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Year 6 > Haem/onc > Flashcards

Haem/onc Flashcards

1
Q

Which leukaemia is philadelphia positive?

A

CML

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2
Q

Cells in Hodgkin’s lymphoma?

A

Reed-sternberg cells

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3
Q

Most common Hodgkin’s lymphoma?

A

Nodular sclerosing

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4
Q

Aggressive non-hodgkin’s?

A

Burkitt’s

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5
Q

Low grade non-hodgkin’s?

A

Follicular

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6
Q

Starry sky appearnace cancer?

A

Burkitt’s lymphoma

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7
Q

Genetics of adult t-cell lymphoma

A

HTLV-1

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8
Q

Treatment for hodgkin’s lymphoma?

A

ABVD chemotherapy

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9
Q

Ann arbor staging?

A

B = Fever >38 degrees, drenching night sweats, unintentional weight loss
Stage III = nodules both sides of the diaphragm

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10
Q

SE cyclophosphamide?

A

Haemorrhagic cystitis

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11
Q

Cisplatin SE?

A

Ototoxicity

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12
Q

Immune mediated anaemia test?

A

DAT test

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13
Q

Warm AIHA (80-90%)?

A

IgG, extravascular haemolysis – lymphoma, CLL, drug allergy, SLE, idiopathic

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14
Q

Cold AIHA (10-15%)?

A

IgM (or IgG), intravascular haemolysis – M. pneumoniae, EBV, CMV

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15
Q
  • TTP (pentad S/S?)
A

MAHA, thrombocytopenia, AKI, neurological impairment, fever
ADAMST13 enzyme

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16
Q
  • HUS (triad S/S
A

MAHA, thrombocytopenia, AKI; E. coli toxin 0157

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17
Q

Secondary prevention post-stroke?

A

o 1st line - clopidogrel (75mg, OD, life-long) + statin
o 2nd line - aspirin (75mg OD) + dipyridamole (200mg BD) + statin

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18
Q

Treatment windows in ischaemic stroke?

A

 <4.5 hours  thrombolysis (alteplase)
 <4.5 hours, occluded proximal anterior circulation  thrombolysis AND thrombectomy
 <6 hours  thrombectomy

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19
Q

 Disability scales post stroke?

A

Barthel index (BI)

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20
Q

Parkinsonism differentials:

A

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+

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21
Q

Ix for parkinsonism?

A

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)

22
Q
  • Management of parkinsonism?
A

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)

23
Q
A
24
Q

co-careldopa - what’s in it?

A

 Levodopa (combined with dopa decarboxylase inhibiters)

25
Q
  • SEs of levodopa?
A

D Dyskinesia
O On/off phenomena
P Psychosis
A Arterial BP down
M Mouth dryness
I Insomnia
N N&V
E EDS

26
Q

o 2nd line adjuncts PD?

A

 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)

27
Q

Medications to avoid in PD?

A

metoclopramide, haloperidol

28
Q

Cluster headache acute treatment?

A

: 100% O2, SC triptan

29
Q

Cluster headache prophylaxis?

A

Verapamil

30
Q

Acute migraine tx?

A

Acute: oral triptan + NSAID/paracetamol

31
Q

Migraine prophylaxis?

A

Prophylaxis *: topiramate/propranolol
* only if ≥2 attacks/month

32
Q

S/S of MS?

A

 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)

33
Q

Ix MS?

A

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

34
Q

Tx for MS

A

 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

35
Q

Symptomatic management of MS?

A

 Fatigue modafinil
 Depression SSRI (citalopram)
 Pain amitryptyline, gabapentin
 Spasticity 1st: baclofen + gabapentin; 2nd: dantrolene
 Urgency/frequency oxybutynin, tolterodine
 ED sildenafil
 Tremor clonazepam

36
Q

Associations with MG?

A

thymoma (15%), thymic hyperplasia (50-70%), AutoImmune disease (PA, AI thyroid, RhA, SLE)

37
Q

o Myasthenic crisis mx?

A

 Ix: ABG (hypercapnia before hypoxia), FVC
 Mx: plasmapheresis, IVIG, intubation

38
Q
  • Investigations MG?
A

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)

39
Q

Tx for long-term control of MG?

A

1st line (long-term control) = immunosuppression:
 1st  prednisolone
 2nd  azathioprine, cyclosporine, mycophenolate mofetil
1st line (symptomatic) = long-acting AChE inhibitors (pyridostigmine, neostigmine)

40
Q

What is MG?

A

An autoimmune disorder characterised by insufficient functioning nicotinic acetylcholine receptors
o Anti-ACh-R in are seen in 85-90% of cases

41
Q

S/S of lambert-eaton syndrome?

A

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)

42
Q

Bulbar palsy signs?

A

Cranial nerves 9, 10, 11, 12
LMN signs

43
Q

Pseudobulbar palsy signs?

A

UMN signs
Cranial nerves 5, 7
Cranial nerves 9, 10, 11, 12

44
Q

Investigations for MND?

A

Diagnostic criteria: Revised El Escorial criteria):
o MRI brain / spinal cord exclude structural causes
o EMG (fasciculations)
o LP exclude inflammatory conditions

45
Q

Mx MND

A

DT management = neurologist, physio, OT, dietician, GP, specialist nurse)
o Riluzole (extends life by ~3 months)

46
Q

Lateral medullary syndrome s/s?

A

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

47
Q

Locations of quadranopias?

A
  • PITS (Quadranopia) = Parietal Inferior, Temporal Superior
  • PIT S (Pituitary tumour vs. craniopharyngioma) = Pituitary Superior
48
Q

Causes of third nerve palsy?

A
  • Causes:
    o DM Vasculitis (GCA, SLE)
    o Uncal herniation through tentorium (raised ICP) Posterior communicating artery aneurysm
    o Cavernous sinus thrombosis Amyloid, MS
49
Q

Normal Pressure Hydrocephalus s/s?

A
  • > 60yo, quick onset
  • “wet, wobbly, wacky” (incontinent, falls, dementia)
50
Q

Anti-emetic choices+indications?

A
  • Ondansetron (+ dexamethasone) chemotherapy-induced nausea
  • Haloperidol (+ dexamethasone)
    intracranial causes (raised ICP, direct effect of tumour)
  • Prochlorperazine
    vestibular causes
  • Metoclopramide
    gastrointestinal causes
51
Q
A

Year 6 (26 decks)

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