Deck 13

Question 1

Low Hb

Answer 1

Anaemia

Question 2

High Hb

Answer 2

Polycythaemia rubra vera, chronic hypoxia, increased EPO, relative increase (decrease in plasma volume)

Question 3

Microcytic anaemia

Answer 3

Thalassaemia, IDA (pregnancy, poor intake), anaemia of chronic disease

Question 4

Normocytic anaemia

Answer 4

acute blood loss, sickle cell, haemolytic anaemia, anaemia of chronic disease, bone marrow failure

Question 5

Macrocytic anaemia

Answer 5

B12/folate deficiency, alcohol excess

Question 6

Reticulocytes

Answer 6

immature cells, raised during excessive production

Question 7

WCC raised

Answer 7

Infection, inflammation, leukaemia, tissue necrosis (surgery/MI/burns), drugs (prednisalone)

Question 8

Reduced WCC

Answer 8

Bone marrow disorder, SLE, autoimmune, HIV

Question 9

Neutrophilia

Answer 9

Bacterial infection, inflammation, steroids, myeloproliferative disoders, stress (surgery)

Question 10

neutropoenia

Answer 10

Post chemo, viral infection, severe sepsis, hypersplenism, bone marrow failure

Question 11

Lymphocytosis

Answer 11

Viral infection, chronic infection (TB), lymphoma/leukaemia

Question 12

lymphocytopoenia

Answer 12

Steroids, HIV, post chemo

Bone marrow failure

Question 13

monocytosis

Answer 13

chronic infection, AML/lymphoma, EBV

Question 14

Eosinophilcytosis

Answer 14

Allergy, drug reaction, parasite, skin disease (eczema)

Question 15

Basophilocytosis

Answer 15

Myeloproliferative disorder, viral infection, IgE, hypersensitivity reaction
Isolated raised basophils suggests malignancy

Question 16

Thrombocytosis

Answer 16

reactive (post bleed, infection, chronic inflammation, malignancy, surgery) or essential (myeloproliferative disorder)

Question 17

Thrombocytopoenia

Answer 17

bone marrow failure, autoimmune (e.g. ITP), viral infection

Question 18

Hyponatraemia

Answer 18

• lost in urine (need to check urine sodium) - can be Addison’s, renal failure, diuretic excess, diarrhoea/vomiting, burns, SBO
  
  • Due to fluid retention (nephrotic, cardiac failure, liver cirrhosis, SIADH - need to rule out other causes first)
    Hyponatraemia gives headache, irritability, confusion, weakness and seizures

Question 19

hypernatraemia

Answer 19

• Diarrhoea/vomiting, diabetes insipidus, incorrect IV replacement
  Hypernatraemia causes lethargy, thirst, weakness, confusion, fits/coma

Question 20

Hypokalaemia

Answer 20

Hypokalaemia can be due to diuretics, V&D, cushing’s, steroids, conn’s.
Causes muscle weakness, hypotonia, hyporeflexia, cramps, palpitations, light headedness

Question 21

Hyperkalaemia

Answer 21

Hyperkalaemia can be due to renal failure, K sparing diuretics, metabolic acidosis, addison’s disease, burns, excess potassium therapy but can also be damaged blood.
Can see Tall, tented T waves, small p waves and wide QRS on ECG
Chest pain
Fast irregular pulse, weakness, palpitations

Question 22

Isolated ALP rise

Answer 22

bone mets, primary bone tumour, vitamin D deficiency, fracture

Question 23

HbA1c impacted in

Answer 23

haemolytic anaemia, IDA, B12/folate deficiency, recent blood transfusion/donation, venesection, haemoglobinopthy, CKD4/5, liver disease, drugs (EPO, anti HIV), alcoholism, severe hperlipidaemia, chronic malaria

Question 24

HbA1C CI in

Answer 24

Not appropriate in children, to diagnose T1DM, acute illness, steroids, pregnancy, recent acute pancreatitis/pancreatic surgery

Question 25

Hypothyroidism presentation

Answer 25

Lethargy, coarsening features, dry hair, cold intolerance, angina, constpiation, fatigue, exertional dyspnoea, muscle weakness, carpal tunnel syndrome, depression, infertility. Weight gain, malar flush, loss of eyebrow, bradycardia, hypercholesterolaemia, abdominal distension (constipation), anaemia, myopathy, hyporeflexia, menorrhagia

Question 26

Main diagnostic for hypothyroidism

Answer 26

TSH level (raised) is strong indicator, along with low T4 (T3 unreliable)

Question 27

Secondary hypothyroidism

Answer 27

Pituitary damage due to autoimmune disorder/tumour. Can get hyponatraemia (cortisol deficiency), hypogonadotrophic hypogonadism (low testosterone with low LH/FSH)

Question 28

Risks of levothyroxine

Answer 28

Go low and slow in elderly and IHD due to risk of AF and osteoporosis

Question 29

Symptomatic hyperthyroidism with normal T4 and suppressed TSH

Answer 29

T3 toxicosis

Question 30

Symptoms of hyperthyroidism

Answer 30

Fatigue, increased appetite, heat intolerance, goitre, weight loss, hair loss, palpitations, tachicardia, myopathy, agitation, psychosis, diarrhoea, vomiting, infertility, amenorrhoea, oligomenorrhoea, pruritis, pretibial myxoedema, exopthalmos, lid retraction, lid lag

Question 31

Type 1 hypersensitivity

Answer 31

IgE and mast cell mediated (e.g. asthma, anaphylaxis, excema, allergic rhinitis)

Question 32

Type 2 Hypersensitivity

Answer 32

IgG against surface antigens leading to NK cells and complement mediated destruction (Goodpastures, MGs)

Question 33

Type 3 hypersensitivity

Answer 33

Immune complex deposition and complement activation (SLE, extrinsic allergic alveolitis)

Question 34

Type 4 Hypersensitivty

Answer 34

T cells, delayed

Question 35

Mnemonic for hypersensitivity

Answer 35

Eczema (atopy, anaphylaxis - IgE) Gives (IgG, goodpastures, MGs) Complex (SLE, extrinsic allergic alveolitis) Tracks