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P4 > haem > Flashcards

haem Flashcards

1
Q

what does APTT signify?

A

intrinsic pathway

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2
Q

what does PT / INR signify?

A

extrinsic pathway (VII)

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3
Q

what diseases affect APTT?

A

intrinsic pathway

haemophillia A / B
von willebrands

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4
Q

what does von willebrands factor do?

A

vWF adheres to vascular injury

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5
Q

what blood tests are seen in DIC?

A

high PT
high INR
high APTT

low platelets

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6
Q

define DIC

A
  1. depletion of platelets + coagulation factors
  2. intravascular thrombi –> multi-organ failure

hallmarks:

  • continuous production of intravascular fibrin
  • platelet / coagulation consumption
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7
Q

DIC triggers

A

major trauma
organ destruction
sepsis
severe infection

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8
Q

what is meropenem

A

beta lactum –> targets cell wall synthesis

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9
Q

what is teicoplanin

A

glycopeptide abx

treats MRSA

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10
Q

in long term penicillin use - what are you concerned about?

A

LFTs
hepatitis
cholestasis

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11
Q

what drugs are used in palliative care?

A

analgesics - morphine
anti-secretions - hyoscine butlybromide
anti-emetics - ondansatron
sedatives - halperidol (agitation / hipcups)

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12
Q

define antiphospholipid syndrome

A

CLOTs

  • Coagulation defect (^APTT)
  • Livido reticularis
  • Obstetric comps (recurrent fetal loss)
  • Thrombocytopenia

commonly associated with SLE

increase in APTT (intrinsic pathway)

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13
Q

define systemic sclerosis

A

limited vs diffuse

limited - face / hands / arms below elbow

diffuse - entire body

anti-centromere - limited
anti-scl-70 - diffuse
ANA is 90% of cases

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14
Q

bisphosphinate rules

A
  • taken on an empty stomach
  • upright for 30 minutes
    swallowed whole

SE:

  • atypical stress fractures (femor)
  • osteonecrosis of the jaw
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15
Q

what is dermatomyosistis

A

inflammatory disorder causing symmetrical, proximal muscle weakness + skin lesions

associated maligancy

polymyositis is a variant of the disease where skin lesions aren’t present

  • Gottron’s papules, - seen on knuckles
  • lung fibrosis
  • raynauds
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16
Q

dermatomyositis Ix

A

ANA 80%

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17
Q

triad of behcet’s

A

oral ulcers
gential ulcers
anterior uveitis

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18
Q

still’s disease

A

polyarthritis most commonly in children

fever
macular rash/salmon pink rash
lymphadenopathy

elevated ferritin (acute phase)

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19
Q

still’s Mx

A
  • NSAIDs
  • steroids
  • refractory (methotrexate)
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20
Q

polymyalgia rheumatica

A

overlaps with temporal arthritis (large cell vas)

vascultitis with giant cells –> skip lesions

muscle bed mostly affect in polymyalgia rheumatica

features:

  • proximal stiffening, no weakness
  • raised ESR
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21
Q

polymyalgia rheumatica
Ix
Mx

A

Ix:
raised ESR
normal creatine kinase + EMG

Mx:
prednisolone

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22
Q

which bones affected in paget’s

A

draw line down the body

skull
vertebral bones
pelvis
femur
tibia
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23
Q

clinical features of paget’s

A

only 5% are symptomatic

  • isolated raised ALP
  • calcium / phos normal
  • fractures
  • skull thickening

associated with deafness - cranial n entrapment

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24
Q

what is needed to confirm a diagnosis of ank spon

A

radiological confirmation

  • sacroilitis on XR
  • subchondral erosions
  • sclerosis

associated with schober’s +

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25
Q

ank spon Mx

A

regular exercise
NSAIDs - 1st line

no role of DMARDs here

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26
Q

features of marfan’s syndrome

A 
hypermobility
tall stature / longer arm span
pectus excavatum
arachnodactyly
high arched palate
flat foot (pes planus)
lens dislocation

heart

  • dilation of the aortic sinus
  • aortic dissection
  • aortic regurg

lung - multiple pneumothoraces

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27
Q

what does an aspirate of RA have inside?

A

high neutrophil count
reduced viscosity
turbid
yellow

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28
Q

features of SLE

A 
skin:
malar rash - spares nasolabial folds
discoid rash
photosensivity
raynauds'
livedo reticularis 
alopecia

msk:
- arthralgia

cardio:

  • pericarditis
  • myocarditis

resp:

  • pleuritis
  • fibrosing alveolitis

renal
- glomerulonephritis

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29
Q

associations with ank spon

A 
anterior uveitis
apical fibrosis
av node bock
aortic regurg
amyloidosis 
achilles tendonitis

HLA-B27 90%

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30
Q

antibodies for SLE diagnosis

A
  • ANA
  • low levels of C3/C4
  • dsDNA negative
  • antihistone antibodies 80-90%
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31
Q

what is felty’s syndrome

A

triad - rare extra articular manifestitation of RA

  • RA
  • hypersplensim
  • neutropnia
32
Q

distinguish between gout and pseudogout

A

pseudo

  • more likely in knee
  • chondrocalcinosis (calcification)
33
Q

pseudogout RF

A 
haemochromatosis
hyperparathyroidism 
hypercalciumia
wilson's
acromegaly
34
Q

what does a positive femoral n stretch test mean

A

hip pain is caused by referred lumbar pain

35
Q

diagnostic antibodies for sjogrens

A

anti - ro

anti - la

36
Q

what is sjogrens

A

autoimmune disorder affecting the endocrime glands

–> resulting in dry mucosa surfaces

increased lymphoid malignancy

37
Q

sjogren Mx

A

artifical tears + saliva

pilocarpine - cholingeric (stimulates saliva production)

38
Q

what is osteogensis imperfecta

A

rare genetic disorder
- commonly multiple one fractures

  1. blue sclera
  2. micrognathia
  3. kyphoscoilosis

normal blood calcium/ phos, PTH

39
Q

score used to test hypermobility

A

beighton score
- out of 9

5/9 = positive

40
Q

what is ehler-danlos syndrome

A

autosomal dominant connectivetissue disorder affecting type 3 collagen

  • hypermobility
  • increased elasticity of the skin
41
Q

patient with RA going into surgery - what are you worried about?

A

atlantoaxial subluxation
- can lead to cervical cord compression in surgerical neck brace

Mx:
- anterior
- posterior
- lateral 
cervical spine radiographs
42
Q

RA associated diseases

A

Ischaemia heart disease

RA accerates atherosclerosis

43
Q

Mx for acute reactive arthritis

A

NSAIDs

44
Q

DEXA scan

A

> -1.0 normal

-1.0 to -2.5 osteopenia

45
Q

rotator cuff muscles

which ones:

  • ex rotate
  • in rotate
  • 20 abduct
A

subscapularis
infraspinatus
supraspinatus
teres minor

46
Q

what drugs can induce lupus

A

procainamide - anti-arrhythmic

hydrazaline - hypertensive for HF

47
Q

what is antisynthetase syndrome

A

RIM JOB

sub-type of dermatomyositis

Raynaud’s
Interstial lung fibrosius
Myositis

JOB - anti-Jo antibodies

48
Q

marfan’s is a mutation in what tissue

A

fillibrin

49
Q

what is in cryoprecipitate?

A

factor 7 (extrinsic)

fibrinogen (common)

(intrinsic)
von willebrand factor
factor 8

50
Q

indications for cryoprecipitate

A
  • major haemorrhage protocol

- uncontrolled bleeding due to haemophillia

51
Q

how does hodgkin’s lymphoma present?

A
  • asymmetrical lymphadenopathy
    (painless, non-tender)

reed sternberg
- multinucleated cells prominent with eosinophilic nucleoi

52
Q

microcytic anaemia (indicating iron deficiency) + patient >60

how should u investigate?

A

colonscopy

to exclude bowel cancer

53
Q

reasons for iron def anaemia

A

intake:

  • poor diet
  • poor absorption

loss:

  • menorrhagia (most common in women)
  • GI bleed (most com in males)
54
Q

sickle cell crises

A

sickle cell anaemia is characterised by periods of good health w/ intervening crisis

thrombotic painful crises:

  • vaso-occlusive crises
  • precipitated by infection, dehydration, deoxygenation
  • multisystem infaracts

sequestration crises
- sickling within organ’s (spleen / lungs)

acute chest syndrome
- SOB, pulmonary inflitrates, low pCO2

aplastic crises

  • infection with parvovirus
  • sudden fall in haem

haemolytic crises
- fall in haem due to mass haemolysis

55
Q

post-DVT treatment complications

A

post-thrombotic syndrome
- following a DVT

features:

  • heavy, painful calf
  • ulceration
  • varicose veins
  • pruritus

Mx:
- graduated compression sock (don’t use as prophylaxis)

56
Q

indication for transfusing a patient

A

platelet <30 + active bleeding

57
Q

contraindications for platelet transfusion

A

chronic bone marrow failure

  • autoimmune thrombocytopenia
  • thrombotic thrombocytopenic purpura
58
Q

burkitt lymphoma biopsy

A

starry sky appearance

associated with EBV

59
Q

DVT / PE in pregnancy

Mx

A

s/c heparin preferred to IV heparin

wafarin contraindicated

60
Q

indications for prothombin complex concentrate

A

emergency reversal anticoagulation w/ severe bleeding or head injury

factors 2, 9, 10

61
Q

what type of infection is mostly likely to occur following a platelet transfusion?

A

bacterial

platelets are stored at room temp –> more favourable environment

62
Q

heinz bodies

A

G6PD

63
Q

most common genetic bleeding disorder

A

von willebrands disease

normal platelets
increased bleeding time
increased APTT (vWF is on intrinsic side)

64
Q

Mx for vWF disease

A

tranexamic acid - mild bleeding

desmopressin - raises levels of vWF by inducing release of vWF via endothelial cels

factor 8 concentrate

65
Q

transfusion complications

A

got a bad unit

G raft vs. Host disease
O verload
T hrombocytopaenia

A lloimmunization

B lood pressure unstable
A cute haemolytic reaction
D elayed haemolytic reaction

U rticaria
N eutrophilia
I nfection
T ransfusion associated lung injury

66
Q

what are the tests to confirm haemolysis?

A

coombs test

  • unconjugated bilirubin
  • haptoglobin
  • serum and urine free haemoglobin
67
Q

bloods for sickle cell

A

low haem
normal MCV
raised reticulocyte - due to haemolysis

68
Q

what are the rules regarding COCP before surgery

A

continue taking pill until 4 weeks before op

69
Q

what are the rules regarding COCP before surgery

A

continue taking pill until 4 weeks before op

–> reduce the risk of clots

70
Q

PE Mx

provoked / unprovoked

A

vit K antagonist (warfarin)
- give within 24hrs

provoked - 3 months

unprovoked - 6 months

71
Q

what is beta thalassaemia

presenting features

A

form of microcystic anaemia

defect in beta-globin gene
–> ineffective erythropoiesis

trait - asymptomatic
major

major:

  • anaemia
  • jaundice
  • failure to thrive
  • extramedullary erythropoiesis from early childhood
72
Q

genetics of haemophillia

A

x-linked recessive

A = factor 8 def (80% most common)
B = factor 9 def

increased APTT
normal PT
increased bleeding time

73
Q

NOACs name 2

+ action

A

apixaban
rivaroxiban

Xa inhibitor

74
Q

dabigatran mech action

+ reversal agent

A

thrombin inhibitor

75
Q

what can be seen on head XR for:

hyperPTH
myeloma
paget’s

A

hyperPTH - pepper-pot skull
myeloma - raindrop skull
paget’s - thickened cranium

76
Q

you are suspicious that a patient has autoimmune anaemia

what test will you do?

A 
blood film
reticulocyte
iron studies
direct coombs test 
(looks for antibodies attached on the RBCs)

indirect coombs used in prenatal testing - looks for free floating antibodies

P4 (11 decks)

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