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
