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Dr. Mel - Hemato/Oncology > First Aid > Flashcards

First Aid Flashcards

1
Q

3 diseases causing splenomegaly

A

Hairy cell leukemia
CML
Myelofibrosis

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2
Q

Reduced platelet function or quantity results in

A

Petechiae

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3
Q

Excess protease activity or deficient antiprotease activity

A

Centriacinar and panacinar emphysema

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4
Q

Elevated neutrophil count in 2 conditions

A

Bacterial infection

After a corticosteroid therapy (falsely elevated)

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5
Q

Hypersegmented neutrophils in 2 conditions

A

Vitamin B12 deficiency

Folate deficiency

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6
Q

5 causes of eosinophilia

A 
Neoplasia
Asthma
Allergic processes
Chronic adrenal insuffisiency
Parasites (invasive)
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7
Q

Basophil granules contain 3 products

A

Heparin (anticoagulant)
Histamine (vasodilator)
Leukotrienes (synthesized on demand)

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8
Q

2 disorders of mast cells

A

Urticaria pigmentosa

Systemic mastocytosis

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9
Q

Langhans cell and Langerhans cell

A

Langhans: multinucleared giant cell - from monocyte - granulomatous inflammation
Langerhans: dendritic cell in skin - from myeloid line

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10
Q

Treatment of ABO hemolytic disease of the newborn

A

Phototherapy or Exchange transfusion

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11
Q

5 thrombolytics

A 
Reteplase
Alteplase
Tenecteplase
Streptokinase
Tissue Plasminogen Activator (tPA)
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12
Q

Platelet plug: 1 pro-aggregation and 2 anti-aggregation factors

A

TXA2 (by platelets)

PGI2 and NO (by endothelial cells)

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13
Q

GpIb, GpIIb/IIIa, vWF deficiencies

A

GpIb: Bernard-Soulier syndrome
GpIIb/IIIa: Glanzmann thrombasthenia
vWF: von Willebrand disease

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14
Q

Difference between thalassemias and porphyrias

A

Thalassemias: abnomal globin synthesis
Porphyrias: abnormal heme synthesis

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15
Q

6 symptoms of lead poisoning

A 
Lead lines on gingivae and metaphyses
Encephalopathy
Erythrocyte basophilic stippling
Abdominal colic
Sideroblastic anemia
Drops (wrist and foot)
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16
Q

Treatment of Lead poisoning: 2 for adults and 1 for kids

A

Dimercaprol and EDTA

Succimer (chelation)

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17
Q

Treatment of sideroblastic anemia

A

Pyridoxine (vit B6)

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18
Q

5 causes of Cobalamin (vit B12) deficiency

A 
Insufficient intake (veganism)
Malabsorption (Crohn ds)
Pernicious anemia
Diphyllobotrium latum
Gastrectomy
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19
Q

2 differences between vitamin B9 and B12 deficiencies

A

B9: normal methylmalonic acid - NO neuro symptoms
B12: elevated methylmalonic acid - Neuro symptoms

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20
Q

Treatment of orotic aciduria

A

Uridine monophosphate

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21
Q

8 findings in intravascular hemolysis

A 
Low haptoglobin
High LDH
Schistocytes
High reticulocytes
Hemoglobinuria
Hemosiderinuria
Urobilinogen in urine
High unconjugated bilirubin
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22
Q

4 findings in extravascular hemolysis

A

Spherocytes
High LDH
High unconjugated bilirubin
Urobilinogen in urine

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23
Q

Anemia of chronic disease associated with 4 conditions

A

Rheumatoid arthritis
SLE
Neoplastic disorders
Chronic kidney disease

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24
Q

Aplastic anemia (by failure or destruction of myeloid stem cells) in 4 conditions

A

Radiation or drugs
Viral agents (ParvoB19, EBV, HIV, hepatitis)
Fanconi anemia
Idiopathic

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25
Q

5 treatments for Aplastic anemia

A 
Withdrawal of offending agent
Immunosuppressive regimens
Bone marrow allograft
RBC/platelet transfusion
Bone marrow stimulation
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26
Q

3 findings + treatment of Hereditary spherocytosis

A

Splenomegaly
Aplastic crisis (ParvoB19)
Osmotic fragility test +

Splenectomy

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27
Q

4 findings in G6PD deficiency

A

Back pain
Hemoglobinuria
Heinz bodies
Degmacytes (bite cells)

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28
Q

Triad + 1 finding + treatment of Paroxysmal nocturnal hemoglobinuria

A

Negative Coombs + pancytopenia + venous thrombosis

CD55/59 deficiency

Eculizumab

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29
Q

4 triggers that precipitate sickling

A

Low O2
High altitude
Acidosis
Dehydration

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30
Q

6 complications of Sickle cell anemia

A

Aplastic crisis (ParvoB19)
Autosplenectomy (Howell-Jolly bodies) / Functional asplenia
Splenic infarct / sequestration crisis
Infection by encapsulated organisms (Salmonella osteomyelitis)
Painful crises (vaso-occlusive)
Renal papillary necrosis + Microhematuria

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31
Q

Diagnosis + Treatment of Sicke cell anemia

A

Hemoglobin electrophoresis

Hydroxuyrea (elevates HbF)
Hydration

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32
Q

Warm and Cold AIHAs associated with 3 conditions each

A

SLE - CLL - certain drugs

CLL - Mycoplasma pneumonia - Infectious mononucleosis

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33
Q

Microangiopathic anemia seen in 4 conditions

A

DIC
TTP/HUS
SLE
Malignant hypertension

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34
Q

Macroangiopathic anemia seen in 2 conditions

A

Prosthetic heart valve

Aortic stenosis

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35
Q

5 causes of Neutropenia

A 
Sepsis / postinfection
Drugs
Aplastic anemia
SLE
Radiation
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36
Q

8 causes of Lymphopenia

A 
HIV
DiGeorge syndrome
SCID
SLE
Corticosteroids
Radiation
Sepsis
Postoperative
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37
Q

2 causes of Eosinopenia

A

Cushing syndrome

Corticosteroids

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38
Q

Effect of Corticosteroids on WBCs

A

Neutrophilia (impaired migration out of Vx)
Eosinopenia (sequestered in lymph nodes)
Lymphopenia (apoptosis)

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39
Q

2 conditions with Left shift (high neutrophil precursors)

A 
In acute response to infection/inflammation (w/ neutrophilia)
Leukoerythroblastic reaction (w/ immature RBCs) when severe anemia or marrow response
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40
Q

5 presentations in Lead poisoning

A

Microcytic anemia
GI disease
Chronic tubulointerstitial nephritis / Acute tubular necrosis
Mental deterioration (children)
Headache, memory loss, demyelination (adults)

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41
Q

5 P’s of Acute intermittent porphyria

A 
Painful abdomen
Port wine-colored urine
Polyneuropathy
Psychological disturbances
Precipitated by drugs (CYP450 inducers), alcohol, starvation
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42
Q

Treatment + MOA of Acute intermittent porphyria

A

Glucose + Heme (inhibit ALA synthase)

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43
Q

Treatment of Iron poisoning

A

IV deferoxamine or Oral deferasirox

Dialysis

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44
Q

Treatment of Hemophilia A, B and C

A

A: Desmopressin + Factor VIII concentrate
B: Factor IX concentrate
C: Factor XI concentrate

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45
Q

Difference between coagulopathies and platelet defects

A

Coagulopathies: deep tissue bleeding

Platelet defects: mucocutaneous bleeding

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46
Q

Treatment of HUS and TTP

A

HUS: plasmapheresis
TTP: plasmapheresis, steroids

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47
Q

Presentations of HUS

A

Thrombocytopenia
Microangiopathic hemolytic anemia
Acute renal failure

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48
Q

Pentad of TTP

A 
Neurologic symptoms
Renal symptoms
Fever
Thrombocytopenia
Microangiopathic hemolytic anemia
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49
Q

2 findings + 3 treatments of Immune thrombocytopenia

A

Anti-GpIIb/IIIa antibodies
High megakaryocytes on marrow biopsy

Steroids
IVIG
Splenectomy (if refractory)

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50
Q

Treatment + MOA of von Willebrand disease

A

Desmopressin (releases vWF stored in endothelium)

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51
Q

7 causes of DIC

A 
Sepsis (Gram -)
Trauma
Obstetric complications
Acute pancreatitis
Malignancy
Nephrotic syndrome
Transfusion
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52
Q

6 lab findings in DIC

A 
Schistocytes
High PT, PTT, BT
High fibrin degradation products (D-dimers)
Low platelet count
Low fibrinogen
Low factors V and VIII
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53
Q

2 causes of Antithrombin deficiency

A

Inherited (diminishes the increase of PTT after Heparin)

Acquired (renal failure/nephrotic syndrome)

54
Q

4 Hereditary Thrombosis syndromes (Hypercoagulability)

A

Antithrombin deficiency
Factor V Leiden
Protein C or S deficiency
Prothrombin gene mutation

55
Q

3 complications of Factor V Leiden

A

DVT
Cerebral vein thromboses
Recurrent pregnancy loss

56
Q

1 finding in Protein C or S deficiency

A

High risk of thrombotic skin necrosis with hemorrhage after Warfarin

57
Q

3 indications of Fresh frozen plasma

A

DIC
Cirrhosis
Immediate Warfarin reversal

58
Q

5 constituents of Cryoprecipitate

A 
Fibrinogene
F VIII
F XIII
vWF
Fibronectin
59
Q

5 risks of blood transfusion

A 
Infection (low)
Transfusion reactions
Iron overload
Hypocalcemia (citrate)
Hyperkalemia (RBC lysis in old blood)
60
Q

7 characteristics of Hodgkin lymphoma

A 
Localized, single node group
Contiguous spread
Good prognosis (predicted by stage)
Reed-Sternberg cells
Bimodal distribution
Ass w/ EBV
B symptoms
61
Q

6 characteristics of Non-Hodgkin lymphoma

A 
Multiple lymph nodes + extranodal
Noncontiguous spread
Majority B cells
Children + adults
Ass w/ HIV and Autoimmune ds
Sometimes B symptoms
62
Q

5 B cells and 2 T cells Non-Hodgkin lymphoma

A 
Burkitt lymphoma
Diffuse large B-cell lymphoma
Follicular lymphoma
Mantle cell lymphoma
Primary central nervous system lymphoma

Adult T-cell lymphoma
Mycosis fungoides / Sézary syndrome

63
Q

6 characteristics of Burkitt lymphoma

A 
Adolescents / yound adults
t(8:14)
"Starry sky" (lymphocytes + macrophages)
Ass w/ EBV
Jaw lesion (endemic)
Pelvis or abdomen (sporadic)
64
Q

4 characteristics of Follicular lymphoma

A

Adults
t(14:18)
Bcl-2 inhibits apoptosis
Painless “waxing+waning” lymphadenopathy

65
Q

4 characteristics of Mantle cell lymphoma

A

Adult males
t(11:14)
Very aggressive
Late-stage presentation

66
Q

4 characteristics of Primary CNS lymphoma

A

Adults
Ass w/ HIV-AIDS
Variable presentation (confusion, memory loss, seizures)
Lesion on MRI (# dg: toxoplasmosis)

67
Q

5 characteristics of Adult T-cell lymphoma

A 
Adults
Caused by HTLV (ass w/ IV drug)
Cutaneous lesions
Lytic bone lesions
Hypercalcemia
68
Q

4 characteristics of Mycosis fungoides / Sézary syndrome

A

Adults
Skin patches-plaques (cutaneous T-cell lymphoma = Mycosis fungoides)
Atypical CD4+ cells
Progression to T-cell Leukemia (= Sézary sd)

69
Q

5 findings of Multiple myeloma

A

High susceptibility to infection
Primary amyloidosis
M spike on serum protein electrophoresis (IgG>IgA)
Ig light chains in urine (Bence Jones protein)
Rouleaux (RBCs)

70
Q

5 signs/symptoms of Multiple myeloma

A 
Hypercalcemia
Renal involvement
Anemia (normocytic normochromic)
Bone lytic lesions
Back pain
71
Q

4 characteristics of MGUS

A

Monoclonal expansion of plasma cells
Asymptomatic
No CRAB
Lead to MM in 1-2%/year

72
Q

3 characteristics of Waldenström macroglobulinemia

A

M spike (IgM)
Hyperviscosity syndrome
No CRAB

73
Q

4 characteristics of Myelodysplastic syndromes

A

Ineffective hematopoiesis
Defects in maturation of all nonlymphoid lineages
De novo mutation or environmental exposure
Risk of transfo to AML

74
Q

7 characteristics of ALL

A 
Children ++ / Worse in adults
Ass w/ Down syndrome
t(12:21) better pg
May spread to CNS/testes
Responsive to ttt
Very high lymphoblasts (blood+marrow)
TdT+ (preB + preT) and CD10+ (preB)
75
Q

6 characteristics of CLL/SLL

A 
>60 yo
B-cell (CD20+ and CD5+)
Asymptomatic
Smudge cells (blood)
Autoimmune hemolytic anemia
Richter transformation (into aggressive lymphoma esp. DLBCL)
76
Q

5 characteristics + treatment of HCL

A 
Adult males
Mature B-cell tumor
Filamentous projections on LM
Marrow fibrosis
Massive splenomegaly

Cladribine
Pentostatin

77
Q

7 characteristics of AML

A 
Adults (~65 yo)
Auer rods
Myeloperoxidase positive (esp in M3AML=APL)
Very high myeloblasts (blood)
4 risk factors
t(15:17) is APL subtype
DIC (common presentation)
78
Q

6 characteristics + treatment of CML

A 
45-85 yo (~64 yo)
Philadelphia chromosome t(9:22), BCR-ABL
Dysregulated production of granulocytes
Splenomegaly
May transform to AML or ALL
Very low LAP

bcr-abl tyrosine kinase inhibitors (Imatinib)

79
Q

Difference between CML and leukemoid reaction

A

CML: malignant neutrophils so very low LAP

Leukemoid reaction: benign neutrophilia so high LAP

80
Q

4 characteristics + 4 symptoms of Langerhans cell histiocytosis

A

Proliferative disorders of dendritic cells (child)
S-100
CD1a
Biberck granules (on EM)

Lytic bone lesions
Skin rash (erythematous + scaling)
Recurrent otitis media
Mass in mastoid bone

81
Q

5 findings of Leukemoid reaction

A

Benign leukocytosis (>50000)
Underlying condition (severe inf/hge, acute hemolysis, solid tumor)
BM: normal or hypercellular w/ mature neutro precursors
Blood: Döhle bodies
High LAP

82
Q

4 myeloproliferative disorders + their association

A

Polycythemia vera
Essential thrombocytopenia
Myelofibrosis
CML

Ass w/ V617F JAK2 mutation

83
Q

4 characteristics + treatment of Polycythemia vera

A

High hematocrit
Intense itching after hot shower
Erythromelalgia (severe burning pain + red-blue)
Low EPO

Aspirin

84
Q

4 characteristics of Essential thrombocythemia

A

Massive proliferation of megakaryocytes + platelets (large or abnormal)
Bleeding
Thrombosis
Erythromelalgia

85
Q

4 characteristics of Myelofibrosis

A

High fibroblast activity
Obliteration of BM with fibrosis
Massive splenomegaly
Dacrocytes (Teardrop RBCs)

86
Q

4 types of polycythemia

A

Relative
Appropriate absolute
Inappropriate absolute
Polycythemia vera

87
Q

3 findings in Heparin-induced thrombocytopenia (HIT)

A

IgG against heparin-PF4 (activating platelets)
Thrombosis
Thrombocytopenia

88
Q

4 indications for Heparin

A

PE
DVT
ACS
MI

89
Q

2 indications for Direct thrombin inhibitors

A

Venous thromboembolism

Atrial fibrillation

90
Q

1 indication for Warfarin

A

Chronic anticoagulation
(Venous thromboembolism prophylaxis
Prevention of stroke in AFib)

91
Q

3 indications for Direct factor X inhibitors

A

Ttt + prophylaxis for DVT
Ttt + prophylaxis for PE
Prophylaxis for stroke when AFib

92
Q

3 indications for Thrombolytics

A

Early MI
Early ischemic stroke
Severe PE

93
Q

3 indications for ADP receptor inhibitors

A

ACS
Coronary stenting
Thrombotic stroke (lowers recurrence)

94
Q

4 indications for Phosphodiesterase III inhibitors

A

Intermittent claudication
Coronary vasodilation
Prevention of stroke/TIA
Angina prophylaxis

95
Q

2 indications for GpIIb/IIIa inhibitors

A

Unstable angina

Percutaneous angioplasty

96
Q

7 antimetabolite drugs

A 
Azathioprine
6-mercaptopurine
Cladribine
Cytarabine
5-fluorouracil
Methotrexate
Hydroxyurea
97
Q

3 characteristics of Azathioprine + 6-MP

A

Purine analog
Activated by HGPRT
Metabolized by xanthine oxidase (high toxicity with Allopurinol or Febuxostat)

98
Q

6 indications for Azathioprine + 6-MP

A 
Preventing organ rejection
Rheumatoid arthritis
IBD
SLE
Wean off steroids in chronic ds
Treat steroid-refractory chronic ds
99
Q

1 characteristic + 1 indication for Cladribine

A

Purine analog

Hairy cell leukemia

100
Q

1 characteristic + 2 indications for Cytarabine

A

Pyrimidine analog

Leukemias (AML)
Lymphomas

101
Q

4 characteristics of 5-FU

A

Pyrimidine analog
Inhibits thymidilate synthase
Effects enhanced w/ addition of Leucovorin
Worsened myelosuppression w/ addition of Leucovorin

102
Q

3 indications for 5-FU

A

Colon cancer
Pancreatic cancer
Basal cell carcinoma (topical)

103
Q

3 characteristics of Methotrexate

A

Folic acid analog
Inhibits dihydrofolate reductase
Reversible myelosuppression w/ Leucovorin

104
Q

10 indications for Methotrexate

A 
Leukemias (ALL)
Lymphomas
Choriocarcinoma
Sarcomas
Ectopic pregnancy
Medical abortion (w/ Misoprostol)
Rheumatoid arthritis
Psoriasis
IBD
Vasculitis
105
Q

4 antitumor antibiotics

A

Bleomycin
Dactinomycin
Doxorubicin
Daunorubicin

106
Q

1 characteristic + 2 indications for Bleomycin

A

Induces free radical formation

Testicular cancerk
Hodgkin lymphoma

107
Q

1 characteristic + 3 indications for Dactinomycin

A

Intercalates in DNA

Wilms tumor
Ewing sarcoma
Rhabdomyosarcoma

108
Q

3 characteristics + 3 indications for Doxorubicin + Daunorubicin

A

Generate free radicals
Intercalate in DNA
Add Dexrazoxane to prevent cardiotoxicity

Solid tumors
Leukemias
Lymphomas

109
Q

4 alkylating agents + MAO

A

Busulfan
Cyclophosphamide
Ifosfamide
Nitrosoureas

Cross-link DNA

110
Q

2 indications of Busulfan

A

CML

Ablate BM before BM transplantation

111
Q

3 indications + 1 adverse effect (+ prevention) for Cyclophosphamide + Ifosfamide

A

Solid tumors
Leukemia
Lymphomas

Hemorrhagic cystitis
Prevented w/ hydration + Mesna or N-acetylcysteine

112
Q

1 characteristic + 1 indication + 1 adverse effect for Nitrosoureas

A

Cross blood-brain barrier

Brain tumors

CNS toxicity (convulsions, dizziness, ataxia)

113
Q

4 microtubule inhibitors

A

Paclitaxel
Other taxols
Vincristine
Vinblastine

114
Q

1 MOA + 2 indications for Paclitaxel + other taxols

A

Hyperstabilize polymerized microtubules in M phase

Ovarian carcinoma
Breast carcinoma

115
Q

MAO + 4 indications of Vincristine + Vinblastine

A

Bind beta-tubulin
Inhibit its polymerization

Solid tumors
Leukemias
Hodking lymphoma (Vinblastine)
Non-Hodgkin lymphoma (Vincristine)

116
Q

4 indications for Cisplatin + Carboplatin

A

Testicular carcinoma
Bladder carcinoma
Ovary carcinoma
Lung carcinoma

117
Q

4 topoisomerase inhibitors

A

Etoposide (topoisomerase II)
Teniposide (topoisomerase II)

Irinotecan (topoisomerase I)
Topotecan (topoisomerase I)

118
Q

3 indications of Etoposide + Teniposide

A

Solid tumors (esp. testicular + small cell lung)
Leukemias
Lymphomas

119
Q

1 indication of Irinotecan + 2 for Topotecan

A

Colon cancer

Ovarian cancer
Small cell lung cancer

120
Q

3 indications for Hydroxyurea

A

Melanoma
CML
Sickle cell disease

121
Q

3 indications for Prednisone + Prednisolone

A

CLL
Non-Hodgkin lymphoma (combination ttt)
Immunosuppression (in autoimmune ds)

122
Q

11 adverse effects of Prednisone + Prednisolone

A 
Cushing-like symptoms
Acne
Central obesity
Osteoporosis
Weight gain
Muscle breakdown
Cataracts
Hypertension
Peptic ulcers
Hyperglycemia
Psychosis
123
Q

MAO + 1 indication + 3 adverse effects of Bevacizumab

A

Anti-VEGF monoclonal Ab / inhibits angiogenesis

Solid tumors (colorectal, renal cell carcinoma)

Hemorrhage
Blood clots
Impaired wound healing

124
Q

MAO + 1 indication + 1 adverse effect of Erlotinib

A

EGFR tyrosine kinase inhibitor

Non-small cell lung carcinoma

Rash

125
Q

MAO + 2 indications + 3 adverse effects of Cetuximab

A

Anti-EGFR monoclonal Ab

Stage IV colorectal cancer
Head + neck cancer

Rash
High LFTs
Diarrhea

126
Q

MAO + 2 indications + 1 adverse effect of Imatinib

A

Tyrosine kinase inhibitor of BCR-ABL and c-kit

CML
GI stromal tumors

Fluid retention

127
Q

MAO + 4 indications + 1 adverse effect of Rituximab

A

Anti-CD20 monoclonal Ab

Non-Hodgkin lymphoma
CLL
ITP
Rheumatoid arthritis

High risk of progressive multifocal leukoencephalopathy

128
Q

2 SERMs + MOA

A

Tamoxifen
Raloxifene

Receptor antagonists in breast
Receptor agonists in bone

129
Q

2 indications + 2 adverse effects of Tamoxifen

A

Breast cancer treatment
Breast cancer prevention

High risk of endometrial cancer
High risk of thromboembolic events

130
Q

2 indications + 1 adverse effect of Raloxifene

A

Breast cancer prevention
Osteoporosis prevention

High risk of thromboembolic events

131
Q

MOA + 2 indications + 1 adverse effect of Trastuzumab (Herceptin)

A

Anti-HER-2 monoclonal Ab

HER-2 positive breast cancer
Gastric cancer

Cardiotoxicity

132
Q

MOA + indication of Vemurafenib

A

Inhibitor of BRAF oncogene positive melanoma (V600E)

Metastatic melanoma

Dr. Mel - Hemato/Oncology (3 decks)

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