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Year 6 Passmed > Haem > Flashcards

Haem Flashcards

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1
Q

What are the diagnostic criteria for multiple myeloma?

A

1 major and 1 minor OR
3 minor

Major
Plasmacytoma
30% plasma cells in BM
Raised M proteins in blood or urine

Minor
10-30% plasma cells in BM
Minor elevation of M proteins
Osteolytic lesions
Low antibody levels
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2
Q

What might a raised LDH indicate in the context of anaemia?

A

It suggests cell lysis, so indicates haemolytic anaemia

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3
Q

Which of NSAIDs and hydroxychloroquine cause haemolytic anaemia?

A

NSAIDs

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4
Q

How would you subcategorise causes of acquired haemolytic anaemia?

A

Immune
Autoimmune (e.g. SLE)
Alloimmune - transfusion reaction
Drugs - methyldoxpa

Non-immune
MAHA, TTP, HUS, DIC
Prosthetic valves
PNH
Malaria
Dapsone
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5
Q

What are the stages of Hodgkin’s lymphoma?

A

1 - single lymph node region
2 - Two or more on same side of diaphragm
3 - LNs on both sides of the diaphragm
4 - Extranodal involvement

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6
Q

What is the hallmark histological feature of Hodgkin’s lymphoma?

A

Reed-Sternberg cells

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7
Q

What type of cancer does H pylori cause?

A

Gastric lymphoma (MALT)

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8
Q

What cancer does HTLV1 cause?

A

Adult T cell leukaemia

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9
Q

What cancers does EBV cause?

A

Nasopharyngeal

Hodgkin’s lymphoma

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10
Q

How long should warfarin be given for VTE?

A

Provoked - 3 months

Unprovoked - 6 months

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11
Q

What is the management of a DVT?

A

Staart LMWH or fondaparinux immediately
Vit K within 24 hours
Continue LMWH/fondaparinux until INR reaches 2.0 and bridge with warfarin
Continue warfarin for 3/6 months depending on cause

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12
Q

What is typically seen on blood film of hyposplenism?

A

Howell Jolly bodies

Siderocytes

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13
Q

What does basophilic stippling on a blood film indicate?

A

Lead poisoning

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14
Q

What does roleaux formation on film indicate?

A

Chronic inflammation

Myeloma

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15
Q

What are schistocystes a feature of

A

Haemolytic anaemia

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16
Q

What is the commonest type of Hodgkin’s lymphoma and what is its prognosis (broadly)?

A

Nodular sclerosing

Good prognosis

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17
Q

What is the universal donor of fresh frozen plasma?

A

AB RhD neg - doesn’t have any antiA or antiB

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18
Q

What mutation is associated with polycythaemia rubria vera?

A

JAK2

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19
Q

What blood picture is seen in DIC?

A

Low platelets
Prolonged APTT, PT and bleeding time
FDPs raised
Schistocytes due to MAHA

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20
Q

Which of the following cause an isolated raise in PT?

Warfarin
Aspirin
Heparin

A

Warfarin

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21
Q

Which of the following cause an isolated raise in APTT?

Warfarin
Aspirin
Heparin

A

Heparin

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22
Q

Which of the following cause an isolated raise in bleeding time?

Warfarin
Aspirin
Heparin

A

Aspirin

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23
Q

What should be done if a patient’s Well’s score for DVT is 2 or more?

A

Proximal Doppler USS within 4 hours. If not possible in this time, give LMWH for cover

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24
Q

What is the likely cause of a macrocytic anaemia with hypersegmented neutrophil polymorphs on blood film?

A

Megaloblastic anaemia (so B12 or folate def)

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25
What is the empirical antibiotic management of neutropenic sepsis?
Tazocin STAT
26
What is the pathophysiology of Factor V Leiden?
Resistance to activated Protein C -> thrombophilia
27
What are the blood findings in CML?
Raised white cells specifically granulocytes which are present and raised at different stages of maturation Thrombocytosis
28
What is the management of CML?
Imatinib 1st line Hydroxyurea Interferon-alpha
29
What are the contents of cryoprecipitate and when is it used?
Factor 8, fibrinogen, vWf, factor 13 Used for massive haemorrhage and uncontrolled bleeding due to haemophilia, determined by a low fibrinogen level
30
Haemophilia A causes: Prolonged PT Prolonged APTT Prolonged both?
Prolonged APTT
31
What should be given to patients pre op who have IDA and can't/won't tolerate oral iron?
IV iron 1g repeated after 1 week
32
When would you see a decrease in haptoglobin levels?
Intravascular haemolysis
33
What is the most common inherited bleeding disorder?
Von Willebrand's disease
34
A 15-year-old girl presents with abdominal pain. She is normally fit and well and currently takes a combined oral contraceptive pill. The patient is accompanied by her mother, who is known to have hereditary spherocytosis. The pain is located in the upper abdomen and is episodic in nature, but has become severe today. There has been no change to her bowel habit and no nausea or vomiting. What is the most likely diagnosis?
Biliary colic - Hereditary spherocytosis causes chronic haemolysis and subsequent gallstone formation
35
What are the features of Acute Sickle Chest Syndrome?
Dyspnoea, chest pain, pulmonary infiltrates, low Po2
36
Which inherited coagulopathy causes only a mildly elevated APTT?
Von Willebrand disease
37
Does tamoxifen have an effect on VTE risk?
Yes - increases risk of recurrent VTE
38
What type of anaemia is seen in beta dhal trait?
Mildly hypo chromic microcytic anaemia
39
Which type of Hodgkin's lymphoma has the worst prognosis?
Lymphocyte depleted
40
What are each of the following in SCD? Hb MCV Reticulocytes
Hb - low MCV - normal (IV haemolytic) Reticulocytes - raised
41
Which bleeding disorder commonly causes intra-articular haemarthosis?
Haemophilia
42
How does Dabigatran work, and what is its reversal agent?
Direct thrombin inhibition Idracizumab
43
What is the reversal agent for heparin?
Protamine
44
What are the features of a non-haemolytic, febrile transfusion reaction - and how is it managed?
Patients experience a mild increase in temperate with otherwise no signs. Manage by slowing the rate of transfusion and with IV paracetamol
45
Disproportionate microcytic anaemia? Think...
Beta thalassaemia trait (will have raised HbA2)
46
Which blood product poses the highest risk of an iatrogenic gram +ve septicaemia and why?
Platelets - as they are stored at room temperature which ideal for culturing gram positives
47
Which blood product poses the highest risk of an iatrogenic gram neginfection?
Packed red cells as they are stored at 4 degrees
48
What haematological complication can phenytoin cause?
Aplastic anaemia, often presenting with bleeding gums
49
What is a G-CSF and when is it used?
Granulocyte colony stimulating factors such as Filagrastim are used to treat neutropenia particularly in chemo patients
50
What should be given in the event of an anaphylactic reaction to blood transfusion?
``` Terminate transfusion IM adrenaline Antihistamines Corticoesteroids Bronchodilators Supportive care ```
51
What is the management of post thrombotic syndrome?
Graduated compression stockings
52
What should all patients with IDA be screened for and how?
Coeliac disease | with an anti-TTG test
53
When should you not prescribe chloramphenicol eye drops?
In patients with concurrent BM suppression esp methotrexate
54
How does ITP present?
Isolated thrombocytopenia
55
Which NOAC is preferred for patients with renal impairment?
Apixaban
56
How often should the PCV vaccine be given to sickle cell patients?
Every 5 years
57
Which cell type is a hallmark of CLL?
Smear/smudge cells
58
What electrolyte abnormalities are seen in TLS?
Hyperkalaemia Hyperphosphataemia Hypocalcaemia
59
What is the phosphate in myeloma>
Normal/high
60
What should be done for a man with a Hb of 104?
Urgent 2WW referral for top and tail (any man with Hb<110)
61
What are the blood findings of Hodgkin's lymphoma?
Normocytic anaemia with eosinophilia
62
What is the transfusion threshold for patients with and without ACS?
With - <80 | Without - <70
63
What is the mechanism of Dabigatran?
Direct thrombin inhibitor
64
What is the mechanism of Rivaroxaban?
Direct Xa inhibirore
65
What is the mechanism of Apixaban?
Direct Xa inhibitor
66
Where would you see Heinz bodies with schistocytes?
G6PD deficiency
67
What are the features lead poisoning?
``` Abdo pain Peripheral neuropathy Fatigue Constipation Blue lines on gum margin ```
68
What test is used to diagnose hereditary spherocytosis?
EMA binding test
69
What else should be done for a patient with an unprovoked DVT?
Investigate for underlying malignancy and check fo anti-phospholipid antibodies
70
What is seen on blood film in myelofibrosis?
Tear drop poikilocytes
71
What translocation is seen in Burrito's lymphoma?
C-myc
72
Normocytic anaemia with low serum iron and low TIBC but raised ferritin indicates/
AoCD
73
What haematological malignancy presents with pain on alcohol consumption?
Hodgkin's lymphoma
74
What does irradiating blood products achieve?
Depletes T cells to reduce risk of GvHD
75
What is Richter's transformation?
When CLL transforms to a high grade lymphoma such as DLBCNHL making patients acutely unwell
76
What electrolyte abnormality is associated with red cell transfusion?
Hyperkalaemia
77
How do you treat an acute haemolytic transfusion reaction?
Terminate transfusion Lots of fluids Inform lab
78
What effect does Desmopressin have on bleeding times?
Reduces it by stimulating release of VWf
79
What is the management of an urticarial transfusion reaction?
Temporary cessation of transfusion | Antihistamine
80
What are 'B' symptoms and what do they indicate?
Weight loss >10% in 6 months Fever > 38 Night sweats Indicates poor prognosis
81
What is the commonest form of lymphoma in the UK?
DLBCL
82
EPO is normal in polycythaemia RV or 2ary?
RV
83
What type of cancer can myelosysplasia progress to?
AML
84
When would you see Bite Cells?
G6PD def
85
What must you be aware of in patients with both B12 and folate deficiency?
Replace B12 first so as to avoid SACDC
86
What condition is associated with thymomas?
Myasthenia graves

Year 6 Passmed (22 decks)

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