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USMLE Step 3 > Hematology > Flashcards

Hematology Flashcards

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USMLE® Step 1 flashcards
1
Q

Iron deficiency is the only anemia with elevated______

A

RDW

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2
Q

Only microcytic anemia with high reticulocyte count _____

A

HgH (hemoglobin H, variant of alpha thalassemia)

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3
Q

B12 deficiency can be tested with a b12 level, and ____

A

methylmalonic acid, homocysteine (both elevated)

B12 deficiency can also look hemolytic (LDH, haptoglobin)

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4
Q

___ electrolyte deficiency can occur after treating B12 deficiency

A

Low potassium

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5
Q

Treatment for severe sickle cell disease______

A

Exchange transfusion

  • Pulm infarction
  • priapism (try aspirating first)
  • Stroke
  • Retinal Infarction

*start fluids, O2, possibly Abx, hydroxyurea, maybe IVIG

Target sickle cell percent = 15%

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6
Q

Sickle cell patient with sudden drop hemoglobin ______, _____

A

Folate deficiency, parvovirus B12

- Reticulocyte count will be abnormally low-normal

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7
Q

Only signs of sickle cell trait ____, ____

A

Dilute urine, hematuria/renal defect

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8
Q

Autoimmune hemolytic anemia (warm antibody) associated with lymphoma, other auto-immune (SLE, RA), drugs (quinine, sulfa, penicillin), will show ______ on the peripheral smear

A

Spherocytes

Tx: Steroids, rituximab—> IVIG —> Splenectomy

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9
Q

Cold antibody hemolytic anemia.
Coombs ____
Complement ____

Only responds to Tx______

A

negative

positive

Tx: Rituximab

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10
Q

Heinz body, bite cells is a sign of ______

Drug most correlated

A

G6PD deficiency

Dx: G6PD level 2 months after episode

Dapsone, rasburicase

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11
Q

Only condition causing elevated MCHC____

Caused by defect in _____

Diagnosed with ____ assay

A

Hereditary spherocytosis
- splenomegaly, hemolysis, bilirubin gallstones

Ankrin/spectrin cytoskeletal proteins

EMA (eosin-5′-maleimide (EMA) binding test) , or osmotic fragility

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12
Q

Treatment of severe HUS or TTP______

A

Plasmapharesis , not steroids

Eculizumab only used for non-infectious HUS

ADAMS TS 13 breaks down Vwf, to break down platelet strands, plasmapheresis replenishes VwF

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13
Q

_____ characterized by pancytopenia, dark urine episodes early morning, diagnosed with ____

A

PNH

CD55, 59

Tx: Eculizumab, vaccinate with menningococal vaccine before

Cx: AML

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14
Q

_____ during pregnancy results in hemolysis, liver injury, distinguished from DIC since no change to PT/PTT

A

HELLP syndrome

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15
Q

Anaphylaxis from blood transfusion caused by ______

A

IgA deficiency

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16
Q

Type of leukemia most associated with DIC_____

A

Promyelocytic leukemia, treated with all trans retinoid acid or arsenic trioxide

17
Q

_____ smoldering, pancytopenia disease with pelger huet cells on smear, treated with linalidomide

A

MDS

Another treatment: azacitidine

18
Q

How to distinguish reactive vs CML neutrophil count____. CML cytogenetic hallmark_____

A

LAP score (Low score)

Philadelphia chromosome (BCR/Abl)

19
Q

____ characterized by elevated lympocytes, and smudge cells on smear

A

CLL

Tx: Rituximab, fludarabine, –> Venetoclax

20
Q

Massive splenomegaly, age = 50, panctopenia ______

A

Hairy cell leukemia

Tx: Cladribine

Dx: Smear + Flow Cytometry

21
Q

Pancytopenia, splenomegaly with tear drop cells_____ treated with _____

A

Myelofibrosis, Ruxolitnib (Anti Jak2)

22
Q

Treatment of polycythemia vera_____

A

aspirin, phlebotomy, hydroxyurea, —> ruxolitnib/anagrelid

Dx: LAP, B12 level

Tx: Hydroxyurea

23
Q

Treatment of polycythemia vera_____

A

aspirin, phlebotomy, hydroxyurea, —> ruxolitnib/anagrelid

Dx: LAP, B12 level (elevated)

Tx: Hydroxyurea

24
Q

Multiple myeloma workup

1) Skeletal Survey
2) SPEP: IgG monoclonal
3) UPEP: Bence jones proteins
4) Free light chain : Kappa/lambda

Most effective therapy:

A

Rouleux formations

Autologous bone marrow transplant, others: lenalidomide/thalidomide/bortezomib

25
Q

Treatment of Waldenstrom_____

A

Plasmapheresis

Rituximab/Fludarabine

26
Q

Reed stern burg, owl eyes cells associated with ____

A

Hodgkins Lymphoma

27
Q

Best diagnostic step for Hodgkins and Non-Hodgkins_____

A

Excisions lymph node biopsy

Tx: CHOP, R-CHOP, ABVD

28
Q

______ caused by lack of platelet stabilization and function, diagnosed with ____

A

Von willibrand, ristocetein assay or Vwf assay

Hack: elevated PTT, Plt levels are normal

Tx: ddAVP, Factor 8 replacement

29
Q

disease characterized by low Plt, no splenomegaly, megakaryocytes in bone marrow with large platelet chunks on peripheral smear____

A

ITP

30
Q

Treatment of ITP_____

A

Only treat if Plt<50,000

Acute: Steroids, IVIG (Plt<20,000 + bleeding)
Chronic: Romiplostim, Splenectomy

31
Q

How to tell if clotting factor deficiency and inhibitor_______

A

Mixing study

- If deficiency, mixing will correct

32
Q

glanzman and bernard soulier act like VwF, ristocetein assay will show no binding, ddAVP can be used to release sub endothelial stores , will show giant platelets on smear

A

Glanzman (low glycoprotein IIb, IIIa) for fibrinogen bridging, like being on abxiximab

Bernard soulier caused by deficiency in a VwF receptor (Giant platelets)

Tx: ddAVP, also only works for hemophilia A (Factor 8)

33
Q

How is a factor 8 inhibitor treated______

A

Factor 7, bypasses to Factor 10

34
Q

HIT

1) Diagnosis:
2) Treatment:

A

Plt Factor 4 Antibody

Fondaparinaux, Argatroban, Bivalirudin

35
Q

Test for antiphospholipid antibody syndrome____

A

Russel viper venom

USMLE Step 3 (19 decks)

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