Clinical cases in Medicine - RhF Flashcards
What is rheumatic fever?
Autoimmune disease 6weeks after strep A beta-haemolytic streptococcal disease as it expresses human antigens and thus results in cross-reactive antibodies to self
Main features of rheumatic fever
Myo/pancarditis Arthritis Brain chorea Erythema marginatum SC nodules
What is the specific name of the chorea in rheumatic fever?
Sydenham’s chorea
Which area is targeted causing the chorea?
Basal ganglia
Miliary TB travels via what? What would the CXR look like?
Travels via blood so the fluffy white stuff is near the bottom of the lungs
Normal potassium and low sodium suggests
SIADH (more common than addisons)
Note: with addisons the potassium would be higher
Differentiate between hypercalcemia of malignancy and hyperparathyroidism.
High phosphate in cancer
Low phosphate in hyperPTH
High platelet count + microcytic anaemia suggests
BLEEDING
e.g. GI blood loss from colon cancer or peptic ulceration
DO ENDOSCOPY
Normal red cell distribution width suggests?
Homogenous population of cells
How can the MCV be high but the red cell DW not be normal?
If they’re all large, but there’s no variation in size, (suggesting macrocytosis)
What is pernicious anaemia
Lack of intrinsic factor so they stop absorbing b12
DNA replicates poorly so cells grow but fail to divide (hence more segments)
High RDW suggests
Anisocytosis / mixed picture
Normal RDW
NORMAL or ACD
What would the range be for WBC if someone has mild infection?
11-12 mild infection
What would the range be for WBC if someone has pneumonia?
15-20 pneumonia
What would the range be for WBC if someone has sepsis?
30+
What would the range be for WBC if someone has leukemia?
Higher than 70 if cancer
What blood features suggest
Low white count
Fever
Low platelet count
Parasites on blood film
If there is a loss of the ribs seen on cxr wit the lung bits looking blacker than usual, what does it suggest?
Pneumothorax
Tension vs normal pneumothorax
No deviation in normal pneumothorax
Features of AF on an ECG
ABSENT P waves
Irregularly irregular rhythm
AF + weight loss - causes?
Hyperthyroidism
Treatment for fast AF
Beta blocker e.g. propranolol
Treatment of hyperthyoidism
Carbimazole
Radioiodine
Dose of carbimazole?
15-40mg/day
What is campbell de morgan spot?
Cherry angioma which you get
Where are spider naevi found?
ONLY in the distribution of SVC i.e. above the nipple line
NOT on abdomen or legs
Causes of splenomegaly
Infective endocarditis
High alk phosph plus jaundice suggests
OBSTRUCTIVE CAUSE e.g. cancer
high alt and ast but normal phosph suggest
ViraL hepatitis (ALT) is higher than AST)
Cirrhosis - aST>at
Differentiate between viral hepatitis and liver cirrhosis on bloods
ViraL hepatitis (ALT) is higher than AST)
Cirrhosis - aST>at
Heart failure is associated with what sound?
Third heart sound
What causes the fourth heart sound?
Atria squeezing blood due to ventricular hypertrophy
