Haematology

Question 1

Iron deficiency anaemia (IX findings)

Answer 1

low hb, low MCV, low serum iron, low ferritin( can be high in inflammation, so not reliable), high TIBC(amount of unbound transferrin blood), wider red blood cell distribution width(as different RBC getting chucked out from bone marrow as it goes into overdrive), peripheral blood smear shows microcytic and hypochromic RBC, low transferrin saturation

Question 2

what breaks down meat into b12

Answer 2

pepsin

Question 3

where is intrinsic factor made

Answer 3

parietal cells in stomach

Question 4

where is B12/intrinsic factor complex absorbed

Answer 4

Terminal ileum

Question 5

excessive WCC, philadelphia chromosome- which leukaemia

Answer 5

Chronic Myeloid leukaemia

Question 6

x-linked(brothers) factor VIII or Factor Ix deficiency, bleeds into joint and muscles

Answer 6

• haemophilia(a- factor VIII)(b-Factor-ix)

- avoid IM injections and NSAID

Question 7

key two investigations for haemophilia(2)

Answer 7

1) Raised APTT

2) low factor VIII or IX assay

Question 8

INR 5.0-8.0- no bleeding - what to do about warfarin

Answer 8

stop warfarin for 1-2 days, reduce subsequent warfarin dose

Question 9

INR 5.0-8.0- with minor bleeding

Answer 9

IV vitamin K 1-3mg, Stop warfarin treatment and restart when INR <5

Question 10

Major bleeding- patients on warfarin

Answer 10

IV Vitamin K 5mg, stop warfarin treatment.+ give dried prothrombin complex/ Fresh frozen plasma

Question 11

Target Cells - which conditions(4)

Answer 11

1) Iron deficiency anaemia
2) Post splenectomy
3) Liver disease
4) Thalassaemia

Question 12

Key bone marrow cells for AML

Answer 12

Auer Rods

Question 13

Heinz bodies(3 causes)

Answer 13

• denatured haemoglobins due to spleen being removed.
• G6PD deficiency
• sulfonamides

Question 14

uraemia cells

Answer 14

Burr

Question 15

why is warfarin not used in pregnancy

Answer 15

it is teratogenic

Question 16

Antiphospholipid syndrome anticoag when pregnant

Answer 16

Aspirin(increased platelet activation opposed by aspirin) and LMWH

Question 17

slowly enlarged lymph nodes, lymphocytosis, treated with chlorambucil and fludarabine, which condition

Answer 17

Chronic Lymphocytic Leukaemia

Question 18

Smear Cells(ruptured cell membranes-lymphocytes), which leukaemia

Answer 18

Chronic lymhocytic leukaemia

Question 19

Type of cell for myelofibrosis,myelodysplastic syndrome,

Answer 19

teardrop red cells

Question 20

G6pd inheritance type

Answer 20

X- linked - predominantly affect African males

Question 21

Polycythemia rubra vera symptoms( hyperviscosity, bath, feet and hands)

Answer 21

• Headaches, dizzyness, tinnitus and visual disturbances
• itching after a hot bath
• burning sensation in fingers and toes(erythromelalgia)

Question 22

photosensitive rashes, arthralgia, anaemia, thrombocytopenia- which condition

Answer 22

SLE

Question 23

pernicious anaemia

Answer 23

low B12

Question 24

reduction in Hb, WCC(leukopenia), thrombocytopenia

Answer 24

Aplastic anaemia

Question 25

2 key risks for patients with aplastic anaemia

Answer 25

Bleeding and infection

Question 26

key side effect of chloramphenicol

Answer 26

Aplastic anaemia(suppression)

Question 27

Amyloidosis investigations

Answer 27

biopsy, positive congo red stain and red green birefringence under polarised light microscopy

Question 28

DVT in cancer patient treatment

Answer 28

LMWH for 6 months and then risk assess

Question 29

Provoked DVT(COCP)

Answer 29

LMWH for 5 days + Vit K antagonist for 3 months/ doac for 3 months

Question 30

which leukaemia caused by chemotherapy

Answer 30

Acute Myeloid leukaemia

Question 31

Complication tumours of chemotherapy

Answer 31

Breast, Lung, Thyroid, Bone , colon

Question 32

key immunosuppresant that causes gingival hypertrophy

Answer 32

ciclosporin

Question 33

Haemolyric transfusion reaction symptoms(3)

Answer 33

fever, hypotension and red-coloured urine.

Question 34

key difference symptom between TRALI and TACO

Answer 34

TRALI has fever

Question 35

First line treatment for hodgkins disease

Answer 35

Chemotherapy and Radiotherapy

Question 36

Thrombocythaemia(>1000 Platelets) what drug to start

Answer 36

Aspirin 75mg OD(minimises risk of thrombosis and stroke)

Question 37

Causes of hyperviscosity syndrome(4)

Answer 37

Polycythemia rubra vera, leukaemia, myeloma, waldenstroms macroglobulinemia

Question 38

Definition of hyperviscosity syndrome

Answer 38

Viscosity of the blood raises enough to impair microcirculation

Question 39

Symptoms of hyperviscosity syndrome

Answer 39

Lethargy, confusion, bleeding from the GI and GU tract, visual disturbances

Question 40

Key pathology of ALL chemotherapy - cytomegalovirus and herpes zoster oesophageal finding

Answer 40

Oesophageal ulceration

Question 41

Which opioid is contraindicated in sickle cell crises

Answer 41

Pethidine

Question 42

CHOP regime for non hodgkins

Answer 42

Cyclophosphamide, hydroxydaunorubicin, vincristine(oncovin), prednisolone

Question 43

Facial features of beta thalassemia major

Answer 43

Prominent forehead(frontal bossing), full cheek bones( prominent Malar eminence), depressed bridge of the nose, and overgrowth( hypertrophy) of the upper jaw( maxillae)

Question 44

Beta thalassemia major ( Cooley's anaemia) features

Answer 44

- recurrent bacterial infections - anaemia - decreased mcv and raised reticulocytes - enlarged spleen and liver

Question 45

Sideroblastic anaemia key cause- you ask if they worked in a particular industry

Answer 45

Lead poisoning( paint industry) - diagnosed with bone marrow biopsy( ring sideroblasts )

Question 46

Key curative treatment for patients with CML

Answer 46

Bone marrow transplantation from HLA

Question 47

aplastic crises - low hb and which infection?

Answer 47

parvovirus