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Phase 2a medicine > Haem > Flashcards

Haem Flashcards

1
Q

What is a PT blood test?

A

Measure of the time for a blood clot to form via the extrinsic pathway.

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2
Q

What is an APTT blood test?

A

Measure of the time for blood to clot via the intrinsic pathway
Associated with factors 8, 9 and 11

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3
Q

What diseases have a prolonged thrombin time?

A

DIC, liver failure malnutrition, abnormal fibrinolysis

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4
Q

Causes of microcytic anaemia?

A

Anaemia of chronic disease, thalassaemia, iron deficiency and sickle cell

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5
Q

Causes of normocytic anaemia?

A

Acute blood loss, chronic disease, pregnancy, renal failure,

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6
Q

Causes of Macrocytic anaemia?

A

B12 deficiency, excess alcohol/liver disease, hypothyroidism, bone marrow failure.

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7
Q

Symptoms of anaemia?

A

Fatigue, headache, irritability, difficulty concentrating, dyspnoea and breathlessness, anorexia, intermittent claudication, palpitations.

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8
Q

Signs of anaemia?

A

Pallor, tachycardia, systolic flow murmur, cardiac failure, spoon shaped nails, angular stomatitis.

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9
Q

Investigations for anaemia?

A

FBC, reticulocyte count, serum iron and ferritin test, peripheral blood smear (to look at shape of RBC’s, Haemoglobin electrophoresis.

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10
Q

Treatment for iron deficiency anaemia?

A

oral iron ferrous sulphate, IV iron in emergencies.

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11
Q

Side effects of ferrous sulphate?

A

Nausea, abdo discomfort, diarrhoea/constipation, black stools,

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12
Q

How to treat normocytic anaemia?

A

Treat underlying cause, improve diet with plenty of vitamins, erythropoietin injections.

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13
Q

How to treat folic acid deficiency?

A

folic acid tablets daily for 4 months

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14
Q

How to treat pernicious anaemia?

A

B12 injections, IM hydroxocobalamin

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15
Q

What is G6PD deficiency?

A

The deficiency of G6PD makes red cells vulnerable to oxidative damage.

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16
Q

Epidemiology of G6PD def?

A

More common in Africa, middle east and SE asia, more common in males as its x-linked

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17
Q

Signs and symptoms of G6PD?

A

Pallor, fatigue, palpiatations, SOB, jaundice, exacerbated by ingesting fava beans

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18
Q

Investigations for G6PD?

A

Bite cells (membrane indentation), irregularly contracted cells, reticulocytosis.

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19
Q

Treatment for G6PD?

A 
Blood transfusion, 
Stop exacerbating drugs such as:
Primaquine
Nitrofurantoin 
Sulphonamides
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20
Q

What is alpha thalassemia?

A

Gene deletion of one or both alpha chains.

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21
Q

How do people with 3 gene deletion in alpha thalassemia present?

A

Moderate anaemia, splenomegaly, not transfusion dependant.

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22
Q

How is alpha thalassaemia diagnosed?

A

Diagnosed with FBC showing microcytic anaemia, elevated serum iron and hamegobin electrophoresis.

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23
Q

How to treat alpha thalassemia?

A

Treat with transfusions during crises
Desferrioxamine to aid iron excretion
and folic acid

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24
Q

What is beta thalassaemia?

A

Excess alpha chains, point mutations in the gene

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25
Q

Minor beta thalassemia presentation?

A

Mild anaemia, pale red blood cells, often asymptomatic

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26
Q

How does intermedia beta thalassemia present?

A

Infections, gallstones, recurrent leg ulcers, bone deformities

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27
Q

How does Major beta thalassaemia present?

A

Failure to thrive, severe anaemia from 3-6months, thalassaemic faces, bone abnormalities.

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28
Q

How to diagnose beta thalassemia?

A

Blood film: reticulocytosis, microcytic anaemia, nucleated RBC’s in circulation.

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29
Q

How to treat beta thalassaemia>

A

Treat with regular life-long transfusions, iron-chelating agents, ascorbic acid and folic acid.

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30
Q

What is sickle cell anaemia?

A

Autosomal recessive disorder, production of abnormal beta-globin chains via a single base mutation of A to T

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31
Q

WHat are the benefits of being a carrier of sickle cell?

A

Protection against falciparum malaria and symptom free.

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32
Q

Symptoms of sickle cell crisis?

A

Acute pain in hands and feet, long bone pain, cognitive defects in children, pulmonary hypertension and chronic lung disease, splenic sequestration

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33
Q

Diagnosis of sickle cell ?

A

Blood film (sickled erythrocytes),
Hb 60-80
Positive sickle solubility test
Haem electrophoresis confirms diagnosis

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34
Q

How to treat sickle cell?

A

Precipitating factors avoided e.g. cold
folic acid
Acute attacks: IV fluids, analgesia, oxygen.
Oral hydroxycarbamide to reduce frequency of crises.

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35
Q

What is acute myeloid leukaemia?

A

Build up of myeloblasts in the bone marrow spilling out into the blood stream

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36
Q

Who does AML affect?

A

Adults between 50-60

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37
Q

Risk factors for AML?

A

Downs’s syndrome, raditation

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38
Q

Symptoms for AML?

A

Anaemia, infection, hepatosplenomegaly, peripheral lymphadenopathy, gum hypertrophy, bone marrow failure and bone pain

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39
Q

Why do you get anaemia with AML?

A

Myeloid cells crowd out the normal cells, leading to fewer RBC’s, anaemia and fatigue

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40
Q

WHat would you see on bone marrow biopsy for AML?

A

AUER RODS

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41
Q

Investigations for AML?

A

FBC: anaemia, thrombocytopaenia and neutropoenia.
Blood film: leukaemic blast cells
Bone marrow biopsy

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42
Q

Treatment of AML?

A 
Blood and platelet infusions 
IV fluids 
Allopurinol 
chemo
steroids
infection control
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43
Q

What is ALL?

A

Malignancy of the lymphoid cells, affecting the B or T lymphocytes.
Uncontrolled proliferation of immature blast cells

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44
Q

What are risk factors for ALL?

A

Radiation during pregnancy, Down’s syndrome

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45
Q

Signs and symptoms of ALL?

A

Anaemia, infection, hepatosplenomegaly, peripheral lymphadenopathy, headache and crainial nerve palsy,

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46
Q

Investigations for ALL?

A

FBC: anaemia, thrombocytopaenia, neutropoenia.
Blood film: leukaemic blast cells
LP
CXR and CT: lymphadenopathy

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47
Q

How to treat ALL?

A

Steroids, allopurinol, methotrexate, antibiotics, chemo, blood and platelet transfusion

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48
Q

Which chromosome is associated with CML?

A

Philadelphia chromosome.

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49
Q

Which cells does CML affect?

A

Neutrophils, basophils, eosinophils and macrophages

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50
Q

What ages does CML most commonly affect?

A

40-60 rare in childhood

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51
Q

Signs and symptoms of CML?

A

Loss of weight, fever, sweats, fatigue, gout, bleeding, abdo pain
HEPATOSPLENOMEGALY

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52
Q

What do you see on FBC in CML?

A

High white cells and anaemia.
Eosinophillia, basophillia, neutrophillia
Increased B12

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53
Q

What do you see on blood film in CML?

A

Left shirt, basophillia

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54
Q

Treatment for CML?

A

Chemo and Tyrosine kinase inhibitors

IMANTINIB

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55
Q

What is chronic lymphocytic leukaemia?

A

Accumulation of mature B cells that have escaped apoptosis.

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56
Q

What ages is CLL seen in?

A

70+

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57
Q

What can trigger CLL?

A

pneumonia

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58
Q

Signs and symptom of CLL?

A

Often asymptomatic:
Enlarged, rubbery non-tender nodes
Weight loss, sweats and anorexia.

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59
Q

What do you see on FBC with CLL?

A

High WCC, with high lymphocytes

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60
Q

What do you see on blood film with CLL?

A

Small mature lymphocytes, smudge cells.

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61
Q

How to treat CLL?

A

Watch and wait
Chemo
Rituximab

62
Q

What is multiple myeloma?

A

Affects plasma cells, excess IgG or IgA

63
Q

WHo is most commonly affected by multiple myeloma?

A

75+ afro-caribbean’s

64
Q

What is the acronym for the signs of multiple myeloma?

65
Q

What does old crab stand for?

A 
Old - over 75
C - Calcium over 2.75
R - Renal impairment 
A - Anaemia 
B - Bone lesions (pepperpot skull and back pain)
66
Q

What would you see on blood film for multiple myeloma?

67
Q

What protein is found in the urine in multiple myeloma?

A

Bence Jones

68
Q

What would you see on x-ray in multiple myeloma?

A

Pepper pot skull and fractures

69
Q

What would you see on CT in multiple myeloma?>

A

Bone lesions and cord compression

70
Q

WHat would you see in an FBC in multiple myeloma?

A

Anaemia and raised ESR

71
Q

Treatment for multiple myeloma?

A 
Bisphosphonates for bones 
Analgesia
Radiotherapy 
Blood transfusions 
Infection control
Chemo: CTD or VAD
72
Q

Which cells are affected in lymphoma?

A

T and B cells in the lymphnodes

73
Q

Who is commonly affected by hodgkins?

A

Young adults and elderly
Male predominance
Associated with EBV, SLE and siblings

74
Q

What are the signs and symptoms of hodgkins?

A

Fever and sweating
Enlarged rubbery, tender nodes
B symptoms
Painful nodes on drinking alcohol

75
Q

What cells do you see in Hodgkins lymphoma and what do they look like?

A

Reed Sternberg cells

Owls eyes

76
Q

Investigations for hodgkins?

A

FBC: anaemia and high ESR
CXR - wide mediastinum
PET scan
Reed sternberg

77
Q

WHat is the chemo regime for hodgkins?

78
Q

What does ABVD stand for?

A

Adriamycin, bleomycin, vinblastine, Dacarbazine

79
Q

Which people get non-Hodgkin?

A

Adults over 40, EBV and Burkitt’s, FH increases risk

80
Q

What are the symptoms of non-hodgkins?

A

Fever and sweating, enlarged rubbery non-tender nodes, systemic B symptoms, GI and skin involvement.

81
Q

What is raised in non-hodkin?

A

Lactose dehydrogenase

82
Q

What investigations would you do for non-hodgkins?

A

Lymphnode biopsy, bone marrow biopsy, FBC (anaemia and high ESR)

83
Q

How would you treat Non-hodgkin?

A

Steroids, Rituximab, CHOP regimen

84
Q

How do you tage lymphoma?

A

Ann-arbour staging

85
Q

What are stages 1 to 4 in the ann-arbour staging system?

A
  1. Single lymphnode region
  2. 2 or more nodal areas on the same side of diaphragm
  3. 2 or more nodal areas on both sides of the diaphragm
  4. spread beyond the lymphnodes to the bone marrow or liver
86
Q

WHat stimulates the production of platelets?

A

TPO (thrombopoietin)

87
Q

Which cells are platelets produced by?

A

megakaryocytes

88
Q

What is the lifespan of a platelt?

89
Q

Thromboxane A2 receptor?

A

Synthesised in platelets via COX 1

Induces platelet aggregation and vasoconstriction

90
Q

What is a P2Y12 receptor?

A

Receptor on platelets, amplifies platelet activation

Important for clopidogrel

91
Q

What is the GP2b/3a receptor?

A

Receptor for vWF factor which is essential for clotting and platelet adherence to vessels

92
Q

What is ITP?

A

Autoimmune destruction of platelets

93
Q

Who is ITP seen in?

A

mainly seen in children ages 2-6

94
Q

Signs and symptoms of ITP?

A

Asymptomatic, purpura (bruising and purple/red rash), nosebleeds, menorrhagia, prolonged bleeding from the gums, severe headache, vomiting, fatigue.

95
Q

Investigations for ITP?

A

FBC: thrombocytopenia, bone marrrow biopsy, platelet autoantibodies present.

96
Q

How to treat ITP?

A

Prednisolone, IV immunoglobulins, platelet transfusions, immunosuppression (oral azathioprine)

97
Q

What is TTP?

A

Caused by a deficiency of VWF cleaving protein

98
Q

Signs and symptoms of TTP?

A

Flu like symptms, purpura, nosebleeds, easy bruising, menorrhagia, headache, haemoptysis, abdo pain, GI bleeding,

99
Q

Investigations for TTP?

A

Normal coag screen
Blood smear - FRAGMENTED ERYTHROCYTES,
Raised creatinine, raised bilirubin, raised reticulocytes, proteinuria and haematuria.

100
Q

Treatment for TTP?

A

IV plasma exchange, methylprednisolone, rituximab, folic acid

101
Q

What is DIC?

A

Systemic activation of blood coagulation, resulting in thrombosis of small/medium size vessels and organ disfunction.
As the clotting factors are used up this may cause bleeding to occur.

102
Q

What are the signs and symptoms of DIC?

A

Large bruises, spontaneous bleeding after venepuncture, nosebleeds, GI bleeds, confusion and shock, ARDS, purpura, gangrene.

103
Q

What would you find on investigations for DIC?

A

Prolonged PT time, prolonged APTT, low fibrinogen and severe thrombocytopenia.

104
Q

Treatment of DIC?

A

Treat underlying cause, platelets in those who present with bleeding, red cell transfusion, FFP to replace clotting factors

105
Q

What is polycythaemia?

A

An increase in RBC count and haematocrit

106
Q

What is absolute polycythaemia due to?

A

Increase in RBC mass (polycythaemia vera)

107
Q

What is secondary polycythemia due to?

A

Hypoxia (high altitude) and high EPO secretion

108
Q

Which mutation do most patients have in polycythaemia?

A

JAK2 mutation

109
Q

Symptoms of polycythemia?

A

Headaches and dizziness, itching, fatigue, tinnitus, erythromelalgia (burning sensation in fingers and toes), hypertension, angina.

110
Q

Investigations for polycythemia?

A

RAISED HAEMOGLOBIN
Raised WCC and platelets, JAK2 mutation on genetic screening
Low serum EPO

111
Q

Treatment of polycythemia?

A

Aim is to maintain normal blood count
Venesection relieves symptoms
Low dose aspirin

112
Q

Haemaphillia A?

A

Factor 8 deficiency

113
Q

Haemaphillia B?

A

Factor 9 deficiency

114
Q

Who gets haem A?

A

Males as x-linked much more common

115
Q

Symptoms of moderate hemophilia A/

A

Bleeding following venepunctire, bleeding following trauma

116
Q

Symptoms of severe hemophilia A?

A

Neonatal bleeding, spontaneous bleeding, GI bleeds, haematuria.

117
Q

Investigations for haemophilia A?

A 
Low Hb
Normal PT and bleeding time 
Prolonged APTT 
reduced factor 8 
CT head to look for hemorrhages
118
Q

Treatment fo haem A?

A

Prophylactic factor 8, FFP containing factor 8 to be given for acute bleeds.
Desmopressin to boost factor 8 activity

119
Q

Which is more common haem A or Haem B?

A

Haem A is much more common

120
Q

Symptoms of Ham B?

A

Bruising, epitaxis, pallor, haemoptysis, heavy bleeding from minor trauma., bleeding from tooth loss in childhood.

121
Q

Investigations for haem B?

A

PROLONGED APTT

low factor 9

122
Q

Treatment for heam B?

A

Treatment must be starred before confirmed diagnosis
Vacc against hep A and B
Recombinant factor 9
Emergency bracelet

123
Q

What is VW disease?

A

deficiency of VWF which is used in forming platelet plugs.

124
Q

Symptoms of VW disease?

A

Bleeding from mucosa, menorrhagia, spontaneous bleeding.

125
Q

Investigations for VWD?

A 
FBC: 
Fibrinogen level 
platelet count 
Clotting screen 
plasma vWF decreased 
factor 8 levels can be decreased.
126
Q

Treatment for VWD

A

Educate on bleeding risk
Stop antiplatelet drugs and NSAIDs
Tranexamic acid for minor bleeds
Desmopressin to ncrease vWF leves

127
Q

What is a DVT?

A

When a blood clot forms in a vein, usually in the legs

128
Q

Causes of DVT?

A

Surgery, immobilisation, contraceptive pill, longhaul flights, leg fractures, malignancy

129
Q

Signs and symptoms of DVT?

A

Pain in calf, swelling, redness and warmth over area, unilateral and ankle oedema.

130
Q

What risk score is used for DVT?

A

Wells score

131
Q

Is a D-dimer diagnostic?

A

If negative it excludes DVT but if positive it isnt diagnostic

132
Q

What to do if d-dimer is positive?

A

Doppler ultrasound

133
Q

Treatment of DVT?

A

LMWH, Warfarin, DOAC (apixaban)

Compression stockings

134
Q

What is the most common parasite to infect for malaria?

A

P.falciparum

135
Q

Is malaria a notifiable disease?

136
Q

Which is the least common parasite infection in malaria>

A

P.malariae

137
Q

When do symptoms occur in malaria?

A

6 days post infection

138
Q

When do p.vivax and p.ovale most commonly present?

A

6 months post infection

139
Q

Symptoms in severe disease of p.falciparum?

A

SOB, fits and hypovolaemia, AKI and nephrotic syndrome.

140
Q

What is the specific investigation for malaria?

A

Thick and thin blood smears

141
Q

Treatment of nonfalciparum malaria?

A

Chloroquine

142
Q

How to treat falciparum malaria?

A

Oral quinine sulphate

143
Q

Angular stomatitis, lemon-yellow skin, ataxia and delusions are hallmarks of which type of anaemia?

A

Pernicious

144
Q

You are a junior doctor on your haematology rotation. You have just seen a 50 year old woman who presented with anaemia, gum hypertrophy and bone pain. You do a full blood count which shows thrombocytopaenia and neutropoenia. A bone marrow biopsy shows Auer rods.

145
Q

You are an F2 on a tropic medicine rotation. You are seeing a patient who has recently been on holiday to Asia and is now complaining of nausea, loss of appetite, abdominal pain and some weight loss. Her symptoms started 6 weeks after returning to the UK. You perform some tests and diagnose tapeworm.

A

Eosinoplilia is raised in parasitic disease

146
Q

You are a junior doctor working on a paediatric ward. Your patient is aged 3 and has anaemia, hepatosplenomegaly, headaches and bone pain. You perform a number of tests and start treating them for cancer.

A

ALL is the most common paeds cancer

147
Q

You are an F1 who sees a 5 year-old patient with diagnosed ITP. His mother tells you that he has recently had a lot of nosebleeds and feels tired all the time.
How would you treat this patient?

A

Prednisalone

148
Q

Mr. Jones has been in hospital for a week recovering from a knee replacement. He is 75, has hypertension and is a smoker. He hasn’t been able to move very much since his surgery and refuses to wear compression stockings. Suddenly, Mr Jones becomes very short of breath and sits up to breath. His heart rate increases to 108 and he is breathing much faster than usual.

What investigation do you want to order?

149
Q

Camilla is a 25 year old lady who has just returned home from visiting Ghana. She presents with very generic flu-like symptoms (fever, headache, cough) and is concerned that something is wrong. Whilst taking her history, you learn that she suffered from many mosquito bites during her trip.

What investigation would you organise to confirm your diagnosis?

A

Thick and thin blood smears

150
Q

Last week you saw a patient in GP who was complaining of tiredness and recurrent infection. You ordered a full blood count and the results have shown neutropenia.

Name 2 causes of neutropenia.

When would you want to repeat the patient’s bloods?

A 
Name 2 causes of neutropenia.
Infection 
Drugs (phenytoin, antipsychotics)
Malignancy 
Excess alcohol and liver disease

When would you want to repeat the patient’s bloods?
4 weeks’ time

Phase 2a medicine (14 decks)

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