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2A - Stuff i just cannot remember > Haematology > Flashcards

Haematology Flashcards

1
Q

DVT risk factors

A

Virchow’s Triad.

Immobility, dehydration, oestrogen (pill, preg), clotting disorders, varicose v, trauma, infection, malignancy

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2
Q

Virchow’s Triad

A

Stasis of blood flow

Hypercoagulability

Vessel wall injury

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3
Q

Myeloma bloods

A

Monoclonal Antibodies + Bence-Jones proteins

IgG >30 g/L
Plasma cells >10%

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4
Q

Chronic Myeloid Leukaemia bloods

A

Low Hb, High platelets, High WBCs

:: ^myeloblast cell turnover > differentiate into basophils, neutrophils, eosinophils.

Leucocytosis :: ^^WBC proliferation

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5
Q

Iron deficiency anaemia presentations

A

= microcytic anaemia

  • brittle hair/nails
  • Koilonychia
  • Pale conjunctivae
  • Systolic flow murmur
  • pica cravings (esp kids)
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6
Q

Presentations of anaemia 2o to hypothyroidism

A

= macrocytic anaemia

  • reduced reflexes (also in B12 deficiency)
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7
Q

Acute management of Acute Coronary Syndrome

A

Aspirin + Ticagrelor
GTN
Morphine
LMW Heparin/Fondaparinux

PCI within 12hr

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8
Q

Acute management of DVT + pharmacology

A

Rivaroxaban - inhibits factor Xa, Fondaparinux - inhibits factor X

LMW Heparin if PREG - inhibits anti-thrombin III

IVC Filter (if bleeding).

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9
Q

DVT presentations

A

Asymmetric calf swelling, localised pain, red skin, vein dilation

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10
Q

What is thrombocytopenia?

Outline the pathophysiology of Idiopathic thrombocytopenic purpura and Thrombotic thrombocytopenic purpura

A

low platelets

ITP - IgG targeted by Macrophage’s Fc_Receptor

TTP - Low ADAMTS-13 > Platelet consumption

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11
Q

Pt presents with painless lymphadenopathy. There is some pain after drinking alcohol.

Likely diagnosis? Risk factors? Management?

A

Hodgkin’s Lymphoma

RF: Young, high socioeconomic class

Mx: ABVD Chemo

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12
Q

Non-Hodgkin’s Lymphoma: Types, Risk Factors, Management

A

EBV - Burkitt’s/ AIDS-related

H. pylori - MALT

Mx: HAART + R-CHOP-21 + Rituximab

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13
Q

Pt presents with pruritus, vision loss, headache and fatigue. They recently suffered a thrombotic event.
They complain of episodes burning pain in their feet and hands (erythomelalgia)

Likely diagnosis?

A

Absolute Polycythaemia

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14
Q

Pt presents with pruritus, vision loss, headache and fatigue. They recently suffered a thrombotic event.
They complain of episodes burning pain in their feet and hands (erythomelalgia)

Their face is ruddy and genetic tests show a JAK2 mutation.

Likely diagnosis?

A

Absolute Secondary Polycythaemia - Polycythaemia Rubra Vera

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15
Q

Gold standard investigation for Malaria

A

Giemsa-stained blood film - Plasmodium falciparum

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16
Q

Management of Malaria

A

Artemisinin Combination Therapy (ACT)

Quinines, Artesunate, Primaquine

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17
Q

Splenomegaly in the context of haematology can indicate

1)
2)
3)

A

1) Lymphoma
2) Leukaemia
3) Myeloproliferative disorders

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18
Q

Erythromelalgia indicates…

A

Polycythaemia Rubra Vera + essential thrombocytosis

= “dusky” extremities + burning pain with hot temperatures.

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19
Q

An IgG paraprotein spike in the context of haematology indicates…

A

Multiple myeloma

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20
Q

Macroglossia in the context of haematology indicates…

A

Amyloidosis

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21
Q

JAK2 mutations are associated with…

A

Polycythaemia Rubra Vera

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22
Q

Middle-age patient presents with massive splenomegaly and his toe is very painful and hot to touch.

A blood film is requested.

Likely diagnosis? What may genetic testing find? What may his blood film reveal?

A

Chronic Myeloid Leukaemia

Blood film - ^^mature myeloid cells , basophils, eosinophils

Genetics: Philadelphia chromosome

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23
Q

Pt presents with anaemia, bleeding and recurrent infections. Examination reveals hepatomegaly, splenomegaly and gum hypertrophy.

Likely diagnosis? Biopsy findings?

A

SnS = BM Failure + BM infiltration

Acute Myeloid Leukaemia

Biopsy: Auer Rods + Blast cells

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24
Q

5 yr old presents with fatigue and easy bruising. They have had recurrent infections this year. The child complains of a sore back.

Examination reveals painless lymphadenopathy and meningism.

Likely diagnosis? Biopsy?

A

Acute Lymphoblastic Leukaemia

Biopsy: Leukaemic Lymphoblastic Cells!

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25
Child under 6 with features of BM infiltration + Lymphadenopathy?
Acute Lymphoblastic Leukaemia
26
Features of Bone Marrow Failure
Anaemia - fatigue Abnormal bleeding Abnormal bruising (low platelets)
27
Pt presents with wt loss, tiredness, fever and sweating. Exam reveals massive splenomegaly, bleeding and gout. Diagnosis?
Chronic Myeloid Leukaemia
28
Rouleaux formations are associated with...due to...
associated with Multiple Myeloma Due to Raised ESR
29
Imatinib uses
Chronic Myeloid Leukaemia Imatinib = Tyrosine Kinase Inhibitor (TK induced by philadelphia c/s mut)
30
Rituximab uses
= monoclonal Ab - NHL (Non Hodgkin's Lymphoma) - CLL (Chronic Lymphocytic Leukaemia)
31
Lenalidomide uses
= Chemotherapy Multiple Myeloma
32
58-F is becoming increasingly tired and has lost 2 stone. She initially put these fown to the menopause, but has recently developed mouth ulcers and pins and needles in the feet. She is mildly jaundiced. Likely diagnosis? Management?
Pernicious anaemia - autoimmune condition - anaemia - peripheral neuropathy - lemon skin (mild jaundice + pallor) - mouth ulcers - depression - dementia Mx: B12 injections
33
Polycythaemia management
Venesection
34
7-F has a known haematological malignancy. Parents bring her to A&E as she is red in the face and her chest veins are dilated. Her facial features include a small chin, slanted eyes and drooping of the left side of the face. Likely haem diagnosis?
Acute Lymphoblastic Leukaemia - young kids - Down's syndrome RF - anaemia, bleeding, infection - hepatosplenomegaly, peripheral lymphadenopathy - SVC obstruction, facial nerve palsy
35
Red face, dilated chest veins
SVC Obstruction
36
Haemophilia B is associated with which clotting factor?
Factor 9
37
Haemophilia A is associated with which clotting factor?
Factor 8 | A before B, 8 before 9
38
Define primary and secondary polycythaemia. Give examples of both.
Primary polycythaemia: RBC over production, eg Polycythaemia Rubra Vera Secondary polycythaemia = RBC production upregulated, eg due to: chronic hypoxia (lung disease, smoking, low FiO2, COPD).
39
56-M is overweight and smokes 30 cigarettes a day. He has COPD and HTN. He presents with a swollen red calf and is diagnosed with DVT. You notice he has red palms and soles. Likely diagnosis?
Secondary Polycythaemia, secondary to hypoxia from smoking + COPD
40
Smudge cells are associated with
Chronic LYMPHOCYTIC leukaemia
41
76-M presents with urinary frequency, haematuria and night sweats. He reports 2 stone recent wt loss. DRE reveals a hard craggy mass. Likely diagnosis? Investigations? Management?
Prostate Cancer 1L: DRE, urine dipstick Gold: Transrectal US Biopsy (TRUS Biopsy) ``` GnRH agonist (analogue) - Goserelin, Leuprolide Androgen antagonist - Biclutamide ```
42
Factors that raise PSA
Acute urinary retention Recent ejaculation PR Examination BPH!! Prostate cancer Infection - urinary tract, prostate
43
Prostate cancer management for: - low grade - high grade
Low Gleason grade: 1. Active surveillance High Gleason grade: 1. Radiotherapy 2. Laparoscopic prostatectomy
44
Management of METASTATIC prostate cancer
HORMONAL Mx: 1. GnRH agonist (analogue) a) Goserelin b) Leuprolide 2. Androgen antagonist ADJUNCT a) Bicalutamide b) Enzalutamide 3. GnRH antagonist a) Degarelix
45
Pharmacology + SE of hormonal management of prostate cancer
GnRH Agonist (Goserelin) > OVER stimulate pituitary > paradoxical blockade of LH & FSH Problem = transient ^^testosterone > makes disease worse SO... add Androgen antagonist (Biclutamide) SE: low libido, infertility, wt gain, osteoporosis, anaemia
46
Aplastic crisis
CLL transforms into NHL
47
Myelofibrosis pathophysiology and features
Myeloproliferative disorder --> Clonal BM disorder chd by deposition of fibrous scar tissue (too many cells > BM compensates and kills itself off - fibrosis - to reduce output) - Pancytopenia - tear drop cells - DRY tap (:: all fibrotic) - MASSIVE splenomegaly
48
Myelodysplasia pathophysiology and features How many progress to AML?
= pre-cancerous stage BM disorder > pancytopenia + production of functionally immature blood cells 1/3 progress to AML
49
Blast crisis
Chronic leukaemia becomes acute leukaemia - outputting a huge number of abnormal cells
50
Amyloidosis
protein aggregates deposit in body tissues - proteinuria - purpura (eyes) - Carpal tunnel - peripheral neuropathy - glossitis
51
Management of major bleeding
Stop anticoagulants IV Prothrombin Complex Concentrate/FFP + IV Vitamin K
52
Management of minor bleeding
Stop anticoagulants IV Vitamin K Repeat INR after 24Hr
53
Management of no bleeding with INR >8
Stop anticoagulants IV/Oral Vitamin K Repeat INR after 24Hr
54
Management of no bleeding with 8>INR>5
Withhold 1-2 doses anticoagulant Review maintenance dose of anticoagulant
55
What is INR? When is it used
International Normalised Ration - measure of blood coagulation. Used in pts - on Warfarin - at high risk of thromboembolic events - prosthetic valve, AF - being treated for DVT/PE
56
Name the 4 products which are readily transfusable
1 - Red Blood Cells 2 - Fresh Frozen Plasma (coagulopathy) 3 - Platelets (1 pool from 4 donors. LS 10 days) 4 - Cryoprecipitate (= thawed FFP. Massive bleed + low fibrinogen)
57
Cryoprecipitate components
Fibrinogen Factor VIII Von Willebrand Factor
58
Management of a patient with a massive bleed and low fibrinogen
Cryoprecipitate
59
Management of a patient with Coagulopathy
Fresh Frozen Plasma
60
Whole blood transfusion indications
Major trauma, eg military trauma patients who need resus Rapid corrects of acidosis, hypothermia, coagulopathy
61
Red blood cell transfusion indications
Acute haemorrhage | Chronic anaemia
62
Platelet transfusion indications
Thrombocytopenia + bleeding Severe thrombocytopenia (prophylaxis)
63
Granulocyte transfusion indications
Neutropenic cancer patients developing bacterial sepsis AND unresponsive to ABX for 24-48Hr
64
Fresh Frozen Plasma indications
DIC Liver disease - coagulation factor deficiency Major trauma/ haemorrhage Urgent warfarin anticoagulation
65
Cryoprecipitate indications
Von Willebrand Disease Severe Hypofibrinaemia
66
IV Immunoglobulin transfusion indications
Immuno-thrombocytopenia Guillain-Barre Syndrome Autoimmune Haemolytic Anaemia
67
Antithrombin III transfusion indications and side effects Normal action of antithrombin III
Congenital Antithrombin III deficiency - increased risk of thrombosis AT III inhibits factors IIa, Xa, IXa, XIa
68
Antithrombin III deficiency homozygosity vs heterozygosity
Homozygosity = In Utero death Heterozygosity = increased risk of VTE 50-fold
69
Factor VIIa transfusion indications
Haemophilia A and B
70
Most common inherited thrombophilia Pathogenesis
Factor V Leiden = mutation in clotting factor V > becomes resistant to inactivation by protein C
71
Protein C deficiency epidemiology Protein C usual pathophysiology
Higher prevalence in Southeast Asian patients Protein C inactivates Factor V and VIII
72
Inherited thrombophilia
Factor V Leiden Protein C Deficiency Antithrombin III deficiency

2A - Stuff i just cannot remember (19 decks)

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