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EOR - Emergency Medicine > Hematology > Flashcards

Hematology Flashcards

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1
Q

leukemias to know

A

ALL
CLL
AML
CML

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2
Q

which acute leukemia is associated w. kids

A

ALL

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3
Q

3 sx of ALL

A

LAD
bone pain
bleeding

in a kid

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4
Q

bone marrow bx findings of ALL

A

20% blasts

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5
Q

mc childhood malignancy

A

ALL

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6
Q

tx for ALL

A

chemo -> 90% remission

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7
Q

what acute leukemia is found in adults

A

AML

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8
Q

2 sx of AML

A

splenomegaly
gingival hyperplasia

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9
Q

lab findings of AML

A

thrombocytopenia
neutropenia
leukostasis: WBC > 100,000

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10
Q

bone marrow bx findings of AML

A

auer rods
> 20% blasts

adults

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11
Q

mc leukemia in adults

A

CLL

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12
Q

CLL is often asymptomatic, but what are 3 possible sx

A

fatigue
LAD
splenomegaly

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13
Q

bx findings of CLL (2)

A

smudge cells
mature lymphocytes

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14
Q

tx for CLL

A

obs
lymphocytes > 100,000 chemo

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15
Q

what type of leukemia is associated w. blastic crisis

A

CML

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16
Q

2 lab findings of CML

A

WBC > 100,000
hyperuricemia

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17
Q

dx for CML (2)

A

-philadelphia chromosome (translocation of 9 and 22)
-splenomegaly

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18
Q

anemias to know

A

anemia of chronic dz
aplastic
folate/B12 deficiency
hemolytic
IDA
SSA
thalasseimia

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19
Q

only anemia where WBC/RBC/platelets are decreased

A

aplastic

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20
Q

what anemias are associated w. elevated MCV

A

B12
folate

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21
Q

what pt pop does macrocytic anemia make you think of

A

alcoholics

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22
Q

what is pathognomonic for folate deficiency

A

hypersegmented PMNs

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23
Q

what sx differentiates folate deficiency from B12 deficiency

A

neurologic deficits w. B12

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24
Q

what anemia occurs after infxn or oxidative stress from meds

A

G6PD

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25
Q

what pt pop does G6PD deficiency make you think of

A

african american male
also middle eastern, s. asian

x linked

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26
Q

2 peripheral smear findings of G6PD

A

bite cells
heinz bodies

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27
Q

fxn of G6PD play

A

protects RBC membrane -> deficiency = hemolytic anemia

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28
Q

3 triggers associated w. G6PD deficiency

A

fava beans
antimalarials
sulfonamides

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29
Q

5 types of hemolytic anemia

A

autoimmune
G6PD
SSA
thalassemia
hereditary spherocytosis

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30
Q

lab findings of hemolytic anemia

A

increased:
reticulocytes
LDH
indirect bilirubin

decreased:
haptoglobin

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31
Q

what coombs test is associaated w. hemolytic anemia

A

direct

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32
Q

what anemia is associated with a positive osmotic fragility test

A

hereditary sphreocytosis

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33
Q

what type of anemia is associaated with very high reticulocytes

A

SSA

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34
Q

dx for SSA:
hallmark finding:

A

electrophoresis -> hemoglobin S
peripheral smear -> howell jolly bodies, target cells

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35
Q

what anemia is associated w. very low MCV and fam hx blood cell d.o

A

thalassemia

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36
Q

most sensitive test for IDA

A

ferritin

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37
Q

peripheral smear findings of IDA

A

target cells

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38
Q

2 PE findings associated w. IDA

A

pica
nail spooning

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39
Q

mc anemia in US

A

IDA

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40
Q

tx for IDA

A

FeS04 325 mg tid
Hgb < 8: transfusion

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41
Q

PE findings of SSA

A

jaundice
splenomegaly
priapism
poor healing
pain/swelling in hands/feet
acute chest syndrome

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42
Q

tx for SSA

A

hydroxyurea

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43
Q

3 types of thalassemia

A

beta major
beta trait
alpha

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44
Q

most severe thalassemia
mediterranean descent
ftt

A

beta thalassemia major

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45
Q

electrophoresis findings of beta thalassemia major

A

hemoglobin A2 and F

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46
Q

tx for beta thalassemia major

A

transfusion
iron cheation - deferoxamine

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47
Q

mild anemia
electrophoresis shows hemoglobin A2
often misdiagnosed as IDA

A

beta thalassemia trait

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48
Q

thalassemia associated w. chinese and southeast asians

A

alpha thalassemia

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49
Q

what does hemoglobin bart’s make you think of

A

hydrops fetalis

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50
Q

hypersegmented neutrophils
normal folate
decreased vibratory/position sense

A

B12 deficiency

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51
Q

B12 anemia is same same

A

pernicious anemia

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52
Q

3 causes of pernicious anemia

A

abs to intrinsic factor
gastrectomy
vegans

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53
Q

3 PE findings of pernicious anemia

A

smooth beefy, sore tongue
poor balance
low proprioception

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54
Q

peripheral smear finding of pernicious anemia

A

hypersegmented neutrophis

55
Q

elevated serum MMA
elevated homocysteine

A

pernicious anemia

56
Q

what is schilling test

A

< 10% radiolabeled B12 in urine
normal when given intrinsic factor

pernicious anemia

57
Q

3 causes of aplastic anemia

A

drugs/toxins
xrt
chemo

58
Q

3 drugs associated w. aplastic anemia

A

ACEI
sulfas
phenytoin

59
Q

6 sx of aplastic anemia

A

severe pallor
weakness
petechiae
ecchymosis
mucosal bleeding
severe infxn

60
Q

gs dx for aplastic anemia

A

bone marrow bx

61
Q

2 clotting factor d.o Smarty PANCE wants us to know

A

von willebrand (vWD)
hemophilias A/B

62
Q

vWD is associated w. missing

A

protein for platelet fxn (von willebrand factor)
factor VIII

63
Q

hemophilia a = decreased _
hemophilia b = decreased _

A

a: VIII
b: IX

64
Q

30 yo woman w. recurrent nosebleeds and heavy menses - has been taking ASA and getting more nosebleeds - has fam hx nosebleeds - labs show increased PTT, normal PT, increased bleeding time

A

vWD

65
Q

mc genetic bleeding d.o
autosomal dominant

A

vWD

66
Q

pathology of wWD

A

missing VW factor in plasma -> platelets can not adhere to vessel wall after injury -> increased bleeding

67
Q

how to differentiate vWD from hemophilias

A

vWD does not involve hemarthrosis

68
Q

tx for vWD

A

DDAVP (dasmopressin)
transfusion w. concentrated VW factor

69
Q

3 yo M - prolonged nosebleeds - right elbow swollen and ttp - maternal uncle has hx unexplained bleeding - labs show increased PTT - imaging shows blood accumulation in knee joint

A

hemophilia

70
Q

mc type of hemophilia

A

A

71
Q

hemophilia B is same same

A

christmas dz

72
Q

hemophilia is _ linked

A

x recessive

73
Q

labs associated w. hemphilia

A

increased PTT
normal PT
normal platelets
decreased factor VIII or IX

74
Q

ddx for easy bruising (3)

A

platelet dysfxn
coag deficiency
meds

75
Q

3 genetic causes of easy bruising

A

vWD
hemophioia
ITP

76
Q

what labs reflect clotting factor deficiency

A

prolonged PT/PTT

77
Q

hypercoagulable states to know

A

PVCs:
platelets elevation
vascular injury
clotting factor antagonists not working
stasis/surgery

78
Q

what conditions are associated w. elevated platelets

A

TTP
HIT (heparin induced thrombocytopenia)
HUS
HELLP

79
Q

3 anti clotting factors to know

A

protein C
protein S
antithrombin III

80
Q

what is virchow’s triad

A

blood stasis
hypercoagulable state
vascular injury

81
Q

6 genetic causes of hypergoaculable states

A

antithrombin III deficiency
factor V leiden (protein C resistance)
protein C deficiency
protein S deficiency
dysfibrinogenemia
abnormal plasminogen

82
Q

protein C resistance -> increased DVT/PE
common in young pt

A

factor V leiden

83
Q

mc genetic hypercoagulation d.o

A

factor V leiden

84
Q

tx for factor V leiden

A

LMWH bridge -> warfarin

85
Q

-vitamin K dependent anticoagulant liver protein that stimulates fibrinolysis and clot lysis
-inactivates factors V and VIII

A

protein C

86
Q

pt w. protein C deficiency are at increased risk for _ on warfarin

A

skin necrosis

87
Q

tx for protein C deficiency

A

LMWH
DOACs fo life

no warfarin!

88
Q

vitamin K dependent anticoagulant that inactivates factors Va and VIIIa -> reduces thrombin

A

protein S

89
Q

tx for protein S deficiency

A

LMWH
DOAC fo life

90
Q

recurrent VTE/PEm repetitive intrauterine fetal death

A

antithrombin III deficiency

91
Q

what anticoagulant inhibits thrombin IIa and Xa

A

antithrombin III

92
Q

-autoimmune clotting d.o associated w. SLE
-thromboses and recurrent spontaneous abortions

A

antiphospholipid antibody syndrome

93
Q

antiphospholipid antibody syndrome involves _ mediated thrombosis

A

complement

94
Q

dx for antiphospholipid antibody syndrome

A

lupus anticoagulant
anticardiolipin
DRVVT test
prolonged PTT

95
Q

2 lymphomas to know

A

hodgkin
non hodgkin

96
Q

painless enlarged posterior cervical and supraclavicular lymph nodes (virchow’s nodes)

A

hodgkin’s lymphoma

97
Q

what are B symptoms associated w. lymphoma

A

fever
chills
night sweats

98
Q

CXR finding of hodgkin lymphoma

A

mediastinal adenopathy

99
Q

what is this showing

A

reed sternberg cells: abnormal multinucleated lymphocyte

hodgkin’s lymphoma

100
Q

immunocompromsed pt w. GI sx and painless peripheral LAD

A

non hodgkin lymphoma

101
Q

age distribution for hodgkin’s lymphoma

A

bimodal:
peaks in 20’s and 50’s

102
Q

bx findings of non hodgkin lymphoma

A

diffuse large B cells
T cell
natural killer cells

103
Q

lymph nodes associated w. non hodgkin’s lymphoma (6)

A

peripheral
axillary
abdominal
pelvic
inguinal
femoral

104
Q

B sx are common w. _ lymphoma
and uncommon w. _ lymphoma

A

common: hodgkin
uncommon: non hodgkin

105
Q

which lymphoma is associated w. EBV

A

hodgkin’s lymphoma

106
Q

malignancy of the bone marrow -> overproduction of RBC

can also increase platelets and WBC

A

polycythemia vera

107
Q

hallmark sx of polycythemia vera

A

pruritis after hot shower -> elevate histamines
swelling
burning pain
rubor of hands and feet (erythromelalgia)

108
Q

comorbidity associated w. polycythemia vera

A

gout

109
Q

4 h’s of polycythemia vera

A

hypervolemia
histaminemia
hyperviscosity
hyperuricemia

110
Q

dx for polycythemia vera

A
  1. positive jak2
  2. bone marrow bx
111
Q

lab elevations w. polycythemia vera (6)

A

RBC/hgb,hct
thrombocytes
leukocytes
B12
uric acid
histamine

112
Q

tx for polycythemia vera

A

-phlebotomies
goal: </= 42
-older pt: hydroxyurea
+/- ASA
+/- anagrelide: lowers platelets

113
Q

causes of secondary polycythemia (6)

A

altitude
COPD
sleep apnea
bloodletting
genetic
neoplasms (pheo, liver)

114
Q

important consideration in management of SSA pt

A

immunizations:
meningococcal
PNA
h.flu
influenza

115
Q

3 thrombotycopenias to know

A

ITP
TTP
HIS
DIC

116
Q

-autoimmune rxn to platelets
-insidious, chronic onset after viral infxn

A

ITP

117
Q

ITP is associated w. (4)

A

HIV
HCV
SLE
CLL

118
Q

lab findings of ITP

A

low platelets (CBC otherwise nl)
positive direct coombs

119
Q

tx for ITP

A

kids: supportive vs IVIG
adults: prednisone

120
Q

acute febrile dz involving multi organ thrombosis

A

thrombotic thrombocytopenia (TTP)

121
Q

lab findings of TTP

A

thrombocytopenia
anemia

122
Q

peripheral smear finding of TTP

A

schistocytes (RBC fragments)

123
Q

causes of TTP

A

quinidine
cyclosporine
pregnancy

124
Q

inhibition of what gene is associated w. TTP

A

ADAMTS13

125
Q

sx of TTP

A

FAT RN:
fever
anemia
thrombocytopenia
renal failure
neuro sx

126
Q

dx for TTP

A

-thrombocytopenia (CBC otherwise nl)
-schistocytes on smear
negative coombs

127
Q

tx for TTP

A

steroids
plasmaphoresis

128
Q

-what thromboytopenia is associated w. e.coli 0157:H7
-think diarrheal illness in kids

A

HUS

129
Q

presentation of HUS (4)

A

post e.coli or shigella
kids
anemia + thrombocytopenia
severe renal failure

130
Q

abnormal activation of coagulation sequene -> microthrombi throughout microcirculation -> low platelets, fibrin, and coag factors -> hemorrhage and thrombosis simultaneously

A

DIC

131
Q

5 causes of DIC

A

infxn
obtetric complications
trauma
malignancy
shock

132
Q

lab findings of DIC

A

decreased: platelets
increased:
bleeding time
PT/PTT
d dimer

133
Q

tx for DIC (4)

A

cryoprecipitate
FFP
platelet transfusion if < 30,000
LMWH

EOR - Emergency Medicine (13 decks)

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