Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

DPD 2020 > interactive cases in general internal medicine 6 > Flashcards

interactive cases in general internal medicine 6 Flashcards

1
Q

What differential diagnosis for microcytic anaemia

A
  • Iron deficiency (low ferritin)
    • Diet
    • Blood loss (GI, UG)
  • Beta thalassaemia heterozygosity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are differential diagnosis for normocytic anaemia?

A
  • Chronic disease
    • e.g. Rheumatoid arthritis
    • Normal/high ferritin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

bleeding ulcer due to NSAIDS

A. Iron deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

• 40 year old woman • Hb: 110 g/L • MCV: 65

The most likely cause is:

A. Iron deficiency

B. Beta thalassaemia heterozygosity

A

B. Beta thalassaemia heterozygosity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are differential diagnosis for macrocytic anaemia?

What are clues that would point you towards one or the other?

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are presentation signs of Polycythaemia

A
  1. Headache
  2. Pruritus after hot bath
  3. Blurred vision (hyperviscosity)
  4. Tinnitus
  5. Thrombosis (stroke, DVT)
  6. Gangrene
  7. Choreiform movements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the different crises you can have in sickle cell?

A
  • Acute painful crises
  • Stroke
  • Sequestration crises (RBC pooling)
    • Lung (SOB, cough, fever)
    • Spleen (exacerbation of anaemia)
  • Gallstones, chronic cholecystitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do manage an acute painful crisis?

A

Analgesia

O2

IV fluids

Antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How would manage a stroke ina patient with sickle cell?

A

Exchange blood transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How would you manage a patient with splenic sequestration?

A

Splenectomy for repeated episodes of splenic sequestration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How would manage a patient with chronic cholecystitis due to sickle cell anaemia?

A

• Cholecystectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the Presentations of Multiple Myeloma?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

50 year old man • Hypercalcaemia • Low PTH • Backache • Normal ALP

The most likely cause is:

A. Malignancy

B. Multiple myeloma

A

B. Multiple myeloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

50 year old man • Hypercalcaemia • Low PTH • Backache • High ALP •

The most likely cause is:

A. Malignancy

B. Multiple myeloma

A

A. Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are differentials anaemias with a high reticulocyte count?

A

Haemolytic crises

(DDx: haemorrhage)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are differentials anaemias with a low reticulocyte count?

A
  • parvovirus B19 infection
  • Aplastic crisis in patients with Sickle cell anaemia
  • Blood transfusion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is diabetes?

A

Fasting > 7 •

Random ≥ 11.1

• Impaired glucose tolerance (IGT)

– 75g OGTT

– 2-hour glc: 7.8-11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the classification

A

Type 1 •

Young, thin, insulin deficiency •

Wt loss •

Ketones •

Acidosis

Type 2

  • Older
  • Overweight, obese
  • Insulin resistant
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Case • A 45 yr old man • lethargy, fatigue, polyuria, polydipsia • urinalysis: – no ketones – glc +++ • Random glc: 12

How would you treat him?

A. Insulin

B. Metformin

C. Sulfonylurea

D. DPP-IV inhibitor

E. GLP-1 agonist

A

B. Metformin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are complications of diabetes

A

Microvascular

– Retinopathy

– Nephropathy

– Neuropathy

• Macrovascular

– MI/Stroke/PVD •

Metabolic –

DKA/HHS/Hypoglycaemia

21
Q

What is the insulin sliding scale

A

scale where there is a blood glucose

measurement and the correspondent insulin dose

used in surgery or sepsis

22
Q

Wt loss • Good appetite • Irritability • Palpitations • irregular periods

O/E •

Tremor • Proptosis • Smooth goitre • Pretibial myxoedema

What will the TFTs show?

A. High free T4/T3, suppressed TSH

B. High free T4/T3, High TSH

A

High free T4/T3, suppressed TSH

23
Q

Wt loss • Good appetite • Irritability • Palpitations • irregular periods

O/E

• Tremor • Proptosis • Smooth goitre • Pretibial myxoedema

Fee T4: 30 (10-20)

TSH < 0.05

What is the next most appropriate investigation? A. TPO antibodies

B. TSH receptor stimulating Ab

A

B. TSH receptor stimulating Ab

24
Q

Wt loss • Good appetite • Irritability • Palpitations • irregular periods

O/E

• Tremor • Proptosis • Smooth goitre • Pretibial myxoedema

Fee T4: 30 (10-20)

TSH < 0.05

What will the NM uptake scan show?

A. Diffuse increased uptake

B. Hot nodule

A

A. Diffuse increased uptake

25
Q

What are risk factors for thyroid cancer

A

Risk factors

– Radiation –

FHx –

Rapid enlargement/compression

– Lymphadenopathy

26
Q

What are investigations you would like to do in someone that has thyroid cancer

A

USS •

FNAC, (Uptake scan: cold nodules)

• MDT

27
Q

What are the treatments for thyroid cancer

A

Surgery

Thyroxine, radioiodine

28
Q

30 year old female • Amenorrhoea • Galactorrhoea • Bitemporal hemianopia

What is the most appropriate treatment?

A. Trans-sphenoidal surgery

B. Cabergoline

A

B. Cabergoline

do not operate for prolactinoma

29
Q

50 year old man

  • Headache, sweating
  • Poor sleep, snoring

– Obstructive sleep apnoea •

Tingling in fingers

– Carpal tunnel syndrome

Initial test: High IGF-1

Which test would you perform ?

A. ITT

B. OGTT

C. Dex suppression test

D. Short Synacthen test

E. GHRH test

A

B. OGTT

30
Q

40 year old woman • Wt gain • Depressed • Fatigue • Central obesity

Is she likely to have Cushing’s syndrome?

A. Yes

B. No

A

B. No

31
Q

What are discriminatory signs of cushings

A

Bruising, thin skin

  • Myopathy
  • purple striae, > 1cm wide
  • DM, HTN, osteoporosis at a young age
32
Q

What are causes of amenorrhea/ Oligomenorrhea

A

Pregnancy

  • Hypothalamus
  • Pituitary
  • Thyroid (hyper/hypo)
  • Ovaries

– PCOS

– Ovarian failure

33
Q

What are investigations you would want to do in someone that presents with Amenorrhea/ Oligomenorrhea

A

Urine BHCG

  • ? Excessive exercise, low BMI
  • Excess prolactin
  • Low LH/FSH
  • TFTs

Excess androgens (or hirsutism)

High FSH

34
Q

Weakness

  • Arrhythmia
  • Polyuria

What does this person have

A

hypokalaemia

35
Q

What are causes of hypokalaemia

A

GI: Vomiting

  • Diuretics
  • Primary hyperaldosteronism (bilateral hyperplasia or Conn’s) – Aldosterone: renin ratio
36
Q

What is this

A

BCC

37
Q

What are causes of AKI

A

Pre-renal

Hypovolaemia

• Sepsis

• Renal

Drugs

• ? Active urine sediment: blood & protein in the urine (Glomerulonephritis)

• Post renal

USS (? Obstruction)

38
Q

21 yr old medical student • Morning of the Yr 3 exam • SOB • Palpitation • Tingling in hands

ABG • pH 7.5 (normal 7.35 - 7.45) • pCO2 3.5 kPa • bicarb 20 mmol/L

What is the most likely cause?

A. Pulmonary embolus

B. Pneumothorax

C. MI

D. SVT

E. Hyperventilation syndrome

A

E. Hyperventilation syndrome

39
Q

What is the diagnosis

A

psoriatic arthropathy

Sacroiliitis

Arthtitis affecting distal interphalangeal joints

40
Q

Which biochem picture is suggestive of Vitamin D deficiency?

A. Low ca, low phosphate, high PTH

B. High ca, low phosphate, high PTH

C. High ca, normal phosphate, low PTH

D.Low ca, high phosphate, low PTH

E. Low ca, high phosphate, high PTH

A

A. Low ca, low phosphate, high PTH

B hyperparathyrodism

C. malignancy

D.hypoparathyrodism

E. renal failure

41
Q

What are the 2 different categories of Hypernatraemia

A

High urine osmolality: 572

– Dehydration (elderly, children)

– HHS (urine high osm: glycosuria), type 2 diabetes

Low urine osmolality

– DI (dilute urine, osm < 300)

42
Q

What are the 3 main causes of thrombocytopaenia?

A

using them: DIC

infiltration of bone marrow: metastasis

pooling in the spleen: portal hypertnesion

43
Q

PAtient comes in with high ferritin and desaturates on exercise and has a cough.

had unprotected sex as a young girl

What does this patient have?

A

Pneumocystis-jirovecii-Pneumonie

gotten HIV

44
Q

What are the light chain in the urine in multplie myloma

A

bence jones protein

45
Q

What are the side effects of sulphanyle ureas

A

hypo

increase in weight

46
Q

how often do you check for retinopathy and how

A

anual digital retinal photography

47
Q

how do you check for diabetic nephropathy

A

ACR

albumin creatinin ratio

48
Q

How do you manage hypoglycaemia?

A

conscious

have them drink glucose

after complex carbohydrates so they don’t have another hypo

unsciousious

glucagon

or intravenous glucose

49
Q

What must you exclude first if you suspect a prolactinoma

A

pregnancy

DPD 2020 (48 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions