Hemato oncologie Flashcards
1
Q
Hyperglycemia and skin findings(2)
A
glucagonoma
hemochromatosis
2
Q
Skin findings in glucagonoma
A
NME necrolytic migratory erythema
3
Q
Zone bastion de NME(3)
A
Face
extremities
perineum
4
Q
Neurologic Manif of glucagonoma(3)
A
Demencia
ataxia
Proximal mx weakness
5
Q
Confirmatory test of glucagonoma
A
Glucagon > 500pg/ml
6
Q
Why anemia in glucagonoma(2)
A
Anemia of chronic disease
Glucagon directly affects erythropoiesis
7
Q
Malt Lymphoma management(3)
A
Omeprazole
clarythro
Amox
8
Q
Failure of antibio in Malt Lymphoma what to do?
A
CHOP + bleomycine
9
Q
Quid for CHOP(4)
A
Cyclophosphamide
adryamycine
vincristine
Prednisone
10
Q
classification of hyper ca++
A
Mild 10-12
Moderate 12-14
severe >14
11
Q
Management of asymptomatic Mild Hyperca++
A
No rx needed
12
Q
What to avoid in Mild hypercalcemia(4)
A
Hctz
Lithium
prolonged bed rest
volume depletion
13
Q
rx of severe hyperca++(2)
A
Normal saline plus calcitonin
Biphosphonate
14
Q
what’s the long term rx for hyper ca++
A
Biphosphonate
15
Q
When to rx moderate hypercalcemia(2)
A
if symptomatic
rx similar to severe hyper ca++
16
Q
Quid of Hairy celle leukemia
A
B cell tumor
17
Q
Marker for Hairy cell leukemia
A
TRAP(Tartrate resistant acid phosphatase)
18
Q
Rx of hairy cell leukemia
A
cladribine
19
Q
What’s cladribine
A
Purine analog
20
Q
clue for waldenstrom macroglobulinemia(3)
A
invasion of reticuloendothelial system
Sensory deficit
visual problems
21
Q
quid for Waldenstrom
A
plasma cell proliferation
22
Q
What’s the only blood cells to be normal or elevated in Waldenstrom
A
WBC
23
Q
What explains the sensory deficit in Waldenstrom
A
demyelinating sensorimotor neuropathy
24
Q
Physiopatho of Hyperviscosity in waldenstrom
A
excess of production of IGM
25
Disease causing gamma gap (4)
Amyloidosis
Multiple Myeloma
MGUS
waldenstrom
26
next step in in presence of isolated trombocytopenia
Test for HIV
27
What are the 2 main causes ot low platelet
Decrease production
| Peripheral destruction
28
What virus could decrease platelet production(3)
HIV
epstein Barr
Hep C
29
What chemicals could cause decrease platelet production?(2)
Chemotherapy
| Alcohol use
30
Congenital disease causing decreased platelet production
Fanconi syndrome
31
What carence could cause decreased platelet production(2)
B12
| folate
32
What other disease can cause decreased platelet production
Myelodysplasia
33
Disease causing increased platelet destruction
```
Lupus
antiphospholipid syndrome
Idiopathic thrombocytopenic purpura
TTP-HUS
DIC
```
34
Drugs causing increased platelet destruction
Heparin
35
Non tender nodes in neck in older patient and smoker?
Squamous cell carcinoma of Head matastasis
36
Management of antiphospholipid syndrome in pregnant women
Low molecular weight Heparin
37
workup of antiphospholipid syndrome
prolonged PTT
thrombocytopenia
VDRL false positive
38
causes of anemia
RBC destruction
decrease red blood cell production
blood loss
39
cause of anemia in lymphoproliferative disorder
invasion of moelle osseuse
40
Cause of decreased red blood cell production(2)
Carence
| Moelle osseuse problem
41
Physio patho of senile purpura
perivascular connective tissue atrophy
42
findings in senile purpura
dark ecchimosis in elderly
| in area of trauma
43
People at risk for B12 anemia
Vegetarians
44
Symptoms of B12 anemia(2)
Memory loss
| Balance problem
45
Megaloblastic anemia in alcoholic
B9 deficiency
46
if you give b9 to correct the megalobalstic anemia in a Veg what will happen?(2)
No more anemia
| persistence of neurologic symtoms
47
Quid of polycythemia vera
erythropietin independent red blood cells overproduction
48
Hmg in polycythemia vera
Everything is high
49
why pruritus after bath in polycyhemia vera(2)
release of Histamine
| and Prostaglandine
50
What causes release of histamine in Polycythemia vera
Mast cell degranulation
51
what cause release of prostaglandine
stimuli comming from red blood cells
52
How to explain the HTA
because of increase blood volume
53
How to explain face plethora in polycythemia vera
because of vasodilation(Histamine and prostaglandine)
54
Confirmatory test of polycythemia vera(2)
Low erythropoietin
| JAK2V617F Mutation
55
Digestive problem in Polycthemia vera
Peptic ulceration
56
How to explain peptic ulceration in Polycythemia vera
Massive release of histamine
57
why abortion in antiphospholipid syndrome
because of thrombosis
| arterial and veinous
58
why anemia in paroxystic nocturnal hemoglobinuria
hemolysis
59
what will be low in intra vxar hemolytic anemia(2)
Hb
| Haptoglobin
60
What will be high in intra vxar hemolytic anemia
Bilirubin
| LDH
61
why hemolytic anmemia in PNH
Absence of CD55 CD59 on RBC
| Attack by complement
62
clue for PNH
Hepatic vein thrombosis
63
confirmatory DX for PNH(2)
Flow cytometry
| Absence CD55 CD59
64
What explain absence of CD55 and 59 in PNH
GP1 abnormality
65
role of GP1
Help CD55 and CD59 to bind to RBC surface
66
Confirmatory test of Myastenia Gravis MG(2)
antibody to acethylcholine receptor
| Electromyogram
67
If you confirm MG what will be the next step
Ct scan of chest for Thymoma
68
lung cancer in non smoker and smoker
adenocarcinoma
69
lung cancer with central localisation(2)S
Scc small cell carcinoma
| SCC squamous cell carcinoma
70
Lung cancer with peripheral localisation(2)
adenocarcinoma
| Large cell carcinoma
71
Paraneoplastic syndrome in Small cell carcinoma(3)
SiADH
Cushing syndrome
Lambert eaton syndrome
72
Paraneoplastic syndrome in squamous cell carcinoma
hypercalcemia
73
Paraneoplastic syndrome in Large cell carcinoma(2)
galactorrhea
| gynecomastia
74
Paraneoplastic syndrome in adenocarcinoma(2)
clubbing
| hypertrophic osteoarthropathy
75
Antibody produced in waldenstrom
IGM
76
Antibody mostly produced in MM
IGG
77
What cells are incriminated in MM
Plasma cells
78
Why reccurrent infection in MM
Inability to produce effective antibody
| leukopenia
79
Clue for MM(CRAB)
High Calcium
ranal impairement
anemia
bone pain
80
What gamma gap
Protein total-albumin>3 a 4
81
Why renal impairement
IGG or paraprotein produced by myeloma cells collect in glomeruli and cause renal impairement
82
Why leukopenia and anemia in MM
Malignant cells invade moelles osseuse
83
Bone pain in MM
bone invasion and Lysis
84
Hypercalcemia in MM why?
Because of bone invasion
85
management of prostate cancer with metastasis
orchiectomy
86
Despite of orchiectomy pain persist in prostate cancer what 's the next step?
radiation
87
why orchiectomy in advanced prostatic cancer?
because androgen plays a key role prostactic cancer
88
workup for Hemachromatosis(3)
serum iron
HFE gene marker
Liver biopsy
89
What are the six organs targeted by hemochromatosis
```
Liver
Pancreas
Heart
Pituitary gland
skin
Musculoskeletic system
```
90
quid of cardiac problem(3) in hemochromatosis
restrictive cardiomyopathy
dilated cardio
trouble de conduction
91
Quid of pancreas problem in hemochromatosis
Diabetes
92
Skin problem in hemochromatosis
Hyperpigmentation of skin
93
Pituitary problem in Hemochromatosis
Hypoptuitarism
94
quid Hypopituitarism(2)
sexual organ problem (amenorrhee femme,impotence sexuelle pour homme)
Hypothyroidism
95
quid of articular pain in hemochromatosis
Pseudo gout
96
cause of pseudogout
deposit of calcium pyrophosphate dihydrate in articulation
97
radiologic hallmark of pseudogout
chondrocalcinosis
98
cause of chondrocalcinosis(3)
Hypomagnesemie
Hyperparathyroidism
Hemochromatosis
99
confirmatory test for hemochromatosis(2)
HFE gene
| liver biopsy
100
rx of hemochromatosis
phlebotomy
101
clue for TTP HUS(4)
Hemolytic anemia
low platelet
renal impairement
neurologic symptoms
102
rx of TTPHUS
Plasma exchange(plasmapheresis)
103
why plasma pherseis works
Because the disease in caused by antibody
104
what antibdy cause TTP-HUS
ADAMTS-13,antibody against von willebrand cleaving protease factor
105
explain low platelet in TTP-HUS(2)
accumulation ao von willebrand factor
| and aggregation of platelets
106
Peripheral smear of TTP-HUS
fragmented cells
107
What's the hallmark of fragmented cells
Microangiopathic hemolytic anemia
108
What's trastuzumab
Monoclonal antibody
109
indication of trastuzumab
breast cancer with HER2 receptor
110
What to before beginning tratuzumab
echocardiographie
111
Breast cancer with progesterone and oestrogene receptor,rx?
chemotherapy
112
Thrombosis and low platelets days after initiating Heparin DX
thrombocytopenia induced by heparin
113
How to explain thrombosis in HIT
because the complexe Heparin -PF4-IGG activates platelets
114
sideroblastic anemia
inability to produce heme
115
What anemia can develop patients on anti TB drugs
sideroblastic anemia
116
why patient on anti TB can develop sideroblatic anemia
because of lack of B6
117
what 's the role of pyridoxine in erytropoiesis
protoporphyrin synthesis
118
cause of b6 deficiency(2)
alcohol
| isoniazid
119
what's salvage therapy
failure of standards rx
| begin a second to eliminate the metastasis
120
adjuvant therapy
rx given in addition to the standard therapy
121
Neoadjuvant therapy
rx given before the standard therapy
122
cancer of esophagus associated with reflux disease
adenocarcinoma
123
ca of esophagus associated with cigarettes and alcohol
squamous cell carcinoma
124
workup of esophageal cancer(2)
baryum swallow
| endoscopy and biopsy
125
work up for sqamous cell carcinoma of the skin
Punch biopsy
126
staging for esophageal cancer
Pet scan
127
most common cause of matastasis in brain
lung cancer
128
Multiple brain metastasis(2)
Lung
| Malignant melanoma
129
solitary brain metastasis(3)
breast cancer
colon cancer
renal cancer
130
MEN 1 syndromes(3)
Pancreatic tumor
Pituatary adenoma
parathyroid hyperplasia
131
pancreatic tumor in MEN 1(4)
gastrinoma
vipoma
glucagonoma
insulinoma
132
quid zollinger ellisson syndrome
Multiple peptique ulcer rebelious to rx
133
management of sickle cell disease complicated by stroke
exchange transfusion
134
Long term treatment of sickle cell disease
hydroxyurea
135
action of hydroxyurea
Increase of HB F
136
Rx anorexia induced by cancer(2)
progesterone analog
137
Quid of progesterone analog(2)
Medroxy progesterone or
| megestrol acetate
138
quid for amsterdam criteria
useful for lynch syndrome diagnosis
139
Criteria for Lynch syndrome(4)
at least 3 relatives with colon cancer ,one of them is first degree relative with the two others
two or more generation involved
at least one dx before 50
FAP has been excluded
140
quid of lynch
Hereditary non polyposis colorectal cancer
141
Quid of lynch 1
only colon is involved
142
quid of Lynch 2
colon plus extra colon involvement
143
The most common extra colon site for lynch 2
endometrial carcinoma
144
Ovarian cancer screening
BRCA 1
| BRCA 2
145
Si BRCA genes positive what's the next step in case of ovarian cancer workup(2)
CA-125
| Pelvis ultrasound
146
Complication of EPO
iron deficiency anemia
147
why anemia in administration of EPO
rapid depletion of body's iron store
148
Treatment of iron deficiency anemia in dyalisis patient
iron dextran
149
Population involved in G6PD deficiency
Afro american(black)
150
Peripheral smear of G6PD(2)
Heinz bodies
| Bite cells
151
Physiopatho of Heinz bodies
oxydation of hB
152
Why Hb is easily oxydized in G6PD deficiency
because of lack of glutathione
153
role of G6PD
formation of NADPH
154
role of NADPH
cofactor in formation of gluthatione
155
what can cause hemolysis in G6PD deficiency(4)
fava beans
sulfa drugs
antimalaric drugs
nitrofurantoin
156
Next step iron deficinecy anemia in Men >40 ans
fecal occult blood
157
Next step iron deficiency anemia in menopause woman
fecal occult blood
158
what's the most common cause of iron deficiency anemia in male or post menopausal women
chronic gastrointestinal blood loss
159
Best confirmatory test for HIT
serotonin release assay
160
Rx of HIT(2)
stop heparin
Direct thrombin inhibitor or
Fondaparinux
161
after how many day can begin HIT
after 5 days or more after the beginning of heparin treatment
162
Microcytic anemia non responsive to iron therapy
Thalassemie
163
epidemio of thalassemia
Europe descendant
164
Physiopatho of thalassemia(2)
Hemoglobinopathy
| globin problem synthesis
165
Marker for mononucleosis
Heterophile antibody
166
Vit K deficiency cause(3)
Dietary
Malabsorbtion
storage problem in liver
167
Lab in Vit K deficiency(3)
Pt prolonged
Ptt prolonged
but PT>PTT
168
role of Vit k
play key role 2, 7 ,9, 10 synthesis
169
molecular action of vit K
cofactor in carboxylation of glutamic residues
170
in case of acute bleeding with vit k deficiency what to do
fresh frozen plasma
171
PICA quid
appetite for other things than food
172
quid of Pagophagia
craving for ice
173
Cause of PICA
iron deficiency anemia
174
key problem in hereditary spherocytosis
Spectrin problem
175
role of spectrin
scallfolding protein of RBC
| if absent RBC is not deformable anymore
176
clue for spherocytosis(2)
Hemolysis
| pigmented gallstones
177
epidemio of hereditary spherocytosis
Mediteraneen
178
work up of herediatary spherocytosis(2)
osmotic fragility test
| Eosin 5maleinide binding test
179
rx of spherocytosis(2)
acid folic
| splenectomy
180
hemogram of hereditary spherocytosis(2)
High mean cell hb concentration
| high red blood cell distribution width
181
transmission of herediatary spherocytosis
autosomal dominant
182
peripheral smear of spherocytosis
spherocytes
183
knee pain ,lytic lesion in distal femur with soap bubble appearance
giant cell tumor
184
rx of giant cell tumor
curettage
185
what's trousseau syndrome
superficial thrombophlebitis
186
Physical exam in superficial thrombophlebitis
cord like veins on chest and arm
187
ca associated with trousseau(6)
```
pancreas
Lung
prostate
colon
stomach
acute leukemias
```
188
first thing to do devant un trousseau syndrome
ct scan of abdomen to rule out pancreatic ca
189
Physio patho of thrombophlitis in trousseau syndrome
Mucin production
| causes aggregation of platelet
190
complication of hyperhmocysteinemia
Venous thrombosis
| atheroclerosis
191
cause of hyperhomocysteinemia
B6
| B12/foalte deficiency
192
role of folate and b12 in homocysteine metabolism
cofactors in tansformation of homocysteine in methionine
193
role of B6 in homocysteine metabolism
cofactor in transformation of homocysteine in cysteine
194
risk in HIT(2)
arterial clot
| vein clot
195
rx of Polycythemia vera
phlebotomy to keep hmt <45
196
triad of pernicious anemia(3)
Macrocytic anemia
glossitis
neurologic changes
197
Physio patho of b12 deficiency in pernicious anemia(2)
antibody against intrinsic factor
| atrophic gastritis,low parietal cells ,no intrinsic factor
198
Long term complication of pernicious anemia
gastric cancer
199
Patient eating only preccoked food whay substance will be deficient
folate
200
patient eating precooked food what substance will be high
Homocysteine
201
Wquid of megalobaste/dx(2)
Hypersegmented neutrophiles
| MEGALOBALSTIC anemia
202
Cause of megalobalstic anemia
Folate
| B12 deficiency
203
How to differentiate B9 and B12 deficiency
high methyl malonic acid ---->B12 deficiency
204
role of B12
transforms methylmalonyl co A en succinyl co A
205
what marker is important in the future management of breast adenocarcinoma(ductal carcinoma)
HER2
206
Why Her 2 so important(2)
because it's determinant for
Prognosis
treatment of breast adenocarcinoma
207
How to determine the presence of HER2(2)
```
FISH or (fluorescent in situ hybridization)
IHC (immuno histo chemical staining)
```
208
If Her2 is positive what will be the next step(2)
trastuzumab or
| antracycline
209
cause of pancytopenia in lupus
autoimmune peripheral destruction of the 3 types of blood cells
210
cause of anemia in lupus(4)
auto immune hemolytic anemia
gastrointestinal blood loss
renal insufficiency
anemia of chronic disease
211
breast ca associated with paget disease
adenocarcinoma
212
prurit in nipple in paget why?
migration of cancer cells
213
Mechanical valve and hemolysis
microangipathic hemolytic anemia
214
peripheral smear in microangiopathic hemolytic anemia
schistocytes
215
ulcerative colitis when to begin surveillance
after 8 years with the disease
216
surveillance of ulcerative colitis
colonoscopy q1 -2 year
217
Patient with adenopathy cerciv]cale ,biopsy shows metastasis od squamous celle carcinoma what to do?
Panendoscopy
- laryngoscopy
- esophagoscopy
- brochoscopy
218
HIT management(2)
stop heparin
| start argatroban
219
Management of fibrocystic disease
aspiration
| follow during 4-6 weeks
220
work up of MM
serum electrophoresis
| M spike
221
urine of MM
bence jones protein
222
cause of cell damage in G6PD
oxidative stress
223
prussian blue stain of urine,role?
detecting hemosiderrin(hemolysis)
224
cause of microcytic anemia
iron deficiency
lead poisonning
thalassemia
chronic disease
225
what are the 4 indicaors used to work up microcytic anemia
serum iron
ferritin
TIBC
% saturation
226
how will be the 4 indicators in iron deficiency anemia
everything is low except TIBC(high)
227
how will be the 4 indicators in thalassemia
everything is high except TIBC(low)
228
how will be the indicators in anemia of chronic disease (2)
everything is low except ferritin (normal or High)
| could also be normal MCV,saturation
229
Normal MCV,Normal % saturation, normal ferritin but low fer and TIBC
anemia of chronic disease
230
characteristic of immune thrombocytopenic purpura(2)
isolated low platelet
| <100 000
231
other name of ITP
idiopathic thrombocytopenic purpura
232
cause thromcytopenia in ITP
auto antibody IGG directed aaginst platelet membrane glycoprotein
233
What the first step in front of isolated thrombocytopenia(2)
test for HIV
| Hep C
234
what 's the clue for rx of isolated thrombocytopenia
platelet level
| 30000
235
ITP with platelet >30000 no bleeding
observe
236
ITP platelet<30000
Rx
237
First line regimen for ITP <30000 or bleeding
corticosteroids
238
second line regimen for ITP <30000 or bleeding
rituximab
239
bad prognosis for CLL
low platelet
240
stage 0 CLL
Lymphocytosis
241
stage 1 CLL
Lymphocytosis and adenopathy
242
stage 2 CLL
splenomegaly
243
stage 3 CLL
anemia
244
stage 4 CLL
Low platelet
245
stage 1 and 2 CLL prognosis
fair
246
stage 3 CLL prognosis
intermediate
247
smudges cells Quid
partial breakdown of leucocytes during preparation because fragility
248
disease with smudge cells
CLL
249
cause of hypotension during transfusion(4)
anaphylactic reaction
transfusion related acute lung injury
primary hypotension reaction
sepsis
250
cause of anaphylactic reaction during transfusion
caused by recipient anti IGA antibodies
251
when anaphylactic reaction can occur during transfusion
seconds to minutes after the transfusion
252
cause of transfusion related acute lung injury
donor anti leucocytes antibody
253
when does the reaction start(acute lung injury)
whitin 6 hours of transfusion
254
Symptoms of tranfusion related acute pulmonary injury
pulmonary edema
255
primary hypotension cause?
bradikinin in blood products
256
people at risk for Primary hypotension and why
People receiving ACE inhibitor
| bradikinin is normally degraded by ACE
257
when does primary hypotension develops(2)
Minutes after the transfusion
| transient
258
when patient will develop sepsis after transfusion
minutes to hours after transfusion
259
people at risk of anaphylactic reaction and why(2)
people with IGA deficiency
| presence of anti IGA antibody
260
whats the rx for anaphylactic reaction induced by transfusion
intra mxar epinephrine
261
how to prevent anaphylactic transfusion reaction
washed red cells products
262
Testicular mass management
remove without bilan d'extension
263
the only cured even with metastasis
testicular cancer
264
Immunologic blood transfusion reaction (6)
```
Febrile non hemolytic
acute hemolytic
delayed hemolytic
anaphylactic
allergic
acute lung injury
```
265
cause of febrile non hemolytic reaction
cytokine accumualation in blood products
266
time for development of febrile non hemolytic reaction
1-6 hres
267
cause of acute hemolytic reaction
ABO mismatching
268
time for development of acute hemolytic rx
within one hour
269
symptoms of acute hemolytic reaction(3)
flank pain
fever
hemolysis
270
Delayed hemolytic reaction cause
anmnestic antibody response
271
time for development of delayed hemolytic reaction
2-10 jours
272
cause of allergic reaction during blood transfusion(2)
IGE
| mast cells activation
273
time for development allergic reaction
within 2-3 hours
274
what's the five ways to diferentiate B12 deficiency caused by pernicious anemia from folate deficiency
```
High LDH
achlrydria
schilling test +
Methylmalonyl co A in urine
neurological symptoms
all favor B12 deficiency
```
275
cause of macrotic anemia en dehros de B12 and folate deficiency(3)
hypothyroidism
severe liver disease
anti metabolites
276
traffic controller with polycythemia dx?
secondary polycythemia induced by co poisonning
277
why co poisonning causes secondary polycythemia(2)
co has high affinity for HB
| compensatory mechanism --->increase of RBC
278
how will be PTT in lupus anti coagulant and why
prolonged
| IGG or IGM is responsible for that
279
rouleux appearance of RBC
MM
280
management of solitary brain metastasis(2)
surgery
| whole brain radiation
281
Management of multiple brain metastasis
radiation
282
Most common brain tumor
Metastatic brain tumor
283
lung cancer involved mostly in solitary brain metastasis
Non small cell lung carcinoma
284
whay t is impaired in splenectomised patient?
phagocytosis
285
why splenectomised patients are prone to infection
because they can opsonised encapsulated bugs
286
infection in patient with splenectomy(3)
S pneumonia
hi flu
Neisseria
287
disease with spherocytes with central pallor(2)
hereditary spherocytosis
| autoimmune hemolytic anemia
288
disease causing extra vascular hemolysis
hereditary spherocytosis
| autoimmune hemolytic anemia (warm agglutinin)
289
2 types of autoimmune hemolytic anemia
warm agglutinin
| cold agglutinin
290
cause of warm agglutunin
autoimmune disease
291
rx of warm agglutinin(3)
corticosteroids
rituximab
splenectomy
292
Lieu of hemolysis in warm agglutinin
extra vascular
293
cause of cold agglutinin(2)
infection or
| auto immune disease
294
Lieu of hemolysis in cold agglutinin
intra vascular
295
rx of cold agglutinin
supportive care
| red blood cell transfusion
296
Hb extra vasculaire
destruction exageree des globules rouges dans le system reticuloendothelial(foie rate moelle osseuse)
297
clue for autoimmune hemolytic anemia
direct test coombs positif
298
athlete with polycythemia why?
steroid s use
299
side effect of steroids on athlete(4)
infertility/decrease libido/gynecomastia
psychiatric problem
left ventricular hypertrophy
Increase LDL and decrease HDL
300
hypocalcemie induced by tumor lysis syndrome why
cells explode
| phosphate binds to ca++
301
workup for tumor lysis syndrome(4)
K+ high
ca++ low
phosphate low
aci uric high
302
mechanism of macrocytosis in B12 deficiency
B12 is cofactor for demethylation Methyl THF
303
role of THF
Purine synthesis
304
role purine
gives DNA
305
quid rituximab
CD 20 antibody
306
Ca in tamoxifen(2)
endometrial carcinoma
| uterine sarcoma
307
other risk with tamoxifen
DVT
308
quid of MGUS
high serum monoclonal protein without any symptom
309
work up for MGUS(2)
-serum monoclonal protein< 10 % plasma cells
310
MM work up(3)
serum monoclonal protein> 3 g
>10 % plasma cells
elevated B2 microglobulin
311
management of all patients with MGUS
skletal bone survey to rule out MM
312
Is there a risk for MGUS to become MM
1% per year
313
anterior mediastinal mass with high AFP and BHCG
Mixed germ cell tumor(non seminomatous teratoma)
314
anterior mediastinal mass(4)
teratoma
thyroid mass
terrible lymphoma
thymoma
315
ant mediastinal mass producing BHCG
seminoma
316
confirmatory diagnostic of CLL
flow ctometry showing clonalityof cells.
317
disease with low leukocyte alkaline phosphatase(3)
CML
PNH
Hypophosphatemia
318
High WBC and high leukocyte alkaline phosphatase dx?(2)
leukemoid reaction
| infection
319
clue for CML
philadelphia chromosome
320
cardiovascular risk for traumatic hemolytic anemia(2)
calcified aorta
| artificial cardiac valves
321
peripheral smear in traumatic hemolytic anemia
Helmet cells or fragmented cells
322
TTP-HUS peripheral smear finding and why(2)
fragmented RB cells or schistocytes
| microangiopathic hemlolytic anemia
323
calcified aorta or mechanical heart valve par psmear finding and why?(2)
Fragmented RBC or Helmet cells
| Macroangiopathic hemolytic anemia
324
hallmark of TTP-HUS
Schistocytes(Microangiopathic hemolytic anemia)
325
rx of anemia chronic disease
rx the chronic disease
326
what's the target in treating CML
Non-receptor tyrosine kinase
327
Quid philadelphia chromosome
translocation 9,22
328
consequence of translocation 9,22(2)
abnormal BCR-Abl
| Abnormal tyrosine kinase
329
action of gleevec(imatinib)
tyrosine kinase inhibitor
| inhibition of abnormal BCR-ABL gene
330
prognosis factor inbreast cancer
TNM stage
331
Marker for future management of breast cancer
HER2
332
Patient with breast cancer ,HER2 positive with EFs the next step
can't use trastuzumab
333
Principle of pain management in ca(2)
begin with non narcotics
| failure,short acting narcotics
334
Patient with axillary adenopathy develops anemia normochromic with high reticulocytes and will WBC Dx
(WARM)autoimmune hemolytic anemia caused by non hogkin Lymphoma or CLL
335
rx of warm hemolytic anemia(2)
Prednisone
| if failure splenectomy
336
what are the factors involved in Hemophilia(2)
8-hemophilia A
| 9-hemophilia B
337
first site of bleeding in hemophilia
Joint
338
weils criteria for DVT 1ant
previous DVT
339
weils criteria 3 causes
Bedridden > 3 days
immobilization
cancer
340
weils criteria 5 sign symptoms
```
localised tenderness over vein distribution
swollen leg
pitting edema
collateral superficialnon varicoses vein
calf swelling >3 cm
```
341
weils criteria exclusion
other dx possible _2 pts
342
interpretation of weils criteria
/ 2 DVT Likely
343
if DVT unlikely what will be the next step
D-dimer
344
DVT likely
Compressive US
345
weils criteria for DVT pointage
1 pt per criterion
346
why arterio veinous shunting can cause secondary polycythemia
because of chronic hypoxemia
347
quid of hereditary telengiectasia
osler weber rendu syndrome
348
clue for osler weber rendu syndrome(2)
Nosebleeding
| oral lesions
349
cause of secondary polycythemia(3)
arterioveinous shunt
steroids
co poisonning
sleep apnea
350
Why macrocytic anemia in Sickle cell disease
Folate deficiency
| hydroxyurea use
351
why folate deficiency in SCD
increase RBC turn over
| increase consumption of folate in bone marrow
352
cause macrocytic anemia MCV>100(8)
```
folate deficiency
B12 deficiency
Myelodysplastic syndrome
AML
drugs induced
liver disease
alcohol abuse
hypothyroidism
```
353
Drugs causing macrocytic anemia(5)
```
Zidovudine
hydroxyurea
chemo agents
TMS
Phenytoin
```
354
what's the two type of HIT(2)
Non immune mediated
| immune mediated
355
criteria to differentiate the two types(2)
time of occuring
| Platelet count
356
Type 1(non immune mediated) HIT(2)
1-4 days after initiation of heparin
| Platelet count more than 100000
357
Quid type 2HIT(2)
5-10 jours after initiation of heparin
| platelet count less than 100 000
358
what's the clinical outcome for type 1 HIT
none
359
what's the management of type 1 HIT(2)
Continue heparin
| observation
360
What's the clinical outcome for type 2 HIT(3)
risk of thrombosis
Necrolytic skin lesions at heparin injections site
acute systemic reaction
361
Management of type 2 HIT(2)
stop heparin
| use alternative anticoagulant to prevent thrombosis(direct thrombin inhibitor , argatroban)
362
Physiopatho of TMS induced macrocytosis
Inhibition of dihydro folate reductase
363
Risk with high dose TMS
Pancytopenia
364
Physiopatho of metrotrexate induced Macrocytosis
Inhibition of dihydrofolate reductase
365
rx macrocytic anemia induced by by metrotrexate
folinic acid(Leucovorin)
366
the most common threat in splenectomy
s Pneumo sepsis
367
How long last the threat for S Pneumo sepsis
More than 30 years after the splenectomy
368
Management before splenectomy(3)
3 vaccines
Anti pneumoccocal
Hi flu
Meningoccoque
369
Management after splenectomy
PNC for 2 to 5 years
370
drug causing a false positive result for protin S deficiency
warfarin
371
Why microcytic anemia in lead poisonning and sideroblastic anemia
reduced heme synthesis
372
cause of reduced heme synthesis
```
Lead poisonning
sideroblastic anemia(B6 deficiency)
```
373
how are Iron and ferritin in sideroblastic anemia
Normal
374
physio patho of sleep apnea induced secondary polycythemia
Increase production of erythropoietine
375
first line regimen of chemotherapy induced vomiting
ondansetron
376
what's ondansetron(2)
5HT3 receptor blocker
| serotonin antagonist
377
why sulfa drugs and primaquine cause hemolysis in G6PD deficiency?
because they have high redox potential
378
two forms of G6PD deficiency
G6PD A
| Mediterranean G6PD
379
Quid G6PD A
Moderate form
380
Quid of Mediteranean G6PD
The severe form
381
clue for hairy cell leukemia(3)
dry tap during bone marrow biosy
TRAP +
cd 11 c marker
382
quid of TRAP
strong phosphatase reaction not inhibited by acid tartaric
383
during hemolysis how is G6PD level
normal
384
approach of pulmonary nodule in less than 40 years non smoker(2)
ask for an old xray
| obtain chest xray q 3 months for 12 months
385
pulmonry nodule in smoker
CT
FNA
for peripheral lesion
386
why brochoscopy is not good for peripheral lesion workup
because you wont reach the lesion with brochoscopy
387
what category of patient is at risk of warfarin induced skin necrosis
patient with protein C deficiency
388
why during the first days of warfarin initiation procoagulant activity is increased
because warfarin does not block all the factors at the same time,in the beginning only protein C and S are blocked
389
management of back pain in patinet with malignancy first step
determine if Myelopathy by physical exam
390
If no Myelopathy what to do in case of back pain in Malignancy
Xray lumbar
391
no myelopathy in back pain xray - next step
bone scan
392
No myelopathy in back pain induce d by malignancy xray +,next step
MRI of the spine within 24 hours
393
severe myelopathy in patient having back pain caused by malignancy(2)
urgent MRI
| IV glucocorticoids
394
If myelopathy is not severe next step
MRI within 24 hours
395
back pain in malignancy plus myelopathy Dx?
epidural spinal cord compression
396
paresthesia after blood transfusion
hypocalcemia
397
why blood transfusion can cause hypocalcemia?
because of chelation calcium by citrate
| NB citrate can also chelate Mg
398
BCC of ear management
excision 1-2 mm of clear margins whre microscopic
| shaving can be done
399
BCC in perioral region management
excision 1-2 mm of clear margins
400
BCC in nose or lips,management
excision 1-2mm of clear margins
401
the most common skin cancer in the US
BCC
402
BCC characteristics
sore that bleeds oozes and remain open for more than 3 weeks
403
clue for febrile non hemolytic reaction(2)
fever gone away with acetaminopen and stopping transfusion
| no sigh of hemolysis
404
prevention of non hemolytic febrile reaction
Leukoreduction
405
Timeline of transfusion reactions(4)
sec to min-ananphylaxis
min to 1 hour-acutehemolysis
1 hour to 6 hour-non hemolytic febrile reaction/TRALI
2 days-10 days delayed hemolytic reaction
406
anti infectious effect of leukoreduction(2)
prevent CMV infection
| because this virus is living inside of white cells
407
dx differentiel of High glucagon level(4)<500 Pg/ml
hypoglycemia
cushing
pancreatitis
sepsis
408
glucagon level more than 500 pg /ml
glucagonoma
409
peripheral smear in thalassemia
target cells
