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MSRA > haem/ onc > Flashcards

haem/ onc Flashcards

1
Q

WHat is the most common cause of inherited thrombophilia? ie clotting

A

Activated protein C resistance (Factor V Leiden) i

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2
Q

Length of tx for unprovoked vs provoked DVT?

A

provoked - 3 m
unprovked - 6 m
cancer is 6 m

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3
Q

What is myelofibrosis? What is associated with this condition on blood film?

A

a myeloproliferative disorder
‘tear-drop’ poikilocytes on blood film

This occurs because they are ‘squeezed’ through the fibrotic tissue in bone marrow in myelofibrotic disorders.

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4
Q

What is the most common inherited bleeding disorder? What is found on ix for this?

A

Von Willebrand’s disease (low von willebrand factor which is needed for platelet aggregation)
AD inheritance

Ix:
prolonged bleeding time
APTT may be prolonged
factor VIII levels may be moderately reduced
defective platelet aggregation with ristocetin

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5
Q

What is tumour lysis syndrome? How is it prevented?

A

breakdown of tumour cells –> release of chemicals from the cell.
Causes high K + high PO4, and low Ca

patients are higher risk should receive either allopurinol or rasburicase

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6
Q

What is Polycythaemia vera? How does it present?

A

Excess RBC and often also excess WBC and plarelets.
Strong association (95%) with JAK2

Presents: itching after bath, spleenomegaly, hyperviscosity, HTN, haemorrhage (low platelets), low ESR

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7
Q

Describe SCLC? What features may it have? mx?

A

arise from APUD* cells

ADH → hyponatraemia
ACTH → Cushing’s syndrome
Lambert-Eaton syndrome: antibodies to voltage gated calcium channels causing myasthenic like syndrome

If VERY early disease (T1-2 with no nodal or mets) then surgery, otherwise poor prognosis, for chemo/ radiotherapy

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8
Q

What blood results would you see in IDA?

A

Total iron-binding capacity (TIBC) + transferrin levels are typically raised in iron-deficiency anaemia
Iron and ferritin are low

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9
Q

When would you do a d-dimer post wells score?

A

If scores 1 but DVT still seems likely - if negative ruled out, if positive USS needed

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10
Q

What would you see on FBC for SCD?

A

Sickle cell disease causes a normocytic anaemia with raised reticulocyte count - due to haemolysis

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11
Q

What do you see on bloods in DIC?

A

Often occurs with sepsis
Low platelets and low coagulation factors (all coagulation factors are depleted)
schistocytes

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12
Q

When do you see elliptocytes?

A

These are rod/ pencil shaped erythrocytes seen in IDA, thalassaemia

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13
Q

When are heinz bodies seen?

A

Alpha thalassemia
G-6-PD deficiency

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14
Q

When are howell-jolly bodies seen?

A

characteristic of decreased splenic function, such as post-splenectomy/ severe haemolytic anaemia/ coeliacs disease

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15
Q

What is Hereditary haemorrhagic telangiectasia?

A

ABnormal blood vessels form —> telangiectasia, epistaxis and chronic bleeding occur –> IDA

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16
Q

Adverse effects of following agents:
Cyclophosphamide
Bleomycin
Anthracyclines (e.g doxorubicin)
Fluorouracil (5-FU)
Vincristine, vinblastine
Cisplatin

A

Cyclophosphamide:Haemorrhagic cystitis/ tranitional cell carcinoma

Bleomycin: lung fibrosis

Anthracyclines (e.g doxorubicin): cardiomyopathy

Fluorouracil (5-FU): coronary vasospasm

Vincristine: peripheral neuropathy

Cisplatin: Ototoxicity, peripheral neuropathy

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17
Q

What do clotting screens look like for liver failure?

A

In liver failure, all clotting factors are low except for factor VIII which is raised. Both PT and APTT can be prolonged.

18
Q

What do clotting screens look like for Haemaphilia A and B?

A

APTT grossly elevated
PT and bleeding time normal
Haemophilia A would have low levels of factor VIII but the other clotting factors are not affected. Haemophilia B would have factor IX deficiency.

19
Q

What does clotting screen look like in VWB?

A

Von Willebrand disease would have low levels of Von Willebrand factor but the other factors are not affected. Factor VIII may be low or normal.

20
Q

What cancer is associated with acanthosis nigricans?

A

gastrointestinal adenocarcinoma

21
Q

Which cancer is associated with pityriasis rotunda?

A

myeloma

22
Q

Which cancer is assoiated with superficial thrombophlebitis?

A

pancreatic carcinoma

23
Q

aplastic vs sequestrian crisis in SCD?

A

Aplastic crises
caused by infection with parvovirus
sudden fall in haemoglobin
bone marrow suppression causes a reduced reticulocyte count

Sequestration crises
sickling within organs such as the spleen or lungs causes pooling of blood with worsening of the anaemia
associated with an increased reticulocyte count

24
Q

When are aeur rods seen on blood film?

A

These needle-shaped inclusions found within the cytoplasm of myeloid blasts indicate AML

25
Q

When are Rouleaux formation seen on blood film?

A

multiple myeloma

26
Q

What does a high PT vs high APTT show?

A

High PT - extrinsic pathway, factor 7, which is rarely deficine tin isolation - so raised if whole body issue eg DIC, liver disease, warfarin, vit K deficient

High APTT - intrinsic pathway, Factor 8,9 and 11. So haemophilias and VWB (binds to factor 8) have raised APTT

27
Q

When does heparin- inducted thrombocytopenia occur?

A

5-14 days post-heparin exposure

28
Q

What should you do if SCD + fever?

A

Admit - high risk of sepsis due to aspleenia

29
Q

What is in cryoprecipitate?

A

Cryoprecipitate contains factor VIII, fibrinogen, von Willebrand factor and factor XIII

30
Q

What is the monitoring for unfractionated heparin?

A

Unlike low molecular weight heparins that do not require monitoring unfractionated heparin does require monitoring, this is done by measuring the APTT.

31
Q

What is post-thrombotic syndrome?

A

chronic venous insufficiency secondary to DV

32
Q

When are smear cells seen?

A

CLL

33
Q

When are target cells seen?

A

iron-deficiency anaemia or hyposplenism.

They are red blood cells that have the appearance of a target with a bullseye (a dark centre, surrounded by a pale ring and a darker peripheral ring). They are caused either by an increase in red cell surface area or a decrease in intracellular haemoglobin.

34
Q

What electroyte imbalance can occur from large volumes of RBC transfusion?

A

HIGH K

35
Q

What is the reversal agent for dabigatran?

A

Idarucizumab

36
Q

How do you differentiate spherocystotis from G6PD defciency?

A

Heritary spherocystosis:
AD inheritance
Northern-European association

Both cause haemolytic anaemia, jaundice + gallstones, can be precipitated by infection

G6PD:
X linked recessive (just boys)
african-mediterranean
heinz bodies
Sulph drugs, anti-malarials and ciprofloxacin CI as can induce haemolysis

37
Q

Mx of warfarin in following situations:
INR 5-8
INR 5-8 + minor bleed
INR >8
INR >8 + minor bleed
Major bleed

A

INR 5-8 - withold dose

INR 5-8 + minor bleed - stop warfarin, give vit K 1-3mg, restart when INR <5

INR >8 - same as above

INR >8 + minor bleed - same as above

Major bleed - IV vit K 5mg, prothrombin complex concentrate

38
Q

Features of CML?

A

Philadephia chromosome associated
Age 60-70 yr
imatinib is now considered first-line treatment which is inhibitor of tyrosine kinase
splenomegaly may be marked

39
Q

Features of AML?

A

Avergae age 25 yrs
auer rods on blood film

40
Q

Features of CLL?

A

Marked lymphadenopathy
SMudge cells on blood film

41
Q

What cancers is alpha feto protein raised levels associated with?

A

liver ca and non seminoatous testiular ca

MSRA (17 decks)

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