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GI/Hematology Flashcards

1
Q
A

All three

1 - px can be taking NSAIDs to treat pain

2 - H.pylori is possible

  1. Steroids can cause ulcers
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2
Q

Patient takes 800mg Ibuprofen daily. Which of the following is true:

  1. By inhibiting cyclooxegenase, NSAIDs can increase the risk of gastric ulcers
  2. He should stop ibuprofen
  3. He should begin a proton pump inhibitor
A

1 , 2, 3

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3
Q
A

none are correct

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4
Q

Inflammatory bowel disease vs Irritable bowel syndrome

A
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5
Q
A

VITAMINS ARE PRIMARILY ABSORBED IN SMALL INTESTINE

B

C

(Not ulcerative colitis- inflammation only in colon)

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6
Q
A

A

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7
Q
A

D

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8
Q
A

C , D

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9
Q

Bilateral episcleritis with ulcerative colitis

A
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10
Q

Erythropoiesis (Red blood cell life cycle)

A
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11
Q

CBC (complete blood count)

A
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12
Q

Complete blood count

Hemoglobin/hematocrit

A

Hemoglobin (HGB)

  • Concentration of hemoglobin (oxygen carrying molecule) in a concentration of whole blood (g/dl)
  • Low O2 = hypochromic (pink colour)
  • Normal O2 = normochromic (red)
  • High O2 = Hyperchromic (dark red)
  • Small size = microcytic
  • Normal = normocytic
  • Large = macrocytic

Hematocrit

  • Packed spun volume of blood that contains intact RBCs (%)
  • Measured followind centrifugation

Low= anemia

High = polycythemia

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13
Q

Bone marrow dyscrasia (disorder) - RBC

A
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14
Q
A

D

(Can have normal iron levels in Anemia- only used to classify anemia)

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15
Q
A

A

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16
Q

Healthy 30 year old woman is found to have anemia. Well nurished, unremarkable medical history. Iron most likely deficient.

Select most appropriate next step in evaluation:

  1. Evaluation to rule out colon cancer
  2. Testing of B12 levels to rule out B12 as cause of anemia
  3. Treat with iron to see is blood count responds
  4. Work up to exclude sickle cell disease
A

3

(1 probable in older individual)

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17
Q
A

A , B

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18
Q
A

Abnormal white blood cells

Large red blood cells (high MCV)

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19
Q

30 year old female presents with anemia

A

A

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20
Q

30year old female.

A

A, B, E

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21
Q

30 year old female

A

A, B, C

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22
Q

Other measures of iron

Transferrin/total iron binding capacity (TIBC)

Ferritin

A
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23
Q
A

A

(C- first check for colon cancer)

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24
Q
A

C

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25
Q
26
Q

Proliferative Sickle Retinopathy

27
Q
A

A, C

(b- increases production of RBC in marrow)

(Reticulocytes - immature RBC)

28
Q
A

D

(B12 causes macrocytic anemia, pernicious anemia)

29
Q
A

All options

30
Q

Leukocytes - WBC

31
Q

Leukocyte disorders

32
Q

Leukemia

33
Q

Lymphoma

A

Reed-sternberg cells only in Hodgkins lymphoma

Only in lymphoid line

34
Q

Leukemia or lymphoma

Are cancer cells circulating

35
Q

Eye findings in leukemia and lymphoma

36
Q
38
Q
39
Q

26 male with no significant medical history, has reduced vision in OS for a month

Saw ER 3 weeks ago with complaint of easy bruising-“could be explained by mild trauma”, ER did not check CBC

Returned to ER 2 weeks later with same complaint in addition to blurry vision OS

In eye clinic patiets admitted to fatigue/malaise; eye dr noticed pale skin

A

Retinopathy in blood dyscrasia

  • Retinal hemorrhaging is related to anemia, thrombocytopenia and increased venous pressure( in hypercoagulable states)
    • Hemes more common with anemia AND thrombocytopenia than either alone (Hgb <8 , PLT<50)
    • Tyoically need Hct <= 50% of normal to get CWS/bleeding due to anemia alone

You need SEVERE or VERY SEVERE anemia to have retinal findings(worse if concurrent thrombocytopenia)

  • Cotton wool spots are signs of retinal ischemia
    • Obstruction of axoplasmic transport = formation of “cytoid bodies” on histology
    • RNFL is thickest around the nerve - often see CWS here
  • Roth spots are nonspecific white-centered hemorrhages
    • Clasiccaly described in leukemia + endocarditis
    • Ischemic RNFL vs fibrin/PLT vs infectious material vs neoplastic cells
40
Q
A

A

Reed-sternberg cells only in Hodgkins

41
Q
A

All of the above

42
Q

Leukocyte disorders - Immunoglobulin disorders

43
Q

Retinopathy in hyperviscosity and clotting disorders

44
Q
45
Q
47
Q

Definition of thrombocytopenia

A

Decreased platelets, Less clotting, more bleeding

Causes: bone marrow failure, Ab-mediated destruction, drugs

  • Thrombotic thrombocytopenic purpura
  • Idiopathic thrombocytopenic purpura

(“-penia” - blood cell deficiency)

48
Q

Thrombocytosis

A

Too much platelets, increased chance of clotting

Causes: Inflammation (physiologic)

(“-cytosis” or “-philia” - blood cell excess)

49
Q

Does aspirin cause reversible or irreversible inhibition of platelets?

A

Irreversible

(NSAIDs are reversible)

50
Q

Coagulation disorders

Protein C deficiency

A

Congenital/acquired condition that leads to increased risk for thrombosis

Causes of aquired deficiency include:

  • Acute thrombosis
  • Warfarin therapy
  • Liver disease
  • Vitamin K deficiency
  • Sepsis
  • Disseminated intravascular coagulation
  • Certain chemotherapeutics
  • Uremia
51
Q

Coagulation disorders

Factor V Leiden Mutation

A

Caused by mutaions in F5 gene

52
Q

Hemochromatosis

A

Genetic predisposition to abnormal iron absorption = plebotomy necessary

Risk for organ damage

53
Q

Coagulation disorders

54
Q
A

Only A

(B- irreversably inhibits)

(C-genetic imparement|)

55
Q
A

B, D

(von willebrands causes more bleeding)

56
Q
A

A, B, D

px has hemochromatosis

58
Q

Irritable bowel disease

59
Q

60 yo white female

Noticed blurry vision for 2months since hitting her head. Right eye gradually improved, left remains poor

Hypertension (lisinopril)

BCVA with correction

  • OD: 20/125
  • OS: 20/40

IOP: OD: 13 ; OS: 14

SLE: anterior segment unremarkable, 1+ NS OU; no AC cells; no vitreous cells

BP 129/66

A1c: 5.8

WBC 354 (leukocytosis) (normal: 3.7-10.5)

RBC 2.37 (normal:4-5.2)

Hb 7.3 (normal: 11.9-15)

hct: 22 (normal:35-45) (anemia)

Plt: 81 (normal:150-400) (Thrombocytopenia)

A

Diagnosis: Leukemia

Clinical medicine (8 decks)

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