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Medicine Part 2 > Random facts_1 > Flashcards

Random facts_1 Flashcards

1
Q

Compare: G6PD deficiency and Hereditary spherocytosis

Consider:

  • gender affected
  • ethnicity
  • typical history
  • what’s characteristic on blood film
  • diagnotstic test
A

G6PD deficiency

Hereditary spherocytosis

Gender

Male (X-linked recessive)

Male + female (autosomal dominant)

Ethnicity

African + Mediterranean descent

Northern European descent

Typical history

  • Neonatal jaundice
  • Infection/drugs precipitate haemolysis
  • Gallstones
  • Neonatal jaundice
  • Chronic symptoms although haemolytic crises may be precipitated by infection
  • Gallstones
  • Splenomegaly is common

Blood film

Heinz bodies

Spherocytes (round, lack of central pallor)

Diagnostic test

Measure enzyme activity of G6PD

Osmotic fragility test

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2
Q

G6PD deficiency

Consider:

  • gender affected
  • ethnicity
  • typical history
  • what’s characteristic on blood film
  • diagnotstic test
A

G6PD deficiency

Gender

Male (X-linked recessive)

Ethnicity

African + Mediterranean descent

Typical history

  • Neonatal jaundice
  • Infection/drugs precipitate haemolysis
  • Gallstones

Blood film

Heinz bodies

Diagnostic test

Measure enzyme activity of G6PD

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3
Q

Hereditary Spherocytosis

Consider:

  • gender affected
  • ethnicity
  • typical history
  • what’s characteristic on blood film
  • diagnotstic test
A

Hereditary spherocytosis

Gender

Male + female (autosomal dominant)

Ethnicity

Northern European descent

Typical history

  • Neonatal jaundice
  • Chronic symptoms although haemolytic crises may be precipitated by infection
  • Gallstones
  • Splenomegaly is common

Blood film

Spherocytes (round, lack of central pallor)

Diagnostic test

Osmotic fragility test

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4
Q

What the following blood products are used for:

  • Packed red blood cells
  • Platelet-rich plasma
A

Fraction

Key points

Packed red cells

Used for transfusion in chronic anaemia and cases where infusion of large volumes of fluid may result in cardiovascular compromise

Platelet rich plasma

Usually administered to patients who are thrombocytopaenic and are bleeding or require surgery

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5
Q

Blood products. What are they used for?

  • platelet concentrate
  • fresh frozen plasma
A

Fraction

Key points

Platelet concentrate

Patients with thrombocytopaenia

Fresh frozen plasma

  • Contains clotting factors, albumin and immunoglobulin.
  • Unit is usually 200 to 250ml.
  • Usually used in correcting clotting deficiencies in patients with hepatic synthetic failure who are due to undergo surgery.
  • Usual dose is 12-15ml/Kg-1.
  • It should not be used as first line therapy for hypovolaemia.
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6
Q

Blood products. What are they used for:

  • Cryoprecipitate
  • SAG-Mannitol blood
A

Fraction

Key points

Cryoprecipitate

  • Rich source of Factor VIII and fibrinogen
  • Allows large concentration of factor VIII to be administered in small volume

SAG-Mannitol Blood

Removal of all plasma from a blood unit and substitution with:

  • Sodium chloride
  • Adenine
  • Anhydrous glucose
  • Mannitol

Up to 4 units of SAG M Blood may be administered. Thereafter whole blood is preferred. After 8 units, clotting factors and platelets should be considered.

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7
Q

Case: an elderly patient treated on ICU for AKI and HAP

Physical condition is improving, but despite previously being a very talkative person, now it takes time and effort to encourage him to answer simple questions. He is lethargic. Obs are all normal.

What’s that?

A

Hypoactive delirium - withdrawal, slow to respond, lethargic and sleepiness

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8
Q

How to differentiate between:

  • delirium (hypoactive)
  • opiate overdose
  • ICU psychosis
  • dementia
A
  • delirium (hypoactive) -> sleepiness and withdrawal, obs normal
  • opiate overdose -> decreased RR will be present
  • ICU psychosis -> delusions and hallucinations present
  • dementia -> chronic onset
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9
Q

Case: a patient recently started on chemo for leukaemia/lymphoma. Deteriorating. Blood results:

K+ is high

phosphate is high

CK high

Ca++ is low

What’s that? What’s the treatment?

A

Tumour lysis syndrome

Pathophysiology: the destruction of tumour cells -> release of uric acid, other chemicals

Risk groups: pts recently started on chemotherapy for lymphoma/leukaemia; rarely pts started on steroids; may be suspected in AKI with high uric acid and phosphate levels

Clinical presentation (apart from blood) may include: arrhythmias, seizures, increased serum creatinine

Prophylactic treatment: IV allopurinol or IV rasburicase

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10
Q

How to differentiate between exudate and transudate?

A

Transudate < 30g/L protein

Exudate >30g/L protein

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11
Q

Pneumonia

  • Infection with what organism causes consolidation on x-Ray?
  • What organism is common, if there is no consolidation on X-ray with the picture of pneumonia?
A
  • the most common organism causing pneumonia (with consolidation) -> Streptococcus Pneumoniae
  • no consolidation -> Haemophilus Influenzae (the most common cause of exacerbations in COPD)
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12
Q
  • How to calculate anion gap?
  • What’s normal anion gap?
A

The anion gap is calculated by:

  • (sodium + potassium) - (bicarbonate + chloride)
  • A normal anion gap is 8-14 mmol/L
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13
Q

What’s the most likely diagnosis in the picture of (in a patient after aortic repair surgery):

  • low platelets
  • raised fibrin degeneration products
A

The combination of low platelet counts + raised FDP in this setting make DIC the most likely diagnosis.

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14
Q

Steps in the management of a primary pneumothorax

A

Primary pneumothorax

Recommendations include:

  • if the rim of air is < 2cm and the patient is not short of breath then discharge should be considered
  • otherwise, aspiration should be attempted
  • if this fails (defined as > 2 cm or still short of breath) then a chest drain should be inserted​

​​

*patients should be advised to avoid smoking to reduce the risk of further episodes - the lifetime risk of developing a pneumothorax in healthy smoking men is around 10% compared with around 0.1% in non-smoking men

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15
Q

Characteristic (buzzword) lung changes seen on X-ray in a patient with idiopathic pulmonary fibrosis

A

‘ground-glass’ opacities in lower zones

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16
Q

Characteristic lung changes seen on X-ray in a patient with coal worker’s pneumoconiosis, another occupational lung disease

A

Multiple rounds nodules predominantly in upper zones

17
Q

Characteristic lung changes seen on X-ray in a patient with sarcoidosis

A

Bilateral hilar lymphadenopathy

18
Q

Characteristic lung changes seen on X-ray in a patient with silicosis

A

(Egg-shell) Calcification of hilar lymph nodes

occupations at risk of silicosis

mining

slate works

foundries

potteries

19
Q

S3 heart sound - cause, conditions, when is it normal

A

S3 (third heart sound)

  • caused by diastolic filling of the ventricle
  • considered normal if < 30 years old (may persist in women up to 50 years old)
  • heard in left ventricular failure (e.g. dilated cardiomyopathy), constrictive pericarditis (called a pericardial knock) and mitral regurgitation
20
Q

S4 - heart sound

  • what is it caused by
  • conditions
A

S4 (fourth heart sound)

  • may be heard in aortic stenosis, hypertrophic cardiomyopathy, hypertension
  • caused by atrial contraction against a stiff ventricle
21
Q

Glasgow Coma Score

  • write components and scoring
A

Glasgow Coma Scale: adults

GCS: Motor (6 points) Verbal (5 points) Eye opening (4 points). Can remember as ‘654…MoVE’

Modality Options Motor response 6. Obeys commands

  1. Localises to pain
  2. Withdraws from pain
  3. Abnormal flexion to pain (decorticate posture)
  4. Extending to pain
  5. None Verbal response 5. Orientated
  6. Confused
  7. Words
  8. Sounds
  9. None Eye opening 4. Spontaneous
  10. To speech
  11. To pain
  12. None
22
Q

Management of DKA

A

Management

  • fluid replacement: most patients with DKA are deplete around 5-8 litres. Isotonic saline is used initially
  • insulin: an intravenous infusion should be started at 0.1 unit/kg/hour. Once blood glucose is < 15 mmol/l an infusion of 5% dextrose/glucose should be started

*as we want to lower ketones; we give dextrose/glucose in order to prevent hypoglycaemia once we try to lover ketones with insulin*

  • correction of hypokalaemia
23
Q

Reactive arthritis

  • associated gene
  • associated infections
  • symptoms
  • treatment
  • prognosis
A

Reactive arthritis

A triad of symptoms (conjunctivitis, urethritis, arthritis*) developing after the infection

  • STDI
  • Dysentery

Associated with HLA B27 gene

Treatment:

  • NSAIDs (in acute)
  • methotrexate and sulfasalazine (anti-inflammatory) if an illness becomes chronic

Usually resolves in 12 months

*cannot see, cannot pee, cannot climb a tree/bend a knee

24
Q

What’s scurvy?

pathology

symptoms

A

Scurvy - vitamin C deficiency

Symptoms:

  • bleeding gums
  • petechiae/ bruising to the skin
  • anaemia
25
Q

What’s Pellagra?

What are the symptoms?

A

Pellagra - deficiency of vitamin B3 (niacin)

Symptoms:

  • sunburn-like dermatitis rash
  • diarrhoea
  • cognitive deficit (dementia/delusion)
26
Q

What’s Beriberi?

  • types
  • symptoms
A

Beriberi is due to a thiamine (vitamin B1) deficiency

Types:

  • wet beriberi -> presenting with tachypnoea, dyspnoea and pedal oedema
  • dry beriberi -> pain, paresthesia and confusion
27
Q

What’s Plummer-Vinson syndrome?

A

Plummer-Vinson syndrome

Triad of:

  • dysphagia (secondary to oesophageal webs)
  • glossitis
  • iron-deficiency anaemia

Treatment includes iron supplementation and dilation of the webs

28
Q

What’s Boerhaave syndrome?

A

severe vomiting -> oesophageal rupture

29
Q

What’s Mallory-Weiss syndrome?

A

Severe vomiting → painful mucosal lacerations at the gastroesophageal junction resulting in haematemesis

*Common in alcoholics

30
Q
A

Medicine Part 2 (12 decks)

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