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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
Q

Intravascular haemolysis blood film?

A

Schistocytes

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26
Q

Megaloblastic anaemia blood film?

A

hypersegmented neutrophils

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27
Q

What are the main blood product (not blood) transfusion reactions?

A

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

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28
Q

What is burkitts lymphoma?

A

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
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29
Q

Main difference in chronic and acute leukaemia?

A

In chronic they are partially matured, in acute they are not matured at all.

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30
Q

Philadelphia chromosome is associated with what?

A

CML

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31
Q

Difference in signs in CLL and CML?

A

CML associated with splenomegaly (and hepatomegaly)

CLL associated with Lymphadenopathy

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32
Q

features of CLL?

A
  • Often none
  • Constitutional: anorexia, weight loss
    bleeding, infections
  • Lymphadenopathy more marked than CML
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33
Q

CLL complications?

A
  • Anaemia
  • Hypogammaglobulinaemia leading to recurrent infections
  • Warm autoimmune haemolytic anaemia in 10-15% of patients
  • Transformation to high-grade lymphoma (Richter’s transformation)
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34
Q

Normal age at presentation in CML?

A

60-70

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35
Q

First line treatment for CML?

A

Imatinib

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36
Q

What is the management for an unprovoked DVT or PE?

A

All patients:

  • Physical examination
  • CXR
  • Blood tests

> 40 years old

  • CT Abdo pelvis
  • Mammography
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37
Q

What is factor V leiden?

A

Common inherited thrombophilia.

38
Q

What is fanconi anaemia, what are the features?

A

Autosomal recessive

Features:

Aplastic anaemia

Increased risk of acute myeloid leukaemia

Neurological

Skeletal abnormalities: short stature

Cafe au lait spots

39
Q

Features of G6PD deficiency?

A

X linked recessive

Neonatal jaundice is often seen

Intravascular haemolysis

Gallstones are common

Splenomegaly may be present

Heinz bodies on blood films

40
Q

Key differences in G6PD deficiency and Hereditary spherocytosis?

A

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
Q

Most common Thrombophilia?

A

Factor V leiden

42
Q

How would Haemophilia present? (features and bloods)

A

Features

  • Haemoarthroses, haematomas
  • Prolonged bleeding after surgery or trauma

Bloods

  • Prolonged APTT
  • Bleeding time, thrombin time, prothrombin time normal
43
Q

How would hereditary spherocytosis present?

A 
Failure to thrive
Jaundice, gallstones
Splenomegaly
Aplastic crisis precipitated by parvovirus infection
Degree of haemolysis variable
MCHC elevated
44
Q

Reed sternberg cells characteristic of?

A

Hodgkins lymphoma

45
Q

Features of hodgkins lymphoma?

A

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
Q

How do you stage in Hodkins lymphoma?

A

CT abdo pelvis

47
Q

Different forms of hodgkins lymphoma?

A
  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
Q

In ITP what are antibodies directed against?

A

Antibodies are directed against the glycoprotein IIb/IIIa or Ib-V-IX complex.

49
Q

Feautures of Iron deficiency anaemia?

A

koilonychia
atrophic glossitis
post-cricoid webs
angular stomatitis

50
Q

Features of lead poisoning?

A

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
Q

What is MGUS? how do you tell it apart from myeloma?

A

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
Q

What is myelodyspasia?

A

acquired neoplastic disorder of hematopoietic stem cells

pre-leukaemia, may progress to AML

53
Q

What is Myelofibrosis?

A

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
Q

CRAB for myeloma?

A

Calcium high

Renal failure

Anaemia

Bone lesions (rain drop skull), bone pain.

55
Q

Major and minor criteria for multiple myeloma?

A

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
Q

Neutropenic sepsis antibiotic choice?

A

Tazocin

57
Q

Features of Non-hodkins lymphoma?

A

median age = 55-60 years
painless widespread lymphadenopathy, hepatosplenomegaly
raised LDH, paraproteinaemia, AIHA

58
Q

Causes of a normocytic anaemia?

A

Anaemia of chronic disease
Chronic kidney disease
Aplastic anaemia
Haemolytic anaemia

59
Q

Threshold for platelet transfusion?

A

In significant bleeding <30, in severe bleeding <100

60
Q

Causes of polycythaemia?

A

Relative causes
dehydration
stress: Gaisbock syndrome

Primary
polycythaemia rubra vera

Secondary (reactive)

  • COPD
  • Altitude
  • Obstructive sleep apnoea
  • Excessive erythropoietin
61
Q

Features of polycythaemia vera?

A 
Hyperviscosity
Pruritus, typically after a hot bath
Splenomegaly
Haemorrhage (secondary to abnormal platelet function)
Plethoric appearance
Hypertension in a third of patients
62
Q

Management of polycythaemia?

A

Aspirin

Venesection - first line treatment

Hydroxyurea -slight increased risk of secondary leukaemia

Phosphorus-32 therapy

63
Q

Sickle cell inheritance?

A

Autosomal recessive

64
Q

Types of sickle cell crises?

A 
thrombotic, 'painful crises'
sequestration
acute chest syndrome
aplastic
haemolytic
65
Q

Management of a sickle cell crisis?

A

Analgesia e.g. opiates
Rehydrate
Oxygen
Consider antibiotics if evidence of infection
Blood transfusion
Exchange transfusion: e.g. if neurological complications

66
Q

Acquired forms of thrombophilia?

A

Antiphospholipid syndrome

Drugs
- the combined oral contraceptive pill

67
Q

How is Tranexamic acid administered?

A

Tranexamic acid is given as an IV bolus followed by an infusion in cases of major haemorrhage

68
Q

What are the B symptoms of hodgkins lymphoma that imply a poor prognosis?

A

Weight loss > 10% in last 6 months
Fever > 38ºC
Night sweats

69
Q

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?

A

1 and 1/2 to 2 hours

HF 3 hours

STAT in trauma

70
Q

Main special blood test for multiple myeloma

A

Serum elecrophoresis

- Monoclonal band

71
Q

Cause of an aplastic crisis in sickle cell?

A

Usually due to parovirus infection

72
Q

Transfusion threshold for red cells?

A

70 without ACS, 80 with ACS

73
Q

Blood transfusion reaction mnemonic?

A

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
Q

Management options for Von willibrands?

A

Tranexamic acid and desmopressin (stimulates release)

75
Q

If a patient is deficient in B12 and Folic acid which do you need to treat first?

A

Treat the B12 first to avoid subacute combined degeneration of the cord

76
Q

DVT and PE management?

A

LMWH initially, warfarin within 24 hours, keep on the LMWH until the INR is within the 2-3 range.

77
Q

The philadelphia chromosome abnormality (CML) is denoted how?

A

t(9:22)

78
Q

Burkitt’s lymphoma associated with what chromosomal abnormality?

A

c-myc t(8:14)

79
Q

Before a CTPA in a suspected PE what do you need to do?

A

CXR

80
Q

What is the mechanism for cocaine induced ACS?

A

Coronary artery spasm

81
Q

How do you differentiate a epididymal cyst and a hydrocele?

A

In a cyst it lies above or behind the testes, in a hydrocele it envelops the whole thing

82
Q

Underlying cardiac disease fluid recommendations?

A

20-25 ml/kg

83
Q

Management of pituitary tumours?

A

Pituitary
- Dopamine agonist (bromocriptine)

Within sella turcica

  • Trans-sphenoidal
  • Can do radiotherapy or drugs before surgery with GH tumours.

ACTH
- Trans-sphenoidal

84
Q

What is Amoebiasis?

A

Entamoeba histolytica (amoeba protozoa), chronic infections often liver abscesses

Presents with:

  • Profuse, bloody diarrhoea
  • Stool microscopy may show trophozoites
  • Treatment is with metronidazole
85
Q

Universal donor in FFP and Red cells?

A

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
Q

How does an acute haemolytic transfusion reaction present?

A

Lack of angioedema/urticaria

Symptoms begin within minutes of starting

  • Fever
  • Abdominal and chest pain
  • Agitation
  • Hypotension
87
Q

How do you manage acute haemolytic transfusion reaction?

A

Transfusion termination, Generous fluid resus, inform the lab

88
Q

How can you test for Polycythaemia Vera?

A

JAK2 mutation screen

89
Q

Large multinucleate cells with prominent eosinophilic nucleoli is a description for what type of cell?

A

Reed-sternberg - Hodgkin lymphoma

90
Q

Elderly person with marked lymphocytosis likely diagnosis?

A

CLL

5th (Final year) (34 decks)

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