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DPD 2020 > interactive cases vi > Flashcards

interactive cases vi Flashcards

1
Q

What would you see in an immediate transfusion reaction?

A

Haemolysis:

-fever, rigors, high PR, low BP, chest pain, dark urine

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2
Q

Possible cause of low MCV, low Hb

A

Iron deficiency (low ferritin)
- diet
- blood loss (GI, periods)
Beta thalassaemia heterozygosity

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3
Q

Possible cause of normal MCV, low Hb

A

Chronic disease

  • RA
  • normal/high ferritin (acute phase protein)
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4
Q

Possible causes of macrocytosis

A

*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?)

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5
Q

How may polycythaemia present?

A 
Headache
Pruritus after hot bath
Blurred vision (hyperviscosity) 
Tinnitus
Thrombosis (stroke, DVT)
Gangrene
Choreiform movements
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6
Q

What are possible complications of sickle cell anaemia and how are they dealt with?

A 
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
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7
Q

What may the reticulocyte count indicate?

A

High: haemolytic crises, haemorrhage
Low: parovirus B19 infection, aplastic crises in pts with sickle cell anaemia, blood transfusion

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8
Q

Diabetes diagnosis

A

Fasting > 7

Random >/= 11.1

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9
Q

Compare the presentations of TI and TII DM

A

TIDM

  • young, thing, insulin deficiency
  • wt loss, ketone acidosis

TIIDM

  • older, overweight/obese
  • insulin resistance
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10
Q

What signs may you see in Graves’?

A

Tremor, proptosis, smooth goitre, pretibial myxoedema

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11
Q

Which antibodies occur in Graves’?

A

TSH receptor stimulating antibodies

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12
Q

What are risk factors and signs for thyroid cancer?

A

Radiation
FHx (medullary thyroid cancer)
Lymphadenopathy
Rapid enlargement (difficulty swallowing/breathing)

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13
Q

Which type of thyroid cancer is prone to mets?

A

Follicular thyroid cancer

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14
Q

Which treatment could you do for thyroid cancer depending on its type?

A

Thyroxine, radioiodine (in general)
Surgery (anaplastic, medullary, papillary, follicular)
FNAC (cold nodule)

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15
Q

How do people present with prolactinomas?

A

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

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16
Q

Main mx for prolactinoma

A

Cabergoline (D2-agonist) - makes it smaller

Surgery is rare

17
Q

How do you diagnose acromegaly?

A

OGTT

- give glucose to suppress GH however presence of GH tumour will not suppress GH

18
Q

Discriminatory signs of Cushing’s

A

Bruising, thin skin, myopathy, purple striae (>1cm wide), DM/HTN/osteoporosis at a young age

19
Q

Ddx of amenorrhoea/oligonorrhoea

A 
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
20
Q

DDx and presentation of hypokalaemia

A

Weakness, arrhythmia, polyuria (nephrogenic DI)

Ddx
- GI, vomiting, diuretics, primary hypoaldosteronism (bilateral hyperlasia/Conn’s)

21
Q

Possible causes of hypernatraemia

A

High plasma osmolality

  • dehydration (elderly, children)
  • hyperosmolar hyperglycaemic state (glycosuria, TIIDM)

Low urine osmolality
- DI (dilute urine, osm<300)

22
Q

What would bloods show in vitamin D deficiency?

A

Low Ca2+
Low PO4^3-
high PTH (loss of -ve feedback system)

23
Q

State the diagnosis of the following:

a) high calcium, low PTH
b) high calcium, high PTH
c) low calcium, high phosphate, high PTH

A

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

24
Q

Main causes of AKI

A 
Pre-renal
- hypovolaemia
- sepsis
Renal
- drugs
- ?active urine sediment: blood and protein in urine (glomerulonephritis)
Post-renal
- obstruction (USS)
25
Q

Ix findings for renal artery stenosis

A

Magnetic resonance angiography (MRA) for vasculature

Asymmetrical kidneys

26
Q

What drug should you not give with RAS?

A

ACEi will lead to deterioration of renal function with bilateral renal artery stenosis

27
Q

Signs of rheumatoid arthritis

A

Sacroilitis

Arthritis affecting distal interphalangeal joints

DPD 2020 (6 decks)

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