Gen Med 6 Flashcards
What haematological issues can you see in a blood test?
Hb Anaemia Polycythaemia Plt Thrombocytopenia Thrombocytosis WCC Infection Malignancy
What are the types of low and normal MCV anaemia?
Low MCV (low ferritin) Iron Deficiency (Diet, Blood loss) Beta thalassaemia heterozygosity
Normal MCV Chronic Disease (RhA, normal/ high ferritin)
What are the causes of high MCV?
Alcohol- Hx, incr. GGT
Myelodysplasia •Pancytopenia •Bone marrow
Hypothyroid •Hx (lethargy, constipation, wt gain) •Low T4, High TSH
Liver disease (Alcohol, autoimmune, drugs, virus) •Hx/Exam Folate/ B12 deficiency •Hx (small bowel disease, ? Gastrectomy) (Alcoholics May Have Liver Failure)
When may there by high ferritin?
Ferritin is an acute phase protein and goes up in inflammation
High ferritin also has haemachromotosis
50 F
Hb 90g/L
Low MCV
takes NSAIDs for joint pain.
Cause?
Likely cause is IDA
40 F with normal Hb and microcytic cells. What investigations and what condition?
Hb electrophoresis Beta thalassaemia trait
What is the polycythaemia presentations?
Headache, Blurred vision, Tinnitus, Choreiform movements
Pruritis
Thrombosis, Gangrene
What are the sickle cell anaemia crises?
Acute painful crises
Stroke Sequestration crises (red cell pooling)- Lungs (SOB, cough, fever) -Spleen (exacerbation of anaemia)
Gallstones, chronic cholecystitis
What is the management of sickle cell crises?
Analgesia Oxygen IV fluids Abx Stroke = exchange blood Splenectomy for repeated episodes of splenic sequestration Cholecystectomy
What does CRAB stand for?
C= calcium, polyuria, polydipsia
R = Renal Failure, Ur/ Cr
A = Anaemia, Breathless, lethargy, FBC
B = Bone pain, Fracture, bone pain, DXA Infection Cord compression
What is the difference between myeloma and malignancy?
Check for myeloma test for urinary bence jones proteins in the urine.
Osteoblasts make ALP which is suppressed by plasma cells in multiple myeloma. Not malignancy because ALP would be high.
What does high reticulocyte count suggest?
Increased reticulocyte count suggests high haemolysis or haemorrhage.
Low reticulocyte count may be infection (e.g. parvovirus B19) or aplastic crisis in sickle cell or blood transfusion.
- 50 year old man
- Hypercalcaemia
- Low PTH
- Backache
- Normal ALP
What is the most likely cause?
Multiple myeloma
- 50 year old man
- Hypercalcaemia
- Low PTH
- Backache
- High ALP
What is the most likely cause?
Malignacy
What is the glucose parameter for diabetes?
Fasting >7
Random > 11.1
(Is when people start getting retinopathy)
What is impaired glucose tolerance?
75g OGTT 2 hour gluc: 7.8-11
What is the difference between Type 1 and 2 diabetes?
Type 1: Young thin, Wt loss, ketones, acidosis
Type 2: Older, overweight, insulin resistant
- A 45 yr old man
- lethargy, fatigue, polyuria, polydipsia
- urinalysis: –no ketones –glc +++
- Random glc: 12
What treatment would you give?
Metformin
What are the diabetic complications?
- Microvascular –Retinopathy –Nephropathy –Neuropathy
- Macrovascular –MI/Stroke/PVD
- Metabolic –DKA/HHS/Hypoglycaemia
What is the insulin sliding scale?
Change in insulin dose based on patient blood glucose
- Wt loss
- Good appetite
- Irritability
- Palpitations
- irregular periods
O/E
- Tremor
- Proptosis
- Smooth goitre
- Pretibial myxoedema
What do TFTs show?
High free T4/T3, suppressed TSH
What electrolyte imbalances cause nephrogenic DI?
Hyperkalaemia and hypercalcaemia
Grave’s disease presentation What investigation would you do after TFTs?
TSH receptor stimulating Ab
What would an NM (technetium) uptake scan show in Graves?
Diffuse increased uptake
What do you look for in Hx and exam of thyroid cancer?
•Lump(s) •Risk factors –Radiation –FHx –Rapid enlargement/compression –Lymphadenopathy •Mets (e.g. lung, follicular thyroid ca)
What investigations and radiological imaging would you use to find thyroid cancer?
•USS •FNAC, (Uptake scan: cold nodules) •MDT •Surgery –Papillary –Follicular –Medullary (? FHx) –Anaplastic •Thyroxine, radioiodine Pituitary tumours may have bitemporal hemianopia.
30 year old female
Amenorrhoea
Galactorrhoea
Bitemporal hemianopia
Treatment?
Cabergoline
•40 year old woman •Wt gain •Depressed •Fatigue •Central obesity Is it cushings?
No
What are the discriminatory signs of cushings?
•Bruising, thin skin •Myopathy •purple striae, > 1cm wide •DM, HTN, osteoporosis at a young age
•Headache, sweating •Poor sleep, snoring –Obstructive sleep apnoea •Tingling in fingers –Carpal tunnel syndrome •Initial test: High IGF-1 What test next?
OGTT (oral glucose tolerance test)
Causes of amenorrhoea?
•Pregnancy •Hypothalamus •Pituitary •Thyroid (hyper/hypo) •Ovaries –PCOS –Ovarian failure
What investigations for amenorrhoea/ oligomenorrhoea?
•Urine BHCG •? Excessive exercise, low BMI •Excess prolactin •Low LH/FSH •TFTs Excess androgens (or hirsutism) High FSH
What is the presentation of hypokalaemia?
- Weakness
- Arrhythmia
- Polyuria
- GI: Vomiting
- Diuretics
- Primary hyperaldosteronism (bilateral hyperplasia or Conn’s) –Aldosterone: renin ratio
What are the signs of hypernatraemia?
•High Plasma osm • Osmolality = 2 x (Na++ K+) + Ur + glc •Urine osmolality: 572 –Dehydration (elderly, children) –HHS (urine high osm: glycosuria), type 2 diabetes • Low urine osmolality –DI (dilute urine, osm < 300)
Which biochem picture is suggestive of Vitamin D deficiency?
Low ca, low phosphate, high PTH
What are the causes of AKI?
Pre-Renal Hypovolaemia Sepsis
Renal Drugs Active urine sediment: blood and protein in the urine (glomerulonephritis)
Post renal USS (?obstruction)
How do you find renal artery stenosis?
•Asymmetrical kidneys •Magnetic Resonance Angiography (MRA) •Deterioration of renal function with ACE inhibitors (bilateral RAS)
Diagnose each of these:
A. Low ca, low phosphate, high PTH
B. High ca, low phosphate, high PTH
C. High ca, normal phosphate, low PTH
D. Low ca, high phosphate, low PTH
E. Low ca, high phosphate, high PTH
A- Vitamin D deficiency
B- Hyperparathyroidism
C- Bony Mets
D- Hypoparathyroidism
E- Renal Failure
What is the clinical presentation of Hyponatraemia?
What is this?
Sacroiliitis
Arthritis affecting DIP joints
Psoriatic arthropathy
What is the diagnosis?
Basal cell carcinoma
