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Medicine Finals: HARD STUFF ONLY > Haematology > Flashcards

Haematology Flashcards

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1
Q

What is the diagnosis of hereditary spherocytosis?

A

EMA binding test

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2
Q

How is hereditary spherocytosis managed? (of both acute haemolytic crises and longer term treatment)

A

Acute haemolytic crisis:
treatment is generally supportive
transfusion if necessary

Longer term treatment:
folate replacement
splenectomy

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3
Q

What is seen on blood film in G6PD? (2)

A

Heinz bodies

Bite/blister cells

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4
Q

What medications should be avoided in G6PD? (3)

A

Sulf drugs
Anti-malarials
Ciprofloxacin

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5
Q

How does iron overload present?

A 
Same as haemochromatosis
DM
Impotence
Joint pain
Liver cirrhosis
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6
Q

What are features of beta thalassaemia major?

A

Severe symptomatic anaemia
Frontal bossing
Maxillary overgrowth
Extramedullary haematopoiesis

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7
Q

What is the management of a sickle cell crisis?

A 
Red cell exchange transfusion
Oxygen
Morphine
IV fluids
IV Abx
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8
Q

What are features of Fanconi anaemia?

A

Café au lait spots
Aplastic anaemia
Increased risk of AML

Short stature and thumb abnomarlities

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9
Q

What is the inheritance pattern of Fanconi anaemia?

A

Autosomal recessive

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10
Q

What is sideroblastic anaemia?

A

Type of microcytic anaemia - can be congenital or ACQUIRED

High ferritin and transferrin saturation

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11
Q

How is sideroblastic anaemia seen on blood film?

A

Basophilic stippling

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12
Q

What is seen on bone marrow biopsy in sideroblastic anaemia?

A

Ringed sideroblasts

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13
Q

What is the most common type of Hodgkin’s lymphoma?

Which one has the best prognosis?

A

Nodular sclerosing

Best prognosis = Lymphocyte predominant

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14
Q

What is the management of non-Hodgkin’s lymphoma?

A

R-CHOP

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15
Q

Which marker is raised in lymphoma?

A

LDH- Lactate dehydrogenase

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16
Q

Which marker is decreased in CML?

A

Leukocyte alkaline phosphatase

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17
Q

What is Richter’s transformation?

A

CLL –> High grade lymphoma

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18
Q

Which type of autoimmune haemolytic anaemia does CLL predispose to?

A

Warm

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19
Q

What is tumour lysis syndrome and what are seen on lab results?

A

Complication of chemo treatment to leukaemia/lymphoma

High creatinine
Abdominal pain
AKI

High uric acid
High potassium
High phosphate
Low calcium

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20
Q

What is given for prophylaxis of tumour lysis syndrome?

A

IV Allopurinol

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21
Q

What are the 4 investigations done in multiple myeloma?

A

BLIP

B= Bence Jones (urine electrophoresis)
L= serum light chain assay
I = Serum immunoglobulins - raised
P= serum protein electrophoresis --> increased monoclonal IgG
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22
Q

What are x-ray signs of multiple myeloma?

A

Lytic lesions
Punched out lesions
Raindrop skull

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23
Q

What is myelodysplastic syndrome?

A

Acquired disorder - blood cells do not develop properly
usually due to chemo or radiotherapy

Low Hb
Low WCC
Low platelets

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24
Q

How does essential thrombocytosis present?

A

Headaches
Dizziness
Burning sensation in hands

Increased risk of thrombosis

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25
How is essential thrombocytosis managed?
Aspirin | Hydroxycarbamide
26
What are causes of polycythaemia?
Relative – dehydration Primary – Polycythaemia rubra vera Secondary – COPD, high altitude, obstructive sleep apnoea
27
How can you differentiate between primary and secondary polycythaemia?
Red cell mass studies
28
How does polycythaemia present?
Plethoric appearance Itching esp in bath/heat Increased risk of thrombosis High ESR Low leukocyte alkaline phosphatase
29
How is polycythaemia rubra vera managed?
Low dose aspirin | Venesuction
30
What clotting results are seen in DIC?
``` Low platelets Low fibrinogen High D-dimer High Prothrombin time High APTT High bleeding time ```
31
How does Graft vs. Host disease present?
Painful maculopapular rash Jaundice Watery/bloody diarrhoea N+V
32
What is hereditary angioedema and how is it managed?
Autosomal dominant condition - low plasma levels of C1 Leads to attacks where there is painless non-pruritic swelling No urticaria Management = IV C1 inhibitor concentrate
33
Which DOAC is preferred in renal impairment?
Apixaban
34
How does chronic steroid use show on FBC?
Neutrophilia
35
Raised ESR and osteoporosis?
Raised ESR + Osteoporosis = Multiple myeloma until proven otherwise
36
Management of DIC
1. Resus measures | 2. Fresh frozen plasma + Cryoprecipitate
37
What are signs on examination of lymphoma?
Nodule Splenomegaly Hepatomegaly
38
What are general signs on examination of anaemia?
Tachypnoea Tachycardia Conjunctival pallor
39
What are iron-deficiency anaemia specific signs?
Angular Cheilitis Koinionychia Atrophic glossitis
40
What are side effects of ferrous sulphate?
Black stools Constipation Diarrhoea Nausea
41
What are acute complications of multiple myeloma?
Hypercalcaemia Spinal cord compression Acute renal failure Hyperviscosity
42
What should be given between every unit of packed red cells?
Stat dose of furosemide - can lead to fluid overload.
43
Multiple Myeloma vs. Waldenstrom’s Macroglobulinaemia
MM - usually IgG Waldenstroms - usually IgM Waldenstorms can still cause systemic upset - weight loss, ltheragy, hyperviscosciy syndrome, hepatomegaly, lymphadenopathy No raised calcium
44
DIC blood results
* ↓ platelets * ↓ fibrinogen * ↑ PT & APTT * ↑ fibrinogen degradation products (D-dimer)
45
Patient with hereditary spherocystosis + Abdominal pain?
Gallstones
46
Why does haemolytic anaemia lead to gallstones?
Haemolysis --> Increased bilirubin --> Excreted into the bile
47
What is seen on blood film in DIC?
Schisocytes
48
What are causes of sideroblastic anaemia?
``` Congenital Myelodysplasia anti-TB meds Alcohol Lead ```
49
Beta thalassaemia trait vs. Beta thalassaemia major?
Beta thalassaemia trait - presents with mild microcytic anaemia Beta thalassaemia major - presents in first year of life with failure to thrive and hepatosplenomegaly
50
Macrocytic anaemia + hyper-segmented neutrophil polymorphs on blood film?
Megaloblastic anaemia - either folate or B12
51
Platelet transfusion thresholds?
Not bleeding = <10 Minor bleeding = <30 Prior to surgery = <50 Surgery at major site/bleeding at major site = <100
52
Do inherited haematological conditions cause early jaundice or prolonged jaundice?
Early jaundice - presents prior to 24 hours.
53
What is seen on blood film in thalassaemia?
Heinz bodies Target cells Basophilic stippling
54
What is seen on blood film in hyposplenism?
``` Target cells Howell-Joly bodies Siderotic granules Acanthocytes Pappenheimer bodies ```
55
What is Graft versus Host disease and how does it present?
Often after a bone marrow transplant but can also occur after organ transplant or blood transfusion in those who are immunosuppressed Painful maculopapular rash Jaundice Watery/bloody diarrhoea N+V
56
How can you prevent Graft versus Host disease from a blood transfusion?
Need to give irradiated RBCs to minimise risk of graft versus host disease
57
What clotting results are seen in vitamin K deficiency?
Raised APTT Raised prothrombin time Normal bleeding time
58
What is the inheritance pattern of haemophilia?
X-linked recessive
59
How is Von Willebrand’s disease managed?
Desmopressin - stimulates release of vWF Tranexamic acid for menorrhagia VWF infusion
60
Which protein is deficient in thrombotic thrombocytopenic purpura?
ADAMTS13
61
How is polycythaemia vera managed?
Venesection to reduce Hb | Aspirin to reduce risk of thrombotic events
62
What is given to reduce the risk of tumour lysis syndrome?
Allopurinol or Rasburicase
63
What does lead poisoning do to the blood?
Causes sideroblastic anaemia Basophilic stippling Microcytic anaemia Raised ferritin and iron
64
What is seen on blood film in myelofibrosis?
Tear drop poikilocytes | Due to RBCs trying to get through sclerosed bone marrow
65
What is seen on blood film in Multiple Myeloma?
Rouleaux formation
66
What prophylactic antibiotics are someone with a splenectomy given?
Penicillin V
67
How is sideroblastic anaemia treated?
Supportive - transfusions may be needed (+Iron chelation with Desferrioxamine) Pyirodixine
68
Why does chemotherapy increase the risk of gout?
Due to increased production of uric acid

Medicine Finals: HARD STUFF ONLY (23 decks)

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