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First Aid Step 2 > Hem Onc > Flashcards

Hem Onc Flashcards

1
Q

Manifestation of initial seroconversion of HIV

A

Mono type syndrome with fever, malaise, pharyngitis, rash, lymphadenopathy

Neonate: oral thrush, FTT< lymphadenopathy.

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2
Q

Dx HIV

A

ELISA confirmed with Western

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3
Q

When to start retrovirals for HIV

A

CD 4<350
Pregnant
Nephropathy
Hep B conifection

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4
Q

CD 4< 200 prophy

A

PCP: TMP-SMX, daponse, or pentamidine

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5
Q

CD4<50 prophy

A

MAC: Azithromycin or Clarithromycin/ or Rifabutin as alternative

Consider cryptococcal and candida prophy with fluconazole

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6
Q

Vaccine must give with CD 4 >200

A

MMR - because is live

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7
Q

Vaccine to give to all HIV pts

A 
Pneumo
Hep B 
Inactivated polio
Annual flu
Tetanus booster q 10 yrs
Annual PPD, CXR if anergic
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8
Q

AIDS associated malignancies

A 
Kaposi - HHV 8
nonHogkin lymphpma (esp primary B cell of CNS)
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9
Q

Positive India Ink

A

Cryptococcus

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10
Q

Ring enhancing lesion

A

Toxoplasmosis

Cysticerosis/Taenia solium in Latin America

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11
Q

Meds to reduce mom-child transmission HIV

A

Mom: AZT/ZDV, no breastfeeding
Kid: ZDV for 6 weeks after birth

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12
Q

CMV retinitis Tx

A

Valganciclovir

Alt: foscarnet or cidofovir

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13
Q

Stains to detect PCP

A

Silver - Wright Giemsa, Giemsa, methanemine silver

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14
Q

Needle stick - what to do

A

HIV testing
Start HAART immediately - lamivudine, zidovudine
Restest 6 wks, 3 months, 6 months

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15
Q

Four causes microcytic anemia

A 
TICS-
Thalessemia
Iron def
anemia of Chronic disease
Sideroblastic anemia
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16
Q

Elderly man with hypochromic microcytic anemia and no Sx, Dx test?

A

FOBT and sigmoidoscopy

Suspect colorectal Ca

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17
Q

Precipitants of hemolytic crisis in pts with G6PD def

A

Sulfonamides
Antimlalarial Rx
Fava beans

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18
Q

Most common inherited cause of hypercoagulability

A

Factor V Leiden

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19
Q

Most common inherited bleeding disorder

A

von Wilebrand’s

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20
Q

Most common inherited hemolytic anemia

A

Hereditary spherocytosis

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21
Q

Dx test for hereditary spherocytosis

A

Osmotic fragility test

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22
Q

Pure RBC aplasia

A

Diamond Blackfan anemia

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23
Q

Anemia associated with absent radii and thumbs, diffuse hyper-pigmentation, cafe au lait, microcephaly, pancytopenia

A

Fanconi’s

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24
Q

Meds and viruses that lead to aplastic anemia

A

Chloramphenicol, sulfonamides, radiation, chemo

Hepatitis, HIV, Parvovirus B19, EBV

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25
Q

How to distinguish polycythemia vera from secondary polycythemia

A

Both have inc HCT and RBC mass

Polycythemia vera: normal O2 sats and low EPO

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26
Q

TTP pentad

A 
FAT RN
Fever
Anemia
Thrombocytopenia
Renal dysfunction
Neuro abnormalities

ADAMTS13

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27
Q

HUS triad

A

Anemia
Thrombocytopenia
Acute renal failure

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28
Q

Tx TTP

A

Emergent large volume plasmapheresis
Corticosteroids
Antiplatelet drugs
NO PLATELET TRANSFUSION - CI!!!!

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29
Q

Tx ITP in children

A

Resolves spontaneously, may require IVIG and/or corticosteroids

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30
Q

Which of following are inc in DIC, fibrin split products, D-dimer, fibrinogen, plts, HCT

A

Inc: fibrin split and D- dimer
Dec: plts, fibrinogen, Hct

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31
Q

8 yr boy presents with hemarthrosis and inc PTT with normal PT and bleeding time. Dx? Tx?

A

Hemophilia A or B

Consider desmopressin for hemophilia A or factor VIII or IX supplements

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32
Q

14 yr girls with prolonged BT after dental surgery and with menses, normal PT, normal or inc PTT, inc BT
Dx?
Tx

A

von Willebrand’s

Tx desmopression, FFP, or cryoprecipitate

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33
Q

60 yr AA man with bone pain. What would a workup for MM reveal?

A

Monoclonal gammopathy
Bence Jones proteinuria
Punched out lesions on x-ray of skull and long bones

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34
Q

Reed Sternberg cells

A

Hodgkin’s lymphoma

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35
Q

10 yr boy with fever, weight loss, night sweats. Exam shows ant mediastinal mass. Dx?

A

Non Hodgkins

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36
Q

Microcytic anemia with dec serum Fe, dec TIBC, normal or inc ferritin

A

Anemia of chronic disease

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37
Q

Microcytic anemia with dec serum Fe, dec ferritin, inc TIBC

A

Fe def anemia

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38
Q

80 yr man with fatigue, lymphadenopathy, splenomegaly, isolated lymphocytosis
Dx?

A

CLL

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39
Q

Lymphoma equivalent of CLL

A

Small lymphocytic lymphoma

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40
Q

Late life threatening complication of CML

A

Blast crisis- fever, bone pain, splenomegaly, pancytopenia

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41
Q

Auer rods

A

AML

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42
Q

AML subtype associated with DIC

Tx

A

M3

Retinoic acid

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43
Q

Electrolyte changes in tumor lysis syndrome

A

Dec Ca
Inc K
Inc Phosphate
INc uric acid

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44
Q

50 yr man presents with early satiety, splenomegaly, bleeding, t(9,22)
Dx

A

CML

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45
Q

Heinz bodies

A

Intracellular inclusions seen in thalessemia, G6PD def, postsplenectomy

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46
Q

Virus - aplastic aneima in sickle cell

A

Parvovirus B19

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47
Q

25 yr AA man with sickle cell anemia has sudden onset bone pain
Management?

A

O2, analgesia, hydration, transfusion if sever

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48
Q

Significant cause of morbidity in thalassemia its

Tx

A

Fe overload

Tx with deferoxamine

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49
Q

Shift Hb-O2 curve to left - what does it mean and causes

A 
Mean- increased affinity for O2
Metabolic alkalosis
Dec body T
Increased HbF
Dec CO2
Dec 2,3, BPG
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50
Q

Shift Hb-O2 curve to right - what does it mean and causes

A 
Mean: lower affinity for O2
Metabolic acidosis
increased body T
High altitude
Inc CO2
Inc 2,3 BPG 
Exercise
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51
Q

Cherry red lips, hypoxia despite normal pulse ox

A

CO poisoning

Tx: O2

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52
Q

Hg Bart

A

Hydrops fetalis with 4 mutated alpha globin genes = fetal death

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53
Q

Ringed sideroblast + basophilic stippling

A

Pb poisoning anemia

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54
Q

Tx Pb poisoning

A

EDTA or DMSA
Dimercaprol if severe
Succimer in kids

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55
Q

Microcytic anemia: Fe def vs thalessemia

  • MCV: RBC >13
  • MCV: RBC <13
A

> 13: Fe def

<13: thal

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56
Q

If microcytic anemia, essential test before Fe administration

A

R/O thalassemia because adding Fe will cause Fe overload

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57
Q

Components of Coombs reagent

A

Rabbit IgM against human IgG and complement

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58
Q

Direct agglutination
What?
Meaning?

A

Coombs reagent + RBC

Agglutinate: presence of IgG and complement on RBC membrane

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59
Q

Indirect agglutination
What?
Meaning

A

Serum + Type O RBC + Coombs reagent

Agglutinate: anti RBC Ab - Rh Alloimmunization

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60
Q

Schistocytes, spherocytes, Burr cells

A

Hemolytic anemia

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61
Q

2 types of hemolytic anemia with + direct coombs

A

Drug

Immune

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62
Q

Cold agglutinin

A

IgM

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63
Q

Warm agglutinin

A

IgG

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64
Q

Bite cells and Heinz bodies (dots of Hg in RBC)

A

G6PD def

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65
Q

Megaloblastic anemia- most common cause

A

Folate def

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66
Q

Hypersegmented neutrophils

A

B12 or folate def

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67
Q

Fatty infiltrate in BM

A

aplastic anemia

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68
Q

Aplastic anemia in sickle cell

A

Parvovirus B 19

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69
Q

Function hydroxyurea in sickle cell

A

Inc HbF

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70
Q

Fish mouth vertebrae, lung infiltrates in acute chest syndrome

A

Sickle cell

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71
Q

Heterozygous carriers sickle cell

A

ASX

more resistance to malaria

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72
Q

Sickle cell increases susceptibility to

A

Salmonella osteomyelitis

SEpsis by encapsulated organisms: Strep pneumo, H flu, N meningitidis, Klebsiella

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73
Q

4 types hypersensitivity reactions

A 
ACID
Anaphylactic
Complement mediated
Immune complex mediated
Delayed
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74
Q

Test to measure heparin

What factors

A

PTT

II, IX, X, XI, XII - intrinsic

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75
Q

Test to measure warfarin

What factors

A

PT

Vit K dep: II, VII, IX, X, c ans d s- extrinsic

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76
Q

Proper way to anticoagulate

A

Start LMWH or until PTT therapeutic on unfractionated heparin then start warfarin
Because warfarin inhibits protein C and S - cause short period of hypercoagulability after starting

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77
Q

Only clotting factors not made by liver

A

vWF and VIII

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78
Q

Food with lots of Vit K

A

green veggies

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79
Q

Signs of TTP HUS

A 
Nasty Fever Torched His Kidneys
Neuro
Fever
Thrombocytopenia
Hemolytic anemia
Kidney failure
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80
Q

ASA mechanisms

A

Inhibits plt aggergation by inhibiting COX activity to suppresses TXA2 synthesis

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81
Q

Thienopyridines (clopidogrel, ticlopidine) mechanism

A

Block ADP receptors to suppress fibrinogen binding to injury and plt adhesion

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82
Q

GP IIb/IIIA inhibitors (abciximab, tirofiban, eptifibatide)

A

Inhibit plt aggregation by binding GP IIB/IIIA receptors

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83
Q

Adenosine reuptake inhibitors (dipyridamole) mechanism

A

Inhibit adenosine deaminase and PDE to inhibit plt aggregation

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84
Q

Heparin mechanisms

A

Bind to antithrombin to increase activity and prevent clot

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85
Q

LMWH (enoxaparin, dalteparin) mechanism

A

Bind factor Xa to prevent clot formation

SAFEST DURING PREGNANCY

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86
Q

Direct thrombin inhibitors (lepirudin, argatroban)

A

Highly selective inhibitors of thrombin to suppress factors V, IX, XIII and plt aggregation

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87
Q

Direct factor Xa inhibitors (fondaparinux)

A

Highly selective inhibition factor Xa without thrombin activity

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88
Q

Use direct thrombin vs factor Xa inhibitors

A

Thrombin: alternative to heparin if pt has had HIT
Xa: DVT, PE anticoag, DVT prevention

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89
Q

Warfarin mechanism

A

Antagonizes Vit K dep carboxylation of factors II, VII, IX, X

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90
Q

Cause sepsis asplenic pts

A

Encapsulated bugs

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91
Q

Sepsis IVDU

A

Staph aureus

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92
Q

Common place malaria

A

Sub-Saharan Africa

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93
Q

Prophy for malaria

A

Chloroquine, Mefloquine

94
Q

Stain for Plasmodium

A

Giemsa - shows ring and Schuffers granules

95
Q

Criteria sepsis

A

2 of following

  • RR > 20 or PaCOR 90
  • WBC >12,000 or 10%
  • T >38 or 90
96
Q

NRTI mechanisms, adverse

A

Abacavir, Didanosine, Lamivudine, Zidovudine (AZT)

  • Inhibit production of viral genome, block incorporation of viral DNA via reverse transcriptase inhibition
  • BM, neuropathy, pancreatitis, hypersensitivity
97
Q

NNRTI mechanisms, adverse

A

Delavuridine, Efavirenz, Nevirapine

  • Inhibit reverse transcriptase
  • Liver, neuro, rash
98
Q

PI mechanisms and adverse

A

“-navir”

  • Interfere with viral replication - produce nonfcnal virus
  • Hyperglc, hyperTG, drug interactions, lipodystrophy
99
Q

Integrase inhibitor mechanisms and adverse

A

Raltegravir

  • Inhibits final step in integration of viral DNA into host
  • Neutropenia, pancreatitis, liver, hyperglc
100
Q

Fusion inhibitor mechanisms and adverse

A

enfuvirtide

  • Inhibits viral ability to fuse with CD4 cell - cannot enter
  • hypersesntivity at injection site, bacterial pneumo
101
Q

CCR5 antag mechanisms and adverse

A

Maraviroc

  • Inhibits viral CCR5 coreceptor –>no entry into host
  • URI infections, peripheral neuro, dizzy
102
Q

Combos

A

Combivir
Trizivir
Epzicom

Good if regimen is confusing and causing noncompliance

103
Q

Complication Polycythemia vera

A

Progress to leukemia

104
Q

bence Jones proteins, M protein, punched out lesion on rad

A

Multiple myeloma

105
Q

Reed Sternberg cells

A

Hodgkin lymphoma- B cells

106
Q

Prognosis Hodgkin vs Non

A

Hodgkin good

Non not good

107
Q

8:14 vs 14:18

A

8: 14 Burkitt
14: 18 follicular small cell

108
Q

Starry sky

A

Burkitt

109
Q

Cleaved cells

A

Follicular small cell

110
Q

Most common leukemia kids

A

ALL

111
Q

bad prognosis ALL

A

Adult of Phl chr

112
Q

Phl chr

A

ALL
CML

9:22 BCR-ABL - imitinab

113
Q

Blood smear shows notched nuclei and Auer rods; stains with myeloperoxidase

A

AML

114
Q

Smudge cells and CD5

A

CLL

115
Q

Possibly due to radiation exposure

A

CML

116
Q

Irregular cytoplasmic projection

A

Hairy cell

Like CML

117
Q

Blast crisis

A

CML

118
Q

Radiation induced malignancies

A

Thyroid
CML
Sarcoma

119
Q

Fatigue, DOE< infections, short, abnormal skin pigmentation (cafe au lait or hypopigment), mutated thumbs, horseshoe kidney - chromosome breakages, AR

A

Fanconi anemia - 2/2 BM failure

120
Q

Fatigue, DOE< cyanosis, pallor, craniofacial abnormalities, thumb abnormalities, heart murmur, mental retardation, hypogonadism = pure RBC anemia

A

Diamond Blackfan

121
Q

Antidote heparin

A

Protamine sulfate

122
Q

Antidote warfarin

A

Vit K

123
Q

What is increased in hemophilia PT or PTT

A

PTT

124
Q

Factors in cryoprecipitate

A

VIII and fibrinogen

Some Factor XIII, vWF, fibronectin

125
Q

Function of DDVAP in hemophilia Tx

A

Release more factor VIII

126
Q

Prolonged PTT and BT

A

von Willebrands disease IF factor VIII def as well

127
Q

Causes of hypercoaguable states

A 
ATIII def
Protein C or S def
Factor V leiden
Hyperhomocysteinemia
Dysfibrinogenemia
Plasminogen def
Prothrombin G20210A mutation
MTHFR mutation
128
Q

5 S/S of TTP

A 
Low plt
Microangiopathic hemolytic anemia
Neuro changes - delirium, seizure, stroke
Impaired kidney
Fever

Need 3 of 5

129
Q

HUS vs TTP

A

HUS: severe elevation Creatinine

130
Q

3 causes microangiopathic hemolytic anemia

A

HUS
TTP
DIC

131
Q

LAP in heme malignancy vs leukemoid reaction (EBV)

A

LAP elevated in leukemoid and low in malignancy

132
Q

College kid consumes alcohol and barbs then has episode abd pain and brown urine next day

A

porphyria

133
Q

Tx nonhemolytic febrile transfusion reaction

A

Acetaminophen

134
Q

Ages Leukemias

A

ALL60

135
Q

Tumor lysis syndrome labs

A

Hyper K
HyperPhos
Hyperuricemia
HypoCa

136
Q

Dutcher bodies
What
Disease

A

IgM that stain with PAS

Waldenstroms

137
Q

Congo red shows apple birefringence

A

amyloidosis

138
Q

Amyloidosis of Mult myeloma and Waldenstroms

A

AL

139
Q

Amyloidosis of chronic inflammatory disease

A

AA

140
Q

Causes secondary eosinophilia

A 
NAACP
Neoplasm
Allergies
ASthma
Collagen vascular disease
Parasites
141
Q

Hematuria with eosinophilia

A

Possibibly schostosomiasis

142
Q

Neoplasm: Down syndrome

A

ALL

143
Q

Neoplasm: Xeroderma pigmentosum

A

SCC and basal cell of skin

144
Q

Neoplasm: chronic atrophic gastritis, pernicious anemia, postsurg gastric remnants

A

Gastric adenocarcinoma

145
Q

Tuberous sclerosis (facial angiofibroma, seizures, mental retardation)

A

Astrocytoma and cardiac rhabdomyoma

146
Q

Actinic keratosis

A

SCC of skin

147
Q

Barrett’s

A

Esophageal adenocarcinoma

148
Q

Plimmer Vinson (atrophic glossitis, esophageal wbs, anemia - due to Fe def)

A

SCC of esophagus

149
Q

Cirrhosis (Etoh, HBV or HCV)

A

Hepatocellular CA

150
Q

UC

A

Colonic adenocarcinoma

151
Q

Paget’s disease of bone

A

Secondary osteosarcoma and fibrosarcoma

152
Q

Immunodef states

A

Malignant lymphomas

153
Q

AIDS

A

Aggressive malignant NHL and Kaposi

154
Q

AI (MG)

A

Benign and malingnant thymomas

155
Q

Acanthosis nigricans

A

Visceral malignancy - stomach, lung, breast, uterus

156
Q

Multiple dysplastic nevi

A

Malignant melanoma

157
Q

Methyldopa, penicillins, and sulfonamides cause

A

RBC Ab and hemolysis

158
Q

Chloroquine and sulfa drugs cause

A

Hemolysis in G6PD

159
Q

Phenytoin causes

A

Megaloblastic anemia by interfering with folate metabolism

160
Q

Chloramphenical, chemo, zidovudine cause

A

aplastic anemia and BM suppression

161
Q

Acanthocytes or spur cells

A

Abetalipoproteinemia

162
Q

Echinocytes, burr cells

A

Uremia

163
Q

Howell Jolly bodies

A

Asplenia,

164
Q

Hypersegmented neutrophils

A

B12 or folate def

165
Q

Fe inclusions in RBC of BM

A

Sideroblastic

Tx: pyridoxine

166
Q

Parasites inside RBC

A

Malaria

Babesiosis

167
Q

Polychromasia

A

Reticulocytosis

168
Q

Rouleaux

A

Multiple Myeloma

169
Q

Schistocytes, helment cell, fragmented RBC

A

Intravascular hemolysis

170
Q

Target cells

A

Thalassemia or liver dis

171
Q

Teardrop shaped RBC

A

Myelofibrosis

172
Q

Cows milk before 1 yr of age

A

Anemia via bleeding in GI tract

173
Q

Type of lung cancer that mets early

A

Small cell

174
Q

Paraneoplastic syndrome of small cell lung ca

A

SIADH
Cushing
Hypercalcemia 2.2 PTH

175
Q

Plaque like itchy skin rash that does not improve with Tx, blood smear shows cerebriform nuclei (“butt cells”), Pautrier abscess in epidermis

A

Mycosis fungoides, Sezary syndrome

176
Q

EBV in Africa

A

Burkitt

177
Q

HTLV-1 is a cause

A

T cell leukemia

178
Q

Best and worst prognosis subtypes NHL

A

Best: small follicular
Worst: large diffuse

179
Q

Anemia, teardrop cell, dry tap on BM biopsy, high MCV and RBC distribution, assoc w/ CML

A

Myelodysplasia/Myelofibrosis

180
Q

Osteolytic, Bence Jones, High calcium

A

Multiple Myeloma- cannot see on PET scan becuase lytic not blastic

181
Q

Hyperviscosity, IgM spike, cold agglutinins

A

Waldenstrom

182
Q

Pruritis after hot bath, high Hg, Tx phlebotomy

A

Polycythemia vera

183
Q

Plt >1,000,000, pts might have bleeding or thormbosis

A

Primary thrombocytopenia

184
Q

Cancer highest mortality

A

Lung

185
Q

Highest incidence cancer

A

Male: prostate
Female: breast

186
Q

Familial polyposis plus osteomas and soft tissue tumors

A

Gardner

187
Q

MEN I

A

Parathyroid
Pituitary
Pancreas- islet cell

188
Q

MEN IIA

A

Medullary thyroid
Parathyroid
Pheo

189
Q

MEN II B

A

Medullary
Pheo
Mucosal neuromas

190
Q

Perioral freckles, multiple noncancerous GI polyps, increased incidence noncolon cancer (stomach, breast, ovaries)

A

Peutz Jeghers

191
Q

Neurofibromas, cafe au lait, inc pheo, bone cyst, Wilms, leukemia

A

NF1

192
Q

BIlat acuoustic schwanoma

A

NF2

193
Q

Adenoma sebaceum, seizures, mental retardation, glial nodules in brain, increased renal angiomyolipomas, cardiac rhabdomyomas

A

Tuberous sclerosis

194
Q

Hemangiomas in cerebellum, renal cell cancer, cyst in liver or kidney

A

Von Hippel Lindau

195
Q

Increased risk skin cancer - genetic

A

Xeroderma pigmentosum, albinism

196
Q

Vinyl chloride cancer

A

Liver angiosarcoma

197
Q

AFP tumor marker

A

Liver, yolk sac testicular

198
Q

Bladder tumor antigen, NMP 2 tumor marker

A

Bladder

199
Q

CA 15-5, CA 27.29

A

Breast

200
Q

CA 19-9

A

Pancreas, lung

201
Q

Ca-125

A

Ovarian

202
Q

CEA

A

colon, ancreas, GI

203
Q

Chromagrnain A

A

Carcinoid, neuroblastoma

204
Q

hCG

A

hyaditaform moles, choriocarcinoma

205
Q

Beta 2 microglobulin

A

multiple myeloma, CLL

206
Q

PSA

A

Prostate

207
Q

S-100

A

Melanoma, CNS, nerve tumors

208
Q

Thyroglobulin

A

Thyroid

209
Q

Most common breast cancer

A

Invasive ductal

210
Q

Good Tx if hormone sensitive breast ca in postmenopausal

A

Aromatase inhibitor- Anastrazole,

Not for premenopausal

211
Q

Good for premenopausal with ER + breast cancer

A

Tamoxifen or Raloxifene

212
Q

Her2/neu Rx

A

Trastuzuma

213
Q

Trousseau sign

A

Migratory thrombophlebitis

Could indicate pancreatic ca- adenoCA

214
Q

Courvoisier sign

A

Palpable nontender GB- may be pancreatic CA- adenoCA

215
Q

4 types pancreatic cancer

A

Insulinoma - beta cell
Gastrinoma
Glucagonoma- alpha cell
VIPoma

216
Q

Whipple triad

A

Hypoglycemia <50
CNS Sx 2/2 hypoglycemia

Give glc to relieve Sx

Think Insulinoma = C peptide will be high (not high with DM)

217
Q

Dx gastrinoma

A

Eleavated fasting serum gastrin or secretin stimulation test

218
Q

Hyperglycemia with high glucagon and migratory necrotizing skin erythema

A

Glucagonoma - alpha cell

219
Q

Watery diarrhea, hypoK, achlorhydria

A

VIPoma

220
Q

Tumor that has skin/teeth/hair/bone

can show up as pelvic calcification on rads

A

Dermoid cyst/teratoma

221
Q

Tumor causes virilization - hirsutism, receding hairline, deepening voice, clitoromegaly

A

Sertoli-Leydig (ovarian cell)

222
Q

Causes feminization and precocious puberty tumor

A

Granulosa theca cell tumor (ovarian tumor)

223
Q

Meigs syndrome

A

Ovarian fibroma, ascites, right hydrothorax, pleural effusion

224
Q

Krukenberg tumor

A

Stomach or other GI ca with mets to ovaries

225
Q

Increased 5HIAA

A

Carcinoid tumor- most commonly in GI - appendix

226
Q

CD1 positive cells + birbeck granules

A

Histiocytosis

227
Q

Liver flukes like Clonorchis

A

Cholangiosarcoma

Also caused by IBD

228
Q

Most common tumor of liver

A

Hemangioma- benign and left alone

229
Q

OCP, benign liver tumor

A

Hepatic adenoma

230
Q

Main primary liver in kids, malignant

A

Hepatoblastoma

231
Q

EBV and Asian and nose

A

Nasopharyngeal cancer

First Aid Step 2 (22 decks)

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