Gen Med 5 Flashcards
• 24 yr old man • Breathlessness • Facial swelling • After having a Chinese take‐ away
What treatment do you give?
IM adrenaline
What are the atypical organisms in pneumonia?
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Legionella pneumophila
- Implicated in up to 40% of CAP
- 50 yr old man
- Dyspepsia
- Wt loss
- Hb: 70
- MCV: 70
What test would you request?
[OGD- check]
How would you identify a GI cause of microcytic anaemia?
- Haematinics
- Coeliac screen* (TTG Ab)
- Remember red flags
- Top & Tail
- Order depends on upper/lower GI symptoms
- 70 year old man
- Bloody diarrhoea
- Stool micro & culture: ‐ve
- Stool C. diff toxin: ‐ve
Most likely diagnosis?
Ischaemic colitis
What are the causes of bloody diarrhoea?
- Infection: infective colitis
- Inflammation: ulcerative/Crohn’s colitis (younger pts)
- Ischaemia: ischaemic colitis (older pts)
- Malignancy
- Diverticulitis
What is associated with portal hypertension?
- Encephalopathy
- Ascites
- Spontaneous bacterial peritonitis
- Variceal bleed
- 20 year old boy
- Recent diarrhoea
- Malaise
- Hb: 70
- Cr: 300
Blood film shows schistocytes
Diagnosis?
Microangiopathic haemolytic anaemia
What can Microangiopathic haemolytic anaemia be caused by?
• DIC (Disseminated Intravascular Coagulation)
–low platelets & fibrinogen
–high PT/APTT
–high D‐dimer/ fibrin degradation products
• HUS (Haemolytic Uraemic Syndrome)
– Haemolysis ( low Hb, high bilirubin)
– Uraemia
– low plts
• TTP (Thrombotic Thrombocytopenic Purpura)
– HUS + fever + neurological manifestations
What are the hereditary causes of haemolytic anaemia?
– Red cell membrane (hereditary spherocytosis)
– Enzyme deficiency (G6PD deficiency)
– Haemoglobinopathy (Sickle cell disease, Thalassaemias)
What are the hereditary causes of haemolytic anaemia?
– Red cell membrane (hereditary spherocytosis)
– Enzyme deficiency (G6PD deficiency)
– Haemoglobinopathy (Sickle cell disease, Thalassaemias)
What are the acquired causes of haemolytic anaemia?
– Autoimmune
– Drugs
– Infection
– MAHA
What are valvulae conniventes?
The circular folds (valves of Kerckring) (also, plicae circulares, or valvulae conniventes) are large valvular flaps projecting into the lumen of the small intestine.
They arise as regular closely spaced rings/ lines on an AXR
- 60 yr old man
- Confused
- Cough
- No postural hypotension
- Na+: 120
- K+: 4.0
- TFTs: normal
- SST: normal
- Urine Na+: 40
- Urine osmolality: 400
What test would you request next?
CXR
What are the hypovolaemic causes of hyponatraemia?
Diarrhoea
Vomiting
Diuretics
Test:
Clinically
Low urine sodium
Measure off diuretics
What are the euvolaemic causes of hyponatraemia?
Hypothyroid
Adrenal insufficiency
SIADH
Test:
TFTs
Short synACTHen test
Plasma and urine osmolality
What are the hypervolaemic causes of hyponatraemia?
Cardiac failure
Cirrhosis
Nephrotic syndrome
Test:
Fluid overload
Low urine sodium
What are the hypervolaemic causes of hyponatraemia?
Cardiac failure
Cirrhosis
Nephrotic syndrome
Test:
Fluid overload
Low urine sodium
What are the causes of SIADH?
CNS pathology
Lung pathology
Drugs (SSRIs/ TCAs/ Opiates/ PPIs/ Carbemazepine)
Tumours
What are the causes of onycholysis?
- Trauma
- Thyrotoxicosis
- Fungal infection
- Psoriasis
- 20 year old woman
- Abdominal pain
- Vomiting
- Type 1 diabetes
- CBG: 20
- Venous pH: 7.20
• What is the most
appropriate next step?
Cap ketones
What are the complications of diabetes?
• Microvascular – Retinopathy – Nephropathy – Neuropathy (foot ulcers) • Macrovascular – MI/Stroke/PVD • Metabolic – DKA/HHS/Hypoglycaemia
• 26 year old man • Chest pain • Smokes 5/day • Auscultation: ‘scratching sound’
ECG shows widespread ST elevation
What is the diagnosis?
Pericarditis
- 60 yr old woman
- Collapse
- BP: 120/70 mmHg
- No postural drop
- HS: S1+S2+ ESM
ECG shows tall QRS complexes
What is the pathology?
Left ventricular hypertrophy
• 40 year old man • Loin pain • CRP: normal • Urinalysis: blood ++ What investigation would you do?
CT KUB to investigate calculi (colic pain)
What might a CT KUB find?
- Pelvi‐ureteric junction obstruction
* Calculus within the dilated renal pelvis
- 50 year old man
- Hypercalcaemia
- Low PTH
- Backache
- Normal ALP
Diagnosis?
Multiple myeloma
[Explanation:
PTH and Ca not both high so not hyperparathyroid
ALP is raised in bone or liver disease (osteoblasts make ALP)
ALP is normal in myeloma
> > > • Calcium is high
• Renal impairment
• Anaemia]
- 23 yr old woman
- Breast lump
- 1cm
- Smooth mobile
Most likely diagnosis?
Fibroadenoma
What does a cavitating lesion on a CXR suggest?
• Infection – TB – Staph – Klebsiella (e.g. alcoholics) • Inflammation (RA) • Infarction (PE) • Malignancy
- 35 yr old woman
- Ankle oedema
- Recent Echocardiogram: NAD
- U&Es: normal
- ALT, AST & ALP: normal
- Albumin: 15
What test would you order
next and why?
Urinalysis to see if protein is being lost in the urine
What is nephrotic syndrome?
- increased permeability of GBM to protein
- Proteinura> 3g/day
- Hypoalbuminaemia
- Oedema
- 30 year old man
- Recurrent GI & nose bleeds
Facial exam shows small red spots on mouth and tongue
What is the diagnosis?
Hereditary telengectasia
What is Hereditary telengectasia?
• Autosomal dominant • Abnormal blood vessels in – Skin – Mucous membranes – lungs – Liver – brain
