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Question 1

Why is ferritin high in anaemia of chronic disease?

Answer 1

Ferritin is elevated in its capacity as an Acute Phase Protein (APP) NOT due to it’s iron storing capacity. It is elevated in anaemia of chronic disease as an inflammatory APP and not a marker of iron overload.

Ferritin = protein which stores iron. Amount of ferritin correlates with the amount of iron stored in the body.

If you have a patient with suspected IDA, then when testing ferritin, have to make sure they do not have an infection as would read a false negative due to ferritins role as an APP.

Question 2

When could you get a false negative when testing for IDA?

Answer 2

If the patient has an infection. Ferritin will be high in inflammation due to its role as an APP. (In IDA, ferritin is low).

Question 3

What is ferroportin?

Answer 3

A transmembrane protein that transfers iron from inside the cell to outside the cell.

Question 4

What is ferritin?

Answer 4

Ferritin is a protein which stores iron and releases it in a controlled fashion.

Low iron in IDA
High iron in iron overload.

Ferritin is also an APP

Question 5

What is transferrin?

Answer 5

Transferrin binds iron and transports it throughout the body.

We see and increase in Transferrin in IDA reflecting and increase in transferrin protein expression.

Question 6

What is TIBC?

Answer 6

Total Iron Binding Capacity

It represents the bloods capacity to bind iron with transferrin.

TIBC increases in IDA

Question 7

What is transferrin saturation?

Answer 7

Value of serum iron/ TIBC in %

In IDA, trasferrin saturation decreases. (there is a decrease in volume of iron and an increase in the total iron binding capacity)

Question 8

What are the general causes of IDA?

Answer 8

Chronic blood loss
Malabsorption
Increased demand (pregnancy)

Question 9

What is the triad seen in Plummer Vinson syndrome?

Answer 9

IDA, post-cricoid dysphagia, upper oesophageal webs

Increased risk for oesophageal SCC and glossitis

Question 10

What murmur do you hear in mitral or tricuspid IE?

Answer 10

Holosystolic murmur

Question 11

What murmur do you hear in IE of the aortic valve?

Answer 11

Early diastolic murmur

Question 12

When can you get false negative blood cultures in the diagnosis of IE?

Answer 12

1. Recent AB use

2. Fastidious bacteria (Coxiella, Bartonella - they require complex nutrition in order to be cultured)

Question 13

What ABs do you add to the normal regime in a patient with IE with prosthetic valve?

Answer 13

Gentamycin and Rifampin

Non prosthesis: Vancomycin + Beta-lactam
(Prosthesis: Vancomycin + Beta-lactam + Gentamycin + Rifampin).

Question 14

What drugs do you use in VRE?

Answer 14

Linezolid + Tigecycline

Question 15

What drugs do you use in ESBL?

Answer 15

Meropenem/ Imipenem + Cilastin

Question 16

What drugs do you use in CPE?

Answer 16

Polymyxin B
Colistin
Tigecycline

(CPE = Carbapenemase preducing Enterobacteri)

Question 17

What is associated with Basophilia?

Answer 17

CML

Question 18

What is associated with Eisnophilia?

Answer 18

Parasitic infections
Allergies
Hodgkin lymphoma (Due to increased IL-5)
Addisons disease
Vasculitis (Eisinophilic granulomatosis with polyangitis)
Hyper IgE syndrome
Drugs (Allopurinol and Macrolides)
Aspergillus Infection

Question 19

What are the Dermatological findings you can see in CLL?

Answer 19

Leukemic Cutis
Chronic Uticaria
Chronic Pruritis

Question 20

What malignancy results in a decreased ESR?

Answer 20

PCV

Question 21

What triad is seen in hyper viscosity syndrome?

Answer 21

Neurological problems
Visual problems
Mucosal bleeding

Question 22

What disorders do you see erythromelelgia?

Answer 22

PCV

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