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DPD 2020 > interactive cases in general internal medicine 6 > Flashcards

interactive cases in general internal medicine 6 Flashcards

1
Q

What differential diagnosis for microcytic anaemia

A
  • Iron deficiency (low ferritin)
    • Diet
    • Blood loss (GI, UG)
  • Beta thalassaemia heterozygosity
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2
Q

What are differential diagnosis for normocytic anaemia?

A
  • Chronic disease
    • e.g. Rheumatoid arthritis
    • Normal/high ferritin
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3
Q

50 year old woman • Hb: 90 g/L • MCV: 75 • On NSAIDs for joint pain

The most likely cause is:

A. Iron deficiency

B. Beta thalassaemia heterozygosity

A

bleeding ulcer due to NSAIDS

A. Iron deficiency

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4
Q

• 40 year old woman • Hb: 110 g/L • MCV: 65

The most likely cause is:

A. Iron deficiency

B. Beta thalassaemia heterozygosity

A

B. Beta thalassaemia heterozygosity

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5
Q

What are differential diagnosis for macrocytic anaemia?

What are clues that would point you towards one or the other?

A

REMEMBER with Alcoholics May Have Liver Failure

Alcohol - Hx, high GGT

Myelodysplasia - Pancytopenia & Bone marrow

Hypothyroidism - Hx (lethargy, constipation, wt gain) &Low T4, High TSH

Liver disease- Hx/Exam

Folate/B12 deficiency - Hx (small bowel disease, ? Gastrectomy)

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6
Q

What are presentation signs of Polycythaemia

A
  1. Headache
  2. Pruritus after hot bath
  3. Blurred vision (hyperviscosity)
  4. Tinnitus
  5. Thrombosis (stroke, DVT)
  6. Gangrene
  7. Choreiform movements
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7
Q

What are the different crises you can have in sickle cell?

A
  • Acute painful crises
  • Stroke
  • Sequestration crises (RBC pooling)
    • Lung (SOB, cough, fever)
    • Spleen (exacerbation of anaemia)
  • Gallstones, chronic cholecystitis
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8
Q

How do manage an acute painful crisis?

A

Analgesia

O2

IV fluids

Antibiotics

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9
Q

How would manage a stroke ina patient with sickle cell?

A

Exchange blood transfusion

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10
Q

How would you manage a patient with splenic sequestration?

A

Splenectomy for repeated episodes of splenic sequestration

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11
Q

How would manage a patient with chronic cholecystitis due to sickle cell anaemia?

A

• Cholecystectomy

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12
Q

What are the Presentations of Multiple Myeloma?

A

Calcium - Polyuria, polydipsia, constipation

Renal failure - Ur & Cr​

Anaemia - Breathlessness, lethargy • FBC

Bone (pain, osteoporosis)- Fracture, bone pain DXA

Might also have infection and cord compression

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13
Q

50 year old man • Hypercalcaemia • Low PTH • Backache • Normal ALP

The most likely cause is:

A. Malignancy

B. Multiple myeloma

A

B. Multiple myeloma

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14
Q

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

The most likely cause is:

A. Malignancy

B. Multiple myeloma

A

A. Malignancy

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15
Q

What are differentials anaemias with a high reticulocyte count?

A

Haemolytic crises

(DDx: haemorrhage)

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16
Q

What are differentials anaemias with a low reticulocyte count?

A
  • parvovirus B19 infection
  • Aplastic crisis in patients with Sickle cell anaemia
  • Blood transfusion
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17
Q

What is diabetes?

A

Fasting > 7 •

Random ≥ 11.1

• Impaired glucose tolerance (IGT)

– 75g OGTT

– 2-hour glc: 7.8-11

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18
Q

What are the classification

A

Type 1 •

Young, thin, insulin deficiency •

Wt loss •

Ketones •

Acidosis

Type 2

  • Older
  • Overweight, obese
  • Insulin resistant
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19
Q

Case • A 45 yr old man • lethargy, fatigue, polyuria, polydipsia • urinalysis: – no ketones – glc +++ • Random glc: 12

How would you treat him?

A. Insulin

B. Metformin

C. Sulfonylurea

D. DPP-IV inhibitor

E. GLP-1 agonist

A

B. Metformin

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20
Q

What are complications of diabetes

A

Microvascular

– Retinopathy

– Nephropathy

– Neuropathy

• Macrovascular

– MI/Stroke/PVD •

Metabolic –

DKA/HHS/Hypoglycaemia

21
Q

What is the insulin sliding scale

A

scale where there is a blood glucose

measurement and the correspondent insulin dose

used in surgery or sepsis

22
Q

Wt loss • Good appetite • Irritability • Palpitations • irregular periods

O/E •

Tremor • Proptosis • Smooth goitre • Pretibial myxoedema

What will the TFTs show?

A. High free T4/T3, suppressed TSH

B. High free T4/T3, High TSH

A

High free T4/T3, suppressed TSH

23
Q

Wt loss • Good appetite • Irritability • Palpitations • irregular periods

O/E

• Tremor • Proptosis • Smooth goitre • Pretibial myxoedema

Fee T4: 30 (10-20)

TSH < 0.05

What is the next most appropriate investigation? A. TPO antibodies

B. TSH receptor stimulating Ab

A

B. TSH receptor stimulating Ab

24
Q

Wt loss • Good appetite • Irritability • Palpitations • irregular periods

O/E

• Tremor • Proptosis • Smooth goitre • Pretibial myxoedema

Fee T4: 30 (10-20)

TSH < 0.05

What will the NM uptake scan show?

A. Diffuse increased uptake

B. Hot nodule

A

A. Diffuse increased uptake

25
What are risk factors for thyroid cancer
Risk factors – Radiation – FHx – Rapid enlargement/compression – Lymphadenopathy
26
What are investigations you would like to do in someone that has thyroid cancer
USS • FNAC, (Uptake scan: cold nodules) • MDT
27
What are the treatments for thyroid cancer
Surgery Thyroxine, radioiodine
28
30 year old female • Amenorrhoea • Galactorrhoea • Bitemporal hemianopia What is the most appropriate treatment? A. Trans-sphenoidal surgery B. Cabergoline
B. Cabergoline do not operate for prolactinoma
29
50 year old man * Headache, sweating * Poor sleep, snoring – Obstructive sleep apnoea • Tingling in fingers – Carpal tunnel syndrome **Initial test: High IGF-1** Which test would you perform ? A. ITT B. OGTT C. Dex suppression test D. Short Synacthen test E. GHRH test
B. OGTT
30
40 year old woman • Wt gain • Depressed • Fatigue • Central obesity Is she likely to have Cushing’s syndrome? A. Yes B. No
B. No
31
What are discriminatory signs of cushings
Bruising, thin skin * Myopathy * purple striae, \> 1cm wide * DM, HTN, osteoporosis at a young age
32
What are causes of amenorrhea/ Oligomenorrhea
Pregnancy * Hypothalamus * Pituitary * Thyroid (hyper/hypo) * Ovaries – PCOS – Ovarian failure
33
What are investigations you would want to do in someone that presents with Amenorrhea/ Oligomenorrhea
Urine BHCG * ? Excessive exercise, low BMI * Excess prolactin * Low LH/FSH * TFTs Excess androgens (or hirsutism) High FSH
34
Weakness * Arrhythmia * Polyuria What does this person have
hypokalaemia
35
What are causes of hypokalaemia
GI: Vomiting * Diuretics * Primary hyperaldosteronism (bilateral hyperplasia or Conn’s) – Aldosterone: renin ratio
36
What is this
BCC
37
What are causes of AKI
**_Pre-renal_** Hypovolaemia • Sepsis **_• Renal_** Drugs • ? Active urine sediment: blood & protein in the urine (Glomerulonephritis) **_• Post renal_** USS (? Obstruction)
38
21 yr old medical student • Morning of the Yr 3 exam • SOB • Palpitation • Tingling in hands ABG • pH 7.5 (normal 7.35 - 7.45) • pCO2 3.5 kPa • bicarb 20 mmol/L What is the most likely cause? A. Pulmonary embolus B. Pneumothorax C. MI D. SVT E. Hyperventilation syndrome
E. Hyperventilation syndrome
39
What is the diagnosis
psoriatic arthropathy Sacroiliitis Arthtitis affecting distal interphalangeal joints
40
Which biochem picture is suggestive of Vitamin D deficiency? A. Low ca, low phosphate, high PTH B. High ca, low phosphate, high PTH C. High ca, normal phosphate, low PTH D.Low ca, high phosphate, low PTH E. Low ca, high phosphate, high PTH
A. Low ca, low phosphate, high PTH B hyperparathyrodism C. malignancy D.hypoparathyrodism E. renal failure
41
What are the 2 different categories of Hypernatraemia
High urine osmolality: 572 – Dehydration (elderly, children) – HHS (urine high osm: glycosuria), type 2 diabetes Low urine osmolality – DI (dilute urine, osm \< 300)
42
What are the 3 main causes of thrombocytopaenia?
using them: DIC infiltration of bone marrow: metastasis pooling in the spleen: portal hypertnesion
43
PAtient comes in with high ferritin and desaturates on exercise and has a cough. had unprotected sex as a young girl What does this patient have?
Pneumocystis-jirovecii-Pneumonie gotten HIV
44
What are the light chain in the urine in multplie myloma
bence jones protein
45
What are the side effects of sulphanyle ureas
hypo increase in weight
46
how often do you check for retinopathy and how
anual digital retinal photography
47
how do you check for diabetic nephropathy
ACR albumin creatinin ratio
48
How do you manage hypoglycaemia?
**conscious** have them drink glucose after complex carbohydrates so they don't have another hypo **unsciousious** glucagon or intravenous glucose
49
What must you exclude first if you suspect a prolactinoma
pregnancy

DPD 2020 (48 decks)

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