Meeran Lecture 29/03/2017

Question 1

Major criteria for Rheumatic Fever

Answer 1

1. carditis
2. Arthritis
3. Chorea
4. Erythema marginatum
5. Subcutaneous nodules

Question 2

ECG

Answer 2

This is a 12 lead ECG on …
It was taken on …
rate
rhythm (usually sinus or fast or slow may be regular or irregular)
axis (usually normal - look at lead 2 st segment positive -> axis is normal)
PR

Question 3

Causes of AF

Answer 3

1. IHD
2. Hyperthyroidism
3. Old Rheumatic fever

Question 4

AF Management

Answer 4

1. Rate control
   Beta blocker (propranolol, atenolol) - younger people
   Digoxin (older people)
2. Rhythm control
3. Thromboembolism prophylaxis

Question 5

AF when to anti coagulate?

Answer 5

CHADS2

CHADS2VASc

Question 6

Aspirin

Answer 6

Prefer recurrent MIs or stroke

anti-platelet

Question 7

HASBLED scoring

Answer 7

Risk of bleeding on anticoagulation

Hypertension
Abnormal liver and renal function 
Stroke
Bleeding 
Labile INR 
Elderly (>65)
Drugs or alcohol 

Score greater than 3 -> increased risk of bleeding on anticoagulation -> caution and regular review

Question 8

High circulating level of thyroxine

Answer 8

Tremor
Palpitations
Tachycardia
Proptosis

Question 9

lid lag

Answer 9

Seen in graves disease

not controlled by high levels of thyroxine

Question 10

ptosis

Answer 10

drooping of eye lid

Question 11

Horners syndrome

Answer 11

ptosis
myosis
anhydrosis
(opposite of lid lag)

Question 12

Graves Disease

Answer 12

Autoimmune (at least 4 antibodies)

Antibodies bind to and stimulate the TSH receptors in the thyroid

Antibodies cause goitre and hyperthyroidism and exophalmos

Hyperthyroidism causes lid lag

Question 13

Exophthalmos

Answer 13

Antibodies bind to muscle behind the eye and cause exophthalmos.

Other antibodies cause pretibial myxoedema

Question 14

Infective endocarditis

Answer 14

Caused by a bacterial infection of the heart

Question 15

Acute rheumatic fever causes

Answer 15

Infection (sore throat) -> antibodies cause the problem

Carditis
Erythema Marginatum 
Subcutaneous nodules
chorea
arthritis 

Autoimmune disease

Non existing in the UK (rural world)

But a lot of 70year olds whom had it in the past

Question 16

Asthma management

Answer 16

1. Beta agonist and inhaled steroid

Question 17

Microcytic anaemia

Answer 17

Iron deficiency

Question 18

Macrocytic anaemia

Answer 18

b12 deficiency

folate deficiency

Question 19

Microcytic anaemia - iron deficiency

Answer 19

Slow GI blood loss (colonic carcinoma)

Iron stores run out as blood contains iron -> once iron stores are zero, smaller red cells appear -> microcytic anaemia typical of iron deficiency -> high platelet count because of bleeding

Question 20

Pernicious anaemia

Answer 20

Big RBCs

Question 21

Red Cell Distribution Width

RDW

Answer 21

standard deviation of the MCV

If there are a lot of big and small ones ->wide -> anisocytosis -> different sizes

If you have a lot of small ones -> low

if you only have larger ones -> low

Question 22

High Red Cell Distribution WIdth (RDW)

Answer 22

Mixed picture

Question 23

Pernicious anaemia

Answer 23

Lack on intrinsic factor
Stop absorbing B12
DNA replicates poorly
Thus cell grows but fails to divide 
Macrocytosis results from B12 or folate deficiency 
Hyper-segmented neutrophils

Question 24

Anaemia of chronic disease

Answer 24

MCV normal
anemia
not mixed picture

Question 25

How to distinguish chronic disease anaemia from mixed picture?

Answer 25

RDW

Question 26

Chronic myeloid leukaemia

Answer 26

very high malignant white count (79) normal range 4-11 in severe sepsis 25

Question 27

MALARIA

Answer 27

``` Very pyrexial patient come back of some part of asia WCC low (3) haemoglobin low Platelet count very low ```

Question 28

Spider Naevus

Answer 28

Touch the centre makes it blanch Found only in the distribution of the SVC It can only be found above the nipple line. Chronic stable liver disease

Question 29

Portal hypertension

Answer 29

large visible veins ascites splenomegaly

Question 30

Campbell de Morgan spot

Answer 30

No pathology known. | Incidence increases with age

Question 31

Infective endocarditis

Answer 31

definitely causes splenomegaly

Question 32

Causes of large spleens

Answer 32

1. CML 2. Infective endocarditis 3. Alcohol

Question 33

Obstructive jaundice

Answer 33

Puts up alkphos the most! | SO if very high -> pancreatic cancer

Question 34

Viral Hepatitis

Answer 34

Higher ALT with AST high too but ALT higher

Question 35

Cirhhosis

Answer 35

AST higher then ALT but both are high

Question 36

Patient with both asthma and heart failure. drug that can be used for both

Answer 36

aminophylline (phosphodiesterase inhibitor) | Beta blocker contraindicated in asthmatics

Question 37

Metabolic acidosis

Answer 37

DKA

Question 38

Respiratory acidosis

Answer 38

acute overdose of drugs that stops breathing (opioid) COPD: chronic. compensation (bicarbonate will be high)

Question 39

ACE Inhibitors

Answer 39

cause an (increase) worsening of the creatinine within days of starting hyperkaemaemia DO not use ace inhibitor in renal artery stenosis (If they get acidotic, pulmonary oedema, hyperkalaemia) -> emergency dialysis less albuminuria (albuminuria causes renal failure in diabetic patients) Prevent end-stage renal failure

Question 40

Diabetes drugs

Answer 40

1. Metformin (biguanide) - Dont give in renal failure, helps loose weight - causes a bit of diarrhea 2. Sulphonylurea (Gliclazide) 3. Thiozolidinediones (Pioglitazone) 4. Incretins (exanatide) 5. Dipeptidyl peptidase IV inhibitors (gliptins) 6. Insulin

Question 41

Diabetes type 2

Answer 41

First diet and exercise