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Flashcards in DPD: Amir Sam 6 Deck (50)
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1

What are the 2 types of polycythaemia?

Primary: polycythaemia vera
Secondary: secondary to chronic hypoxia in COPD, tumour producing excess EPO (e.g. renal cell cancer)

2

List 3 broad causes of thrombocytopenia

Not making platelets (e.g. BM infiltration, lymphoma, leukaemia, drugs e.g. chemotherapy)
Destroying platelets (e.g. consumption in DIC)
Pooling of platelets (e.g. pooling in spleen in portal HTN)

3

If a patient is anaemic, what should you look at?

Low MCV: haematenics - IDA, B thalassemia
Normal MCV: Infection, Inflammation (ACD), malignancy

4

What are 5 causes of raised MCV? What is the mneumonic? What are the clues to these?

Alcoholics May Have Liver Failure
Alcohol: Hx, raised GGT
Myleodysplasia: pancytopenia
Hypothyroidism: low T4, high TSH
Liver disease: Hx, exam
Folate/ B12 deficiency: Hx (small bowel disease, gastrectomy)

5

List 7 manifestations of polycythemia

Headache
Pruritus after a hot bath
Blurred vision (hyper viscosity)
Tinnitus
Thrombosis (stroke, DVT)
Gangrene
Choreiform movements

6

List 4 complications of sickle cell anaemia and the treatment of each

Acute painful crises: Analgesia, O2, IV fluids, Abx
Stroke: Exchange blood transfusion
Sequestration crises: splenectomy for repeated episodes
Gallstones, chronic cholecystitis: Cholecystectomy

7

What is affected in multiple myeloma? What are the features caused by this?

Calcium: polyuria, polydipsia (hypercalcaemia causes nephrogenic DI), constipation. U+Es
Renal failure: Raised urea + creatinine. U+Es
Anaemia: SOB, lethargy. FBC count
Bone: fracture, bone pain, osteoporosis. DEXA scan

8

Why are patients with multiple myeloma predisposed to infection?

Increased production of a immunoglobulin means reduced production of other immunoglobulins so they are prone to infections

9

What may occur if vertebrae are affected in multiple myeloma?

Cord Compression
Can cause spastic paraparesis (partial paralysis of lower limbs)

10

What does anaemia with reticulocytosis indicate?

Attempt to make more RBCs because of: Haemolysis or Haemorrhage (increased demand for red cell production)

11

What does anaemia with a reduced reticulocyte count indicate?

Pathology affecting bone marrow:
Parvovirus B19 infection
Aplastic crisis in patients with SCA
Blood transfusion (interferes with production)

12

What is the diagnostic criteria for diabetes? What range indicates impaired glucose tolerance?

Diabetes
Fasting > 7
Random ≥ 11.1
Impaired glucose tolerance (IGT)
75g OGTT
2-hour glc: 7.8-11

13

Give 4 drugs used in the treatment of T2DM

Metformin: reduces insulin resistance
Sulphonylureas: stimulate insulin release
DPP-4 Inhibitors: inhibit enzyme break down of GLP-1
GLP-1 Agonists: stimulate glucose-induced insulin release. Also inhibit glucagon release, reduce appetite + cause weight loss

14

What are the 3 classes of complications that may arise in T2DM? Give 3 examples of each

Microvascular
Retinopathy
Nephropathy: raised urine albumin: creatinine ratio (ACR)
Neuropathy
Macrovascular
MI
Stroke
Peripheral Vascular Disease
Metabolic
DKA
Hyperosmolar hyperglycaemic state
Hypoglycaemia

15

What is sliding scale insulin? When is it used?

Variable rate IV insulin infusion: rate determined by blood glucose
If pt is not eating or unwell (e.g. surgery, sepsis)

16

List 4 signs of Graves disease

Proptosis/ exophthalmus
Pretibial myxoedema
Tremor
Smooth goitre

17

List 5 symptoms of Graves disease

Weight loss
Increased appetite
Irritability
Palpitations
Irregular periods

18

How do primary and secondary hyperthyroidism differ?

Primary: High T4/T3, suppressed TSH
Secondary: High T4/T3, high TSH

19

What can be found in the blood of a patient with Graves disease?

TSH receptor stimulating antibodies
Graves' is caused by an antibody that mimics TSH + stimulates the TSH receptor

20

What pattern may be seen on a nuclear medicine scan of the thyroid with increased uptake?

Diffuse increased uptake: Graves
Need TSH/ something that acts like TSH for uptake (ie TSH receptor antibody)

Hot nodule= autonomous
A toxic thyroid nodule producing excess thyroid hormone would appear hot

21

List 4 risk factors for thyroid cancer

Radiation
FH
Rapid enlargement/ compression
Lymphadenopathy

22

What investigations are appropriate for thyroid cancer?

USS: look for suspicious features
Uptake scan: cold nodules
FNAC (FNA cytology)

23

What treatment may be used for thyroid cancer?

Surgery: Papillary, Follicular, Medullary (check FH), Anaplastic (poor prognosis)
Following Surgery
Thyroxine (to replace lost thyroid function)
Radioiodine (in high risk pts)

24

What are the 2 types of prolactinoma?

Macroprolactinoma: causes compression of the optic chiasm= bitemporal hemianopia
Microprolactinomas: DONT compress the optic chiasm

25

List 3 symptoms caused by prolactinomas

Galactorrhoea
Amenorrhoea
Sexual dysfunction

26

What is the first line treatment of prolactinomas? How do these work?

Dopamine agonists e.g. cabergoline, bromocriptine
Shrink prolactinomas + reduce prolactin level
Never do surgery for prolactinoma before DA as these shrink the tumour

27

What condition causes obstructive sleep apnoea and carpel tunnel syndrome?

Acromegaly
OSA: excess soft tissue in neck
CTS: excess soft tissue in carpal tunnel compressing median nerve

28

What tests are used in diagnosis of acromegaly?

IGF-1: high
OGTT: GH won't be suppressed

29

What is an Insulin Tolerance Test?

Normal: Causes hypoglycaemia, which leads to a rise in cortisol + GH
Abnormal: GH + cortisol remain low in hypopituitarism

30

What is a short synACTHen test?

Normal: cortisol rises
Abnormal: No rise in cortisol, indicates adrenal insufficiency