hematologie

Question 1

coagulation cascade

Answer 1

12. 3
13. 7
    9
    8
    X
    5
    2
    1

Question 2

Normale INR

Answer 2

0,8-1,1

Question 3

Wat werk ADP tgene

Answer 3

Clopidogril/ticagrelor/dipyridomol

Question 4

Wat werk thromboxane A2 tegen

Answer 4

Aspirin

Question 5

wat bind platelets aan elkaar

Answer 5

Gp11b/111a

Question 6

wat werk tegen Gp111a

Answer 6

aboximab

Question 7

Wat doen direct oral anticoag

Answer 7

inhibit factor X

apixaban, endoxaban, rivaroxaban

Question 8

Welke factoren zijn Vit k afhankelijk

Answer 8

10972 prot c en s
wafarin en acenocumarol
measure INR

Question 9

Oorzaken massive splenomegaly

Answer 9

CML/CLL
myelofibrosis
polycythemia vera

Question 10

Wat is belangrijk post splenectomie

Answer 10

vaccinatie tegen
H.influenza
N.meningitides
S.pneumonia

Question 11

Verschill tussen bloeding bij VWf ziekten en hemofilia

Answer 11

VWF ziekte: slijmvliesbloed

Hemofilie: gewrichtsbloed

Question 12

Afbraak van clot stel wat vrij

Answer 12

d-dimer

fibrinogeen

Question 13

Wat doen desmopressin

Answer 13

stimuleer Vwf production

Question 14

Welke stollingsfactoren geaffecteerd bij lever ziekten

Answer 14

almal behalwe 3, 4 , 12

Question 15

wat is antiphospholipid syndroom

Answer 15

verhoogd risico thrombosis door deactivering anticoag prot en activeren van plaatjes
en preganacy complications
causes: idiopathic
lupus,RA,HIV,syphilis,Heb b

serology: lupus anticoagulant
verhoogd aptt
anticardiolipin antibody positive( false pos syphilis)
mixing study neg

management: stop coagulation–>heparin
severe: high dose steroids

prophylaxis:
low dose aspirin
high risk no children—. wafarin
high risk children—> heparin

Question 16

Von willebrands disease

Answer 16

increase predisposition for platelet type bleeding from decreased amounts of VWF

autosomal dominant
most common congenital disorder of hemostasis
decreased ability of platelets to adhere to surface of endothelium

mucosal bleeding, incr menstruation,petechiae,bruising
incr bleeding after aspirin use

dx: normal plt, increased bleeding time
ristocetin plt binding test abnormal

rx: desmopressin/ factor 8

Question 17

oorzaken van verlengde PT

Answer 17

inherited: Factor7 def
acquired: Vit K def
liver disease
wafarin use
factor 7 inhibitor

Question 18

Oorzaken verlngde PTT

Answer 18

inherited:
VWF
Factor 7,9,11,12 def
acquired;
Heparin
antiphospholipid syndrome

Question 19

Oorzaken van verlengde PTT en PT

Answer 19

inherited:
Prothrombin
fibrinogen
factor5
factor10
acquired:
Vit k def
liver disease
DIC
Subtherapeutic heparin/wafarin
Direct thrombin inhibitors
inhibitors of factor 10, 5, fibrinogen, prothrombin

Question 20

Multiple myeloma

Answer 20

Malignan disease of plasma cells in bone marrow

signs:
Backpain
bonepain
hypercalceamia
spont fractures
increased infections
petechial bleeding
foamy urine

workup:
vehoogd ESR
pancytopenia
renal dysfunctie
verhoogd ldh
uitstrijk: Rouleoux formation
urine 24 hour electrophoresis M protein
bone marrow: monoclonal plasmacells in clusters

Behandeling:
watchfull waiting
stemcell transplant

Question 21

indolent non hodgekins lymphoma

Answer 21

CLL
Hairy cell
Folicular
Marginal zone(H pylori)
Ziekte walderstorm

Question 22

Aggresief non hodgekins lymfoon

Answer 22

Diffuse grootcellig b-cell
Burkit
Mantelcell
primer mediastinal

Question 23

langdurig immunosupresive medicatie welke 2 lymfoma verhoogd risico

Answer 23

Hodgekins

Diffuse grootzellig

Question 24

Hodgekins lymfoom

Answer 24

EBV (b-symptoms and LN)
Reed sternberg op histo

behandeling chemo/radiation
levenslang opvolg

Question 25

Mastocytose

Answer 25

hoog tryptase anaphalactic shock

Question 26

CML

Answer 26

Philadelphichromosome (9,22)

Question 27

Differentielen telling vit b 12 anemie

Answer 27

Hypersegmentatie van neutrofielen 1% 6 lobben 5% 5 of meer lobben

Question 28

Berekening van MCV

Answer 28

10 x heamatocrit / erythrocyten

Question 29

Behandeling vit B12 anemie

Answer 29

Cyanocobalamine 1000mg po 1 dd Hydroxocobaline 1mg IMI x 10 3 dagen uit elkaar dan 2 maandelijks degelijks folic acid

Question 30

oorzake macrocytic anemie

Answer 30

megaloblasties: Vit b12 en Folic acid | Niet megaloblasties: etoh, hypothyroid, meyeloproliferAative disorders

Question 31

G6PD deficiency

Answer 31

``` hemolytic anemie g6pd beskerm de rooibloedsel tegen oxidatieve stress x-linked ( vrouw dragen) flava beans alleen supportive mng vermij oxidative situaties ```

Question 32

Vitamine A deficiency

Answer 32

retinol Nachtblind xeroftalmie keratopathie ``` Intoxicatie: diplop[lia botschade braken hoofdpijn ```

Question 33

Vitamine B1 def

Answer 33

Thiamine verlies sensibiliteit en motorische uitval hartfalen verlies korttermijnheugen, desorientatie, konfubulatie

Question 34

Vitamine B6 deficiency

Answer 34

Pyridoxine perifere neuropatie sensoriesche ataxia amnesie intoxicatie: polyneuropathie

Question 35

sjogrens

Answer 35

``` autoimmune disease exocrine gland xerostomia sicca extraglandulaire: gewrichten mononeuritis polyneuritis raynauds ILD Onderzoek: ANA pos. RF pos. schirmertest(traan) sialografie behandeling: kunsttrane NSAIDS Glucocorticoids hydroxychloroquin dMARDS ```