Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MRCEM INTERMEDIATE > Haematology & Oncology > Flashcards

Haematology & Oncology Flashcards

1
Q

Unfractionated heparin (UFH) MOA

A

UFH enhances the activity of antithrombin, leading to the inhibition of coagulation factors IIa (thrombin) and Xa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Low molecular weight heparins (LMWHs) MOA

A

LMWHs exert their anticoagulant effect by targeting factor Xa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Dabigatran MOA

A

Dabigatran is an inactive prodrug. It acts by reversibly inhibiting free thrombin, fibrin-bound thrombin, and thrombin-induced platelet aggregation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Apixaban, edoxaban and rivaroxaban MOA

A

These DOACs competitively inhibit both free and clot-bound factor Xa,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

DIC blood results

Platelet count
Fibrinogen
PT
D d-dimer
TT
Coag factors

A

Platelet count - low
Fibrinogen - low
PT - prolonged
D d-dimer - elevated
TT - prolonged
Coag factors - low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

INR 5-8 no bleeding

A

Withhold 1-2 doses of warfarin and reduced maintenance dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

INR 5-8 w/ bleeding

A

IV Vit K (phytomenadione)
Stop warfarin and restart when INR <5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

INR >8 but no bleeding

A

Give oral Vit K (rpt if still high after 24hrs)
Stop warfarin and restart when INR <5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

INR >8 minor bleeding

A

Give IV Vit K (rpt if still high after 24hrs)
Stop warfarin and restart when INR <5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Major bleeding on wafarin

A

IV Vit K & dried PT complex (or FFP if not available)
Stop warfarin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Reversal agent for dabigatran?

A

Idaruccizumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is andexanet alfa used for?

A

To reverse apixaban & rivaroxaban in pts with life threatening or uncontrolled bleeding, IF THE BLEED IS IN THE GI TRACT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Heparin reversal agent

A

Protamine sulfate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which virus causes sickle cell aplastic crisis?

A

Parovirus B19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Most common cause of osteomyelitis in children with sickle cell

A

Salmonella enterica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Most common leukaemia in adults

A

CLL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MSCC signs / symptoms

A

Severe or progressive lumbar back pain
Nocturnal pain interfering with sleep
Localised spinal tenderness
Radicular pain
Neurological symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MASCC Risk Index Score cut off for OP tx of neutropenic sepsis

A

21 or greater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Most common causes of MSCC

A

prostate (1st), lung, breast and myeloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

peripheral blood smear in iron deficiency anaemia

A

poikilocytosis (variation in shape) and anisocytosis (variation in size). Pencil cells are typical of iron deficiency anaemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The most common virus transmitted by blood transfusion

A

parvovirus B19

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

The most common bacterial organism associated with transfusion-transmitted bacterial infection

A

Yersinia enterocolitica

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment for Transfusion-associated graft-vs-host disease

A

Supportive only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Microcytic anaemia
(MCV < 80 fl)

(6)

A

Iron deficiency anaemia

Thalassaemia

Anaemia of chronic disease (can also be normocytic)

Sideroblastic anaemia (can also be normocytic)

Lead poisoning

Aluminium toxicity (affects some haemodialysis patients but now rare)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Normocytic anaemia
(MCV 80-100 fl)

(8)

A

Haemolysis
Acute haemorrhage
Bone marrow failure
Anaemia of chronic disease (can also be microcytic)
Mixed iron and folate deficiency
Pregnancy
Chronic renal failure
Sickle-cell disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Macrocytic anaemia
(MCV > 100 fl)

(9)

A

B12 deficiency
Folate deficiency
Hypothyroidism
Reticulocytosis
Liver disease
Alcohol abuse
Myeloproliferative disease
Myelodysplastic disease
Drugs e.g. methotrexate, hydroxyurea, azathioprine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Bacterial infection is more common with what blood products

A

Platelet transfusion (as platelets are stored at room temperature)
Previously frozen components thawed by immersion in a water bath
Red cell components stored for several weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Most common type of transfusion reaction

A

Febrile transfusion reactions are the commonest type of transfusion reaction, occurring in approximately 1 in 8 transfusions.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Glanzmann’s thrombasthenia

A

is a rare platelet disorder in which platelets contain defective or low levels of glycoprotein IIb/IIIa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Distinguish iron-deficiency anaemia from anaemia of chronic disease

A

TIBC is typically increased, and serum ferritin is typically low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Auer rods most commonly seen on blood films in which disease states?

A

They are most commonly seen in acute myeloid leukaemia but can also be seen in high-grade myelodysplastic syndromes and myeloproliferative disorders.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Sickle-cell disease is caused by a point mutation in what?

A

The beta-globin chain of haemoglobin

32
Q

Febrile transfusion reaction is caused by?

A

Usually caused by cytokines from leukocytes in transfused red cell or platelet components.

33
Q

Acute haemolytic reaction is caused by?

A

Often ABO incompatibility due to administration error.

34
Q

Allergic reaction in the context of a blood transfusion is caused by?

A

Usually caused by foreign plasma proteins but may be due to anti-IgA.

35
Q

Transfusion Related Acute Lung Injury is caused by?

A

Step 1: underlying illness -> complement activation -> pulmonary sequestration of neutrophils
Step 2: transfusion -> neutrophil activation -> endothelial cell damage and capillary leak syndrome

36
Q

Graft vs host disease in the context of blood transfusions

A

Viable T lymphocytes in blood components are transfused, engraft and react against the recipient’s tissues and the recipient is unable to reject the donor lymphocytes because of immunodeficiency, severe immunosuppression, or shared HLA antigens.

37
Q
A
37
Q

Multiple myeloma is a malignant neoplasm of

A

Plasma cells

38
Q

Monitoring blood test for UFH?

A

APTT/APTTr

39
Q

Monitoring blood test for LWMH / Fondaparinux?

A

Anti-factor Xa assay

40
Q

Fondaparinux reversal agent?

A

Recombinant factor VIIa (minimal evidence)

41
Q

LMWH reversal

A

LMWH has no specific antidote for its reversal but protamine will neutralise approximately 60% of its anticoagulant effect.

42
Q

Asymptomatic / minor bleeding

Monitoring time for:

UFH
LMWH & fondiparinux

A

6 hrs

24hrs

43
Q

Dabigatran reversal agent

A

Idarucizumab

44
Q

What is used for immediate reversal of warfarin?

A

Octaplex and Beriplex

45
Q

What is seen on a blood smear in DIC?

A

Schistocytes

46
Q

Thrombotic Thrombocytopenic Purpura pathogenesis

A

Characterised by a decrease in proteolytic activity of the von Willebrand factor (vWF) cleaving enzyme ADAMTS 13, usually as a result of abnormal antibody production

47
Q

Causes of secondary ITP?

A

Infectious diseases such as HIV, Hepatitis C, Helicobacter pylori, and immunodeficiencies

Autoimmune disorders, for instance, systemic lupus erythematosus, antiphospholipid syndrome, and autoimmune thyroid disease

Lymphoproliferative disorders

ITP triggered by specific medications

Cases related to vaccine exposure

48
Q

Coagulation profile in ITP

A

Normal

49
Q

Fibrogen level in ITP

A

Normal

50
Q

D-dimer level in ITP

A

Normal

51
Q

First line treatment in ITP where treatment warrented (Platlets <30 or <50 and bleeding)

A

prednisolone: 1-2 mg/kg/day orally or methylprednisolone: 30 mg/kg/day orally or dexamethasone: 40 mg/day orally.

52
Q

Indications for Hospital Admission in ITP

A

Unclear Diagnosis
Challenges in Arranging Timely Follow-Up
Significant Bleeding
Severely Low Platelet Count (<10,000/uL)

53
Q

Sickling can produce two mechanisms that lead to pathology:

A

a shortened red cell survival and impaired passage through the microcirculation leading to obstruction and infarction.

54
Q

Hydroxycarbamide (hydroxyurea) MOA in sickle cell patients

A

It works by increasing the HbF concentration, which does not polymerise, therefore interfering with HbS polymerisation. This leads to less sickling complications.

55
Q

Important side effect of Hydroxycarbamide (hydroxyurea) in sickle cell patients

A

Importantly, it can cause neutropenia and thrombocytopenia, so check FBC if the patient is presenting with a fever or bleeding symptoms.

56
Q

Crizanlizumab MOA in sickle cell patients

A

Approved to reduce frequency of vaso-occlusive crises in patients aged 16 or over. It is a monoclonal antibody that targets an adhesion molecule on endothelium and platelets.

57
Q

Most common cause for sickle cell chest crisis (organism) ?

A

Chlamydia pneumoniae

58
Q

Acute transfusion reaction

A

Reactions occurring within 24 hours of the administration of blood or blood components

59
Q

Delayed transfusion reaction

A

Occur more than 24 hours after transfusion

60
Q

Define mild febrile transfusion reaction

and the recommended management

A

Mild – temperature ≥38°C or 1-2°C above pre-transfusion baseline

BSH guidelines recommend that patients with mild febrile reactions only are treated with oral paracetamol and the transfusion continued with close observation.

61
Q

Management of mild to moderate allergic reactions to transfusion

A

Antihistamines and slow down the transfusion

62
Q

TRALI is defined as:

A

Non-cardiogenic pulmonary oedema and acute hypoxia occurring within six hours of a transfusion in the absence of other causes of acute lung injury or circulatory overload.

63
Q

If bacterial contamination is suspected, the implicated unit should be…?

A

Sent to the lab for further testing

64
Q

Transfusion-Associated Graft-Versus-Host Disease pathophysiology

A

It is primarily observed in immunodeficient patients, where lymphocytes in a blood donation mount an immune response against the recipient’s cells.

65
Q

Which biomarker can differentiate between TACO and TRALI

A

BNP

66
Q

Treatment for Post-Transfusion Purpura

A

Treatment is with high dose intravenous immunoglobulin

67
Q

Management for patients with recurrent febrile reactions to transfusions

A

BSH guidelines recommend premedication with oral paracetamol one hour before the reaction is anticipated

68
Q

Management for patients with recurrent mild allergic transfusion reactions

A

There is no evidence to support routine prophylaxis with antihistamines or corticosteroids

69
Q

Management for patients with recurrent moderate to severe allergic reactions

A

Antihistamine prophylaxis and transfusion of washed products can be considered

70
Q

Cells in the Myeloid lineage

A

Neutrophils, eosinophils, basophils, monocytes and platelets

71
Q

Cells in the Lymphoid lineage

A

B-lymphocytes, T-lymphocytes and NK-cells

72
Q

Leukaemia =

A

Refers to the presence of malignant cells in the peripheral blood

73
Q

Lymphoma =

A

malignant proliferation of lymphocytes; which can present with lymphadenopathy or with diseased cells within the blood (i.e. a leukaemia

74
Q

Threshold for diagnosis of leukaemia on a blood film / bone marrow

A

m. A diagnosis of acute leukaemia is made if blasts account for over 20% of the total white cell count in either peripheral blood or bone marrow

75
Q

Predominant cell in CLL?

A

B cells

76
Q

Causes of ‘target cells’ on blood films include:

A

Sickle cell
Thalassaemia
Liver disease
Iron-deficiency anaemia
Post splenectomy
Haemoglobin C disease

77
Q

The most common virus transmitted by blood transfusion:

A

Parovirus, B19

MRCEM INTERMEDIATE (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions