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Haem&Endo Flashcards

1
Q

What are the two main components of a full blood count and what are the names of the conditions in which they get deranged?

A

Hb – anaemia or polycythaemia

Platelets – thrombocytopaenia or thrombocytosis

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2
Q

List two causes of polycythaemia

A

Primary polycythaemia (polycythaemia rubra vera)

Secondary polycythaemia (secondary to chronic hypoxia in COPD patients, a tumour that is producing ectopic EPO)

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3
Q

What are the three mechanisms of thrombocytopaenia? State a cause for each

A

Reduced production of platelets (e.g. bone marrow infiltration, leukaemia, lymphoma, drugs (e.g. chemotherapy))

Destruction of platelets (e.g. consumption of platelets in DIC)

Pooling of platelets (e.g. pooling within the spleen in patients with chronic liver disease and portal hypertension)

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4
Q

Broadly speaking, what can cause a high WCC?

A

Infection

Malignancy

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5
Q

List two main causes of microcytic anaemia

A

Iron deficiency anaemia

Beta thalassemia heterozygosity

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6
Q

What are the two main mechanisms of iron deficiency anaemia

A

Blood loss

Dietary deficiency

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7
Q

List some causes of normocytic anaemia

A

Anaemia of chronic disease

Infection

Malignancy

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8
Q

Describe the ferritin level in anaemia of chronic disease

A

Normal/high – because ferritin is an inflammatory marker, that is raised in inflammatory conditions (e.g. rheumatoid arthritis)

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9
Q

Describe the relationship between MCV and Hb in beta thalassemia heterozygosity

A

The MCV is very low and out of proportion to the degree of anaemia

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10
Q

List 5 causes of macrocytic anaemia. State some clinical clues that can be found on history, examination and investigation.

A

Alcoholism – history + raised GGT
Myelodysplasia – pancytopaenia + bone marrow biopsy
Hypothyroidism – history + TFTs (low T4 + high TSH)
Liver disease – history + exam
Folate/B12 deficiency – history (e.g. small bowel disease)

NOTE: mnemonic – alcoholics may have liver failure

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11
Q

List the main symptoms of polycythaemia.

A 
Headache
Pruritus after a hot bath
Blurred vision
Tinnitus
Thrombosis (DVT/stroke)
Gangrene
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12
Q

What are the three main complications of sickle cell anaemia

A

Acute painful crisis

Sequestration crisis

Gallstones/chronic cholecystitis

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13
Q

Describe the management of acute painful crisis

A

Analgesia

Oxygen (hypoxia can cause sickling)

IV fluids (dehydration can cause sickling)

Antibiotics

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14
Q

How is stroke treated in sickle cell patients?

A

Exchange blood transfusion to remove the sickled cells

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15
Q

Where can blood cells pool in sequestration crisis and what symptoms does this cause?

A

Lungs – SOB, cough, fever

Spleen – exacerbation of anaemia

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16
Q

How do you treat splenic sequestration crisis?

A

Splenectomy

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17
Q

Why do patients with sickle cell anaemia suffer from chronic cholecystitis?

A

Increased breakdown of Hb leads to increased risk of forming pigment stones

This can lead to chronic cholecystitis

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18
Q

How is chronic cholecystitis treated in sickle cell patients?

A

Cholecystectomy

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19
Q

What are the four main features of multiple myeloma? List important findings on presentation/investigation

A

Calcium – polyuria, polydipsia, constipation

Renan impairment – high urea and creatinine

Anaemia – SOB, lethargy, FBC

Bone – fracture, pain, DEXA scan

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20
Q

What are two other important complications of multiple myeloma?

A

Increased risk of infection

Cord compression

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21
Q

Why are multiple myeloma patients more likely to suffer from infections?

A

Multiple myeloma leads to increased production of one type of immunoglobulin

This leads to reduced production of other immunoglobulins, which increases risk of infection

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22
Q

What can cord compression due to multiple myeloma lead to?

A

Spastic paraparesis – partial paralysis of the lower limb

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23
Q

Describe the ALP in multiple myeloma. Why is this the case?

A

ALP is normal/low in multiple myeloma

Multiple myeloma suppresses the osteoblasts, which are responsible for producing ALP

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24
Q

List the two main causes of anaemia with HIGH reticulocytosis

A

Haemorrhage

Haemolysis

NOTE: reticulocytosis occurs when there is an increased demand for red blood cells

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25
List three causes of anaemia with LOW reticulocytes
Parvovirus B19 Aplastic crisis in sickle cell patients Blood transplant
26
List the three main diagnostic criteria for diabetes mellitus
Fasting blood glucose > 7 mmol/L Random blood glucose > 11.1 mmol/L HbA1c > 6.5% or > 48 mmol/mol
27
Why was the diagnostic cut-off for fasting blood glucose set at > 7 mmol/L?
Epidemiological studies showed that the rate of incidence of retinopathy significantly increased in patients with fasting blood glucose > 7 mmol/L
28
What is impaired glucose tolerance (IGT)?
A blood glucose of 7.8-11.1 mmol/L measured 2 hours after an oral glucose tolerance test (OGTT), in which 75 g of glucose is administered orally
29
Other than type 1 and type 2 diabetes mellitus, what else can cause diabetes?
Pancreatic insufficiency NOTE: complete pancreatic insufficiency is difficult to treat because the lack of glucagon and pancreatic polypeptide is difficult to manage
30
What is the first drug that is given to patients with type 2 diabetes mellitus?
Metformin
31
At what point do you add more medications for diabetics on metformin?
If the patient fails to achieve the target HbA1c despite metformin
32
Which commonly used medication for type 2 diabetes can cause hypoglycaemia?
Sulfonylureas
33
If the patient is overweight or you want to avoid hypoglycaemia, which diabetic medication might you consider using?
GLP-1 agonists
34
``` Briefly describe the mechanism of action of: Metformin Sulfonyureas DPP-IV inhibitors GLP-1 agonists ```
Metformin Decreases insulin resistance Sulfonylureas Stimulates insulin release DPP-IV inhibitors Reduces GLP-1 breakdown GLP-1 agonists Incretin that stimulates glucose-stimulated insulin release. Also inhibits glucagon release, reduces appetite and may cause some weight los
35
What is one of the first signs of diabetic nephropathy?
Increase in albumin: creatinine ratio
36
When might you put a patient on an insulin sliding scale
If a diabetic patient is not eating or really unwell
37
Sliding scales are not indicated in patients with sepsis. What medication would you initially try
Daily long-acting insulin is preferred NOTE: if the patient is ill and not eating very much, the long-acting insulin along may be sufficient to meet their insulin demands at the time
38
What is the main difficulty with insulin sliding scales?
It requires constant monitoring of blood glucose and constant adjustment of the insulin delivery rate
39
In what context is a sliding scale most useful?
Surgery – a patient might have to be NBM for a long time
40
List some symptoms of Graves’ disease.
Weight loss Increased appetite Irritability Palpitations Irregular periods
41
Describe the TFT results in a patient with Graves’ disease?
High T4/T3 Low TSH
42
What would a high TSH with high T4/T3 suggest?
Secondary hyperthyroidism
43
After performing TFTs and putting together a clinical picture of primary hyperthyroidism, what test would you do next?
TSH receptor stimulating antibodies
44
Other than stimulating the TSH receptors, what else do TSH receptor stimulating antibodies do?
They stimulate adipocytes and fibroblasts at the back of the eye to produce glycosaminoglycans (GAGs), which are hydrophilic and cause proptosis They are also responsible for the skin changes in pretibial myxedema
45
What are TPO antibodies a marker of?
Autoimmunity They are present in about 5% of the general population
46
What will radioiodine uptake scans of Graves’ disease patients show?
Diffuse increased uptake
47
What needs to happen for the thyroid gland to be able to take up iodine?
The TSH receptor must be stimulated for there to be iodine uptake
48
Describe and explain the iodine uptake in thyroiditis
NO iodine uptake because TSH is suppressed in thyroiditis
49
Describe and explain the iodine uptake in toxic nodular goitre
The scan will show a single hot nodule that is autonomous and no longer controlled by TSH There will not be much uptake from the rest of the gland, because high T4/T3 suppresses TSH levels, which, therefore, will not stimulate iodine uptake in the rest of the thyroid gland that is functioning normally
50
List some risk factors for thyroid cancer
Radiation Family history Rapid enlargement/compression Lymphadenopathy
51
What percentage of the general population has thyroid nodules?
60-70%
52
Where do most thyroid cancers metastasise to? Which type of thyroid cancer has a propensity to metastasise to this location?
Lungs These tend to be mostly follicular thyroid cancer
53
List two investigations that may be used in the diagnosis of thyroid cancer
Ultrasound scan Fine needle aspiration cytology Uptake scan (thyroid cancers are cold)
54
List four types of thyroid cancer
Papillary Follicular Medullary Anaplastic
55
Which type of thyroid cancer has the worst prognosis?
Anaplastic
56
List two treatments that are used after surgery in patients with thyroid cancer
Thyroxine – replace the function of the lost thyroid gland Radioiodine – in high-risk patients
57
List the signs of a prolactinoma
Amenorrhoea Galactorrhoea Bitemporal hemianopia Sexual dysfunction
58
Which type of prolactinoma can compress the pituitary stalk?
Macroprolactinoma
59
What is the first-line treatment for prolactinoma?
Dopamine agonists (e.g. cabergoline, bromocriptine)
60
Roughly how long are prolactinoma patients kept on this treatment?
4 years – then they can gradually be weaned off and some may be able to stop it entirely
61
Describe the symptoms of acromegaly
Headaches Sweating Obstructive sleep apnoea (poor sleep, snoring) Carpal tunnel syndrome (tingling fingers)
62
What causes obstructive sleep apnoea?
Excessive soft tissue obstructing the upper airways during sleep
63
What is the first test you do in the investigation of acromegaly?
IGF-1 levels
64
What is the test you do to diagnose acromegaly after IGF-1 levels?
Oral Glucose Tolerance Test Failure of suppression of GH after oral intake of glucose suggests acromegaly
65
How do you test pituitary function?
Insulin tolerance test Insulin causes hypoglycaemia, which should lead to an increase in the production of GH
66
What is a dexamethasone suppression test used for?
Test for Cushing’s syndrome In normal people, dexamethasone will suppress ACTH and hence suppress cortisol In people with Cushing’s syndrome, the cortisol level will remain high
67
What is a short synacthen test used for?
Test for adrenal insufficiency In normal people, synacthen will stimulate the adrenals to produce cortisol so cortisol levels will rise considerably following the administration of cortisol In people with adrenal insufficiency, cortisol levels will not rise considerably after the administration of synacthen
68
What are the three distinguishing symptoms of Cushing’s syndrome?
Proximal myopathy Easy bruising Striae > 1 cm wide
69
List some disease states that are caused by Cushing’s syndrome
Hypertension Diabetes mellitus Osteoporosis
70
What are striae?
Capillaries that become visible due to stretching and thinning of the skin
71
Broadly speaking, how can the causes of amenorrhoea/oligomenorrhoea be divided?
Pregnancy Hypothalamus Pituitary Thyroid Ovaries
72
List two hypothalamic causes of amenorrhoea
Excessive exercise Low BMI
73
Why does low BMI lead to amenorrhoea?
Low BMI will mean that leptin levels are low Leptin has a permissive effect over the hypothalamo-pitutiary-gonadal axis
74
What is the main pituitary cause of amenorrhoea?
Prolactinoma
75
What derangements of thyroid function can cause amenorrhoea?
Hypothyroidism Hyperthyroidism
76
List two ovarian causes of amenorrhoea
PCOS -> excess androgens Ovarian failure -> low oestradiol + high FSH/LH
77
What are the three main signs of hypokalaemia?
Weakness Arrhythmia Polyuria
78
List the three main causes of hypokalaemia
Vomiting Diuretics Primary hyperaldosteronism
79
Describe how hypokalaemia leads to polyuria
Hypokalaemia causes nephrogenic diabetes insipidus, which leads to polyuria
80
List two examples of primary hyperaldosteronism
Conn’s syndrome Bilateral adrenal hyperplasia
81
What can be measured to assist with a diagnosis of primary hyperaldosteronism?
Aldosterone: renin ratio
82
Why is hypernatraemia very rare?
Normally, if our serum Na+ is high, we would drink some water to dilute it
83
List two conditions that can cause hypernatraemia
Diabetes insipidus Dementia (forgetting to drink water
84
State the formula for calculation of urine osmolality
Osmolality = 2(Na+ + K+) + Ur + glucose
85
List causes for hypernatraemia with: High urine osmolality Low urine osmolality
High urine osmolality Dehydration Hyperosmolar hyperglycaemic state (HHS) NOTE: urine osmolality is high in HHS because of glycosuria Low urine osmolality Diabetes insipidus
86
Describe the actions of PTH
Increase resorption of calcium in the bones Increased reabsorption of calcium in the kidneys Increased excretion of phosphate in the kidneys
87
Describe biochemical features of primary hyperparathyroidism
High Ca2+ Low phosphate
88
Describe the calcium, phosphate and PTH levels in hypercalcaemia of malignancy
High Ca2+ Normal phosphate Low PTH
89
Name the two hormones that control serum calcium concentration
PTH Calcitriol (Vitamin D)
90
Describe the biochemical features of hypoparathyroidism
Low Ca2+ High phosphate Low PTH
91
Describe the biochemical features of renal failure
Low Ca2+ High phosphate High PTH
92
Explain the biochemical features of renal failure
The kidneys are not able to reabsorb calcium and they are not able to activate vitamin D leading to hypocalcaemia The kidneys are also unable to excrete phosphate leading to hyperphosphataemia The hypocalcaemia leads to a secondary hyperparathyroidism
93
Describe the biochemical features of vitamin D deficiency
Low Ca2+ Low phosphate High PTH
94
List causes for each of the following types of AKI: Pre-renal Intrinsic renal Post-renal
Pre-renal Hypovolaemia Sepsis Heart failure Intrinsic renal Drugs Glomerulonephritis Post-renal Obstruction (e.g. stones)
95
What can be found in the urine of a patient with glomerulonephritis?
Active urine sediment: blood and protein
96
Which investigation does every AKI patient need?
Ultrasound scan – check for signs of obstruction
97
What anatomical deformity does renal artery stenosis lead to?
Asymmetrical kidneys
98
How is renal artery stenosis investigated?
Magnetic resonance angiography (MRA)
99
Which drug class is contraindicated in bilateral renal artery stenosis and why?
ACE inhibitors It can cause a massive drop in GFR
100
Why does hyperventilation cause tingling in the hands?
Hyperventilation leads to hypocalcaemia, which causes neuromuscular excitation -> tingling
101
Describe the pattern of arthritis in rheumatoid arthritis
Symmetrical polyarthritis
102
List the five types of psoriatic arthritis
Asymmetrical oligoarthritis (more common and affects distal joints) Symmetrical polyarthritis (look like rheumatoid arthritis) Large joints (e.g. swollen knee) Arthritis mutilans (telescoping of the fingers) Psoriatic spondyloarthritis (axial skeleton involvement e.g. sacroiliitis)
103
Describe the appearance of a BCC
Pearl-like lesion with a rolled edge and telangiectasia

DPD (4 decks)

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