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Revision Flashcards

1
Q

Ach receptor blocked by autoantibodies resulting in weak , but not atrophied, muscles

A

Myaesthenia gravis

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2
Q

Pernicious anaemia is lack of absorption of what? Why?

A

B12 due to lack of intrinsic factor

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3
Q

what does ANCA stand for?

A

anti-neutrophil cytoplasmic antibodies

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4
Q

3 forms ANCA vasculitis

A

Microscopy polynagitis
Granulomatosis with polyangitis
Eosinophilic granulomatosis with polyangitis

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5
Q

All forms of ANCA vasculitis have what? Some have what?

A

All- polyangitis

Some- granulomatosis

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6
Q

ANA is positive in what type of raynauds?

A

Secondary

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7
Q

Skin fibrosis and tightening in fingers and face, finger ulcers, lung fibrosis=? What antibody?

A

Scleroderma

ANA

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8
Q

What is a positive predictive value?

A

Proportion of people with a positive test who have the target disorder (true positive/all positives)

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9
Q

Type II hypersensitivity reaction called what? Which antibodies? Example?

A

Cytotoxic
IgM and IgG
Rh incompatibility

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10
Q

Type III hypersensitivity reaction called what? Which antibodies? Example?

A

Immune complex
IgG/M (+ antigen = complex)
SLE
Serum sickness

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11
Q

Type IV hypersensitivity reaction called? Mediated by what? Example?

A

Delayed
T cells
Contact dermatitis

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12
Q

In a type I hypersensitivity reaction, Th2 cells secrete what, and what stimulates them to do so?

A

APCs stimulate them (using the allergen)
to secrete IL4 to B cells
and
IL-3,5,GM-CSF to eosinophils

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13
Q

In a type I hypersensitivity reaction, B cells, having been activated by IL-4, do what?

A

Produce IgE which degranulates mast cells to stimulate the initial and late responses.
Also releases IL3 and IL5 to stimulate eosinophils

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14
Q

In a type I hypersensitivity reaction, eosinophils, having been activated by IL3,5,GM-CSF, do what?

A

Degranulate and activate the late phase response.

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15
Q

T cell deficient patients present with what? How to treat?

A

Opportunistic infection

Stem cell transplant, somatic gene therapy

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16
Q

B cell deficient patients present with what? Treatment?

A

Recurrent pyogenic bacterial infection

Antibiotics then IV IgG

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17
Q

X linked agammaglobulinaemia is a type of?

A

B cell deficiency

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18
Q

Phagocyte deficient patients present with what?

A

Recurrent, prolonged infections that respond poorly to Abx.
Staphylococcal
Skin and mucous membranes
Supporative lymphadenopathy

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19
Q

C1,2,4 deficient patients present with what?

A

Immune complex symptoms e.g malar rash, vasculitis

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20
Q

C3 deficient patients present with what?

A

Increased susceptibility to bacterial infection- pneumonia, sepsis, meningitis

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21
Q

C5-8 deficient patients present with what?

A

Recurrent neisserial infection (meningococcal meningitis)

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22
Q

Immune stimulants other than immunisation?

A

alpha, beta, gamma interferons
IL-2
G/GM-CSF

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23
Q

3 classes of immune suppressant

A

Corticosteroids
Lymphocyte targeting
DMARDs

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24
Q

4 lymphocyte targeting therapies

A

Antimetabolites
Calcineurin inhibitors
M-TOR inhibitors
IL-2 receptor MABs

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25
Q

What are the classical HLA antigens? What region codes for them?

A

A, B, C

Class I region

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26
Q

Class II region encodes which HLAs?

A

HLA-DR, DQ, DP

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27
Q

Class III region encodes which MHCs?

A

HSP70, TNF, C4a, C4b, C2, BF, CYP21

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28
Q

Where are all of the classical HLAs found?

A

All nucleated cells

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29
Q

What sort of expression do MHC genes have?

A

Codominant

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30
Q

3 types of recognition of the foreign body in transplantation?

A

Direct (T cells bind directly to graft)
Indirect (graft peptides)
Semi-direct (in lymph nodes)

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31
Q

What is cRF/sensitisation percentage?

A

percentage of deceased donors that will not be a suitable match

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32
Q

What is the minimum inhibitory concentration of an antibacterial agent?

A

Minimum concentration at which visible growth is inhibited

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33
Q

Aminoglycosides bind to what to inhibit protein synthesis?

A

30S

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34
Q

Macrolides etc. bind to what to inhibit protein synthesis?

A

50S

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35
Q

Tetracyclines bind to what to inhibit protein synthesis?

A

30S

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36
Q

Oxazolidinones bind to what to inhibit protein synthesis?

A

50S

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37
Q

Cephalosporins treat what?

A

Gram negative bacilli

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38
Q

Action of aciclovir? Used to treat?

A

Nucleoside analogue

HSV, VZV

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39
Q

Rx CMV?

A

Ganciclovir

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40
Q

Rx influenza?

A

Oseltamivir and zanamavir

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41
Q

Rx Hep C and RSV

A

Ribavirin

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42
Q

Rx Hep C and B

A

Interferons

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43
Q

Ciprofloxacin is what type of antibiotic?

A

Quinolone

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44
Q

Co-amoxiclav is what type of antibiotic?

A

penicillin

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45
Q

Which antifungal is nephrotoxic?

A

Amphotericin B

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46
Q

Which antifungals are hepatotoxic?

A

Allylamines and azoles- ergosterol synthesis inhibitors

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47
Q

Ascariasis type of pathogen

A

Nematode (helminth)

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48
Q

Ascariasis where in body?

A

Digestive system, migrates to lung (Loeffler’s syndrome)

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49
Q

Rx ascariasis?

A

Albendazole-benzimidazole

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50
Q

Schistosomiasis action in body?

A

Matures in GI blood vessels, exists in faeces after sexual reproduction

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51
Q

Definitive and intermediate hosts in schisto?

A

Def- human

Int- snails

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52
Q

Definitive and intermediate hosts in hyatid?

A

Def- dogs

Int- sheep

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53
Q

Type of pathogen in hyatid

A

Platyhelminth- tape worm

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54
Q

4 plasmodiums in malaria and which is most common

A

Ovale
Malariae
Vivax
Falciparium

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55
Q

Cryptosporidium spread

A

Faeco-oral human to human

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56
Q

Measles type of virus

A

Paramyxovirus

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57
Q

What involves cough, conjunctivitis, coryza?

A

Measles

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58
Q

What do you get prior to measles rash?

A

Koplik spots

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59
Q

Slapped cheek syndrome caused by which virus?

A

Parvovirus B19

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60
Q

‘everything else’ infant viral rash? Dx of exclusion

A

Enteroviral

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61
Q

Croup is caused by what?

A

Parainfluenza

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62
Q

Respiratory virus with conjunctivitis and diarrhoea is likely to be what?

A

Adenovirus

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63
Q

The frequency of reactions decreases with number of doses in live or inactivated vaccines?

A

Live

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64
Q

Difference between sterilisation and disinfection?

A

Sterilisation is killing all micro-organisms, disinfection is just killing sufficient numbers to make an item safe to use.

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65
Q

Disinfection applied to the skin is what?

A

Antisepsis

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66
Q

Decontamination method of surgical equipment

A

Moist heat

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67
Q

Decontamination method of syringe needle

A

gamma irradiation and disposal after use

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68
Q

Decontamination method of surgeons hands

A

surgial scrub

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69
Q

Decontamination method of flexible endoscope

A

Chemical

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70
Q

Decontamination method of catheter insertion site

A

Chemical

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71
Q

Pa O2 of respiratory failure

A

more than 8.0kpa

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72
Q

Type 1 resp failure pa O2 and what is driving it?

A

less than 6.3kpa, hypoxic

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73
Q

Type 2 resp failure pa O2 and what is driving it?

A

more than 6.3kpa, hypercapnic drived

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74
Q

4 types non-small cell lung carcinoma

A

Squamous
Adenocarcinoma
Undifferentiated large cell
Large cell neuroendocrine

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75
Q

What type of cancer can mimic pneumonia?

A

Bronchioloalveolar

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76
Q

CD56 detects what?

A

Neuroendocrine lung tumours

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77
Q

4 features typical carcinoid tumours? (lung cancer)

A

No necrosis, bland
Distant mets are rare
NOT assoc with smoking
May occlude bronchioles

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78
Q

TTF is expressed by which 3 lung cancers?

A

Adenocarcinoma
Undifferentiated large cell
Small cell

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79
Q

What colour asbestos is the worst?

A

Blue

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80
Q

Small plaques on parietal pleura + effusion =?

A

Mesothelioma

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81
Q

Which type of pneumonia in elderly and diabetic and alcoholic?

A

Klebsiella

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82
Q

3 distributions of emphysema

A

Centrilobar (smoking)
Panlobar (alpha-1-anti trypsin)
Paraseptal

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83
Q

Acute interstitial lung disease is?

A

Adult resp distress synd

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84
Q

What cellular change is seen in acute interstitial lung disease?

A

Type II pneumocyte hyperplasia

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85
Q

Appearance of chronic interstitial lung disease?

A

Honeycomb lung

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86
Q

What 2 serum substrates are increased in sarcoidosis?

A

Calcium and ACE

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87
Q

Dx criteria for chronic bronchitis?

A

Productive cough on most days during at least 3 months of 2 successive years (with no alternative cause)

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88
Q

90% lobar pneumoniae is due to which pathogen?

A

Strep. pneumoniae

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89
Q

2 pathogens that cause hospital acquired pneumonia?

A

Enterobateraceae

Pseudomonas ssp

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90
Q

2 pathogens that are spread from person to person causing community acquired pneumonia

A

S pneumoniae

H influenzae

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91
Q

Pathogen from the environment that might cause community acquired pneumonia

A

L pneumophilia

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92
Q

Animal derived cause of community acquired pneumonia

A

C psittaci

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93
Q

4 atypical pneumonias

A

Mycoplasma pneumonia
Legionella pneumophilia
Chlamydophila pneumonia
Chlamydophila psittaci

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94
Q

Rare complications of Mycoplasma pneumonia?

A

Neuropathies, guilliane barre

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95
Q

Incidence of Chlamydophila pneumonia is highest in what group?

A

Elderly

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96
Q

What score is used to quantify the severity of pneumonia?

A

CURB65

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97
Q

Paul Bunnell Test is for what?

A

EBV

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98
Q

Rx malignant otitis externa

A

ceftazidime then ciprofloxacin

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99
Q

3 features mycobacteria

A 
waxy cell wall (high in lipids)
slow growing
acid fast
intracellular
combination therapy required
latent phase
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100
Q

2 mycobacteria that cause TB

BCG is against which?

A

m. tuberculosis and m.bovis

Bovis is BCG

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101
Q

how does primary TB present?

A

influenza like

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102
Q

What is another name for disseminated TB?

A

Miliary

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103
Q

After the TB pathogen has multiplied, what are the 2 things that can happen?

A

Latency or dissemination

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104
Q

Rx TB?

A

Rifampicin, isoniazide (4 months), pyrazinamide, ethambutol or streptomycin (2 months)
If pericarditis or meningitis then add steroids
Sites other than meninges- 6 months

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105
Q

Tuberculoid leprosy is what cell type response? What symptoms?

A

Th1

Skin plaques and nerve involvement

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106
Q

Lepromatous leprosy is what cell type response? Symptoms?

A

Th2
Subcut tissue accumulation
Leonine facies
Earlobes and face

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107
Q

Rx m. leprae?

A

Dapsone, rifampicin, clofazimine

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108
Q

2 types oesophageal carcinoma?

A

Squamous cell

Adenocarcinoma

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109
Q

Barrett’s oesophagus leads to which cancer?

A

Adenocarcinoma of the oesophagus

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110
Q

4 types gastric carcinoma, which is most common?

A

ADENOCARCINOMA
Endocrine
MALT
Stromal

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111
Q

CDH1/E-cadherin mutation = ?

A

Hereditary diffuse type gastric cancer

112
Q

Pathogenesis of coeliac disease?

A

Gliadin in gluten induces epithelial cells to express IL-15
Causes actiation of CD8+ and IELs
These are cytotoxic

113
Q

2 cancer types assoc with coeliac?

A

Enteropathy- associated T cell lymphoma

Small intestinal adenocarcinoma

114
Q

3 investigative tests for coeliac?

A

IgA antibodies to TTG
IgA or G antibodies to deamidated gluten
Biopsy- diagnostic

115
Q

Where in the bowel are diverticula, commonly?

A

Sigmoid colon

116
Q

Where on the circumference of the bowel are diverticula often positioned?

A

Between the mesenteric and antimesenteric taenia coli

117
Q

Pathogenesis of diverticula?

A

Increased intra luminal pressure + points of relative weakness in the bowel wall

118
Q

short bowel syndrome is a complication of what?

A

IBD

119
Q

Apthoid and fissuring ulcers are in crohns or UC?

A

Crohns

120
Q

Strictures are common in crohn’s or UC?

A

Crohns

121
Q

No spontaneous fistulae are present in crohns or UC?

A

UC

122
Q

Crypt abscesses are common and crypt distortion is severe in crohn’s or UC?

A

UC

123
Q

Granulomas present in crohns or UC?

A

Crohns

124
Q

7 extra-intestinal manifestations of IBD?

A 
Hepatic
Skeletal
Mucocutaneous
Renal
Heamatological
Systemic
125
Q

Which hyperplastic polyps may give rise to microsatellite unstable carcinoma?

A

Large, right sided

126
Q

What benign polyp is a CRC precursor?

A

Adenoma

127
Q

2 genetic traits that increase susceptibility to colorectal cancer

A

FAP

HNPCC

128
Q

FAP is due to a mutation in what?

A

APC tumour supressor gene

129
Q

HNPCC also increases risk of which cancers?

A

Endometrial, ovarian, gastric, small bowel, urinary tract, biliary tract

130
Q

HNPCC what mutation?

A

DNA mismatch repair genes

131
Q

Pathogens that cause intra abdominal infection

A 
Pseudomonas ssp
Clostridium spp
Bacteriodes ssp
Enterococcus ssp
Enterobacteraceae
Prevotella ssp
132
Q

Rx of intra abdominal infection of intestinal source

A

Cefuroxime and metronidazole if under 65
Piperacillin/tazobactam if over 65
Then depends on culture results

133
Q

Pain in shoulder
Hiccoughs
Apparent hepatomegaly
Pleural effusion/lung collapse

A

Subphrenic abscess

134
Q

Pathogens that cause gastroenteritis?

A 
Bacterial:
Bacillus cereus
Vibrio cholerae
Salmonella
C diff
Staph aureus
E coli
Shigella
Campylobacter

Viral:
Norovirus and Rotavirus

Parasitic:
Entamoeba histolytica
Cryptosporidium
Giardia lamblia

Non-infective

135
Q

How might you catch cryptosporidium gastroenteritis?

A

Waterborne- e.g. swimming pool or salad washed in infected water

136
Q

Of the bacterial causes of gastroenteritis, which produce enterotoxins and which act by adherence?

A 
Enterotoxins:
Bacillus cereus
Vibrio cholerae
C. diff and C. perfringens
Staph aureus
E. coli
Adherence:
Shigella sonnei/flexneri
E. Coli
Campylobacter jejuni
Salmonella
137
Q

EHEC/VTEC form of E.coli =?

A

Enterohaemorrhagic

Colitis/HUS

138
Q

ETEC form of E.coli =?

A

Enterotoxigenic

Traveller’s diarrhoea

139
Q

EAggEC

A

Enteroaggregative

Traveller’s diarrhoea

140
Q

EIEC form of E.coli =?

A

Enteroinvasive dystentry like

141
Q

EPEC form of E.coli =?

A

Enteropathogenic

Childhood

142
Q

E Coli 0157 releases what virulence factor?

A

Shiga toxin

143
Q

Shiga toxin mechanism?

A

Like cholera

144
Q

Salmonella mechanism?

A

It is the bacteria itself not the toxin.

145
Q

Typhoidal strains of salmonella do what?

A

Affect cells outside of GI tract and spread

146
Q

Rx gastroenteritis?

A

Supportive
Avoid abx unless very young/old, campylobacter infection or it has invaded (positive blood cultures)
Abd may make e coli hus worse or increase the duration of salmonella carriage

147
Q

Type of colitis in abx associated diarrhoea?

A

Pseudomembranous

148
Q

rx c diff

A

metronidazole or vancomycin

faecal transplant

149
Q

8 causes aseptic meningitis

A 
Viruses
Partially treated bacterial
Listeria
TB
syphilis
Malignancy
autoimmune
drugs
150
Q

2 main causes of viral meningitis?

A 
Enteroviruses
Herpes virus (HSV2, VZV)
151
Q

2 extra signs of viral meningitis seen in neonates/infants?

A

Nuchal rigidity

Bluging anterior fontanelle

152
Q

What is Kernig’s sign?

A

Tight hamstrings

153
Q

Brudzinski’s sign?

A

Flexing neck causes hips and knees to flex

154
Q

What investigation must you do ASAP in viral meningitis (and what would contraindicate it?) What is the gold standard test?

A

Lumbar puncture unless raised ICP (do a CT to check)

Gold standard is viral PCR

155
Q

difference in CSF between bacterial and viral meningitis?

A

White cell count- B very high, V high
Predominant WBC- B neutrophils, V lymphocytes
Protein- B high or very high, V normal or high
Glucose- B low, V normal

156
Q

Rx viral meningitis

A

If risk of bacterial then abx

Otherwise supportive

157
Q

What is Mollaret’s meningitis?

A

Recurrent aseptic, normally HSV2

158
Q

Viral meningitis + fever, lymphadenopathy, pharyngitis, rash =?

A

HIV meningitis

159
Q

Viral encephalitis causes that are different to meningitis?

A

HSV1, rubella, rabies, acute disseminated encephalomyopathy

160
Q

Rx viral encephalitis

A

High dose aciclovir

161
Q

What is ADEM?

A

Immune mediated CNS demyelination

162
Q

Difference between onset of encephalitis and brain abscess?

A

Encephalitis is acute

163
Q

3 causes of bacterial meninigitis?

A

Neisseria meningitidis
Haemophilus influenza
Strep pneumoniae

164
Q

Rx of bacterial meningitis?

A

Ceftraixone and cefotaxime
Rifampicin to contacts
+steroids for s. pneumoniae

165
Q

3 causes neonatal meningitis

A

Group B strep
E coli
Listeria monocytogenes

166
Q

Rx neonatal meningitis

A

Cefotaxime

Ampicillin and gentamicin

167
Q

Marfan syndrome is associated with what valvular heart disease?

A

Aortic regurg

168
Q

Cyanosis in R to L or L to R shunts?

A

R to L

169
Q

Downs syndrome is associated with which heart defect?

A

AVSD

170
Q

Which 3 heart conditions require a shunt to survive?

A

Transposition great arteries
Tricuspid atresia
Total anomalous pulmonary venous connection

171
Q

Coarctation of the aorta is associated with what genetic defect?

A

Turner’s syndrome

172
Q

Murmur in aortic regurg

A

Diastolic

173
Q

Murmur in mitral stenosis

A

Opening snap and diastolic

174
Q

Murmur in aortic stenosis

A

Ejection systolic

175
Q

Murmur in mitral regurg

A

Pansystolic

176
Q

3 types endocarditis

A

Infective
Non bacterial thrombotic
Endocarditis of SLE (Libman-Sacks Disease)

177
Q

What pathogen found to be causing infective endocarditis should prompt investigation for bowel cancer?

A

Strep bovis

178
Q

Signs of infective endocarditis

A

FROM JANE

fever, roth spots, osler’s nodes, murmur, janeway lesions, anaemia, nail haemorrhage, emboli

179
Q

In whom does non-bacterial thrombotic endocarditis occur?

A

Debiliated patients in hypercoagulable state

180
Q

Which valves affected in Libman-Sacks endocarditis?

A

Mitral and tricuspid (atrioventricular valves)

181
Q

Aschoff bodies are found in what?

A

Rheumatic fever

182
Q

3 pathogens that cause infective endocarditis

A

Strep viridans
Staph aureus
Strep bovis

183
Q

5 types acute pericarditis and their causes

A
  1. purulent (infection)
  2. serous (adjacent inflammation)
  3. Caseous (TB or fungal)
  4. Fibrinous/serofibrinous (Dressler’s syndrome post MI)
  5. Haemorrhagic (trauma, neoplasm, surgery, infection)
184
Q

3 types chronic pericarditis

A
  • Adhesive
  • Adhesive mediastino pericarditis (follows pericarditis caused by infection, surgery, radiation)
  • Constrictive
185
Q

4 classes of cardiomyopathies

A
  • Dilated
  • Restrictive
  • Hypertrophic
  • Arrythmogenic right ventricular
186
Q

4 causes of dilated cardiomyopathy

A

Genetic, myocarditis, alcohol/toxin, autoimmune

187
Q

Cause hypertrophic cardiomyopathy

A

Genetic

188
Q

Sign of hypertrophic cardiomyopathy on examination?

A

Systolic ejection murmur

189
Q

Restrictive cardiomyopathies are either idiopathic or secondary to which 5 things?

A 
Amyloidosis
Fibrosis
Inborn errors of metabolism
Sarcoidosis
Tumours
190
Q

Myocarditis is caused by which two infections?

A

Coxsackie virus A+B

Chagas disease

191
Q

Giant cell arteritis is a type of? It involves what sort of inflammation?

A

Vasculitis. Granulomatous.

192
Q

What type of cells are seen in giant cell arteritis?

A

Multi-nucleated giant cells

193
Q

Rx giant cell arteritis?

A

Corticosteroid, anti TNF

194
Q

6 types aneurysm

A 
Atherosclerotic
Dissecting
False
Berry
Micro and syphilitic
Mycotic
195
Q

Which type of aneurysm is associated with subacute bacterial endocarditis?

A

Mycotic

196
Q

3 signs nephrotic syndrome

A

Oedema
Proteinurea
Hypoalbuminaemia

197
Q

5 signs acute nephritis

A 
Oedema
Haematuria
Proteinuria
HTN
AKI
198
Q

What is nephrotic syndrome?

A

Glomerular damage

199
Q

5 causes nephrotic syndrome

A 
Membranous nephropathy
Diabetes
FSGS
minimal change disease
SLE
200
Q

6 causes acute nephritis?

A 
IgA nephropathy
Post infective
HUS
Vasculitis
Henoch schonlein purpura
SLE
201
Q

Myeloma can have what effect on the kidneys?

A

Immunoglobulins in the tubules

202
Q

Major cause of CKI and 3 other causes

A

DIABETES
Malformation
Reflux nephropathy
Glomerulonephritis

203
Q

Haematuria + ear and eye problems = ?

A

Alport type hereditary nephrophathy

204
Q

4 caues proteinuria

A

SLE
FSGS
Diabetes
Henoch schonlein purpura

205
Q

4 possible composition of renal stones?

A

Calcium
Struvite (Mg NH4+ P)
Urate
Cystine

206
Q

Cause of struvite stones

A

Urease producing bacterial infection (urease converts urea to ammonia)

207
Q

Staghorn caliculi are a sign of which type of stone?

A

Struvite

208
Q

What is the gold standard investigation for renal stones?

A

Non-contrast CT

209
Q

Majority of renal cancers are what tyoe?

A

Clear cell

210
Q

Renal cancer is associated with which genetic disease?

A

Von Hippel-Lindau syndrome

211
Q

Foamy cell renal tumours are likely to be

A

Papillary tumours

212
Q

True or false renal cell carcinoma responds well to chemo?

A

False

213
Q

Urothelial cell carcinoma is found in the?

A

Bladder

214
Q

Prostate carcinomas normally arise from which zone of the prostate?

A

Peripheral

215
Q

Seminoma or teratoma is after puberty?

A

Teratoma

216
Q

What serum substrates are increased in seminoma?

A

PLAP and hCG

217
Q

True or false teratomas do not secrete tumour markers

A

True

218
Q

Pain and swelling in the epididymis following a vasectomy

A

Sperm granuloma

219
Q

Inflammatory and myofibroblastic mass in the testis of unknown aetiology

A

Myofibroplastic pseudotumour of testis

220
Q

Swollen, tender testis with flu-like illness and a granulomatous mass

A

Idiopathic granulomatous orchitis

221
Q

Painless scrotal swelling

Caseating, granulomatous inflammation, fibrosis

A

Tuberculous orchitis

222
Q

Infarcted seminiferous tubules

A

Epididymoorchitis

223
Q

Yellow/brown nodules and histiocytes in testis

A

Malakoplakia

224
Q

Rx pyelonephritis

A

Cefuroxime, ciprofloxacin (or pip and tazo if over 65)

225
Q

3 common pathogens that cause UTIs

A 
E coli
Staph saprophyticus (GP)
Enterococcus ssp (hospital)
226
Q

Rx cystitis

A

Nitrofurantoin
Pivmecillinam
Trimethoprim
Fosfomycin

227
Q

What is urethral syndrome?

A

Symptoms UTI w/o infection

228
Q

When would you treat asymptomatic bacteriuria

A

Pregnancy
Infant
Prior to urological procedures

229
Q

Thalassaemia leads to what type of anaemia?

A

Microcytic hypochromic

230
Q

Megaloblastic macrocytic anaemia can be caused by what?

A

B12 or folate deficiency

231
Q

Pathogenesis of acute haemolytic reaction (ABO incompatibility)

A

Release of free Hb

232
Q

Fatigue, jaundice and fever 3-14 days post blood transfusion =? Due to what?

A

Delayed haemolytic reaction

Due to RBC antigens other than ABO

233
Q

What does coomb’s test detect?

A

IgG antibodies

234
Q

True or false febrile non haemolytic transfusion reaction is life threatening?

A

False

235
Q

Prothrombin time measures which pathway?

A

Extrinsic

236
Q

Time from thrombin to fibrin is measured by what test?

A

Thrombin clotting time

237
Q

4 in vivo anticoagulants

A

protein c
protein s
anti-thrombin III
fibrinolytic system

238
Q

What does the fibrinolytic system involve?

A

Plasmin an ezyme that causes fibrin breakdown
Plasminogen cleaved by plasminogen tissue activator to plasmin
Alpha 2 anti plasmin mops up excess plasmin in plasma

239
Q

Coagulation problems that are platelet/vessel wall defects give rise to what sort of symptoms?

A

Mucosal and skin bleeding e.g. heavy periods, nose bleeds

240
Q

Coagulation problems that are coagulation defects give rise to what sort of symptoms?

A

Deep muscular and joint beds

241
Q

VW disease affects what part of clotting?

A

Aggregation

242
Q

True or false haemophilias VIII and IX have different presentations to each other

A

False

243
Q

Which clotting test is abnormal in VWD and haemophilia?

A

APTT

244
Q

What is a treatment of VWD that stimulates VWF release?

A

DDAVP a vasopressin/ADH analogue

245
Q

Patients with liver disease invariably have what blood problem?

A

Impaired haemostasis

246
Q

4 features of impaired haemostasis in liver disease?

A

Low and dysfunctional platelets
Reduced synthesis of all coagulation factors except VIII
Fibrin polymerisation is delayed
Excessive plasmin activity

247
Q

Massive transfusion can have what 2 problems?

A

DIC

Dilutional depletion of platelets and coagulation factors

248
Q

What chromosomes are the different Hbs found on?

A

Alpha- 16

Gamma, delta and beta- 11

249
Q

4 acute complications of sickle cell disease

A

Vaso-occulsive crisis
Septicaemia
Aplastic crisis
Sequestration crisis

250
Q

Chronic complications of sickle cell disease

A

Hyposplenism
Renal disease
Avascular necrosis
Leg ulcers, osteomyelitis, gall stones, retinopathy, cardiac, respiratory

251
Q

True or false sickle cell is an inflammatory condition in some ways

A

true

252
Q

Alpha thalassaemia results in which 2 types of Hb?

A

Hb Barts and HbH

253
Q

True or false alpha thalassaemia trait is clinically significant

A

False

254
Q

Thalassaemia beta major has what 6 features?

A

Severe aneamia
Skeletal abnormalities and stunted growth
Increased BM activity so increased iron absorption
Splenomegaly (RBC pooling)
Abnormal dentition
Frontal bossing

255
Q

Rx thalassaemia beta major?

A

Transfusion to maintain Hb and suppress rbc production

And chelation with desferrioxamine to get rid of excess iron.

256
Q

What do most thalassaemia maj beta patients die of?

A

Heart disease

257
Q

Blood differences in pregnancy?

A 
MCV +
Prothrombotic
Fe and folic acid used
Neutrophilia
Haemodilution
Reduced platelets
258
Q

3 main areas of chronic myeloproliferative disorders

A

Polycythaemia vera
Essential thrombocytosis
Idiopathic myelofibrosis

259
Q

Symptoms polycythaemia vera

A

Redness, itching, gout, splenomegaly

260
Q

Some causes of secondary polycythaemia?

A 
Chronic lung disease
R-L shunts
Smoking
altitude
renal disease
EPO producing tumours
drugs
congenital
261
Q

Rx polycythaemia

A

Aspirin

Venesection

262
Q

What mutations are associated with thrombocytosis and myelofibrosis?

A

JAK2 and CALR

263
Q

Thrombocytosis is increase in what?

A

Megakaryocytes and platelets

264
Q

What are the two types of thrombocytosis?

A

Primary essential

Reactive

265
Q

What is myelofibrosis?

A

BM fibrosis

266
Q

What are the symptoms of myelofibrosis?

A

Pancytopenia
Fever, weight loss, night sweats
Splenomegaly

267
Q

Chronic myeloid leukaemia symptoms

A 
Leucocytosis ++
Leukoerythroblastic blood picture
Anaemia
Splenomegaly
Venous occulsion
Gout
268
Q

What chromosome is associated with CML?

A

Philadelphia (9 and 22 swap= cell proliferation = active tyrosine kinase. Inhibited by imatinib)

269
Q

Name the two light chains of Igs

A

Kappa and lambda

270
Q

What 2 states precede myeloma?

A

MGUS, asymptomatic myeloma

271
Q

What are the diagnosis criteria for myeloma?

A

more than 10% BM plasma cells neoplastic
OR
Lump of plasma cells found

AND

One of more of either CRAB or MDEs
hyperCalcaemia, Renal insufficiency, Anaemia, Bone lesoins

272
Q

What can myeloma go on to become?

A

Plasma cell leukaemia

273
Q

AKI and myeloma is what?

A

A medical emergency! Give steroids

274
Q

Non hodgkins lymphoma is what?

A

Too many follicles in lymph nodes, lump on neck

275
Q

Hodgkins lymphoma has what cells? Linked to what virus?

A

Hodgkin Reed-Sternberg cells with infiltrate of non-malignant inflammatory cells.
EBV

AH extra cards (29 decks)

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