HAEM/IMMUNO Flashcards by Lauren Pienaar

Definition of anaemia

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

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What is the difference between iron deficiency and iron deficiency anaemia

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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Causes of iron deficiency

increased demand
environmental
pathologic
decreased absorption
chronic blood loss
acute blood loss
genetic
drug related

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Minority and population groups at risk for iron deficiency anaemia

Minority - indigenous, vietnamese, arabic

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

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Signs and symptoms of iron deficiency anaemia

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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What influences iron intake in vegetarians and children?

Vegetarians - no red meat/haem iron

Children - late weaning, and lack of appropriate foods

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What are the two types of lymphoma?

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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What is the staging of hodgkins lymphoma?

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

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

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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What is acute rheumatic fever?

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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Which groups are at risk of developing ARF/RHD?

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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What are the major manifestations of ARF?

and minor

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

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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What tools are important for implementing secondary prevention of ARF?

RF/RHD register
BPG and other a/b supply
provision of secondary prophylaxis

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Signs and symptoms of acute coronary syndromes

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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4 Reasons people delay seeking treatment in acute coronary syndromes

failure to recognise heart attack
failure to act
inappropriate contact with GP first
rural location

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Initial mgmt in person with acute coronary syndrome

Assess - ECG
Assess - history, pain
Assess - obersvations, BSL and troponin
Initial meds - aspirin, clopidogrel, oxygen, glyceryl trinitrate
risk stratification - non STEMI
thrombosis (within 30mins of presentation)

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Chest pain differentials

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

Modifiable risk factors for CVD

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

Non modifiable risk factors for CVD

old age
ethnicity
family history

CVD absolute risk chart factors

gender
smoking
age
systolic BP
HDL cholesterol ratio
indigenous ancestry

Symptoms of chronic heart failure

dyspnoea
orthopnoea
PND
fatigue
oedema
palpitations/syncope

Causes of chronic heart failure

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

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

Lack of referral (74%)

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

25%

Barriers to cardiac rehabilitation

- lack of available programs - distance and transport issues - inconvenient times - poor motivation - age and ethnicity issues

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

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

Diagnostic tests/factors making asthma more common

- 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

Risk factors for asthma

- indigenous - lower socioeconomic status - other chronic conditions like rhinitis, sinusitis, mental and behavioural disorders

Barriers to asthma management adherence

- busy - lack of motivation - lack of knowledge - incorrect technique - habit formation - side effects - financial

Community acquired penumonia risk factors

- respiratory infection in past month - age >65 - underweight - smoking - previous pneumonia - COPD, asthma etc - alcoholism - institutionalisation

What are specific risk factors for 1. gram negatives 2. klebsiella pneumoniae 3. CA-MRSA

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

What investigations would be done on suspicion of pneumonia?

- CXR - FBC - EUC - Blood glucose - pulse oximetry - sputum test

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

Prediction rule for short-term mortality among patients with CAP

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

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

What are the advantages of CORB?

- simple severity score - but less sensitive that SMART-COP - removes patient age bias

When should SMART-COP be used?

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

What is the difference between dementia and delirium?

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

``` What exposures are associated with: Rhinitis Asthma Pneumoconiosis Lung cancer Mesothelioma ```

``` Rhinitis - irritants Asthma - irritants Hypersensitivity pneumonitis - bacteria Pneumoconiosis - asbestos, silica, coal Lung cancer - asbestos, radon Mesothelioma - asbestos ```

Lung conditions related to asbestos exposure

- pleural plaques - benign pleural effusion - diffuse pleural thickening - asbestosis - mesothelioma - lung cancer

Asbestosis

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

What were the 3 waves of absestosis

1 - miners exposed 2 - construction workers 3 - renovators

Types of asbestos

Amphiboles - blue = WORST Amosite - brown Serpentine - white

4 classic findings on pleural mesothelioma

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