DPD: Amir Sam 6 Flashcards
What are the 2 types of polycythaemia?
Primary: polycythaemia vera
Secondary: secondary to chronic hypoxia in COPD, tumour producing excess EPO (e.g. renal cell cancer)
List 3 broad causes of thrombocytopenia
Not making platelets (e.g. BM infiltration, lymphoma, leukaemia, drugs e.g. chemotherapy)
Destroying platelets (e.g. consumption in DIC)
Pooling of platelets (e.g. pooling in spleen in portal HTN)
If a patient is anaemic, what should you look at?
Low MCV: haematenics - IDA, B thalassemia
Normal MCV: Infection, Inflammation (ACD), malignancy
What are 5 causes of raised MCV? What is the mneumonic? What are the clues to these?
Alcoholics May Have Liver Failure Alcohol: Hx, raised GGT Myleodysplasia: pancytopenia Hypothyroidism: low T4, high TSH Liver disease: Hx, exam Folate/ B12 deficiency: Hx (small bowel disease, gastrectomy)
List 7 manifestations of polycythemia
Headache Pruritus after a hot bath Blurred vision (hyper viscosity) Tinnitus Thrombosis (stroke, DVT) Gangrene Choreiform movements
List 4 complications of sickle cell anaemia and the treatment of each
Acute painful crises: Analgesia, O2, IV fluids, Abx
Stroke: Exchange blood transfusion
Sequestration crises: splenectomy for repeated episodes
Gallstones, chronic cholecystitis: Cholecystectomy
What is affected in multiple myeloma? What are the features caused by this?
Calcium: polyuria, polydipsia (hypercalcaemia causes nephrogenic DI), constipation. U+Es
Renal failure: Raised urea + creatinine. U+Es
Anaemia: SOB, lethargy. FBC count
Bone: fracture, bone pain, osteoporosis. DEXA scan
Why are patients with multiple myeloma predisposed to infection?
Increased production of a immunoglobulin means reduced production of other immunoglobulins so they are prone to infections
What may occur if vertebrae are affected in multiple myeloma?
Cord Compression
Can cause spastic paraparesis (partial paralysis of lower limbs)
What does anaemia with reticulocytosis indicate?
Attempt to make more RBCs because of: Haemolysis or Haemorrhage (increased demand for red cell production)
What does anaemia with a reduced reticulocyte count indicate?
Pathology affecting bone marrow:
Parvovirus B19 infection
Aplastic crisis in patients with SCA
Blood transfusion (interferes with production)
What is the diagnostic criteria for diabetes? What range indicates impaired glucose tolerance?
Diabetes Fasting > 7 Random ≥ 11.1 Impaired glucose tolerance (IGT) 75g OGTT 2-hour glc: 7.8-11
Give 4 drugs used in the treatment of T2DM
Metformin: reduces insulin resistance
Sulphonylureas: stimulate insulin release
DPP-4 Inhibitors: inhibit enzyme break down of GLP-1
GLP-1 Agonists: stimulate glucose-induced insulin release. Also inhibit glucagon release, reduce appetite + cause weight loss
What are the 3 classes of complications that may arise in T2DM? Give 3 examples of each
Microvascular Retinopathy Nephropathy: raised urine albumin: creatinine ratio (ACR) Neuropathy Macrovascular MI Stroke Peripheral Vascular Disease Metabolic DKA Hyperosmolar hyperglycaemic state Hypoglycaemia
What is sliding scale insulin? When is it used?
Variable rate IV insulin infusion: rate determined by blood glucose
If pt is not eating or unwell (e.g. surgery, sepsis)
List 4 signs of Graves disease
Proptosis/ exophthalmus
Pretibial myxoedema
Tremor
Smooth goitre
List 5 symptoms of Graves disease
Weight loss Increased appetite Irritability Palpitations Irregular periods
How do primary and secondary hyperthyroidism differ?
Primary: High T4/T3, suppressed TSH
Secondary: High T4/T3, high TSH
What can be found in the blood of a patient with Graves disease?
TSH receptor stimulating antibodies
Graves’ is caused by an antibody that mimics TSH + stimulates the TSH receptor
What pattern may be seen on a nuclear medicine scan of the thyroid with increased uptake?
Diffuse increased uptake: Graves
Need TSH/ something that acts like TSH for uptake (ie TSH receptor antibody)
Hot nodule= autonomous
A toxic thyroid nodule producing excess thyroid hormone would appear hot
List 4 risk factors for thyroid cancer
Radiation
FH
Rapid enlargement/ compression
Lymphadenopathy
What investigations are appropriate for thyroid cancer?
USS: look for suspicious features
Uptake scan: cold nodules
FNAC (FNA cytology)
What treatment may be used for thyroid cancer?
Surgery: Papillary, Follicular, Medullary (check FH), Anaplastic (poor prognosis)
Following Surgery
Thyroxine (to replace lost thyroid function)
Radioiodine (in high risk pts)
What are the 2 types of prolactinoma?
Macroprolactinoma: causes compression of the optic chiasm= bitemporal hemianopia
Microprolactinomas: DONT compress the optic chiasm
List 3 symptoms caused by prolactinomas
Galactorrhoea
Amenorrhoea
Sexual dysfunction
What is the first line treatment of prolactinomas? How do these work?
Dopamine agonists e.g. cabergoline, bromocriptine
Shrink prolactinomas + reduce prolactin level
Never do surgery for prolactinoma before DA as these shrink the tumour
What condition causes obstructive sleep apnoea and carpel tunnel syndrome?
Acromegaly
OSA: excess soft tissue in neck
CTS: excess soft tissue in carpal tunnel compressing median nerve
What tests are used in diagnosis of acromegaly?
IGF-1: high
OGTT: GH won’t be suppressed
What is an Insulin Tolerance Test?
Normal: Causes hypoglycaemia, which leads to a rise in cortisol + GH
Abnormal: GH + cortisol remain low in hypopituitarism
What is a short synACTHen test?
Normal: cortisol rises
Abnormal: No rise in cortisol, indicates adrenal insufficiency
What is the dexamethasone suppression test?
Normal: suppresses ACTH + thus suppresses cortisol
Abnormal: ACTH remains high thus cortisol remains high e.g. ACTH secreting pituitary tumour
List 3 discriminatory signs of Cushing’s. What other indication may there be?
Bruising + Thin skin
Proximal Myopathy
Purple striae, > 1cm wide
diabetes, HTN + osteoporosis at a young age
How do you determine the cause of amennhorea?
Pregnancy: Urine BHCG
Hypothalamus: low BMI + lots of exercise= functional hypothalamic amenorrhoea
Pituitary: excess prolactin (prolactinoma) or pituitary tumour (compressing cells that make LH + FSH- low)
Thyroid: hypothyroidism or hyperthyroidism. Check TFTs
Ovaries:
PCOS: excess androgens/ hirsutism
Ovarian failure: High FSH due to lack of negative feedback, as less oestradiol + less inhibins
List 3 features of hypokalaemia
Weakness
Arrhythmia
Polyuria: caused by nephrogenic DI
Low K+ leads to ADH resistance (same effect as hypercalceamia)
What are the 3 main differential causes for hypokalaemia?
GI: Vomiting
Diuretics
Primary hyperaldosteronism: aldosterone will be very high, renin will be low due to negative feedback
Give 2 causes of high urine osmolality
Dehydration
HHS
What may cause low urine osmolality?
Diabetes insipidus
What helps you remember the effect of PTH on phosphate?
“Phosphate Trashing Hormone”
High PTH= Low Phosphate
Low PTH= High Phosphate
What levels of calcium, phosphate and PTH indicate Primary Hyperparathyroidism?
High Calcium
Low Phosphate
High PTH
What levels of calcium, phosphate and PTH indicate malignancy?
High Calcium
Normal Phosphate
Low PTH
Which 2 hormones control levels of calcium?
Vitamin D
PTH
What levels of calcium, phosphate and PTH indicate hypoparathyroidism?
Low Calcium
High Phosphate
Low PTH
What levels of calcium, phosphate and PTH indicate vitamin D deficiency?
Low Calcium
Low Phosphate
High PTH
What levels of calcium, phosphate and PTH indicate renal failure?
Low calcium
High phosphate: not filtering + excreting it out through kidneys
High PTH: No hydroxylation of Vitamin D so low calcitriol + low calcium, Causes secondary hyperparathyroidism
Give 2 examples of pre-renal pathology causing AKI
Hypovolaemia
Sepsis
Give an example of renal pathology causing AKI. How may this be detected?
Drugs causing Glomerulonephritis
Active urine sediment: blood + protein in urine
Give an example of a post renal pathology causing AKI. How may this be detected?
Obstruction
USS: Hydronephrosis, dilation of pelvis
How do you detect renal artery stenosis?
Magnetic Resonance Angiography (MRA) Asymmetrical kidneys (as not perfusing one side)
What indicates bilateral renal artery stenosis?
Deterioration of renal function with ACE inhibitors as causes drop in GFR
Which 5 types of arthritis may present with psoriasis?
Symmetrical Polyarthropathy (looks exactly like RA) Asymmetrical Oligoarthropathy (more common + affects distal joints) Arthritis Mutilans (telescoping of the fingers) Large Joints (e.g. swollen knee) Axial Skeleton (spondyloarthritis e.g. sacroiliitis)
