interactive cases v

Question 1

Name atypical organisms that cause pneumonia and which abx class you would use to cover them alongside amoxicillin

Answer 1

Mycoplasma
Chlamydia
Legionella

Macrolides as up to 40% of CAP are atypical org.

Question 2

Possible ddx of bloody diarrhoea

Answer 2

Infection - infective colitis
Inflammation - UC/Crohn's, younger pts
Ischaemia - ischaemic colitis, older pts 
Malignancy 
Diverticulitis

Question 3

What can portal hypertension lead to?

Answer 3

Encephalopathy
Ascites
Spontaneous bacterial peritonitis
Variceal bleed

Question 4

What differences would you see in the three causes of microangiopathic haemolytic anaemia (MAHA)?

Answer 4

DIC (disseminated intravascular coagulation)
= low platelets + fibrinogen
= raised PT/APTT
= raised D-dimer/fibrin degradation products

HUS (haemolytic uraemic syndrome)
= haemolysis so lowed Hb, raised bilirubin
= uraemia
= low platelets

TTP (thrombotic thrombocytopenic purpura)
= HUS findings + fever + neurological manifestations

Question 5

What are possible causes of haemolytic anaemia?

Answer 5

Hereditary
= red cell membrane (hereditary spherocytosis)
= enzyme deficiencies (G6PD def.)
= haemoglobinopathy (sickle cell, thalassaemias)

Acquired
= Autoimmune, drugs, infection, MAHA

Question 6

What do you see in small bowel obstruction?

Answer 6

Full line, circular folds of dilated bowel

- valvulae conniventes

Question 7

What three mechanisms could lead to hyponatraemia?

Answer 7

Hypovolaemia, euvolaemia, hypervolaemia

Question 8

What would you expect to see and which tests would you do for the three different mechanisms of hyponatraemia?

Answer 8

Hypovolaemia

• diarrhoea, vomiting, diuretics
• low urine Na+
• measure off diuretics

Euvolaemia

• hypothyroidism, adrenal insuffiency, SIADH
• TFTs, short synacthten test, plasma + urine osmolality

Hypervolaemia

• cardiac failure, cirrhosis, nephrotic syndrome
• fluid overloaded, low urine Na+

Question 9

What tests would you do if you suspect SIADH and why?

Answer 9

SIADH is expected in most pts with hyponatraemia

Would follow bloods with CXR + head CT (whatever’s indicated with hx first)

SIADH can be caused by CNS pathology, lung pathology, drugs and tumours

Question 10

Which drugs can cause SIADH?

Answer 10

SSRI, TCA, opiates, PPIs, carbamazepine

Question 11

What does onycholysis suggest?

Answer 11

Separation of nail from nail bed

Occurs due to trauma, thyrotoxicosis, fungal infections and psoriasis

Question 12

What test would you follow with pt with loin pain, normal CRP and urinalysis +++ for blood?

Answer 12

CT KUB

• sensitive for stones
• check for pelvi-ureteric junction obstruction
• check for calculus within dilated renal pelvis

Question 13

When is ALP raised?

Answer 13

Raised in obstructive liver disease and bone disease

• malignancy
• fractures
• Paget’s disease

Question 14

Why is ALP normal in multiple myeloma?

Answer 14

• osteoblasts make ALP
• osteoblasts are suppressed by plasma cells
• myeloma there is decreased bone formation thus reduced osteoblasts
• ALP is normal/potentially reduced

Question 15

What do you see in multiple myeloma?

Answer 15

C alcium elevation
R enal impairment
A naemia
B one disease

Question 16

What are possible causes of cavitating lung lesions?

Answer 16

Infection - TB, staph, Klebsiella (alcoholics)
Inflammation - RA
Infarction - PE
Malignancy

Question 17

What do you see in nephrotic syndrome?

Answer 17

Increased permeability of glomerular basement membrane to protein

• proteinurea >3g/day
• hypoalbuminaemia
• oedema

Check U&Es, LFTS, urinalysis

Question 18

What is hereditary haemorrhagic telangiecstasia?

Answer 18

AD condition
Results in abnormal blood vessels, affecting:
- skin
- mucous membranes
- lungs
- liver
- brain

Question 19

What results do you expect to see for a multinodular goitre?

Answer 19

normal endocrine measurements