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1
Q

Tumor lysis syndrome features?

A

High potassium >6mmol/L
High PO4
High Urate
LOW Calcium

The high serum phosphate binds to Calcium
Prophylactic IV allopurinol/rasburicase for hyperuricaemia

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2
Q

High APTT, low factor 8, bleeding time prolonged. Dx?

A

VWD

In Haemophillia bleeding time is not affected

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3
Q

Causes of raised anion gap metabolic acidosis?

A

GOLDMARK

Glycol
Oxoproline (chronic paracetamol)
Lactate (sepsis)
D-lactate (short bowel syndrome)
Methanol
Aspirin
Renal failure
Ketoacidosis (DKA, alcoholics, starvation)

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4
Q

Causes of raised anion AND osmolar gap metabolic acidosis?

A

Glycols, methanol, ethanol, mannitol

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5
Q

Causes of normal anion gap metabolic acidosis?

A

ABCD

Addisons
Bicarb loss (Diarrhoea, laxatives, Renal Tubular Acidosis)
Chloride gain (0.9% Saline infusion)
Drug (Azetazolamide)

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6
Q

Indications for acute dialysis?

A

AEIOU

Acidosis - intractable
Electrolyte disarray
Intoxication - methanol, glycol, lithium, aspirin
Overload - intractable fluid overload
Uraemic symptoms - nausea, seizure, pericarditis, bleeding

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7
Q

Causes of hypoglycaemia?

A

.

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8
Q

Causes of hyperglycaemia?

A

.

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9
Q

Causes of hyperthyroidism?

A

.

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10
Q

Causes of hypothyroidism?

A

.

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11
Q

Causes of hyperPTH?

A

.

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12
Q

Causes of hypoPTH?

A

.

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13
Q

Features of subdural haemorrhage?

A

Subdural = “SUBmarine”
Bridging veins -> SLOW venous bleeding

NO initial LOC -> presents later with LOC/confusion

CRESCENT shape on CT

Old people + Alcoholics

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14
Q

Features of extradural haemorrhage?

A

Extradural = EXTRA LOC
Middle meningeal artery -> RAPID arterial bleeding

Immediate LOC -> Lucid interval -> EXTRA LOC

CONVEX/Lens-shaped on CT

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15
Q

Features of subarachnoid haemorrhage?

A

Ruptured berry aneurysms
Internal carotid bifurcation
Thunderclap headache (occipital) -> vomiting + LOC

Assoc. with PKD, Ehler Danlos syndrome (stretchy skin), co-arctation of aorta

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16
Q

Features of intraparenchymal haemorrhage?

A

50% due to HTN
Commonly at basal ganglia
Charcot-bouchard microaneurysms

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17
Q

Features of stroke?

A

.

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18
Q

Features of TIA?

A

.

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19
Q

NF2 - which brain tumour?

A

meningioma

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20
Q

Ventricular tumour + hydrocephalus = which tumour?

A

Ependymoma

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21
Q

Indolent, child hood brain tumour?

A

Pilocytic astrocytoma

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22
Q

Soft , gelatinous, calcified brain tumour?

A

Oligodendroma

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23
Q

What type of tumours do you get in Von Hippel-Lindau syndrome?

A

Hemangioblastomas of cerebellum, brainstem and spinal cord

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24
Q

Features of Tuberous Sclerosis

A

Ash-leaf spots (depigmented)
Shagreen patches

Epilepsy + LD + developmental problems

Giant cell astrocytomas

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25
Q

Features of Neurofibromatosis Type 1

A

Cafe au lait spots
Axillary/groin freckles
Lisch nodules (iris hamatomas - areas of pigmentation)
Phaeo

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26
Q

Features of Neurofibromatosis Type 2

A

Bilateral vestibular schwannomas -> hearing loss
Meningiomas

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27
Q

MEN1, 2A, 2B

A

MEN1 (3Ps) = Parathyroid, Pituitary, Pancreatic (insulinoma,gastrinoma). Most commonly presents w/ hypercalcaemia

MEN2a (2Ps + 1M) = Parathyroid, Phaeo, Medullary thyroid

MEN2b (1P + 2Ms) = Phaeo, Medullary thyroid, Marfanoid, Neuromas

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28
Q

Primary sclerosing cholangitis

A

MEN
Assoc. w/ Ulcerative colitis
p-ANCA (myeloperoxidase)

USS: Bile duct DILATATION
ERCP: BEADING of bile ducts
Histology: Onion-skin fibrosis

->RISK OF CHOLANGIOCARCINOMA

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29
Q

Hepatocellular carcinoma

Associations? Marker used to investigate it?

A

Viral hepatitis, Alcoholic cirrhosis, haemochromatosis, NAFLD, Aflatoxin (Aspergillus), androgenic steroids

AFP (Alpha-fetoprotein) + USS

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30
Q

Hepatocellular carcinoma

Associations? Marker used to investigate it?

A

Viral hepatitis, Alcoholic cirrhosis, haemochromatosis, NAFLD, Aflatoxin (Aspergillus), androgenic steroids

AFP (Alpha-fetoprotein) + USS

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31
Q

Signs of portal HTN?

A
  1. SPLENOMEGALY
  2. Caput medusae
  3. Ascites (shifting dullness)
  4. Jaundice
  5. GI bleeding

Liver flap =

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32
Q

Differentials for jaundice?

A

PRE-hepatic = Gilberts, haemolysis

HEPATIC = Viral/alcoholic hepatitis, Cirrhosis

POST-hepatic = Obstructive (gallstones, pancreatic cancer)

33
Q

Most common thyroid cancer? Features?

A

Papillary
Spread = Lymph nodes + lung

Histology: Psammoma bodies
Orphan Annie eyes (empty-appearing nuclei w/ central clearing)

34
Q

Tumour markers for thyroid cancers?

A

Papillary + Follicular = Thyroglobulin

Medullary = CALCITONIN secreted by parafollicular C cells (lowers Calcium)

35
Q

Second most common thyroid cancer? Features?

A

Follicular
Spread = BLOOD

36
Q

Most common type of malarial infection?

A

Plasmodium Falciparum malaria
MOST COMMON and most severe

Protozoal infection spread by female Anopheles mosquito
Invades RBCs

Features: 48hr (Tertian) fever, malaise, hepatosplenomegaly, anaemia

THICK film = check for malaria
THIN film = check species

37
Q

Features of severe falciparum malaria?

A

Parasitaemia >2% = biggest indicator

1 SCHIZONT (multiple parasites in a single RBC) confirms severe malaria

Other: Hypoglycaemia, seizures, DIC, shock, acidosis, anaemia <8.

Pregnancy + vomiting also indications for IV therapy

38
Q

Tx of falciparum malaria?

A 
Mild = Artemesin combination therapy (Riamet) 
SEVERE = IV artesunate
39
Q

Types of non-falciparum malaria + features?

A

Plasmodium vivax, ovale, malariae, knowlesi

P. malariae = Quartan fevers (every 72hrs)

Others = Tertian fever (every 48hrs)

40
Q

Treatments for gout?

A

Acute Tx = NSAIDs or colchicine (inhibits TUBULIN reduces neutrophil motility)

Interval Tx =

  1. Allopurinol (inhibits XO) - never give with Azathioprine
  2. Probenecid (Increases Fractional Excretion of Uric Acid)
41
Q

Ibrutinib

A

BCR Kinase inhibitor - targets BTK (survival signal protein)

Used in CLL

42
Q

Venetoclax

A

BCL2 inhibitor - used in CLL

Permits APOPTOSIS

43
Q

Treatment for MM?

A

Proteasome inhibitor (Bortezomib) + Immunomodulation (Lenalidomide) + Dexamethasone

44
Q

Jarisch-Herxheimer reaction

A

Flu-like reaction after administering Abx for syphilis (IM Benzathine Penicillin)

Resolves after 24hrs

45
Q

Mycoplasma pneumonia features?

A 
Erythema multiforme (target lesions) 
Autoimmune haemolytic anaemia - COLD AGGLUTININ +VE
46
Q

Classic features of myelodysplastic syndrome?

A

Cytopenia

Pegler-Huet anomaly (Bi-lobed nucleus “reduced nuclear lobes”)

Reduced neutrophil granularity

Ring sideroblasts with Prussian blue/Perl’s stain

HYPERcellular BM - <20% blasts (>20% = AML)

47
Q

Classic features of Aplastic anaemia?

A
  1. Cytopenia
  2. HYPOcellular BM

Severe AA:
Reticulocytes <1%
Neutrophils <0.5
Pt <20
BM <25% cellularity

48
Q

Inherited Aplastic Anaemia syndromes

A

Fanconi anaemia = PANCYTOPAENIA
Skeletal problems, short stature, small eyes.
30% MDS, 10% AML

Dyskeratosis Congenita = PANCYTOPAENIA
Triad of: Skin pigmentation, nail dystrophy, oral leukoplakia (Skin + Nail + Mouth)

Schwachman-Diamond syndrome = NEUTROPHILS ONLY
Endocrine/pancreas dysfunction
AML risk

Diamond-Blackfan syndrome = RED CELLS ONLY
Presents as neonate

49
Q

Burkitts lymphoma

A

Commonest <15yo

IgH-cMYC
t(8;14)

EBV associated - africa - Jaw involvement + abdo mass

Starry sky appearance - Macrophages containing phagocytosed/apoptotic lymphocytes

Tx: Rituximab (anti-CD20) + Treat like acute leukemia

50
Q

Diffuse large B cell lymphoma

A

Commonest NHL subtype
Commonest in >40yo

CLL can undergo Richter transformation into this lymphoma

“Sheets of large lymphoid cells”

Tx = Rituximab-CHOP

51
Q

Mantle cell lymphoma

A

IgH-cyclin D1
t(11;14)

Can present as GI polyps

Tx = Rituximab CHOP

52
Q

Follicular lymphoma

A

IgH-BCL2
t(14;18)

BCL-2 gene +ve in germinal centre
Indolent, mostly incurable

Tx = Watch and wait

53
Q

Lymphoma associated with coeliac

A

EATL

54
Q

Carribean/japan, viral infection - which lymphoma

A

Adult T-cell Leukaemia/Lymphoma (ATLL)

HTLV-1 infection

55
Q

Agressive lymphoma, large T-cells, reactive cells espcially eosinophils?

A

Peripheral T-cell lymphoma

56
Q

Lymphoma associated with mycosis fungoides? Forms patches + plaques on skin

A

Cutaneous T-cell

57
Q

Lymphoma of children/young adults with t(2;5) translocation, Alk-1 protein expression. Histology shows large “epithelioid” lymphocytes.

A

Anaplastic large cell lymphoma

58
Q

Lymphoma associated with H.pylori

A

Mucosal Associated Lymphoid Tissue (MALT)

59
Q

Auto-immune causes of lymphoma?

A

Sjogrens
Hashimoto’s thyroiditis (Marginal zone lymphoma of thyroid)

60
Q

Which lymphomas can undergo Richter transformation?

A

Small lymphocytic lymphoma (SMALL lymphocytes, CD5/CD23+ve which are normally -ve in B cells)

Or CLL

61
Q

Most common type of Hodgkin’s lymphoma?
Features?

A

Nodular sclerosing - Germinal centre B-cells
EBV associated

Mixed cell population with Reed-sternberg cells and eosinophils

CD15/CD30 +ve
CD20-ve

62
Q

Isolated lymphadenopathy. No EBV infection. CD20+, CD15/CD30 -ve . What lymphoma is this?

A

Nodular lymphocyte predominant

63
Q

Classic markers for B-cells and T-cells for lymphoma histology?

A

B = CD20

T = CD3, CD5

64
Q

Pembrolizumab/Nivolumab

A

Anti-PD1 antibody

prevents inactivation of T-cells by PD1-Ligand produced by tumours

Used in advanced melanoma

65
Q

Ipilimumab

A

Anti-CTLA4

CTLA4 is found on T-cells

Normally an inhibitory checkpoint. Competes with CD28 (also on T-cells) to bind to B7 on APCs.

By blocking it, more T-cells can bind to APCs

Used in advanced melanoma

66
Q

Interferon alpha/beta/gamma uses

A

Interferon Alpha = ABC - Alpha for Hep B/C + CML

Interferon Beta = Behcet’s

Interferon Gamma = Chronic Granulomatous Disease

67
Q

Which drug can be used for psoriasis/psoriatic arthritis if not responding to anti-TNFa therapy?

A

The ‘kinumabs’

Ustekinumab - Anti-IL12/23

Secukinumab - Anti-IL17

68
Q

Treatments for Rheumatoid resistant to DMARDs (anti-TNFa)?

A

Abatacept - Anti-CTLA4-Ig fusion protein (inhibits T-cell activation via APCs)

Etanercept - TNFalpha/beta receptor Fusion protein

69
Q

Causes of DAT +ve haemolysis with spherocytes

A

Auto-Immune Haemolytic anaemia

  1. Malignant: Lymphoma or CLL
  2. Non-malignant: SLE
  3. Infection: Mycoplasma pneumonia (Cold agglutinin +ve)
  4. Idiopathic
70
Q

Causes of DAT-ve haemolysis

A
  1. Malaria
  2. MAHA (schistocytes)
71
Q

Causes of MAHA

A
  1. Underlying adenocarcinoma
  2. HUS
  3. TTP
  4. DIC
  5. Malignant Hypertension (>180/130)
  6. SLE

HUS = Anaemia + Thrombocytopenia + Renal failure

TTP = HUS + Fever + Neuro Sx (Normal PT/APTT)

DIC = HUS + Fever + Neuro Sx (Abnormal PT/APTT)

Heparin induced Thrombocytopenia = HUS + Heparin

If 4/5 of TTP criteria fulfilled:

CHILD = HUS, ADULT = TTP

72
Q

t(9;22) with TdT+ve, Surface immunoglobulin +ve. What is this?

A

t(9;22) = Philadelphia chromosome

Normally associated with CML

But TdT is only found in IMMATURE B-cells, hence indicates B-cell ALL

73
Q

What would you find in multiple myeloma:

TdT

Surface immunoglobulin

CD?

A

Tdt -ve

Surface Ig +ve (Indicates mature B-cells)

CD138+ (Specific marker for plasma cells)

74
Q

Ph-ve myeloproliferative disorders have which mutations?

A

JAK2 V617F

Calreticulin (CALR) mutation in Essential Thrombocythaemia + Primary Myelofibrosis

75
Q

Features of the 3 Ph-ve myeloproliferative disorders?

A
  1. Polycythaemia Vera
    • High Hb + Hct
    • Hyperviscosity - Headache, stroke, Visual disturbance
    • Peptic ulcers
    • Itchy skin after HOT SHOWER
    • Tx: Venesection/Phlebotomy ± Hydroxycarbamide
  2. Essential Thrombocythaemia
    • High Pt
    • Thrombosis - TIA, DVT, PE
    • Bleeding
    • MODEST Splenomegaly
    • Tx = Aspirin + Hydroxycarbamide. Anagrelide (Pt inhibitor)
  3. Primary Myelofibrosis
    • Anaemia / Thrombocytopenia
    • MASSIVE splenomegaly
    • Hepatomegaly
    • Hypermetabolic state
    • Leukoerythroblastic film
    • Dry tap on BM aspirate
    • BM core sample = Increased reticulin or collagen fibrosis
    • Tx = JAK2 inhibitor (Ruxolotinib), Allogeneic SCT
76
Q

Features of CML?

A
  • MASSIVE splenomegaly
  • Massively raised WCC (50-200)
  • NORMAL/raised Hb + Pt
  • Blood film:
    • Neutrophils + Myelocytes (immature myeloid cells, but no BLAST cells)
    • Raised BASOPHILS (only found in CML)

Chronic phase = <5% blasts

Accelereated phase = 10-19% blasts

Blast crisis = >20% blasts

Treatment

1st line = 1st gen BCR-ABL Tyrosine Kinase Inhibitor - Imatinib

2nd line = 2nd/3rd gen TK inhibitor - Dasatanib/Nilotonib/Bosutinib

3rd line = Allogeneic SCT

77
Q

Treatment for Acute Promyelocytic Leukemia?

A

ATRA - All-trans Retinoic Acid

78
Q

Normal INR ranges

A

2-3

PATH RANDOM FACTS (5 decks)

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