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Amir Sam Lectures > Lecture 4 - Mixed > Flashcards

Lecture 4 - Mixed Flashcards

1
Q

What are the typical symptoms a patient wold present with when suffering from an immediate transfusion reaction and why?

A

Due to Haemolysis

Fever

Rigor

Tachycardia

Hypotension

Chest Pain

Dark Urine

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2
Q

Give a couple of examples of causes of polycythaemia.

A

Physiological (Response to chronic hypoxia casused by COPD)

Pathological (excess EPO)

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3
Q

What are the main causes of thrombocytopenia?

A

Decreased production

Increased breakdown/usage

Pooling in the spleen

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4
Q

Give a couple of causes of a thrombocytosis.

A

Primary - Myeloproliferative Disorder, CML

Response to haemorrhage

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5
Q

What causes microcytic anaemia?

A

Iron Deficiency - Diet, blood loss (GI, UG)

Beta Thalassaemia heterozygosity

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6
Q

What causes a normocytic anaemia?

A

Chronic Disease - eg. Rheumatoid Arthritis

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7
Q

How do ferritin levels present in a patient with a normocytic anaemia and why?

A

Normal/High

Ferritin production is an acute phase reaction, seen in chronic disease (similar to CRP)

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8
Q

In which condition are ferritin levels extremely high?

A

Haemochromatosis

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9
Q

What are the main causes of a macrocytic anaemia?

A

Alcoholics May Have Liver Failure

Alcohol

Myelodysplasia

Hypothyroidism

Liver Disease

Folate/B12 Deficiency

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10
Q

How does polycythaemia present?

A

Headache

Pruritus after a hot bath

Blurred vision (hyperviscosity)

Tinnitus

Thrombosis (Stroke, DVT)

Gangrene

Choreiform Movements

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11
Q

What are the main types of Sickle Cell Crises?

A

Acute Painful

Stroke

Sequestration

Gallstones/Chronic Cholecystitis

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12
Q

How would you manage an acute painful Sickle Cell crisis?

A

Analgesia

O2

IV Fluids

Antibiotics

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13
Q

How would you manage a stroke secondary to Sickle Cell disease?

A

Exchange Blood Transfusion

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14
Q

What is a Sequestration crisis and how does it present?

A

RBC Pooling

Affects the Lungs (SOB, Cough, Fever)

Affects the Spleen (Exacerbation of anaemia)

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15
Q

How would you manage a Sickle Cell sequestration crisis?

A

Usually symptomatic.

Chronic splenic episodes requires a Splenectomy.

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16
Q

Why does Hypercalcaemia cause Polyuria and Polydipsia?

A

Impairs ADH function, leading to the development of Nephrogenic Diabetes Insipidus.

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17
Q

How might a patient with Multiple Myeloma present?

A

CRAB

Hypercalcaemia (Stones, bones etc.)

Renal Failure (Ur/Cr)

Anaemia (SOB, Lethargy)

Bone Pain/Osteoporosis (Fractures, Pain, Check DXA)

Infection

Cord Compression

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18
Q

What do you test the urine for when investigating a suspected case of Multiple Myeloma?

A

Bence-Jones Proteins.

IG Light chains, excreted in the urine due to excess IG production by neoplastic Plasma Cells.

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19
Q

What may cause an Anaemia with an increased reticulocyte count?

A

Haemolytic Crisis

Haemorrhage

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20
Q

What may cause an anaemia with a decreased reticulocyte count?

A

Parvovirus B19 Infection

Aplastic Crisis in Sickle Cell patients

Blood Transfusion

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21
Q

What is the diagnostic criteria that defines Diabetes?

A

Fasting Glucose >7

Random Glucose >11.1

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22
Q

Describe a typical T1DM patient.

A

Young, thin, insulin deficient.

Present with:

Weight Loss

High Ketones (may present with DKA initially)

Acidotic (^)

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23
Q

Describe a typical T2DM patient.

A

Older, Overweight, Insulin resistent

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24
Q

How would you treat a newly diagnosed case of Type 2 Diabetes?

A

Lifestyle Advice

Metformin

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25
What do Sulfonylureas do and what are the common side-effects?
Stimulate Insulin release by Pancreatic ß-Cells Weight Gain Hypoglycaemia (Add onto Metformin after a few months - progressive disease must be proven)
26
Give an example of a DPP-IV Inhibitor.
Linagliptan Sitagliptan
27
How do DPP-IV Inhibitors work?
DPP-IV breaks down GLP-1 (Glucagon-like Peptide). Inhibition has a similar effect to GLP-1 Agonists.
28
What are the main classes of Diabetes complications, and how do you investigate them?
**_Microvascular_** - Retinopathy - Nephropathy - Neuropathy **_Macrovascular_** -MI/Stroke/PVD **_Metabolic_** - DKA - HHS (Hyperosmolar Hyperglycaemic State) - Hypoglycaemia
29
How would you monitor Nephropathic progression in Diabetes patients, and how would you treat it?
Monitor ACR (Albumin-Creatinine ratio) every time you see the patient. Microalbuminurea occurs with Diabetic Nephropathy. If Nephropathy is detected, start the patient on an ACE Inhibitor.
30
How would you manage a case of Hypoglycaemia in a Diabetic patient?
**If Conscious:** - Drink glucose & milk - Long-acting carbohydrates **If Confused:** -Buccal Glucose Gel **If Unconscious:** - IV Glucose - Glucagon
31
How does Graves Disease present?
Weight Loss w/ Good Appetite Irritability Palpitations Oligomenorrhoea **O/E:** Tremor Proptosis Smooth Goitre Pretibial Myxoedema
32
What will a Graves' Patient's TFTs show?
High T3/4 Low TSH
33
What is the difference between 'Pretibial Myxoedema' and 'Myxoedema'?
Pretibial Myxoedema is a waxy, discoloured rash on the shins of a patient with **Graves' Disease.** Myxoedema is a term given to the consistency of the skin in a patient with **Hypothyrodism**
34
Which Antibody is responsible for Graves' Disease?
TSH Receptor Stimulating Antibody
35
What will the Nuclear Medicine Technetium uptake scan show in a case of Graves' Disease?
Diffuse, increased uptake
36
What would you look for in the History and Examination of a patient when suspecting Thyroid Cancer?
Lump Typical Hyperthyroid Symptoms (eg. Thyroid Acropachy) Risk Factors (Radiation, FHx, Rapid Enlargement/Compression, Lymphadenopathy) Metastases (Lung, follicular thyroid carcinoma)
37
How would you investigate a possible case of Thyroid Cancer?
1) Ultrasound 2) Fine Needle Aspiration (Uptake Scan may show cold nodules)
38
How might you treat a case of Thyroid Cancer?
**Surgery:** - Papillary - Follicular - Medullary - Anaplastic (Poor Prognosis) **Thyroxine** **Radioiodine**
39
How would a Prolactinoma case typically present?
Irregular Periods Galactorrhoea Bitemporal Hemianopia Sexual Dysfunction
40
What is the most appropriate treatment for a Prolactinoma?
Cabergoline (Dopamine Agonist)
41
How could a Pituitary Tumour present?
Headache & Hemianopia Hyposecretion (of most other hormones) Hypersecretion (of a particular hormone) Local compression of other structures
42
How would someone with Acromegaly typically present?
Headache, sweating Poor sleep (Snoring is common), Obstructive Sleep Apnoea Tingling in fingers (Carpal Tunnel, compression of Median Nerve)
43
What are the initial investigations for a suspected case of Acromegaly?
1) IGF-1 2) Oral Glucose Tolerance Test (OGTT)
44
When should you test for Cushing's?
Only when you have a high pre-test probability of a positive result.
45
What are the discriminatory signs of Cushing's Syndrome?
Bruising Thick Skin Myopathy Purple Striae \>1cm wide Diabetes Hypertension Osteoporosis at a young age
46
What would be your Ddx for a patient presenting with Amenorrhoea/Oligomenorrhoea?
Pregnancy Hypothalamus Pituitary Thyroid (Hyper/Hypo) Ovaries (PCOS, Failure)
47
How would you investigate a patient presenting with Amenorrhoea/Oligomenorrhoea?
**1) Urine BHCG** Hypothalamus - ?excess exercise, low BMI? Pituitary (Prolactinoma) - ?excess prolactin, Low LH/FSH Thyroid -TFTs PCOS - Androgen levels Ovarian Failure - High FSH
48
How does Hypoklaemia present?
Weakness Arrhythmia Polyuria
49
What are the main causes of Hypokalaemia?
Vomiting Diuretics Primary Hyperalodesetornism - Either Bilateral hyperplasia or Conn's
50
Why does Hypokalaemia cause Polyuria?
Hypokalaemia is a cause of Nephrogenic Diabetes Insipidus.
51
How would you calculate Plasma Osmolality?
2 x (Na + K) + Ur + Glucose
52
What cause low urine osmolality (dilute urine)?
Diabetes Insipidus - Decreased response to ADH
53
What would the likely diagnosis be in a patient presenting with Low Ca Low Phosphate High PTH ?
Vitamin D Deficiency Low Ca/Phosphate absorption Less negative feedback means PTH increases
54
What would the likely diagnosis be in a patient presenting with High Ca Low Phosphate High PTH ?
Hyperparathyroidism High Ca High PTH Low Phosphate is a response to high PTH
55
What would the likely diagnosis be in a patient presenting with High Ca Normal Phosphate Low PTH ?
Malignancy High Ca Low PTH therefore.. Normal Phosphate
56
What would the likely diagnosis be in a patient presenting with Low Ca High Phosphate Low PTH ?
Hypoparathyroidism Low PTH Leads to.. Low Ca & High Phosphate
57
What would the likely diagnosis be in a patient presenting with Low Ca High Phosphate High PTH ?
Renal Failure Vitamin D needs to be hydroxylated in the kidneys. Different from Vit D Deficiency because of the High Phosphate. In Renal failure, Phosphate cannot be effectively excreted.
58
How would you classify AKI?
**_Pre-Renal:_** - Hypovolaemia - Sepsis **_Renal:_** - Drugs - Glomerulonephritis **_Post-Renal:_** -Obstruction
59
How would you investigate an Acute AKI suspected to be due to Glomerulonephritis?
?Active Urine Sediment Haematurea Proteinurea
60
How would you investgate an Acute AKI suspected to be due to obstruction?
Ultrasound Check for malignancy/prostate hyperplasia
61
How would you investigate Renal Artery Stenosis?
Asymmetrical Kidneys (USS) Magnetic Resonance Angiography is Gold Standard In Bilateral RAS, ACE Inhibitors **worsen** renal function.
62
How do you determine the cause of an Alkalosis?
Check CO2 Low = Respiratory High = Metabolic
63
Which ABG abnormality indicates a complex mixed picture?
CO2 and Bicarbonate going in opposite directions (Increasing/Decreasing)
64
What are the main ways in which a Seronegative Arthropathy (eg. Psoriatic Arthritis) can present?
Symmetric Polyarthropathy, identical to RA - must check the skin Distal Oligoarthritis Sacroilitis
65
What is the most likely diagnosis if a patient presents with a pearl-like lesion with telangiecstasias, as seen below?
Basal Cell Carcinoma

Amir Sam Lectures (6 decks)

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