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Phase 2A case studies > SBA > Flashcards

SBA Flashcards

1
Q

State 3 cancers than can cause SIADH

A 
Small cell carcinoma 
Prostate cancer
Pancreatic cancer 
Lymphomas 
Thymic cancer
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2
Q

What happens in corticosteroid withdrawal?

A

Adrenal glands have atrophied due to prolonged suppression so withdrawal gives you secondary adrenal insuffiency

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3
Q

What are the hyperkalemia changes on ECG?

A 
Absent or flattened P waves
Prolonged PR 
Wide QRS
Tall tented T waves 
Bradycardia
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4
Q

What are some causes of hyperkalemia

A 
Renal injry 
DKA
Addisons 
trauna 
Medications
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5
Q

What are symptoms of hyperkalaemia?

A

Muscle weakness/ Painful cramping/ parasthesia/ neurological derangement / irritablity/ palpatations/ abdominal cramping/ diarrheoa/ dyspnoea/ hyperreflexia

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6
Q

What do you put instead of acromegaly?

A

GH secreting pituitary adenoma

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7
Q

What are some complications of acromegaly?

A

Obstructive sleep apnoea , IGT or T2DM, cardiomyopathy, hypertension, IHD and stroke and colorectal cancer

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8
Q

Whats the first line acromegaly investigation and treatment

A

Raised IGF-1 and treat with Tran sphenoidal resection plus minus SST analogues such as octreotide, GH antagonists such as pegvisomant and DA agonists such as bromocriptine and cabergoline

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9
Q

Give 4 differential diagnosis of polydipsia and polyuria?

A

DM,DI, primary polydipsia , hypercalcaemia

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10
Q

Whats the main cause and symptoms of primary hyperparathyroidism?

A

Solitary adenoma
Bones, stones, groans, psychic moans and thrones

Definitive treatment is total parathyroidectomy

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11
Q

What are differentials for weight gain and endocrine symptoms

A

Cushing’s, acromegaly and hypothyroidism

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12
Q

Whats first line for cushings?

A

Overnight dexamethasone suppression

Most commonly exogenous steroids

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13
Q

Generalised headache, fatugue, parasthesia and muscle cramps, thirst and urinating

A

Primary hyperaldosteronism, SIADH, DM, renal artery stenosis

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14
Q

Whats the main primary hyperaldosteronism feature?

A

Hyperkalaemai

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15
Q

Whats conns first line?

A

Aldosterone renin ratio

High primary
Low secondary

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16
Q

What ECG changes can be seen in hypercalcaemia? (

A

Shortening of the QT interval

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17
Q

Hypocalcaemia signs?

A

Chvostek’s sign - tap over the facial nerve causes spasm of the facial muscles
Trousseau’s sign - inflate the blood pressure cuff to 20mmHg above systolic for 5 minutes and the
hand should form a claw.

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18
Q

What’s the arterial supply to the thyroid?

A

Arterial supply to the thyroid gland arises from the external carotid artery and the thyrocervical
trunk. The superior thyroid artery is the first branch of the external carotid artery and the inferior
thyroid artery forms from the thyrocervical trunk which is the 3rd branch of the subclavian artery.
The branches of the subclavian artery are as follows in order - vertebral artery. Internal thoracic
artery, thyrocervical trunk, costocervical trunk.

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19
Q

How can you get hypercalcaemia from tumours?

A

Hypercalcaemia of malignancy is caused by excessive secretion of Parathyroid hormone released peptide

20
Q

4 roles of PTH?

A

• PTH increases bone remodelling and turnover. PTH stimulates osteoclasts to reabsorb bone mineral
which liberate calcium into blood (breaks down bone).
• PTH increases the amount of calcium reabsorbed in the kidney which means that less is excreted in
urine.
• PTH decreases phosphate reabsorption in the kidney.
• PTH decreases phosphate reabsorption in the kidney, increasing the amount excreted.
• PTH increases absorption of Ca2+ in the

21
Q

What are some symptoms of pituitary adenoma?

A 
Headache
Visual defects 
N and V
Changes in behaviour including hostility, depression and anxiety 
Changes in the sense of smell 
Nasal drainage
Sexual dysfunction 
Infertility
Fatigue 
Unexplained weight gain or loss
Achy joints and muscle weakness
Early menapoause 
Changes in monthly periods
22
Q

Symptoms’ of hyperthyroidism?

A

sweating, heat intolerance, shaky
hands, palpitations, nervousness, increased stool frequency, weight loss, poor sleep quality, fatigue,
and irregular periods. They may also present with headache, visual disturbance, an enlarged thyroid
gland (goitre) and galactorrhoea (inappropriate milky discharge from the breasts)

23
Q

What are the symptoms’ of carcinoid syndrome?

A

Flushing, diarrhoea ( increased bowel motilty ) abdominal cramps and wheeze, facial skin lesions , rapid heartbeat

Tends to secrete seratonin

can lead to heart disease and crisis

24
Q

What drug is commonly used to reduce thyroid fucntion?

A

Carbimazole and it blocks thyroid peroxidase from coupling and iodinating the tyrosine residues on thyroglobulin - decreased thryoid production

25
Q

4 S+S of DKA

A 
Fruit breath - pear drop
Nausea and vomiting
muscle cramps 
polydipsia and polyuria
Abdominal pain
Reduced consciousness
Hypotension and tachycardia
Kussmauls breathing
26
Q

What cells is pheochromocytoma of?

A

Chromaffin cells

Hypertension, tachycardia, diaphoresis , hypertensive retinopathy , pallor and diabetes

27
Q

. A 60-year-old man presents to his GP with blood in his stools. He has also been experiencing fatigue and
reports unintentional weight loss of a stone over the past month. The GP requests some blood tests,
obtaining the following results:
Hb 120 g/L (130-180)
WCC 14.9 x109
/L (3.6-11.0)
MCV 69 fL (80-100)
Ferritin 18 ng/mL (25-350)
What is the diagnosis and the underlying clinical cause of these blood results?

A

Iron deficency anaemia due to a colorectal cancer

Causes – GI bleeding (inc. cancer), menorrhagia, hookworm, poor diet, veggie/vegan, increased
demand (growth, pregnancy), malabsorption and coeliac disease
Blood results – low Hb (anaemia), low WCC (cancer), low MCV (microcytic anaemia), low ferritin
(confirms iron deficiency anaemia although this could be raised in malignancy)
Other results not mentioned in question – low serum iron (total iron binding capacity rises compared to
normal) low transferrin, low transferrin. Blood film (microcytic hypochromic RBCs, poikilocytosis
(variation in RBC shape) and anisocytosis (variation in RBC size)

28
Q

Name 3 signs or symptoms of immune thrombocytopenia purpura

A

Easy brusing, gum bleeding, purpura, epistaxis

Caused by splenomegaly an major haemorrhage

29
Q

Tell me everything you can about ITP?

A

• Primary ITP in children (acute)
o Occurs most commonly in the 2-6 year age group
o Acute onset with muco-cutaneous bleeding
o May be a history of recent viral infection including chicken pox and measles
o May also follow immunisation
o Although bleeding may be severe, life-threatening haemorrhage is rare
o Sudden self-limiting purpura
• Secondary ITP in adults (chronic)
o Characteristically seen in women
o May be associated with other autoimmune disorders such as SLE, thyroid
disease and autoimmune haemolytic anaemia
o Also seen in patients with chronic lymphocytic leukaemia and solid
tumours
o May be a history of HIV or Hep C
Investigations and diagnosis:
• Bone marrow examination shows thrombocytopenia with increased or normal
megakaryocytes in the marrow
• Platelet autoantibodies - present in 60-70%, not needed for diagnosis

Management:
• First line
o Corticosteroids e.g. Prednisolone
o IV immunoglobulin e.g. IV IgG - raises platelet count more rapidly than
steroids
• Second line
o Splenectomy
o If splenectomy fails then immunosuppression e.g. Oral/IV azathioprine
30
Q

. A pregnant mother is attending antenatal clinic, she is originally from Ghana and is a known sickle cell trait
carrier. Her husband is also a carrier. She is concerned about the risks to her unborn baby.
What is the chance of their child having sickle cell anaemia? (1 mark)

A

1/4

31
Q

Name 3 signs you might see on examination of a patients’ face, skin, and nails that are associated with iron
deficiency anaemia. (3 marks)

A

Brittle skin/nails, koilonychia, subconjunctival pallor, atrophic glossitis, angular stomatitis

32
Q

What signs would you expect to see in a patient when diagnosing malaria? (3 marks)

A

. Patients often present with a fever
(often 39 degrees or higher), sweats and/or chills, chills, headache, myalgia, fatigue, diarrhoea,
vomiting and abdominal discomfort.
The signs you would expect include anaemia, jaundice, hepatosplenomegaly and ‘Black Water Fever’.
Black water fever is a complication of malaria causing haemolysis of RBCs which results in Hb being
released directly into the urine.

33
Q

Which species of protozoa can cause malarial relapses?

A

P. ovale and P. vivax can form hypnozoites in the liver which can lie dormant for years and cause
relapses. The medication primaquine can be given to eliminate these – however be careful as this can
cause haemolysis in those with G6PD. Primaquine is also contraindicated in pregnancy and
breastfeeding.

34
Q

What criteria are needed to characterise multiple myeloma?

A

Monoclonal protein in serum or urine

  • Lytic bone lesions/ CRAB end organ damage
  • Excess plasma cells in bone marrow
35
Q

Which chromosomal abnormalities are associated with multiple myeloma?

A

. The most common chromosome abnormality associated with myeloma is t (11;14) – this is a reciprocal
translocation between chromosome 11 and 14. An abnormality in chromosome 13q is associated with
treatment resistance and poorer prognosis.

36
Q

You see a 50-year-old male in A&E who has presented with breathlessness, bone pain and a severe infection.
His temperature is 39.1, his heart rate is 110 and his blood pressure is 130/85. He tells you this is the 3rd
severe infection he has had in 6 months and thinks they are causing him to lose weight. On examination, you
note hepatosplenomegaly and see some gum hypertrophy.

A

AML

Auer rods on bone biopsy

Associated with down syndrome and radiation

Treatments:Chemotherapy, transfusions, IV antibiotics , allopurinol ( prevents tumour lysis, chemotherapu, steroids , bone marrow transpalnt

37
Q
  1. You are a medical student on placement where you see a patient with diagnosed chronic lymphoblastic
    leukaemia. You have the opportunity to speak with him and examine him.
    a) What age would you expect this man to be? (1 mark)
    b) What would you expect to find on examination? (2 marks)
    c) What would you expect to see on a blood film? (1 mark)
    d) What treatment would this man be receiving? (2 marks)
    e) What is a complication of CLL that you should be aware of? (1 mark)
A
  1. 70+
  2. Enlarged rubbery non tender lymph nodes, sweating , anorexia,asymptomatic
  3. Smudge cells
  4. Chemotherapy , monoclonal antibodies - rituximab and bruton kinase inhibtors ( ibrutinib )
  5. Richters syndrome - transforms into aggressive lymphoma
38
Q
  1. You see a 17-year-old male with fever and night sweats. He admits to sometimes drinking with his friends
    and tells you that over the last 2 months he gets painful lumps in his neck and armpits when he drinks. He
    has no significant family history, does not smoke or take any recreational drugs.
    a) What investigations would you want to order before making a diagnosis and what signs would you
    expect to see reported in the results? (6 marks)
    b) What is the most likely diagnosis for this patient? (1 mark)
    c) What would you be the treatment plan for this patient? (3 marks)
A

Full blood count - anaemia and high ESR, CXR ( wide mediastinum
Blood film - reed sternberg cells

Hodkins lymphoma

treat: ABVD chemotherapy and marrow transplant

39
Q
  1. A 35-year-old male presents with increased urinary frequency, pain on urination and mild back pain. He is
    pyrexic, tachycardic and tachypnoeic. You send a urine sample which returns positive for a UTI. You explain
    the diagnosis to the man, and tell him that he will need antibiotics to get rid of the infection. At this point, he
    tells you that he has G6PD deficiency.
    a) What is the function of G6PD? (2 marks)
    b) What are 3 of the common symptoms of G6PD deficiency? (3 marks)
    c) What would you see on a blood film for this man? (2 marks)
    d) What antibiotic is now contraindicated for his UTI? (1 mark)
A

G6P protects RBC against oxidative damage and can lead to fatigue palpatations, SOB and pallor

You would see bite cells and reticulocytes on film

Nitrofurantoin is CI

40
Q
  1. An 80-year-old man recently had a fall which resulted in a fracture neck of femur. He successfully underwent
    a total hip replacement and is currently being warded in the NGH. During the ward rounds, being a good F1
    doctor, you assess and examine him. It is noted that he has a swell in his left calf only. It appears slightly pale
    and it is painful when you squeeze it.
    a) What is the most likely diagnosis? (1 mark)
    b) Pain and pallor are 2 out of the 6 symptoms for acute limb ischaemia. What are the 4 other symptoms?
    (4 marks) (HINT 6 P’s)
    c) Name 1 possible complication. (1 mark)
    d) What is the first line investigation? (1 mark)
    e) What is the name of the Scoring system used in making a diagnosis? (1 mark)
    f) List 4 factors in the scoring system. (4 marks)
A
  1. DVT
  2. Pulselessness, paraesthesia, perishing cold, paralysis
  3. PE
    d. D dimer positive do doppler
  4. Wells score
  5. Previous DVT, clnical signs, HR, no other diaagnnose, imobalization, previous DVT ir OE, haemoptysis, malignancy over 4 likely
41
Q
  1. 75yo M patient presented with severe SOB, hypotension, fever and increased RR. He has a history of an
    untreated UTI caused by E. Coli. His vital signs are as below. SIRS Criteria is met.
    • Temp 38.5
    • HR 160bpm
    • BP 80/60mmHg
    • RR 26/min
    • O2 Sats 88%
    On physical examination, there was tachypnoea. Chest auscultation was positive for bilateral wet crackles. The
    patient is coughing up pink frothy sputum.
    He began to bleed from his mouth, nose, ears and eyes. The patient is presenting with UTI that has led to a septic
    shock and eventually into Acute Respiratory Distress Syndrome.
    You took some bloods as part of SEPSIS 6, and the results are shown below.
    • Platelet Count: Low
    • Prothrombin Time: Elevated
    • APTT: Elevated
    • Bleeding Time: Elevated
    • Fibrin Degradation Products: High D-Dimer: Elevated
    • Fibrinogen levels: Low Coagulation Factor Levels: Low

a) What haematological condition does this patient have? (1 mark)
b) Explain its pathophysiology (3 marks)
c) What does a sepsis 6 involve? (6 marks) (HINT – Give 3, take 3)
d) Which antibiotic is to be prescribed for the complicated UTI caused by E. coli? (1 mark)

A
  1. Disseminated IVC
  2. Tissue damage from ARDS causes release and activation of tissue factor leading to widespread clot formation and consumption of platlets and coagulaiton factors ( thrombosis ) also tissue plasminogen activator leads to increased fibrinolysis risk of bleeding

Causes coagulation leading to thrombosis but increased fibrinolysis so bleeding

Sepsis 6:
Give fluids, Antibiotics and O2, take bloods urine output and lactate levels

Nitrofurantoin or trimethoprim for 3 days

42
Q
  1. 35yo M patient presents with blurred vision, headaches and SOB. He has been feeling increasingly tired and
    has lost weight over the past few months. He has a history of TIAs and angina.
    On examination, there is tenderness in the Left Upper Quadrant. It is noted that he has gum bleeding.
    ECG was normal. Abdominal X Ray showed splenomegaly. Blood Results are seen below:
    • RBC: Elevated
    • Haematocrit: Elevated
    • Haemoglobin Count: Elevated
    a) What other investigations would you carry out that affects RBC production? (1 mark)
    A genetic test was carried out which indicated a JAK-2 mutation
    b) What is the diagnosis? (1 mark)
    c) What are some potential differential diagnoses? (2 marks)
A

A. EPO levels
B. Polycythaemia ruba vera
3. Acute dehydration, chronic obesity, HTN, alcohol excess

43
Q

A genetic test was carried out which indicated a JAK-2 mutation

b) What is the diagnosis? (1 mark)
c) What are some potential differential diagnoses? (2 mark

A

a. Polycythaemia Vera

Diffrentials are haemophilia A is X linked recessive and a defiency infactor V111
Haemophilia B is deficency in IX
C is autosomal recessive and defiency in IX

44
Q

What are some bleeding tests?

A

Platelet count – level of platelets. A normal platelet count ranges from 150,000 to
450,000 platelets per microliter of blood. Having more than 450,000 platelets is a condition called
thrombocytosis; having less than 150,000 is known as thrombocytopenia.
Bleeding time - Bleeding time is a laboratory test to assess platelet function and the body’s ability to
form a clot. The test involves making a puncture wound in a superficial area of the skin and monitoring
the time needed for bleeding to stop (ie, bleeding site turns “glassy”).
PT – The prothrombin time is a measure of the integrity of the extrinsic and final common pathways of
the coagulation cascade. This consists of tissue factor and factors VII, II (prothrombin), V, X, and
fibrinogen. The test is performed by adding calcium and thromboplastin, an activator of the extrinsic
pathway, to the blood sample then measuring the time (in seconds) required for fibrin clot formation.
APTT – a measure of the functionality of the intrinsic and common pathways of the coagulation
cascade.
Thrombin time – Thrombin time is a screening coagulation test designed to assess fibrin formation
from fibrinogen in plasma.
The reference range for the thrombin time is usually less than 20 seconds
Fibrin degradation products - Fibrin and fibrinogen-degradation product (FDP) testing is commonly
used to diagnose disseminated intravascular coagulation (DIC).
d-dimer – D-dimer is the degradation product of crosslinked (by factor XIII) fibrin. It reflects ongoing
activation of the hemostatic system. The reference concentration of D-dimer is < 250 ng/mL, or < 0.4
mcg/mL.

45
Q

Haemophilia Presentation?

A

d) Deep bruising, pain and swelling in joints, epistaxis, other unexplained bleeding, bleeds into heads
can cause headaches/double vision/weakness/vomiting
e) Replace the missing factor with plasma

Phase 2A case studies (7 decks)

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