Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Kat's Pathology > Malabsorption CPC > Flashcards

Malabsorption CPC Flashcards

1
Q

What blood tests do you request in someone who is tired all the time (6)

A 
FBC
Electrolytes, creatinine, calcium 
LFTs
Blood glucose 
TFTs
Vitamin D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of low MCV (3)

A

Iron deficiency
Thalassaemia trait
Anaemia of chronic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Low Hb
Low Serum Iron
Raised TIBC or transferrin
Low Ferritin

A

Iron deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Low Hb
Low Serum Iron
Normal or low TIBC or transferrin
Normal or high (acute phase) Ferritin

A

Anaemia of chronic disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Normal or low Hb
Normal Serum Iron
Normal TIBC or transferrin
Normal Ferritin

A

Thalassaemia trait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q 
Hypochromic RBC (pale) 
Microcytic RBC (small)
A

Iron deficiency

Thalassaemia trait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Poikolocytes e.g. Tear drop RBC

A

Iron deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Anisopoikilocytosis e.g. elliptocyte

A

Iron deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Basophilic stippling - aggregated ribosomal material (4)

A

Beta thalassaemia trait
lead poisoning
Alcoholism
Sideroblastic anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Hypersegmented neutrophils

A

Megaloblastic anaemia - reflects impaired DNA synthesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are some causes of megaloblastic anaemia (3)

A

B12 deficiency
Folate deficiency
Drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Target cells (4)

A

Iron deficiency
Thalassaemia
Hyposplenism
Liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are howell jolly bodies

A

Nuclear remnants visible in red cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Howell Jolly bodies

A

Hyposplenism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Iron deficiency (2)

A

Hypochromic and microcytic

Anisopoikilocytosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Megaloblastic anaemia (2)

A

Hypersegmented neutrophils

Large /macrocytic’ cells

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Hyposplenic features (2)

A

Target cells

Howell Jolly bodies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Causes of iron deficiency (3)

A

Major blood loss
Poor diet
Malabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Causes of megaloblastic changes (2)

A

B12 or folate deficiency (poor diet, malabsoprtion, pernicious anaemia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Causes of hyposplenism (2)

A

Absent spleen

Poorly functioning spleen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Causes of absent spleen (2)

A

Therapeutic

Trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Causes of poorly functioning sleep (4)

A

Inflammatory bowel disease
Coeliac disease
Sickle cell disease
SLE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Vitamin D deficneicy
B12/Folate deficiency
Iron deficiency
Hyposplenism

What unifies the above conditions

A

Bowel disease with malabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q 
Iron deficiency 
B12 deficiency 
Folate deficiency 
Fat deficiency (steatorrhoea/weight loss)
Calcium deficiency
A

Coeliac disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

B12 deficiency

Bile salt deficiency

A

Crohn’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q 
Fat deficiency (steatorrhoea/weight loss)
Calcium deficiency 
B12 deficiency
A

Pancreatic disease

27
Q 
Fat deficiency (steatorrhoea/weight loss) 
Folate deficiency
A

Infective/Post-infective

28
Q

What HLA is associated with coeliac disease (2)

A

HLA DQ2 in 90% of patients

HLA DQ8 in the rest

29
Q

What is the concordance of coeliac in monozygotic twins

A

75%

30
Q

What type of inheritance is coeliac disease

A

Polygenic auto-immune disease

31
Q

What immunological function underpins coeliac disease

A

T cell response to gluten

Peptides from gliadin are deamidated by tissue transglutaminase and presented by APC
CD4 T cells recognise these deamidated peptides presented by HLA DQ2 or DQ8
CD4 T cell activation results in secretion of IFN-g and may indirectly lead to increased IL-15 secretion
IL-15 promotes activation of the intra-epithelial lymphocytes (IEL)
Intra-epithelial lymphocytes kill epithelial cells in an NKG2D dependent manner
The activation and function of the intra-epithelial lymphocytes appears to be independent of engagement of their T cell receptor

32
Q

What mediates the cell damage in coeliac disease

A

Damage mediated by gamma-delta TCR expressing IEL

33
Q

What antibodies are present in coeliac disease (3)

A

Anti-gliadin antibodies
Anti-tissue transglutaminase
Anti-endomysial antibodies

34
Q

What are anti-gliadin antibodies

A

Gliadin is a component of gluten
IgA antibodies more sensitive than IgG antibodies, but both unreliable
Outdated test – but suggested an immune response against a ‘foreign’ protein in food was occurring in patients

35
Q

What are the specific tests for coeliac disease (3)

A

IgA anti-endomysial antibody
IgA anti-transglutaminase antibody
IgG or IgA anti-gliadin antibody

36
Q

What is the first line immunological test in coeliac disease

A

IgA anti-transglutaminase antibody

37
Q

What is the gold standard diagnostic test in coeliac disease

A

Duodenal biopsy

38
Q

What is characteristic in a duodenal biopsy for coeliac disease

A

Villous atrophy

39
Q

What is the normal duodenal villous:crypt ratio

A

4:1

40
Q

What is the pathology of villous atrophy is coeliac disease (2)

A

In coeliac disease, the villous height is reduced and crypts become hyperplastic, resulting in reduced or reversed villous:crypt ratio
Although height of villi are reduced, mucosal thickness remains the same due to crypt hyperplasia
Villous atrophy results in decreased surface area = malabsorption

41
Q

What causes malabsorption in coeliac disease

A

Villous atrophy

42
Q

What is the pathology RE IELs in coeliac disease

A

Normal duodenal villi contain less than 20 intraepithelial lymphocytes/100 epithelial cells
In coeliac disease, this is increased to >20 IELs/100 epithelial cells
These lymphocytes are gamma-o T cells

43
Q

What are IELs

A

Intra-epithelial lymphocytes

44
Q

What is the normal IEL ration

A

5/100 epithelial cells

45
Q

What is the coeliac IEL presentation

A

> 20/100 epithelial cells

46
Q

What are the causes of increased epithelial lymphocytes (8)

A 
Coeliac disease 
Dermatitis herpetiformis 
Cows milk proteins sensitivity 
IgA deficiency 
Tropical sprue 
Post infective malabsorption 
Drugs (NSAIDs)
Lymphoma
47
Q

What are some causes of villous atrophy (10)

A 
Coeliac disease 
Giardiasis 
Troipical sprue 
Crohn's disease 
Radiation/chemotherapy 
Bacterial overgrowth 
Nutritional deficiencies
Graft versus host disease 
Microvillous inclusion disease 
Common variable immunodeficiency
48
Q

What are the histological features of coeliac disease (6)

A

Subtotal villous atrophy
Increased intraepithelial lymphocytes
Crypt hyperplasia
Increased inflammatory cells in the lamina propria
No evidence of Giardia
Consistent with coeliac disease, need to correlate with serology and clinical picture

49
Q

What are the principles of management of coeliac disease (5)

A 
Dietary management
Advice re long term complications
Implications for family
Sources of patient information
Ongoing monitoring
50
Q

What are the principles of a gluten free diet for coeliac disease (3)

A

Gluten is present in wheat, barley rye and oats (some)
Strict adherence is important in eliminating symptoms and preventing complications
Good dietetic support is vital

51
Q

What are the complications of coeliac disease (5)

A 
Malabsorption
Osteomalacia and osteoporosis
Neurological disease (Epilepsy, Cerebral calcification)
Lymphoma
Hyposplenism
52
Q

What are the practical implications of a gluten free diet

A

Cost of a gluten free diet

Do all the family have to eat gluten free?

53
Q

What are the prognostic indicators for coeliac disease

A

genetic component - HLA0-DQ2 - increased risk in other family members

54
Q

What is essential to provide the patient in a newly diagnosed coeliac disease

A

VERY important to provide support and information (patient support groups, dieticians, medical staff, family)

55
Q

What are the follow up investigations for patients with coeliac disease (4)

A

Haematology - FBC, iron level, TIBC, ferritin, vitamin B12, folate, prothrombin time
Biochemistry - U&Es, creatinine, calcium, phosphate, LFTs, albumin and total serum protein levels
Serological tests, IgA antitransglutaminase antibody or IgA endomysial antibody
Imaging - DEXA of spine and hip - every 3-5 years

56
Q

Key features for dietary adherence in coeliac disease

A

Strict adherence is vital
Additives to gluten free foods can catch out the unwary
- Processed starch, and processed foods
- Mustards, salad dressings
- Some ice cream thickeners
Some patients have problems adhering to diet
- Inconvenient
- Foods are not always labelled clearly
- Specific problems of adolescents, elderly

57
Q

How many patients present with typical coeliac disease symptoms

A

10%

58
Q

Where is coeliac disease most common

A

North Africa

59
Q

What are the consequences of undiagnosed coeliac disease (3)

A

Often have undiagnosed deficiencies - iron, folate, B12, vitamin D and K.
Dietary compliance protects against malignancy
Often feel better physically and psychologically when treated.

60
Q

What is the mortality in untreated coeliac disease

A

Mortality rate is 2-3 times greater than the general population (malignancy, (especially lymphoma), infection)

The excess mortality returns to normal after 3-5 years on gluten free diet.

61
Q

What is coeliac disease associated with

A

Other auto-immune disorders

62
Q

What auto-immune disorders is coeliac disease associated with (4)

A

Dwrematitis herpetiformis (100% prevalence)
T1DM (7% prevalence)
Autoimmune thyroid disease
Down’s syndrome

63
Q

What is the commonest presentation of coeliac disease (3)

A

Microcytic anaemia, past or present
Family history of coeliac disease
Feeling tired all the time

Kat's Pathology (105 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions