Blood and infection Flashcards
(85 cards)
1
Q
what is used to correct B12 deficiency
A
IV hydroxycobalamin
2
Q
normal lifespan of RBC
A
120 days - can be as short as 5 days in haemolytic anaemia
3
Q
3 types of acquired immune haemolytic anaemias
A
- autoimmune (warm/cold antibody type)
- alloimmune (transfusion reaction, haemolytic disease of newborn)
- drugs (methyldopa, penicillin)
4
Q
types of acquired non-immune haemolytic anaemias
A
- microangiopathic (TTP/HUS, DIC, malignancy, pre-eclampsia)
- prosthetic heart valves
- infections (malaria)
- dapsone
- paroxysmal nocturnal haemoglobinuria
5
Q
treatment of autoimmune haemolytic anaemia
A
- corticosteroids
- rituximab/ azathioprine/ cyclophosphamide
6
Q
what virus is found in 50% of cases of Hodgkin’s lymphoma
A
EBV
HIV and immunosuppression and smoking are also risk factors
7
Q
B symptoms found in 25% of patients with Hodgkin’s lymphoma
A
- night sweats
- unexplained fever >38
- weight loss >10% over 6 months
8
Q
what blood test finding shows a poor prognosis in Hodgkin’s lymphoma
A
ESR >70
9
Q
vaccines given in lymphoma
A
pneumococcal and flu
10
Q
risk of giving chemotherapy in Hodgkin’s lymphoma
A
can cause leukaemia, especially AML
11
Q
poor prognostic factors for Hodgkin’s lymphoma
A
- older
- male
- low albumin
- stage IV disease
- anaemia, leukocytosis, lymphopenia, monocytosis
12
Q
type of non-hodgkin’s lymphoma associated with EBV
A
Burkitt’s
13
Q
how does Burkitt’s lymphoma present
A
large abdo mass and symptoms of bowel obstruction
14
Q
appearance of biopsy in Burkitt’s lymphoma
A
starry sky
15
Q
what is MGUS
A
monoclonal gammopathy of undetermined significance
can progress to smouldering myeloma which leads to multiple myeloma
16
Q
presentation of myeloma - CRABBI
A
- Calcium - hypercalcaemia due to increased osteoclast activity within bones
- Renal damage (elevated creatinine)
- Anaemia (BM crowding suppresses erythropoiesis)
- Bleeding (thrombocytopenia)
- Bones - lytic bone lesions
- Infection (reduced production of normal immunoglobulins)
17
Q
investigation to do for myeloma
A
serum/urine protein electrophoresis
raised concentration of monoclonal immunoglobulins
Bence Jones proteins in urine
18
Q
common MRI finding in myeloma
A
rain drop skull due to bone lysis
19
Q
BM biopsy in myeloma
A
monoclonal plasma cells in BM >10%
20
Q
management of myeloma in younger healthier patients
A
autologous stem cell transplantation
given with bortezomib (proteasome inhibitor) and dexamethasone
21
Q
management of myeloma in older patients
A
thalidomide, dexamethasone and an alkylating agent
22
Q
complications of myeloma
A
- hypercalcaemia
- renal impairment
- anaemia
- infection
- hyper viscosity (stroke?)
- SCC
- pathological fractures
- bleeding
- amyloidosis
- peripheral neuropathy
23
Q
most common causes of DIC
A
sepsis
also malignancy - especially leukaemia
then trauma, pregnancy complications etc.
24
Q
typical presentation of DIC
A
bleeding from at least 3 unrelated sites
confusion and disorientation
fever
bruising, purpura
25
features of sickle cell disease in infancy
- dactylics
- splenic sequestration
- pneumococcal sepsis
26
features of sickle cell disease in young children
- infections, parvovirus
- vaso-occlusive crises in long bones
- upper airway obstruction
- stroke
27
features of sickle cell disease in older children
- vaso-occlusive crises
- avascular necrosis
- stroke
28
management of acute sickle cell crisis
- analgesia
- antihistamine
- hydration 150% of normal maintenance oral or IV
- abx if needed
- blood transfusion in aplastic crisis, sequestration or anaemia
29
maintenance management of sickle cell disease
- avoid precipitating factors
- hydroxycarbamide
- L-glutamine
- repeated blood transfusions
- vaccinations
- lifetime oral penicillin V prophylaxis
- daily oral folic acid
30
what can be curative for sickle cell disease
BM transplantation
31
commonest cause of mortality in sickle cell disease
acute chest syndrome - vast-occlusion and collapse in the lungs
32
trigger for aplastic crisis in sickle cell
parvovirus B19
33
what is splenic sequestration in sickle cell
life threatening sudden enlargement of the spleen leading to hypovolaemia
34
what can sickle cell do to the penis
cause priapism - risk of long term impotence
35
when does someone with haemophilia require prophylactic factor VIII concentrate
if <1% activity = severe disease
36
what can IM bleeds in haemophilia lead to
compartment syndrome
nerve compression
ischaemic contracture
37
clotting results in haemophilia
increased APTT
| normal PT
38
prophylactic treatment in haemophilia A
regular injections of octocog alfa (FVIII)
39
prophylactic treatment of haemophilia B
regular injections of nonacog alfa (FIX)
40
what is indicated if bleeding in haemophilia doesn't respond to treatment
FVIII inhibitor development
41
most common type of thalassaemia
beta - heterozygous
42
how is diagnosis of thalassaemia made
haemoglobin electrophoresis
- beta = high levels of HbA2 and HbF
- alpha = normal levels
43
features of homozygous beta-thalassaemia
- severe haemolytic anaemia
- compensatory bone marrow hyperplasia
- protruding characteristic bossing of facial and skull bones and dental abnormalities
- hepatosplenomegaly
44
why is desferrioxamine given when doing blood transfusions for thalassaemia
blood transfusions cause haemosiderosis due to iron overload therefore give a chelating agent with it
45
drugs which can cause neutropenia
- chemotherapy/ radiotherapy
- alcohol
- phenytoin
- chloramphenicol
46
infections which can cause neutropenia
```
malaria
hep B/C
HIV
CMV
infectious mononucleosis
```
47
definition of febrile neutropenia
temp >38.5 or 2 temps >38 for 2 hours
and absolute neutrophil count <0.5
48
autologous vs allogenic bone marrow replacement
autologous = stem cells for transplant from own body (sourced when in remission)
allogenic = stem cells from a donor
49
cells on blood film in AML
blast cells
| Auer rods
50
what is diagnostic of AML
bone marrow aspiration
51
first line treatment for CML
imatinib (tyrosine kinase inhibitor)
52
what is Richter's syndrome
transformation of CLL to terminal lymphoma in 10%
53
when to give antibiotic prophylaxis during surgery with anaesthesia
- prosthesis or valve
- clean-contaminated surgery
- contaminated surgery
- surgery on dirty/infected wound
- tourniquet is used
54
type of cancer associated with infectious mononucleosis
- Burkitt's lymphoma
| - B cell lymphomas
55
difference in symptoms between tonsillitis and infectious mononucleosis
EBV = generalised tender lymphadenopathy
tonsilitis = only enlarges upper anterior cervical chain
56
when can there be a false positive with a mono spot test
lymphomas
leukaemia
RA/SLE
some viral illnesses
57
diagnostic test for infectious mononucleosis in the immunosuppressed
quantitative PCR
58
CNS complications of infectious mononucleosis
- aseptic meningitis
- encephalitis
- Guillain-Barre syndrome
59
suppression if MRSA positive
- mupirocin for nose TDS 5 days
| - chlorhexidine gluconate for skin, OD for 5 days
60
typical antibiotic which can cause C. diff
clindamycin
61
severe complication of C. diff
toxic megacolon
62
test to do if symptomatic (C. diff)
C. diff toxin in stool
63
management of C. diff
- supportive
- AVOID loperamide/codeine (retention of toxins?)
- cease causative antibiotic
- oral METRONIDAZOLE 10-14 days
- if not responding - VANCOMYCIN
64
antibiotics to give in life-threatening C. diff
oral vancomycin + IV metronidazole
65
is C. diff a reportable disease
yes
66
3 types of influenza
A B C
A and B cause most disease (A causes most flu outbreaks)
67
when to use antivirals in influenza (oseltamivir, zanamivir)
significant comorbidities, immunosuppression, pregnancy
68
most common complication of influenza
acute bronchitis
69
blood film - measles
leucopenia
| lymphopenia
70
LFTs - measles
raised transaminases
71
complications of measles
- acute OM
- pneumonitis
- febrile convulsions
- keratoconjunctivitis, corneal ulceration
- encephalitis
- subcutaneous sclerosing pan encephalitis (about 7 years after measles infection)
72
complications of mumps
- orchitis
- hearing loss
- meningoencephalitis
- pancreatitis
- oophoritis
73
school exclusion for mumps
for 5 days following parotid swelling
74
school exclusion for chicken pox
5 days from start of skin eruption
75
when to use acyclovir in chicken pox
- severe varicella
- encephalitis
- pneumonia
- babies
- immunosuppressed
76
complications of chicken pox
bacterial infection may occur with invasive group A strep - leading to cellulitis, necrotising fasciitis or TSS
NSAIDs may increase this risk
77
antibiotics given for whooping cough
azithromycin (5 days)
clarithromycin (7 days0
erythromycin if pregnant
78
when to do stool culture in infective gastro-enteritis
- suspected sepsis
- blood/mucus in stool
- immunocompromised
- recently been abroad
- diarrhoea not improving
79
complications of infective-gastroenteritis
- dehydration and electrolyte disturbance
- HUS
- reactive arthritis
- erythema nodosum
- GBS
- malnutrition
80
what virus commonly causes Guillain-Barre
campylobacter
81
protective factors for malaria
- sickle cell trait
- G6PD deficiency
- HLA-B53
82
what to check before giving primaquine
G6PD deficiency
83
management of non-falciparum malaria
outpatient
chloroquine
primaquine used for prevention of relapse
84
management of falciparum malaria
quinine plus doxycycline orally if uncomplicated
IV quinine if severe with ECG monitoring
85
antimicrobial therapy given for traveller's diarrhoea
fluoroquinolone
