Haem presentations and emergencies

Question 1

SPLENOMEGALY
i) which direction does an enlarged spleen expand in? where should palpation therefore be started? what other organ may be enlarged
ii) how does it sound on percussion? can you get above it? is it ballotable?
iii) what are the two main umbrella causes

Answer 1

i) expands infero medially therefore start palp in RIF
may also have hepatomegaly
ii) dull to percussion, cant get above it, not balotable
iii) haemtological and infective

Question 2

CAUSES OF SPLENOMEGALY
i) name three myeloproliferative causes? name three lymphoprolif causes? name a haemolytic state that causes it?
ii) name three infective causes
iii) how can liver disease cause splenomegaly?
iv) what rheum condition can cause it

Answer 2

i) myeloprolif - myelofibrosis = massive spleen, CML, PRV, ET
lymphoprolif = CLL, hairy cell leuk, lymphoma
haem state = thalassemia major
ii) infective = viral eg EBV, CMV, HIV or tropical = malaria, schistomiasis
iii) portal HT due to liver disease
iv) RA (felty syndrome)

Question 3

LYMPHADENOPATHY
i) which three regions should be examined?
ii) what is the likely cause if tender or inflamed? likely cause if firm and rubbery? if hard and craggy?
iii) what condition causes alcohol induced LN pain

Answer 3

i) examine cervical, axillary and inguinal regions
ii) tender/inflammed = infection
firm/rubbery = lymphoma
hard/craggy = metastatic carcinoma
iii) hodgkins lymphoma

Question 4

CAUSES OF LYMPHADENOPATHY
i) name three viral illnesses that can cause it? what is seen on the blood film? how can this be confirmed? name a bacterial infection that can cause it
ii) name two haematological causes
iii) name three metastatic causes

Answer 4

i) EBV, CMV, HIV
see atypical lymphocytes on blood film (activated T cells) > monospot and viral serology confirms
TB - bacterial infection
ii) lymphoma and CLL
iii) secondary LN spread eg lung, breast, melanoma, head and neck

Question 5

HAEM EMERGENCIES
i) what should be given immediately in NP sepsis? which investigation should be sent? name two other things that need to be done?
ii) what should be done first in a major transfusion reaction? how should resus be done? which two drugs may need to be given?
iii) what should always be considered if a patient present with hypercalcaemia? name three drugs that can be given
iv) name three things that need to be admin in DIC

Answer 5

i) broad spec abx immediately (eg piperacillin tazobactam - tazocin), send cultures, fluid resus (may need ITU support and inotropes)
ii) treat shock and give adrenaline if requred, resus with fluids
give hydrocortisone and chlorphenamine
iii) consider myeloma
give pamindronate, IV fluid with or without dex
iv) DIC - give FFP and cryoppt, plats and treat underlying cause

Question 6

HAEM EMERGENCIES 2
i) what imaging is urgently needed in cord compression? how is it treated (2) which drug can be given?
ii) which imaging is needed in SVC obstruction? which two emergency tx can be given? which drug can be given?
iii) what is warfarin overdose usually due to? what needs to be given? what is given if life threatening?
iv) name four things that need to be given in a sickle crisis? what type of transfusion is given?

Answer 6

i) cord compress > do MRI
surgical decompression or emergency RT
give dex
ii) SVCO - CT imaging
give dex
may do emergency RT or chemo
iii) warf OD usually due to interac with another drug
give IV/PO vitamin K to reverse or octaplex if life threatening
iv) sickle crisis - analgesia (morphine), hydration, abx
give an exchange transfusion