Random Flashcards
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
2
Q
High APTT, low factor 8, bleeding time prolonged. Dx?
A
VWD
In Haemophillia bleeding time is not affected
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)
4
Q
Causes of raised anion AND osmolar gap metabolic acidosis?
A
Glycols, methanol, ethanol, mannitol
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)
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
7
Q
Causes of hypoglycaemia?
A
.
8
Q
Causes of hyperglycaemia?
A
.
9
Q
Causes of hyperthyroidism?
A
.
10
Q
Causes of hypothyroidism?
A
.
11
Q
Causes of hyperPTH?
A
.
12
Q
Causes of hypoPTH?
A
.
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
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
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
16
Q
Features of intraparenchymal haemorrhage?
A
50% due to HTN
Commonly at basal ganglia
Charcot-bouchard microaneurysms
17
Q
Features of stroke?
A
.
18
Q
Features of TIA?
A
.
19
Q
NF2 - which brain tumour?
A
meningioma
20
Q
Ventricular tumour + hydrocephalus = which tumour?
A
Ependymoma
21
Q
Indolent, child hood brain tumour?
A
Pilocytic astrocytoma
22
Q
Soft , gelatinous, calcified brain tumour?
A
Oligodendroma
23
Q
What type of tumours do you get in Von Hippel-Lindau syndrome?
A
Hemangioblastomas of cerebellum, brainstem and spinal cord
24
Q
Features of Tuberous Sclerosis
A
Ash-leaf spots (depigmented)
Shagreen patches
Epilepsy + LD + developmental problems
Giant cell astrocytomas
25
Features of Neurofibromatosis Type 1
Cafe au lait spots
Axillary/groin freckles
Lisch nodules (iris hamatomas - areas of pigmentation)
Phaeo
26
Features of Neurofibromatosis Type 2
Bilateral vestibular schwannomas -\> hearing loss
Meningiomas
27
MEN1, 2A, 2B
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
28
Primary sclerosing cholangitis
MEN
Assoc. w/ Ulcerative colitis
p-ANCA (myeloperoxidase)
USS: Bile duct DILATATION
ERCP: BEADING of bile ducts
Histology: Onion-skin fibrosis
-\>RISK OF CHOLANGIOCARCINOMA
29
Hepatocellular carcinoma
Associations? Marker used to investigate it?
Viral hepatitis, Alcoholic cirrhosis, haemochromatosis, NAFLD, Aflatoxin (Aspergillus), androgenic steroids
AFP (Alpha-fetoprotein) + USS
30
Hepatocellular carcinoma
Associations? Marker used to investigate it?
Viral hepatitis, Alcoholic cirrhosis, haemochromatosis, NAFLD, Aflatoxin (Aspergillus), androgenic steroids
AFP (Alpha-fetoprotein) + USS
31
Signs of portal HTN?
1. SPLENOMEGALY
2. Caput medusae
3. Ascites (shifting dullness)
4. Jaundice
5. GI bleeding
Liver flap =
32
Differentials for jaundice?
PRE-hepatic = Gilberts, haemolysis
HEPATIC = Viral/alcoholic hepatitis, Cirrhosis
POST-hepatic = Obstructive (gallstones, pancreatic cancer)
33
Most common thyroid cancer? Features?
Papillary
Spread = Lymph nodes + lung
Histology: Psammoma bodies
Orphan Annie eyes (empty-appearing nuclei w/ central clearing)
34
Tumour markers for thyroid cancers?
Papillary + Follicular = Thyroglobulin
Medullary = CALCITONIN secreted by parafollicular C cells (lowers Calcium)
35
Second most common thyroid cancer? Features?
Follicular
Spread = BLOOD
36
Most common type of malarial infection?
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
Features of severe falciparum malaria?
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
Tx of falciparum malaria?
```
Mild = Artemesin combination therapy (Riamet)
SEVERE = IV artesunate
```
39
Types of non-falciparum malaria + features?
Plasmodium vivax, ovale, malariae, knowlesi
P. malariae = Quartan fevers (every 72hrs)
Others = Tertian fever (every 48hrs)
40
Treatments for gout?
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
Ibrutinib
BCR Kinase inhibitor - targets BTK (survival signal protein)
Used in CLL
42
Venetoclax
BCL2 inhibitor - used in CLL
Permits APOPTOSIS
43
Treatment for MM?
Proteasome inhibitor (Bortezomib) + Immunomodulation (Lenalidomide) + Dexamethasone
44
Jarisch-Herxheimer reaction
Flu-like reaction after administering Abx for syphilis (IM Benzathine Penicillin)
Resolves after 24hrs
45
Mycoplasma pneumonia features?
```
Erythema multiforme (target lesions)
Autoimmune haemolytic anaemia - COLD AGGLUTININ +VE
```
46
Classic features of myelodysplastic syndrome?
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
Classic features of Aplastic anaemia?
1. Cytopenia
2. HYPOcellular BM
Severe AA:
Reticulocytes \<1%
Neutrophils \<0.5
Pt \<20
BM \<25% cellularity
48
Inherited Aplastic Anaemia syndromes
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
Burkitts lymphoma
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
Diffuse large B cell lymphoma
Commonest NHL subtype
Commonest in \>40yo
CLL can undergo Richter transformation into this lymphoma
"Sheets of large lymphoid cells"
Tx = Rituximab-CHOP
51
Mantle cell lymphoma
IgH-cyclin D1
t(11;14)
Can present as GI polyps
Tx = Rituximab CHOP
52
Follicular lymphoma
IgH-BCL2
t(14;18)
BCL-2 gene +ve in germinal centre
Indolent, mostly incurable
Tx = Watch and wait
53
Lymphoma associated with coeliac
EATL
54
Carribean/japan, viral infection - which lymphoma
Adult T-cell Leukaemia/Lymphoma (ATLL)
HTLV-1 infection
55
Agressive lymphoma, large T-cells, reactive cells espcially eosinophils?
Peripheral T-cell lymphoma
56
Lymphoma associated with mycosis fungoides? Forms patches + plaques on skin
Cutaneous T-cell
57
Lymphoma of children/young adults with t(2;5) translocation, Alk-1 protein expression. Histology shows large "epithelioid" lymphocytes.
Anaplastic large cell lymphoma
58
Lymphoma associated with H.pylori
Mucosal Associated Lymphoid Tissue (MALT)
59
Auto-immune causes of lymphoma?
Sjogrens
Hashimoto's thyroiditis (Marginal zone lymphoma of thyroid)
60
Which lymphomas can undergo Richter transformation?
Small lymphocytic lymphoma (SMALL lymphocytes, CD5/CD23+ve which are normally -ve in B cells)
Or CLL
61
Most common type of Hodgkin's lymphoma?
Features?
Nodular sclerosing - Germinal centre B-cells
EBV associated
Mixed cell population with **Reed-sternberg cells** and eosinophils
CD15/CD30 +ve
CD20-ve
62
Isolated lymphadenopathy. No EBV infection. CD20+, CD15/CD30 -ve . What lymphoma is this?
Nodular lymphocyte predominant
63
Classic markers for B-cells and T-cells for lymphoma histology?
B = CD20
T = CD3, CD5
64
Pembrolizumab/Nivolumab
Anti-PD1 antibody
prevents inactivation of T-cells by PD1-Ligand produced by tumours
Used in advanced melanoma
65
Ipilimumab
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
Interferon alpha/beta/gamma uses
Interferon Alpha = **ABC** - **A**lpha for Hep **B**/**C** + **C**ML
Interferon **B**eta = **B**ehcet's
Interferon **G**amma = Chronic **G**ranulomatous Disease
67
Which drug can be used for psoriasis/psoriatic arthritis if not responding to anti-TNFa therapy?
The 'kinumabs'
Ustekinumab - Anti-IL12/23
Secukinumab - Anti-IL17
68
Treatments for Rheumatoid resistant to DMARDs (anti-TNFa)?
**Abatacept** - Anti-CTLA4-Ig fusion protein (inhibits T-cell activation via APCs)
**Etanercept** - TNFalpha/beta receptor Fusion protein
69
Causes of DAT +ve haemolysis with spherocytes
_**Auto-Immune** Haemolytic anaemia_
1. Malignant: **Lymphoma** or **CLL**
2. Non-malignant: **SLE**
3. Infection: **Mycoplasma** pneumonia (Cold agglutinin +ve)
4. Idiopathic
70
Causes of DAT-ve haemolysis
1. Malaria
2. MAHA (schistocytes)
71
Causes of MAHA
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
t(9;22) with TdT+ve, Surface immunoglobulin +ve. What is this?
t(9;22) = Philadelphia chromosome
Normally associated with CML
**But _TdT_** is only found in **_IMMATURE B-cells,_** hence indicates **_B-cell ALL_**
73
What would you find in multiple myeloma:
TdT
Surface immunoglobulin
CD?
Tdt -ve
Surface Ig +ve (Indicates **mature** B-cells)
**CD138+** (Specific marker for **_plasma cells_**)
74
Ph-ve myeloproliferative disorders have which mutations?
**JAK2 V617F**
**Calreticulin (CALR)** mutation in Essential Thrombocythaemia + Primary Myelofibrosis
75
Features of the 3 Ph-ve myeloproliferative disorders?
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
Features of CML?
* 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
Treatment for Acute Promyelocytic Leukemia?
**ATRA** - All-trans Retinoic Acid
78
Normal INR ranges
2-3
