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Step 2CK > Hematology > Flashcards

Hematology Flashcards

1
Q

What are the 5 causes of low MCV anemia?

A
  1. Iron deficiency
  2. Thalassemia
  3. Sideroblastic
  4. Anemia of chronic dz
  5. Spherocytosis
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2
Q

What are the 4 causes of normocytic anemia?

A
  1. Blood loss
  2. Hemolysis
  3. Anemia of chronic dz
  4. Aplasia
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3
Q

What are the 6 causes of macrocytic anemia?

A
  1. Vit B12 & folate deficiency
  2. Alcoholism
  3. Liver disease
  4. Drugs
  5. Mydelodysplastic syndrome
  6. Sideroblastic
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4
Q

If reticulocytes are high, what type of anemia is it (only 2 options)?

A

Hemolytic or chronic blood loss (both normocytic)

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5
Q

What does cryoprecipitate replace?

A

Fibrinogen, Factor 8, VWF

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6
Q

What can cryoprecipitate aid?

A

DIC

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7
Q

What is FFP used for?

A

Elevated PTT, aPTT, or INR

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8
Q

When is the platelet count low enough to transfuse platelets?

A

<50,000

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9
Q

What common condition can cause sideroblastic anemia?

A

Alcoholism

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10
Q 
Which type of anemia has: 
Serum iron: low
Ferritin: low
TIBC: high
Transferrin %: low
A

Iron deficiency

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11
Q

Which type of anemia has high iron?

A

Sideroblastic anemia

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12
Q

Which type of anemia has normal iron studies?

A

Thalassemia

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13
Q 
Which type of anemia has: 
Serum iron: high
Ferritin: high
TIBC: low
Transferrin %: high
A

Hemochromatosis

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14
Q 
Which type of anemia has: 
Serum iron: low
Ferritin: high
TIBC: low
Transferrin %: low
A

Chronic dz

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15
Q 
Which type of anemia has: 
Serum iron: high
Ferritin: high
TIBC: low
Transferrin %: high
A

Hemolytic anemia

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16
Q 
Which type of anemia has: 
Serum iron: high
Ferritin: high
TIBC: low
Transferrin %: high
A

Sideroblastic anemia

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17
Q

When you see increased HbF, what dx’s might be possible?

A

Thalassemia, sickle cell

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18
Q

What does megaloblastic mean?

A

Presence of hypersegmented neutrophils

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19
Q

Only ___ and _____ deficiency cause megaloblastic anemia?

A

B12 and folate

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20
Q

Only ___ deficiency is associated with an increased MMA level?

A

B12

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21
Q

How is pernicious anemia confirmed (2 Ab’s)?

A
  1. Anti-intrinsic factor

2. Anti-parietal cell

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22
Q

What electrolyte abnormality is associated with B12 or folate replacement?

A

Hypokalemia

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23
Q

Chronic hemolysis is associated with which type of gallstone?

A

Bilirubin

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24
Q

Does sickle cell have a high reticulocyte count?

A

Yes

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25
Q

Sickle cell is caused by a point mutation at position __ of the __ globin chain, causing ____ to replace _____ ___?

A

Position 6 of the B-globin chain; valine replaces glutamic acid

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26
Q

What’s the most common type of gallstone in sickle cell?

A

Bilirubin

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27
Q

What can be found on the smear of sickle cell or splenectomy patient?

A

Howell-Jolly bodies

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28
Q

What’s the best initial test for sickle cell?

A

Peripheral smear

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29
Q

What’s the most accurate test for sickle cell?

A

Electrophoresis

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30
Q

What 2 medications lower mortality in sickle cell patients?

A
  1. Hydroxyurea

2. Abx with fever

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31
Q

What virus causes an aplastic crisis in sickle cell anemia?

A

Parvovirus B-19

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32
Q

When is exchange transfusion used (4)?

A
  1. Acute chest syndrome
  2. Priapism
  3. Stroke
  4. Visual disturbance from retinal infarction
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33
Q

What’s the only symptom of sickle cell trait?

A

Inability to concentrate urine

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34
Q

What type of gallstones are seen in hereditary spherocytosis?

A

Bilirubin

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35
Q

What’s the most accurate test for hereditary spherocytosis?

A

Eosin-5-maleimide flow cytometry

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36
Q

What’s the tx for hereditary spherocytosis?

A

Folic acid supplementation, splenectomy

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37
Q

What is warm hemolysis?

A

Autoantibodies (IgG) against RBCs, often unknown cause but can be from penicillin and other drugs

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38
Q

What’s the best initial tx for warm hemolysis?

A

Glucocorticoids

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39
Q

What is cold agglutinin?

A

IgM antibodies against RBCs “Mm it’s cold in here” often showing mottled extremities in the cold

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40
Q

What’s the tx for cold agglutinin?

A

Warmth and rituximab

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41
Q

What’s the inheritance pattern of G6PD?

A

XLR

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42
Q 
What can the following all precipitate:?
Dapsone
Quinidine
Sulfa drugs
Primaquine
Nitrofurantoin
Fava beans
A

Oxidative crisis in G6PD (sudden anemia and jaundice)

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43
Q

What does a smear show in G6PD (2)?

A
  1. Heinz bodies

2. Bite cells

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44
Q

What are HUS and TTP?

A

Intravascular hemolysis with schistocytes, thrombocytopenia, renal insufficiency

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45
Q

What are low ADAMST13 associated with?

A

TTP

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46
Q

What is HUS associated with?

A

E. Coli 157:H7

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47
Q

What is TTP associated with?

A

Ticlopdipine, clopidogrel, cyclosporine, AIDS, SLE

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48
Q

What’s the tx for severe HUS or TTP?

A

Plasmapharesis

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49
Q

What dx causes episodic dark urine, pancytopenia, iron deficiency anemia, and clots in unusual places, due to a clonal stem cell defect with increased RBC sensitivity to complement in acidosis?

A

Paroxysmal Nocturnal Hemoglobinuria (PNH)

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50
Q

What markers are associated with PNH (4)

A
  1. CD55
  2. CD59
  3. DAF
  4. PIG-A
51
Q

What’s the best tx for PNH?

A

Prednisone

52
Q

What’s the only cure for PNH?

A

BM transplant

53
Q

What’s the most common cause of death in PNH?

A

Thrombosis

54
Q

What is aplastic anemia?

A

Autoimmune pancytopenia of unknown origin

55
Q

Which leukocyte is involved in aplastic anemia?

A

T cells

56
Q

What 2 medications can be used for aplastic anemia?

A

Cyclosporine, tacrolimus

57
Q

What dx is due to a JAK2 mutation?

A

Polycythemia Vera

58
Q

What are the following levels in Polycythemia Vera?:
O2:
EPO:
Vit B12:

A

O2: normal
EPO: low
Vit B12: high

59
Q

What cancer can Polycythemia Vera turn into?

A

AML

60
Q

What’s the tx for Polycythemia Vera?

A

Phlebotomy, aspirin, hydroxyurea, allopurinol, and antihistamines

61
Q

What’s the tx for hypereosinophilic syndrome?

A

Steroids (otherwise death from cardiomyopathy or thromboembolism!)

62
Q

What dx presents with itchy skin lesions and abdominal pain, nausea, urticaria pigmentosa, Darier sign (hives at point of touch), and is triggered by NSAIDs, aspirin, narcotics?

A

Systemic Mastocytosis

63
Q

What’s the best diagnostic test for Systemic Mastocytosis?

A

Serum tryptase

64
Q

What’s the best treatment for Systemic Mastocytosis?

A

Antihistamines, steroids, montelukast

65
Q

Which dx presents with pancytopenia, teardrop-shaped clels, and nucleated RBC’s on smear?

A

Myelofibrosis

66
Q

What’s the best tx for Myelofibrosis?

A

Thalidomide (TNF-inhibitors)

67
Q

Which type of leukemia is associated with DIC?

A

PML

68
Q

What type of cancer is myeloperoxidase characteristic of?

A

AML

69
Q

What cancer are Auer rods associated with?

A

AML

70
Q

Are AML and ALL treated with chemotherapy?

A

Yes

71
Q

What are Auer rods?

A

Azurophilic rods composed of lysosomes

72
Q

What dx presents with itchiness in the shower?

A

Polycythemia Vera

73
Q

Which blood cancer presents age <13?

A

ALL

74
Q

Which blood cancer presents age 13-40?

A

AML

75
Q

Which blood cancer presents age 40-60?

A

CML

76
Q

Which blood cancer presents age >60?

A

CLL

77
Q

Does CML have splenomegaly?

A

Yes

78
Q

What can CML turn into?

A

AML

79
Q

What dx presents with pancytopenia, often asymptomatic, with ringed Pelger-Huet cells (bilobed nucleus) on smear?

A

Myelodysplastic syndrome

80
Q

Which blood cancer shows smudge cells?

A

CLL

81
Q

What prophylaxis is indicated in CLL?

A

PCP

82
Q

What dx presents in middle aged and presents with pancytopenia, splenomegaly, dry tap, and monocytopenia?

A

Hairy Cell Leukemia

83
Q

What’s the tx for Hairy Cell Leukemia?

A

Cladribine

84
Q

What’s the best way to dx Non-Hodgkin’s Lymphoma?

A

Excisional lymph node biopsy

85
Q

What dx presents with painless LAD?

A

Non-Hodgkin Lymphoma

86
Q

What is “CHOP” therapy for stage III and IV Non-Hodgkin Lymphoma?

A

Cyclophosphamide
Hydroxydaunorubicin
Ovincristine
Prednisone

87
Q

What’s “ABVD” therapy for stage III and IV Hodgkin Lymphoma?

A

Adriamycin
Bleomycin
Vinblastine
Dacarbazine

88
Q

Which form of lymphoma has Reed-Sternberg cells?

A

Hodgkin

89
Q

Which form of lymphoma often presents with Stage III or IV disease?

A

Non-Hodgkin Lymphoma

90
Q

Which 2 types of lymphoma present with B symptoms?

A

Hodgkin and Non-Hodgkin Lymphoma

91
Q

What’s the adverse effect of doxorubicin?

A

Cardiomyopathy

92
Q

What’s the adverse effect of vincristine?

A

Neuropathy

93
Q

What’s the adverse effect of bleomycin?

A

Lung fibrosis

94
Q

What’s the adverse effect of cyclophosphamide?

A

Hemorrhagic cystitis

95
Q

What’s the adverse effect of cisplatin?

A

Renal toxicity, ototoxicity, neurotoxicity

96
Q

What’s the most common presenting symptom of Multiple Myeloma?

A

Bone pain from fractures

97
Q

What dx presents with hyperuricemia, anemia, renal failures, bone pain, and hypercalcemia?

A

Multiple Myeloma

98
Q

What will a bone x-ray show in Multiple Myeloma?

A

Punched out “lytic” lesions

99
Q

What does the SPEP show in Multiple Myeloma?

A

Monoclonal “M” spike

100
Q

What are the two most common Ig’s that produce monoclonal proliferation in Multiple Myeloma?

A

IgG and IgA

101
Q

What dx has Bence-Jones protein?

A

Multiple Myeloma

102
Q

What dx has rouleaux?

A

Multiple Myeloma

103
Q

What’s the most accurate test for myeloma?

A

BM biopsy (shows >10% plasma cells)

104
Q

What do you need to give prophylaxis against when using thalidomide or lenalidomide?

A

Clotting prophylaxis

105
Q

What dx is associated with serum free light chain ratio of 100:1?

A

Myeloma

106
Q

What’s a precurser dx that can lead to MM in 1% of cases and presents with spike of IgA or IgG as well?

A

MGUS

107
Q

What dx presents with an overproduction of IgM from malignant B cells, leading to hyperviscosity and presenting with engorged BV’s in eye, mucosal bleeding, Raynaud, and blurry vision?

A

Waldenstrom Macroglobulinemia

108
Q

What’s the best initial therapy for Waldenstrom Macroglobulinemia?

A

Plasmapharesis

109
Q

What can present similarly to vWF deficiency but is sudden onset, shows elevated megakaryocytes, and is treated with prednisone?

A

ITP

110
Q

What 3 vaccines do splenectomy patients need prior to surgery?

A
  1. N. meningitidis
  2. H. influenzae
  3. Pneumococcus
111
Q

Does vWFd present with normal platelet count?

A

Yes

112
Q

What is the aPTT in vWFd?

A

Elevated in half of the patients

113
Q

What assay detects vWFd?

A

Ristocetin

114
Q

What’s the best initial therapy for vWFd?

A

DDAVP (desmopressin)

115
Q

Which diagnosis has giant platelets?

A

Bernard-Soulier

116
Q

What’s the tx for Glanzmann Thrombasthenia and Bernard-Soulier?

A

DDAVP (desmopressin)

117
Q

What are the PT and aPTT in hemophilia?

A

PT: normal
aPTT: prolonged

118
Q

How do you treat mild cases of hemophilia?

A

DDAVP

119
Q

How do you treat severe cases of hemophilia?

A

Factor replacement

120
Q 
What are the following labs in DIC?:
PT:
aPTT:
D-dimer: 
Fibrin split: 
Fibrinogen:
A 
PT: prolonged
aPTT: prolonged
D-dimer: elevated
Fibrin split: elevated
Fibrinogen: decreased
121
Q

How do you treat factor V Leiden?

A

Warfarin to INR 2-3 for 3-6 months

122
Q

What dx appears 5-10 days after starting heparin, and has a marked drop in platelet count?

A

HIT

123
Q

What does the serotonin release assay test?

A

HIT

124
Q

What’s the tx for HIT?

A

Stop heparin, start fondaparinux, then do warfarin

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