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Haem Flashcards

1
Q

27F. Menorrhagia, anaemia.

What kind of anaemia does she have, and what is the treatment?

A

Iron deficiency anaemia.
Ferrous sulphate

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2
Q

19M, university student. Presents to A&E with headache and breathlessness. Family lives in Nigeria.
Investigations show severe anaemia, reticulocytosis, bite cells.
Recent prescription of nitrofurantoin for a UTI.

Most likely cause of symptoms?

A

Oxidative crisis due to G6PD deficiency

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3
Q

GS investigation for DVT

A

Doppler US

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4
Q

Which of these is not a cause of thrombocytopenia?
A. Chronickidneydisease
B. HIV
C. Excessive alcohol consumption
D. Myeloma
E. Heparin

A

Heparin

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5
Q

A 3 year-old is a patient on the oncology ward following severe anaemia, recurrent infection, and pain in her bones. Most likely diagnosis?

A

ALL

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6
Q

What is the diagnostic test for sickle cell anaemia?

A

Hb electrophoresis

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7
Q

Most appropriate treatment for CML?

A

Imatinib (tyrosine kinase inhibitor)

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8
Q

What is the pathophysiology of hereditary spherocytosis?

A

It is caused by defects in the red cell membrane, resulting in them having an increased permeability to sodium

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9
Q

What is the infective stage of the malaria parasite?

A

Sporozite

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10
Q

What are you most likely to see on a blood smear in suspected ALL?

A

Blast cells

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11
Q

What malignancy is Philadelphia Chromosome associated with?

A

CML

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12
Q

Explain the mechanism of action of Imatinib

A

Tyrosine kinase inhibitor

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13
Q

A 74 year old gentleman is investigated for multiple myeloma following a fragility fracture he sustained at home.
Which of these findings on a series of blood tests would NOT be suggestive of myeloma?
A. Anaemia
B. Hypocalcemia
C. Raised Creatinine
D. Raised Urea
E. Monoclonal proteins in Serum

A

Hypocalcaemia

HypER rather than hypOcalcemia is seen in myeloma

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14
Q

What would you expect to see on a blood film for a patient with multiple myeloma?

A

Rouleaux formation. RBCs look like a stack of coins

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15
Q

DVT.
What is the duration of treatment with Apixaban?

A

6 months

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16
Q

68M. Thirst, constipation, confusion. Osteoarthritis had returned, severe back pain in the thoracic region. FBC shows anaemia.

Most likely diagnosis?

A

Multiple myeloma

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17
Q

Haemophilia A is inherited in a X linked recessive pattern. In this case, the Father has the disease and the mother is a carrier.
What is the chance of their daughter also having the disease?

A

50%

        X*          X

X* XX X*X

Y X*Y XY

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18
Q

48M. Alcoholic.
What type of anaemia would be seen on FBC?

A

Chronic alcoholism anaemia causes Macrocytic anaemia

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19
Q

68F. Lower back pain, numbness and weakness in fingers.
Weight loss (unintentional), hypercalcaemia, anaemia.

What is the most likely diagnosis and which gene is associated with it?

A

Multiple Myeloma.

MGUS

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20
Q

You suspect a haematological disorder, so perform a blood film. It shows blast cells with Auer rods.
What is your diagnosis?

A

AML

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21
Q

What protein is deficient in Haemophilia A?

A

Factor VIII

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22
Q

5month old baby, south-east Asian origin.
Weak, swollen abdo, dark urine. Small size, facial deformities.
Blood smear: microcytic, hypochromic anaemia, with target cells.
Low Hb, high iron.

Most likely diagnosis and the result of Hb electrophoresis that would confirm it?

A

Thallasemia

Decreased HbA, increased HbA2, present HbF

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23
Q

List 4 causes of microcytic anaemia

A
  • iron deficiency
  • β thalassaemia
  • anaemia of chronic disease
  • lead poisoning
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24
Q

List 4 causes of macrocytic anaemia

A
  • B12 deficiency
  • folate deficiency
  • alcohol access
  • myelodysplastic neoplasm
  • hypothyroidism
  • pregnancy
  • methotrexate
  • reticulocytosis
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25
Q

List 4 causes of normocytic anaemia

A
  • anaemia of chronic disease
  • CKD
  • anaemia of traumatic blood loss
  • combined (iron and B12 deficiencies for example)
  • inflammatory disease
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26
Q

Describe the mechanism of absorption of vitamins B12

A

B12 binds to intrinsic factor, which is produced by parietal cells in the stomach. It is then actively absorbed in the terminal ileum

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27
Q

List 3 causes of B12 deficiency. Which is most common?

A

Most common = pernicious anaemia
- vegan / poor diet
- disorder of the terminal ileum e.g. Crohn’s, ileocaecal resection

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28
Q

What is the treatment of B12 deficiency anaemia ?

A
  • B12 replacement
  • IM hydroxocobalamin
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29
Q

What is the management for hereditary spherocytosis?

A

Splenectomy

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30
Q

What finding on blood film would confirm a diagnosis of multiple myeloma?

A

Rouleaux formation

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31
Q

The most severe form of the disease malaria with the highest rate of mortality in humans is caused by which species of mosquito?

A

Plasmodium falciparum

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32
Q

List 3 protective factors for malaria

A
  • sickle cell trait
  • G6PD deficiency
  • HLA-B53
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33
Q

What does complicated malaria entail?

A

Vascular occlusion
Can cause raised ICP, seizure, coma

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34
Q

Ann Arbor Classification:
Describe class Ia

A

One nodal area, no systemic symptoms

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35
Q

Ann Arbor Classification:
Describe class IIa

A

Two or more nodal areas on the same side of the diaphragm
No systemic symptoms

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36
Q

Ann Arbor Classification:
Describe class IIb

A

Two or more nodal areas on the same side of the diaphragm
Systemic symtoms

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37
Q

Ann Arbor Classification:
Describe class IIIa

A

Nodal areas on both sides of the diaphragm
No systemic symptoms

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38
Q

Ann Arbor Classification:
Describe class IIIb

A

Nodes on both sides of the diaphragm
Systemic symptoms

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39
Q

Describe the Pathophysiology of Hereditary Spherocytosis

A
  • autosomal dominant defect of the red blood cell cytoskeleton
  • increased permeability to Na+ (therefore more water drawn in)
  • normal biconcave disc shape replaced by sphere shape
  • unable to pass through spleen without being destroyed
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40
Q

How is hereditary spherocytosis diagnosed?

A

Mostly family history and clinical picture.
BLood film will show spherocytes

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41
Q

Describe the Pathophysiology of thrombotic thrombocytopenic purpura

A

ADAMTS13 deficiency causes Von Willebrand’s factor to form thromboses
The body breaks these down, causing haemolytic anaemia and raised bilirubin

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42
Q

Describe the pathology and give two causes of relative polycythaemia

A

Fluid loss causing highly concentrated blood
- dehydration
- stress

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43
Q

Describe the pathology of secondary polycythaemia and give two examples of causes

A

Chronic hypoxia stimulated erythropoietin production in the kidney

  • high altitude
  • COPD
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44
Q

Describe the pathology of polycythaemia rubra Vera

A

Primary polycythaemia
JAK2 mutation -> bone marrow stem cell proliferation -> overproduction of RBCs, neutrophils, platelets -> increased clotting risk

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45
Q

What is Virchow’s triad?

A

Risk of DVT / PE
- stasis of blood flow
- hypercoagubility
- endothelial injury

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46
Q

What is the difference between ITP in children and adults?

A
  • children = acute (primary)
  • adults = chronic (secondary)
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47
Q

Name 3 signs / symtoms of immune thrombocytopenia

A
  • easy bruising
  • epistaxis
  • menorrhagia
  • purpura
  • gum bleeding
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48
Q

How is ITP diagnosed?

A

FBC: isolated thrombocytopenia

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49
Q

What is the first line management of ITP?

A

Corticosteroids (Prednisolone)
IV IgG

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50
Q

Which causative organisms of malaria can cause relapses?

A

Plasmodium vivas
Plasmodium ovale

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51
Q

What signs would you expect to see in a patient when diagnosing malaria?

A
  • fever, often >39
  • sweats / chills
  • headache
  • myalgia
  • fatigue
  • diarrhoea
  • vomiting
  • abdominal discomfort
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52
Q

Name 3 signs you might see on examination of a patients’ face, skin, and nails that are associated with iron deficiency anaemia

A
  • brittle nails
  • koilonychia
  • subconjuctival pallor
  • pallor
  • atrophic glossitis
  • angular stomatitis
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53
Q

List the diagnostic criteria of multiple myeloma

A
  • osteolytic lesions on imagine
  • elevated plasma cells in bone marrow
  • monoclonal protein in serum or urine
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54
Q

Which chromosomal abnormalities are assisted with multiple myeloma?

55
Q

50M presenting with recurrent infections, weight loss, hepatosplenomegaly, gum hypertrophy. Most likely diagnosis?

A

Acute Myeloid Leukaemia

56
Q

What would be expected on bone marrow biopsy in AML?

57
Q

What 2 things are associated with AML?

A

Down syndrome
Radiation

58
Q

What 3 treatments are commonly used in AML?

A
  • blood transfusion
  • chemotherapy
  • bone marrow transplant
  • steroids
  • IV antibiotics
  • Allopurinol (to prevent tumour lysis)
59
Q

Pt with CLL. What age do you expect them to be?

60
Q

What is expected on clinical examination of someone with CLL?

A
  • anorexia
  • non-tender lymphadenopathy
61
Q

What treatments are commonly used in CLL?

A
  • Chemotherapy,
  • Rituximab (monoclonal antibody)
  • Ibrutinib (bruton kinase inhibitor)
62
Q

What is a complication of CLL that you should be aware of?

A

Richter’s transformation
(Progression to aggressive leukaemia)

63
Q

Alcohol induced painful lymph nodes?

A

Hodgkin’s lymphoma

64
Q

What investigation are done to diagnose Hodgkin’s lymphoma and what are the results?

A

FBC: normocytic anaemia
CXR: wide mediastinum
Blood film: Reed sternberg cells

65
Q

What is the treatment plan for Hodgkin’s lymphoma?

A

Chemotherapy ABVD treatment
Bone marrow transplant

66
Q

What would be seen on blood film in G6PD deficiency?

A

Heinz bodies
Bite cells
Reticulocytes

67
Q

What antibiotic is contraindicated in G6PD deficiency?

A

Nitrofurantoin

68
Q

What are the 6Ps ?

A

Pain
Pallor
Perishingly cold
Pulselessness
Paralysis
Paraesthesia

69
Q

What is the scoring system used in DVT diagnosis?

A

Well’s score

70
Q

List the factors of the Well’s score

A

Clinical signs / symptoms of DVT or PE
No alternative diagnosis
Heart rate >100bpm
Immobilisation for at least 3 days
Past history of DVT or PE
Haemoptosis
Malignancy with active treatment in the last 6 months or palliative management

71
Q

What is the first line investigation of DVT?

72
Q

Explain the Pathophysiology of disseminated intravascular coagulation

A

Simultaneous coagulation and haemorrhage caused by the initial formation of thrombi containing clotting factors and platelets, causing more bleeding

73
Q

List 3 features of DIC

A
  • clinically bleeding
  • bruising
  • ischaemia
  • organ failure
74
Q

List 3 causes of DIC

A
  • infection
  • malignancy
  • trauma - burns, shock, surgery
  • liver disease
  • obstetric complications
75
Q

What would the blood tests in DIC show?

A

Increased bleeding time
Low platelets
Low fibrinogen
Increased fibrin degradation products

76
Q

Haemophilia A: genetic inheritance and deficiency

A

X linked recessive
Factor VIII

77
Q

Haemophilia B: genetic inheritance and deficiency

A

X linked recessive
Factor IX

78
Q

Haemophilia C: genetic inheritance and deficiency

A

Autosomal recessive
Factor XI

79
Q

define bleeding time

A

Assessment of platelet function
Superficial puncture would, measure time taken for bleeding to stop (bleeding site turns glassy)

80
Q

Define d-dimer

A

D-dimer is the degradation product of crosslinked (by factor XIII) fibrin. It reflects ongoing activation of the hemostatic system.

81
Q

What plasma protein transports iron in the blood to the bone marrow?

A

Transferrin

82
Q

What is ferritin?

A

Storage molecule of iron

83
Q

Give 2 features of microcytic anaemia that would be seen on blood film?

A
  • small red blood cells
  • pale red blood cells (hypochromic)
  • variation in RBC shape
84
Q

Name 2 blood tests that would be carried out to diagnose microcytic anaemia

A
  • serum ferritin
  • serum iron
  • reticulocyte count
85
Q

What’s the pharmacological treatment of iron deficiency anaemia ?

A

Oral iron e.g. ferrous sulphate

86
Q

Give 2 SEs of ferrous sulphate

A
  • nausea
  • abdominal discomfort
  • black stools
87
Q

What cells would you expect to find on microscopy of a Hodgkin’s lymphoma?

A

Reed stern berg cells

88
Q

What lymphocyte is most likely affected in non-Hodgkin’s lymphoma?

A

B-lymphocyte

89
Q

What virus is strongly associated with non-Hodgkin’s lymphoma?

A

Epstein Barr virus

90
Q

What are the B symptoms?

A

Fever, weight loss, night sweats

91
Q

Define pancytopenia

A

Deficiency of all blood types - red blood cells, white blood cells, platelets

92
Q

Which form of viral hepatitis is a notifiable disease and to whom should it be reported?

A

Hepatitis A.

Consultant in Communicable Disease Control OR Public Health England OR local health protection team

93
Q

Why is Hepatitis D only able to cause disease in those with Hepatitis B?

A

Incomplete RNA virus - needs HepB to be able to assemble

94
Q

Name 3 management protocol for acute Hepatitis B

A
  • avoid alcohol
  • vaccinate contacts
  • monitor liver function
95
Q

What type of virus is HIV?

A

Retrovirus subgroup lentivirus

96
Q

What CD4 count is the defining level for an AIDS diagnosis?

97
Q

What is the overall name for treatment given to HIV patients and what sub-groups of medication are given – write in full (4 marks)

A

HAART (highly active antiretroviral therapy) – NRTI (nucleoside reverse transcriptase inhibitors) OR NNRTI (non-nucleoside reverse transcriptase inhibitors)

98
Q

Nail bed flattening - what is it called? What is it a sign of?

A

Koilonychia

Iron deficiency anaemia

99
Q

In iron deficiency anaemia, what 3 changes will be seen in plasma iron studies other than decreased MCV?

A

Decreased iron
Decreased ferritin
Increased total iron binding capacity

100
Q

What is the most common type of myeloma?

101
Q

What is the second most common type of myeloma?

102
Q

What pathological feature of myeloma could cause backache backache?

A

Osteopathic bone lesions

103
Q

What 3 features would you expect to see on FBC in myeloma?

A

Anaemia
Neutropenia
Thrombocytopenia

104
Q

XR features of myeloma?

A
  • lyric lesions
  • punched out lesions
  • pepper pot skull
  • fractures
  • vertebral collapse
  • osteoporosis
105
Q

COmplications of myeloma?

A
  • hypercalcaemia
  • spinal cord compression
  • hyperviscosity
  • AKI
  • amyloidosis
  • recurrent infections
106
Q

Sickle cell disease causes what kind of anaemia?

A

Haemolytic anaemia

107
Q

What is included in Warfarin reversal treatment?

A
  • IV prothrombin complex concentrate
    AND
  • IV vitamin K
108
Q

Px: sepsis, DIC, low fibrinogen

Treatment?

A

Cryoprecipitate

109
Q

What is cryoprecipitate?

A

Derivative of fresh frozen plasma
More concentrated clotting factors

110
Q

Describe the anaemia caused by T1DM

A
  • pernicious anaemia -> B12 deficiency anaemia
  • oval macrocytes and hypersegmented neutrophils
111
Q

What cell is involved in myeloma?

A

Plasma cell

112
Q

What is the platelet count in ITP?

113
Q

If fibrin degradation products are raised, what does this indicate?

A

Disseminated Intravascular Coagulation

114
Q

D-dimer - what do?

A

Assesses the degradation products of cross linked fibrin

115
Q

Antiphospholipid lipid syndrome antibodies

A

Lupus anticoagulant
Anti cardiolipin
Anti beta 2 GBI

116
Q

Antiphospholipid syndrome gene association?

117
Q

SLE gene associations?

A

HLA B8
HLA DR2
HLA DR3

118
Q

Intrinsic factor antibodies indicates which anaemia?

A

Pernicious anaemia -> B12 anaemia

119
Q

Smudge cells on blood film indicate what ?

120
Q

What is the inheritance pattern of β thalassaemia?

A

Autosomal recessive

121
Q

What factor is affected in each type of haemophilia?

A

A = VIII
B = IX
C = XI

122
Q

On blood tests, how can haemophilia C be differentiated from the others?

A

Partial thromboplastin time is raised in A and B but not in C

123
Q

What are the electrolyte imbalanced seen in tumour lysis syndrome?

A
  • hypocalcaemia
  • hyperphosphatemia
  • Hyperuricaemia
  • hyperkalaemia
124
Q

What is the standard management of ITP?

A

Watch and wait as most cases are self limiting - supportive care at home

125
Q

If there is major bleeding in ITP, what are the management options?

A
  • IV Prednisolone
  • IV Ig
  • platelet transfusion
126
Q

What is Ann Arbor staging for?

A

Hodgkin’s lymphoma

127
Q

Briefly describe what a lymphoma is

A

A malignant tumour causing proliferation of lymphocytes mainly in lymph nodes

128
Q

Other than lymph nodes, give 4 sites that Hodgkin’s lymphoma affects

A
  • bone marrow
  • spleen
  • liver
  • blood
129
Q

Symptoms of Hodgkin’s lymphoma:

A

Enlarged lymph nodes
General B symptoms i.e weight loss, night sweats, malaise, fatigue
Hepato/ splenomegaly
Easy bruising
Anaemia
Frequent infections
Enlarged abdomen

130
Q

Give two signs that are specific to iron deficiency anaemia

A

Angular stomatitis and koilonychia

131
Q

Where in the intestine is B12 absorbed? What bind to B12 in the stomach?

A

Terminal ileum
Intrinsic factor

132
Q

What causes B12 deficiency in pernicious anaemia?

A

Atrophic gastritis

133
Q

Neurological signs of B12 deficiency anaemia?

A
  • irritability
  • depression
  • psychosis
  • dementia
  • paraesthesia
  • peripheral neuropathy

Phase 2a mocks (11 decks)

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