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My haem > NICE > Flashcards

NICE Flashcards

1
Q

megaloblastic anaemia has immature nuclei due to what

A

defective DNA synthesis

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2
Q

most common cause of severe vitb12 deficiency in the UK

A

pernicious anaemia

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3
Q

drugs that can cause folate deficiency

A

alcohol and anticonvulsants

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4
Q

If folate levels are low, and the history suggests malabsorption, tests for anti-endomysial or anti-transglutaminase antibodies should be done (depending on the local laboratory) to exclude

A

coeliac

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5
Q

how to treat if got vitb12 def in people with neurological involvement

A

IM hydrococobalamin on alternate days then every 2 months

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6
Q

tretmetn for vitb12 def with no neurologiccal involvemetn

A

Initial treatment with hydroxocobalamin 1 mg intramuscularly three times a week for 2 weeks.
Maintenance treatment, usually with hydroxocobalamin 1 mg intramuscularly every 3 months for life — where B12 deficiency is not thought to be diet related.

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7
Q

what is the maintenace treatment if the vitb12 def is thought to be diet related

A

oral cyanocobalamin tablets or a twice-yearly hydroxocobalamin 1 mg injection

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8
Q

There is no gold standard test for measuring vitamin B12 deficiency, but the likelihood of deficiency can be determined by measuring

A

serum cobalamin

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9
Q

drugs that can cause vitb12 deficiency

A

Drugs — colchicine, metformin, nitrous oxide, protein pump inhibitors, H2-receptor antagonists.

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10
Q

maternal folate deficiency is associated with

A

prematurity

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11
Q

severe neuropathy does not occur with what deficinecy

A

folate

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12
Q

what is the onset of megaloblastic anaemia like

A

insidious

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13
Q

oval macrocytes, hypersegmented neutrohphils adn circulatig megaloblasts in

A

macrocytic anaemia

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14
Q

cobalamin levels are less accurate for determining b12 def in what pts

A

women taking contraceptive and in pregnancy

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15
Q

what levels indicate b12 and foalte defic

A

folate - seum folate
b12- serum cobalamin

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16
Q

what is the main cause of a rasied MCV in the abscence of anaemia

A

alcohol

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17
Q

should do what 7-10days after starting treatment for b12 or folate def

A

FBC and reticulocyte count

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18
Q

when to not prescribe folic acid

A

Pernicious anaemia or undiagnosed megaloblastic anaemia (unless also prescribing vitamin B12) — use of folic acid alone may precipitate subacute combined degeneration of the spinal cord.
Malignant disease (unless megaloblastic anaemia caused by folate deficiency is an important complication).

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19
Q

Hydroxocobalamin should not be given until

A

vitb12 def has been confirmed

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20
Q

what test most reliably correlates with relative total body iron stores

A

serum ferritin level - remeber is an acute phase protein

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21
Q

should get 2 week cancer referral if iron deficiency and over what age

A

60

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22
Q

hypochormic refers to

A

MCH -mean cell haemoglobin

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23
Q

what is the most common cause of iron deficiency anaemia in adult men or post menopausal woman

A

GI blood loss eg apsirin, nsaids, cancer

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24
Q

restless leg syndrome may be a sign of

A

iron deficiency anaemia

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25
Q

anisocytosis is the

A

variation in size of rbcs

26
Q

poikilocytosis is the

A

presence of irregularly shaped rbcs

27
Q

blood film of iron deficiency anaemia may show microctyic and hypochromic and characterisitc pencil cells in who

A

preg woman

28
Q

hypochromia may also occur in what

A

thalassamias

29
Q

what are both associated with an increase in serum iron and ferritin and a low total iron binding capacity

A

thalassaemia and sideroblastic anaemia

30
Q

what may be a cuase of reversible sideroblastic anaemia

A

alcoholism

31
Q

these can do what:
Zinc or magnesium salts (for example in antacids).
Calcium (for example in milk and dairy products).
Tannins (for example in tea, coffee, and cocoa).
Phytates (present in cereal grains, legumes, nuts, and seeds).

A

reduce the absorption of iron

32
Q

what are reversible inhibitors of factor Xa

A

apixaban, rivaroxaban and edoxaban

33
Q

what is dabiagtran

A

reversible inhibitor of free thrombin, fibrin-bound thrombin, and thrombin-induced platelet aggregation.

34
Q

what anticoagulatns are licenesed for after elective hip or knee replacement surgery

A

DOACs

35
Q

what DOAC is licensed for prophylaxis of atherothrombotic events following an acute coronary syndrome (in combincation with aspirin alone or aspirin and clopidogrel)

A

rivaroxaban

36
Q

why are anticoagulatns less good in arteries

A

as in arteries thrombi are mainly composed of platelets with little fibrin

37
Q

what 4 things is warfarin licensed for

A

-Prophylaxis of systemic embolism in people with rheumatic heart disease and atrial fibrillation.
-Prophylaxis after insertion of prosthetic heart valves.
-Prophylaxis and treatment of venous thrombosis and pulmonary embolism.
-Transient ischaemic attacks.

38
Q

delayed reaction eg haemorrhage 24hrs after a dental extraction suggests a coagualtion disorder such as

A

haemophilia

39
Q

brusing or excessive bleeding but occurs soon after trauma suggest what kind of disorder

A

platelet

40
Q

ix if likely to have dvt based on wells score

A

US scan of leg

41
Q

what are dalteparin, enoxaparin, and tinzaparin

A

LMWH- these should be adminsitered subcutaneously in cases of DVT

42
Q

how should rivaroxaban be taken

A

with food

43
Q

if prescribing warfarin for DVT what also needs to be prescribes for at least the first 5 days

A

LMWH or fondaparinux

44
Q

what is the most common complication of anticancer tretemnt

A

febrile neutropenia - presence of fever in a person with neutropenia

45
Q

symptoms that may occur with neutropenic sepssi

A

dysuria, diarrhoea, productive cough

46
Q

drug that can mask an elevated temp

A

steriods

47
Q

what might a first line choice for neutropenic sepsis be

A

piperacillin/ tazobactam

48
Q

do platelets have a nucleus

A

no

49
Q

leukemia that can cause thrombocytosis

A

CML

50
Q

medication that can cause thrombocytopenia

A

heparin

51
Q

the initial clinical manifestation in CML can be

A

isolated thrombocytosis

52
Q

full blood count shows normochromic or macrocytic red blood corpuscles (RBCs) and morphological abnormalities such as oval macrocytic RBCs and granulocytes with the pseudo-Pelger-Huet anomaly (hypogranular and hypolobulated granulocytes).

A

myelodysplastic syndromes

53
Q

erythrocytosis leads to increased what

A

blood viscocity

54
Q

how to tell the difference between primary and secondary erythrocytosis

A

primary- reduced erythropoietin
second- raised erythropoietin

55
Q

headache in hyperviscocity may be described as

A

sense of fullness in the head and neck

56
Q

itch on contact with warm water think

A

polycythaemia vera

57
Q

what 2 doacs can be given for PE as interim

A

apixaban or rivaroxaban

58
Q

what globin chain is abnormal in sickle

A

beta

59
Q

suddent onset of pain, infection, anaemia or priapism should suspect

A

sickle

60
Q

what is a common presenting symptom in infants aged 9-18 months for sickle cell

A

dactylitis (painful swelling of the bones of the hands and feet)

61
Q

what is the % chance that affected with sickle passes into onto their child

A

1 in 2

My haem (8 decks)

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