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Year 3 - Exams > Haematology Cases AS > Flashcards

Haematology Cases AS Flashcards

1
Q

What abnormalities can you get with these?

Hb/Plt/WCC

A

Hb - anaemia, polycythaemia

Plt - thrombocytopenia(e.g. in chronic liver disease because of pooling in the spleen), thrombocytosis

WCC - infection, malignancy

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2
Q

What causes low MCV anaemia?

A

normal - 80-100

  • Iron deficiency (low ferritin) - from diet, blood loss (GI, UG)
  • Beta thalassaemia heterozygosity
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3
Q

What causes normal MCV anaemia?

A

Chronic disease e.g. rheumatoid arthritis, normal/high ferritin( e.g. haemochromatosis- excessive iron absorption in GI tract)

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4
Q

What causes desaturation on exercise(?)

A

PCV

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5
Q

What investigation would you request in beta thalassaemia?

A

Hb electrophoresis

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6
Q

What are the causes of macrocytic anaemia?

A

Alcohol

Myelodysplasia

Hypothyroidism

Liver disease

Folate/B12 deficiency

Alcoholics May Have Liver Disease

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7
Q

How does polycythaemia present?

A
  • Headache
  • Pruritus after hot bath
  • Blurred viison
  • Tinnitus
  • Thrombosis (stroke, DVT)
  • Gangrene
  • Choreiform movements
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8
Q

What are some crises which occur in sickle cell anaemia? Summarise their management.

A
  • Acute painful crises - analgesia, oxygen, IV fluids, antibiotics
  • Stroke - exchange blood transfusion
  • Sequestration crises (lung (SOB) spleen (exacerbation anaemia) - splenectomy for repeated episodes of splenic sequestation
  • Gall stones, cholecystitis - cholecystectomy
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9
Q

What is the menmonic for myltiple myeloma?

A
  • Calcium
  • Renal failure
  • Anaemia
  • Bone (pain, osteopororsis)
  • Infection
  • Cord compression

Presentation: polyuria, polydispsia, constipation, Ur + Cr, FBC, fracture bone pain, DXA.

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10
Q

What do you test for in urine in multiple myeloma?

A

Bence Jones proteins in urine

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11
Q

What is the significance of ALP in malignancy/multiple myeloma?

A

ALP is a marker of bone formation

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12
Q

Give examples of situations where you would have reduced or increased reticulocyte counts.

A

Anaemia with increased reticulocyte count - haemolytic crises, Ddx

Reduced - parvovirus B19 infection, aplastic crises in sickle cell, blood transfusion

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13
Q

What is the diabetes range for fasting/random? Why is this so?

A

Diabetes - fasting >7, random >11.1. Above these ranges people start getting retinopathy so this is diabetes.

Impaired glucose tolerance (IGT) - 75 OGTT, 2 hour glucose 7.8-11

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14
Q

How does type 1 diabetes present? (3)

A

Weight loss, ketones, acidosis.

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15
Q

45 year old with lthargy, ,fatigue, polyuria, polydipsia, urinalysis shows no ketones and high glc. Random glc is 12. What treatment would you give?

A

Start with metformin and then add sulfonylurea (e.g. gliptin)

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16
Q

Diabetes complications?

A

Micro - retino/nephro/neuropathy

Macro - MI/stroke/PVD

Metabolic - DKA/HHS/hypoglycaemia/hyperosmolar state(?)

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17
Q

What is the sliding scale?

A

If pt unwell or nor eating this is prescribed for diabetics

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18
Q

Give a diagnosis:

  • Weight loss
  • Good appetite
  • Irritability
  • Palpitaions
  • Irregular periods
  • O/E tremor/proptosis/smooth goitre/pretibial myxoedema.
  • Free T4: 30(10-20)
  • TSH <0.05
A

TSH receptor antibody attacks thyroid - Graves’ disease

19
Q

What will nuclear medicine scan show in graves?

A

Diffuse increased uptake

20
Q

What investigations would you do for thyroid cancer?

A

USS

FNAC (uptake scan: cold nodule)

MDT

21
Q

What are the types of thyroid cancer? (4)

A
  • papillary
  • follicular
  • medullary
  • anaplastic
22
Q

What are the risk factors for thyroid cancer?

A

Radiation

FHx

Rapid enlargement/compression symptoms e.g. swallowing, coughing

Lymphadenopathy

23
Q

When does bitemporal hemianopia commonly occur?

A

Pituitary tumour compressing optic chiasm

24
Q

Describe a common presentation of prolactinoma in a female patient.

A
  • Amenorrhoea
  • Galactorrhoea
  • Bitemporal hemianopia
  • Milk
  • Irregular periods
  • Sexual dysfunction
25
Q

Why do men with prolactinomas present later?

A

No periods

Will complain once bitemporal hemianopia occurs

26
Q

What is the treatment for prolactinoma?

A

Cabergoline (only operate if unresponsive to treatment)

27
Q

50 yr old

headache, sweating

snoring, poor sleep

tingling in fingers (carpal tunnel syndrome)

What is the first test?

A

Oral glucose tolerance test (OGTT)

Acromegaly

28
Q

Describe the results of OGTT.

A

Glucose will not suppress IGF-1 if there is a pituitary tumour

29
Q
  • 40yr old woman
  • wt gain
  • depressed
  • fatigue
  • cental adiposity

What is the diagnosis?

A

Can’t tell - this is probably NOT Cushing’s

These are very common features in the population

30
Q

What are the discriminatory signs in Cushing’s/when would you start testing for Cushing’s?

A
  • Bruising, thin skin
  • Myopathy
  • Purple striae, >1cm wide
  • DM, HTN, osteoporosis at young age
31
Q

Amenorrhoea/oligomenorrhoea - differential diagnosis?

A
  • Pregnancy - urine BHCG
  • Hypothalamus - excessive exercise, low BMI
  • Pituitary - excess prolactin, low LH/FSH
  • Thyroid (hyper/hypo)- TFTs
  • Ovaries - PCOS/ovarian failure- excess androgens (or hirsutism), high FSH
32
Q

Give a common presentation of hypokalaemia. (3)

A

Weakness/arrhythmia/polyuria

Polyuria because of nephrogenic diabetes insipidus

33
Q

Which endocrine condition can cause hypokalaemia?

A

A third of hypokalaemias are caused by Conn’s

34
Q

Describe the osmolality of blood/urine in hyponatraemia.

A

plasma osmolality low in blood in hyponatraemia and high in urine

35
Q

When can you get a high urine osmolality?

A

dehydration (ederly, children)

hyperosmolar hyperglycaemic state (T2DM)

36
Q

What biochem picture is suggestive of Vit D deficiency?

A

low ca, low phosphate, high PTH

(PTH goes up in low Ca/phosphate)

37
Q

How do you distinguish between hyperparathyroidism and vit D deficiency?

A

high PTH in hyperparathyroidism and high Ca, low phophate (phosphate trashing hormone)

38
Q

high ca, normal phosphate, low PTH?

A

Malignancy

39
Q

Low Ca, high phosphate, low PTH?

A

hypoparathyroidism

40
Q

Low Ca, high phosphate, high PTH?

A

Renal failure - Vit D needs to be activated in kidney/liver. If it is not activated then low Ca because low Vit D. PTH will be high due to low negative feedback

41
Q

Causes of AKI?

A
  • Pre-renal - hypovolaemia/sepsis
  • Renal - drugs/ active urine sediment (blood and protein in urine e.g. glomerulonephritis)
  • Post renal - obstruction (e.g. large prostate/malignancy)
42
Q

Renal artery stenosis - what are the features? What investigation would you do?

A

Asymmetrical kidneys

MRA

Deterioration of renal function with ACE inhibition

43
Q

What can you deduce from CO2 and bicarbonate in aBG?

A

CO2 and bicarbonate should always go in the same direction

Always look at pH first then CO2 (if CO2 is low then respiratory cause)

If they are going in opposite directions then there is a “mixed picture”

44
Q

What is sarcoilitis?

A

Arthritis affecting the DIP joints

Distal oligarthritis - rheumatoid is symmetric polyarthropathy

Year 3 - Exams (25 decks)

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