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RITE/PSBIM review > Hematology > Flashcards

Hematology Flashcards

1
Q

Protein most responsible for iron transport in plasma

A

Transferrin

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2
Q

Protein that represents an indirect measure of total body iron stores

A

Ferritin

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3
Q

Iron supplements should be taken in an empty or full stomach?

A

Empty since food inhibits iron absorption

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4
Q

After iron supplementation, reticulocyte begin to increase in how many days

A

4-7 days , peak at 1-1/2 weeks

Tx must be sustined for 6-12 months

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5
Q

When do you transfuse blood for IDA?

A

reserved for symptomatic anemia, cardiovascular instability and continued and excessive blood loss and who require immediate intervention

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6
Q

Formula for amount of iron needed by an individual patient

A

Body weight x 2.3 x (15-px hb in g/dL) + 500 or 1000 for iron stores

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7
Q

Pathogenic changes in the ____ protein can cause spherocytosis

A

Ankyrin

whereas changes in junctional complexes = elliptocytosis

Stomatocytosis= abnormalities of channel molecules

Other notes: anemia of hereditary spherocytosis is usually NORMOcytic

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8
Q

When do you advocate for splenectomy in patients with hereditary spherocytosis

A

Mild - avoided
Moderate - delayed until puberty
Severe - 4-6 yrs of age

must vaccinate against encapsulated organisms BEFORE splenectomy

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9
Q

Most typical feature of G6PD deficiency on blood film

A

Poikilocytes

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10
Q

Expected levels of the following in G6PD deficiency

Hemoglobin
LDH
Haptoglobin

A

Decreased hemoglobin due to hemoglobinuria

Hig LDH due to hemolysis

Low to absent haptoglobin because haptoglobin binds free hemoglobin hence low in intravascular hemolysis

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11
Q

Tx for acute hemolytic anemia in G6PD deficiency

A

No specific tx unless severe which may require transfusion

If there is acute renal failure, HD may be necessary

If with chronic non severe hemolytic anemia, regular folic acid supplements and surveillance will suffice

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12
Q

Next line of tx when steroids do not improve autoimmune hemolytic anemia

A

Rituximab

If very rare and severe refractory case, may need high dose cyclophosphamide OR anti CD52 Alemtuzumab

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13
Q

Predictors or probability of relapse of autoimmune hemolytic anemia (AIHA)

A

Severe anemia (Hb <6 g/dL)
Certain characteristics of Ab
Acute renal failure
infection

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14
Q

Which presents as chronic and indolent : cold agglutinin dse or warm AIHA ?

A

Cold

C= chronic

No predominance of spleen in Cold agglutinin dse

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15
Q

First line tx for cold agglutinin dse

A

Rituximab

Prednisone and splenectomy = NOT effective

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16
Q

Poisoning from which susbance is associated with Burton’s line?

A

Lead poisoning

Burton’s lie = bluish pigmentation of gum tooth line

Also assoc with basophilic stippling

so mga assoc with blue = lead

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17
Q

Paroxysmal nocturnal hemoglobinuria is due to deficiency of what surface proteins?

A

CD 59 and 55

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18
Q

Tx for PNH

A

Allogeneic transplant - defiinitive

Eculizumab for INTRA not extravascular hemolysis

do NOT give steroids- no effect on chronic hemolysis

Any px with venous thrombosis should be on anticoag prophy

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19
Q

How does pernicious anemia cause cobalamin deficiency?

A

anti IF antibodies decrease the availability of IF that binds to cobalamin

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20
Q

How does ZES cause cobalamin deficiency?

A

Inc acid causes inactivation of trypsin resulting in failure to release cobalamin from R binding protein

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21
Q

How does GVHD cause cobalamin deficiency?

A

Malabsorption of cobalamin due to abnormal gut flora and ilealmucosa damage

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22
Q

Characteristic peripheral blood smear pattern of thalassemia

A

Target cells

Another way of differentiating thalassemia from IDA is that IDA has low ferritin and obv low iron

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23
Q

Most common hypoproliferative anemia

A

IDA

next: anemia of inflammation

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24
Q

Mechanism most contributory to anemia in px with CKD

A

Dec EPO and reduction in red cell survival

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25
Q

First line for severe aplastic anemia

A

HSCT

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26
Q

Only tx that offers a chance of cure for MDS

A

HSCT

However due to significant tx related mortality and morbidity that increases with recipient age, only small proportion undergo this

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27
Q

The only symptoms that would differentiate polycthemia vera from other causes of erythrocytosis

A

Aquagenic pruritus
Erythromelalgia

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28
Q

1st step in the evaluation of elevated hemoglonin

A

Measure RBC mass

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29
Q

What would you consider when px has elevated rbc mass and low hb

A

Polycthemia vera

Confirm JAK2 mutation

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30
Q

Next step when px has elevated hb, rbc mass and elevated EPO

A

Measure arterial o2 sat

If low: diagnostic eval for heart or lung dse
if normal: ask if smoker or not.
If smoker: measure carboxyhemoglobin levels.

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31
Q

Next step when px has elevated hb, rbc mass and elevated EPO, NON smoker and has normal hemoglobinaffinity

A

Search for tumor as source of EPO

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32
Q

Maintaining hemoglobin and hematocrit in polycythemia vera

A

<=14 g/dL and <45% in men
<=12g/dL and <42% in women

1445
1242

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33
Q

Tx for symptomatic splenomegaly in polycythemia vera

A

Ruxolitinib - a JAK 2 inhibitor

PEG IFN a is an alternative

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34
Q

How does survival of px with essential thrombocytosis compare with general population

A

Same

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35
Q

Major hormone regulator of plt production

A

Thrombopeitin

synthesized primarily in the liver parenchymal cells

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36
Q

Most common cause of NON iatrogenic thrombocytopenia

A

Infection

if iatrogenic –> medications

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37
Q

deficient protease in TTP

A

ADAMTS13

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38
Q

What constitutes TTP pentad

A

CNS symptoms, fever, renal failure, MAHA, thrombocytopenia

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39
Q

Mainstay of tx for TTP

A

TPE

therapeutic plasma exchange

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40
Q

Primary tx for HUS

A

Supportive

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41
Q

Target of antibodies that cause HIT

A

PF4 and heparin/ other GAG

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42
Q

Risk of developing HIT is highest after exposure to heparin for ______ days

A

5-14

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43
Q

Most common inherited bleeding disorder

A

von willebrand dse

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44
Q

what constitues ISTH scoring for DIC

A
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45
Q

central mechanism of DIC

A

uncontrolled generation of thrombin

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46
Q

Butt cells with auer rods in PBS is seen in what condition

A

Acute promyelocytic leukemia

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47
Q

Cases in which whole blood may be transfused

A

massive blood loss and coagulopathy
trauma casualties requiring massive transfusion
hemorrhagic shock
neonatal exchange transfusion

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48
Q

Hemoglobin transfusion thresholds for the ff
hemodynamically stable
preexisting cardiovascular disease
acute coronary artery dse

A

hemodynamically stable <7 (except for px undergoing orthopedic/cardiac surgery)

preexisting cardiovascular disease <8

acute coronary artery dse <9-10

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49
Q

Platelet transfusion thresholds for the ff:
Absence of fever or infection
With fever or infection
For surgery, with DIC or other invasive procedure
Neurosurg/ eye surgery

A

Absence of fever or infection <=5

With fever or infection <= 10-20

For surgery, with DIC or other invasive procedure <= 50

Neurosurg/ eye surgery <=80

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50
Q

Indications for FFP transfusion

A

Multiple coag factor deficiencies or DIC
Single coag factor def when factor replacement is NOT available
Trauma casualties with >30% blood loss
SEVERE bleeding due to warfarin OR taking warfarin for emergent surgery

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51
Q

Cause of febrile non hemolytic transfusion rxn

A

Anti HLA antibodies and cytokines released from leukocytes in non leukoreduced blood

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52
Q

Cause of acute hemolytic transfusion rxn

A

preformed antibodies that lyse donor erythrocytes

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53
Q

Cause of DELAYED hemolytic transfusion rxn

A

Sensitization to RBC alloantigens

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54
Q

Cause of allergic rxns during blood transfusion

A

plasma proteins

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55
Q

Cause of GVHD during blood transfusion

A

donor T lymphocytes that attack host HLA antigens

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56
Q

What should be given in pregnant px with Rh neg blood transfused with Rh positive blood to prevent allosensitization

A

Anti D Ig

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57
Q

Treatment for TRALI

A

supportive

may occur within 6 hrs although delayed cases may occur up to 72h later

58
Q

Recipient risk factors assoc with inc risk of TRALI

A

Smoking, chronic alcohol use
Shock
Liver and cancer surgery
Mech vent
positive fluid balance

59
Q

Definition of massive transfusion

A

Transfusion of 50% of the patient’s total blood volume over 3 hrs OR

> 5-10 units of RBC

60
Q

What diagnostic tests can be requested to assess for iron overload

A

Serum ferritin
MRI
Liver biopsy

61
Q

Alemtuzumab is a an anti CD ___

A

52

** marami akong alam. 52 ang alem ko

62
Q

Blinanutumab is a an anti CD ___

A

19

63
Q

Rituximab is a an anti CD ___

A

20

64
Q

Moxetumumab is a an anti CD ___

A

22

65
Q

Brentuximab is a an anti CD ___

A

30

bRENTuximab - tRENTa

66
Q

Mechanism of action of Bevacizumab

A

inhibits VEGF to block angiogenesis

67
Q

Mechanism of action of Denosumab

A

RANK ligand inhibitor

68
Q

Mechanism of action of Everolimus

A

mTOR inhibitor

69
Q

Mechanism of action of Venetoclax

A

inhibtis Bcl-2

70
Q

Cardioprotectant that may be given with doxorubicin

A

Dexrazoxane

71
Q

Most feared pulmonary complication of bleomycin

A

Pulmonary fibrosis

Earliest indicator of adverse effect is a dec in DLCO or coughing

72
Q

Dose of doxorubicin assoc with cardiomyopatht

A

> 550 mg/m2

73
Q

Dose of bleomycin that inc incidence of pulmo fibrosis

A

> 300 cumulative units

minimally responsive to glucocorticoids

74
Q

MOA of renal toxicity of methotrexate

A

from crystallization in renal tubules

75
Q

Mesna lessens toxicity of which chemo agent

A

Cyclophosphamide

76
Q

Treatment for acute promyelocytic leukemia

A

ATRA

assoc with t(15;17) chromosomal tanslocation

77
Q

Supportive tx of choice for nausea and vomiting for high riskagents

A

Serotonin antagonisis (eg. odansetron) and neurokinin 1 antagonists (aprepitant)

78
Q

Plerixafor blocks what receptor

A

CXCR4

79
Q

most commonly mutated oncogene in cancers

A

RAS

80
Q

Trisomy 21 inc or dec risk of AML?

A

inc

81
Q

Genetic abnormalities when present will classify a patient to have AML regardless of marrow blast count %

A

t (15;17)
t (8;21)
inv(16)
t (16;16)

otherwise, need blast count >=205

82
Q

Most impt prognostic factor that predict outcome of AML

A

Chromosome and molecular investigations

83
Q

Most common PE finding in CML

A

Splenomegaly

84
Q

Most common symptom of myeloma

A

Bone pain

affecting nearly 70% of px

85
Q

Criteria for initiation tx for CLL

A

Watchful waitng for most px except if with the ff

86
Q

Single most powerful predictor of survival in myeloma

A

Serum beta 2 microglobulin

can also substitute for staging

87
Q

Criteria for diagnosis solitary plasmacytoma

A

> Biopsy-proven solitary lesion of bone or soft tissue with evidence of clonal plasma cells
Normal bone marrow with no evidence of clonal plasma cells
Normal skeletal survey and MRI (or CT) of spine and pelvis (except for the primary solitary lesion)
Absence of end-organ damage such as hypercalcemia, renal insufficiency, anemia, or bone lesions (CRAB) that can be attributed to a lymphoplasma cell proliferative
disorde

88
Q

Criteria for dx multiple myeloma

A

> Clonal bone marrow plasma cells or biopsy-proven bony or extramedullary plasmacytoma
and any one or more of the following myeloma-defining events:
1.) Evidence of one or more indicators of end-organ damage that can be attributed to the underlying plasma cell proliferative disorder, specifically:
a. Hypercalcemia: serum calcium >0.25 mmol/L (>1 mg/dL) higher than the upper limit of normal or >2.75 mmol/L (>11 mg/dL)
b. Renal insufficiency: creatinine clearance <40 mL/minb or serum creatinine >177 μmol/L (>2 mg/dL)
c. Anemia: hemoglobin value of >20 g/L below the lower limit of normal, or a hemoglobin value <100 g/L
d. Bone lesions: one or more osteolytic lesions on skeletal radiography, CT, or PET-CTc
e. Any one or more of the following biomarkers of malignancy:
* Clonal bone marrow plasma cell percentage
≥60%
* Involved: uninvolved serum free light chain ratio ≥100
* >1 focal lesion on MRI studies

89
Q

What class of drugs do bortezomib, carfilzomib and ixazomin belong to

A

Proteoseoe inhibitors

90
Q

Class of drug: Panobinostat

A

Histone deacetylase inhibitor

tx for myeloma

91
Q

Class of drug: Selinexor

A

Selective inhibitor of nuclear export (SINE)

tx for myeloma

92
Q

An MCHC > ___ on ordinary blood count should raise suspicion of hereditary spherocytosis

A

34

93
Q

PNH is an acquired mutation of ___ gene

A

PIG-A gene

94
Q

Most common early symptom of aplastic anemia

A

bleeding

95
Q

Thalidomide derivative that is effective in reversing anemia of MDS with 5q- syndrome

A

Lenalidomide

96
Q

Nilotinib is not recommended in this subset of px

A

DM px on insulin

higher rates of hyperglycemia 10-20%

97
Q

Optimal TKI if with T315I mutation

A

Ponatinib

98
Q

Typical immunophenotype of B cell lymphomas would test positive for these markers

A

CD 19, 20,23
CD 5 (although this is a T cell marker)

99
Q

What is Richter’s transformation

A

Transformation of CLL to more aggressive lymphoma eg. DLBCl

100
Q

Most sensitive test for DIC level

A

FDP

101
Q

These are seen in what disease conditions?

A

Thalassemia and liver dse

102
Q

A patient presents at the outpatient clinic with pallor. An initial blood count done in their barangay diagnostic center is as follows: Hgb 7.5g/dL, Hct 20%, reticulocyte count 15%. Which of the following is a likely possible cause of the anemia based on the given data?
A. Intravascular hemolysis
B. Myelodysplasia
C. Renal disease
D. Thalassemia

A

A. Intravascular hemolysis

since reticulocyte index is > 2.5 or high in px with hemorrhage/hemolysis

103
Q

Which of the following is the most common mechanism of acquired neutropenias?
A. Bone marrow invasion by solid/ hematologic malignancies
B. Decreased production of progenitor cells due to cytotoxic/ immunosuppressive therapy
C. Immune-mediated peripheral destruction by drug haptens
D. Peripheral destruction due to circulating anti-neutrophil antibodies

A

C. Immune-mediated peripheral destruction by drug haptens

Most common cause of neutropenia: iatrogenic

104
Q

Based on retrospective analyses on patients with lymphadenopathy (LAD), which of the following clinical scenarios warrants lymph node biopsy the most?
A. 25-year-old with painless pre-auricular LAD, measuring 1.0 cm
B. 30-year-old with bilateral cervical LADs, largest at 2.0 cm who recently had a sore throat C. 35-year-old with tender unilateral cervical LAD, measuring 1.5 cm
D. 40-year-old with painless supraclavicular LAD, measuring 2.0 cm

A

D. 40-year-old with painless supraclavicular LAD, measuring 2.0 cm

105
Q

Which stage in the evolution of IDA is characterized by decreasing ferritin, normal to high TIBC and normal serum iron?
A. Iron-deficient erythropoiesis
B. Iron-deficiency anemia
C. Iron-sufficient erythropoiesis
D. Negative iron balance

A

D. Negative iron balance

106
Q

A 35-year old is seen for easy fatigability for many months. She is now 24 weeks pregnant with her 3rd child in 3 years. She does not see any obstetrician and does not take any vitamins. Lately, she has developed a taste for eating ice. She has no other complaints. Family and past history are negative. She does not smoke nor drink. Physical examination is pertinent for pale conjunctiva, mild spooning of nails, and a grade II/VI systolic murmur at the left lower sternal border. Stools are negative for occult blood. Labs are as follows: Hgb 7.1 gm/dL, Hct 23%, WBC 5,400/uL, Plt 450,000/uL; MCV 74 fL (85-95); RDW is 17.1% (13-15). What other laboratory finding will be consistent with your diagnosis?

A. Low ferritin
B. High RBC protopophyrin
C. High reticulocyte index
D. Normal total iron-binding capacity (TIBC)

A

A and B

Dx: IDA

107
Q

What laboratory test will best differentiate anemia of chronic disease from true iron-deficiency anemia?

A

Serum ferritin

IDA- low <15
Anemia of chronic dse - normal to high 30-200

108
Q

What laboratory test will best differentiate anemia of chronic disease from true iron-deficiency anemia?

A

Hydroxyurea

109
Q

Unless with severe megaloblastic anemia due to folate deficiency, folate supplementation is generally avoided in which of the following conditions?
A. Chronic dialysis
B. Chronic hepatitis
C. Hemolytic anemias
D. Malignancy

A

D. Malignancy

b12 may feed tumors

110
Q

Serum cobalamin less than ____ in px with colabamin deficiency

A

100ng/L

111
Q

A 45-year-old man presents to the outpatient clinic with pallor. A CBC done reveals the following: Hgb 6.3 g/dL, Hct 21%, WBC 4.5, Plt 167, MCV 106 fl, MCH 32 pg, MCHC 30 gm%. Medical history is pertinent for a partial gastrectomy done 6 months prior for recurrent bleeding gastric ulcers. What should be supplemented in this patient?
A. Cobalamin
B. Copper
C. Folic acid
D. Iron

A

A. Cobalamin

112
Q

What medication may induce hemolysis in patients with G6PD deficiency undergoing treatment for tumor lysis syndrome?
A. Allopurinol
B. Febuxostat
C. Rasburicase
D. Sodium Bicarbonate

A

C. Rasburicase

112
Q
A
113
Q

Gold std for PNH

A

Flow cytometry

114
Q

What is the most common cause of death among patients with myelodysplasia syndrome (MDS)?
A. Complications of pancytopenia
B. Complications of treatment
C. Diseases unrelated to MDS
D. Leukemic transformation

A

A. Complications of pancytopenia

115
Q

This can be given prophylactically before and after elective surgery to prevent bleeding in px with essential thrombocytosis

A

ε-aminocaproic acid

116
Q

A 62-year-old man presents with a 6-month history of fatigue, weight loss, anorexia and increasing abdominal enlargement. Physical examination shows pallor, gingival hypertrophy, and splenomegaly. A peripheral blood smear shows granules in cytoplasm with fine, lacy chromatin in the nucleus. Abnormal rod-shaped granules are also seen. What is the most likely diagnosis?
A. Acute lymphoid leukemia
B. Acute myeloid leukemia
C. Chronic lymphocytic leukemia
D. Chronic myeloid leukemia

A

B. Acute myeloid leukemia

Auer rods

117
Q

A 42-year-old woman is newly diagnosed with acute myeloid leukemia. She has been receiving platelet transfusions since her admission 2 weeks prior. Her platelet count two days ago was 8,000. 8 units of platelet concentrate is transfused, and her repeat platelet count was 11,000. Earlier this morning, the platelet count is 4,000, and the latest post transfusion platelet count is 8,000. No bleeding is noted. What will you transfuse?
A. HLA-matched platelets
B. Irradiated platelets
C. Washed platelets
D. No indication to transfuse for now; observe trends

A

A. HLA-matched platelets

118
Q

Only one cytogenetic abnormality in acute myelogenous leukemia has been invariably associated with the t(15;17)(q22;q12) cytogenetic rearrangement. What would you recommend for the treatment of this condition?
A. Cytarabine + daunorubicin
B. Gemtuzumab ozogamicin
C. Imatinib
D. Tretinoin

A

D. Tretinoin

Dx: Acute promyelocytic leukemia

119
Q

Which of the following findings in chronic myelogenous leukemia (CML) would suggest a worse prognosis?
A. Eosinophilia
B. Increased reticulin fibrosis
C. Presence of bands
D. Thrombocytopenia

A

D. Thrombocytopenia

Thrombocytosis is common but thrombocytopenia is rare and suggests worse prognosis

120
Q

At what percentage of peripheral or marrow blasts is blastic-phase CML defined?
A. 20%
B. 25%
C. 30%
D. 35%

A

C. 30%

121
Q

A 64-year-old woman presents with a 6 month history of weight loss, recurrent low-grade fevers and night sweats. PE is pertinent for cervical and axillary lymphadenopathies. An excision biopsy of a cervical node is consistent with diffuse large B-cell lymphoma. A PET/CT scan reveals enlarged cervical and axillary nodes, as well as involvement of the thyroid and GI tract. What is the recommended mode of treatment in this patient’s case?

A. Chemotherapy alone
B. Combination chemotherapy and radiation therapy
C. Field radiation therapy alone
D. Palliative treatment

A

A. Chemotherapy alone

Chemotx offers potentially curative x for DLBCL REGARDLESS of stage

122
Q

A PET/CT scan reveals enlarged cervical and axillary nodes, as well as para-aortic and iliac nodes. Based on the Ann Arbor Staging System, what is the patient’s stage?
A. Stage II
B. Stage III
C. Stage IV-A
D. Stage IV-B

A

B. Stage III

123
Q

most common cause of renal failure in patients with multiple myeloma?

A

hypercalcemia

124
Q

A 65-year-old woman presents with a 2-month history of low back and extremity pain, associated with weight loss, easy fatigability and decreasing urine output. She has no co-mordbid illnesses. On PE, she appears pale, with normal chest and abdominal examination. There is grade 2 bipedal edema. Pertinent in her laboratories are the following: Hgb 8.2 g/dL, Hct 24.6%, WBC 4,700, Plt 104,000; BUN 36 mg/dL, creatinine 2.54 mg/dL, Na 124, K 5.2 Cl 102, total calcium 11.2 mg/dL, In addition to these clinical features, which of the following diagnostic tests will confirm your impression?
A. 24-h urine electrophoresis and immunofixation
B. Bone marrow aspirate and biopsy
C. Serum albumin and beta-2 macroglobulin
D. Skeletal radiography (x-rays/ CT scan)

A

B. Bone marrow aspirate and biopsy

Dx: multiple myeloma

125
Q

What is the most common reaction associated with transfusion of blood components?
A. Acute hemolytic transfusion reaction
B. Allergic (urticarial) reaction
C. Febrile non-hemolytic transfusion reaction
D. Transfusion-related acute lung injury

A

C. Febrile non-hemolytic transfusion reaction

126
Q

A 44-year-old presents at the ER for vaginal bleeding due to multiple myoma uteri. She has hypertension and is on twice-daily enalapril. Her hemoglobin on admission is 8.5 g/dL. A blood transfusion is ordered. Prior to the transfusion, her vital signs are as follows: BP 130/80 mmHg HR 85/min RR 16/min T 36.5C. She tolerates transfusion of 1 packed RBCs. 1 hour post- transfusion, vitals are: BP 90/60 mmHg HR 90/min RR 15/min T36.5C. She denies any symptoms, and her BP 2 hours post-transfusion is 120/80 mmHg without intervention. What is the most likely mechanism of her hypotension?
A. Anaphylactoid reaction
B. Anti-HLA class II antibodies
C. Immune mediated hemolysis
D. Increase in bradykinin levels

A

D. Increase in bradykinin levels

Blood products contain bradykinin normally degraded by ACE hence those on ACE-I –> inc bradykinin –> transient hypotension

127
Q

Indications for irradiated blood components

A
127
Q

What is the initial site of presentation of petechiae and purpura in patients with markedly decreased platelet counts? (C111 P823)
A. Abdomen
B. Distal lower extremities
C. Mucous membranes
D. Upper chest/ trunk

A

B. Distal lower extremities

Petechiae first appear in areas of inc venous pressure eg ankles and feet

128
Q

Which of the following concepts regarding heparin-induced thrombocytopenia (HIT) is TRUE?
A. HIT is not associated with bleeding but paradoxically markedly increases the risk of thrombosis.
B. Most patients develop HIT after two weeks of exposure to heparin.
C. The diagnosis of HIT requires IgG-specific ELISA or serotonin release assay.
D. When heparin is given in the last 100 days, HIT will occur within 5- 14 days after re-exposure.

A

A. HIT is not associated with bleeding but paradoxically markedly increases the risk of thrombosis.

B. Most patients develop HIT after two weeks of exposure to heparin. – occurs 5-14 days after exposure (days 5-10 in Ch114); HIT after 14 days is rare

C. The diagnosis of HIT requires IgG-specific ELISA or serotonin release assay. – HIT remains a clinical diagnosis.

D. When heparin is given in the last 100 days, HIT will occur within 5-14 days after re-exposure. – it will occur before 5 days

129
Q

A 35-year-old woman presents with rash on the legs of recent onset. Platelet is 48,000 with no signs of overt bleeding. A repeat CBC 1 week later shows a platelet count of 46,000. There is no active bleeding. You suspect immune thrombocytopenic purpura (ITP). How should this patient be managed?
A. Eltrombopag
B. Prednisone
C. Prednisone + Rh0(D) immune globulin
D. Observe and monitor CBCs

A

D. Observe and monitor CBCs

If plt count >30K, not inc mortality related to thrombocytopenia

C is for severe ITP and/or symptoms of bleeding

130
Q

A 24-year-old college student presents at the emergency room with weakness. 2 weeks prior, she recalls having loose bloody stools that resolved with a course of antibiotics. On PE, she is hemodynamically stable and afebrile. She is seen awake, oriented, with pale conjunctivae, clear breath sounds, soft abdomen, minimal bipedal edema, and petechiae on her lower extremities. Pertinent in her diagnostics is a hemoglobin of 9.5 mg/dL, platelet count of 88,000, and a creatinine of 2.2 mg/dL. Her peripheral blood smear reveals schistocytes. What is the mainstay of treatment in this clinical scenario?
A. Corticosteroids
B. Plasma exchange
C. Rituximab
D. Treatment is primarily supportive

A

D. Treatment is primarily supportive

Schistocytes is characteristic of MAHA
Dx: HUS

131
Q

How much factor VIII does a bag of cryoprecipitate contain?

A

80 IU

132
Q

Which of the following antiplatelet drugs is CORRECTLY matched with its mechanism of action?
A. Abciximab: inhibits final common pathway of platelet aggregation by blocking fibrinogen binding to Gp IIb/IIIa
B. Aspirin: inhibits thromboxane synthesis by targeting protease- activated receptor-1 (PAR-1) C. Ticagrelor: irreversibly blocks P2Y12 receptors on platelet surfaces
D. Tirofiban: decreases platelet recruitment by acetylating cyclooxygenase-1 (COX-1)

A
133
Q

How do you treat Heparin induced thrombocytopenia?

A
134
Q

Patients on warfarin with stable dose requirements should still have their INR determined at least: (C114 P854)
A. Every week
B. Every 2 weeks
C. Every month
D. Every 2 months

A

C. Every month

135
Q

A 73-year-old woman presents at the ER following a fall at home. She has ischemic heart disease and atrial fibrillation and is compliant to warfarin. All trauma workup (cranial CT, chest, pelvic x-rays) are unremarkable. Aside from some minor right thigh pain, she is asymptomatic. A CBC is normal, but her INR is 8.2. There are no hematomas nor signs of bleeding. You discontinue the warfarin. How is the INR managed?
A. Administer IV vitamin K
B. Administer oral vitamin K
C. Transfuse 4-factor prothrombin complex concentrate
D. No additional therapy is required

A

D. No additional therapy is required

since INR < 10 and no bleeding

136
Q

A 32-year-old is referred for anticoagulation after spontaneous vaginal delivery. She was diagnosed with pulmonary embolism at 25 weeks AOG. She was managed with low-molecular weight heparin during the pregnancy that was discontinued at the onset of labor. She is now prepared for discharge. She wishes to breastfeed. Which of the following is the preferred agent?
A. Apixaban
B. Dabigatran
C. Rivaroxaban
D. Warfarin

A

D. Warfarin

DOACs are avoided in nursing mothers

137
Q

Examination of CSF is an essential routine diagnostic measure for acute lymphocytic leukemia (ALL), but should be performed only when the platelet count is >___ x 10^9/ L

A

20

138
Q

Examination of CSF is an essential routine diagnostic measure for acute lymphocytic leukemia (ALL), but should be performed only when the platelet count is > x 10^9/ L

A

Autoimmune hemolytic anemia

139
Q

A 71-year-old man is referred to you for an incidental finding of an elevated WBC count (22,000/ uL) with lymphocytic predominance. He has no other co-morbidities and aside from urinary retention, denies any other symptoms. Aside from mild anemia (Hgb 11.0 g/dL), the rest of the laboratory investigation is normal. Extensive workup later reveals chronic lymphocytic leukemia. What is the most appropriate treatment at this time?
A. Allogenic stem cell transplant
B. B-cell receptor signaling inhibitors
C. Monoclonal antibodies +/- chemotherapy
D. No treatment indicated at present

A

D. No treatment indicated at present

140
Q

“Dry taps,” or inability to aspirate bone marrow, occur in about 4% of attempts with the most common differential diagnosis being:

A

Metastatic carcinoma filtration

RITE/PSBIM review (19 decks)

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