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Haematology 2 Flashcards

1
Q

What is lymphoma?

A

Malignancy of lymphatic system

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2
Q

Who does Hodgkin lymphoma commonly affect?

A

Young adults

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3
Q

When does non-Hodgkin lymphoma typically present?

A

> 50 years

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4
Q

What is immune thrombocytopenic purpura?

A

Autoimmune destruction of platelets

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5
Q

What is the epidemiology of ITP?

A

More common than ITP
Acute/primary - children following infection
Chronic/secondary - young women

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6
Q

How does ITP present?

A 
Purpura
Epistaxis
Easy bruising
Menorrhagia
Gum bleeding
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7
Q

What is the first line investigation for ITP?

A

FBC (thrombocytopoenia)

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8
Q

How do you manage ITP?

A

IV corticosteroids
IV immunoglobulin
Splenectomy

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9
Q

What is thrombotic thrombocytopenic purpura (TTP)?

A

Platelet deficiency due to ADAMTS13 deficiency

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10
Q

What causes TTP?

A

Congenital or acquired
Postpartum or during pregnancy 10-25%
70% idiopathic
RF: HIV, autoimmunity, cancer, pregnancy

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11
Q

How does TTP present?

A 
Flu like symptoms
Purpura
Easy bruising and bleeding
Abdo/chest pain
Arrhythmias
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12
Q

How do you investigate TTP?

A

First line - FBC (thrombocytopenia)

Gold standard: low ADAMTS13, high ADAMTS13 antibodies

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13
Q

How do you manage TTP?

A 
Emergency
Plasma exchange to remove antibodies
FFP
IV methylprednisolone
Immunosuppression
Splenectomy
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14
Q

What is disseminated intravascular coagulation (DIC)?

A

Systemic activation of coagulation system

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15
Q

What are the risk factors for DIC?

A 
Sepsis (30-50% of patients)
Malignancy (leukaemia)
Major trauma - crush/burn
Pregnancy complications
Rejection of transplant/transfusion
Liver/pancreatic disease
Post op complications
Recreational drugs
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16
Q

How does DIC present?

A 
Bleeding & thrombosis out of control
ARDS
Bruising
Bleeding from at least 3 unrelated sites
Confusion
Fever
Infarction/necrosis/gangrene
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17
Q

How do you investigate DIC?

A

Repeat platelet count (low and decreasing)
Elevated D dimer
Prolonged PT/aPTT
Low fibrinogen

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18
Q

How do you manage DIC?

A

Transfusion of FFP/platelets
Heparin if thrombosis dominant (if not bleeding)
Tranexamic acid (TXA) if bleeding dominant
Treat underlying condition

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19
Q

What is DVT?

A

Venous thrombus in deep vein (leg/pelvis)

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20
Q

What are the risk factors for DVT?

A 
Hx DVT
60+
Surgery
Obesity
Long haul flights
Cancer
Fracture (immobility)
Pregnancy
HRT/COC
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21
Q

How does DVT present?

A 
Discolouration
Pitting oedema
Tenderness along deep veins
Increased skin temperature
Palpable cord
Pain
(in leg)
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22
Q

How do you investigate DVT?

A

Raised D-dimer

US duplex

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23
Q

How do you manage DVT?

A

Heparin 5 days
DOAC/warfarin 6 months
IVC filter

24
Q

What is DVT prophylaxis?

A

Compression stockings

LMWH

25
How do you treat myeloma in young patients?
Chemo and autologous stem cell transplant
26
Why is myeloma monitored after treatment?
Monitoring every 3 months for smoldering myeloma
27
What are the risk factors for Hodgkin lymphoma?
Previous EBV
28
What cells are affected in Hodgkin lymphoma?
T/B cells
29
How does Hodgkin lymphoma present?
Painless lymph node enlargement (pain after drinking) Hepatosplenomegaly B symptoms
30
What are 'B symptoms'?
Fever Night sweats Weight loss
31
How do you investigate Hodgkin lymphoma?
Lymph node biopsy
32
What is seen on biopsy for Hodgkin lymphoma?
Reed Sternberg cells
33
How is lymphoma staged?
Ann Arbour staging
34
What is the Ann Arbour staging system?
Stage 1 -> the disease is in one area only Stage 2 - the disease is in 2 or more areas on the same side of the diaphragm Stage 3 -> the disease is in 2 or more areas on both sides of the diaphragm Stage 4 - the disease has spread beyond the lymph nodes
35
How is Hodgkin lymphoma treated?
``` 1A-2A = brief ABVD chemotherapy 2A-4B = 8 cycles of ABVD and irradiation ```
36
What is the most common childhood cancer?
Acute lymphoid leukaemia
37
How is acute lymphoid leukaemia diagnosed?
Blast cells in blood film
38
How is acute lymphoid leukaemia treated?
Chemo, stem cell transplant | 80-90% cure rate
39
What are the key clinical features of nephrotic syndrome?
``` Proteinuria ++++++ Hypoalbuminaemia Oedema +++ GFR ↓/↔ Hyperlipidaemia ```
40
What does FBC show for sickle cell anaemia?
Low Hb, high reticulocytes
41
What does blood film show for sickle cell anaemia?
Sickled RBCs
42
What does Hb electrophoresis show for sickle cell anaemia?
HbS present, no HbA
43
What are the risk factors for non-Hodgkin lymphoma?
EBV, hep C, HIV, H pylori, ionising radiation, genetics, autoimmune disease
44
What cells does non-Hodgkin lymphoma affects?
B cells
45
How does indolent non-Hodgkin lymphoma present?
Slow, presents advanced, incurable
46
How does aggressive non-Hodgkin lymphoma present?
Severe but curable
47
How does non-Hodgkin lymphoma present?
Painless lymphadenopathy Hepatosplenomegaly B symptoms Extra nodal involvement
48
How do you investigate non-Hodgkin lymphoma?
Lymph node biopsy, BM aspirate
49
How do you treat low grade non-Hodgkin lymphoma?
Watch and wait, monoclonal antibodies, chemo
50
How do you treat high grade non-Hodgkin lymphoma?
RCHOP chemo
51
How do you slow the progression of CKD?
DM treatment HTN treatment Glomerulonephritis treatment
52
How do thiazide diuretics prevent urolithiasis?
Helps with recurrent stones by reducing calcium levels
53
Describe the course of chronic lymphocytic leukaemia.
Indolent/slow course
54
How does chronic lymphocytic leukaemia present?
Enlarged lymph nodes & frequent infection
55
How do you investigate chronic lymphocytic leukaemia?
Smudge cells on blood film
56
How do you treat chronic lymphocytic leukaemia?
Incurable - chemo +/- stem cell transplant if young
57
What are the gold standard investigations for ITP?
``` Blood smear (thrombocytopoenia) Platelet autoantibodies Increased megakaryocytes in BM ```

Phase 2a (25 decks)

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