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LEAPS > HAEM/IMMUNO > Flashcards

HAEM/IMMUNO Flashcards

1
Q

Definition of anaemia

A

Reduction in hb concentration, RCC, PCV = subsequent impairment in meeting oxygen demands

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2
Q

What is the difference between iron deficiency and iron deficiency anaemia

A

Iron deficiency - reduction in iron stores, preceding iron deficiency anaemia
Iron deficiency anaemia - low levels of iron associated with anaemia and presence of microcytic hypo chromic red cells

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3
Q

Causes of iron deficiency

A
  • increased demand
  • environmental
  • pathologic
  • decreased absorption
  • chronic blood loss
  • acute blood loss
  • genetic
  • drug related
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4
Q

Minority and population groups at risk for iron deficiency anaemia

A

Minority - indigenous, vietnamese, arabic

Population - coeliac, pregnant women, younger women, cancer patients, malnutrition

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5
Q

Signs and symptoms of iron deficiency anaemia

A 
skin - pale, dry 
hair - thinning 
mouth/GI - angular stomatitis, gastric atrophy, tongue erythema 
eyes - white/blue sclera 
nails - brittle, concave
CVD - tachycardia, cardiomegaly
oral intake - pica
spleen - splenomegaly
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6
Q

What influences iron intake in vegetarians and children?

A

Vegetarians - no red meat/haem iron

Children - late weaning, and lack of appropriate foods

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7
Q

What are the two types of lymphoma?

A 
Hodgkin - Reed-sternberg cells
- uncommon 10%
- EBV
- 90% nodal 
- 80% cure
- continuous  spread
4 types: nodular sclerosis, lymphocyte predominance, mixed cellularity, lymphocyte depletion

Non-hodgkin

  • 90% B cell, 10% T cell
  • elderly more affected
  • 60% nodal
  • haematogenous spread
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8
Q

What is the staging of hodgkins lymphoma?

A

I: involvement of 1 lymph node/structure
II: involvement of 2+ lymph node regions on same side of diaphragm
III: involvement of lymph nodes on both sides of diaphragm
IV: involvement of extra nodal sites other than one continuous or proximal extra nodal site

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9
Q

What are the modifying symptoms in the classification of hodgkins lymphoma?

A 
A = no symptoms 
B = fever, drenching night sweats, weight loss 
X = bulky disease, mediastinal mass > 1/3 of thoracic diameter, or any mass >10cm
E = involvement of one contiguous or proximal extra nodal site
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10
Q

What is the international prognostic index (IPI) based on?

A
  • Age
  • Stage 1/2 vs 3/4
  • number of extra nodal sites involved (>1?)
  • eastern cooperative oncology group performance status, 0/1 vs 2? (ability to function/daily/physically)
  • serum LDH
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11
Q

What is acute rheumatic fever?

A

Illness caused by AI reaction to infection with group A streptococcus
Heart damage that remains after ARF has resolved = rheumatic heart disease

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12
Q

Which groups are at risk of developing ARF/RHD?

A
  • Children 5-14 - GAS pharyngitis common
  • aboriginal/torres strait islanders in rural/remote settings
  • immigrants from developing countries
  • overcrowding, poor hygiene, malnutrition, lack of access to healthcare
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13
Q

What are the major manifestations of ARF?

and minor

A
  • Carditis
  • poly arthritis
  • mono arthritis/polyarthralgia
  • sydenham’s chorea - unco mvmt
  • erythema marginatum
  • subcutaneous nodules

Minor: fever, elevated acute phase reactants, prolonged P-R interval

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14
Q

What is the primary, secondary and tertiary prevention of ARF?

A

Primary - prevent initial attack by treating acute throat infections caused by group A strep (10 days of a/b)

Secondary - regular a/b for 10 years, compliance is crucial

Tertiary - surgery often required to repair/replace damaged heart valves

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15
Q

What tools are important for implementing secondary prevention of ARF?

A
  • RF/RHD register
  • BPG and other a/b supply
  • provision of secondary prophylaxis
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16
Q

Signs and symptoms of acute coronary syndromes

A
  • chest discomfort >10mins
  • recurrent chest pain
  • pain radiation to jaw/neck/upper limb
  • severe pain - nothing eases
  • short of breath
  • sweating, pallor
  • tachycardia, bradycarda
  • nausea, vomiting
  • fatigue
  • palpitations
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17
Q

4 Reasons people delay seeking treatment in acute coronary syndromes

A
  1. failure to recognise heart attack
  2. failure to act
  3. inappropriate contact with GP first
  4. rural location
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18
Q

Initial mgmt in person with acute coronary syndrome

A
  1. Assess - ECG
  2. Assess - history, pain
  3. Assess - obersvations, BSL and troponin
  4. Initial meds - aspirin, clopidogrel, oxygen, glyceryl trinitrate
  5. risk stratification - non STEMI
  6. thrombosis (within 30mins of presentation)
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19
Q

Chest pain differentials

A

CVD - MI, angina, pericarditis, aortic dissection, stenosis or aneurysm
Pulmonary - pneumothorax, bronchitis, asthma, cold
Neuro - shingles
Chest wall - fracture
GI - ulcer, reflux
Psych - anxiety

20
Q

Modifiable risk factors for CVD

A 
BIOMEDICAL 
- HTN
- high cholesterol
- Overweight 
- depression 
- Diabetes
BEHAVIOURAL 
- smoking 
- exercise lack 
- poor diet 
- alcohol XS
21
Q

Non modifiable risk factors for CVD

A
  • old age
  • ethnicity
  • family history
22
Q

CVD absolute risk chart factors

A
  • gender
  • smoking
  • age
  • systolic BP
  • HDL cholesterol ratio
  • indigenous ancestry
23
Q

Symptoms of chronic heart failure

A
  • dyspnoea
  • orthopnoea
  • PND
  • fatigue
  • oedema
  • palpitations/syncope
24
Q

Causes of chronic heart failure

A 
Systolic heart failure
- chronic heart disease 
- prior myocardial infarction 
- ischaemic heart disease 
- hypertension 
Diastolic heart failure 
- chronic heart disease 
- hypertension 
- diabetes
25
Q

What is the biggest contributor to non-completion of cardiac rehabilitation?

A

Lack of referral (74%)

26
Q

How much does cardiac rehab reduce all cause and cardiovascular mortality?

A

25%

27
Q

Barriers to cardiac rehabilitation

A
  • lack of available programs
  • distance and transport issues
  • inconvenient times
  • poor motivation
  • age and ethnicity issues
28
Q

In clinical practice, asthma is defined by the presence of the following:

A
  1. XS variation in lung function - variable airflow limitation
  2. respiratory symptoms - wheeze, SOB, cough, chest tightness which may vary over time/be absent
29
Q

Diagnostic tests/factors making asthma more common

A
  • no gold standard
  • history
  • presence of allergies/family history
  • absence of physical findings suggests alternative diagnosis
  • spirometry supports diagnosis
  • symptoms worse at night/early morning
  • symptoms began in childhood
  • FEV1 or PEF lower than predicted
  • eosinophilia or raised blood IgE level
  • symptoms relieved by SABA bronchodilator
30
Q

Risk factors for asthma

A
  • indigenous
  • lower socioeconomic status
  • other chronic conditions like rhinitis, sinusitis, mental and behavioural disorders
31
Q

Barriers to asthma management adherence

A
  • busy
  • lack of motivation
  • lack of knowledge
  • incorrect technique
  • habit formation
  • side effects
  • financial
32
Q

Community acquired penumonia risk factors

A
  • respiratory infection in past month
  • age >65
  • underweight
  • smoking
  • previous pneumonia
  • COPD, asthma etc
  • alcoholism
  • institutionalisation
33
Q

What are specific risk factors for

  1. gram negatives
  2. klebsiella pneumoniae
  3. CA-MRSA
A
  1. gram negatives - dementia, cerebrovascular disease
  2. klebsiella pneumoniae - alcoholism (aspiration)
  3. CA-MRSA - indigenous, alcoholism, HIV, prison
34
Q

What investigations would be done on suspicion of pneumonia?

A
  • CXR
  • FBC
  • EUC
  • Blood glucose
  • pulse oximetry
  • sputum test
35
Q

What is the pneumonia severity index (PSI) best for?

A

Prediction rule for short-term mortality among patients with CAP

36
Q

What is the best pneumonia prediction tool? and what does it do

A

CURB-65: clinical tool for risk stratifying patients presenting with CAP, more precise at predicting admission to icu

37
Q

What are the advantages of CORB?

A
  • simple severity score
  • but less sensitive that SMART-COP
  • removes patient age bias
38
Q

When should SMART-COP be used?

A

identification of patients with severe pneumonia who need to be referred to ICU
- less validation, more targeted outcome

39
Q

What is the difference between dementia and delirium?

A

Delirium has a sudden onset and fluctuating changes, dementia is progressive and gradual onset

40
Q 
What exposures are associated with:
Rhinitis 
Asthma
Pneumoconiosis 
Lung cancer 
Mesothelioma
A 
Rhinitis - irritants
Asthma - irritants
Hypersensitivity pneumonitis - bacteria
Pneumoconiosis - asbestos, silica, coal  
Lung cancer - asbestos, radon
Mesothelioma - asbestos
41
Q

Lung conditions related to asbestos exposure

A
  • pleural plaques
  • benign pleural effusion
  • diffuse pleural thickening
  • asbestosis
  • mesothelioma
  • lung cancer
42
Q

Asbestosis

A

a lung disease resulting from the inhalation of asbestos particles, marked by severe fibrosis and a high risk of mesothelioma.

43
Q

What were the 3 waves of absestosis

A

1 - miners exposed
2 - construction workers
3 - renovators

44
Q

Types of asbestos

A

Amphiboles - blue = WORST
Amosite - brown
Serpentine - white

45
Q

4 classic findings on pleural mesothelioma

A
  • pleural thickening
  • pleural effusion
  • decreased thoracic volume
  • no shift of mediastinum to affected side

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