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Lancaster FINALS _slide > Medicine (7) > Flashcards

Medicine (7) Flashcards

1
Q

Ottawa rules for knee

A

Who to X-ray

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2
Q

Ottawa rules for ankle and foot

A

An ankle x-ray is required only if there is any pain in the malleolar zone and any one of the following findings:

  • bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)
  • bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
  • inability to walk four weight bearing steps immediately after the injury and in the emergency department
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3
Q

What two areas to palpate for Ottawa rule for foot?

A
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4
Q

What types of anaemia all of these pictures are?

A
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5
Q

Causes of anaemia considering MCV levles

A
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6
Q

Causes, signs/symptoms and investigations for iron deficiency anaemia

A

Common causes:

Gastrointestinal loss, Gynaecological loss, diet

Symptoms:

Fatigue, dyspnoea, palpitations

Signs:

Angular stomatitis, koilonychia, tachycardia

Check serum ferritin and iron studies

Replace if deficient

Investigate cause (GI investigations)

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7
Q

What’s thalassemia ?

A
  • reduced production rate of either alpha or beta chains.
  • deficiency in one chain causes excess in other
  • occurs as alpha-thalassemia or beta-thalaassemia
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8
Q

Types of thalassemia

A

Alpha-thalassaemia

  • Four genes affect alpha-chain

1-2: mild microcytosis

3: microcytic anaemia + splenomegaly
4: death

Beta-thalassaemia

  • Major: Syndrome of anaemia, growth stunting and hepatosplenomegaly arises. Autosomal recessive
  • Minor: asymptomatic. Autosomal recessive
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9
Q

Com on causes of normocytic anaemia

A
  • Anaemia of Chronic Disease
  • Acute haemorrhage
  • Combined Iron + Folate deficiency
  • Occasionally haemolytic anaemia
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10
Q

Common causes of macrocytic anaemia and investigations

A
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11
Q

What findings (blood) suggest haemolytic anaemia? (3)

A
  • normocytic/macrocytic anaemia
  • raised bilirubin (jaundice)
  • raised LDH
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12
Q

How to test for autoimmune haemolytic anaemia?

A

Direct Antiglobulin Test (DAT) = Coomb’s test

DAT Positive (and ↑ reticulocytes) = autoimmune haemolytic anaemia

DAT Negative:

  1. Membrane – Hereditary Spherocytosis/elliptocytosis
  2. Cytoplasm – G6PD
  3. Haemoglobin – Sickle Cell Anaemia, thalassaemia
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13
Q

Subtypes of Autoimmune Haemolytic Anaemia (AIHA)

A

warm and cold types → according to at what temperature the antibodies best cause haemolysis

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14
Q

Warm Autoimmune Haemolytic Anaemia

  • what happens
  • management
  • causes
A
  • the antibody (usually IgG) causes haemolysis best at body temperature
  • haemolysis tends to occur in extravascular sites, for example the spleen

Management options: steroids, immunosuppression and splenectomy

Causes of warm AIHA

  • autoimmune disease e.g. SLE
  • neoplasia: e.g. lymphoma, CLL
  • drugs: e.g. methyldopa
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15
Q

Cold Autoimmune Haemolytic Anaemia

  • what happens
  • features/symptoms
  • management
  • causes
A
  • IgM antibody
  • haemolysis best at 4 deg C
  • haemolysis is mediated by complement
  • more commonly intravascular

Features may include symptoms of Raynaud’s and acrocynaosis (cyanosis of hand, feet, face)

Management: steroids

Causes of cold AIHA

  • neoplasia: e.g. lymphoma
  • infections: e.g. mycoplasma, EBV
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16
Q

What conditions may be classified as myeloproliferative?

A
  • Chronic myeloid leukaemia (it is also classified as myeloproliferative)
  • Polycythaemia vera

• Essential thrombocythaemia

• Primary myelofibrosis

17
Q

Acute Myeloid Leukaemia

  • investigations
  • what’s seen on blood film
  • treatment
A
18
Q

How to differentiate between ALL and AML?

A
19
Q

Chronic lymphocytic leukaemia

  • features
A
20
Q

CLL complications

A
21
Q

Ix and characteristic ‘buzzword’ for CLL

A
22
Q

Cause/ pathophysiology of CML

A

CML

  • type of myeloproliferative disorder
  • proliferation of mature granulocytes and their precursors leading to their accumulation in the blood and bone marrow

PHILADEPHIA CHROMOSOME (9,22) translocation

(part of the ABL proto-oncogene from chromosome 9 being fused with the BCR gene from chromosome 22

The resulting BCR-ABL gene codes for a fusion protein which has tyrosine kinase activity in excess of normal

23
Q

Management of CML

A
  • imatinib is now considered first-line treatment
  • hydroxyurea
  • interferon-alpha
  • allogenic bone marrow transplant
24
Q

How to differentiate CML and CLL?

A
25
Q

buzzwords for ALL, AML, CLL and CML (shortly)

A
26
Q

Spot diagnosis

A

Polycythaemia

27
Q

Types of polycythaemia (2)

A

Polycythaemia

Primary

  • Polycythaemia Rubra Vera

Secondary

  • Hypoxia (COPD, altitude, cardiac hypoxia)
  • ↑EPO (Tumour – Renal, liver, cerebellar)
  • Renal artery stenosis
  • High-affinity haemoglobinopathies (keep hold of O2 so trick kidneys)
28
Q

Pathophysiology of Polycythaemia Rubra Vera

A
29
Q

Clinical features of polycythaemia rubra vera

A
30
Q

Lab findings and treatment of polycythaemia rubra vera

A

Lancaster FINALS _slide (31 decks)

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