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3rd Year Conditions > Haem > Flashcards

Haem Flashcards

1
Q

What are the risk factors for DVT?

A
  • immobility
  • recent surgery
  • long haul flights
  • pregnancy
  • hormone therapy with oestrogen
  • malignancy
  • polycythaemia
  • SLE
  • thrombophilia
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2
Q

Examples of thrombophilia

A
  • antiphospholipid syndrome
  • antithrombin deficiency
  • protein C or S deficiency
  • factor V Leiden
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3
Q

How and when do we give DVT prophylaxis?

A
  • all patients are assessed for their risk
  • low molecular weight heparin e.g
    enoxaparin
  • contraindication with active bleeding or existing anti coagulation
  • anti-embolic stockings unless they have peripheral arterial disease
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4
Q

DVT presentation

A

Usually unilateral

Calf or leg swelling

Tenderness to the calf

Oedema

Colour changes to the leg

More than 3cm difference in circumference between legs (10cm below tibial tuberosity)

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5
Q

What is the Wells Score?

A

Risk of a patient with symptoms actually having a DVT or pulmonary embolism.

Takes into account risk factors and clinical findings

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6
Q

How is DVT diagnosed?

A
  1. D-dimer is a sensitive test, so good to exclude DVT.
  2. US Doppler
  3. CT angiogram for PE
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7
Q

In what conditions is D dimer raised?

A 
DVT
Pneumonia
Malignancy
Heart failure 
Surgery
Pregnancy
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8
Q

Management of DVT

A
  1. Initial - LMWH even before confirmation of diagnosis e.g enoxaparin, dalteparin
  2. Long-term use warfarin, DOAC or LMWH
  3. IVC filter is a sieve that collects clots in the IVC - used it unsuitable for anti coagulation and have recurrent PEs
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9
Q

When does each type of leukaemia usually present?

A

ALL CELL MATES HAVE COMMON AMBITIONS

  1. ALL = less than 5 or over 45
  2. CLL = over 55
  3. CML = over 65
  4. AML = over 75
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10
Q

How does leukaemia present?

A

fatigue, fever, pallor, petechiae, abnormal bruising, abnormal bleeding, lymphadenopathy, hepatosplenomegaly

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11
Q

What causes petechiae?

A

thrombocytopenia

Caused by: leukaemia, meningococcal septicaemia, vasculitis, Henoch-Schonlein purpura, idiopathic thrombocytopenia, non-accidental injury

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12
Q

How is leukaemia diagnosed?

A

petechiae + hepatosplenomegaly = urgent referral

blood film

raised LDH

bone marrow biopsy

LP to check to CNS involvement

CT, MRI, PET for staging and assessing

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13
Q

What are the 2 types of bone marrow biopsy?

A

Aspiration - liquid, quicker

Trephine - solid, slower, better to see cells

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14
Q

What causes ALL and what is it associated with?

A

Malignant change in a lymphocyte precursor cells

  • acute proliferation, usually B lymphocytes
  • film shows blast cells
  • associated with DOWNS SYNDROME
  • Philadelphia chromosome 9:22 translocation
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15
Q

What causes CLL and what is it associated with?

A
  • chronic proliferation of a well-differentiated lymphocyte
  • usually a B lymphocyte
  • often asymptomatic but can present with anaemia, bleeding and weight loss
  • warm autoimmune haemolytic anaemia
  • can transform into a high-grade lymphoma
  • film shows smear or smudge cells
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16
Q

CLL can transform into _____

A

high-grade lymphoma

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17
Q

What cause AML and what is it associated with?

A
  • most common acute leukaemia in adults
  • transformation of myeloproliferative disorder e.g. polycythaemia vera or myelofibrosis
  • film shows blast cells with rods (auer rods)
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18
Q

What causes CML and what is it associated with?

A
  • chronic, accelerated and blast phases
  • raised WBC (asymptomatic) to anaemia, thrombocytopenia and immunocompromised to severe symptoms (fatal)
  • philadelphia chromosome
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19
Q

How is leukaemia managed? Side effects?

A

Chemo and steroids are primary
radiotherapy, bone marrow, surgery

But can chemo can cause: stunted growth, infections, neurotoxicity, infertility, cardiotoxicity

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20
Q

What is tumour lysis syndrome?

A

release of uric acid from killed tumour cells

  • forms crystals in interstitial tissue and tubules of kidneys causing an AKI
  • use allopurinol or rasburicane to reduce uric acid
  • potassium and phosphate can also rise to monitor calcium levels
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21
Q

What is lymphoma?

A

group of cancers that affect the lymphocytes inside the lymphatic system.

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22
Q

When does Hodgkin’s Lymphoma present?

A

peaks around 20 and 75

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23
Q

Risk factors for Hodgkin’s lymphoma

A

HIV
EBV
Autoimmune conditions such as RA and sarcoidosis
Family history

24
Q

How does Hodgkin’s lymphoma present?

A
  • lymphadenopathy is key
  • non-tender and rubbery
  • can be pain in nodes when they drink
  • fever, night sweats, weight loss
  • fatigue
  • itching
  • cough
  • SOB
  • abdominal pain
  • recurrent infections
25
Q

Investigations for Hodgkin’s lymphoma

A

raised LDH

lymph node biopsy is key

  • Reed-Sternberg test = abnormally large B cells with multiple nuclei inside them
  • CT, MRI and PET for staging
26
Q

What is Ann Arbor Staging?

A

used for all lymphoma

puts importance on whether the affected nodes are above or below the diaphragm

Stage 1: confined to one region of lymph nodes
Stage 2: in more than one region but on the same side of the diaphragm
Stage 3: affects nodes above and below the diaphragm
Stage 4: widespread involvement including non-lymphatic organs such as the lungs or liver

27
Q

How is Hodgkin’s lymphoma treated?

A

chemo and radio

can lead to leukaemia and infertility due to chemo

radio can lead to cancer, tissue damage and hypothyroidism

28
Q

Give some examples of Non-Hodgkin Lymphomas and their associations

A
  • Burkitt = EBV, malaria and HIV
  • MALT = H.pylori
  • Diffuse large B cell = rapidly growing mass in over 65s
29
Q

Risk factors for non-Hodgkin’s

A 
HIV
EBV
H pylori
Hep B or C
Exposure to trichloroethylene
Family history
30
Q

Treatment of non-Hodgkin’s lymphoma

A
  • watchful waiting
  • chemo
  • rituximab
  • radio
  • stem cell transplant
31
Q

What is anaemia?

A

low level of Hb in the blood as a result of an underlying disease

32
Q

What are the 3 main categories of anaemia?

A

Microcytic, normocytic and macrocytic

33
Q

What are the causes of microcytic anaemia?

A

TAILS

Thalassaemia
Anaemia of chronic disease
Iron deficiency anaemia
Lead poisoning
Sideroblastic anaemia
34
Q

What are the causes of normocytic anaemia?

A

3As and 2Hs

Acute blood loss
Anaemia of chronic disease
Aplastic anaemia
Haemolytic anaemia
Hypothyroidism
35
Q

What are the causes of macrocytic anaemia?

A

can be megaloblastic (due to impaired DNA synthesis) or normoblastic

Megaloblastic = B12 or folate deficiency

Normoblastic = alcohol, reticulocytosis, hypothyroidism, liver disease, azathioprine

36
Q

Symptoms of anaemia

Signs on examination

A
  • tiredness
  • SOB
  • headaches
  • dizziness
  • palpitations
  • worsening of other conditions
  • Pale skin
  • conjunctival pallor
  • tachycardia
  • raised RR
  • koilonychia (iron deficiency)
  • angular chelitis (iron deficiency)
  • atrophic glossitis
  • jaundice (haemolytic)
37
Q

What symptoms are specific to iron deficiency anaemia?

A

Pica (describes dietary changes for abnormal things such as dirt)

Hair loss

38
Q

How should anaemia be investigated?

A

Hb, MCV, B12, folate, ferritin, blood film

OGD and colonoscopy to look for GI cause of unexplained iron deficiency anaemia

Bone marrow biopsy if the cause is unclear

39
Q

In what broad scenarios can iron deficiency anaemia occur?

A
  • insufficient dietary iron
  • iron requirements increase (pregnancy)
  • iron lost (slow bleeding)
  • inadequate iron absorption
40
Q

How can PPIs cause iron deficiency?

A
  • reduces the stomach acid
  • stomach acid is required to keep the iron soluble (Fe2+)
  • Fe3+ is insoluble
41
Q

Causes of iron deficiency anaemia?

A
  • blood loss (menorrhagia or in GI tract, oesophagitis or gastritis)
  • dietary insufficiency
  • poor iron absorption (IBD, coeliac)
  • increased requirements during pregnancy
42
Q

What would a high/low ferritin level suggest?

A

Low suggests iron deficiency
High suggests inflammation
(can have normal ferritin level if you have both)

43
Q

What does a high/low total iron binding capacity suggest?

A
  • marker for how much transferrin is in the blood
  • increases in iron deficiency
  • decreases in iron overload
44
Q

What does transferrin saturation tell us?

A
  • total iron in the body
  • normal is around 30%
  • less iron in body = less saturation of transferrin
  • more iron in body = more saturation of transferrin
45
Q

What two things can increase the values of all the iron markers to suggest iron overload?

A
  • supplementation

- acute liver damage

46
Q

What is pernicious anaemia?

A

autoimmune condition where antibodies form against the parietal cells or intrinsic factor, preventing the absorption of vitamin B12

47
Q

What antibodies can be investigated to diagnose pernicious anaemia?

A
  • intrinsic factor antibody

- gastric parietal cell antibody

48
Q

How can we treat pernicious anaemia/B12 deficiency?

A
  • dietary deficiency can be treated with cyanocobalamin

- the anaemia can be treated with hydroxocobalamin to sort out the absorption

49
Q

What should you treat first: B12 or folate deficiency?

A
  • B12 because treating the folate first can lead to subacute combined degeneration of the cord
50
Q

Haemophilia A is caused by a deficiency in factor ____

A

VIII

51
Q

Haemophilia B is caused by a deficiency in factor

A

IX

52
Q

Describe the inheritance pattern of haemophilia

A

X linked recessive

So men only need one abnormal X whereas women can be carrier

Almost exclusively affects males

53
Q

Signs and symptoms of haemophilia

A
  • spontaneous haemorrhage
  • usually presents in neonates with intracranial haemorrhage, haematomas and cord bleeding.
  • abnormal bleeding into joints and muscles are classic feature of severe haemophilia
  • bleeding into gums, GI tract, urinary tract, intracranial, following procedures
54
Q

How is haemophilia diagnosed?

A

based on bleeding scores, coagulation factor assays and genetic testing

55
Q

How should haemophilia be managed

A
  • by a specialist
  • replace the relevant clotting factor by intravenous infusions, either prophylactic or in response to bleeding

Acute = infusions of factor, desmopressin to simulate VWF and antifibrinolytics (tranexamic acid)

56
Q

Complication of haemophilia treatment

A

antibodies against clotting factor resulting in the treatment becoming ineffective

3rd Year Conditions (16 decks)

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