DPD: Amir Sam 6 Flashcards
(50 cards)
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)
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)
If a patient is anaemic, what should you look at?
Low MCV: haematenics - IDA, B thalassemia
Normal MCV: Infection, Inflammation (ACD), malignancy
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)
List 7 manifestations of polycythemia
Headache Pruritus after a hot bath Blurred vision (hyper viscosity) Tinnitus Thrombosis (stroke, DVT) Gangrene Choreiform movements
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
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
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
What may occur if vertebrae are affected in multiple myeloma?
Cord Compression
Can cause spastic paraparesis (partial paralysis of lower limbs)
What does anaemia with reticulocytosis indicate?
Attempt to make more RBCs because of: Haemolysis or Haemorrhage (increased demand for red cell production)
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)
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
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
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
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)
List 4 signs of Graves disease
Proptosis/ exophthalmus
Pretibial myxoedema
Tremor
Smooth goitre
List 5 symptoms of Graves disease
Weight loss Increased appetite Irritability Palpitations Irregular periods
How do primary and secondary hyperthyroidism differ?
Primary: High T4/T3, suppressed TSH
Secondary: High T4/T3, high TSH
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
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
List 4 risk factors for thyroid cancer
Radiation
FH
Rapid enlargement/ compression
Lymphadenopathy
What investigations are appropriate for thyroid cancer?
USS: look for suspicious features
Uptake scan: cold nodules
FNAC (FNA cytology)
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)
What are the 2 types of prolactinoma?
Macroprolactinoma: causes compression of the optic chiasm= bitemporal hemianopia
Microprolactinomas: DONT compress the optic chiasm
