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Year 2 Heme lymph > CIS Pales > Flashcards

CIS Pales Flashcards

1
Q

definition lymphadenopathy

A

feel abnormal

painful to touch

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2
Q

what fungi can cause lymphadenopathy

A

histoplasmosis, coccidiodes

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3
Q

supraclavicular nodes drain from where

A

thorax and abdomen

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4
Q

what is panniculitis

A

inflammation of abdominal fat

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5
Q

heterophile test

A

mono

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6
Q

one very suspicious lymph node on neck

what imaging is gold standard

A

CT

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7
Q

factor VII intrinsic or extrinsic

A

intrinsic

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8
Q 
14 y.o F
heavy menstruation, weakness lack concentration, Sx 7-8 mo
periods heavy and last 7-9 days
easy bruising, bleed after tooth extraction age 7
normal vital signs
WN/WD, pale, no bruises
Hb 9.5 MCV 69
ddx?
A

Fe deficiency anemia

bleed disorder- vwD, hemophilia

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9
Q 
14 y.o F
heavy menstruation, weakness lack concentration, Sx 7-8 mo
periods heavy and last 7-9 days
easy bruising, bleed after tooth extraction age 7
normal vital signs
WN/WD, pale, no bruises
Hb 9.5 MCV 69
Labs to order?
A 
CBC
PT
PTT
platelet count
PS
Iron panel
PFA platelet function analyzer
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10
Q 
14 y.o F
heavy menstruation, weakness lack concentration, Sx 7-8 mo
periods heavy and last 7-9 days
easy bruising, bleed after tooth extraction age 7
normal vital signs
WN/WD, pale, no bruises
Hb 9.5 MCV 69
normal PTT PT platelet count
elevated bleeding time, elevated PFA
A

not problems in coagulation cascade

qualitative problem with platelets

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11
Q

medicaitons that can cause qualitative problems with platelets

A

aspirin, NSAIDs

clopidogrel, abcixumab (IIa/IIIB inhibitor)

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12
Q

What is type 2N vwD

A

normal levels vWF, RIPA and multimer pattern

low factor VIII (prolongs PTT)

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13
Q

how will low VIII change PT PTT

A

prolonged PTT

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14
Q

20 mo boy with Hx joint swelling and bruising
deep hematomas in thigh mm, not walking on own
no Hx bleeding problems in parents, or 3 siblings
pale wd/wn
tenderness around ankles dec ROM b/l
no petechial rashes
ddx?

A

hemophilia
ITP
single factor deficiency

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15
Q

what do you have to check with rashes

A

blanching or not?

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16
Q

20 mo boy with Hx joint swelling and bruising
deep hematomas in thigh mm, not walking on own
no Hx bleeding problems in parents, or 3 siblings
pale wd/wn
tenderness around ankles dec ROM b/l
no petechial rashes
tests to order?

A 
platelet count
bleedting time
PT
PTT
PFA
CBC
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17
Q

20 mo Hx hematomas
elevated PTT normal PT
ddx?

A 
inherited deficiency VIII, IX, XI
deficiency facotr XII
vwD
acquired: heparin, inhibitor VIII, IX XI XII
acquired vwD
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18
Q

normal PTT long PT

ddx?

A

inherited factor VII deficiency

acquired: factor VII def, vit K def, liver disease, coumadin/warfarin, inhibitor factor VII

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19
Q

prolonged PT and PTT

ddx?

A

liver disease
DIC!!!
heparin and warfarin
inherited: combined def, def prothrombin etc…

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20
Q

how can you differentiate between factor deficiency and factor inhibitor problems?

A

mixing study: mix plasma with normal plasma
if corrects PTT then was deficiency
if does not correct there is an inhibitor

21
Q

factor VII shows deficiency and when mixed with normal plasma PTT was corrected
what 2 diseases need to check for

A

Hemophilia A

vwD

22
Q

boy with hemophilia, what family Hx do you look into

A

males on mothers side

23
Q

bleeding in minor cuts more likely platelets or hemophilia?

A

platelets

24
Q

large subcutaneous soft tissue hematomas more likely in hemophilia or platelet deficiency

A

hemophilia

25
Q

Pt PTT and BT for DIC

A

long BT, long PT long PTT

26
Q

55 y.o F Hx HTN and RA
on lisinopril, aspirin, methotrexate and ibuprofen
no Hx easy bruising or bleeding
WBC7.5, Hb 11.1 MCV98, platelets 84 (low)
repeated platelets 85
why no Sx?

A

Sx start between 10 and 20k

27
Q

first thing to do when see asymptomatic patient with thrombocytopenia

A

redo it

could have pseudothrombocytpenia (clumping from EDTA)

28
Q

platelet levels needed for minor surgery? major?

A

minor >80

major >100

29
Q

What can cause thrombocytopenia from decreased production

A

viral infecito, chemo
alcohol
BM aplasia
Vit B12/folate deficiency

30
Q

what can cause thrombocytopenia from increased destruction

A 
ITP, autoimmune, viral infection, drugs, MAHA= DIC, TTP, HUS
HELLP syndrome (pregnancy)
31
Q

what are weird causes of thrombocytopenia

A

dilution (after big transfusion)

splenic sequestration

32
Q

what do you want to known in patient with low platelets but asymptomatic
some macrocytic cells

A

viral infection
nutrition
recent Hx hospitalization requiring DVT prophylaxis

33
Q

tests to order for asymptomatic thrombocytopenic patient

A 
PS to look for schistocytes
PT 
PTT
Fibrinogen
BM biopsy
HIV
34
Q

alcohol can cause what in blood

A

thrombocytopenia by suppressing bone marrow and increase splenic sequestration

35
Q

PS normal, PT normal, PTT normal, fibrinogen normal, BM biopsy normal
in asymptomatic thrombocytopenic patient
most likley?

A

Ab to platelets

ITP

36
Q

DIC labs

A

PT PTT fibrinogen levels!!!

37
Q

fibrinogen(II) levels in DIC

A

decreased because used up

38
Q

what are confirmatory tests for ITP

A

Dx by exclusion

39
Q

Tx ITP

A

steroids and splenectomy

40
Q

59 y.o M alcoholism, severe pneumonia, intubated and got a rash, melena
high WBC, Hb8.1 platelets 17 (LOW) PTT 71 PT 21 (both high)
on antibiotics, pantoprazole(PPI) prophylaxis enoxaparin for DVT, DT, delerium tremons prophylaxis diazepam
ddx?

A 
HIT
liver cirrhosis/liver disease
alcohol related BM suppression
infection
splenic sequestration
DIC
41
Q

59 y.o M alcoholism, severe pneumonia, intubated and got a rash, melena
high WBC, Hb8.1 platelets 17 (LOW) PTT 71 PT 21 (both high)
on antibiotics, pantoprazole(PPI) prophylaxis enoxaparin for DVT, DT, delerium tremons prophylaxis diazepam
tests to order?

A 
liver enzymes
fibrinogen
retic count
free plasma Hb
U/s spleen
PS
haptoglobin
42
Q

normal coagulation studies with non-blanching rash

A

vasculitis until proven otherwise

43
Q

C-ANCA elevated

biopsy shows leukocytoclastic vasculitis

A

wegeners GN

44
Q

26 y.o F ER with SOB hemoptysis and painfully swollen left leg, no previous medical or surgical Hx, takes Yaz, MVI, parents and siblings healthy, CBC and CMP normal
labs?

A

PT PTT U/S leg
CXR
V/Q scan
CT

45
Q

after labs F with swollen leg and SOB has DVT found on U/s and V/Q mismatch showing PE
CT scan shadow in pulmonary artery, clot in L side
causes?

A

genetic predisposition- factor V leiden, protein C or S deficiency, antithrombin III def, antiphospholipid Ab
virchows triad
procoagulant drugs: birth control pills

46
Q

what are primary hypercoagulable states

A

deficiencies of antithrombotic factors: antithrombin III, protein C or S
excess of prothrombotic factors: factor V leiden and prothrombin mutation

47
Q

what are secondary causes of hypercoagulable states

A

cancer, pregnancy, BCP
anti-phospholipid syndrome
trauma, surgery and immobilization

48
Q

what disorders predispose to arterial AND venous clots

A 
antiphospholipid syndrome (SLE)
hyperhomocysteine
49
Q

clotting tx duration if not genetic

A

3-6 mo

Year 2 Heme lymph (28 decks)

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