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MRCP Part 1 > Haem, Onc, Palliative Care > Flashcards

Haem, Onc, Palliative Care Flashcards

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1
Q

What causes a normocytic anaemia?

A

Anaemia without altered RBC structure

Anaemia of chronic disease

Acute blood loss

Aplastic anaemia

Haemolytic anaemia

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2
Q

What are the causes of microcytic anaemia

A

Thalassaemia: AR defects of haem chains

Anaemic of chronic disease

Iron deficency:can also be normocytic

Lead poisoning: blocks heme synthesising enzymes

Sideroblastic: Iron wont fit into RBCs

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3
Q

How do you investigate iron deficiency anaemia?

A

FBCs showing low Hb, can confirm if low ferritin

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4
Q

What is the initial management of iron deficiency anaemia?

A
  1. oral iron

+ IV iron or blood transfusion

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5
Q

For anaemia, when do you refer to…

Haematology

A

Supplementation fails to increase by 20g/L over 2-4 weeks and no GI or Gynae criteria

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6
Q

Paraesthesia, changes to mood and vision+/- mild jaundice suggests which anaemia?

A

B12 deficiency

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7
Q

What investigations suggest B12 deficiency

A

Macrocytic anaemia

Hypersegmented polymorphs

Low cobalamin is B12, low folate is folate

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8
Q

How do you treat B12 deficiency?

A

No neuro: IM hydroxycobalamin 3x day 2 weeks; 1 per 3 months afterwards

Neuro: IM 1mg every other day until improves

TREAT B12 BEFORE FOLATE

give folic acid 5mg day 4 months

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9
Q

When do you refer a vit B12 deficiency to…

Haem

Gastro

A

Haem: Uncertain, malignancy, resistant to treatment

Gastro: IBD, malabsorption, GI malignancy

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10
Q

How doe sickle cell present on…

FBC

Blood film

A

Microcytic anaemia

Sickle cells, howell-Jolly bodies

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11
Q

Outline the inheritance of sickle cell anaemia

A

AR inheritance of HbS instead of A.

One gene casues trait

Two causes disease

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12
Q

Compare vaso-occlusive, splenic sequestration, aplastic crisis and acute chest syndrome in terms of…

Pain

Associated symptoms

Lab findings

A

VOC // SS // AC // ACS

Localised pain // abdo pain // painless // painless

Fever, priapism // HSM, hypotension // infective Hx // Resp symptoms

Raised Hc // Severe anaemia // severe anaemia // Infiltrates on X-ray

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13
Q

How do you treat sickle cell crises?

A

Admit

Treat infection

IV fluids

Keep warm

Analgesia

Aspirate if priapism

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14
Q

What prophylaxis is given to sickle cell patients

A

Penicillin 3m-5yrs

PPV23 every 5 years

MenB + ACWY then another MenB 4 weeks later

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15
Q

What patient features might point towards thalassaemia?

A

Pronounced forehead and jaw

Jaundice, gallstone, splenomegaly

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16
Q

How do you diagnose thalassaemia?

A

Haem electrophoresis

DNA testing

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17
Q

How do you treat thalassaemia that is

alpha

Beta…

minor

intermedia

major

A

Alpha: monitor. Transfusions and bone marrow transplant potentially.

Bm: Conservative

BI: monitor + transfuse

BM: regular transfusion, chelation and splenectomy. Bone transplant can be curative

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18
Q

Anaemia + gallstones + large spleen

Blood film…

Diagnose and treat

A

Hereditary spherocytosis

Folate supplementation + splenectomy

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19
Q

Patient with PMHx of infections + jaundice after eating beans

A

G6PD deficiency

Heinz enzyme assay to confirm

Avoid triggers

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20
Q

What are the features of leukaemia?

A

Abnormal bruising

Splenomegaly, lymphadenopathy

Palness, fever, fatigue

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21
Q

Where suspected, what are the 1st line and GS test in leukaemia?

A

1st: <48hr FBC

GS: Bone marrow biopsy

+ blood film biopsy

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22
Q

How are the leukaemias distributed by age?

A

ALL CLLmates have CMMon AMbitions

ALL: <5s, >45s

CLL: Over 55

CML: Over 65

AML: Over 75

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23
Q

How can ALL, CLL, AML and CML be differentiate based on

Clinical history

Blood results

A

ALL: Children, Down’s syndrome, Blast cells (left)

CLL: Most common in adults, Smudge cells (right

AML: Myeloproliferative, Auer rods (middle)

CML: Raised WCC/low Hb, plts, pancyto

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24
Q

How do you treat leukaemia?

A

Chemo and steroids

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25
What are the general features of a lymphoma?
Painless, assymetrical lymphadenopathy + systemic B symptoms
26
How do NHL and HL differ on... Age Symptoms Cells Associations
NHL // HL \>75s // 20s, 70s Early B symptoms, extra-nodal disease // painful nodes on alcohol Depends on subtype // Reed sternberg cells
27
How is Lymphoma confirmed?
Lymph node biopsy +CT/MRI/PET
28
What is myeloma and its subgroups
Plasma cell malignancy resulting in excess antibody production MGUS: Raised antibodies without specific infection Multiple myeloma: affected multiple sites Smouldering: MGUS progression with higher Ig levels; waldenstrom's if specifically IgM raised
29
\>60s presents with bone pain. Bloods show rasied calcium, total protein and renal impairment What is the diagnosis
myeloma
30
What investigations are performed in suspected myeloma?
Monoclonal IgM or IgA in serum and urine (BJ proteins) Increased plasma cells on bone marrow biopsy Whole body MRI for bone lesions + 'tear-drop skull' on X-ray
31
B symptoms + splenomegaly + the following bloods indicate what? Raised Hb Raised platelets Low Hb, abnormal platelets + WCC, teardrop RBCs
Myeloproliferative disorders Polycythaemia vera Essential thrombocytopaenia Myelofibrosis
32
How do you treat... Polycythaemia vera Essential thrombocytopaenia MF
PC: Venesection, chemo ET: chemo MF: Chemo + stem cell transplant
33
How do you stage Hodgkin's lymphoma?
Ann-Arbor staging I: Single lymph node II: 2 or more nodes/regions on same diaphragm side III: Nodes on both sides of diaphragm IV: Spread beyond lymph nodes + A: Pruritis only B: \>10% weight loss, fever \>38 degrees, night sweats
34
What are the diagnostic criteria for myeloma
_Factor: Major // minor_ Imaging: Plasmacytoma // osteolytic lesions Plasma cells: 30% // 10-30% M protein: Elevated // minor elevations + low antibody levels for minor **NEED 1 MAJOR + 1 MINOR / 3 MINOR**
35
What are the subtypes of non-hodgkin's lymphoma and their associations?
Burkitt's: EBV, tumour lysis, 'starry sky' histology MALT: H. pylori, perigastric tissue Diffuse B cell: rapidly growing painless mass in \>65yrs
36
Muscle cramps in a NHL patient just starting chemo suggests what and how is it prevented?
Tumour lysis syndrome in burkitt's lymphoma Give rasburicase to prevent uric acid --\> allantoin Allopurinol is alternative
37
Infant experiencing painful swelling in hands and feet in absence of other pathology suggests what?
Thrombotic crises
38
How can you distinguish ITP, TTP and DIC in terms of... Symptoms Labs Cells
ITP // TTP // DIC Bleeding // 'The Terrible Pentad'\* // Bleeding, sepsis high bleed time // high bleed, low platelets // high bleed, low platelets + D-dimer none // schistocytes // schistocytes
39
Polycythaemia rubra vera is most likely to convert into which cancer?
AML or myelofibrosis
40
What test confirms the diagnosis if spherocytes are found on blood film?
DIRECT coomb's test confirms diagnosis of haemolytic anaemia
41
What is offered for palliative pain intially?
Unless co-morbidities… 20-30mg MR morphine daily + 5mg breakthrough pain + Laxatives Nausea and drowsiness should be transient
42
What should be offered as therapy for those with renal impairment?
Mild-mod: Oxycodone Severe: Buprenorphine, fentanyl, alfentanil
43
What pain relief is available for bone pain?
Strong opioids Bisphosphonates Radiotherapy
44
How much should you increase an opioid dose?
30-50%
45
How do you convert between oral codeine and morphine Oral tramadol and oral morphine
Divide both instances by 10
46
How do you convert… Oral morphine to SC morphine Oral morphine to SC diamorphine Oral oxycodone to SC diamorphine
/2 /3 /1.5
47
How much oral morphine are the following equal to… TD fentanyl 12ug TD buprenorphine 10mg
30mg 24mg
48
If a palliative patient is agitated or confused what do you give 1st line Alternatives If in terminal phase
Haloperidol -promazines midazolam
49
Antiemesis for GI related stasis
Metoclopramide (unless prokinesis will worsen eg obstruction) Domperidone
50
Antiemesis for chemical nausea (eg chemo)
Correct the cause first Ondansetron/haloperidol/levomepromazine
51
Antiemesis for visceral/serosal causes of nausea
Cyclizine, levopromazine + Anti-cholinerigcs eg hyoscine
52
Antiemesis for raised intracranial pressure
Cyclizine for nausea Dexamethasone can be used Radiotherapy to reduce mass effect
53
Antiemesis for vestibular nausea
Cyclizine Metoclopramide/prochlorperazine if refractory
54
Antiemesis for anxiety/pain (cortical)
Antiemesis for anxiety/pain (cortical)
55
For syringe drivers what is… Used for respiratory secretions the choice for pain the drug that can cause interactions most generally
Hyoscine, glycopyrronium Diamorphine Cyclizine
56
What is good for mouth pain in palliative care Generally With evidence of gum disease
Benzydamine hydrochloride
57
What can you give for hiccups in palliative care
Chlorpromazine or haloperidol
58
What are the top 5 cancers in terms of: Prevalence Mortality
Prevalence // Mortality 1. Breast // Lung 2. Lung // Colorecal 3. Colorectal // Breast 4. Prostate // Prostate 5. Bladder // Pancreas
59
What biomarker indicates poor prognosis in myeloma
Raised B2 microglobulin
60
How can you differentiate G6PD and hereditary spherocytosis
G6PD // Hereditary spherocystosis Both: Neonatal jaundice + gallstones Haemolysis: Drugs/infection // chronic Inheritance: X-linked // AD Splenomegaly: Less common // more common Blood film: Heinz bodies // spherocytes Diagnostic test: G6PD enzyme activity // EMA binding
61
How is the does the BCR-ABL protein... Come about Affect cell activity
Translocation of philadelphia chromosome (9:22)(Q34;Q11) Creates abnormally active tyrosine kinase Subsequent phosphorylation leads to continuous cell division and proliferation.results
62
What cancer are the following markers linked to CA15-3 CA19-9 CA125 CEA AFP
Breast Pancreatic Ovarian Colorectal Hepatocellular
63
What is the universal donor of FFP
AB (does not contain antibodies)
64
What primary immunodeficiencies are neutrophil disorders
Chronic granulomatous disease: NADPH oxidase reduces phagocytic ROS Chediak-Higashi: microtubule defect reduces phagocytosis Leukocyte adhesion deficiency
65
What drugs can induce symptoms in G6PD
Anti-malarials Cipro Sulph-group drugs
66
Which neutrophil disorder are the following Recurrent pneumonia due to catalase +ve bacteria Partial albinism + bacterial infections + giant granules in neutrophils Recurrent infections + delayed umbilical cord sloughing + absence of neutrophils at infection sites
Chronic granulomatous disease Chediak Highashi syndrome Leukocyte adhesion deficiency
67
What are the primary B cell disoders
Common variable ID: low IgA/G/M Bruton's congenital agammaglobulinaemia: X-linked recessive + absent B cells + reduced IgG Selective immunoglobulin A ID: Severe reactions to blood transfusions + positive coeliac testing
68
What T cell disorder causes primary immunodeficiency?
DiGeorge: Cleft palate + Tetralogy of Fallot + learning needs
69
What are the combined B+T cell primary immunodeficiencies
SCID WAS Ataxic SCID: Reduced T cell receptor excision Wiskott-Aldrich: X-linked recessive + eczema + low IgM Ataxic telangectasia: Autosomal recessive
70
What blood film result can be seen in lead poisoning
Basophilic stippling
71
What are the following translocations associated with 9;22 15;17 8;14 11;14 14;18
9;22: CML, poor prognosis in AML 15;17: APML 8;14: Burkitt's lymphoma (Burkitt has 8 letters) 11;14: Mantle cell lymphoma 14;18: follicular lymphoma (18 as most letters)
72
What is the key investigation in chronic lymphocytic leukaemia?
Immunophenotyping
73
Which haemolytic anaemias are Intravascular Extravascular
Intra: MRCGP Mismatched transfusion Red cell fragmentation: DIC, HUS, TTP Cold AIHA G6PD deficiency Paroxysmal nocturnal haemoglobinuria Extra: 4 Hs HDNB Hereditary spherocytosis Haemoglobinopathies Hot (warm) AIHA
74
What is the most common organisms (by lab grouping) in neutropaenic sepsis?
Gram positive, coag negative bacteria
75
What cancer is BRCA2 associated with in men
Prostate
76
Which chemotherapies cause Haemorrhagic cystitis Lung fibrosis Cardiomyopathy Lung + liver fibrosis Dermatitis Ataxia Periperhal neuropathy + paralytic ileus Nerve damage + low magnesium
Cyclophosphamide Bleomycin Antracyclines (doxorubicin) Methotrexate 5-FU Cytarabine (cytara-been drinking too much = ataxia) Vincristine/vinblastine Cisplatin
77
Which chemotherapies DO NOT cause myelosuppression
Bleomycin Anthracyclines Docetaxel Cisplatin
78
What is the first line treatment for ITP
Oral prednisolone
79
What is the most common inherited Bleeding disorder Thrombophilia
Von Willebrand's (Reduced platelet activity + factor VIII) Factor V leiden (activated protein C resistance)
80
What are contraindications to platelet transfusions?
Chronic bone marrow failure Thrombocytopaenias: Heparin, Autoimmune, TTP
80
What is the threshold for platelet transfusion Stable Unwell Pre-op
10 30 50
81
Outline the ECOG score
0: Independent 1: Restricted to light work 2: Ambulatory but unable to work; >50% up and about 3: Limited selfcare, <50% up and about 4: Completely disabled, bedbound 5: Dead
82
What haem condition sees angioedema without urticaria +/- preceding macular rash What serial blood markers are useful How do you treat
Hereditary angioedema C1-INH, C2-4 low C1 inhibitor concentrate/FFP
83
What are the risk factors of cervical cancer
HPV Huffing cigs HIV
84
What condition is a result of failure to cleave vWF normally
TTP
85
What is a leukaemoid reaction and how is it differentiated from CML
Presence of immature cells in peripheral blood due to increased strain on bone marrow production (haemolysis, haemorrhage, cancer) Leukaemoid // CML l-ALP: High // low toxic granulation of WCC // none left shift (<3 segments) // no left shift of neutrophils
86
What is the rarest thrombophilia?
Antithrombin III deficiency (highest VTE risk though)
87
How can you quickly determine from lab values which bleeding disorder you have?
Haemophilia (1 word): APTT vWB: APTT, PT DIC (3 words): APTT, PT, BT
87
How can vWB, haemophilia, antiphospholipid syndrome be differentiated since it causes prolonged APTT
vWB // haemophilia // low factor XIII (A) or IX (B)
88
Why are anaphylaxis patients observed for a day?
Biphasic reactions 20% patients
89
What blood test findings indicate thalassaemia How can alpha and B be distinguished
Disproportionate microcytic anaemia Electrophoresis: Normal in A, HBA2 raised in B
90
Raised K, PO4, Uric acid + low Ca indicates what post chemo? When is it deemed clinically worrying? How is it managed?
Tumour lysis syndrome Clinical: 1.5 creat, cardiac arrhythmia, seizure IV fluids, + rasburicase (uric acid --> allantoin) OR allopurinol; this helps excretion of salts
91
Hamolytic anaemia with thrombosis + dark urine in morning suggests what? What test would confirm How is it treated?
PNH Flow cytometry of CD59+55 Blood products + anticoag
92

MRCP Part 1 (32 decks)

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