Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Medicine MBBS year 3 > Haematology and Oncology > Flashcards

Haematology and Oncology Flashcards

1
Q

What are the history and examination findings in DIC? How do you investigate it?

A

Signs of circulatory collapse - oliguria, hypotension, or tachycardia

microvascular/ macrovascular thrombosis - purpura fulminans,

gangrene, acral cyanosis, delrium, coma
Petechiae, ecchymosis, hematuria, epistaxis

Diagnosis = at least 1 underlying condition causing DIC + abnormal global coagulation tests (decreased PC, increased PT and PTT, elevated FDPS, decreased fibrinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the findings in essential thrombocytosis?

Investigation?

Management?

A

Erythromelalgia - burning pain and redness in different parts of body
Splenomegaly
Bleeding, arterial and venous thrombosis
Livedo reticularis

FBC & Blood smear -> thrombocytosis

Acute = plateletpheresis
Cytoreductive therapy if high risk and non-pregnant
Antiplatelet therapy if high risk and pregnat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the findings, investigation and management for myelofibrosis?

A

leukoerythroblastosis(nucleated Rbcs and immature wbcs) + splenomegaly = hallmarks

History and Examination
Constitutional symptoms - weight loss, night sweats, low-grade fever, pruritus, etc
Splenomegaly
Extramedullary hematopoeisis - Hematuria, spinal cord compression, focal siezures

Investigation 
FBC - anemia 
Peripheral blood smear - teardrop RBCs
Bone marrow aspiration - dry tap 
Bone marrow biopsy - fibrosis

Management
Asymptomatic = folic acid and pyridoxine
Symptomatic = stem cell transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is pancytopenia?

A

combination of anaemia, leukopenia, and thrombocytopenia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the findings, investigation and management for polycythemia vera?

A

Features of thrombosis - stroke, MI, PE, DVT etc
pruritus - often aquagenic
Erythromelalgia - tender or painful burning and/or redness of fingers, palms, heels or toes
Headache, facial redness

Investigation
Hb and hematocrit - elevated
Wbc and platelets - may be elevated
JAK2 mutation screen - usually present

Management
Acute = PHLEBOTOMY + low dose aspirin
Acute High-risk thrombosis patients = cytoreductive therapy(hydroxycarbamide) + aspirin
Ongoing = busulfan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the key findings in TRALI?

A

Dyspnea, hypoxemia, pulmonary oedema

- CXR - bilateral lung infiltrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Key findings in GvHD?

A

maculopapular rash is common

  • diarrhoea, abdominal pain, nausea
  • LFTs may be elevated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Key findings in allergic/anaphylactic reactions?

A

respiratory distress, angioedema, hives and itching, hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Key findings in febrile non-hemolytic reactions?

A

negative DAT test.

- 1 degree rise in temp may have chills/malaise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Key findings in acute hemolytic reactions?

A

fever, abdominal pain, hypotension, tachycardia

Haemoglobinaemia, hemoglobinuria, positive DAT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Key findings in TACO?

A

pulmonary oedema and hypotension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hemophilia findings and investigations?

A

Heamarthrosis, bleeding into muscles, mucocutaneous bleeding

pT time - normal
ApTT time - usually prolonged
Plasma factor 8 and 9 assays - decreased or absent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Findings, investigation and management for sickle cell disease?

A
  • persistent pain in skeleton, chest, and/or abdomen
  • dactylitis - swollen dorsa of hands and feet
  • Others: pneumonia like syndrome, visual floaters, jaundice(indicates hemolysis of rbcs), protuberant abdomen often with umbilical hernia(enlarged spleen), pallor

Hb electrophoresis
Peripheral blood smear- nucleated red blood cells, sickle-shaped cells, and Howell-Jolly bodies(seen in hyposplenia)
Fbc

Crisis = analgesia + o2 + treatment of cause

hydroxycarbamide, L-glutamine, crizanlizumab, voxeltor, blood transfusions may sometimes be used. Bone marrow transplantation in severe cases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are anticoagulants used for?

Give name of a drug from each group

A

Treat arterial and venous thrombosis

  1. Direct thrombin inhibitors - Dabigatran, lepirudin
  2. Indirect thrombin inhibitors - heparin
  3. Vitamin K epoxide reductase inhibitor - warfarin
  4. Direct Xa inhibitor - apixaban
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are antiplatelet drugs used for? Give an example from each class

A

Arterial disease

  1. Cox inhibitor - aspirin
  2. Glycoprotein inhibitors - eptifibatide, tirofiban
  3. ADP inhibitors - clopidogrel
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are thrombolytics used for?

Give examples

A

Arterial and venous thrombosis

Plasminogen activators - streptokinase, tenecteplase

17
Q

How does alpha thalassemi present? What are the different types?
Treatment?

A

Microcytic anemia

  1. Alpha thalessemia minima - silent carrier
  2. Minor - mild anaemia
  3. Hemoglobin h disease - moderate to severe anaemia
  4. Hemoglobin barts disease - incompatible with life

Acute hemolytic episodes- identification of cause + folic acid
Aplastic crisis - red blood cell transfusion

18
Q

Findings, investigation and management for beta thalessemia?

A

Microcytic anemia
Chipmunk facies
Hepatospleenomegaly and jaundice may occur

Diagnosis = increase in HbA2 on electrophoresis

Management - transfusions at times of symptomatic anaemia

19
Q

What are the findings in hodgkins lymphoma?

Investigations?

A

painless lymphadenopathy - cervical, supraclavicular, axillary, inguinofemoral

B SYMPTOMS! (fevers, night sweats, weight loss)

Dyspnea, cough, chest pain - mediastinal involvement

uncommonly but CHARACTERISTIC: pruritus, alcohol-induced pain at involved sites

PET-CT
Biopsy - Reed-Sternberg cells

20
Q

Non hodgkins lymphoma?

A
  • non-hodgkins = NO reed-sternberg cells
  • multiplel lymph nodes often involved
  • extranodal involvement unlike HL

painless lymphadenopathy
b symptoms - fevers, Night sweats, weight loss)
extranodal GI involvement - Bowel obstruction
extranodal bone marrow - fatigue, easy bruising, infections
spinal cord - weakness and loss of sensation

  • subdivided into b cell lymphomas (large b-cell lymphoma being the most common) and t cell lymphomas
21
Q

Acute lymphocytic leukemia/ALL findings?

A

> 20% blasts
Tdt +ve with immunophenotyping. T(ALL)
common in children

Peripheral blood smear = leukaemic lymphoblasts
FBC: aneamia, thrombocytopenia, ELEVATED WCC but neutropenia(=infection risk)

Definitive diagnosis = biopsy which shows >20% blasts

22
Q

Chronic lymphocytic leukemia/ CLL findings?

A
  • WBC count elevated with absolute lymphocytosis

- Blood film shows SMUDGE/SMEAR cells. CL(L) -> clean -> smudge

23
Q

Acute myelogenous leukemia

Investigations?
Management?

A

blast cells ≥20%
A in acronym -> Aeur Rods (cytoplasmic inclusions)
M in acronym -> MPO+ve
PML subtype associated with DIC and responds to treatment with all trans retinoic acid
common in older adults

FBC: may show pancytopenia
Peripheral blood smear: Auer rods
Definitive diagnosis = bone marrow biopsy and shows >20% blasts

24
Q

What is Chronic myelogenous leukemia?

Investigations?

Management?

Complications?

A

Myeloid stem cell proliferation - productions of mature and maturing granulocytes = neutrophils, metamyelocytes, myelocytes, basophils

FBC: may show aneamia and thrombocytopenia. ELEVATED WBC!!!!
Cytogenetic testing confirms diagnosis = Philadelphia chromosome t(9,22)

Tyrosine kinase inhibitor to treat

blast crisis: blast rises to >20%
low lap score differentiates from leukomoid reaction (benign neutrophilia)

25
Q

Multiple myeloma findings investigation and managment

A

A haematological cancer characterised by clonal proliferation of plasma cells in the bone marrow, typically associated with a monoclonal immunoglobulin in the serum and/or urine.

Bone pain(typically localised to the back) and anemia - most common

CRAB = Hypercalcemia, renal involvement, anemia, back pain

serum and urine protein electrophoresis = 1st line - paraprotein spike (IgG >35 g/L [>3.5 g/dL] or IgA >20 g/L [>2.0 g/dL] and light chain urinary excretion >1 g/day); hypogammaglobulinaemia
bone marrow aspirate and biopsy - plasma cell infiltration
whole-body low-dose CT - osteolytic lesions, pathological fractures

Under 65: Induction therapy (thalidomide + dexamethasone) + DVT prophylaxis(aspirin) + stem cell transplant. + bisphosphonates/denosumab for bone disease
Non transplant: Melphalan, prednisolon

26
Q

Classic hemolysis findings?

A 
Normocytic anemia (normal MCV) 
Increase in LDH 
Increase in indirect bilirubin 
Increase in reticulocyte count 
Urine hgb and hemosiderin (intravascular)
decrease in haptoglobin
27
Q

Findings and treatment for herdeitary spherocytosis?

A

Labs consistent with hemolytic anemia
Spherocytes on blood film
Splenomegaly
Treatment = red blood cell transfusion for symptomatic aneamia. folic acid, splenectomy if severe

28
Q

What are the findings, investigations and treatment for paroxysmal nocturnal hemoglobinuria?

A

Hemoglobinuria(dark brown urine, typically occurring at night), budd-chiari syndrome, thrombosis
Flow cytometry for GPI anchor proteins - >1% of anchor deficient granulocytes
Urine dipstick - hemoglobinuria
Treatment = eculizumab

29
Q

Findings investigation and management for G6PD deficiency?

A

Labs consistent with hemolytic anemia
Blood film shows heinz bodies (precipitated oxidized hemoglobin)
Ghost cells and hemighost cells from intravascular hemolysis, bite cells
avoid fava beans, oxidant drugs, and naphthalene. + give folic acid

30
Q

How does pyruvate kinase deficiency present?

A

A cause of hemolytic anemia in a newborn. Echinocytes on blood film

31
Q

Differentiate between iron deficiency anemia and aneamia of chronic disease

A

In iron deficiency - low iron and low ferritin(store of iron). Transferrin/TIBC is HIGH (transports iron around the body). Transferrin saturation (iron/TIBC) is low

In anemia of chronic disease - low iron and HIGH ferritin. Transferrin and transferrin saturation is low.
Associated with Chronic infections (TB, HIV) autoimmune disorders like RA, malignancy.

32
Q

How does aplastic aneamia present?

A

May present with neutropenia, anemia or thrombocytopenia

Bone marrow biopsy - hypocellular without abnormal cells

RFs - radiation and drugs, PNH
Immunosuppressants + stem cell transplantation

33
Q

Differentiate between the different causes of megaloblastic anemia and how they present

A

Vitamin B12 - neurological symptoms, increase in methylmalonic acid and homocysteine
Folate deficiency - no neurological symptoms, normal methylmalonic acid. Raised homocysteine. If both B12 and folate deficiency, treat B12 first to prevent SACD

Agents or mutations that impair DNA synthesis:
azathioprine
cytotoxic chemotherapy
Folate antagonists - methotrexate
Bone marrow cancers - myelodysplastic syndrome

34
Q

Treatment for b12 and folate deficiency?

A 
B12 = IM hydroxycobalamin 
Folate = oral supplements
35
Q

key leukemia symptoms?

A

fatigue - anemia
easy bleeding -thrombocytopenia
infections - neutropenia
pain and tenderness in bones due to blast production in acute leukemias
hepatomegaly, spleenomegaly, lymphadenopathy variable

36
Q

What is tumour lysis syndrome?

What are the features?

A

Complication of cancer treatment/chemo

  1. Kidney Failure and Hypocalcemia - due to released phosphate that forms crystals
  2. Released Uric acid -> Gout
  3. Released Potassium -> Hyperkalemia and arrhythmias
37
Q

What are the findings in TTP?

A

HUS + fever and neurological manifestations

Hemolytic ureamic syndrome = triad of Hemolytic anemia(low Hb, high bilirubin), uremia(AKI- may show rise in creatinine, proteinuria, hematuria) and thrombocytopenia.
Usually following Diarrhea episode!! which is usually bloody!!! and due to shiga-toxin producing e.coli.

Medicine MBBS year 3 (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions