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Family Medicine Boards 2020 > Hematology > Flashcards

Hematology Flashcards

1
Q

Virchows triad

A

stasis, hypercoagulability, endothelial injury

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2
Q

What is the D Dimer cutoff?

A

500 mcg/L
Consider Age x 10 for > 50 years old
Very sensitive, not specific

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3
Q

What do you do if clinical suspicion for DVT is high but US is negative?

A

Repeat US in 5-7 days

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4
Q

If someone is diagnosed with VTE, what general workup should be done to evaluate for cancer?

A
  • complete H and P with rectal and pelvic exam
  • CBC, LFT, CXR, stool guaiac

Extensive workup not necessary or effective as cancer usually makes its presence known prior to VTE

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5
Q

If someone is diagnosed with VTE, when should you consider workup for thrombophilia?

A
  • Initial thrombosis prior to 50
  • family history of VTE
  • recurrent VTE
  • unusual vascular beds (not extremities)
  • Warfarin-induced skin necrosis
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6
Q

What testing should be obtained in thrombophilia workup?

A
  • Protein C and S
  • Fibrinogen
  • antithrombin III
  • Factor V leiden
  • lupus anticoagulant
  • anticardiolipin Ab
  • prothrombin 20210 gene mutation
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7
Q

Test of choice for diagnosis of PE

A

CT angiogram

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8
Q

Test of choice to diagnose PE in pregnancy

A

VQ scan

or low dose CTA

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9
Q

Preferred treatment modality for VTE according to ACCP 2016 guidelines

A
  • DOAC when cancer not present

- cancer associated VTE use LMWH (lovanox)

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10
Q

Management of distal DVT according to 2016 ACCP guidelines

A
  • if no severe symptoms and low risk for extension, then serial imaging x 2 weeks rather than anticoagulation
  • risk factors for extension: high D dimer, > 5 cm thrombus, close to proximal veins, no reversible provoking factors, active cancer, hx of VTE, inpatient status
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11
Q

What criteria should be met for patient to be treated outpatient for VTE

A
  • ambulatory and stable - no O2, IV Abx, IV pain control
  • low risk of bleed
  • no renal insufficiency
  • reliable patient and system
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12
Q

Duration of treatment of VTE according to 2016 ACCP guidelines

A
  • 3 months for provoked DVT/PE
  • 3+ months if unprovoked DVT/PE
  • indefinite if recurrent DVT/PE
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13
Q

According to 2016 ACCP guidelines, what is the role of the following in management of DVT/PE?

  • movement
  • compression stockings
A
  • movement recommended over bedrest

- compression stockings non-beneficial

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14
Q

Management of subsegmental PE according to according to 2016 ACCP guidelines

A

Clinical surveillance recommended over anticoagulation if the following

  • no proximal pulm artery involvement
  • no proximal DVT in legs
  • low risk for recurrent VTW
  • fairly healthy patient
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15
Q

Treatment of choice for VTE in pregnancy

A

LMWH (lovenox)

  • this is due to more data than DOACs. Warfarin strictly contraindicated
  • doesn’t cross placenta and safe SOR B
  • epidural anesthesia 12 hours after last dose of LMWH SOR C
  • Convert from LMWH to unfractionated heparin for last month of pregnancy
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16
Q

When should anti coagulation be restarted in postpartum?

A
  • 4-6 hours after vaginal delivery

- 6-12 hours after C section delivery

17
Q

What are the recommendations for contraception in history of VTE

A
  • avoid estrogen

- Use of progesterone controversial. Per NIH it is OK with first DVT but not if recurrent

18
Q

Major causes of normocytic, normochromic anemia

A
  • acute blood loss
  • acute hemolysis
  • hypersplenism
  • anemia of chronic disease (most common cause)
19
Q

How do you monitor response to iron therapy?

A
  • Reticulocyte count should normalize in 5-7 days
  • Hct 4-6 weeks
  • iron stores 4-6 months

**should stay on iron for at least 4-6 months

20
Q

Management of penicillin in children with sickle cell - who should be on it and for how long?

A
  • all types of SSD
  • Pen V 125 mg BID from 3 mo to 3 years (fetal Hb stays 3-6 months)
  • Pen V 250 BID from 3-5 years
  • after age 5 its controversial
21
Q

Who should be on hydroxyurea for sickle cell disease?

A
  • Age 9-42 months (3.5 years)

- Adults who have had 3 or more crisis in 12 months (decrease vasocclusive effects and risk of acute chest syndrome)

22
Q

When re-initiaing hydroxyurea in sickle cell disease, what counseling or monitoring needs to take place?

A
  • contraceptive counseling: teratogen and present in breast milk
  • monitor CBC and reticulocyte xount Q4Weeks
  • disease modifying therapy that increases levels of HbF
23
Q

What are the most common signs and symptoms of multiple myeloma?

A

Sx:

  • Anemia (73%)
  • bone pain
  • elevated creatinine
  • hypercalcemia
  • N/V, weakness, recurrent infections, weight loss

DX:

  • abnormal plasma cells in marrow
  • monoclonal protein in serum/urine
  • bone lesions
24
Q

When suspecting multiple myeloma, what is the workup?

A 
CBC with Diff
Creatinine
LDH
Beta-2 macroglobulin
immunoglobulin studies
skeletal survey
BM biopsy
25
Q

After diagnosis of multiple myeloma, what is the management?

A

primary care:

  • Bisphosphonate tx upon diagnosis (inhibit osteoclasts)
  • DVT prevention
  • prophylactic Abx
  • referral to oncology for chemo and stem cell transplant
26
Q

In hemophilia, what action can be taken to help improve joints from destruction?

A

early initiation of factor concentrate treatments

27
Q

Pentad of thrombotic Thrombocytopenic purpura (ttp)

A
  • thrombocytopenia with purpura
  • fever
  • microangiopathic hemolytic anemia (MAHA)
  • acute renal insufficiency (HUS)
  • neurological symptoms (TTP)

rare for all 5 to be present

28
Q

Causes of thrombotic Thrombocytopenic purpura (ttp)

A
  • idiopathic
  • ADAMTS13 deficiency: protease of VWF, long polymers of VWF attract platelets
  • shiga toxin from E coli (0157 H7)
  • collagen vascular disease
  • meds: Plavix
29
Q

Treatment of thrombotic Thrombocytopenic purpura (ttp)

A

plasma exchange therapy is curative

30
Q

Acute lymphoblastic leukemia (ALL)

  • age group
  • findings
A
  • children
  • fever, bleeding***
  • MSK sxs
  • hepatosplenomegaly (75%), lymphadenopathy (60%)
31
Q

Acute Myelogenous leukemia (AML)

  • age group
  • findings
A
  • adults
  • fever, bleeding***
  • fatigue, weight loss
  • anemia
  • thrombocytopenia
32
Q

Chronic Myelogenous leukemia (CML)

  • age group
  • findings
A
  • adults
  • asymptomatic
  • discovered with leukocytosis on CBC
  • splenomegaly
33
Q

Chronic Lymphocytic leukemia (CLL)

  • age group
  • findings
A
  • adults
  • asymptomatic
  • discovered with leukocytosis on CBC
  • Hepatosplenomegaly and lymphadenopathy
34
Q

Workup in adults with elevated WBC on CBC while asymptomatic

A
  • repeat CBC
  • peripheral smear
  • flow cytometry
  • oncology referral
35
Q

A child with sickle cell disease is on your panel. What screening image do they need yearly?

A

Annual screening with transcranial doppler ultrasound to eval risk of stroke age 2-16 years

Family Medicine Boards 2020 (46 decks)

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