•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

•What is the link between obesity and diabetes mellitus?

-Fat cells release free fatty acids and also TNF-a which are responsible for insulin resistance. A new protein called resistin secreted by the fat cells, also causes insulin resistance.

#Medicine
#Diabetes

C-peptide: can help differentiate between types of diabetes:

↑ C-peptide levels may indicate insulin resistanceand hyperinsulinmia → T2DM
Q.  What are the  causes of unilateral wasting  of leg? A.  As follows: Y Diabetic amyotrophy Y Old poliomyelitis Y Arthritis or trauma Y Cerebral palsy Y Disc prolapse.
↓ C-peptide levels indicate an absolute insulindeficiency → T1DM