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Y3 AFT 2 Flashcards

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1
Q

What is G6PD deficiency?

A

Agenetic disorder causing deficiency in glucose 6 phosphate which is an enzyme used to prevent against oxidative stress.

It can lead to haemolytic anaemia when the person is exposed to triggers such as infections.

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2
Q

Reticulocyte count is usually lowered in autoimmune haemolytic anaemia. True/false?

A

False

Usually raised reticulocyte count

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3
Q

What do intravascular causes of haemolysis usually present with?

A

Presents with abnormal breakdown products such as haemoglobinuria (resulting in pink urine) and hemoglobinemia (detected by low haptoglobin which is what binds free Hb in the blood).

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4
Q

What are the only 2 causes of intravascular haemolytic anaemia?

A

Alloimmune and G6PD are however the only intravascular causes (where the red cells are destroyed within the circulation), the rest being extravascular.

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5
Q

What are features of extravascular haemolysis?

A

Extravascular haemolysis leads to release of protoporphyrin (unconjugated bilirubin) in the blood and in urine and this leads to symptoms such as jaundice and gall stones.

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6
Q

Both alloimmune haemolytic anaemia and G6PD deficiency are intrvascular causes. How can they be differentiated?

A

G6PD deficiency mostly associated with African ethnicity and has a strong family history. Triggered by foods (fava beans), medications and infections.

Alloimmune haemolytic anaemia is related to a blood trigger (often incompatible transfusion).

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7
Q

What type of anaemia is pernicious anaemia?

A

Macrocytic megaloblastic anaemia

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8
Q

What antibodies are associated with pernicious anaemia?

A

Intrinsic factor antibodies.

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9
Q

What are the causes of microcytic anaemia (TAILS)?

A

Mnemonic: TAILS

Thalassaemia

Anaemia of chronic disease

Iron deficiency anaemia

Lead poisoning

Sideroblastic anaemia

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10
Q

What are causes of normocytic anaemia (ABCD)?

A

Mnemonic: ABCD

Acute blood loss

Bone marrow failure

Chronic disease

Destruction (haemolysis)

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11
Q

What are causes of macrocytic anaemia (FAT RBC)?

A

Mnemonic: FAT RBC

Foetus (pregnancy)

Alcohol excess

Thyroid (hypothyroidism)

Reticulocytosis

B12/folate deficiency

Chronic liver disease/cirrhosis

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12
Q

What is sideroblastic anaemia?

A

When bone marrow produces ringed sideroblasts instead of healthy RBC’s.

In sideroblastic anaemia, the body contains iron however cannot incorporate it into haemoglobin leading to iron overload.

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13
Q

What is a blood film feature of sideroblastic anaemia?

A

Pappenheimer bodies

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14
Q

What is the appearance of Pappenheimer bodies on blood film?

A

Pappenheimer bodies within RBCs appear as pyknotic violet dots (MG Giemsa stain) and appear blue with Perl’s Prussian blue stain for iron.

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15
Q

What is the most appropriate eradication therapy for MALT lymphoma?

A

MALT lymphoma is a type of non-hodgkin lymphoma. Treatment involves eradication of H.pylori in gastric MALT lymphoma.

Treatment:
Omeprazole, amoxicillin and clarithromycin

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16
Q

Eradication therapy for gastric MALT lymphoma in those with a penicillin allergy?

A

Omeprazole, metronidazole and clarithromycin.

Amoxicillin is replaced with metronidazole

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17
Q

Polycythemia carries a reduced risk of thrombosis. True/false?

A

False

Polycythemia carries increased thrombosis risk.

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18
Q

What is treatment of polycythemia vera?

A

Aspirin

Polycythemia vera is a malignancy characterised by high RBC count. Carries an increased risk of thrombosis so aspirin is used to reduce the risk.

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19
Q

Antibiotics play no role in the prevention of polycythemia vera. True/false?

A

True

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20
Q

Which test that is most useful for monitoring the therapeutic effect of Warfarin?

A

INR (international normalised ratio)

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21
Q

What are neutrophils and their blood film appearance?

A

Neutrophils are the most abundant type of white blood cells and have multi-lobed nuclei.

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22
Q

Function of neutrophils?

A

They are primarily involved in combating bacterial infections through phagocytosis (engulfing and destroying bacteria).

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23
Q

What are lymphocytes and their blood film appearance?

A

Lymphocytes have a large, round nucleus that occupies most of the cell.

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24
Q

Function of lymphocytes?

A

They play a key role in the immune response, including the production of antibodies and coordination of the body’s immune defenses.

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25
What are monocytes and their blood film appearance?
Monocytes are larger cells with a kidney-shaped or horseshoe-shaped nucleus.
26
Function of monocytes?
They are precursors to tissue macrophages and play a role in engulfing pathogens, cellular debris, and foreign substances.
27
What are eosinophils and their blood film appearance?
Eosinophils have bi-lobed nuclei and distinctive red-orange granules in their cytoplasm.
28
Functions of eosinophils?
They are involved in allergic reactions and defense against parasitic infections.
29
What are basophils and their blood film appearance?
Basophils have a lobed or irregularly shaped nucleus and large, dark-staining granules in their cytoplasm.
30
Function of basophils?
Basophils release histamine and other chemicals involved in inflammatory and allergic responses.
31
Characteristic features of anti-phospholipid syndrome?
Characterised by recurrent thrombotic events i.e. recurrent miscarriages and ischemic stroke.
32
Underlying pathology of anti-phospholipid syndrome?
In antiphospholipid syndrome, the autoantibodies cause a conformational change in B2 glycoprotein which leads to activation of both primary and secondary haemostasis and vessel wall abnormalities.
33
What is Factor V Leiden deficiency?
A point mutation of factor V resulting in an elimination of the cleavage site in factor V and factor Va. This genetic defect increases the risk of thrombosis.
34
What differentiates factor V Leiden deficiency from anti-phospholipid syndrome?
Factor 5 Leiden deficiency is another example of a thrombophilia (abnormal tendency to form clots) however it is inherited rather than acquired like anti-phospholipid syndrome.
35
What does Factor V Leiden deficiency typically present with?
Factor 5 Leiden is most likely to present with a pulmonary embolism or DVT.
36
Inheritance pattern of factor V Leiden deficiency?
Autosomal dominant
37
Up to 40% of untreated women may develop sepsis from asymptomatic untreated bacteriuria. True/false?
True
38
What is doxycycline not advised in pregnancy?
Can cause foetal dental staining.
39
Antibiotic treatment for pregnant woman with asymptomatic bacteriuria?
1st and 2nd trimester: nitrofurantoin 3rd trimester: trimethoprim
40
What is the initial investigation for meningococcal septicaemia?
Blood cultures
41
When is a lumbar puncture mainly contraindicated?
In patients with potential raised ICP (intracranial pressure).
42
Which hormone provides negative feedback to the hypothalamus during the follicular phase of the ovarian cycle?
Oestrogen Acts as a negative feedback, sending signals to the anterior pituitary in order to inhibit further production of FSH and LH.
43
What is zero order kinetics in pharmacology?
In zero-order kinetics, the rate of drug elimination is constant regardless of the concentration of the drug in the body.
44
What is an example of zero order kinetics?
Alcohol metabolism follows zero-order kinetics. No matter how much alcohol is consumed, the body can only metabolise it at a certain rate per unit of time.
45
What is first order kinetics in pharmacology?
In first-order kinetics, the rate of drug elimination is directly proportional to the concentration of the drug in the body.
46
What is an example of first order kinetics?
Most drugs follow first-order kinetics. As the concentration of the drug in the body increases, the rate of elimination also increases proportionally.
47
What is the CAGE questionnaire used for?
The CAGE questionnaire is used in assessment of alcohol dependence.
48
What is the LUNSERS assessment tool used for?
A self-rating scale for measuring the side-effect of antipsychotic medications.
49
What is a case report?
A detailed report of the diagnosis, treatment, and follow-up of an individual patient.
50
What is a case control study?
A type of observational study. It looks at 2 sets of participants. One group has the condition you are interested in (the cases) and one group does not have it (the controls).
51
What is a cross sectional study?
Cross-sectional studies are observational studies that analyse data from a population at a single point in time. Often used to measure the prevalence of health outcomes, understand determinants of health, and describe features of a population.
52
Difference between retrospective and prospective cohort studies?
Retrospective studies “look back” in time contrasting with prospective studies, which “look ahead” to examine causal associations.
53
Which cells help increase the membrane resistance within the central nervous system?
Oligodendrocytes are cells which produce myelin in the CNS. Myelin is an insulating material which increases the membrane resistance.
54
Difference between oligodendrocytes and schwann cells?
They both share the same function of producing myelin however oligodendrocytes function in the CNS whilst schwann cells function in the PNS.
55
Functions of astrocytes?
Maintaining the blood brain barrier and environmental homeostasis.
56
What are microglial cells and where do they come from?
Microglial cells are antigen presenting cells similar to macrophages. They come from bone marrow but remain in the CNS.
57
What are ependymal cells and their function?
Ependymal cells are ciliated cuboidal/columnar epithelial cells that line the ventricles and produce cerebrospinal fluid.
58
What type of ABG result would diarrhoea and vomiting cause?
Metabolic alkalosis
59
First line investigation for endometriosis?
Transvaginal ultrasound
60
The use of CA125 is not recommended for endometriosis as it is not sensitive to diagnosing endometriosis. True/false?
True CA-125 along with the presence of masses on ultrasound and menopausal status are used for the risk of malignancy index in ovarian cancer.
61
What is a pelvic MRI used for in endometriosis?
Should be used to assess the extent of the endometriosis.
62
What is the gold standard investigation for endometriosis?
Laparoscopy is very good at diagnosing endometriosis and can be used to surgically remove areas of endometrial tissue.
63
Underlying cause of urge urinary incontinence?
Urge incontinence (urgency, increased urinary frequency) is most commonly due to detrusor muscle overactivity; especially in women.
64
Underlying cause of stress urinary incontinence?
Loss of pelvic floor musculature is common in women due to childbirth but typically causes stress symptoms (small volume leaks during coughing/laughing/lifting or exercise).
65
What is incomplete bladder emptying/atonic bladder characterised by?
Characterised by frequent dribbling of urine and symptoms similar to stress incontinence.
66
What is a common cause of incontinence in the elderly?
Immobility is a common cause of incontinence in the elderly.
67
What is mastitis?
An inflammation of breast tissue that sometimes involves an infection. The inflammation results in breast pain, swelling, warmth and redness. Patient might also have fever and chills. Mastitis most commonly affects women who are breast-feeding (lactation mastitis).
68
Management of mastitis in breastfeeding woman?
Continue breastfeeding, take paracetamol and ibuprofen, massage breast, hydrate and rest.
69
Mastitis when breastfeeding resolves quicker if breastfeeding continues as well as being better for her baby. True/false?
True
70
Ibuprofen is NOT safe in breastfeeding. True/false?
False Ibuprofen is safe in breastfeeding.
71
When are antibiotics indicated in mastitis?
In the presence of sepsis, where the mastitis doesn’t resolve with initial measures or if not breastfeeding.
72
What are contraindications to COCP?
BMI>35 History of VTE Migraine with aura Uncontrolled hypertension
73
What is a contraindication to the progesterone only pill?
Active breast cancer
74
When is whole exome sequencing used?
When there are a number of genes to be looked at.
75
What is chromosome microarray used for?
Chromosome microarray is used for uncovering copy number variants. Looks in detail at a person's chromosomes to see if there are any extra or missing sections which might account for problems they have been experiencing.
76
What is karyotyping used for?
Karyotype is used for looking at the variation within the chromosome.
77
What is PCR and sequencing used for?
PCR and sequencing is used for mapping the DNA through amplification of the tissue sample.
78
What is N-acetycystine used for?
Acute liver failure and in paracetamol toxicity
79
What are the effects of sudden diazepam cessation?
Benzodiazepines (i.e. diazepam) cause GABA activation which results in inhibitory post synaptic potential which inhibits neurotransmission. It has anticonvulsant properties and therefore sudden cessation of diazepam is what likely resulted in the seizure. Alcohol has similar anticonvulsant properties.
80
What are features of haemophilia B?
Abnormally heavy bleeding, typically affecting the muscles and joints (particularly lower limb). Iron in the blood irritates the synovium of the joints and causes neovascularisation. These vessels are easily damaged and can bleed. This can lead to haemarthrosis which causes reduced movement in joints after one or repeated bleeds.
81
What is a major difference between haemophilia A and B?
Haemophilia A - factor 8 deficiency Haemophilia B - factor 9 deficiency
82
What are the typical APTT and PT results for haemophilia A and B?
In haemophilia A or B, the activated partial thrombin time is prolonged however the prothrombin time is not. This is because the APTT only measures the intrinsic pathway i.e. clotting factors 8 and 9.
83
What does APTT measure?
Measures the intrinsic pathway i.e. clotting factors 8 and 9.
84
What does PT measure?
Measures the time taken for prothrombin to form and measures thrombus formation, clotting factors VII, V, Xa, IIa and I.
85
In vitamin K deficiency, liver failure and DIC. APTT and PT are usually both prolonged. True/false?
True
86
What are the 2 main types of HSV?
HSV 1 = cold sores HSV 2 = genital ulcers "1 mouth 2 balls"
87
What are characteristic features of thrombotic thrombocytopenia purpura (TTP)?
Intravascular haemolysis associated with schistocytes (fragmented RBC's) and thrombocytopenia (low platelets).
88
Features of endometriosis?
Cyclic pelvic pain (associated with menstrual cycle) Dyspareunia (pain during sexual intercourse) Infertility Endometrial tissue may also be found in bladder leading to bowel and bladder symptoms.
89
Features of fibroids?
Usually asymptomatic, particularly occurring in young women Menorrhagia (heavy bleeding) is usually a typical symptomatic complaint.
90
Lithium can lead to nephrogenic diabetes insipidus, what can this present with?
This presents with nocturia and excessive thirst.

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