Haem

Question 1

What are 5 causes of iron deficiency anaemia?

Answer 1

1. Blood loss: GI, menstruation, malignancy
2. Poor diet/poverty
3. Malabsorption: coeliac, H.pylori, meds
4. Hook worm - GI blood loss: ask about travel
5. Family History: thalassaemia, bleeding disorders, IDA

Question 2

What symptoms may present with iron deficiency anaemia?

Answer 2

• Fatigue
• SOB
• Palpitations
• Atrophic glossitis
• Headache
• Pale
• Koilonychia

Question 3

What type of anaemia is iron deficiency?

Answer 3

Hypochromic microcytic

Question 4

What does a serum ferritin of less than 12 indicate?

Answer 4

Iron deficiency anaemia

Question 5

What does a low MCH and MCV indicated?

Answer 5

Hypochromic microcytic anaemia: iron deficiency

Question 6

What will the blood film display in iron deficiency anaemia?

Answer 6

Anisocytosis

Poikilocytosis

Question 7

What signs suggest marked iron deficiency anaemia?

Answer 7

• Tachycardia
• Cardiomegaly
• Ankle oedema
• Flow murmur
• HF

Question 8

How is iron deficiency anaemia treated?

Answer 8

Treat underlying cause.
Oral ferrous sulphate tablets: nausea, constipation and black stool - should rise by 10g/L/week. Normal at 3 months.
IV iron if NBM or in chronic renal failure

Question 9

What is megaloblastic macrocytic anaemia due to?

Answer 9

B12 deficiency, folate deficiency, cytotoxic drugs

Question 10

What causes non-megaloblastic macrocytic anaemia?

Answer 10

Alcohol, liver disease, hypothyroid, pregnancy

Question 11

What are the signs and symptoms of megaloblastic anaemia?

Answer 11

Pallor
Fatigue
Dyspnoea
Bowel disturbance and loss of appetite 
Gum hypertrophy 
Atrophic glossitis

Question 12

How is macrocytic anaemia managed?

Answer 12

Address underlying cause

Give 4 months folic acid and B12

Question 13

Which type of lymphoma is more common?

Answer 13

Non-hodgkins (5x)

Question 14

How might a low grade non-hodgkin lymphoma present?

Answer 14

Painless slow growing lymphadenopathy
Cytopenia if bone marrow involved
Enlarged spleen and liver

Question 15

How might a high grade non-hodgkin lymphoma present?

Answer 15

Rapid growing, bulky lymphadenopathy.
Systemic multi-organ involvement
Spleno & hepatomegaly
Skin lesions

Question 16

What type of non-hodgkins lymphoma can have a mediastinal mass and CNS involvement?

Answer 16

Lymphoblastic

Question 17

What type of non-hodgkins lymphoma may have a large abdo mass/bowel obstruction?

Answer 17

Burkitts

Question 18

How is non-hodgkin’s lymphoma managed?

Answer 18

Watch and wait.
Chemo/radiotherapy
Give pneumococcal, flu and Men C vaccine and immune system compromised
Prophylactic AB with chemo - neutropenia would be severe

Question 19

What type of treatment are intermediate/high grade more aggressive non-hodgkin lymphomas more responsive to?

Answer 19

Chemotherapy

Question 20

What is an emergency presentation of lymphoma?

Answer 20

SVC obstruction:facial oedema, raised JVP, fullness of head, dyspnoea, blackouts
Infection

Question 21

What cells characterise hodgkin’s lymphoma?

Answer 21

Reed sternberg cells: mirror image nuclei

Question 22

What does an increased ESR and decreased Hb suggest in hodgkin’s lymphoma suggest?

Answer 22

A poorer prognosis

Question 23

What are the symptoms of Hodgkin’s lymphoma?

Answer 23

• Enlarged, tender, painless, rubbery superficial lymph nodes: cervical, axilla and inguinal
• Node may become matted
• Size fluctuates
• Lymph node pain made worse by alcohol
• Systemic fever, weight loss, night sweats, pruritus
• Pleural effusion due to mediastinal mass effect
• Enlarged liver and spleen
• Anaemia, cachexia

Question 24

How is Hodgkin’s Lymphoma staged?

Answer 24

1. Single node region
2. 2 areas on same side of diaphragm
3. Nodes on both sides of diaphragm
4. Spread beyond nodes

A= no symptoms 
B = 6 months 10% weight loss, temperature, night sweats

Question 25

How is Hogkin’s lymphoma managed?

Answer 25

Chemo therapy - more intense and high dose for higher grades.
Peripheral stem cell transplant in relapse