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Steep 2 CK hematology > heamatology 3 > Flashcards

heamatology 3 Flashcards

1
Q

What do we do for a patient with DVT for C/I for anticoagulant?

A

Inferior venaca filiter

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2
Q

proximal/massive/limb ischemia risk Dvt with PE or life tret?

A

Thrombolitic

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3
Q

If C/I thrombolytic therapy?

A

Thrombectomy

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4
Q

a common cause of b12 deficincy?

A

Gastrectomy

Autoimmune gastritis

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5
Q

did megaloboastic animia cause jaundice?

A

yes (intramedullary mechanical hemolysis)

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6
Q

mutation in JAK 2?

A

polycythemia vera

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7
Q

A complication of PV?

A

Thrombosis
myelofibrosis
leukemia

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8
Q

a common cause of anemia after erythropoietin administrasion?

A

IDA(especially microcytic anemia)

B/C depletion of Iron store by erythropoiesis and chronic disease

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9
Q

management?

A

Intravenous IRON

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10
Q

ITP management in children?

A

only mucocutaneous bleeding –observe

if bleeding-corticosteroid,anti D and Iv Ig

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11
Q

Role of anti-D in ITP?

A

Anti-D therapy appears to inhibit macrophage phagocytosis by a combination of both FcR blockade and inflammatory cytokine inhibition of platelet phagocytosis within the spleen. Anti-RhD treatment is associated with mild to moderate infusion toxicities.

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12
Q

hereditary spherocytosis lab finding?

A

Increase MCHC
small, hypochromic, round RBC w/o central pallor
Negative coombs test
Increase osmotic fragility by acidic glycerol lytic test
Abnormal eosin 5 maleimide binding test

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13
Q

Treatment?

A

Folic acid
Transfusion
Splenectomy(reduce hemolysis and gall stone risk)

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14
Q

why MCHC?

A

RBC dehydration

Membrane loss

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15
Q

Inheritance?

A

Autosomal dominant

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16
Q

Calcium (serum) normal level?

A

8.6-10.3 mg/dL

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17
Q

APL CM?

A

common in young and middle-aged adult

Pancytopenia

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18
Q

laboratory?

A

pancytopenia
myeloblast with our road
15:17 muchation-APL gene to retinoic acid receptor alpha

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19
Q

management?

A

ALTRA-induce lukocyte diferenciation

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20
Q

complication?

A

DIC by inducing TF release and plasmin release-CVS and pulmonary hemorrhage

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21
Q

IDA in older patients require?

A

endoscopic evaluation

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22
Q

Investigation for pernicious anemia?

A

Esophagogastroduodenoscopy. especially when they have suspicious symptoms for gastric ca.

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23
Q

A complication of atrophic gastritis?

A

gastric ca

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24
Q

Pica?

A

excessive appetite for non-food particles like paper products, ice, clay, or dirt.

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25
Q

what does it indicate?

A

IDA(it may precede the anemia)

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26
Q

Role of bisphosphonate therapy in hypercalcemia?

A

Inhibit osteoclastic activity

Also, Prevent complications of bone metastasis I.E # and malignant hypercalcemia.

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27
Q

what do things indicate polycythemia is due to OSA?

A

Presence of OSA complication

  • HF
  • HTN
  • Erectile dysfunction
  • Arrhythmia
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28
Q

How does OSA cause polycythemia?

A

Increase erythropoietin production

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29
Q

Hereditary hemorrhagic telangiectasis?

A

Osler-weber-rendu syndrome

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30
Q

CM?

A

Autosomal dominant
Telagectaiss
AV malformation
Recurent epistaxix

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31
Q

AV malformation common location?

A 
Skin
Mucous membrane
GI tract
Brain
Liver 
Lung
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32
Q

Telaegctasia CM?

A

Telangiectasia is a condition in which widened venules (tiny blood vessels) cause threadlike red lines or patterns on the skin
Ruby colored vision that Blanche with pressure

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33
Q

a complication of AVM with a right to left shunt?

A

chronic hypoxia
Clubbing
Polycythemia

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34
Q

Pulmonary AVM?

A

Can present with massive hemoptysis

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35
Q

acanthocyte?

A

spur cell

projection with varying interval and size

36
Q

cause?

A

Liver disease
Abetalipoproteinemia
Vit-E deficiency

37
Q

echinocyte?

A

burr cell

symmetric projection

38
Q

cause?

A

Liver disease
ESRD
PKD

39
Q

Scleroderma renal crisis mechanism?

A 
Acute renal failure
Increase vascular permeability
Activation of the coagulation system
Increase renin release
Proteinuria on urinalysis
40
Q

Symptoms related to the complication?

A

HTN
Shistocotes and thrombocytopnia
RF

41
Q

sideroblastic anemia?

A

anemia due to impaired heme synthesis

42
Q

cause?

A

Congenital sidroblastic anemia
Acquired clonal sideroblastic anemia
Acquired reversible sideroblastic anemia

43
Q

Congenital sidroblastic anemia?

A

X-linked sideroblastic anemia:
Autosomal recessive sideroblastic anemia?
Genetic syndromes:

44
Q

X-linked sideroblastic anemia?

A

This is the MC congenital cause
Involves a defect in ALAS2
Although X-linked, approximately one-third of patients are women due to skewed X-inactivation (lyonizations).

45
Q

Autosomal recessive sideroblastic anemia?

A

Involves mutations in the SLC25A38 gene.
The function of this protein is involved in the mitochondrial transport of glycine.
Is typically severe in presentation.

46
Q

Genetic syndrome?

A

Rarely, maybe part of a congenital syndrome and present with associated findings, such as ataxia, myopathy, and pancreatic insufficiency

47
Q

Acquired clonal sideroblastic anemia?

A

Fall under the broader category of myelodysplastic syndromes (MDS).
These anemias are associated with an increased risk for leukemic evolution.

48
Q

Diagnosis?

A

On the peripheral blood, smear can be found erythrocytes with basophilic stippling (cytoplasmic granules of RNA precipitates) and Pappenheimer bodies (cytoplasmic granules of iron)
Microcytic hypochromic /microcytic normochromic
In BM sideroblasts(ringed sideroblasts with nuclus)

49
Q

Acquired reversible sideroblastic anemia?

A

Excessive alcohol use(MCC)
pyridoxine deficiency (vitamin B6 is the cofactor in the first step of heme synthesis),
lead poisoning
copper deficiency
Excess zinc(cause by decreasing absorption and increasing excretion of copper).
Isoniazid (which interferes with pyridoxine metabolism), chloramphenicol (which, by inhibiting the synthesis of mitochondrial membrane protein, impairs mitochondrial respiration.
cycloserine
linezolid

50
Q

Anemia of chronic disease treatment?

A

Treat the underlying cause
If not respond erythropoietin/dabaproitin
If not still respond-packd RBC

51
Q

G6PD deficiency pheripherial sign?

A

Bite cell

Hienze bodie

52
Q

cause of spherocytosis?

A

Autoimmune Immune hemolytic anemia

Hereditary spherocytosis

53
Q

How to D/T?

A

AIHA
posetive comb test
absent family history

54
Q

How to D/T warm from cold AIHA?

A

Cause
CM
Treatment
complication

55
Q

cause?

A 
WARM
       viral infection
       drugs
       SLE(autoimmune disease)
       CLL(lymphoproliferative disease0
        Immunodeficiency state
COLD
    Infn(Mycoplasma,I mononuclosis)
    Lymphoproliferative diasese
56
Q

CM?

A 
Warm
asymptomatic to life treating anemia
positive for IgG and anti C3
COLD
symptom of anemia
acrocyanosis(cold exposure)
anti C3 and IgM comb posetive
57
Q

treatment?

A 
WARM
Corticosteroid
Splenectomy for refractory case
Cold
Avoid cold environment
Rituximab
Fludarabine
58
Q

Complication?

A 
WARM"
TE
Lymphoproliferative disease
COLD
Ischemia and pheripherial gangren
Lymphoproliferative disease
59
Q

aplastic anemia?

A

BM failure due to hematopoietic stem cell deficiency(CD34)

60
Q

cause?

A

autoimmune
DRUG
Infection
Radiation and toxin exposures(benzen)

61
Q

Autoimmune

A

lupus

eosinophilic fascitis

62
Q

Drug?

A

Carbamazepine
Chloroamphinicol
Sulphonamide

63
Q

Infection?

A

HBV
HIV
EPV
parvo

64
Q

diagnosis?

A

pancytopenia
no abnormal cell in pheripherial morphology
BM biopsy; BM filled with FAT

65
Q

chemotherapy-induced vomiting tx?

A

first-line-5HT3 blocker(ondasetron)

dopamin receptor antagonist 2nd/3rd line

66
Q

Direct factor 10 inhibitors?

A

Apixaban/Rivaroxaban

67
Q

the D/C between warfarin?

A

M.Action
Onset
Overlap needed
LAB monitoring

68
Q

M.Action?

A

FxaI-directly inhibit factor xa

warfarin–Vit Kmetabolism

69
Q

The onset of therapeutic action?

A

FXaI-2-4 Hr

W-5-7 day

70
Q

Did overlap need with UH?

A

FXaI-No

W-yes

71
Q

Follow up with INR needed?

A

FXaI-No

W-Yes/2-3 wk interval)

72
Q

Thrombolytic TX in DVT?

A

PE with hemodynamic instability

Proximal DVT with sever symptom

73
Q

IV filter indication?

A

Anticoagulation failure

Anticoagulation C/I

74
Q

HIT CM?

A

occur 5-7 day after heparin(H/L) initiation
thrombocytopenia
arterial/venous thrombosis

75
Q

management?

A

stop heparin immediately

start non-heparin anticoagulant(enoxaparin)

76
Q

pathophysiology?

A

heparin bind with plasmaPP4 protein-attach to platelet membrane-Ab formation –Platelet destruction–venous/arterial thrombosis from factor release by platelet

77
Q

Diagnosis?

A

Serotonin release assay

Antibody titer

78
Q

Tumour lysis syndrome risk?

A

Tumor with high burden/turnover

Initiation of chemotherapy/radiotherapy

79
Q

manifestation?

A

High Phosphorous, K and uric acid, and low Ca
AKI(uric acid,Ca stone)
Cardiac arrhythmia

80
Q

treatment?

A

continue chemotherapy
aggressive fluid/electrolyte monitoring
prophylaxis: allopurinol, rasburicase, and feboxitat

81
Q

Hairy cell leukemia feature?

A

Clonal B cell neoplasm
Middle/older age
BRAF gene mutation

82
Q

clinical future?

A 
agranulocytosis
anemia
thrombocytopenia
mild lymphocytosis
splenomegaly(tumor infiltration)
hepatomegaly/LND/B symtom  is rare
83
Q

Diagnosis?

A

hairy cell in pheripherial smear

flow cytometry in BM biopsy(All cases were bright positive for CD11c and negative for CD5.)

84
Q

management?

A

Chemotherapy

life expectancy is mainly normal

85
Q

sign of glossitis?

A

smooth shiny tongue

86
Q

mechanism?

A

defect in epithelium proliferation

87
Q

cause?

A

B12 deficiency
Iron deficiency
Riboflavin deficiency
Folic acid deficiency

Steep 2 CK hematology (4 decks)

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