GIM

Question 1

FHH

Answer 1

Genetic
Life long hypercalcemia (never had normal ca)
PTH normal / mild elevated (unlike primary hyperparathyroidism)

Question 2

Hypercalcemia and low PTH

Answer 2

Causes - malignancy, Thyroid, drugs such as calcium, vit d and diuretics, ectopic vit d production

Question 3

Daptomycin

Answer 3

Used in skin and soft tissue / endocarditis / staph aureus Bacteria.

NOT used in pneumonia

Can cause myopathy and rhabdo. Check CK at start of treatment and weekly. Hold statins

Question 4

Dalbavancin

Answer 4

Long acting antibiotics - good for IVDU and non compliance.

Good for gram positive

Question 5

Beta D Glucan

Answer 5

For fungal infections -pcp or aspergillus

Question 6

Galactomanin

Answer 6

Useful to investigate aspergillus

Question 7

Tricyclic overdose

Answer 7

Indication for sodium bicarbonate
- dosnt need to be a idiotic
- wide QRS complex, hypotension, arrhythmia

Question 8

Bacterial meningitis

Answer 8

In addition to antibiotics, dexamethasone should be added in with the first dose if there is severe meningism

Question 9

Sickle cell anaemia

Answer 9

Multisystem condition

Periods and pregnancy trigger for crisis

Pain +++
- treatment with opioids

Most have personalised care pathway

Treatment
- hydroxycarbamide
-stem cell transplant / gene therapy

Any transfusion should be discussed with haematology expert
- patients will have low baseline hb
- increase risk of antibody formation and haemolytic transfusion reaction

Reticulocyte count helpful
Also check for parovirus as well

Question 10

Sickle cell anaemia - acute chest syndrome

Answer 10

Sickle cell anaemia emergency

Acute chest syndrome
- acute sickling that effects the lungs
- fever, CXR changes, increased resp effort

Vaso occlusive painful episodes are triggers

Can get fat embolism syndrome
- another acute sickle cell emergency
- associated with parvovirus
- tends to occur in more mild phenotypes
- treatment PLEX

Question 11

GCSF in neutropenia

Answer 11

Haem oncology disorders - Avoid in myeloid cancers
E.g myelodysplastic disorders, aml

Question 12

Von wilibrand

Answer 12

Will have a normal clotting profile
Need to send separate specific test
Increase bleeding e.g epistaxisis

Question 13

Clotting factor cutoff

Answer 13

Liver disease
- fibrinogen and platelets more useful than clotting