DPD Deck - MISC Flashcards by Rahul Penumaka

How do you identify Microangiopathic hemolytic anemia?

The presence of schistocytes on the blood film

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What occurs during DIC?

In disseminated intravascular coagulation
Systemic activation of the coagulation pathway
This leads to widespread generation of fibrin and deposition in blood vessels
This leads to thrombosis and multiorgan failure
As a result, platelets and coagulation factors are used up
Fibrin degradation produced and D-dimer are produced to break up the clots

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What are the lab findings in DIC?

DECREASED Platelets and Fibrinogen
INCREASED Fibrin degradation products and D-dimer
PROLONGER Prothrombin time and Activated partial thromboplastin time

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Name the 3 features of HUS

Haemolysis occurs results in decreased haemoglobin and increased bilirubin
Decreased platelets
Uraemia

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What is the classic traid of HUS?

Microangiopathic hemolytic anemia
AKI
Thrombocytopenia

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What are the features of Thrombotic Thrombocytic Purpura

Purpura
Fever
Fluctuating cerebral dysfunction 
AKI 
Microangiopathic haemolytic anemia

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In a patient who had microangiopathic haemolytic anaemia what would you expect to see in a blood test?

High bilirubin
Low haemoglobin
High creatinine

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What are the two types causes of haemolytic anemia?

Hereditary and Acquired

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List the hereditary causes of haemolytic anemia?

RBC membrane problems: HEREDITARY SPHEROCYTOSIS
Enzyme deficiency: G6PD deficiency
Haemoglobinopathies: Sickle cell, thalassemia

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List the acquired causes of haemolytic anemia?

MAID:

Microangiopathic haemolytic anemia
Autoimmune
Infection
Drugs

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What is the framework one must use when dealing with a patient who is HYPONATRAEMIC?

Think about blood volume, a hyponatraemic patient will be either:

HYPOVOLAEMIC
EUVOLAEMIC
HYPERVOLAEMIC

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What do all patients with Hyponatraemia have in common?

They have excess water due to EXCESS ADH

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What are the HYPOVOAEMIC causes of hyponatraemia and how would you test for it?

Diarrhoea
Vomitting
Diuretics

DETECT BY: Clinically hypovolaemic, low urine sodium (because kidneys hold onto salt)

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What are the EUVOLAEMIC causes of hyponatraemia and how would you test for it?

E for Endocrine causes

Hypothyroidsim - Thyroid Function Tests
Adrenal insufficiency (Addison’s) - Short Synacthen test
SIADH - LOW plasma osmolality, HIGH urine osmolality

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What are the HYPERVOLAEMIC causes of hyponatraemia and how would you test for it?

Cardiac failure
Cirrhosis
Nephrotic Syndrome

Signs of fluid overload
Low urine sodium?

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List two reasons other than increased ADH that would lead to hyponatraemia?

Excess water intake

Sodium-free irrigation solutions (Used in TURP)

List the causes of SIADH

CNS Pathology
Lung Pathology
Tumours

Drugs - SSRI, TCA, Opiates, PPI, Carbamazepine

What is Onycholysis?

Seperation of the nail bed

What are some of the causes of onycholysis?

Trauma
Thyrotoxicosis
Fungal infection
Psoriasis

List the MICROvascular complications of diabetes

Retinopathy
Nephropathy
Neuropathy

List the MACROvascular comlpications of diabetes

Myocardial Infarction
Stroke
Peripheral vascular disease

List the METABOLIC complications of diabetes

DKA
Hyperosmolar hyperglycaemic state
Hypoglycaemia

What is the treatment of a patient with DKA or Hyperosmolar hyperglycaemic state?

Fluids
Potassium
Insulin

What is the treatment of a patient who is Hypoglycaemic

First we must decide on their level of conscioussness and thus their severity

Consciouss - Glucose
Slightly confused - Buccal dextrogel
Very confused/Comatose - IV 10-20% glucose or IM glucagon

What changes would you see in an INFERIOR MI?

Posterior MI - ST depression in V1, V2, V3 with a dominant R wave and ST elevation in leads V5 and V6

In an acute episode of pain where there is blood in the urine what kind of investigation do you want to do?

Non-contrast CT Kidney Ureter Bladder

What are the two sources of Alkaline Phosphatase?

The Liver | Bones

Which conditions cause a rise in Alkaline Phosphatase?

Obstructive liver disease Fracture Malignancy Paget's disease

Which cells in bones produce ALP?

OsteoBlasts | Plasma cells suppress osteoblasts

What happens to ALP in patients with myeloma?

ALP will be normal

What does CRAB stand for and which condition does it relate to?

Calcium Renal impairment Anaemia Bone It is used to describe Multiple Myeloma

What would PTH, Calcium and phosphate levels be like in Primary Hyperparathyroidism

High PTH High Calcium Low Phosphte Because PTH is phosphate thrashing hormone

What would PTH, Calcium and phosphate levels be like in Secondary Hyperparathyroidism due to Vitamin D deficiency

High PTH Low Calcium Low phosphate

What would PTH, Calcium and phosphate levels be like in Secondary Hyperparathyroidism with kidney failure

High PTH Low Calcium High phosphate Because the kidneys cannot excrete out the phosphate

What would PTH, Calcium and phosphate levels be like in Tertiary Hyperparathyroidism

High PTH High Calcium High Phosphate Due to chronic kidney disease

What are the features of Nephrotic syndrome?

There is increased permeability to the glomerular basement membrane to proteins As a result proteinuria occurs. Specific features of Nephrotic syndrome include: 1. Proteinuria > 3.5 g/day 2. Hypoalbuminaemia 3. Oedema 4. DYSLIPIDAEMIA (as the liver tries to compensate for the decreased albumin production and produced lipids as well)

List the features of HEREDITARY HAEMORRHAGIC TELANGIECTASIA

Autosomal dominant condition Abnormal blood vessels will be seen in: ``` Skin Mucous membranes Lungs Liver Brain ```