Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Amir Sam DPD > 15/12/2015 Interactive Cases in General Medicine 5 > Flashcards

15/12/2015 Interactive Cases in General Medicine 5 Flashcards

1
Q

40M with fever, rigour, tachycardia, hypotension, chest pain, dark urine. Post-op, what is the diagnosis?

A

Immediate transfusion reaction, haemolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the causes of polycythaemia?

A

If primary: myeloproliferative

If secondary: high altitude, chronic hypoxia (COPD), EPO from iatrogenic/artificial sources or renal cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Low platelets, thrombocytopenia causes?

A

Increased use: DIC, ITP
Decreased production: infiltration
Increased pooling in the spleen: chronic liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

50M with rheumatoid arthritis, normal/high ferritin, normocytic anaemia. What must still be investigated?

A

Ferritin is an acute phase reactant which increases in chronic disease (hence normocytic), it is artificially normal and will mask a GI/UG bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

40F, Hb 110, MCV 65 what is the diagnosis?

A

Beta thalassaemia heterozygosity, the MCV is disproportionately low in comparison to the Hb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Causes of a macrocytic anaemia?

A

“Alcoholics May Have Liver Failure”

  • Alcohol (raised GGT)
  • Myelodysplasia (pancytopaenia, low cell lines)
  • Hypothyroidism (history, T4, TSH)
  • Liver disease
  • Folate/B12 deficiency (small bowel disease, gastrectomy, Schilling Test)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Presentation of polycythaemia?

A

Headache, blurred vision (hyper viscosity), tinnitus, pruritus after a hot bath, stroke/DVT, gangrene, choreiform movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is an acute painful crisis of sickle cell anaemia managed?

A

Analgesia, O2, IV fluids, Abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How is a stroke from SCA managed?

A

Exchange blood transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is sequestration managed?

A

RBC pooling in lungs causes cough, fever, SOB. In spleen causes exacerbation of anaemia; treat with splenectomy and Abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How are gallstones managed?

A

Cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the complications of sickle cell anaemia?

A

Painful crises, splenic/lung sequestration, gallstones/cholecystitis, stroke

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Presenting features of multiple myeloma?

A

CRAB

  • Hypercalcaemia (polyuria, polydipsia, constipation due to nephrogenic DI, insensitive to ADH)
  • Renal failure (Ur+Cr)
  • Anaemia
  • Bone pain, osteoporosis (DXA)
  • Infection due to immunoparesis from clonal expansion of one Ig
  • Cord compression due to spinal involvement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the pathophysiology of MM? How is it investigated and confirmed?

A

Clonal proliferation of immunoglobulin paraprotein. Confirm with urine Bence-Jones proteins (light chain Ig) or serum electrophoresis showing Ig

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the differential diagnosis for a 50M with high calcium, low PTH?

A

Malignancy, myeloma, sarcoidosis

  • HIGH ALP = malignancy or sarcoidosis
  • LOW/NORMAL ALP = myeloma. Plasma cells suppress osteoblasts, hence ALP is unchanged
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the differential diagnosis for a 50M with high calcium, high PTH?

A

Primary hyperparathyroidism

FHH familial hypocalciuric hypercalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Causes of anaemia with reticulocytosis

A

Haemolytic crisis: haemorrhage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Causes of anaemia with low reticulocytes

A

Marrow problem: parvovirus B19 infection, SCA aplastic crisis, blood transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is diabetes diagnosed?

A

Fasting >7, random >11.1 (retinopathy increases beyond these figures)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is impaired fasting glucose/impaired glucose tolerance?

A

IFG 6-7

IGT 7.8-11.1 after OGTT; 75g glucose 2h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Which antibodies may be present in T1DM?

A

Anti-islet cell Ab

Anti-GAD Ab

22
Q

Metformin and sulphonylurea (weight loss/neutral/gain?)

A

Metfomin weight neutral (and reduced mortality), sulphonylurea weight gain

23
Q

Diabetic drugs

A

Metformin - biguanide
Sulphonylureas include gliclazide, glibenclamide. Weight gain
Pioglitazone - thiazolidinediones, not for heart failure (rosiglitazone), weight gain
Insulin - weight gain
Sitagliptin - DPP4 inhibitor, weight neutral
GLP-1 agonist - exenatide, incretin mimetic lower risk of hypos, weight loss
SGLT2 inhibitors - glifozin, weight loss, inhibit resorption of glucose from the kidney
Acarbose - alpha glucosidase inhibitor

24
Q

How is diabetic nephropathy screened for?

A

ACR albumin-creatinine ratio. Want to detect microscopic albuminuria before urine dipstick and prevent progression of renal disease

25
Q

How is DKA/HHS treated?

A

IV fluids, potassium, insulin

26
Q

What is sliding scale insulin?

A

A variable rate IV insulin infusion, if glucose X, give dose Y. in T1DM, never give 0. Given as actrapid + saline, if patient is unwell, sepsis, surgery, not eating

27
Q

Graves signs and symptoms

A

Tremor, tachycardia, palpitations, weight loss good appetite, irregular periods, proptosis, pretibial myxoedema, cheimosis, smooth goitre,

28
Q

Investigations for Graves

A

TFT high T3/4, low TSH, TSH-R AutoAb high

Tc-99m uptake scan high diffuse uptake, as TSH-like Ab is present

29
Q

Thyroid cancer presentation

A

Lump in the neck, family history, radiotherapy/radiation exposure, rapid enlargement and compression, lymphadenopathy

30
Q

Types of thyroid cancer

A

Follicular, papillary, medullary, anaplastic

31
Q

Investigations thyroid cancer

A

USS malignant features, Tc-99m scan cold nodules, no uptake. FNAC, MDT

32
Q

Treatment thyroid cancer

A

Surgery, thyroxine replacement, radio iodine ablation

33
Q

Bitemporal hemianopia, expressing milk, low sex drive, no periods

A

Prolactinoma: galactorrhea, amenorrhoea, low libido. Men present later with bitemporal hemianopia. Give cabergoline to shrink the tumour and lower PRL. Transphenoidal surgery is possible

34
Q

Cushing syndrome symptoms

A

Thin skin/easy bruising, proximal myopathy, purple striae. HTN, DM, osteoporosis at a young age

Tired, depressed, hairy, weight gain central obesity

35
Q

Causes of amenorrhoea/oligomenorrhoea?

A

Pregnancy - b-HCG
Hypothalamus - low BMI, excess exercise
Pituitary - prolactinoma high PRL, low FSH/LH suppressed
Thyroid - high or low
Ovarian failure - high FSH, low oestrogen
PCOS - hirsute, high androgens

36
Q

How does hypokalaemia present?

A

Arrhythmia, weakness, polyuria (similar to hyperCa, nephrogenic DI develops)

37
Q

What are the causes of hypokalaemia?

A

Vomiting, diuretics, primary hyperaldosteronism (bilateral hyperplasia or Conn’s) this is investigated with aldosterone:renin ratio, renin is low due to negative feedback

38
Q

A young man on 3 antihypertensives (and still uncontrolled) presents with HTN, low K, high aldosterone. What is the diagnosis and how is he investigated?

A

Aldosterone:renin ratio is high due to Conn’s syndrome, primary hyperaldosteronism: Na retention, K excretion. 1 sided tumour remove, give spironolactone if bilateral

39
Q

How do you assess for euvolaemic causes of hyponatraemia?

A

SIADH, hypothyroid, hypo adrenal: urine/plasma osmolality, TFT, short synACTHen test

40
Q

What is the urine sodium in hyper/hypovolaemic hyponatraemia?

A

LOW in both due to low renal perfusion, renin increase, aldosterone increase, more water and salt resorption

41
Q

How is osmolality calculated?

A

2(Na+K)+U+glucose

42
Q

Causes of high urine osmolality?

A

Dehydration, HHS, T2DM

43
Q

Causes of low urine osmolality?

A

Diabetes insipidus –> dilute urine

44
Q

1 Low Ca, high PTH, low phosphate

A

Vitamin D deficiency, secondary hyperparathyroidism due to low Ca

45
Q

2 High Ca, low phosphate, high PTH

A

Primary hyperparathyroidism (phosphate trashing hormone)

46
Q

3 Low Ca, high phosphate, low PTH

A

Primary hypoparathyroidism

47
Q

4 High Ca, low PTH, normal phosphate

A

Malignancy, myeloma, sarcoidosis (check ALP, if high, then malignancy. Serum ACE for sarcoid)

48
Q

5 High phosphate, low Ca, high PTH

A

Renal failure, secondary hyperparathyroidism. High phosphate due to renal failure, low Ca due to kidney failure inability to hydroxylate vitamin D

49
Q

Pearly lesion on skin

A

BCC

50
Q

Oligoarthritis, sacroilitis, DIP arthritis, nail changes

A

Psoriatic arthritis

51
Q

Why is there tingling of fingers in hyperventilation?

A

Respiratory alkalosis causes albumin to bind Ca, transient low Ca causes tingling sensation. Chvostek and Trousseau sign

52
Q

Renal artery stenosis Ix

A

Small kidney = stenosis, asymmetrical. Investigate with MR angiography, if bilateral, do NOT give ACEi causes renal failure. Cause of pre-renal AKI

Amir Sam DPD (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions