Flashcards in DPD: Meeran cases Deck (20)
What are the 5 major criteria of rheumatic fever?
Carditis (changing heart murmur)
What is Rheumatic fever caused by?
AI disease occurring after surviving Strep sore throat- no strep bacteria present
What is the most likely organism causing lobar pneumonia?
What happens to blood components when there is slow GI blood loss?
Iron stores are exhausted
Microcytic anaemia arises
High platelet count due to bleeding
What are the 2 most likely causes of slow GI bleeds in the young and elderly, thus which investigations should be performed?
Young: endoscopy then colonoscopy commonest cause = peptic ulceration
Old: colonoscopy then endoscopy commonest cause = colonic carcinoma
What is shown by red cell distribution width? How does microcytic/ macrocytic anaemia affect this?
Standard deviation of MCV
RDW stays the same
What causes a high red cell distribution width?
Malabsorption e.g. coeliac disease
causes a mixed picture
Some small cells (iron deficient) some large cells (b12 deficient)
Describe the pathophysiology of pernicious anaemia
Lack of intrinsic factor
Stop absorbing B12
DNA replicates poorly
Thus cell grows but fails to divide
Macrocytosis results from B12 or folate deficiency
Hypersegmented neutrophils (grow but don’t divide)
How do you distinguish between ACD and a mixed picture?
Measure the RDW
Mixed picture: have small cells + big cells so large RDW. Normal MCV
In ACD: have normal RDW. Normal or low MCV
What WCC would be seen in infection, sepsis and chronic myeloid leukaemia?
What is R wave progression?
R wave should progress in size across leads V1 to V6. Normally, in lead V1, there is a small R wave with a deep S wave; the R-wave amplitude should increase in size with the transition zone, normally in leads V2 to V4. Poor or late R-wave progression consists of a transition zone in lead V5 or V6, indicates previous anterior MI
What may be the underlying cause of AF in a patient with weight loss?
What anti-thyroid drugs are used in Graves disease?
What is a Campbell de Morgan spot?
Benign skin lesions
Formed by proliferating, dilated capillaries + postcapillary venules
No pathology known
Common (present in many >40s)
What 2 features are cardinal of spider naevi?
Touching the centre makes it blanche (do this O/E to prove)
Only be found in the distribution of the SVC (above the nipple line)
What is the most likely diagnosis in patients presenting with spider naevi?
Chronic stable liver disease
What are Strawberry Naevi?
benign overgrowth of blood vessel cells that is self-limiting
Most shrink or dissapear
‘haemangioma’ of Infancy
How can you distinguish between viral hepatitis and hepatic cirrhosis?
VIRAL has an L = favours aLt ALT>AST
Cirrhosis has an S = favours aSt AST> ALT
What heart sound is associated with heart failure?
3rd heart sound
due to rapid ventricular filling (heart is dilated, filling pressure rises + blood rushes into ventricle)
Occurs early on when heart starts to fail
Pump pressure begins to fall- noticed by JGA. Activates RAAS.
Aldosterone makes you retain Na+, + increase venous pressure + increase filling pressure. By starlings law this maintains BP
Slowly rising JVP