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Medicine Phase 2a Haematology > General > Flashcards

General Flashcards

1
Q

Constituents of the blood

A

Plasma
RBCs
Platelets
WBCs

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2
Q

What % of blood is plasma

A

55%

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3
Q

What % of the blood is RBCs, Platelets or WBCs

A

45%

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4
Q

Where are RBCs produced

A

Bone marrow

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5
Q

Describe appearance of RBC

A

Biconcave

Anucleated

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6
Q

Lifespan of RBC

A

120 days

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7
Q

Where does eryptosis occur

A

Old RBCs are destroyed by spleen, liver and bone marrow

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8
Q

Types of WBCs

A

Granulocytes
Lymphocytes
Monocytes

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9
Q

Types of Granulocytes

A

Neutrophils
Basophils
Eosinophils

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10
Q

Features of neutrophil (appearance etc)

A

Multi-lobular nucleus

Phagocytic and play a role in inflammation, infection and myeloid leukemia

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11
Q

Features of eosinophil (appearance etc)

A

Bi-lobular or tri-lobular nuclei
Show diurnal variation, being more common in morning
Number raised in parasitic infections

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12
Q

Features of basophil (appearance etc)

A

Associated with hypersensitivity reactions

Similar role to mast cells - secrete histamine when stimulated

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13
Q

Types of lymphocytes

A

T cells - mediators in cellular immunity

B-cells - mediators in humoral immunity e.g. antibody mediated responses

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14
Q

Types of T-cells

A

Cytotoxic (CD8+)

T-helper (CD4+)

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15
Q

Features of lymphocytes

A

Numbers increase in viral infection, inflammation and leukaemia
Numbers decrease in HIV and chemotherapy

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16
Q

Features of monocytes

A

Immature cells that differentiate once they leave the bloodstream
Many monocytes form macrophages

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17
Q

Where are platelets derived from

A

Megakaryocytes in bone marrow

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18
Q

Functions of platelets

A

Major role in clotting:

Platelet plug and Coagulation cascade (cascade helps to strengthen the platelet plug, ultimately producing fibrin)

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19
Q

Functions of thrombin

A

Converts fibrinogen to fibrin
Activates factor XIII to XIIIa
Positive feedback effect on further thrombin production

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20
Q

What factors in coagulation cascade are inhibited by warfarin/vitamin K deficiency

A

2 (pro-thrombin), 7, 9, 10

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21
Q

What factor in coagulation cascade is inhibited by Heparin or NOACs

A

Xa

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22
Q

What is function of plasmin

A

Cuts fibrin into fragments

Prevents blood clots from growing and becoming problematic

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23
Q

Important of liver to clotting

A

Liver synthesises many coagulation factors

Liver produces BILE sals needed for Vitamin K absorption

24
Q

Examples of Haematological investigations

A

FBC
Reticulocyte count
Serum ferritin (measure iron levels in body)
Blood film

25
Q

What can a FBC show you

A 
Red blood cell volume
WBC volume
Platelet volume
Hb conc
Mean corpuscular volume
etc
26
Q

Purpose of Reticulocyte count

A

Allows you to see how quickly the bone marrow is producing new RBCs

27
Q

What is implied by a low reticulocyte count

A

indicative that something is preventing RBCs from being produced e.g. a haematinic deficiency

28
Q

What is implied by a high reticulocyte count

A

Indicate that RBCs are being lost or destroyed (e.g. bleeding / haemolytic anaemia). New RBC production is increased to act as a compensatory mechanism

29
Q

When can serum ferritin be falsely high?

A

Inflammation

Malignancy

30
Q

Describe process of blood film

A

Smears of blood are placed onto slides and then examined under a microscope.

31
Q

Types of Blood film

A

Thick

Thin

32
Q

What can you examine with thick blood film

A

examination of a large amount of blood for the presence of parasites

33
Q

What can you observe with thin blood film

A

Observation of RBC morphology, inclusion and Intra/Extra-cellular parasites

34
Q

Normal function of Hb

A

To carry and deliver oxygen to tissues

35
Q 
What is the characteristic genetic abnormality in Chronic Myeloid Leukaemia?
t(15;17) ATRA gene
t(9;22) Philadelphia chromosome
t(8;21) AML/ETO gene
t(8;14) cMYC oncogene
A

t(9;22) Philadelphia chromosome

Resulting in 210-kDa fusion protein –activated tyrosine kinase

36
Q

Chronic myeloid leukamia:

Describe investigations and their results

A

FBC - high WCC

Film - Left shift + basophilia

37
Q

Treatment of Chronic Myeloid Leukaemia and how it works

A

Imatinib:
Blocks abnormal tyrosine kinase activity
Can result in molecular remission
BCR -ABL mutations may result in resistance

38
Q

What class of drug best describes Rituximab?

A

Monoclonal antibody

39
Q

How does Rituximab work

A

Monoclonal antibody that targets CD20 expressed on cell surface of B-cells

Chimeric mouse/human protein
Infusional side-effects
Widely used

40
Q

Which age group is characteristically affected by Hodgkin’s lymphoma?

A

Teenagers and young adults

41
Q

How is myeloma bone disease usually assessed?

A

Plain X-ray

Lytic lesions seen

42
Q

How do lytic lesions result from myeloma bone disease

A

Production of Osteoclast-activating factors OAFs include RANKL, IL-3 and TNF-α

43
Q

Examples of Osteoclast-activating factors

A

RANKL, IL-3 and TNF-alpha

44
Q 
What is the correct mechanism of action for the anti-emetic drug Ondansetron?
Peripheral D2 antagonist
Central D2 antagonist
Anti-cholinergic
5HT3 antagonist
A

5HT3 antagonist

For chemo induced

45
Q

Anti-emetic for gastostasis

A

Pro-kinetics

46
Q

In sickle cell anaemia what would you expect to see the reticulocyte count?

A

Raised

47
Q

How many RBCs are lost per hour in body

A

9 billion

48
Q 
Bacterial infection usually causes?
Low lymphocytes
Low neutrophils
High lymphocytes
High neutrophils
A

High neutrophil count

49
Q

Which best outlines the approach to the management of a patient with suspected febrile neutropaenia?
Encourage fluids and paracetamol
Perform cultures and wait for results before starting antibiotics
Perform cultures and start oral antibiotics
Perform cultures and start broad spectrum iv antibiotics

A

Perform cultures and start broad spectrum iv antibiotics

50
Q

Treatment of Febrile Neutropaenia

A 
Haematologic emergency
ABC
Perform cultures
Broad spectrum iv Abs with 1 hour
E.g. Tazosin and Gentamicin
51
Q

Malignant spinal cord compression usually presents with:
Back pain, ataxia and sensory neuropathy
Back pain, spastic paresis and a sensory level
Perianal numbness and urinary incontinence
Weak legs impaired joint position sense

A

Back pain, spastic paresis and a sensory level

52
Q

*Treatment of malignant spinal cord compression

A 
Emergency
Urgent MRI
Bed rest + pressure area care
Steroids
Analgesia
Chemo or Radiotherapy
53
Q

How does Aspirin exert its antiplatelet effect?

A

Inhibition of Cyclooxygenase enzyme

54
Q

How does Tirofiban exert its antiplatelet effect

A

Inhibition of Glycoprotein IIb-IIIa

55
Q

How does Clopidogrel exert its antiplatelet effect

A

Inhibition of P2Y12

56
Q

Describe platelet function

A

P2Y12 and Glycoprotein IIbIIIa help make ARACHIODONIC ACID
->PGH2:
with COX1 -> TXA2
or with COX2 -> PGI1

Medicine Phase 2a Haematology (16 decks)

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