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phase 2a > Haem > Flashcards

Haem Flashcards

1
Q

Downs syndrome = which cancer?

A

ALL

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2
Q

philadelphia chromosome = which cancer?

A

ALL

CML

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3
Q

smudge cells = which cancer?

A

CLL

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4
Q

Warm autoimmune haemolytic anaemia = which cancer?

A

CLL

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5
Q

Auer rods = which cancer?

A

AML

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6
Q

What are the 3 stages of CML?

A
  1. chronic - 5yrs - high white cell count
  2. accelerated – blasts, thrombocytopenia, anaemia
  3. blast - pancytopenia
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7
Q

pain in neck when drinking = which cancer?

A

Hodgkins lymphoma

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8
Q

reed sternberg cells = which cancer?

A

Hodgkins lymphoma

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9
Q

Owls eye = which cancer?

A

Hodgkins lymphoma

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10
Q

rouleux formation = which cancer?

A

myeloma

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11
Q

Lymphoblastic leukaemias come from which cell line?

A

Lymphocytes (B)

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12
Q

CML and AML come from which cell line?

A

Myeloid (hence myeloblastic in name)

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13
Q

Chronic leukaemias come from ______ cells whereas acute leukaemias come from _______ cells

A

chronic - from well defined line

acute - from blasts

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14
Q

Lymphomas are usually from what cell line?

A

B

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15
Q

3 Causes of microcytic anaemia?

A 
T thallassaemia 
Anaemia of chronic disease 
Iron deficiency (most common)
Lead
Sideroblastic
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16
Q

3 causes of normocytic anaemia?

A 
Anaemia of chronic disease 
Aplastic 
Acute bleeding 
Hypothyroid
Haemolytic
Sickle cell
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17
Q

Cause of megaloblastic macrocytic anaemia?

A

Low vit B12

Low folate

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18
Q

3 Causes of normoblastic macrocytic anaemia?

A 
alcohol
liver dis 
hypothyroid
azathiopurine
reticular cytosis
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19
Q

what is the definition of anaemia?

A

low haemoglobin in the blood

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20
Q

what is pernicious anaemia?

A

autoimmune destruction - of parietal cells or intrinsic factor
= cannot absorb B12

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21
Q

2 causes of low folate?

A

pregnancy
lack of green veg
malabsorption
haemolysis

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22
Q

5 symptoms of anaemia?

A 
tired 
SOB
headache
dizzy
palpitations
pale
conjunctival pallor 
resp rate high
tachycardia
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23
Q

5 symptoms / signs specifically of iron deficiency anaemia?

A 
pica
hair loss
koilonychia 
angular cheilitis 
atrophic glossitis 
brittle hair / nails
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24
Q

investigations for haemolytic anaemia?

A

haemoglobin, MCV
blood film - spherocytes and polychromasia
haptoglobin (low)
lactate dehydrogenase (high)

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25
Q

blood tests that indicate the amount of iron?

A

ferritin - low
transferrin saturation - low
total iron binding capacity - high

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26
Q

an example of an oral iron supplement? a problem with this?

A

ferrous sulphate

slow so not good enough for severe cases

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27
Q

4 presenting features of DVT?

A 
pain
unilateral swelling
warmth 
tender 
discolouration
phlegmasia
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28
Q

gold standard investigation for ?DVT?

A

ultrasound/doppler

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29
Q

first line investigations in DVT?

A 
measure the calf 
D dimer (sensitive not specific)
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30
Q

management of DVT?

A

heparin
warfarin
apixaban
recannalisation

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31
Q

what part of haemoglobin is affected in sickle cell?

A

beta

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31
Q

what part of haemoglobin is affected in sickle cell?

A

beta

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32
Q

what haemoglobin proteins to adults have?

A

2 alpha 2 beta

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33
Q

3 main features of sickle cell disease? & the symptoms this causes?

A

pain
haemolysis = jaundice, gallstones
anaemia = tired, dizzy, palpitations

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34
Q

3 consequences of sequestration crisis in sickle cell?

A 
thrombocytopenia 
splenomegaly 
abdo pain
hypovolaemic shock
fibrosis of spleen 
infection with encapsulated bacteria
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35
Q

3 complications of sickle cell?

A 
sequestration crisis 
acute chest
sepsis 
heart failure
vaso occlusion of bone (avascular necrosis, dactylitis)
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36
Q

what kind of anaemia in sickle cell?

A

normocytic

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37
Q

what test for screening newborns for sickle cell?

A

guthrie

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38
Q

what do you see on the blood film in sickle cell? 3

A

sickled RBCs
target cells
howell jolly bodies

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39
Q

gold standard for sickle cell?

A

Hb electrophoresis

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40
Q

drug for sickle cell, how does it work?

A

hydroxycarbamide, stimulates production of foetal haemoglobin which is unaffected

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41
Q

supportive management for sickle cell?

A 
antibiotics 
transfusions
iron chelation
folic acid 
vaccination
bone marrow transplant 
analgaesia 
oxygen
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42
Q

5 symptoms / signs of leukaemia?

A 
tiredness
failure to thrive 
anaemia (pallor, dizzy etc)
petechiae 
bleeding 
lymphadenopathy 
hepatosplenomegaly 
infection
testicular swelling
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43
Q

gold standard diagnosis for leukaemia?

A

bone marrow biopsy (trephine or liquid aspiration) shows smudge cells - not specific for CLL

for CLL you would use peripheral blood flow cytometry

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44
Q

risk factors for lymphoma?

A

immunosupression:

  • wiscott aldrich
  • drugs eg methotrexate
  • HIV

infection eg HIV, H pylori

45
Q

what are the B symptoms?

A

fever
night sweat
weight loss

associated with lymphoma

46
Q

apart from B symptoms 3 other symptoms of lymphoma?

A 
lymphadenopathy (rubbery non tender)
fatigue
itching
SOB 
infection
abdo pain 
splenomegaly
compression syndrome eg optic nerve
47
Q

gold standard diagnosis for lymphoma?

A

core needle lymph node biopsy

48
Q

what staging system is used for lymphoma?

A

ann arbour

49
Q

explain the classes of ann arbour staging?

A

1 - one lymph node or area of nodes
2 - more than one lymph node on same side of diaphragm
3 - in lymph nodes above + below diaphragm
4 - widespread, in organs

50
Q

what is MGUS?

A

pre malignant myeloma - 1% progression per year
excess of an antibody, no symptoms

MGUS is also the name of a gene associated with myeloma

51
Q

what is smouldering myeloma?

A

pre malignant

plasma cells make up 10% of bone marrow population

52
Q

what is Waldenstroms macroglobulinaemia?

A

smoulding myeloma with IgM

53
Q

what does CRAB stand for?

A

calcium
renal
anaemia
bone

54
Q

what is the monoclonal paraprotein?

A

the antibody that is overproduced in myeloma

55
Q

what is the benz jones protein and where can you test to find it?

A

in the urine

the light chai of the monoclonal paraprotein in myeloma

56
Q

what happens to the bones in myeloma?

A

lytic and circular lesions
because of osteoclast activity
pepperpot skull

57
Q

what happens to the viscosity of the blood in myeloma?

A

viscosity increases because of all the protein in the blood
= vascular eye disease
but there are few platelets (because bone marrow busy making plasma cells) so bleeding, bruising, erythema

58
Q

what technique do you use to look for the benz jones protein in urine and the monoclonal paraprotein in serum?

A

electrophoresis

59
Q

what is the usual treatment for myeloma?

A

induction therapy (bortezamid, dexamethasone and thalidomide) followed by stem cell transplant

bisphosphonates
thromboembolism prophylaxis

60
Q

where do malaria parasites go in the body?

A 
mosquito saliva 
patients bloodstream
liver
blood cells  
bitten by mosq -- mosq saliva
61
Q

3 traits that protect against malaria?

A

sickle cell
thalassaemia
G6PD deficiency

62
Q

which species causes the most severe form of malaria?

A

plasmodium falciparum

63
Q

presentation of malaria?

A

cyclical fever (sweats, rigors) and anaemia (jaundice)

hypoglycaemia 
myalgia 
vomitting 
hepatosplenomegaly
headache 
fatigue
64
Q

3 complications of ‘complicated malaria’?

A

coagulation = cerebral ischaemia, resp ischaemia, ARDS
vascular permeability = translocation of bacteria from bowel = sepsis
AKI
disseminated intravascular coagulation

65
Q

tests for malaria?

A

blood film
- thick - is there malaria?
- thin - what species?
rapid antigen diagnostic test

66
Q

what type of anaemia in malaria?

A

normocytic

67
Q

treatment for complicated malaria?

A

IV artesunate

quinine dihydrochloride

68
Q

treatment for mild malaria?

A

proguanil

atorvaquone

69
Q

3 causes of secondary polycythaemia?

A

smoking
hypoxia
altitude
renal or hepatocellular carcinoma that is ectopically producing EPO

70
Q

what is the most common mutation in polycythaemia? There are 2 more?

A

JAK 2 - most common (= EPO stimulated proliferation physiologically)
MPL
CALR

71
Q

what leukaemia are myeloproliferative disorders incl polycythaemia most likely to progress into?

A

AML

72
Q

There are 2 phases in polycythaemia vera, what happens in each?

A

first phase: increase platelets, neutrophils and RBCs
= hyperviscosity of blood = DVT
but also bleeding because even though there are a lot of RBCs they arent properly regulated / functional

spent phase: BM cannot produce cells = low platelets, leucocytes and anaemia, fibrosis of the bone marrow, hepatosplenomegaly in an attempt to compensate

73
Q

5 presenting features of PCV?

A 
ruddy / plethoric complexion
red eyes (conjunctival plethora)
palmar erythema 
HTN 
hepatosplenomegaly 
DVT etc 
symptoms of anaemia eg fatigue, dizzy etc
blurred vision
sweating/flushing 
pruritis 
eythromyalgia
74
Q

2 ways you can work out if its primary or secondary polycythaemia?

A

EPO: low in primary, high in secondary
(secondary polycythaemia = high EPO so high RBCs etc)

ABG: high pCO2 could explain the need for secondary polycythemia

75
Q

On a blood film in PCV what would you see?

A

tear drop cells
poikylocytosis
blasts

76
Q

management of PCV?

A

venesection
aspirin

stem cell transplant
chemo

77
Q

what are the intrinsic and extrinsic clotting pathways?

A 
intrinsic = activated by platelets close to the damage
extrinsic = activated by exposed tissue factor
78
Q

how is von Willebrand disease inherited & what does it cause?

A

dominant

deficiency of vWF = abnormal bleeding

79
Q

what is ITP?

A

immune system produces antibodies against platelets
= destruction of platelets, rubbish clotting, purpura, bruising, bleeding
treat with prednisolone, retuximab

80
Q

what is TTP?

A

mutation in or autoimmunity to the protein that activates vWF
multiple clots in small vessels = angiopathy and uses up the platelets

81
Q

Heinz bodies / bite cells indicate?

A

G6PD deficiency

82
Q

Investigations for haemophilia?

A

coagulation factor assay

genetic testing

PT time normal (as is extrinsic and intrinsic pathways)
activated partial prothrombin time is prolonged (as is only the intrinsic and common pathway. Haemophilia affects intrinsic pathway only)

83
Q

what is haemophilia A and B?

A 
A = low factor 8 
B = low factor 9
84
Q

Which leukaemia is most likely to affect young children?

A

ALL

85
Q

How long do you need to be on anticoagulants for after DVT?

A

3 months if provoked

6 months if unprovoked

86
Q

low haemoglobin but high reticulocyte is ..

A

sickle cell
hereditary spherocytosis

low Hb because of increased haemolysis
high reticulocytes bc body attempting to replace damaged

87
Q

what is thalassaemia?

A

a defect in alpha or beta globin – abnormally functioning Hb – microcytic anaemia and haemolysis

88
Q

presentation of thalassaemia?

A 
prominent forehead/cheek bones due to bone marrow expansion
fractures 
splenomegaly
jaundice 
symptoms of anaemia 
failure to thrive 
gallstones
89
Q

what is hereditary spherocytosis?

A 
jaundice, anaemia and splenomegaly
RBCs are more permeable to sodium 
aplastic crisis with parvovirus
autosomal dominant inheritance
north europe
management = splenectomy
90
Q

what condition causes jaundice, splenomegaly and anaemia especially after antimalarials/antibiotics, broad beans or infections?

A

G6Pd deficiency

91
Q

are lymphoma myeloproliferative disorders?

A

no, myeloproliferative disorders affect the myeloid line not the lymphoid line (so some leukaemia are myeloproliferative)

92
Q

what bleeding disorder causes raised bilirubin?

A

TTP

bilirubin from the body breaking down all the clots that TTP goes about making

93
Q

3 things that myeloma is characterised by?

A

Malignant proliferation of plasma cells
Lytic deposits in bones
Presence of abnormal globulin (usually IgG or A)

94
Q

Which cancer has gum hypertrophy?

A

AML

95
Q

Treatment for Hodgkin lymphoma?

A

ABVD (Adriamycin, bleomycin, vinblastine, dacarbazine)

96
Q

Treatment for non Hodgkin lymphoma?

A 
R-CHOP
rituximab
cyclophosphamide 
prednisolone
vincristine
97
Q

Treatment for ALL and AML?

A 
Chemo 
Radio
Stem cell transplant 
allopurinol - for all
blood/platelet tranfusion
98
Q

Treatment for CML and CLL?

A

CML - imatinab (philadelphia)

CLL - chemo and radio, nothing is curative

99
Q

presentation of TTP?

A 
neuro - eg headache confusion dysarthria
fever 
microangiopathic haemolytic anaemia 
thrombocytopenia - bleeding bruising 
renal failure
100
Q

Tests and results for TTP?

A

Blood smear shows fragmented erythrocytes, ie schistocytes
high LDH.
Indirect bilirubin level
reticulocyte count is elevated
Urinalysis shows proteinuria and microscopic haematuria

101
Q

treatment for TTP?

A

plasma exchange
IV prednisolone
IV rituximab

102
Q

presentation of DIC?

A 
asymptomatic 
bleeding 
bruising 
petechiae 
SOB 
haemoptysis
103
Q

investigations and results for DIC?

A

Low platelets
Prolonged APTT, prothrombin and bleeding time
Fibrin degradation products raised (eg. D-dimer)
Blood film; Schistocytes due to microangiopathic haemolytic anaemia

104
Q

3 presentations of ‘bleeding disorders’

A 
gum bleeding 
menorrhagia 
epistaxis 
petechiae 
bruising
105
Q

which species of protozoa cause relapses of malaria?

A

p ovale

p vivax

106
Q

What chromosomal translocation is there in myeloma?

A

11;14

107
Q

Which leukaemia can undergo a Richter’s transformation to malignancy?

A

CLL

108
Q

3 symptoms of G6PD deficiency?

A

fatigue
palpitations
SOB
pallor

109
Q

4 things in the wells score?

A

heart rate over 100
haemoptysis
malignancy
signs of DVT

110
Q

explain the pathophysiology of DIC?

A

consumptive coagulopathy
tissue damage = release of tissue factor = widespread clot
tissue plasminogen activator = fibrinolysis

thrombosis and then fibrinolysis of those clots = bleeding

111
Q

sepsis 6?

A 
give fluuid
give broad spec abx 
give oxygen
take blood culture
lactate dehydrogenase 
urine output

phase 2a (10 decks)

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