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Amir Sam DPD 2018 > DPD 6 - Haem, Endo > Flashcards

DPD 6 - Haem, Endo Flashcards

1
Q

What are the symptoms of immediate transfusion reaction?

A

Fever, rigor, increased HR, decreased BP, chest pain, dark urine

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2
Q

What is polycythaemia?

A

Increased Hb

Primary - polycythaemia rubra vera, sedondary - chronic hypoxia e.g. COPD or EPO drugs used by athletes

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3
Q

What is thrombocytopenia?

A 
Decreased platelets 
Causes:
Decreased production (marrow infiltration)
Increased destruction (DIC)
Pooled in spleen (CLD, portal HTN)
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4
Q

What is thrombocytosis?

A

Increased platelet

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5
Q

What are the causes of microcytic anaemia?

A

Iron deficiency (low ferritin) - diet or blood loss (GI, urogenital); a complication is Plummer-Vinson syndrome = oesophageal web
Anaemia of chronic disease
Thalassaemia - beta thalassaemia heterozygosity

Siderblastic anaemia
Lead poisoning

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6
Q

What Ix would you do for microcytic anaemia?

A

FBC
Blood film - hypochromic
Hb electrophoresis - for beta thalassaemia

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7
Q

What causes normocytic anaemia?

A

Chronic disease (normal/high ferritin - ferritin is an acute phase protein): infection, inflammation e.g. RhA, malignancy

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8
Q

What are the causes of macrocytic anaemia?

A 
Alcohol
Myelodysplasia
Hypothyroidism
Liver failure
Folate/B12 deficiency
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9
Q

What Ix would you do for macrocytic anaemia?

A

FBC
Blood film
Schilling test for pernicious anaemia

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10
Q

What is the Tx for folate/B12 deficiency?

A

IM hydroxycobalamin

PO cyanobalamin

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11
Q

A 50 y/o woman presents w/ microcytic anaemia and has been on NSAIDs for joint pain. What is the most likely cause?

  1. Iron deficiency
  2. Beta thalassaemia
A

Iron deficiency
NSAIDs increase risk of gastric erosions therefore gastric ulcers. Prostaglandins required for protection of gastric mucosa

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12
Q

A 40 y/o woman; Hb 110; MCV 65 (80-100). What is the most likely diagnosis?

  1. Iron deficiency
  2. Beta thalassaemia
A

Beta thalassaemia heterozygosity - MCV is out of proportion of the Hb (low MCV in relation to degree of anaemia)

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13
Q

What are the symptoms of polycythaemia?

A

Headache, pruritus after a hot bath, blurred vision (hyperviscosity), tinnitus, thrombosis (stroke, DVT), gangrene, choreiform movement (dance-like)

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14
Q

What Ix would you do for sickle cell anaemia?

A

Blood film: Howell-Jolly bodies = DNA in electrophoresis

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15
Q

What is the Tx for acute painful crises?

A

Analgesia (morphine)
Oxygen - hypoxia causes sickling
IV fluids - dehydration causes sickling
ABx (if underlying infection)

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16
Q

What is the Tx for a stroke crisis from sickle cell anaemia?

A

Exchange blood transfusion (remove sickle cells)

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17
Q

What is the Tx for a sequestrian crisis (Sickle cell anaemia)?

A

Sequestrian crises are caused by RBC pooling and can occur in the lungs causing SOB, fever, cough or in the spleen causing exacerbation of anaemia. A splenectomy will be the most appropriate step for recurrent splenic sequestrian

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18
Q

What is the Tx for gallstones, chronic cholecystitis caused by sickle cell anaemia?

A

Cholecystectomy

Chronic haemolysis causes pigment stones thus causing gallstones

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19
Q

What are the symptoms of multiple myeloma?

A

Think CRAB
Calcium - polyuria, polydipsia, constipation; hypercalcaemia causes increased ADH resistance which causes nephrogenic diabetes insipidus
Renal failure - Ix: urea + creatinine
Anaemia - Breathlessness, lethargy; Ix: FBC
Bone - fracture, bone pain, osteoporosis; Ix: DKA scan (assess bone mineral density). Osteoporosis T score <2.5
Infection
Cord compression - spastic paraperesis (weakness in legs)

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20
Q

A 50 y/o man presents w/ hypercalcaemia, low PTH + backache. ALP normal. What is the most likely cause?

  1. Malignancy
  2. Multiple myeloma
A

Multiple myeloma
ALP is normal - this is a big hint as ALP is made by osteopblasts. In MM, plasma cells suppress osteoblasts so in myeloma, ALP is normal whereas in malignancy it is raised.

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21
Q

A 50 y/o man presents w/ hypercalcaemia, low PTH + backache. ALP high. What is the most likely cause?

  1. Malignancy
  2. Multiple myeloma
A

Malignancy

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22
Q

What are reticulocytes?

A

Precursors to RBCs

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23
Q

What are the causes of anaemia with increased reticulocyte count?

A

This is a compensation to loss of RBC so causes include haemolytic crises and haemorrhage (blood loss)

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24
Q

What are the causes of anaemia with decreased reticulocyte count?

A

This is when the marrow is affected so causes include:
Parvovirus B19 infection
Aplastic crisis in patients w/ sickle cell anaemia
Blood transfusion

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25
Q

What are the diagnostic values of fasting and random blood glucose for diabetes?

A

Fasting glucose >7 - rate of retinopathy significantly increases after fasting glucose > 7
Random glucose of 11.1 or more
Impaired glucose tolerance (IGT), 75g OGTT, 2 hour glucose. Impaired glucose tolerance = 7.8-11.0

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26
Q

What are the 3 types of diabetes?

A

Type 1: young, thin, insulin deficiency, weight loss, ketones + acidosis
Type 2: older, overweight + obese, insulin resistance
Type 3: Pancreatectomy - total lack of pancreatic hormones + enzymes

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27
Q

What is the management of diabetes?

A
  1. Conservative: diet and exercise
  2. Medical: Metformin - reduces insulin resistance
  3. Check HbA1c - if not in range, add sulfonylurea (insulin secretagogue) or GLP-1 agonist (incretin effect). If still not in range: DPP4 inhibitor (decreases breakdown of GLP-1). Eventually, consider Insulin
28
Q

What are the stages of diabetic retinopathy?

A

Background - hard exudates (leaked lipid content from blood vessels), microaneurysms + blot haemorrhages
Pre-proliferative - soft exudates/cotton wool spots (regions of retinal ischaemia)
Proliferative - Angiogenesis

29
Q

What are the complications of diabetes?

A

Retinopathy
Nephropathy - raised urine ACR (Albumin:creatinine ratio), decreased renal function. Not urinalysis (can’t get the ratio)
Neuropathy - must examine feet

30
Q

A 45 y/o man presents w/ lethargy, fatigue, polyuria, polydipsia. Urinalysis: glucose +++, no ketones. Random glucose 18. How would you treat him?

  1. Metformin
  2. Insulin
  3. Sulfonylurea
  4. DPP4 inhibitor
  5. GLP1 agonist
A

Metformin

31
Q

What is the sliding scale?

A

Variable rate IV insulin infusion dependent by blood glucose. Indications: patient not eating, unwell e.g. surgery, sepsis. Disadvantages: constantly need to change dose, assoc. w/ decreased mortality

32
Q

What are the symptoms and signs of Graves’ disease?

A 
Weight loss + good appetite
Irritability
Palpitations
Irregular periods 
Tremor
Proptosis 
Smooth goitre
Pretibial myxoedema - specific to Graves'
33
Q

What are the Ix for suspected Graves’ disease?

A

TFT: Increased free T4/T3 but decreased TSH
TSHr stimulating antibody: +ve
Uptake scan: diffuse uptake - uptake requires TSH or TSH receptor stimulating Ab

34
Q

What would the uptake scan be like in viral thyroiditis?

A

No uptake due to decreased TSH

35
Q

What is the presentation of thyroid cancer?

A

Lumps
Rx: radiation, FHx, rapid enlargement/compression, lymphadenopathy
Mets (lung, follicular thyroid cancer)

36
Q

What Ix would you do for thyroid cancer?

A

USS

FNAC: uptake scan: cold nodules

37
Q

What is the Tx for thyroid cancer?

A

MDT
Surgery
After surgery: thyroxine, radioiodine (if high risk)

38
Q

A 30 y/o female presents w/ amenorrhoea, galactorrhoea + bitemporal hemianopia, irregular periods and sexual dysfunction. What is the most appropriate Tx?

A

The symptoms all point towards prolactinoma, the bitemporal hemianopia suggests macroprolactinoma. The 1st line Tx is cabergoline which is a DA agonist - the prolactinoma shrinks then the prolactin normalises.
Trans-sphenoidal surgery only performed if not responding to DA agonists (rarely performed)

39
Q

What is the Tx for prolactinoma

A

Cabergoline - DA agonist which shrinks the prolactinoma as DA suppresses prolactin

40
Q

A 50 y/o man presents w/ headache, sweating, poor sleep + snoring. He also presents w/ tingling in fingers. What is the initial investigation?

A

IGF-1 - look for suspected acromegaly. The snoring indicates obstructive sleep apnoea caused by increased soft tissue in upper airways + the tingling in fingers indicate carpal tunnel syndrome.

41
Q

What is the next Ix for acromegaly after IGF-1?

  1. Insulin tolerance test
  2. OGTT
  3. Dexamethosone suppression test
  4. Short synacthen test
  5. GHRH test
A

OGTT - GH is a counter regulative hormone that increases glucose level to protect against hypoglycaemia. Normal: decreased GH. Acromegaly: unsuppressed increased GH

42
Q

What Ix would you do for Cushing’s disease?

  1. Insulin tolerance test
  2. OGTT
  3. Dexamethosone suppression test
  4. Short synacthen test
  5. GHRH test
A

Dexamethasone suppression test
Normal: decreased ACTH as it is suppressedd so decreased cortisol
Cushing’s: increased cortisol as failure to suppress cortisol due to increased ACTH

43
Q

What Ix would you do for adrenal insufficiency?

  1. Insulin tolerance test
  2. OGTT
  3. Dexamethosone suppression test
  4. Short synacthen test
  5. GHRH test
A

Short synacthen test

Normal: increased ACTH - increased cortisol

44
Q

A 40 y/o woman presents w/ weight gain, depression, fatigue, central obesity + googled her symptoms which suggested Cushing’s syndrome. Is she likely to have cushing’s syndrome?

A

No

Overweight, fatigue is a universal phenomenon as ageing

45
Q

What is the difference between Cushing’s syndrome and Cushing’s disease?

A

Cushing’s syndrome are a collection of symptoms caused by an increased cortisol regardless of cause.
Cushing’s disease is excess cortisol caused by pituitary tumour

46
Q

What are the discriminatory signs of Cushing’s syndrome?

A

Easy bruising, thin skin
Proximal myopathy
Purple striae - thinning and stretching of the skin allows you to see the capillaries
DM, HTN, osteoporosis at a young age

47
Q

What are the causes of amenorrhoea/oligomenorrhoea?

A

Pregnancy
Hypothalamus - would ask for exercessive exercise
Pituitary - excess prolactin, low LH/FSH
Thyroid - TFTs
ovaries - excess androgens or hirsutism due to PCOS, Ovarian failure

48
Q

What are the symptoms of hypokalaemia?

A

Weakness
Arrhythmia
Polyura - decreased K+ causes increased ADH resistance which causes nephrogenic DI
Vomiting

49
Q

What are the causes of hypernatraemia?

A

Increased urine osmolality - dehydration; HHS in T2DM (increased urine oscmolality due to glucose in urine)
Decreased urine osmolality - diabetes insipidus (dilute urine) due to lack of ADH so decreased water reabsorption + increased water loss in urine so dilute urine

50
Q

Decreased Ca, decreased phosphate and increased PTH

A

Vitamin D deficiency

51
Q

Decreased Ca, increased phosphate, decreased PTH

A

Hypoparathyroidism

52
Q

Decreased Ca, increased phosphate, increased PTH

A

Pseudohypoparathyroidism

53
Q

Increased Ca, normal phosphate, decreased PTH

A

Malignancy or multiple myeloma

54
Q

Increased Ca, decreased phosphate, increased PTH

A

Primary hyperparathyroidism

55
Q

Decreased Ca, increased phosphate, increased PTH

A

Secondary hyperparathyroidism (chronic kidney disease)

56
Q

Increased Ca, decreased phosphate, increased PTH

A

Tertiary hyperparathyroidism

57
Q

What does PTH do?

A

Phosphate Trashing Hormone

Increased PTH causes decreased phosphate

58
Q

What are the causes of acute kidney injury?

A

Pre-renal - decreased perfusion: hypovolaemia, sepsis (hypovolaemia)
Renal - Drugs, glomerulonephritis (+ve active urine sediment = blood + protein in urine)
Post-renal - Obstruction –> urgent nephrostomy to relieve obstruction. Ix: USS

59
Q

What results in asymmetrical kidneys?

A

Renal artery stenosis

60
Q

What Ix would you do for renal artery stenosis?

A

Magnetic Resonance Angiography (MRA)

Deterioration of renal function with ACE inhibitors (bilateral RAS)

61
Q

A 21 y/o medical student on morning of exam presents w/ SOB, palpitations, tingling in hands. ABG: pH 7.5, pO2 13, pCO2, 3.5, Bicarb 26. What is the most likely cause?

  1. PE
  2. Pneumothorax
  3. MI
  4. SVT
  5. Hyperventilation syndrome
A

Hyperventilation syndrome

62
Q

Patient presents w/ sacroiliitis and arthritis affecting DP joints. He has asymmetrical oligoarthropathy. What is the most likely Dx?

A

Psoriatic arthritis - fingers become sausage like

63
Q

What are the 5 types of psoriatic arthritis?

A

Symmetrical arthritis
Asymmetrical arthritis
DIP joint predominant
Arthritis mutilans (telescoping of finger)
Spondylitis (sacroiliitis, affects axial skeleton)

64
Q

What are the symptoms of psoriatic arthritis?

A

Swollen fingers + toes, tender, painful or swollen joints
Red scaly skin patches i.e. plaques
Reduced range of motion of joints
Morning stiffness

65
Q

Pearl like lesion w/ telangiectasia. What is the Dx?

A

Basal cell carcinoma

Amir Sam DPD 2018 (8 decks)

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