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5th (Final year) > Gen Med #4 > Flashcards

Gen Med #4 Flashcards

1
Q

Most common presenting feature for spinal cord compression?

A

Back pain.

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2
Q

What are the terms we should now use for sepsis, and what do they mean?

A

Sepsis and Septic shock

Sepsis: life-threatening organ dysfunction caused by a dysregulated host response to infection

Septic shock: a more severe form sepsis, technically defined as ‘in which circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone’*

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3
Q

Metastatic bone pain management options?

A

Analgesia, Bisphosphonates or Radiotherapy

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4
Q

How can you tell shigella apart from giardia?

A

Giardia is non bloody diarrhoea, shigella is bloody

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5
Q

What causes of gastroenteritis are bloody?

A

Shigella
Campylobacter (not always)
Amoebiasis

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6
Q

Which antibiotic classes can/can’t be used in pregnancy?

A

Penicillins and cephalosporins are suitable for use during pregnancy, but sulfonamides (such as sulfasalazine) and quinolones (such as ciprofloxacin) should be avoided in pregnancy.

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7
Q

Common presentation for encephalitis? what would differentiate a viral and bacterial cause?

A

Sudden change in behaviour and a fever, is highly suggestive of encephalitis. could have seizures.

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8
Q

What are the bugs in Group A and Group B beta haemolytic strep called?

A

Group A
- Strep Pyogenes

Group B
- Strep alginate

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9
Q

What are the main infective causes of genital ulcers and how do you differentiate?

A

Painful is either chancroid or Herpes. Herpes is more common than chancroid.

Painless is either syphilis or LGV, syphilis is more common.

LGV and Chancroid can cause painful inguinal lymphadenopathy

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10
Q

India ink and Ziehl niesen used to identify what organisms?

A

India ink - cryptococcus

Ziehl niesen - mycoplasma

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11
Q

What is acute intermittent porphyria?

A

Autosomal dominant condition caused by a defect in porphobilinogen deaminase.

Presents with abdominal and neuropsychiatric symptoms in 20-40 year olds, more common in females.

Abdominal: abdominal pain, vomiting
Neurological: motor neuropathy
Psychiatric: e.g. depression
Hypertension and tachycardia common

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12
Q

What is the more common form of acute leukaemia in adults?

A

Acute myeloid leukaemia?

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13
Q

What are the symptoms of AML?

A

Features are largely related to bone marrow failure:

  • Anaemia: pallor, lethargy, weakness
  • Neutropenia: whilst white cell counts may be very high, functioning neutrophil levels may be low leading to frequent infections etc.
  • Thrombocytopenia: bleeding
  • Splenomegaly
  • Bone pain
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14
Q

Poor prognostic features in AML?

A

> 60 years

> 20% blasts after first course of chemo
cytogenetics: deletions of chromosome 5 or 7

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15
Q

What is aplastic anaemia? Causes?

A

Chronic pancytoaenia, due to hypoplastic bone marrow.

Can either be congenital or acquired

Congenital (fanconi) is autosomal recessive

Acquired has an identifiable cause, viral infection, radiation or drug exposure.

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16
Q

Treatment for aplastic anaemia?

A

Immunosuppression

Androgens

Stem cell transplantation

Blood product support

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17
Q

How may bone marrow failure present?

A

Anaemia
Infections
Easy bruising

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18
Q

What is autoimmune haemolytic anaemia? What are the types?

A

Either warm or cold. Normally idiopathic but can be due to lymphoproliferative disorder.

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19
Q

What are the causes of warm haemolytic anaemia?

A

Autoimmune disease: e.g. systemic lupus erythematosus*

Neoplasia: e.g. lymphoma, CLL

Drugs: e.g. methyldopa

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20
Q

What are the causes of cold haemolytic anaemia?

A

Neoplasia: e.g. lymphoma

Infections: e.g. mycoplasma, EBV

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21
Q

What are the features of beta thalassaemia? Pathogenesis?

A

Features:
- Presents in first year of life with failure to thrive and hepatosplenomegaly

  • Microcytic anaemia
  • HbA2 & HbF raised
  • HbA absent

Caused by absent beta chains

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22
Q

Typical blood film picture post splenectomy?

A

Target cells
Howell-Jolly bodies
Pappenheimer bodies
Siderotic granules
Acanthocytes

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23
Q

Iron deficiency anaemia blood film picture?

A

Target cells
‘pencil’ poikilocytes
If combined with B12/folate deficiency a ‘dimorphic’ film occurs with mixed microcytic and macrocytic cells

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24
Q

Myelofibrosis typical blood film picture?

A

‘tear-drop’ poikilocytes

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25
Intravascular haemolysis blood film?
Schistocytes
26
Megaloblastic anaemia blood film?
hypersegmented neutrophils
27
What are the main blood product (not blood) transfusion reactions?
Acute haemolytic transfusion reaction - ABO mismatch - Fever, abdo pain, chest pain, agitation, hypotension Non-haemolytic febrile reaction - HLA antibodies Anaphylaxis - Range of reactions - Simple urticaria okay - Any more serious reaction A-E resus Infective - vCJD
28
What is burkitts lymphoma?
High-grade B-cell neoplasm Two forms - Endemic (African) form: typically involves maxilla or mandible. EBV highly related. - Sporadic form: abdominal (e.g. ileo-caecal) tumours are the most common form. More common in patients with HIV
29
Main difference in chronic and acute leukaemia?
In chronic they are partially matured, in acute they are not matured at all.
30
Philadelphia chromosome is associated with what?
CML
31
Difference in signs in CLL and CML?
CML associated with splenomegaly (and hepatomegaly) CLL associated with Lymphadenopathy
32
features of CLL?
- Often none - Constitutional: anorexia, weight loss bleeding, infections - Lymphadenopathy more marked than CML
33
CLL complications?
- Anaemia - Hypogammaglobulinaemia leading to recurrent infections - Warm autoimmune haemolytic anaemia in 10-15% of patients - Transformation to high-grade lymphoma (Richter's transformation)
34
Normal age at presentation in CML?
60-70
35
First line treatment for CML?
Imatinib
36
What is the management for an unprovoked DVT or PE?
All patients: - Physical examination - CXR - Blood tests >40 years old - CT Abdo pelvis - Mammography
37
What is factor V leiden?
Common inherited thrombophilia.
38
What is fanconi anaemia, what are the features?
Autosomal recessive Features: Aplastic anaemia Increased risk of acute myeloid leukaemia Neurological Skeletal abnormalities: short stature Cafe au lait spots
39
Features of G6PD deficiency?
X linked recessive Neonatal jaundice is often seen Intravascular haemolysis Gallstones are common Splenomegaly may be present Heinz bodies on blood films
40
Key differences in G6PD deficiency and Hereditary spherocytosis?
G6PD is X linked so males Spherocytosis is Autosomal dominant Hereditary spherocytosis is northern european, G6PD is African and Mediterranean On blood film there is spherocytes in HS, and Heinz bodies in G6PD
41
Most common Thrombophilia?
Factor V leiden
42
How would Haemophilia present? (features and bloods)
Features - Haemoarthroses, haematomas - Prolonged bleeding after surgery or trauma Bloods - Prolonged APTT - Bleeding time, thrombin time, prothrombin time normal
43
How would hereditary spherocytosis present?
Failure to thrive Jaundice, gallstones Splenomegaly Aplastic crisis precipitated by parvovirus infection Degree of haemolysis variable MCHC elevated
44
Reed sternberg cells characteristic of?
Hodgkins lymphoma
45
Features of hodgkins lymphoma?
Lymphadenopathy (75%) - painless, non-tender, asymmetrical Systemic (25%): weight loss, pruritus, night sweats, fever (Pel-Ebstein) Alcohol pain in HL Normocytic anaemia, eosinophilia LDH raised
46
How do you stage in Hodkins lymphoma?
CT abdo pelvis
47
Different forms of hodgkins lymphoma?
1. Nodular sclerosing Hodgkin lymphoma (NSHL) 2. Mixed-cellularity Hodgkin lymphoma (MCHL) 3. Lymphocyte-depleted Hodgkin lymphoma (LDHL) 4. Lymphocyte-rich classical Hodgkin lymphoma (LRHL)
48
In ITP what are antibodies directed against?
Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex.
49
Feautures of Iron deficiency anaemia?
koilonychia atrophic glossitis post-cricoid webs angular stomatitis
50
Features of lead poisoning?
Consider when Neurological and abdo pain abdominal pain peripheral neuropathy (mainly motor) fatigue constipation blue lines on gum margin (only 20% of adult patients, very rare in children)
51
What is MGUS? how do you tell it apart from myeloma?
Monoclonal gammopathy, resembles myeloma, but: normal immune function normal beta-2 microglobulin levels lower level of paraproteinaemia than myeloma (e.g. < 30g/l IgG, or < 20g/l IgA) stable level of paraproteinaemia no clinical features of myeloma
52
What is myelodyspasia?
acquired neoplastic disorder of hematopoietic stem cells pre-leukaemia, may progress to AML
53
What is Myelofibrosis?
a myeloproliferative disorder (bone marrow proliferation) thought to be caused by hyperplasia of abnormal megakaryocytes the resultant release of platelet derived growth factor is thought to stimulate fibroblasts haematopoiesis develops in the liver and spleen Presents with: - elderly person with symptoms of anaemia e.g. fatigue (the most common presenting symptom) - massive splenomegaly - hypermetabolic symptoms: weight loss, night sweats etc
54
CRAB for myeloma?
Calcium high Renal failure Anaemia Bone lesions (rain drop skull), bone pain.
55
Major and minor criteria for multiple myeloma?
Major criteria Plasmacytoma (as demonstrated on evaluation of biopsy specimen) 30% plasma cells in a bone marrow sample Elevated levels of M protein in the blood or urine Minor criteria 10% to 30% plasma cells in a bone marrow sample. Minor elevations in the level of M protein in the blood or urine. Osteolytic lesions (as demonstrated on imaging studies). Low levels of antibodies (not produced by the cancer cells) in the blood.
56
Neutropenic sepsis antibiotic choice?
Tazocin
57
Features of Non-hodkins lymphoma?
median age = 55-60 years painless widespread lymphadenopathy, hepatosplenomegaly raised LDH, paraproteinaemia, AIHA
58
Causes of a normocytic anaemia?
Anaemia of chronic disease Chronic kidney disease Aplastic anaemia Haemolytic anaemia
59
Threshold for platelet transfusion?
In significant bleeding <30, in severe bleeding <100
60
Causes of polycythaemia?
Relative causes dehydration stress: Gaisbock syndrome Primary polycythaemia rubra vera Secondary (reactive) - COPD - Altitude - Obstructive sleep apnoea - Excessive erythropoietin
61
Features of polycythaemia vera?
Hyperviscosity Pruritus, typically after a hot bath Splenomegaly Haemorrhage (secondary to abnormal platelet function) Plethoric appearance Hypertension in a third of patients
62
Management of polycythaemia?
Aspirin Venesection - first line treatment Hydroxyurea -slight increased risk of secondary leukaemia Phosphorus-32 therapy
63
Sickle cell inheritance?
Autosomal recessive
64
Types of sickle cell crises?
thrombotic, 'painful crises' sequestration acute chest syndrome aplastic haemolytic
65
Management of a sickle cell crisis?
Analgesia e.g. opiates Rehydrate Oxygen Consider antibiotics if evidence of infection Blood transfusion Exchange transfusion: e.g. if neurological complications
66
Acquired forms of thrombophilia?
Antiphospholipid syndrome Drugs - the combined oral contraceptive pill
67
How is Tranexamic acid administered?
Tranexamic acid is given as an IV bolus followed by an infusion in cases of major haemorrhage
68
What are the B symptoms of hodgkins lymphoma that imply a poor prognosis?
Weight loss > 10% in last 6 months Fever > 38ºC Night sweats
69
In non-urgent patients how long would you transfuse a red cell infusion over? If they had HF? If it was a trauma /major haemorrhage?
1 and 1/2 to 2 hours HF 3 hours STAT in trauma
70
Main special blood test for multiple myeloma
Serum elecrophoresis - Monoclonal band
71
Cause of an aplastic crisis in sickle cell?
Usually due to parovirus infection
72
Transfusion threshold for red cells?
70 without ACS, 80 with ACS
73
Blood transfusion reaction mnemonic?
Got a bad unit G raft vs. Host disease O verload T hrombocytopaenia A lloimmunization B lood pressure unstable A cute haemolytic reaction D elayed haemolytic reaction U rticaria N eutrophilia I nfection T ransfusion associated lung injury
74
Management options for Von willibrands?
Tranexamic acid and desmopressin (stimulates release)
75
If a patient is deficient in B12 and Folic acid which do you need to treat first?
Treat the B12 first to avoid subacute combined degeneration of the cord
76
DVT and PE management?
LMWH initially, warfarin within 24 hours, keep on the LMWH until the INR is within the 2-3 range.
77
The philadelphia chromosome abnormality (CML) is denoted how?
t(9:22)
78
Burkitt's lymphoma associated with what chromosomal abnormality?
c-myc t(8:14)
79
Before a CTPA in a suspected PE what do you need to do?
CXR
80
What is the mechanism for cocaine induced ACS?
Coronary artery spasm
81
How do you differentiate a epididymal cyst and a hydrocele?
In a cyst it lies above or behind the testes, in a hydrocele it envelops the whole thing
82
Underlying cardiac disease fluid recommendations?
20-25 ml/kg
83
Management of pituitary tumours?
Pituitary - Dopamine agonist (bromocriptine) Within sella turcica - Trans-sphenoidal - Can do radiotherapy or drugs before surgery with GH tumours. ACTH - Trans-sphenoidal
84
What is Amoebiasis?
Entamoeba histolytica (amoeba protozoa), chronic infections often liver abscesses Presents with: - Profuse, bloody diarrhoea - Stool microscopy may show trophozoites - Treatment is with metronidazole
85
Universal donor in FFP and Red cells?
FFP is just plasma (so no A or B or AB antigens). So you only need to worry about antibodies, The one you are giving can't have the antibody to the patients cell type
86
How does an acute haemolytic transfusion reaction present?
Lack of angioedema/urticaria Symptoms begin within minutes of starting - Fever - Abdominal and chest pain - Agitation - Hypotension
87
How do you manage acute haemolytic transfusion reaction?
Transfusion termination, Generous fluid resus, inform the lab
88
How can you test for Polycythaemia Vera?
JAK2 mutation screen
89
Large multinucleate cells with prominent eosinophilic nucleoli is a description for what type of cell?
Reed-sternberg - Hodgkin lymphoma
90
Elderly person with marked lymphocytosis likely diagnosis?
CLL

5th (Final year) (34 decks)

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