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Year 5 MBChB > JB-Blood > Flashcards

JB-Blood Flashcards

1
Q

Where is most iron absorbed

A

Duodenum and jejunum

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2
Q

One medication and two conditions most associated with poor iron absorption

A

PPIs
Crohns and Coeliac
(Menstruation)

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3
Q

When is iron contraindicated

A

In patients with sepsis as ‘feeds’ infection

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4
Q

Key question to ask in anaemia hx

A

Menstruation history
GI

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5
Q

Difference between anaemia of chronic disease and iron deficiency

A

TIBC low in AOCD, high in IDA
Ferritin high in AOCD, low in IDA

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6
Q

5 causes of microcytic anaemia

A

TAILS

Thalassaemia
Anaemia of chronic disease
IronDA
Lead poisoning
Sideroblastic anemia

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7
Q

Test for pernicious anaemia

A

FBC + B12
Intrinsic factor antibodies

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8
Q

Group of symptoms found in pernicious anaemia

A

Neurological

Peripheral neuropathy
Loss of vibration and proprioception
Visual changes and mood changes

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9
Q

Pernicious anaemia treatment

A

Oral B12 only works in pts with dietary deficiency

B12 IM (hydroxycobalamin) 3 times weekly for 2 weeks then 3 monthly

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10
Q

In patients with B12 and folate deficiency what must be treated first

A

B12 first

Folic acid to B12 deficiency patients can cause degeneration of cord

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11
Q

How to differentiate IronDA and minor thalasemia on FBC

A

MCV very very low in minor thalassemia (20/30)

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12
Q

IDA, glossitis and dysphagia/ oesophageal web

A

Plummer Vinson syndrome

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13
Q

When are hypersegmented neutrophils seen

A

Macrocytic anaemia (B12)

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14
Q

Clinical difference between B12 and folate deficiency

A

No neurological defect in folate deficiency

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15
Q

Disease where swellings get more painful with alcohol

A

Lymphoma (normally non-tender rubbery)

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16
Q

Age distribution of lymphoma

A

Bimodal
20 and 75 years

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17
Q

Key finding on biopsy in patients with Hodgkin lymphoma

A

Reed-Sternberg cells present

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18
Q

Appearance of Reed Sternberg cells

A

Abnormally large B cells
Multiple nuclei
(look like an owl)

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19
Q

Staging criteria in lymphoma

A

Ann Arbor

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20
Q

What infection is MALT lymphoma associated with

A

H pylori

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21
Q

Key diagnostic history in diffuse large B cells lymphoma

A

Rapidly growing single painless mass in pt over 65

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22
Q

Unique chemical risk factor in lymphoma

A

Pesticide (trichloroethylene)

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23
Q

What is myeloma a cancer of

A

Plasma cells (B antibodies)

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24
Q

What is MGUS

A

Monoclonal gammopathy of undetermined significance

An excess of a single type of antibody which out features of cancer.

It may progress to myeloma so must be closely monitored

25
Q

What is Smouldering myeloma

A

Progression of MGUS

Increasing number of antibodies are formed.

Increased chance of myeloma

25
Q

What is Smouldering myeloma

A

Progression of MGUS

Increasing number of antibodies are formed.

Increased chance of myeloma

26
Q

What is a Bence Jones protein and why is it significant

A

Protein in urine of patients with myeloma from Ab breakdown

27
Q

Urine test in myeloma patients

A

Bence Jones protein

28
Q

Calcium level in myeloma

A

Raised

Increased osteoclast activity as increased cytokines from all the plasma cells

29
Q

Myeloma effect on bones

A

Increased osteoclast and suppressed osteoblast activity

More bone is absorbed than constructed

Pathological fractures and osteolytic (thin) bone

30
Q

Effect of myeloma on kidneys

A

Myeloma renal disease

High ab levels block flow of blood through tubules

High levels of Ca2+ and therefore dehydration

31
Q

4 key features of myeloma

A

CRAB

Calcium (raised)
Renal failure
Anaemia (normocytic)
Bone lesions

32
Q

Two key investigations if patient has signs of myeloma on routine bloods

A

Serum protein electrophoresis
Urine Bence-Jones protein

33
Q

Myeloma effect of blood viscosity

A

Increased

(?sticky blood as more Ab’s)

34
Q

Effect of myeloma on FBC

A

Anaemia (normal MCV)
Low WBCs
ESR raised
Plasma viscosity raised

35
Q

Investigation to confirm myeloma

A

Bone marrow biopsy

36
Q

X ray signs of myeloma

A

Punched out lesions
Lytic lesions
Raindrop skull

37
Q

What is Thalassemia

A

A inherited condition which results in a reduction in the production of haemoglobin

38
Q

What blood film is seen in thalassemia

A

Schistocytes (fragments of RBCs)

39
Q

What special test is used to diagnose autoimmune haemolytic anaemia

A

Direct Coombs test

40
Q

What is the most common cause of haemolytic anaemia (in Europeans

A

Hereditary spherocytosis

41
Q

Most common presentation in patients with undiagnosed hereditary spherocytosis

A

Aplastic crisis (with parvovirus infection), jaundice, gallstones, splenomegaly.

42
Q

Treatment of hereditary spherocytosis

A

Folate and splenectomy (+/- cholecystectomy)

43
Q

Blood film finding in patients with G6PD deficiency

A

Heinz bodies

44
Q

Inheritance of G6PD

A

X linked

45
Q

Common causes of G6PD triggers

A

Fava beans, antimalarials, ciprofloxacin sulfasalazine, sulfonyureas (other sulphonamide drugs)

46
Q

Two types of Autoimmune Haemolytic Anaemia

A

Warm - idiopathic

Cold - antibodies attach themselves to RBC at temperatures below 10C. Often secondary to other conditions (blood cancers, SLE, EBV, HIV)

47
Q

What type of Autoimmune Haemolytic Anaemia is normally secondary?

A

Cold - blood cancers, SLE, EBV, HIV

48
Q

Two types of Alloimmune Haemolytic Anaemia

A

Transfusion reactions and haemolytic disease of the newborn

49
Q

Key complication of prosthetic heart valves

A

Haemolytic anaemia

50
Q

Inheritance of thalassemia

A

AR

51
Q

Possible effect on facial features in thalassemia

A

Pronounced forehead
Malar eminences (cheek bones)

Caused by expanding bone barrow

52
Q

MCV in thalassemia

A

Low

53
Q

Diagnosis of thalasseamia

A

Haemoglobin electrophoresis/ DNA testting

Offered to pregnant women at booking

54
Q

Most common complication of thalassaemia

A

Iron overload

55
Q

What is Richter’s transformation

A

CLL transforms to high grade non-Hodgkin lymphoma.

Patients become suddenly unwell with B symptoms

56
Q

CLL -> lymphoma non-Hodgkin transformation name

A

Richters

57
Q

How is sickle cell anaemia confirmed

A

Haemoglobin electrophoresis

58
Q

Key drug in sickle cell management

A

hydroxyurea

Increases HbF

Year 5 MBChB (17 decks)

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