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DPD > Haematology + Endocrinology (2) > Flashcards

Haematology + Endocrinology (2) Flashcards

1
Q

Features of immediate transfusion reaction?

A

Haemolysis
• Fever
• Rigor
• Chest pain

  • Dark urine
  • High HR
  • Low BP
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2
Q

Causes of microcytic anaemia?

A
  • Iron deficiency - diet, blood loss

* Beta thalassaemi

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3
Q

Cause of normal MCV?

A

• Chronic disease e.g. RA

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4
Q

Patient has high ferritin and O2 sats drop on exercise. Likely diagnosis?

A

Pneumocystis carinii pneumonia from HIV

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5
Q

50 year old woman
• Microcytic anaemia
• NSAIDs for joint pain

Cause?

A

Iron deficiency - blood loss from bleeding gastric ulcer

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6
Q

40 year old woman
• Normal Hb
• Low MCV

What do you suspect? What other test would you request?

A

Beta thalassaemia

Haemoglobin electrophoresis

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7
Q

Causes of macrocytic anaemia?

A
  • Alcohol
  • Myelodysplasia (pancytopaenia)
  • Hypothyroidism
  • Liver disease
  • Folate/B12 deficiency

Alcoholics May Have Liver Failure

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8
Q

Presentation of polycythaemia?

A
  • Headache
  • Pruritus after hot bath
  • Blurred vision
  • Tinnitus
  • Thrombosis
  • Gangrene
  • Choreiform movements
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9
Q

Management of acute painful crisis for sickle cell anaemia?

A
  • Analgesia
  • O2
  • IV fluids
  • ABx
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10
Q

Management of stroke in sickle cell anaemia?

A

Exchange blood transfusion

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11
Q

Presentation of sequestration crises in sickle cell anaemia?

A

Lung - SOB, cough, fever

Spleen - exacerbation of anaemia

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12
Q

Management of splenic sequestration crises in sickle cell anaemia?

A

Splenectomy for repeated episodes

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13
Q

Management of gallstones or chronic cholecystitis in sickle cell anaemia?

A

Cholecystectomy

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14
Q

How does a persion with mutiple myeloma present, with reference to CRAB + 2 other problems?

A

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

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15
Q 
50 year old man
• Hypercalcaemia
• Low PTH
• Backache
• High ALP

Most likely cause?

A

Malignancy

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16
Q

Causes of anaemia with increased reticulocyte count?

A

Haemolytic crises

Haemorrhage

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17
Q

Causes of anaemia with low reticulocyte count?

A
  • Aplastic crisis due to parvovirus B19 infection
  • Aplastic crisis in SCA
  • Blood transfusion
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18
Q

Diagnosis of diabetes?

A

> 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

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19
Q 
45 year old man
• Lethargy, fatigue
• Polyuria, polydipsia
• Urinalysis - no ketones, glucose +++
• Random glucose: 12

How would you treat him?

A
  1. Lifestyle advice
  2. Metformin
  3. Add sulphonylurea if progressing
  4. DPP-IV inhibitor
  5. GLP-1 agonist
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20
Q

How do sulphonylureas work?

A

Stimulate insulin release from beta cells

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21
Q

Side effect of sulphonylureas?

A

Weight gain and hypoglycaemia

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22
Q

Other name for DPP-4 inhibitors and how do they work?

A

Gliptins

DPP-4 breaks down GLP-1, so inhibiting it with gliptins reduces breakdown of GLP-1

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23
Q

Which diabetes drug would be added if their control is suboptimal, they are overweight and there is a risk of hypoglycaemia, and why?

A

GLP-1 agonists

Reduce weight as well as HbA1c

24
Q

What do diabetes patients need to monitor retinopathy?

A

Annual digital retinal photography

not opthalmoscopy

25
Q

What treatment is generally used if diabetic retinopathy is advanced?

A

Laser treatment

26
Q

How do you check for nephropathy in diabetic patients?

A

Albumin-creatinine ratio (ACR) every time you see them

27
Q

Which drug slows the progression of diabetic nephropathy causing microalbuminuria?

A

ACE inhibitor

28
Q

Hyperglycaemic hyperosmolar state (HHS), which diabetes type, presentation and treatment?

A

T2DM

  • Drowsy
  • Confused
  • IV fluids
  • Low dose IV insulin (if glucose is no longer falling or if ketonaemia)
29
Q

Treatment of hypoglycaemia?

A
  • Conscious - sugary drink, carbohydrate meal later
  • Confused - glucose gel
  • Unconscious - glucagon or IV glucose 20%
30
Q

Which chart determines how much IV insulin to give to patient depending on their blood glucose (patient not eating, unwell e.g. sepsis)?

A

Sliding scale

31
Q

Feature of Grave’s specifically in women?

A

Irregular periods

32
Q

TFTs in Graves’?

A
  • High free T4/T3

* Low TSH

33
Q

Weight and appetitie in Graves’?

A
  • Weight loss

* Good appetite

34
Q

Antibody in Graves’?

A

TSH-receptor stimulating Ab

35
Q

What would radioactive uptake scan show in Graves’?

A

Diffuse increased uptake

36
Q

Investigations for thyroid cancer?

A
  1. USS
  2. FNA
  3. Uptake scan - cold nodules
37
Q

Treatment for thyroid cancer?

A
  1. Surgery
  2. Thyroxine
  3. May need radioiodine
38
Q

Presentation of prolactinoma?

A
  • Amenorrhoea
  • Galactorrhea
  • Bitemporal hemianopia (men present later with this or sexual dysfunction)
39
Q

Most appropriate treatment for prolactinoma? Medical or surgical?

A

Cabergoline

Want to try and avoid trans-sphenoidal surgery

40
Q
  • Headache, sweating
  • Poor sleep, snoring
  • Tingling in fingers
  • High IGF-1

Next test?

A

OGTT

41
Q 
40 year old woman
• Weight gain
• Depressed
• Fatigue
• Central adiposity

Diagnosis?

A

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

42
Q

First test in amenorrhoea?

A

Pregnancy test - urine BHCG

43
Q

Next investigations (general) for amenorrhoea after 1st test?

A
  • Hypothalamus - ask about exessive exercise, low BMI
  • Pituitary - excess prolactin, low LH/FSH
  • TFTs - high/low
  • PCOS - excess androgens
  • Ovarian failure - high FSH
44
Q

Presentation of hypokalaemia?

A
  • Weakness
  • Arrhythmia
  • Polyuria - nephrogenic diabetes insipidus (like hypercalcaemia)
45
Q

Causes of hypokalaemia?

A
  • Vomiting
  • Diuretics
  • Primary hyperaldosteronism (bilateral hyperplasia or Conn’s)
46
Q

Where is hypernatraemia seen?

A
  • Dehydration in elderly or children - high urine osm
  • HHS (T2DM) - high urine osm
  • DI - low urine osm
47
Q

Calcium, phosphate and PTH in vitamin D deficiency and why?

A
  • Low calcium
  • Low phosphate
  • High PTH

Vitamin D needed for calcium and phosphate absorption

Low calcium causes high PTH

48
Q

What are 2 main possibilities for high calcium, and what is the PTH in those 2 options?

A

Primary hyperparathyroidism - high PTH causing high calcium

Malignancy/myeloma - low PTH suppressed by high calcium

49
Q

Calcium, phosphate and PTH in kidney failure and why?

A
  • Low calcium
  • High phosphate
  • High PTH

Low calcium because of low vitamin D
High phophate as you can’t excrete phosphate

50
Q

Cause of renal AKI?

A
  • Drugs

* Glomerulonephritis - active urine sediment (blood and urine)

51
Q

Investigations for post-renal AKI?

A

USS for obstruction

52
Q

Investigations for renal artery stenosis?

A
  1. USS - asymmetrical kidneys

2. Magnetic resonance angiography - GOLD STANDARD

53
Q

Which drug worsens renal function in bilateral renal artery stenosis?

A

ACE inhibitors

54
Q

21 year old before exam
• SOB
• Palpitations
• Tingling of hands

  • High pH
  • low pCO2
  • low HCO3

Cause?

A

Respiratory alkalosis

Hyperventilation

55
Q

Presentation of psioriatic arthropathy?

A
  • Symmetric polyarthropathy - like RA
  • Asymmetric distal oligoarthritis (2-4 joints)
  • Sacroiliitis

DPD (6 decks)

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