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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
What is Smouldering myeloma
Progression of MGUS Increasing number of antibodies are formed. Increased chance of myeloma
25
What is Smouldering myeloma
Progression of MGUS Increasing number of antibodies are formed. Increased chance of myeloma
26
What is a Bence Jones protein and why is it significant
Protein in urine of patients with myeloma from Ab breakdown
27
Urine test in myeloma patients
Bence Jones protein
28
Calcium level in myeloma
Raised Increased osteoclast activity as increased cytokines from all the plasma cells
29
Myeloma effect on bones
Increased osteoclast and suppressed osteoblast activity More bone is absorbed than constructed Pathological fractures and osteolytic (thin) bone
30
Effect of myeloma on kidneys
Myeloma renal disease High ab levels block flow of blood through tubules High levels of Ca2+ and therefore dehydration
31
4 key features of myeloma
CRAB Calcium (raised) Renal failure Anaemia (normocytic) Bone lesions
32
Two key investigations if patient has signs of myeloma on routine bloods
Serum protein electrophoresis Urine Bence-Jones protein
33
Myeloma effect of blood viscosity
Increased (?sticky blood as more Ab's)
34
Effect of myeloma on FBC
Anaemia (normal MCV) Low WBCs ESR raised Plasma viscosity raised
35
Investigation to confirm myeloma
Bone marrow biopsy
36
X ray signs of myeloma
Punched out lesions Lytic lesions Raindrop skull
37
What is Thalassemia
A inherited condition which results in a reduction in the production of haemoglobin
38
What blood film is seen in thalassemia
Schistocytes (fragments of RBCs)
39
What special test is used to diagnose autoimmune haemolytic anaemia
Direct Coombs test
40
What is the most common cause of haemolytic anaemia (in Europeans
Hereditary spherocytosis
41
Most common presentation in patients with undiagnosed hereditary spherocytosis
Aplastic crisis (with parvovirus infection), jaundice, gallstones, splenomegaly.
42
Treatment of hereditary spherocytosis
Folate and splenectomy (+/- cholecystectomy)
43
Blood film finding in patients with G6PD deficiency
Heinz bodies
44
Inheritance of G6PD
X linked
45
Common causes of G6PD triggers
Fava beans, antimalarials, ciprofloxacin sulfasalazine, sulfonyureas (other sulphonamide drugs)
46
Two types of Autoimmune Haemolytic Anaemia
Warm - idiopathic Cold - antibodies attach themselves to RBC at temperatures below 10C. Often secondary to other conditions (blood cancers, SLE, EBV, HIV)
47
What type of Autoimmune Haemolytic Anaemia is normally secondary?
Cold - blood cancers, SLE, EBV, HIV
48
Two types of Alloimmune Haemolytic Anaemia
Transfusion reactions and haemolytic disease of the newborn
49
Key complication of prosthetic heart valves
Haemolytic anaemia
50
Inheritance of thalassemia
AR
51
Possible effect on facial features in thalassemia
Pronounced forehead Malar eminences (cheek bones) Caused by expanding bone barrow
52
MCV in thalassemia
Low
53
Diagnosis of thalasseamia
Haemoglobin electrophoresis/ DNA testting Offered to pregnant women at booking
54
Most common complication of thalassaemia
Iron overload
55
What is Richter's transformation
CLL transforms to high grade non-Hodgkin lymphoma. Patients become suddenly unwell with B symptoms
56
CLL -> lymphoma non-Hodgkin transformation name
Richters
57
How is sickle cell anaemia confirmed
Haemoglobin electrophoresis
58
Key drug in sickle cell management
hydroxyurea Increases HbF

Year 5 MBChB (17 decks)

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