Brainscape's Knowledge GenomeTM

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


See full index

DPD Amir Sam GK > 5. Interactive Cases in General Internal Medicine 4 > Flashcards

5. Interactive Cases in General Internal Medicine 4 Flashcards

1
Q

Signs of immediate transfusion reaction.

A 
Fever
Rigor
Increased HR
Decreased BP
Chest pain
Dark urine

(Haemolysis)

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

Polycythaemia DDx

A

Primary Polycythaemia:
Polycythaemia rubra vera

Secondary Polycythaemia:
Appropriate increase in erythropoietin:
-Chronic hypoxia e.g COPD

Inappropriate increase in erythropoietin:

  • Renal (carcinoma, cysts, hydronephrosis)
  • Hepatocellular carcinoma
  • Fibroids
  • Cerebellar haemangioblastoma
  • Erythropoietin abuse amongst athletes

Relative polycythaemia:

  • Dehydration
  • Gaisbock’s syndrome (in obese, HTN causes hypovolaemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Subclassifications of Anaemia

A 
Macrocytic
Microcytic
Normocytic
Haemolytic (hereditary and acquired)
Aplastic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Macrocytic anaemia DDx

A

Alcoholics May Have Liver Failure:

Alcohol

  • Hx
  • Raised GGT

Myelodysplasia

  • Pancytopenia (low platelets/Hb/WCC)
  • Bone marrow problems

Hypothyroidism

  • Hx (lethargy, weight gain, constipation)
  • Low T4
  • High TSH

Liver disease
-Hx and Examination

Folate/B12 deficiency
-Hx (small bowel disease, ? Gastrectomy - lack of intrinsic factor produced by stomach required for B12 absorption)

[Alcohol
Folate/B12 deficiency
Haemolytic anaemia
Hypothyroidism
Liver disease
Myelodysplasia
Drugs: methotrexate, hydroxyurea, azathioprine, zidovudine]
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Microcytic anaemia DDx

A

Iron Deficiency (low ferritin)

  • Diet
  • Blood loss (GI/UG)

Beta thalassaemia heterozygosity

[Iron deficiency: blood loss (GI - peptic ulcer, malignancy, etc; Urogenital - menorrhagia, haematuria; Hookworm; Decreased absorption - gastrectomy, small bowel disease; Increased demands - growth, pregnancy; Decreased intake - vegans)
Thalassaemia
Sideroblastic anaemia: congenital (X-linked), alcohol, drugs (isoniazid, chloramphenicol), lead, myelodysplasia
Lead poisoning
Anaemia of chronic disease (often normocytic but may be microcytic)]

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

Normocytic anaemia DDx

A

Chronic disease

  • Infection, inflammation, malignancy. eg. RA
  • Normal or high ferritin.

[Anaemia of chronic disease (chronic infection, inflammatory/connective tissue diseases, malignancy)
Haemolytic anaemia (may also cause macrocytic anaemia)
Hypothyoidism (may also cause macrocytic anaemia)
Pregnancy
Renal failure
Bone marrow failure]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Haemolytic anaemia DDx

A

Hereditary:
Haemoglobinopathies: sickle cell anaemia, thalassaemia
Membrane defects: spherocytosis, elliptocytosis
Metabolic defects: pyruvate kinase deficiency, glucose-6-phosphate dehydrogenase deficiency.

Acquired:
Autoimmune: Warm antibodies (idiopathic, SLE, lymphoma, drugs e.g. methyldopa), Cold antibodies (idiopathic, infections e.g. Mycoplasma, EBV, lymphoma)
Alloimmune: Transfusion reaction, haemolytic disease of newborn
Drugs: penicillin, quinidine
Microangiopathic haemolytic anaemia: TTP, HUS, DIC, malignant hypertension, malignancy (widespread adenocarcinoma), pregnancy complications (preeclampsia, HELLP syndrome: haemolysis, incrased liver enzymes, decreased platelets)
Artificial heart valves
March haemoglobinuria
Infection: malaria, clostridia
Paroxysmal nocturnal haemoglobinuria
Secondary to liver and renal failure

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

Aplastic anaemia DDx

A

Idiopathic

Inherited: Fanconi anaemia, dykeratosis congenita

Acquired: Drugs (cytotoxics, chloramphenicol, gold, methotrexate) chemicals, radiation, viral infection, paroxysmal nocturnal haemoglobinuria, sepsis

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

Thrombocytopenia DDx

A

Not making them - marrow infiltration by lymphomas, leukaemias, drugs, cancer., radiotherapy.

Breaking them down - DIC

Pooling in spleen - alcoholic chronic liver disease with portal hypertension.

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

WCC raised when?

A

Infection or malignancy

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

Ferritin

A

Acute phase reactant, up in inflammation etc.

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

50 yr old woman
Hb 90g/L
MCV 75 (decreased)
On NSAIDs for joint pain

Most likely cause?

A

Iron deficiency

Microcytic anaemia
On NSAIDs - therefore likely to be due to gastric erosion - inhibition of prostaglandins by NSAIDs leads to reduced protection of mucosa by acid.

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

40 yr old woman
Hb 110 g/L
MCV 65

Most likely diagnosis

A

Beta thalassaemia heterozygosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Markers of XS alcoholic intake

A

High MCV

High gamma g t

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

Polycythaemia presentations

A 
Headache
Pruritus after hot bath
Blurred vision (hyperviscosity)
Tinnitus
Thrombosis (stroke, DVT)
Gangrene

Choreiform movements

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Sickle Cell Anaemia Crises and their Managements

A

Acute painful crises
–>Analgesia, O2, IV fluids, Antibiotics

Stroke
–>Exchange blood transfusion (remove sickled cells)

Sequestration crises (RBC pooling)

  • Lung (SOB, cough, fever)
  • Spleen (exacerbation of anaemia)
  • ->Splenectomy for repeated episodes of splenic sequestration

Gallstones, chronic cholecystitis
–>Cholecystectomy

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

Environment in which red blood cells sickle

A

Low oxygen tension; irreversible.

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

Multiple Myeloma Framework + presentation

A

CRAB

hyperCalcium (polyuria, polydipsia, constipation)

Renal Failure (Ur & Cr)

Anaemia (Breathlessness, lethargy - FBC)

Bone (pain, osteoporosis, fracture - DXA)

Infection
Cord Compression (spastic paraparesis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Complication of hypercalcaemia

A

Nephrogenic Diabetes Insipidus

…also: “Stones, Bones, Groans, Thrones, Psychiatric overtones.”

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

Osteoporosis

A

T score on a DXA scan of less than -2.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q 
50 yr old man
Hypercalcaemia
Low PTH
Backache
Normal ALP

Most likely cause?

A

Multiple Myeloma

(normal ALP - alkaline phosphatase is made by osteoblasts in myeloma; plasma cells suppress the osteoblasts, therefore normal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Reticulocytes framework (up or down)

A

Anaemia with increased reticulocyte count:

  • Haemolytic crisis
  • Haemorrhage

Anaemia with reduced reticulocyte count: problem with bone marrow…

  • Parvovirus B19 infection
  • Aplastic crisis in patients with sickle cell anaemia
  • Blood transfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Definition of Diabetes Mellitus

A

Fasting glucose of more than 7 (as after this level the rate of retinopathy is significantly increased)

Random glucose of at least 11.1

HbA1c more than 48 (or greater than 6.5% DCCT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Definition of Impaired glucose tolerance

A

Pre-diabetic state of hyperglycaemia associated with insulin resistance and increased risk of cardiovascular pathology. May precede T2DM by many years.
Give 75g OGTT
2-hr glucose: 7.8-11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Stereotypical Diabetic Presentations

A

Type 1:
Young, thin, insulin deficiency - wt loss, ketones, acidosis

Type 2:
Older, overweight, obese, insulin resistant

Type 3c:
Patients with impaired pancreatic function e.g. pancreatectomy. V difficult to manage; also have decreased glucagon.

26
Q

45 yr old man
Lethargy, fatigue, polyuria, polydipsia
Urinalysis: no ketones, glucose +++
Random glc: 18

How to treat?

A

Metformin

1st drug in treatment of T2 diabetes after lifestyle and diet advice.

(Then sulfonylurea, then DPP-IV inhibitor, then insulin if not controlled by tablets. If patient is overweight, or want to avoid hypoglycaemia, think about GLP-1 agonist.)

27
Q

Metformin action

A

Reduces insulin resistance

28
Q

Sulfonylurea action

A

Stimulate insulin release

29
Q

DPP-IV inhibitor action

A

Inhibits the enzyme that break down GLP-1

30
Q

GLP-1 agonist action

A

Stimulates release of protein that increases insulin secretion, decreases glucagon secretion, reduce appetite, causes some wt loss.

31
Q

Sliding scale/Variable rate IV insulin infusion

A

Used when patient is in worse condition, e.g. not eating, unwell, surgery/sepsis etc

Blood glucose (mmol/L)/Insulin Dose (units/hr)

0-3.9 / 0.5
4-7.9 / 1
8-11.9 / 2
12-15.9 / 4
16-19.9 / 6
20+ / 8-12 (Consult doctor)
32
Q

Graves’ Disease: Presentation, TFTs and Ix

A 
Wt loss
Good appetite
Irritability
Palpitations
Irregular periods
O/E:
Tremor
Proptosis
Smooth goitre
Pretibial myxoedema

High free T4/T3, suppressed TSH

Next investigation: TSH receptor stimulating antibody

33
Q

TPO antibodies

A

Marker of autoimmunity

34
Q

Uptake in different thyroid conditions:

Graves’
Thyroiditis
Toxic Nodular Goitre

A

Graves’: diffuse increased uptake
Thyroiditis: no uptake
Toxic Nodular Goitre: One spot of increased uptake, absent elsewhere (autonomous nodule)

35
Q

Thyroid Cancer Hx and Ex, RF

A

Lumps

Risk factors:
Radiation
FHx
Rapid enlargement/compression
Lymphadenopathy

Mets (lung, follicular thyroid ca)

36
Q

Thyroid Ix and Rx

A

USS
FNAC (Uptake scan: cold nodules)
MDT

Surgery:
Papillary
Follicular
Medullary
Anaplastic (poor prognosis)

Thyroxine, Radioiodine

37
Q

Bitemporal Hemianopia cause

A

Pituitary tumour compressing optic chiasm

38
Q

30 yr old female
Amenorrhoea
Galactorrhoea
Bitemporal Hemianopia

Diagnosis and Treatment

A

Prolactinoma compressing optic chiasm.

Cabergoline: dopamine agonist

39
Q

50 yr old man
Headache, sweating
Poor sleep, snoring - obstructive sleep apnoea
Tingling in fingers - carpal tunnel syndrome
Initial test: High IGF-1

Next investigation?

A

OGTT

suspect acromegaly

40
Q

Suspected Acromegaly Tests

A
  1. IGF-1

2. OGTT

41
Q

Insulin Tolerance Test

A

Test of Pituitary Function

In normal, give insulin –> decreased blood glucose –> hypoglycaemia –> rise in cortisol and growth hormone.

Dynamic pituitary function test

42
Q

Oral Glucose Tolerance Test

A

Test for Acromegaly
75g Glucose

In normal, this will suppress GH. If doesn’t happen, consistent with acromegaly.

43
Q

Dexamethasone Suppression Test

A

Test for Cushing’s

In normal, dexamethasone suppresses ACTH and Cortisol. If not low, abnormal –> Cushing’s

44
Q

Short Synacthen Test

A

Test for adrenal insufficiency

Normal: ACTH –> increased cortisol.

45
Q

Discriminatory signs of Cushing’s

A

Bruising
Myopathy
Purple Striae more than 1cm wide (due to wt gain and thin skin)

DM/HTN/Osteoporosis at young age.

46
Q

Amenorrhoea/Oligomenorrhoea

A

Pregnancy
-Urine BHCG

Hypothalamus
-? Excessive exercise, low BMI

Pituitary

  • Excess prolactin
  • Low LH/FSH

Thyroid (hyper/hypo)
-TFTs

Ovaries

  • PCOS: Excess androgens or hirsutism
  • Ovarian Failure: High FSH (low oestradiol –> less negative feedback –> high FSH)
47
Q

Hypokalaemia Presentation and DDx

A

Presentation:
Polyuria (caused by nephrogenic diabetes inspidus –> ADH resistance)
Weakness
Arrhythmia

DDx:
GI: vomiting
Diuretics
Primary hyperaldosteronism (bilateral hyperplasia or Conn's)
-aldosterone:renin ratio

(Aldosterone stimulates sodium absorption and potassium excretion)

48
Q

Hypernatraemia

A

High plasma osmolality [= 2 X (Na + K) + Ur + glc]

High urine osmolality?

  • Dehydration (elderly/children)
  • HHS (urine high osm: glycosuria), Type 2 diabetes

Low urine osmolality
-Diabetes insipidus (DIlute urine, osm , 300)

49
Q

Low Ca
Low phosphate
High PTH

A

Vitamin D deficiency

50
Q

PTH

A

Parathyroid hormone
(Phosphate trashing hormone)

Increased PTH –> Increased Ca, Decreased Phosphate

51
Q

High Ca
Low phosphate
High PTH

A

Primary Hyperparathyroidism

52
Q

High Ca
Normal Phosphate
Low PTH

A

Malignancy/Myeloma

53
Q

Low Ca
High Phosphate
Low PTH

A

Hypoparathyroidism

54
Q

Low Ca
High Phosphate
High PTH

A

Chronic Kidney Disease

(PTH high because calcium is low; Phosphate high due to renal failure, therefore no hydroxylation of Vit. D in kidneys. No renal filtration of phosphate)

55
Q

AKI framework

A

Pre-renal

  • Hypovolaemia
  • Sepsis

Renal

  • Drugs
  • ? Active urine sediment: blood and protein in the urine (glomerulonephritis)

Post-renal
-USS (?Obstruction)

56
Q

Renal artery stenosis

A

Asymmetrical Kidneys

Magnetic Resonance Angiography

Deterioration of renal function with ACE inhibitors (bilateral RAS)

57
Q

Types of psoriatic arthritis

A 
Oligoarticular
Polyarticular
Arthritis Mutilans
Spondyloarthritis
Distal interphalangeal predominant
58
Q

Oligoarticular Psoriatic Arthritis

A

Affects 70% of patients
Generally mild
Does not occur in the same joints on both sides of the body
Usually only involves fewer than 3 joints.

59
Q

Polyarticular Psoriatic Arthritis

A

25% of cases

Five or more joints on both sides of the body simutaneously

60
Q

Arthritis Mutilans

A

Less than 5% of patients
Severe, deforming and destructive
Can progress over months or years causing sever joint damage

61
Q

Spondyloarthritis Psoriatic Arthritis

A

Characterised by stiffness in the neck or the sacroiliac joint of the spine; can also affect hands and feet

62
Q

Distal interphalangeal predominant Psoriatic Arthritis

A

Characterised by inflammation and stiffness in the joints nearest to the ends of the fingers and toes; nail changes often marked.

DPD Amir Sam GK (5 decks)

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