interactive haem, endo, renal and rheum cases

Question 1

what macrolide is given for atypical pneumonia

Answer 1

clarithromycin or erythromycin

Question 2

atypical pneumonia organisms

Answer 2

mycoplasma pneumoniae, chlamydia pneumoniae, legionella pneumophila

Question 3

how is microcytic anaemia diagnosis confirmed

Answer 3

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

Question 4

how is microcytic anaemia investigated

Answer 4

ogd and colonoscopy depending on upper/lower gi symptoms

Question 5

causes of bloody diarrhoea

Answer 5

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

Question 6

what is caput medusa

Answer 6

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

Question 7

what can portal hypertension cause

Answer 7

encephalopathy, ascites, spontaneous bacterial peritonitis, variceal bleed

Question 8

what signs indicate haemolytic uraemic syndrome (HUS)

Answer 8

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

Question 9

how to recognise immediate transfusion reaction due to haemolysis

Answer 9

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

Question 10

what three things can microangiopathic haemolytic anaemia be caused by

Answer 10

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

Question 11

what are the signs of DIC

Answer 11

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

Question 12

what are the signs of TTP (thrombotic thrombocytopenic purpura)

Answer 12

HUS + fever + neurological manifestations (headaches)

Question 13

causes of hereditary haemolytic anaemia

Answer 13

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

Question 14

causes of acquired haemolytic anaemia

Answer 14

autoimmune
drugs
infection
maha (microangiopathic haemolytic anaemia)

Question 15

anaemia signs and symptoms

Answer 15

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

Question 16

what can polycythaemia be secondary to

Answer 16

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

Question 17

what blood markers increase in bacterial and viral infections

Answer 17

bacterial - neutrophils

viral - lymphocytes

Question 18

what are the features of hypovolaemia

Answer 18

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

Question 19

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

Answer 19

diarrhoea, vomiting, diuretics and salt losing nephropathy

Question 20

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

Answer 20

hypothyroidism, adrenal insufficiency, SIADH

Question 21

ix of hypovolaemia

Answer 21

low urine sodium

Question 22

ix of euvolaemia

Answer 22

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

Question 23

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

Answer 23

cardiac failure
cirrhosis
nephrotic syndrome

Question 24

ix of hypervolaemia

Answer 24

fluid oveloaded, low urine sodium

Question 25

how does hypokalaemia present

Answer 25

weakness arrhythmia polyuria

Question 26

what are the ddx of hypokalaemia

Answer 26

vomiting diuretics primary hyperaldosteronism - bilateral hyperplasia or conns tumour

Question 27

what are almost all cases of hyponatraemia due to

Answer 27

too much ADH

Question 28

what are some rarer causes of hyponatraemia

Answer 28

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)

Question 29

causes of siadh

Answer 29

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

Question 30

causes of onycholysis

Answer 30

trauma, thyrotoxicosis, fungal infection, psoriasis

Question 31

sweating, weight loss n onycholysis diagnosis

Answer 31

thyrotoxicosis

Question 32

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

Answer 32

capillary ketone (DKA)

Question 33

microvascular complications of diabetes

Answer 33

microvascular, retinopathy, nephropathy (foot ulcers)

Question 34

macrovascular complications of diabetes

Answer 34

mi,stroke,pvd

Question 35

metabolic complications of diabetes

Answer 35

dka, hhs, hypoglycaemia

Question 36

distinguishing bt small bowel and large bowel on axr

Answer 36

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)

Question 37

what are digoxin and metoprolol used for

Answer 37

to rate control for chronic persistent af/>48hr

Question 38

how to rate control <48h af

Answer 38

dc cardioversion

Question 39

how to rate control <48h af

Answer 39

dc cardioversion

Question 40

what is troussseaus sign caused by

Answer 40

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

Question 41

what is virchows node

Answer 41

a lymph node in left supraclavicular fossa

Question 42

what is caput medusae caused by

Answer 42

porto-systemic shunting in portal hypertension

Question 43

what is troisiers sign

Answer 43

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

Question 44

when does grey turners sign occur

Answer 44

in pancreatitis, aortic rupture and ectopic pregnancy

Question 45

what is microangiopathic haemolytic anaemia

Answer 45

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

Question 46

what is haemolytic uraemic syndrome

Answer 46

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

Question 47

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

Answer 47

CXR

Question 48

what are the signs of hypervolaemia

Answer 48

raised jvp and oedema

Question 49

above what urine osmolality is ADH inappropriate

Answer 49

100

Question 50

what is nail pitting caused by

Answer 50

psoriasis, connective tissue disorders, sarcoidosis

Question 51

what is koilnycha caused by

Answer 51

iron deficiency anaemia

Question 52

what is leukonychia caused by

Answer 52

low albumin

Question 53

what are beau's lines and what causes them

Answer 53

arrested nail growth because of severe illness, chemo

Question 54

how are fool ulcers ix n tx

Answer 54

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

Question 55

global st elevation ddx

Answer 55

pericarditis

Question 56

case: loin pain, normal crp and blood in urine. | What ix do u request

Answer 56

non contrast CT (KUB) - to visualise stones

Question 57

what is primary hyperparathyroidism

Answer 57

high pth drives high calcium, tumour secreting pth

Question 58

what is secondary hyperparathyroidism

Answer 58

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

Question 59

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

Answer 59

pth

Question 60

causes of hypercalcaemia if pth is high

Answer 60

hyperparathyroidism

Question 61

causes of hypercalcaemia if pth is low

Answer 61

malignancy, inflammatory

Question 62

what are the sources of alkaline phosphatase

Answer 62

liver n bone

Question 63

when is alp increased

Answer 63

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

Question 64

signs n symptoms of bone metastases

Answer 64

backache, high calcium and high alp

Question 65

what cells make alp

Answer 65

osteoblasts

Question 66

why is alp normal in myeloma

Answer 66

plasma cells suppress osteoblasts and activate osteoclasts

Question 67

multiple myeloma acronym

Answer 67

``` CRAB calcium is up renal impairment anaemia bone pain n osteoporosis ```

Question 68

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

Answer 68

fibroadenoma

Question 69

causes of cavitating lung lesions

Answer 69

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

Question 70

ankle oedema causes

Answer 70

heart failure or low albumin (nephrotic syndrome)

Question 71

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

Answer 71

urinalysis

Question 72

what is nephrotic syndromw

Answer 72

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

Question 73

nephritic syndrome signs

Answer 73

haematuria, hypertension, proteinuria (oedema)

Question 74

what is hereditary haemorrhagic telangiacstasia

Answer 74

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

Question 75

how to manage hyperglycaemia

Answer 75

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

Question 76

signs n symptoms of addisons disease/ adrenal insufficiency

Answer 76

low na, high k, short synacthen test | pigmentation and postural hypotension

Question 77

signs of prolactinoma

Answer 77

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

Question 78

signsof acromegaly

Answer 78

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

Question 79

signs of premature ovarian failure

Answer 79

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

Question 80

signs of hypothyoridism

Answer 80

low t3/t4 and high tsh | high prolactin as its stimulated by high levels of trh

Question 81

what is toxic multinodular goitre

Answer 81

when nodules start making excess thyroxine

Question 82

what is conns syndrome (primary hyperaldosteronism)

Answer 82

high na low k - metabolic alkalosis hypertension treat w spironolacctone

Question 83

6 endocrine causes of hypertension

Answer 83

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