26 November Flashcards
What are investigation findings of hereditary spherocytosis?
Increased MCHC
Increased unconjugated bilirubin
Increased LDH
Decreased haptoglobin
Increased reticulocytes (due to increased RBC production)
Increased urinary urobilinogen
What are features of pernicious anaemia?
Low B12
Low intrinsic factor (due to antibodies- specific for diagnosis)
Parietal cell antibodies
What are features of thalassaemia?
Hypochromic microcytic anaemia
High iron and ferritin
low TIBC
What are features of Infectious mononucleosis?
Tonsillitis picture
Splenomegaly
Heterophile antibodies- found on monospot test
What are symptoms of CML?
Anaemia- lethargy
Weight loss and sweating
Splenomegaly/abdo discomfort
Massive increase in WBC
Imatinib is treatment for chronic phase
What is the management of warfarin if INR 5-8?
No bleeding- withold 1-2 doses and reduce maintenance dose
Minor bleeding- stop warfarin, give IV Vit K 1-3mg and restart when INR <5
What is the management of warfarin when INR >8
No bleeding- stop warfarin, PO Vitamin K 1-5mg and restart when INR <5
Minor bleeding- stop warfarin, IV Vit K 1-3mg, restart when INR <5
What is the management of warfarin in major bleeding?
Stop warfarin
Vitamin K IV 5mg
Dried Prothrombin complex 25-30units/kg
What is seen on blood film in iron deficient anaemia?
Target cells
What is seen on bone marrow film in in AML?
Auer rods
What are features of AML?
Symptoms of pancytopenia
Blas cells/ rod cells on blood film
Treat with chemotherapy or bone marrow transplant if relapse
What are features of CLL?
No symptoms- often incidental finding of lymphocytosis
May have anorexia and weight loss
Bleeding/infections
More marked cervical lymphadenopathy
Smudge cells on blood film
What are features of myelofibrosis?
Elderly person with symptoms of anaemia
Massive splenomegaly
Anorexia, weight loss, night sweats
What is found on investigation of myelofibrosis?
Tear drop cells
Anaemia
High WCC and platelet in early disease
High LDH and urate
What is the management for nocturnal eneuresis in children?
Look for underlying causes e.g. constipation/UTI
General advice- fluid intake, toileting patterns
Reward system
Enuresis alarm
Desmopressin- for short term or if alarms do not work
What are Ottawa rules for ankle X rays
Any pain in the malleolar zone with one of the findings
- bony tenderness at lateral malleolar zone
- bony tenderness at the medial malleolar zone
- inability to walk 4 steps immediately after or in ED
What are risk factors for umbilical cord prolapse?
Prematurity
Multiparity
Polyhydraminos
Twin pregnancy
Cephalopelvic disproportion
Abnormal presentations
50% occur due to artifical rupture of membranes
What is the management of COPD with asthma features if SABA not working?
LABA and inhaled ICS
What are side effects of acetylcholinesterase inhibitors e.g. donepezil?
Bradycardia
GI- nausea/vomiting
Agitation
Hallucinations
Syncope
What are features of pityriasis versicolor?
Due to fungal infection
Commonly affects trunk with hypopigmented patches- more noticeable post sun tan
Managed with ketoconazole shampoo- if not working consider alternative diagnosis and oral itraconazole
What are features of anterior uveitis?
Acute onset
Painful red eye
Pupil small/irregular shaped
Blurred vision
Photophobia
Hypopyon
Ciliary flush
What are features of viral labrinythitis?
Vertigo
N&V
Hearing loss
Tinnitus
Following URTI
What are signs of viral labrinythitis?
Unidirectional horizontal nystagmus towards unaffected side
Sensorineural hearing loss
Gait disturbance
What are features of pseudogout?
Knee/wrist/shoulder commonly affected
Joint aspiration- positive birefringent rhomboid shaped crystals
X ray- chondrocalcinosis
What is the management of haemorrhoids?
Soften stools- fibre intake
Topical LA and steroids
Rubber band ligation as outpatient
Surgery only for large symptomatic haemorrhoids that do not respond to treatment
What is the management of sulphonylurea administration on the day of surgery?
Omit day of surgery
Unless surgery is in morning and patient takes BD dose- can have PM dose
What are features of episcleritis?
Red eye
Mild irritation
Watering
Mild photophobia
