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Year 6 > Haem/onc > Flashcards

Haem/onc Flashcards

1
Q

Which leukaemia is philadelphia positive?

A

CML

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2
Q

Cells in Hodgkin’s lymphoma?

A

Reed-sternberg cells

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3
Q

Most common Hodgkin’s lymphoma?

A

Nodular sclerosing

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4
Q

Aggressive non-hodgkin’s?

A

Burkitt’s

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5
Q

Low grade non-hodgkin’s?

A

Follicular

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6
Q

Starry sky appearnace cancer?

A

Burkitt’s lymphoma

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7
Q

Genetics of adult t-cell lymphoma

A

HTLV-1

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8
Q

Treatment for hodgkin’s lymphoma?

A

ABVD chemotherapy

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9
Q

Ann arbor staging?

A

B = Fever >38 degrees, drenching night sweats, unintentional weight loss
Stage III = nodules both sides of the diaphragm

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10
Q

SE cyclophosphamide?

A

Haemorrhagic cystitis

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11
Q

Cisplatin SE?

A

Ototoxicity

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12
Q

Immune mediated anaemia test?

A

DAT test

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13
Q

Warm AIHA (80-90%)?

A

IgG, extravascular haemolysis – lymphoma, CLL, drug allergy, SLE, idiopathic

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14
Q

Cold AIHA (10-15%)?

A

IgM (or IgG), intravascular haemolysis – M. pneumoniae, EBV, CMV

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15
Q
  • TTP (pentad S/S?)
A

MAHA, thrombocytopenia, AKI, neurological impairment, fever
ADAMST13 enzyme

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16
Q
  • HUS (triad S/S
A

MAHA, thrombocytopenia, AKI; E. coli toxin 0157

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17
Q

Secondary prevention post-stroke?

A

o 1st line - clopidogrel (75mg, OD, life-long) + statin
o 2nd line - aspirin (75mg OD) + dipyridamole (200mg BD) + statin

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18
Q

Treatment windows in ischaemic stroke?

A

 <4.5 hours  thrombolysis (alteplase)
 <4.5 hours, occluded proximal anterior circulation  thrombolysis AND thrombectomy
 <6 hours  thrombectomy

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19
Q

 Disability scales post stroke?

A

Barthel index (BI)

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20
Q

Parkinsonism differentials:

A

o Vascular Strokes
o Infective / Inflammatory Syphilis, CJD, HIV
o Trauma Dementia pugilistica
o Autoimmune Autoimmune encephalopathy
o Metabolic Neuroglycopaenic
o Iatrogenic / Idiopathic (incl. drugs) antipsychotics, metoclopramide
o Neoplasm -
o Congenital Wilson’s disease
o Degenerative / Drugs PD, PD+

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21
Q

Ix for parkinsonism?

A

o CT/MRI (rule out any vascular causes)
o DaTScan; a tracer (ioflupane) 123I-FP-CIP used in Single Photon Emission CT (123I-FP-CIP SPECT)

22
Q
  • Management of parkinsonism?
A

o General management:
 MDT
 Disability (UPDRS – Unified PD Rating Scale)
 Physiotherapy (postural exercises)
 Depression (screening)
Levodopa is first line or co-careldopa
 MAO-B inhibitors (i.e. selegiline)
 DA agonists (i.e. pramipexole, ropinirole)

24
Q

co-careldopa - what’s in it?

A

 Levodopa (combined with dopa decarboxylase inhibiters)

25
* SEs of levodopa?
D Dyskinesia O On/off phenomena P Psychosis A Arterial BP down M Mouth dryness I Insomnia N N&V E EDS
26
o 2nd line adjuncts PD?
 COMT inhibitors (i.e. entacapone, tolcapone) * Given with levodopa to improve compliance but may increase SEs * Entacapone = peripheral COMT inhibitor * Tolcapone = central + peripheral COMT inhibitor  Amantadine (PO; nicotinic antagonist, DA agonist, non-competitive NMDA antagonist)  Apomorphine (SC; DA agonist)  Deep brain stimulation (of subthalamic nucleus)
27
Medications to avoid in PD?
metoclopramide, haloperidol
28
Cluster headache acute treatment?
: 100% O2, SC triptan
29
Cluster headache prophylaxis?
Verapamil
30
Acute migraine tx?
Acute: oral triptan + NSAID/paracetamol
31
Migraine prophylaxis?
Prophylaxis *: topiramate/propranolol * only if ≥2 attacks/month
32
S/S of MS?
 Tingling  Eye / optic neuritis (CRAP = Central scotoma, RAPD, Acuity (↓ central vision, ↓colour vision), Pain on movement)  Ataxia (and other cerebellar signs – DANISH)  Motor (spastic paraparesis – i.e. shoulder paralysis)
33
Ix MS?
revised McDonald criteria, demonstration of lesions disseminated in time and space o Contrast MRI (gadolinium-enhanced, T2-weighted) o LP (IgG oligoclonal bands) o Blood antibodies:  Anti-MBP (myelin basic protein)  NMO-IgG (neuromyelitis optica)  Devic’s syndrome (S/S: MS + transverse myelitis + optic atrophy) o Evoked potentials
34
Tx for MS
 DMARDs: * IFN-beta reduces relapses by 30% * Glatiramer  Biologicals: * Natalizumab (anti-VLA-4 AB) 1st line RRMS (reduces relapses by 66%) * Alemtuzumab (anti-CD52) 2nd line RRMS Methylprednisolone in relapses for 3 days
35
Symptomatic management of MS?
 Fatigue modafinil  Depression SSRI (citalopram)  Pain amitryptyline, gabapentin  Spasticity 1st: baclofen + gabapentin; 2nd: dantrolene  Urgency/frequency oxybutynin, tolterodine  ED sildenafil  Tremor clonazepam
36
Associations with MG?
thymoma (15%), thymic hyperplasia (50-70%), AutoImmune disease (PA, AI thyroid, RhA, SLE)
37
o Myasthenic crisis mx?
 Ix: ABG (hypercapnia before hypoxia), FVC  Mx: plasmapheresis, IVIG, intubation
38
* Investigations MG?
o Single fibre EMG ≥92% sensitivity o Repetitive nerve stimulation test fatiguability o Serial pulmonary function testing test fatiguability o Antibodies:  Anti-ACh-R AB 85-90%  Anti-muscle-specific-receptor TK AB 40% o Tensilon test (IV edrophonium bromide relieves muscle weakness temporarily)
39
Tx for long-term control of MG?
1st line (long-term control) = immunosuppression:  1st  prednisolone  2nd  azathioprine, cyclosporine, mycophenolate mofetil 1st line (symptomatic) = long-acting AChE inhibitors (pyridostigmine, neostigmine)
40
What is MG?
An autoimmune disorder characterised by insufficient functioning nicotinic acetylcholine receptors o Anti-ACh-R in are seen in 85-90% of cases
41
S/S of lambert-eaton syndrome?
symptoms :  Repeated muscle contractions lead to increased muscle strength (seen in only 50% of patients)  Limb-girdle weakness (affects lower limbs first)  Hyporeflexia  ANS symptoms (dry mouth, impotence, difficulty micturating)  Eye signs are rarer (ophthalmoplegia and ptosis not commonly a feature) Associated with small cell lung cancer Mx:  Treat cancer  Immunosuppression (prednisolone ± azathioprine)
42
Bulbar palsy signs?
Cranial nerves 9, 10, 11, 12 LMN signs
43
Pseudobulbar palsy signs?
UMN signs Cranial nerves 5, 7 Cranial nerves 9, 10, 11, 12
44
Investigations for MND?
Diagnostic criteria: Revised El Escorial criteria): o MRI brain / spinal cord exclude structural causes o EMG (fasciculations) o LP exclude inflammatory conditions
45
Mx MND
DT management = neurologist, physio, OT, dietician, GP, specialist nurse) o Riluzole (extends life by ~3 months)
46
Lateral medullary syndrome s/s?
Wallenberg’s syndrome) occurs after occlusion of the posterior inferior cerebellar artery (PICA) * Signs & symptoms: o Cerebellar:  Ataxia  Nystagmus o Brainstem:  Ipsilateral: dysphagia, facial numbness, cranial nerve palsy (Horner's – miosis, anhidrosis, ptosis)  Contralateral: limb sensory loss
47
Locations of quadranopias?
* PITS (Quadranopia) = Parietal Inferior, Temporal Superior * PIT S (Pituitary tumour vs. craniopharyngioma) = Pituitary Superior
48
Causes of third nerve palsy?
* Causes: o DM Vasculitis (GCA, SLE) o Uncal herniation through tentorium (raised ICP) Posterior communicating artery aneurysm o Cavernous sinus thrombosis Amyloid, MS
49
Normal Pressure Hydrocephalus s/s?
* >60yo, quick onset * “wet, wobbly, wacky” (incontinent, falls, dementia)
50
Anti-emetic choices+indications?
* Ondansetron (+ dexamethasone) chemotherapy-induced nausea * Haloperidol (+ dexamethasone) intracranial causes (raised ICP, direct effect of tumour) * Prochlorperazine vestibular causes * Metoclopramide gastrointestinal causes
51

Year 6 (26 decks)

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