ILOs 2 Flashcards

Question

How can lymphoma be investigated?

Answer 1

FBC U&Es: tumour lysis syndrome can occur before treatment begins in lymphomas with rapid cell turnover LDH (lactate dehydrogenase) levels are usually elevated Imaging USS CXR may be required if there are symptoms of mediastinal node involvement. A full body CT to determine extent of disease Biopsy Lymph node biopsy

Answer 2

Lugano Classification Stage 1: single group of lymph nodes or a single organ Stage 2: 2 or more groups of lymph nodes or organs on the same side of the diaphragm Stage 3: lymph nodes or organs on both sides of the diaphragm Stage 4: diffuse involvement of lymph nodes and organs such as the liver and bones

Answer 3

The majority of children will recover completely, with Hodgkin’s lymphoma carrying a more favourable prognosis than non-Hodgkin’s lymphoma Complications: tumour lysis syndrome neutropenia alopecia sub-fertility

Answer 4

autosomal recessive condition affecting the gene for beta-globin on chromosome 11 One abnormal copy of the gene = sickle-cell trait Two abnormal copies = sickle-cell disease abnormal variant called haemoglobin S (HbS) results in sickle-shaped red blood cells.

Answer 5

Anaemia Increased risk of infection CKD Sickle cell crises Acute chest syndrome Stroke Avascular necrosis in large joints such as the hip Pulmonary hypertension Gallstones Priapism (painful and persistent penile erections)

Answer 6

when the flow of blood is blocked to an area because the sickled cells have become stuck in the blood vessel- often very painful can occur spontaneously or triggered by dehydration, infection, stress or cold weather supportive mx

Answer 7

complication of sickle cell when the vessels supplying the lungs become clogged with red blood cells presents with fever, shortness of breath, chest pain, cough and hypoxia CXR will show pulmonary infiltrates medical emergency!!!

Answer 8

Analgesia IV fluids Antibiotics if indicated Blood transfusions Incentive spirometry using a machine that encourages effective and deep breathing Respiratory support with oxygen, non-invasive ventilation or mechanical ventilation

Answer 9

Avoid triggers for crises, such as dehydration Up-to-date vaccinations Antibiotic prophylaxis to protect against infection, typically with penicillin V (phenoxymethylpenicillin) Hydroxycarbamide (stimulates HbF) Crizanlizumab Blood transfusions for severe anaemia Bone marrow transplant can be curative

Answer 10

FBC, U&Es blood glucose and HbA1c Thyroid function tests and thyroid peroxidase antibodies (TPO) to test for associated autoimmune thyroid disease Tissue transglutaminase (anti-TTG) antibodies for associated coeliac disease Insulin antibodies, anti-GAD antibodies and islet cell antibodies

Answer 11

basal bolus SC insulin regime long acting insulin, such as “Lantus”, typically in the evening, short acting insulin, such as “Actrapid”, usually three times a day before meals or insulin pump (Tethered / Patch pump) Monitoring dietary carbohydrate intake Monitoring blood sugar levels on waking, at each meal and before bed Monitoring for and managing complications

Answer 12

advantages: better blood sugar control, more flexibility with eating and less injections disadvantages: difficulties learning to use the pump, having it attached at all times, blockages in the infusion set and a small risk of infection

Answer 13

hunger, tremor, sweating, irritability, dizziness and pallor more severe hypoglycaemia will lead to reduced consciousness, coma and death unless treated

Answer 14

rapid acting glucose such as lucozade and slower acting carbohydrates such as biscuits or toast oral glucose not safe = IV dextrose (2mg/kg bolus followed by a 5mg/kg/hour infusion) or intramuscular glucagon

Answer 15

Macrovascular Complications: Coronary artery disease Peripheral ischaemia causes poor healing, ulcers and “diabetic foot” Stroke Hypertension Microvascular Complications: Peripheral neuropathy Retinopathy Nephropathy Infection Related Complications UTIs Pneumonia Skin and soft tissue infections, particularly in the feet Fungal infections, particularly oral and vaginal candidiasis

Answer 16

Polyuria, Polydipsia, WL (poor diabetic control) Nausea and vomiting Dehydration and hypotension Altered consciousness Acetone smell to their breath

Answer 17

Hyperglycaemia (i.e. blood glucose > 11 mmol/l) Ketosis (i.e. blood ketones > 3 mmol/l) Acidosis (i.e. pH < 7.3)

Answer 18

Correct dehydration evenly over 48 hours -correcting it faster increases the risk of cerebral oedema Give a fixed rate insulin infusion Prevent hypoglycaemia with IV dextrose once blood glucose falls below 14mmol/l Add potassium to IV fluids and monitor serum potassium closely Treat underlying triggers Monitor for signs of cerebral oedema Monitor glucose, ketones and pH to assess their progress and determine when to switch to SC insulin

Answer 19

screened for on the newborn blood spot screening test. Where it is not picked up a birth, patients can present with: Prolonged neonatal jaundice Poor feeding Constipation Increased sleeping Reduced activity Slow growth and development

Answer 20

autoimmune thyroiditis, also known as Hashimoto’s thyroiditis (association with T1DM and coeliac disease) antithyroid peroxidase (anti-TPO) antibodies and antithyroglobulin antibodies Fatigue and low energy Poor growth Weight gain Poor school performance Constipation Dry skin and hair loss

Answer 21

managed by paediatric endocrinology IX: full thyroid function blood tests (TSH, T3 and T4), thyroid ultrasound and thyroid antibodies. Levothyroxine orally OD

Answer 22

all children aged 6 months - 5 years babies fed with formula milk do not need to take a supplement if they are taking more than 500ml of milk a day, as formula milk is fortified with vitamin D

Answer 23

Most cases caused by Grave's disease TSH down, T4 and T3 up thyroid autoantibodies Weight loss Restlessness, anxiety, tremor Heat intolerance Palpitations, tachycardia Diarrhoea mx = carbimazole and BB

Answer 24

“GIST” mnemonic: G – Graves’ disease I – Inflammation (thyroiditis) S – Solitary toxic thyroid nodule T – Toxic multinodular goitre

Answer 25

a condition characterised by either a decreased secretion of antidiuretic hormone (ADH) from the pituitary (cranial DI) or an insensitivity to antidiuretic hormone (nephrogenic DI) presents with polyuria and polydipsia

Answer 26

idiopathic post head injury pituitary surgery hereditary haemochromatosis

Answer 27

genetic lithium tubulo-interstitial disease: obstruction, sickle-cell, pyelonephritis

Answer 28

Investigation high plasma osmolality, low urine osmolality (urine osmolality of >700 mOsm/kg excludes DI) water deprivation test Mx cranial = desmopressin (synthetic ADH) nephrogenic = thiazides and low salt/protein diet

Answer 29

Type 2 usually affects children or young people, more commonly girls It presents with acute hepatitis with high transaminases and jaundice.

Answer 30

Anti-liver kidney microsomes-1 (anti-LKM1) Anti-liver cytosol antigen type 1 (anti-LC1)

Answer 31

Treatment is with high-dose steroids (e.g., prednisolone). Other immunosuppressants are also used, particularly azathioprine.

Answer 32

paracetamol overdose alcohol viral hepatitis (usually A or B) acute fatty liver of pregnancy

Answer 33

jaundice coagulopathy: raised prothrombin time hypoalbuminaemia hepatic encephalopathy renal failure is common ('hepatorenal syndrome')

Answer 34

sweet and fecal breath - sign of liver failure

Answer 35

Diarrhoea Abdominal pain Rectal bleeding Fatigue Weight loss

Answer 36

N – No blood or mucus (PR bleeding is less common) E – Entire gastrointestinal tract affected (from mouth to anus) S – “Skip lesions” on endoscopy T – Terminal ileum most affected and Transmural (full thickness) inflammation S – Smoking is a risk factor (don’t set the nest on fire)

Answer 37

C – Continuous inflammation L – Limited to the colon and rectum O – Only superficial mucosa affected S – Smoking may be protective (ulcerative colitis is less common in smokers) E – Excrete blood and mucus U – Use aminosalicylates P – Primary sclerosing cholangitis

Answer 38

Erythema nodosum (tender, red nodules on the shins caused by inflammation of the subcutaneous fat) Pyoderma gangrenosum (rapidly enlarging, painful skin ulcers) Enteropathic arthritis (a type of inflammatory arthritis) Primary sclerosing cholangitis (particularly with ulcerative colitis) Red eye conditions (e.g., episcleritis, scleritis and anterior uveitis)

Answer 39

UC: 15-25 years and 55-65 years Crohn's: late adolescence and early adulthood

Answer 40

Bloods: * FBC for haemoglobin (low in anaemia) and platelet count (raised with inflammation) * U&Es and LFTs can show low albumin in severe disease (protein is lost in the bowel) * CRP * TFTs for hyperthyroidism as a cause of diarrhoea * anti-TTG for coeliac disease Stool microscopy and culture Faecal calprotectin Colonoscopy with multiple intestinal biopsies

Answer 41

UC- proctitis Crohn’s- ileitis

Answer 42

Inflammation in all layers from mucosa to serosa increased goblet cells granulomas

Answer 43

No inflammation beyond submucosa crypt abscesses depletion of goblet cells and mucin

Answer 44

ESR can be used to assess disease progression first-line management strategy for the induction of remission is glucocorticoids Azathioprine or mercaptopurine is used first-line to maintain remission Managing complications: MRI is the investigation of choice for suspected perianal fistulae- provides visualisation of the course Wound swab can be used for recurrent abscesses

Answer 45

Options for inducing remission: Aminosalicylate (e.g., oral or rectal mesalazine) first-line Corticosteroids (e.g., oral or rectal prednisolone) second-line Options for maintaining remission in ulcerative colitis are: Aminosalicylate (e.g., oral or rectal mesalazine) first-line Azathioprine Mercaptopurine

Answer 46

occurs in neonates as a result of hypoxia during birth, can lead to permanent damage to the brain, causing cerebral palsy Causes: Maternal shock Intrapartum haemorrhage Prolapsed cord, causing compression of the cord during birth Nuchal cord, where the cord is wrapped around the neck of the baby

Answer 47

an IgA mediated small vessel vasculitis classically presents with abdominal pain, arthritis, haematuria and a purpuric rash over the buttocks and extensor surfaces of arms and legs Patients with active Henoch-Schonlein purpura: blood pressure and urinanalysis should be monitored to detect progressive renal involvement tx is usually supportive

Answer 48

Full blood count and blood film for thrombocytopenia, sepsis and leukaemia Renal profile for kidney involvement Serum albumin for nephrotic syndrome CRP for sepsis Blood cultures for sepsis Urine dipstick for proteinuria Urine protein:creatinine ratio to quantify the proteinuria Blood pressure for hypertension

Answer 49

HLA-B27 associated seronegative spondyloarthropathy develops following an infection where the organism cannot be recovered from the joint warm, swollen and painful joint, typically presents after gastroenteritis or STI

Answer 50

Joint aspiration Synovial fluid is sent for microscopy, culture and sensitivity testing for infection, and crystal examination for gout and pseudogout.

Answer 51

symptomatic: analgesia, NSAIDS, intra-articular steroids sulfasalazine and methotrexate are sometimes used for persistent disease symptoms rarely last more than 12 months