NICE

Question 1

megaloblastic anaemia has immature nuclei due to what

Answer 1

defective DNA synthesis

Question 2

most common cause of severe vitb12 deficiency in the UK

Answer 2

pernicious anaemia

Question 3

drugs that can cause folate deficiency

Answer 3

alcohol and anticonvulsants

Question 4

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

Answer 4

coeliac

Question 5

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

Answer 5

IM hydrococobalamin on alternate days then every 2 months

Question 6

tretmetn for vitb12 def with no neurologiccal involvemetn

Answer 6

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.

Question 7

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

Answer 7

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

Question 8

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

Answer 8

serum cobalamin

Question 9

drugs that can cause vitb12 deficiency

Answer 9

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

Question 10

maternal folate deficiency is associated with

Answer 10

prematurity

Question 11

severe neuropathy does not occur with what deficinecy

Answer 11

folate

Question 12

what is the onset of megaloblastic anaemia like

Answer 12

insidious

Question 13

oval macrocytes, hypersegmented neutrohphils adn circulatig megaloblasts in

Answer 13

macrocytic anaemia

Question 14

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

Answer 14

women taking contraceptive and in pregnancy

Question 15

what levels indicate b12 and foalte defic

Answer 15

folate - seum folate
b12- serum cobalamin

Question 16

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

Answer 16

alcohol

Question 17

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

Answer 17

FBC and reticulocyte count

Question 18

when to not prescribe folic acid

Answer 18

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).

Question 19

Hydroxocobalamin should not be given until

Answer 19

vitb12 def has been confirmed

Question 20

what test most reliably correlates with relative total body iron stores

Answer 20

serum ferritin level - remeber is an acute phase protein

Question 21

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

Answer 21

60

Question 22

hypochormic refers to

Answer 22

MCH -mean cell haemoglobin

Question 23

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

Answer 23

GI blood loss eg apsirin, nsaids, cancer

Question 24

restless leg syndrome may be a sign of

Answer 24

iron deficiency anaemia

Question 25

anisocytosis is the

Answer 25

variation in size of rbcs

Question 26

poikilocytosis is the

Answer 26

presence of irregularly shaped rbcs

Question 27

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

Answer 27

preg woman

Question 28

hypochromia may also occur in what

Answer 28

thalassamias

Question 29

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

Answer 29

thalassaemia and sideroblastic anaemia

Question 30

what may be a cuase of reversible sideroblastic anaemia

Answer 30

alcoholism

Question 31

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).

Answer 31

reduce the absorption of iron

Question 32

what are reversible inhibitors of factor Xa

Answer 32

apixaban, rivaroxaban and edoxaban

Question 33

what is dabiagtran

Answer 33

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

Question 34

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

Answer 34

DOACs

Question 35

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

Answer 35

rivaroxaban

Question 36

why are anticoagulatns less good in arteries

Answer 36

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

Question 37

what 4 things is warfarin licensed for

Answer 37

-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.

Question 38

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

Answer 38

haemophilia

Question 39

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

Answer 39

platelet

Question 40

ix if likely to have dvt based on wells score

Answer 40

US scan of leg

Question 41

what are dalteparin, enoxaparin, and tinzaparin

Answer 41

LMWH- these should be adminsitered subcutaneously in cases of DVT

Question 42

how should rivaroxaban be taken

Answer 42

with food

Question 43

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

Answer 43

LMWH or fondaparinux

Question 44

what is the most common complication of anticancer tretemnt

Answer 44

febrile neutropenia - presence of fever in a person with neutropenia

Question 45

symptoms that may occur with neutropenic sepssi

Answer 45

dysuria, diarrhoea, productive cough

Question 46

drug that can mask an elevated temp

Answer 46

steriods

Question 47

what might a first line choice for neutropenic sepsis be

Answer 47

piperacillin/ tazobactam

Question 48

do platelets have a nucleus

Answer 48

no

Question 49

leukemia that can cause thrombocytosis

Answer 49

CML

Question 50

medication that can cause thrombocytopenia

Answer 50

heparin

Question 51

the initial clinical manifestation in CML can be

Answer 51

isolated thrombocytosis

Question 52

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).

Answer 52

myelodysplastic syndromes

Question 53

erythrocytosis leads to increased what

Answer 53

blood viscocity

Question 54

how to tell the difference between primary and secondary erythrocytosis

Answer 54

primary- reduced erythropoietin second- raised erythropoietin

Question 55

headache in hyperviscocity may be described as

Answer 55

sense of fullness in the head and neck

Question 56

itch on contact with warm water think

Answer 56

polycythaemia vera

Question 57

what 2 doacs can be given for PE as interim

Answer 57

apixaban or rivaroxaban

Question 58

what globin chain is abnormal in sickle

Answer 58

beta

Question 59

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

Answer 59

sickle

Question 60

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

Answer 60

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

Question 61

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

Answer 61

1 in 2