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DPD 2019 > Interactive cases 4 > Flashcards

Interactive cases 4 Flashcards

1
Q

Causes of thrombocytopaenia

A

Fever, rigor, increased PR interval, reduced BP, chest pain, dark urine

  1. Reduced production (bone marrow disorders)
  2. Increased use (DIC)
  3. Pooling of spleen (this occurs in liver disease as the spleen enlarges due to portal hypertension, and then platelets can pol there!)
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2
Q

DDx for micro and normocytic anaemia

A

Microcytic: Fe deficiency anaemia, beta thalassaemia heterozygosity

Normocytic: Anaemia of chronic disease. Normal/high ferritin

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3
Q

Why might ferritin be high in anaemia of chronic disease

A

Because it’s an acute phase reactant

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4
Q

High ferritin and desaturation on exercise, SoB

A

PCP (pneumocystic pneumoniae)

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5
Q

Ddx macrocytic anaemia

A

Alcohol excess

Myelodysplasia

Hypothyroidism

Liver failure

Folate/b12 deficiency

Alcoholics May Have Liver Failure

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6
Q

Clues that macrocytic is a result of each of the following

Alcohol excess

Myelodysplasia

Hypothyroidism

Liver failure

Folate/b12 deficiency

A

EtOH: Hx, raised GGT

Myelodysplasia: pancytopaenia, bone marrow

Hypothyroidism: Hx (lethargy, constipation, weight gain), low T4, high TSH

Liver failure : Hx/exam

Folate/b12 deficiency: Hx, small bowel disease, gastrectomy

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7
Q

Presentation of polycythaemia

A

Headache,

pruritis after hot bath,

blurred vision (hyperviscosity)

tinnitus

Thrombosis (stroke, dvt)

gangrene

choreiform movements

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8
Q

Sickle cell anaemia: list possible crises

A

Acute painful

Stroke

Sequestration crises (RBC pooling)

Gall stones/chronic cholecystitis

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9
Q

List the 2 types of sequestration crises in SCA and the symptoms of each

A

– Lung (SOB, cough, fever)

– Spleen (exacerbation of anaemia)

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10
Q

Management of each of the following sickle cell crises:

Acute painful
Stroke (IMPORTANT)
Sequestration (lung?spleen?)
Gallstones/chronic cholecystitis

A

Acute painful:

  • Analgesia
  • o2
  • IV fluids Abx

Stroke:
-Exchange blood transfusion

Sequestration:
Splenectomy

Gallstones/chronic cholecystits: cholecystectomy

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11
Q

Multiple myeloma features

CRABIC

A

Calcium (high). Leads to nephrogenic diabetes insipidus: polyuria, polydipsia. Constipation too.

Renal failure: Urea and creatinine

Anaemia: breathlessness, lethargy, FBC

Bone (pain, osteoporosis):
fracture, bone pain, DXA

Infection

Cord compression

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12
Q

What might you detect in the urine in multiple myeloma

A

Bence Jones proteins

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13
Q

Which bone cells make ALP

A

Osteoblasts

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14
Q

Hypercalcaemia, low PTH, backache, normal ALP

A

Multiple myeloma (it’s the exception because it suppresses osteoblasts, which usually produce ALP!)

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15
Q

If there’s high calcium, low PTH, backache and normal ALP what’s the diagnosis

A

It’s multiple myeloma

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16
Q

If there’s high calcium, low PTH, backache and high ALP what’s the diagnosis

A

In this case it’s likely to be malignancy (not MM)

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17
Q

Anaemia associated with high reticulocyte count

A

Haemolysis

Acute blood loss

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18
Q

Anaemia with low reticulocyte?

A

Parvovirus b19 infection

Aplastic crisis in patients with sickle cell anaemia

Blood transfsuion

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19
Q

What conditions are associated with parvovirus 19 infection in:

children
adults
those with sickle cell

A

children: slap cheek ( Fifth disease or erythema infectiosum)
adults: arthraligas

sickle cell: aplastic crisis (the virus causes a reduced production of RBCs in everyone. This is fine for people if their RBCs have a normal lifespan, but in people with SCD, and also hereditary spherocytosis, the RBCs have reduced life span so they can go into an aplastic crisis)

20
Q

How is diabetes diagnosed

Outline OGTT

A

> 7 on fasting

> 11.1 on random.

Impaired glucose tolerance. 75g OGTT. 2hr glucose: 7.8-11

21
Q

-gliclazide?

A

Sulphonyureas

22
Q

-gliptin?

A

DPP4-inhibitor

23
Q

-itide

A

GLP-1 agonist

24
Q

-flozins

A

SGLT2 inhibitors

25
Q

How do you measure nephropathy and what do you do if they have it

A

ACR…. check at the lab!

You can put them o`n ACEi

26
Q

How to manage hypoglycaemia

A

Conscious: get them glucose to drink, and then a long acting carb for after

Confused- gel

Unconscious: IV glucagon or IV glucose 20%

27
Q

What is sliding scale insulin

A

When patient is not eating or unwell (surgery, sepsis)

Variable rate IV insulin infusion

28
Q

What is pretibial myxoedema, what is myoedema

A

pretibial myxoedema is the rash seen almost always in Grave’s (also rarely in hashimotos)

myxoedema means underactive thryoid

29
Q

What type of thyroid cancer particularly metastases to the lungs

A

Follicular

30
Q

What is the most appropriate treatment of prolactinoma

A

Cabergoline

Don’t operate with trans-sphenoidal surgery unless it’s really really refractory

31
Q

What is the initial test if you think they have acromegaly, what is diagnositc

A

INITIAL TEST is IGF1

Then you go on to do a OGTT

32
Q

Weight gain, depressed, central obesity, fatigue. Are they likely to have cushings

A

No…. this describes a lot of the population!

Don’t start investigating for cushing’s if the pre-test probability is low because you get a lot of false positives and the patient may be labelled as having cushings when they actually don’t

33
Q

What are the discriminatory features of cushings

A

Purple stretch marks
Bruising
Myopathy

DM, HTN osteoporosis AT A YOUNG AGE

34
Q

Causes of amenorrhoea

A 
Pregnancy 
Hypothalamus 
Pituitary 
Thyroid (hyper/hypo) 
Ovaries (PCOS/ovarian failure)
35
Q 
What would the investigations for the following:
Pregnancy 
Hypothalamus 
Pituitary 
Thyroid (hyper/hypo) 
Ovaries (PCOS/ovarian failure)
A 
Pregnancy- urine bHCG
Hypothalamus- ?Excessive thirst, low BMI
Pituitary- excess prolactin/low FSH/LH
Thyroid (hyper/hypo)- TFTs
Ovaries (PCOS/ovarian failure) - excess androgens (or hirsutism), high FSH
36
Q

How can hypothalamus cause amennorrhoea

A

Too much exercise and low BMI causes amenorrhoea

37
Q

Causes of pituitary amenorrhoea

A

Prolactinoma or pituitary adenoma that is reducing LH/FSH secretion

38
Q

Presentation of hypokalaemia

A

Polyuria (it causes nephrogenic diabetes insipidus, like hypercalcaemia does!)
Weakness
Arrhythmia

39
Q

DDx for hypokalamaemia

A

Primary hyperaldosteronism (Conn’s–> look at aldosterone:renin ratio)

GI: vomiting

Diuretics

40
Q

Causes of hypernatraemia when urine osmolality is high

A

High plasma osmolarity- 572

Due to dehydration or HHS (urine high osmolarity glycosuria)

41
Q

Causes of hypernatraemia when the urine osmolality is low

A

Diabetes indipidus (DIlute urine osmolarity <300)

42
Q

Low calcium, high phosphate, high PTH

Low calcium, low phosphate, high PTH

A

PTH is phosphate trashing hormone!

So if phosphate is low then it means PTH is effectively excreting it. The calcium is low due to vit D deficiency. So the second one is vit D deficiency.

In the first one, the phosphate is high. So why is the phosphate high, even though PTH is meant to excrete phosphate. It’s because the kidneys fail to excrete phosphate.

But calcium is low because there is low levels of ACTIVATED vit D (due to reduced hydroxylation in the poorly functioning kidney) leading to low calcium. PTH will go up due to a reduced -ve feedback response. BUT phsopahte is not excreted because of the kidney failure

43
Q

Someone recently put on ACEi, and had a deterioration of renal function.

Finding of asymmetrical kidneys on ultrasound.

A

BILATERAL renal artery stenosis

44
Q

Gold standard investigation for RAS

A

Magnetic resonance angiography

45
Q

Should CO2 and bicarbonate be going in the same direction?

A

Yes.

If CO2 is going up, then you would expect bicarb to go up

If CO2 is going down you would expect bicarb to go down.

46
Q

What if co2 is going up but bicarb is going down

A

If the co2 and bicarb are going in different directions, we know there is MIXED PICTURE. I.e. there must be an element of respiratory and metabolic disturbance

47
Q

Investigations for thyroid cancer

A
  1. USS
  2. FNAC
  3. Uptake scan

Discuss at MDT

DPD 2019 (30 decks)

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