1
Q
what does APTT signify?
A
intrinsic pathway
2
Q
what does PT / INR signify?
A
extrinsic pathway (VII)
3
Q
what diseases affect APTT?
A
intrinsic pathway
haemophillia A / B
von willebrands
4
Q
what does von willebrands factor do?
A
vWF adheres to vascular injury
5
Q
what blood tests are seen in DIC?
A
high PT
high INR
high APTT
low platelets
6
Q
define DIC
A
- depletion of platelets + coagulation factors
- intravascular thrombi –> multi-organ failure
hallmarks:
- continuous production of intravascular fibrin
- platelet / coagulation consumption
7
Q
DIC triggers
A
major trauma
organ destruction
sepsis
severe infection
8
Q
what is meropenem
A
beta lactum –> targets cell wall synthesis
9
Q
what is teicoplanin
A
glycopeptide abx
treats MRSA
10
Q
in long term penicillin use - what are you concerned about?
A
LFTs
hepatitis
cholestasis
11
Q
what drugs are used in palliative care?
A
analgesics - morphine
anti-secretions - hyoscine butlybromide
anti-emetics - ondansatron
sedatives - halperidol (agitation / hipcups)
12
Q
define antiphospholipid syndrome
A
CLOTs
- Coagulation defect (^APTT)
- Livido reticularis
- Obstetric comps (recurrent fetal loss)
- Thrombocytopenia
commonly associated with SLE
increase in APTT (intrinsic pathway)
13
Q
define systemic sclerosis
A
limited vs diffuse
limited - face / hands / arms below elbow
diffuse - entire body
anti-centromere - limited
anti-scl-70 - diffuse
ANA is 90% of cases
14
Q
bisphosphinate rules
A
- taken on an empty stomach
- upright for 30 minutes
swallowed whole
SE:
- atypical stress fractures (femor)
- osteonecrosis of the jaw
15
Q
what is dermatomyosistis
A
inflammatory disorder causing symmetrical, proximal muscle weakness + skin lesions
associated maligancy
polymyositis is a variant of the disease where skin lesions aren’t present
- Gottron’s papules, - seen on knuckles
- lung fibrosis
- raynauds
16
Q
dermatomyositis Ix
A
ANA 80%
17
Q
triad of behcet’s
A
oral ulcers
gential ulcers
anterior uveitis
18
Q
still’s disease
A
polyarthritis most commonly in children
fever
macular rash/salmon pink rash
lymphadenopathy
elevated ferritin (acute phase)
19
Q
still’s Mx
A
- NSAIDs
- steroids
- refractory (methotrexate)
20
Q
polymyalgia rheumatica
A
overlaps with temporal arthritis (large cell vas)
vascultitis with giant cells –> skip lesions
muscle bed mostly affect in polymyalgia rheumatica
features:
- proximal stiffening, no weakness
- raised ESR
21
Q
polymyalgia rheumatica
Ix
Mx
A
Ix:
raised ESR
normal creatine kinase + EMG
Mx:
prednisolone
22
Q
which bones affected in paget’s
A
draw line down the body
skull vertebral bones pelvis femur tibia
23
Q
clinical features of paget’s
A
only 5% are symptomatic
- isolated raised ALP
- calcium / phos normal
- fractures
- skull thickening
associated with deafness - cranial n entrapment
24
Q
what is needed to confirm a diagnosis of ank spon
A
radiological confirmation
- sacroilitis on XR
- subchondral erosions
- sclerosis
associated with schober’s +
25
ank spon Mx
regular exercise
NSAIDs - 1st line
no role of DMARDs here
26
features of marfan's syndrome
```
hypermobility
tall stature / longer arm span
pectus excavatum
arachnodactyly
high arched palate
flat foot (pes planus)
lens dislocation
```
heart
- dilation of the aortic sinus
- aortic dissection
- aortic regurg
lung - multiple pneumothoraces
27
what does an aspirate of RA have inside?
high neutrophil count
reduced viscosity
turbid
yellow
28
features of SLE
```
skin:
malar rash - spares nasolabial folds
discoid rash
photosensivity
raynauds'
livedo reticularis
alopecia
```
msk:
- arthralgia
cardio:
- pericarditis
- myocarditis
resp:
- pleuritis
- fibrosing alveolitis
renal
- glomerulonephritis
29
associations with ank spon
```
anterior uveitis
apical fibrosis
av node bock
aortic regurg
amyloidosis
achilles tendonitis
```
HLA-B27 90%
30
antibodies for SLE diagnosis
- ANA
- low levels of C3/C4
- dsDNA negative
- antihistone antibodies 80-90%
31
what is felty's syndrome
triad - rare extra articular manifestitation of RA
- RA
- hypersplensim
- neutropnia
32
distinguish between gout and pseudogout
pseudo
- more likely in knee
- chondrocalcinosis (calcification)
33
pseudogout RF
```
haemochromatosis
hyperparathyroidism
hypercalciumia
wilson's
acromegaly
```
34
what does a positive femoral n stretch test mean
hip pain is caused by referred lumbar pain
35
diagnostic antibodies for sjogrens
anti - ro
| anti - la
36
what is sjogrens
autoimmune disorder affecting the endocrime glands
--> resulting in dry mucosa surfaces
increased lymphoid malignancy
37
sjogren Mx
artifical tears + saliva
| pilocarpine - cholingeric (stimulates saliva production)
38
what is osteogensis imperfecta
rare genetic disorder
- commonly multiple one fractures
1. blue sclera
2. micrognathia
3. kyphoscoilosis
normal blood calcium/ phos, PTH
39
score used to test hypermobility
beighton score
- out of 9
5/9 = positive
40
what is ehler-danlos syndrome
autosomal dominant connectivetissue disorder affecting type 3 collagen
- hypermobility
- increased elasticity of the skin
41
patient with RA going into surgery - what are you worried about?
atlantoaxial subluxation
- can lead to cervical cord compression in surgerical neck brace
```
Mx:
- anterior
- posterior
- lateral
cervical spine radiographs
```
42
RA associated diseases
Ischaemia heart disease
RA accerates atherosclerosis
43
Mx for acute reactive arthritis
NSAIDs
44
DEXA scan
>-1.0 normal
| -1.0 to -2.5 osteopenia
45
rotator cuff muscles
which ones:
- ex rotate
- in rotate
- 20 abduct
subscapularis
infraspinatus
supraspinatus
teres minor
46
what drugs can induce lupus
procainamide - anti-arrhythmic
| hydrazaline - hypertensive for HF
47
what is antisynthetase syndrome
RIM JOB
sub-type of dermatomyositis
Raynaud's
Interstial lung fibrosius
Myositis
JOB - anti-Jo antibodies
48
marfan's is a mutation in what tissue
fillibrin
49
what is in cryoprecipitate?
factor 7 (extrinsic)
fibrinogen (common)
(intrinsic)
von willebrand factor
factor 8
50
indications for cryoprecipitate
- major haemorrhage protocol
| - uncontrolled bleeding due to haemophillia
51
how does hodgkin's lymphoma present?
- asymmetrical lymphadenopathy
(painless, non-tender)
reed sternberg
- multinucleated cells prominent with eosinophilic nucleoi
52
microcytic anaemia (indicating iron deficiency) + patient >60
how should u investigate?
colonscopy
to exclude bowel cancer
53
reasons for iron def anaemia
intake:
- poor diet
- poor absorption
loss:
- menorrhagia (most common in women)
- GI bleed (most com in males)
54
sickle cell crises
sickle cell anaemia is characterised by periods of good health w/ intervening crisis
thrombotic painful crises:
- vaso-occlusive crises
- precipitated by infection, dehydration, deoxygenation
- multisystem infaracts
sequestration crises
- sickling within organ's (spleen / lungs)
acute chest syndrome
- SOB, pulmonary inflitrates, low pCO2
aplastic crises
- infection with parvovirus
- sudden fall in haem
haemolytic crises
- fall in haem due to mass haemolysis
55
post-DVT treatment complications
post-thrombotic syndrome
- following a DVT
features:
- heavy, painful calf
- ulceration
- varicose veins
- pruritus
Mx:
- graduated compression sock (don't use as prophylaxis)
56
indication for transfusing a patient
platelet <30 + active bleeding
57
contraindications for platelet transfusion
chronic bone marrow failure
- autoimmune thrombocytopenia
- thrombotic thrombocytopenic purpura
58
burkitt lymphoma biopsy
starry sky appearance
associated with EBV
59
DVT / PE in pregnancy
Mx
s/c heparin preferred to IV heparin
wafarin contraindicated
60
indications for prothombin complex concentrate
emergency reversal anticoagulation w/ severe bleeding or head injury
factors 2, 9, 10
61
what type of infection is mostly likely to occur following a platelet transfusion?
bacterial
platelets are stored at room temp --> more favourable environment
62
heinz bodies
G6PD
63
most common genetic bleeding disorder
von willebrands disease
normal platelets
increased bleeding time
increased APTT (vWF is on intrinsic side)
64
Mx for vWF disease
tranexamic acid - mild bleeding
desmopressin - raises levels of vWF by inducing release of vWF via endothelial cels
factor 8 concentrate
65
transfusion complications
got a bad unit
G raft vs. Host disease
O verload
T hrombocytopaenia
A lloimmunization
B lood pressure unstable
A cute haemolytic reaction
D elayed haemolytic reaction
U rticaria
N eutrophilia
I nfection
T ransfusion associated lung injury
66
what are the tests to confirm haemolysis?
coombs test
- unconjugated bilirubin
- haptoglobin
- serum and urine free haemoglobin
67
bloods for sickle cell
low haem
normal MCV
raised reticulocyte - due to haemolysis
68
what are the rules regarding COCP before surgery
continue taking pill until 4 weeks before op
69
what are the rules regarding COCP before surgery
continue taking pill until 4 weeks before op
--> reduce the risk of clots
70
PE Mx
provoked / unprovoked
vit K antagonist (warfarin)
- give within 24hrs
provoked - 3 months
unprovoked - 6 months
71
what is beta thalassaemia
presenting features
form of microcystic anaemia
defect in beta-globin gene
--> ineffective erythropoiesis
trait - asymptomatic
major
major:
- anaemia
- jaundice
- failure to thrive
- extramedullary erythropoiesis from early childhood
72
genetics of haemophillia
x-linked recessive
```
A = factor 8 def (80% most common)
B = factor 9 def
```
increased APTT
normal PT
increased bleeding time
73
NOACs name 2
| + action
apixaban
rivaroxiban
Xa inhibitor
74
dabigatran mech action
+ reversal agent
thrombin inhibitor
75
what can be seen on head XR for:
hyperPTH
myeloma
paget's
hyperPTH - pepper-pot skull
myeloma - raindrop skull
paget's - thickened cranium
76
you are suspicious that a patient has autoimmune anaemia
what test will you do?
```
blood film
reticulocyte
iron studies
direct coombs test
(looks for antibodies attached on the RBCs)
```
indirect coombs used in prenatal testing - looks for free floating antibodies
