Haem/onc Flashcards
Which leukaemia is philadelphia positive?
CML
Cells in Hodgkin’s lymphoma?
Reed-sternberg cells
Most common Hodgkin’s lymphoma?
Nodular sclerosing
Aggressive non-hodgkin’s?
Burkitt’s
Low grade non-hodgkin’s?
Follicular
Starry sky appearnace cancer?
Burkitt’s lymphoma
Genetics of adult t-cell lymphoma
HTLV-1
Treatment for hodgkin’s lymphoma?
ABVD chemotherapy
Ann arbor staging?
B = Fever >38 degrees, drenching night sweats, unintentional weight loss
Stage III = nodules both sides of the diaphragm
SE cyclophosphamide?
Haemorrhagic cystitis
Cisplatin SE?
Ototoxicity
Immune mediated anaemia test?
DAT test
Warm AIHA (80-90%)?
IgG, extravascular haemolysis – lymphoma, CLL, drug allergy, SLE, idiopathic
Cold AIHA (10-15%)?
IgM (or IgG), intravascular haemolysis – M. pneumoniae, EBV, CMV
- TTP (pentad S/S?)
MAHA, thrombocytopenia, AKI, neurological impairment, fever
ADAMST13 enzyme
- HUS (triad S/S
MAHA, thrombocytopenia, AKI; E. coli toxin 0157
Secondary prevention post-stroke?
o 1st line - clopidogrel (75mg, OD, life-long) + statin
o 2nd line - aspirin (75mg OD) + dipyridamole (200mg BD) + statin
Treatment windows in ischaemic stroke?
<4.5 hours thrombolysis (alteplase)
<4.5 hours, occluded proximal anterior circulation thrombolysis AND thrombectomy
<6 hours thrombectomy
Disability scales post stroke?
Barthel index (BI)
Parkinsonism differentials:
o Vascular Strokes
o Infective / Inflammatory Syphilis, CJD, HIV
o Trauma Dementia pugilistica
o Autoimmune Autoimmune encephalopathy
o Metabolic Neuroglycopaenic
o Iatrogenic / Idiopathic (incl. drugs) antipsychotics, metoclopramide
o Neoplasm -
o Congenital Wilson’s disease
o Degenerative / Drugs PD, PD+
Ix for parkinsonism?
o CT/MRI (rule out any vascular causes)
o DaTScan; a tracer (ioflupane) 123I-FP-CIP used in Single Photon Emission CT (123I-FP-CIP SPECT)
- Management of parkinsonism?
o General management:
MDT
Disability (UPDRS – Unified PD Rating Scale)
Physiotherapy (postural exercises)
Depression (screening)
Levodopa is first line or co-careldopa
MAO-B inhibitors (i.e. selegiline)
DA agonists (i.e. pramipexole, ropinirole)
co-careldopa - what’s in it?
Levodopa (combined with dopa decarboxylase inhibiters)
- SEs of levodopa?
D Dyskinesia
O On/off phenomena
P Psychosis
A Arterial BP down
M Mouth dryness
I Insomnia
N N&V
E EDS
o 2nd line adjuncts PD?
COMT inhibitors (i.e. entacapone, tolcapone)
* Given with levodopa to improve compliance but may increase SEs
* Entacapone = peripheral COMT inhibitor
* Tolcapone = central + peripheral COMT inhibitor
Amantadine (PO; nicotinic antagonist, DA agonist, non-competitive NMDA antagonist)
Apomorphine (SC; DA agonist)
Deep brain stimulation (of subthalamic nucleus)
Medications to avoid in PD?
metoclopramide, haloperidol
Cluster headache acute treatment?
: 100% O2, SC triptan
Cluster headache prophylaxis?
Verapamil
Acute migraine tx?
Acute: oral triptan + NSAID/paracetamol
Migraine prophylaxis?
Prophylaxis *: topiramate/propranolol
* only if ≥2 attacks/month
S/S of MS?
Tingling
Eye / optic neuritis (CRAP = Central scotoma, RAPD, Acuity (↓ central vision, ↓colour vision), Pain on movement)
Ataxia (and other cerebellar signs – DANISH)
Motor (spastic paraparesis – i.e. shoulder paralysis)
Ix MS?
revised McDonald criteria, demonstration of lesions disseminated in time and space
o Contrast MRI (gadolinium-enhanced, T2-weighted)
o LP (IgG oligoclonal bands)
o Blood antibodies:
Anti-MBP (myelin basic protein)
NMO-IgG (neuromyelitis optica) Devic’s syndrome (S/S: MS + transverse myelitis + optic atrophy)
o Evoked potentials
Tx for MS
DMARDs:
* IFN-beta reduces relapses by 30%
* Glatiramer
Biologicals:
* Natalizumab (anti-VLA-4 AB) 1st line RRMS (reduces relapses by 66%)
* Alemtuzumab (anti-CD52) 2nd line RRMS
Methylprednisolone in relapses for 3 days
Symptomatic management of MS?
Fatigue modafinil
Depression SSRI (citalopram)
Pain amitryptyline, gabapentin
Spasticity 1st: baclofen + gabapentin; 2nd: dantrolene
Urgency/frequency oxybutynin, tolterodine
ED sildenafil
Tremor clonazepam
Associations with MG?
thymoma (15%), thymic hyperplasia (50-70%), AutoImmune disease (PA, AI thyroid, RhA, SLE)
o Myasthenic crisis mx?
Ix: ABG (hypercapnia before hypoxia), FVC
Mx: plasmapheresis, IVIG, intubation
- Investigations MG?
o Single fibre EMG ≥92% sensitivity
o Repetitive nerve stimulation test fatiguability
o Serial pulmonary function testing test fatiguability
o Antibodies:
Anti-ACh-R AB 85-90%
Anti-muscle-specific-receptor TK AB 40%
o Tensilon test (IV edrophonium bromide relieves muscle weakness temporarily)
Tx for long-term control of MG?
1st line (long-term control) = immunosuppression:
1st prednisolone
2nd azathioprine, cyclosporine, mycophenolate mofetil
1st line (symptomatic) = long-acting AChE inhibitors (pyridostigmine, neostigmine)
What is MG?
An autoimmune disorder characterised by insufficient functioning nicotinic acetylcholine receptors
o Anti-ACh-R in are seen in 85-90% of cases
S/S of lambert-eaton syndrome?
symptoms :
Repeated muscle contractions lead to increased muscle strength (seen in only 50% of patients)
Limb-girdle weakness (affects lower limbs first)
Hyporeflexia
ANS symptoms (dry mouth, impotence, difficulty micturating)
Eye signs are rarer (ophthalmoplegia and ptosis not commonly a feature)
Associated with small cell lung cancer
Mx: Treat cancer
Immunosuppression (prednisolone ± azathioprine)
Bulbar palsy signs?
Cranial nerves 9, 10, 11, 12
LMN signs
Pseudobulbar palsy signs?
UMN signs
Cranial nerves 5, 7
Cranial nerves 9, 10, 11, 12
Investigations for MND?
Diagnostic criteria: Revised El Escorial criteria):
o MRI brain / spinal cord exclude structural causes
o EMG (fasciculations)
o LP exclude inflammatory conditions
Mx MND
DT management = neurologist, physio, OT, dietician, GP, specialist nurse)
o Riluzole (extends life by ~3 months)
Lateral medullary syndrome s/s?
Wallenberg’s syndrome) occurs after occlusion of the posterior inferior cerebellar artery (PICA)
* Signs & symptoms:
o Cerebellar:
Ataxia
Nystagmus
o Brainstem:
Ipsilateral: dysphagia, facial numbness, cranial nerve palsy (Horner’s – miosis, anhidrosis, ptosis)
Contralateral: limb sensory loss
Locations of quadranopias?
- PITS (Quadranopia) = Parietal Inferior, Temporal Superior
- PIT S (Pituitary tumour vs. craniopharyngioma) = Pituitary Superior
Causes of third nerve palsy?
- Causes:
o DM Vasculitis (GCA, SLE)
o Uncal herniation through tentorium (raised ICP) Posterior communicating artery aneurysm
o Cavernous sinus thrombosis Amyloid, MS
Normal Pressure Hydrocephalus s/s?
- > 60yo, quick onset
- “wet, wobbly, wacky” (incontinent, falls, dementia)
Anti-emetic choices+indications?
- Ondansetron (+ dexamethasone) chemotherapy-induced nausea
- Haloperidol (+ dexamethasone)
intracranial causes (raised ICP, direct effect of tumour) - Prochlorperazine
vestibular causes - Metoclopramide
gastrointestinal causes
