Hem/Onc

Question 1

Ferritin, iron, and TIBC levels in iron deficiency anemia?

Answer 1

Ferritin: low ferritin (if this is low it’s Iron def anemia no matter what!)
Iron: low
TIBC: high

Question 2

Ferritin, iron, and TIBC levels in anemia of chronic dz?

Answer 2

Ferritin: high
Iron: low
TIBC: low

Question 3

Ferritin, iron, and TIBC levels in hemochromatosis? (hepcidin deficiency)

Answer 3

Ferritin: high
Iron: high
TIBC: low

Question 4

Ferritin, iron, and TIBC levels in thalassemia?

Answer 4

NORMAL

Question 5

the only microcytic anemia with elevated Fe on iron studies

Answer 5

sideroblastic anemia. caused by lead poisoning, EtOH, Isoniazid or other cause of B6 deficiency, and Myelodysplasia/AML

Question 6

on CBC, person has microcytic anemia. what is next step in workup?

Answer 6

iron studies

Question 7

CBC shows normocytic anemia. what is next step in workup?

Answer 7

hemolysis studies: reticulocyte count, LDH, Bili, Haptoglobin.
if this confirms hemolysis, do a blood smear.

Question 8

on CBC, person has macrocytic anemia. what is next step in workup?

Answer 8

go straight to blood smear

Question 9

what are causes of NONmegaloblastic macrocytic anemia?

Answer 9

liver dz
drugs (AZT, 5-FU, ARA-C/cytarabine)
metabolic syndromes (Lesch-Nyhan, Oritic Aciduria)
EtOH use

Question 10

homocysteine levels are elevated in both folate and b12 deficiency, but which one has elevated methylmalonic acid?

Answer 10

B12 defic

Question 11

what part of small bowel absorbs b12?

Answer 11

parietal cells secrete intrinsic factor -> absorbed in terminal ileum

Question 12

3 drugs that trigger hemolysis in G6PD

Answer 12

trimethoprim sulfate
dapsone (be careful in patients with HIV before u start treating them with this!)
nitrofurantoin

Question 13

spherocytosis is from defective what? (general and specific)

Answer 13

cytoskeleton scaffolding proteins: spectrin, ankrin, palllidin

Question 14

besides hereditary spherocytosis, autoimmune hemolytic anemia can also show spherocytes on blood smear. how do you confirm dx for each?

Answer 14

hereditary - osmotic fragility test

autoimmune - coombs test (direct and/or indirect +, either igG for hot or igM for cold)

Question 15

what is pathyophys of anemia caused by hereditary spherocytosis? what is treatment?

Answer 15

spheres cant get thru spleen -> sequestered and destroyed by spleen macrophages -> hemolytic anemia

tx: splenectomy. doesnt fix the spheres! but will fix the anemia

Question 16

causes/associations of warm autoimmune hemolytic anemia (spherocytes, positive coombs test, positive igG NOT igM) (3)

Answer 16

rheumatological dz
drugs (PCN, Sulfa, Rifampin)
Cancer causing Anti RBC IgG Ab to be made

Question 17

what is cold autoimmune hemolytic anemia (positive coombs test, IgM) caused by (2)

Answer 17

Mycoplasma

Mono

Question 18

treatment for paroxysmal nocturnal hematuria (it’s a specific immunotherapy drug)

Answer 18

eculizumab

Question 19

what does flow cytometry show in PNH? to dx

Answer 19

absence of CD55 and CD59

Question 20

paraneoplastic syndrome: migratory thrombophlebitis (Trousseau’s syndrome) and nonbacterial/sterile thrombotic endocarditis

what cancer is this associated with

Answer 20

pancreatic adenocarcinoma

Question 21

paraneoplastic syndrome: dermatomyositis

what cancer is this associated with

Answer 21

adenocarcinomas, especially ovarian

Question 22

paraneoplastic syndrome: Leser Trelat = suddenly brown spots everywhere on skin

what cancer is this related to? what are those brown spots?

Answer 22

brown spots are multiple seborrheic keratoses

GI adenocarcinomas and other visceral cancers

(note that acathosis nigricans can also these cancers! even tho mostly for insulin resistance)

Question 23

paraneoplastic syndrome: hypertrophic osteoarthropathy

what cancer is this associated with

Answer 23

adenocarcinoma of lung

Question 24

hypercalcemia and weight loss. PTH is normal. what next?? why?

Answer 24

order PTHrp levels (doesnt get picked up on regular PTH test). this is paraneoplastic syndrome from malignancy.

Question 25

paraneoplastic syndrome: SIADH and Cushings, Lambert Eaton (anti resynaptic (P/Q-type) Ca2+ at NMJ antibodies), cerebellar degeneration (from antibodies against Purkinje cells), encephalomyelitis (ab against neurons)

what cancer is this associated with. how to treat this cancer specifically?

Answer 25

small cell/oat cell lung cancer

DO NOT RESECT. it’s VERY responsive to chemo!

the cerebellar degeneration one can also be from gyn/breast cancers, or Hodgkin lymphoma

Question 26

in tumor lysis syndrome, you have high uric acid, K+, and phosphate in blood, but calcium is low. why is that?

Answer 26

phosphate binds w/ and precipitates Ca which reduces intravascular levels (the precipitate can also deposit in kidneys along with uric acid, which facilitates the AKI in TLS)

Question 27

how to tell between leukemoid reaction and CLL if person has profound leukocytosis?

Answer 27

leukocyte alkaline phosphatase is also elevated in leukemoid reaction (infection). it’s not in the abnormal neutrophils of CLL so it’s low to normal.
also absolute basophils are present on peripheral smear in CLL.