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USMLE Step 2 CK > Hematology > Flashcards

Hematology Flashcards

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USMLE® Step 1 flashcards
1
Q
  • TIP- HEMATOCRIT:>30-35% SYMPTOMS
  • TIP- HEMATOCRIT:25-30% SYMPTOMS
  • TIP- HEMATOCRIT: 20-25% SYMPTOMS
  • TIP- HEMATOCRIT: <20-25% SYMPTOMS
  • TI- MI CAUSES?
A
  • NONE
  • DYSPNEA (WORSE ON EXERTION), FATIGUE
  • LIGHTHEADEDNESS, ANGINA
  • SYNCOPE, CHEST PAIN
  • ANEMIA, HYPOXIA, CAD, CARBON MONOXIDE POISONING
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2
Q

TARGET CELLS; LOW HEMOGLOBIN, LOW RETICULARCYTE COUNT, DYSPNEA, FATIGUE, LOW MCV (N:80-100)

  • DIAGNOSIS/ IS A RESULT OF?
  • INITIAL TEST
  • INITIAL TREAT- IF SEVERE?
A

*MICROCYTOSIS

ANEMIA CAUSED BY: IRON DEF, BETA-THAL, SIDEROBLASTIC ANEMIA, ANEMIA OF CHRONIC DISEASE

  • CBC AND (IRON STUDIES)FERRITIN: LOW=IRON DEFICIENCY; IRON: HIGH SIDEROBLASTIC ANEMIA; NORMAL IRON STUDIES: THALASSEMIA
  • SEVERE: PACKED RBC (W/DISEASE OR OLD PT. OR SYMPTOMATIC: SHORTNESS OF BREATH, LIGHTHEADED, CONFUSED, SYNCOPE, BP)
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3
Q

B12 AND FOLATE DEF, SIDEROBLASTIC, ALCOHOLISM, ANTI-PUR.PHARM, LIVER/HYPOTHYROID,ZIDOVUDINE OR PHENYTOIN, MYEKODYSPLATIC SX.

  • DIAGNOSIS/ ALL CAUSE?
  • INITIAL TREAT- IF SEVERE?
A
  • MACROCYTIC ANEMIA

* SEVERE: PACKED RBC (W/DISEASE OR OLD PT. OR SYMPTOMATIC: SHORTNESS OF BREATH, LIGHTHEADED, CONFUSED, SYNCOPE, BP)

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4
Q

TIP- MACRO AND MICRO ANEMIA GIVE?

A

LOW RETICULOCYTE COUNT

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5
Q

TIP- NORMOCYTIC ANEMIA CAUSED BY?

A

BLOOD LOSS OR HEMOLYSIS (AT FIRST: FAST LOSS NO TIME FOR MCV CHANGE; THEN MACRO)

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6
Q
  • TIP- PACKED RBC; HEMATOCRIT? HOW MANY POINT RISE PER UNIT?
  • TIP- FRESH FROZEN PLASMA; WHAT IS IT? WHAT LEVELS DOES IT HELP WITH?
  • TIP- CRYOPRECIPITATE; WHAT IS IT? WHAT LEVELS DOES IT HELP WITH? [NEVER USED FIRST]
  • TIP- WHEN TO USE WHOLE BLOOD?
A
  • 70-80% RISES 3 POINTS PER UNIT
  • CLOTTING FACTORS OF PLASMA; LOWERS PT, PTT, INR AND BLEEDING TIME (MAYBE USED AS REPLACEMENT WITH PLASMAPHERESIS
  • REPLACE FIBRINOGEN, CLOTT FACTORS; (GOOD IN DIC), INCREASES FACTOR VIII AND VWF LEVELS
  • NEVER
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7
Q

5ML LOSS OF BLOOD A DAY; FROM SLOW GI BLEED OR MENSTRUATION, [HIGH TIBC]

  • DIAGNOSIS
  • INITIAL TEST
  • ACC TEST
  • INITIAL TREAT
A
  • MICROCYTIC IRON DEFICIENCY
  • (IRON STUDIES)FERRITIN: LOW=IRON DEFICIENCY; IRON: HIGH SIDEROBLASTIC ANEMIA; NORMAL IRON STUDIES: THALASSEMIA
  • BONE MARROW BIOPSY
  • REPLACE IRON(FERROUS SULFATE) THEN IM-IRON
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8
Q

DISEASE DOES NOT MOVE IRON; OR NO ERYTHROPIETIN; CANCER OR CRHONIC INFECTION (e.g. RA), [LOW TIBC]

  • DIAGNOSIS
  • INITIAL TEST
  • INITIAL TREAT
A
  • MICROCYTIC ANEMIA OF CHRONIC DISEASE (INITIALLY NORMAL MCV)
  • (IRON STUDIES)FERRITIN: LOW=IRON DEFICIENCY; IRON: HIGH SIDEROBLASTIC ANEMIA; NORMAL IRON STUDIES: THALASSEMIA
  • TX. CAUSE, IF END STAGE RENAL FAILURE: ERYTHROPOIETIN
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9
Q

ALCOHOL SUPPRESSIVE; LEAD; ISONIAZID AND VIT B6 HAVE MAJOR EFFECT; [ALCOHOLIC; IRON:HIGH WITH LOW MCV]

  • DIAGNOSIS
  • INITIAL TEST
  • ACC. TEST
  • INITIAL TEST
A
  • SIDEROBLASTIC ANEMIA ( MACRO OR MICROCYTIC)
  • (IRON STUDIES)FERRITIN: LOW=IRON DEFICIENCY; IRON: HIGH SIDEROBLASTIC ANEMIA; NORMAL IRON STUDIES: THALASSEMIA
  • PRUSSIAN BLUE (RINGED SIDEROBLASTS) BASOPHILIC STIPPLING MAY OCCUR
  • TX. CAUSE + VIT B6 (PYRIDOXINE)
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10
Q

ASYMPTOMATIC LOW MCV AND [NORMAL IRON]

  • DIAGNOSIS
  • INITIAL TEST
  • ACC. TEST
  • INITIAL TREAT
A
  • THALASSEMIA MICROCYTIC
  • (IRON STUDIES)FERRITIN: LOW=IRON DEFICIENCY; IRON: HIGH SIDEROBLASTIC ANEMIA; NORMAL IRON STUDIES: THALASSEMIA
  • HEMOGLOBIN ELECTROPHOESIS (FOR ALFA-GENETIC)
  • MAJOR: TRANSFUSION LIFELONG; IRON OVERLOAD: DEFERASIROX OR DEFERIPRONE IRON CHELATORS

TIP- ALPHA THALASSEMIA ELECTROPHORESIS: 1D=NORM;2D=MILD ANEMIA, NORM ELEC.PH.; 3D=MODRT ANEMIA, Hb-H(BETA TETRADS), HIGH RETIC,4D=GAMMA-4 OR BART Hb,CHF, STILL BIRTH

TIP-BETA THALASSEMIA ELECTROPHORESIS: 1D=INC. Hb F AND A2; 2D=N/A;3D=NORMAL HbF NO TRANSFUSION DEPENDENCE; 4D=N/A

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11
Q

TIP-LOW MCV: IRON DEF VS ANEMIA OF CHRONIC DISEASE

A

BOTH LOW FERRITIN; BUT, TIBC IS HIGH IN IRON DEF. AND LOW IN CHRONIC DISEASE

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12
Q

TIP- RED CELL DISTRIBUTION OF WIDTH IS INCREASED

A

IRON DEFICIENCY RDW(SMALLER TO BIGGER CELLS ACCOUNTS TO WIDTH)

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13
Q

MACROCYTIC ANEMIA+DIETARY DEF OR PSORIASIS AND SKIN LOSS; DRUGS: PHYNYTOIN, SULFA

  • DIAGNOSIS
  • INITIAL TREAT
A
  • FOLATE DEFICIENCY MACROCYTIC ANEMIA

* TREAT WHAT IS DEF.=B12 NEURO, FOLATE=HEME (TREATMENT MAY RESULT IN HYPOKAKEMIA FROM FAST CELL PRODUCTION)

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14
Q

MACRO.ANEMIA+ PERNICIOUS ANEMIA,PANCREATIC INSUFF,LOW MEAT,DISEASE DAMAGE TO TERMINAL ILEUM OR STOMACH,DIPHYLLOB.,HIV

  • DIAGNOSIS
  • P.ASS.
  • INITIAL TREAT
A
  • VIT B 12 DEFICIENCY
  • PERIPHERAL NEUROPATHY, P.COLUMN DAMAGE(VIBRATORY SENSATION)=ATAXIA; AND RARE DEMENTIA, INC. METHYLMALONIC (MMA)
  • TREAT WHAT IS DEF.=B12 NEURO, FOLATE=HEME (TREATMENT MAY RESULT IN HYPOKAKEMIA FROM FAST CELL PRODUCTION)
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15
Q

HYPERSEGMENTATION OF NEUTROPHILS, HIGH MCV ANEMIA

  • DIAGNOSIS
  • INITIAL TEST
  • INITIAL TREAT
A
  • MEGALOBLASTIC ANEMIA: VIT B12 OR FOLATE DEF.
  • B12 AND FOLATE LEVELS; INC. LDH AND INDIRECT BILIRUBIN, DEC. RETICULOCYTES, HYPERCELLULAR BONE MARROW, MACROOVALOCYTES, INC. HOMOCYCTEINE
  • TREAT WHAT IS DEF.=B12 NEURO, FOLATE=HEME (TREATMENT MAY RESULT IN HYPOKAKEMIA FROM FAST CELL PRODUCTION)
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16
Q
  • TIP- ALWAYS CONFIRM B12 IF NEAR NORMAL WITH?
  • TIP-SCHILLING TEST IS NEVER THE RIGHT ANSWER; PERNICIOUS ANEMIA IS TESTED WITH ANTI INTRINSIC FACTOR AND ANTI PERIETAL ANTIBODIES
  • TIP- WHY IS RETICULOCYTE LOW IF CELLS ARE BIG?
  • TIP-B12 AND FOLATE CAN ALSO CAUSE?
  • TIP- PANCREATIC ENZYMES ARE NEEDED TO?
  • TIP- NEUROLOGICAL SYMPTOMES ARE REVERSABLE AT FIRST?
A
  • MMA
  • TRUE
  • THEY ARE DESTROYED AS THET LEAVE THE MARROW
  • PANCYTOPENIA
  • BREAK CARRIER PROTEINS AND ABSORB B12
  • TRUE
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17
Q

DEC. Hct, HAPTOGLOBIN; INCREASED:LDH,IND.BILI,RET:HYPERKALEMIA, FOLATE DEF., SLIGHT INCR. IN MCV

*DIAGNOSIS

A

*HEMOLYTIC ANEMIA

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18
Q

HEMOLYTIC ANEMIA+AFRICAN,(PAIN:CHEST,BACK,THIGHS) FEVER YOUNGER

  • DIAGNOSIS
  • P.ASS.
  • INTIAL TEST
  • ACC TEST
  • INITIAL TREAT
A
  • SICKLE CELL HEMOLYTIC ANEMIA
  • BILE G. STONES, INFECT: ENCAPS, OSTEOMYELITIS(SAL),RETINOPATHY,STROKE,BIGHEART,SKIN ULCERS, AVASCULAR NECROSIS, DACTYLITIS,PAPILLARY NECROSIS
  • PERIPHERAL SMEAR(AS DISEASE DOES NOT HAVE SICKLED CELLS)
  • Hb ELECTROPHORESIS
  • O2,HYDRATION,ANALGESIA; FEVER: ANTIBIOTICS (CEFTRIAXONE,LEVOFLOX); FOLATE; PNEUMCOCCAL VAC.; PHARM: HYDROXYUREA (INC. Hb-F); SEVERE: TRANSFUSE
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19
Q

TIP- ASPLEENIC SICKLE CELL SMEAR

TIP- SICKLE TRAIT (AS)

TIP- LOOK FOR APLASTIC CRISIS IN SICKLE CELL

A
  • SICKLED CELL, TARGET CELLS, HOWELL JOLLY BODIES
  • DOES NOT HAVE SICKLED CELLS, BUT CANNOT CONCENTRATE URINE(ISOSTHENURIA) AND HEMATURIA: NO TX.
  • RETICULOCYTE COUNT: PARVO B-19
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20
Q

HEMOLYTIC ANEMIA+ INTERMITTENT JAUNDICE, SPLENOMEGALY,FAMILY HX,B.GALLSTONES

  • DIAGNOSIS
  • INTIAL TEST
  • ACC. TEST
  • INITIAL TREAT
A
  • HEREDITARY SPHEROCYTOSIS
  • LOW MCV,INC. MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION(MCHC), NEG. COOMBS
  • OSMOTIC FRAGILITY
  • FOLATE, SPLENECTOMY
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21
Q

HEMOLYTIC ANEMIA+ CLL,LYMPHOMA,SLE,OR DRUGS: PENICILLIN, ALPHA, METHYLDOPA, RIFAMPIN, PHENYTOIN

  • DIAGNOSIS
  • INITIAL TEST
  • ACC TEST
  • INITIAL TREAT
A
  • AUTOIMMUNE (WARM OR IgG) HEMOLYSIS
  • COOMBS (INDIRECT GETS MORE ANTIBODIES), SMEAR: MICROSPHEROCYTES, NO SCHYSTOCITYS (B.C.- THEY STAY IN SPLEEN)
  • COOMBS
  • GLUCOCORTICOIDS, IF RECURRENT:SPLENECTOMY,SEVERE ACUTE:IVIG, RITUXIMAB,AZATHIOPRINE, CYCLOPHOSPHAMIDE OR CYCLOSPORINE AFTER SPLENECTOMY
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22
Q

TIP- ALTERNATE TX IN AUTOIMMUNE HEMOLYSIS

A

CYCLOPHOSPHAMIDE,CYCLOSPORINE, AZATHIOPRINE, MYCOPHENOLATE MOFETIL

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23
Q

HEMOLYTIC ANEMIA+ COLDER PARTS OF BODY WITH SYMPTOMS OF NUMBNESS; BETTER BY WARMING

  • DIAGNOSIS
  • P.ASS.
  • INITIAL TEST
  • ACC. TEST
  • INITIAL TREAT
A
  • COLD AGGLUTININ DISEASE
  • EBV, WALDENSTROM MACROGLOBULINEMIA OR MYCOPLASMA PNEUMONIAE
  • DIRECT COOMBS
  • COLD AGGLUTININ TITER
  • STAY WARM, RITUXIMAB THEN PLASMAPHERESIS, PHARM: CYCLOPHOSPHAMIDE, CYCLOSPORINE, OR OTHER IMMUNOSUPPRESSIVE AGENTS

TIP- WHAT DOES NOT WORK FOR COLD AGGLUTININ DISEASE=[STEROIDS AND SPLENECTOMY]

TIP-CRYOGLOBULINS ARE P.ASS.= [COLD AGGLUTININS AND DO NOT RESPOND TO STEROIDS EITHER; HEP-C, JOINT PAIN,GLOMERULONEPHRITIS]

24
Q

X-LINKED, OXIDANT STRESS INFECTION, AFRICAN AMERICAN/MEDITERRANEAN, ANEMIA, JAUNDICE,PHARM USE

  • DIAGNOSIS
  • INITIAL TEST
  • ACC. TEST
  • INITIAL TREAT
A
  • G6PDD
  • SMEAR/METHYLENE BLUE STAIN (HEINZ BODIES AND BITE CELLS), G6PD LEVEL AFTER 1-2 MONTHS OF HEMOLYTIC EVENT
  • G6PD LEVEL AFTER HEMOLYTIC EVENT
  • AVOID OXIDANT STRESS
25
Q

CHILD INTRAVASCULAR HEMOLYSIS, SCHISTOCYTES,THROMBOCYTOPENIA, RENAL INSUFFICIENCY

  • DIAGNOSIS
  • INITIAL TEST
  • INITIAL TREAT
A
  • (HUS) HEMOLYTIC UREMIC SYNDROME
  • PT/PTT ARE NORMAL, NEGATIVE COOMBS, ECOLI 0157:H7 TITERS
  • SEVERE: FFP THEN PLASMAPHERESIS, ANTIBIOTICS
26
Q

ADULT, INTRAVASCULAR HEMOLYSIS, SCHISTOCYTES,THROMBOCYTOPENIA, RENAL INSUFFICIENCY, SEIZURES, CONFUSION

  • DIAGNOSIS
  • INITIAL TEST
  • INTIAL TREAT- TTP
A
  • TTP (METALLOPROTEINASE DEFICIENCY) ADAMTS 13
  • PT/PTT ARE NORMAL, NEGATIVE COOMBS
  • SEVERE: FFP THEN PLASMAPHERESIS, STERIODS
27
Q

EPISODIC DARK URINE IN THE MORNING,PANCYTOPENIA AND IRON DEFICIENCY ANEMIA

  • DIAGNOSIS
  • INTIAL TEST
  • ACC TEST
  • INITIAL TREAT
A
  • (PNH) PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (CD 55&59[DECAY ACCELERATING FACTOR ON RBC] DEFICIENCY)
  • CBC: PANCYTOPENIA (ANEMIA), FLOW CYTOMETRY (CD55&59)
  • FLOW CYTOMETRY
  • PREDNISONE (HEMOLYSIS), BONE MARROW TRANSPLANT (CURE), ECULIZUMAB (INACTIVATES C5); THEN FOLIC ACID IF TRANSFUSED

TIP- P.ASS PNH=APLASTIC ANEMIA, MYELODYSPLASIA, ACUTE LEUKEMIA, THROMBOISIS: LARGE VESSELS, HEPATIC VEINS

28
Q

PANCYTOPENIA ANEMIA, HX.-C. INFECTION:HIV,HEP,CMV,EBV, CANCER, RADIATION, CHEMO, B12 DEF.,THYROID:PTU/METHIMAZOLE,SLE,PNH

  • DIAGNOSIS
  • INITIAL TEST
  • ACC. TEST
  • INTIAL TREAT
A
  • APLASTIC ANEMIA
  • CBC: PANCYTOPENIA, MARROW BIOPSY
  • BONE MARROW BIOPSY
  • S.THERAPY: TRANSFUS,ANTIBIOTIC AND PLATELETS, BMT(ALLO) <50, ABOVE 50YRS OF NO DONOR: ANTITHYMOCITE GLOBUILIN AND CYCLOSPORINE/TACROLIMUS

TIP- APLASTIC ANEMIA=COULD BE AUTOIMMUNE; HENCE, THE CYCLOSPORINE

29
Q

HEADACHE,BLURRED VISION, TINNITUS, HYPERTENSION, FATIGUE,SPLENOMEGALY, BLEEDING, THROMBOSIS

  • DIAGNOSIS
  • INTIAL TEST
  • ACC. TEST
  • P.ASS.
  • INTIAL TREAT
A
  • POLYCYTHEMIA VERA
  • CBC: HEMATOCRIT >60%, RBC HIGH ALL CELLS HIGH (JAK2 PROTEIN MUTATION DOES NOT REGULATE); LOW ERYTHROPIETIN LEVEL, HIGH:B12
  • JAK2 MUTATION TEST
  • AML, RENAL CELL CANCER: HIGH Hct + ERYTHROPOIETIN, PRURITIS:AFTER HOT SHOWERS(BASOPHILES), LOW MCV
  • PHLEBOTOMY, ASPIRIN (FOR THROMBUS), HYDROXYUREA (LOWERS CELL COUNT), ALLOPURINOL/RASBURICASE, ANTIHISTAMINES
30
Q

BLEEDING, ELEVATED PLATELET COUNT;EXCLUDE:INFECTION,CANCER, IRON DEF.;JAK2 50% OF THE TIME

  • DIAGNOSIS
  • INITIAL TREAT
A
  • ESSENTIAL THROMBOCYTOSIS
  • 60YRS, >1.5MIL=HYDROXYUREA THEN ANAGRELIDE IF LOW RBC RESULT; ASPIRIN(ERYTHRMOMELALGIA)

TIP- ERYTHROMOMELALGIA=PAINFUL, RED HANDS IN ET

31
Q

BLOOD PRODUCTION: IN LIVER&SPLEEN (MEGALY), NUCLEATED TEARDROP RBC; PANCYTOPENIA; MARROW BIOPYS: FIBROSIS

  • DIAGNOSIS
  • INITIAL TREAT
A
  • MYELOFIBROSIS

* THALIDOMIDE AND LENALIDOMIDE (TNF-INH)= INCR. MARROW PRODUCTION, TRANSPLANT UNDER 50-55YRS

32
Q

FATIGUE, INFECTION, BLEEDING (WBC NORMAL OR INCREASED) YET INFECTIONS, DIC (MAYBE)

  • DIAGNOSIS
  • INTIAL TEST
  • ACC. TEST
  • INITIAL TREAT

TIP- FATIGUE, INFECTION AND BLEEDING SYMPTOMS ARE?

A
  • ACUTE LEUKEMIA
  • BLOOD SMEAR SHOWING BLASTS
  • FLOW CYTOMETRY (DIFFERENT SUBTYPES ARE DETECTED:CD MARKER CONTROLLED)
  • LEUKAPHERESIS; CHEMO(REMOVE BLASTS FROM SMEAR)=INDUCING REMISSION; THEN BMT(IF POOR PROGNOSIS) OR CHEMO AGAIN(IF GOOD PROG.)

TIP=MYELODYSPLASTIC SYNDROME

TIP- AML-M3 P.ASS.?=CHROM 15-17; AUER RODS(EOSINOPHILIC INCLUSION)

33
Q

INITIAL TREAT- AML AND ALL

TIP- PROGNOSIS OF AML OR ALL IS?

INITIAL TREAT- AML M3 SPECIFIC

INITIAL TREAT- ALL

P.ASS. AML-M3?

A

LEUKAPHERESIS;CHEMO(REMOVE BLASTS FROM SMEAR)=INDUCING REMISSION; THEN BMT(IF POOR PROGNOSIS) OR CHEMO AGAIN(IF GOOD PROG.)

CYTOGENTICS(CHROMOSOMAL CHARACTERISTICS) GOOD=LESS RELAPSE=CHEMO;BAD=MORE RELAPSE=BMT

ALL TRANS RETINOIC ACID(ATRA)

ADD INTRATHECAL CHEMO (MTX) PREVENTS CNS RELAPSE

DIC

34
Q

HIGH WBC-ALL NEUTROPHILS, PRURITUS (BASOPHILS), SPLENOMEGALY(SATIETY), FATIGUE NIGHT SWEATS, AND FEVER

  • DIAGNOSIS
  • INITIAL TEST
  • ACC. TEST
  • INITIAL TREAT
A
  • CML
  • EXCLUDE(LEUKOMOID REACTION) FROM HIGH NEUTROPHILS, LEUKOCYTE ALKALINE PHOSPHATASE SCORE(LAP) IS LOW; HIGH BASOPHILS;PCR/FISH:BCR-ABL
  • PCR/FISH: BCR-ABL (9:22)
  • TYROSINE KINASE INHIBITORS (IMATINIB), DASATINIB, OR NILOTINIB; THEN BMT IF POSIBLE (MOST EFFECTIVE)

TIP- CML CBC:=HIGH: NEUTROPHILS, BASOPHILS NORMAL: BLASTS (LESS THAN 5%)

TIP-P.ASS. ACUTE LEUKEMIA (BLAST CRISIS)=CML

35
Q

PANCYTOPENIA; HYPERCELLULAR BONE MARROW; SEVERE INFECTIONS AND BLEEDING, OLDER >60YRS

  • DIAGNOSIS
  • INTIAL TEST
  • INTIAL TREAT
A
  • MYELODYPLASTIC SYNDROME
  • CBC: MACROCYTIC ANEMIA WITH NUCLEATED CELLS, LOW BLASTS MARROW: HYPERCELLULAR; SMEAR/STAIN: PELGER-HUET CELLS/RINGED SIDEROBLASTS
  • TRANSFUSION;ERYTHROPOIETIN;LENALIDOMIDE(5q DELETE); AZACITIDINE (DECREASES TRANSFUSION)

TIP- BLASTS IN MYELODYSPLASTIC SYNDROME=SEVERITY

36
Q

AGE:>50YRS, BAD B LYMPHOCYTES; SLIGHTLY HIGH WBC, FATIGUE,LYMPHADENOPATHY, SPLEEN/LIVER ENLARGE, INFECTION

  • DIAGNOSIS
  • INTIAL TEST
  • P.ASS.
  • INITIAL TREAT
A
  • CLL
  • CBC: WBC (~20,000) MOSLTY LYMPH-B&LOW GAMMAGLOB; PARADOXICAL EVENTS:ANEMIA/LOW PLATELETS WHEN LYMPH IS NEEDED*;SMEAR:SMUDGE
  • HIGH-GRADE LYMPHOMA (MOST DIE BEFORE)
  • INTIAL TREAT- CLL STAGE 0 (ELEVATED WBC) AND STAGE 1 (LYMPHADENOPATHY)=NOTHING

INTIAL TREAT- CLL STAGE 2 (HEPATOSPLENOMEGALY), 3 (ANEMIA), 4 (THROMBOCYTOPENIA)=FLUDARABINE AND RITUXIMAB

INITIAL TREAT- CLL REFRACTORY? MILD? SEVERE INFECTION? AND AUTOIMMUNE:HEMOLYSIS/LOW P.?=CYCLOPHOSPHAMIDE(EFFICACY), CHLORAMBUCIL, IV IMMUNOGLOBULINS, PREDNISONE

TIP- IN CLL ANEMIA/LOW PLATELETS CAN BE FROM CLL OR AUTOIMMUNE, WHICH IS MORE DANGER?=AUTOIMMUNE

37
Q

PANCYTOPENIA, MASSIVE SPLENOMEGALY, MONOCYTOPENIA, DRY MARROW WITH HYPERCELL, MIDDLE AGED MAN

  • DIAGNOSIS
  • INITIAL TEST
  • ACC TEST
  • INITIAL TREAT
A
  • CD 11c HAIRY CELL LEUKEMIA
  • SMEAR: FILAMENTOUS PROJECTIONS; FLOW CYTOMETRY(CD11c)
  • FLOW CYTOMETRY
  • CLADRIBINE OR PENTOSTATIN
38
Q

PAINLESS LYMPHADENOPATHY, MAY INVOLVE PELVIC, RETROPERITONEAL, MESENTERIC STRUCTURES, NODES, “B”SX

  • DIAGNOSIS
  • INITIAL TEST
  • INTIAL TREAT
A
  • NON-HODGKIN LYMPHOMA
  • EXISIONAL BIOPSY; CBC: NORMAL (LDH MAYBE HIGH=WORSE SEVERITY); STAGING:CT SCAN(CHEST,ABDOMEN&PELVIS),BONE MARROW BIOPSY
  • STAGE 1(1LYMPH NODE) 2(2 OR MORE ON SAME SIDE OF DIAPHRAGM) 3. BOTH SIDES OF DIAPH. 4 WIDESPREAD=1&2= LOCAL RADIATION AND SMALL DOSE/COURSE OF CHEMO; 3&4(“B”SX)=C.H.O.P+RITUXIMAB(CD20)

TIP- NHL VS CLL=CLL (IS “LIQUID/CIRCULATING IN VESSELS) VS NHL (IS A SOLID MASS)

TIP-NHL (BURKITT AND IMMUNOBLASTIC HAVE THE WORST PROGNOSIS)=TRUE

39
Q
  • TIP-COLD NODE=CANCER; WARM NODE=INFECTION(RED AND TENDER)
  • TIP- C.H.O.P IS?
  • TIP- NHL IS DIAGNOSED AT STAGE: 3&4 80-90% OF THE TIME?
A
  • TRUE
  • CYCLOPHOSPHAMIDE; HYDROXYDAUNORUBICIN(ADRIAMYCIN)/DOXORUBICIN; ONCOVIN (VINCRISTIN); PREDNISONE
  • TRUE
40
Q

GERD, PEPTIC ULCER FOR YEARS TREATED WITH PEPTOBISMOL; FATIGUE, FEVER, NIGHT SWEATS & WEIGHT LOSS

  • DIAGNOSIS
  • INTIAL TREAT
A
  • MUCOSAL ASSOCIATED LYMPHOID TISSUE

* CLARITHROMYCIN AND AMOXICILLIN

41
Q

PAINLESS LYMPHADENOPATHY, CERVICAL AREA NODES, “B” SX, REED-S.CELLS

  • DIAGNOSIS
  • INTIAL TEST
  • INTIAL TREAT
A
  • HODGKIN DISEASE
  • EXISIONAL BIOPSY; CBC: NORMAL; STAGING:CT SCAN(CHEST,ABDOMEN&PELVIS),BONE MARROW BIOPSY
  • STAGE:1&2 LOCAL RAD/LITTLE CHEMO; 3&4ABVD: ADRIAMYCIN(DOXORUBICIN), BLEOMYCIN, VINBLASTINE, DACARBAZINE

INTIAL TREAT- RELAPSED HODGKIN=
AFTER RADIATION: CHEMO; AFTER CHEMO: EXTRA HIGH CHEMO AND BONE MARROW TRANSPLANT

42
Q

TIP- HODGKIN=REED STERNBERG AND HIGH AMOUNT IS BAD(LYMPHOCYTE PREDOMINANT IS THE BEST PROGNOSIS)

TIP- SIDE EFFECTS OF RADIATION AND CHEMOTHERAPY?

TIP- CHEMO DOSING?

TIP- SIDE EFFECT: DOXORUBICIN

TIP-SIDE EFFECT: VINCRISTINE

TIP-SIDE EFFECT: BLEOMYCIN

TIP-SIDE EFFECT: CYCLOPHOSPHAMIDE

TIP-SIDE EFFECT: CISPLATIN

A

TRUE

CHEMO=HEART: CAD, (LEUKEMIA,MDS,NHL ONLY 1% PER YEAR) RADATION: RISK OF FUTURE SOLID TUMORS(BREAST,THYROID, LUNG-SCREEN AFTER 8YRS)

TEST HEART WITH (MUGA) MULTI-GATED-ACQUISITION SCAN OR NUCLEAR VENTRICULOGRAM MOST ACC. TEST-FOR EF OF LEFT VENT.

CARDIOMYOPATHY

NEUROPATHY

LUNG FIBROSIS

HEMORRHAGIC CYSTITIS

RENAL AND OTOTOXICITY

43
Q

BONE PAIN, FRACTURES, HYPERURICEMIA, ANEMIA(FULL MARROW WITH PLASMA), RENAL FAILURE(BENCE-JONES), HYPERCALCEMIA

DIAGNOSIS
P.ASS.
INITIAL TEST
ACC TEST
INITIAL TREAT
A
  • MULTIPLE MYELOMA
  • P.ASS.-OSTEOCLAST ACTIVATING FACTOR (OAF) HYPERCALCEMIA; BAD PLASMA CELLS(INFECTIONS/LOW GLOBUILINS)
  • XRAY(LYTIC “PUNCHED OUT LESIONS”); SERUM PROTEIN ELECTROPHORESIS(SPEP) SHOWS AN IgG(60%) OR IgA(25%) SPIKE=”M” OR CLONE; URINE:BENCE-JONES

HYPERCALCEMIA;BETA2MICRGLOBULIN(SEVERITY);SMEAR(ROULEAUX);INC. BUN/Cr; BMB(PLASMA CELLS >10%) INC. TOTAL PROTEIN; DEC. ANION GAP/INC. CL&BICARB

  • BMB: >10% PLAMA CELLS
  • 70 USE MELPHALAN;
44
Q

TIP- CAUSE OF DEATH MULTIPLE MYELOMA
TIP- ROULEAUX
TIP- M SPIKE DOES NOT MEAN IgM SPIKE
TIP- TECHNETIUM BONE SCAN=RADIONUCLIDE BONE SKAN AND DOES NOT PICK LYTIC LESIONS; THEY ARE FOR?
TIP- DIPSTICK ANALYSIS IS LIMITED TO REACT WITH ALBUMIN AND WILL NOT SHOW BENCE-JONES; YOU NEED WHAT?
TIP- MGUS (MONOCLONAL GAMMOPATHY OF UNKNOWN SIGNIFICANCE) ALSO GIVES M SPIKE AND IS BENIGN IN OLDER PP. BUT?

A

INFECTION/RENAL FAILURE

IgG ADHERES RBS TOGETHER

TRUE

INDICATION OF INCREASED UPTAKE WITH OSTEOBLASTIC ACTIVITY

IMMUNOELECTROPHORESIS

1% TRANSFORM INTO MYELOMA AND THE MORE MGUS THE MORE THE CHANCE

45
Q

LETHARGY,BLURRY VISION/VERTIGO, ENGORGED BLOOD VESSES IN THE EYE, MUCOSAL BLEEDING,RAYNAUD PHENOMENON

  • DIAGNOSIS
  • INITIAL TEST
  • INTIAL TREAT
A
  • WALDENSTROM MACROGLOBULINEMIA
  • IGM SPIKE (MALIGNANT B CELLS/ HYPERVISCOSITY); CBC:ANEMIA
  • ACUTE: PLASMAPHERESIS; CHRONIC: RITUXIMAB OR PREDNISONE&CYCLOPHOS. (PRODUCTION IGM) + BORTEZOMIB OR LENALIDOMIDE (CONTROL CELLS)
46
Q

SUPERFICIAL BLEEDING-EPISTAXIS,GINGIVAL,PETECIAE,PURPURA,MUCOSAL SURFACE:GUMS,VAGINAL BLEED

  • DIAGNOSIS
  • INITIAL TEST-
  • INITIAL TREAT-
A
  • PLATELET BLEEDING: ITP
  • EXCLUSION: ANTIPLATELET ANTBODIES(NOT SPECIFIC),ULTRASOUND OR CT EXCLUDES:HYPERSPLENISM, MEGAKARYOCYTES ARE ELEVATED
  • 1.NO BLEED,CT:>30000=NOTHING; 2. MILD BLEED,CT:<30000=STEROIDS;
    3. RECURRENT:SPLENECTOMY; 4.IF FAILED:ROMIPLOSTIMOR ELTROMBOPAG,RITUXIMAB,AZATHIOPRINE,CYCLOSPORIN,MYCOPHENOLATE
47
Q

TIP-(ISOLATED THROMBOCYTOPENIA:NORMAL HEMATOCRIT&WBC) NORMAL SPLEEN

TIP- ROMIPLOSTIM AND ELTROMBOPOIETIN ARE FOR? AND DOES WHAT?

TIP- ALWAYS VACCINATE: FOR? IN TIP

TIP- BRAIN AND GI COULD BE BOTH PLATELET OR/AND FACTOR BLEED

A

TRUE

ITP AND IS A THROMBOPOIETIN

NEISSERIA MENINGITIDIS, HAEMOPHILUS INFLUENZAE,
PNEUMOCOCCUS

TRUE

48
Q

HX. OF PARENT+SX W/ BLEEDING-EPISTAXIS,GINGIVAL,PETECIAE,PURPURA,MUCOSAL SURFACE:GUMS,VAGINAL BLEED

  • DIAGNOSIS
  • INTIAL TEST-
  • INTIAL TREAT-
A
  • ONLY FACTOR BLEEDING WITH PLATELET SYMPTOMS ALONE: VON WILLEBRAND DISEASE (AD)
  • VWF LEVEL (MAYBE 50%), RISTOCETIN COFACTOR ASSAY: VWF DYSFUNCTION/ACTIVITY;FACTOR VIII ACTIVITY; BLEEDING:INCREASED(RARE)
  • DDAVP(DESMOPRESSIN)-RELEASES SUBENDOTHELIAL STORES OF VWF, FACTOR VIII OR VWF CONCENTRATE
49
Q

DEEP BLEEDING- JOINTS AND MUSCLES+ MALE CHILD

  • DIAGNOSIS
  • INITIAL TEST
  • ACC TEST
  • INITIAL TREAT
A
  • HEMOPHILIA
  • PT&PTT- PTT PROLONGED+MIXING WILL CORRECT PTT; ASSAY FACTOR VIII&IX
  • ASSAY FACTOR VIII&IX
  • MILD: DDAVP; SEVERE: WITH LOW LEVELS OF FACTOR VIII OR IX
50
Q

PROLONGED BLEEDING WITH TRAUMA OR SURGERY ONLY

  • DIAGNOSIS
  • INTIAL TEST
  • INITIAL TREAT
A
  • FACTOR XI DEFICIENCY
  • PT/PTT=PROLONGED PTT; MIXING ASSAY FACTOR XI (GETS BETTER)
  • FRESH FROZEN PLASMA (ONLY WITH ACUTE TRAUMA/SURGERY)
51
Q

PROLONGED PTT AND NORMAL BLEEDING TIME BEFORE SURGERY LAB EXAMS

DIAGNOSIS-
INITIAL

A

FACTOR XII DEFICIENCY

NOTHING

52
Q

DEEP BLEEDING+SUPERFICIAL BLEEDING+(SEPSIS/BURNS/ABRUPTIO PLACENTAE OR AMNIOTIC FLUID EMBOLUS/SNAKE BITE/CANCER/TRAUMA)

DIAGNOSIS-
INITIAL TEST-
INITIAL TREAT-

A

DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

ELEVATED PT AND PTT; LOW PLATELETS; ELEVATED D-DIMER&FIBRIN SPLIT PRODUCTS; DEC. FIBRINOGEN LEVEL

<50000=PLATELETS AND CLOTTING FACTORS (FFP); THEN CRYOPRECIPITATE IF FFP DOES NOT HELP

53
Q

HYPERCOAGULABLE STATE/THROMBOPHILIA

DIAGNOSIS-
INITIAL TEST-
INITIAL TREAT-

A

FACTOR LEIDEN MUTATION

ANTIPHOSPHOLIPID & COAGULATION TEST

WARFARIN: TO INR 2-3 FOR 6 MONTHS

54
Q

USE OF UNFRACTIONATED HEPARIN OR LOW MOLECULAR HEPARIN(RARE) 5-10 DAYS AFTER STARTS; VENOUS CLOTS

DIAGNOSIS-
INITIAL TEST-
INITIAL TREAT-

A
  • HIT
  • ELISA FOR PLATELET FACTOR IV (PF4) ANTIBODIES OR SEROTONIN RELEASE ASSAY
  • STOP ALL HEPARIN; THROMBIN INH:ARGATROBAN,LEPIRUDIN,BIVALIRUDIN; WARFARIN(AFTER DIRECT THROMBIN INH)
55
Q

TIP- DO NOT TRANSFUSE PLATELETS INTO HIT; IT MAY WORSEN THROMBOSIS

TIP- HIT MAY PRESENT WITH BLEEDING(LOW Pt)

A

TRUE

TRUE

USMLE Step 2 CK (9 decks)

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