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DPD > Haematology + Endocrinology > Flashcards

Haematology + Endocrinology Flashcards

1
Q
  • Cough
  • Breathlessness
  • Recent travel
  • Coarse crepitations and bronchial breathing
  • Hyponatraemia
  • Deranged LFTs

Prescribe amoxicillin and …?
Why?

A

Clarithromycin

• Typical pneumonia

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2
Q

What are 3 organisms in atypical pneumonia?

A
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Legionella pneumpphilia
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3
Q
  • Dyspepsia
  • Weight loss
  • Microcytic anaemia

Next appropriate investigation?

A

OGD (gastroscopy)

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4
Q

What tests should you do in microcytic anaemia?

A
  • Haematinics

* Coeliac screen (TTG Ab) - can also cause B12 deficiency

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5
Q

How do you confirm coeliac disease?

A

Duodenal biopsy - villous atrophy

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6
Q

70 year old man
• Bloody diarrhoea
• Negative culture and C. diff toxin

Most likely diagnosis?

A

Ischaemic colitis

• Bloody diarrhoea in elderly patients

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7
Q

40 year old man
• Palpitations for 4 hours
• ECG: AF

Treatment and why?

A

DC cardioversion

  • Less than 48 hours
  • Converts AF to sinus rhythm
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8
Q

How is an SVT converted back to sinus rhythm?

A

Adenosine (rate control)

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9
Q

What is used to control rate in AF?

A
  • Beta-blocker or verapamil

* Digoxin or amiodarone if contraindication

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10
Q

When is amiodarone used?

A

Pulseless VT / VF

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11
Q

Complications of portal hypertension?

A
  • Encephalopathy
  • Ascites
  • Spontaneous bacterial peritonitis
  • Variceal bleed
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12
Q 
20 year old boy
• Diarrhoea
• Malaise
• Low Hb
• High creatinine
• Schistocytes

What skin sign would you expect to see and what is the diagnosis?

A

Jaundice

Schistocytes = haemolysis

Haemolytic Uraemic syndrome

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13
Q

Which 3 conditions have microangiopathic haemolytic anaemia?

A
  • DIC
  • HUS
  • TTP
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14
Q

Bloods tests in DIC and HUS?

A

DIC
• low platelets
• high PT/APTT
• high D-dimer

HUS
• Low Hb
• High bilirubin
• High creatinine (uraemia)
• Low platelets
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15
Q

Hereditary (3) and acquired (4) causes of haemolytic anaemia?

A

Hereditary
• Red cell membrane (hereditary spherocytosis)
• Enzyme deficiency (G6PD)
• Haemoglobinopathy (sickle cell disease, thalassaemia)

Acquired
• Autoimmune
• Drugs
• Infection
• MAHA
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16
Q

What are small bowel folds called and what size would you expect the small bowel to be in obstruction?

A

Valvulae conniventes

> 3cm

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17
Q

What are large bowel folds called and what size would you expect the large bowel to be in obstruction?

A

Haustra

> 6cm, > 9cm at caecum

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18
Q

3 causes of hyponatramia with hypovolaemia?

A
  • Diarrhoea
  • Vomiting
  • Diuretics
19
Q

3 causes of hyponatraemia with euvolaemia and their tests?

A
  • Hypothyroidism - TFTs
  • Adrenal insufficiency - short synacthen test
  • SIADH - plasma + urine osmolality
20
Q

3 causes of hyponatraemia with hypervolaemia?

A
  • Cardiac failure
  • Cirrhosis
  • Nephrotic syndrome
21
Q 
60 year old man
• Confused
• Cough
• Low sodium
• Low plasma osmolality (low sodium)
• High urine osmolality (high sodium)

Next most appropriate investigation and why?

A

CXR

• Lung cancer producing excess ADH

22
Q

What are almost all cases of hyponatraemia due to?

A

Rise in ADH - but this isn’t always ‘inappropriate’ as in SIADH

23
Q

Top 2 investigations for SIADH (and other cause)?

A
  • CXR - lung cancer
  • Brain CT - brain tumour

Drugs e.g. SSRI, TCA

24
Q

35 year old man with sweating, weight loss, nail separating from nail bed. What is the nail sign called and what is the cause? What are other causes of this sign?

A

Onycholysis caused by thyrotoxicosis

  • Trauma
  • Fungal infections
  • Psoriasis
25
Q 
20 year old woman
• Abdominal pain
• Vomiting
• T1DM
• High BM

Most appropriate next investigation?

A

Capillary ketone

26
Q 
26 year old man
• Chest pain
• Smoker
• Scratching sound on auscultation
• Global ST elevation

Diagnosis?

A

Pericarditis

27
Q 
60 year old
• Collapse
• T1DM
• Normal BP
• Ejection systolic murmur
• ECG: S from V1/V2 and R from V5/V6 add up to ≥7

What does the ECG suggest?

A

Left ventricular hypertrophy

28
Q
  • Loin pain
  • Normal CRP
  • Urinalysis: +++ blood

Next appropriate investigation?

A

CT KUB

Stones: pain, haematuria

29
Q
  • Hypercalcaemia
  • Low PTH
  • Backache
  • Normal ALP

Most likely diagnosis?

A

Multiple myeloma

30
Q

2 main causes of hypercalcaemia?

A
  • Primary hyperparathyroidism

* Malignancy

31
Q

When is ALP high?

A
  • Obstructive liver disease

* Bone disease - malignancy, fracture, Paget’s disease

32
Q

Why is ALP normal in multiple myeloma?

A
  • Osteoblasts make ALP
  • Plasma cells from MM suppress osteoblasts
  • So ALP is normal
33
Q

Mnemonic for multiple myeloma?

A 
CRAB
• Calcium - high
• Renal impairment
• Anaemia
• Bone - pain, osteoporosis
34
Q

60 year old man
• Cough
• Haemoptysis
• Air-fluid level on CXR

What does this CXR finding suggest?

A

Cavitating lesion

35
Q

Causes of cavitating lung lesions?

A
  • TB, Staph, Klebsiella
  • Rheumatoid arthritis
  • Pulmonary embolism
36
Q

35 year old woman
• Ankle oedema
• Normal echo
• Low albumin

Next most appropriate investigation? Expected diagnosis?

A

Urinalysis - proteinuria

• Nephrotic syndrome

37
Q

30 year old man
• Recurrent GI and nosebleeds
• Red dots over mouth and tongue

Diagnosis?

A

Hereditary haemorrhagic telangiectasia

Autosomal dominant

38
Q
  • Low sodium
  • Short synacthen test shows small increase in cortisol (100 to 200)

Diagnosis?

A

Adrenal insufficiency

Normal patient short synacthen increase to > 600

39
Q
  • Very high prolactin
  • Low testosterone
  • Low LH
  • Low FSH

Diagnosis?

A

Prolactinoma

pituitary adenoma

40
Q
  • High prolactin
  • High IGF-1
  • OGTT: failure of GH suppression

Diagnosis?

A

Acromegaly

pituitary adenoma

41
Q
  • Low oestradiol
  • High FSH
  • High LH

Diagnosis?

A

If older - menopause

If younger - premature ovarian insufficiency

42
Q
  • Low free T4
  • High TSH

Diagnosis?

A

Primary hypothyroidism

43
Q

Endocrine function tests in multinodular goitre?

A

Normal

DPD (6 decks)

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