16/12/20 Flashcards Preview

Passmedicine > 16/12/20 > Flashcards

Flashcards in 16/12/20 Deck (37)
Loading flashcards...

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


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.


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


Vitamin B12 deficiency

Other complications

increased risk of gallstones

increased risk of gastric cancer


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)




- Slow down or stop the transfusion

- Give paracetamol

- Monitor


Blood transfusion products - complications


What are the features of a minor allergic reaction?


What is the management?




Management: Temporarily stop the transfusion, antihistamine, monitor


Blood transfusion products - complications


What is the cause of anaphylaxis 

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


Blood transfusion products - complications


What are the features of anaphylaxis






Blood transfusion products - complications


What is the treatment of anaphylaxis?

Stop the transfusion

IM adrenaline

ABC support




What are the features of an acute haemolytic reaction?

Fever, abdominal pain, hypotension


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


What are the features of transfusion associated circulatory overload?

Pulmonary oedema, hypertension


What is the management of a TACO?

Slow or stop transfusion

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


What is the mechanism of TACO?

Excessive rate of transfusion, pre-existing heart failure


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


What are the features of TRALI?

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


What is the management of TRALI?

Stop the transfusion

Oxygen and supportive care


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.


What are the complications of actue haemolytic transfusion reaction?

Complications include disseminated intravascular coagulation, and renal failure


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


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.


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.


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.


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.


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


What are the causes of hypokalaemia without hypertension?


GI loss (e.g. Diarrhoea, vomiting)

renal tubular acidosis (type 1 and 2**)

Bartter's syndrome

Gitelman syndrome


What is the inheritance pattern of beta thalassaemia?

autosomal recessive condition


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%)


What type of organism is chlamydia?

obligate intracellular pathogen


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


What are the potential complications of chlamydia?


pelvic inflammatory disease


increased incidence of ectopic pregnancies


reactive arthritis

perihepatitis (Fitz-Hugh-Curtis syndrome)


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