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haem Flashcards

1
Q

presentations of Hodgkin’s lymphoma?

A
  • bimodal
  • painless asymmetrical
  • pain when drinking alcohol
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2
Q

presentations of multiple myeloma?

A
  • 70+,
  • anaemia,
  • bone pain
  • neutropenia
  • thrombocytopenia (due to bone marrow infiltration), recurrent infections due to monoclonal Igs, renal impairment due to free light chains, pathological fractures and vertebral collapse due to bone lesions
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3
Q

what is polycythaemia rubra vera?

A

blood hyper viscosity due to increase in cellular content, causing thrombosis and poor O2 delivery

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4
Q

presentations of polycythaemia rubra vera?

A
  • thrombosis and poor O2 delivery
  • headaches, dizziness, visual disturbances, vertigo, tinnitus, intermittent claudication
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5
Q

why is stomach cancer sometimes a differential for lymphomas?

A

can present with Virchow’s node - supraclavicular

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6
Q

where are Auer rod’s found?

A

acute myeloid leukaemia

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7
Q

where are Reed-Steinburg cells found?

A

Hodgkin’s lymphoma

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8
Q

are basophils increased or decreased in chronic myeloid leukaemia?

A

increased

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9
Q

describe haemoglobin and platelet count in chronic myeloid leukaemia

A

decreased due to replacement of normal bone marrow cells with cancerous

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10
Q

describe Ann Arbor classification for Hodgkin’s and non lymphoma

A
  1. Single LN region
  2. > /= 2 nodal area on the same side of the diaphragm
  3. Nodes on both sides of the diaphragm
  4. Disseminate e.g. metastasised to the liver
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11
Q

where would you find monoclonal antibodies and Bence-Jones proteins?

A

multiple myeloma

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12
Q

what would the FBC show for chronic myeloid leukaemia?

A

high WCC; haemoglobin and platelets can be higher or lower

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13
Q

list the risk factors of DVT

A
  • immobility (e.g. hospital bed, long haul flight)
  • dehydration
  • oestrogen increase (e.g. pregnancy, OCP)
  • obesity (atherosclerosis)
  • age
  • varicose veins
  • surgery
  • previous DVT
  • trauma
  • infection
  • malignancy
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14
Q

what is the gold standard investigation for DVT?

A

Doppler US

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15
Q

when do you use the D-dimer test?

A

suspected DVT - high sensitivity and low specificity; negative - rules out DVT, positive - does not confirm

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16
Q

which type of anaemia is reduced reflexes a symptom of?

A

macrocytic anaemia caused by hypothyroidism and vitB12 deficiency

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17
Q

which type of anaemia can a vegan diet cause?

A

vit B12 deficiency - macrocytic megaloblastic anaemia

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18
Q

how do you differentiate between vit B12 and folate deficiency which both lead to macrocytic, megaloblastic anaemia?

A

vit B12 deficiency may present with neurological symptoms e.g. peripheral neuropathy

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19
Q

A patient recently started ceftriaxone for meningitis which has caused haemolysis, what would you expect to see on assessment of the patient?

A

darker urine (haematuria), acute anaemia, jaundice, dyspnoea, fatigue, tachycardia

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20
Q

list some causes of iron deficiency anaemia

A

CKD, GI bleed, NSAIDs, pregnancy, colorectal cancer, low dietary intake

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21
Q

3 signs and symptoms of immune thrombocytopenia purpura

A

easy bruising, epistaxis, gum bleeding

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22
Q

what is immune thrombocytopenia purpura?

A

A condition causing platelets to be destroyed by immune system

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23
Q

Name 4 signs you might see on examination of a patients’ face, skin, and nails that are associated with iron deficiency anaemia.

A

angular stomatitis, brittle skin, nails and hair, koilonychia, Atrophic glossitis

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24
Q

what signs would you expect to see in a patient when diagnosing malaria?

A

fever, chills/sweats, headache, myalgia, fatigue, diarrhoea, nausea, vomiting, abdominal discomfort, anaemia, jaundice etc

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25
Q

what species of protozoa can cause relapses of malaria?

A

plasmodium ovale and plasmodium vivax - can form hypnozoites in the liver which can lie dormant for years and cause relapses

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26
Q

What are the criteria needed to characterise multiple myeloma?

A
  • monoclonal protein in serum or urine
  • lytic bone lesions / CRAB end organ damage
  • excess plasma cells in bone marrow
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27
Q

Which chromosomal abnormalities are associated with multiple myeloma?

A

t(11;14)

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28
Q

What would you expect to see on a bone marrow biopsy for acute myeloid leukaemia?

A

Auer rods

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29
Q

what 2 things are associated with acute myeloid leukaemia?

A

down’s syndrome, radiation

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30
Q

5 potential treatments of acute myeloid leukaemia?

A

blood transfusion, IV antibiotics, chemotherapy, steroids, bone marrow transplant

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31
Q

expected age range for chronic lymphoblastic leukaemia?

A

70+

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32
Q

examination findings of chronic lymphoblastic leukaemia?

A

commonly asymptomatic, enlarged, rubbery, non-tender lymph nodes, sweating, anorexia

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33
Q

blood film of chronic lymphoblastic leukaemia?

A

smudge cells

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34
Q

treatment for chronic lymphoblastic leukaemia?

A

chemotherapy, monoclonal antibodies (rituximab), bruton kinase inhibitors (ibrutinib)

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35
Q

main complication of chronic lymphoblastic leukaemia?

A

Richter’s syndrome - transformation of CLL to an aggressive lymphoma

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36
Q

what investigations would you do for suspected lymphoma?

A

FBC, CXR, blood film

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37
Q

what would a FBC show for someone with Hodgkin’s lymphoma?

A

anaemia, high ESR

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38
Q

what would a CXR show for someone with Hodgkin’s lymphoma?

A

wide mediastinum

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39
Q

what would a blood film show for someone with Hodgkin’s lymphoma?

A

Reed-Sternberg cells

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40
Q

treatment for Hodgkin’s lymphoma?

A

chemotherapy ABVD treatment, marrow transplant

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41
Q

what is the function of G6PD?

A

protects the RBCs against oxidative damage

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42
Q

4 common presentations of G6PD deficiency?

A

fatigue, palpitations, SOB, pallor

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43
Q

What would you see on a blood film for G6PD deficiency?

A

bite cells, reticulocytes

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44
Q

which antibiotic is contraindicated for UTIs with a G6PD deficiency?

A

nitrofurantoin

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45
Q

6 symptoms for acute limb ischaemia?

A

Pulselessness, Perishingly cold, Pain, Pallor, Paraesthesia, Paralysis

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46
Q

complications of DVT?

A

PE, post-thrombotic syndrome, chronic venous insufficiency

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47
Q

first line investigation of DVT?

A

D-dimer test

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48
Q

name of scoring system used in making a diagnosis of DVT?

A

Well’s score

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49
Q

list 5 factors in the Well’s scoring system for DVT

A
  • clinical S/S of DVT
  • HR > 11bpm
  • previous DVT or PE
  • hemoptysis
  • immobilization >/ days or surgery in the previous 4 weeks
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50
Q

what is the platelet count for someone with disseminated intravascular coagulation?

A

low

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51
Q

how would prothrombin times change in disseminated intravascular coagulation?

A
  • PTT - elevated
  • APTT - elevated
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52
Q

how would the bleeding time change in disseminated intravascular coagulation?

A

elevated

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53
Q

what would the levels of fibrin degradation products and fibrinogen levels look like in disseminated intravascular coagulation?

A

high fibrin degradation products, low fibrinogen

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54
Q

what would D-dimer levels look like in disseminated intravascular coagulation?

A

elevated

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55
Q

what would coagulation factor show in disseminated intravascular coagulation?

A

low

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56
Q

explain the pathophysiology of disseminated intravascular coagulation

A
  • Cytokine release in response to a systemic inflammatory response syndrome
  • This causes fibrin to be deposited and the initiation of the coagulation pathway
  • This causes platelets and coagulation factors to be used up leading to EITHER microvascular thrombosis and organ failure OR bleeding
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57
Q

what are the sepsis 6?

A

BUFALO:
- Blood cultures
- Urine sample
- Fluids
- Antibiotics
- Lactate
- Oxygen

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58
Q

Which antibiotic is to be prescribed for the complicated UTI caused by E. coli?

A

nitrofurantoin or trimethoprim

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59
Q

differentials of polycythaemia rubra vera?

A

acute dehydration, chronic obesity, HTN, alcohol excess

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60
Q

typical presentations of polycythaemia rubra vera?

A
  • blurred vision, headaches, SOB, fatigue, weight loss, history of TIA/stroke/angina
  • LUQ tenderness, gum bleeding, splenomegaly
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61
Q

what would the blood test results show for polycythaemia rubra vera?

A
  • RBC: elevated
  • haematocrit: elevated
  • haemoglobin count: elevated
  • EPO levels: low - normal
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62
Q

what mutation may suggest polycythaemia rubra vera?

A

JAK-2

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63
Q

mode of inheritance for haemophilia A?

A

x linked recessive

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64
Q

mode of inheritance for haemophilia B?

A

x linked recessive

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65
Q

mode of inheritance for haemophilia C?

A

autosomal recessive

66
Q

haemophilia A is a deficiency of what?

A

factor VIII

67
Q

haemophilia B is a deficiency of what?

A

factor IX

68
Q

haemophilia C is a deficiency of what?

A

factor XI

69
Q

define platelet count

A

level of platelets per microlitre of blood

70
Q

define bleeding time

A
  • lab test to assess platelet function and the body’s ability to form a clot.
  • puncture wound is made and time taken for bleeding to stop is monitored
71
Q

define prothrombin time

A

measures the extrinsic pathway of clotting cascade - the time in seconds required for fibrin clot formation in a blood sample

72
Q

define activated partial prothrombin time

A

a measure of the functionality of the intrinsic and common pathways of the coagulation cascade.

73
Q

define thrombin time

A

a screening coagulation test designed to assess fibrin formation from fibrinogen in plasma

74
Q

define fibrin degradation products

A

a measure of the substances left behind when clots dissolve in the blood

75
Q

define d-dimer

A

degradation product of crosslinked (by factor XIII) fibrin, reflects ongoing activation of the hemostatic system

76
Q

activated partial thromboplastin time in haemophilia?

A

increased

77
Q

thrombin time in haemophilia?

A

normal or increased

78
Q

state 5 presentations of haemophilia

A
  • deep bruising
  • pain/swelling of joints
  • epistaxis
  • bleeds into heads causing headaches/double vision/weakness/vomiting
79
Q

treatment for haemophilia?

A

replace the missing factor with plasma

80
Q

which clotting factors does disseminated intravascular coagulation affect?

A

V and VIII

81
Q

what is hereditary spherocytosis?

A
  • defect in RBC membrane causing loss of membrane as they pass through the spleen
  • this causes increased Na+ permeability, requiring increased active transport out
  • SA:V decreases and cells become spherocytic
82
Q

define spherocytic

A

rigid and less deformable (than a normal RBC)

83
Q

What is the management for hereditary spherocytosis?

A

splenectomy

84
Q

describe the appearance of a blood film of a patient with beta thalassaemia major?

A

Large and small irregular hypochromic RBCs

85
Q

what differentiates to multiple myeloma in a question?

A

monoclonal antibodies, rouleaux formation and Bence-Jones proteins

86
Q

The most severe form of malaria with the highest rate of mortality in humans is caused by which species of mosquito?

A

Plasmodium falciparum

87
Q

what is the difference between complicated and uncomplicated malaria?

A

complicated - characterised by vascular occlusion (e.g. drowsiness, increased ICP -> seizures, coma)

88
Q

paediatric cancer?

A

acute lymphoblastic leukaemia (ALL)

89
Q

imatinib?

A

tyrosine kinase inhibitor, given in CML alongside chemo

90
Q

ibrutinib?

A

bruton kinase inhibitor, given in CLL

91
Q

rituximab?

A

monoclonal antibody, given in CLL

92
Q

describe Virchow’s triad

A

stasis of blood flow, hypercoagulability, endothelial injury

93
Q

what is the first line treatment for iron deficiency anaemia?

A

ferrous sulphate

94
Q

what drug is contraindicated in G6PD deficiency?

A

nitrofurantoin - can cause drug induced oxidative crisis; presents with symptoms associated with anaemia

95
Q

name 4 things that can cause thrombocytopenia

A
  • viral infections such as HIV / TB
  • toxins e.g. alcohol can reduce platelet production
  • myeloma and other cancers that can reduce platelet production
  • heparin can increase destruction of platelets (drug induced)
96
Q

what test is diagnostic for sickle cell anaemia?

A

Hb electrophoresis

97
Q

what drug is first line treatment for CML and what is its mechanism?

A

imatinib - tyrosine kinase inhibitor

98
Q

describe stage 1a of the Ann Arbor classification system

A

1 nodal area with no systemic symptoms (e.g. weight loss, fever, night sweats)

99
Q

describe stage 2a of the Ann Arbor classification system

A

2 or more nodal areas on the same side of the diaphragm with no systemic symptoms

100
Q

describe stage 2b of the Ann Arbor classification system

A

2 or more nodal areas on the same side of the diaphragm with systemic symptoms

101
Q

describe stage 3a of the Ann Arbor classification system

A

Involvement of nodal areas on both sides of the
diaphragm, with no systemic symptoms

102
Q

describe stage 3b of the Ann Arbor classification system

A

Involvement of nodal areas on both sides of the
diaphragm, with systemic symptoms

103
Q

describe the pathophysiology of hereditary spherocytosis

A

Spherocytosis is caused by a defect in the red cell membrane, which causes them to lose part of their membrane as they pass through the spleen. This abnormality is then associated with an increased permeability to sodium ions

104
Q

which stage of development of malaria is infective?

A

sporozoites

105
Q

what is the duration of apixiban treatment in provoked DVT?

A

3 months

106
Q

what is the duration of apixiban treatment in unprovoked DVT?

A

6 months

107
Q

what would the MVC be in a chronic alcoholic?

A

macrocytic anaemia

108
Q

what factor indicates a poor prognosis if found at time of diagnosis in ALL?

A

WCC > 20

109
Q

state 4 side effects of ABVD

A

infertility, cardiomyopathy, lung damage, peripheral neuropathy

110
Q

which gene is associated with multiple myeloma?

A

MGUS

111
Q

bimodal age incidence is characteristic of which leukaemia?

A

acute lymphoblastic

112
Q

decreased HbA, increased HbA2 and present HbF on Haemoglobin electrophoresis would confirm your diagnosis of what?

A

beta thalassaemia major

113
Q

state some presentations of beta thalassaemia major

A

jaundice, slow growth, chipmunk faces, swollen abdomen, fatigue/weakness

114
Q

what is the haemoglobin and reticulocyte count for sickle cell anaemia?

A

low haem, high reticulocyte

115
Q

previous infection with what is thought to have an association with developing non and Hodgkin’s lymphoma?

A

epstein-barr virus

116
Q

define pancytopenia

A

deficiency of all blood types - RBCs, WBCs, platelets

117
Q

what is the proper term for “spoon nails”?

A

koilonychia

118
Q

Give three possible causes of iron deficiency

A

low dietary intake, menorrhagia, pregnancy, GI malignancy

119
Q

In iron deficiency anaemia what three changes will be seen in plasma iron studies other than decreased MCV?

A

decreased ferritin levels, low iron levels, increased total binding capacity

120
Q

What plasma protein transports iron in the blood to the bone marrow?

A

transferrin

121
Q

Give 2 features of Microcytic Anaemia that would be seen on a blood film

A
  • small red blood cells
  • Pale red blood cells (hypochromic)
  • Variation in red blood cell shape (poikilocytosis)
  • Variation in red blood cell size (anisocytosis)
122
Q

Name 2 blood tests that would be carried out to diagnose Microcytic Anaemia

A
  • Serum ferritin
  • Serum iron
  • Serum soluble transferrin receptors
  • Reticulocyte count
123
Q

give 2 side effects of iron supplements

A

nausea, abdo discomfort, black stools, diarrhoea/constipation

124
Q

define monoclonal paraprotein

A

One immunoglobulin which is excessively produced (in myeloma)

125
Q

Which electrolyte is raised in patients with myeloma?

A

calcium

126
Q

Which type of anaemia is commonly observed in patients with myeloma?

A

normocytic normochromic anaemia

127
Q

Why do you give bisphosphonates to patients with myeloma?

A

to reduce fracture rates and bone pains

128
Q

How much fluid should myeloma patients drink daily?

A

3L

129
Q

What is the urgent gold standard treatment for someone with thrombotic thrombocytopenic purpura?

A

plasma exchange

130
Q

A 65-year-old man is on the ward recovering from a recent total hip replacement following a neck of femur fracture. What is an appropriate thromboprophylaxis regimen?

A

Dalteparin acutely and then maintenance treatment with apixaban

131
Q

What is the protein target of Rituximab?

A

CD20 protein on surface of B cells

132
Q

What is the ideal first line treatment for severe/complicated malaria?

A

IV artesunate

133
Q

define anaemia

A

low Hb conc due to reduced cell mass or increased plasma volume

134
Q

give 4 causes of macrocytic anaemia

A

alcohol excess, hypothyroidism, B12/folate deficiency, reticulocytosis

135
Q

what is the cause of chronic myeloid leukaemia?

A

translocation of a gene between chromosome 9 and 22 leading to the Philadelphia chromosome

136
Q

how do you treat tumour lysis syndrome?

A

IV fluids, meds to decrease uric acid, electrolyte replacement

137
Q

What are the 2 features required for a diagnosis of febrile neutropenia?

A
  • temp > 30 degrees
  • absolute neutrophil count < 1
138
Q

Why do patients with myeloma experience bone loss?

A

Myeloma leads to cytokines stimulating osteoclasts and inhibiting osteoblasts

139
Q

which kind of anaemia is typically seen in sickle cell disease?

A

haemolytic

140
Q

treatment for reversal of warfarin?

A

IV prothrombin complex concentrate and IV vit K

141
Q

how is iron transported in blood and stored?

A

transported as transferrin and stored as ferritin in tissues

142
Q

what is the most common subtype of Hodgkin’s?

A

nodular sclerosing

143
Q

which subtype of Hodgkin’s has the worst prognosis?

A

lymphocyte depleted

144
Q

what does ABVD stand for?

A

Adriamycin, Bleomycin, Vinblastine, Decarbazine

145
Q

give 3 signs of Hodgkin’s lymphoma

A

hepatosplenomegaly, anaemia, lymphadenopathy

146
Q

define carcinoma

A

malignant tumour of epithelial cells

147
Q

name 4 causes of neutrophilia?

A

appendicitis, CML, MI, strep pyogenes

148
Q

what is the most common cause of secondary polycythaemia?

A

chronic hypoxia e.g. lung disease smoking or low FiO2

149
Q

what can precipitate a sickle cell crisis?

A

parvovirus B19

150
Q

which main cells are involved in CLL?

A

B cells

151
Q

give 2 FBC findings and 1 blood smear with CLL

A

anaemia, lymphocytosis, smudge cells

152
Q

what test can be done to confirm a diagnosis of CLL?

A

immunophenotyping

153
Q

What is the most common cause of microcytic anaemia worldwide?

A

iron deficiency

154
Q

what is the treatment for haemochromatosis?

A

therapeutic phlebotomy

155
Q

what can be given as prophylaxis of tumour lysis syndrome in leukaemia?

A

allopurinol - reduces the conversion of nucleic acid byproducts to uric acid in order to prevent nephropathy and subsequent renal failure

156
Q

what is prophylaxis for sickle cell crisis?

A

hydroxycarbamide - increases HbF conc. -> reducing proportion of RBCs with haem S

157
Q

give 4 symptoms of chronic limb ischaemia

A
  • Hair loss,
  • atrophic skin
  • brittle / slow-growing nails
  • ulcers
  • numbness in feet
  • absent distal pulses,
  • intermittent claudication
158
Q

what causes renal failure in myeloma?

A

light chain deposition in kidney

159
Q

what is absolute polycythaemia?

A

an increase in red blood cell mass

160
Q

why does dehydration cause APPARENT polycythaemia?

A

decreased plasma volume in dehydration. Although the patient’s RBC mass is normal, in proportion to the plasma it will look higher

past questions (11 decks)

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