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Passmed Flashcards

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1
Q

Why is B12 deficiency treated first in combined b12 and folate deficiency

A

To avoid subacute combined degeneration of the spinal cord.

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2
Q

B12 deficiency treatment

A

1mg IM hydroxocobalamin 3x weekly 2 weeks the. 3 monthly

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3
Q

B12 deficiency symptoms

A

Macrocyctic anaemia
Sore mouth and tongue
Neurological symptoms- dorsal column (vibration, proprioception)
Mood disturbances

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4
Q

Causes of B12 Deficiency

A

Pernicious anaemia
Vegan diet
Malabsorption disorder
Post gastrectomy
Metformin

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5
Q

Alternative to morphine in palliative patients with renal failure

A

Oxycodone

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6
Q

What is Richters transformation

A

CLL cells enter the lymph node and change into a high grade fast growing non-Hodgkin’s lymphoma

Patient v illl v quick

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7
Q

Richters transformation symptoms

A

Lymph node swelling
Fever without infection
Weightloss
Night sweats
Nausea
Abdo pain

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8
Q

What to do with patients over 60 with iron deficiency anaemia

A

Refer via 2ww for colonoscopy

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9
Q

Causes of iron deficiency anaemia

A

Blood loss (menorrhagia, GI bleed)
GI bleeding
Inadequate dietary intake
Poor intestinal absorption
Increased iron requirements (pregnancy)

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10
Q

Features of iron deficiency anaemia

A

Fatigue
SoB
Palpitations
Pallor
Koilonychia
Angular stomatitis
Atrophied glossitis

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11
Q

Iron deficiency anaemia Ivx

A

FBC - hypochromic micro cystic anaemia
Serum ferritin - usually low
TIBC/transferrin - high
Blood film - target cells, anisopoikilocytosis

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12
Q

Iron deficiency anaemia management

A

Find and treat cause
Oral ferrous sulphate
Iron rich diet

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13
Q

Causes of renal impairment in multiple myeloma

A

AL type amyloidosis, Bence Jones nephropathy, nephrocalcinosis, nephrolithiasis

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14
Q

Hyposplenism blood film

A

Target cells,
Howell-jolly bodies
Siderotic granules
Pappenheimer bodies
Acanthocytes

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15
Q

Iron deficiency anaemia blood film

A

Target cells
Pencil poikilocytes

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16
Q

Myelofibrosis blood film

A

Tear drop poikilocytes

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17
Q

Intravascular haemolysis blood film

A

Schistocytes

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18
Q

Megaloblastic anaemia blood film

A

Hypersegmented neutrophils

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19
Q

How often should sickle cell patients get a pneumococcal vaccine

A

Every 5 years

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20
Q

Prophylactic management of sickle cell

A

Hydroxyurea - increases HbF levels

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21
Q

Lead poisoning features

A

Abdo pain
Peripheral neuropathy
Fatigue
Neuropsychiatric features
Constipation
Blue lines on gums

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22
Q

Lead poisoning management

A

Various chelating agents - dimercaprol, EDTA

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23
Q

Risk of Iga deficiency in blood transfusion

A

Increased risk of anaphylaxis

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24
Q

Beta thalassaemia trait features

A

Mild hypochromic, microcytic anaemia
Raised HbA2

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25
G6PD deficiency features
Neonatal jaundice Gallstones Splenomegaly Intravascular haemolysis
26
G6PD deficiency blood film
Heinz bodies, bite cells, blister cells
27
G6PD inheritance
X-linked recessive
28
G6PD deficiency diagnosis
G6PD enzyme assay. 3 months post acute episode
29
Pancreatic cancer tumour marker
CA 19-9
30
Why use irradiated blood products
Reduces risk of graft v host disease by destroying T cells. Required in Hodgkin’s lymphoma, immunocompromised,neonates
31
TACO symptoms (transfusion associated circulatory overload)
Htn, raised jvp, afebrile, S3 present
32
TRALI symptoms (Transfusion related acute lung injury)
Hypotension, pyrexia, normal jvp
33
Blood transfusion complications
GOT A BAD UNIT Graft v Host disease Overload Thrombocytopenia Alloimunisation Blood pressure unstable Acute haemolytic reaction Delayed Haamolytic reaction Urticaria Neutrophillia Infection Transfusion related lung injury
34
What can cause an aplastic crisis in hereditary spherocytosis
Parvovirus
35
Hereditary spherocytosis features
Failure to thrive Aplastic crisis Jaundice Gallstones Splenomegaly MCHC raised
36
Hereditary spherocytosis ethnicity
Northern european
37
Benign neutropenia ethnicity
Black Afro Caribbean
38
Factors associated with poor prognosis in Hodgkin’s lymphoma
Presence of B symptoms Age over 45 Male Hb less than 10.5 Lymphocytes less than 600
39
Most common cause neutropenic sepsis
Coagulase positive, gram negative bacteria- staphylococcus epidermidis
40
How to convert morphine oral to subcutaneous
Divide by 2
41
What does a ‘starry’ sky biopsy suggest
Burkitt lymphoma
42
What is ITP
Idiopathic thrombocytopenic purpura Immune mediated reduction in platelet count, antibodies directed against glycoprotein 2b or 3a
43
Thrombocytopenia causes
ITP DIC Haem malignancy Alcohol Liver disease Antiphospholipid syndrome Pregnancy
44
Symptoms of spinal cord compression
Back pain (may be worse lying down or coughing) Lower limb weakness Sensory changes Urinary retention Urinary/faecal incontinence
45
Spinal cord compression Ivx
Whole spine MRI within 24hrs presentation
46
Spinal cord compression mx
High dose oral dexamethasone Urgent assessment for surgery or radiotherapy
47
What can cause haemolytic anaemia in G6PD deficiency
Malaria prophylaxis
48
Most common tumour to cause bony mets
Prostate Breast Lung
49
Features of bone mets
Bone pain Pathological fractures Hypercalcaemia Raised ALP
50
Most common sites of bone mets
Spine Pelvis Ribs Skull Long bones
51
Von willibrand disease -APTT, platelets + bleed time
Prolonged bleed time Normal platelet count Prolonged APTT
52
Aplastic anaemia features
Normochromic, normocytic anaemia Leukopenia Thrombocytopenia
53
Aplastic anaemia causes
Idiopathic Drugs - phenytoin Parvovirus, hepatitis Radiation
54
Universal donor of FFP
AB RhD negative
55
Features of thrombotic thrombocytic purpura
Fever Altered mental state - confusion, headache, seizure Haemolytic anaemia Reduced renal function Thrombocytopenia
56
What is TTP
Thrombotic thrombocytic purpura Microangiopathic haemolytic anaemia
57
TTP causes
Post infection Pregnancy Drugs - penicillin, oral contraceptives SLE HIV
58
Dabigatran reversal agent
Idarucizumab
59
Causes of hyposplenism
Post-splenectomy Coeliac disease
60
Hyposplenism blood film
Target cells Howell-jolly bodies
61
Breast cancer tumour market
CA15-3
62
Ovarian cancer tumour marker
CA125
63
Von willibrand treatment
Tranexamic acid for bleeding Desmopressin Factor vIII concentrate
64
What causes electrolyte abnormalities in tumour lysis syndrome + what are they?
Release of intracellular contents into bloodstream Hyperkalaemia, hyperuricaemia, hyperphosphataemia and hypocalcemia
65
DIC typical blood picture
Dec platelets Dec fibrinogen Inc PT and APTT
66
What type of anaemia is CLL associated with
Warm autoimmune haemolytic anaemia
67
Prevention measures for tumour lysis syndrome
IV fluids Rasburicase Allopurinol (not alongside rasburicase)
68
Define laboratory tumour lysis syndrome
Abnormally in 2 or more of the following occurring within 3 days before or 7 days after chemo 25% Inc Uris acid, potassium or phosphate 25% decrease in calcium
69
Define clinical tumour lysis syndrome
Lab tumour lysis syndrome plus one of Inc serum creatinine Arrhythmia or sudden death Seizure
70
Reversal agent of rivatoxaban + apixaban
Andexanet Alfa
71
Criteria for young person referral for leukaemia
0-24 Unexplained petechiae or hepatosplenomegaly Immediate specialist assessment
72
Anticoagulant for antiphospholipid syndrome in pregnancy
Aspirin + Lmwh
73
ITP treatment
Oral prednisolone Pooled normal human immunoglobulin
74
What is evans syndrome
ITP in association with AIHA
75
Causes of massive Splenomegaly
Myelofibrosis CML malaria Gauchers syndrome Visceral leishmaniasis
76
Graft v host disease signs + symptoms (acute)
Painful maculopapular rash Jaundice Diarrhoea Persistent N+V Culture negative fever
77
Chronic graft v host disease symptoms
Lichen planus, scleroderma, vitiligo Corneal ulcers Dysphagia,oral ulcers Lung disease
78
Most common lung cancer in non Smokers
Lung Adenocarcinoma Peripheral leision
79
What is calcitonin a tumour marker for?
Medullary thyroid cancer
80
1st line abx for neutropenic sepsis
Tazocin
81
What is anaemia with reticulocytosis indicative of
Haemolysis or bleeding
82
Haemolysis blood results
Raised bilirubin (other LFTs normal) Low haptoglobins Raised LDH Low Hb High reticulocytes
83
Threshold for platelet transfusion
<30 with significant bleeding. (Higher if bleeding at critical sites I.e CNS)
84
What is used for emergency reversal of anticoagulants
Prothrombin complex concentrate
85
What is Myelofibrosis
Myeloproliferative disorder caused by hyperplasia of abnormal megakaryocytes
86
Myelofibrosis features
Elderly with symptomatic anaemia High urate and LDH tear drop poikilocytes

Cancer Care (4 decks)

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