Haematology + Endocrinology Flashcards
- Cough
- Breathlessness
- Recent travel
- Coarse crepitations and bronchial breathing
- Hyponatraemia
- Deranged LFTs
Prescribe amoxicillin and …?
Why?
Clarithromycin
• Typical pneumonia
What are 3 organisms in atypical pneumonia?
- Mycoplasma pneumoniae
- Chlamydia pneumoniae
- Legionella pneumpphilia
- Dyspepsia
- Weight loss
- Microcytic anaemia
Next appropriate investigation?
OGD (gastroscopy)
What tests should you do in microcytic anaemia?
- Haematinics
* Coeliac screen (TTG Ab) - can also cause B12 deficiency
How do you confirm coeliac disease?
Duodenal biopsy - villous atrophy
70 year old man
• Bloody diarrhoea
• Negative culture and C. diff toxin
Most likely diagnosis?
Ischaemic colitis
• Bloody diarrhoea in elderly patients
40 year old man
• Palpitations for 4 hours
• ECG: AF
Treatment and why?
DC cardioversion
- Less than 48 hours
- Converts AF to sinus rhythm
How is an SVT converted back to sinus rhythm?
Adenosine (rate control)
What is used to control rate in AF?
- Beta-blocker or verapamil
* Digoxin or amiodarone if contraindication
When is amiodarone used?
Pulseless VT / VF
Complications of portal hypertension?
- Encephalopathy
- Ascites
- Spontaneous bacterial peritonitis
- Variceal bleed
20 year old boy • Diarrhoea • Malaise • Low Hb • High creatinine • Schistocytes
What skin sign would you expect to see and what is the diagnosis?
Jaundice
Schistocytes = haemolysis
Haemolytic Uraemic syndrome
Which 3 conditions have microangiopathic haemolytic anaemia?
- DIC
- HUS
- TTP
Bloods tests in DIC and HUS?
DIC
• low platelets
• high PT/APTT
• high D-dimer
HUS • Low Hb • High bilirubin • High creatinine (uraemia) • Low platelets
Hereditary (3) and acquired (4) causes of haemolytic anaemia?
Hereditary
• Red cell membrane (hereditary spherocytosis)
• Enzyme deficiency (G6PD)
• Haemoglobinopathy (sickle cell disease, thalassaemia)
Acquired • Autoimmune • Drugs • Infection • MAHA
What are small bowel folds called and what size would you expect the small bowel to be in obstruction?
Valvulae conniventes
> 3cm
What are large bowel folds called and what size would you expect the large bowel to be in obstruction?
Haustra
> 6cm, > 9cm at caecum
3 causes of hyponatramia with hypovolaemia?
- Diarrhoea
- Vomiting
- Diuretics
3 causes of hyponatraemia with euvolaemia and their tests?
- Hypothyroidism - TFTs
- Adrenal insufficiency - short synacthen test
- SIADH - plasma + urine osmolality
3 causes of hyponatraemia with hypervolaemia?
- Cardiac failure
- Cirrhosis
- Nephrotic syndrome
60 year old man • Confused • Cough • Low sodium • Low plasma osmolality (low sodium) • High urine osmolality (high sodium)
Next most appropriate investigation and why?
CXR
• Lung cancer producing excess ADH
What are almost all cases of hyponatraemia due to?
Rise in ADH - but this isn’t always ‘inappropriate’ as in SIADH
Top 2 investigations for SIADH (and other cause)?
- CXR - lung cancer
- Brain CT - brain tumour
Drugs e.g. SSRI, TCA
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?
Onycholysis caused by thyrotoxicosis
- Trauma
- Fungal infections
- Psoriasis
20 year old woman • Abdominal pain • Vomiting • T1DM • High BM
Most appropriate next investigation?
Capillary ketone
26 year old man • Chest pain • Smoker • Scratching sound on auscultation • Global ST elevation
Diagnosis?
Pericarditis
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?
Left ventricular hypertrophy
- Loin pain
- Normal CRP
- Urinalysis: +++ blood
Next appropriate investigation?
CT KUB
Stones: pain, haematuria
- Hypercalcaemia
- Low PTH
- Backache
- Normal ALP
Most likely diagnosis?
Multiple myeloma
2 main causes of hypercalcaemia?
- Primary hyperparathyroidism
* Malignancy
When is ALP high?
- Obstructive liver disease
* Bone disease - malignancy, fracture, Paget’s disease
Why is ALP normal in multiple myeloma?
- Osteoblasts make ALP
- Plasma cells from MM suppress osteoblasts
- So ALP is normal
Mnemonic for multiple myeloma?
CRAB • Calcium - high • Renal impairment • Anaemia • Bone - pain, osteoporosis
60 year old man
• Cough
• Haemoptysis
• Air-fluid level on CXR
What does this CXR finding suggest?
Cavitating lesion
Causes of cavitating lung lesions?
- TB, Staph, Klebsiella
- Rheumatoid arthritis
- Pulmonary embolism
35 year old woman
• Ankle oedema
• Normal echo
• Low albumin
Next most appropriate investigation? Expected diagnosis?
Urinalysis - proteinuria
• Nephrotic syndrome
30 year old man
• Recurrent GI and nosebleeds
• Red dots over mouth and tongue
Diagnosis?
Hereditary haemorrhagic telangiectasia
Autosomal dominant
- Low sodium
- Short synacthen test shows small increase in cortisol (100 to 200)
Diagnosis?
Adrenal insufficiency
Normal patient short synacthen increase to > 600
- Very high prolactin
- Low testosterone
- Low LH
- Low FSH
Diagnosis?
Prolactinoma
pituitary adenoma
- High prolactin
- High IGF-1
- OGTT: failure of GH suppression
Diagnosis?
Acromegaly
pituitary adenoma
- Low oestradiol
- High FSH
- High LH
Diagnosis?
If older - menopause
If younger - premature ovarian insufficiency
- Low free T4
- High TSH
Diagnosis?
Primary hypothyroidism
Endocrine function tests in multinodular goitre?
Normal
