questions

Question 1

what are immunoglobulins

Answer 1

produced by B-cells and plasma cells
each immunoglobulin recognises a specific antigen
can be expressed on B cell surface or released into blood stream as antibodies by plasma cells

Question 2

what are immunoglobulins made up of

Answer 2

2 heavy chains- determines the class of antibody produced
2 light chains
together the type of heavy and light chains are called isotype of the antibody

Question 3

common blood results in alcoholic liver disease

Answer 3

macrocytic anaemia and thrombocytopenia

Question 4

first line management of patient with autoimmune haemolytic anaemia

Answer 4

steroids

Question 5

basophilic stippling of red blood cells means

Answer 5

lead poising or siderblastic anaemia

Question 6

presentation of siderblastic anaemia

Answer 6

microcytic anaemia
fatigue
pallor
SOB

Question 7

where is folate absorbed

Answer 7

the jejunum

Question 8

causes of B12 deficiency

Answer 8

not enough dietary intake
pernicious anaemia
gastrectomy
malabsorbtion: crohn’s
medicine: metaformin

Question 9

causes of folate deficiency

Answer 9

diet
malabsorption: coeliac
excessive peeing: heart failure, liver damage, long term dialysis
medicine: anticonvuslants
pregnancy
malignancy
exfoliating dermatitis

Question 10

what is pernicious anaemia

Answer 10

autoimmune condition resulting in destruction of gastric parietal cells > intrinsic factor deficiency

Question 11

importance of B12 and folate

Answer 11

co-factors in DNA synthesis and nuclear maturation and DNA modification and gene activity

Question 12

how is folate absorbed

Answer 12

dietary folates converted to monoglutamate
absorbed in jejunum
stores are lower than for B12

Question 13

presentation of B12/folate deficiency

Answer 13

anaemia
weight loss
diarrhoea
infertility
sore tongue
jaundice
development problems

Question 14

why can patients with macrocytic anaemia appear jaundiced

Answer 14

due to ineffective erythropoiesis caused by intramedullary haemolysis
meaning a breakdown of cell within the bone marrow

Question 15

B12 deficiency specific symptoms

Answer 15

neurological problems
- posterior/dorsal column abnormalities
- neuropathy
- dementia
- psychiatric manifestations

Question 16

management of pernicious anaemia

Answer 16

vit B12 injections for life- hydroxocobalamin

Question 17

causes of microcytic anaemia

Answer 17

TAILS
- thalassaemia
- anaemia of chronic disease
- iron deficiency
- lead poising
- sideroblastic

Question 18

what causes anaemia of chronic disease

Answer 18

IL-6 is released due to chronic diseases and increases production of hepcidin > this down regulates ferroportin expression, reducing iron absorption and precipitating anaemia

Question 19

what is sideroblastic anaemia

Answer 19

excess iron buildup in mitochondria due to failure to incorporate iron into haem
can be hereditary

Question 20

most common type of Hodgkin’s lymphoma

Answer 20

nodular sclerosing

Question 21

bleeding and bruising, petechial and purpuric rash
often with a history of viral illness

Answer 21

immune thrombocytopenic purpura

Question 22

management of immune thrombocytopenic purpura

Answer 22

prednisolone
IV immunoglobulins
blood transfusion
platelet transfusions only work temporarily

Question 23

management of thrombotic thrombocytopenic purpura

Answer 23

IV plasma exchange
splenectomy

Question 24

what does cryoprecipitate contain

Answer 24

factor VIII, fibrinogen, von Willebrand factor and factor XIII

Question 25

when is hydroxyurea used in sickle cell disease

Answer 25

to prevent a further crisis if the patient has had repeated attacks

Question 26

diagnostic of beta thalassaemia trait

Answer 26

raised HbA2

Question 27

presentation of beta thalassaemia major

Answer 27

presents aged 6-24 months (as HbF falls) pallor failure to thrive hepatosplenomegaly skeletal changes organ damage

Question 28

haemoglobin analysis of beta thalassaemia major

Answer 28

mainly HbF no HbA

Question 29

management of beta thal major

Answer 29

regular transfusion programme to maintain Hb - risk of iron overload from transfusion bone marrow transplant may be option

Question 30

consequences of iron overload

Answer 30

endocrine dysfunction: impaired growth and pubertal development, diabetes, osteoporosis cardiac disease: cardiomyopathy, arrhythmias liver disease: cirrhosis, hepatocellular cancer

Question 31

management of iron overload

Answer 31

250mg of iron per unit packed red cells chronic anaemia also drives increased iron absorption iron chelating drugs: desferrioxamine

Question 32

what type of haemophilia is turners related to

Answer 32

haemophilia A - because it is X linked recessive and people with turners only have one X chromosome