Endocrine and orthopaedic

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jaz_walker
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302234
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Endocrine and orthopaedic
Updated:
2015-05-06 09:14:41
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  1. What are the commonest causes of goitre?
    Grave's, multinodular, physiological (pregnancy/puberty), other (iodine deficiency, lithium)
  2. What are causes of diffuse goitre?
    simple (e.g. physiological, iodine deficiency), autoimmune (grave's, hashimoto's), infective (acute viral, de quervains)
  3. What are causes of a nodular goitre?
    Multinodular, toxic multinodular, solitary nodule (cancer, plummer's)
  4. What are complications of a goitre?
    Endocrine: hyper/hypothyroidism. Anatomical: tracheal compression, recurrent laryngeal, oesophageus, SVC, cosmetic.
  5. how is hyperthyroidism managed?
    symptomatic: b blocker. Curative: carbimazole (TPO inhibitor), radioiodine/surgery
  6. What is Cushing's disease?
    ACTH producing pituitary tumour.
  7. What is Nelson's syndrome?
    Rapid enlargement of pre-existing pituiary tumour after bilateral adrenalectomy
  8. What are the ACTH dependant causes of Cushing's syndrome?
    cushing's disease, ectopic ACTH secretion (SCLC)
  9. What are the ACTH independent causes of Cushing's syndrome?
    Steroids, adrenal adenoma, adrenal hyperplasia
  10. What is the first line tests for cushing's syndrome?
    overnight dexamethasone suppression test, or 24 hour urinary cortisol.
  11. Second line tests for cushing's disease?
    48 hour dexamethasone suppression test, midnight cortisol.
  12. If high ACTH then what test should you do next?
    High dose dexamethasone suppression test
  13. How can symptoms of Cushing's be medically managed?
    metyrapone/ketoconazole
  14. What are symptoms of acromegaly?
    Pituitary enlargement (hypopituitarism, bitemporal hemianopia, headache), soft tissue growth (hand and foot size, facial features, macroglossia, hoarseness, osteoarthritis, carpal tunnel), activity (sweating, hypertension)
  15. What investigations confirm acromegaly?
    IGF-1 level, glucose tolerance test.
  16. What investigations follow up acromegaly?
    pituitary function tests (serum prolactin), MRI pituitary
  17. What are complications of acromegaly?
    diabetes, cardiomyopathy, colon cancer
  18. what is management of acromegaly?
    definitive: surgical transsphenectomy. Radiotherapy. Octreotide (somatostatin analogue)
  19. What causes gout?
    renal disease, metabolic syndrome, polycythemia, haemolytic anaemia, psoriasis, solid organ transplants, ciclosporin, tacrolimus
  20. what are causes of dupytren's contracture?
    genetic, liver disease, anti-epileptics, diabetes, peyronie's disease, lederhose disease (callous under foot), garrod's disease (pads on backs of knuckles)
  21. what is management of dupytren's contracture?
    non-surgical: splint + physio, collagenase. Minimally invasive: needle fasciotomy. Surgical: partial fasciectomy or dermofasciectomy.
  22. Which two tests are useful for diagnosing carpal tunnel?
    phalen's sign, tinnel's test
  23. what are causes of carpal tunnel?
    endocrine: diabetes, hypothyroid, acromegaly. Local: ganglion, lipoma. Other: obesity, pregnancy, idiopathic.
  24. what are differentials for carpal tunnel?
    thoracic outlet syndrome, pronator syndrome
  25. what bone deformities might you expect in paget's disease?
    sabre tibia, kyphosis, frontal bossing, enlarged maxilla, pathological fractures, nerve deafness.
  26. what radiological findings occur in paget's?
    bone enlargement, cotton wool pattern
  27. what tests are abnormal in paget's?
    ALP: increased. Urinary/serum hydroxyproline: increased.
  28. What is management of paget's?
    NSAIDS, bisphosphonates, maintain vit D + calcium intake
  29. What are complications of paget's?
    osteosarcoma, nerve compression
  30. What heart condition is common in marfan's?
    aortic dilation
  31. which gene is affected in marfan's?
    Autosomal dominant FBN-1 gene for Fibrillin-1
  32. what are the important features to check for in marfan's?
    genetic test, eye exam for myopia + lens dislocation, echo for aortic regurg.
  33. what are the main complications of systemic sclerosis?
    lung fibrosis (give cyclophosphamide), pulmonary hypertension, renal crises (give low dose ACE inhibitor)
  34. What is treatment of gout?
    colchicine for treatment, allopurinol for prevention
  35. What are the classic radiological features of osteoarthritis?
    loss of joint space, osteophytes, subchondral sclerosis, subchondral cysts
  36. What are the extraarticular features of ankylosing spondylitis?
    (7 A's) Acute anterior uveitis, aortitis, aortic regurg, AV node block, apical pulmonary fibrosis, amyloidosis, achiles tendon enthesitis

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