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13.04.05 Clinic notes

Thyroid cancer
  • Types
    • Papillary
    • Folicular
    • Anaplasti (Dead in 6 months)
    • Medullary (Different to the other three)
      • Comes from C cells (different origin)
      • Treat with wide excision (big scar)
      • Follow with external beam radiotherapy
      • Produce calcitonin
  • Check-ups
    • TSH levels
      • In order to check suppression by exogenous thyroxine
      • Make sure there's no TSH around to stimulate remaining cells
    • Thyroglobulin
      • Produced by remaining cancerous thyroid cells

Macular degeneration
  • Risk factors
    • FHx, Smoking, Age, (HTN)
  • Types
    • Dry
      • Common, Slow, Untreatable
    • Wet
      • Rare, Fast decline, Treatable in early stages
      • Can use anti-VEGF agents, injected into eye (pricey)


RA

  • Atlantoaxial subluxation
  • Swan-neck vs boutonniere deformity
  • Check ESR as well as CRP as one or both my rise
  • Inflammation makes you tired
  • Associated symptoms
    • Sicca
    • Sun rash
    • Rash
    • Mouth ulcers
    • Raynauds
    • Migraine
    • GI
  • Smokers do worse
  • Hydroxychloroquine
    • Safe in pregnancy
    • Slow offset
    • Ophthalmological complications
      • Binds melatin => Retinopathy
  • 50% can't work within 5 years



Notes
  • Acetazolamide side effects
    • Flatulence, dry skin, taste changes, "fizzing feeling"
  • Tinnitus:
    • Prevalence: 30% at some point, 10% permanently
    • CBT, Retraining therapy, Mindful meditation, Relaxation therapy (? effect above just the counselling)
  • White noise desensitisation in hyperacusis => Decreased central gain (6-8 dB)
  • Steroids raise IOP
  • Causes of straight-line distortion
    • Lens
    • Cornea
    • Retina
      • RPE detachment
      • Haemorrhage
      • Scarring
  • Xalatan (Latanoprost)
    • Used for controlling the progression of glaucoma or ocular hypertension by reducing intraocular pressure
    • Prostaglandin F2α analogue
    • Works by increasing the outflow of aqueous fluid from the eyes, through the uvealsclearal tract
  • Sarcoidosis
    • Check serum ACE levels
    • Non-caseating granulomas
    • Derranged calcium
  • NSAIDs block spine fusion post-surgery
  • Tibialis anterior (dorsiflexion) for L5 function after spinal injury
  • Proximal muscle weakness: Steroids, Low Vit. D
  • Tapentadol
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