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FACEM > Haem/Onc > Flashcards

Haem/Onc Flashcards

1
Q

Triggers for G6PD deficiency

A

Favs beans
Drugs (Sulfa, nitrofurantoin, aspirin, methylene blue)
Ketoacidosis
Infection

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2
Q

Investigations G6PD

A 
FBC and film (Heinz bodies)
Coombes (negative)
High LDH
Low haptoglobin
High unconjugated bilirubin
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3
Q

Treatment G6PD

A

Treat precipitate
IV Fluids
Oral folate
Admission

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4
Q

MAHA causes

A 
DIC
TTP
HUS
HELLP
Malignant hyperthermia
Wegeners
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5
Q

Sickle cell precipitants

A

Infection
Dehydration
Hypoxia
Acidosis

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6
Q

Symptoms of Sickle Cell

A 
Vaso-occlusive crisis
Acute chest syndrome 
Priapism
Splenic sequestration
Haemolytic crisis
Infection (salmonella OM)
Infarction (brain, bone, eye, kidney)
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7
Q

Explain acute chest syndrome and management

A

Diffuse infiltrates with cough, SOB and fever AFTER crisis from pneumonia, PE, ARDS or fluid overload

Treatment: empiric antibiotics (SHiN cover) & plasma exchange (treatment for all complications of sickle cell)

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8
Q

Vaso-occlusive crisis management and prevention

A 
Warm
Oxygen
Fluids
Analgesia
Consider plasma exchange

Prevent:
Hydroxyurea
Bone marrow transplant

Never use tPA or heparin (NOT CLOT)

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9
Q

Pernicious anaemia features

A

Blood: Howell Jolly Bodies, high MCV, low B12
Neuro: dementia, depression, subacute degeneration of spinal cord
GI: carcinoid and adenocarinoma

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10
Q

Aplastic Anaemia causes and bloods

A

GVHD
Ionised radiation
Fanconi Syndrome (renal failure)
Pregnancy

Drugs:
Chloramphenicol
Phenylbutazone
Anticonvulsants

Inv:
Pancytopaenia with low reticulocytes

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11
Q

Intrinsic haemolytic anaemia

A

Enzyme: G6PD def, pyruvate kinase def
Membrane: spherocytosis
Hb: Sickle Cell

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12
Q

Extrinsic Haemolysis

A

Autoimmune: Coombs +
Mechanical: MAHA, prosthetic valve
Env: burns, toxins, infection
Splenic sequestration

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13
Q

Sideroblastic anaemia causes

A

Isoniazid toxicity
Pyridoxine def
Lead poisoning
Alcohol

Tx: Pyrodoxine

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14
Q

Mechanism of HIT

A

Platelet factor 4 binds to heparin to inactivate it as part of metabolism.
If develop PF4-heparin complex antibodies (HS III) binds to platelets forming clots (consumptive coagulopathy)

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15
Q

APLS antibodies and RF for high risk of clots

A

Anti B2 glycoproteins
Lupus anticoagulant
Anticardiolipin

RF
Presence of anti B2 glycoproteins
High antibody levels
IHD RF (smoking, DM, lipids, HTN)

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16
Q 
Management of APLS:
No SLE
SLE
Arterial clot
Venous clot
Pregnancy
Refractory
A 
No SLE: aspirin
SLE: hydroxychloroquine
Arterial: warfarin and aspirin
Venous: warfarin
Pregnancy: heparin and aspirin
Refractory: hydroxychloroquine, IVIG
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17
Q

Indications for thrombophlebitis screen

A 
Unprovoked DVT and <45yrs
2nd unprovoked DVT
DVT pregnancy
Recurrent miscarriages or stillbirth
Family hx
Atypical DVT site (arm)
DVT and HIV
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18
Q

HASBLED Score

A 
HTN 160
Ab renal (200), LFT (Bili 2, AST 3)
Stroke
Previous bleed
Labile INR
ETOH/drugs
Drugs that bleed (anticoagulants)
Age >65
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19
Q

LMWH benefits to heparin

A 
Single daily dose
No monitoring
Less HIT
Better anti-Xa activity
SC delivery (not IV)
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20
Q

Reversing heparin

A

Protamine max 50mg IV

1mg for 100units UFH <3 hours
1mg per 1mg LMWH <8 hours
0.5mg for LMWH >8 hours

S/E: anaphylaxis, Brady, hypotension

21
Q

Petechia causes

A 
Mechanical: coughing, vomiting, pressure
Thrombocytopaenia
Infection: meningococcal, IE, RMSF
Vasculitis
Platelets dysfunction (vWD, renal failure)
22
Q

Thrombocytopenia causes

A

Production: aplastic anaemia, chemo, leukaemia
Destruction: ITP, DIC, TTP, HUS
HELLP
Splenic sequestration
Drugs: quinine, heparin, NSAIDS, phenytoin, paracetamol, abciximab
Elimination: Bleeding, ECMO

23
Q

ITP causes and high risk factors

A

Causes:
Viral illnesses EBV, HIV, CMV, hep C

RF: old (>60), low plt, liver failure, on anticogaulation

24
Q

ITP treatment

A

Steroids
Plt if <10 or <30 and bleeding
IVIG
Splenectomy

25
Q

TTP

A 
ADAMTS-13 deficiency
BRAIN FART (fever, anaemia, renal failure, thrombocytopaenia)

MAHA (schistocytes, LDH)

Tx: plasma exchange, FFP, steroids

Triggers:
Shigella/Salmonella
OCP
Pregnancy
Cancer
26
Q

HUS

A

Kids, bloody diarrhoea, renal failure, MAHA

Shigella/Ecoli
Strep (atypical)
EBV, VZV
Cancer

Toxin mediated

Supportive with dialysis only

27
Q

DIC bloods

A 
Sky high Ddimer
High aPPT
High INR
Low Plt
Low fibrinogen
28
Q

Difference in plt vs factor bleed

A

Bruising
Immediate
Holes (nose, menses, gums, haematuria, GI bleeding)

Factor:
Deep (muscle, joint, head, retroperioneal)
Delayed onset
Congenital

29
Q

Cryo contents

A 
150units of 
Fibrinogen
Factor 8
Factor 13
vWF

All in 30mls

30
Q

FFP

A 
250mls
Everything 
250 units Factor 8
Thawed
Matched
31
Q

Haemophilia A
Mild, moderate, severe
% per factor

A

Mild 5-10%
Moderate 1-5%
Severe less than 1%

1 unit increases 2%
(1:1 in Haemophilia B)

32
Q

Classification of bleeding severity in haemophilia

A

Very mild: no factor, nose bleed
Mild: 12u/kg: haematuria, mucosal
Mod: 25u/kg: deep lac, trauma to nose, early haemarthrosis
Severe: deep muscle, headstrike, dental extraction

33
Q

Acute porphyria features

A

Disproportionate abdo pain
Confusion & focal deficits
Painful blistering skin

34
Q

Prophyria dx and tx

A

Urinary porphobilirubin

Tx:
IV fluids
Haemin
Liver transplant

35
Q

Role of tryptase

A

Confirm anaphylaxis (>5ug/L)
Dx mastocytosis
75% sensitive

36
Q

Causes angioedema

A 
C1 esterase def
Meds: ACEI, tPA
Idiopathic 
Acquired C1ED (sepsis, DIC, ECMO)
Infection
Allergic reaction
37
Q

Management angioedema

A

Icatibant 30mg SC
C1 esterase conc 20u/kg
FFP
TXA

38
Q

Difference in angioedema/urticaria

A

Sub dermal and submucosal
Skin, mucosa, GI, lips
Delayed onset 1-2 days
Painful, not itchy

Urticaria:
Itchy, rapid, skin only
Epidermis and dermis

39
Q

4 causes of pericardial effusion in malignancy

A

Malignancy itself
Radiation
Chemo
Low albumin

40
Q

SVC syndrome features

A

Symptoms:
SOB, headache in bending, chest pain, dysphasia

Signs:
Permbertons, oedema, flushing, distended upper body veins, right pleural effusion 25%

41
Q

SVC obstruction management

A 
Sit up
Lower limb IVC
Oxygen
Steroids
Radiotherapy/Stenting
42
Q

MASCC Criteria

A 
Age <60
Asymptomatic
Normotensive
Solid tumour
No dehydration
No fever in hospital
Haem cancer with no prev fungal infection
43
Q

Features of hyperviscosity syndrome

A

Mucosal bleeding
Visual disturbance
Reduced GCS

44
Q

Tumour Lysis Syndrome components

A

High uric acid
High K
High phosphate
Low calcium

45
Q

Risk factors for TLS

A 
High tumour burden
Cytotoxic chemo
Renal impairment
Dehydrated
High uric acid (gout)
46
Q

Treatment TLS

A 
Fluids (200ml/hr)
Dialysis
Insulin & Dextrose
Calcium only if unstable
Allopurinol
Rasburicase
Alkalination of urine
47
Q

Different system features of paraneoplastic

A 
Metabolic (ca, SIADH, ADH)
NMJ: lambert eaton 
CT: HPOA, clubbing
Haem: thrombosis, DIC
Renal: nephrotic 
Skin: acanthodians nigiricans
48
Q

High risk for Fleischer nodules

A 
Smoker
Old
Hx cancer
Fam hx lung cancer
Environmental (asbestos)

FACEM (8 decks)

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