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FINALS > Haematology > Flashcards

Haematology Flashcards

1
Q

What is lymphoma?

A

Malignant proliferation of lymphocytes
Lymph nodes, liver, spleen
Rubbery enlarged glands

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2
Q

What tests should be done for lymphoma?

A
  1. Viral screen
  2. Excision/CT guided biopsy
  3. Contrast CT neck, thorax, abdo, pelvis
  4. FBC, LDH
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3
Q

What are the symptoms of lymphoma?

A

Painless lymphadenopathy

Fever, weight loss, night sweats, lethargy

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4
Q

How is lymphoma staged?

A
  1. Single lymph node
  2. 2 lymph nodes same side of the diaphragm
  3. Regions on both sides of the diaphragm
  4. Extra-nodal site - BM, liver, spleen

A - absence of constitutional symptoms
B - symptoms
X - bulky disease
E - single extra-nodal site

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5
Q

What are some features of Hodgkin’s lymphoma?

A 
Commonest type = nodular sclerosing 
2 peaks: young adults and elderly 
Linked to EBV 
Reed-Sternberg cells 
Radiotherapy and chemotherapy
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6
Q

What are some features of Non-Hodgkin’s lymphoma?

A

Most are B cell
Gut extra-nodal disease common
Split into indolent and aggressive
Associated with immunodeficiency - HIV, EBV, H pylori

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7
Q

What is myeloma?

A

Clonal B cell malignancy with proliferation of plasma cells
Accumulate in bone marrow and secrete m-protein
Other Ig levels are low

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8
Q

What are some clinical features of myeloma?

A 
Osteolytic lesions - backache, wedge #
Hypercalcaemia
Anaemia, neutropenia, thrombocytopenia
Recurrent bacterial infections
Renal impairment - light chain deposition
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9
Q

What investigations should be done for suspected myeloma?

A 
FBC - normocytic anaemia
ESR
UEs - raised urea, creatinine and calcium
X-rays
Bone marrow biopsy
Serum and/or urine electrophoresis
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10
Q

What are the diagnostic criteria for myeloma?

A
  1. Monoclonal protein band in serum electrophoresis
  2. Plasma cells on BM biopsy
  3. Evidence of end organ damage - hypercalcaemia, anaemia, renal insufficiency
  4. Bone lesions
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11
Q

What is the management of myeloma?

A 
Analgesia (not NSAIDs)
Bisphosphonates 
Anaemia - transfuse
Hydration
Treat infections 
Chemo
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12
Q

What are some complications of myeloma?

A

Hypercalcaemia
Spinal cord compression
Hyperviscosity
Acute renal injury

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13
Q

What is leukaemia and what are the four types?

A 
Malignant neoplastic process involving one of the white cell lines 
Acute lymphoblastic 
Acute myeloid
Chronic lymphocytic 
Chronic myeloid
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14
Q

What are the features of ALL?

A

B or T cell lineages
Arrests maturation and promotes uncontrolled proliferation of immature blast cells
Marrow failure
Infiltration - hepatosplenomegaly, lymphadenopathy

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15
Q

What tests should be done for ALL?

A

Blood film and BM biopsy
CXR and CT
LP (CNS involvement)

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16
Q

What is the treatment of ALL?

A 
Blood/platelet transfusion 
IV fluids
Allopurinol 
Hickman line 
Treat infections aggressively
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17
Q

What are some features of acute myeloid leukaemia?

A

Progresses rapidly
Can be a long term complication of chemotherapy
Auer rods
Intensive chemo and BM transplant

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18
Q

What are some features of chronic myeloid leukaemia?

A

Uncontrolled proliferation of myeloid cells - increased WCC
Philadelphia chromosome
Massive splenomegaly, hepatomegaly, anaemia, bruising

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19
Q

What is chronic lymphocytic leukaemia?

A

Accumulation of functionally incompetent B cells

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20
Q

What 3 things halt bleeding?

A
  1. Vasoconstriction
  2. Gap plugging by platelets
  3. Coagulation cascade
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21
Q

What can cause issues with vasoconstriction?

A 
CTD
Senile purpura 
Infection - meningococcal, measles 
Steroids
Henoch-Scholein purpura
22
Q

What can cause issues with platelet?

A 
Aplastic and megaloblastic anaemia 
Myeloma, leukaemia
Cytotoxic drugs, radiotherapy
ITP 
SLE
DIC, TTP
23
Q

What does the APTT monitor?

A

Intrinsic pathway

Factors XII, XI, IX, VIII, VII

24
Q

What does PT monitor?

A

Extrinsic pathway
Factors X, VII, V, II
Prothrombin and fibrinogen

25
Q

What are some causes of an increased PT?

A

Warfarin
Factor VII deficiency
Factors II, V, X deficiency

26
Q

What are some causes of an increased APTT?

A

Heparin
VII-XII deficiency
Von-Willebrands

27
Q

What are some causes of an increased PT and APTT?

A

Vitamin K deficiency
DIC
Heparin toxicity

28
Q

What are the three types of von-Willebrands?

A
  1. Reduced amount of vW protein
  2. Abnormal vW protein
  3. Little or no vW protein
29
Q

What are some features of haemophilia?

A

X-linked recessive
A = factor VIII deficiency
B - factor IX deficiency
Avoid NSAIDs and IM injections

30
Q

What are some causes of normocytic anaemia?

A

Acute blood loss
Anaemia of chronic disease
Haemolytic anaemia

31
Q

What are some causes of microcytic anaemia?

A

Iron deficiency
Thalassaemia
Sideroblastic

32
Q

What are some causes of macrocytic anaemia?

A

B12 or folate deficiency
Alcohol excess
Reticulocytosis
Marrow infiltration

33
Q

What investigations should be done for IDA?

A

Coeliac serology

If not menstruating - urgent gastroscopy and colonoscopy

34
Q

What are some causes of anaemia of chronic disease?

A 
Chronic infection 
Vasculitis 
RA
Malignancy 
CKD
35
Q

What is sideroblastic anaemia?

A

Ineffective erythropoiesis leads to increased iron absorption
Post chemo, radio, anti-TB drugs
Suspect if refractory microcytic anaemia

36
Q

What investigations should be done for macrocytic anaemia?

A

LFTs, TFTs, serum B12 and folate

37
Q

What is pernicious anaemia?

A

Parietal cell antibodies leads to lack of intrinsic factor

IF binds to B12 in stomach - without it cannot be absorbed in terminal ileum

38
Q

What are the signs and symptoms of B12 deficiency?

A

Pallor, mild jaundice, glossitis
Irritability, depression, psychosis, dementia
Subacute degeneration of spinal cord

39
Q

What is haemolytic anaemia?

A

Premature breakdown of RBCs before their normal lifespan
In circulation = intravascular
Macrophages of liver/spleen/BM = extravascular

40
Q

What tests should be done for haemolytic anaemia?

A

FBC, LDH
Urinary urobilinogen
Thick and thin films for malaria
Reticulocytes, bilirubin, haptoglobin

41
Q

What are the types of Coomb’s positive anaemia?

A
  1. Drug induced
  2. Autoimmune haemolytic anaemia
    - Warm = IgG mediated, extravascular - steroids
    - Cold = IgM mediated, intravascular
42
Q

What are some causes of Coomb’s negative anaemia?

A

Autoimmune hepatitis
Hepatitis B and C
Post vaccination
Piperacillin, rituximab

43
Q

What are some hereditary causes of haemolytic anaemia?

A

G6PD deficiency
Pyruvate kinase deficiency
Hereditary spherocytosis
Sickle cell anaemia

44
Q

What are some features of G6PD deficiency?

A

X-linkd
Episodic intravascular haemolysis
Bite and blister cells

45
Q

What are some features of pyruvate kinase deficiency?

A

Autosomal recessive
Decreased ATP production, decreased RBC survival
Haemolysis + splenomegaly + jaundice
Sputnik cells

46
Q

What are some features of hereditary spherocytosis?

A

Autosomal dominant
Spherical RBCs get trapped in spleen
Cause of neonatal jaundice

47
Q

What is sickle cell anaemia?

A

Production of abnormal Hb results in vaso-occlusive crises
Autosomal recessive
Hb electrophoresis confirms diagnosis

48
Q

What are some features of sickle cell crises?

A

Triggers: cold, infection, hypoxia, dehydration
Small blood vessels are occluded - infarction
Severe pain due to bony infarction
IV opioids, fluids and antibiotics

49
Q

What is acute chest in SCA?

A

Pulmonary infiltrates involving complete lung segments

Pain, fever, tachypnoea, wheeze, cough

50
Q

What are some complications of SCA?

A 
Splenic infarction 
Poor growth 
Chronic renal failure 
Gallstones 
Iron overload
Lung damage
51
Q

What is thalassaemia?

A

Genetic disease of unbalanced Hb synthesis

Decreased or no production of one global chain

FINALS (19 decks)

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