clinical cases Flashcards
criteria for rheumatic fever
carditis arthritis erythema marginatum sydenham's chorea subcut nodules
summarise pathology of rheumatic fever
have b-haemolytic streptococcal sore throat
immune system cope with the strep
= human Ab after 6wk - against non-self Ag
= autoimmune disease because of molecular mimicry
Ab against the basal ganglia = chorea
signs of old rheumatic fever
murmur
valvular problems
what is huntigton’s chorea
at start of life normal
then develop develop chorea that gets worse and worse – hereditary dominant – older person presents with it
o Anticipation – if father had huntigtons and you anticipate have it – so present earlier. Also with anticipation gene gets more aggressive down generations – cannon repeats in gene
why do met go to the bottom of lung
more blood supply at the bottom
where does miliary TB spread from
blood
so will be seen at bottom of lungs
how does cancer cause haemoptysis
o Cancer – get nodule – one cell growing, when invades bv – blood into airway – haemoptysis
summarise SIADH
– low Na – lung cancer/renal cancer- retain water – commonest cause of low Na in old people
suggestion from low Ca and low Phos
primary hyperparathyroidism
likely dx if have IDA
o Good at recycling iron – so difficult to have low unless lose it slow
o Iron stores run out – ferritin low and iron 0
o Platelet high – happens when slow bleeding to stop the bleeding
o So loss because of slow GI blood loss
colon cancer/peptic ulcer - both treatable if early
investigations for IDA
if young - endoscopy then colonoscopy
if old - colonoscopy then endoscopy
describe red cell distribution width (RDW)
• Normal RDW suggests:
o There is a homogeneous population of red cells
• Standard deviation of the MCV
• If malabsorption – coeliac – don’t absorb B12/iron = mixed picture – MCV still 90 – but have high RDW – if >17% have a mixed picture - because some micro and some macrocytic red cells
help distinguish anaemia of chronic disease and normal from mixed picture
likely dx of macrocytosis
pernicious anaemia – malabsorb B12 – autoimmune condition – don’t have IF
o Therefore DNA replicates poorly
o The cell grows bigger but don’t divide = macrocytosis – Can happen with B12/folate deficienc
o Hypersegmented neutrophils – because they don’t divide
anaemia of chronic disease MCV
normo/micro
description of cells in mixed picture anaemia
anisocytosis
blood count for CML
REALLY high WCC wouldnt get >30 w/o cancer of white cells
bacterial meningitis WCC
around 30
malaria WCC
normal or slightly low
presentation of viral meningitis
severe headache
LP - lots of lymphocytes
if pyrexial with low WCC
look platelet, if low- suggest malaria: history travelling, mosquito, low WCC, fever, low platelet, look at film for paracites. Haemolysis can get anaemia
HIV WCC
low
what is the problem with pneumothorax
pain rather than hypoxia
ECG of AF
irregular
no p waves
pulse with AF
Irregular pulse rate and intensity - - if short RR weak pulse – if big RR – more heart filling = more intense
ECG of sinus arrhythmia
RR would be slowly shorter and bigger over time
causes of AF
o PE
o Hyperthyroidism – makes B adrenocepters more sensitive = tachycardia- irritability flip into AF
o Drugs
rapid AF treatment
o B blocker – for hyperthyroidism unless CI
Metoprolol- in thyroid crisis because can be IV, get rapidly better
Propranolol- cant give IV
o Digoxin – not if hyperthyroidism
drug for hyperthyroidism
• Needs drug to slow down thyrpid – carbimazole 15-40mg daily – start with 40 and then slowly titrate.
propylthiouracil
Which one of these has been
proven to prevent diabetes in the
diabetes prevention programme?
metformin
• What other treatment was even more effective
than metformin at preventing diabetes?
diet and exercise
can you reverse early stages of dm
yes with diet and exercise - strain on family though
what are campbell de morgan spots
no pathology known
present in many pts >40yrs
never pre-malignant
characteristics of spider naevae
• Touching the centre makes it blanch – arterial from middle is coming out from deep – and then goes superficial
can only be found in the distribution of the SVC – top part of the chest – ie above the nipple line
what does presence of spider naevus suggest
- chronic stable liver disease
a cause of splenomegaly
infective endocarditis - because chronic inflammatory process
association between RA and splenomegaly
Felty syndrome - not causative
high ALP and jaundice
obstructive
high ALT and AST jaundice - ALT higher
• Viral hepatitis – put up ALT more than AST
high ALT and AST jaundice - AST higher
• cirrhosis – AST more than ALT
3rd heart sound cause
HF
rapid ventricular filling – when heart dilated – blood hit vent wall, occur early on when heart starts to fail
• When fails to pump adequately – JVP rise as BP falls. Kidney notice JGA notice reduction in pressure – renin – ang1 – aldosterone make retain Na and increase venous pressure = increase filling pressure – blood rush into ventricle = S3
cause of S4
atrium squeeze onto thicker ventricular pressure – atrial contraction into stiffened toughened vent wall (LVH) – due to long standing HTN
