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Haematology > Haem PassQues > Flashcards

Haem PassQues Flashcards

1
Q

Gold standard investigation for sickle cell disease

A

Haemoglobin electrophoresis

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2
Q

Men with haemoglobin below 110g/L

A

Do urgent GI endoscopy to rule out malignancy

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3
Q

Patient deficient in B12 and folate - which do you treat first?

A

B12

  • to avoid precipitating subacute combined degeneration of the cord
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4
Q

Management of haemorrhage in patient with Von-Willebrand disease

A

Tranexamic acid + desmopressin

  • Tranexamic acid for mild bleeding
  • Desmopressin: raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
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5
Q

Reversal agent for dabigatran

A

Idarucizumab

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6
Q

Why are irradiated blood products used for immunocompromised patients?

A

Depletes T-lymphocyte numbers which reduces risk of transfusion-associated graft vs host disease (TA-GVHD)

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7
Q

High GGT + macrocytic anaemia =

A

Alcohol excess

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8
Q

Transfusion-associated circulatory overload

(pulmonary oedema + hypertension following a transfusion)

Treatment = ?

A

IV loop diuretics

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9
Q

Suspicious of leukaemia - what investigations?

A

FBCs within 48 hours

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10
Q

Megaloblastic anaemia =

A

Increased MCV, reduced Hb

(B12, folate, methotrexate)

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11
Q

Causes of megaloblastic anaemia =

A

B12, folate, methotrexate

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12
Q

Which virus can trigger an aplastic crisis (bone marrow stops producing red cells causing extreme anaemia) in patients with hereditary spherocytosis ?

(*happens in sickle cell disease)

A

Parvovirus

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13
Q

Multiple myeloma symptoms (mnemonic)

A

CRAB:
hyperCalcaemia
Renal failure
Anaemia
Bone pain/fractures (both due to lytic lesions)

+susceptible to infection
+rouleaux formation on blood film

bone pain normally in vertebrae causing back pain. sometimes in ribs causing chest pain

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14
Q

Beta-thalassaemia major treatment ?

A

Lifelong blood transfusions

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15
Q

TRALI vs TACO

A

TRALI = Hypotension
TACO = Hypertension

TRALI = Transfusion-related acute lung injury
TACO = Transfusion-associated circulatory overload

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16
Q

Hyposplenism blood film findings =

A

Howell-Jolly bodies and siderocytes

Howell-Jolly = No spleeny

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17
Q

Lead poisoning blood film findings =

A

Basophilic stippling and cabot rings

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18
Q

Howell-Jolly

A

No spleeny

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19
Q

Features of acute haemolytic transfusion reaction (confirmed by DAT/Coombs test)

A

Fever, abdominal pain, hypotension

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20
Q

Treatment of non-haemolytic febrile transfusion reaction ?

A

Oral paracetamol

(reduces pyrexia)

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21
Q

Intense itching after exposure to hot water =

A

Polycythaemia vera

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22
Q

Minor anaphylactic reaction during blood transfusion. What to do?

A

Temporarily stop transfusion and give an antihistamine

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23
Q

Rouleaux formation on blood film =

A

Myeloma

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24
Q

G6PD deficiency

A

X-linked recessive disorder affecting red cell enzymes

Results in a reduced ability of the red cells to respond to oxidative stress.
Therefore, red cells have a shorter life span and are more susceptible to haemolysis

particularly in response to drugs (e.g. nitrofurantoin), infection, acidosis and certain dietary agents (e.g. fava beans).

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25
Q

Cancer associated with myasthenia gravis ?

A

Thymoma

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26
Q

What to use for emergency reversal of anticoagulation in patients with severe bleeding or a head injury

A

Prothrombin complex concentrate

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27
Q

Immunocompromised patient has a tender maculopapular rash primarily confined to his neck, the palms of his hands and the soles of his feet

A

Graft versus host disease (GVHD)

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28
Q

Reversal agent for dabigatran (new oral anticoagulant)

A

Idarucizumab

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29
Q

Myeloma investigations

A

Protein serum electrophoresis

  • raised concentrations of monoclonal IgA/IgG proteins will be present in the serum
  • urine = Bence Jones proteins
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30
Q

Haemarthroses without trauma =

A

Haemophilia A

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31
Q

Haemophilia A vs vWF bleeds ?

A

Haemophilia A = haemarthroses
vWF = mucosal bleeds (epistaxis, menorrhagia) + easy bruising

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32
Q

Treatment for DVT while pregnant

A

Subcutaneous LMWH

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33
Q

Treatment for DVT

A

Apixaban/rivaroxaban (DOACs)

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34
Q

Benign ethnic neutropaenia = what ethnicity ?

A

Black African and Afro-Caribbean

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35
Q

3-7 days after starting chemotherapy for Burkitt’s lymphoma, patient starts to feel confused and experience muscle cramps

A

Tumour lysis syndrome

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36
Q

Reed-Sternberg cells

A

Hodgkin’s lymphoma

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37
Q

When to do a Doppler for DVT ?

A

Either high Wells Score or raised D-dimers

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38
Q

Lymph node pain when drinking alcohol =

A

Hodgkin’s lymphoma

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39
Q

Heinz cells =

A

G6PD

Heinz Beans - G6PD gets worse when you eat fava beans

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40
Q

Treatment for autoimmune haemolytic anaemia

A

Steroids (+/- rituximab)

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41
Q

At what age does polycythaemia vera peak?

A

60s

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42
Q

Raised haemoglobin + hypertension

Plethoric appearance (puffy, red face), itchy when showering, splenomegaly

Diagnosis = ?

A

Polycythaemia vera

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43
Q

‘Starry sky’ appearance on lymph node biopsy =

A

Burkitt’s lymphoma

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44
Q

Raised ESR and osteoporosis =

A

Myeloma

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45
Q

Rivaroxaban MOA

A

Direct factor Xa inhibitor

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46
Q

What is a sequestration crisis?

(patients with Sickle cell disease)

A

Sickling within organs such as the spleen or lungs causes pooling of blood with worsening of the anaemia

associated with reticulocytosis

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47
Q

Treatment for flares of acute intermittent porphyria

A

IV haem arginate

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48
Q

What is the most common inherited clotting disorder?

A

Von-Willebrand’s

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49
Q

Most common cause of neutropaenic sepsis =

A

Staphylococcus epidermidis

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50
Q

Acute lymphoblastic leukaemia age group =

A

2-5 years old

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51
Q

Auer rods on blood film ?

A

Acute promyelocytic leukaemia

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52
Q

‘Tear-drop’ poikilocytes on blood film

A

Myelofibrosis

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53
Q

Smear cells on blood film

A

Chronic lymphocytic leukaemia

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54
Q

Target cells on blood film

A

Iron-deficiency anaemia or hyposplenism

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55
Q

Treatment for post-thrombotic syndrome ?

A

Compression stockings

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56
Q

Thrombocytopaenia =

A

Low platelets

(Thrombocyte = thrombosis cell)

57
Q

Isolated thrombocytopaenia (no other symptoms)

A

Immune thrombocytopaenic purpura (ITP)

58
Q

Which drugs can cause haemolytic anaemia ?

A

Cephalosporins and quinine

59
Q

How long to transfuse 1 unit of blood (non-urgent)

A

90-120 minutes

60
Q

What is used to confirm a diagnosis of pernicious anaemia ?

A

Autoantibodies against intrinsic factor

61
Q

Suspected cancer with raised neutrophils and platelets (myeloid-derived cells)

A

Chronic Myelogenous Leukaemia

62
Q

Treatment for Chronic Myelogeous Leukaemia (CML)

A

Imatinib

(highly successful treatment)

63
Q

Translocation present in CML

A

t(9;22) Bcr-Abl

64
Q

Translocation in Burkitt’s Non-Hodgkin’s Lymphoma = ?

A

t(8;14) IgH-Myc

65
Q

Immune thrombocytopaenic purpura in children - treatment = ?

A

85% are self-limiting

  • tends to follow a viral infection
66
Q

Does total iron binding capacity (TIBC) increase or decrease in iron deficiency anaemia ?

A

Increase (because less iron so more is taken up)

67
Q

Beta-thalassaemia age of presentation

A

1st year of life

68
Q

Haematological cause of frontal bossing? (unusually prominent forehead)

A

Beta-thalassaemia

69
Q

D-dimer =

A

Clotting

70
Q

Why does DIC cause reduced platelets and clotting factors, and cause increased APTT and PT?

A

Clots use up platelets and clotting factors, therefore APTT and PT are longer, and excessive bleeding can occur

71
Q

Diagnostic investigation for Haemophilia A =

A

Factor VIII assay

72
Q

Philadelphia chromosome indicates which haematological cancer ?

A

CML (Chronic Myeloid Leukaemia)

73
Q

Carbimazole + sore throat shows…

A

Agranulocytosis + neutropaenia

74
Q

Polycythaemia vera mutation =

A

JAK2 (V617F) mutation

75
Q

Abnormal proteins in multiple myeloma

A

Serum protein electrophoresis = high levels of M proteins
Urine protein electrophoresis = Bence Jones proteins

76
Q

Blood product used for reversal of warfarin

A

Prothrombin complex concentrate + Vitamin K

  • PCC contains clotting factors 2,7,9,10 - which warfarin inhibit
  • Vitamin K ensures reversal continues over subsequent hours
77
Q

Why is ferritin sometimes raised in iron deficiency anaemia ?

A

It is an acute phase reactant
therefore raised in infection/inflammation

78
Q

Why is weekly blood monitoring necessary for patients on clozapine (atypical antipsychotic) ?

A

Can cause agranulocytosis and neutropaenia

79
Q

Smudge cells =

A

CLL (Chronic lymphocytic leukaemia)

80
Q

Bence-Jones protein

A

Multiple myeloma
(found by urine protein electrophoresis)

81
Q

Medication used for prophylaxis of hyperuricaemia related to chemotherapy ?

A

Allopurinol

(high number of cancer cells die at once, causing hyperuricaemia)

82
Q

Lymphoma with absence of Reed-Sternberg cells =

A

Non-Hodgkin’s lymphoma

83
Q

Lymphoma with presence of Reed-Sternberg cells =

A

Hodgkin’s lymphoma

84
Q

Pernicious anaemia causes which deficiency ?

A

Vitamin B12

85
Q

Normocytic anaemia with normal ferritin, + an inflammatory/malignant chronic condition =

A

Anaemia of chronic disease

a.k.a. anaemia of inflammation

86
Q

Pancytopaenia + no abnormal cells =

A

Aplastic anaemia

(Pancytopaenia = deficiency in all three blood cells: red cells, white cells, platelets)

87
Q

Example of a thrombin inhibitor =

A

Dabigatran

88
Q

Beta-thalassaemia major patient presents with reddish-brown macules over her legs

A

Haemosiderosis (iron deposition due to frequent blood transfusions)

89
Q

Teardrop cells + leucoerythroblastic reaction in blood film + massive splenomegaly =

A

Myelofibrosis

90
Q

Spur cells + acanthocytes + clusters of megakaryocytes =

A

Myelodysplastic syndrome

91
Q

Type 1 vWF vs Type 2 vWF

A

Type 1 = less severe, presents in adulthood
Type 2 = more severe, presents earlier in life

92
Q

Thrombotic thrombocytopaenic purpura - what protein deficiency ?

A

ADAMTS13

93
Q

Alcoholism
Splenomegaly and thrombocytopaenia

A

Oesophageal varices

94
Q

Auer rods + blast cells on bone marrow biopsy =

A

Acute myeloid leukaemia

95
Q

Treatment for neutropaenic sepsis

A

IV piperacillin with tazobactam (broad-spectrum antibiotic)

96
Q

Waldenstrom macroglobulinaemia causes what syndrome ?

A

Hyperviscosity syndrome

97
Q

Von-Willebrand factor stabilises which clotting factor ?

A

Factor 8

98
Q

Medication for non-Hodgkin’s lymphoma =

A

Rituximab

(in addition to CHOP chemotherapy)

99
Q

Definitive treatment of tapeworm

A

Praziquantel + Niclosamide

100
Q

Treatment for scabies

A

Permethrin

101
Q

Schistocytes on blood film

A

Haemolytic anaemia

102
Q

What immunoglobulin is involved in cold autoimmune haemolytic anaemia ?

A

IgM

103
Q

G6PD-deficiency inheritance pattern =

A

X-linked recessive

104
Q

Large number of malignant pro-myelocytes accumulating in bone marrow + easy bruising - which blood cancer ?

A

Acute myeloid leukaemia

105
Q

Investigations for pernicious anaemia =

A

Methylmalonic acid + anti-intrinsic factor antibody

106
Q

Multiple myeloma blood film findings

A

Rouleaux formation

107
Q

MOA of hydroxyurea

A

Suppresses platelet production in bones

108
Q

Tumour lysis syndrome (acute) treatment

A

Rasburicase

  • metabolises uric acid to allantoin

(Allopurinol used to prevent TLS)

109
Q

Investigation for myelofibrosis

A

Dry tap on bone marrow aspiration

110
Q

Which antibiotic is contraindicated in methotrexate users ?

A

Trimethoprim

(also a folate antagonist)

111
Q

Prolonged PT = which factor is deficient ?

A

Factor VII

112
Q

Essential thrombocythaemia treatment ?

A

Hydroxycarbamide and aspirin

  • Hydroxycarbamide = cytoreductive
  • Aspirin = anti-platelet
113
Q

Myelofibrosis investigation

A

Bone marrow biopsy

114
Q

Autoimmune haemolytic anaemia first-line treatment

A

Corticosteroids

  • suppress the immune system, which suppresses the production of autoantibodies
115
Q

Foetal complications of alpha-thalassaemia ?

A

Bart’s hydrops fetalis

116
Q

Suspected antiphospholipid syndrome - investigation?

A

Thrombophilia testing

117
Q

Haemophilia with a normal Factor VIII assay = ?

A

Haemophilia B

  • Factor IX deficiency

(rare)

118
Q

Inheritance pattern of haemophilia

A

X-linked recessive

  • affects only males
119
Q

Minor bleed in Haemophilia A/B - management ?

A

Desmopressin

120
Q

Major bleed in Haemophilia A/B - management ?

A

Recombinant factor VIII/IX

121
Q

Patient has a high-grade diffuse large B-cell Lymphoma.
What should be prescribed before starting R-CHOP chemotherapy ?

A

Rasburicase (recombinant xanthine oxidase)

122
Q

vWF inheritance pattern

A

Autosomal dominant

123
Q

Cold autoimmune haemolytic anaemia is most commonly caused by which Ig antibodies?

A

IgM

124
Q

Neutropenia + fever - management ?

A

Neutropenic sepsis

Sepsis 6 bundle:
Blood culture, fluid balance monitoring, lactate measurement, broad-spectrum antibiotics, IV fluids and supplemental oxygen

125
Q

Iron study results in anaemia of chronic disease

A

Low serum iron, high ferritin and low transferrin saturation

126
Q

Macrocytic megaloblastic anaemia
Fatigue, pallor, paraesthesias, and neurological symptoms such as decreased vibratory sensation and proprioception

A

Pernicious anaemia

127
Q

Most common thrombophilia = ?

A

Factor V Leiden

128
Q

Reversal agent for rivaroxaban and apixaban

A

Andexanet alfa

129
Q

Neutropenic sepsis antibiotic = ?

A

Tazocin (a.k.a. Piperacillin with tazobactam)

130
Q

Vitamin B12 and folate deficiency - what must be treated first ?

A

Treat Vitamin B12 first with cyanocobalamin IM injections

*treat Vit B12 first to prevent subacute combined degeneration of spinal cord

131
Q

Myelodysplastic syndrome can progress into…

A

Acute myeloid leukaemia

132
Q

Cancer patient with a VTE - treatment ?

A

6 months of DOAC

(apixaban, rivaroxaban)

133
Q

Rivaroxaban/apixaban reversal agent

A

Andexanet alfa

134
Q

Malaria prophylaxis can cause ________ in patients with G6PD deficiency?

A

Haemolytic anaemia

135
Q

Taeniasis/Tapeworm treatment

A

Praziquantel and Niclosamide

136
Q

Dry tap on bone marrow aspirate =

A

Myelofibrosis

137
Q

O+ blood - what blood can patient receive ?

A

O+ and O-

(Rhesus +ve so can receive both)

138
Q
A

Haematology (12 decks)

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