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Clinical Medicine 1 > Hematology exam review (summer) > Flashcards

Hematology exam review (summer) Flashcards

1
Q

Hgb number in anemia?

A

Male <12

Female <15

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2
Q

Where is iron absorbed?

A

Duodenum

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3
Q

What conditions is iron absorbed?

A

Acidic conditions

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4
Q

Which iron study reflects total body stores of iron? Normal value?

A

Serum Fe

>30 is normal

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5
Q

Men and non-menstural women need how much iron/day?

A

1mg/day

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6
Q

Menstural women need how much iron/day?

A

3-4mg/d

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7
Q

Preggers women need how much iron/day?

A

2-5mg/d

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8
Q

Normal Recitulocyte Count range?

A

0.5-2%

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9
Q

What does Reticulocyte Count measure?

A

Bone marrow function.

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10
Q

High Reticulocyte Count means what type of cells being produced?

A

Immature cells

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11
Q

Normal Reticulocyte Index Count range?

A

2-3

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12
Q

Normal Serum B12? Deficiency?

A

Normal >210

Deficiency <170

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13
Q

Normal RBC Folic Acid level? Deficiency?

A

Normal >140

Deficiency <140

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14
Q

What is #1 MC anemia?

A

Iron Deficiency Anemia

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15
Q

MC cause of Iron Deficiency Anemia?

A

BLEEDING (menstural or GI)

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16
Q

How often screen 12-18 y/o F (non-preggers) for Iron Deficiency Anemia?

A

q5-10 year

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17
Q

When to first screen preggers for Iron Deficiency Anemia?

A

At first prenatal visit

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18
Q

When to screen men and post-menopausal F for Iron Deficiency Anemia?

A

No screening

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19
Q

What very weird craving in Iron Deficiency Anemia?

A

Pagophagia (ice craving)

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20
Q

What happens to tongue, nails, and corners of mouth in severe Iron Deficiency Anemia?

A

Brittle nails, nail spooning (koilonychia), and cheilosis of mouth corners

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21
Q

How much iron lost from menstural bleed?

A

1mg/day

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22
Q

How much iron lost from preggers, delivery, and nursing?

A

1g/d

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23
Q

How much iron lost per 100mL whole blood?

A

50mg Fe per 100mL whole blood

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24
Q

CBC and Iron Deficiency Anemia?

A

Hgb low, RBC low

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25
Q

TIBC up or down in Iron Deficiency Anemia?

A

Up. More binding places for iron due to not enough iron.

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26
Q

Serum Fe, Serum Iron, and % Sat in Iron Deficiency Anemia?

A

DOWN

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27
Q

Two essential lab tests for Iron Deficiency Anemia?

A

Hgb <12 or 15, Serum Fe <30

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28
Q

MCV and MCHC levels in Iron Deficiency Anemia?

A

Microcytic <80

Hypochromic <27

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29
Q

TOC for Iron Deficiency Anemia?

A

Ferrous Sulfate 325mg TID x1-2 mo until normal CBC

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30
Q

When to do CBCs in Iron Deficiency Anemia?

A

3 weeks (half better), 2 months (normal), 6 months (normal and stores rebuilt)

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31
Q

Tx of Iron Deficiency Anemia months 3-6?

A

325mg PO qd to rebuild stores

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32
Q

2 things which increase iron absorption?

A
  1. Empty stomach

2. Orange juice

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33
Q

SEs of Ferrous Sulfate?

A

Nausea, constipation, diarrhea, dark stool. Reduce dose.

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34
Q

When to use IV iron in Iron Deficiency Anemia?

A

Can’t absorb iron orally. IBD, gastric bypass, etc.

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35
Q

What is reduced in Thalassemia?

A

Reduced production of alpha or beta blobin chains

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36
Q

Alpha Thalassemia reduction of what?

A

Reduced alpha globin production

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37
Q

Who gets Alpha-1-Thalassemia? (two)

A

MC in S.E. Asia and China

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38
Q

Geneotype in Alpha-1-Thalassemia?

A

Heterozygous. Each parent missing one gene.

alpha ____/alpha ____

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39
Q

Who gets Alpha-2-Thalassemia?

A

MC black

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40
Q

Geneotype in Alpha-2-Thalassemia?

A

Homozygous. One parent missing each.

alpha alpha/____ ____

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41
Q

Genotype in Alpha Thalassemia Intermedia (aka Hgb H Dz)?

A

alpha ___/___ ___

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42
Q

Genotype of Alpha Thalassemia Majora (aka Hydrops Fetalis)?

A

No alpha globin at all

___ ___ / ___ ___

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43
Q

MCV in Alpha Thalassemia?

A

Microcytic

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44
Q

What does electrophoresis show in Alpha Thalassemia trait?

A

Normal Hgb.

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45
Q

What does electrophoresis show in Alpha Thalassemia Intermediate (Hgb H Dz)?

A

10-40% HgbH

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46
Q

S/Sx of Alpha Thalassemia trait?

A

No clinical S/Sx.

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47
Q

Tx of Alpha Thalassemia trait? Life expectency?

A

No tx. Normal expectency.

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48
Q

S/Sx of Alpha Thalassemia Intermediate (Hgb H Dz)?

A

Pallor, splenomegaly, fatigue, weakness

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49
Q

TIBC normal/increased/decreased in Alpha Thalassemia?

A

Normal or increased

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50
Q

Iron normal/increased/decreased in Alpha Thalassemia?

A

Normal or increased

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51
Q

Tx for Alpha Thalassemia Intermediate (Hgb H Dz)?

A

Folic Acid 1mg PO

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52
Q

What to avoid with Alpha Thalassemia Intermediate (Hgb H Dz)?

A

Avoid oxidative (sulfa) drugs, avoid iron

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53
Q

When to tranfuse PRBC in Alpha Thalassemia Intermediate (Hgb H Dz)? Goal Hgb?

A

If severely low Hgb. Goal 9-10.

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54
Q

Tx for refractory Alpha Thalassemia Intermediate (Hgb H Dz)? (Hint: take something out)

A

Splenectomy

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55
Q

When needed if getting regular transfusions for Alpha Thalassemia?

A

Iron chelation with Deferastrox 20-30mg/kg/d

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56
Q

Type of counseling needed for Alpha Thalassemia?

A

Genetic

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57
Q

Genetic bases of Beta Thalassemia?

A

Point delection on chromosome 11

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58
Q

Which globin chains are affected in Beta Thalassemia?

A

Beta-globin chains

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59
Q

What happens to Beta-globin chains in Beta Thalassemia?

A

Replaced with Beta-like chains (Delta and Gamma)

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60
Q

Beta Thalassemia MC in which population? (Hint: 2)

A

Mediterranian and Middle Eastern

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61
Q

Genotype of Beta Thalassemia Minor (aka Trait)? (Hint: two)

A

B/B+ or B/B˚

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62
Q

What percent are Beta-chains reduced in Beta Thalassemia Minor/Trait?

A

50%

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63
Q

S/Sx of Beta Thalassemia Minor/Trait?

A

ASx

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64
Q

CBC shows what in Beta Thalassemia Minor/Trait?

A

Clinically insignificant microcytic anemia

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65
Q

Electrophoresis shows what in Beta Thalassemia Minor/Trait?

A

HgbA2 4-8%

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66
Q

Tx required in Beta Thalassemia Minor/Trait?

A

No tx required

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67
Q

Counseling in Beta Thalassemia Minor/Trait?

A

Genetic counseling

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68
Q

Genotype of Beta Thalassemia Intermedia?

A

B+/B+

homozyous

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69
Q

When does Beta Thalassemia Intermedia begin to manifest?

A

6mo old when HgbF goes away

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70
Q

Where are bone deformities in Beta Thalassemia Intermedia?

A

Face

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71
Q

What type of fractures in Beta Thalassemia Intermedia?

A

Pathologic

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72
Q

Spleen and liver in Beta Thalassemia Intermedia?

A

Hepatosplenomegaly

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73
Q

When does severe anemia start in Beta Thalassemia Intermedia?

A

6 months

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74
Q

Three types of hemoglobin in Beta Thalassemia Intermedia?

A

HgbA 30%
HgbA2 10%
HgbF 6-100%

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75
Q

What does Peripheral Smear show in Beta Thalassemia Intermedia?

A

Bsophillic Stipling

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76
Q

Beta Thalassemia Majora aka?

A

Cooley Anemia

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77
Q

Growth and deformity in Beta Thalassemia Majora/Cooley Anemia?

A

Stunted growth, bone deformity

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78
Q

Spleen and liver in Beta Thalassemia Majora/Cooley Anemia?

A

Hepatosplenomegaly and jaundice

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79
Q

MCV in Beta Thalassemia Majora/Cooley Anemia?

A

Severe low

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80
Q

Majority of Hgb type in Beta Thalassemia Majora/Cooley Anemia?

A

HgbF

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81
Q

Tx of choice in Beta Thalassemia Majora/Cooley Anemia?

A

Allogeneic stem cell transplant

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82
Q

How often to transfuse PRBC in Beta Thalassemia Majora/Cooley Anemia?

A

Weekly

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83
Q

What to avoid in Beta Thalassemia Majora/Cooley Anemia?

A

Oxidative meds (sulfa, iron)

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84
Q

How to treat iron overload?

A

Deferoxamine

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85
Q

Prophyria due to what?

A

No porpherin ring in RBC

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86
Q

Skin in Prophyria?

A

Very pale skin

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87
Q

Light exposure does what in Prophyria?

A

Burns, blisters

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88
Q

Teeth in Prophyria?

A

Vampire-like teeth

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89
Q

Anemia of Chronic Dz due to what?

A

Conditions which reduce iron uptake

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90
Q

EPO response in Anemia of Chronic Dz?

A

Down

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91
Q

S/Sx in Anemia of Chronic Dz?

A

Fatigue, weak, dizzy

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92
Q

Hepcidin levels in Anemia of Chronic Inflammation?

A

Increased!

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93
Q

Serum Iron levels in Anemia of Chronic Inflammation?

A

Low

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94
Q

Serum Fe levels in Anemia of Chronic Inflammation?

A

Normal or inc

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95
Q

RBC life and mass in Anemia of Chronic Dz?

A

Decreased

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96
Q

Tx for Anemia of Chronic Dz?

A

Tx underlying condition

Folic Acid and/or Iron def

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97
Q

When to transfuse PRBC in Anemia of Chronic Dz?

A

If severe anemia

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98
Q

What med to give in Hgb <10 in Anemia of Chronic Dz? Goal Hgb?

A

Recombinant EPO until 10-12

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99
Q

Shape of Sideroblast in Sideroblastic Anemia?

A

Ringed sideroblast.

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100
Q

Where is ringed sideroblast found in Sideroblastic Anemia?

A

Bone Marrow

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101
Q

Iron levels in Sideroblastic Anemia?

A

Too much iron. Can’t get into RBC.

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102
Q

4 causes of acquired Sideroblastic Anemia?

A
  1. Cu deficiency
  2. INH
  3. Linezolid
  4. Chloramphenicol
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103
Q

Tx for INH acquired Sideroblastic Anemia?

A

B6 to fix

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104
Q

TIBC in Sideroblastic Anemia?

A

DOWN

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105
Q

SI, SFe, and % Sat in Sideroblastic Anemia?

A

Up!

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106
Q

Dx for Sideroblastic Anemia?

A

Bone marrow biopsy

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107
Q

Why splenectomy in congenital Sideroblastic Anemia?

A

Tertiary RBC production center.

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108
Q

Lead Toxcity does what to iron binding?

A

Decreases iron binding in proporphyrin ring

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109
Q

Chromic in Lead Toxcity?

A

Hypochromic

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110
Q

What type of cells seen on peripheral smear in Lead Toxcity?

A

Basophillic Stipiling

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111
Q

Basophillic Stipiling seen in what type of toxicity?

A

Lead Toxcity

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112
Q

Tx for Lead Toxcity?

A

Chelate

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113
Q

MCV in Alcoholic Anemia?

A

Macrocytic 100-110

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114
Q

How much EtOH per day to cause Alcoholic Anemia?

A

80g/day (1 bottle of wine)

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115
Q

Tx for Alcoholic Anemia? When resolves?

A

Stop drinking. Resolves in 2-4 months.

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116
Q

Myelodysplastic Syndromes are due to an inappropriately low response to what?

A

Reticulocytes

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117
Q

Which population has 2-3x higher instance of Aplastic Anemia?

A

East Asian

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118
Q

Ages of Aplastic Anemia?

A

Biphasic. 10-25, >60.

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119
Q

Aplastic Anemia due to injury of what?

A

Pluripotent stem cells in BM. Impairs proliferation and differentiation.

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120
Q

What is low in Aplastic Anemia?

A

Low PLT, RBCs, WBCs

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121
Q

Causes of Aplastic Anemia?

A

Viruses, drugs, chemo, radiation, toxins

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122
Q

What does CBC show in Aplastic Anemia?

A

Pancytoanemia

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123
Q

What does Peripheral Smear show in Aplastic Anemia?

A

Look normal but reduced number

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124
Q

Reticulocyte Count/Index increased or decreased in Aplastic Anemia?

A

Decreased

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125
Q

Tx for Aplastic Anemia under 20 y/o?

A

Allogenic hepatopoietic stemm cell transplant

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126
Q

Tx for Aplastic Anemia under 50 y/o?

A

Immunisuppressive therapy

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127
Q

Most common type of Aplastic Anemia?

A

Fanconi Anemia

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128
Q

Fingers and Fanconi Anemia?

A

Sindactyly (fused digits)

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129
Q

Where is B12 absorbed?

A

Terminal Ileum

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130
Q

What is B12 a cofactor for synthesis of? (Hint: 2)

A
  1. Nucleic acid synthesis

2. Myelin synthesis

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131
Q

How long are B12 stores good for?

A

3 years

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132
Q

Causes of B12 anemia?

A

Vegans, Pernicious Anemia, Chron’s DZ, EtOH

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133
Q

Pernicious Anemia what type immune disease?

A

Autoimmune.

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134
Q

What is destroyed in Pernicious Anemia by Abs?

A

Parietal cells and intrinsic factor

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135
Q

MCV in Pernicious Anemia?

A

>

  1. Megaloblastic anemia.
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136
Q

Blood smear in Pernicious Anemia?

A

Hypersegmented neurophils and macro-ovalcytes.

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137
Q

Sx in Pernicious Anemia?

A

Anemia, pale, neuro symptoms (vibration, proprioception, memory)

138
Q

When do Sx develop in Pernicious Anemia?

A

About 3 years

139
Q

Normal Serum B12? When deficient?

A

Normal >210

Deficient <170

140
Q

Tx for Pernicious Anemia?

A

VitB12 100mcg SC/IM qd x1wk, then 1/wk, then monthly for life

141
Q

When do check CBC and B12 levels in Pernicious Anemia?

A

1-2 wk, 2 mo, then periodic indefinitely

142
Q

What is the natural form of Folic Acid called?

A

Folate

143
Q

Daily intake of Folic Acid is preggers or lactating?

A

600-800mcg

144
Q

Folic Acid absorbed where?

A

Duodenum and jejunum

145
Q

Folic Acid in what foods?

A

Fruits and veggies

146
Q

How long are stores of Folic Acid?

A

2-3 months

147
Q

MC cause of Folic Acid decifiency?

A

Inadequate intake. (Then EtOH abuse.)

148
Q

MCV in Folic Acid decifiency?

A

Megaloblastic. MCV >115.

149
Q

When do Sx appear in Folic Acid decifiency?

A

4-5 months

150
Q

Tx for Folic Acid decifiency?

A

Folic Acid 1mg PO qd x1-4mo or until hematologic recovery

151
Q

Expected response from tx in Folic Acid decifiency?

A

Rapid improvement and sense of well-being

152
Q

When will see reticulocytosis after tx in Folic Acid decifiency?

A

5-7d

153
Q

Sickle Cell is autosomal recessive or dominant?

A

Recessive

154
Q

Hgb type in Sickle Cell? Which Hgb completely absent?

A

HgbS

HgbA absent.

155
Q

AA substitution in Sickle Cell? In which globin chain?

A

Glutamic Acid becomes Valine in Beta-globin chain.

156
Q

When do HgbS change into and do poorly when deoxygenated?

A

Poorly soluable. Turn into sickle shape.

157
Q

HgbS RBC lifespan?

A

10-20 days.

Normal HgbA is 100 days.

158
Q

What does Sickle Cell cause in microcirculation?

A

Recurrent vasoocclusion

159
Q

What is a Sickle Cell Crisis? What causes it?

A

Acute episode with many sickle cells. Due to Infection, hypoxia, dehydration, acidosis, exercise at high altitude

160
Q

What bacteria type due to bad spleen in Sickle Cell?

A

Encapsulated (pneomococcal, h flu, meningitis)

161
Q

What is Chest Syndrome in Sickle Cell?

A

Lung injury and infarction due to occlusion

162
Q

DX for Sickle Cell?

A

Hgb electrophoresis. Shows HgbS.

163
Q

Daily tx for Sickle Cell?

A

Folic Acid 1mg PO qd

164
Q

What to avoid in Sickle Cell?

A

Precipitation factors

165
Q

What to give in acute crisis in Sickle Cell?

A

IV hydration, oxygen, and lots of analgesia for pain.

166
Q

Tx for intractable pain or severe chest syndrome in Sickle Cell?

A

Exchange transfusion

167
Q

What does Hydroxyurea do for Sickle Cell?

A

Increased production of HgbF

168
Q

Tx for children with Sickle Cell?

A

Allogenic hematopoietic stem cell transplant

169
Q

G6PD deficiency MC in?

A

Back males

170
Q

What do G6PD enzymes do?

A

Maintain RBC membrane from oxidative stress

171
Q

Does G6PD deficiency cause immune or non-immune hemolytic anemia?

A

Non-immune

172
Q

G6PD deficiency due to what?

A

X-linked mutation. RBC damage triggered by Oxidative drugs, infection, or fava beans.

173
Q

How often is hemolytic anemia in G6PD deficiency? (Constant, episodic, rarely, never?)

A

Episodic

174
Q

What drugs to avoid in G6PD deficiency?

A

Oxidative drugs.

Bactrim, Dapsone (TB and Leprosy, antimalarials, INH, etc.

175
Q

Coombs test in G6PD deficiency?

A

Negative

176
Q

When will G6PD enzyme assay be low in G6PD deficiency?

A

During or after hemolysis

177
Q

Peripheral Smear shows what type of cells in G6PD deficiency?

A

Shistocytes with bite or blister fragments

178
Q

Tx for G6PD deficiency?

A

Self-limiting. Avoid oxidating drugs and fava beans. Transfuse PRBC when severe or symptomatic anemia.

179
Q

Hemolytic Anemia do to what?

A

RBC destruction

180
Q

Do Petechia and Purpura blance?

A

No

181
Q

What does increased indirect bilirubin cause?

A

Jaundice (yellowed eyes and skin)

182
Q

Dark urine due to what?

A

Increased bilirubin

183
Q

Direct Coombs tests for what?

A

RBCs coated with Ab or complement

184
Q

Indirect Coombs tests for what?

A

Ab against in RBCs in serum

185
Q

MC Hemolytic Anemia?

A

Hereditary Sperocytosis

186
Q

Hereditary Sperocytosis due to defect where in RBCs?

A

Membrane defect

187
Q

Hereditary Sperocytosis and coombs test?

A

Negative! Not an immune issue!

188
Q

Peripheral smart in Hereditary Sperocytosis?

A

Spherocytes

189
Q

Tx for Hereditary Sperocytosis?

A

Supportive care and Folic Acid. Transfuse PRBC as needed. Splenectomy if severe.

190
Q

Autoimmune Hemolytic Anemia cause?

A

IgG Ab bind to RBC membrane at room temp and activate complement to attack RBC membrane. “Warm”.

191
Q

Which Coombs test in Autoimmune Hemolytic Anemia?

A

Positive direct coombs!

192
Q

Tx for Autoimmune Hemolytic Anemia?

A

Steroids to blunt immune system. Splenectomy to remove site of RBC destruction. Plasma pheresis and transfusion.

193
Q

What is Leukemia a malignancy of?

A

WBCs

194
Q

Leukemia causes bone marrow to produce what number of WBCs?

A

Increased # of RBCs

195
Q

What happens to cell lines in Leukemia?

A

Pancytopenia (Neutropenia, anemia, thromboytopenia)

196
Q

Meyloid line gives rise to which WBCs?

A

Neutrophila
Eosinophils
Basophils

197
Q

Which are the “granulocytes”?

A

Neutrophila
Eosinophils
Basophils

198
Q

Lymphoid line gives rise to which WBCs?

A

B and T Lymphocytes

199
Q

Which leukemia developes fast and has signs/symptoms- Acute or Chronic?

A

Acute leukemia

200
Q

Speed of chronic leukemias? Sx?

A

Slow/insidious. ASx until progession or blast crisis.

201
Q

Chronic Lymphocytic Leukemia (CLL) MC in who? (color and age)

A

White males, >65

202
Q

Chronic Lymphocytic Leukemia malignancy of which WBC?

A

B Lymphocyte cells

203
Q

Chronic Lymphocytic Leukemia S/Sx? Speed?

A

Slow onset. Often ASx.

204
Q

Dx for Chronic Lymphocytic Leukemia?

A

> 5000 absolute B-Lymphocutes in peripheral smear >3mo

205
Q

Tx for Chronic Lymphocytic Leukemia?

A

Only tx if +sx.

206
Q

Cure for Chronic Lymphocytic Leukemia?

A

Allogeneic stem cell t/p

207
Q

What is the MC childhood malignancy?

A

Acute Lymphocytic Leukemia “ALL”

208
Q

Acute Lymphocytic Leukemia malignancy of which WBCs?

A

Clonal proliferation of immature B and T Lymphocytes in BM.

209
Q

Onset of Acute Lymphocytic Leukemia?

A

Rapid onset

210
Q

S/Sx in Acute Lymphocytic Leukemia?

A

Fever, fatigue, pallor

211
Q

Anemic picture in Acute Lymphocytic Leukemia?

A

Pancytopenia/Anemia

212
Q

DX for Acute Lymphocytic Leukemia?

A

BM Biopsy showing hypercellular >20% blasts

213
Q

When to transfuse PRBC in Acute Lymphocytic Leukemia?

A

Hgb <8

214
Q

Tx for Acute Lymphocytic Leukemia?

A

Chemo.

215
Q

When to do BM transplant in ALL?

A

If relapses

216
Q

Philadelphia Chromosome in which leukemia?

A

Chronic Myeloid Leukemia

217
Q

Chronic Myeloid Leukemia malignant proliferatin of which WBC line?

A

Granulocytic/Meyloid line (N.E.B)

218
Q

Chronic Myeloid Leukemia MC in what age?

A

> 50 y/o

219
Q

Speed of onset in Chronic Myeloid Leukemia?

A

Slow

220
Q

Chronic Myeloid Leukemia asx until what?

A

Blastic crisis

221
Q

WBC number in Chronic Myeloid Leukemia?

A

> 100,000

222
Q

Age of granulocytes in Chronic Myeloid Leukemia?

A

Increased number of old granulocytes with low or no leukocyte alk phos

223
Q

Tx for Chronic Myeloid Leukemia?

A

Treat anemias. TKIs.

224
Q

WHat is MC leukemia in adults?

A

Acute Myeloid Leukemia

225
Q

What percent of blasts in BM with Acute Myeloid Leukemia?

A

> 20% blasts in BM

226
Q

Time of onset in Acute Myeloid Leukemia?

A

Rapid onset

227
Q

Bleeding in Acute Myeloid Leukemia?

A

Mucocutaneous bleeding. Petechiae and ecchymosis.

228
Q

Acute Myeloid Leukemia and gingiva

A

Gingivitis

229
Q

Peripheral smear shows what kind of cells in Acute Myeloid Leukemia?

A

Auer Rods

230
Q

Auer Rods in which leukemia?

A

Acute Myeloid Leukemia

231
Q

Tx for Acute Myeloid Leukemia?

A

Chemo + bone marrow transplant

232
Q

Lymphoma is a malignancy of which tissues?

A

Lymphatic tissue

233
Q

2 MC lymphatic tissues?

A

Lymphnodes, spleen

234
Q

2 types of Lymphoma?

A
  1. Hodgkins Lymphoma

2. Non-Hodgkins Lymphoma

235
Q

Reed-Sternberg Cells seen in which Lymphoma?

A

Hodgins Lymphoma

236
Q

MC age for Non-Hodgkins Lymphoma?

A

> 50 y/o

237
Q

2 types of Non-Hodgkins Lymphoma?

A
  1. Indolent

2. Aggressive

238
Q

S/Sx of Indolent Non-Hodgkins Lymphoma?

A

Slow, waxing/waning s/sx. Hepatosplenomegaly. Painless lymphadenopathy. B Symptoms.

239
Q

Is the lymphadenopathy in Lymptoms painful or painless?

A

PAINLESS

240
Q

What are the B-symptoms in Lymphoma?

A

Fever, night sweats, weight loss

241
Q

S/Sx of Aggressive Non-Hodgkins Lymphoma?

A

Acute, rapidly growing painless lymphedenopathy. Hepatosplenomegaly. Extranodal involvement on GI, skin, CNS

242
Q

Dx of Non-Hodgkins Lymphoma?

A

Lymph node and tissue biopsy

243
Q

What test to stage Non-Hodgkins Lymphoma?

A

PET/CT

244
Q

Stage 1 Lymphoma how many lymph nodes?

A

Single lymph node

245
Q

Stage 2 Lymphoma how many lymph nodes?

A

≥2 lymph nodes on same side of diaphragm

246
Q

Stage 3 Lymphoma how many lymph nodes?

A

Both sides of diaphragm

247
Q

Stage 4 Lymphoma how many lymph nodes?

A

In extra-lymphatic sites (liver, lungs, B.M.)

248
Q

Hodgkins Lymphoma MC in people with what other dz?

A

HIV

249
Q

Ages who get Hodgkins Lymphoma?

A

25-30, >55 y/o

250
Q

Type of cells shown on excisional biopsy of Hodgkins Lymphoma?

A

Reed-Sternberg Cells

251
Q

Multiple Myeloma is malignant proliferation of which cells?

A

Plasma cells d/t overproduction of monoclonal immunoglobulin

252
Q

Multiple Myeloma d/t over production of what?

A

Monoclonal immunoglobulin (esp IgA and IgG) -> increased plasma cells

253
Q

Where do plasma cells accumulate in Hodgkins Lymphoma?

A

Bone Marrow

254
Q

MC bone malignancy?

A

Multiple Myeloma

255
Q

Multiple Myeloma age of onset?

A

4-6th decade of life

256
Q

Exposure to what two big things increase risk of Multiple Myeloma?

A

Radiation and pesticide exposure

257
Q

Where is pain in Multiple Myeloma?

A

Bone pain. MC in spine and ribs.

258
Q

What is bone pain due to in Multiple Myeloma?

A

Boney lytic lisons

259
Q

What “formation” seen on CBC in Multiple Myeloma?

A

Roulex Formation (RBCs sticking together)

260
Q

Calcium and Multiple Myeloma?

A

Increased serum Ca2+ d/t lytic lesions

261
Q

ESR in Multiple Myeloma?

A

Increased

262
Q

Tx for Hypercalcemia and pathologic fx in Multiple Myeloma?

A

Bisphosphonates

263
Q

Tx for Multiple Myeloma?

A

Hematopoietic stem cell transplant + chemo

264
Q

Hemophilia A is a deficiency of which factor?

A

Factor 8

265
Q

Which pathway does Hemophilia A affect?

A

Instrinsic pathway

266
Q

Lack of Factor 8 causes what to not form?

A

Thrombin

267
Q

MC hemophilia?

A

Hemophilia A

268
Q

Where does bleeding MC occur in Hemophilia A?

A

Weight-bearing joints. “Hemarthosis”.

269
Q

Hemophilia A and aPTT time?

A

Prolonged!

270
Q

How to dx Hemophilia A?

A

Very low F8 levels. <10IU.

271
Q

How to treat mild Hemophilia A?

A

Demopressin. Releases stored Factor 8 from endothelium

272
Q

Emergent tx for Hemophilia A?

A

IV Fresh frozen Plasma

273
Q

Office treatment for severe Hemophilia A?

A

Recombinant Factor 8

274
Q

Who gets Hemophilia A?

A

Males only. X-linked.

275
Q

Hemophilia B due to lack of which factor?

A

Factor 9 deficiency

276
Q

Where is bleeding in Hemophilia B?

A

Deep tissue bleeding

277
Q

Hemophilia A and B bleed more or longer?

A

More, not longer.

278
Q

Hemophilia B and aPTT?

A

Prolonged PTT

279
Q

Office tx of Hemophilia B?

A

Factor 9 infusion

280
Q

Emergent tx of Hemophilia B?

A

IV FFP

281
Q

Hemophilia C due to which Factor?

A

Factor 11 decifiency

282
Q

Disseminated Intravascular Coagulation due to sort of activation?

A

Pathological activation of coagulation system

283
Q

What does pathological activation of coagulation system lead to in DIC?

A

Widespread microthrombi which use up coagulation proteins

284
Q

Widespread microthrombi which use up coagulation proteins leads to what in DIC?

A

Severe thrombocytopenia and bleeding

285
Q

What caues the pathological activation in DIC?

A

Infx, malignancy, OB issues, trauma/burns, rattlesnake bites

286
Q

When to transfuse platlets in DIC?

A

If <20k

287
Q

How to replace coag factors in DIC?

A

IV FFP

288
Q

How to replace Fibrinogen in DIC?

A

Cryopercipitate

289
Q

What to use for thrombosis in DIC?

A

Heparin

290
Q

Polycythemia Vera causes what to be overproduced?

A

RBCs

291
Q

Viscosity in Polycythemia Vera?

A

Increased

292
Q

Polycythemia Vera age of onset?

A

60 y/o

293
Q

What is Erythromelalgia in Polycythemia Vera?

A

Burning pain in hands and feet d/t increased PLT number and aggregation. Red/blue skin color.

294
Q

Aquagenic Pruritus and Polycythemia Vera?

A

Itching after warm water exposure

295
Q

Hgb, HCT, WBC, and PLT levels in Polycythemia Vera?

A

Increased

296
Q

EPO levels in Polycythemia Vera?

A

Decreased!

297
Q

Goal of tx in Polycythemia Vera?

A

Decreased thrombotic complications. Give 81mg ASA.

298
Q

Phlebotomy target in Polycythemia Vera?

A

<45%

299
Q

Idiopathic Thrombocytopenia immune or non-immune?

A

Autoimmune. Ab destroy megakaryocutes.

300
Q

Idiopathic Thrombocytopenia MC in?

A

Kids s/p viral infection

301
Q

Where is bleeding in Idiopathic Thrombocytopenia

A

Gingival and mucosal bleed

302
Q

Rash in Idiopathic Thrombocytopenia?

A

Purpuric rash with petechiae.

303
Q

Tx in Idiopathic Thrombocytopenia?

A

High dose glucocorticoids to blunt immune response.

304
Q

Tx of Idiopathic Thrombocytopenia if severe?

A

IVIG

305
Q

Tx of refractory Idiopathic Thrombocytopenia?

A

Splenomegaly

306
Q

Thombotic Thombocytopenic Purpura due to what being destroyed?

A

Enzyme ADAMTS12

307
Q

What does enzyme ADAMTS13 do?

A

Cuts large vonWillibrant Factor

308
Q

What happens to RBCs in Thombotic Thombocytopenic Purpura?

A

Damaged due to microthombi. Causes intravasular hemolysis and shistocyte formation.

309
Q

Pentad of S/Sx in Thombotic Thombocytopenic Purpura?

A
  1. Bruising and purpura
  2. Jaundice
  3. Neuro problems (HA, AMS, CVA, hallucinations)
  4. Renal failure
  5. Fever
310
Q

PLT count in Thombotic Thombocytopenic Purpura?

A

Very low PLT count

311
Q

TOC in Thombotic Thombocytopenic Purpura?

A

Early plasmapheresis qd

312
Q

2 major roles of von Willenbrand Factor?

A
  1. Mediates adhesion of PLTs to site of vascular injuey

2. Binds and stabilize Factor 8

313
Q

What is MC herediatary coagulation abnormality?

A

von Willenbrand Disease

314
Q

von Willenbrand Disease d/t what?

A

Deficiency of vWF

315
Q

MC type of von Willenbrand Disease?

A

Type 1= decreased vWF levels

316
Q

S/Sx of Type 1 von Willenbrand Disease?

A

Asx or mild

317
Q

Type 2 vW Disease due to what?

A

Quality defect of vWF

318
Q

Type 3 vW Disease due to?

A

Complete absence of vWF -> decreased Factor 8 levels

319
Q

Where bleed and bleeding time in von Willenbrand Disease?

A

Mucosal bleed- epistaxis, gingival, and menorrhagia.

Increased bleeding time.

320
Q

PTT normal or prolonged in vW Disease?

A

Prolonged

321
Q

Tx for moderate vW Disease?

A

Desmopressin

322
Q

Tx for severe/Type 3 vW Disease

A

Virus inactivated vW Factor or cryopercipitate/FFP

323
Q

PPX for surgery in vW Disease?

A

vWF-containine F8 concentrates

324
Q

Heparin Induced Thrombocytopenia due to?

A

UFH exposure. Massive PLT decrease.

325
Q

Type 1 HIT within how many hours of UFH explosure?

A

48h

326
Q

Type 1 HIT immune or non-immune?

A

Non-immune

327
Q

What will happen to PLTs in Type 1 HIT with continued exposure?

A

Normalize with continued UFH exposure

328
Q

What happens to PLTs in Type 2 HIT?

A

PLTs activated after UFH exposure. CVA/MI/DVT/PE.

329
Q

HIT risk decreased with which other heparin?

A

LMWH

330
Q

Dx of Heparin Induced Thrombocytopenia?

A

HIT antibodies

331
Q

Tx for HIT?

A

D/C UFH immediately

332
Q

What to use instead of UFH for Warfarin bridge if have HIT?

A

Direct Thrombin Inhibitor (Dargatroban, Lepiridu)

333
Q

When safe to switch to Warfarin in HIT if using Direct Thrombin Inhibitor?

A

When PLT >150,000

334
Q

Tranfuse PLT in HIT?

A

NO! Risk Thrombosis!

335
Q

HIT more than 100 days ago. OK to use UFH?

A

Yes

336
Q

Warfarin’s MOA?

A

Decreases Vitamin K dependent clotting factors and decreases Vitamin K reserves

337
Q

Warfarin indicated for?

A

DVT, PE, CVA, Afib, valve replacement

338
Q

Warfarin dose?

A

2-10mg PO qd

339
Q

Goal INR with Warfarin?

A

2-3

340
Q

Warfarin’s inhibitors?

A

Vitamin K PO or IV.

Prothrombin Complex Concentrate > FFP

341
Q

Warfarin CI’d with which 2 classes of anticoagulants?

A
  1. IIa inhibitors

2. Xa inhibitors

342
Q

Warfarin PT education

A
  • Inform all medical and dental providers
  • Soft toothbrush
  • No heavy contact sports
  • No huge increase in leafy greens (contain VitK, can decrease INR)
  • No new multivitamins, OTCs, or herbal supplements
  • No preggers

Clinical Medicine 1 (8 decks)

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