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AG-ACNP Boards > Hematology > Flashcards

Hematology Flashcards

1
Q

What is a shift to the left with an increase overall WBC count?

A

Bandemia

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2
Q

What is pain profile of cluster headaches?

A

severe, unilateral periorbital pain occurring daily for several weeks around the eye

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3
Q

What are the complications of Enteral Nutritional Support aka Refeeding syndrome?

A

Hypo:
phosphatemia
kalemia
magnesemia
calcemia
thiamine deficiency

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4
Q

What are the causes of HYPOKALEMIA?

A
  1. Chronic use of diuretics
  2. GI loss
  3. Excess renal loss
  4. Alkalosis from DKA: increase in pH: decrease in K+ bc H+ leaves the cell & K+ enters the cell
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5
Q

What is the common reason for Hyponatremia (low Na) but increase serum osmolality?

A

Hyperglycemia usually from HHNK

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6
Q

What are NL Ca++ levels?

A

Total Ca++: 2.2 - 2.6 mmol/L
8.5 - 10.5 mg/dl
Ionized Ca++: 1.1 -1.4

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7
Q

How does pH affect Ca++?

A

Acidosis = increase ion Ca++
Alkalosis = decrease ion Ca++

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8
Q

How much CA++ is bound to albumin?

A

50%; therefore, NL Ca++ in low albumin levels suggest pt is HYPERcalcemic.

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9
Q

What are the causes of HYPER-kalemia?

A

drugs: i.e., NSAIDS
Excess intake
renal failure
hypoaldosteronism
cell death (apoptosis)

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10
Q

How much does K+ increase with each drop of pH?

A

K increases by 0.7 mEq/L with each 0.1 drop in potential hydrogen (pH)

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11
Q

What happens to K+ when acidosis occurs?

A

Shifts of intracellular K+ to the extracellular space occur with acidosis.

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12
Q

What are the EKG classic sign of HYPER-kalemia?

A

tall peaked T waves

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13
Q

What is the emergent tx for HYPER-K+? >6.5 mEq/L or cardiac toxicity or muscle paralysis?

A

Regular Insulin 10 U + one amp of D50 (pushes K+ into the cell)

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14
Q

What is the classic symptom of Respiratory Acidosis?

A

Myoclonus with asterixis

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15
Q

What are the s/sx of respiratory ALKALOSIS?

A
  1. Stocking/glove tingling
  2. Paresthesia
  3. light-headedness
  4. anxiety
  5. TETANY - if very severe
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16
Q

Causes of metabolic ACIDOSIS with INCREASED anion gap

A
  1. DKA
  2. Alcoholic ketoacidosis
  3. Lactic acidosis - trauma patients
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17
Q

Causes of metabolic ACIDOSIS with NORMAL anion gap

A
  1. Diarrhea - losing HCO3
  2. Ileostomy
  3. Renal tubular acidosis - RTA intra renal
  4. Recovery from DKA
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18
Q

What do you use if 0.9% Saline is contraindicated for tx of Metabolic ACIDOSIS?

A

Acetazolamide 250 - 500 mg IV every 4 -6 hours.

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19
Q

What are the 5 common infections affecting the adult from Streptococcus Pneumonia (S. Pneumoniae)?

A
  1. Sinusitis
  2. Meningitis
  3. Acute otitis media
  4. Bronchitis
  5. CAP
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20
Q

What are the s/s of acute organ rejection?

A
  1. Immediate organ failure
  2. Flu-like sx (i.e. fever, chills, malaise, etc.)

Tx: Immediate bx of the transplanted organ ASAP

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21
Q

What is the immediate action when herpes zoster is found in the ocular (eye)?

A

STAT referral to ophthalmologist - medical emergency bc can cause blindness

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22
Q

What are the most effective anti-rejection regiments for tranplant?

A

Triple therapy: 3 immunosuppressants from different classes:

  1. CORTICOSTEROIDS: steroids

Ex: Methylprednisolone or
Prednisone (Deltasone, Orasone, Meticorten)

                                      AND
  1. ANTIMETABOLITE: antiproliferative agents
    maintenance immunosuppressantsEx: Azathioprine (Imuran),
    Mycophenolate mofetil (Cellcept), or
    Mycophenolate sodium (Myfortic), or
    Cyclophosphamide (Cytoxan).
                                            AND
  2. Mammalian Target of Rapamycin (mTOR) inhibitorEx: Sirolimus (Rapamune), t
    Temsirolimus (Torisel),
    Everolimus (Afinitor).
                                     OR
  3. Calcineurin inhibitors:Ex: Tacrolimus (Prograf) or
    Cyclosporine (Sandimmune, Neoral, Gengraf).
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23
Q

What is the drug of choice for post-herpetic neuralgia?

A

Gapapentin (Neurotin) or Pregabalin (Lyrica)

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24
Q

What is the recommended Shingrix vaccine?

A

All adults > 50 y.o., regardless of previous shingles vaccine - 2 doses
2nd dose given 2 - 6 months after the initial dose

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25
Q

Name the End-Of-Life terminal extubation considerations.

A
  1. Family: prepartation, education, support
  2. MSO4 or another opioid: tx tachypnea and respiratory distress
  3. Scopolamine patches behind the ear or SL atropine otic drops under the tongue to reduce excessive secretions
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26
Q

What is anemia of chronic disease?

A

normo - cytic,
normo - chromic

from inflammation, infection, renal failure, and malignancy, DM

Tx: underlying cause

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27
Q

What are the lab values for anemia of chronic disease?

A

Normo - cytic [MCV NL]

normo - chromic [MCHC NL]

LOW serum iron/TIBC

serum ferritin HI > 100 ng/mL

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28
Q

What is Thalassemia major (Cooley’s anemia)?

A

2 genes for beta-thalassemia and NO normal beta-chain gene:
a. HOMOZYGOUS for beta thalassemia
b. causes striking deficiency in beta chain production and production of Hb A

Normal presentation at birth bc protective effects of fetal Hgb

Anemia develops w/in first few months of life and becomes progressively worse/severe.

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29
Q

What are the lab findings for Cooley’s anemia?

A

low Hgb
low MCV: microcytic
low MCHC: microchromic
NL TIBC
NL Ferritin
low alpha/beta Hgb chains

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30
Q

Tx for Cooley’s anemia?

A

No tx for mild or moderate forms

RBC transfusion/splenectomy for severe forms

Iron is CONTRAINDICATED as iron overload can result

Prenatal genetic testing of parents - if desired

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31
Q

Which anemia has neurological signs?

A

Pernicious Anemia - malabsorption of B12

Serum B12 < 200 pg/mL

Anti-IF (intrinsic factor) and anti-parietal cell antibody test

MCV increased

Hgb/Hct/RBC’s low/decrease

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32
Q

What is the tx for pernicious anemia?

A

B12 - cyanocobalamin 100 mcg IM daily x 1 week
Monthly administration for maintenance

33
Q

S/sx of pernicious anemia

A

weakness
glossitis
palpitations
dizziness
anorexia
paresthesia
loss of vibratory sense
loss of fine motor control
+ romberg
+ babinski

34
Q

What is folic acid deficiency?

A

Inadequate intake/malabsorption of folic acid ( needed for RBC production)

35
Q

s/sx of folic acid deficiency

A

fatigue
DOE
pallor
HA
tachycardia
anorexia
glossitis
NO NEUROLOGICAL signs

36
Q

lab values for folic deficiency

A

MACRO cytic
NL MCHC normo chromic
decrease serum folate
RBC folate < 100 ng/m

37
Q

Tx for folic acid deficiency

A

Folate 1 mg orally every day
Eat foods HI in folate:
banana
peanut butter
fish
green leafy veggies
iron-fortified breads/cereals

38
Q

ETOH abusers will present with folic acid deficiency. What is the tx?

A

Administer thiamine (B1), folic acid and banana bag

39
Q

What is Von Willebrand factor?

A

Genetic disorder: mutation of deficiency in von Willebrand factor/clotting factor VIII

40
Q

s/sx of Von Willebrand factor?

A

frequent prolonged or severe episode of bleeding
easy bruising

41
Q

Tx for Von Willebrand factor

A

desmopressin, recombinant van Willebrand Factor (vWF)/ factor VIII concentrate

42
Q

What are leukemias?

A

Neoplasms arising from hematopoietic cells in the bone marrow

43
Q

Hallmark of Acute Myelogenous Leukemia (AML)

A

80% OF acute leukemias in adults
remission rates from 50% to 85%
long term survival rates appx 40%

44
Q

Hallmark of Acute Lymphocytic Leukemia (ALL)

A

90% remission in children
PANCYTOPENIA with circulation blasts

45
Q

Gold standard or diagnostic test for abnormal Hgb, i.e.,:
1. Alpha or Beta Thalassemia
2. sickle cell

A

Hgb electrophoresis

46
Q

Gold standard or diagnostic tool for Temporal arteritis

A

Biopsy of the temporal artery & refer to ophthalmologist for management

47
Q

NL Hgb males

A

14 - 17.4 g/dL

48
Q

NL Hgb females

A

12 - 16 g/dL

49
Q

NL Hct males

A

42 - 52 %

50
Q

NL Hct females

A

36 % - 48%

51
Q

NL MCV

A

80 - 100 fL

52
Q

NL RDW (red cell distribution width)

A

> 14.5%
elevated RDW is indicative of IDA

53
Q

Plt count at risk for bleeding

A

<14, 000 (ITP)

54
Q

What is the NL values for recticulocytes?

A

0.5% - 1.5% of red cells (Increase acute bleeds),

starting tx for Vitamin deficiencies ( iron, B12, folate)

acute hemolytic episodes

55
Q

NL WBC

A

4,500 - 11,000 (increase bacterial infections)

56
Q

What causes an increase in neutrophils or segs?

A

> 50% (increase bacterial infections)

57
Q

What is the % increase of Band forms (immature WBCs) in bandemia?

A

> 6% (increase severe bacterial infections)
aka shift to the left

58
Q

What causes an increase in eosinophils?

A

> 3% (increase allergies, intestinal parasites)

59
Q

What are the s/sx of Thalasemia major (Cooley’s anemia)?

A

a. Failure to thrive
b. Feeding difficulties (d/t easy fatigue and lack of O2)
c. bouts of fever
d. diarrhea
e. hepatosplenomegaly and jaundice
f. maxillary enlargement

60
Q

Hallmark of Chronic lymphocytic leukemia (CLL)

A

Lymphocytosis

61
Q

Hallmark of Chronic Myelogenous leukemia (CML)

A

occurs in > 40 y.o.
survival rate: 65% alive in 5 years
Philadelphia chromosome.

62
Q

What is the management for leukemias?

A

Chemotherapy
- Initiate allopurinol to reduce tumor lysis syndrome in high risk patients

Bone marrow transplant

Control symptoms

63
Q

What confirms dx of leukemia?

A

Bone marrow aspiration

64
Q

What lab values are found in tumor lysis syndrome?

A

hyperuricemia - causes renal failure

hyper K+

hyper PO4

hypo Ca++

65
Q

What is stage I lymphoma?

A

dz localized to single lymph node or group

66
Q

What is stage II lymphoma?

A

More than one lymph node group

confined to one side of the diaphragm

67
Q

What is stage III lymphoma?

A

Both side of diaphragm

spleen involvement

68
Q

What is stage IV lymphoma?

A

Liver or bone marrow involvement.

69
Q

What are the characteristics of Non-Hodgkin’s Lymphoma?

A

Cause is unknown, possible VIRAL etiology.

less predictable pattern of spread than Hodgkin’s disease

Most common neoplasm in young adult: 20 & 40 yrs

Spike of incidence in age 57

Advanced stage dz is usually apparent

70
Q

What is the characteristic of Hodgkin’s dz?

A

Cause unknown

Reed Sternberg cells

More common in males age: 32

Presents with cervical adenopathy and spreads in a predictable fashion along lymph node groups

71
Q

What laboratory/dx to test for Hodgkin’s dz?

A

CT
Xrays
US
MRI used to locate and stage the dz

Bx and histopathologic examination confirm dx

72
Q

What is the management of Non/Hodgkin’s dz?

A

Radiation
Chemotherapy
Bone marrow transplantation

73
Q

What is NL range for plateletes?

A

150,000 - 450, 000

74
Q

How to differentiate ITP from SLE?

A

Bone marrow analysis

75
Q

What two drugs are used to reverse HIT?

A

Argatroban

Lepirudin

76
Q

What is DIC?

A

An acquired coagulation disorder which results from the intravascular activation of both the coagulation and fibrinolytic systems, causing simultaneous thrombosis and hemorrhage; mortality rate is 50% - 80%.

Lab:
- Thrombocytopenia
- HI PT/PTT
- HI FDP

Seen in:
- severe cases of septic shock

77
Q

What is the reason for cryoprecipitate transfusion?

A

to maintain FIBRINOGEN levels

78
Q

What is the reason for FFP transfusion?

A

to replace clotting factors

79
Q

What is the reason for platelet transfusion?

A

for thrombocytopenia

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