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Year 3 Incorrect Questions > Haematology > Flashcards

Haematology Flashcards

1
Q

FBC results for pt with thalassaemia trait

A

Normal ferritin
High RBC

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2
Q

Pt undergoing transfusion with known heart failure develops bibasal crackles and pitting oedema, how do you manage this?

A

Stop transfusion and 40mg IV furosemide
- pt is in fluid overload

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3
Q

Other than sudden awful headache, name 3 other symptoms of subarachnoid haemorrhage

A

Neck stiffness, photophobia, focal deficit (especially CNIII

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4
Q

How to remember which side of body will be affected in half spinal cord injury?

A

Bus STOP across the road:
Brown Sequard = Temperature + Pain opposite
- motor control and fine touch on ipsi side is affected

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5
Q

Haemolysis, elevated liver enzymes, and a low platelet count in pre-eclamptic pt

A

HELLP syndrome

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6
Q

Prophylaxis for tumour lysis syndrome

A

IV hydration, allopurinol and avoiding nephrotoxic drugs.

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7
Q

Haemophilia A =

A

haemArthrosis
- more common in girls w Turner syndrome

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8
Q

Key drug interaction to know about that can induce neutropenic sepsis

A

Allopurinol and azathioprine

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9
Q

How to remember side effects of TB drugs?

A

RIPE ONGO
Rifampicin = Orange secretions
Isoniazid = Neuropathy (peripheral)
Pyrazinamide = Gout/athralgia/hepatitis
Ethambutol = Optic neuropathy

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10
Q

fever + neuro signs (seizures, confusion) + haemolysis + thrombocytopenia + renal failure

A

TTP
- its essentially HUS + fever + Neuro signs

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11
Q

Febrile 3 yo with SOB worse in past 2 days, nosebleeds in past 2 days, pallor, blanching purpuric rash, bruising and bright red cheeks

Low Hb, low white cells, low platelets

A

Parvovirus
- fever and worse SOB suggests viral illness
- esp with bright red checks indicating slapped cheek syndrome
- causes aplastic anaemia

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12
Q

Uncontrolled production of essentially normally functioning blood cells

A

Polycythaemia rubra vera

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13
Q

Clonal B cell disorder usually resulting in a large number of circulating malignant cells

A

Chronic lymphocytuc lukaemi

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14
Q

MoA of clpidogrel

A

ADP antagonist

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15
Q

Rituximab targets…..

A

CD20+

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16
Q

Imatinib treating CLL targets…

A

BCR-ABL 1 tyrosine kinase

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17
Q

mild anaemia in the presence of a normal serum ferritin in a pregnant person

A

Physiological chnage assoc with pregnancy

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18
Q

What does disproportionate reduction in MCV and MCH compared to the haemoglobin suggest?

A

Possible haemaglobinopathy trait
- investigate with haemoglobin analysis

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19
Q

A high haemoglobin in someone without a history to suggest a secondary polycythaemia should be investigated by the analysis of…..

A

JAK2 gene

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20
Q

What type of mutation causes sickle cell disease?

A

Point mutation in globin gene affecting globin synthesis

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21
Q

Microcytic anaemia with reticulocytosis, elevated lactate dehydrogenase and + Direct Coombs test

A

Autoimmune haemolytic anaemia
- steroid (1mg/kg of prednisolone per day) and folic acid
- suppress the autoimmune process
- folic acid supplements prevent deficiency which can occur when the red cell turnover is high

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22
Q

Management of pancytopenia after chemotherapy

A

Red cell transfusion
- as a result of absence of intrinsic haemopoietic cell activity

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23
Q

Breathlessness 2 hours after FFP transfusion

A

Transfusion related acute lung injury
- anti- leucocyte antibodies present in the donation that bind to the patients white cells and cause acute lung injury by degranulation of the affected neutrophils in the lungs.

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24
Q

Pulmonary infiltrates are seen on CXR after FFP transfusin

A

TRALI

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25
Q

Other than megaloblastic macrocytic anaemia, what other blood count abnormality may pts with pernicious anaemia present with?

A

Pancytopenia
- due to DNA synthesis defect, erythrocytes are most common (causing the anaemia) but can also affect other blood cell lineages

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26
Q

An 18 year old man with fatigue and a family history of a haemolytic disorder has a blood count performed with the results as follows: Normocytic anaemia, FBC normal otherwise. Blood film shows polychromasia and red cells with loss of central pallor.

A
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27
Q

Red cell that has lost its central pallor

A

Spherocyte

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28
Q

Auer rods are specific to…

A

Acute myeloid leukaemia
- due to abnormalities of granulation in blasts (blasts are overproduced in absence of mature blood cells in leukaemia)

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29
Q

Excess platelets, some in giant form

A

Essential thrombocythaemia
- chronic myeloproliferative disorder characterised by excess production of platelets in the bone marrow and an increased risk of thrombosis.

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30
Q

Management of sickle cell disease (not in crisis)

A

Prophylactic penicillin, vaccines, folic acid supplementation, hydroxycarbamide (induces HbF production)

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31
Q

How to remember where haematinics are absorbed in GI tract?

A

I Fuck Bears
Do Join In

Iron - Duodenum
Folate - Jejunum
B12 - Ileum

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32
Q

How can urinalysis help determine cause of jaundice i.e. 2o to haemolysis?

A

↓conjugated bilirubin + ↑urobilinogen = pre-hepatic (urine often very dark)

↑conjugated bilirubin + ↓urobilinogen = post-hepatic or hepatic

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33
Q

Normocytic anaemia, eosinophilia + painless neck swelling

A

Hodgkin’s

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34
Q

New fever, loin pain on red cell transfusion

A

ABO incompatible haemolytic reaction
- direct coombs test for diag

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35
Q

Ig involved in acute haemolytic reaction to transfusion?

A

IgM
- Mediates immediate inflam response

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36
Q

Cancer pt with VTE, how long should you anticoag for?

A

6 months
(3 months for provoked non-cancer VTE, 6 months for unprovoked non-cancer VTE)

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37
Q

Universal donor FFP

A

AB
- they don’t prod anti-A or anti-B

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38
Q

How can you reverse rivaroxiban?

A

Andexanet alfa

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39
Q

Reversal of heparin

A

Protein sulfate

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40
Q

Reversal of dabigatran

A

Idarucizumab

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41
Q

Hallmark of tumour lysis syndrome

A

High urate
- also high K

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42
Q

Aplastic anaemia vs MDS

A

Both present as pancytopenia
- AA has hypocellular marrow
- MDS has hypercellular marrow (cells are dysplastic so not functional)

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43
Q

Define plasma cell

A

Fully diff B lymphocytes that secrete antibodies into blood

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44
Q

What cells lose their abilitiy to differentiate but not to replicate?

A

Blasts
- that’s why in AML or ALL the cells can keep growing like crazy but they’re all the same cell type

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45
Q

WHy does proliferation of blast cells cause cytopenias?

A

They overcrowd the bone marrow and haematopoiesis
- RBCs (anaemia)
- white cells (infection)
- plates (muc bleeding)

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46
Q

Smudge/smear cells

A

Looks like a cell w a tail
Seen in CLL

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47
Q

IgA deficiency incr risk of

A

Anaphylaxis to transfusion

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48
Q

Characteristic FBC finding in aplastic sickle crisis

A

Sudden drop in Hb and red cells and no retics
- e.g. incr symptoms of SOb and palpitations after an illness e.g. parvo

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49
Q

High red cells and retics in sickle cell crisis

A

Acute splenic sequestratian crisis

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50
Q

Rouleaux formation…..

A

Myeloma
- stacking of pos charged cells that all clump together

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51
Q

New onset ID anaemia in over 60s

A

FIT test
2 week ref for colonscopy

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52
Q

How does factor V Leiden incr VTE risk?

A

Activated factor V is inactivated much more slowly by activated protein C

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53
Q

Highest risk of bacterial infection transmission intransfusion

A

Platelet transfusion

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54
Q

Gm pos or gm neg sepsis caused by transfusion

A

Platelet - gm Positive
Red cells - gm Negative (stains red)

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55
Q

Primary haemostasis

A

Formation of platelet plug

56
Q

Secondary haemostasis

A

Formation of stable fibrin clot

57
Q

3 components of DIC

A
  1. excessive and inappropriate response of haemostatic system
  2. microvasc thrombus formation
  3. clotting factor consumption
58
Q

Virchow’s triad

A

Stasis
Vessel wall damage
Hypercoagulability

59
Q

Why do clotting factors incr as pregnancy gets closer to term?

A

To prevent PPH
- physiological response

60
Q

Why does Vit K carboxylate the clotting factors?

A

To give them a negative charge so they can stick to the phospholipid membrane more easily

61
Q

INR

A

Correction of PT ratio

62
Q

Why is PT measured in warfarin?

A

It’s the parameter that is most affected/prolonged by warfarin

63
Q

Drugs affecting warfarin metabolism

A

CYP enzyme inducers/inhibitors

64
Q

Reversal of warfarin in steps

A

No action
Omit warfarin dose
Oral vit K
Admin clotting factors
Clinical and lab assessment of response

65
Q

Vit K or clotting factors in acute bleeding?

A

Clotting factors
- act immediately
- vit K takes 12-24 hours to act

66
Q

Management of essential thrombocythaemia

A

Hydroxyurea

67
Q

Management of polycythaemia rubra vera

A

Venesection

68
Q

Antibiotic class causing neutropenia

A

Macrolides e.g. clarithromycin

69
Q

Hypo or hypercalcaemia in myeloma?

A

Hypercalcaemia
- due to incr secretion of PTH assoc peptide

70
Q

Raindrop/pepperpot skull

A

Multiple myeloma
- looks like black splotches on skull
- like rain on pavement

71
Q

Test to help confirm PRV diagnosis

A

JAK2 mutation
- present in more than 90% of PRV pts

72
Q

Targetted treatment for CML

A

Imatinib
- targets BCRABL1

73
Q

Example of a high grade NHL

A

Diffuse large B cell lymphoma

74
Q

Example of low grade NHL

A

Follicular lymphoma

75
Q

Electrolyte changes in tumour lysis syndrome

A

Incr K
Incr creat
Decr urea
Decr Ca

76
Q

Spread of lymphadenopathy in HL and NHL

A

Local spread - Hodgkin’s
Widespread - Non-Hodgkin’s

77
Q

Discoloured eyelids and big tongues

A

Amyloidosis

78
Q

Raised LDH as a prognosticator?

A

Poor prognosticator
- apparently can also suggest haemolysis as it’s released when RBCs are broken down

79
Q

Dry tap on bone marrow biopsy

A

Myelofibrosis
- dry as hell no cells

80
Q

Symptoms of mutliple myeloma

A

CRAB HAI
C - Hypercalcaemia
R - Renal Impairment
A - Anaemia
B - Bone disease
H - Hyperviscosity
A - Amyloidosis
I - Immunoparesis

81
Q

Poor prognosticators in Hodgkin’s

A

Large mediastinal lymphadenopathy
ESR >50 mm/Hr without B symptoms
ESR > 30 mm/Hr with B symptoms
Age >50
4 lymph node sites involved

82
Q

What cells would show upon blood film in myelofibrosis?

A

Tear drop poikilocytes
- myelo-CRY-brosis

83
Q

Skin manifestation of APS

A

Bilateral blotchy, lace-like erythematous rash affecting legs

84
Q

2Platelet thresholds for procedures

A

> 50×109/L for most patients
50-75×109/L if high risk of bleeding
100×109/L if surgery at critical site

85
Q

Joint pains, easy bruising and bleeding gums in a woman who lives alone

A

Scurvy/vit C deficiency
- due to poor diet

86
Q

VTE following lengthy anticoag with heparin

A

Heparin induced thrombocytopenia

causes prothrombotic state
=
HIT is caused by the formation of abnormal antibodies that activate plateles. Activated platelets release microparticles that activate thrombin, thereby leading to thrombosis

87
Q

What does irradiating blood products do?

A

Depleted T-lymphocyte numbers reduce the risk of transfusion graft versus host disease

88
Q

Are spherocytes extra or intravascular?

A

Extravascular

89
Q

Triad of HSP

A

Purpura, joint pain and abdominal pain.

90
Q

4 components of HUS

A

Normocytic anaemia
Thrombocytopaenia
AKI
Post-diarrhoeal illness

91
Q

Bite and blister cells

A

G6PD

92
Q

How to remember effect on fibrinogen, plates, and D dimer in DIC?

A

3 Ds
Decr fibrinogen
Decr platelets
D-dimer incr

93
Q

Low or high EPO in PRV

A

Low

94
Q

Osteomyelitis is commonly assoc with which haem condition?

A

Sickle cell disease
- due to salmonella

95
Q

Wells score and what it indicates

A

1 or less
- D dimer and anticoag
- pos do doppler 4h
- neg doppler in 7 days
2 or more
- doppler US within 4h
- if not avail D dimer and anticoag, doppler wihin 24h

96
Q

Anaemia + low retics in sickle cell

A

Aplastic crisis
- commonly caused by parvo b19

97
Q

Managment of bilateral acute chest crisis in sickle cell

A

IV opiates, oxygen, antibiotics

98
Q

Core triad of acute chest crisis management in sickle cell

A

high-flow oxygen, antibiotics (with atypical cover) and exchange transfusion
- as well as IV opiates

99
Q

Spherocytes in AI haemolytic anaemia is more likely to be?

A

Warm

100
Q

Diagnostic test for paroxysmal nocturnal haemoglobinuria

A

Flow cytometry for CD55 and CD59

101
Q

ITP vs TTP

A

ITP typically weeks of petichiae, mild symptoms, no underlying cause
TTP more severe symptoms, neuro deficit, VTE (abdo pain, fever, anaemia)

102
Q

High HbA1 outwith context of diabetes

A

Splenectomy

103
Q

Organisms that pts are especially susceptible to after splenectomy (may need vax or Ab prophx)

A

Some Killers Have Pretty Nice Capsules
Streptococcus pneumoniae,
Klebsiella pneumoniae,
Haemophilus influenzae,
Pseudomonas aeruginosa,
Neisseria meningitidis,
Cryptococcus neoformans

104
Q

First line treatment for ITP

A

Steroids

105
Q

New murmur and jaundice

A

MAHA due to new mechanical valvular defect

106
Q

ABG shows difference between the SaO2 and the PaO2, O2 sats are abnormally low in a breathless and dizzy patient?

A

Methaemoglobinaemia
- has Fe3+ iron instead of Fe2+

107
Q

Best diagnostic inv for haemphilia A

A

Factor VIII assay

108
Q

Fall in the bathtub with profound hypotension resulting in death

A

Splenic rupture

109
Q

Macrocytic anaemia assoc with hypothyroidism features

A

Hashimoto’s

110
Q

HbA2 rise

A

Beta thalassaemia trait

111
Q

Most common paraprotein in multiple myeloma

A

IgG

112
Q

Spiky red cells that look like those rubber earrings kids used to have

A

Burr cells
- consistent with end stage CKD

113
Q

Most common cause of:
- low haemoglobin at 95 g/L
- low mean corpuscular volume (MCV) at 77 fl
- low mean cell haemoglobin concentration (MCHC)
- elevated red cell distribution width (RDW)

A

Iron defic anaemia

114
Q

Most likely cause of really microcytic anaemia in a man who has no symptoms

A

Thalassaemia
- e.g. alpha minor

115
Q

Most common haemophilia

A

A
- even in stems that are vague e.g. nosebledds

116
Q

3 months of iron supplements but no improvement in Hb levels - FL?

A

Inv cause of low iron

117
Q

Late onset asthma and prominent upper respiratory tract symptoms + petechial rash + antiMPO positive

A

Eosinophilia with GPA

118
Q

Pentameric Ig

A

IgM

119
Q

New onset epistaxis, headache, and blurred vision + long standing fatigue and WL

A

Waldenstrom’s macoglobulinaemia

120
Q

Ig in Waldenstrom’s

A

IgM

121
Q

Development of mild fever and urticarial chest rash during red cell transfusion

A

Mild allergic reaction to transfusion
- stop transfusion and monitor

122
Q

Blood film in ALL

A

Lymphoblastic cells

123
Q

FL for new microcytic anaemia with super super low Hb in stable 55yo man

A

Urgent red cell transfusion
- defo needs a GI scope for cancer inv but this can wait bc he is stable and really needs red cells

124
Q

Focal neurology, haemolysis and thrombocytopenia + schistocytes on blood film

A

Microangiopathic haemolytic anaemia
- 2o to TTP

125
Q

Complication of PRV causing massive splenomegaly

A

Myelofibrosis
- tear drop poikilocytes

126
Q

Management acute malaria

A

Artesunate

127
Q

Signet ring red cells and crescent shaped gametes on blood smear

A

Malaria

128
Q

Functional hyposplenism could e a result of which GI disease causing vesicular rash on bum

A

Coeliac
- rash is dermatitis herpetiformis

129
Q

A- blood

A

Agglutination with anti-A demonstrates the presence of A antigen only on her red cells
- no agglutnation with Anti-Rh or anti-B

130
Q

Management chronic ITP

A

Steroids
- to suppress the immune response
- plate transfusion can worsen symptoms

131
Q

New DVT in pt just started on warfarin for AF with strong FHx of VTE

A

Protein C defic
- 1-2 days after warfrain initiation pts become hypercoagulable

132
Q

Neuro symptoms, Fever, Renal, MAHA, Thrombocytopenia, Schistocytes, African Origin

A

TTP

133
Q

Main physical symptom of CML

A

MMMMMMMMassive splenomegaly in MMMMMMMIddle aged

134
Q

Findings in PRV

A

Raised red cell mass, low serum erythropoetin, JAK2 mutation present

135
Q

What lymphoma does CLL become?

A

Diffuse large B-cell lymphoma
- richter transformation

136
Q
A

Year 3 Incorrect Questions (6 decks)

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