haematology

Question 1

Multiple myeloma - key features in presentation

Answer 1

• wide consellation of symptoms including
  “CRAB”:
• Calcium elevated (bones, moans, stones, groans)
• Renal failure/impairment (+ Creatinine, +/- Ur)
• Anaemia (TATT, fatigue, SOBOE, exertional angina)
• Bony pain, pathological # (lytic bony lesions, sclerotic picture xr, multiple vertebral compression #)
  +/- recurrent bacterial infections >2 in 6/12

Question 2

Suspected Multiple myeloma - Initial ix

Answer 2

FBC
blood film - rouleaux 
UEC
Ca
LFT
ESR

Question 3

Multiple myeloma - Ix

Answer 3

serum protein electrophoresis - monoclonal paraproteins
24hr urine protein + electrophoresis
serum light chain analysis (kappa/lambda)
skeletal survey xray

Question 4

Multiple myeloma - Mx

Answer 4

referral to haematology for bone marrow biopsy and ongoing management

Question 5

Fatigue/TATT - most likely ddx

Answer 5

stress/anxiety/depression
post + viral infection
sleep related disorders
lifestyle factors

Question 6

Fatigue/TATT - serious/not to miss ddx

Answer 6

Thyroid 
DMT2
CKD
malignancy
cardiac arrhythmia
anaemias
haemochromatosis
CCF
HIV/Chronic Hepatitis C

Question 7

Fatigue/TATT - red flag features

Answer 7

new onset fatigue in previously well older patient
unintentional wt loss
abnormal bleeding
SOB
lymphadenopathy
fever
recent onset or progression of cvd, rheum, neuro, git symptoms

Question 8

Fatigue/TATT - hx key features

Answer 8

onset, duration, severity
assocuated symptoms
social hx - snap, drugs, sleep
occupation hx 
medications
red flags - constitutional symptoms

Question 9

Fatigue/TATT - examination

Answer 9

vitals
ht wt BMI
Pallor, jaundice, skin pigmentation
Thyroid exam 
Abdo - hepatosplenomegaly, 
Lymphaednopathy
CVS/Resp exam 
MSE

Question 10

Fatigue/TATT - mx

Answer 10

Office tests - urine dipstick, BSL, +/- ECG
No red flags/disease unlikely - lifestyle advice
watch and wait, review in 4 weeks

Question 11

Fatigue/TATT - Initial Ix

Answer 11

FBC
ESR
BSL
TSH
\+/- Iron studies
\+/- LFTs
\+/- UEC

Question 12

Thrombocytopenia - aetiology/broad categories (4)

Answer 12

1. Increased destruction (immune):
Immune mediated thrombocytopenia (ITP)
Drug induced thrombocytopenia
Viral induced thrombocytopenia
2. Increased destruction (non-immune):
DIC
TTP-HUS
3. decreased production: malignancy, HIV, vit b12 deficiency
4. splenic sequestration

Question 13

Thrombocytopenia - key features in hx

Answer 13

Alcohol intake
Bleeding
bruising
PMHx - thyroid, CTX, malignancy
Medications
Possible HIV/HCV exposure
Recent illness - sore throat 
Rashes

Question 14

Thrombocytopenia - key features in ex

Answer 14

Lymphadenopathy
splenomegaly
Stigmata of CLD - hepatomegaly, jaundice ascites
Sepsis - HR, Temp, BP