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Amir Sam Lectures > Lecture 4 - Mixed > Flashcards

Lecture 4 - Mixed Flashcards

1
Q

What are the typical symptoms a patient wold present with when suffering from an immediate transfusion reaction and why?

A

Due to Haemolysis

Fever

Rigor

Tachycardia

Hypotension

Chest Pain

Dark Urine

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2
Q

Give a couple of examples of causes of polycythaemia.

A

Physiological (Response to chronic hypoxia casused by COPD)

Pathological (excess EPO)

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3
Q

What are the main causes of thrombocytopenia?

A

Decreased production

Increased breakdown/usage

Pooling in the spleen

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4
Q

Give a couple of causes of a thrombocytosis.

A

Primary - Myeloproliferative Disorder, CML

Response to haemorrhage

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5
Q

What causes microcytic anaemia?

A

Iron Deficiency - Diet, blood loss (GI, UG)

Beta Thalassaemia heterozygosity

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6
Q

What causes a normocytic anaemia?

A

Chronic Disease - eg. Rheumatoid Arthritis

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7
Q

How do ferritin levels present in a patient with a normocytic anaemia and why?

A

Normal/High

Ferritin production is an acute phase reaction, seen in chronic disease (similar to CRP)

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8
Q

In which condition are ferritin levels extremely high?

A

Haemochromatosis

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9
Q

What are the main causes of a macrocytic anaemia?

A

Alcoholics May Have Liver Failure

Alcohol

Myelodysplasia

Hypothyroidism

Liver Disease

Folate/B12 Deficiency

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10
Q

How does polycythaemia present?

A

Headache

Pruritus after a hot bath

Blurred vision (hyperviscosity)

Tinnitus

Thrombosis (Stroke, DVT)

Gangrene

Choreiform Movements

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11
Q

What are the main types of Sickle Cell Crises?

A

Acute Painful

Stroke

Sequestration

Gallstones/Chronic Cholecystitis

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12
Q

How would you manage an acute painful Sickle Cell crisis?

A

Analgesia

O2

IV Fluids

Antibiotics

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13
Q

How would you manage a stroke secondary to Sickle Cell disease?

A

Exchange Blood Transfusion

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14
Q

What is a Sequestration crisis and how does it present?

A

RBC Pooling

Affects the Lungs (SOB, Cough, Fever)

Affects the Spleen (Exacerbation of anaemia)

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15
Q

How would you manage a Sickle Cell sequestration crisis?

A

Usually symptomatic.

Chronic splenic episodes requires a Splenectomy.

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16
Q

Why does Hypercalcaemia cause Polyuria and Polydipsia?

A

Impairs ADH function, leading to the development of Nephrogenic Diabetes Insipidus.

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17
Q

How might a patient with Multiple Myeloma present?

A

CRAB

Hypercalcaemia (Stones, bones etc.)

Renal Failure (Ur/Cr)

Anaemia (SOB, Lethargy)

Bone Pain/Osteoporosis (Fractures, Pain, Check DXA)

Infection

Cord Compression

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18
Q

What do you test the urine for when investigating a suspected case of Multiple Myeloma?

A

Bence-Jones Proteins.

IG Light chains, excreted in the urine due to excess IG production by neoplastic Plasma Cells.

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19
Q

What may cause an Anaemia with an increased reticulocyte count?

A

Haemolytic Crisis

Haemorrhage

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20
Q

What may cause an anaemia with a decreased reticulocyte count?

A

Parvovirus B19 Infection

Aplastic Crisis in Sickle Cell patients

Blood Transfusion

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21
Q

What is the diagnostic criteria that defines Diabetes?

A

Fasting Glucose >7

Random Glucose >11.1

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22
Q

Describe a typical T1DM patient.

A

Young, thin, insulin deficient.

Present with:

Weight Loss

High Ketones (may present with DKA initially)

Acidotic (^)

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23
Q

Describe a typical T2DM patient.

A

Older, Overweight, Insulin resistent

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24
Q

How would you treat a newly diagnosed case of Type 2 Diabetes?

A

Lifestyle Advice

Metformin

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25
Q

What do Sulfonylureas do and what are the common side-effects?

A

Stimulate Insulin release by Pancreatic ß-Cells

Weight Gain

Hypoglycaemia

(Add onto Metformin after a few months - progressive disease must be proven)

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26
Q

Give an example of a DPP-IV Inhibitor.

A

Linagliptan

Sitagliptan

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27
Q

How do DPP-IV Inhibitors work?

A

DPP-IV breaks down GLP-1 (Glucagon-like Peptide). Inhibition has a similar effect to GLP-1 Agonists.

28
Q

What are the main classes of Diabetes complications, and how do you investigate them?

A

Microvascular

  • Retinopathy
  • Nephropathy
  • Neuropathy

Macrovascular

-MI/Stroke/PVD

Metabolic

  • DKA
  • HHS (Hyperosmolar Hyperglycaemic State)
  • Hypoglycaemia
29
Q

How would you monitor Nephropathic progression in Diabetes patients, and how would you treat it?

A

Monitor ACR (Albumin-Creatinine ratio) every time you see the patient. Microalbuminurea occurs with Diabetic Nephropathy.

If Nephropathy is detected, start the patient on an ACE Inhibitor.

30
Q

How would you manage a case of Hypoglycaemia in a Diabetic patient?

A

If Conscious:

  • Drink glucose & milk
  • Long-acting carbohydrates

If Confused:

-Buccal Glucose Gel

If Unconscious:

  • IV Glucose
  • Glucagon
31
Q

How does Graves Disease present?

A

Weight Loss w/ Good Appetite

Irritability

Palpitations

Oligomenorrhoea

O/E:

Tremor

Proptosis

Smooth Goitre

Pretibial Myxoedema

32
Q

What will a Graves’ Patient’s TFTs show?

A

High T3/4

Low TSH

33
Q

What is the difference between ‘Pretibial Myxoedema’ and ‘Myxoedema’?

A

Pretibial Myxoedema is a waxy, discoloured rash on the shins of a patient with Graves’ Disease.

Myxoedema is a term given to the consistency of the skin in a patient with Hypothyrodism

34
Q

Which Antibody is responsible for Graves’ Disease?

A

TSH Receptor Stimulating Antibody

35
Q

What will the Nuclear Medicine Technetium uptake scan show in a case of Graves’ Disease?

A

Diffuse, increased uptake

36
Q

What would you look for in the History and Examination of a patient when suspecting Thyroid Cancer?

A

Lump

Typical Hyperthyroid Symptoms (eg. Thyroid Acropachy)

Risk Factors (Radiation, FHx, Rapid Enlargement/Compression, Lymphadenopathy)

Metastases (Lung, follicular thyroid carcinoma)

37
Q

How would you investigate a possible case of Thyroid Cancer?

A

1) Ultrasound
2) Fine Needle Aspiration (Uptake Scan may show cold nodules)

38
Q

How might you treat a case of Thyroid Cancer?

A

Surgery:

  • Papillary
  • Follicular
  • Medullary
  • Anaplastic (Poor Prognosis)

Thyroxine

Radioiodine

39
Q

How would a Prolactinoma case typically present?

A

Irregular Periods

Galactorrhoea

Bitemporal Hemianopia

Sexual Dysfunction

40
Q

What is the most appropriate treatment for a Prolactinoma?

A

Cabergoline (Dopamine Agonist)

41
Q

How could a Pituitary Tumour present?

A

Headache & Hemianopia

Hyposecretion (of most other hormones)

Hypersecretion (of a particular hormone)

Local compression of other structures

42
Q

How would someone with Acromegaly typically present?

A

Headache, sweating

Poor sleep (Snoring is common), Obstructive Sleep Apnoea

Tingling in fingers (Carpal Tunnel, compression of Median Nerve)

43
Q

What are the initial investigations for a suspected case of Acromegaly?

A

1) IGF-1
2) Oral Glucose Tolerance Test (OGTT)

44
Q

When should you test for Cushing’s?

A

Only when you have a high pre-test probability of a positive result.

45
Q

What are the discriminatory signs of Cushing’s Syndrome?

A

Bruising

Thick Skin

Myopathy

Purple Striae >1cm wide

Diabetes

Hypertension

Osteoporosis at a young age

46
Q

What would be your Ddx for a patient presenting with Amenorrhoea/Oligomenorrhoea?

A

Pregnancy

Hypothalamus

Pituitary

Thyroid (Hyper/Hypo)

Ovaries (PCOS, Failure)

47
Q

How would you investigate a patient presenting with Amenorrhoea/Oligomenorrhoea?

A

1) Urine BHCG

Hypothalamus - ?excess exercise, low BMI?

Pituitary (Prolactinoma) - ?excess prolactin, Low LH/FSH

Thyroid -TFTs

PCOS - Androgen levels

Ovarian Failure - High FSH

48
Q

How does Hypoklaemia present?

A

Weakness

Arrhythmia

Polyuria

49
Q

What are the main causes of Hypokalaemia?

A

Vomiting

Diuretics

Primary Hyperalodesetornism - Either Bilateral hyperplasia or Conn’s

50
Q

Why does Hypokalaemia cause Polyuria?

A

Hypokalaemia is a cause of Nephrogenic Diabetes Insipidus.

51
Q

How would you calculate Plasma Osmolality?

A

2 x (Na + K) + Ur + Glucose

52
Q

What cause low urine osmolality (dilute urine)?

A

Diabetes Insipidus - Decreased response to ADH

53
Q

What would the likely diagnosis be in a patient presenting with

Low Ca

Low Phosphate

High PTH

?

A

Vitamin D Deficiency

Low Ca/Phosphate absorption

Less negative feedback means PTH increases

54
Q

What would the likely diagnosis be in a patient presenting with

High Ca

Low Phosphate

High PTH

?

A

Hyperparathyroidism

High Ca

High PTH

Low Phosphate is a response to high PTH

55
Q

What would the likely diagnosis be in a patient presenting with

High Ca

Normal Phosphate

Low PTH

?

A

Malignancy

High Ca

Low PTH therefore..

Normal Phosphate

56
Q

What would the likely diagnosis be in a patient presenting with

Low Ca

High Phosphate

Low PTH

?

A

Hypoparathyroidism

Low PTH

Leads to..

Low Ca &

High Phosphate

57
Q

What would the likely diagnosis be in a patient presenting with

Low Ca

High Phosphate

High PTH

?

A

Renal Failure

Vitamin D needs to be hydroxylated in the kidneys.

Different from Vit D Deficiency because of the High Phosphate. In Renal failure, Phosphate cannot be effectively excreted.

58
Q

How would you classify AKI?

A

Pre-Renal:

  • Hypovolaemia
  • Sepsis

Renal:

  • Drugs
  • Glomerulonephritis

Post-Renal:

-Obstruction

59
Q

How would you investigate an Acute AKI suspected to be due to Glomerulonephritis?

A

?Active Urine Sediment

Haematurea

Proteinurea

60
Q

How would you investgate an Acute AKI suspected to be due to obstruction?

A

Ultrasound

Check for malignancy/prostate hyperplasia

61
Q

How would you investigate Renal Artery Stenosis?

A

Asymmetrical Kidneys (USS)

Magnetic Resonance Angiography is Gold Standard

In Bilateral RAS, ACE Inhibitors worsen renal function.

62
Q

How do you determine the cause of an Alkalosis?

A

Check CO2

Low = Respiratory

High = Metabolic

63
Q

Which ABG abnormality indicates a complex mixed picture?

A

CO2 and Bicarbonate going in opposite directions (Increasing/Decreasing)

64
Q

What are the main ways in which a Seronegative Arthropathy (eg. Psoriatic Arthritis) can present?

A

Symmetric Polyarthropathy, identical to RA - must check the skin

Distal Oligoarthritis

Sacroilitis

65
Q

What is the most likely diagnosis if a patient presents with a pearl-like lesion with telangiecstasias, as seen below?

A

Basal Cell Carcinoma

Amir Sam Lectures (6 decks)

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