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Awesome Review: ABIM > Hematology > Flashcards

Hematology Flashcards

1
Q

most sensitive assay for IDA

A

transferrin receptor index (TRI)

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2
Q

if Hb 10 g/dL, MCV 85, TIBC low, transferrin saturation 22%, ferritin 120, what will BM bx show?

A

ACD: INCREASED Fe2+ in macrophages (RES) and decreased sideroblasts

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3
Q

70 yo male or post-menopausal female w/ Hb 9.5 g/dL, MCV 70, decreased ferritin, wtd?

A

GI w/u

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4
Q

young pt, < 40 yoa w/ Hb 9.5 g/dL, MCV 70, decreased ferritin, wtd?

A

EGD

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5
Q

older pt, > 50 yoa w/ Hb 9.5 g/dL, MCV 70, decreased ferritin, wtd?

A

colonoscopy first

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6
Q

45 yo pt w/ LEFT supraclavicular LAD w/ Hb 9.5 g/dL, MCV 70, decreased ferritin, wtd?

A

EGD to r/o stomach CA

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7
Q

25 yo female w/ Hb 9 g/dL, MCV 63, decreased ferritin, RDW 17%

  • smear: hypochromic microcytic, anisocytosis, target cells, pencil/cigar cells
  • dx
A

either menstrual loss or pregnancy w/ increased need

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8
Q

25 yo female w/ Hb 9 g/dL, MCV 63, decreased ferritin, RDW 17%

  • smear: hypochromic microcytic, anisocytosis, target cells, pencil/cigar cells
  • tx
A

ferrous sulfate PO

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9
Q

pt started on tx for IDA w/ Fe2+ and vitamin C, what to check for response and how soon?

A
  • reticulocyte count

- 5-7 days

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10
Q

60 yo female w/ h/o DM and CKD p/w fatigue, Hb is 9 g/dL, stool guaiac negative, serum EPO is 10 mg/dL, is started on EPO tx, 4 weeks later Hb is 9.2 g/dL, wtd?

A

start supplemental ferrous sulfate

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11
Q

pregnant female in 2nd trimester, Hb 10.5 g/dL, MCV 80, RDW 14%

A

increased plasma volume

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12
Q

pregnant female in 2nd trimester, Hb 10.5 g/dL, MCV 75, RDW 17%

A

IDA

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13
Q

elderly male p/w nausea, abd pain and diarrhea, on exam, slight confusion, gait abnormality, and decreased vibration sensation, Hb 9 g/dL, MCV 78, wtd?

A

urine heavy metal screening

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14
Q

elderly pt works at factory that makes batteries, or lives in an old building, or is a chronic alcoholic, p/w h/o anemia, and gout, Hb 9 g/dL, MCV 80, dx?

A

lead poisoning

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15
Q

young pt presents for regular check up, Hb 12.2 g/dL, MCV 70, RDW 13.5%, smear shows hypochromic microcytic cells, target cells, how to establish dx?

A

Hb electrophoresis

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16
Q

Asian pt (India/Vietnam/Laos/Cambodia) p/w Hb 12 g/dL, MCV 75, blood refused when trying to donate, smear shows target cells, dx?

A

alpha thalassemia trait

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17
Q

black male p/w SC anemia w/ arthralgia, fever, Hb 8 g/dL, increased LDH, increased reticulocyte count, normal ferritin, dx?

A

painful vaso-occlusive crisis

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18
Q

painful vaso-occlusive crisis tx

A

hydration, analgesics, O2

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19
Q

painful vaso-occlusive crisis, best way to prevent

A

hydroxyurea

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20
Q

black male p/w SC anemia w/ arthralgia, fever, Hb 8 g/dL, increased LDH, increased reticulocyte count, normal ferritin, supportive tx started, next day Hb drops, wtd?

A

don’t transfuse, c/w current management

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21
Q

Hb level to transfuse pt

A

< 7 g/dL

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22
Q

how many units PRBC to transfuse in pt NOT bleeding?

A

ONE unit and recheck

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23
Q

pt w/ chronic IDA scheduled for surgery, Hb 8 g/dL, wtd?

A

iron

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24
Q

black male w/ SC disease p/w right hip pain, no h/o recent trauma, XR hip shows diffuse articular sclerosis and patches of decalcification, dx?

A

avascular necrosis of femoral head

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25
Q

pt w/ SC anemia w/ CP, fever, sputum negative for PMNs, CXR shows infiltrate, IV morphine given, dx?

A

acute chest syndrome

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26
Q

acute chest syndrome tx

A

IV abx, O2 if hypoxic, PRBCs if severe anemia

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27
Q

acute chest syndrome tx if hypoxia persists despite O2 and PRBCs

A

EXCHANGE transfusion

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28
Q

pt w/ SCT w/ LUQ pain, enlarging spleen and dropping H/H, BP 100/80 and HR 96 supine, SBP 80 and HR 114 sitting up, dx?

A

splenic sequestration crisis

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29
Q

splenic sequestration crisis tx after IVF

A

PRBCs

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30
Q

school teacher w/ arthralgias, Hb 8 g/dL, no h/o bleeds, no rash, reticulocyte count 0.2%, dx?

A

aplastic anemia 2/2 parvovirus B19

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31
Q

aplastic anemia 2/2 parvovirus B19 tx

A

IVIG

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32
Q

pregnant teacher worried about hepatitis A (or parvovirus B19, or hepatitis B) breakout in school, w/ which Ab titers can you reassure her?

A

IgM negative, IgG positive (already immune, no acute infection)

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33
Q

MCC of OM in SC disease

A

Salmonella > Staph (2:1)

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34
Q

pt w/ Hb 13 g/dL, MCV 70, Hb electrophoresis shows Hb A 75%, Hb S 25%, and Hb F 0.3%, dx?

A

SCT or alpha thalassemia

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35
Q

pt w/ SC disease and seizure d/o on phenytoin p/w severe anemia w/ Hb drop from 11 g/dL to 9 g/dL, MCV 110, reticulocyte count 0.7%, LDH 750, dx?

A

phenytoin-induced folate deficiency

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36
Q

55 yo chronic alcoholic w/ anemia, increased MCV, decreased folate, dx w/ folic acid deficiency anemia, started on folate PO daily, couple of weeks later, Plt count increases from 150,000 to 750,000, wtd?

A

c/w folate treatment (platelets known to increase w/ folate tx)

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37
Q

PCP started 60 yo pt w/ Hb 10 g/dL, MCV of 120 on folate, several years later, Hb is 11.2 g/dL, pt has dementia and gait problem, wtd?

A

check B12 level

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38
Q

PCP started 60 yo pt w/ Hb 10 g/dL, MCV of 120 on folate, several years later, Hb is 11.2 g/dL, pt has dementia and gait problem, if B12 level is 300, wtd?

A

check MMA level (if increased, B12 deficiency!!)

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39
Q

74 yo female p/w sxs of forgetfulness, exam shows Romberg sign positive, B12 level is 310, Hb 13 g/dL, MCV 103, wtd?

A

check MMA level

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40
Q

which meds decrease B12 absorption?

A

metformin and PPIs

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41
Q

best tx for B12 deficiency

A

cobalamin PO (even in pernicious anemia)

42
Q

best way to differentiate between B12 and B6 deficiency

A

high MCV

  • B6 def (high homocysteine, MMA WNL)
  • folate def (high homocysteine, MMA WNL)
  • B12 def (high homocysteine, MMA HIGH also)
43
Q

in any chronic hemolytic anemia (SC anemia, HS, etc), pt should be tx’d w/?

A

folate

44
Q

long time dock worker, now 80 yo, p/w c/o improper gait and forgetfulness, unable to remember names, exam shows Romberg sign positive, decreased vibration sense, Hb 10.5 g/dL, MCV 118, B12 275, homocysteine 22 (high), dx?

A

B12 deficiency

45
Q

leukopenia, anemia, and thrombocytopenia is likely to be seen in which conditions?

A

DIC, ITP, and TTP (double check this answer)

46
Q

elderly pt p/w anemia +/- thrombocytopenia +/- leukopenia w/ hypOsegmented PMNs, macrocytosis, megakaryocytes, hypercellular BM, 5q gene deletion, dx?

A

myelodysplastic syndrome

47
Q

elderly pt p/w anemia +/- thrombocytopenia +/- leukopenia w/ hypOsegmented PMNs, macrocytosis, megakaryocytes, hypercellular BM, 5q gene deletion, tx if < 55 yo?

A

ALLOgenic BMT

48
Q

elderly pt p/w anemia +/- thrombocytopenia +/- leukopenia w/ hypOsegmented PMNs, macrocytosis, megakaryocytes, hypercellular BM, 5q gene deletion, tx if > 55 yo?

A

azacitidine

49
Q

myelodysplastic syndrome w/ 5q gene deletion tx

A

lenalidomide

50
Q

best screening tool for hemochromatosis

A

serum transferrin saturation

51
Q

diagnostic test for hemochromatosis

A

HFE gene test

52
Q

to find out extent of Fe2+ overload, wtd?

A

liver bx

53
Q

tx for hemochromatosis

A

phlebotomy

54
Q

pt p/w fatigue, h/o PNA x 2 in past couple of months, exam shows petechiae, WBC 2000, Hb 6 g/dL, Plt count 62,000, reticulocyte count 1%, MCV 104, BM bx shows hypOcellularity and FAT cells, dx?

A

aplastic anemia

55
Q

aplastic anemia tx if < 50 yo

A

ALLOgenic BMT

56
Q

pt w/ uremia, low Hb, PBS w/ BURR cells, dx?

A

anemia of renal failure

57
Q

etiology of anemia of renal failure

A

low EPO

58
Q

anemia of renal failure tx

A

EPO w/ target Hb 10-11 g/dL

59
Q

pt w/ alcoholic cirrhosis and worsening anemia, high bilirubin, high reticulocyte count, no evidence of bleeding, PBS shows RBCs w/ irregular spiculations, dx?

A

spur cell anemia of liver disease (bad prognosis)

60
Q

pt w/ unstable angina is started on IV nitrates, or pt post EGD or post bronchoscopy, suddenly turns cyanotic and becomes SOB, EKG shows no acute ST/T wave changes, ABG shows PO2 96, and pulse ox 85%, dx?

A

methemoglobinemia

61
Q

methemoglobinemia tx

A

methylene blue

62
Q
  • warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
  • PCN/cephalosporin/methyldopa
A

warm Ab (anti-IgG)

63
Q
  • warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
  • SLE
A

warm Ab (anti-IgG)

64
Q
  • warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
  • CLL/lymphoma
A

mixed

65
Q
  • warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
  • quinidine
A

cold Ab (anti-IgM)

66
Q
  • warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
  • infection (Mycoplasma, infectious mononucleosis)
A

cold Ab (anti-IgM)

67
Q
  • warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
  • can be treated w/ steroids
A

warm Ab (anti-IgG)

68
Q
  • warm Ab (anti-IgG), cold Ab (anti-IgM), mixed, paroxysmal cold hemoglobinuria
  • influenza
A

cold Ab (anti-IgM) OR paroxysmal cold hemoglobinuria

69
Q

43 yo pt on Bactrim for URI develops anemia, LDH and reticulocyte count increased, Mycoplasma titer positive, cold agglutinin positive, dx?

A

Mycoplasma induced hemolysis

70
Q

48 yo male p/w colicky abd pain, UA shows blood positive, no RBCs, WBCs, and hemosiderin positive; Hb 8 g/dL, MCV 83, reticulocyte count 7%, LDH 210, amylase 16, lipase 35, PT 13, PTT 38, direct Coombs negative, indirect Coombs negative, abd US shows no gallstones, no renal stones, mesenteric vein thrombosis positive, dx?

A

paroxysmal nocturnal hemoglobinuria

71
Q

paroxysmal nocturnal hemoglobinuria dx

A

DAF assay or flow cytometry positive for CD55 and CD59

72
Q

paroxysmal nocturnal hemoglobinuria tx

A

ALLOgenic BMT or eculizumab

73
Q

what should be given 2 weeks prior to treating PNH w/ eculizumab?

A

meningococcal vaccine

74
Q

40 yo female w/ h/o smoking x 15 years, consumes 6 drinks per week, seizure d/o on barbiturates, takes progesterone OCP since she had a DVT 2 years ago, skips meals occaisonally, on exam BMI of 19, p/w acute onset abd pain, vomiting, pain/paresthesias in arms, constipated x 3 days, temperature 99, HR 100, WBC 8000, Hb 13 g/dL, AST 80, ALT 90, urine is dark red, blood negative, WBC negative, dx?

A

acute intermittent porphyria

75
Q

acute intermittent porphyria etiology

A

decreased PBG deaminase activity

76
Q

young female on routine exam found to have Hb of 9 g/dL, palpable spleen, family h/o anemia, MCV 86, MCHC 38, reticulocyte count 5%, direct Coombs test negative, esoin-5-maleimide binding test positive, dx and most etiology?

A
  • hereditary spherocytosis

- cytoskeletal spectrin membrane defect

77
Q

hereditary spherocytosis tx

A

folate

78
Q

35 yo female w/ recent URI, treated w/ amoxicillin or PCN, p/w fatigue and pallor, blood indices WNL 1 year ago, Hb now 9 g/dL, MCV 92, MCHC 39, reticulocyte count 12%, polychromasia positive, spherocytes positive, dx?

A

autoimmune hemolytic anemia

79
Q

pt p/w hemolytic anemia, suspected to have G6PD deficiency, G6PD levels are normal, wtd?

A

recheck levels in 2-3 months (falsely normal)

80
Q

18 yo p/w abd pain and bloody diarrhea, no fever or mental status change, Hb 10 g/dL, Plt 60,000, reticulocyte count 8%, LDH 650, PT/PTT normal, BUN 30, creatinine 2.2, PBS shows reticulocytes w/ polychromasia, schistocytes positive, dx?

A

HUS

81
Q

25 yo female has normal labor, 7 days postpartum p/w fatigue, exam shows petechiae on arms, Hb 8 g/dL, Plt 20,000, reticulocyte count 7%, LDH 850, PT/PTT normal, BUN 30, creatinine 1.6, AST 120, ALT 250, PBS shows anisocytosis w/ polychromasia, schistocytes positive, dx?

A

HELLP syndrome

82
Q

HELLP syndrome tx if < 32 weeks pregnant

A

steroids

83
Q

HELLP syndrome tx if > 32 weeks pregnant

A

early delivery

84
Q

young female is brought by family w/ mild confusion or headache for past 2 days, exam shows fallor, temp 100.4, Hb 9.5 g/dL, WBC 7000, Plt 25,000, PBS shows RBC fragments, polychromasia positive, BUN 40, creatinine 2.5, PT 12, PTT 25, tx?

A

plasmapheresis

85
Q

tx for TTP if plasmapheresis machine is not available?

A

plasma infusion (give FFP)

86
Q

pt w/ a Plt count of 50,000 w/ PNA, what will help establish dx of TTP?

A

PBS

87
Q

which conditions will you see schistocytes?

A

DIC, HUS, HELLP, and TTP

88
Q

pt is getting a blood transfusion, w/i 1 hour he becomes restless, dyspneic, c/o LBP, fevers, and chills, temp 101.5, HR increases from 80 to 110 bpm, urine is dark red, Hb drops from 9 g/dL to 7 g/dL, direct Coombs test is positive for IgG Abs, dx?

A

major hemolytic reaction d/t early ABO incompatibility

89
Q

most likely cause of ABO incompatibility leading to hemolysis reaction?

A

clerical error w/ ABO mismatch

90
Q

50 y/o alcoholic p/w GIB, 1 month ago was hospitalized w/ Mallory Weiss tear and had received 2 units of PRBCs, on exam BP is 80/60, HR 120 bpm, Hb 6.5 g/dL, pt receives vigorous IVF and 2 units of PRBCs and PPI, 2 days later on discharge planning pt c/o lightheadedness, temperature is 101.5, repeat Hb is 6.1 g/dL, best test to explain PE and lab findings?

A

Coombs test (will show delayed Rh incompatibility reaction)

91
Q

pt receives blood transfusion 2 units PRBCs during surgery, is discharged, returns to office 1 week later w/ episode of dark urine and mild scleral icterus, dx?

A

late hemolytic reaction d/t Rh incompatibility

92
Q

role of steroids in Rh incompatibility?

A

NONE

93
Q

which electrolyte is most likely decreased after massive blood transfusion?

A

calcium

94
Q

which electrolyte is most likely decreased after plasmapheresis?

A

calcium

95
Q

most likely cause of seizures after massive blood transfusion?

A

citrate toxicity

96
Q

pt w/ h/o urticaria and allergies needs blood transfusion, wtd?

A

transfuse washed PRBCs

97
Q

pt has fevers and chills every time he is transfused, H/H does NOT drop, dx and wtd?

A
  • febrile reaction to leukocytes from donor blood

- leukocyte reduced PRBCs for future transfusions

98
Q

blood transfusion is started, few minutes later, HR increases to 110 bpm, BP drops to 80/60, pt appears SOB w/ RR 28/min, lips are swollen, temperature 99, most likely cause?

A

IgA deficiency

99
Q

pt w/ severe IgA deficiency requires blood transfusion, wtd?

A

washed PRBCs

100
Q

pt receives Plt transfusion, 2 hours later has fevers, hypotension, headache, backache, chest pain, oliguria, but no red colored urine, dx?

A

bacterial contamination

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