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MRCP Part 1 > MRCP Haem > Flashcards

MRCP Haem Flashcards

1
Q

Triad:
Haemolytic anaemia
pancytopenia
Large vessel thrombosis

  • Dark urine
  • microscopic haematuria
  • no red cell in microscope
A

PNH
paroxysmal nocturnal haemoglobinuria
intravascular haemolysis
associated with VTE
Mx: eculizumab monoclonal antibody inhibit complement

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2
Q

Ferritin

A

Normal- not iron deficient
In inflammation may mask IDA

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3
Q

Beta thalassaemia

A

trait
- microcytic anaemia, raised HbA2

major
- no beta globulin, chr 11, microcytic anaemia, raised HbA2 and HbF, absent HbA

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4
Q

NHL

A

painless LN
B symptoms
cytopenia
extranodal disease
raised LDH in proliferative

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4
Q

Most common extranodal lymphoma

A

upper GI tract

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5
Q

Haematological cause of nephrogenic DI

A

sickle cell

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6
Q

PNH gene defect in…

A

PIG A gene

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7
Q

Von willebrand disease types

A

Types
type 1: partial reduction in vWF (80% of patients)
type 2*: abnormal form of vWF
type 3**: total lack of vWF (autosomal recessive)

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8
Q

Management of von willebrand disease

A

Management
- tranexamic acid for mild bleeding
- desmopressin (DDAVP): raises levels of vWF by inducing release of vWF from Weibel-Palade bodies in endothelial cells
- factor VIII concentrate

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9
Q

Heparin-induced thrombocytopaenia (HIT)

A

bind to the PF4-heparin complexes on the platelet surface and induce platelet activation

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10
Q

Anaemia and jaundice

A

HAEMOLYTIC ANAEMIA

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11
Q

Raised reticulocytes mean…

A

intravascular haemolysis

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12
Q

When is osmotic fragility high?

A

hereditary spherocytosis

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13
Q

Howel jolly bodies indicate…

A

hyposplenism

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14
Q

Crohns patient with macrocytic anaemia

A

terminal ileal disease

B12 and folate deficiency

without b12, RBC cannot mature -> haemolyse

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15
Q

When to do haemoglobin electrophoresis

A

non white patient with microcytic anaemia

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16
Q

Aplastic anaemia

A

pancytopenia
hypoplastic bone marrow

Mx: haematopoietic stem cell transplant

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17
Q

Lead poisoning associated with…

A

normocytic anaemia with sideroblastic change

accumulation of **iron around nuclei **of developing RBC

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18
Q

Invasive aspergillosis test

A

galactomannan test via ELISA

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19
Q

vitamin K dependent clotting factors

A

1972
2, 7, 10, 9

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20
Q

Poor prognosis for AML

A

AGE > 60 years
more than > 20% blasts after first course of chemo
cytogenetics: deletions of chromosome 5 or 7

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21
Q

Acute promyelocytic leukaemia M3

A

associated with t(15;17)
fusion of PML and RAR-alpha genes
presents younger than other types of AML (average = 25 years old)
Auer rods (seen with myeloperoxidase stain)
DIC or thrombocytopenia often at presentation
good prognosis

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22
Q

CML

A

BCR/ABL fusion gene (philadephia)
9:22
tyrosine kinase production
mx: imatinib (tyrosine kinase inhibitor)

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23
Q

Acute transfusion reaction

A
  1. non haemolytic febrile reaction
    - paracetamol
  2. minor allergic reaction
    - antihistamine
  3. anaphylaxis
    - stop transfusion IM adrenalione
  4. Acute haemolytic reaction (ABOincompatible)
    - direct coombs test, stop transfusion
  5. TACO
    - stop and give diuretics
  6. TRALI
    - stop transfusion
    - anti HLA antibodies donor
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24
Q

Acute haemolytic reaction (ABOincompatible) presents as…

A

tachycardia
back pain

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25
Q

Which immune cell does CLL affect

A

B cell disorder

blood film: smudge cells (also known as smear cells)

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26
Q

Thrombocytopenia with VTE risk and miscarriages

A

Antiphospholipid syndrome

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27
Q

Polycythaemia

A

primary:
- JAK 2+ve
- polycythaemia vera
- pruritis and splenomegaly

secondary:
- JAK -ve
- hypoxia —> EPO
- COPD/fibrosis/altitude

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28
Q

Haemophilia A and B inherited pattern

A

X linked recessive
BOYS get it
women can be carriers

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28
Q
A
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29
Q

Ann arbor staging for Hodgkins

A

I: single lymph node
II: 2 or more lymph nodes/regions on the same side of the diaphragm
III: nodes on both sides of the diaphragm
IV: spread beyond lymph nodes

Type:
A = no systemic symptoms other than pruritus
B = weight loss > 10% in last 6 months, fever > 38c, night sweats (poor prognosis)

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30
Q
A
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31
Q

Hodgkin 2 types

A

nodular lymphocyte predominant
- good prognosis

classical hodgkins lymphoma
- nodular sclerosis
- mixed cellularity
- lymphocyte rich
- lymphocyte depletes

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32
Q

Coagulation factor deficiency…

A

prolonged PT and APTT

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33
Q

Causes of cold agglutinin

autoantibodies react at <37 degrees

A

Lymphoproliferative
- non hodgkins

infections
- mycoplasma
- EBV

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34
Q

What vitamin aids iron absorption

A

vitamin C

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35
Q

HRT risk proportion

A

DVT: 2-3 times risk
Breast ca: 1 in 1000/yr

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35
Q

CLL investigation

A

**blood film: smudge cells **(also known as smear cells)
immunophenotyping is the key investigation
most cases can be identified using a panel of antibodies specific for CD5, CD19, CD20 and CD23

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36
Q

Another name for immunophenotyping

A

Flow cytometry

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37
Q

Antiphospholipid syndrome management of clots

A

lifelong with target INR 2-3

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38
Q

Diagnostic criteria for antiphospholipid syndrom

A

antibody should be rechecked after 3 months to ensure persistence

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39
Q

Anaemia causes…

A

retinopathy including haemorrhage

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40
Q

Haemolytic anaemia due to primaquine

A

G6PD deficiency
heinz bodies (denatures haemaglobin)

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41
Q

Side effects of vincristine

A

peripheral neuropathy

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42
Q

DIC

A

prolonged clotting time
low fibrinogen

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43
Q

Sickle cell anaemia

A

howell jolly body (hyposplenism)
frontal bossing of skull

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44
Q

Spleen size difference between sickle cell and thalassaemia

A

sickle cell- hyposplenism from infarct
thalassaemia- megaly due to haematopoiesis

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45
Q

Secondary polycythaemia due to hypoxia…

A

increased affinity haemoglobin

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46
Q

What is reactive thrombocytosis

A

infection/inflammation/surgery etc causing increased plt

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47
Q

Complication of multiple blood transfusion

A

iron overload –> pericarditis

Mx: iron chelator desferrioxamine

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48
Q

Italian women with Hypochromic microcytic anaemia
nucleated RBC

A

Thalassaemia

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49
Q

Pancytopenia

A

Bone marrow disorder

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50
Q

Elderly
lymphocytosis
splenomegaly
pancytopenia

A

CLL

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51
Q

Diarrhoea
abdo pain
AKI
rash in lower limbs

A

HUS

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52
Q

ITP

A

isolated thrombocytopenia
brusing and bleeding

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53
Q

Myeloproliferative - myelofibrosis

A

fibroblast overstimulation
splenomegaly
high WCC and plt
tear drop poikilcytes blood film
dry tap on marrow biopsy

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54
Q

Isolated prolonged APTT

A

antiphospholipid syndrome

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55
Q

Idiopathic hypereosinophilic syndrome

A

steroids to treat

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56
Q

AML chromosome associated with///

A

5 or 7

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57
Q

Myeloproliferative disorder may transform into…

A

AML

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58
Q

Irradiated blood is for…

inactivated donor lymphocyte

A

CLL on purine analogue are T cell depleted hence risk of graft vs host

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59
Q

GVHD ….

A

Allogenic bone marrow transplant
T cell in donor mount immune on host
NOT a transplant rejection
Acute - within 100 days (skin, liver, GI)
Chronic- after 100 days (+lung, eyes)

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60
Q

Managmenent of GVHD

A

Steroids

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61
Q

reversal of alteplase (tPA)

A

FFP

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62
Q

Beta thalassaemia common in which ethnic groups

A

Mediterranean
Middle east
Central and south east asia

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63
Q

Auer rods seen in…

A

AML

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64
Q

(Richter’s transformation)

A

CLL transformation to high-grade lymphoma

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65
Q

(Richter’s transformation)

A

lymph node swelling
fever without infection
weight loss
night sweats
nausea
abdominal pain

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66
Q

Most common inherited prothrombotic disorder

A

Factor V Laden

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67
Q

Cytotoxic Purine analogue abx prophylaxis

affects t cell function

A

co-trimoxazole for PCP

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68
Q

Capecitabine vs 5-FU

A

5-FU -fluiiidd (intravenous)

capecitabine (prodrug of 5FU)

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69
Q

Common side effect of imatinib

A

nausea

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70
Q

Tumour lysis syndrome prevention

A
  • IV fluids
  • higher risk s- allopurinol or rasburicase
  • rasburicase- high risk group
    a recombinant version of urate oxidase
  • allopurinol- lower-risk groups
  • rasburicase and allopurinol should not be given together
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71
Q

G6PD hallmarks

A

red blood cell enzyme defect Mediterranean and Africa
inherited in an X-linked recessive drugs can precipitate a crisis as well as infections and broad (fava) beans
reduced NADPH

72
Q

Haemolytic anaemia

A

reduced haptoglobulin
raised reticulocytes

73
Q

Waldenstrom’s macroglobulinaemia

A

Low grade lymphoma
monoclonal IgM (Walden and M) paraprotein
hyperviscosity syndrome
cryoglobulinaemia e.g. Raynaud’s`

W upside down M

74
Q

Koilonychia

75
Q

CD20 targetted therapy for..

A

lymphoma (B cell)
Rheumatoid arthritis

76
Q

Anicytosis

variation in RBC size

A

macrocytic anaemia due to B12 deficiency

77
Q

Gallstones and anaemia

A

Hereditary spherocytosis

77
Q

Which medication should be checked with Haem for VWD?

A

NSAID (affects plt aggregation)

79
Q

Most common sx of myelofibrosis

80
Q

Burkitts lymphoma

A

c-Myc
high grade NHL

81
Q

T(11;14)

A

Mantle cell lymphoma

82
Q

t(14;18)

A

follicular lymphoma

83
Q

Aplastic crisis

A

parvovirus

joint pain
fever
facial rash

84
Q

ITP antibody

A

Antibodies against the glycoprotein IIb/IIIa or Ib-V-IX complex.

85
Q

Evan’s syndrome

A

ITP + autoimmune haemolytic anaemia (AIHA)

Mx: steroid

86
Q

Management of ITP

A

Prednisolone
IVIG
Splenectomy

87
Q

ALL poor prognosis

A

age < 2 years or > 10 years
WBC > 20 at diagnosis
T or B cell surface markers
non-Caucasian
male sex
presence of philadelphia Chr

89
Q

Fat embolism syndrome

A

recent traumatic fracture
petechiae in upper body and axillae

90
Q

Hodgkins

A

supraclavicular
mediastinal
young patient

91
Q

Prolonged PT

A

Lack of vit K dependent clotting factors
1972

92
Q

False positive VDRL

A

Antiphospholipid syndrome

93
Q

VWD

A

autosomal dominant
post op bleed
nose bleed
menorrhagia

94
Q

Most common inherited clotting disorder

95
Q

Most common inherited bleeding disorder

96
Q

Most common cause of death in CLL

97
Q

LMWH action

A

potentiates antithrombin 3

98
Q

Major complication of polycythaemia vera

A

bleeding
thrombosis

99
Q

Platelet target

A

more than 20 if fever
more than 10 if no fever

100
Q

Bite cells on blood film

101
Q

rbc life span

A

120 days

17 days in sickle

102
Q

TTP pentad

A

FATRN

fever
anaemia
thrombocytopenia
renal
neurological symptom

102
Q

mycosis fungoides

A

T-cell lymphoma that affects the skin.

103
Q

Fragment cells on blood film

104
Q

Hairy cell leukaemia

A

BRAF mutation

105
Q

Sideroblastic anaemia

A

genetic
increased iron stores in RBC (mitochondria)
- ringed sideroblasts around the nuclei

107
Q

Myelodysplastic syndrome

A

older population
can lead to AML
unexplained cytopenia and macrocytosis
Ix: bone marrow biopsy + cytogenetic

108
Q

Haemophilia A and B

109
Q

haemophilia A complication

A

factor 8 inhibitor can happen in multiple factor 9 infusions

110
Q

Methaemaglobinaemia

A

drugs: sulphonamides, nitrates (including recreational nitrates e.g. amyl nitrite ‘poppers’), dapsone, sodium nitroprusside, primaquine
chemicals: aniline dyes

methylene blue

112
Q

Cabot rings

A

lead poisoning

113
Q

Warfarin reduced effect by…

A

azathioprine
COCP
carbamazepine

114
Q

Poor prognosis of hodgkins

A

LYMPHOCYTE DEPLETED

115
Q

Post transplant complications

A

most common:
- skin cancer

second most common:
- lymphoma

116
Q

Management of essential thrombocytosis

A

aspirin and hydroxycarbamide (reduce plt)

117
Q

Long term risk of radiotherapy

A

secondary cancer

118
Q

Which leukaemia can lead to DIC

119
Q

Complication of heparin induced thrombocytopenia

A
  • THROMBOCYTOPENIA
  • THROMBOSIS
120
Q

Painless lymph node in neck
PUO

121
Q

Which heparin has higher risk of HIT

A

UFH > LMWH

122
Q

Thrombocytopenia on chemotherapy

A

myelosuppression

123
Q

What is the most important prognostic factor for AML

A

cytogenetics:
- poor - Chr 5 or 7
- good - t(8:21) or 16

124
Q

Action of desmopressin in haemophilia A

A

leads to release of pre-formed VWF –> bind to factor 8 and prolong factor 8 lifespan

125
Q

Complication of myeloproliferative disorder

126
Q

Myeloproliferation

A

raised wcc
raised plt

127
Q

Long term complication of chemotherapy and radiotherapy

128
Q

Why do you see raised LDH and BR

A

haemolysis

129
Q

basophilic stippling

A

lead poisoning
impaired Hb synthesis
alcoholism
megaloblastic anemias

130
Q

Pappenheimer body
- iron containing inclusion body in reticulocyte

A

myelodysplastic syndrome (MDS), sideroblastic anemia
hemolytic anemia
lead poisoning
sickle cell disease.

131
Q

adult T cell leukaemia/lymphoma

A

HTLV1 virus
skin lesion
lymphadenopathy

132
Q

Lymphoma diagnosis

A

EXCISION biopsy

133
Q

Felty syndrom

A

neutropenia
splenomegaly
rheumatoid arthritis

134
Q

G6PD drug induced

A

heinz body –> oxidised –> removed by spleen –> extravascular haemolysis –> bite cells

135
Q

Black water fever

A

falciparum + malariae spp
acute jaundice, haemolysis, AKI
due to acute anaemia

follows acute treatment for malaria

136
Q

Significant splenomegaly

A

CML
- raised WCC
Myelofibrosis
- pancytopenia

138
Q

Most useful test for haemolysis vs aplastic anaemia

A

reticulocyte count
- high in haemolysis
- low in aplastic anaemia

139
Q

Methaemoglobinaemia

A

oxidation of Fe2+ to Fe3+

140
Q

Antiphospholipid syndrome with x2 VTE

A

Lifelong warfarin

141
Q

TTP treatment

A

urgent plasma exchange

142
Q

TTP

A

deficiency of ADAMTS13
overlaps with haemolytic uraemic syndrome (HUS)

143
Q

Prolonged bleeding time does not occur in

A

Haemophilia

144
Q

beta thalassaemia trait

A

low HbF
high HbA2

145
Q

Parvomyxovirus

A

measles
mumps

146
Q

Aplastic crisis

A

pancytopenia
bone marrow failure
parvovirus 19

147
Q

Polycythaemia vera complications

A
  • thrombotic events
  • myelofibrosis
  • acute leukaemia (risk increased with chemotherapy treatment)
148
Q

Complication of myelofibrosis

149
Q

Primary Polycythaemia EPO level

A

LOW
(negative feedback)

150
Q

Paraprotein in multiple myeloma

151
Q

Gestational thrombocytopenia

A

no intervention
observe

152
Q

fatty bone marrow

A

aplastic anaemia

153
Q

Blood products in UK negative for

A

Hep B and C
syphillis
HIV

154
Q

Which virus must be negative for pregnant women for blood transfusion

155
Q

DAT (coombs test)

A

direct antiglobulin test

  • for haemolytic anaemia
  • warm vs cold (acitivity)
  • warm- IgG
  • cold- IgM
156
Q

Warm coombs

A

SLE
CLL
Lymphoma

157
Q

Cold coombs

A

mycoplasma
EBV
Influenza

non hodgkins

158
Q

MAHA

microangiopathic haemolytic anaemia

A

small vessel
red cell breakdown
- RBC shredded and sheared from platelet plug (mechanism not a disease)

159
Q

HUS

Haemolytic uraemic syndrome

MAHA + renal failure + thrombocytopenia

A

Ecoli–> shiga like toxin –> endothelial damage –> plt plug forms –> RBC shears –> plt being consumed in plug formation –> renal failure

160
Q

TTP

Thrombotic throbocytopaenic purpura

clot form + low plt + rash

A

VWF sticky –> stick to healthy endothelium –> reduced ADAMTS13 (usually present) –> persistence of sticky VWF –> plug form –> consume plt –> MAHA

NOTE: Brain (confusion and neuro)

161
Q

DIC

disseminated intravascular coagulation

all over body + within blood vessel + clotting

A

sepsis/tumour/pancreatitis –> XS tissue factor –> XS extrinsic clotting cascade –> lots of clots form –> deplete plt and clotting factors –> wide spread bleed

162
Q

ADAMTS13 role

A

protein that cleans up dodgy sticky VWF

163
Q

Extrinsic clotting cascade

A

exposed tissue factor on damaged tissue –> activate F7 to F7a –> eventual fibrinogen to fibrin –> fibrin mesh

164
Q

VWF role

A

form initial plt plug
bind to factor 8 and stabilise
(therefore F8 is low in VWD)

165
Q

Management of acute promyelocytic leukaemia

A

ATRA
all transretinoic acid

166
Q

Hodgkins vs non hodgkin

A

Hodgkin:
- b cell only
- single group of LN usually
- reed steinberg cell

Non hodgkin
- 90% of all lymphoma
- b or t cell
- multiple groups of nodes
- painless LN, B symptoms, pruritis

167
Q

MGUS
Smouldering multiple myeloma
multiple myeloma

spectrum of plasma cell disease

A

MGUS and smouldering - premalignant

MGUS:
- M protein <3
- Marrow plasma cell <10%
- no CRAB sx

Smouldering
- M protein >3
- marrow plasma cell 10-60%
- no CRAB sx

myeloma
- CRAB
- Marrow plasma >60%
- more than 1 lesion on MRI

168
Q

Multiple myeloma

A

explanded MONOCLONAL clone of plasma cells and paraprotein (immunoglobulin)

169
Q

Non hodgkins lymphoma types

A

Follicular
MALT lymphoma (H.pyelori)
Mantle lymphoma (11)
Diffuse large B cell lymphoma
Burkitt (8)
Peripheral T cell lymphoma

170
Q

Active bleed INR 8

A

PCC and Vit K

171
Q

Myelodysplasia

A

abnormal differentiation of cells in bone marrow
therefore pancytopenia
can progress to AML (1/3)

172
Q

Myelofibrosis

A

cloncal expansion -> fibrotic scar tissue
pancytopenia
tear drop cell
dry tap
massive splenomegaly (outside cell production)

173
Q

ATRA mechanism

A

promote APML cell to mature to granulocyte
apoptosis of these cells

174
Q

Most common infection in plt transfusion

A

s.aureus

stored in room temp for up to 5 days

175
Q

RBC storing

176
Q

FFP storing

MRCP Part 1 (17 decks)

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