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STEP 2 AG > Hem/Onc/Immunology > Flashcards

Hem/Onc/Immunology Flashcards

1
Q

Thrombotic thrombocytopenic purpura

A

Pt is SICK, FATRN loves Adam
Fever, abdominal pain, thrombocytopenia, renal, neuro
Management: get smear to confirm schistocytes, plex
ADAMTS-15 def, can’t cleave vWF

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2
Q

Testicular ca

A

Lung Mets w retroperitoneal LNs

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3
Q

alpha thalassemia major

A

–/– no alpha chains, have all gHb very high affinity for O2 doesn’t let go to the tissues, fetus will have hydrops (polyhydramnios fluid pocket >8, ascites, EDEMA) also parvo B19 (MC), Rh alloimmunization (no dysmorphic features), congenital

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4
Q

polycythemia

A

crit > 65%

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5
Q

Idiopathic thrombocytopenia

A

NOT SICK, anti-plt IgG, nl labs and smear, prednisone, test for HIV HepC

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6
Q

HUS

A

after diarrhea, thrombocytopenia anemia, intravascular shearing

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7
Q

Multiple myeloma

A

Infx, fatigue/wt loss, bone fx, hyperCa, renal probs (MC tubular casts, also glomerulus amyloidosis), normocytic anemia, hyperviscosity, plasma cells, M-spike, rouleaux formation, dx XR, SPEP, conf w/ BM bx

ddx Mixed cryoglobulinemia syndrome (low C3, C4, +RF anti-IgG IgM HepC SLE HIV)

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8
Q

B cell immunodeficiencies

A

SHiN + giardia
X linked agammaglobulinemia (Brutons) ALL LOW
CVID nl B cells, low IgG +- A, M
Hyper IgM, low other Igs (x-linked, CD40 no class switching + opportunistic and viruses)
Hyper IgE, nl others
Selective IgA def (anaphylaxis w tfusion, autoimmune probs)
Tx IVIG

(SCID T cell, tx stem cell tplant)

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9
Q

Lead poisoning

A

anemia (basophilic stippling), GI, neuro (foot drop), whiskey, plumbers, batteries

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10
Q

CLL

A

CD-20, rituximab, dx flow cyto (mature Bs), smudge cells, Richter transformation

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11
Q

CML

A

BCR-ABL, imatinib, indolent=3 mo, myeloCYTES (less mature), DECREASED neutrophil function bc they are abnormal= LOW leukocyte alkaline phosphatase score (vs leukemoid rxn 2/2 infx LAP high, METAmyelocytes more mature)

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12
Q

Reactive thrombocytosis

A

Surg/trauma–>splenectomy, minority of pts persistent, can see in acute illness transiently

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13
Q

ALL

A

> 25% lymphoblasts on BM bx, +bone pain, +splenomegaly (NOT SEEN in aplastic anemia)

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14
Q

AML

A

Auer rods, PNMs, myeloBLASTS, (APML=15;17 consumptive coagulopathy hemorrhage, transretinoic acid)

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15
Q

Alloimmunzation

A

AFTER DELIVERY sometimes need more

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16
Q

G6PD

A

avoid dapsone, nitrofurantoin, primaquine, sulfa, fava beans, test can be nl recheck 3mo

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17
Q

Hemolytic anemia

A

LOW HAPTOGLOBIN (binds hemoglobin)

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18
Q

Craniopharyngioma

A

CALCIFICATIONS (pit adenoma, rathke cleft cyst no calc)

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19
Q

LMWH

A

enoxaparin (end in arin), NO CKD use unfractionated hep

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20
Q

HIT

A

5-10d hep P4 new antigen, thrombocytopenia (60k) + thrombus stop hep –> dabigatran

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21
Q

Hereditary spherocytosis

A

hemolytic anemia, jaundice, splenomegaly, pigment gallstones, Eosin-5-maleimide, acidified glycerol lysis, MCHC >36, MCV low-nl

22
Q

Acute graft-versus-host disease

A

donor CD8, <100d

23
Q

Hereditary hemorrhagic telangiectasia

A

Osler-Weber-Rendu, blanching papules, epistaxis, AVMs, lung probs

24
Q

Anemia in CKD

A

too much epo –> hypertensive crisis 2-8w

25
Q

Alcoholics w/ anemia

A

Folate (5-10w) more common than B12, folate alone anemia better neuro worse

26
Q

Postop hematoma w/ no h/o coagulopathy

A

inadequate hemostasis

27
Q

Anterior mediastinal mass (4 T’s)

A

Thymoma, terrible lymphoma, thyroid ca, teratoma (germ cell tumor, seminoma high bHCG NORMAL AFP, nonsem both high)

28
Q

a-thal vs IDA

A

target cells, RBCs are nl in athal, w/u for IDA first

29
Q

Homocysteine

A

Too much = hypercoag, B6 + folate +/- B12

30
Q

Immune thrombocytopenia

A

Can be transient (3mo postviral pred), chronic <100k for >1y (w/u BM bx, HIV HepC CMV, autoimmune, tx 2nd line splenectomy)

31
Q

Splenectomy

A

Splenic macrophages present antigens to B cells –> Ab

32
Q

Febrile nonhemolytic transfusion reaction

A

sec–>anaphylaxis, 1h–>acute hemolytic (ABO incompatibility), 6h–>cytokines/nonhemolytic leukoreduce, 2d–>delayed hemolytic

33
Q

Aplastic anemia

A

Autoimmune, infx (parvoB19), drugs, exposure

NOT THE SAME AS APLASTIC CRISIS=sickle cell

34
Q

Waldenstrom macroglobulinemia

A

IgM gamma gap “sausage link” retinal changes

35
Q

Metastatic prostate cancer

A

OsteoBlastic low-nl Ca, sclerotic bone lesions

36
Q

Autoimmune hemolytic anemia

A

Warm (IgG pred splenectomy) cold (IgM mono mycoplasma rituximab)

37
Q

Acquired sideroblastic anemia

A

hypochromic + normochromic, mimics IDA but iron is high, isoniazid (tx B6)

38
Q

Chronic granulomatous disease

A

Catalase+ (staph a, serratia, aspergillus) Xlinked recessive, leuk adh def no pus

39
Q

SEs of immunosuppressants

A

Azathioprine (purine synth inh, GI, WBC, hepatotoxic)
Mycophenolate (purine synth inh, bone Marrow suppression)
Cyclosporine (IL2 inh, hyper K+, hyperglycemia, HTN, hypertrophy of gums, renal, hirsuitism, tremor)
Tacrolimus (same a cyclo -gums, -hirsuitism)

40
Q

Hereditary thrombophilias

A 
Factor V Leiden (Prot C resistance)
Prothrombin mutation (inc proT)
Antithrombin def (acquired DIC, cirr, nephrotic syndrome)
Prot C or S def (warfarin skin necrosis)
41
Q

Pernicious anemia

A

Gastric cancer

42
Q

Chemotherapy nausea

A

ondansetron 1st line, metoclopramide 2nd

43
Q

Spinal cord compression

A

IV steroids immediately, rad later

44
Q

Cancer-related anorexia/cachexia

A

progesterone analog

45
Q

Post-transplant infections

A

<1mo nosocomial, 1-6mo opportunistic, >6mo reg but higher risk

46
Q

Nasopharyngeal carcinoma

A

EBV

47
Q

Wiskott-Aldrich

A

cytoskeleton, infx + eczema + plt, tx stem cell tplant

48
Q

CD3

A

B cells

49
Q

CD19

A

T cells

50
Q

Pilocytic astrocytoma

A

MC kids, cerebellum (medulloblastoma 2nd MC truncal ataxia vermis)

51
Q

B12 deficiency

A

Can look hemolytic!! (LDH, bili) intramedullary destruction of megaloblasts

STEP 2 AG (16 decks)

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