1 / 8

Feeling tired

Feeling tired . ISBAR. Introduction: My name is Dr. X, a GP in Brisbane.

ingrid
Download Presentation

Feeling tired

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Feeling tired

  2. ISBAR • Introduction: My name is Dr. X, a GP in Brisbane. • Situation: Miss Agnes B is 92 years old, has been lethargic for the past 5-6 months, has poor appetite, blood results show low Hb and RBC, high bilirubin, antibody for intrinsic factor, endoscopy reveals atrophic gastritis • Background: Had a partial gastrectomy stomach ulcer was malignant, no other significant past medical hx, currently on iron supplements • Assessment: She has anemia due to a vitamin B12 deficiency and atrophic gastritis • Recommendation: Miss B is seeking a second opinion on her management

  3. Exam paper – 2006 PSA 1PART A2 Paul is a 27 year old house painter. He is usually fit, and in fact regularly runs inmarathons. He had a sore throat and “swollen glands” in his neck, and saw anotherdoctor who gave him penicillin. His sore throat has settled but he feels worse. He isso exhausted that he cannot do any running at all.

  4. On further questioning, Paul says his urine isdark, and he is not just too tired to run,he is actually short of breath. You find that he is very pale, and slightly jaundiced. Yoususpect that he has a haemolyticanaemia, and arrange for haematological tests. Hisfull blood count demonstrates:

  5. Hb 93 (130-180 g/L) • RCC 3.8 (4.5-6.5 x 1012/L) • MCV 105 (80-100 fL) • PCV 27% (40-54 %) • Reticulocyte count 5% (<2%) • Comment: some anisocytosis and polychromasia

  6. Question 1. (12 marks) • Explain the mechanism(s) behind the changes in each of the abnormal parameters. • Question 2. (4 marks) • Explain the mechanism of jaundice in haemolyticanaemia.

  7. Question 3. (6 marks) • What changes (if any) would you expect in the levels of the following parameters inhaemolyticanaemia? Briefly explain your answer. • (a) serum lactate dehydrogenase • (b) serum haptoglobin • (c) urinary urobilinogen

  8. Question 4. (4 marks) • List four (4) possible causes of Paul’s haemolysis.

More Related