interactive cases vi Flashcards
What would you see in an immediate transfusion reaction?
Haemolysis:
-fever, rigors, high PR, low BP, chest pain, dark urine
Possible cause of low MCV, low Hb
Iron deficiency (low ferritin)
- diet
- blood loss (GI, periods)
Beta thalassaemia heterozygosity
Possible cause of normal MCV, low Hb
Chronic disease
- RA
- normal/high ferritin (acute phase protein)
Possible causes of macrocytosis
*alcoholics may have liver failure
A lcohol (hx, increased GGT)
M yelodysplasia (pancytopenia, bone marrow)
H ypothyroidism (hx, low T4, high TSH)
L iver disease (hx, exam)
F olate/B12 deficiency (hx; small bowel disease? gastrectomy?)
How may polycythaemia present?
Headache Pruritus after hot bath Blurred vision (hyperviscosity) Tinnitus Thrombosis (stroke, DVT) Gangrene Choreiform movements
What are possible complications of sickle cell anaemia and how are they dealt with?
Acute painful crises - analgesia, oxygen, IV fluids, antibiotics Stroke - exchange blood transfusion Sequestration crises (RBC pooling) - lung (SOB, cough, fever) - spleen (exacerbation of anaemia) - splenectomy for repeated episodes Gallstones, chronic cholecystitis (due to haemolysis of RBCs) - cholecystectomy
What may the reticulocyte count indicate?
High: haemolytic crises, haemorrhage
Low: parovirus B19 infection, aplastic crises in pts with sickle cell anaemia, blood transfusion
Diabetes diagnosis
Fasting > 7
Random >/= 11.1
Compare the presentations of TI and TII DM
TIDM
- young, thing, insulin deficiency
- wt loss, ketone acidosis
TIIDM
- older, overweight/obese
- insulin resistance
What signs may you see in Graves’?
Tremor, proptosis, smooth goitre, pretibial myxoedema
Which antibodies occur in Graves’?
TSH receptor stimulating antibodies
What are risk factors and signs for thyroid cancer?
Radiation
FHx (medullary thyroid cancer)
Lymphadenopathy
Rapid enlargement (difficulty swallowing/breathing)
Which type of thyroid cancer is prone to mets?
Follicular thyroid cancer
Which treatment could you do for thyroid cancer depending on its type?
Thyroxine, radioiodine (in general)
Surgery (anaplastic, medullary, papillary, follicular)
FNAC (cold nodule)
How do people present with prolactinomas?
Amenorrhoea/galactorrhoea
Sexual dysfunction
Bitemporal hemianopia
*men tend to present later as they don’t have menstrual cycles, come in when they go blind or can’t have sex
Main mx for prolactinoma
Cabergoline (D2-agonist) - makes it smaller
Surgery is rare
How do you diagnose acromegaly?
OGTT
- give glucose to suppress GH however presence of GH tumour will not suppress GH
Discriminatory signs of Cushing’s
Bruising, thin skin, myopathy, purple striae (>1cm wide), DM/HTN/osteoporosis at a young age
Ddx of amenorrhoea/oligonorrhoea
Pregnancy - ALWAYS CHECK IN FERTILE WOMEN Hypothalamus - excessive exercise, low BMI Pituitary - excess prolaction, low LH/FSH Thyroid (hypo/hyper) - do TFTs Ovaries (PCOS/ovarian failure) - excess androgens/high FSH
DDx and presentation of hypokalaemia
Weakness, arrhythmia, polyuria (nephrogenic DI)
Ddx
- GI, vomiting, diuretics, primary hypoaldosteronism (bilateral hyperlasia/Conn’s)
Possible causes of hypernatraemia
High plasma osmolality
- dehydration (elderly, children)
- hyperosmolar hyperglycaemic state (glycosuria, TIIDM)
Low urine osmolality
- DI (dilute urine, osm<300)
What would bloods show in vitamin D deficiency?
Low Ca2+
Low PO4^3-
high PTH (loss of -ve feedback system)
State the diagnosis of the following:
a) high calcium, low PTH
b) high calcium, high PTH
c) low calcium, high phosphate, high PTH
a) malignancy
b) hyperparathyroidism
c) renal failure (kidneys unable to excrete phosphates)
*remember think of PTH as ‘phosphate trashing molecule’ so high PTH should mean low phosphates
Main causes of AKI
Pre-renal - hypovolaemia - sepsis Renal - drugs - ?active urine sediment: blood and protein in urine (glomerulonephritis) Post-renal - obstruction (USS)
Ix findings for renal artery stenosis
Magnetic resonance angiography (MRA) for vasculature
Asymmetrical kidneys
What drug should you not give with RAS?
ACEi will lead to deterioration of renal function with bilateral renal artery stenosis
Signs of rheumatoid arthritis
Sacroilitis
Arthritis affecting distal interphalangeal joints
