DPD: Amir Sam 5 Flashcards
In what cases would you give IV or IM adrenaline?
IV: Cardiac arrest
IM: Anaphylaxis
What antibiotic would you give in add-on to amoxicillin to cover the atypical organisms causing pneumonia?
Clarithromycin (Macrolide)
List 3 atypical organisms that cause pneumonia
Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophila
What investigations are performed in patients with microcytic anaemia?
Haematinics (Ferritin, B12, folate)
Coeliac screen (TTG Ab)
Top (OGD) + Tail (colonoscopy)
Give 5 differentials for bloody diarrhoea
Infection: Infective colitis Inflammation: UC/ Crohns (Younger pts) Ischaemia: Ischaemic colitis (Older pts) Malignancy Diverticulitis
How do you treat a patient with AF within and after 48 hours of onset?
<48 hours: DC Cardioversion
>48 hours: Rate control (Digoxin/ Metoprolol) + Anticoagulation (Reduce risk of thromboembolism)
What is Trousseau syndrome? In which disease is it seen?
Acquired blood clotting disorder that results in migratory thrombophlebitis (inflammationof a vein due to a blood clot).
Pancreatic cancer
What is Troisier’s sign? What does it indicate?
Presence of Virchows node= lymphadenopathy in supraclavicular fossa
Abdominal Malignancy
Give 4 signs of portal hypertension
Encephalopathy
Ascites
Spontaneous bacterial peritonitis (>250 WCC)
Variceal bleeds
Give 3 causes of microangiopathic haemolytic anaemia
Disseminated Intravascular Coagulation (DIC)
Haemolytic Uraemic Syndrome (HUS)
Thrombotic Thrombocytopenic Purpura (TTP)
Give 3 haematological features of DIC
Low platelets + fibrinogen (as forming clots)
High PT + APTT (as used clotting factors)
High D-dimer + fibrin degradation products (as start breaking clots)
Give 3 haematological features of HUS
Low Hb + High BR (haemolysis)
Uraemia
Low platelets (using in clotting process)
Give 3 features of TTP
HUS
Fever
Neurological manifestations
Give 3 hereditary causes of haemolytic anaemia
Red cell membrane (hereditary spherocytosis)
Enzyme deficiency (G6PD deficiency)
Haemoglobinopathy (SCD, Thalassemias)
Give 4 acquired causes of haemolytic anaemia
AI
Drugs
Infection
Microangiopathic haemolytic anaemia (MAHA)
What 2 features on a blood film indicate MAHA?
Schistocytes
Anaemia
How do haustra and valvulae conniventes differ?
Haustra: In Large bowel. Don’t traverse bowel
Valvulae conniventes: In Small bowel. Traverse small bowel
What do prominent valvulae conniventes indicate?
Small bowel obstruction
What are the 3 states hyponatraemia can arise in?
Hypovolaemia
Euvolaemia
Hypervolaemia
What occurs in hypovolaemic hyponatraemia? How may you detect this?
Hypovolaemia stimulates ADH secretion
Kidneys re-absorb salt + water
Low urine Na+
Postural hypotension
List 3 causes of euvolaemic hyponatraemia. How do you test for each of these?
Hypothyroidism: TFTs (low T4)
Adrenal insufficiency: Short synACTHen test
SIADH: plasma (low)+ urine (high) osmolality
How does cardiac failure cause hypervolaemic hyponatraemia? How may you detect this?
Less renal perfusion- body thinks its hypovolaemic, activates RAAS, increases aldosterone, increases water + Na+ retention
Low urine Na+ due to secondary hyperaldosteronism
Peripheral oedema
List 3 causes of hypovolaemic hyponatraemia.
Diarrhoea
Vomiting
Diuretics
List 3 causes of hypervolaemic hyponatraemia.
Cardiac failure
Cirrhosis
Nephrotic syndrome
List 2 sites of pathology where cause of SIADH may be found
CNS pathology: infection, malignancy, drugs
Lung pathology: infections, malignancy, drugs
List 5 drugs that can cause SIADH
SSRI TCA Opiates PPIs Carbamazepine
List 4 conditions that onycholysis can be a feature of
Drugs (e.g. tetracyclines, OCP, diabetes drugs) Reactive arthritis, Reiter’s syndrome Psoriais Infection (especially fungal) Trauma Hyper + Hypothyroidism Sarcoidosis, Scleroderma
Give 2 features of left ventricular hypertrophy on ECG. What valvular disease may this be a result of?
Deep S in V1
Tall R in V6
Aortic stenosis
Which condition causes widespread saddle-shaped ST elevation in an ECG?
Pericarditis
What investigation should you perform if you suspect renal colic?
CT KUB
What physiological picture is seen in primary hyperparathyroidism? What is seen in secondary?
Primary: High PTH, high Ca2+
Secondary: High PTH, low Ca2+
List 3 causes hypercalcaemia when PTH is low
Malignancy
Sarcoidosis
Myeloma
What are the 2 sources of ALP? What can cause elevated ALP?
Liver: Obstructive liver disease (+raised GGT)
Bone: Malignancy, Fracture, Paget’s Disease
Why is ALP normal in myeloma?
In the bone, ALP is produced by osteoblasts
Plasma cells in myeloma SUPPRESS the osteoblasts
What cancer causes ALP to rise?
Metastases to bone
Give 4 features of multiple myeloma
Calcium high
Renal impairment
Anaemia
Bone pains
List 4 causes of cavetating lung lesions
Infection: TB, Staph aureus, Klebsiella (e.g. alcoholics)
Inflammation: RA
Infarction: PE
Malignancy: SqCC
List 3 broad causes of oedema. How would you test for each?
Heart failure: Echocardiogram
Albumin loss in bowel: Endoscopy
Albumin loss in urine: Urinalysis
What is nephrotic syndrome?
increased permeability of the glomerular basement membrane to protein
Proteinuria > 3.5 g/day
hypoalbuminaemia (<30 g/L)
Peripheral oedema
What are those with nephrotic syndrome prone to?
Thromboembolic disease (lose natural anticoagulants in urine along with protein). May present with renal vein thrombosis
What is the inheritance pattern of hereditary haemorrhagic telangiectasia? What does it cause?
Autosomal dominant Abnormal blood vessels in: Skin Mucous membranes Lungs Liver Brain
What condition would cause hyperkalaemia, hyponatraemia and a failed short synACTHen test?
Primary adrenal insufficiency
What would cause a high prolactin, low testosterone, low FSH and low LH?
Prolactinoma
Prolactin inhibits reproductive axis, suppresses LH + FSH thus testosterone will be low
What would cause high IGF1, high prolactin and a failed OGTT?
Acromegaly
What would cause high FSH and LH, with low oestradiol ?
Premature ovarian insufficiency
Reduced negative feedback on LH + FSH
What would cause low T4, high TSH and high prolactin?
Myxoedema (hypothyroidism)
TSH high (reduced negative feedback)
TRH is also high due to reduced negative feedback
High TRH stimulates prolactin
