Bruising/spontaneous bleeding

Question 1

Differentials for bruising

Answer 1

1. ITP
2. Acute leukaemia
3. Liver disease
4. Aspirin use
5. Haematinic deficiency
6. Physiological/explainable bruising
7. Thrombotic thrombocytopenic purpura

Question 2

Aside from dehydration, what else does a high Urea suggest?

Answer 2

bleeding

Question 3

Which protein stimulates the production of platelets? Where is this produced?

Answer 3

thrombopoeitin, produced in the liver (therefore LFTs are important in bruising investigations)

Question 4

Blood film shows blasts. What is the likely diagnosis?

Answer 4

Acute leukaemia

Question 5

Blood film shows shistocytes. What could a possible diagnosis be?

Answer 5

TTP

Question 6

Blood film shows megaloblasts and hypersegmented neutrophils. Possible diagnosis?

Answer 6

haematinic deficiency

Question 7

Blood film shows isolated thrombocytopaenia. Possible diagnosis?

Answer 7

ITP

Question 8

Blood film shows target cells and acanthocytes. Possible diagnosis?

Answer 8

Liver failure

Question 9

Differential diagnoses for young lady with SoB, fever, and haemoptysis?

Answer 9

complicated pneumonia
sepsis + DIC 
PE
Acute leukaemia 
TTP

Question 10

Out of:
1. Purpura in the oropharynx
2. Subconjunctival haemorrhages
3. Blood stained handkerchief
Which is the most concerning sign?

Answer 10

‘Wet’ purpura in the oropharynx is a sign of a significant haemostatic defect and is often associated with a platelet count of <30. It is considered a herald for eminent GI and deeper bleeding and should be urgently assessed.

Question 11

When would you used oral versus IV clarithromycin?

Answer 11

Both have similar biovailabilities, therefore if oral admin is appropriate then go with this as IV clari is 10x more expensive