Passmedicine Flashcards by Gillian Miller

Treatment for chronic myeloid leukaemia?

Imatinib

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Treatment for chronic lymphocytic leukaemia (requiring treatment)

Fludarabine, cyclophosphamide and rituximab (FCR)

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Which drugs could cause thrombocytopenia?

Heparin
Sodium valproate
Thiazides
Valproic acid
Quinidine

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Which drugs could cause pancreatitis?

Corticosteroids
Sodium valproate
Thiazides
Valproic acid

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What condition would you see smudge/smear cells?

Chronic lymphocytic leukaemia

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How would Von Willebrand’s disease present?

Bleeding problems
Normal platelets
Raised bleeding time
Slightly raised APTT

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Which drug can cause nasal congestion?

Sildenafil

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Which drugs are associated with hyperkalaemia?

ACE inhibitors
Spironolactone
ARBs
Heparin
Ciclosporin
Amiloride
Succinylcholine

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What is the underlying pathology of polycythemia rubra vera?

Mutation in JAK2

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What is the underlying pathology in lead poisoning?

Defective ferratochelatase and ALA dehdratase function

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Age group affected in multiple myeloma?

Age 60-70

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Why do you get hypercalcemia in myeloma?

Primarily this is due to increased osteoclastic bon resorption caused by local cytokines (e.g. IL-1. TNF) released by the myeloma cells
Much less common contributing factors: impaired renal function, increased renal tubular calcium reabsorption and elevated PTH-rP levels)

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Treatment for restless legs syndrome

Ropinirole

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Treatment for polycythemia rubra vera

Venesection

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Which condition would you find Auer rods in?

Acute myeloid leukaemia

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Features of Cryoglobulinaemia?

Purpuric rash

Hepatitis C positive

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HER2/neu receptor antagonist

Imatinib

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Inhibitor of the tyrosine kinase associated with the BCR-ABL defect

Imatinib

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Which drugs can cause osteoporosis?

Corticosteroids
Heparin
Pioglitazone

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Which drugs could cause epistaxis?

Isotretinoin

Warfarin

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Hereditary haemorrhagic telangiectasia inheritance pattern?

Autosomal dominant

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Features of hereditary haemorrhagic telangiectasia?

Epistaxis
Spider Naevi
Arteriovenous malformations

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“A 60 year old woman presents with cold peripheries. Investigations show a normocytic anaemia and a positive direct antiglobulin test”

Autoimmune haemolytic anaemia

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“A 15 year old Greek boy develops pallor and jaundice after having a lower respiratory tract infection. He has a history of neonatal jaundice. The blood film shows Heinz bodies”

G6PD deficiency

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G6PD inheritence

X-linked recessive | -so you're going to see it in males

Why is a decreased level of G6PD bad?

It means there will be a reduced level of glutathione, and this increases red cell susceptibility to oxidative stress

Diagnostic test for hereditary spherocyosis?

Osmotic fragility test

Which stupid food can precipitate a crisis in G6PD deficiency?

Broad beans

How do you diagnose G6PD deficiency?

G6PD enzyme assay

Drugs which can cause haemolysis?

Anti-malarials: primaquine Ciprofloxacin Sulph-group drugs: sulphonamides, sulphasalazine, sulfonylureas

What type of haemolysis in G6PD deficiency?

Intravascular

What type of haemolysis in hereditary spherocytosis?

Extravascular (so spleen etc)

How does standard heparin work?

Activates anti-thrombin III | Forms a complex that inhibits thrombin, factors Xa, IXa, XIa and XIIa

How does LMWH work?

Activates anti-thrombin III. | Forms a complex that inhibits factor Xa

How do you monitor standard heparin?

APTT

How do you monitor LMWH?

Anti-factor Xa (although routine monitoring is not required)

Why can heparin and LMWH cause hyperkalaemia?

It is thought to be due to inhibition of aldosterone secretion

Causes of normocytic anaemia?

Anaemia of chronic disease Chronic kidney disease Aplastic anaemia Haemolytic anaemia

Activated protein C resistance

Factor V leiden

C1-1NH deficiency

Hereditary angioedmea

What is tumour lysis syndrome associated with?

Burkitt's lymphoma (treated with chemotherapy)

What is hypogammaglobulinaemia associated with?

Chronic lymphocytic leukaemia

Macrocytic (normoblastic)

Reticulocytosis

Macrocytic (megaloblastic)

Vitamin B12 deficiency

"a 10 year old child with a history of neonatal jaundice develops pallor and jaundice after an upper respiratory tract infection associated with erythematous cheeks. Splenomegaly is noted on examination"

Hereditary spherocytosis (the clue is in the splenomegaly!! --> hereditary spherocytosis = extravascular haemolysis = the spleen is going to be working overtime = splenomegaly! Although you can sometimes get splenomegaly with G6PD)

Management of hereditary spherocytosis?

Folate replacement | Splenectomy

Which medication can cause a slate-grey appearance?

Amiodarone

Which medication can cause skin necrosis?

Warfarin

Factors that may potentiate warfarin?

- Liver disease - P450 enzyme inhibitors (e.g. amiodarone, ciprofloxacin) - Cranberry juice - Drugs which displace warfarin from plasma alubmin (e.g. NSAIDS) - Inhibit platelet function: NSAIDS

Dark coloured urine, haemolytic anaemia and thrombosis are features of which disease?

Paroxysmal nocturnal haemoglobulinuria

Treatment of essential thrombocytosis?

Hydroxyuria

The philadelphia chromosome is present in more than 95% of people with this condition?

Chronic myeloid leukaemia

Imatinib method of action

Inhibitor of the tyrosine kinase associated with BCR-ABL defect -Very high response rate in chronic phase CML

This type of hodgkins lymphoma is associated with lacunar cells

Nodular sclerosing hodgkins lymphoma (the most common type)

This condition is characterised by the presence of Reed-Sternberg cells

Hodgkins lymphoma

Hodgkins lymphoma with the best prognosis

Lymphocyte predominant

Hodgkins lymphoma with the worst prognosis

Lymphocyte depletes

Hodgkins lymphoma symptoms which imply poor prognosis

Weight loss more than 10% in the last 6 months Fever greater than 38 degrees C Night sweats

Common cause of tumour lysis syndrome

Burkitts lymphoma

What is felty's syndrome?

Splenomegaly and neutropenia in a patient with Rheumatoid arthritis

t (9,22)

Philadelphia chromosome: Present in >95% of patients with CML -also a poor prognostic factor in ALL

t(15,17)

Seen in acute promyelocytic leukaemia

t(8,14)

Burkitt's lymphoma

t(11,14)

Mantle cell lymphoma

How can you reverse heparin?

Protamine sulphate (although this only partially reverses effects of LMWH)

How do you monitor heparin?

APTT

How could you monitor LMWH?

Anti-factor Xa (although routine monitoring is not required)

How do you give heparin?

Treatment for DVT

LMWH or fondaparinux should be given initially after a DVT is diagnosed -a vitamin K antagonist (e.g. warfarin) should be given within 24 hours of the diagnosis

How long should you continue LMWH/fondaparinux after DVT?

Continue for at least 5 days of until the INR is 2.0 or above for at least 24 hours