DI Flashcards
What are common causes of pancytopenia?
Aplastic anaemia BM infiltration Hypersplenism Sepsis SLE
Blood film abnormalities:
Hypochromic cells
Hypochromic cells - iron deficiency anaemia
Blood film abnormalities:
Spherocytes
Hereditary spherocytosis
Haemolytic anaemia
Burns
Blood film abnormalities:
Target cells
Thalassaemia
Iron deficiency
Post-splenectomy
Liver disease
Blood film abnormalities:
Fragmented cells
Microangiopathic haemolytic anaemia
Haemolytic uraemic syndrome
TTP
Mechanical heart valves
Blood film abnormalities:
Howell-Jolly bodies
Hyposplenism
Post-splenectomy
What test is the most commonly used clinically to assess the function of the liver?
Prothrombin time
What test is commonly done to assess heparin use?
Activated partial thromboplastin time APTT
Give some causes of a raised PT
Warfarin treatment
Liver disease
DIC
Give some causes of a raised APTT
Heparin treatment
Haemophilia A/B
Liver disease
DIC
What test is done to distinguish between the various causes of B12 deficiency?
Schilling test
What can cause a high opening pressure of CSF?
Meningitis
Tumour
High ICP
Idiopathic intracranial HTN
What can causes an elevated WCC in the CSF?
Cerebral infection - meningitis/encephalitis
Inflammatory diseases
Malignancy
What cells would the CSF contain predominantly in…
a) bacterial meningitis
b) other infective causes
a) bacterial meningitis = neutrophils
b) other infective causes = lymphocytes
What can causes raised protein in the CSF?
Meningitis, brain abscess, intracerebral haemorrhage, neoplastic disease, GBS, MS
Give examples of neurophysiological investigations
- Nerve conduction studies
- Electromyography
- Visually evoked responses
- Electroencephalopathy
Give an example of when a nerve conduction study would be used?
Carpal tunnel syndrome - median nerve
When might electromyography be used?
MG
- Fatiguability following repetitive stimulation
When might visually evoked responses be used?
MS
- delayed P100 latencies without amplitude loss
Give other causes of oligoclonal bands in the CSF, other then MS?
GBS
Neurosyphilis
Lyme disease
Neurosarcoidosis
What is the lights criteria?
It is used to distinguish with greater certainty between transudate and exudate effusions
1) Pleural fluid proteins
2) Serum fluid proteins
3) Lactate dehydrogenase levels
What are the common parameters measured in pleural fluid and what can they be used for?
Total protein (lights) Lactate dehydrogenase (lights) Microscopy, cell count, gram stain & culture pH (low in empyema) Cytology (malignancy)
What are the causes of a transudate pleural effusion?
(Proteins stopped - not enough to pass) Failures... Cardiac Liver (cirrhosis) Renal (nephrotic syndrome) Thyroid (hypo) Nutritional (low albumin)
What are the causes of exudate pleural effusion?
(Proteins exciting - pumped out - local problem) Cancer Pneumonia PE/infarction TB Connective tissue disease (RA) Pancreatitis
What is the most common cause of ascites?
Portal HTN secondary to liver cirrhosis
What are the causes of transudate ascites?
Cirrhosis/liver failure
Cardiac failure
Hypoalbuminaemia
Nephrotic syndrome
When classifying ascites - what can be measured other than proteins to improve the accuracy?
The serum-ascites-albumin gradient
What are the parameters measured in ascitic fluid and what can they show?
WCC Total protein and albumin (SAAG + Trans/exudate) Microscopy + culture + gram staining Glucose (low in malignancy) Cytology (malignancy) Amylase (high in pancreatitis)
What Abs?
AI haemolytic anaemia
RBC autoantibodies
What Abs?
AI hepatitis
Anti-nuclear
Anti-smooth muscle
Anti- liver/kidney microsomal 1
pANCA
What Abs?
Addisons
Anti-21 hydroxylase
What Abs?
Anti-phospholipid syndrome
Anti-cardiolipin
Lupus anti-coagulant abs
What Abs?
a) diffuse cutaneous scleroderma
b) limited cutaneous scleroderma
a) Diffuse = Anti-ScL 70 + RF + ANA
b) Cutaneous = Anti-centromere
What Abs?
Good pastures
Anti-glomerular basement membrane
What Abs?
Pernicious anaemia
Anti-parietal cell
Anti-intrinsic factor
What Abs?
Primary biliary cirrhosis
Anti-mitochondrial
What Abs?
Sjogren syndrome
RF + ANA
Anti Ro + Anti La
What Abs?
Wegener
cANCA
cytoplasmic anti-nuclear cytoplasmic antibody
What can raise amylase?
Raised in:
- Pancreas - pancreatitis, pancreatic ca, DKA
- Salivary gland - mumps, salivary gland tumours
- Bowel - acute cholecystitis, bowel obstruction, perforated peptic ulcer, ruptured ectopic
- Kidney - renal disease
Give causes of raised CK
- Muscle disease: rhabdomyolysis, muscular dystrophy
- Vigorous exercise
- Drugs: statins & AP
- Hypothyroidism
When is lactate dehydrogenase a useful serum marker?
To look for haemolysis - RBC contain high amounts of this enzyme
What is M protein a hallmark feature of?
Multiple Myeloma
What 2 conditions cause a raised ESR but normal CRP?
SLE
MM
