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Internal Medicine Board Exam > Hematology > Flashcards

Hematology Flashcards

1
Q

Jak2 V617F mutation that have essential thrombocytopenia, what is the best treatment regimen?

A

Aspirin and Hydroxyurea

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2
Q

What heme/onc medication can reduce neutrophils?

A

Methotrexate

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3
Q

IgG monoclonal antibody spike, everything else is normal, what else should be done?

A

Nothing, observation, MGUS, no follow up testing required.

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4
Q

Sickle cell patient needs gallbladder removal, what should be the hemoglobin goal?

A

Pre-surgery, hemoglobin above 10

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5
Q

A patient has parvo-virus s/p chemo, and she is a Kindergarten teacher. What is the next best treatment if reticulocyte count is low?

A

IV immunoglobulin

Parvovirus can lead to red cell aplasia

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6
Q

If a patient has CAD and a GI bleed, they take Plavix and aspirin on a routine basis. Hemoglobin 10, platelets are wnl. What should be next best step?

A

Hold plavix, give ASA, call cardiology

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7
Q

If a patient has a normal hemoglobin electrophoresis, a thalassemia is suspected, what is the most likely concern?

A

Alpha Thalassemia

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8
Q

C282Y, H63D, and 65C mutations are the most common mutations with what liver pathology?

A

Hemochromatosis

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9
Q

If all three cell lines are low, no blast cells are seen, what is the most likely heme pathology?

A

Myelodysplastic Syndrome

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10
Q

What is a very common cause of neutrophilia?

A

Chronic Smoking

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11
Q

Superficial vein thrombosis usually has AC treatment for how long?

Superficial vein thrombosis greater than 5cm should have treatment for how long?

A

6 weeks

3 months

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12
Q

If a patient has an elevated INR less than 10 and they are asymptommatic, what should be done?

A

Watch and wait

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13
Q

If a patient has an elevated INR greater than 10 and no bleeding, what should be given?

A

Vitamin K

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14
Q

If a patient has an elevated INR greater than 10 and bleeding, what should be given?

A

Vitamin K and Kcentra (4-factor prothrombin complex concentrate)

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15
Q

If a patient has unexplained ITP, what are the first things to test for?

A

Hep C and HIV

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16
Q

Pediatric Leukemia patients that have had treatment are at an increased risk of what?

A

Diabetes Mellitus and HLD

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17
Q

If a patient is starting chemotherapy, what should be given to them to maintain neutrophil count?

A

Granulocyte-CSF, helps preserve WBC count

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18
Q

Warm autoimmune hemolytic anemia obscures detection of what?

A

Alloantibodies, complicating identification of compatible donors

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19
Q

Warm autoimmune hemolytic anemia, how does one eliminate antibody production?

A

Glucocorticoids and Rituximab

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20
Q

A patient has hereditary spherocytosis, mild symptoms, what should be done?

Severe Symptoms, what should be done?

A

Folate

Splenectomy

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21
Q

If a patient has a central venous catheter placed, clot forms, and the central venous catheter is still functioning, what should be done?

A

Keep the central venous catheter in place, and AC for three months

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22
Q

If a patient is low risk and he has multiple subsegmental PE, what should be done?

A

D/C home with Rivaroxaban

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23
Q

A patient has G6PD deficiency, no acute symptoms, what is the best treatment course?

A

Symptom management

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24
Q

Are steroids used in DIC treatment?

What is the treatment?

A

No

Treat the underlying cause

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25
Q

A patient has platelets less than 50, what should be done?

If a patient requires a platelet transfusion, how much should the platelet count go up?

A

Transfusion

Should go up 20,000 to 30,000

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26
Q

A bone marrow biopsy shows marked hypocellularity, increased fat content without dysplastic cells, hepatitis is negative, what is this?

What is the treatment?

A

Aplastic anemia

If an HLA match is available and less than 50, should have a stem cell transplant

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27
Q

What is the aplastic anemia treatment for older than 50, no suitable stem cell donor?

A

Immunosuppression with antithymocyte globulin, cyclosporine, and prednisone

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28
Q

What is the drug Azacytidine or other hypomethylating agents are used to treat what?

A

Treat symptomatic

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29
Q

Antiphospholipid syndrome has what unique clotting pattern?

A

Arterial and Venous embolism

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30
Q

What is the drug of choice for antiphospholipid syndrome??

A

Warfarin, should start with heparin first

Particularly triple positive lupus patients

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31
Q

A patient takes a macrolide and has hemolytic anemia. What is the best test to run?

A

Cold agglutin Titer

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32
Q

Thrombocytopenia and microangiopathic hemolytic anemia, easy bruising, what is the best initial treatment?

A

Plasma Exchange, Glucocorticoids, and Rituximab

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33
Q

What enzyme is missing in the TTP?

A

ADAMS13

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34
Q

If a patient has a PESI score of 1 with a pulmonary embolism, what is the best treatment?

A

Apixaban or Elliquis

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35
Q

In a patient with an unprovoked DVT, how long should the treatment course be?

A

3-6 months, can be reduced after a discussion

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36
Q

Does pregnancy naturally have an elevated D-dimer?

What scoring criteria is used to evaluate if a pregnant woman should undergo radiological testing?

A

Yes

YEARS algorithm

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37
Q

Transfusion-associated circulatory overload occurs when?

What is it?

A

6 hours

Respiratory Distress, positive fluid balance, pulmonary edema

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38
Q

How is the difference between Gestational Thrombocytopenia and ITP found?

A

Gestational Thrombocytopenia: later in pregnancy, platelets around 100,000

ITP: Early in pregnancy, platelets around 70,000

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39
Q

A sickle cell patient with fever, hypoxia, chest pain, and pulmonary edema, would benefit from what treatment?

A

Erythrocyte Exchange Transfusion

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40
Q

Platelet Transfusion does not normally occur in thrombocytopenia unless the patient is bleeding and below what number?

A

10-20k

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41
Q

If a patient has platelets less than 30k and no active bleeding, what treatment is indicated?

A

Steroids

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42
Q

Hemophilia A has what inheritance pattern?

Who will be affected?

A

X-linked recessive

men only are affected, women are asymptomatic

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43
Q

If a patient is undergoing Multiple Myeloma Treatment with proteasome inhibitors, what other medications should be given?

A

Valacyclovir, helps any viral/varicella reactivation occurrence

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44
Q

Patients with unexplained splanchnic vein thrombosis, what should be tested?

A

JAK2 mutation

45
Q

Normocytic anemia, what are the next best tests to order?

A

Reticulocyte Count and peripheral blood smear

46
Q

The first step in evaluating thrombocytopenia is what?

A

Peripheral Blood Smear

47
Q

Immune Mediated hemolysis is detected by what?

A

Positive Direct antiglobulin test

48
Q

If a patient has a chemoradiation due to breast cancer, and they have myelodysplastic syndrome. What is the next best test?

A

Bone Biopsy

49
Q

Hydroxyurea treatment can inadvertently cause what?

A

Macrocytic Anemia

50
Q

AML in a 79 year old woman, she responds well to induction therapy, what is the next best consolidation therapy step?

A

Allogenic Hematopoietic Stem Cell Transplantation

51
Q

Patient most likely has Heparin Induced Thrombocytopenia, what is the next best treatment step? Assuming she needs to be anticoagulated

A

Start Rivaroxaban

52
Q

Polycythemia Vera, patient under 60, and low risk, what should be done?

Polycythemia Vera, patients over 60, and high risk, what should be done?

A

Low Risk patient: Low Dose Aspirin and phlebotomy

High Risk patient: Hydroxyurea or IFN-alpha, and phlebotomy

53
Q

Before starting chemotherapy and managing VTE, what should be done to assess the need for DVT prophylaxis?

A

Khorana Score

54
Q

Dabigatran causes a large hemorrhagic bleed, what is the reversal agent?

A

Idarucizumab

55
Q

A whole-body low-dose CT scan is negative for smoldering myeloma, what is the next best step?

A

Whole Body MRI

56
Q

Elevated IgM, hyperviscosity, difficulty with vision, fever, night sweats, weight loss, what is the next treatment step?

A

Plasmapharesis

57
Q

B-thalassemia patients should be heavily monitored for what?

A

iron overload

58
Q

All multiple myeloma patients should have what treatment done?

A

Pneumococcal Vaccination

59
Q

Anemia of chronic disease, what is the best treatment course?

A

Reverse the original cause and give steroids

60
Q

In liver disease vs. DIC, what clotting factor should be measured?

A

Factor VIII

61
Q

Amyloidosis can be confirmed by a biopsy located where?

A

Abdominal Fat Pad

62
Q

Elevated aPTT, what is the best step to evaluate the cause?

A

Mixing Study

63
Q

Warm autoimmune hemolytic anemia is best detected how?

A

Positive Direct antiglobulin test that detects IgG and C3

64
Q

A patient receives chimeric T cell therapy, patients with a high disease burden may develop what?

A

Cytokine Release Syndrome

65
Q

Proximal Deep venous clot treatment with ESRD on dialysis, is what?

A

Apixaban (Eliquis), lowest renal elimination

Rivaroxaban is eliminated through the kidneys

66
Q

What is this?

A

Iron Deficiency Anemia

67
Q

What is this?

A

Normal Heme Path Slide

68
Q

What is this?

A

Normal packed RBCs

69
Q

What is the black arrow pointing at?

A

Iron deficiency anemia

70
Q

What two pathologies are on this slide?

A

Target Cell and Thalassemia

71
Q

What is this?

A

Warm IHA

72
Q

Autoimmune, lymphoproliferative disorders, B-cell non-Hodgkin lymphoma, and drug induced problems can cause what type of anemia?

A

Warm Autoimmune Hemolytic anemia

73
Q

Here/Onc: Autoimmune, what process is typically infectious?

A

Cold Autoimmune Hemolytic Anemia

74
Q

Cold agglutinin disease can be treated how?

A

Rituximab

75
Q

CLL, what feature (Path slide) will be there for a diagnosis?

A

Smudge Cell

76
Q

What is this?

A

CLL

77
Q

What is this? What is the distinguishing feature?

A

CLL, smudge cell

78
Q

What is this?

A

ALL, note, no myeloid or granules in the picture

79
Q

What is this?

A

Multiple Myeloma

80
Q

What is this?

A

AML, look at the auer rods

81
Q

What is this?

A

CML

82
Q

What cell shows up in a CML smear slide?

A

Basophils are heavy, slide will show multiple different myelocyte phases

83
Q

What is this?

A

TTP, low platelet with AIHA

84
Q

What is this?
What are the black arrows pointing at?

A

Schistocytes

85
Q

What is this? What can be see on the pathology slide?

A

ITP, no platelets around

86
Q

What is this?

A

Essential Thrombocytosis

87
Q

Increased reticulocyte count (RI > 2%), increased LDH, decreased haptoglobin, increased indirect bilirubin, what is this?

A

Hemolytic Anemia

88
Q

Extravascular hemolytic anemia has what issue?

A

Splenomegaly

89
Q

What syndrome has acquired clonal stem cell disorder, inactivating somatic mutation of PIG-A gene deficiency of GPI-anchor fo CD55 and CD59, pooor complement inhibition?

A

Paroxysmal nocturnal hemoglobinuria (PNH)

90
Q

What is one of the treatments for paroxysmal nocturnal hemoglobinuria?

A

Eculizumab

91
Q

Paroxysmal nocturnal hemoglobinuria is what type of hemoglobin disorder?

A

Myelodysplastic Syndromes

92
Q

G6PD has what issue?

A

X-linked defect of metabolism, susceptibility to oxidative damage

93
Q

Sulfonamides
Dapsone
Nitrofurantoin
Rasburicase
Primaquine
Doxorubicin
Methylene Blue
INFX, DKA, fava beans can cause what?

A

G6PD Deficiency

94
Q

Bite Cells show up in what problem?

A

G6PD Deficiency

95
Q

Sickle Cell, what can be given to prevent a pain crisis?

A

L-glutamine

96
Q

Sickle Cell, pain, and vaso-occlusive crises, what is the =mab?

A

Crizanlizumab

97
Q

What type of infections are particularly scary with sickle cell?

A

Osteomyelitis, encapsulated organisms

98
Q

Hereditary Spherocytosis has a defect in what?

A

Ankyrin, alpa and beta spectrin, band 3

99
Q

Osmotic Fragility Test and low Eosin-5-maleimide binding is code for what hematology problem?

A

Hereditary Spherocytosis

100
Q

Warm Autoimmune Hemolytic Anemia is caused by what?

A

Idiopathic, CLL, NHL (Non-hodgkin lymphoma), autoimmune (SLE), HIV, Babesiosis, and drugs

101
Q

Cold Autoimmune Hemolytic Anemia is caused by what?

A

Intravascular hemolysis and acrocyanosis, Lymphoprolif. disorders (Waldenstroom’s monoclonal), Mycoplasma Pneumoniae and EBV

102
Q

Warm AIHA treatment is what?

A

Corticosteroids, splenectomy, IVIG, Cytotoxic agents, rituximab

103
Q

Cold AIHA treatment is what?

A

Corticosteroids and rituximab

104
Q

Low ADAMTS13 is code for what disease?

A

Thrombotic Thrombocytopenic Purpura (TTP)

105
Q

Burr cell (Echinocytes) is seen in what disease?

A

Uremia and MAHA

106
Q

Acanththocytes (Spur cells) are seen in what disease?

A

Severe Liver Disease

107
Q

Target cells are seen in what 3 diseases?

A

Liver Disease, Thalassemia, HbC disease

108
Q

Tear Drop RBCs with nucleated RBCs and immature WBCs, a dry tap is seen most times, time course is a few months?

A

Primary Myelofibrosis

109
Q
A

Internal Medicine Board Exam (18 decks)

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