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Year 5 notes > Blood and infection > Flashcards

Blood and infection Flashcards

1
Q

what is used to correct B12 deficiency

A

IV hydroxycobalamin

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2
Q

normal lifespan of RBC

A

120 days - can be as short as 5 days in haemolytic anaemia

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3
Q

3 types of acquired immune haemolytic anaemias

A
  • autoimmune (warm/cold antibody type)
  • alloimmune (transfusion reaction, haemolytic disease of newborn)
  • drugs (methyldopa, penicillin)
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4
Q

types of acquired non-immune haemolytic anaemias

A
  • microangiopathic (TTP/HUS, DIC, malignancy, pre-eclampsia)
  • prosthetic heart valves
  • infections (malaria)
  • dapsone
  • paroxysmal nocturnal haemoglobinuria
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5
Q

treatment of autoimmune haemolytic anaemia

A
  • corticosteroids

- rituximab/ azathioprine/ cyclophosphamide

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6
Q

what virus is found in 50% of cases of Hodgkin’s lymphoma

A

EBV

HIV and immunosuppression and smoking are also risk factors

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7
Q

B symptoms found in 25% of patients with Hodgkin’s lymphoma

A
  • night sweats
  • unexplained fever >38
  • weight loss >10% over 6 months
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8
Q

what blood test finding shows a poor prognosis in Hodgkin’s lymphoma

A

ESR >70

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9
Q

vaccines given in lymphoma

A

pneumococcal and flu

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10
Q

risk of giving chemotherapy in Hodgkin’s lymphoma

A

can cause leukaemia, especially AML

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11
Q

poor prognostic factors for Hodgkin’s lymphoma

A
  • older
  • male
  • low albumin
  • stage IV disease
  • anaemia, leukocytosis, lymphopenia, monocytosis
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12
Q

type of non-hodgkin’s lymphoma associated with EBV

A

Burkitt’s

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13
Q

how does Burkitt’s lymphoma present

A

large abdo mass and symptoms of bowel obstruction

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14
Q

appearance of biopsy in Burkitt’s lymphoma

A

starry sky

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15
Q

what is MGUS

A

monoclonal gammopathy of undetermined significance

can progress to smouldering myeloma which leads to multiple myeloma

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16
Q

presentation of myeloma - CRABBI

A
  • Calcium - hypercalcaemia due to increased osteoclast activity within bones
  • Renal damage (elevated creatinine)
  • Anaemia (BM crowding suppresses erythropoiesis)
  • Bleeding (thrombocytopenia)
  • Bones - lytic bone lesions
  • Infection (reduced production of normal immunoglobulins)
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17
Q

investigation to do for myeloma

A

serum/urine protein electrophoresis

raised concentration of monoclonal immunoglobulins

Bence Jones proteins in urine

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18
Q

common MRI finding in myeloma

A

rain drop skull due to bone lysis

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19
Q

BM biopsy in myeloma

A

monoclonal plasma cells in BM >10%

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20
Q

management of myeloma in younger healthier patients

A

autologous stem cell transplantation

given with bortezomib (proteasome inhibitor) and dexamethasone

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21
Q

management of myeloma in older patients

A

thalidomide, dexamethasone and an alkylating agent

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22
Q

complications of myeloma

A
  • hypercalcaemia
  • renal impairment
  • anaemia
  • infection
  • hyper viscosity (stroke?)
  • SCC
  • pathological fractures
  • bleeding
  • amyloidosis
  • peripheral neuropathy
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23
Q

most common causes of DIC

A

sepsis

also malignancy - especially leukaemia

then trauma, pregnancy complications etc.

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24
Q

typical presentation of DIC

A

bleeding from at least 3 unrelated sites

confusion and disorientation

fever

bruising, purpura

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25
Q

features of sickle cell disease in infancy

A
  • dactylics
  • splenic sequestration
  • pneumococcal sepsis
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26
Q

features of sickle cell disease in young children

A
  • infections, parvovirus
  • vaso-occlusive crises in long bones
  • upper airway obstruction
  • stroke
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27
Q

features of sickle cell disease in older children

A
  • vaso-occlusive crises
  • avascular necrosis
  • stroke
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28
Q

management of acute sickle cell crisis

A
  • analgesia
  • antihistamine
  • hydration 150% of normal maintenance oral or IV
  • abx if needed
  • blood transfusion in aplastic crisis, sequestration or anaemia
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29
Q

maintenance management of sickle cell disease

A
  • avoid precipitating factors
  • hydroxycarbamide
  • L-glutamine
  • repeated blood transfusions
  • vaccinations
  • lifetime oral penicillin V prophylaxis
  • daily oral folic acid
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30
Q

what can be curative for sickle cell disease

A

BM transplantation

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31
Q

commonest cause of mortality in sickle cell disease

A

acute chest syndrome - vast-occlusion and collapse in the lungs

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32
Q

trigger for aplastic crisis in sickle cell

A

parvovirus B19

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33
Q

what is splenic sequestration in sickle cell

A

life threatening sudden enlargement of the spleen leading to hypovolaemia

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34
Q

what can sickle cell do to the penis

A

cause priapism - risk of long term impotence

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35
Q

when does someone with haemophilia require prophylactic factor VIII concentrate

A

if <1% activity = severe disease

36
Q

what can IM bleeds in haemophilia lead to

A

compartment syndrome
nerve compression
ischaemic contracture

37
Q

clotting results in haemophilia

A

increased APTT

normal PT

38
Q

prophylactic treatment in haemophilia A

A

regular injections of octocog alfa (FVIII)

39
Q

prophylactic treatment of haemophilia B

A

regular injections of nonacog alfa (FIX)

40
Q

what is indicated if bleeding in haemophilia doesn’t respond to treatment

A

FVIII inhibitor development

41
Q

most common type of thalassaemia

A

beta - heterozygous

42
Q

how is diagnosis of thalassaemia made

A

haemoglobin electrophoresis

  • beta = high levels of HbA2 and HbF
  • alpha = normal levels
43
Q

features of homozygous beta-thalassaemia

A
  • severe haemolytic anaemia
  • compensatory bone marrow hyperplasia
  • protruding characteristic bossing of facial and skull bones and dental abnormalities
  • hepatosplenomegaly
44
Q

why is desferrioxamine given when doing blood transfusions for thalassaemia

A

blood transfusions cause haemosiderosis due to iron overload therefore give a chelating agent with it

45
Q

drugs which can cause neutropenia

A
  • chemotherapy/ radiotherapy
  • alcohol
  • phenytoin
  • chloramphenicol
46
Q

infections which can cause neutropenia

A 
malaria 
hep B/C
HIV
CMV
infectious mononucleosis
47
Q

definition of febrile neutropenia

A

temp >38.5 or 2 temps >38 for 2 hours

and absolute neutrophil count <0.5

48
Q

autologous vs allogenic bone marrow replacement

A

autologous = stem cells for transplant from own body (sourced when in remission)

allogenic = stem cells from a donor

49
Q

cells on blood film in AML

A

blast cells

Auer rods

50
Q

what is diagnostic of AML

A

bone marrow aspiration

51
Q

first line treatment for CML

A

imatinib (tyrosine kinase inhibitor)

52
Q

what is Richter’s syndrome

A

transformation of CLL to terminal lymphoma in 10%

53
Q

when to give antibiotic prophylaxis during surgery with anaesthesia

A
  • prosthesis or valve
  • clean-contaminated surgery
  • contaminated surgery
  • surgery on dirty/infected wound
  • tourniquet is used
54
Q

type of cancer associated with infectious mononucleosis

A
  • Burkitt’s lymphoma

- B cell lymphomas

55
Q

difference in symptoms between tonsillitis and infectious mononucleosis

A

EBV = generalised tender lymphadenopathy

tonsilitis = only enlarges upper anterior cervical chain

56
Q

when can there be a false positive with a mono spot test

A

lymphomas
leukaemia
RA/SLE
some viral illnesses

57
Q

diagnostic test for infectious mononucleosis in the immunosuppressed

A

quantitative PCR

58
Q

CNS complications of infectious mononucleosis

A
  • aseptic meningitis
  • encephalitis
  • Guillain-Barre syndrome
59
Q

suppression if MRSA positive

A
  • mupirocin for nose TDS 5 days

- chlorhexidine gluconate for skin, OD for 5 days

60
Q

typical antibiotic which can cause C. diff

A

clindamycin

61
Q

severe complication of C. diff

A

toxic megacolon

62
Q

test to do if symptomatic (C. diff)

A

C. diff toxin in stool

63
Q

management of C. diff

A
  • supportive
  • AVOID loperamide/codeine (retention of toxins?)
  • cease causative antibiotic
  • oral METRONIDAZOLE 10-14 days
  • if not responding - VANCOMYCIN
64
Q

antibiotics to give in life-threatening C. diff

A

oral vancomycin + IV metronidazole

65
Q

is C. diff a reportable disease

A

yes

66
Q

3 types of influenza

A

A B C

A and B cause most disease (A causes most flu outbreaks)

67
Q

when to use antivirals in influenza (oseltamivir, zanamivir)

A

significant comorbidities, immunosuppression, pregnancy

68
Q

most common complication of influenza

A

acute bronchitis

69
Q

blood film - measles

A

leucopenia

lymphopenia

70
Q

LFTs - measles

A

raised transaminases

71
Q

complications of measles

A
  • acute OM
  • pneumonitis
  • febrile convulsions
  • keratoconjunctivitis, corneal ulceration
  • encephalitis
  • subcutaneous sclerosing pan encephalitis (about 7 years after measles infection)
72
Q

complications of mumps

A
  • orchitis
  • hearing loss
  • meningoencephalitis
  • pancreatitis
  • oophoritis
73
Q

school exclusion for mumps

A

for 5 days following parotid swelling

74
Q

school exclusion for chicken pox

A

5 days from start of skin eruption

75
Q

when to use acyclovir in chicken pox

A
  • severe varicella
  • encephalitis
  • pneumonia
  • babies
  • immunosuppressed
76
Q

complications of chicken pox

A

bacterial infection may occur with invasive group A strep - leading to cellulitis, necrotising fasciitis or TSS

NSAIDs may increase this risk

77
Q

antibiotics given for whooping cough

A

azithromycin (5 days)
clarithromycin (7 days0

erythromycin if pregnant

78
Q

when to do stool culture in infective gastro-enteritis

A
  • suspected sepsis
  • blood/mucus in stool
  • immunocompromised
  • recently been abroad
  • diarrhoea not improving
79
Q

complications of infective-gastroenteritis

A
  • dehydration and electrolyte disturbance
  • HUS
  • reactive arthritis
  • erythema nodosum
  • GBS
  • malnutrition
80
Q

what virus commonly causes Guillain-Barre

A

campylobacter

81
Q

protective factors for malaria

A
  • sickle cell trait
  • G6PD deficiency
  • HLA-B53
82
Q

what to check before giving primaquine

A

G6PD deficiency

83
Q

management of non-falciparum malaria

A

outpatient

chloroquine

primaquine used for prevention of relapse

84
Q

management of falciparum malaria

A

quinine plus doxycycline orally if uncomplicated

IV quinine if severe with ECG monitoring

85
Q

antimicrobial therapy given for traveller’s diarrhoea

A

fluoroquinolone

Year 5 notes (10 decks)

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