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Flashcards in DPD: Meeran cases Deck (20)
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1

What are the 5 major criteria of rheumatic fever?

Subcutaneous nodules
Carditis (changing heart murmur)
Arthritis
Sydenham’s chorea
Erythema marginatum

2

What is Rheumatic fever caused by?

AI disease occurring after surviving Strep sore throat- no strep bacteria present

3

What is the most likely organism causing lobar pneumonia?

Streptococcus pneumoniae

4

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

5

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

6

What is shown by red cell distribution width? How does microcytic/ macrocytic anaemia affect this?

Standard deviation of MCV
RDW stays the same

7

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)

8

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)

9

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

10

What WCC would be seen in infection, sepsis and chronic myeloid leukaemia?

Infection: 12
Sepsis: 25-30
CML: >30

11

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

12

What may be the underlying cause of AF in a patient with weight loss?

Hyperthyroidism

13

What anti-thyroid drugs are used in Graves disease?

Carbimazole
Propylthiouricil

14

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)

15

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)

16

What is the most likely diagnosis in patients presenting with spider naevi?

Chronic stable liver disease

17

What are Strawberry Naevi?

benign overgrowth of blood vessel cells that is self-limiting
Most shrink or dissapear
‘haemangioma’ of Infancy

18

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

19

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

20

What is a 4th heart sound caused by?

Atrium squeezing blood into ventricles
Caused by atrial contraction
Occurs in those with toughened ventricular wall (usually due to long standing HTN causing LV hypertrophy)