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Amir Sam DPD > 15/12/2015 Interactive Cases in General Medicine 5 > Flashcards

15/12/2015 Interactive Cases in General Medicine 5 Flashcards

(52 cards)

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1
Q

40M with fever, rigour, tachycardia, hypotension, chest pain, dark urine. Post-op, what is the diagnosis?

A

Immediate transfusion reaction, haemolysis

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2
Q

What are the causes of polycythaemia?

A

If primary: myeloproliferative

If secondary: high altitude, chronic hypoxia (COPD), EPO from iatrogenic/artificial sources or renal cell carcinoma

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3
Q

Low platelets, thrombocytopenia causes?

A

Increased use: DIC, ITP
Decreased production: infiltration
Increased pooling in the spleen: chronic liver disease

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4
Q

50M with rheumatoid arthritis, normal/high ferritin, normocytic anaemia. What must still be investigated?

A

Ferritin is an acute phase reactant which increases in chronic disease (hence normocytic), it is artificially normal and will mask a GI/UG bleed

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5
Q

40F, Hb 110, MCV 65 what is the diagnosis?

A

Beta thalassaemia heterozygosity, the MCV is disproportionately low in comparison to the Hb

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6
Q

Causes of a macrocytic anaemia?

A

“Alcoholics May Have Liver Failure”

  • Alcohol (raised GGT)
  • Myelodysplasia (pancytopaenia, low cell lines)
  • Hypothyroidism (history, T4, TSH)
  • Liver disease
  • Folate/B12 deficiency (small bowel disease, gastrectomy, Schilling Test)
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7
Q

Presentation of polycythaemia?

A

Headache, blurred vision (hyper viscosity), tinnitus, pruritus after a hot bath, stroke/DVT, gangrene, choreiform movements

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8
Q

How is an acute painful crisis of sickle cell anaemia managed?

A

Analgesia, O2, IV fluids, Abx

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9
Q

How is a stroke from SCA managed?

A

Exchange blood transfusion

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10
Q

How is sequestration managed?

A

RBC pooling in lungs causes cough, fever, SOB. In spleen causes exacerbation of anaemia; treat with splenectomy and Abx

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11
Q

How are gallstones managed?

A

Cholecystectomy

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12
Q

What are the complications of sickle cell anaemia?

A

Painful crises, splenic/lung sequestration, gallstones/cholecystitis, stroke

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13
Q

Presenting features of multiple myeloma?

A

CRAB

  • Hypercalcaemia (polyuria, polydipsia, constipation due to nephrogenic DI, insensitive to ADH)
  • Renal failure (Ur+Cr)
  • Anaemia
  • Bone pain, osteoporosis (DXA)
  • Infection due to immunoparesis from clonal expansion of one Ig
  • Cord compression due to spinal involvement
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14
Q

What is the pathophysiology of MM? How is it investigated and confirmed?

A

Clonal proliferation of immunoglobulin paraprotein. Confirm with urine Bence-Jones proteins (light chain Ig) or serum electrophoresis showing Ig

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15
Q

What is the differential diagnosis for a 50M with high calcium, low PTH?

A

Malignancy, myeloma, sarcoidosis

  • HIGH ALP = malignancy or sarcoidosis
  • LOW/NORMAL ALP = myeloma. Plasma cells suppress osteoblasts, hence ALP is unchanged
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16
Q

What is the differential diagnosis for a 50M with high calcium, high PTH?

A

Primary hyperparathyroidism

FHH familial hypocalciuric hypercalcaemia

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17
Q

Causes of anaemia with reticulocytosis

A

Haemolytic crisis: haemorrhage

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18
Q

Causes of anaemia with low reticulocytes

A

Marrow problem: parvovirus B19 infection, SCA aplastic crisis, blood transfusion

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19
Q

How is diabetes diagnosed?

A

Fasting >7, random >11.1 (retinopathy increases beyond these figures)

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20
Q

What is impaired fasting glucose/impaired glucose tolerance?

A

IFG 6-7

IGT 7.8-11.1 after OGTT; 75g glucose 2h

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21
Q

Which antibodies may be present in T1DM?

Study These Flashcards
A

Anti-islet cell Ab

Anti-GAD Ab

22
Q

Metformin and sulphonylurea (weight loss/neutral/gain?)

Study These Flashcards
A

Metfomin weight neutral (and reduced mortality), sulphonylurea weight gain

23
Q

Diabetic drugs

Study These Flashcards
A

Metformin - biguanide
Sulphonylureas include gliclazide, glibenclamide. Weight gain
Pioglitazone - thiazolidinediones, not for heart failure (rosiglitazone), weight gain
Insulin - weight gain
Sitagliptin - DPP4 inhibitor, weight neutral
GLP-1 agonist - exenatide, incretin mimetic lower risk of hypos, weight loss
SGLT2 inhibitors - glifozin, weight loss, inhibit resorption of glucose from the kidney
Acarbose - alpha glucosidase inhibitor

24
Q

How is diabetic nephropathy screened for?

Study These Flashcards
A

ACR albumin-creatinine ratio. Want to detect microscopic albuminuria before urine dipstick and prevent progression of renal disease

25
How is DKA/HHS treated?
IV fluids, potassium, insulin
26
What is sliding scale insulin?
A variable rate IV insulin infusion, if glucose X, give dose Y. in T1DM, never give 0. Given as actrapid + saline, if patient is unwell, sepsis, surgery, not eating
27
Graves signs and symptoms
Tremor, tachycardia, palpitations, weight loss good appetite, irregular periods, proptosis, pretibial myxoedema, cheimosis, smooth goitre,
28
Investigations for Graves
TFT high T3/4, low TSH, TSH-R AutoAb high | Tc-99m uptake scan high diffuse uptake, as TSH-like Ab is present
29
Thyroid cancer presentation
Lump in the neck, family history, radiotherapy/radiation exposure, rapid enlargement and compression, lymphadenopathy
30
Types of thyroid cancer
Follicular, papillary, medullary, anaplastic
31
Investigations thyroid cancer
USS malignant features, Tc-99m scan cold nodules, no uptake. FNAC, MDT
32
Treatment thyroid cancer
Surgery, thyroxine replacement, radio iodine ablation
33
Bitemporal hemianopia, expressing milk, low sex drive, no periods
Prolactinoma: galactorrhea, amenorrhoea, low libido. Men present later with bitemporal hemianopia. Give cabergoline to shrink the tumour and lower PRL. Transphenoidal surgery is possible
34
Cushing syndrome symptoms
Thin skin/easy bruising, proximal myopathy, purple striae. HTN, DM, osteoporosis at a young age Tired, depressed, hairy, weight gain central obesity
35
Causes of amenorrhoea/oligomenorrhoea?
Pregnancy - b-HCG Hypothalamus - low BMI, excess exercise Pituitary - prolactinoma high PRL, low FSH/LH suppressed Thyroid - high or low Ovarian failure - high FSH, low oestrogen PCOS - hirsute, high androgens
36
How does hypokalaemia present?
Arrhythmia, weakness, polyuria (similar to hyperCa, nephrogenic DI develops)
37
What are the causes of hypokalaemia?
Vomiting, diuretics, primary hyperaldosteronism (bilateral hyperplasia or Conn's) this is investigated with aldosterone:renin ratio, renin is low due to negative feedback
38
A young man on 3 antihypertensives (and still uncontrolled) presents with HTN, low K, high aldosterone. What is the diagnosis and how is he investigated?
Aldosterone:renin ratio is high due to Conn's syndrome, primary hyperaldosteronism: Na retention, K excretion. 1 sided tumour remove, give spironolactone if bilateral
39
How do you assess for euvolaemic causes of hyponatraemia?
SIADH, hypothyroid, hypo adrenal: urine/plasma osmolality, TFT, short synACTHen test
40
What is the urine sodium in hyper/hypovolaemic hyponatraemia?
LOW in both due to low renal perfusion, renin increase, aldosterone increase, more water and salt resorption
41
How is osmolality calculated?
2(Na+K)+U+glucose
42
Causes of high urine osmolality?
Dehydration, HHS, T2DM
43
Causes of low urine osmolality?
Diabetes insipidus --> dilute urine
44
1 Low Ca, high PTH, low phosphate
Vitamin D deficiency, secondary hyperparathyroidism due to low Ca
45
2 High Ca, low phosphate, high PTH
Primary hyperparathyroidism (phosphate trashing hormone)
46
3 Low Ca, high phosphate, low PTH
Primary hypoparathyroidism
47
4 High Ca, low PTH, normal phosphate
Malignancy, myeloma, sarcoidosis (check ALP, if high, then malignancy. Serum ACE for sarcoid)
48
5 High phosphate, low Ca, high PTH
Renal failure, secondary hyperparathyroidism. High phosphate due to renal failure, low Ca due to kidney failure inability to hydroxylate vitamin D
49
Pearly lesion on skin
BCC
50
Oligoarthritis, sacroilitis, DIP arthritis, nail changes
Psoriatic arthritis
51
Why is there tingling of fingers in hyperventilation?
Respiratory alkalosis causes albumin to bind Ca, transient low Ca causes tingling sensation. Chvostek and Trousseau sign
52
Renal artery stenosis Ix
Small kidney = stenosis, asymmetrical. Investigate with MR angiography, if bilateral, do NOT give ACEi causes renal failure. Cause of pre-renal AKI

Amir Sam DPD (6 decks)

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