Miscellaneous inc NCDs, haematology Flashcards
Definition / level of neutropenia?
Defined as neutrophil count <1.5×109/L
What is sickle trait protective against?
Severe falciparum malaria - 90% less likely than normal Hb
Causes of neutropenia
- Some races (Africans, African Americans, Yemenite Jews, Palestinians and Saudi Arabians) have slightly lower neutrophil count possibly due to an increase in the bone marrow storage pool.
- Neonatal alloimmune neutropenia
- Could be a useful indicator to differentiate typhoid/paratyphoid fever from other pyogenic infections
What types of infections cause a monocytosis?
Protozoan infections such as typhus, trypanosomiasis and kala-azar (visceral leishmaniasis)
What affects lymphocyte count?
High: viral, EBV, smoking
Low: HIV
Causes of high Hb count?
Altitude, smoking, alcohol, testosterone use, steroids, OSA, PRV
What are some tropical infections causing anaemia?
Helminths
Schists
HIV
Malaria
Visceral leishmaniasis
What are some non infectious but tropical causes of anaemia?
Poor nutrition
Local dietary culture
Sickle
Thalassemia
Hereditary elliptocytosis/ovalocytosis
G6PD
what are typical organisms affecting people with sickle cell disease?
- S. pneumoniae
- H. influenzae type b
- Neisseria meningitis
- Osteomyelitis by Salmonella species
- UTI due to E.coli
What is Mentzer Index?
Menzter Index: MCV (fl)/RBC count (106/uL) to differentiate iron deficiency anaemia
<13 likely thalasemia
NCDs - Top three causes of death?
IHD, stroke, COPD
How to manage and prevent RHD?
Management:
Penicillin is effective in the treatment of acute rheumatic fever and
RHD and the cornerstone to prevent complications.
Aspirin can be used for symptomatic relief of joint pain and fever.
Surgery is mandatory for uncontrolled heart failure secondary to
acute rheumatic mitral regurgitation.
\Prevention: Prevention strategies based on the eradication of Streptococcus sp. by preventing either the initial acute rheumatic fever attack (primary prophylaxis) or disease recurrences (secondary prophylaxis) can lead to a near complete eradication and sustainable disease control
What are the cause and symptoms of rheumatic heart disease?
RHD is a long-term consequence of untreated acute rheumatic fever caused by group A streptococcal infection
In 2016, nearly 300 000 deaths worldwide were a result of RHD (4% of CVD deaths in that year)
Symptoms: Around 3 weeks after pharyngitis, acute rheumatic fever occurs. This presents with fever, painful polyarthritis (arthritis in more than five joints simultaneously), and carditis (inflammation of the heart).
In 7–28% of the cases Sydenham’s chorea, involuntary, irregular movements, occur 1–6 months after initial onset.
In half of the patients with acute rheumatic fever, carditis – including valvulitis, pericarditis, and myocarditis – occurs within a few weeks of the original infection. Indicative is a soft, blowing, pansystolic murmur of mitral regurgitation (leakage of blood through the mitral valve
How to manage pre-eclampsia?
-Stabilize mother first - MgSO4 for seizures
-Only definitive cure, delivery of placenta
-Monitor Cr, Plt
-Seizure proph
-Prompt control of HTN
-Ensure fluid balance
How to manage PPH?
-Ensure uterus contraction
-Remove anything impeding contraction (tissue)
-Improve tone
-Repair trauma
-Transfuse and correct coagulopathy
How to improve uterine atony?
Manual:
-Bimanual compression first
-Empty bladder
-EUA and intrauterine balloon
-Consider laparotomy
Meds:
-Slow 5U UV oxytocin
-Ergometrine IM or IV
-Oxytocin
-Carborprost
-Misoprostol
why was there a high rate of pneumonia after tsunami?
1) Nursing home residents: Inappropriate nutrition, loss of regular medicines, a shortage of caregivers
2) Residents of evacuation shelters: Crowding as a risk for S. pneumonia and H. influenzae
3) Hypothermia (-3 to -5°C): a risk for infections
4) Insufficient Materials: running water, gas, electricity or oil
5) Psychological stress: weaken immune system
6) The medical supply systems: more than 100 relief teams
why are NCDs important?
Account for 68% of all deaths worldwide
3/4 of them occur in LMICs
What is the definition of herd immunity?
The resistance to the spread of a contagious disease within a population and prevention of infection among unvaccinated individuals that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination
side effects of quinolones eg cipro
arthropathy/tendon rupture
peripheral neuropathy
low mood inc suicidality
Top 3 causes of cancer by sex?
Men - Lung, prostate, colorectal
Women - Breast, colorectal, lung
What is myiasis?
Infestation of humans with maggots from fly larva
Often human botfly in C and S America
What are the symptoms of myiasis?
itchy painful boil over 2-3 weeks
How is myiasis treated?
Vaseline or jelly to starve of oxygen then surgical removal
What is tungiasis?
Skin infestation with jigger flea
Where is tungiasis found?
Mexico to South America, the West Indies and Africa. The fleas normally occur in sandy climates, including beaches, stables and farms.
What is the treatment of tungiasis?
Removal - surgery/electrosurgery/dessication
What does tungiasis look like?
skin inflammation, severe pain, itching, and a lesion at the site of infection that is characterized by a black dot at the center of a swollen red lesion, surrounded by what looks like a white halo.
What is this blood film? What caused it?
Basophilic stippling
Could be lead poisoning or pernicious anaemia
Lead poisoning treatment is chelation
