic thyroiditis

51

Main causes of goitrous thyroiditis?

Hashimotos thyroiditis
Iodine deficiency