HAEM/IMMUNO Flashcards
Definition of anaemia
Reduction in hb concentration, RCC, PCV = subsequent impairment in meeting oxygen demands
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
Causes of iron deficiency
- increased demand
- environmental
- pathologic
- decreased absorption
- chronic blood loss
- acute blood loss
- genetic
- drug related
Minority and population groups at risk for iron deficiency anaemia
Minority - indigenous, vietnamese, arabic
Population - coeliac, pregnant women, younger women, cancer patients, malnutrition
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
What influences iron intake in vegetarians and children?
Vegetarians - no red meat/haem iron
Children - late weaning, and lack of appropriate foods
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
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
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
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
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
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
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
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
What tools are important for implementing secondary prevention of ARF?
- RF/RHD register
- BPG and other a/b supply
- provision of secondary prophylaxis
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
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
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)
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:
- XS variation in lung function - variable airflow limitation
- 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
- gram negatives
- klebsiella pneumoniae
- CA-MRSA
- gram negatives - dementia, cerebrovascular disease
- klebsiella pneumoniae - alcoholism (aspiration)
- 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
