•Cave!!

-If the patient has deficiency of cortisol (as in hypopituitarism or Addison’s disease), corticosteroid should be given first and then thyroxine. Otherwise, if thyroxine is given first without correcting cortisol deficiency, there will be severe Addisonian crisis.

#Thyroid
#Medicine

•What is Hashimoto’s thyroiditis?

-It is an autoimmune thyroiditis characterized by destructive lymphoid infiltration of thyroid leading to atrophic change with regeneration and goiter formation.
-It is more common in middle aged woman.

-The goiter is usually diffuse, moderately enlarged and firm or rubbery. Sometimes, it may be soft to hard.

-Antithyroid antibody (very high, >1000 IU/L)—antimicrosomal (antiperoxidase) in 90% and antithyroglobulin antibodies (no rise of TSH-receptor antibody).

-Initially, the patient may present with features of toxicosis, called Hashi-toxicosis.

-About 25% patients are hypothyroid at presentation. In the remaining patients, serum T4 is normal and TSH is normal or raised.
-There is risk of developing overt hypothyroidism in future.

-Treatment– thyroxine (it reduces the size of goiter also).

#Thyroid
#Medicine
#Surgery

•What is the natural history of Graves’ disease?

-It may be hyperthyroid, euthyroid followed by hypothyroidism.

•What is euthyroid Graves’ disease?

-The patient is clinically and biochemically euthyroid, but there is ophthalmopathy (also there is diffuse goiter, dermopathy).
-Thyroid releasing hormone (TRH) stimulation test show flat response curve.

#Thyroid
#Surgery
#Medicine

•What is thyrotoxic crisis?

-Thyrotoxic crisis is a medical emergency that's characterized by life threatening increase of signs and symptoms of thyrotoxicosis (also called thyroid storm).

•What are the Precipitating factors for thyroid crisis?

1-Infection
2-Stress
3-Surgery in unprepared patient
4-Following radioiodine therapy (due to radiation thyroiditis).

#Thyroid
#Medicine

•What are the Features of thyrotoxic crisis?

-High fever
-Restlessness,agitation and irritability
-Nausea, vomiting, diarrhea and abdominal pain
-Tachycardia, AF and in elderly, cardiac failure
-Confusion, delirium and coma.

•Diagnosis:
-Mostly clinical and high degree of suspicion is vital.
-FT3, FT4 and TSH should be done immediately.

#Thyroid
#Medicine

•Treatment of Thyrotoxic crisis

(Blood sample is taken for T3, T4 and TSH).
1-The patient should be treated in intensive care unit (ICU).

2-Propranolol 80 mg 6 hourly (or 1 to 5 mg IV 6 hourly).

2-IV fluid (normal saline and glucose).

3-Carbimazole 40 to 60 mg daily. Or propylthiouracil 150 mg 6 hourly (if needed, through Ryle’s tube). Carbimazole can be given per rectally also.

•Other therapy:
-Sodium ipodate, a radiographical contrast media, 500 mg daily is rapidly effective. Or potassium iodide or Lugol’s iodine may be given.
-Dexamethasone 2 mg 6 hourly and amiodarone are also effective.
-Broad spectrum antibiotic.

•General measures:
-Control of temperature and O2 therapy.
-After 10 to 14 days, the patient can usually be maintained on carbimazole alone.

Mortality rate in thyrotoxic crisis is 10%.

#Thyroid
#Medicine

•HELLP SYNDROME

-Hemolysis
-Elevated Liver enzymes
-Low platelets.

#Obs_Gyne

•Cirrhosis Complications:

VARICES

Varices
Ascites/Anemia
Renal failure (hepatorenal syndrome)
Infection
Coagulopathy
Encephalopathy
Sepsis.

#Liver
#Medicine

Radiological features of Rheumatoid Arthritis:

(LESS):

L: Loss of joint space
E: Erosions
S: Soft tissue swelling
S: Soft bones (osteopenia).

#Rheumatology
#Medicine

•Falciparum Malaria complications:

CHAPLIN

-Cerebral malaria/ Coma
-Hypoglycemia
-Anemia
-Pulmonary edema
-Lactic acidosis
-Infections
-Necrosis of renal tubules.

#Infections
#Medicine

•Carcinoid Syndrome Symptoms:

F D R

- Flushing
- Diarrhea
- Right sided heart failure.

#Medicine

•Biliary tract Lesions:

•Pain = Cholelithiasis
•Pain + Pyrexia = Acute Cholecystitis
•Pain + Jaundice = Choledocholithiasis
•Pain + Pyrexia + Jaundice (Charcot's triad) = Ascending Cholangitis


#Surgery

•Elevated jugular veins:

“PQRST"

-Pericardial effusion (tamponade)
-Quantity (fluid overload)
-Right heart failure
-SVC obstruction
-Tricuspid stenosis.

#Medicine

Normal anion gap value is 8 to 14 mmol/L.

•Causes of metabolic acidosis with high anion gap:

1-Diabetic ketoacidosis
2-Renal failure
3-Lactic acidosis
4-Salicylate poisoning.

#Medicine
#Diabetes

•Causes of metabolic acidosis with normal anion gap are:

1-Renal tubular acidosis
2-Diarrhea
3-Ureterosigmoidostomy
4-Acetazolamide therapy
5-Ammonium chloride ingestion.

#Medicine
#Diabetes

-Normal osmolarity is 285 to 300 mosm/kg.

-If it is > 340 mosm, consciousness is depressed.

-Normal anion gap value is 8 to 14 mmol/L.

#Medicine
#Diabetes

•Causes of neuropathic ulcer:

1-Leprosy
2-Diabetes mellitus
3-Polyneuropathy (due to any cause)
4-Tabes dorsalis
5-Syringomyelia
6-Amyloidosis
7-Porphyria
8-Progressive sensory neuropathy.

#Medicine

•What are the causes of ulcer in DM?

-Ischemia
-Neuropathy
-Combined ischemia and neuropathy
-Secondary infection.

#Medicine

•What are the causes of loss of vision in DM?

1-Diabetic retinopathy
2-Cataract
3-Age-related macular degeneration
4-Retinal vein occlusion
5-Retinal artery occlusion
6-Nonarteritic ischemic optic neuropathy
7-Glaucoma.

#Medicine
#Diabetes

•What are the  causes of unilateral wasting of leg?

1-Diabetic amyotrophy
2-Old poliomyelitis
3-Arthritis or trauma
4-Cerebral palsy
5-Disc prolapse.

#Medicine
#Diabetes