Haematology/ Infectious Diseases Flashcards
CML chromosome abnormality? Name and translocation?
Phildelphia chromosome! (‘CreaMLy cheese!)
Translocation 9,22
Chromosome abnormality in ALL?
T (4;11)
3 phases of CML?
-chronic phase (easily controlled, near-normal life)
-accelerate phase (unstable course)
-Blast crisis (usually fatal)
Malaria - what does temperature do during illness?
Spikes of fever each day - up and down
Lymphadenopathy, splenomegaly, weight loss, fatigue, night sweats. Likely DX?
Non-Hodgkin’s lymphoma
How does acute lymphocytic leukaemia present?
Purpura, bleeding, infection
Antibodies in SLE?
Antinuclear antibodies
Is Hodgkin’s or non-hodgkin’s lymphoma more common?
What is the most common non-Hodgkin’s lymphoma
NHL is >5x as common as Hodgkin’s
Diffuse large B-cell lymphoma
What type of lymphoma is H pylori associated with?
Gastric MALT lymphoma
Staging system for Lymphoma?
Ann Arbour
Epidemiology of NHL?
White people are higher risk than black/Asian people
Median age of presentation = 50
Whereabouts in lung does primary lesion of TB usually present?
Upper region of lung
Sputum sample test to diagnose TB?
Ziehl-Neelsen stain for acid-fast bacilli
Treatment for ACTIVE TB?
RIPE for 4 months
Continue RI for 2 months
(Rifampicin, isoniazid, pyrazinamide & ethambutol)
Treatment for LATENT TB?
RI (rifampicin & isoniazid) for 3 months
OR
isoniazid alone for 6 months
Screening skin test for latent TB?
Mantoux test
What is Malaria and how is it spread?
Infection with Plasmodium Protozoa
Transmitted by female mosquitoes
How long after infection, and with what symptoms, does Malaria present?
-weeks after exposure
-HEADACHE
-flu-like illness (fever, malaise, fatigue, body aches)
-may have diarrhoea/GI syx
Severe malaria - cerebral malaria, severe anaemia, renal failure, pulmonary oedema
Standard to diagnose malaria?
Giemsa-stained thick and thin peripheral blood films/smears
When after ingestion of Salmonella typhi does typhoid fever present?
7-14 days
Symptoms of typhoid fever?
-rising temp over course of each day, drops by subsequent morning
-CONSTIPATION (abdo pain and constipation) from inflamed Peyer patches
-3rd week 1 - severe abdo distension, foul ‘pea-soup’ diarrhoea
-Blanching, truncal maculopapules
Diagnosis of typhoid fever?
CULTURE isolation
(Can also culture bone marrow aspirate)
How is Dengue spread?
Dengue virus is spread by mosquitoes
How does Dengue present?
High fevers
FACIAL FLUSHING
bleeding
Abdo pain
Cardiomyopathy
Serodiagnosis for Dengue?
Rise in antibody titre in paired igG or IgM specimens
In VWD, what happens to
-bleeding time
-platelet count
-APTT
Prolonged bleeding time
NORMAL platelet level
Prolonged APTT
How is VWD inherited?
Autosomal dominant (mostly!)
Treatment for VWD bleeding?
TXA (mild bleeding)
Desmopressin
factor 8 concentrate
How does non-haemolytic transfusion reaction present?
Fever, chills, malaise
How does TACO (Transfusion associated circulatory overload) present? When, in regards to transfusion?
Acute onset pulmonary oedema
Usually occurs 6 HOURS post transfusion
Hypertension
SOB
Hypoxaemia
Tachycardia
Short stature, shield-shaped chest, widely spaced nipples, triangular shaped neck, primary/secondary amenorrhoea. Dx?
Turner’s syndrome (45XO)
Best investigation for typhoid?
Blood cultures (technically best to do bone marrow cultures but painful!)
How and when does typhoid present?
Symptoms start 7-14 days after ingestion of salmonella typhi!
TyPhoid- several Ps!
-GI syx - diffuse abdominal pain, constipation (inflamed PEYER patches)
-Skin - blanching, truncal maculoPapules
-2nd week - splenomegaly, bradycardia
-3rd week - abdominal distension, bowel PERFORATION due to necrotic PEYER patches, PEA soup diarrhoea!
Most common cause of Scarlet fever?
Group A strep! (Remember because causes inflamed red tonsils)
Cause of Slapped cheek/5th disease?
Parvovirus B19 virus
Is HIV a notifiable disease?
What about Creutzfeld-Jakob disease?
NO to both!!
How is Haemophilia inherited?
X-linked recessive
Therefore occurs almost exclusively in males!
Most useful blood test to diagnose haemophilia?
APTT (activated partial thromboplastin time)
Which clotting factor does Haemophilia A affect?
Haemophilia B?
A = 8 (‘At!’)
B = 9
What parts of the coagulation cascade does warfarin affect?
2,7,9,10 (Cab’s phone Lock Screen!)
Anaphylaxis is mediated with which antibody!
IgA (‘IgAnanaphylaxis!’)
What causes allergic rhinitis? (3 categories)
-Seasonal - grass, tree pollens
-Perennial (throughout year) -House dust mites!
-Occupational - workplace allergens ie flour
Hyposensitization (specific allergen immunotherapy) is of proven benefit from what allergy?
Wasp venom anaphylaxis
Both parents are carriers of cystic fibrosis. Chances of child having CF?
25%!
(25% normal, 50% carrier, 25% affected)
How does autoimmune haemolytic anaemia look like on bloods?
Anaemia
Signs of haemolysis- reticulocytosis, low haptoglobin, increased lactate dehydrogenase, elevated indirect bilirubin, positive Coombs test
Blood film - reticulocytes and spherocytes (Note- spherocytes not specific to spherocytosis!!)
Young patient with microcytic anaemia but normal ferritin . Likely Dx?
Thalassaemia!
Name of anaemia with pancytopenia and hypOcellular bone marrow?
Aplastic anaemia - bone marrow stops making enough stem cells! Commoner in YOUNGER patients
1st line treatment for chlamydia?
Doxycycline!! (Note CHANGED FROM Azithromycin Unless in pregnancy/breastfeeding, contraindicated so still use Azithromycin!)
Causes of macrocytic anaemia? (2 categories)
MEGALOBLASTIC:
-B12 deficiency
-folate deficiency
-terminal ileum resection/gastrectomy
-drugs - sulfonamides
NORMOBLASTIC:
Liver disease
Alcoholism
Hypothyroidism
Myelodysplasia
Drugs - anticonvulsants
HIV-related opportunistic infections
-Mycobacterium
-Candidiasis
-Pnemocystis jirovecii pneumonia
-Toxoplasmosis
-Cryptococcus
-Cytomegalovirus
Target appearance following insect bite - Dx?
Tx?
Erythema migrans - LYME DISEASE from tick bite
- treat with abx
How is sickle cell inherited?
Autosomal recessive
How is spherocytosis inherited?
Autosomal DOMINANT (often linked to chromosomes 8)
How does hereditary spherocytosis present?
Anaemia, splenomegaly, and jaundice
Highest risk sexual behaviour for getting HIV!
Receptive anal sex (bottoming) as lining of rectum is thin
Complication of chlamydia in:
-women
-men
Pelvic inflammatory disease
Epididymo-orchitis
Main advantage of active over passive immunisation?
Antibody persists for LONGER PERIOD
(may take days/ weeks to develop but lasts longer, whereas passive gives immediate, but short lived protection!)
What is multiple myeloma?
How is it characterised?
-progressive malignant disease of PLASMA CELLS
-characterised by PARAPROTEINAEMIA (Proliferation of abnormal monoclonal immunoglobulins in the blood) - this causes diffuse bone marrow infiltration. Causing bone destruction and bone marrow failure!!
How does multiple myeloma present?
Most commonly BONE PAIN & ANAEMIA
Also fatigue, infections, hypercalcaemia, renal impairment as affects MULTIPLE organs including bones, kidneys, immune system!
How common is multiple myeloma?
2ND most common haematological malignancy (after non-Hodgkin’s lymphoma)
What type of virus is influenza?
Orthomyxovirus
Risk of having a child with Down’s syndrome at these ages?:
-20
-30
-35
-40
-45
20 = 1/1500
30 = 1/800
35 = 1/270
40 = 1/100
45 = >1/50
Most common cause of bacterial meningitis in adults ?
Strep pneumoniae
Most common causes of bacterial meningitis in
-kids >3m and adults?
-neonates
Kids >3m/adults: ‘PIM’ (2nd word starts)
-Strep Pneumoniae
-Haemophilus Influenza B
-Neisseria meningitidis
Neonates <1m: ‘LESA’ (‘lesser/smaller’)
-Listeria monocytogenes
-E Coli
-Strep Agalactiae
If, on haemoglobin electrophoresis of pt with IDA, there are ‘absent beta bands’ what is the diagnosis?
Beta-thalassaemia
(With Alpha-thalassaemia, there should be absent alpha chains)
How does Schistosomiasis present?
‘Swimmer’s itch’ - fresh water - caused by flatworm
Also fever, lethargy, myalgia
Difference in symptoms between
-acute haemolytic transfusion reaction?
-non-haemolytic transfusion reaction?
Haemolytic:
Flushed, tachycardia, tachypnoea, dark urine, chest tightness, burning at IV site, chest tightness, restless
Non-haemolytic:
Fever, chills, malaise, sometimes dyspnoea
What is it and what are the Triggers of glucose-6-phosphate dehydrogenase (G6P6) deficiency?
What shows on blood film?
X linked disorder - leads to HAEMOLYTIC CRISES within hrs of exposure to oxidant stress
Viral/bacterial
Drugs - sulfa drugs, quinines
FAVA BEANS
(‘Quinines, beans and infectious nasties!)
HEINZ BODIES (like the beans that trigger!)
What is aplastic anaemia!?
Bone marrow failure characterised by peripheral pancytopaenia and marrow hypoplasia
Hodgkin’s lymphoma:
-specific cells
-what happens when you drink alcohol?
Reed-Sternberg cells
Alcohol induced pain at nodal disease
3 phases of CML?
Chronic - near-normal life
Accelerated phase - unstable
Blast crisis - usually fatal
CML presentation?
Often insidious. Elevated WBC
Tiredness, fatigue, weight loss
Enlarged spleen/ liver
Which is more common - HL or NHL?
Non-Hodgkin’s lymphoma - 5x as common!
Risk factors for NHL?
-white ethnicity
-age >50
-viruses: EBV, Hep C
-bacteria: H pylori
-autoimmune disorders: Hashimoto’s thyroiditis (linked to MALT)
What is the Ann Arbor staging used for?
Both HL and NHL
What is multiple myeloma?
How did it present?
What are the proteins found in 24 hour urine collection?
Malignant neoplasm of PLASMA cells (that arise in bone marrow)
-marrow infiltration (anaemia, thrombocytopenia, neutropenia)
-bone pain (lumbar vertebrae)
-pathologic fractures (long bones)
-hypercalcaemia syx
BENCE JONES PROTEINURIA
What is CLL?
Who generally gets it ?
How does it present?
Treatment?
-Malignant expansion of B lymphocytes
-Western world, older people
-90% asymptomatic! Picked up on routine blood tests
-No curative treatment, but treatable disease with chemotherapy that prolongs survival
‘Oh Cecelia! (CLL Older Western lady) You’re Breaking my heart!’ (B lymphocytes, no cure)
Woman with HIV and diarrhoea. Zeil-Neilson stained stool shows characteristic cysts. Dx?
Cryptosporidiosis
Patient with HIV, symptoms of headache, neck stiffness, vomiting, photophobia. LP shows organism that stains positive with India Ink dye. What is the organism?
Cryptococcosis (opportunistic fungal infection)
(Commonly causes meningoencephalitis in HIV patients)
Causes of MICROCYTIC anaemia?
PITS
Pica (where you want to eat clay/soil)
Iron deficiency
Thalassaemia
Sideroblastic anaemia
