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DPD > Haematology + Endocrinology (2) > Flashcards

Haematology + Endocrinology (2) Flashcards

(55 cards)

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1
Q

Features of immediate transfusion reaction?

A

Haemolysis
• Fever
• Rigor
• Chest pain

  • Dark urine
  • High HR
  • Low BP
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2
Q

Causes of microcytic anaemia?

A
  • Iron deficiency - diet, blood loss

* Beta thalassaemi

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3
Q

Cause of normal MCV?

A

• Chronic disease e.g. RA

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4
Q

Patient has high ferritin and O2 sats drop on exercise. Likely diagnosis?

A

Pneumocystis carinii pneumonia from HIV

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5
Q

50 year old woman
• Microcytic anaemia
• NSAIDs for joint pain

Cause?

A

Iron deficiency - blood loss from bleeding gastric ulcer

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6
Q

40 year old woman
• Normal Hb
• Low MCV

What do you suspect? What other test would you request?

A

Beta thalassaemia

Haemoglobin electrophoresis

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7
Q

Causes of macrocytic anaemia?

A
  • Alcohol
  • Myelodysplasia (pancytopaenia)
  • Hypothyroidism
  • Liver disease
  • Folate/B12 deficiency

Alcoholics May Have Liver Failure

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8
Q

Presentation of polycythaemia?

A
  • Headache
  • Pruritus after hot bath
  • Blurred vision
  • Tinnitus
  • Thrombosis
  • Gangrene
  • Choreiform movements
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9
Q

Management of acute painful crisis for sickle cell anaemia?

A
  • Analgesia
  • O2
  • IV fluids
  • ABx
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10
Q

Management of stroke in sickle cell anaemia?

A

Exchange blood transfusion

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11
Q

Presentation of sequestration crises in sickle cell anaemia?

A

Lung - SOB, cough, fever

Spleen - exacerbation of anaemia

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12
Q

Management of splenic sequestration crises in sickle cell anaemia?

A

Splenectomy for repeated episodes

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13
Q

Management of gallstones or chronic cholecystitis in sickle cell anaemia?

A

Cholecystectomy

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14
Q

How does a persion with mutiple myeloma present, with reference to CRAB + 2 other problems?

A

C - polyuria, polydipsia, constipation
R - high urea and creatinine
A - breathlessness, lethargy, low Hb
B - fracture, bone pain, DEXA -2.5 or lower

May have infection or cord compression too

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15
Q 
50 year old man
• Hypercalcaemia
• Low PTH
• Backache
• High ALP

Most likely cause?

A

Malignancy

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16
Q

Causes of anaemia with increased reticulocyte count?

A

Haemolytic crises

Haemorrhage

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17
Q

Causes of anaemia with low reticulocyte count?

A
  • Aplastic crisis due to parvovirus B19 infection
  • Aplastic crisis in SCA
  • Blood transfusion
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18
Q

Diagnosis of diabetes?

A

> 7 - fasting
≥ 11.1 - random

Once if symptomatic
Twice in a row if asymptomatic

Impaired glucose tolerance
• 75g OGTT
• 2-hour glucose: 7.8-11

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19
Q 
45 year old man
• Lethargy, fatigue
• Polyuria, polydipsia
• Urinalysis - no ketones, glucose +++
• Random glucose: 12

How would you treat him?

A
  1. Lifestyle advice
  2. Metformin
  3. Add sulphonylurea if progressing
  4. DPP-IV inhibitor
  5. GLP-1 agonist
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20
Q

How do sulphonylureas work?

A

Stimulate insulin release from beta cells

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21
Q

Side effect of sulphonylureas?

A

Weight gain and hypoglycaemia

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22
Q

Other name for DPP-4 inhibitors and how do they work?

A

Gliptins

DPP-4 breaks down GLP-1, so inhibiting it with gliptins reduces breakdown of GLP-1

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23
Q

Which diabetes drug would be added if their control is suboptimal, they are overweight and there is a risk of hypoglycaemia, and why?

Study These Flashcards
A

GLP-1 agonists

Reduce weight as well as HbA1c

24
Q

What do diabetes patients need to monitor retinopathy?

Study These Flashcards
A

Annual digital retinal photography

not opthalmoscopy

25
What treatment is generally used if diabetic retinopathy is advanced?
Laser treatment
26
How do you check for nephropathy in diabetic patients?
Albumin-creatinine ratio (ACR) every time you see them
27
Which drug slows the progression of diabetic nephropathy causing microalbuminuria?
ACE inhibitor
28
Hyperglycaemic hyperosmolar state (HHS), which diabetes type, presentation and treatment?
T2DM * Drowsy * Confused * IV fluids * Low dose IV insulin (if glucose is no longer falling or if ketonaemia)
29
Treatment of hypoglycaemia?
* Conscious - sugary drink, carbohydrate meal later * Confused - glucose gel * Unconscious - glucagon or IV glucose 20%
30
Which chart determines how much IV insulin to give to patient depending on their blood glucose (patient not eating, unwell e.g. sepsis)?
Sliding scale
31
Feature of Grave's specifically in women?
Irregular periods
32
TFTs in Graves'?
* High free T4/T3 | * Low TSH
33
Weight and appetitie in Graves'?
* Weight loss | * Good appetite
34
Antibody in Graves'?
TSH-receptor stimulating Ab
35
What would radioactive uptake scan show in Graves'?
Diffuse increased uptake
36
Investigations for thyroid cancer?
1. USS 2. FNA 3. Uptake scan - cold nodules
37
Treatment for thyroid cancer?
1. Surgery 2. Thyroxine 3. May need radioiodine
38
Presentation of prolactinoma?
* Amenorrhoea * Galactorrhea * Bitemporal hemianopia (men present later with this or sexual dysfunction)
39
Most appropriate treatment for prolactinoma? Medical or surgical?
Cabergoline Want to try and avoid trans-sphenoidal surgery
40
* Headache, sweating * Poor sleep, snoring * Tingling in fingers * High IGF-1 Next test?
OGTT
41
``` 40 year old woman • Weight gain • Depressed • Fatigue • Central adiposity ``` Diagnosis?
Nothing specific yet, this presentation is common - low pre-test possibility for Cushing's Don't test straight away due to risk of false positives
42
First test in amenorrhoea?
Pregnancy test - urine BHCG
43
Next investigations (general) for amenorrhoea after 1st test?
* Hypothalamus - ask about exessive exercise, low BMI * Pituitary - excess prolactin, low LH/FSH * TFTs - high/low * PCOS - excess androgens * Ovarian failure - high FSH
44
Presentation of hypokalaemia?
* Weakness * Arrhythmia * Polyuria - nephrogenic diabetes insipidus (like hypercalcaemia)
45
Causes of hypokalaemia?
* Vomiting * Diuretics * Primary hyperaldosteronism (bilateral hyperplasia or Conn's)
46
Where is hypernatraemia seen?
* Dehydration in elderly or children - high urine osm * HHS (T2DM) - high urine osm * DI - low urine osm
47
Calcium, phosphate and PTH in vitamin D deficiency and why?
* Low calcium * Low phosphate * High PTH Vitamin D needed for calcium and phosphate absorption Low calcium causes high PTH
48
What are 2 main possibilities for high calcium, and what is the PTH in those 2 options?
Primary hyperparathyroidism - high PTH causing high calcium Malignancy/myeloma - low PTH suppressed by high calcium
49
Calcium, phosphate and PTH in kidney failure and why?
* Low calcium * High phosphate * High PTH Low calcium because of low vitamin D High phophate as you can't excrete phosphate
50
Cause of renal AKI?
* Drugs | * Glomerulonephritis - active urine sediment (blood and urine)
51
Investigations for post-renal AKI?
USS for obstruction
52
Investigations for renal artery stenosis?
1. USS - asymmetrical kidneys | 2. Magnetic resonance angiography - GOLD STANDARD
53
Which drug worsens renal function in bilateral renal artery stenosis?
ACE inhibitors
54
21 year old before exam • SOB • Palpitations • Tingling of hands * High pH * low pCO2 * low HCO3 Cause?
Respiratory alkalosis Hyperventilation
55
Presentation of psioriatic arthropathy?
* Symmetric polyarthropathy - like RA * Asymmetric distal oligoarthritis (2-4 joints) * Sacroiliitis

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