DPD: Meeran cases

Question 1

What are the 5 major criteria of rheumatic fever?

Answer 1

Subcutaneous nodules 
Carditis (changing heart murmur)
Arthritis
Sydenham’s chorea
Erythema marginatum

Question 2

What is Rheumatic fever caused by?

Answer 2

AI disease occurring after surviving Strep sore throat- no strep bacteria present

Question 3

What is the most likely organism causing lobar pneumonia?

Answer 3

Streptococcus pneumoniae

Question 4

What happens to blood components when there is slow GI blood loss?

Answer 4

Iron stores are exhausted
Microcytic anaemia arises
High platelet count due to bleeding

Question 5

What are the 2 most likely causes of slow GI bleeds in the young and elderly, thus which investigations should be performed?

Answer 5

Young: endoscopy then colonoscopy commonest cause = peptic ulceration

Old: colonoscopy then endoscopy commonest cause = colonic carcinoma

Question 6

What is shown by red cell distribution width? How does microcytic/ macrocytic anaemia affect this?

Answer 6

Standard deviation of MCV

RDW stays the same

Question 7

What causes a high red cell distribution width?

Answer 7

Malabsorption e.g. coeliac disease
causes a mixed picture
Some small cells (iron deficient) some large cells (b12 deficient)

Question 8

Describe the pathophysiology of pernicious anaemia

Answer 8

Lack of intrinsic factor
Stop absorbing B12
DNA replicates poorly
Thus cell grows but fails to divide
Macrocytosis results from B12 or folate deficiency
Hypersegmented neutrophils (grow but don’t divide)

Question 9

How do you distinguish between ACD and a mixed picture?

Answer 9

Measure the RDW
Mixed picture: have small cells + big cells so large RDW. Normal MCV
In ACD: have normal RDW. Normal or low MCV

Question 10

What WCC would be seen in infection, sepsis and chronic myeloid leukaemia?

Answer 10

Infection: 12
Sepsis: 25-30
CML: >30

Question 11

What is R wave progression?

Answer 11

R wave should progress in size across leads V1 to V6. Normally, in lead V1, there is a small R wave with a deep S wave; the R-wave amplitude should increase in size with the transition zone, normally in leads V2 to V4. Poor or late R-wave progression consists of a transition zone in lead V5 or V6, indicates previous anterior MI

Question 12

What may be the underlying cause of AF in a patient with weight loss?

Answer 12

Hyperthyroidism

Question 13

What anti-thyroid drugs are used in Graves disease?

Answer 13

Carbimazole

Propylthiouricil

Question 14

What is a Campbell de Morgan spot?

Answer 14

Benign skin lesions
Formed by proliferating, dilated capillaries + postcapillary venules
No pathology known
Common (present in many >40s)

Question 15

What 2 features are cardinal of spider naevi?

Answer 15

Touching the centre makes it blanche (do this O/E to prove)

Only be found in the distribution of the SVC (above the nipple line)

Question 16

What is the most likely diagnosis in patients presenting with spider naevi?

Answer 16

Chronic stable liver disease

Question 17

What are Strawberry Naevi?

Answer 17

benign overgrowth of blood vessel cells that is self-limiting
Most shrink or dissapear
‘haemangioma’ of Infancy

Question 18

How can you distinguish between viral hepatitis and hepatic cirrhosis?

Answer 18

VIRAL has an L = favours aLt ALT>AST

Cirrhosis has an S = favours aSt AST> ALT

Question 19

What heart sound is associated with heart failure?

Answer 19

3rd heart sound
due to rapid ventricular filling (heart is dilated, filling pressure rises + blood rushes into ventricle)
Occurs early on when heart starts to fail
Pump pressure begins to fall- noticed by JGA. Activates RAAS.
Aldosterone makes you retain Na+, + increase venous pressure + increase filling pressure. By starlings law this maintains BP
Slowly rising JVP

Question 20

What is a 4th heart sound caused by?

Answer 20

Atrium squeezing blood into ventricles
Caused by atrial contraction
Occurs in those with toughened ventricular wall (usually due to long standing HTN causing LV hypertrophy)