PBL Relevant
List 4 causes of iron deficiency anaemia
- Colon polyps / carcinoma
- Hookworm infections (resource limited countries)
- Menorrhagia
- Pregnancy
- Peptic ulcer disease
- Diet
Anything related to underlying principles of bleeding/decrease dietary intake/decreased absorption
Which of the following is/are autoimmune disease(s)?
A) Rheumatoid arthritis
B) Type 1 diabetes mellitus
C) Myasthenia gravis
D) Hashimotos disease
E) All of the above
ANSWER: E) All the above
A patient has a sudden change in their arterial blood pressure. To determine the cause, the two components that would need to be assessed are:
A) Cardiac output & total peripheral resistance
B) Total peripheral resistance & heart rate
C) Heart rate & cardiac output
D) Cardiac output & stroke volume
E) Stroke volume & heart rate
ANSWER: A) CO & TPR
Explanation: MAP = CO x TPR
What are haematinics? Provide two examples.
Answer: A substance that improves the quality of blood by increasing Hb production or by increasing RBC number. Examples include folate & vitamin B12.
Name the two most common causes of GI bleeding.
1. Peptic ulcers
2. Mallory-Weiss tears
With regard to tumours of the heart which of the following statements is most correct?
A) They are usually multiple
B) The majority arise from the interventricular septum on the R side
C) The most common atrial tumour is a fibroma
D) They may present as sudden death
E) Atrial myxomas are hard, irregular polypoid lesions usually 1-2cm in diameter.
ANSWER: D) They may present as sudden death
Explanation:
A) Usually solitary
B) Usually in left atrium
C) Most common is atrial myxoma
E) Usually soft, gelatinous and pedunculated + larger (4-8cm)
List 4 potential findings on physical examination consistent with a suspected anaemic patient
- Pallor (palmar crease, conjunctival, general)
- SOB
- Sinus tachy.
- Koilonychia
- Angular stomatitis/cheilitis
- Atrophic glossitis
- Ankle oedema
- Raised JVP
- Fatigue
Explain the role of hepcidin in the context of iron regulation in the body.
Hepcidin is a liver-derived peptide hormone that plays a central role in iron regulation by controlling iron absorption, distribution, and storage. It prevents iron overload and helps maintain iron balance.
- Regulated by HFE protein
- Increased iron stores - increases HFE protein - increases hepcidin - decreases Fe absorption
- Opposite with iron deficiency
A 14M has an anaphylactic reaction to a sting from a paper wasp. He has had IM adrenaline & oxygen via a Hudson mask. On arrival in ED, vitals systolic BP 85 mmHg, O2 sats 85%. He loses consciousness & becomes apnoeic.
What would be the most appropriate management?
A) Place in recovery position & increase oxygen therapy
B) IV adrenaline & continue oxygen
C) Endotracheal intubation
D) Intravenous antihistamine
E) Emergency surgical tracheostomy
ANSWER: C) Endotracheal intubation
What are the histopathological findings of pernicious anaemia?
1. Bone Marrow (megaloblastic changes)
- Large, immature erythroid precursors with open chromatin
- Enlarged granulocyte precursors with hyper segmented neutrophils
2. Gastric Mucosa (atrophic gastritis)
- Mucosal atrophy (fundus/body)
- Loss of parietal cells
- Intestinal metaplasia
3. Peripheral Blood Smear
- Macrocytosis
- Hypersegmented neutrophils
List the 4 causes of folate deficiency.
1. Inadequate intake (poor diet, alcoholism, etc.)
2. Malabsorption (celiac disease, IBD, etc.)
3. Increased demand (pregnancy, haemolysis, etc.)
4. Drug-induced (methotrexate, phenytoin, etc.)
A 26F presents with calf pain & recent onset of worsening SOB. She smokes 15 cigs. daily & returned on a direct flight from USA 4 days ago.
Which one of the following investigations is most likely to give an accurate diagnosis in this situation?
A) Ventilation/Perfusion scan
B) CT pulmonary angiogram
C) Magnetic resonance imaging
D) Chest X-Ray in expiration
E) Positron emission tomography
ANSWER: B) CTPA
Explanation: Concerns of a PE .. CTPA offers high sensitivity + specificity as an imaging modality in this clinical context (gold standard)
How is pernicious anaemia or any autoimmune disease detected in a laboratory setting (using ELISA, IFA, or agglutination as an example?)
ELISA
- Used to detect anti-intrinsic factor (IF) antibodies in serum.
- IF is immobilized on a plate → Patient’s serum is added → If antibodies are present, they bind → An enzyme-linked secondary antibody is used for detection.
- Note: Highly specific for PA but not very sensitive
A 38F presents to the surgery complaining of tiredness. She is a non-smoker & drinks 2 glasses of wine each week. She has a healthy diet & no significant PMHx. Examination is normal apart from conjunctival pallor.
A FBC result is as follows:
Hb = 100 g/L (115-165)
MCV = 78.9 f/L (80-100)
MCHC = 300 g/L (300-350)
What is the most likely cause of this result?
A) Intrinsic factor deficiency
B) Chronic blood loss
C) Folate deficiency
D) Gastric bypass
E) Vitamin E deficiency
ANSWER: B) Chronic blood loss
Explanation: Mild microcytic anaemia secondary to blood loss.
A 75M presents with acute onset of painful left lower leg. O/E, his left leg is pale & cold. The posterior tibial, dorsalis pedis & popliteal pulses are absent.
Which on the following is the most likely antecedent condition leading to this complication?
A) Aortic valve stenosis
B) Thoracic aortic aneurysm
C) Portal vein thrombosis
D) Intracardiac mural thrombosis
E) Thrombosed greater saphenous vein
ANSWER: D) Intracardiac mural thrombosis
Explanation: Acute limb ischaemia is commonly caused by an arterial embolism, often originating from the heart.