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PLABABLE 2.0 > Hematology > Flashcards

Hematology Flashcards

1
Q

CRAB of Multiple Myeloma

A

Calcium
Renal Failure
Alkaline Phosphatase
Bence-Jones protein

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2
Q

Platelet count less than 100K with no other causes + non-blanching rash (mainly in the arms and legs) + post-infection or immunization

A

Idiopathic Thrombocytopenic Purpura

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3
Q

What is considered low risk in managing ITP? And how are they managed?

A

Low Risk is comprised of patients presenting with petechia or large bruises with no active bleeding.

They are managed on an outpatient basis. Follow-up after 1 week with a repeat full blood count.

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4
Q

What is considered medium-risk in managing ITP? What is the management?

A

Medium-Risk refers to patients with epistaxis lasting for more than 5 minutes.

Mangement: Admit then start them on oral prednisolone. If after a few days, platelet count does not rise, then may give IVIG.

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5
Q

Who are patient at severe risk ITP?

What is the management?

A

Severe-risk are ITP patients suspicious for internal hemorrhage.
They are managed by giving a combination of IV methylprednisolone + IVIG.
Start platelet transfusion if platelet drops to less than 20.

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6
Q

Erythema associated with TB

A

Erythema nodosum - painful nodules in the shin

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7
Q

Most common HIV-related lymphoma

A

Diffuse large B-cell NHL

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8
Q

Diagnostic test used in lymphoma

A

lymph node biopsy

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9
Q

Prolonged PTT + bleeding into muscles or joints

A

Hemophilia

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10
Q

Prolonged PTT + prolonged bleeding time + mucosal bleeding

A

VWD

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11
Q

Prolonged PTT + Prolonged PT + prolonged Bleeding time + bleeding at any site

A

DIC

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12
Q

Decreased platelet + bleeding/purpura + history of URTI

A

ITP

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13
Q

Fatigue + tiredness + lethargy

A
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14
Q

Mode of inheritance of Hemophilia

A

X-linked recessive

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15
Q

Mode of inheritance of G6PD deficiency

A

X-linked recessive

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16
Q

Mode of inheritance of Von Willebrand disease

A

Mostly autosomal dominant

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17
Q

Mode of inheritance of hereditary spherocytosis

A

mostly autosomal dominant

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18
Q

Mode of inheritance of thalassemia

A

Autosomal recessive

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19
Q

Mode of inheritance of sickle cell anemia

A

Autosomal recessive

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20
Q

Hematuria + hypertension
Diagnosis
Diagnostics?

A

ADPKD

Ultrasound

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21
Q

Hematuria + Hemoptysis
Diagnosis?
Diagnostics?

A

Goodpasture Syndrome

Anti-GBM antibodies

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22
Q

Hematuria + Hemoptysis + Nasal/sinus problems
Diagnosis?
Diagnostics?

A

Wegener’s Granulomatosis

C-ANCA

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23
Q

Hematuria + Bloody diarrhea (after GI infection)

A

Hemolytic Uremic Syndrome

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24
Q

Cell type most likely to be found in a bone marrow biopsy of a patient who presents with back pain, thirst and fatigue. Diagnostic tests show low hemoglobin, increased calcium, decreased eGFR.

A

(Multiple Myeloma)

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25
Q

Likely finding in a blood film of multiple myeloma

A

Rouleaux formation

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26
Q

Heinz bodies + bite cells

A

G6PD

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27
Q

Target INR in most cases including warfarin intake for AF and DVT

A

2-3

28
Q

Target INR in mechanical valve replacement

A

3-4

29
Q

Why is D-dimer not helpful to be requested for a patient who just underwent a procedure and you’re suspecting superficial thrombophlebitis?

A

D-dimer is elevated in both superficial thrombophlebitis and DVT.

30
Q

What is the UK Pc of Tumor lysis syndrome?

A

hyperUricemia
hyperPhosphatemia
hyperKalemia
hypoCalcemia

31
Q

What does CML of CML mean?

A

Crazy Massive Lien of Chronic Lymphocytic Leukemia

- massive splenomegaly which may extend up to the right iliac fossa

32
Q

Differentials for spherocytes and how to distinguish one from the other

A

Hereditary Spherocytosis v. Autoimmune Hemolytic Anemia

They are both positive for osmotic fragility test.
AIHA is positive for direct Coombs test while hereditary spherocytosis is negative.

33
Q

Sample of a drug causing aplastic anemia

A

Methotrexate

34
Q

Massive splenomegaly + WBC exceeding 100 x 10^9/L + differential count: granulocytes at all stages of development without blast cells + predominantly neutrophilic + cytogenetics: Philadelphia chromosome

A

Chronic Myeloid Leukemia

35
Q

Usually older patient (>65 years old) + asymptomatic or may present with anemia and recurrent infections (due to dysfunctional WBCs) + lymphadenopathy + leukocytosis (but duysfunctional) with B lymphocytes predominance + blood smear: mature lymphocytes with smudge cells

A

Chronic Lymphocytic Leukemia

36
Q

Patients are usually children + pancytopenia [low Hgb (fatigue), low WBC (infections), low platelet (bleeding)] + bone marrow biopsy: numerous blast cells

A

ACUTE LYMPHOBLASTIC LEUKEMIA

***Think of ALL v. Aplastic Anemia when pancytopenia is encountered. Bone marrow biopsy can differentiate between the two as ALL would show blast cells.

37
Q

Most common presenting feature in ALL

A

Pallor and Fatigue (manifestation of anemia)

38
Q

Why do you request for a bone marrow biopsy in a patient with ALL?

A

Bone marrow biopsy will show blast cells, thus, confirming the diagnosis.

39
Q

In PLAB, differentials for Massive Spenomegaly?

A

CML or Malaria

***Remember crazy massive lien. Malaria also presents with massive splenomegaly but patients often present with a significant history of travel to malaria-endemic areas.

40
Q

In PLAB, differential diagnosis for pancytopenia? How would you differentiate between the two?

A

ALL vs. Aplastic anemia

Bone marrow biopsy would show blast cells in ALL while it is not present in aplastic anemia.

41
Q

Findings you would likely see in a patient with CLL.

A

Mature lymphocytes with smudge cells

42
Q

child + Bleeding from gums + RECURRENT sore throat + pallor. What does this indicate?

A

Pancytopenia and probable ALL (important to differentiate from apastic anemia through bone marrow biopsy)

***Also take note of RECURRENT sore throat and not history of URTI.

43
Q

Typical findings in a blood film of a patient in DIC

A

Low platelet, Low Fibrinogen

High PT/PTT, INR, D-dimer, bleeding time

44
Q

When you see an isolated increase in PTT, you automatically think of… (of course, in addition to bleeding into the muscles or joints)

A

Hemophilia

***X-linked recessive

45
Q

Investigation of choice in patient with Polycythemia Rubra Vera

A

JAK mutation screen

46
Q

Pancytopenia can be seen in either Acute Lymphoblastic Leukemia or Apastic Anemia (can be differentiated by bone marrow biopsy). On the other end of the spectrum, elevation in Hgb, WBC, and platelet is seen in…

A

Polycythemia Rubra Vera

47
Q

Differentiate Polycythemia Rubra Vera and Secondary Polycythemia.

A

A. PRV is the complete opposite of pancytopenia of ALL/Aplastic Anemia. It shows elevated Hgb, WBC and platelet. EPO is normal or low. Secondary polycythemia only shows elevated Hgb.
B. EPO is only elevated in secondary polycythemia.

48
Q

The definitive diagnostic test for G6PD. When do you request for it?

A

G6PD enzyme activity;

6 weeks after the hemolytic attack

49
Q

You are presented with hypercalcemia. Differentials?

A 
SCC of the Lung
Bone metastasis (e.g., from prostate or breast)
Multiple Myeloma (normal ALP)
Primary Hyperparathyroidism (elevated PTH, decreased phosphate)
50
Q

What does a CYP450 inducer or an inhibitor do to the INR?

A

CYP450 inducer - decreases the effect of warfarin - decrease INR
CYP450 inhibitor - increases the effect of warfarin - increase INR

51
Q

Management of High INR in patients on warfarin: patient presents with MAJOR BLEEDING.

A

STOP warfarin
ADMINISTER vitamin K 5mg IV
ADMINISTER prothrombin complex concentrate (if unavailable, FFP transfusion)

52
Q

Management of High INR in patients on warfarin: INR > 8 with or without minor bleeding

A

STOP warfarin.

Administer oral or IV vitamin K.

53
Q

Management of High INR in patients on warfarin: INR is 5-8.

A

STOP warfarin.
REPEAT INR the next day.
RESTART warfarin if INR<5.

54
Q

Management of High INR in patients on warfarin: INR < 5 with or without minor bleeding but INR is more than the target

A

REDUCE or OMIT dose of warfarin.
REPEAT INR after 2-3 days

***Remember target for patients taking warfarin for AF or DVT is 2-3, while target for patients on mechanical prosthetic valve is 3-4

55
Q

Important Risk factors for deep venous thrombosis

A

Smoking
Major Surgery
Immobility
Long sitting (e.g., long trip)

56
Q

A 62-year old smoker has undergone hip replacement surgery three days ago. His left leg is SWOLLEN and TENDER. The diameter of left calf is LARGER THAN THE RIGHT CALF. The calf is TENDER on touch.

A

DVT

57
Q

Differentiate Hemolytic Uremic Syndrome and Thrombotic Thrombocytopenic Purpura?

A

HUS - triad of Hemolysis (anemia) + Uremia (AKI) + thrombocytopenia (bloody diarrhea)
TTP - triad of HUS + fever + neurological manifestations

58
Q

Management of Hemolytic Uremic Syndrome

A

Supportive: IVF + blood transfusion + dialysis

59
Q

Management for a patient with both B12 and folate deficiency?

A

Correct B12 deficiency first before administering oral folic acid.

60
Q

What are the elecrolyte findings seen in tumor lysis syndrome?

A

UKPc

Elevated uric acid
Elevated potassium
Elevated phosphate
Decreased calcium

***Commonly seen in ALL or Burkitt’s lymphoma usually after chemotherapy

61
Q

When do consider anemia in pregnant?

A

1st trimester - <11
2nd and 3rd trimester - <10.5
Postpartum - <10

62
Q

Management of hereditary spherocytosis

A

Steroids
Folic acid
Splenectomy

63
Q

What is heparin bridging?

A

A patient who takes warfarin and is for surgery must stop taking warfarin 3-5 days before his planned procedure. Instead, he must take heparin as heparin is easier to be reversed. Target INR before surgery: less than 1.5

***Resume warfarin on the night of the operation day

64
Q

It is the most common complication of aplastic anemia and common scenarios include MESENTERIC ISCHEMIA or AVASCULAR NECROSIS (FEMORAL HEAD).

A

Vaso-occlusive (thrombotic) crisis

65
Q

Complication of aplastic anemia presenting with very low hemoglobin, very low EPO commonly due to parvovirus B19.

A

Aplastic crisis

66
Q

Sudden enlargement of spleen in a patient with aplastic anemia + very low Hgb + high reticulocytes

A

Splenic Sequestration Crisis

PLABABLE 2.0 (33 decks)

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