Hemato oncologie Flashcards
Hyperglycemia and skin findings(2)
glucagonoma
hemochromatosis
Skin findings in glucagonoma
NME necrolytic migratory erythema
Zone bastion de NME(3)
Face
extremities
perineum
Neurologic Manif of glucagonoma(3)
Demencia
ataxia
Proximal mx weakness
Confirmatory test of glucagonoma
Glucagon > 500pg/ml
Why anemia in glucagonoma(2)
Anemia of chronic disease
Glucagon directly affects erythropoiesis
Malt Lymphoma management(3)
Omeprazole
clarythro
Amox
Failure of antibio in Malt Lymphoma what to do?
CHOP + bleomycine
Quid for CHOP(4)
Cyclophosphamide
adryamycine
vincristine
Prednisone
classification of hyper ca++
Mild 10-12
Moderate 12-14
severe >14
Management of asymptomatic Mild Hyperca++
No rx needed
What to avoid in Mild hypercalcemia(4)
Hctz
Lithium
prolonged bed rest
volume depletion
rx of severe hyperca++(2)
Normal saline plus calcitonin
Biphosphonate
what’s the long term rx for hyper ca++
Biphosphonate
When to rx moderate hypercalcemia(2)
if symptomatic
rx similar to severe hyper ca++
Quid of Hairy celle leukemia
B cell tumor
Marker for Hairy cell leukemia
TRAP(Tartrate resistant acid phosphatase)
Rx of hairy cell leukemia
cladribine
What’s cladribine
Purine analog
clue for waldenstrom macroglobulinemia(3)
invasion of reticuloendothelial system
Sensory deficit
visual problems
quid for Waldenstrom
plasma cell proliferation
What’s the only blood cells to be normal or elevated in Waldenstrom
WBC
What explains the sensory deficit in Waldenstrom
demyelinating sensorimotor neuropathy
Physiopatho of Hyperviscosity in waldenstrom
excess of production of IGM
Disease causing gamma gap (4)
Amyloidosis
Multiple Myeloma
MGUS
waldenstrom
next step in in presence of isolated trombocytopenia
Test for HIV
What are the 2 main causes ot low platelet
Decrease production
Peripheral destruction
What virus could decrease platelet production(3)
HIV
epstein Barr
Hep C
What chemicals could cause decrease platelet production?(2)
Chemotherapy
Alcohol use
Congenital disease causing decreased platelet production
Fanconi syndrome
What carence could cause decreased platelet production(2)
B12
folate
What other disease can cause decreased platelet production
Myelodysplasia
Disease causing increased platelet destruction
Lupus antiphospholipid syndrome Idiopathic thrombocytopenic purpura TTP-HUS DIC
Drugs causing increased platelet destruction
Heparin
Non tender nodes in neck in older patient and smoker?
Squamous cell carcinoma of Head matastasis
Management of antiphospholipid syndrome in pregnant women
Low molecular weight Heparin
workup of antiphospholipid syndrome
prolonged PTT
thrombocytopenia
VDRL false positive
causes of anemia
RBC destruction
decrease red blood cell production
blood loss
cause of anemia in lymphoproliferative disorder
invasion of moelle osseuse
Cause of decreased red blood cell production(2)
Carence
Moelle osseuse problem
Physio patho of senile purpura
perivascular connective tissue atrophy
findings in senile purpura
dark ecchimosis in elderly
in area of trauma
People at risk for B12 anemia
Vegetarians
Symptoms of B12 anemia(2)
Memory loss
Balance problem
Megaloblastic anemia in alcoholic
B9 deficiency
if you give b9 to correct the megalobalstic anemia in a Veg what will happen?(2)
No more anemia
persistence of neurologic symtoms
Quid of polycythemia vera
erythropietin independent red blood cells overproduction
Hmg in polycythemia vera
Everything is high
why pruritus after bath in polycyhemia vera(2)
release of Histamine
and Prostaglandine
What causes release of histamine in Polycythemia vera
Mast cell degranulation
what cause release of prostaglandine
stimuli comming from red blood cells
How to explain the HTA
because of increase blood volume
How to explain face plethora in polycythemia vera
because of vasodilation(Histamine and prostaglandine)
Confirmatory test of polycythemia vera(2)
Low erythropoietin
JAK2V617F Mutation
Digestive problem in Polycthemia vera
Peptic ulceration
How to explain peptic ulceration in Polycythemia vera
Massive release of histamine
why abortion in antiphospholipid syndrome
because of thrombosis
arterial and veinous
why anemia in paroxystic nocturnal hemoglobinuria
hemolysis
what will be low in intra vxar hemolytic anemia(2)
Hb
Haptoglobin
What will be high in intra vxar hemolytic anemia
Bilirubin
LDH
why hemolytic anmemia in PNH
Absence of CD55 CD59 on RBC
Attack by complement
clue for PNH
Hepatic vein thrombosis
confirmatory DX for PNH(2)
Flow cytometry
Absence CD55 CD59
What explain absence of CD55 and 59 in PNH
GP1 abnormality
role of GP1
Help CD55 and CD59 to bind to RBC surface
Confirmatory test of Myastenia Gravis MG(2)
antibody to acethylcholine receptor
Electromyogram
If you confirm MG what will be the next step
Ct scan of chest for Thymoma
lung cancer in non smoker and smoker
adenocarcinoma
lung cancer with central localisation(2)S
Scc small cell carcinoma
SCC squamous cell carcinoma
Lung cancer with peripheral localisation(2)
adenocarcinoma
Large cell carcinoma
Paraneoplastic syndrome in Small cell carcinoma(3)
SiADH
Cushing syndrome
Lambert eaton syndrome
Paraneoplastic syndrome in squamous cell carcinoma
hypercalcemia
Paraneoplastic syndrome in Large cell carcinoma(2)
galactorrhea
gynecomastia
Paraneoplastic syndrome in adenocarcinoma(2)
clubbing
hypertrophic osteoarthropathy
Antibody produced in waldenstrom
IGM
Antibody mostly produced in MM
IGG
What cells are incriminated in MM
Plasma cells
Why reccurrent infection in MM
Inability to produce effective antibody
leukopenia
Clue for MM(CRAB)
High Calcium
ranal impairement
anemia
bone pain
What gamma gap
Protein total-albumin>3 a 4
Why renal impairement
IGG or paraprotein produced by myeloma cells collect in glomeruli and cause renal impairement
Why leukopenia and anemia in MM
Malignant cells invade moelles osseuse
Bone pain in MM
bone invasion and Lysis
Hypercalcemia in MM why?
Because of bone invasion
management of prostate cancer with metastasis
orchiectomy
Despite of orchiectomy pain persist in prostate cancer what ‘s the next step?
radiation
why orchiectomy in advanced prostatic cancer?
because androgen plays a key role prostactic cancer
workup for Hemachromatosis(3)
serum iron
HFE gene marker
Liver biopsy
What are the six organs targeted by hemochromatosis
Liver Pancreas Heart Pituitary gland skin Musculoskeletic system
quid of cardiac problem(3) in hemochromatosis
restrictive cardiomyopathy
dilated cardio
trouble de conduction
Quid of pancreas problem in hemochromatosis
Diabetes
Skin problem in hemochromatosis
Hyperpigmentation of skin
Pituitary problem in Hemochromatosis
Hypoptuitarism
quid Hypopituitarism(2)
sexual organ problem (amenorrhee femme,impotence sexuelle pour homme)
Hypothyroidism
quid of articular pain in hemochromatosis
Pseudo gout
cause of pseudogout
deposit of calcium pyrophosphate dihydrate in articulation
radiologic hallmark of pseudogout
chondrocalcinosis
cause of chondrocalcinosis(3)
Hypomagnesemie
Hyperparathyroidism
Hemochromatosis
confirmatory test for hemochromatosis(2)
HFE gene
liver biopsy
rx of hemochromatosis
phlebotomy
clue for TTP HUS(4)
Hemolytic anemia
low platelet
renal impairement
neurologic symptoms
rx of TTPHUS
Plasma exchange(plasmapheresis)
why plasma pherseis works
Because the disease in caused by antibody
what antibdy cause TTP-HUS
ADAMTS-13,antibody against von willebrand cleaving protease factor
explain low platelet in TTP-HUS(2)
accumulation ao von willebrand factor
and aggregation of platelets
Peripheral smear of TTP-HUS
fragmented cells
What’s the hallmark of fragmented cells
Microangiopathic hemolytic anemia
What’s trastuzumab
Monoclonal antibody
indication of trastuzumab
breast cancer with HER2 receptor
What to before beginning tratuzumab
echocardiographie
Breast cancer with progesterone and oestrogene receptor,rx?
chemotherapy
Thrombosis and low platelets days after initiating Heparin DX
thrombocytopenia induced by heparin
How to explain thrombosis in HIT
because the complexe Heparin -PF4-IGG activates platelets
sideroblastic anemia
inability to produce heme
What anemia can develop patients on anti TB drugs
sideroblastic anemia
why patient on anti TB can develop sideroblatic anemia
because of lack of B6
what ‘s the role of pyridoxine in erytropoiesis
protoporphyrin synthesis
cause of b6 deficiency(2)
alcohol
isoniazid
what’s salvage therapy
failure of standards rx
begin a second to eliminate the metastasis
adjuvant therapy
rx given in addition to the standard therapy
Neoadjuvant therapy
rx given before the standard therapy
cancer of esophagus associated with reflux disease
adenocarcinoma
ca of esophagus associated with cigarettes and alcohol
squamous cell carcinoma
workup of esophageal cancer(2)
baryum swallow
endoscopy and biopsy
work up for sqamous cell carcinoma of the skin
Punch biopsy
staging for esophageal cancer
Pet scan
most common cause of matastasis in brain
lung cancer
Multiple brain metastasis(2)
Lung
Malignant melanoma
solitary brain metastasis(3)
breast cancer
colon cancer
renal cancer
MEN 1 syndromes(3)
Pancreatic tumor
Pituatary adenoma
parathyroid hyperplasia
pancreatic tumor in MEN 1(4)
gastrinoma
vipoma
glucagonoma
insulinoma
quid zollinger ellisson syndrome
Multiple peptique ulcer rebelious to rx
management of sickle cell disease complicated by stroke
exchange transfusion
Long term treatment of sickle cell disease
hydroxyurea
action of hydroxyurea
Increase of HB F
Rx anorexia induced by cancer(2)
progesterone analog
Quid of progesterone analog(2)
Medroxy progesterone or
megestrol acetate
quid for amsterdam criteria
useful for lynch syndrome diagnosis
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
quid of lynch
Hereditary non polyposis colorectal cancer
Quid of lynch 1
only colon is involved
quid of Lynch 2
colon plus extra colon involvement
The most common extra colon site for lynch 2
endometrial carcinoma
Ovarian cancer screening
BRCA 1
BRCA 2
Si BRCA genes positive what’s the next step in case of ovarian cancer workup(2)
CA-125
Pelvis ultrasound
Complication of EPO
iron deficiency anemia
why anemia in administration of EPO
rapid depletion of body’s iron store
Treatment of iron deficiency anemia in dyalisis patient
iron dextran
Population involved in G6PD deficiency
Afro american(black)
Peripheral smear of G6PD(2)
Heinz bodies
Bite cells
Physiopatho of Heinz bodies
oxydation of hB
Why Hb is easily oxydized in G6PD deficiency
because of lack of glutathione
role of G6PD
formation of NADPH
role of NADPH
cofactor in formation of gluthatione
what can cause hemolysis in G6PD deficiency(4)
fava beans
sulfa drugs
antimalaric drugs
nitrofurantoin
Next step iron deficinecy anemia in Men >40 ans
fecal occult blood
Next step iron deficiency anemia in menopause woman
fecal occult blood
what’s the most common cause of iron deficiency anemia in male or post menopausal women
chronic gastrointestinal blood loss
Best confirmatory test for HIT
serotonin release assay
Rx of HIT(2)
stop heparin
Direct thrombin inhibitor or
Fondaparinux
after how many day can begin HIT
after 5 days or more after the beginning of heparin treatment
Microcytic anemia non responsive to iron therapy
Thalassemie
epidemio of thalassemia
Europe descendant
Physiopatho of thalassemia(2)
Hemoglobinopathy
globin problem synthesis
Marker for mononucleosis
Heterophile antibody
Vit K deficiency cause(3)
Dietary
Malabsorbtion
storage problem in liver
Lab in Vit K deficiency(3)
Pt prolonged
Ptt prolonged
but PT>PTT
role of Vit k
play key role 2, 7 ,9, 10 synthesis
molecular action of vit K
cofactor in carboxylation of glutamic residues
in case of acute bleeding with vit k deficiency what to do
fresh frozen plasma
PICA quid
appetite for other things than food
quid of Pagophagia
craving for ice
Cause of PICA
iron deficiency anemia
key problem in hereditary spherocytosis
Spectrin problem
role of spectrin
scallfolding protein of RBC
if absent RBC is not deformable anymore
clue for spherocytosis(2)
Hemolysis
pigmented gallstones
epidemio of hereditary spherocytosis
Mediteraneen
work up of herediatary spherocytosis(2)
osmotic fragility test
Eosin 5maleinide binding test
rx of spherocytosis(2)
acid folic
splenectomy
hemogram of hereditary spherocytosis(2)
High mean cell hb concentration
high red blood cell distribution width
transmission of herediatary spherocytosis
autosomal dominant
peripheral smear of spherocytosis
spherocytes
knee pain ,lytic lesion in distal femur with soap bubble appearance
giant cell tumor
rx of giant cell tumor
curettage
what’s trousseau syndrome
superficial thrombophlebitis
Physical exam in superficial thrombophlebitis
cord like veins on chest and arm
ca associated with trousseau(6)
pancreas Lung prostate colon stomach acute leukemias
first thing to do devant un trousseau syndrome
ct scan of abdomen to rule out pancreatic ca
Physio patho of thrombophlitis in trousseau syndrome
Mucin production
causes aggregation of platelet
complication of hyperhmocysteinemia
Venous thrombosis
atheroclerosis
cause of hyperhomocysteinemia
B6
B12/foalte deficiency
role of folate and b12 in homocysteine metabolism
cofactors in tansformation of homocysteine in methionine
role of B6 in homocysteine metabolism
cofactor in transformation of homocysteine in cysteine
risk in HIT(2)
arterial clot
vein clot
rx of Polycythemia vera
phlebotomy to keep hmt <45
triad of pernicious anemia(3)
Macrocytic anemia
glossitis
neurologic changes
Physio patho of b12 deficiency in pernicious anemia(2)
antibody against intrinsic factor
atrophic gastritis,low parietal cells ,no intrinsic factor
Long term complication of pernicious anemia
gastric cancer
Patient eating only preccoked food whay substance will be deficient
folate
patient eating precooked food what substance will be high
Homocysteine
Wquid of megalobaste/dx(2)
Hypersegmented neutrophiles
MEGALOBALSTIC anemia
Cause of megalobalstic anemia
Folate
B12 deficiency
How to differentiate B9 and B12 deficiency
high methyl malonic acid —->B12 deficiency
role of B12
transforms methylmalonyl co A en succinyl co A
what marker is important in the future management of breast adenocarcinoma(ductal carcinoma)
HER2
Why Her 2 so important(2)
because it’s determinant for
Prognosis
treatment of breast adenocarcinoma
How to determine the presence of HER2(2)
FISH or (fluorescent in situ hybridization) IHC (immuno histo chemical staining)
If Her2 is positive what will be the next step(2)
trastuzumab or
antracycline
cause of pancytopenia in lupus
autoimmune peripheral destruction of the 3 types of blood cells
cause of anemia in lupus(4)
auto immune hemolytic anemia
gastrointestinal blood loss
renal insufficiency
anemia of chronic disease
breast ca associated with paget disease
adenocarcinoma
prurit in nipple in paget why?
migration of cancer cells
Mechanical valve and hemolysis
microangipathic hemolytic anemia
peripheral smear in microangiopathic hemolytic anemia
schistocytes
ulcerative colitis when to begin surveillance
after 8 years with the disease
surveillance of ulcerative colitis
colonoscopy q1 -2 year
Patient with adenopathy cerciv]cale ,biopsy shows metastasis od squamous celle carcinoma what to do?
Panendoscopy
- laryngoscopy
- esophagoscopy
- brochoscopy
HIT management(2)
stop heparin
start argatroban
Management of fibrocystic disease
aspiration
follow during 4-6 weeks
work up of MM
serum electrophoresis
M spike
urine of MM
bence jones protein
cause of cell damage in G6PD
oxidative stress
prussian blue stain of urine,role?
detecting hemosiderrin(hemolysis)
cause of microcytic anemia
iron deficiency
lead poisonning
thalassemia
chronic disease
what are the 4 indicaors used to work up microcytic anemia
serum iron
ferritin
TIBC
% saturation
how will be the 4 indicators in iron deficiency anemia
everything is low except TIBC(high)
how will be the 4 indicators in thalassemia
everything is high except TIBC(low)
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
Normal MCV,Normal % saturation, normal ferritin but low fer and TIBC
anemia of chronic disease
characteristic of immune thrombocytopenic purpura(2)
isolated low platelet
<100 000
other name of ITP
idiopathic thrombocytopenic purpura
cause thromcytopenia in ITP
auto antibody IGG directed aaginst platelet membrane glycoprotein
What the first step in front of isolated thrombocytopenia(2)
test for HIV
Hep C
what ‘s the clue for rx of isolated thrombocytopenia
platelet level
30000
ITP with platelet >30000 no bleeding
observe
ITP platelet<30000
Rx
First line regimen for ITP <30000 or bleeding
corticosteroids
second line regimen for ITP <30000 or bleeding
rituximab
bad prognosis for CLL
low platelet
stage 0 CLL
Lymphocytosis
stage 1 CLL
Lymphocytosis and adenopathy
stage 2 CLL
splenomegaly
stage 3 CLL
anemia
stage 4 CLL
Low platelet
stage 1 and 2 CLL prognosis
fair
stage 3 CLL prognosis
intermediate
smudges cells Quid
partial breakdown of leucocytes during preparation because fragility
disease with smudge cells
CLL
cause of hypotension during transfusion(4)
anaphylactic reaction
transfusion related acute lung injury
primary hypotension reaction
sepsis
cause of anaphylactic reaction during transfusion
caused by recipient anti IGA antibodies
when anaphylactic reaction can occur during transfusion
seconds to minutes after the transfusion
cause of transfusion related acute lung injury
donor anti leucocytes antibody
when does the reaction start(acute lung injury)
whitin 6 hours of transfusion
Symptoms of tranfusion related acute pulmonary injury
pulmonary edema
primary hypotension cause?
bradikinin in blood products
people at risk for Primary hypotension and why
People receiving ACE inhibitor
bradikinin is normally degraded by ACE
when does primary hypotension develops(2)
Minutes after the transfusion
transient
when patient will develop sepsis after transfusion
minutes to hours after transfusion
people at risk of anaphylactic reaction and why(2)
people with IGA deficiency
presence of anti IGA antibody
whats the rx for anaphylactic reaction induced by transfusion
intra mxar epinephrine
how to prevent anaphylactic transfusion reaction
washed red cells products
Testicular mass management
remove without bilan d’extension
the only cured even with metastasis
testicular cancer
Immunologic blood transfusion reaction (6)
Febrile non hemolytic acute hemolytic delayed hemolytic anaphylactic allergic acute lung injury
cause of febrile non hemolytic reaction
cytokine accumualation in blood products
time for development of febrile non hemolytic reaction
1-6 hres
cause of acute hemolytic reaction
ABO mismatching
time for development of acute hemolytic rx
within one hour
symptoms of acute hemolytic reaction(3)
flank pain
fever
hemolysis
Delayed hemolytic reaction cause
anmnestic antibody response
time for development of delayed hemolytic reaction
2-10 jours
cause of allergic reaction during blood transfusion(2)
IGE
mast cells activation
time for development allergic reaction
within 2-3 hours
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
cause of macrotic anemia en dehros de B12 and folate deficiency(3)
hypothyroidism
severe liver disease
anti metabolites
traffic controller with polycythemia dx?
secondary polycythemia induced by co poisonning
why co poisonning causes secondary polycythemia(2)
co has high affinity for HB
compensatory mechanism —>increase of RBC
how will be PTT in lupus anti coagulant and why
prolonged
IGG or IGM is responsible for that
rouleux appearance of RBC
MM
management of solitary brain metastasis(2)
surgery
whole brain radiation
Management of multiple brain metastasis
radiation
Most common brain tumor
Metastatic brain tumor
lung cancer involved mostly in solitary brain metastasis
Non small cell lung carcinoma
whay t is impaired in splenectomised patient?
phagocytosis
why splenectomised patients are prone to infection
because they can opsonised encapsulated bugs
infection in patient with splenectomy(3)
S pneumonia
hi flu
Neisseria
disease with spherocytes with central pallor(2)
hereditary spherocytosis
autoimmune hemolytic anemia
disease causing extra vascular hemolysis
hereditary spherocytosis
autoimmune hemolytic anemia (warm agglutinin)
2 types of autoimmune hemolytic anemia
warm agglutinin
cold agglutinin
cause of warm agglutunin
autoimmune disease
rx of warm agglutinin(3)
corticosteroids
rituximab
splenectomy
Lieu of hemolysis in warm agglutinin
extra vascular
cause of cold agglutinin(2)
infection or
auto immune disease
Lieu of hemolysis in cold agglutinin
intra vascular
rx of cold agglutinin
supportive care
red blood cell transfusion
Hb extra vasculaire
destruction exageree des globules rouges dans le system reticuloendothelial(foie rate moelle osseuse)
clue for autoimmune hemolytic anemia
direct test coombs positif
athlete with polycythemia why?
steroid s use
side effect of steroids on athlete(4)
infertility/decrease libido/gynecomastia
psychiatric problem
left ventricular hypertrophy
Increase LDL and decrease HDL
hypocalcemie induced by tumor lysis syndrome why
cells explode
phosphate binds to ca++
workup for tumor lysis syndrome(4)
K+ high
ca++ low
phosphate low
aci uric high
mechanism of macrocytosis in B12 deficiency
B12 is cofactor for demethylation Methyl THF
role of THF
Purine synthesis
role purine
gives DNA
quid rituximab
CD 20 antibody
Ca in tamoxifen(2)
endometrial carcinoma
uterine sarcoma
other risk with tamoxifen
DVT
quid of MGUS
high serum monoclonal protein without any symptom
work up for MGUS(2)
-serum monoclonal protein< 10 % plasma cells
MM work up(3)
serum monoclonal protein> 3 g
>10 % plasma cells
elevated B2 microglobulin
management of all patients with MGUS
skletal bone survey to rule out MM
Is there a risk for MGUS to become MM
1% per year
anterior mediastinal mass with high AFP and BHCG
Mixed germ cell tumor(non seminomatous teratoma)
anterior mediastinal mass(4)
teratoma
thyroid mass
terrible lymphoma
thymoma
ant mediastinal mass producing BHCG
seminoma
confirmatory diagnostic of CLL
flow ctometry showing clonalityof cells.
disease with low leukocyte alkaline phosphatase(3)
CML
PNH
Hypophosphatemia
High WBC and high leukocyte alkaline phosphatase dx?(2)
leukemoid reaction
infection
clue for CML
philadelphia chromosome
cardiovascular risk for traumatic hemolytic anemia(2)
calcified aorta
artificial cardiac valves
peripheral smear in traumatic hemolytic anemia
Helmet cells or fragmented cells
TTP-HUS peripheral smear finding and why(2)
fragmented RB cells or schistocytes
microangiopathic hemlolytic anemia
calcified aorta or mechanical heart valve par psmear finding and why?(2)
Fragmented RBC or Helmet cells
Macroangiopathic hemolytic anemia
hallmark of TTP-HUS
Schistocytes(Microangiopathic hemolytic anemia)
rx of anemia chronic disease
rx the chronic disease
what’s the target in treating CML
Non-receptor tyrosine kinase
Quid philadelphia chromosome
translocation 9,22
consequence of translocation 9,22(2)
abnormal BCR-Abl
Abnormal tyrosine kinase
action of gleevec(imatinib)
tyrosine kinase inhibitor
inhibition of abnormal BCR-ABL gene
prognosis factor inbreast cancer
TNM stage
Marker for future management of breast cancer
HER2
Patient with breast cancer ,HER2 positive with EFs the next step
can’t use trastuzumab
Principle of pain management in ca(2)
begin with non narcotics
failure,short acting narcotics
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
rx of warm hemolytic anemia(2)
Prednisone
if failure splenectomy
what are the factors involved in Hemophilia(2)
8-hemophilia A
9-hemophilia B
first site of bleeding in hemophilia
Joint
weils criteria for DVT 1ant
previous DVT
weils criteria 3 causes
Bedridden > 3 days
immobilization
cancer
weils criteria 5 sign symptoms
localised tenderness over vein distribution swollen leg pitting edema collateral superficialnon varicoses vein calf swelling >3 cm
weils criteria exclusion
other dx possible _2 pts
interpretation of weils criteria
/ 2 DVT Likely
if DVT unlikely what will be the next step
D-dimer
DVT likely
Compressive US
weils criteria for DVT pointage
1 pt per criterion
why arterio veinous shunting can cause secondary polycythemia
because of chronic hypoxemia
quid of hereditary telengiectasia
osler weber rendu syndrome
clue for osler weber rendu syndrome(2)
Nosebleeding
oral lesions
cause of secondary polycythemia(3)
arterioveinous shunt
steroids
co poisonning
sleep apnea
Why macrocytic anemia in Sickle cell disease
Folate deficiency
hydroxyurea use
why folate deficiency in SCD
increase RBC turn over
increase consumption of folate in bone marrow
cause macrocytic anemia MCV>100(8)
folate deficiency B12 deficiency Myelodysplastic syndrome AML drugs induced liver disease alcohol abuse hypothyroidism
Drugs causing macrocytic anemia(5)
Zidovudine hydroxyurea chemo agents TMS Phenytoin
what’s the two type of HIT(2)
Non immune mediated
immune mediated
criteria to differentiate the two types(2)
time of occuring
Platelet count
Type 1(non immune mediated) HIT(2)
1-4 days after initiation of heparin
Platelet count more than 100000
Quid type 2HIT(2)
5-10 jours after initiation of heparin
platelet count less than 100 000
what’s the clinical outcome for type 1 HIT
none
what’s the management of type 1 HIT(2)
Continue heparin
observation
What’s the clinical outcome for type 2 HIT(3)
risk of thrombosis
Necrolytic skin lesions at heparin injections site
acute systemic reaction
Management of type 2 HIT(2)
stop heparin
use alternative anticoagulant to prevent thrombosis(direct thrombin inhibitor , argatroban)
Physiopatho of TMS induced macrocytosis
Inhibition of dihydro folate reductase
Risk with high dose TMS
Pancytopenia
Physiopatho of metrotrexate induced Macrocytosis
Inhibition of dihydrofolate reductase
rx macrocytic anemia induced by by metrotrexate
folinic acid(Leucovorin)
the most common threat in splenectomy
s Pneumo sepsis
How long last the threat for S Pneumo sepsis
More than 30 years after the splenectomy
Management before splenectomy(3)
3 vaccines
Anti pneumoccocal
Hi flu
Meningoccoque
Management after splenectomy
PNC for 2 to 5 years
drug causing a false positive result for protin S deficiency
warfarin
Why microcytic anemia in lead poisonning and sideroblastic anemia
reduced heme synthesis
cause of reduced heme synthesis
Lead poisonning sideroblastic anemia(B6 deficiency)
how are Iron and ferritin in sideroblastic anemia
Normal
physio patho of sleep apnea induced secondary polycythemia
Increase production of erythropoietine
first line regimen of chemotherapy induced vomiting
ondansetron
what’s ondansetron(2)
5HT3 receptor blocker
serotonin antagonist
why sulfa drugs and primaquine cause hemolysis in G6PD deficiency?
because they have high redox potential
two forms of G6PD deficiency
G6PD A
Mediterranean G6PD
Quid G6PD A
Moderate form
Quid of Mediteranean G6PD
The severe form
clue for hairy cell leukemia(3)
dry tap during bone marrow biosy
TRAP +
cd 11 c marker
quid of TRAP
strong phosphatase reaction not inhibited by acid tartaric
during hemolysis how is G6PD level
normal
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
pulmonry nodule in smoker
CT
FNA
for peripheral lesion
why brochoscopy is not good for peripheral lesion workup
because you wont reach the lesion with brochoscopy
what category of patient is at risk of warfarin induced skin necrosis
patient with protein C deficiency
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
management of back pain in patinet with malignancy first step
determine if Myelopathy by physical exam
If no Myelopathy what to do in case of back pain in Malignancy
Xray lumbar
no myelopathy in back pain xray - next step
bone scan
No myelopathy in back pain induce d by malignancy xray +,next step
MRI of the spine within 24 hours
severe myelopathy in patient having back pain caused by malignancy(2)
urgent MRI
IV glucocorticoids
If myelopathy is not severe next step
MRI within 24 hours
back pain in malignancy plus myelopathy Dx?
epidural spinal cord compression
paresthesia after blood transfusion
hypocalcemia
why blood transfusion can cause hypocalcemia?
because of chelation calcium by citrate
NB citrate can also chelate Mg
BCC of ear management
excision 1-2 mm of clear margins whre microscopic
shaving can be done
BCC in perioral region management
excision 1-2 mm of clear margins
BCC in nose or lips,management
excision 1-2mm of clear margins
the most common skin cancer in the US
BCC
BCC characteristics
sore that bleeds oozes and remain open for more than 3 weeks
clue for febrile non hemolytic reaction(2)
fever gone away with acetaminopen and stopping transfusion
no sigh of hemolysis
prevention of non hemolytic febrile reaction
Leukoreduction
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
anti infectious effect of leukoreduction(2)
prevent CMV infection
because this virus is living inside of white cells
dx differentiel of High glucagon level(4)<500 Pg/ml
hypoglycemia
cushing
pancreatitis
sepsis
glucagon level more than 500 pg /ml
glucagonoma
peripheral smear in thalassemia
target cells
