interactive cases in general internal medicine 6 Flashcards
What differential diagnosis for microcytic anaemia
- Iron deficiency (low ferritin)
- Diet
- Blood loss (GI, UG)
- Beta thalassaemia heterozygosity
What are differential diagnosis for normocytic anaemia?
- Chronic disease
- e.g. Rheumatoid arthritis
- Normal/high ferritin
50 year old woman • Hb: 90 g/L • MCV: 75 • On NSAIDs for joint pain
The most likely cause is:
A. Iron deficiency
B. Beta thalassaemia heterozygosity
• 40 year old woman • Hb: 110 g/L • MCV: 65
The most likely cause is:
A. Iron deficiency
B. Beta thalassaemia heterozygosity
What are differential diagnosis for macrocytic anaemia?
What are clues that would point you towards one or the other?
REMEMBER with Alcoholics May Have Liver Failure
Alcohol - Hx, high GGT
Myelodysplasia - Pancytopenia & Bone marrow
Hypothyroidism - Hx (lethargy, constipation, wt gain) &Low T4, High TSH
Liver disease- Hx/Exam
Folate/B12 deficiency - Hx (small bowel disease, ? Gastrectomy)
What are presentation signs of Polycythaemia
- Headache
- Pruritus after hot bath
- Blurred vision (hyperviscosity)
- Tinnitus
- Thrombosis (stroke, DVT)
- Gangrene
- Choreiform movements
What are the different crises you can have in sickle cell?
- Acute painful crises
- Stroke
-
Sequestration crises (RBC pooling)
- Lung (SOB, cough, fever)
- Spleen (exacerbation of anaemia)
- Gallstones, chronic cholecystitis
How do manage an acute painful crisis?
Analgesia
O2
IV fluids
Antibiotics
How would manage a stroke ina patient with sickle cell?
Exchange blood transfusion
How would you manage a patient with splenic sequestration?
Splenectomy for repeated episodes of splenic sequestration
How would manage a patient with chronic cholecystitis due to sickle cell anaemia?
• Cholecystectomy
What are the Presentations of Multiple Myeloma?
Calcium - Polyuria, polydipsia, constipation
Renal failure - Ur & Cr
Anaemia - Breathlessness, lethargy • FBC
Bone (pain, osteoporosis)- Fracture, bone pain DXA
Might also have infection and cord compression
50 year old man • Hypercalcaemia • Low PTH • Backache • Normal ALP
The most likely cause is:
A. Malignancy
B. Multiple myeloma
B. Multiple myeloma
50 year old man • Hypercalcaemia • Low PTH • Backache • High ALP •
The most likely cause is:
A. Malignancy
B. Multiple myeloma
A. Malignancy
What are differentials anaemias with a high reticulocyte count?
Haemolytic crises
(DDx: haemorrhage)
