Hematology (Alice) (3%) Flashcards
1
Q
microcytic anemias (4)
A
IDA
sideroblastic
thalassemias
anemia of chronic dz
lead poisoning
2
Q
normocytic anemias are divided into (2)
A
hemolytic
non hemolytic
3
Q
intrinsic hemolytic anemias (5)
A
hereditary spherocytosis
g6pd
puruvate kinase deficiency
ssa
hbc dz
4
Q
extrinsic hemolytic anemia
A
autoimmune hemolytic anemia
5
Q
macrocytic anemias are divided in to
A
megaloblastic
non megaloblastic
6
Q
megaloblastic macrocytic anemias (4)
A
folate deficiency
b12 deficiency
copper deficiency
drugs
7
Q
non megaloblastic macrocytic anemias
A
etoh
liver dz
8
Q
work up for microcytic anemia (3)
A
ferritin
iron
TIBC
9
Q
work up for normocytic anemias (3)
A
coombs
iron
bilirubin
10
Q
work up for macrocytic anemias (2)
A
RBC folate
B12
11
Q
only anemia with elevated TIBC
A
IDA
12
Q
what does “basophilic stippling” make you think of
A
lead poisoning
13
Q
4 infxns associated w. anemia
A
14
Q
4 infxns associated w. extrinsic hemolysis
A
osteolmyelitis
HIV
mycoplasma
EBV
15
Q
type of anemia associated w. bone marrow malignancy
A
normocytic
16
Q
lab findings associated w. intrinsic hemolytic anemia (4)
A
increased reticulocytes
positive coombs
spherocytosis
decreased haptoglobin
17
Q
labs associated w. extrinsic hemolytic anemias (3)
A
cold agglutinins
increased: LDH, K+, bilirubin
decreased haptoglobin
18
Q
what does spherocytosis make you think of
A
g6pd deficiency
19
Q
3 causes of extrinsic hemolysis
A
cold agglutinins
autoimmune
mechanical destruction
20
Q
3 causes of mechanical destruction extrinsic hemolytic anemia (microangiopathic hemolysis)
A
TTP
HUS
DIC
21
Q
hemostatic problems are divided into (2)
A
primary
seconday
22
Q
describe primary hemostatic problems
A
weak platelet plug -> mucocutaneous bleeding
23
Q
describe secondary hemostatic problems
A
problems w. coagulation factors -> deep tissue bleeding
24
Q
sx of primary hemostatic problems (4)
A
-petechiae
-anterior epistaxis
-immediate post op bleeding (ex tooth extraction)
-mucosal, gingival, GI, vaginal bleeding
25
sx of secondary hemostasis (5)
-large bruises
-deep tissue hematomas
-hemarthrosis
-posterior epistaxis
-persistant bleedig post op (ex ICH)
26
problems w. hemostasis are caused by decreased (3)
PLT number
PLT fxn
clotting factors
27
primary hemostasis disorders (5)
von willebrand
bernard-soulier
glanzmann thrombasthenia
uremic PLT dysfxn (CKD)
meds: NSAIDs, clopidogrel
28
secondary hemostasis disorders (5)
anticoagulant use
hemophilia
cirrhosis
vit K deficiency
DIC
29
labs associated w. primary hemostatic problems
prolonged PT
prolonged PTT
30
_ is elevated in bleeding from warfarin
_ is elevated in bleeding from heparin
warfarin: PT
heparin: PTT
31
what factors are decreased in von willebrand dz
von willebrand
VIII
32
hemophilia is classified in to
A: VII
B: IX (christmas)
33
lab findings associated w. hemophilia
prolonged aPTT
normal PTT
normal PLT
34
three presentations of hemophilia in peds
-excessive bleeding from circumcision
-cephalohematoma during delivery
-hemearthrosis when walking starts
35
3 conditions where you see prolonged PT and PTT
liver cirrhosis
vitamin K deficiency
DIC
36
lab findings of DIC
everything out of whack:
-elevated PT, PTT
-decreased PLT
-(+) schistocytes
-smear: microangiopathic hemolytic anemia
37
pediatric brain tumors to know mc -> lc (4)
astrocytoma
medulloblastoma
ependymoma
retinoblastoma
38
5 yo w. occipital HA, ataxic gait, nystagmus, papilledema
astrocytoma
39
mc primary childhood CNS tumor
astrocytoma
40
sx of brain tumors are mc related to
**increased ICP:**
morning HA
vomiting
lethargy
41
t/f astrocytomas are often benign
t!
42
sx of astrocytoma based on location
**cerebellum:** weakness, tremor, ataxia
**visual pathway:** vision loss, proptosis, nystagmus
**spinal cord:** pain, weakness, gait disturbance
43
dx for brain tumors
MRI
bx
44
which type of astrocytoma has the best prognosis
posterior fossa
45
5 yo w. 1 month of AM HA, nausea, vomiting, mild f/c - PE shows wide based gait, impaired heel to toe walking, bilat papilledema
medulloblastoma
46
MRI findings of medulloblastoma
heterogenous midline lesion w. hydrocephalus
47
mc malignant posterior fossa tumor in peds
posterior fossa tumor
48
4 mc sx of medulloblastoma
n.v
HA
visual changes
unsteady walking/clumsy
49
pediatric brain tumor that is sometimes associated w. sz, balance/gait disturbance, or sx of spinal cord compression
ependymoma
50
tx for ependymoma
surgery
+/- chemo
51
3 yo w. strabismus - in pics, one eye is white, other is red
retinoblastoma
52
mc age for retinoblastoma
< 3 yo
53
medical term for absent red reflex
leukocoria
54
tx for retinoblastoma
surgical enucleation of the eye
chemo
55
hemophilia is _ linked
X, recessive
56
presentation of hemophilia (both types)
bleeding
bruising
hemarthrosis
57
grading of hemophilia
**mild (5-25% nl):** bleeding after surgery/dental extractions/injury, usually non fatal
**moderate (1-5% of nl):** little unprovoked bleeding, bleeding after surgery/injury may be fatal
**severe (< 1% nl):** unprovoked bleeding,
58
when is severe hemophilia often diagnosed
bleeding immediately after delivery -> ex cephalohematoma
59
mod/severe hemophilia is commonly diagnosed at what age
< 18 mo
60
lab findings of hemophilia
increased: PTT
normal: PT, bleeding time
decreased: factor VIII vs IX
61
hallmark lab findings of hemophilia (2)
increased PTT
normal PLT
62
most specific test for hemophilia
functional assay for factor VIII vs IX
63
tx for hemophilia
replace deficient factor
64
4 yo M presents w. abd pain, constipation x 2 days - has also been lethargic, irritable x 2 weeks and has stopped talking - PMH includes failing to meet developmental milestones x 1 year
lead poisoning
65
mc environmental illness of children in the US
lead poisoning
66
most significant source of lead for peds
environmental: lead-based paint, food, water, soil
67
big HPI clue for lead poisoning
old house w. paint chips
68
sx of lead poisoning (lots!)
**anemia**
behavior changes
temperamental lability
irritability
hyper/hypoactivity
developmental delays
abd pain
vomiting
constipation
lethargy
HA
ataxia
sz
69
what blood level of lead is considered positive
>/= 10
70
lab findings of lead poisoning
-basophilic stippling
-low vs nl MCV
-low MCH
-hemolysis: elevated indirect bili, LDH; low haptoglobin
71
tx for lead poisoning
>45: chelation
>80: hospitalization
-diet
72
when do you have to contact health department w. lead poisoning (2)
>20
elevation > 3 mos
73
3 chelation meds used in lead poisoning
dimercaprol
CaNaEDTA
pencill
74
pediatric leukemias to know (2)
ALL
AML
75
mc childhood malignancy
leukemia
76
2 mc childhood leukemia
ALL
AML
77
child + LAD + bone pain + bleeding + fever
ALL
78
hallmark finding of ALL (2)
20% blasts in bone marrow
ANC < 1,000
79
mc childood malignancy
ALL
80
tx for ALL
chemo
81
t/f: AML is much more common in males
t!
82
pt's w. AML may develop a greenish soft tissue tumor called a _
which is located in the _ (2)
chloroma
spinal cord, skin
83
hallmark finding of AML
auer rods on smear
+/- blast cells
84
sx of AML (5)
pallor
ecchymoses
petechiae
fever
bone pain
85
_ are present at dx w. 90% of AML cases (2)
-anemia (normochromic, normocytic)
-thrombocytopenia
*low reticulocytes also common*
86
tx for ALL vs AML
ALL: chemo
AML: combo chemo/bone marrow transplant
87
lethal s.e of chemo
tumor lysis syndrome
88
tx for tumor lysis syndrome
allopurinol
89
pediatric lymphomas to know (2)
hodgkin
non-hodgkin
90
hodgkin lymphoma is derived from _ cells in lymph nodes
B
91
LAD associated w. hodgkin lymphoma
painless LAD: cervical vs supraclavicular vs upper body
92
what are B symptoms associated w. lymphoma (3)
wt loss > 10%
T > 38
night sweats
93
hodgkin lymphoma is assocated w. what virus
EBV
94
t/f: hodgkin lymphoma rarely has extranodal spread
t!
95
2 types of hodgkin lymphoma
classical
nodular
96
4 types of classical hodgkin lymphoma
nodular sclerosis
mixed cellularity
lymphocyte-rich
lymphocyte depleted
97
if you suspect hodgkin lymphoma, order a _
CXR -> look for mediastinal LAD
98
hallmark finding of hodgkin lymphoma
**reed-sternberg cells:** B cells fused together to form **"owl eye"**
99
tx for hodgkin lymphoma
chemo/xrt: highly effective
100
non hodgkin lymphoma is derived from _ cells (2)
B
T
101
sx of non hodgkin lymphoma (5)
constitutional
painless LAD
bowel obstruction
fatigue/bruising/infxns
loss of sensation
102
2 types of non hodgkin lymphoma
B cell
T cell
103
types of non hodgkins B cell lymphoma
**diffuse large B cell** -> mc/aggressive
follicular
burkitt
mantle cell
marginal zone
nodal marginal
splenic marginal
lymphoplasmacytic
104
starry sky appearance
burkitt lymphoma
105
2 types of non hodgkin T cell lymphoma
adult t-cell -> leukemia
mycosis fungoides -> skin
106
typical presentation of T cell hodgkin lymphoma (3)
immunocompromised
painless peripheral LAD
extranodal spread (skin/GI/brain)
107
t/f: non hodgkin lymphoma has a worse prognosis than hodgkin
t!
108
neutropenia definition
ANC < 1,000
109
earliest sign of neutropenia
fever
110
tx for neutropenia
**outpt/low risk:** cipro PLUS augmentin, +/- moxifloxacin
**monotherapy/pseudomonas:** cefepime vs imipenem vs augmentin
**dual therapy/unstable:** monotherapy + vanc vs flagyl
