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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/ trauma
Low platelets and low coagulation factors (all coagulation factors are depleted), low fibrinogen (as microvascular clotting), raised d-dimer
schistocytes (sheared blood cells) - also see in TTP and HUS

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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

herediatry spherocytosis

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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
methotrexte

A

Cyclophosphamide:Haemorrhagic cystitis/ tranitional cell carcinoma, myelosuppression

Bleomycin: lung fibrosis

Anthracyclines (e.g doxorubicin): cardiomyopathy

Fluorouracil (5-FU): Myelosuppression, mucositis, dermatitis

Vincristine: peripheral neuropathy

Cisplatin: Ototoxicity, peripheral neuropathy, nephropathy, low magnesium

Methotrexate: Myelosuppression, mucositis, liver fibrosis, lung fibrosis

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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.

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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.

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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.

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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 vs thromotic 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

Thrombotic crises
precipitated by infection, dehydration, deoxygenation
painful vaso-occlusive crises should be diagnosed clinically
infarcts occur in various organs including the bones (e.g. avascular necrosis of hip, hand-foot syndrome in children, lungs, spleen and brain

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 deficinent in 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 DVT

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
middle eastern, mediterannian + SE asia association

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

G6PD:
X linked recessive (just boys)
african-mediterranean
heinz bodies and bite cells
Sulph drugs, anti-malarials, fava beans 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 - stop warfarin, give bit K 1-5mg PO, restart when INR <5

INR >8 + minor bleed -Stop warfarin
Give IV vitamin K 1-3mg, restart when INR <5

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
CAN progress to AML

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 (crushes little lymphocytes)
roughly 80 years of age - often asx

41
Q

What cancers is alpha feto protein raised levels associated with?

A

liver ca and non seminoatous testiular ca

42
Q

What blood results/ hx would you see for antiphospholipid syndrome? mx

A

young female patient with recurrent deep vein thrombosis, miscarriage and livedo reticularis
association with SLE

mild thrombocytopenia + prolonged APTT
anticardiolipin antibodies

–> the antiphospholipid antibodies which interfere with phospholipid-dependent coagulation tests, leading to a prolonged APTT.

mx - low-dose aspirin

43
Q

Which blood products have the highest chance of causing infection

A

Platelet transfusions have the highest risk of bacterial contamination compared to other types of blood products as they are not kept refridgerated

44
Q

What cancers is BRACA-2 associated with?

A

BRCA2 mutations substantially increase the risk of developing breast cancer in both men and women. It is also associated with ovarian cancer in women and prostate cancer in men.

45
Q

What is Lynch Syndrome?

A

AD inheritance
Develop colonic cancer and endometrial cancer at young age
High risk individuals may be identified using the Amsterdam criteria, need to exclude FAP (Familial adenomatous polyposi)

46
Q

When are target cells seen?

A

Sickle-cell/thalassaemia
Iron-deficiency anaemia
Hyposplenism
Liver disease

47
Q

What is more common hodkins lymphoma or non-hodgkins lymphoma? Which lymphoma worsens with alcohol?

A

NHL is more common

Hodkins painful lympadenopathy with alcohol

48
Q

When is FFP given?

A

PT > 1.5 x the normal

MSRA (17 decks)

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