Rheumatology & Haematology UK Medical PG Flashcards - Medical Study Cards
Master Rheumatology & Haematology with OnCourse flashcards. These spaced repetition flashcards are designed for medical students preparing for NEET PG, USMLE Step 1, USMLE Step 2, MBBS exams, and other medical licensing examinations.
Rheumatology & Haematology Flashcard Deck - 853 Cards
Flashcard 1: D-Dimer is a marker of _____
Answer: fibrin degredation
Flashcard 2: Management of No Bleeding on warfarin when INR 5.0-8.0 involves:
_____
Reduce subsequent maintenance dose
Answer: Withhold 1 or 2 doses of warfarin
Flashcard 3: Common causes of acute leukocytosis include:
_____
Steroids
Acute Leukaemias
Answer: Infection, Inflammation, Post-Surgery
Flashcard 4: APL can be distinguised from other types of AML based on:
_____
Repsonsivness to all-trans retinoic acid (ATRA: tretinoin)
Answer: Prescence of promyelocytes containing multiple Auer Rods
Flashcard 5: Management of Minor Bleeding on warfarin when INR 5.0-8.0 involves:
_____
Restart when INR <5.0
Answer: Give IV vitamin K 1-3mg
Flashcard 6: Management of Minor Bleeding on warfarin INR > 8.0 involves:
_____
Restart dose of vitamin K if INR still too high after 24hrs
restart warfarin when INR <5.0
Answer: IV Vitamin K 1-3mg
Flashcard 7: There is an increased risk of VTE in nephrotic syndrome due to a _____
Answer: loss of Antithrombin III
Flashcard 8: Sodium valproate can cause _____ and Hyponatremia
Answer: thrombocytopenia
Flashcard 9: Management of No Bleeding on warfarin when INR >8.0 involves:
_____
Repeat dose of vit K if INR still too high after 24 hours
Restart when INR <5.0
Answer: Give vitamin K 1-5mg by mouth, using the IV preparation orally
Flashcard 10: Common causes of chronic leukocytosis include:
_____
Leukaemia, subtypes of lymphoma
Hyposplenism
Pregnancy
Answer: Chronic Infection, Smoking
Flashcard 11: Metastatic Bone Pain may responsd to _____, bisphosphonates or radiotherapy
Answer: strong opioids
Flashcard 12: Aspirin functions _____
Answer: non-reversible COX 1and 2 Inhibitor
Flashcard 13: Buerger's Disease is a _____
Answer: small and medium vessel vasculitis
Flashcard 14: Features of Buerger's Disease includes:
_____
Answer: Extremity Ischaemia (Intermittent claudication, Ischaemic Ulcers)
Superficial Thrombophlebitis
Raynaud's Phenomenon
Flashcard 15: Buerger's disease is also known as _____
Answer: thromboangiitis obliterans
Flashcard 16: DOACs are advantageous over warfarin due to the fact that they do not _____ to check the INR
Answer: require regular blood tests
Flashcard 17: A patient with a Well's score of <4 would indicate?
Answer:
• A low-risk patient
• They should have D-dimer measured
• CTPA if D-Dimer is elevated
Flashcard 18: What is given as VTE prophylaxis for patients?
Answer:
• LMWH (e.g. enoxaparin)
Flashcard 19: The variables involved in assesing the ORBIT score is:
_____
Age >74
Bleeding History (GI bleeding, Intracranial bleeding or haemorrhagic stroke
Renal Impairment (GFR <60)
Treatment with antiplatelet agents
Answer: Haemoglobin <130g/L in makes <120g/L in females Anaemia
Flashcard 20: What are the skin features of Sarcoidosis?
Answer:
• Erythema Nodosum -> on shins
• Lupus Pernio -> cheeks and nose
Flashcard 21: What should be used to measure iron deficiency anaemia?
Answer:
• Transferrin saturation, iron, total iron binding capacity
Flashcard 22: INR 5.0-8.0 + Minor Bleeding management?
Answer:
• Stop Warfarin
• Give IV Vitamin K 1-3mg
• Restart when INR < 5.0
Flashcard 23: What are the blood test findings to remember for Sarcoidosis?
Answer:
• Raised ACE
• Hypercalcaemia
Flashcard 24: What is the managment for Sjogren's Syndrome?
Answer:
• Artificial tears
• Artificial Saliva
Vignal lubricants
Flashcard 25: What are the classic signs of a Hip Fracture?
Answer:
• Shortened and externally rotated leg
Flashcard 26: Haemoglobin of 18.4 g/dl?
Answer:
• Raised haemoglobin
• suggests secondary polycythaemia
Flashcard 27: What is the reversal agent for bleeding on dabigatran?
Answer:
• Idarucizumab
Flashcard 28: would Heamoglobin of 10.1g/dl indicate LTOT?
Answer:
• No
• 10.1 = anaemic
Flashcard 29: What can acute reactive arthritis be treated with?
Answer:
• NSAIDs
Flashcard 30: What is the imaging of choice for suspected Osteomyelitis?
Answer:
• MRI
Flashcard 31: What is the classic triad of Fat Embolism Syndrome?
Answer: 1. Respiratory changes -> hypoxia, dyspnea
2. Neurological signs -> confusion
3. Petechial Rash
Flashcard 32: 711a6778d3644243aad60aadbe804f0a-ao-2
Answer:
Flashcard 33: Young Asian woman with headaches, unequal blood pressure in upper limbs, and claudication, diagnosis?
Answer:
• Takayasu Arteritis
Flashcard 34: Patients allergic to aspirin may also react to which DMARD?
Answer:
• Sulfasalazine
Flashcard 35: How does Sjogren's Syndrome present?
Answer:
• Dry Mouth
• Dry Eyes
• Dry Vagina
*also dry skin, joint pain and stiffness
Flashcard 36: What are the antibodies associated with Sjogren's syndrome?
Answer:
• Anti-Ro
• Anti-La
Flashcard 37: Patient presents with abdominal pain, arthritis, haematuria and a purpuric rash over the buttocks and extensor surfaces of arms and legs, diagnosis?
Answer:
• Henoch-Schonlein purpura
Flashcard 38: What other condition is Takakayasu Arteritis Associated with?
Answer:
• Renal artery stenosis
Flashcard 39: Why is folate prescribes alongside methotrexate?
Answer:
• To reduce risk of myelosupression
Flashcard 40: How can undisplaced patella fractures with an intact extensor mechanism be managed?
Answer:
• Conservatively with knee immobilisation
Flashcard 41: What
is the first-line investigation for suspected Paget’s disease of the bone?
Answer: Plain
radiographs, which are usually diagnostic.
Flashcard 42: Can Psoriatic arthropathy present before psoriatic skin lesions?
Answer:
• Yes
Flashcard 43: What Antibodies are used in Rheumatoid Arthritis diagnosis?
Answer:
• Rhematoid Factor (RF)
• Anti-CCP
Flashcard 44: What antibodies are used to test for SLE?
Answer:
• ANA
• Anti-dsDNA
• Anti-Smith
• Anti - Ro
• Anti - La
Flashcard 45: What does Dactylitis (Swelling of a whole digit) suggest?
Answer:
• Psoriatic arthritis or ankylosing spondylitis
Flashcard 46: What can help distinguish Pseudogout from Gout?
Answer:
• Chondrocalcinosis
Flashcard 47: Most common causative organism of septic
arthritis?
Answer: Staphylococcus aureus
Flashcard 48: What are the antibodies used to diagnose Antiphospholipid syndrome?
Answer:
• Anticardiolipin antibodies
Flashcard 49: Does OA or RA get worse with use?
Answer:
• OA
Flashcard 50: Which condition usually spares the DIPs?
Answer:
• Rheumatoid Arthritis
Flashcard 51: What joints are most affected in OA?
Answer:
• Carpometacarpal joints (CMCs)
• Distal Interphalangeal joints (DIPs)
Flashcard 52: Which infection can cause a polyarthritis?
Answer: Tuberculosis
Flashcard 53: What investigation is used to diagnose pernicious anaemia?
Answer:
• Intrinsic factor antibody titre
Flashcard 54: What location is a red flag in back pain?
Answer:
• Thoracic pain
Flashcard 55: Psoas abscess is an important differential for back pain in which patient group?
Answer:
• IVDU
Flashcard 56: What is used to manage acute flares of Rheumatoid Arthritis?
Answer:
• IM methylprednisolone
Flashcard 57: What is the first-line for Knee Osteoarthritis?
Answer:
• topical NSAIDs
Flashcard 58: Infectious mononucleosis typically has _____ pharyngitis/tonsilitis
Answer: exudative
Flashcard 59: Infectious mononucleosis is transmitted via _____
Answer: saliva
Flashcard 60: What would Bone Marrow Aspirate show in multiple myeloma?
Answer:
• Increased plasma cells
Flashcard 61: What is the gold-standard investigation for infectious mononucleosis?
_____
Answer: Anti-VCA antibodies (EBV specific)
Flashcard 62: Infectious mononucleosis is most commonly caused by _____ and less commonly caused by cytomegalovirus (CMV)
Answer: Epstein-Barr virus (EBV)
Flashcard 63: What is the management for infectious mononucleosis?
_____
Answer: Supportive; no contact sports for 4 weeks
Flashcard 64: _____ infectious mononucleosis results in +ve Monospot test
CMV infectious mononucleosis results in -ve Monospot test
Answer: EBV
Flashcard 65: Infectious mononucleosis causes _____megaly that has ↑ risk for rupture
Answer: spleno
Flashcard 66: When should Sickle Cell patients should recieve the pneumococcal vaccine?
Answer: Every 5 years
Flashcard 67: What is the initial screening investigation for infectious mononucleosis?
_____
Answer: Monospot (heterophil antibody) test
Flashcard 68: The peak incidence for infectious mononucleosis is _____
Answer: teens/young adults
Flashcard 69: Advise patients with infectious mononucleosis to avoid _____ for 4 weeks because of ↑ risk of splenic rupture
Answer: contact sports
Flashcard 70: FBC for infectious mononucleosis shows _____ and >10% atypical lymphocytes
Answer: lymphocytosis
Flashcard 71: What is the likely diagnosis in a teen with 3-day history of fever, exudative tonsils, posterior cervical lymphadenopathy, & splenomegaly O/E. There is lymphocytosis on FBC and a -ve monospot test.
_____
Answer: Infectious mononucleosis
Flashcard 72: Pharyngitis/tonsilitis in infectious mononucleosis treated with _____ often results in a(n) maculopapular rash
Answer: aminopenicillins
Flashcard 73: A patient with suspected strep A pharyngitis is treated with amoxicillin develops a maculopapular rash, what is the likely diagnosis?
_____
Answer: Infectious mononucleosis
Flashcard 74: Infectious mononucleosis presents with _____itis/tonsilitis, fever, posterior cervical lymphadenopathy, & hepatosplenomegaly
Answer: pharyng
Flashcard 75: Blood smear for infectious mononucleosis shows _____
Answer: atypical/reactive lymphocytes
Flashcard 76: Infectious mononucleosis has an incubation period of _____
Answer: ~6 weeks
Flashcard 77: _____ is an acute, self-limited viral infection most commonly caused by EBV that is also known as "glandular fever", "mono", or the "kissing disease"
Answer: Infectious mononucleosis
Flashcard 78: What causes Pernicious Anaemia?
Answer: Vitamin B12 deficiency due to intrinsic factor (IF) deficiency
Which is essential for B12 absorption in the ileum
Flashcard 79: What is the diagnosis when external rotation of shoulder (on both active and passive movement) is impaired?
Answer:
• Adhesive capsulitis
Flashcard 80: What is used to monitor treatment in haemochromatosis?
Answer:
• Ferritin and Transferrin saturation
Flashcard 81: What is the next step in the event of a major bleed in a patient on warfarin?
Answer:
• Stop warfarin, give IV Vitamin K 5mg and Prothrombin Complex Concentration (PCC)
Flashcard 82: Loss of _____ in nephrotic syndrome results in a hyper-coaguable state
Answer: antithrombin III
Flashcard 83: _____ can cause class V lupus nephritis with a membranous pattern on biopsy
Answer: SLE
Flashcard 84: Chronic kidney disease causes _____cytic normochromic anaemia from ↓ production of erythropoietin (EPO)
Answer: normo
Flashcard 85: Minimal change disease is rarely associated with _____
Answer: Hodgkin lymphoma
Flashcard 86: What medication should never be prescribed with methotrexate?
Answer:
• Trimeothprim containing medication
e.g. Co-trimoxazole
Flashcard 87: What is prescribed alongside methotrexate to prevent myelosupression?
Answer:
• Folate
Flashcard 88: What result is associated with good prognosis in RA?
Answer:
• Rheumatoid factor negative
Flashcard 89: What Imaging is required for an RA patient before having surgery?
Answer:
• Anteroposterior and lateral cervical spinal radiographs
Flashcard 90: What complication can arise if Trimethoprim is prescribed alongside methotrexate?
Answer:
• Bone marrow supression
• Severe or fatal pancytopaenia
Flashcard 91: What advise is given for pregnant patients on Methotrexate?
Answer:
• Women should avoid pregnancy for atleast 6 months after treatment has stopped
Flashcard 92: What is the antidote for Methotrexate overdose?
Answer:
• Folinic Acid
Flashcard 93: What Investigation do you need to order before prescribing Biologics in RA?
Answer: Chest X-Ray
To look for TB prior to starting biologics for RA, as they can cause reactivation
Flashcard 94: What cardiovascular disease do RA patients have an increased risk of?
Answer:
• IHD
due to systemic inflammation
Flashcard 95: What is Systemic Sclerosis?
Answer:
• An automimmune connective tissue disease involving inflammation and fibrosis of the connective tissues, skin and internal organs
Flashcard 96: Patients with _____ anemia should be monitored for development of gastric cancer
Answer: pernicious
Flashcard 97: _____ is the most important complication of carbimazole
Answer: Agranulocytosis
Flashcard 98: Thalassaemia is associated with a(n) _____ red cell distribution width (RDW)
Answer: normal
Flashcard 99: Beta thalassaemia _____ and sickle cell anemia are characterised by expansion of haematopoiesis into facial bones, leading to "chipmunk facies"
Answer: major
Flashcard 100: Patients with thalassaemias will be offered genetic _____ and family members will be offered screening
Answer: counselling
Flashcard 101: Haemophilia A is an _____ pattern of inheritance
Answer: X-linked
Flashcard 102: Beta thalassaemia is predominant in individuals from _____ descent
Answer: Mediterranean
Flashcard 103: What is the confirmatory investigation for essential thrombocythaemia?
_____
Answer: Bone marrow studies
Flashcard 104: Haemaglobin A is composed of _____α-globin chains and x2β-globin chains
Answer: x2
Flashcard 105: What is the management for hemophilia A?
Mild: _____
Severe: Factor VIII concentrate
Answer: desmopressin
Flashcard 106: The most common cause of thrombocythaemia is _____ that is triggered by infection, inflammation, etc
Answer: secondary (reactive) thrombocythaemia
Flashcard 107: _____ are caused by deficient clotting factors, which leads to haemoarthrosis, recurrent ecchymosis, and prolonged haemorrhages
Answer: Haemophilias
Flashcard 108: What is the management for asymptomatic thalassaemias?
_____
Answer: No specific management
Flashcard 109: Thalassaemia causes _____cytic hypochromic RBCs with or without anaemia
Answer: micro
Flashcard 110: _____ alleles encode for the x2 α-globin chain
2 alleles encode the x2 β-globin chains
Answer: 4
Flashcard 111: Alpha thalassaemia _____ is due to -α/αα and presents asymptomatically
Answer: silent carrier
Flashcard 112: Haemophilia A, B, and C disrupts the _____ coagulation pathway
Answer: intrinsic
Flashcard 113: Essential thrombocythaemia typically occurs at age _____-60 years old
Answer: 50
Flashcard 114: What is the most accurate investigation for haemophilia?
_____
Answer: Factor VIII & IX assay
Flashcard 115: What is the supportive management required to improve long-term surivial in beta thalassaemia?
_____
Answer: Iron chelation therapy e.g. desferrioxamine mesilate
Flashcard 116: What is the management for hemophilia B & C?
Severe: _____
Answer: Factor IX concentrate or factor XI concentrate respectively
Flashcard 117: Symptoms of essential thrombocythaemia are related to an increased risk of _____ and/or thrombosis
Answer: bleeding
Flashcard 118: What is the management for essential thrombocythaemia?
_____ to prevent thrombosis
Hydroxyurea to ↓ platelets
Answer: Low-dose aspirin
Flashcard 119: Beta thalassaemia _____ is due to β/β+ or β/β0 and presents asymptomatically
Answer: minor (trait)
Flashcard 120: Spot diagnosis = _____
Answer: ”crew cut” in beta thalassaemia major / sickle cell disease from extramedullary haematopoiesis
Flashcard 121: Spot diagnosis = _____
Answer: haemophilia; presenting with haemarthrosis. Patients know what it feels like.
Flashcard 122: ~20% of cases are haemophilia _____ caused by genetic factor IX deficiency
Answer: B (Christmas disease)
Flashcard 123: Haemophilia C has an _____ pattern of inheritance
Answer: autosommal recessive
Flashcard 124: Alpha thalassaemia _____ is due to --/-- and is incompatible with life
Answer: major (haemoglobin Bart's disease)
Flashcard 125: In haemophilia A, mixing normal plasma with the patient's plasma (mixing study) _____ correct the aPTT
Answer: does
Flashcard 126: The _____ index is used to distinguish iron deficiency anaemia vs minor thalassaemia
Answer: Mentzer
Flashcard 127: What is the general management for thalassaemia intermedia or haemoglobin H disease (- -/-α)?
_____
Answer: Transfusions when needed (e.g. pregnancy)
Flashcard 128: _____ is a neoplastic proliferation of mature myeloid cells, especially platelets
Answer: Essential thrombocythaemia
Flashcard 129: Thalassaemia genes are inherited in a _____ fashion
Answer: autosommal recessive
Flashcard 130: _____ thalassaemia is usually due to gene mutations
Alpha thalassaemia is usually due to gene deletions
Answer: Beta
Flashcard 131: Management of beta thalassemia major involves chronic _____, which increases risk for secondary hemochromatosis
Answer: blood transfusions
Flashcard 132: _____ is a haemoglobinopathy due to decreased synthesis of globin chains
Answer: Thalassaemia
Flashcard 133: _____ is due to --/-α and presents with moderate/severe anaemia
Answer: Haemaglobin H disease
Flashcard 134: Petechial bleeding is a common sign of _____ disorders
Answer: platelet
Flashcard 135: Alpha thalassaemia major (haemoglobin Bart's disease) often results in _____ in utero
Answer: hydrops fetalis
Flashcard 136: Alpha thalassaemia _____ is due to --/αα or -α /-α and presents with mild anaemia
Answer: trait
Flashcard 137: Public Health England recommend all _____ women are screened for thalassaemia
Answer: pregnant
Flashcard 138: ~80% of cases are haemophilia _____ caused by genetic factor VIII deficiency
Answer: A
Flashcard 139: An italian patient presents with fatigue, pallor, & tiredness with microcytic hypochromic RBCs and normal iron studies and ↓ RDW. What is the next step?
_____
Answer: Haemoglobin electrophoresis
Flashcard 140: FBC for essential thrombocythaemia has sustained isolated _____
Answer: thrombocythaemia
Flashcard 141: Beta thalassaemia _____ is due to β+/β+ or β+/β0 and presents with moderate anaemia
Answer: intermedia
Flashcard 142: Very few cases are haemophilia _____ caused by genetic factor XI deficiency
Answer: C
Flashcard 143: Haemophilia has _____ aPTT and normal PT
Answer: raised
Flashcard 144: What are the initial investigations for suspected haemophilia?
_____
Answer: Coagulation studies (aPTT) & FBC (rule out thrombocytopenia)
Flashcard 145: Haemophilias present with _____ commonly affecting the knees, ankles, & elbows; recurrent ecchymoses; and prolonged haemorrhage particularly after surgery/procedures
Answer: haemarthroses
Flashcard 146: Haemophilia B is an _____ pattern of inheritance
Answer: X-linked
Flashcard 147: Which coagulation disorder presents with recurrent haemarthroses, spontaneous / easy bruising, and bleeding after surgery?
_____
Answer: Hemophilia (A, B, C)
Flashcard 148: Beta thalassaemia _____ is due to β0/β0 and presents with severe anaemia that is transfusion-dependent
Answer: major (Cooley's anaemia)
Flashcard 149: On palpation beta thalassaemia can present with _____ because of extramedullary haematopoiesis
Answer: hepatosplenomegaly
Flashcard 150: What is the general management for thalassaemia major?
_____
Answer: Transfusion therapy Hb > 95 g/L
Iron chelation!! e.g. desferrioxamine mesilate
Flashcard 151: A young boy presents with heamarthrosis and easy bruising.
Coagulation studies reveal ↑ aPTT & normal PT. Mixing studies are corrected. You suspect haemophilia.
What other bleeding disorder must be ruled out?
_____
Answer: von Willebrand's Disease (remember, vWF carries factor VIII)
Flashcard 152: Beta thalassaemia _____ is the most severe form of the disease; causes severe anemia a few months after birth
Answer: major (β0/β0)
Flashcard 153: Haemophilias predominantly affect _____ **bonus, why?
Answer: men
Flashcard 154: Haemophilia A can arise from a(n) _____ mutation without any family history (20%)
Answer: new (de novo)
Flashcard 155: Thalassemia provides protection against _____
Answer: malaria (Plasmodium falciparum)
Flashcard 156: Blood smear in thalassaemia is associated with _____ cells
Answer: target
Flashcard 157: Alpha thalassaemia is predominant in individuals from _____ descent
Answer: Asian / African
Flashcard 158: Patients with microcytic hypochromic anaemia and family history of thalassaemia should get _____ done first
Answer: iron studies
Flashcard 159: What is the confirmatory diagnostic investigation for thalassaemia?
_____
Answer: Haemoglobin electrophoresis
Flashcard 160: What is the most common cause of paediatric stroke?
_____
Answer: Sickle cell disease
Flashcard 161: Sickle cell trait presents _____, unless in severe conditions
Answer: asymptomatically
Flashcard 162: Acute haemolytic crisis in sickle cell disease may require _____
Answer: normal blood transfusions
Flashcard 163: Vaso-occlusive crisis is also known as _____ crisis
Answer: painful
Flashcard 164: In sickle cell disease antibiotic prophylaxis with _____ is given at ages >3months until 5 years old (or lifelong)
Answer: phenoxymethypenicillin (penicillin V)
Flashcard 165: Sickle cell disease can cause _____ that involves splenic vaso-occlusion and pooling of large amounts of blood in the spleen
Answer: splenic sequestration
Flashcard 166: Vaso-occlusive crisis presents with _____ to an affected area (e.g. limbs, chest, back) for several hours up to ~7 days
Answer: severe pain
Flashcard 167: Sickling in sickle cell anaemia results in _____ of the erythrocytes & vaso-occlusion of vessels
Answer: haemolysis
Flashcard 168: Manage hypovolaemic shock in splenic sequestration with _____
Answer: normal blood transfusions
Flashcard 169: Aplastic crisis will present with a _____ reticulocyte count
Answer: low
Flashcard 170: Vaso-occlusive events can affect multiple organs:
_____= bones in hand & feet (especially in <5yrs)
Priapism= penis
Stroke= cerebral vessels
Acute chest syndrome = lungs
Avascular necrosis= bones (particularly femoral head)
Answer: Dactylitis
Flashcard 171: Acute haemolytic crisis in sickle cell disease may require _____
Answer: normal blood transfusions
Flashcard 172: hydroxycarbamide(hydroxyurea) is useful in the treatment of sickle cell disease because it increases ↑ levels of _____ (typically >15%)
Answer: HbF
Flashcard 173: _____ in sickle cell disease is accelerated destruction of sickled RBC leading to worsening anaemia, jaundice, & ↑ bilirubin
Answer: Acute haemolytic crisis
Flashcard 174: What is the initial general management for vaso-occlusive crisis/events?
_____
Answer: Analgesia (don't be scared to climb the WHO pain ladder)
Hydration
Oxygen
Flashcard 175: What is the best initial investigation for sickle cell anaemia?
_____
Answer: Peripheral blood smear
Flashcard 176: Sickle cell disease/anaemia often presents in _____ complications
Answer: acute
Flashcard 177: Newborn babies are screened for sickle cell disease on _____ with the newborn blood spot screening programme (heel prick test)
Answer: day 5 (latest day 8)
Flashcard 178: Spot diagnosis = _____
Answer: sickle cell disease
Flashcard 179: _____ is done to detect stroke risk in sickle cell disease from ages 2-16
Answer: Transcranial doppler ultrasonography
Flashcard 180: Vaso-occlusive crisis is _____ of tissue secondary to microvascular occlusion from sickled RBCs
Answer: infarction
Flashcard 181: In sickle cell disease, the spleen becomes dysfunctional in _____ ("splenic fatigue")
Answer: early childhood (autosplenectomy/hyposplenism by age 5)
Flashcard 182: _____ on peripheral blood smear is pathognomonic for sickle cell disease
Answer: Sickle cells
Flashcard 183: _____ is the most common cause of osteomyelitis in patients with sickle cell disease
Answer: Salmonella spp.
Flashcard 184: Patients with sickle cell disease are given _____ to prevent infection with encapsulated organisms
Answer: immunizations
Flashcard 185: What is the likely diagnosis in an African American infant that presents with symmetric swelling/tenderness of the bilateral hands and feet?
_____
Answer: Dactylitis (secondary to sickle cell disease)
Flashcard 186: What RBC pathology is characterized by the following Hb electrophoresis findings:
55% HbA, 43% HbS, and 2% HbA2
_____
Answer: Sickle cell trait
Flashcard 187: Suspect _____ in patients with sickle cell disease that have LUQ tenderness, hypovolaemic shock, & splenomegaly
Answer: splenic sequestration
Flashcard 188: Sickle cell disease will likely cause chronic _____ presenting with persistent fatigue, pallor, & delayed growth in children
Answer: anaemia
Flashcard 189: _____ commonly causes aplastic crisis in patients with sickle cell disease because of temporary suppression of erythropoiesis
Answer: Parvovirus B19
Flashcard 190: Sickle cell disease can be complicated with _____ from encapsulated organisms causing sepsis, pneumonia, & meningitis
Answer: infections
Flashcard 191: The sickle cell allele / HbS provides protection against _____, which likely explains the high prevalence in Africans
Answer: malaria (Plasmodium falciparum)
Flashcard 192: What is the 1st-line management for sickle cell disease if clinically indicated?
_____
Answer: hydroxycarbamide (hydroxyurea)
Flashcard 193: Sickle cell disease often has persistent, mild _____cytic anaemia on FBC
Answer: normo
Flashcard 194: Sickle cell anaemia has _____ reticulocyte count
Answer: increased ↑
Flashcard 195: _____ is a possible feature of sickle cell disease that involves acute & reversible reticulocytopaenia
Answer: Aplastic crisis
Flashcard 196: Suspect _____ in patients with sickle cell disease that have chest pain, fever, dyspnoea, & lung infiltrates
Answer: acute chest syndrome
Flashcard 197: What are the major causes of acute severe anaemia in sickle cell disease?
_____: ↓ reticulocyte count + no splenomegaly
Splenic sequestration (Vaso-occlusion): ↑ reticulocyte count + splenomegaly
Answer: Aplastic crisis (Parvovirus B19)
Flashcard 198: One consequence of autosplenectomy in sickle cell disease is increased risk of infection with _____ organisms
Answer: encapsulated
Flashcard 199: Sickle cell disease can present as _____ in the male sex organ
Answer: priapism
Flashcard 200: What is the confirmatory diagnosis of sickle cell disease?
_____
Answer: Haemoglobin electrophoresis
Flashcard 201: Acute chest syndrome in patients with sickle cell disease is often precipitated by _____
Answer: pneumonia
Flashcard 202: The most important management in aplastic crisis is _____
Answer: normal blood transfusions
Flashcard 203: What RBC pathology is characterised by the following Hb electrophoresis findings:
90% HbS, 8% HbF, and 2% HbA2 (no HbA)
_____
Answer: Sickle cell disease
Flashcard 204: What is the initial general management for sickle cell disease acute crisis?
_____
Hydration
Oxygen
Blood transfusions to manage severe anaemia, stroke, & acute chest syndrome
Antibiotics for infection
Answer: Analgesia (don't be scared to climb the WHO pain ladder)
Flashcard 205: What is the most common acute complication/event in sickle cell disease?
_____
Answer: Vaso-occlusive crisis/event
Flashcard 206: Sickle cell anaemia is often _____ in newborns
**Bonus, why???
Answer: asymptomatic
Flashcard 207: Sickle cell disease and fever is managed with _____
Answer: antibiotics
Flashcard 208: Sickle cell disease can cause _____ due to vaso-occlusion of cerebral vessels
Answer: ischemic stroke (large vessel)
Flashcard 209: _____ is typically the earliest manifestation of sickle cell disease in infants <5yrs old
Answer: Dactylitis
Flashcard 210: _____ is considered in severe vaso-occlusive crisis/events, e.g. acute chest syndrome or stroke
Answer: Exchange transfusion
Flashcard 211: List of the acute complications/crisis in sickle cell disease:
_____
Answer: Vaso-occlusive crisis/event
Infectious complication
Sequestration crisis
Aplastic crisis
Haemolytic crisis
Flashcard 212: Sickle cell disease can cause _____ due to vaso-occlusion in the pulmonary vasculature
Answer: acute chest syndrome
Flashcard 213: Stored intracellular iron is bound to _____, which prevents iron from forming free radicals (•OH) via the Fenton reaction
Answer: ferritin
Flashcard 214: Iron deficiency is caused by
1. dietary _____
2. increased iron requirement e.g. growth spurt, pregnancy
3. increased iron loss e.g. GI bleeding from malignancy or peptic ulcer disease, menstrual bleeding, frequent blood donation
4. malabsorption e.g. IBD, coeliac disease, bariatric surgery
Answer: deficiencies e.g. chronic undernutrition, cereal-based diet
Flashcard 215: What conditions precipiate sickling in sickle cell anaemia?
_____
Acidosis
Dehydration
Answer: Hypoxaemia
Flashcard 216: _____ is a inherited haemoglobinopathy that forms Haemoglobin S (HbS), which causes sickling of RBCs leading to various complications
Answer: Sickle cell disease
Flashcard 217:
Ferritin levels can be artificially raised in _____ or inflammatory states
Answer: infection
Flashcard 218: Clinical sign = _____
Answer: pallor (anaemia)
Flashcard 219: What is the most common cause of iron deficiency in females aged 20-50?
_____
Answer: Menorrhagia or pregnancy
Flashcard 220: Sickle cell anaemia has a(n) _____ pattern of inheritance
Answer: autosommal recessive
Flashcard 221: Iron deficiency anaemia in children is often caused by excess consumption of _____
Answer: nonfortified cow's milk (> 700 ml/day)
Flashcard 222: Hb_____A= normal
HbAS= sickle cell trait
HbSS= sickle cell anaemia/disease
Answer: A
Flashcard 223: What is the most common form of anaemia?
_____
Answer: Iron deficiency anaemia (IDA)
Flashcard 224: What is the first-line management of iron deficiency anaemia?
_____
Answer: oral ferrous sulfate
Flashcard 225: What lifestyle advice is given to patients with iron deficiency anaemia?
_____
Answer: - Iron-rich food (e.g. red meats, legumes, green leafy veg)
- Foods with vitamin C to ↑ absorption (e.g. citrus fruit)
- Eliminate foods that ↓ absorption (e.g. cereal, tea, dairy products)
Flashcard 226:
_____ haemoglobin (HbS) contains an abnormal β-globin chain that polymerises altering the RBC shape into a sickle form
Answer: Sickle
Flashcard 227: What haematologic pathology is associated with restless legs syndrome?
_____
Answer: Iron deficiency anemia
Flashcard 228: Iron deficiency anaemia is _____chromic and microcytic anaemia
Answer: hypo
Flashcard 229: Iron deficiency anaemia:
_____ iron
↓ ferritin
↓ transferrin saturation
↑ total iron-binding capacity (TIBC)
Answer: ↓
Flashcard 230: What is the most common cause of iron deficiency in children?
_____
Answer: ↑ iron requirement with growth (worsened with poor diet)
Flashcard 231: The underlying _____ of iron deficiency anaemia should be identified & treated first
Answer: cause
Flashcard 232: What is the initial investigation for (iron deficiency) anaemia?
_____
Answer: FBC
Flashcard 233:
_____ is reduced RBC production due to low iron stores
Answer: Iron deficiency anaemia (IDA)
Flashcard 234:
Ferritin levels are unreliable in women who are _____
Answer: pregnant
Flashcard 235: What is the investigation for iron deficiency anaemia after a FBC?
_____
Answer: Serum ferritin (iron studies)
Flashcard 236: Iron deficiency anaemia presents with _____, SOB, & headaches
Answer: fatigue
Flashcard 237: What is the most common cause of iron deficiency in infants?
_____
Answer: Exclusive breastfeeding particularly > 4 months of age without iron supplementation
Flashcard 238: _____ and angular cheilitis are clinical manifestations of iron deficiency anemia
Answer: Atrophic glossitis
Flashcard 239: Iron deficiency anemia may present with _____ conjunctiva and skin
Answer: pale
Flashcard 240: Iron deficiency anaemia FBC:
_____ Hb
↓ MCV
Answer: ↓
Flashcard 241: Iron deficiency anemia is associated with a(n) _____ red cell distribution width (RDW)
Answer: increased
Flashcard 242: How do platelet levels change post-splenectomy?
_____
Answer: Increased (thrombocytosis)
Flashcard 243: Disseminated intravascular coagulation (DIC) is associated with thrombosis, resulting in _____ failure
Answer: organ
Flashcard 244: What RBC abnormalities are seen on blood smear post-splenectomy?
_____
Answer: Howell-Jolly bodies and target cells
Flashcard 245: What peripheral blood smear finding is associated with disseminated intravascular coagulation (DIC)?
_____
Answer: Schistocytes
Flashcard 246: In disseminated intravascular coagulation (DIC) the consumption of platelets & clotting factors results in _____
Answer: bleeding
Flashcard 247: What are the causes of disseminated intravascular coagulation (DIC)?
1. _____
2. Trauma (inc. burns)
3. Obstetric conditions (e.g. amniotic fluid embolism)
4. Malignancy (e.g. APL)
Answer: Sepsis (gram -ve bacteria)
Flashcard 248: Encapsulated bacteria causes in splenectomy/hyposplenic infections:
_____
Haemophilus influenzae
Neisseria meningitidis
Answer: Steptococcus pneumoniae
Flashcard 249: Disseminated intravascular coagulation (DIC) may occur secondary to obstetric complications due to activation of the coagulation cascade by _____ in the amniotic fluid
Answer: tissue factor
Flashcard 250: What is the most common cause of pancytopenia?
_____
Answer: Malignancy (chemotherapy is the 2nd most common cause)
Flashcard 251: Antibiotic prophylaxis in splenectomy/hyposplenic patients who are immunocomprimised or had previous post-splenectomy sepsis should be taken for _____ year(s)
Answer: unlimited (lifelong)
Flashcard 252: Pancytopenia presentation:
_____ = fatigue, pallor, dyspnoea
Neutropaenia = recurrent or severe infections
Thrombocytopenia = ecchymoses, petechiae, gingival bleeding, epistaxis
Answer: Anaemia
Flashcard 253: Antibiotic prophylaxis post-splenectomy should be taken for _____ year(s)
Answer: 1
Flashcard 254: Disseminated intravascular coagulation (DIC) is associated with bleeding, especially from _____ sites & mucosal surfaces
Answer: IV
Flashcard 255: Consider _____ transfusion in bleeding patients with disseminated intravascular coagulation (DIC) & fibrinogen levels < 1-1.5g/L
Answer: cryoprecipitate
Flashcard 256: Severe sepsis (gram -ve bacteria), trauma & burns, obstetric complications, malignancy (APL), major surgery are all causes of _____
Answer: disseminated intravascular coagulation (DIC)
Flashcard 257: Splenectomy / hyposplenic patients are at risk of _____, which is a bacterial infection that rapidly progresses into overwhelming sepsis
Answer: overwhelming post-splenectomy infection (OPSI)
Flashcard 258: The management for splenectomy/hyposplenic patients is 2-fold:
1. _____
2. Prophylactic antibiotics (dependent on risk factors)
Answer: Vaccinate
Flashcard 259: What is the antibiotic prophylactic medication of choice for splenectomy/hyposplenic patients?
_____
Answer: Phenoxymethypenicillin (penicillin V)
Flashcard 260: Where possible, immunisations should be completed at least _____ prior to splenectomy
Answer: 2 weeks
Flashcard 261: Consider _____ transfusion in bleeding patients with disseminated intravascular coagulation (DIC) & ↑ aPTT & ↑ PT
Answer: fresh frozen plasma
Flashcard 262: _____ is a severe form of hyposplenism where the spleen "self destructs" causing physiological loss of splenic function
Answer: Autosplenectomy
Flashcard 263: Annual influenza vaccine is done for splenectomy / hyposplenic patients to prevent _____
Answer: secondary bacterial infections
Flashcard 264: What is the management for a haemodynamically unstable patient with a spleen injury?
_____
Answer: Splenectomy to prevent further haemorrhage
Flashcard 265: Disseminated intravascular coagulation (DIC) presents with:
_____ platelet count (FBC)
↑ aPTT (coagulation studies)
↑ PT
↓ fibrinogen
↑ D-dimer
Answer: ↓
Flashcard 266: Disseminated intravascular coagulation (DIC) presents with _____ & thrombosis
Answer: bleeding
Flashcard 267: Surgical _____ is done as prophylaxis to prevent further complications e.g. hereditary spherocytosis, ITP
Answer: splenectomy
Flashcard 268: If it is not practicable to vaccinate 2 weeks before splenectomy, immunisations should be delayed until at least _____ after
Answer: 2 weeks
Flashcard 269: What is the cornerstone management of disseminated intravascular coagulation (DIC)?
_____
Answer: Treat the underlying cause!
Flashcard 270: Disseminated intravascular coagulation (DIC) is characterised by widespread _____ formation, resulting in ischaemia & infarction
Answer: microthrombi
Flashcard 271: Antibiotic prophylaxis for asplenic children should be taken until at least _____ years old
Answer: 5
Flashcard 272: Consider _____ transfusion in a patient with disseminated intravascular coagulation (DIC) & platelet count < 50 x 109/L
Answer: platelet
Flashcard 273: Why are patients with splenectomy/hyposplenism at risk of encapsulated bacteria?
_____
Answer: The spleen filters blood, including bacteria. Encapsulated bacteria is opsinised, then specialised macrophages phagocytose them. The immune system finds difficulty detecting & destroying them without the spleen, thus making patients susceptible to encapsulated bacteria
Flashcard 274: _____ is a decrease ↓ in the number of cells in both major blood cell lines in the peripheral blood leading to ↓ RBC, WBC, & thrombocytes
Answer: Pancytopenia
Flashcard 275: _____ is the physiological loss of splenic function e.g. in sickle cell anaemia
Answer: Hyposplenism
Flashcard 276: What vaccinations are used in splenectomy / hyposplenism?
_____
Men ACWY (5 yearly), Men B vaccine
Hib vaccine (one-off or not needed)
Influenza vaccine (anually) to prevent secondary bacterial infections
Answer: Pneumococcal vaccine (one-off, then 5 yearly)
Flashcard 277: Disseminated intravascular coagulation (DIC) may occur secondary to sepsis, especially gram _____ bacteria
Answer: -ve
Flashcard 278: What are the three main causes of splenectomy?
1. _____ ~75%
2. Traumatic ~20%
3. Hyposplenism/autosplenectomy ~5%
Answer: Surgical
Flashcard 279: Splenectomy/hyposplenism is associated with a long-term risk for sepsis with _____ bacteria
Answer: encapsulated
Flashcard 280: In DIC where thrombosis predominates, consider management with _____
Answer: heparin
Flashcard 281: Disseminated intravascular coagulation (DIC) typically presents with _____ bleeding time
Answer: increased ↑
Flashcard 282: Consider _____ transfusion in a patient with disseminated intravascular coagulation (DIC) & bleeding
Answer: RBC
Flashcard 283: Patients with splenectomy/hyposplenism should be strongly cautioned of _____ and should take all precautions
Answer: malaria (Falciparum)
Flashcard 284: How do lymphocyte levels change post-splenectomy?
_____
Answer: Increased (lymphocytosis)
Flashcard 285: How do you manage a splenectomy/hyposplenic patient developing pyrexia, malaise, or/and shivering?
_____
Answer: Immediate reserve antibiotics
Flashcard 286: _____ occurs due to pathologic activation of the coagulation cascade
Answer: Disseminated intravascular coagulation (DIC)
Flashcard 287: What is the most common cause of disseminated intravascular coagulation (DIC)?
_____
Answer: Sepsis → particularly gram -ve bacteria
Flashcard 288: What are the initial investigations for suspected disseminated intravascular coagulation (DIC)?
_____
Answer: Coagulation studies (aPTT, PT, fibrinogen, D-dimer) & FBC (platelets)
Flashcard 289: _____ is thrombosis, haemorrhage, & organ dysfunction caused by systemic activation of blood coagulation causing fibrin clots, platelet consumption & exhaustion of clotting factors
Answer: Disseminated intravascular coagulation (DIC)
Flashcard 290: FBC for acute myeloid leukaemia:
_____ thrombocytes
↓ Hb
↓/normal/↑ WBC **see below for caveat
Answer: ↓
Flashcard 291: What is the general management for acute lymphoblastic leukaemia?
_____
Answer: - Induction chemotherapy
- Consolidation chemotherapy
- Maintenance
Flashcard 292: Acute myeloid leukaemia may arise from pre-existing _____ syndromes & myeloproliferative disorders
Answer: myelodysplastic
Flashcard 293: Patients presenting with ALL and fever should be treated for _____
Answer: neutropaenic sepsis
Flashcard 294: Acute lymphoblastic leukemia may present with _____ and/or hepatosplenomegaly on examination
Answer: lymphadenopathy
Flashcard 295: Acute lymphoblastic leukemia may present with pain_____ lymphadenopathy due to infiltration of malignant lymphocytes in lymphoid tissue
Answer: less
Flashcard 296: Tumor Lysis Syndrome is most common with treatment of _____ and acute lymphoblastic leukemia
Answer: lymphomas
Flashcard 297: Acute myeloid leukemia can cause _____ because of suppression of erythropoiesis
Answer: fatigue
Flashcard 298: Acute myeloid leukemia can cause _____ because of suppression of thrombocytopoiesis
Answer: bleeding/bruising
Flashcard 299: _____ may occur secondary to AML, due to a markedly elevated WBC count leading to impaired microcirculation
Answer: Leukostasis
Flashcard 300: Acute lymphoblastic leukemia can cause _____ because of suppression of immune cells
Answer: infections
Flashcard 301: Leukaemic cells can infiltrate the skin resulting in leukaemia cutis particularly in acute _____ leukaemia
Answer: myeloid
Flashcard 302: Acute myeloid leukaemia is a malignant proliferation of _____ cells
Answer: myeloid progenitor
Flashcard 303: Acute lymphoblastic leukemia can cause _____ because of suppression of thrombocytopoiesis
Answer: bleeding/bruising
Flashcard 304: What is the confirmatory investigation for acute myeloid leukaemia?
_____
Answer: Bone marrow aspiration & biopsy
Flashcard 305: Does acute myeloid leukaemia typically present with lymphadenopathy and hepatosplenomegaly?
_____
Answer: No (rare)
Flashcard 306: Acute _____ leukemia presents with fever, bone pain, weakness and fatigue
Answer: lymphoblastic
Flashcard 307: Acute leukaemias are at increased risk with _____ syndrome
Answer: Down
Flashcard 308: What is the confirmatory investigation for acute lymphoblastic leukaemia?
_____
Answer: Bone marrow aspiration & biopsy
Flashcard 309: Disseminated intravascular coagulation (DIC) may occur secondary to malignancy, such as _____, due to activation of the coagulation cascade by primary granules
Answer: acute promyelocytic leukemia (AML sub-type)
Flashcard 310: Acute lymphoblastic leukamia most often occurs in _____
Answer: children
Flashcard 311: Acute lymphoblastic leukemia can cause _____ because of suppression of erythropoiesis
Answer: fatigue
Flashcard 312: Blood smear in acute myeloid leukaemia (esp APL) is associated with _____
Answer: Auer rods
Flashcard 313: What is the most common childhood malignancy?
_____
Answer: Acute lymphoblastic leukaemia
Flashcard 314: Blood smear for acute lymphoblastic leukaemia is associated with _____ blasts with irregular nuclei
Answer: large
Flashcard 315: What are the initial investigations for acute myeloid leukaemia?
_____
Answer: FBC (very urgent within 48 hours) & peripheral blood smear
Flashcard 316: Acute leukaemia is of increased risk in patients with prior _____
Answer: chemotherapy / ionising radiation
Flashcard 317: Acute myeloid leukemia progresses _____ within days to weeks
Answer: rapidly
Flashcard 318: Acute lymphoblastic leukemia may present with _____ pain due to infiltration of leukaemic cells in the periosteum
Answer: bone
Flashcard 319: Acute myeloid leukaemia is classified using the _____ classification system to predict prognosis and guide management decisions
Answer: WHO (2016)
Flashcard 320: Acute myeloid leukamia most often occurs in _____
Answer: older adults
Flashcard 321: A _____ is often done in patients with AML (esp APL) to screen for / rule out disseminated intravascular coagulation
Answer: coagulation screen
Flashcard 322: What is the general management for acute myeloid leukaemia?
_____
Answer: - Induction chemotherapy
- Consolidation chemotherapy
- Maintenance
Flashcard 323: What are the initial investigations for acute lymphoblastic leukaemia?
_____
Answer: FBC (very urgent within 48 hours) & peripheral blood smear
Flashcard 324: FBC for acute lymphoblastic leukaemia:
_____ thrombocytes
↓ Hb
↓/normal/↑ WBC
Answer: ↓
Flashcard 325: Before induction chemotherapy for acute lymphocytic leukaemia patients will be hydrated and given _____ as prophylaxis for tumour lysis syndrome
Answer: allopurinol
Flashcard 326: Acute lymphoblastic leukemia progresses _____ within days to weeks
Answer: rapidly
Flashcard 327: What is the likely diagnosis in an elderly patient with recurrent infections, ecchymoses, and a dermatological rash. Blood smear shows Auer rods.
_____
Answer: Acute myeloid leukaemia
Flashcard 328: Acute myeloid leukemia can cause _____ because of suppression of immune cells
Answer: infections
Flashcard 329: What are the initial investigations for chronic lymphocytic leukaemia?
_____
Answer: FBC (very urgent within 48 hours) & peripheral blood smear
Flashcard 330: What is the most common cause of death in patients with chronic lymphocytic leukaemia (CLL)?
_____
Answer: Infection (due to hypogammaglobulinemia)
Flashcard 331: Chronic lymphocytic leukaemia is a malignant proliferation of naive _____
Answer: B lymphocytes
Flashcard 332: What is the role of bone marrow aspiration/biopsy in chronic lymphocytic leukaemia?
_____
Answer: Not routinely required for diagnosis. Consider in patients with cytopenias to determine the cause. Typical findings would be ↑ % of small mature lymphocytes
Flashcard 333: Blood smear for _____ is associated with smudge cells
Answer: chronic lymphocytic leukaemia
Flashcard 334: Chronic lymphocytic leukemia cause is idiopathic but has a strong _____ link
Answer: familial
Flashcard 335: Acute lymphoblastic leukaemia is a malignant proliferation of _____ cells
Answer: lymphoid progenitor
Flashcard 336: Acute lymphoblastic leukaemia is classified using the _____ classification system to predict prognosis and guide management decisions
Answer: WHO (2016)
Flashcard 337: What cancer is associated with autoimmune hemolytic anemia?
_____
Answer: Chronic lymphocytic leukaemia (CLL)
Flashcard 338: Chronic lymphocytic leukaemia is often diagnosed _____ on a FBC
Answer: incidentally
Flashcard 339: Transformation of chronic lymphocytic leukaemia (CLL) into diffuse large B-cell lymphoma presents clinically as a(n) _____
Answer: enlarging lymph node or spleen
Flashcard 340: What is the most common leukaemia in adults?
_____
Answer: Chronic lymphocytic leukaemia
Flashcard 341: Chronic lymphocytic leukaemia can cause _____ because of suppression of immune cells
Answer: recurrent infections
Flashcard 342: Manage autoimmune haemolytic anaemia in CLL with _____
Answer: steroids
Flashcard 343: Chronic lymphocytic leukemia is usually insidious in onset and seen in _____
Answer: older adults
Flashcard 344: What is the likely diagnosis in an elderly patient with recurrent infections and with hepatosplenomegaly, lymphadenopathy, and marked lymphocytosis on physical/laboratory exam?
_____
Answer: Chronic lymphocytic leukaemia (CLL)
Flashcard 345: What is the general management of asymptomatic chronic lymphocytic leukaemia?
_____
Answer: Active monitoring (regular FBC & clinical exams)
Flashcard 346: What is the definitive investigation for chronic lymphocytic leukaemia (CLL)?
_____
Answer: Flow cytometry (immunophenotyping)
Flashcard 347: FBC for chronic lymphocytic leukaemia has sustained _____
Answer: lymphocytosis
Flashcard 348: Acute leukaemia is defined as a malignant proliferation of blasts _____% in the bone marrow
Answer: > 20
Flashcard 349: Chronic lymphocytic leukaemia can cause _____ because of suppression of erythropoiesis
Answer: fatigue
Flashcard 350: Acute lymphoblastic leukaemia is subclassified into _____-ALL and T-ALL based on surface markers
Answer: B
Flashcard 351: Which type of acute lymphoblastic leukaemia (B- or T-ALL) is the most common?
_____
Answer: B-ALL
Flashcard 352: Chronic lymphocytic leukaemia may transform into _____ via the Richter transformation
Answer: diffuse large B-cell lymphoma (DLBCL)
Flashcard 353: The _____ staging system is used for chronic lymphocytic leukaemia
Answer: Binet
Flashcard 354: One complication of chronic lymphocytic leukaemia is _____ anemia
Answer: autoimmune haemolytic (AIHA)
Flashcard 355: Chronic lymphocytic leukaemia typically presents asymptomatically but can cause _____ symptoms
Answer: B
Flashcard 356: What is the general management of symptomatic/active chronic lymphocytic leukaemia?
_____
Answer: Chemotherapy (FTR= Fludarabine, cyclophosphamide, & rituximab)
Flashcard 357: Chronic lymphocytic leukaemia can cause _____ because of suppression of thrombocytopoiesis
Answer: bleeding/bruising
Flashcard 358: What is the curative management for chronic lymphocytic leukaemia?
_____
Answer: Allogeneic stem cell transplant
Flashcard 359: Chronic lymphocytic leukaemia may present with _____ and/or hepatosplenomegaly on examination
Answer: lymphadenopathy
Flashcard 360: Chronic lymphocytic leukaemia may present with pain_____ lymphadenopathy due to infiltration of malignant lymphocytes in lymphoid tissue
Answer: less
Flashcard 361: Myelofibrosis causes increased ↑ risk of infection, thrombosis, and bleeding due to _____
Answer: pancytopenia
Flashcard 362: What is the likely diagnosis in a patient that develops fever / chills, flank pain, haemoglobinuria, and DIC within 1 hour after starting RBC tranfusion?
_____
Answer: Acute hemolytic transfusion reaction (AHTR)
Flashcard 363: What blood transfusion is the most common cause of death?
_____
Answer: Transfusion-related acute lung injury (TRALI)
Flashcard 364: What is the management of acute haemolytic transfusion reactions?
_____
Answer: Stop transfusion, aggressive IV fluids
Flashcard 365: What vital sign helps distinguish between TACO and TRALI?
_____
Answer: TACO is fluid overload → hypertension
TRALI is fluid shift into lungs → hypotension
Flashcard 366: What is the most likely diagnosis in a patient who presents days to weeks post-transfusion with worsening Hb after initial improvement and laboratory evidence of hemolysis?
_____
Answer: Delayed haemolytic transfusion reaction (DHTR)
Flashcard 367: What physical exam finding can distinguish myelofibrosis from aplastic anemia?
_____
Answer: Hepatosplenomegaly
Flashcard 368: _____ myelofibrosis occurs as a result of disease progression in patients with previously diagnosed myeloproliferatie disorder (e.g. PV, ET)
Answer: Secondary
Flashcard 369: What are the bone marrow aspiration finding(s) for myelofibrosis?
_____
Answer: "Dry tap" because of severe marrow fibrosis
Flashcard 370: What pathologic RBC is associated with myelofibrosis?
_____
Answer: "Tear drop" cells (dacrocyte)
Flashcard 371: What is the likely diagnosis in a patient with respiratory distress, hypotension, and noncardiogenic pulmonary oedema up to 6 hours after a blood transfusion?
_____
Answer: Transfusion-related acute lung injury (TRALI)
Flashcard 372: What is the management of transfusion-associated circulatory overload?
_____
Answer: Stop/slow transfusion, respiratory support (O2), diuretics
Flashcard 373: What are the initial investigations for myelofibrosis?
_____
Answer: FBC & blood smear
Flashcard 374: What is the management of delayed haemolytic transfusion reactions?
_____
Answer: Nothing; self-limiting
Flashcard 375: What blood transfusion reaction is caused by fluid overload?
_____
Answer: Transfusion-associated circulatory overload
Flashcard 376: What is the definitive management of myelofibrosis?
_____
Answer: Haematopoietic stem cell transplant
Flashcard 377: What is the most common blood transfusion reaction?
_____
Answer: Febrile non-haemolytic transfusion reaction
Flashcard 378: Blood transfusion reactions
1) _____
2) Tranfusion associated circulatory overload (TACO)
3) Delayed haemolytic transfusion reaction
4) Acute haemolytic transfusion reaction
5) Transfusion-related acute lung injury (TRALI)
6) Anaphylactic transfusion reaction
Answer: Febrile non-haemolytic tranfusion reaction
Flashcard 379: Myelofibrosis can present with _____ splenomegaly
Answer: symptomatic
Flashcard 380: What imaging is done in suspected transfusion-associated circulatory overload (TACO)?
_____
Answer: CXR → confirm pulmonary oedema & exclude other causes of respiratory distress
Flashcard 381: Which blood transfusion reaction is a reaction against donor plasma proteins in transfused blood?
_____
Answer: Allergic/anaphylactic reaction
Flashcard 382: Which blood transfusion reaction is caused by antibodies against minor antigens (e.g. Rh(D) antigen) leading to extravascular haemolysis?
_____
Answer: Delayed haemoltyic transfusion reaction
Flashcard 383: What condition is associated with increased risk for anaphylactic reaction when receiving blood transfusions?
_____
Answer: Selective IgA deficiency
Flashcard 384: What hypersensitivity reaction is allergic transfusion reaction?
_____
Answer: Type I HSR
Flashcard 385: Which blood transfusion reaction can be caused by accumulation of cytokines from donor WBC
-or-
type II HSR with host antibodies against donor HLA/WBCs?
_____
Answer: Febrile nonhemolytic transfusion reaction (FNHTR)
Flashcard 386: What is the first step in management for any blood transfusion reaction?
_____
Answer: STOP the transfusion
Flashcard 387: What hypersensitivity reaction is acute haemolytic transfusion reactions?
_____
Answer: Type II HSR
Flashcard 388: Delayed transfusion haemolytic transfusion reaction has +ve _____ test
Answer: direct antiglobulin (Coombs)
Flashcard 389: What hypersensitivity reaction is febrile non-haemolytic transfusion reactions?
_____
Answer: Type II HSR
Flashcard 390: What is the likely diagnosis in a patient that develops wheezing, urticaria, respiratory distress, and hypotension minutes after receiving a RBC transfusion?
_____
Answer: Anaphylactic transfusion reaction
Flashcard 391: What is the recommended RBC pre-treatment for a patient who will receive a RBC transfusion and has a history of febrile non-hemolytic transfusion reaction?
_____
Answer: Leukoreduction
Flashcard 392: What is the What is the management of transfusion-related acute lung injury (TRALI)?
_____
Answer: Stop transfusion, fluid resuscitation, vasopressors, aggressive respiratory support (O2)
Flashcard 393: How does myelofibrosis lead to massive splenomegaly (pathophysiology)?
_____
Answer: Proliferation of megakaryocytes that activate fibroblasts → fibrosis of bone marrow → erythropoiesis is impaired → extramedullary haematopoiesis (esp. spleen & liver) → hepatosplenomegaly
Flashcard 394: _____ is a neoplastic proliferation of mature myeloid cells, especially megakaryocytes that activate fibroblasts
Answer: Myelofibrosis
Flashcard 395: Acute haemolytic transfusion reaction is distinguished from febrile non-haemolytic reaction by the presence of a positive _____ test
Answer: direct antiglobulin (Coombs)
Flashcard 396: Patients with selective IgA deficiency should receive _____ blood products to prevent anaphylaxis
Answer: washed
Flashcard 397: _____ is a myeloproliferative disorder that leads to bone marrow fibrosis, extramedullary haematopoiesis, & splenomegaly
Answer: Myelofibrosis
Flashcard 398: What is the likely diagnosis in a patient that develops a fever, chills, flushing, and malaise two hours after starting RBC tranfusion? Coombs test is negative.
_____
Answer: Febrile non-haemolytic transfusion reaction
Flashcard 399: Which blood transfusion reaction is caused by donor anti-leukocyte antibodies against recipient neutrophils and pulmonary endothelial cells?
_____
Answer: Transfusion-related acute lung injury (TRALI)
Flashcard 400: What is the management of minor allergic transfusion reaction (urticaria, no signs of anaphylaxis)?
_____
Answer: Stop transfusion, antihistamines, resume transfusion if otherwise asymptomatic
Flashcard 401: Which blood transfusion reaction can be caused by ABO incompatability?
_____
Answer: Acute haemolytic transfusion reaction (AHTR)
Flashcard 402: What is the management of febrile non-haemolytic transfusion reactions?
_____
Answer: Stop/slow transfusion, IV paracetamol
Flashcard 403: What is the likely diagnosis in a patient that develops respiratory distress, hypertension, tachycardia and signs of a heart failure 6-12 hours after a RBC transfusion?
_____
Answer: Transfusion-associated circulatory overload (TACO)
Flashcard 404: Direct antiglobluin (Coombs) test _____ = febrile non-haemolytic transfusion reaction
Direct antiglobluin (Coombs) test +ve = acute haemolytic transfusion reaction
Answer: -ve
Flashcard 405: What distinguishing symptom is seen in acute haemolytic transfusion reaction?
_____
Answer: Haemoglobinuria (due to a massive release of Hb)
Flashcard 406: What is the management of anaphylactic transfusion reaction?
_____
Answer: Stop transfusion, IM adrenaline, ABC support (O2, fluids)
Flashcard 407: What are the examination finding(s) of myelofibrosis?
_____
Answer: Massive splenomegaly + hepatomegaly
Flashcard 408: Tranfusions can rarely cause transfusion _____
Answer: reactions
Flashcard 409: _____ erythrocytosis is ↑ haematocrit & haemoglobin with normal red cell mass due to ↓ plasma volume
Answer: Apparent
Flashcard 410: How does _____ affect cells?
↑ Erythrocytosis with or without ↑ granulocytosis or thrombocytosis
Answer: polycythaemia vera
Flashcard 411: What is the effect of polycythemia on blood viscosity?
_____
Answer: Increased
Flashcard 412: How does _____ affect cells?
↑ granulocytes (neutrophils, eosinophils, & basophils)
Answer: chronic myeloid leukaemia
Flashcard 413: Chronic phase of CML can be asymptomatic, when symptomatic it presents with _____
Answer: weight loss, fever, night sweats
Flashcard 414: ↑ Hb ↑ Haematocrit with ↓ EPO normal O2 sats = _____
↑ Hb ↑ Haematocrit with ↑ EPO & ↓ O2 sats = secondary polycythaemia
Answer: Primary polcythaemia (polycythaemia vera)
Flashcard 415: _____ phase of CML presents with hyperviscosity syndrome because of the significantly ↑↑ number of cells (blasts, granulocytes)
Answer: Accelerated
Flashcard 416: Chronic myeloid leukaemia is overexpression of the _____ lineage, particularly granulocytes (neutrophils, basophils, eosinophils)
Answer: myeloid
Flashcard 417: Polycythaemia vera can present with _____ syndrome (e.g. visual changes, headaches, dizziness)
Answer: hyperviscosity
Flashcard 418: Polycythaemia vera has a mutation of the _____ gene that ↑ tyrosine kinase activity causing EPO-independent erythrocytosis
Answer: JAK2
Flashcard 419: Polycythaemia vera is variable but typically occurs in ages >_____ years
Answer: 60
Flashcard 420: What are the examination finding(s) of chronic myeloid leukaemia?
_____
Answer: Massive splenomegaly (larger as the phases progress)
Flashcard 421: Secondary polycythaemia is characterised by _____ O2 saturation %
Answer: decreased
Flashcard 422: What is the likely diagnosis in a patient with night sweats, weight loss, and splenomegaly? Laboratory exam reveals leucocytosis with increased levels of basophils and myelocytes.
_____
Answer: Chronic myeloid leukaemia
Flashcard 423: What is the management for polycythaemia vera?
_____
Answer: Low-dose aspirin
Scheduled venesection
Flashcard 424: Chronic myeloid leukaemia may transform to acute _____ leukaemia (2/3rd of cases)
Chronic myeloid leukaemia may transform to acute lymphoblastic leukaemia (1/3rd of cases)
Answer: myeloid
Flashcard 425: The t(_____;22) translocation generates a(n) BCR-ABL fusion protein with increased tyrosine kinase activity in chronic myeloid leukaemia
Answer: 9
Flashcard 426: What phases does chronic myeloid leukaemia present in?
_____ → Accelerated phase → Blast crisis / phase
Answer: Chronic phase
Flashcard 427: _____ are a group of disorders characterised by abnormal proliferation of normally developed stem cells of the myeloid cell lineage
Answer: Myeloproliferative disorders
Flashcard 428: What is the most common cause of morbidity in polycythaemia vera?
_____
Answer: Thrombosis
Flashcard 429: Chronic myeloid leukaemia is distinguished from a leukemoid reaction (benign neutrophilia) by a(n) -ve _____ stain
Answer: leukocyte alkaline phosphatase (LAP)
Flashcard 430: A rapidly enlarging _____ in chronic myeloid leukemia (CML) suggests progression from accelerated phase to blast crisis
Answer: spleen
Flashcard 431: _____ is the terminal phase in CML where it progresses to an acute leukaemia
Answer: Blast crisis
Flashcard 432: Accelerated phase of CML presents with fatigue because of _____
Answer: anaemia
Flashcard 433: What phase do >90% of patients present in with chronic myeloid leukaemia?
_____
Answer: Chronic phase
Flashcard 434: What are the initial investigations for chronic myeloid leukaemia?
_____
Answer: FBC & peripheral blood smear
Flashcard 435: How does _____ affect cells?
Initial hyperproliferative phase (esp megakaryocytes) → followed by pancytopenia
Answer: primary myelofibrosis
Flashcard 436: What are the confirmatory investigations for polycythaemia vera?
_____
Answer: EPO & JAK2 V617F mutation testing
Flashcard 437: Polycythaemia vera is a form of _____ polycythemia
Answer: primary
Flashcard 438: Which form of polycythaemia is associated with lung disease (e.g. COPD / obstructive sleep apnea), congenital heart disease, high altitude, or low birth weight?
_____
Answer: Secondary polycythaemia
Flashcard 439: The t(9;22) translocation (BCR-ABL) is also known as the _____ chromosome most commonly seen in chronic myeloid leukaemia (CML)
Answer: Philadelphia
Flashcard 440: _____ is a myeloproliferative disorder that leads to erythrocytosis with or without granulocytosis & thrombocytosis
Answer: Polycythaemia vera
Flashcard 441: Accelerated phase of CML presents with _____ because of neutropaenia
Answer: recurrent infections
Flashcard 442: Chronic myeloid leukaemia is often diagnosed _____ on a FBC
Answer: incidentally
Flashcard 443: What is the first-line management of chronic myeloid leukaemia that is used regardless of the phase?
_____
Answer: Tyrosine kinase inhibitors (e.g. imatinib)
Flashcard 444: High-risk polycythaemia vera can be managed with _____ alongside low-dose aspirin & venesection
Answer: cytoreductive therapy (hydroxyurea)
Flashcard 445: Polycythemia vera classically presents with intense pruritis espeically after a hot shower/bath, this is known as _____
Answer: aquagenic pruitis
Flashcard 446: What is the management of chronic myeloid leukaemia in the blastic crisis?
_____
Answer: Tyrosine kinase inhibitors (e.g. imatinib, nilotinib)
+ systemic chemotherapy
Flashcard 447: Polycythemia vera may present with _____ due to excessive RBCs causing tissue congestion
Answer: facial plethora
Flashcard 448: Polycythemia vera classically presents with intense _____, especially after a hot shower/bath
Answer: pruritis
Flashcard 449: Chronic myeloid leukemia is usually insidious in onset and seen in _____
Answer: older adults
Flashcard 450: What is the confirmatory investigation for chronic myeloid leukaemia which helps determine the management?
_____
Answer: Genetic testing
Flashcard 451: What is the initial investigation for polycythaemia vera?
_____
Answer: FBC
Flashcard 452: Chronic myeloid leukaemia is a _____ disorder
Answer: myeloproliferative
Flashcard 453: ↑ _____ on a FBC is chronic myeloid leukaemia until proven otherwise
Answer: basophilia
Flashcard 454: How does _____ affect cells?
↑ thrombocytes
Answer: essential thrombocythaemia
Flashcard 455: _____ is a myeloproliferative disorder causing a neoplastic proliferation of mature myeloid cells, especially red blood cells
Answer: Polycythaemia vera
Flashcard 456: What is the most common cause of secondary polycythaemia?
_____
Answer: Chronic lung disease (chronic hypoxia)
Flashcard 457: What is the likely diagnosis in a patient with pruritus, especially after bathing, splenomegaly, headaches, and pancytosis on laboratory exam?
_____
Answer: Polycythemia vera
Flashcard 458: Chronic myeloid leukaemia is distinguished from a leukaemoid reaction (benign neutrophilia) by presence of increased _____
Answer: basophils
Flashcard 459: What is the definitive investigation for chronic myeloid leukaemia which helps with determining the phase?
_____
Answer: Bone marrow aspiration & biopsy
Flashcard 460: What are the examination finding(s) of polycythaemia vera?
_____
Answer: Splenomegaly (can also present w/hepatomegaly)
Flashcard 461: How are infections prevented in SLE?
_____
Answer: Vaccinate! Offer influenza & pneumococcal vaccinations
Flashcard 462: Deficiency of early _____ proteins is associated with SLE in active disease
Answer: complement (C3, C4)
Flashcard 463: _____ endocarditis is due to sterile vegetations that arise in association with systemic lupus erythematosus (SLE)
Answer: Libman-Sacks
Flashcard 464: SLE is associated with hyper_____ states
Answer: oestrogenic
Flashcard 465: What HLA subtypes are associated with SLE?
_____
Answer: HLA-DR2 & HLA-DR3
Flashcard 466: What is the biggest trigger for SLE?
_____
Answer: UV light exposure
Flashcard 467: A diagnostic criteria for SLE is ≥ _____ out of the 11 criteria
Answer: 4
Flashcard 468: SLE is associated with _____ and discoid rashes, especially upon exposure to sunlight
Answer: malar ("butterfly")
Flashcard 469: _____ is the most common culprit for drug-induced SLE
Answer: Hydralazine
Flashcard 470: Which antibody is sensitive, but not specific for SLE?
_____
Answer: Antinuclear antibodies (ANA)
Flashcard 471: Which antibodies are specific, but not sensitive for SLE?
_____
Answer: anti-dsDNA and anti-Smith antibodies
Flashcard 472: SLE causes of death:
1) _____
2) infection (cytopaenias & immunosuppressive therapy)
3) renal disease
4) neurological (seizures)
Answer: cardiovascular disease
Flashcard 473: The characteristics of systemic lupus erythematosus (SLE) may be remembered with the mnemonic _____
Answer: RASH OR PAIN
Flashcard 474: SLE malar rash ("butterfly rash") spares the _____
Answer: nasolabial folds
Flashcard 475: _____ is an idiopathic, multisystem autoimmune disease characterised by +ve ANA, arthralgias, & constituitional symptoms
Answer: Systemic lupus erythematosus (SLE)
Flashcard 476: SLE patients taking hydroxychloroquine should be monitored for _____
Answer: retinal toxicity (chloroquine maculopathy)
Flashcard 477: SLE affects _____ 10:1 typically of child-bearing age
Answer: females
Flashcard 478: The characteristics of _____ may be remembered with the mnemonic "RASH OR PAIN":
Rash (malar or discoid)
Arthritis (usually involving ≥ 2 joints)
Serositis (pleuritis and pericarditis)
Hematologic disorders (e.g. cytopenias)
Oral or nasopharyngeal ulcers (usually painless)
Renal disease
Photosensitivity
Antinuclear antibodies
Immunologic disorder (anti-dsDNA, anti-Smith, antiphospholipid)
Neurologic disorder (seizures, psychosis)
Answer: systemic lupus erythematosus (SLE)
Flashcard 479: SLE has accelerated _____ that is the most common cause of death
Answer: atherosclerosis
Flashcard 480: Spot diagnosis = _____
Answer: Malar rash ("butterfly rash"); Systemic lupus erythematosus
Flashcard 481: Diffuse proliferative glomerulonephritis (DPGN) is a common cause of death in patients with _____
Answer: SLE
Flashcard 482: Which antibody correlates with disease activity & lupus nephritis activity in SLE?
_____
Answer: anti-dsDNA
Flashcard 483: Spot diagnosis = _____
Answer: Discoid rash, seen in discoid lupus erythematosus
Flashcard 484: Systemic lupus erythematosus (SLE) may affect the brain, causing _____ or psychosis
Answer: seizures
Flashcard 485: SLE clasically presents with _____, malar rash ("butterfly rash"), & constitutional symptoms
Answer: arthritis
Flashcard 486: SLE patients have a life expectancy _____ years shorter on average
Answer: 25
Flashcard 487: What protein deficiency is associated with SLE?
_____
Answer: Early complement proteins (C1q, C2, C4)
Flashcard 488: What is the symptomatic management of SLE?
_____
Answer: NSAIDs
Flashcard 489: Which antibody is sensitive for drug-induced lupus?
_____
Answer: anti-histone
Flashcard 490: Patients with SLE should protect themselves from _____
Answer: UV exposure (sunscreen, clothing)
Flashcard 491: SLE follows a _____ course progression
Answer: relapsing-remitting
Flashcard 492: _____ ethnicity is more commonly affected by SLE
Answer: African
Flashcard 493: What is the immunosuppressive management of SLE?
Long-term: _____
Acute exacerbations/flares: Glucorticoids
Active glomerulonephritis/severe flares: IV cyclophosphamide + glucocorticoid
Answer: Hydroxychloroquine
Flashcard 494: -ve _____ = rules OUT lupus
Answer: ANA (sensitive)
Flashcard 495: Fibromyalgia more commonly affects _____ 2:1
Answer: females
Flashcard 496: _____ ↓ renal excretion of uric acid and ↑ uric acid production, which can precipitate gout
Answer: Alcohol
Flashcard 497: _____ disease leads to ↓ renal excretion of uric acid, thus ↑ risk of gout
Answer: Chronic kidney
Flashcard 498:
What is the second-line investigation for gout if serum urate levels are negative?
_____
Answer: Joint aspiration & microscopy
Flashcard 499: Gout risk factors: _____ and/or ↑ uric acid production
Answer: ↓ renal excretion
Flashcard 500: _____ is the go to convenional DMARD for rheumatoid arthritis
Answer: Methotrexate
Flashcard 501: Gout has a bimodal distribution at _____ and 60 years
Answer: 30
Flashcard 502: What antibodies can be tested for in suspected rheumatoid arthritis?
- _____
- anti-cyclic citrullinated peptide (anti-CCP)
Answer: Rheumatoid factor
Flashcard 503: Gout more commonly affects _____ 3:1
Answer: men
Flashcard 504: Findings on synovial fluid analysis for gout:
_____-shaped
-vely birefringent
Monosodium urate crystals
Answer: needle
Flashcard 505: What is the first-line investigation for gout?
_____
Answer: Serum urate levels
Flashcard 506: What is the acute management for pseudogout?
_____, colchicine, or NSAIDs
Answer: Intra-articular steroids
Flashcard 507: Pseudogout classically presents with _____ on X-ray
Answer: cartilage calcification (chondrocalcinosis)
Flashcard 508: Pseudogout occurs in adults > _____ years
Answer: 60
Flashcard 509: The most common joint affected in gout is the _____
Answer: 1st metatarsophalangeal (podagra)
Flashcard 510:
What imaging may be done in rheumatoid arthritis?
_____
Answer: X-ray
Flashcard 511: Pseudogout typically affects _____ joints than gout
Answer: larger
Flashcard 512: Inflammatory markers are _____ and creatinine kinase is normal in fibromyalgia
Answer: normal
Flashcard 513: What is the specialist management for rheumatoid arthritis?
1st-line: _____
2nd-line: 2x cDMARD combination
3rd-line: Biologics ± cDMARD
Answer: cDMARD
Flashcard 514: What is a final management option for rheumatoid arthritis?
_____
Answer: Surgical opinion
Flashcard 515: Rheumatologists may treat rheumatoid arthritis with _____ whilst waiting for DMARDs to take effect
Answer: short-term bridging glucocorticoids
Flashcard 516: Findings on synovial fluid analysis for pseudogout:
_____-shaped
weakly +vely birefringent
calcium pyrophosphate crystals
Answer: rhomboid
Flashcard 517: One complication of long standing rheumatoid arthritis is _____ of the cervical spine
Answer: subluxation
Flashcard 518: _____ is an idiopathic chronic functional neurosensory disorder characterised by diffuse chronic MSK pain
Answer: Fibromyalgia
Flashcard 519: _____ is an acute crystal arthropathy caused by calcium pyrophosphate crystal deposition in joints
Answer: Pseudogout
Flashcard 520: _____ characteristically presents with pain "all over", fatigue, & unrefreshing sleep
Answer: Fibromyalgia
Flashcard 521: _____ is used for severe pain in fibromyalgia (short-term)
Answer: Pregabalin
Flashcard 522: What is the initial management of rheumatoid arthritis in primary care?
_____
NSAIDs for analgesia
Answer: Refer to rheumatology
Flashcard 523: Tophi, secondary to gout, often arise on the _____, olecranon bursa, or Achilles tendon
Answer: external ear
Flashcard 524: Fibromyalgia often presents with "_____"; difficulty concentrating and reduced clarity of thought
Answer: fibro fog
Flashcard 525: What is the first-line management for fibromyalgia?
_____
Answer: Exercise
Flashcard 526: On examination a joint affected by gout appears _____ & swollen
Answer: erythematous
Flashcard 527: _____ and thiazide diuretics can cause hyperuricemia, which can lead to the precipitation of gout
Answer: Loop
Flashcard 528: Purine-rich food such as _____ & sea food cause ↑ uric acid production thus can precipitate gout
Answer: red meats
Flashcard 529: What scoring criteria can be used for rheumatoid arthritis severity?
_____
Answer: DAS28; often used to monitor treatment efficacy
Flashcard 530: Spot diagnosis = _____
Answer: Rheumatoid arthritis
Flashcard 531: Chronic gout leads to _____ formation, which is a white, chalky aggregate of uric acid crystals
Answer: tophus
Flashcard 532: Rheumatoid arthritis joint x-ray will show _____, soft tissue swelling, loss of joint space, & marginal erosions
Answer: juxta-articular osteopenia
Flashcard 533:
What is the acute management for gout?
_____, colchicine, or oral steroids
Answer: NSAIDs
Flashcard 534: Gout has a _____-onset, severely painful joint
Answer: rapid
Flashcard 535: What is the likely diagnosis in a patient with diffuse musculoskeletal pain that worsens with weather changes, psychological stress, or reduced sleep?
_____
Answer: Fibromyalgia
Flashcard 536: _____ antibodies are specific ≥ 90% for rheumatoid arthritis
Answer: Anti-cyclic citrullinated peptide (anti-CCP)
Flashcard 537: Which psychological management can be used in fibromyalgia?
_____
Answer: CBT
Flashcard 538: What is the prophylactic management for gout?
1st-line: _____
2nd-line: Febuxostat
Answer: Allopurinol
Flashcard 539: What is the first-line investigation for pseudogout?
_____
Answer: Synovial fluid analysis
Flashcard 540: _____ is a risk factor for gout
Answer: Obesity
Flashcard 541: What is the pharmacological management for fibromyalgia?
_____
Answer: Amytriptyline is most often used **look below for more information
Flashcard 542: _____ is a crystal arthropathy caused by monosodium urate crystals forming in synovial joints and tissues
Answer: Gout
Flashcard 543: Fibromyalgia is NOT a diagnosis of _____
Answer: exclusion
Flashcard 544: The most common joint affected in pseudogout is the _____
Answer: knee
Flashcard 545: An obese 35 year old man presents with a severely painful erythematous and swollen first metatarsophalangeal joint over the last 15 hours. What is likely diagnosis?
_____
Answer: Gout
Flashcard 546: Serum urate levels of ≥ _____ micromol/L is diagnostic for gout
Answer: 360
Flashcard 547: Aspirin at _____-doses inhibits ↓ uric acid excretion, which can cause gout
Answer: low
Flashcard 548: Fibromyalgia has an absence of identifiable _____ or structural changes on examination, labs, imaging, & histology
Answer: inflammation
Flashcard 549: Pseudogout acute attacks are _____ duration than gout
Answer: longer
Flashcard 550: Herbeden's nodes are bony swellings in _____ joints
Answer: distal interphalangeal (DIP)
Flashcard 551:
What is the management for folate deficiency?
_____
Answer: Oral folic acid
Flashcard 552: Primary/hereditary haemochromatosis is a hereditary condition resulting in ↓ _____ (iron regulatory hormone)
Answer: hepcidin
Flashcard 553: Osteoarthritis has _____metrical joint involvement
Answer: asym
Flashcard 554: What behavioural risk factor markedly ↑↑ risk for rheumatoid arthritis?
_____
Answer: Smoking
Flashcard 555: Does folate deficiency present with neurological symptoms?
_____
Answer: No, that is vitamin B12 deficiency
Flashcard 556: Folate deficiency is predominantly caused by _____ issues; malnutrition & excessive alcohol
Answer: dietary
Flashcard 557: Folate is stored in the liver for up to _____
Vitamin B12 is stored in the liver for up to 3-4 years
Answer: 3-4 months
Flashcard 558: Rheumatoid arthritis has morning stiffness for _____
Answer: > 30 minutes
Flashcard 559: Why does haemochromatosis affect women at a later age?
_____
Answer: Chronic blood loss from menstruation. Usually onsets postmenopausal
Flashcard 560: What is the final-line management for osteoarthritis?
_____
Answer: Joint replacement
Flashcard 561: Haemachromatosis is categorised into _____ & secondary (acquired)
Answer: primary (hereditary)
Flashcard 562: Osteoarthritis joint x-ray will show _____, osteophytes, subchondral sclerosis, & subchondral cysts
Answer: loss of joint space
Flashcard 563: What is the likely diagnosis in an elderly patient that presents with a 6-month history of unilateral knee pain? The pain is worse in the evening and with activity
_____
Answer: Osteoarthritis
Flashcard 564: Folate deficiency blood smear will show _____ polymorphonuclear cells
Answer: hypersegmented
Flashcard 565: What is the 1st line lifestyle/conservative management of osteoarthritis?
_____
Answer: Weight loss & individualised therapeutic exercise
Flashcard 566: Rheumatoid arthritis more commonly affects _____ 3:1
Answer: women
Flashcard 567: Hemochromatosis has a slowed progression in _____
Answer: females
Flashcard 568: Rheumatoid arthritis often has _____cytic anaemia
Answer: normo
Flashcard 569: _____ is characterised by the accumulation of excess iron which may result in organ damage
Answer: Haemochromatosis
Flashcard 570: Haemochromatosis:
_____ ferritin
↑ ≥ 55% transferrin
↓ total iron-binding capacity (TIBC)
Answer: ↑
Flashcard 571: Examination findings of _____ may include enlarged joints, crepitus with movement, and decreased range of motion
Answer: osteoarthritis
Flashcard 572: Clinical sign = _____
Answer: Osteoarthritis; Heberden's & Bouchard's nodes
Flashcard 573: Haemochromatosis age of onset is > _____ years when body iron levels reach > 20g
Answer: 40
Flashcard 574: Why is iron chelation therapy used in secondary haemochromatosis e.g. beta thalassemia major instead of phlebotomy?
_____
Answer: Phlebotomy is contraindicated
Flashcard 575: Hereditary haemochromatosis is _____
Answer: autosommal recessive
Flashcard 576: Only take paracetamol & opioids for osteoarthritis if it is _____-term
Answer: short
Flashcard 577: Osteoarthritis is _____ with activity
Answer: worsened
Flashcard 578: Folate can be found in _____ vegetables & fortified food
Answer: leafy green
Flashcard 579: _____ arthritis presents with joint pain, swelling, stiffness over weeks to months ±
- constitutional symptoms
- extra-articular symptoms
Answer: Rheumatoid
Flashcard 580: Osteoarthritis most commonly affects the _____, hips, & hands (which joints?)
Answer: knees
Flashcard 581: Osteoarthritis is _____ with rest
Answer: improved
Flashcard 582:
Osteoarthritis is a clinical diagnosis in patients ≥ _____ years with activity-related joint pain AND no morning stiffness > 30 minutes
Answer: 45
Flashcard 583:
_____ is a chronic, systemic, inflammatory disorder that primarily affects the synovial joints due to autoimmunity
Answer: Rheumatoid arthritis (RA)
Flashcard 584: Systemic inflammation in rheumatoid arthritis may present with:
- _____
- Keratoconjunctivitis sicca
- Rheumatoid nodules
- Osteoporosis & cervical spine subluxation
- Pulmonary fibrosis
- Pericarditis & vasculitis
Answer: Anaemia of chronic disease
Flashcard 585: Spot diagnosis in a patient with joint pain in the hands = _____
Answer: Rheumatoid nodules; rheumatoid arthritis
Flashcard 586: Rheumatoid arthritis is a type _____ hypersensitivity reaction
Answer: 3
Flashcard 587: Osteoarthritis is common in patients with prior joint injury, especially _____ injuries
Answer: anterior cruciate ligament
Flashcard 588: Osteoarthritis more commonly affects _____
Answer: females
Flashcard 589: Systemic inflammation in rheumatoid arthritis dramatically increases _____ disease risk burden
Answer: cardiovascular
Flashcard 590: Rheumatoid arthritis can be _____ with rest **
Answer: worsened
Flashcard 591: What is the first-line management for haemochromatosis with ↑ ferritin or symptoms?
_____
Answer: Phlebotomy
Flashcard 592: On examination for rheumatoid arthritis there is pain on _____ test
Answer: Gaenslen/MCP squeeze
Flashcard 593: Folate deficiency presents with anaemic symptoms; _____, pallor, & dyspnoea
Answer: fatigue
Flashcard 594: Rheumatoid arthritis has _____metrical joint involvement
Answer: sym
Flashcard 595: What investigation can distinguish between folate & vitamin B12 deficiency?
_____
Answer: Homocysteine ↑ in both
- Methylmalonic acid (MMA) is normal/↓ in folate
- Methylmalonic acid (MMA) is ↑ in vitamin B12
Flashcard 596: What is the initial investigation for haemochromatosis?
_____
Answer: Iron studies:
↑ ferritin
↑ transferrin
↓ total iron binding capacity
Flashcard 597: Secondary haemochromatosis is often caused by chronic _____
Answer: transfusions
Flashcard 598: Haemochromatosis can cause arthropathy, especially in _____ joints with "hook-like" osteophytes
Answer: metocarpophalangeal (MCP)
Flashcard 599: Rheumatoid arthritis most commonly affects _____ & feet (which joints?)
Answer: hands
Flashcard 600: What is the second-line management for haemochromatosis?
_____
Answer: Iron chelation therapy
e.g. both Deferasirox & Desferrioxamine
Flashcard 601:
When should you refer osteoarthritis for a joint replacement?
_____
Answer: Substantial impact on QOL or non-surgical mx is ineffective/unsuitable
Flashcard 602: Clinical sign = _____
Answer: Swan neck deformity; advanced RA
Flashcard 603: What investigation is needed to confirm hereditary haemochromatosis alongside iron studies?
_____
Answer: Genetic testing!
Flashcard 604: Rheumatoid arthritis is _____ with activity
Answer: improved
Flashcard 605: _____ is a degenerative disorder of the synovial joints due to advanced age & overuse
Answer: Osteoarthritis (OA)
Flashcard 606: _____ BMI is a modifiable risk factor for osteoarthritis
**bonus: why?
Answer: High
Flashcard 607: Spot Diagnosis = _____
Answer: Osteoarthritis
Flashcard 608: A red flag symptom in rheumatoid arthritis is _____ stiffness/pain because it can lead to atlantoaxial subluxation
Answer: neck
Flashcard 609: Haemochromatosis is often a(n) _____ finding as it is asymptomatic until a later stage
Answer: incidental
Flashcard 610: _____ can be done to help rule out inflammatory arthritis when suspecting osteoarthritis
Answer: CRP
Flashcard 611: Osteoarthritis has a _____ onset
Answer: gradual
Flashcard 612: Clinical sign = _____
Answer: Boutonniere deformity; advanced RA
Flashcard 613: Haemochromatosis can cause _____ cardiomyopathy or dilated cardiomyopathy
Answer: restrictive
Flashcard 614: _____ syndrome is rheumatoid arthritis with splenomegaly & neutropenia
Answer: Felty
Flashcard 615: What is the pharmacological management for osteoarthritis?
1st-line: _____
2nd-line: oral NSAIDs + PPI
Answer: topical NSAIDs
Flashcard 616: Which finger/hand joints are affected in osteoarthritis?
_____
Answer: PIPs, DIPs, and 1st CMC
Flashcard 617: What is the next-step management for osteoarthritis if analgesia is not working?
_____
Answer: Intra-articular steroids
Flashcard 618:
What is the first-line imaging for osteoarthritis?
_____
Answer: X-ray of joint
Flashcard 619: Folate deficiency (anaemia) will have
_____ Hb
↑ MCV
↑ MCH
Answer: ↓
Flashcard 620: Bouchard's nodes are bony swellings in _____ joints
Answer: proximal interphalangeal (PIP)
Flashcard 621: Rheumatoid arthritis can present with constitutional symptoms: _____, low-grade fever, & weight loss
Answer: fatigue
Flashcard 622:
Rheumatoid arthritis has a peak incidence at _____-60 years
Answer: 30
Flashcard 623: Osteoarthritis has morning stiffness for _____
Answer: < 30 minutes
Flashcard 624: Which finger/hand joints are affected in rheumatoid arthritis?
_____
Answer: PIPs, MCPs and wrist
Flashcard 625: On examination patients with vitamin B12 can have _____
Answer: glossitis
Flashcard 626: Pernicious anaemia will have
_____ Hb
↑ MCV
↑ MCH
Answer: ↓
Flashcard 627:
_____ & folate deficiencies are the primary causes of megaloblastic anaemia
Answer: Vitamin B12
Flashcard 628: What is the most common cause of vitamin B12 deficiency?
_____
Answer: Pernicious anaemia
Flashcard 629: Vitamin B12 deficiency is predominantly caused by _____ issues
Answer: malabsorption
Flashcard 630: _____ deficiency = ↑ homocysteine + ↑ methylmalonic acid (MMA)
Folate deficiency = ↑ homocysteine + normal/↓ methylmalonic acid (MMA)
Answer: Vitamin B12
Flashcard 631: Pernicious anaemia blood smear will show _____ polymorphonuclear cells
Answer: hypersegmented
Flashcard 632: Patients with pernicious anemia should be monitored for development of _____ cancer
Answer: gastric
Flashcard 633: Vitamin B12 deficiency presents with _____ symptoms ± neurological symptoms
Answer: ANAEMIA
Flashcard 634: _____ is the autoimmune destruction of intrinsic factor leading to a deficiency in vitamin B12
Answer: Pernicious anaemia
Flashcard 635: Vitamin B12 deficiency will have anaemia presenting with _____, pallor, and shortness of breath
Answer: fatigue
Flashcard 636: What is the management of pernicious anaemia?
_____ vitamin B12
Answer: IM
Flashcard 637: Patient with suspected folate deficiency is treated with folic acid, but then develops rapidly progressive neurological deficits. What is going on?
_____
Answer: Vitamin B12 deficiency, need IM vit B12
Flashcard 638: What specific investigations are done for pernicious anaemia?
_____
Anti-intrinsic factor antibody test
Answer: Total/active serum B12
Flashcard 639: It is important to diagnose and treat vitamin B12 deficiency because neurological symptoms may be _____
Answer: irreversible
Flashcard 640:
Pressure sores present with _____ & non-blanching erythema
Answer: discomfort/tingling
Flashcard 641: What is the main side effect of Vincristine/Vinblastine (chemo)?
_____
Answer: Peripheral neuropathy (vincristine) & Myelosupression (vinblastine)
Flashcard 642: Lymphoma is staged using the _____ staging system
Answer: Ann Arbor
Flashcard 643: _____ lymphoma is associated with malaria infection
Answer: Burkitt's
Flashcard 644: _____-grade NHL usually has a worse prognosis but is more curable
Answer: High
Flashcard 645: What is the pharmacological managment of high-grade NHL?
_____
Answer: Chemotherapy - R-CHOP
Flashcard 646: NHL may present with extranodal symptoms due to _____ of structures:
Vena cava: Superior vena cava syndrome
External biliary tree: Jaundice
Ureters: Hydronephrosis
GIT: Bowel obstruction
Meninges: CN palsy
Answer: compression
Flashcard 647: A typical FBC in a patient with NHL will show _____, thrombocytopenia, neutropenia, lymphocytosis
Answer: anaemia
Flashcard 648: Hodgkin's lymphoma is usually limited to the _____ body
Answer: upper
Flashcard 649: All patients with NHL should be tested for _____
Answer: HIV
Flashcard 650: _____-grade NHL usually has a better prognosis but is less curable
Answer: Low
Flashcard 651: _____ lymphoma is common in West Africa
Answer: Burkitt's
Flashcard 652: Mangement of _____ lymphoma can vary due to the broad nature of the disease. Treatment may vary from watchful waiting to aggressive chemoradiotherapy
Answer: Non-Hodgkin's
Flashcard 653: The spread of Non-Hodgkin's lymphoma is _____ between LN groups
Answer: discontinuous
Flashcard 654: _____ may be offered for Hodgkin's lymphoma with bulky/resistant disease alongside chemotherapy?
Answer: Radiotherapy
Flashcard 655: What are the diagnostic investigations for NHL?
_____, Immunophenotyping
Answer: LN excision biopsy
Flashcard 656: What is the main side effect of asparagine (chemo)?
_____
Answer: Neurotoxicity
Flashcard 657: What is the 1st line managment of Hodgkin's lymphoma?
_____
Answer: Chemotherapy (ABVD)
Flashcard 658: _____ lymphoma is associated with translocation of the MYC oncogene
Answer: Burkitt
Flashcard 659: Lymphoma is staged using the Ann Arbor staging system:
Stage 1: _____
Stage 2: ≥2 lymph node regions on the same side of the diaphragm
Stage 3: Lymph node regions on both sides of the diaphragm (may include extralymphatic involvement)
Stage 4: Diffuse extralymphatic disease
A - B symptoms absent
B - With B symptoms
E - Extra-nodal site involved
X - Bulky disease
Answer: Single lymph node region or extralymphatic site
Flashcard 660: What medications does ABVD chemotherapy include?
_____
Bleomycin
Vinblastine
Dacarbazine
Answer: Doxorubicin (Adriamycin)
Flashcard 661: Which type of lymphoma has the greatest association with _____?
Burkitt's lymphoma
Answer: EBV
Flashcard 662: There are more than _____ types of Non-Hodgkin's lymphoma which can be broadly categorised into low-grade and high-grade
Answer: 60
Flashcard 663: _____ lymphoma usually causes jaw lymphadenopathy
Answer: Burkitt's
Flashcard 664: Hodgkin's lymphoma generally has a _____ prognosis
Answer: good
Flashcard 665: _____ of Hodgkin's lymphoma may lead to neurological symptoms (e.g. headache, vision changes, stroke-like)
Answer: Hyperviscosity syndrome
Flashcard 666: Usually lymphomas arising from _____ are low-grade and lymphomas arising from lymphoblasts are high-grade
Answer: mature lymphocytes
Flashcard 667: What is the main side effect of Doxorubicin (chemo)?
_____
Answer: Reversible congestive heart failure AND red urine
Flashcard 668: All patients undergoing treatment for NHL should be offered the following vaccinations: _____, Influenza, Meningococcal, Hib
Answer: Pneumococcal
Flashcard 669: _____ of patients diagnosed with NHL survive for >10 years following diagnosis
Answer: 2/3
Flashcard 670: The spread of Hodgkin's lymphoma is _____ between LN groups
Answer: continuous
Flashcard 671: Non-Hodgkin's lymphoma is more common in _____
Answer: the elderly (60-70)
Flashcard 672: What is the pharmacological managment of high-grade NHL at risk of CNS involvement?
_____ and Intrathecal methotrexate or cytarabine
Answer: Chemotherapy - R-CHOP
Flashcard 673: NHL may arise from which cell types?
_____, T lymphocyte, NK cell
Answer: B lymphocyte
Flashcard 674: Risk factors for Hodgkin's lymphoma include _____, immunosupression and 1st degree relative affected
Answer: EBV
Flashcard 675: Painless lymphadenopathy with fever, pruritus, weight loss and nightsweats is suggestive of what condition?
_____
Answer: Lymphoma
Flashcard 676: _____ related to lymphoma may cause recurrent infections or bleeding
Answer: Bone marrow infiltration
Flashcard 677: Myeloma may cause decreased production of _____ which leads to an increased susceptibility to infection
Answer: normal immunoglobulins
Flashcard 678: _____ can be used as a prognostic indicator in Hodgkin's lymphoma
Answer: LDH
Flashcard 679: FBC in a patient with Hodgkin's lymphoma may show _____, lymphocytopenia and eosinophilia
Answer: normocytic, normochromic anaemia
Flashcard 680: The _____ and liver are the most commonly affected organs in lymphoma
Answer: spleen
Flashcard 681: Myeloma is a _____ disease - there is no cure
Answer: relapsing / remitting
Flashcard 682: 60% of Hodgkin's lymphoma has _____ or mediastinal lymph node involvement
Answer: cervical
Flashcard 683: Diagnostic criteria for MGUS in patients with serum paraprotein:
1. _____
2. Monoclonal plasma cells in bone marrow <10%
3. Absence of symptoms (or organ involvement)
Answer: Serum paraprotein <30 g/L
Flashcard 684: Organise a 2-week-wait referral for patients with _____ or Bence-Jones protein urine test results suggestive of myeloma
Answer: serum protein elcetrophoresis
Flashcard 685: Myeloma may cause hypercalcaemia due to increased _____ activity which results in osteolytic lesions
Answer: osteoclast
Flashcard 686: _____ presenting with unexplained lymphadenopathy should be considered for a 2-week-wait referral for lymphoma
Answer: Adults
Flashcard 687: _____ may be found upon X-ray of the skull in myeloma patients
Answer: Rain-drop skull
Flashcard 688: Patients may take _____ following stem cell transplantation for myeloma in the form of lenalidomide
Answer: maintenance therapy
Flashcard 689: Induction therapy prior to stem cell transplantation in myeloma involves a combination of:
1. _____
2. Chemotherapy (e.g. cyclophosphamide)
3. Steroids (e.g. dexamethasone)
Answer: Targeted immunomodulatory drugs (e.g. thalidomide or bortezomib)
Flashcard 690: Anaemia and thrombocytopenia associated with myeloma is caused by _____
Answer: overcrowding of the bone marrow
Flashcard 691: Hodgkin's lymphoma with _____ lymph node involvement may experience dyspnoea or chest pain
Answer: mediastinal
Flashcard 692: Multiple myeloma is a cancer of the _____ cells
Answer: plasma
Flashcard 693: Hodgkin's lymphoma has a _____ incidence, with the peak incidence occuring in patients aged 20-30 years
Answer: bimodal
Flashcard 694: _____ of patients with MGUS go on to develop Myeloma
Answer: 1%
Flashcard 695: Patients >60 years old with persistent bone pain or an unexplained fracture should be assessed for _____
Answer: myeloma
Flashcard 696: End stage progression of myeloma may be reduced with long term use of _____
Answer: bisphosphonates
Flashcard 697: What are the diagnostic investigations for myeloma?
Bloods: _____
Imaging: Whole body MRI
Invasive: Bone marrow aspirate
Other: Urine protein electrophoresis
Answer: Serum paraprotein electrophoresis
Flashcard 698: _____% of Hodgkin's lymphoma is associated with EBV infection
Answer: 40
Flashcard 699: _____ lymph node biopsy is preferred in Hodgkin's lymphoma
Answer: Excision
Flashcard 700: Lymphomas commonly present with _____, B symptoms and pruritus
Answer: unexplained lymphadenopathy
Flashcard 701: The features of myeloma can be memorised using the CRABBI mnemonic:
_____
Answer: HyperCalcaemia
Renal involvement
Anaemia
Bleeding
Bones
Infection
Flashcard 702: Osteolytic lesions caused by myeloma typically occur in the _____
Answer: skull & vertebrae
Flashcard 703: _____ presenting with unexplained lymphadenopathy should be considered for a very urgent 48 hr referral for lymphoma
Answer: Children and young people
Flashcard 704: Bone pain caused by myeloma may be treated with _____ or radiotherapy
Answer: NSAIDS
Flashcard 705: Diagnostic criteria for smouldering myeloma:
1. _____
2. Absence of symptoms (and organ involvement)
Answer: Serum paraprotein ≥30 g/L (and/or clonal marrow plasma cells 10-60%)
Flashcard 706: What are the B symptoms?
_____, Drenching night sweats, Unintentional weight loss of >10% over 6 months
Answer: Fever (>38 C)
Flashcard 707: _____ lymphoma is caused by uncontrolled proliferation of B-lymphocytes
Answer: Hodgkin's
Flashcard 708: What is the management of myeloma?
_____
Answer: Autologous stem cell transplant
Flashcard 709: Hodgkin's lymphoma is rarely associated with painful lymph nodes after consuming _____
Answer: alcohol
Flashcard 710: Lymphoma associated lymphadenopathy is _____ and asymmetrical
Answer: painless
Flashcard 711: Hodgkin's and Non-Hodgkin's lymphoma are differentiated based on the presence of _____ cells upon histological examination
Answer: Reed-Sternberg
Flashcard 712: _____ is used for staging and assessing treatment response in lymphomas
Answer: PET-CT
Flashcard 713: Multiple myeloma most commoly occurs in _____
Answer: the elderly (60-70)
Flashcard 714: The clinical features of myeloma can be memorised using the _____ mnemonic
Answer: CRABBI
Flashcard 715: _____ impairment associated with myeloma is a result of light chain deposition within the tubules
Answer: Renal
Flashcard 716: _____ lymphoma is much more common
Answer: Non-Hodgkin's
Flashcard 717: Which lymphoma affects younger patients?
_____
Answer: Hodgkin's
Flashcard 718: Immunoglobulin light chains in the urine of a patient with myeloma are known as _____
Answer: Bence-Jones proteins
Flashcard 719: The diagnostic investigation for Hodgkin's lymphoma is _____
Answer: lymph node excision biopsy
Flashcard 720: What are the 2 types of Bence-Jones proteins?
_____
Answer: Lambda and Kappa
Flashcard 721: The diagnostic criteria for myeloma can be remebered using the SLiM CRAB mnemonic.
A individual with _____ AND any 1 of the following has myeloma:
≥ Sixty % plasma cells in marrow
Light chain ratio ≥100
≥ 1 focal lesion ≥5mm on MRI
HyperCalcaemia
Renal impairment
Anaemia: Hb <100 g/L or 20g below normal
Bone involvement (lytic lesion, osteoporosis, pathological fractures)
Answer: clonal bone marrow plasma cells ≥10%
Flashcard 722: Myeloma patients at risk of infection may be given _____
Answer: prophylactic antibiotics
Flashcard 723: The 2 main management options for superior vena cava obstruction are _____ and Chemotherapy &/or Radiotherapy
Answer: endovascular stenting
Flashcard 724: What lifestyle advice is given for herniated discs?
_____
Answer: Get back to normal activity as quickly as possible, some discomfort is tolerated as long as it does not cause a lot of pain
Flashcard 725: What is the first-line analgesic for herniated disc?
_____
Answer: NSAIDs e.g. ibuprofen, naproxen
Flashcard 726: The most effective management of superior vena cava obstruction is _____
Answer: endovascular stenting
Flashcard 727:
What physical examination can test for herniated disc?
_____
Answer: Straight leg test → +ve at 30-70° for lumbar disc herniation esp. roots L4-S1
Flashcard 728: What is the diagnosis of a 40 year-old construction worker who felt a severe sudden back pain radiates down the back of the leg?
_____
Answer: Herniated disc in the lumbar spine
Flashcard 729: Herniated disc risk factors:
A job that involves lots of _____
A job that involves lots of sitting (esp driving)
Smoking
Genetics & age (the usual)
Answer: lifting
Flashcard 730: ~75% of patients with herniated discs will improve after _____ due to re-absorption of the prolapsed disc over-time
Answer: 4 weeks
Flashcard 731: Superior vena cava obstruction can rarely be caused by _____ of intravascular devices (e.g. central venous catheters, pacemaker leads, or dialysis catheter)
Answer: thrombosis
Flashcard 732: Patients with superior vena cava obstruction may be given an initial dose of _____ in unstable patients with suspected/known malignancy
Answer: dexamethasone (4mg 6 hourly)
Flashcard 733: Vaccinations against H.influenzae type b, meningococcus groups B & C, S. pneumoniae are given _____
Answer: in childhood
Flashcard 734: The most common symptom from a herniated disc is _____
Answer: lower back pain
Flashcard 735: A(n) _____ is when the nucleus pulposus herniates through the annulus fibrosus
Answer: herniated disc
Flashcard 736: All patients with malignancy of unknown origin should have the following investigations:
Blood tests: _____, U&Es, LFT, Calcium, Lactate dehydrogenase, AFP and hCG
Imaging: CXR, CT (chest, abdomen & pelvis)
Other: Urinalysis
Answer: FBC
Flashcard 737: Chronic anticoagulation with drugs such as warfarin increase the risk for _____ haemorrhages following injury (especially in elderly)
Answer: subdural
Flashcard 738: Patients with malignancy of unknown origin and lytic bone lesions should have a _____
Answer: myeloma screen
Flashcard 739: What blood test is important to check for subdural haemorrhage?
_____
Answer: Coagulation screen
Flashcard 740: _____ may be used to reduce risk of vertebral fracture or collapse due to spinal metastases from myeloma, breast or prostate cancer
Answer: Bisphosphonates
Flashcard 741: Investigations for malignancy of unknown origin _____ be offered to patients who are unfit for treatment
Answer: should not
Flashcard 742: A breakthrough dose of analgesia should be given _____ of anticipated painful movement
Answer: well in advance
Flashcard 743: In psoriatic arthritis there _____ morning stiffness > 30 minutes that improves with activity
Answer: is
Flashcard 744: If x-ray changes are absent in psoriatic arthritis, what investigation can be helpful?
_____
Answer: US which shows tendon swelling, ↑ blood flow, & erosions
Flashcard 745: DMARDs are particularly useful in _____ ankylosing spondylitis
Answer: peripheral
Flashcard 746: _____ is an iatrogenic complication of polymyalgia rheumatica that should be assessed & managed
Answer: Osteoporosis
Flashcard 747: Polymyalgia rheumatica patients are typically treated with prednisolone for ~_____ followed by gradual tapering over 1-2 years, the reduction in dose is guided by symptom control & inflammatory marker trends (CRP, ESR)
Answer: 4-8 weeks
Flashcard 748: What is the initial symptomatic management of psoriatic arthritis?
_____
Answer: NSAIDs for joint pain
Flashcard 749: Psoriatic rashes / nail changes often _____ arthritic changes in psoriatic arthritis
Answer: precedes
Flashcard 750: Polymyalgia rheumatica _____ involve loss of power in affected limbs
Answer: doesn't
Flashcard 751: Psoriatic arthritis is a _____ spondylarthropathy
Answer: seronegative
Flashcard 752:
Polymyalgia rheumatica average age of onset is typically > _____ years and is more common in women
Answer: 70
Flashcard 753: What is the management of psoriatic arthritis after symptomatic relief?
1st line: _____
2nd line: Biological DMARDs - e.g. anti-TNF
3rd line: Targeted synthetic DMARDs - e.g. Tofacitinib
Answer: Conventional synthetic DMARDs
Flashcard 754: Skin lesions _____ required for diagnosis of psoriatic arthritis
Answer: are not
Flashcard 755: Psoriatic rashes are typically found on _____ surfaces
Answer: extensor
Flashcard 756: _____ are raised in less than 50% of patient with psoriatic arthritis
Answer: Inflammatory markers
Flashcard 757: What investigations should be ordered for suspected psoriatic arthritis?
_____, inflammatory markers, Rheumatoid factor, Anti-CCP
Answer: X-ray of hands and feet
Flashcard 758: _____ is inflammation of a finger or toe. Also known as 'sausage finger'
Answer: Dactylitis
Flashcard 759:
What investigations should be ordered as part of a polymyalgia rheumatica diagnosis?
_____, Creatinine kinase
Answer: Inflammatory markers (e.g. ESR, plasma viscosity, CRP)
Flashcard 760: Rheumatoid factor and Anti-CCP antibodies are usually _____ in psoriatic arthritis
Answer: normal
Flashcard 761:
Polymyalgia rheumatica typically presents with _____ & morning stiffness of the proximal limb muscles
Answer: aching
Flashcard 762: If patients with suspected PMR do not respond substantially to _____, consider an alternative diagnosis
Answer: prednisolone
Flashcard 763: Inflammatory markers are _____ and creatinine kinase is normal in polymyalgia rheumatica
Answer: raised
Flashcard 764: Patterns of psoriatic arthritis:
• _____ - most common and very similar to rheumatoid arthritis
• Asymmetrical oligarthritis - usually affects hands and feet
• Distal interphalangeal disease - about 10%
• Sacroilitis - inflammation primarily involving the spine (spondylitic) & sacroiliac joints
• Arthritis mutilans - rare and severe form. Can cause telescoping of digits indicating significant joint damage
Answer: Symmetrical polyarthritis
Flashcard 765:
What changes are seen upon X-ray of hands and feet in psoriatic arthritis?
_____ and periarticular new bone formation
Answer: Erosion of the DIP joint
Flashcard 766: If PMR is the most likely diagnosis then it should be managed with _____
Answer: prednisolone (15-25mg)
Flashcard 767: What complication of PMR should be excluded before initiating treatment?
_____
Answer: Giant cell arteritis
Flashcard 768: Psoriatic arthritis is often associated with additional features such as _____, nail changes, dactylitis, enthesopathy
Answer: rash
Flashcard 769: What MSK pathologies are associated with IBD?
_____ (can be related & unrelated to disease activity)
Osteoporosis (related to disease activity)
Answer: Enteropathic arthritis
Flashcard 770: What is the most common extra-intestinal feature of both IBD?
_____ (can be related & unrelated to disease activity)
Answer: Enteropathic arthritis
Flashcard 771: If ankylosing spondylitis is suspected but there are no signs of sacroiliac joint abnormality on x-ray, what is the next step?
_____
Answer: MRI
Flashcard 772: What is the initial management of ankylosing spondylitis?
lifestyle: _____, physiotherapy
pharmacology: NSAIDs
Answer: Exercise programme
Flashcard 773: Presentation of ankylosing spondilitis usually involves _____ which is worse in the mornings and improves with exercise
Answer: lower back pain/stiffness
Flashcard 774:
What drug classes can be used by rheumatologists to treat ankylosing spondylitis?
_____ & TNF-alpha inhibitors (e.g. adalimumab)
Answer: DMARDs (e.g. sulfasalazine)
Flashcard 775: Ankylosing spondylitis is associated with the _____ gene
Answer: HLA-B27
Flashcard 776: What sign can be seen in spinal radiographs of ankylosing spondylitis?
_____
Answer: Bamboo spine
Flashcard 777: What are the common findings upon X-ray of ankylosing spondylitis?
Pelvic: _____
Spinal: Squaring of lumbar vertebrae, syndesmophytes
Answer: Sacroilitis
Flashcard 778: Patients with ankylosing spondylitis will often have concurrent musculoskeletal problems such as _____ and peripheral arthritis
Answer: peripheral enthesitis
Flashcard 779:
Ankylosing spondylitis usually affects _____ aged 20-30 years old
Answer: males
Flashcard 780:
Spirometry in patients with ankylosing spondylitis may show a _____ pattern
Answer: restrictive
Flashcard 781:
Sacroilitis on X-ray film may appear as _____, sclerosis as well as fusion of the articular surfaces
Answer: subchondral erosions
Flashcard 782: What is the most useful investigation for ankylosing spondylitis?
_____
Answer: X-ray of the sacroiliac joints
Flashcard 783:
A CXR of a patient with ankylosing spondylitis may show _____
Answer: apical fibrosis (late feature)
Flashcard 784: What ophthalmological condition is ankylosing spondylitis associated with?
_____
Answer: Anterior uveitis
Flashcard 785: Upon examination, patients with ankylosing spondilitis will have _____ lateral and forward lumbar flexion and chest expansion
Answer: reduced
Flashcard 786: What cardiac conditions are associated with ankylosing spondylitis?
_____ & AV node block
Answer: Aortic regurgitation
Flashcard 787: Length of anticoagulation continuation for pulmonary embolisms
Provoked → _____
Unprovoked → 6 months
Answer: 3 months
Flashcard 788: A pulmonary embolism risk factor is underlying _____
Answer: cancer
Flashcard 789: If a PE is unlikely (≤ 4 points) then _____
Answer: arrage a D-dimer
Flashcard 790: _____ increases the risk of pulmonary embolisms
Answer: Oral contraceptive pills
Flashcard 791: What is the second-line anticoagulation for pulmonary embolism?
_____
Answer: LMWH; followed by dabigitran/edoxaban or warfarin
Flashcard 792:
D-dimers are highly _____ but have poor specificity
Answer: sensitive
Flashcard 793: If a PE is likely (≥ 5 points) a CTPA is negative then _____ if DVT is suspected
Answer: consider a proximal leg vein ultrasound
Flashcard 794: Which RIPE drug can cause uric acid crystal formation and ultimately gout?
_____
Answer: Pyrazinamide
Flashcard 795: RIPE drugs are used to treat active tuberculosis. What is the notable side effect of pyrazinamide?
_____
Answer: Hyperuricaemia causing gout
Flashcard 796:
Extra-pulmonary tuberculosis can cause _____ of the spine (vertebrae)
Answer: Pott's disease
Flashcard 797: Which antibacterial drug may produce a red-orange discoloration of body fluids?
_____
Answer: Rifampin
Flashcard 798: On bloods raised _____ may be seen in lung cancer
Answer: platelets
Flashcard 799: Sarcoidosis is associated with _____
Answer: uveitis
Flashcard 800: What is the most accurate investigation for sarcoidosis?
_____
Answer: Lymph node biopsy
Flashcard 801: Lupus pernio is pathognomonic for _____
Answer: sarcoidosis
Flashcard 802: _____ syndrome is an acute form of sarcoidosis characterized by erythema nodosum, bilateral hilar lymphadenopathy (BHL), and polyarthralgia
Answer: Löfgren
Flashcard 803: _____ & erythema nodosum are skin pathologies associated with sarcoidosis
Answer: Lupus pernio
Flashcard 804: _____ syndrome is a variant of sarcoidosis characterized by parotid enlargement, facial nerve palsy, and uveitis
Answer: Heerfrodt's
Flashcard 805: The main complication of hypogammaglobulinemia is _____
Answer: bronchiectasis
Flashcard 806: What is the management in asymptomatic sarcoidosis?
_____
Answer: Monitoring
Flashcard 807: The most common location of a DVT are the _____
Answer: lower extremities
Flashcard 808: It may be important to explore the underlying diagnosis of _____ if a patient has a DVT
Answer: cancer
Flashcard 809:
A _____ occurs when a thrombus forms in a deep vein, usually in the legs, which obstructs blood flow and can lead to serious complications e.g. pulmonary embolism
Answer: deep vein thrombosis (DVT)
Flashcard 810: What is the anticoagulation for DVT if the patient has "triple positive" antiphospholipid syndrome?
_____
Answer: Low-molecular weight heparin followed by vitamin K antagonist
Flashcard 811: What is the first-line anticoagulation for DVT?
_____
Answer: DOACs - apixaban or rivaroxaban
Flashcard 812: Patients admitted to hospital are at risk of DVT because of _____
Answer: immobility
Flashcard 813: DVT commonly presents with _____ pain & oedema
Answer: unilateral
Flashcard 814: The three major risk factors for thrombosis are _____, hypercoagulability, and endothelial cell damage (Virchow triad)
Answer: disruption in blood flow (stasis)
Flashcard 815: A unprovoked DVT involves anticoagulation for _____ or longer
Answer: 6 months
Flashcard 816: What is the second-line anticoagulation for DVT?
_____
Answer: Low-molecular weight heparin
Flashcard 817: What is the anticoagulation for DVT if renal impairment is severe (<15/min)?
_____
Answer: Low-molecular weight heparin
Flashcard 818: Can anticoagulation therapy be witheld soley due to risk of falls and old age?
_____
Answer: No
Flashcard 819: Connective tissue syndromes (_____ & Ehlers-Danlos) can predispose risk of aortic dissection, mitral prolapse, aortic regurgitation
Answer: Marfan's
Flashcard 820: A _____ fracture is a low impact fracture from standing height or lower
Answer: fragility
Flashcard 821: The most common fragility fractures are
- _____
- Hip fractures (NOF#)
- Colles fracture
Answer: Vertebral crush fractures
Flashcard 822: _____ exercise can increase bone mineral density for osteoporosis
Answer: Weight-bearing
Flashcard 823: Spondylarthropathies (e.g. ankylosing spondylitis) can cause _____
Answer: aortic regurgitation
Flashcard 824: Osteoporosis is important because it can cause _____
Answer: fragility fractures
Flashcard 825: Dactylitis, and asymmetric involvement of DIP's and nails suggests _____ or psoriatic arthritis
Answer: reactive
Flashcard 826: FRAX assessment for 10-year risk of fragility fractures
Low risk = _____
Intermediate risk = offer DEXA scan
High risk = offer bisphosphonates
Answer: reassure & give lifestyle advice
Flashcard 827: ~1/4th of patients do not tolerate alendronate because of _____
Answer: indigestion
Flashcard 828:
NICE advise all women aged ≥ _____ years old & men aged ≥ 75 years old should be considered for assessment of osteoporosis fragility fractures
Answer: 65
Flashcard 829:
Reactive arthritis resolves spontaneously within ~_____ months
Answer: 12
Flashcard 830:
Reactive arthritis is associated with _____ infections and GI infections
Answer: sexually transmitted
Flashcard 831:
Reactive arthritis is more common in _____ 3:1
Answer: men
Flashcard 832: What autoimmune MSK condition is a risk factor for osteoporosis?
_____
Answer: Rheumatoid arthritis
Flashcard 833: What is the second-line management of osteoporosis if they cannot tolerate alendronate?
_____
Answer: Risedronate or IV zoledronate
Flashcard 834:
What is the management for persistent/severe reactive arthritis?
_____
Answer: DMARDs e.g. sulfasalazine
Flashcard 835: _____ can mimic osteoporosis and should be ruled out
Answer: Myeloma
Flashcard 836: What DEXA (DXA) T score is diagnostic of osteoporosis?
_____
Answer: ≤ -2.5
Flashcard 837: Reactive arthritis typically presents with _____ oligoarthritis of the lower limbs
Answer: asymmetrical
Flashcard 838: For osteoporosis, it is recommended to use _____ or QFracture screening tool to assess for 10-year risk of fragility fractures
Answer: FRAX
Flashcard 839:
_____ is a skeletal disorder characterised by low bone mass and structural deterioration of bone tissue
Answer: Osteoporosis
Flashcard 840: DEXA scan _____ score is based on bone mass of a young reference population & measured with standard deviations
Answer: T
Flashcard 841: Reactive arthritis is a _____ associated seronegative spondyloarthropathy
Answer: HLA-B27
Flashcard 842:
Osteoporosis risk factors:
- _____
- Female (postmenopausal)
- Family history
- Chronic corticosteroids use
- Low BMI
Answer: Age
Flashcard 843: Reactive arthritis typically onsets ~_____ from infection
Answer: 4 weeks
Flashcard 844: What is the most common organism that causes reactive arthritis?
_____
Answer: Chlamydia
Flashcard 845:
_____ is a post-infectious autoimmune condition that classically presents with the triad of urethritis, conjunctivitis, and arthritis following a STI/GI infection
Answer: Reactive arthritis
Flashcard 846: What is the first-line management of osteoporosis?
_____
Answer: Alendronate (bisphosphonate)
Flashcard 847: _____ is the triad of urethritis, conjunctivitis, and arthritis after a sexually transmitted infection (STI)
Answer: Reactive arthritis
Flashcard 848: What supplements are given to patients with osteoporosis?
_____
Answer: Calcium & vitamin D unless they have adequate levels
Flashcard 849: Which seronegative spondyloarthropathy is associated with keratoderma blennorhagicum (waxy yellow), a skin lesion that resembles pustular psoriasis?
_____
Answer: Reactive arthritis
Flashcard 850:
Patients who are likely to be on steroids for at least _____ should be offered bisphosphonates
Answer: 3 months
Flashcard 851: A _____ & FBC should be done to investigate secondary causes of osteoporosis
Answer: history + physical examination
Flashcard 852: What is the symptomatic treatment of reactive arthritis?
_____ or intra-articular steroids
Answer: NSAIDs
Flashcard 853:
If pharmacological options fail to control bleeding in postpartum haemorrhage, then then consider _____ before surgical options
Answer: intrauterine balloon tamponade
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