Haematology + Endocrinology (2) Flashcards
Features of immediate transfusion reaction?
Haemolysis
• Fever
• Rigor
• Chest pain
- Dark urine
- High HR
- Low BP
Causes of microcytic anaemia?
- Iron deficiency - diet, blood loss
* Beta thalassaemi
Cause of normal MCV?
• Chronic disease e.g. RA
Patient has high ferritin and O2 sats drop on exercise. Likely diagnosis?
Pneumocystis carinii pneumonia from HIV
50 year old woman
• Microcytic anaemia
• NSAIDs for joint pain
Cause?
Iron deficiency - blood loss from bleeding gastric ulcer
40 year old woman
• Normal Hb
• Low MCV
What do you suspect? What other test would you request?
Beta thalassaemia
Haemoglobin electrophoresis
Causes of macrocytic anaemia?
- Alcohol
- Myelodysplasia (pancytopaenia)
- Hypothyroidism
- Liver disease
- Folate/B12 deficiency
Alcoholics May Have Liver Failure
Presentation of polycythaemia?
- Headache
- Pruritus after hot bath
- Blurred vision
- Tinnitus
- Thrombosis
- Gangrene
- Choreiform movements
Management of acute painful crisis for sickle cell anaemia?
- Analgesia
- O2
- IV fluids
- ABx
Management of stroke in sickle cell anaemia?
Exchange blood transfusion
Presentation of sequestration crises in sickle cell anaemia?
Lung - SOB, cough, fever
Spleen - exacerbation of anaemia
Management of splenic sequestration crises in sickle cell anaemia?
Splenectomy for repeated episodes
Management of gallstones or chronic cholecystitis in sickle cell anaemia?
Cholecystectomy
How does a persion with mutiple myeloma present, with reference to CRAB + 2 other problems?
C - polyuria, polydipsia, constipation
R - high urea and creatinine
A - breathlessness, lethargy, low Hb
B - fracture, bone pain, DEXA -2.5 or lower
May have infection or cord compression too
50 year old man • Hypercalcaemia • Low PTH • Backache • High ALP
Most likely cause?
Malignancy
Causes of anaemia with increased reticulocyte count?
Haemolytic crises
Haemorrhage
Causes of anaemia with low reticulocyte count?
- Aplastic crisis due to parvovirus B19 infection
- Aplastic crisis in SCA
- Blood transfusion
Diagnosis of diabetes?
> 7 - fasting
≥ 11.1 - random
Once if symptomatic
Twice in a row if asymptomatic
Impaired glucose tolerance
• 75g OGTT
• 2-hour glucose: 7.8-11
45 year old man • Lethargy, fatigue • Polyuria, polydipsia • Urinalysis - no ketones, glucose +++ • Random glucose: 12
How would you treat him?
- Lifestyle advice
- Metformin
- Add sulphonylurea if progressing
- DPP-IV inhibitor
- GLP-1 agonist
How do sulphonylureas work?
Stimulate insulin release from beta cells
Side effect of sulphonylureas?
Weight gain and hypoglycaemia
Other name for DPP-4 inhibitors and how do they work?
Gliptins
DPP-4 breaks down GLP-1, so inhibiting it with gliptins reduces breakdown of GLP-1
Which diabetes drug would be added if their control is suboptimal, they are overweight and there is a risk of hypoglycaemia, and why?
GLP-1 agonists
Reduce weight as well as HbA1c
What do diabetes patients need to monitor retinopathy?
Annual digital retinal photography
not opthalmoscopy
What treatment is generally used if diabetic retinopathy is advanced?
Laser treatment
How do you check for nephropathy in diabetic patients?
Albumin-creatinine ratio (ACR) every time you see them
Which drug slows the progression of diabetic nephropathy causing microalbuminuria?
ACE inhibitor
Hyperglycaemic hyperosmolar state (HHS), which diabetes type, presentation and treatment?
T2DM
- Drowsy
- Confused
- IV fluids
- Low dose IV insulin (if glucose is no longer falling or if ketonaemia)
Treatment of hypoglycaemia?
- Conscious - sugary drink, carbohydrate meal later
- Confused - glucose gel
- Unconscious - glucagon or IV glucose 20%
Which chart determines how much IV insulin to give to patient depending on their blood glucose (patient not eating, unwell e.g. sepsis)?
Sliding scale
Feature of Grave’s specifically in women?
Irregular periods
TFTs in Graves’?
- High free T4/T3
* Low TSH
Weight and appetitie in Graves’?
- Weight loss
* Good appetite
Antibody in Graves’?
TSH-receptor stimulating Ab
What would radioactive uptake scan show in Graves’?
Diffuse increased uptake
Investigations for thyroid cancer?
- USS
- FNA
- Uptake scan - cold nodules
Treatment for thyroid cancer?
- Surgery
- Thyroxine
- May need radioiodine
Presentation of prolactinoma?
- Amenorrhoea
- Galactorrhea
- Bitemporal hemianopia (men present later with this or sexual dysfunction)
Most appropriate treatment for prolactinoma? Medical or surgical?
Cabergoline
Want to try and avoid trans-sphenoidal surgery
- Headache, sweating
- Poor sleep, snoring
- Tingling in fingers
- High IGF-1
Next test?
OGTT
40 year old woman • Weight gain • Depressed • Fatigue • Central adiposity
Diagnosis?
Nothing specific yet, this presentation is common - low pre-test possibility for Cushing’s
Don’t test straight away due to risk of false positives
First test in amenorrhoea?
Pregnancy test - urine BHCG
Next investigations (general) for amenorrhoea after 1st test?
- Hypothalamus - ask about exessive exercise, low BMI
- Pituitary - excess prolactin, low LH/FSH
- TFTs - high/low
- PCOS - excess androgens
- Ovarian failure - high FSH
Presentation of hypokalaemia?
- Weakness
- Arrhythmia
- Polyuria - nephrogenic diabetes insipidus (like hypercalcaemia)
Causes of hypokalaemia?
- Vomiting
- Diuretics
- Primary hyperaldosteronism (bilateral hyperplasia or Conn’s)
Where is hypernatraemia seen?
- Dehydration in elderly or children - high urine osm
- HHS (T2DM) - high urine osm
- DI - low urine osm
Calcium, phosphate and PTH in vitamin D deficiency and why?
- Low calcium
- Low phosphate
- High PTH
Vitamin D needed for calcium and phosphate absorption
Low calcium causes high PTH
What are 2 main possibilities for high calcium, and what is the PTH in those 2 options?
Primary hyperparathyroidism - high PTH causing high calcium
Malignancy/myeloma - low PTH suppressed by high calcium
Calcium, phosphate and PTH in kidney failure and why?
- Low calcium
- High phosphate
- High PTH
Low calcium because of low vitamin D
High phophate as you can’t excrete phosphate
Cause of renal AKI?
- Drugs
* Glomerulonephritis - active urine sediment (blood and urine)
Investigations for post-renal AKI?
USS for obstruction
Investigations for renal artery stenosis?
- USS - asymmetrical kidneys
2. Magnetic resonance angiography - GOLD STANDARD
Which drug worsens renal function in bilateral renal artery stenosis?
ACE inhibitors
21 year old before exam
• SOB
• Palpitations
• Tingling of hands
- High pH
- low pCO2
- low HCO3
Cause?
Respiratory alkalosis
Hyperventilation
Presentation of psioriatic arthropathy?
- Symmetric polyarthropathy - like RA
- Asymmetric distal oligoarthritis (2-4 joints)
- Sacroiliitis
