Clinical cases in Medicine - RhF

Question 1

What is rheumatic fever?

Answer 1

Autoimmune disease 6weeks after strep A beta-haemolytic streptococcal disease as it expresses human antigens and thus results in cross-reactive antibodies to self

Question 2

Main features of rheumatic fever

Answer 2

Myo/pancarditis
Arthritis
Brain chorea
Erythema
marginatum
SC nodules

Question 3

What is the specific name of the chorea in rheumatic fever?

Answer 3

Sydenham’s chorea

Question 4

Which area is targeted causing the chorea?

Answer 4

Basal ganglia

Question 5

Miliary TB travels via what? What would the CXR look like?

Answer 5

Travels via blood so the fluffy white stuff is near the bottom of the lungs

Question 6

Normal potassium and low sodium suggests

Answer 6

SIADH (more common than addisons)

Note: with addisons the potassium would be higher

Question 7

Differentiate between hypercalcemia of malignancy and hyperparathyroidism.

Answer 7

High phosphate in cancer

Low phosphate in hyperPTH

Question 8

High platelet count + microcytic anaemia suggests

Answer 8

BLEEDING
e.g. GI blood loss from colon cancer or peptic ulceration

DO ENDOSCOPY

Question 9

Normal red cell distribution width suggests?

Answer 9

Homogenous population of cells

Question 10

How can the MCV be high but the red cell DW not be normal?

Answer 10

If they’re all large, but there’s no variation in size, (suggesting macrocytosis)

Question 11

What is pernicious anaemia

Answer 11

Lack of intrinsic factor so they stop absorbing b12

DNA replicates poorly so cells grow but fail to divide (hence more segments)

Question 12

High RDW suggests

Answer 12

Anisocytosis / mixed picture

Question 13

Normal RDW

Answer 13

NORMAL or ACD

Question 14

What would the range be for WBC if someone has mild infection?

Answer 14

11-12 mild infection

Question 15

What would the range be for WBC if someone has pneumonia?

Answer 15

15-20 pneumonia

Question 16

What would the range be for WBC if someone has sepsis?

Answer 16

30+

Question 17

What would the range be for WBC if someone has leukemia?

Answer 17

Higher than 70 if cancer

Question 18

What blood features suggest

Answer 18

Low white count
Fever
Low platelet count
Parasites on blood film

Question 19

If there is a loss of the ribs seen on cxr wit the lung bits looking blacker than usual, what does it suggest?

Answer 19

Pneumothorax

Question 20

Tension vs normal pneumothorax

Answer 20

No deviation in normal pneumothorax

Question 21

Features of AF on an ECG

Answer 21

ABSENT P waves

Irregularly irregular rhythm

Question 22

AF + weight loss - causes?

Answer 22

Hyperthyroidism

Question 23

Treatment for fast AF

Answer 23

Beta blocker e.g. propranolol

Question 24

Treatment of hyperthyoidism

Answer 24

Carbimazole

Radioiodine

Question 25

Dose of carbimazole?

Answer 25

15-40mg/day

Question 26

What is campbell de morgan spot?

Answer 26

Cherry angioma which you get

Question 27

Where are spider naevi found?

Answer 27

ONLY in the distribution of SVC i.e. above the nipple line

NOT on abdomen or legs

Question 28

Causes of splenomegaly

Answer 28

Infective endocarditis

Question 29

High alk phosph plus jaundice suggests

Answer 29

OBSTRUCTIVE CAUSE e.g. cancer

Question 30

high alt and ast but normal phosph suggest

Answer 30

ViraL hepatitis (ALT) is higher than AST)

Cirrhosis - aST>at

Question 31

Differentiate between viral hepatitis and liver cirrhosis on bloods

Answer 31

ViraL hepatitis (ALT) is higher than AST)

Cirrhosis - aST>at

Question 32

Heart failure is associated with what sound?

Answer 32

Third heart sound

Question 33

What causes the fourth heart sound?

Answer 33

Atria squeezing blood due to ventricular hypertrophy