Misc 5 Flashcards
Liver biopsy contraindications
deranged clotting (e.g. INR > 1.4)
low platelets (e.g. < 60 * 109/l)
anaemia
extrahepatic biliary obstruction
hydatid cyst
haemoangioma
uncooperative patient
ascites
Fabry disease
Overview
X-linked recessive
deficiency of alpha-galactosidase A
Features
burning pain/paraesthesia in childhood
angiokeratomas
lens opacities
proteinuria
early cardiovascular disease
Causative pathogen
SBP vs peritoneal dialysis infection
- SBP - E. Coli
- PD infection - Staph Epididermidis
Causative pathogen for bronchiectasis
Haemophilus influenzae is correct. This is the most common organism found in bronchiectasis.
Malaria treatment
Non-falciparum malaria
Chloroquine sensitive area
* ACT or chloroquine
Chloroquine resistant area
* Artemisin based combination therapy like artemther-lumefantrine
Malaria treatment
Ovale, vivax
Describe the features distinguishing between vivax/ovale & malariae
Give chloroquine after initial treatment to destroy liver hypnozoites and prevent relapse
Features
* general features of malaria: fever, headache, splenomegaly
* Plasmodium vivax/ovale: cyclical fever every 48 hours.
* Plasmodium malariae: cyclical fever every 72 hours, is associated with nephrotic syndrome.
Malaria treatment
When is IV artesunate indicated?
IV artesunate - parasite count >2%
Give ACT for uncomplicated falciparum malaria
>10% artesunate - exchange transfusion
Antibodies involved in
Pemphigus vulgaris vs Bullous pemphigoid
Pemphigus vulgaris
* Desmoglein 3
Bullous pemphigoid
* Hemidesmosomal BP antigens
Nuclear Scintigraphy
What thyroid problem shows:
patchy uptake
diffuse and increased activity
absent or trace uptake
Nuclear scintigraphy uses very small, tracer amounts of radioactive molecules to diagnose diseases involving bone, soft tissues and vessels.
Patchy uptake is seen with toxic multinodular goitre.
Diffusely and increased activity with a decreased background is seen in Graves disease.
Trace or absent uptake may indicate the presence of thyroiditis resulting in inflammation or destruction of thyroid tissue.
7 layers of the skin
Why is HBA1C falsely low in sickle cell anaemia?
HbA1c (glycated haemoglobin) is a measure of the average blood glucose levels over the past 2-3 months. In sickle-cell anaemia, red blood cells have an abnormally short lifespan due to their sickle shape, leading to a faster turnover of red blood cells. This means that there is less time for glucose to bind to haemoglobin, resulting in lower HbA1c levels despite elevated fasting glucose levels.
What is the difference between HSP, IgA nephropathy and Minimal change disease?
IgA nephropathy
* Most common nephritic syndrome, comes 1-2 days after viral URTI, young males
* Macroscopic haematuria
Henoch Schonlein Purpura
* Child with palpable purpuric rash over buttocks and ext surface arms and legs
* Abdo pain, polyarthralgia
* Features of IgA - haematuria, renal failure
* Prognosis - 2/3 have full recovery, supportive tx.
Minimal change disease - nephrotic syndrome 75% children, 25% adults, steroid responsive, 30% prognosis rule
What is the difference between
Haemolytic uraemic syndrome
Henoch schonlein purpura
HUS
* Caused by ECOLI 0157 (typical)
* Triad of AKI, microangiopathic haemolytic anaemia, thrombocytopenia
HSP
* Rash
* Features of IgA nephropathy
* Abdo pain, arthralgia
ADPDK Chromosomal defect
Chromosome 4
Sickle cell crises
Thrombotic
Sequestration
Thrombotic
* Painful crises precipitated by infection, dehydration, high altitude
* Infarct in bone, lung, spleen, brain.
Sequestration
* Sickling within spleen/lungs cause pooling of blood (gets stuck)
* Anaemia falls with increased reticulocyte count
Aplastic crises
* Parvovirus infection > sudden fall in Hb causing reduced reticulocyte
* Low reticulocytosis must be in proportion to anaemia, if retic 3% (slightly above normal)