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Flashcards in Endocrine Deck (25)
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1

What should the value of Serum Osmolality be?

290mOSm/kg

2

what should the value of urine osmolality be?

500-800mOsm/kg. Typically 1-3x serum osmolality.
12-24hrs fluid restriction= >850mOsm/kg

3

conditions that increase serum osmolality?

dehydration/sepsis/fever/burns
DM (hyperglycaemia)
Diabetes Insipidus
Uraemia
Hypernatremia
Ethanol/methanol/ethylene glycol
Mannitol Therapy
Sweating

4

conditions that decrease serum osmolality?

excess hydration
hyponaetremia
syndrome of inapproproate ADH secretion

5

conditions that increases urine osmolality?

dehydration
syndrome of inappropriate ADH secretion
adrenal insufficiency
glycosuria
hypernateamia
high protein diet

6

conditions that decreases urine osmolality?

diabetes insipiduc
excess hydration
acute renal insufficiency
glomerulonephritis

7

what is myopia?

short sightedness
long eye, steep cornea, lens too weak, distance clear, near blurred

8

what is hyperopia?

long sightedness
small eye, flat cornea, lens too weak, distance clear, near blurred

9

causes of corneal clouding?

Trauma
Keratoconus
Inherited dystrophy
infection: eg bacterial/viral keratitis, contact lens keratitis

10

causes of cataract?

Drugs: steroid, amiodarone,chlorpromazine,gold, busulphan
Trauma: direct, radiation, electricity, glassblowers, intra-occular surgery
Metabolic: diabetes, hypoglycaemia
Acquired: Senile, atopic
Presenile: myotonia dystrophy, NF2, retinitis pigmentosa
Congential: inherited, infective trisomy 3, metabolic
Inflammation

11

What is retinitis Pigmentosa?

Rare inherited disorder
Black Pigment on the retina
typically presents with tunnel vision and night blindness

12

What are the red flags for retinal detachment?

Floaters, loss of field vision and flashing lights.

Urgent surgical repair if macula is on.

13

What are the causes of retinal detachment?

Rhegmatogenous: break in retina+ vitreous liquification allows fluid to enter the sub-retinal space and seperate. Worse if superior.

Tractional: contracting, retinal membranes, abnormal adhesions and vitreous changes.

Exudatitve: damage to outer blood-retinal barrier allowing fluid into sub-retinal space.

14

What are the causes of retinal central vascular occlusion?

Atherosclerosis
`hyperviscoisty
vasculitis
glaucoma

15

What are the signs of central artery occlusion?

Cherry red spot

Embolic

Tx unsatiactory if <4hrs
exclude giant cell artiritis
TIA referal and Aspirin

16

Important differential for painless loss of unilateral vision?

Temporal Artiritis- Anterior Ischaemic Optic Neuropathay
Need to do ESR
Can go blind bilaterally within 10 days

17

Hypertensive retinopathy:

causes?
Signs?

arteriolar constriction
areriolosclerosis

signs: flame shaped retinal haemorrhage, cotton wool spots and macular stars

disc oedema

18

Explain the pathophysiology of diabetic retinopathy?

MACULOPATHY (M0-M1)= focal, diffuse oedema, ischamia caused by leakages from microaneurysms, exudates, loss of central vision

RETINOPATH& (R0-R1= pre-proliferative, R2-R3= proliferative).
microvascular occlusions= hypoxia= release of VEGF= new vessel stimulation.
New vessels are poor leading to vitreous haemorrhage + tractional retinal detachment. The new vessels i the iridocorneal angle= glaucoma.

19

How to you treat diabetic retinopathy?

OCCULAR: laser- prevents leakage and decreases retinal ischaemia

SYSTEMIC: good diabetic and HTN control
stop smoking
reduce weight and increase exercise
Tx anaemia and renal disease
ACE inhibitors and Statins

20

What is open angle glaucoma?

acquired optic neuropathy associated w/ raised IOP, characteristic pattern of field loss (arculate defect within central 30 degrees) and appearance of the optic disc (progressive disc cupping). Develops slowly over time and is painless.

21

What causes open angle glaucoma?

Raised pressure to due blocakge of outflow through the trabacular. open vs closed angle and primary vs secondary

22

Treatment of glaucoma?

Reduce the IO pressure
95% medically with drops
laser/selective trabeculoplasty

23

Signs of acute angle closure glaucoma?

Red Painfu Eye
Halos
reduced vision
unresponsive semi dialted pupil (from ischaemia)

24

Cause of acute angle closure glaucoma?

shallow AC
closed iridocorneal angle + rapid increase in IOP

25

Treatment of acute angle closure glaucoma?

Admit
systemic acetazolamide
miotics

laser- periperal iridotomies/ cataract removal.