Passmed Flashcards
Why is B12 deficiency treated first in combined b12 and folate deficiency
To avoid subacute combined degeneration of the spinal cord.
B12 deficiency treatment
1mg IM hydroxocobalamin 3x weekly 2 weeks the. 3 monthly
B12 deficiency symptoms
Macrocyctic anaemia
Sore mouth and tongue
Neurological symptoms- dorsal column (vibration, proprioception)
Mood disturbances
Causes of B12 Deficiency
Pernicious anaemia
Vegan diet
Malabsorption disorder
Post gastrectomy
Metformin
Alternative to morphine in palliative patients with renal failure
Oxycodone
What is Richters transformation
CLL cells enter the lymph node and change into a high grade fast growing non-Hodgkin’s lymphoma
Patient v illl v quick
Richters transformation symptoms
Lymph node swelling
Fever without infection
Weightloss
Night sweats
Nausea
Abdo pain
What to do with patients over 60 with iron deficiency anaemia
Refer via 2ww for colonoscopy
Causes of iron deficiency anaemia
Blood loss (menorrhagia, GI bleed)
GI bleeding
Inadequate dietary intake
Poor intestinal absorption
Increased iron requirements (pregnancy)
Features of iron deficiency anaemia
Fatigue
SoB
Palpitations
Pallor
Koilonychia
Angular stomatitis
Atrophied glossitis
Iron deficiency anaemia Ivx
FBC - hypochromic micro cystic anaemia
Serum ferritin - usually low
TIBC/transferrin - high
Blood film - target cells, anisopoikilocytosis
Iron deficiency anaemia management
Find and treat cause
Oral ferrous sulphate
Iron rich diet
Causes of renal impairment in multiple myeloma
AL type amyloidosis, Bence Jones nephropathy, nephrocalcinosis, nephrolithiasis
Hyposplenism blood film
Target cells,
Howell-jolly bodies
Siderotic granules
Pappenheimer bodies
Acanthocytes
Iron deficiency anaemia blood film
Target cells
Pencil poikilocytes
Myelofibrosis blood film
Tear drop poikilocytes
Intravascular haemolysis blood film
Schistocytes
Megaloblastic anaemia blood film
Hypersegmented neutrophils
How often should sickle cell patients get a pneumococcal vaccine
Every 5 years
Prophylactic management of sickle cell
Hydroxyurea - increases HbF levels
Lead poisoning features
Abdo pain
Peripheral neuropathy
Fatigue
Neuropsychiatric features
Constipation
Blue lines on gums
Lead poisoning management
Various chelating agents - dimercaprol, EDTA
Risk of Iga deficiency in blood transfusion
Increased risk of anaphylaxis
Beta thalassaemia trait features
Mild hypochromic, microcytic anaemia
Raised HbA2
G6PD deficiency features
Neonatal jaundice
Gallstones
Splenomegaly
Intravascular haemolysis
G6PD deficiency blood film
Heinz bodies, bite cells, blister cells
G6PD inheritance
X-linked recessive
G6PD deficiency diagnosis
G6PD enzyme assay. 3 months post acute episode
Pancreatic cancer tumour marker
CA 19-9
Why use irradiated blood products
Reduces risk of graft v host disease by destroying T cells.
Required in Hodgkin’s lymphoma, immunocompromised,neonates
TACO symptoms (transfusion associated circulatory overload)
Htn, raised jvp, afebrile, S3 present
TRALI symptoms (Transfusion related acute lung injury)
Hypotension, pyrexia, normal jvp
Blood transfusion complications
GOT A BAD UNIT
Graft v Host disease
Overload
Thrombocytopenia
Alloimunisation
Blood pressure unstable
Acute haemolytic reaction
Delayed Haamolytic reaction
Urticaria
Neutrophillia
Infection
Transfusion related lung injury
What can cause an aplastic crisis in hereditary spherocytosis
Parvovirus
Hereditary spherocytosis features
Failure to thrive
Aplastic crisis
Jaundice
Gallstones
Splenomegaly
MCHC raised
Hereditary spherocytosis ethnicity
Northern european
Benign neutropenia ethnicity
Black Afro Caribbean
Factors associated with poor prognosis in Hodgkin’s lymphoma
Presence of B symptoms
Age over 45
Male
Hb less than 10.5
Lymphocytes less than 600
Most common cause neutropenic sepsis
Coagulase positive, gram negative bacteria- staphylococcus epidermidis
How to convert morphine oral to subcutaneous
Divide by 2
What does a ‘starry’ sky biopsy suggest
Burkitt lymphoma
What is ITP
Idiopathic thrombocytopenic purpura
Immune mediated reduction in platelet count, antibodies directed against glycoprotein 2b or 3a
Thrombocytopenia causes
ITP
DIC
Haem malignancy
Alcohol
Liver disease
Antiphospholipid syndrome
Pregnancy
Symptoms of spinal cord compression
Back pain (may be worse lying down or coughing)
Lower limb weakness
Sensory changes
Urinary retention
Urinary/faecal incontinence
Spinal cord compression Ivx
Whole spine MRI within 24hrs presentation
Spinal cord compression mx
High dose oral dexamethasone
Urgent assessment for surgery or radiotherapy
What can cause haemolytic anaemia in G6PD deficiency
Malaria prophylaxis
Most common tumour to cause bony mets
Prostate
Breast
Lung
Features of bone mets
Bone pain
Pathological fractures
Hypercalcaemia
Raised ALP
Most common sites of bone mets
Spine
Pelvis
Ribs
Skull
Long bones
Von willibrand disease -APTT, platelets + bleed time
Prolonged bleed time
Normal platelet count
Prolonged APTT
Aplastic anaemia features
Normochromic, normocytic anaemia
Leukopenia
Thrombocytopenia
Aplastic anaemia causes
Idiopathic
Drugs - phenytoin
Parvovirus, hepatitis
Radiation
Universal donor of FFP
AB RhD negative
Features of thrombotic thrombocytic purpura
Fever
Altered mental state - confusion, headache, seizure
Haemolytic anaemia
Reduced renal function
Thrombocytopenia
What is TTP
Thrombotic thrombocytic purpura
Microangiopathic haemolytic anaemia
TTP causes
Post infection
Pregnancy
Drugs - penicillin, oral contraceptives
SLE
HIV
Dabigatran reversal agent
Idarucizumab
Causes of hyposplenism
Post-splenectomy
Coeliac disease
Hyposplenism blood film
Target cells
Howell-jolly bodies
Breast cancer tumour market
CA15-3
Ovarian cancer tumour marker
CA125
Von willibrand treatment
Tranexamic acid for bleeding
Desmopressin
Factor vIII concentrate
What causes electrolyte abnormalities in tumour lysis syndrome + what are they?
Release of intracellular contents into bloodstream
Hyperkalaemia, hyperuricaemia, hyperphosphataemia and hypocalcemia
DIC typical blood picture
Dec platelets
Dec fibrinogen
Inc PT and APTT
What type of anaemia is CLL associated with
Warm autoimmune haemolytic anaemia
Prevention measures for tumour lysis syndrome
IV fluids
Rasburicase
Allopurinol (not alongside rasburicase)
Define laboratory tumour lysis syndrome
Abnormally in 2 or more of the following occurring within 3 days before or 7 days after chemo
25% Inc Uris acid, potassium or phosphate
25% decrease in calcium
Define clinical tumour lysis syndrome
Lab tumour lysis syndrome plus one of
Inc serum creatinine
Arrhythmia or sudden death
Seizure
Reversal agent of rivatoxaban + apixaban
Andexanet Alfa
Criteria for young person referral for leukaemia
0-24
Unexplained petechiae or hepatosplenomegaly
Immediate specialist assessment
Anticoagulant for antiphospholipid syndrome in pregnancy
Aspirin + Lmwh
ITP treatment
Oral prednisolone
Pooled normal human immunoglobulin
What is evans syndrome
ITP in association with AIHA
Causes of massive Splenomegaly
Myelofibrosis
CML
malaria
Gauchers syndrome
Visceral leishmaniasis
Graft v host disease signs + symptoms (acute)
Painful maculopapular rash
Jaundice
Diarrhoea
Persistent N+V
Culture negative fever
Chronic graft v host disease symptoms
Lichen planus, scleroderma, vitiligo
Corneal ulcers
Dysphagia,oral ulcers
Lung disease
Most common lung cancer in non Smokers
Lung Adenocarcinoma
Peripheral leision
What is calcitonin a tumour marker for?
Medullary thyroid cancer
1st line abx for neutropenic sepsis
Tazocin
What is anaemia with reticulocytosis indicative of
Haemolysis or bleeding
Haemolysis blood results
Raised bilirubin (other LFTs normal)
Low haptoglobins
Raised LDH
Low Hb
High reticulocytes
Threshold for platelet transfusion
<30 with significant bleeding. (Higher if bleeding at critical sites I.e CNS)
What is used for emergency reversal of anticoagulants
Prothrombin complex concentrate
What is Myelofibrosis
Myeloproliferative disorder caused by hyperplasia of abnormal megakaryocytes
Myelofibrosis features
Elderly with symptomatic anaemia
High urate and LDH
tear drop poikilocytes
