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Flashcards in 16/12/20 Deck (37)
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1

What are the signs of subacute combined degeneration of the spinal cord?

Ataxia

Absent ankle reflexes

Loss of vibration sensation

 

B12 deficiency is a known complication of total and sub-total gastrectomy, a consequence of removing of the intrinsic factor secreting cells that reside in the fundus and body of the stomach.

2

What are the complications of gastrectomy?

Dumping syndrome

early: food of high osmotic potential moves into small intestine causing fluid shift

late: (rebound hypoglycaemia): surge of insulin following food of high glucose value in small intestine - 2-3 hours later the insulin 'overshoots' causing hypoglycaemia


Weight loss, early satiety

Iron-deficiency anaemia

Osteoporosis/osteomalacia

Vitamin B12 deficiency

Other complications

increased risk of gallstones

increased risk of gastric cancer

3

Blood transfusion products - complications

 

What are the features of non-febrile haemolytic reaction?

 

How is it managed?

Fever and chills

(most likely to be caused by platelets)

 

 

Management:

- Slow down or stop the transfusion

- Give paracetamol

- Monitor

4

Blood transfusion products - complications

 

What are the features of a minor allergic reaction?

 

What is the management?

Pruritus

Urticaria

 

Management: Temporarily stop the transfusion, antihistamine, monitor

5

Blood transfusion products - complications

 

What is the cause of anaphylaxis 

Seen in patients with IgA deficiency who have anti-IgA antibodies.

6

Blood transfusion products - complications

 

What are the features of anaphylaxis

Hypotension

Dyspnoea

Wheezing

 

7

Blood transfusion products - complications

 

What is the treatment of anaphylaxis?

Stop the transfusion

IM adrenaline

ABC support

oxygen

fluids

8

What are the features of an acute haemolytic reaction?

Fever, abdominal pain, hypotension

9

What is the management for acute haemolytic reaction?

Stop transfusion

Confirm diagnosis

check the identity of patient/name on blood product

send blood for direct Coombs test, repeat typing and cross-matching


Supportive care

fluid resuscitation

10

What are the features of transfusion associated circulatory overload?

Pulmonary oedema, hypertension

11

What is the management of a TACO?

Slow or stop transfusion

Consider intravenous loop diuretic (e.g. furosemide) and oxygen

12

What is the mechanism of TACO?

Excessive rate of transfusion, pre-existing heart failure

13

What causes a TRALI?

Non-cardiogenic pulmonary oedema thought to be secondary to increased vascular permeability caused by host neutrophils that become activated by substances in donated blood

14

What are the features of TRALI?

Hypoxia, pulmonary infiltrates on chest x-ray, fever, hypotension

15

What is the management of TRALI?

Stop the transfusion

Oxygen and supportive care

16

What is the cause of acute haemolytic reaction?

Acute haemolytic transfusion reaction results from a mismatch of blood group (ABO) which causes massive intravascular haemolysis. This is usually the result of red blood cell destruction by IgM-type antibodies.

17

What are the complications of actue haemolytic transfusion reaction?

Complications include disseminated intravascular coagulation, and renal failure

18

What is the cause of cervical myelpathy?

Dorsomedial herniation of a disc and the development of transverse bony bars or posterior osteophytes may result in pressure on the spinal cord or the anterior spinal artery, which supplies the anterior two-thirds of the cord

 

Can occur after trauma - ezpecially hyperextension injury

19

What are the features of degenerative cervical myelopathy?

Pain (affecting the neck, upper or lower limbs)

Loss of motor function (loss of digital dexterity, preventing simple tasks such as holding a fork or doing up their shirt buttons, arm or leg weakness/stiffness leading to impaired gait and imbalance

Loss of sensory function causing numbness

Loss of autonomic function (urinary or faecal incontinence and/or impotence) - these can occur and do not necessarily suggest cauda equina syndrome in the absence of other hallmarks of that condition

Hoffman's sign: is a reflex test to assess for cervical myelopathy. It is performed by gently flicking one finger on a patient's hand. A positive test results in reflex twitching of the other fingers on the same hand in response to the flick.

20

What is the investigation for cervical myelopathy?

MRI (or rarely myelography) will direct surgical intervention. MRI also provides information on the state of the spinal cord at the level of compression.

21

What is the managment for cervical myelopathy?

Decompressive surgery (laminectomy or anterior discectomy)

Manual manipulation of the cervical spine is of no proven benefit and may precipitate acute neurologi- cal deterioration.

22

What is a post-operative complication of laminectomy/anterior discectomy for cervical myelopathy?

Postoperatively, patients with cervical myelopathy require ongoing follow-up as pathology can 'recur' at adjacent spinal levels, which were not treated by the initial decompressive surgery. This is called adjacent segment disease. Furthermore, surgery can change spinal dynamics increasing the likelihood of other levels being affected. Patients sometimes develop mal-alignment of the spine, including kyphosis and spondylolisthesis, and this can also affect the spinal cord. All patients with recurrent symptoms should be evaluated urgently by specialist spinal services.

23

What are the differentials for hypokalaemia and hypertension?

The differential for hypertension with low potassium includes Conn's, Cushing's, renal artery stenosis and Liddle's

24

What are the causes of hypokalaemia without hypertension?

diuretics

GI loss (e.g. Diarrhoea, vomiting)

renal tubular acidosis (type 1 and 2**)

Bartter's syndrome

Gitelman syndrome

25

What is the inheritance pattern of beta thalassaemia?

autosomal recessive condition

26

What type of anaemia is beta thalassaemia?

mild hypochromic, microcytic anaemia. It is usually asymptomatic

 

mild hypochromic, microcytic anaemia - microcytosis is characteristically disproportionate to the anaemia

HbA2 raised (> 3.5%)

27

What type of organism is chlamydia?

obligate intracellular pathogen

28

What are the features of chlamydia?

asymptomatic in around 70% of women and 50% of men

women: cervicitis (discharge, bleeding), dysuria

men: urethral discharge, dysuria

29

What are the potential complications of chlamydia?

epididymitis

pelvic inflammatory disease

endometritis

increased incidence of ectopic pregnancies

infertility

reactive arthritis

perihepatitis (Fitz-Hugh-Curtis syndrome)

30

What is the investigation for chlamydia?

traditional cell culture is no longer widely used

nuclear acid amplification tests (NAATs) are now the investigation of choice

urine (first void urine sample), vulvovaginal swab or cervical swab may be tested using the NAAT technique

for women: the vulvovaginal swab is first-line

for men: the urine test is first-line

Chlamydiatesting should be carried out two weeks after a possible exposure