Rheum/Haem/Endo Cases AS

Question 1

Answer 1

B

Question 2

What atypical organisms cause pneumonia?

Answer 2

• Mycoplasma pneumoniae•Chlamydia pneumoniae•Legionella pneumophila
• Implicated in up to 40% of CA

Question 3

Answer 3

E

Question 4

Describe a cause of microcytic anaemia.

Answer 4

• Haematinics
• Coeliac screen* (TTG Ab) (diagnosis confirmed on duodenal biopsy - villous atrophy)
• Remember red flags
• Top & Tail
• Order depends on upper/lower GI symptoms

Question 5

Answer 5

Ischaemic colitis is a common cause of bloody stools in elderly

Question 6

Answer 6

E because less than 48hours

Question 7

Name 3 causes of bloody diarrhoea.

Answer 7

• •Infection: infective colitis
• •Inflammation: ulcerative/Crohn’s colitis (younger pts)
• •Ischaemia: ischaemic colitis (older pts)
• Malignancy
• Diverticulitis

Question 8

What is a dangerous complication of ascites?

Answer 8

Spontaneous bacterial peritonitis

Question 9

Answer 9

D

Question 10

Describe 3 causes of microangiopathic haemolytic anaemia.

Answer 10

Question 11

How can haemolytic anaemia be classified?

Answer 11

Question 12

Answer 12

E

Question 13

Describe the folds of the large and small bowel.

Answer 13

Large bowel - haustra

Small bowel - circular folds

Question 14

Answer 14

Na should be 135-145, low urine sodium if kidneys are holding on to sodium due to ADH release.

?SIADH due to lung cancer

Therefore CXR

Question 15

What is hyponatraemia? What algorithm would you use when treating them?

Answer 15

Hyponatraemia - EXCESS water diluting Na. Either appropriate or inappropriate.

• Appropriate if retaining more water e.g. from vomiting causing more ADH –> SIADH
• If tumour is releaseing ADH - this is inappropriate

Causes: almost always due to increased ADH

Rarer causes: excess water intake, sodium-free irrigation solutions(e.g. used in TURP).

Question 16

What test is used to test for SIADH?

Answer 16

SynACTHen test

Question 17

When will urine sodium be low in hyponatraemia?

Answer 17

Urine sodium will be low in hyper and hypovolaemic patients.

Question 18

List some causes of SIADH.

Answer 18

1. CNS pathology
2. Lung pathology
3. Drugs (SSRI, opiates, carbamazepine)
4. Tumours

Question 19

Answer 19

Beau’s lines - in chemotherapy patients when nail stops growing then grows again

Oncholysiis - nail detaches from the nail bed

Question 20

List 4 causes of onycholysis.

Answer 20

• Trauma
• Thyrotoxicosis
• Fungal infection
• Psoriasis

Question 21

Answer 21

A

Question 22

List 3 macrovasuclar complications of diabetes.

Answer 22

MI/stroke/PVD

Question 23

Name 3 metabolic complications of diabetes.

Answer 23

DKA/HHS/hypoglycaemia

Question 24

Answer 24

D

Question 25

Answer 25

B - LVH Cardiac cause of collapse Ejection systolic murmur - aortic stenosis --\> hypertrophy of left ventricle

Question 26

Answer 26

CT KUB - NON CONTRAST is very sensitive. Calculus

Question 28

Answer 28

In malignancy ALP goes up so answer is multiple myeloma.

Answer 29

Fat necrosis is caused by trauma ## Footnote **Fibroadenoma**

Question 30

Answer 30

A

Question 31

What are 4 consequences of multiple myeloma?

Answer 31

Question 32

Answer 32

D

Question 33

Give 4 causes of cavitating lung lesions.

Answer 33

Question 34

What is nephrotic syndrome?

Answer 34

Nephrotic syndrome• * increased permeability of GBM to protein * Proteinura\> 3g/day * Hypoalbuminaemia * Oedema

Question 35

Explain the answer.

Answer 35

C. HHT - Autosomal dominant, abnormal blood vessels in skin, mucous membranes, lungs, liver, brain. Causes small mouth.

Question 36

Answer 36

A

Question 37

Answer 37

High prolactin supresses LH/FSH and therefore testosterone H

Question 38

Answer 38

Tumour is secreting prolactin and GH therefore there is excess IGF-1 production by liver IGF-1 is measured (not GF) because GH is pulsatile Investigation: oral glucose tolerance test shoudl suppress GH in normal people

Question 39

Answer 39

F

Question 40

Answer 40

E Excess TRH can stimulate prolactin

Question 41

Answer 41

I - blood tests would be normal