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DPD COURSE > interactive haem, endo, renal and rheum cases > Flashcards

interactive haem, endo, renal and rheum cases Flashcards

1
Q

what macrolide is given for atypical pneumonia

A

clarithromycin or erythromycin

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2
Q

atypical pneumonia organisms

A

mycoplasma pneumoniae, chlamydia pneumoniae, legionella pneumophila

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3
Q

how is microcytic anaemia diagnosis confirmed

A

coeliac screen and confirm diagnosis on duodenal biopsy which shows villous atrophy

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4
Q

how is microcytic anaemia investigated

A

ogd and colonoscopy depending on upper/lower gi symptoms

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5
Q

causes of bloody diarrhoea

A

infection - infective colitis
inflammation - ulcerative/crohns colitis (young)
ischaemia - ischaemic colitis (older)
malignancy (more likely to be constipation), diverticulitis

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6
Q

what is caput medusa

A

direction of flow in the veins below the umbilicus is towards the legs

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7
Q

what can portal hypertension cause

A

encephalopathy, ascites, spontaneous bacterial peritonitis, variceal bleed

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8
Q

what signs indicate haemolytic uraemic syndrome (HUS)

A 
low haemoglobin and high bilirubin (due to haemolysis).
high urea and creatinine (uraemia). 
low platelets
diarrhoea
schistocytes - red cell fragments
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9
Q

how to recognise immediate transfusion reaction due to haemolysis

A

fever, rigor, increase pulse rate, decreased bp, chest pain, dark urine (conjugated bilirubin)

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10
Q

what three things can microangiopathic haemolytic anaemia be caused by

A

DIC (disseminaed intravascular coagulation), HUS (haemolytic uraemic syndrome), TTP (thrombotic thrombocytopenic purpura)

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11
Q

what are the signs of DIC

A

low platelets and fibronogen (used to make clots)
high PT/APTT (due to low clotting factors n platelets)
high D-dimer/fibrin degradation products (due to increased fibrinolysis

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12
Q

what are the signs of TTP (thrombotic thrombocytopenic purpura)

A

HUS + fever + neurological manifestations (headaches)

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13
Q

causes of hereditary haemolytic anaemia

A
  • Defects of RBC membrane production (hereditary spherocytosis)
  • Haemoglobinopathy (sickle-cell disease, thalassaemia)
  • Defective RBC metabolism (G6PD deficiency, PK deficiency)
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14
Q

causes of acquired haemolytic anaemia

A

autoimmune
drugs
infection
maha (microangiopathic haemolytic anaemia)

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15
Q

anaemia signs and symptoms

A

fatigue, breathlessness on walking, pallor, conjunctival pallor, koilonychia, tachycardia, soft systolic murmur- flow murmur

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16
Q

what can polycythaemia be secondary to

A

chronic hypoxia in chronic lung disease, high altititude, renal cell tumours secreting EPO

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17
Q

what blood markers increase in bacterial and viral infections

A

bacterial - neutrophils

viral - lymphocytes

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18
Q

what are the features of hypovolaemia

A

postural hypotension, tachycardia, reduced skin turgor, dry mucous membranes

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19
Q

if the pt is hypovalaemia, what are the causes of their hyponatraemia

A

diarrhoea, vomiting, diuretics and salt losing nephropathy

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20
Q

if the pt. is euvolaemic, what is the cause of their hyponatraemia

A

hypothyroidism, adrenal insufficiency, SIADH

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21
Q

ix of hypovolaemia

A

low urine sodium

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22
Q

ix of euvolaemia

A

tfts - hypothyroidism
short syncacthen trst - adrenal insufficiency
plasma and urine osmolality

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23
Q

if the pt is hypervolaemia, what is the cause of their hyponatraemia

A

cardiac failure
cirrhosis
nephrotic syndrome

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24
Q

ix of hypervolaemia

A

fluid oveloaded, low urine sodium

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25
Q

how does hypokalaemia present

A

weakness
arrhythmia
polyuria

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26
Q

what are the ddx of hypokalaemia

A

vomiting
diuretics
primary hyperaldosteronism - bilateral hyperplasia or conns tumour

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27
Q

what are almost all cases of hyponatraemia due to

A

too much ADH

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28
Q

what are some rarer causes of hyponatraemia

A

excess water intake
sodium free irrigation solutions(e.g glycine solution used in TURP –> post op - pt may wake up confused due to low na as they have absorbed the irrigation fluid)

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29
Q

causes of siadh

A

cns pathology - haemotoma, stroke, tumour
lung pathology - pneumonia, cancer
drugs - ssri, ppi, opiates
tumours

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30
Q

causes of onycholysis

A

trauma, thyrotoxicosis, fungal infection, psoriasis

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31
Q

sweating, weight loss n onycholysis diagnosis

A

thyrotoxicosis

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32
Q

case: abdo pain, vomiting, t1dm, cbg:20, venous ph:7.20. What is the most appropriate next step

A

capillary ketone (DKA)

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33
Q

microvascular complications of diabetes

A

microvascular, retinopathy, nephropathy (foot ulcers)

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34
Q

macrovascular complications of diabetes

A

mi,stroke,pvd

35
Q

metabolic complications of diabetes

A

dka, hhs, hypoglycaemia

36
Q

distinguishing bt small bowel and large bowel on axr

A

small bowel - valvulae conniventes (folds go all the way across the lumen)
large bowel - haustra (semi-lunar folds; dont go all the way across lumen)

37
Q

what are digoxin and metoprolol used for

A

to rate control for chronic persistent af/>48hr

38
Q

how to rate control <48h af

A

dc cardioversion

39
Q

how to rate control <48h af

A

dc cardioversion

40
Q

what is troussseaus sign caused by

A

low calcium, thrombophlebitis migrans (sign of malignancy - pancreatic or gastric cancer)

41
Q

what is virchows node

A

a lymph node in left supraclavicular fossa

42
Q

what is caput medusae caused by

A

porto-systemic shunting in portal hypertension

43
Q

what is troisiers sign

A

the finding of a hard left supraclavicular node (sign of intra-abdominal malignancy - gastric)

44
Q

when does grey turners sign occur

A

in pancreatitis, aortic rupture and ectopic pregnancy

45
Q

what is microangiopathic haemolytic anaemia

A

fibrin deposition in vessels which fragment the blood cells as they pass -i.e haemolysis in small vessels due to clots

46
Q

what is haemolytic uraemic syndrome

A

endothelial damage triggers thrombosis, platelet consumption and fibrin strand deposition, mainly in renal vasculature

47
Q

case: confused, cough no postural hypotension, low na, high urine osmolality
What test do u request next

A

CXR

48
Q

what are the signs of hypervolaemia

A

raised jvp and oedema

49
Q

above what urine osmolality is ADH inappropriate

A

100

50
Q

what is nail pitting caused by

A

psoriasis, connective tissue disorders, sarcoidosis

51
Q

what is koilnycha caused by

A

iron deficiency anaemia

52
Q

what is leukonychia caused by

A

low albumin

53
Q

what are beau’s lines and what causes them

A

arrested nail growth because of severe illness, chemo

54
Q

how are fool ulcers ix n tx

A

swabs taken, eradicate infection, reduce weight bearing, look at vascular supply

55
Q

global st elevation ddx

A

pericarditis

56
Q

case: loin pain, normal crp and blood in urine.

What ix do u request

A

non contrast CT (KUB) - to visualise stones

57
Q

what is primary hyperparathyroidism

A

high pth drives high calcium, tumour secreting pth

58
Q

what is secondary hyperparathyroidism

A

pth is high because of low calcium. vit d deficiency or renal failure

59
Q

when u see hypercalcaemia what is the next test to look at

A

pth

60
Q

causes of hypercalcaemia if pth is high

A

hyperparathyroidism

61
Q

causes of hypercalcaemia if pth is low

A

malignancy, inflammatory

62
Q

what are the sources of alkaline phosphatase

A

liver n bone

63
Q

when is alp increased

A

in obstructive liver disease and bone disease (malignancy, fracture, pagets disease i.e inc bone turnover)

64
Q

signs n symptoms of bone metastases

A

backache, high calcium and high alp

65
Q

what cells make alp

A

osteoblasts

66
Q

why is alp normal in myeloma

A

plasma cells suppress osteoblasts and activate osteoclasts

67
Q

multiple myeloma acronym

A 
CRAB
calcium is up 
renal impairment
anaemia
bone pain n osteoporosis
68
Q

case: young woman w a smooth mobile 1cm lump. what is the most likely ddx

A

fibroadenoma

69
Q

causes of cavitating lung lesions

A

infection - tb, staph, klebsiella (alcoholics)
inflammation (rhematoid arthritis)
infarction - pe
malignancy

70
Q

ankle oedema causes

A

heart failure or low albumin (nephrotic syndrome)

71
Q

case: ankle oedema, normal u+es, normal alt, ast, alp, low albumin, normal echo/
What test dy do next

A

urinalysis

72
Q

what is nephrotic syndromw

A

increased permeability of the glomerular basement membrane to protein. proteinura >3g/day.
hypoalbuminaemia
oedema

73
Q

nephritic syndrome signs

A

haematuria, hypertension, proteinuria (oedema)

74
Q

what is hereditary haemorrhagic telangiacstasia

A

autosomal dominant. abnormal blood vessels in skin, mucous membranes, lungs, liver, brain
nose bleeds n gi bleeds

75
Q

how to manage hyperglycaemia

A 
diet n exercise
metformin if overweight 
sulphonylureas if not overweight
insulin sensitisers
insulin
glp1 analogues
gliptins (dpp4 inhibitor
76
Q

signs n symptoms of addisons disease/ adrenal insufficiency

A

low na, high k, short synacthen test

pigmentation and postural hypotension

77
Q

signs of prolactinoma

A

high prolactin –> low lh n fsh –> low testosterone

78
Q

signsof acromegaly

A

tumour secreting prolactin and growth hormone (high prolactin n gh)
high growth hormone –> high igf -1 production in the liver
failure of gh suppression in ogtt

79
Q

signs of premature ovarian failure

A

low oestrogen and high lh and fsh (due to reduced negative feedback)

80
Q

signs of hypothyoridism

A

low t3/t4 and high tsh

high prolactin as its stimulated by high levels of trh

81
Q

what is toxic multinodular goitre

A

when nodules start making excess thyroxine

82
Q

what is conns syndrome (primary hyperaldosteronism)

A

high na low k - metabolic alkalosis
hypertension
treat w spironolacctone

83
Q

6 endocrine causes of hypertension

A

phaeochromocytoma, cushings, conns, acromegaly, renal artery stenosis, co-arctation of the aorta

DPD COURSE (5 decks)

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