Haematology Flashcards
Pastest majorly and other imp info
two conditions associated with isolated angioedema without utricaria
hereditary angioema [c1 esterase inh def]
ACE inhibitor induced angioedema
why tamoxifen cause hot flushes and what are its effects on LH and fsh release
tamoxifen acts as estrogen antagonist at hypothalamus disruption thermoregulation leading to hot flushes,sweating [Tx= valnafexine]
As antagonist it leads to increased lh fsh but not necessarily induce ovulation[disrupts the normal cycle actually].Clomifene however acts as antagonist increasing lh fsh and induce ovulation.[pcos]
investigation of choice for CLL
imunophenityping/flow cytometry of peripheral blood for CD 5 19 20 23.
first line tx of CLL for IGHV mutation
and tp53 mutation
FCR regimen= fludarabine cyclophosphamide rituximab
for tp53 mutations= ibrutinib [brunton tyrosine kinase inhibitor] and venetoclax [bcl2 inhibitor]
hallmark feature of igG4 disease
Storiform Whorled fibrosis in diff tissues.retroperitoneal,ridels thyroidtis,pancreatitis,miculicz.
normal mature neutophils have how many lobes of nuclei
3-5 lobes.
riased to more than 6 in megaloblastic anemia.
less than 3 in leukamoid reaction and CML as they have immature cells[left shift].do LAP score to differentiate.
disorders associated with JAK2 mutation
Primary myelofibrosis PMF
Polycythemia rubra vera PRV
Essential thrombocythemia ET
treatment regimen for
CLL
HODGKING
NON-HODGKIN
FCR if indications.
ABVD
R-CHOP
on blood fim of hodgkin lymphoma what can you see as all blood counts are mostly normal
Eosinophilia
also remember raised ESR
smouldering myeloma v MGUS
both have NO manifestations of paraproteinemia.difference lies in the levels of plasma cells in bone marrow and paroproteinemia levels.
>10 % plasma cells in BM and > 30g/L paraproteinema without symptoms is smouldering myeloma.less than that without symptom obv will be MGUS.
How can you differentiate heparin induced prolonged APTT from other scenarios like DIC.
Reptilase time [15 to 18] is normal and thrombin time is prolonged.Reptilase is added to sample,it converts fibrinogen to fibrin INDEPENDTLY of thrombin.In DIC low fibrinogen so it may be prolonged.In Heparin effectees,as it leads to effects without needing thrombin so it is normal
HRT risk of stroke,breast cancer,dvt.how many times it is increased
dvt 2-3 times
breast cancer 1 in 1000
stroke only if above 60 on hrt.
long term complication of radiotherapy
Secondary cancers.
prophylaxis for VWB disease in a patient e hx of previous bleed after a procedure and now undergoing another procedure.
DDVAP e tranaxemic acaid for mild cases
vWBF plus factor VIII [HAEMATE-P] for majorrr cases.
most important prognostic marker in AML is
Cytogenics = i,e chromosomal analysis of BM blast cells.Del 5 and 7 imply poor prognosis.
reversal agent of alteplase
Tranexemic acid which decrease plasminogen to plasmin and thus is antifibrinolytic.exact reverse of alteplase.
give alongside FFPs.
NOW a days what is the only major role of cryoprecipitate
DIC
typical features of graft versus host disease GVHD [only occur in BM or stem cell transpant mostly in UNRELATED ALLOGRAFT]
FEVER
RASH
DIARRHEA
JAUNDICE.
Acute if less than 100 days.donor tcells cause this.
HYPERACUTE VS ACUTE VS CHRONIC GRAFT REJECTIONS vs CMV
HYPERACUTE occurs immediately due to preformed antibodies in donor type 2 sensitivity.immediate graft failure.Like in kidney transplant.
ACUTE in less than 6 months.fever tenderness and graft failure.
CHRONIC 6 months to years chronic graft failure.
both these due to cells [type 4].chronic also has antibodies formation.
CMV will lead to fever,hepatosplenomegaly,lymphadenopathy.
diagnostic tests for leukemias
ALL AND CLL = imunophenotyping for specific markers.
AML = bone marrow biopsy and imunophenotyping and cytogenics.not sure
CML = BCR/ABL cytogenics by PCR OR FISH.
you suspect AML in young patient with AURIER rod positive.what investigation is key,
Clotting profile to rule out DIC -APML.
protein C inactivates which factors
V and VIII.
effect of pregnancy on hemotocrit,neutrophils and platelets,
decreased haemotcrit due to dilutional.
Thrmobocytopenia.Only treat by prednisolone if persistently less than 30 and it is in last 2 weeks of pregnancy.
NEUTROPHILIA with left shift.
most common type of non-hodgkins lymphoma
High grade B-cell non-hodgkins
fat embolism skin rash typical manifestation.
petechiae in axilla and upper body.
which antigen are involved in the entry Plasmodium Vivax into RBCs.
Duffy antigen.
Fludarabine is a cytotoxic agent [purine analogue] its side effect is
PCP pneumonia.Give co-trimaxole alongside.
which drugs other than CRAPGPs can reduce warfarin effect
Azathiopurine.
OCPs
most common finding/symptom in Walderstorm Macroglobinemia
Generalized muscle weakness.
What are Russel bodies
imunoglubulin inclusion bodies seen in plasma cells.
present MM,WM etc.
apart of anti-thrombin 3 deficiency what other thrombophilic clotting problem can occur in nephrotic syndrome leading to thromboembolism
Protein S deficiency.
most common infections in sickle cell patients.
infections by encapsulated bacteria.
strep pneumo,h influenza,nesseiria
Give prophylactic pencillins due to their hyposplenic state.
best test to detect protein C deficiency
Copperhead snake venom assay.cccc of snake
severe ITP in diabetics tx
IVIG preffered as steroids can worsen diabetic control.
genereally steroids are first used.But if a RAPID rise in platelets is required IVIG do that quickly.
manifestation of paraneoplastic neurological disorders
confusion
seizure
cerebellar dysfunction etc
asso e many cancers like SCLC.
GVHD vs Post transplant CMV
GVHD = fevere,rash,diarrhea,liver
CMV = collitis [diarrhea],liver,kidneys,graft rejection.
CMV mainly occurs in post-allogenic transpants e,g kidney transpant.
most common site of primary extra nodal lymphoma in immunocompetent patients
Stomach
a post transplant patient develops lymphadenopathy after 3 years.diagnosis
post transplant lymphoma.earlier in 1 year if form ebv positive source.
CEA in colon cancer is used for
post-operative surveillance
target Hb in thalssaemia patients undergoing transfusions
9.5
Imatinib has a role in which maliganancies
CML-inhibits BCL-ABR tyrosine kinase
GIST-inhibits c-kit tyrosine kinase here.
how can you differentiate carcinoid from pheochromocytoma from symptoms
carcinoid have diarrhea,wheeze and normal BP
also NIACIN association [pallegra]
mode of distant spread of squamous cell cancer SCC of skin
lymphatics.
B cell malignancy targeted therapy is directed against which CD
CD 20.rituximab.e,g CLL,NON hodgkin,RA[not a malignancy tho]
pharmaceutical trial phases
Phase 1 = pharmokinetics and toxic effects of a drug
phase 2 = anti-tumor activity,optimimal dosing and general common side effects[not toxic]
phase 3 = compare with best present drug
phase 4 = long term toxic effects
Tx of T2N0 oesophageal adenocarcinoma
Chemoradiotherapy followed by surgery.
tx of SVC obstruction secondary to SCLC for early and long term benefits
Radiotherpay to tumor plus minus stenting of SVC
two drugs associated with transitional cell carcinoma of bladder
Cyclophosphamide
Phenacetin-an NSAID
chemotherapy regimen of choice of SCLC non-SCLC
Cisplatin and etoposide for SCLC
Cisplatin and paclitaxel for Non-SCLC
what eye findings can be found on fundoscopy in cases of severe anemia
cotton wool spots and hemorrhages.
pathophysiology of TRALI and other transfusion problems.
DONOR ANTIBODIES [anti HLA] activating host neutrophils leading to ARDS.
In Acute hemolytic reactions igM antibodies react against donor s mismatched RBCs triggering complement activation.
In non-hemolytic febrile reactions antibodies against donor white cell fragments like neutrophils etc.
In Anaphylaxis,in igA defienct patients donor igAs are recognized by preformed igEs [due to previous transfusions etc] and their reaction lead to mast cell degranulation.
which chemotherapy is of benefit in CA colon specially with metastasis.
5-Flurouracil.give alongside folic acid.
Radiotherapy have role only in rectal and anal cancers.
percentage of malignant foci in prostate by 80 years of age
80 percent.
triad of felty syndrome
RA
splenomegaly
neutropenia [even pancytopenia due to hypersplenism]
tx of idiopathic hypeosinophilic syndrome
Steroids.
in Aplastic anemia marrow is replaced by
Fatty marrow.fatty tissue.fibrosis in myelofibrosis.
how can you tell that acanthosis nigricans is associated with underlying malignancy like stomach cancer
AN associated with malignancy is typically itchy and tender.
most likely sequle of anaplastic thyroid cancer
upper airway obstruction.local presssure symptoms.do tracheostomy.
first line tx of hodgkins
ABVD plus localized radiotherapy of involved nodes.
best for stage 1 and 2.ie above the diaphragm.
Milan criteria for liver transplant in HCC
also compare with resection of tumor.
HCC with single disease < 5cm and no metastais and AFP less than 1000.best.child pugh is not mandatory e,g patient can have assictis sec to liver cirhosis etc,doesnt mean metastasis.
Resection of lesion is an option in patients with CHILD PUGH 1 category.ABCDE.
CHEMO e sorafenib and palliative stenting,emobilization of artey etc are options for metastatic tumors.
what is
spo2
po2
co-oximetry/sao2.
Sao2
Spo2 = is pulse oximetry.simple.low in methhaemo.falsely normal in co poisoning.
Po2 = is ABGs showing total disolved o2 in plasma.normal in both.
Co-oximetry = combine sphectrophotometry oximetry.It measures different haemoglobins in blood like methhameglobin,carboxy haemoglobin.GOLD STANDARD.
Sao2 done by ABGs is arterial haemoglobin saturation by o2.LOW in both.
markers associated with carcinoid tumors
Chromogranin A. (typical).
Neuron specific enolase.
a patient with brain metastasis suddenly deteriotes over a background of raised icp signs.cause
hemmorhage in the mets.
histology of oesophageal adenocarcinoma (sec to gerd or barrets)
Tubulo-pappillary growth with mucinous cells.mucinous refers to the glandular nature.
in which phase of cell cycle,cells are resistant to cytotoxic therapy
Go phase. NO DRUG.
G1 phase = Etoposide
S phase = methotrexate and 5-flurouracil
G2 phase = Bleomycin
M phase = Docetaxel
Typical features of Adult T cell Leukemia.
Association e HTLV1 (affro carribeans)
Plaque like skin lesions
Hypercalcemia (sec to PTHrp or bone invasion)
lymphadenopath,splenomegaly
Characteristic flower like lymphocytes with multi-lobed nuclei.
Two not so known findings of b12 defieciency
Pancytopenia
Haemolysis. sec to imature erthrocyte/blast being destroyed.
MESNA is used to prevent hemorrhagic cystitis in which 2 drugs
Cyclophasphamide
Ifosfamide
A person cannot donate blood acc to NHS guidelines when
Travel to endemic area - 6 months.
Tattoo or piercings - 4 months.
weight < 50kg.
Age 17 - 66 can donate.
what is RET proto-oncogene.
located on chromosome 10.
gain of function mutation is associated with MEN 2.
loss of function mutation is associated with Hirschprung disease.
if a women develop dvt in pregnancy.thmbophilia screen is negative.What should be done for future
LMWH for in case of pregnancy.
