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phase 2a pain > haem stuff to memorise > Flashcards

haem stuff to memorise Flashcards

1
Q

microcytic anaemia mnemonic

A 
(low MCV, small RBC)
Thalassaemia
Anaemia of chronic disease
Iron def anaemia
Lead poisoning
Sideroblastic anaemia
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2
Q

normocytic anaemia mnemonic

A 
(normal MCV, normal RBC)
Anaemia of chronic disease
Aplastic anaemia
Acute blood loss
Hypothyroidism
Haemolytic anaemia
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3
Q

causes of macrocytic, megaloblastic

A

(impaired DNA synth - cannot divide so keeps growing into large abnormal cell)
B12/folate def

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4
Q

causes of macrocytic, normoblastic

A

alcohol, reticulocytosis, hypothyroidism, azathioprine

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5
Q

normal haemoglobin, normal MCV

A

120-165, 130-180 men

80-100 both

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6
Q

signs of iron def

A

pica, hair loss, angular cheilitis, spoon shaped nails, atrophic glossitis, brittle hair/nails

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7
Q

key sign for each: thalassaemia, CKD, haemolytic

A

thal - bone deformities
CKD - oedema, hypertension
haem - jaundice, splenomegaly

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8
Q

genetic patterns for thalassaemia, sickle cell, G6PD def, hereditary spherocytosis/elliptocytosis, von willebrand dis, haemophilia

A

thal - auto recess, sickle - auto recess, G6PD - X linked, hered sph - auto dom, vwf - auto dom, haemo - x linked

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9
Q

chromosomes for alpha and beta thal

A

alpha - 16

beta - 11

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10
Q

thal minor vs thal intermedia vs thal major?

A

1 norm 1 abnorm
2 abnorm
2 deletion

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11
Q

genetics of sickle cell

A

abnormal beta-globin gene on chrom 11

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12
Q

prophylaxis for sickle cell

A

penicllin V

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13
Q

drug that stimulates prod of what in sickle cell

A

hydroxycarbamide - stim prod of HbF (protective)

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14
Q

3 types of sickle cell crisis

A

vaso-occlusive (distal ischaemia)
splenic sequestration (RBC block flow in spleen)
aplastic (parvovirus 19, no RBC made)

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15
Q

treat sickle cell crises

A

keep warm, hydrate, treat infection, penile aspiration

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16
Q

diagnose sickle cell, thalassaemia

A

haemoglobin electrophoresis, screened at preg (dna test in thal, heel prick in sickle)

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17
Q

diagnose g6pd def

A

enzyme assay (defect on enzyme that is usually protective against reactive oxygen species)

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18
Q

meds to avoid in g6pd

A 
primaquine
ciprofloxacin
nitrofurantoin
trimethoprim
sulfasalazine
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19
Q

where is iron absorbed

A

duodenum jejunum

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20
Q

drug that reduces iron absorption

A

PPI (crohns and coeliac also has this effect)

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21
Q

if no clear cause of iron def then what management?

A

gastroduodenoscopy and colonoscopy

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22
Q

3 types of treatment for iron def

A
  1. blood trans correct anaemia but not cause
  2. iron infusion eg. cosmofer (risk of anaphylaxis)
  3. oral iron eg. ferrous sulphate (can feed bacteria in sepsis, constip and black stool)
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23
Q

haemolytic anaemia on blood film? test for autoimmune

A

spherocytes

direct coombs test

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24
Q

general tests for anaemia

A 
haem level
mcv
b12/folate 
ferritin (TIBC marker for transferrin)
blood film
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25
Q

treat hered spherocytosis, elliptocytosis

A

folate suppl
splenectomy
cholecystectomy

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26
Q

temps for warm/cold autoimmune haemolytic anaemia

manage

A

warm - normal, idiopathic
cold - under 10 degrees, agglutination
manage both with transfusions, steroid, rituximab
splenectomy

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27
Q

paroxysmal nocturnal haemoglobinuria

A

mutation causes complement cascade to be activated = red urine in morning
treat - eculizumab targets C5

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28
Q

alloimmune haemolytic anaemia

A

disease of newborn

antib cross placenta causing immune resp

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29
Q

causes of pernicious anaemia

A

b12 def

insuf diet intake

30
Q

signs of pern anaem

A 
low mood
peripheral neuropathy
pins and needles
less proprioception
visual changes
lemon yellow skin
31
Q

antib in pern anaem

A

intrinsic factor antibod

gastric parietal cell antibod

32
Q

why treat b12 before folate in pern anaem

A

subacute combined degeneration of the spinal cord

33
Q

treat dietary insuf cause of pern anaem

A

cyanocobalamin

34
Q

treat autoimmune cause of pern anaem

A

IM hydroxocobalamin

35
Q

most toxic, dormant species of malaria

A

plasmodium falciparum

plas ovale & vivax

36
Q

4 stages of malaria

A

sporozoites, hypnozoites (dorm), merozoites (mature), RBC rupture releasing more

37
Q

invest malaria

A

blood film in EDTA bottle - 3 samples over 3 days bc 48hrs regen

38
Q

uncomplicated oral treatment malaria

A

riamet
malarone
quinine sulphate
doxycycline

39
Q

complicated/severe malaria treat

A
  1. IV artesunate

2. Quinine dihydrochloride

40
Q

malaria prophyl and side effects

A

malarone
doxycycline - sun and take longer
mefloquine - hallucinations, seizures

41
Q

hodgkins lymph RF

A

fam hist
EBV
HIV
autoimmune cond

42
Q

large lymph nodes, non-tender

pain after alcohol

A

hodgkins lymphoma

43
Q

treat hodgkins and diag test

A

ABVD chemo, lymph node biop showing reed sternberg cells

44
Q

mutation in JAK2 indicates which dis and what may it lead to

A

polycythaemia vera - prolif of erythroid cell, can become AML, myelofibrosis
hepatosplenomegaly from rbc being produced there to compensate

45
Q

treat polycythaemia vera

A

1st venesection

aspirin and chemo

46
Q

ALL pres, assoc, key bits

A

child
downs syn
blast cells

47
Q

CLL pres, assoc, key bits

A 
warm autoimmune haem anaem
can become high grade lymph = richters trans
smear/smudge cells
treat with rituximab
most common in adults
48
Q

CML pres, assoc, key bits

A

chronic phase (5yrs)
accelerated phase
blast phase - worse symptoms
philadelph chrom 9:22 translocation

49
Q

AML pres, assoc, key bits

A

most common acute in adults
polycythaemia ruby vera becomes AML
blast cells - auer rods

50
Q

define pancytopenia

A

anaemia, leukopenia, thrombocytopenia

51
Q

tumour lysis syndrome cause and treat

A

release of uric acid during chemo - crystals in interstitial tissue and tubules of kidney = aki

treat with allopurinol, rasburicase
monitor calcium phosphate potass

52
Q

treat vW dis

A

desmopressin
vWF infused
clot factor 8
heavy period - tranexamic acid

53
Q

presentation of haemophilia and their factors

A

haem a - factor 8
haem b - factor 9
severe bleeding, haematoma, umbilical cord, intercran haemorrhage, bleed into joints and muscles

54
Q

invest haemophilia

A

coag factor assay
bleeding score
gen testing

55
Q

treat hameophilia

A

intraven infusion = clotting factors replaced but can develop antib against them
desmopressin to stim release of vwf

56
Q

5 features of myeloma mnemonic

A 
OLD
Calcium (elevated)
Renal failure
Anaemia (normocytic, normochromic) from replacement of bone marrow.
Bone lesions/pain
57
Q

myeloma?

A

cancer of plasma b cells - produce immunoglobulins which infiltrate the bone marrow

58
Q

myeloma antib protein?

A

bence jones protein

59
Q

myeloma rf

A

black, old, male, fma hist, obese

60
Q

4 initial tests when suspect myeloma

if posi then what?

A 
FBC (low white blood cell count in myeloma)
Calcium (raised in myeloma)
ESR (raised in myeloma)
Plasma viscosity (raised in myeloma)

posi = urgent serum protein electrophoresis and a urine Bence-Jones protein test

61
Q

4 initial invest for myeloma mnemonic

A

B – Bence–Jones protein (request urine electrophoresis)
L – Serum‑free Light‑chain assay
I – Serum Immunoglobulins
P – Serum Protein electrophoresis

then whole body mri (skeletal survey if they cant hack it)

62
Q

signs on xray for myeloma

A

Punched out lesions
Lytic lesions
“Raindrop skull”

63
Q

first line treat myeloma

A

chemo with:
Bortezomid
Thalidomide
Dexamethasone

  • high risk of develop thrombus so also need venous thromboembolism prophylaxis
64
Q

improve bone comp in myeloma?

A

bisphosphonates - suppress osteoclast activity.
Radiotherapy to bone lesions can improve bone pain.
Orthopaedic surgery can stabilise bones
Cement augmentation - injecting cement into vertebral fractures or lesions to stabilise

65
Q

complications of myeloma

A 
Infection
Pain
Renal failure
Anaemia
Hypercalcaemia
Peripheral neuropathy
Spinal cord compression
Hyperviscocity
66
Q

treat immune thrombocytopenic purpura

A

prednisolone
iv immunoglobulins
rituximab
splenectomy

67
Q

treat thrombotic thrombocytopenic purpura

A

prednisolone
rituximab
plasma exchange

68
Q

which protein impairment in TTP

A

ADAMTS 13 cannot inactivate vWF so extra platelet adhesion

69
Q

define thrombocytopenia and causes

A

low platelet count

itp, ttp, hit, sodium valproate, alcohol

70
Q

describe heparin induced thrombocytopenia

A

antib against platelets develop in response to heparin
anti PF4/heparin antib
swap to diff anticoag!!

phase 2a pain (27 decks)

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