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Year 3 Incorrect Questions > Haematology > Flashcards

Haematology Flashcards

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1
Q

FBC results for pt with thalassaemia trait

A

Normal ferritin
High RBC

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2
Q

Pt undergoing transfusion with known heart failure develops bibasal crackles and pitting oedema, how do you manage this?

A

Stop transfusion and 40mg IV furosemide
- pt is in fluid overload

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3
Q

Other than sudden awful headache, name 3 other symptoms of subarachnoid haemorrhage

A

Neck stiffness, photophobia, focal deficit (especially CNIII

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4
Q

How to remember which side of body will be affected in half spinal cord injury?

A

Bus STOP across the road:
Brown Sequard = Temperature + Pain opposite
- motor control and fine touch on ipsi side is affected

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5
Q

Haemolysis, elevated liver enzymes, and a low platelet count in pre-eclamptic pt

A

HELLP syndrome

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6
Q

Prophylaxis for tumour lysis syndrome

A

IV hydration, allopurinol and avoiding nephrotoxic drugs.

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7
Q

Haemophilia A =

A

haemArthrosis
- more common in girls w Turner syndrome

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8
Q

Key drug interaction to know about that can induce neutropenic sepsis

A

Allopurinol and azathioprine

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9
Q

How to remember side effects of TB drugs?

A

RIPE ONGO
Rifampicin = Orange secretions
Isoniazid = Neuropathy (peripheral)
Pyrazinamide = Gout/athralgia/hepatitis
Ethambutol = Optic neuropathy

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10
Q

fever + neuro signs (seizures, confusion) + haemolysis + thrombocytopenia + renal failure

A

TTP
- its essentially HUS + fever + Neuro signs

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11
Q

Febrile 3 yo with SOB worse in past 2 days, nosebleeds in past 2 days, pallor, blanching purpuric rash, bruising and bright red cheeks

Low Hb, low white cells, low platelets

A

Parvovirus
- fever and worse SOB suggests viral illness
- esp with bright red checks indicating slapped cheek syndrome
- causes aplastic anaemia

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12
Q

Uncontrolled production of essentially normally functioning blood cells

A

Polycythaemia rubra vera

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13
Q

Clonal B cell disorder usually resulting in a large number of circulating malignant cells

A

Chronic lymphocytuc lukaemi

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14
Q

MoA of clpidogrel

A

ADP antagonist

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15
Q

Rituximab targets…..

A

CD20+

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16
Q

Imatinib treating CLL targets…

A

BCR-ABL 1 tyrosine kinase

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17
Q

mild anaemia in the presence of a normal serum ferritin in a pregnant person

A

Physiological chnage assoc with pregnancy

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18
Q

What does disproportionate reduction in MCV and MCH compared to the haemoglobin suggest?

A

Possible haemaglobinopathy trait
- investigate with haemoglobin analysis

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19
Q

A high haemoglobin in someone without a history to suggest a secondary polycythaemia should be investigated by the analysis of…..

A

JAK2 gene

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20
Q

What type of mutation causes sickle cell disease?

A

Point mutation in globin gene affecting globin synthesis

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21
Q

Microcytic anaemia with reticulocytosis, elevated lactate dehydrogenase and + Direct Coombs test

A

Autoimmune haemolytic anaemia
- steroid (1mg/kg of prednisolone per day) and folic acid
- suppress the autoimmune process
- folic acid supplements prevent deficiency which can occur when the red cell turnover is high

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22
Q

Management of pancytopenia after chemotherapy

A

Red cell transfusion
- as a result of absence of intrinsic haemopoietic cell activity

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23
Q

Breathlessness 2 hours after FFP transfusion

A

Transfusion related acute lung injury
- anti- leucocyte antibodies present in the donation that bind to the patients white cells and cause acute lung injury by degranulation of the affected neutrophils in the lungs.

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24
Q

Pulmonary infiltrates are seen on CXR after FFP transfusin

A

TRALI

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25
Other than megaloblastic macrocytic anaemia, what other blood count abnormality may pts with pernicious anaemia present with?
Pancytopenia - due to DNA synthesis defect, erythrocytes are most common (causing the anaemia) but can also affect other blood cell lineages
26
An 18 year old man with fatigue and a family history of a haemolytic disorder has a blood count performed with the results as follows: Normocytic anaemia, FBC normal otherwise. Blood film shows polychromasia and red cells with loss of central pallor.
Hereditary spherocytosis -
27
Red cell that has lost its central pallor
Spherocyte
28
Auer rods are specific to...
Acute myeloid leukaemia - due to abnormalities of granulation in blasts (blasts are overproduced in absence of mature blood cells in leukaemia)
29
Excess platelets, some in giant form
Essential thrombocythaemia - chronic myeloproliferative disorder characterised by excess production of platelets in the bone marrow and an increased risk of thrombosis.
30
Management of sickle cell disease (not in crisis)
Prophylactic penicillin, vaccines, folic acid supplementation, hydroxycarbamide (induces HbF production)
31
How to remember where haematinics are absorbed in GI tract?
I Fuck Bears Do Join In Iron - Duodenum Folate - Jejunum B12 - Ileum
32
How can urinalysis help determine cause of jaundice i.e. 2o to haemolysis?
↓conjugated bilirubin + ↑urobilinogen = pre-hepatic (urine often very dark) ↑conjugated bilirubin + ↓urobilinogen = post-hepatic or hepatic
33
Normocytic anaemia, eosinophilia + painless neck swelling
Hodgkin's
34
New fever, loin pain on red cell transfusion
ABO incompatible haemolytic reaction - direct coombs test for diag
35
Ig involved in acute haemolytic reaction to transfusion?
IgM - Mediates immediate inflam response
36
Cancer pt with VTE, how long should you anticoag for?
6 months (3 months for provoked non-cancer VTE, 6 months for unprovoked non-cancer VTE)
37
Universal donor FFP
AB - they don't prod anti-A or anti-B
38
How can you reverse rivaroxiban?
Andexanet alfa
39
Reversal of heparin
Protein sulfate
40
Reversal of dabigatran
Idarucizumab
41
Hallmark of tumour lysis syndrome
High urate - also high K
42
Aplastic anaemia vs MDS
Both present as pancytopenia - AA has hypocellular marrow - MDS has hypercellular marrow (cells are dysplastic so not functional)
43
Define plasma cell
Fully diff B lymphocytes that secrete antibodies into blood
44
What cells lose their abilitiy to differentiate but not to replicate?
Blasts - that's why in AML or ALL the cells can keep growing like crazy but they're all the same cell type
45
WHy does proliferation of blast cells cause cytopenias?
They overcrowd the bone marrow and haematopoiesis - RBCs (anaemia) - white cells (infection) - plates (muc bleeding)
46
Smudge/smear cells
Looks like a cell w a tail Seen in CLL
47
IgA deficiency incr risk of
Anaphylaxis to transfusion
48
Characteristic FBC finding in aplastic sickle crisis
Sudden drop in Hb and red cells and no retics - e.g. incr symptoms of SOb and palpitations after an illness e.g. parvo
49
High red cells and retics in sickle cell crisis
Acute splenic sequestratian crisis
50
Rouleaux formation.....
Myeloma - stacking of pos charged cells that all clump together
51
New onset ID anaemia in over 60s
FIT test 2 week ref for colonscopy
52
How does factor V Leiden incr VTE risk?
Activated factor V is inactivated much more slowly by activated protein C
53
Highest risk of bacterial infection transmission intransfusion
Platelet transfusion
54
Gm pos or gm neg sepsis caused by transfusion
Platelet - gm Positive Red cells - gm Negative (stains red)
55
Primary haemostasis
Formation of platelet plug
56
Secondary haemostasis
Formation of stable fibrin clot
57
3 components of DIC
1. excessive and inappropriate response of haemostatic system 2. microvasc thrombus formation 3. clotting factor consumption
58
Virchow's triad
Stasis Vessel wall damage Hypercoagulability
59
Why do clotting factors incr as pregnancy gets closer to term?
To prevent PPH - physiological response
60
Why does Vit K carboxylate the clotting factors?
To give them a negative charge so they can stick to the phospholipid membrane more easily
61
INR
Correction of PT ratio
62
Why is PT measured in warfarin?
It's the parameter that is most affected/prolonged by warfarin
63
Drugs affecting warfarin metabolism
CYP enzyme inducers/inhibitors
64
Reversal of warfarin in steps
No action Omit warfarin dose Oral vit K Admin clotting factors Clinical and lab assessment of response
65
Vit K or clotting factors in acute bleeding?
Clotting factors - act immediately - vit K takes 12-24 hours to act
66
Management of essential thrombocythaemia
Hydroxyurea
67
Management of polycythaemia rubra vera
Venesection
68
Antibiotic class causing neutropenia
Macrolides e.g. clarithromycin
69
Hypo or hypercalcaemia in myeloma?
Hypercalcaemia - due to incr secretion of PTH assoc peptide
70
Raindrop/pepperpot skull
Multiple myeloma - looks like black splotches on skull - like rain on pavement
71
Test to help confirm PRV diagnosis
JAK2 mutation - present in more than 90% of PRV pts
72
Targetted treatment for CML
Imatinib - targets BCRABL1
73
Example of a high grade NHL
Diffuse large B cell lymphoma
74
Example of low grade NHL
Follicular lymphoma
75
Electrolyte changes in tumour lysis syndrome
Incr K Incr creat Decr urea Decr Ca
76
Spread of lymphadenopathy in HL and NHL
Local spread - Hodgkin's Widespread - Non-Hodgkin's
77
Discoloured eyelids and big tongues
Amyloidosis
78
Raised LDH as a prognosticator?
Poor prognosticator - apparently can also suggest haemolysis as it's released when RBCs are broken down
79
Dry tap on bone marrow biopsy
Myelofibrosis - dry as hell no cells
80
Symptoms of mutliple myeloma
CRAB HAI C - Hypercalcaemia R - Renal Impairment A - Anaemia B - Bone disease H - Hyperviscosity A - Amyloidosis I - Immunoparesis
81
Poor prognosticators in Hodgkin's
Large mediastinal lymphadenopathy ESR >50 mm/Hr without B symptoms ESR > 30 mm/Hr with B symptoms Age >50 4 lymph node sites involved
82
What cells would show upon blood film in myelofibrosis?
Tear drop poikilocytes - myelo-CRY-brosis
83
Skin manifestation of APS
Bilateral blotchy, lace-like erythematous rash affecting legs
84
2Platelet thresholds for procedures
> 50×109/L for most patients 50-75×109/L if high risk of bleeding >100×109/L if surgery at critical site
85
Joint pains, easy bruising and bleeding gums in a woman who lives alone
Scurvy/vit C deficiency - due to poor diet
86
VTE following lengthy anticoag with heparin
Heparin induced thrombocytopenia = causes prothrombotic state = HIT is caused by the formation of abnormal antibodies that activate plateles. Activated platelets release microparticles that activate thrombin, thereby leading to thrombosis
87
What does irradiating blood products do?
Depleted T-lymphocyte numbers reduce the risk of transfusion graft versus host disease
88
Are spherocytes extra or intravascular?
Extravascular
89
Triad of HSP
Purpura, joint pain and abdominal pain.
90
4 components of HUS
Normocytic anaemia Thrombocytopaenia AKI Post-diarrhoeal illness
91
Bite and blister cells
G6PD
92
How to remember effect on fibrinogen, plates, and D dimer in DIC?
3 Ds Decr fibrinogen Decr platelets D-dimer incr
93
Low or high EPO in PRV
Low
94
Osteomyelitis is commonly assoc with which haem condition?
Sickle cell disease - due to salmonella
95
Wells score and what it indicates
1 or less - D dimer and anticoag - pos do doppler 4h - neg doppler in 7 days 2 or more - doppler US within 4h - if not avail D dimer and anticoag, doppler wihin 24h
96
Anaemia + low retics in sickle cell
Aplastic crisis - commonly caused by parvo b19
97
Managment of bilateral acute chest crisis in sickle cell
IV opiates, oxygen, antibiotics
98
Core triad of acute chest crisis management in sickle cell
high-flow oxygen, antibiotics (with atypical cover) and exchange transfusion - as well as IV opiates
99
Spherocytes in AI haemolytic anaemia is more likely to be?
Warm
100
Diagnostic test for paroxysmal nocturnal haemoglobinuria
Flow cytometry for CD55 and CD59
101
ITP vs TTP
ITP typically weeks of petichiae, mild symptoms, no underlying cause TTP more severe symptoms, neuro deficit, VTE (abdo pain, fever, anaemia)
102
High HbA1 outwith context of diabetes
Splenectomy
103
Organisms that pts are especially susceptible to after splenectomy (may need vax or Ab prophx)
Some Killers Have Pretty Nice Capsules Streptococcus pneumoniae, Klebsiella pneumoniae, Haemophilus influenzae, Pseudomonas aeruginosa, Neisseria meningitidis, Cryptococcus neoformans
104
First line treatment for ITP
Steroids
105
New murmur and jaundice
MAHA due to new mechanical valvular defect
106
ABG shows difference between the SaO2 and the PaO2, O2 sats are abnormally low in a breathless and dizzy patient?
Methaemoglobinaemia - has Fe3+ iron instead of Fe2+
107
Best diagnostic inv for haemphilia A
Factor VIII assay
108
Fall in the bathtub with profound hypotension resulting in death
Splenic rupture
109
Macrocytic anaemia assoc with hypothyroidism features
Hashimoto's
110
HbA2 rise
Beta thalassaemia trait
111
Most common paraprotein in multiple myeloma
IgG
112
Spiky red cells that look like those rubber earrings kids used to have
Burr cells - consistent with end stage CKD
113
Most common cause of: - low haemoglobin at 95 g/L - low mean corpuscular volume (MCV) at 77 fl - low mean cell haemoglobin concentration (MCHC) - elevated red cell distribution width (RDW)
Iron defic anaemia
114
Most likely cause of really microcytic anaemia in a man who has no symptoms
Thalassaemia - e.g. alpha minor
115
Most common haemophilia
A - even in stems that are vague e.g. nosebledds
116
3 months of iron supplements but no improvement in Hb levels - FL?
Inv cause of low iron
117
Late onset asthma and prominent upper respiratory tract symptoms + petechial rash + antiMPO positive
Eosinophilia with GPA
118
Pentameric Ig
IgM
119
New onset epistaxis, headache, and blurred vision + long standing fatigue and WL
Waldenstrom's macoglobulinaemia
120
Ig in Waldenstrom's
IgM
121
Development of mild fever and urticarial chest rash during red cell transfusion
Mild allergic reaction to transfusion - stop transfusion and monitor
122
Blood film in ALL
Lymphoblastic cells
123
FL for new microcytic anaemia with super super low Hb in stable 55yo man
Urgent red cell transfusion - defo needs a GI scope for cancer inv but this can wait bc he is stable and really needs red cells
124
Focal neurology, haemolysis and thrombocytopenia + schistocytes on blood film
Microangiopathic haemolytic anaemia - 2o to TTP
125
Complication of PRV causing massive splenomegaly
Myelofibrosis - tear drop poikilocytes
126
Management acute malaria
Artesunate
127
Signet ring red cells and crescent shaped gametes on blood smear
Malaria
128
Functional hyposplenism could e a result of which GI disease causing vesicular rash on bum
Coeliac - rash is dermatitis herpetiformis
129
A- blood
Agglutination with anti-A demonstrates the presence of A antigen only on her red cells - no agglutnation with Anti-Rh or anti-B
130
Management chronic ITP
Steroids - to suppress the immune response - plate transfusion can worsen symptoms
131
New DVT in pt just started on warfarin for AF with strong FHx of VTE
Protein C defic - 1-2 days after warfrain initiation pts become hypercoagulable
132
Neuro symptoms, Fever, Renal, MAHA, Thrombocytopenia, Schistocytes, African Origin
TTP
133
Main physical symptom of CML
MMMMMMMMassive splenomegaly in MMMMMMMIddle aged
134
Findings in PRV
Raised red cell mass, low serum erythropoetin, JAK2 mutation present
135
What lymphoma does CLL become?
Diffuse large B-cell lymphoma - richter transformation
136

Year 3 Incorrect Questions (6 decks)

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