mock questions Flashcards
what can malaria be caused by?
5 species of the same family
(plasmodium). Plasmodium falciparum = can cause most severe form of malaria
(complicated malaria) and has the highest mortality, it is most prevalent in Sub-Saharan
Africa. Others include: plasmodium ovale, plasmodium vivax, plasmodium malariae ,
plasmodium knowlesi
how is TTP treated?
plasma exchange (replenishes ADAMTS13 and removes antibody).
how is venous thromboembolism in post-hip replacement patients managed?
thromboprophylaxis with either a low molecular weight heparin administered for 10 days
followed by low-dose aspirin for a further 28 days, or a low molecular weight heparin
administered for 28 days in combination with anti-embolism stockings until discharge,
or rivaroxaban
what is the target for rituximab?
CD20, cancer drug used in CLL and NHL
what is the first line treatment for severe complicated malaria?
IV arthesunate
what is felty’s triad?
neutropenia, splenomegaly, RA
how would hereditary spherocytosis be treated?
splenectomy
what make malaria complicated?
characterised by vascular occlusion which can affect different organs therefore causing specific symptoms
what is TTP?
deficiency in ADAMTS13 enzyme causing vWF to thromboses, leads to raised bilirubin
what is secondary polycythaemia caused by?
Alcohol
Chronic hypoxia
Obstructive sleep apnoea
Living at altitude
Lung disease affecting oxygen transfer
Smoking (In hypoxic conditions, kidneys release high levels of EPO and hence more RBC are produced)
In abnormal conditions, it could be a tumour secreting EPO, GGWP.
what would be seen on the blood film of someone with multiple myeloma?
rouleaux formation
what would be seen in the urine of someone with multiple myeloma?
bence jones proteins
what cells are affected in multiple myeloma?
plasma cells
what type of crises can be suffered by patients with sickle cell?
- vaso-occlusive - occlusion of vessles, swelling in hands and feet due to distal occlusion
- Splenic sequestration crisis – where the blood flow in the spleen is compromised, resulting in acute splenomegaly and pain. This results in pooling of blood which can lead to severe anaemia and circulatory collapse hypovolaemic shock
- Aplastic crisis – temporary loss of the creation of new blood cells – commonly triggered by parvovirus B19 infection. Leads to significant anaemia – supportive management may require blood transfusions.
- Acute chest syndrome – vasoocclusie crisis of pulmonary vasculature. diagnosed when there is fever or respiratory symptoms with new infiltrates seen on chest x-ray – may be due to infection such as pneumonia or bronchiolitis, or due to pulmonary vaso-occlusion. This is an emergency – high mortality rate. Requires prompt supportive management and treatment of underlying cause (antibiotics or antivirals, blood transfusion, incentive spirometry, intubation may be required).
how is a vasoocclusive sickle cell crisis managed in hospital?
Management is supportive: have a low threshold for hospital admission due to risks of complications.
- Treat underlying infection
- Keep warm
- Maintain good hydration – IV fluids
- Simple analgesia (paracetamol and ibuprofen if not contraindicated)
in which type of leukaemia would you fine auer rods on the blood smear?
AML
in vitamin B12 anaemia, what blood test would you carry out and what would be the results?
- FBC ↓Hb ↑MCV (macrocytic anaemia) - Blood film Hypersegmented neutrophils (>5 lobes) and presence of oval macrocytes - Serum cobalamin ↓
what is the most common cause of B12 anaemia?
pernicious anaemia
what features in a history would point towards pernicious anemaia?
other autoimmune disease
what tests are needed to diagnose pernicious anaemia?
Test for antibodies: parietal cell and intrinsic factor (specific) antibodies
what is the most common cell of origin for NHL?
B lymphocytes
which autoantibody does warm autoimmune heamolytic anaemia involve?
IgG
what would be seen on a bold smear in both PBS and G6PD deficiency?
bite cells and heinz bodies
what is the direct antiglobulin test (Coombs’) used to distinguish?
autoimmune from non-immune aetiologies of haemolytic anaemia
what happens to hepatoglobulin levels in haemolytic anaemia?
decreased
what is haemolytic uraemic syndrome?
triad of microangiopathic haemolytic anaemia, thrombocytopenia and renal impairment.
Most are diarrhoea-associated (caused by Shiga-toxin producing E.coli) in children
Blood test results show:
FBC: anaemia and thrombocytopenia
Haemolysis: LDH, bilirubin
Peripheral blood smear: schistocytes
U&E: raised creatinine and electrolyte abnormalities
Management is mainly supportive
what is the trestment for mild uncomplicated malaria?
oral hydroxychloroquine
what changes would you see on the blood film of someone with iron deficiency anaemia?
hypochromic, poikilocytosis microcytic, anisocytosis
what causes microcytic anaemia?
iron deficiency, thalassaemia, chronic disease, sideroblastic
what are 4 signs of iron deficiency anaemia?
Koilonychia (spoon shaped nails), angular stomatitis, atrophic glossitis, pallor
what are the complications of PV?
dizziness, itching, haemorrhage and thrombosis
which plasmodium can cause relapses of malaria?
P. ovale and P. vivax
how is multiple myeloma characterised?
Monoclonal protein in serum or urine
- Lytic bone lesions/ CRAB end organ damage
- Excess plasma cells in bone marrow
what is the most common chromosomal abnormality in multiple myeloma?
t (11;14)
You see a 50-year-old male in A&E who has presented with breathlessness, bone pain and a severe infection.
His temperature is 39.1, his heart rate is 110 and his blood pressure is 130/85. He tells you this is the 3rd
severe infection he has had in 6 months and thinks they are causing him to lose weight. On examination, you
note hepatosplenomegaly and see some gum hypertrophy.
AML
what are 2 things associated with multiple myeloma?
downs syndrome, raditation
what are the treatments fo multiple myeloma?
Blood transfusion Allopurinol (to prevent tumour lysis) IV antibiotics Chemotherapy Steroids Bone marrow transplant
what age would you expect someone with CLL to be?
over 70
what would you notice on examination of someone with CLL?
Enlarged, rubbery, non-tender lymph nodes
Sweating, anorexia
Commonly asymptomatic
what would be seen on the blood smear of someone with CLL?
smudge cells
how is CLL treated?
Chemotherapy
Monoclonal antibodies (rituximab)
Bruton kinase inhibitors (ibrutinib)
what is a complication of CLL?
Richter’s syndrome – transformation of CLL to an aggressive lymphoma
what does G6PD do?
It protects the RBCs against oxidative damage
what are the common symptoms of G6PD deficiency?
Fatigue, palpitations, shortness of breath, pallor
what would be seen on a blood smear of someone with G6PD deficiency?
bite cells, reticulocytes
which antibiotic should be avoided in G6PD deficiency?
nitrofuratoin - can cause severe haemolytic anaemia
what are the 6 Ps of critical limb ischaemia?
pain, pallor, perishingly cold, pulselessness, paralysis, paraesthesia
what is the process of disseminated intravascular coagulation?
Tissue damage (from ARDS) will cause release and activation of tissue factor. This leads to
widespread clot formation and the consumption of platelets and coagulation factors (thrombosis
formation).A lso, the Tissue Plasminogen Activator is activated leading to increased fibrinolysis
hence clotting is removed but increased risk of bleeding.
Tissue Factor Release causes coagulation from both intrinsic & extrinsic pathways ➔ THROMBOSIS
Thrombus are broken down by Fibrinolysis ➔ BLEEDING
what is the SEPSIS 6?
Give: Fluids, Broad spectrum Abx, Administer O2 if required Take: Bloods, Urine Output, Lactate
levels
how are haemophilia A and B inherited?
X linked recessive
how is haemophilia C inherited?
autosomal recessive
what clotting factors are affected in haemophillia?
A=8, B=9, C=11
what is platelet count?
level of platelets. A normal platelet count ranges from 150,000 to
450,000 platelets per microliter of blood.
what is bleeding time?
- Bleeding time is a laboratory test to assess platelet function and the body’s ability to
form a clot.
what is prothrombin time?
The prothrombin time is a measure of the integrity of the extrinsic and final common pathways of
the coagulation cascade. This consists of tissue factor and factors VII, II (prothrombin), V, X, and
fibrinogen.
what is APTT?
– a measure of the functionality of the intrinsic and common pathways of the coagulation
cascade.
what is thrombin time?
– Thrombin time is a screening coagulation test designed to assess fibrin formation
from fibrinogen in plasma.
The reference range for the thrombin time is usually less than 20 seconds
what is fibrin degredation products testing for?
Fibrin and fibrinogen-degradation product (FDP) testing is commonly
used to diagnose disseminated intravascular coagulation (DIC).
what is D-dimer?
D-dimer is the degradation product of crosslinked (by factor XIII) fibrin. It reflects ongoing
activation of the hemostatic system.
which blood tests would be affected in haemophilia?
APTT and possibly TT would be increased
what is spherocytosis?
caused by a defect in the red cell membrane, which causes them to lose part of their membrane as they pass through the spleen. This abnormality is then associated with an increased permeability to sodium ions
how would you treat at DVT that was unprovoked and no cause was identified?
apixaban for 6 months
what is the chance of a daughter inheriting an X-link recessive condition where the father has the disease and the mother is a carrier?
50%
what would signify a poor prognosis in AML?
WCC>20 at time of diagnosis
what is an anaemia with a low haemoglobulin but a high reticulocyte count?
sickle cell anaemia
what is the gold standard treatment for haemochromatosis?
therapeutic phlebotomy
what would the copper levels be in the serum of someone with wilson’s disease?
low
what can be given to prevent sickle cell crisis?
hydroxycarbamide
what are the symptoms of CLL?
bleeding, infection, abdo pain, fatigue, weight loss
what is the gold standard investigation for diagnosing CLL?
immunophenotyping
what are the treatment options for CLL?
chemo, radiotherapy, stem cell transplant, splenectomy
what is it called when CLL turns into NHL?
richter’s transformation
what is acute promyelocytic leukaemia?
APL is an aggressive form of AML - This build up of promyelocytes leads to a shortage of normal white and red blood cells and platelets in the body.
how does von willebrand disease affect APTT?
prolonged, affects the intrinsic pathway
what would a d-dimer score over over 2 indicate?
treat with compression ultrasound
how is ITP treated?
prednisolone
what is the mechanism of action of clopidogrel?
Clopidogrel is an antiplatelet medication like aspirin, but acts as an ADP-receptor antagonist by binding irreversibly to ADP receptors on the surface of platelets
what are the risk factors for folate deficiency?
being elderly; malabsorption due to coeliac or Crohn’s disease; alcoholism; and low intake of green vegetable
what is SEPSIS 6?
Blood cultures, Urine sample, Fluids, Antibiotics, blood Lactate, and Oxygen.
what would a gram positive cocci with a positive catalase test suggest?
a staphlococcus?
which staph would have a positive coagulase?
staph aureas
what is DIC?
causes a systemic activation of coagulation, eventually leading to the consumption of platelets and clotting factors which results in bleeding. Patients are often acutely unwell (e.g. severe sepsis).
what are the chances of being a carrier of sickle cell disease if a sibling has the disease but both parents don’t?
67%
50% of being a carrier but know NOT to have disease so 2/3 not 2/4
