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NP Prep > Hematology > Flashcards

Hematology Flashcards

1
Q

Blood loss of 15% or higher results in

A

Orthostatic hypotension

Systolic drop more than 20mm ahh

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2
Q

What is defined as an absolute neutrophil count of less than 1500 mm

A

Neutropenia

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3
Q

What condition is consistent with a gradual onset of symmetrical peripheral neuropathy starting in the feet and or arms

A

Vitamin B 12 deficiency

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4
Q

Neurological signs such as numbness, ataxia “positive Romberg test”, loss of vibration and positive sense, impaired memory, And dementia “severe cases”

A

Vitamin B 12 deficiency

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5
Q

What type of cancer affects the beta lymphocytes “B cells”

A

Hodgkin’s lymphoma

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6
Q

Night sweats, fevers, pain with ingestion of alcoholic drinks, generalized Pruritus with painless enlarged lymph nodes (neck), anorexia, and weight loss are all symptoms of

A

Hodgkin’s lymphoma

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7
Q

What type of cancer affects the lymphocytes “usually B cells” and killer cells

A

Non-Hodgkin’s lymphoma

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8
Q

What type of cancer affects older adults greater than 65 years of age, with night sweats, fever, weight loss, generalized lymphadenopathy “painless”.

A

Non-Hodgkin’s lymphoma

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9
Q

What type of cancer affects the plasma cells. Symptoms include fatigue, weakness, and bone pain that is usually located in the back or chest. Proteinuria with Bence-Jones proteins, hypercalcemia, normocytic anemia. More common in older adults

A

Multiple myeloma

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10
Q

What is defined as a platelet count of less than 150,000

A

Thrombocytopenia

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11
Q

When a patient presents with thrombocytopenia, you have to look for

A

Bleeds

Easy bruising, bleeding gums, nosebleeds, hematuria

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12
Q

Bruising on the distal lower and upper extremities is usually related to

A

Physical activity

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13
Q

Aspirin, NSAIDs, heparin, Washington, SSRI, steroids can all cause

A

Bruising

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14
Q

If a patient presents with bruising what should they be evaluated for

A

Von Willebrand’s disease, vitamin C deficiency, or scurvy. Possible coagulation disorder

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15
Q

What is the proportion of red blood cells in 1 mL of plasma

A

Hematocrit

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16
Q

What is the measure of the average size of red blood cells

A

MCV

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17
Q

What is the measure of the average color of red blood cells

A

MCH

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18
Q

What is a measure of available transferrin that is left unbound to iron

A

Total iron binding capacity

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19
Q

If the iron count is high, the total iron binding capacity he is

A

Low

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20
Q

If The iron count is low, the total iron binding capacity is

A

High

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21
Q

What is the storage form of iron

A

Serum ferritin

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22
Q

What is the most sensitive test for iron deficiency anemia

A

Serum ferritin

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23
Q

In iron deficiency anemia, serum ferritin is

A

Decreased

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24
Q

In thalassemia trait, serum ferritin is

A

Normal to high

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25
Q

What is decreased in iron deficiency anemia

A

Serum iron

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26
Q

Serum iron is normal to high in

A

Thalassemia and macrocytic anemia’s

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27
Q

When testing Serum levels

A

The patient needs to avoid iron supplements 24 hours before testing the serum ferritin level

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28
Q

A measure of the variability of the size of red blood cells in a given sample

A

RDW

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29
Q

Immature red blood cells

A

Reticulocytes

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30
Q

What is the cause of an elevation of reticulocytes or reticulocytosis

A

It is elevated with supplementation of iron, folate, or B 12 after just deficiency, after acute bleeding episodes, hemolysis, leukemia, and with erythropoietin treatment. Chronic bleeding does not cause elevation of the reticulocytes due to compensation

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31
Q

If there is no reticulocytosis after in acute bleeding episode (after 3-4 days), Hemolysis, or after appropriate supplementation of deficient mineral “iron, folate, or B 12” rule out

A

Bone marrow failure i.e. aplastic anemia. Which is diagnosed by bone marrow biopsy

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32
Q

What is poikilocytosis

A

Peripheral smear

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33
Q

Poikilocytosis or peripheral smear is seen with

A

Severe iron deficiency anemia. Red blood cells abnormal with variable shapes seen in the peripheral smear

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34
Q

If there is a deficiency in folate or B 12 what type of anemia would this be

A

Macrocytic anemia

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35
Q

What test is the gold standard for sickle cell anemia and the thalassemias

A

Hemoglobin electrophoresis

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36
Q

What types of patients have secondary polycythemia

A

Chronic smoker, long time COPD, long-term residents at high-altitude’s, or EPO treatment

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37
Q

What is and elevated immaculate and hemoglobin

A

Polycythemia

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38
Q

What is a decrease in the hemoglobin and hematocrit value below the norm for the patient’s age and gender

A

AnemiA

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39
Q

What is a microcytic hypochromic anemia

A

Iron deficiency anemia

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40
Q

What is the term for spoon shaped nails often found in Iron deficiencyanemia

A

Koilonychia

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41
Q

What is the most common cause of iron deficiency anemia

A 
Blood loss (overt or occult)
heavy menses, pregnancy, Poor diet, G.I. blood loss, post gastrectomy, and increased physiological requirement
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42
Q

Giving an infant cows milk before 12 months of age can cause

A

G.I. bleeding

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43
Q

What do these labs indicate:

Decreased hemoglobin and hematocrit, decreased MCV, decreased MCH, Decreased Ferritin and iron level, increased total iron binding capacity , increased RDW

A

Iron deficiency anemia

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44
Q

What type of anemia would cause an increase in antiparietal anti-bodies, MCV also increased, MCH within normal limits

A

Pernicious anemia

B 12 deficiency anemia

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45
Q

What type of anemia would cause an increase in the MCV, MCH in normal limits, and a decrease in folate level

A

Folate deficiency

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46
Q

What type of anemia would have an MCV within normal limits, MCH within normal limits.

A

Normocytic anemia or anemia of chronic disease such as rheumatoid arthritis or inflammatory diseases

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47
Q

What type of anemia would produce Howell jolly bodies and target cells on the peripheral smear with a normocytic normochromic anemia

A

Sickle cell anemia

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48
Q

What is the norm value for a red blood cell count

A

4.2 to 4.9

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49
Q

What is the normal value for hemoglobin

A

12 to 15

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50
Q

What is the norm value for hematocrit

A

37 to 51%

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51
Q

Does COPD increase or decrease hemoglobin and hematocrit

A

Increase

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52
Q

Measure of iron in circulation

A

Serum iron

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53
Q

Indicates ability of bone marrow to produce red blood cells usually immature red blood cells

A

Reticulocyte count

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54
Q

What labs should you always order with a patient that presents with anemia

A

Peripheral smear

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55
Q

If a patient is found to have I am deficiency anemia and B 12 anemia what term is used to describe two concurrent anemias

A

Mixed anemia

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56
Q

What test is very useful with mixed anemias

A

Peripheral smear

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57
Q

Hey macrocytic normochromic anemia would be consistent with

A

Folate or B 12 anemia

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58
Q

What is two distinct populations of red blood cells

A

Dimorphic smear

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59
Q

If the iron count is high, The total iron binding capacity is

A

Love

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60
Q

If the iron count is low the total iron binding capacity is

A

High

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61
Q

What is the average lifespan of a normal red blood cell

A

Three month or 100 to 120 days

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62
Q

What is the average lifespan of a platelet

A

Three days

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63
Q

What are two common causes of microcytic anemia

A

Iron deficiency anemia and thalassemia

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64
Q

What is the mostcommon reason for Iron deficiency anemia

A

Blood loss

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65
Q

What is another cause of microcytic anemia that may not be as common

A

lead toxicity

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66
Q

Most people with microcytic anemia’s are a symptomatic until their H&H reach

A

30/10

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67
Q

Weakness, headache, irritability, fatigue, exercise intolerance are all classic presentation of

A

Microcytic anemia’s

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68
Q

Older adults may present with exacerbation of co-morbids such as angina, worsening dementia in

A

Microcytic anemia’s

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69
Q

In Iron deficiency anemia the RDW count is greater or less than 15%

A

Greater than 15%

70
Q

What is the average lifespan of red blood cells

A

100 to 120 days

71
Q

In long-standing iron deficiency anemia RDW is greater or less than 15%

A

Less than 15%

72
Q

What types of foods can help with iron deficiency anemia

A

Organ meats “liver”, red meat, dried peas and beans, dark green leafy vegetables, whole grains.

73
Q

How much elemental iron is needed to correct iron deficiency anemia

A

150 to 200 mg per day of elemental iron

74
Q

How long do you replace and treat Iron deficiency anemia with elemental iron

A

4 to 6 months of oral replacement. If hemoglobin is not increased after one month of iron replacement therapy, trouble

75
Q

What are common side effects of iron supplementation

A

G.I. upset and constipation

76
Q

What is the most common form of iron replacement

A

Ferrous sulfate

77
Q

After four weeks of iron supplementation the hematocrit and hemoglobin should go up how many points in the first month

A

Hematocrit will go up three points, hemoglobin will go up one point

78
Q

What must be rolled out with iron ore deficiency anemia

A

G.I. malignancy

79
Q

How should supplemental iron be taken for better absorption

A

It should be taken between meals with vitamin C or orange juice for better absorption

80
Q

What are some drug interactions with supplemental iron

A

Antacids, dairy products, quinolones, or tetracycline

81
Q

A genetic disorder in which the bone marrow produces abnormal hemoglobin and results in a microcytic hypochromic anemia

A

Thalassemia

82
Q

What ethnic groups are more destined for Thalassemia

A

Mediterranean, north African, Middle Eastern and South Asians

83
Q

Alpha thalassemia is most common in what ethnic group

A

South east Asians such as Chinese, Cambodian, Filipinos and Thai

84
Q

What is the gold standard diagnostic test for thalassemia

A

Hemoglobin electrophoresis

85
Q

what is recommended for patients with thalassemia

A

Genetic counseling

86
Q

Does thalassemia minor trait need treatment

A

No

87
Q

What is the screening test for all anemias

A

CBC “hemoglobin/hematocrit”

88
Q

What is a diagnostic test for thalassemia and sickle cell anemia

A

Hemoglobin electrophoresis

89
Q

If the ferritin level is low, the patient has

A

Iron deficiency anemia

90
Q

If the ferritin level is high, the patient has

A

Thalassemia minor/trait

91
Q

Patients with chronic illness and or auto immune disease have a higher risk of what type of anemia

A

Normocytic

92
Q

If a patient up and an acid, they must wait how many hours before taking their iron pill

A

Four hours

93
Q

Failure to respond to iron supplementation may be a sign of

A

Continuing blood loss, misdiagnosis “have thalassemia instead of iron deficiency anemia”, malabsorption i.e. celiac disease

94
Q

Iron poisoning in children less than the age of six may cause

A

DEAth

95
Q

In beta thalassemia types, what must be avoided

A

Excessive consumption of iron

96
Q

What type of anemia is caused by the destruction of the pluripotent stem cells in side the bone marrow

A

APlastic anemia

97
Q

Radiation, adverse effect of a drug, and viral infection can cause what kind of anemia

A

Aplastic anemia

98
Q

What is the gold standard diagnostic test for aplastic anemia

A

Bone marrow biopsy

99
Q

How do you treat aplastic anemia

A

Refer to hematologist as soon as possible if septic refer to ED

100
Q

Mild to moderate normocytic normal chronic anemia is what type of anemia

A

Anemia of chronic disease or chronic inflammation

101
Q

How do you treat anemia of chronic disease

A

Treatment is aimed at control of underlying disease

102
Q

What are the types of macrocytic anemia’s

A

B 12 or pernicious anemia and folate deficiency

103
Q

What vitamin is necessary for the health of the neurons and the brain, and from normal DNA production of the red blood cells

A

B 12

104
Q

Chronic B 12 deficiency causes

A

Severe nerve damage and brain damage i.e. dementia. Neurologic damage may not be reversible

105
Q

And auto immune disorder caused by the distraction of parietal cells in the fun death resulting in cessation of intrinsic factor production.

A

Pernicious anemia

106
Q

What is necessaryin order to absorb B12 from the small intestine

A

Intrinsic factor

107
Q

What are some other causes of B 12 deficiency

A

Gastrectomy, strict vegan, alcoholics, small bowel disease

108
Q

What foods are B12 sources

A

All foods of animal origin such as meat, poultry, eggs, milk, cheese

109
Q

Tingling/numbness of hands and feet, neuropathy starts in peripheral nerves and migrates centrally, difficulty walking and difficulty in performing fine motor skills is example of what type of deficiency

A

B 12

110
Q

What value represents a normal reflex

A

+2

111
Q

What value represents a sluggish reflex

A

+1

112
Q

Abnormal Rhomberg test is consistent with what type of anemia

A

Pernicious anemia or 12 deficiency

113
Q

B12 is also known as

A

Cobolamin

114
Q

When you check a B 12 level what other level needs to be checked. These two levels must always be checked together

A

Folate

115
Q

Alcohol and substance abuse consumption is a cause of

A

Macrocytosis

116
Q

What deficiency is characterized by neurological changes

A

B 12 deficiency

117
Q

If a patient has a normal MMA level and an elevated homocysteine level this is consistent with

A

Folate deficiency

118
Q

If a patient has an elevated MMA level and an elevated homocysteine level this is consistent with

A

B12 deficiency

119
Q

How is B 12 deficiency managed

A

Vitamin B 12 (cobalamin) IM administered every day for one week, then weekly for one month, then monthly for life.

120
Q

How is folic acid deficiency treated

A

Folic acid given PO

121
Q

Neurologic deficit of B12 deficiency is usually reversible an improvement should be seen and how many days

A

5 to 10 days

122
Q

How long does a patient need to be treated for B 12 deficiency

A

Lifelong

123
Q

How long do you treat folate deficiency

A

1 to 4 months or until hematologic recovery

124
Q

What value represents a decreased B 12 level

A

Less than 200

125
Q

What are antibody tests for B 12 deficiency

A

Anti-parietal and anti-intrinsic factor antibody

126
Q

Homocysteine level is elevated or decreased in B12 and folate deficiency

A

Elevated

127
Q

MMA is elevated or decreased in B12 deficiency

A

Elevated

128
Q

B12 deficiency anemia, macrocytic anemia, neurologic symptoms are all associated with

A

Pernicious anemia

129
Q

A cheap screening test for sickle cell anemia is

A

Sickledex

130
Q

If the parietal antibody test and or the intrinsic factor antibody test are elevated the patient has

A

Pernicious anemia

131
Q

Any patient complaining of neuropathy or dementia should have what levels checked

A

B 12

132
Q

If there is a decrease in platelet count but the rest of the CBC is normal the patient has

A

Thrombocytopenia

133
Q

What is the platelet count in thrombocytopenia

A

Less than 150,000

White blood cells usually within normal limits

134
Q

What are some causes of thrombocytopenia

A

Recent infection either viral or bacterial, idiopathic, drug induced, SLE, leukemia

135
Q

How should thrombocytopenia be managed

A

Refer to hematologist
Prednisones for 4 to 6 weeks, may need daily course of chronic ITP, minimal activity to prevent injury or bruising no contact sports and avoidance of aspirin

136
Q

What is the most common cause of folic acid deficiency anemia

A

In adequate dietary intake

137
Q

What drugs interfere with folate absorption

A

Phenytoin, trimethoprim-sulfa, methotrexate, zidovidine

138
Q

What constitutes as the most white blood cells in the body at greatest quantity

A

Neutrophils

139
Q

When poly and lymphs are close together think

A

Viral

140
Q

When poly And lymphs are far apart think

A

Bacterial

141
Q

When mono is high on a CBC it is most likely that

A

The person has been inspected for greater than 24 hours

142
Q

If you see bands on a CBC it means

A

Immature red blood cells. Really bad infection

143
Q

Patients with sickle cell have an increased resistance to what type of infection

A

Malaria

144
Q

Patients with what type of anemia are at higher risk of death from infection with encapsulated bacteria i.e. streptococcus pneumonia and haemophilus influenza due to hyposplenia

A

Sickle cell anemia

145
Q

Ischemic necrosis of bones or skin, renal and or liver dysfunction, priapism, hemolytic episodes, hyposplenism, and frequent infections are all symptoms of

A

Sickle cell anemia

146
Q

What isThe screening test for sickle cell anemia

A

CBC

147
Q

What is the gold standard diagnostic tool for sickle cell anemia

A

Hemoglobin electrophoresis

148
Q

How do you treat sickle cell anemia

A

Refer patients with disease to hematologist

149
Q

Only what type of anemia has neurologic symptoms i.e. tingling and numbness

A

B 12 deficiency anemia

150
Q

With mixed in the me as such as iron deficiency and B12 the MCV is usually

A

Within normal limits

151
Q

What is the most common type of thrombocytopenia found in children between the ages of two and four

A

Idiopathic thrombocytopenia purpura

ITP

152
Q

How is iron better absorbed

A

On an empty stomach

153
Q

What is an expected finding if a laboratory identifies metamyelocytes in a patient

A

Splenomegaly

154
Q

What type of medication for arthritis contributes to iron deficiency anemia

A

Nonsteroidal anti-inflammatory drugs (NSAIDS)

155
Q

in a patient with recent onset iron deficiency anemia i.e. the last 3 to 4 months how would the RDW look would it be increased or decreased

A

Increased

156
Q

A measure of the degree of variation in red blood cell size is indicated by

A

RDW

157
Q

If a patient has leukocytosis this means

A

They have an infection of unknown origin

158
Q

Patients with pernicious anemia may be observed to have

A

Glossitis

159
Q

What disease is characterized By Low platelet count and other red or white cell abnormality’s

A

Acute lymphocytic leukemia

160
Q

The nurse practitioner differentiates physiologic jaundice from pathologic jaundice by assessment of the

A

Timing of the onset of the jaundice

161
Q

If a newborn develops a cephalomatoma the newborn is at an increased risk for

A

Jaundice

162
Q

A child with sickle cell anemia presents with a history of sudden onset of rapid breathing with left upper quadrant tenderness upon palpation. The child is most likely experiencing

A

Sequestration crisis

163
Q

What symptom is associated with B 12 deficiency anemia

A

Tingling and numbness of both feet

164
Q

Today the patient is diagnosed with iron deficiency anemia and started on a daily iron supplement. In order to best assess the adequacy of supplementation the nurse practitioner would appropriately order a follow up

A

Hemoglobin level in one month

165
Q

A 23-year-old female patient of Italian descent has been diagnosed with anemia secondary to glucose-6-phosphate dehydrogenase deficiency. It is important to teach this patient to avoid

A

Fava beans, ASA, anti-malarials

166
Q

The most appropriate therapy for an elderly patient with pernicious anemia is

A

Intramuscular injections of vitamin B 12

167
Q

Is shakiness or jitteriness associated with anemia

A

No

168
Q

A 17-year-old has mononucleosis. His CBC is best categorized by

A

Increased lymphocytes and decreased total white count

169
Q

The INR for a patient taking Coumadin for a fib is expected to be increased or decreased

A

Increased

170
Q

Ecchymotic lesions greater than how many centimeters without a history of significant trauma is most likely to indicate an underlying bleeding problem

A

6 cm

NP Prep (20 decks)

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