Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CCFP-EM > Hematology / Oncology > Flashcards

Hematology / Oncology Flashcards

1
Q

Transfusion targets in sickle cell disease

A

Hgb < 50 unless heart failure, dyspnea, hypotension
Hgb ~ 100 in acute chest syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

3 causes of acute drop in hemoglobin in sickle cell disease

A

Splenic Sequestration
Aplastic Crisis - First test is RETICS (Low in aplastic)
Hemolysis / MAHA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Causes of sickle cell disease

A

HgbS + HgbS
HgbS + Hgb BThal
HgbS + HgbC

  • Usual first presentation of dactylitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Acute Chest Syndrome Diagnosis and Mgmt

A

Rehydration
Analgesia
Incentive spirometry
02 > 92%
Empiric antibiotics -

Consider exchange transfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

treatment of vaso-occlusive crisis

A

Can be triggered by cold, humidity, stress, EtOH
+++ Pain meds. i.e 1 Dilaudid IV Q15 mins
O2 and IV fluids PRN
Hydroxyurea can prevent reduce incidence.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CLL Diagnosis

A

Lymphocytes > 5 on repeat test without underlying illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Blast Crisis definition / mgmt

A

Hyperviscocity syndrome
- WBC > 100, blasts > 20
- Mucosal bleeding
- Headaches and ataxia
- Visual changes

Tx: Dilute: hydration, oxygen and supportive care. Hematology consult
- Phlebotomy: withdraw 2U of blood.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

TTP Presentation and treatment and Mimics

A

Fever (rare)
Anemia
Thrombocytopenia
Renal failure
Neurologic Sx

Mgmt: Supportive care, Plex, FFP as a temporization

Mimics:
SLE - APLA
Vasculitis
Malignant Hypertension
Compliment mediated HUS
DIC
Pre-eclampsia / HELLP
Disseminated Malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ITP

A

Look for “wet puppura” in oral mucosa
Usually do ok - low rates of bleeding
Plts < 30, call heme
If > 30, observe ensure f/u

Tx: steroid, IVIG, rituximab (down the road), consult heme
If severe bleed: IVIG 1g/kg. Methylpred 1g IV,, TXA 1g over 15 plus 1g over 8 hrs, call heme, transfuse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Platelet transfusion threshold

A

Chemotherapy: < 10
Chemo + Fever: < 20
ITP: 30 with bleeding
DIC with bleeding: 50
Life threating bleeding: 50
ICH: 100
LP: 50
Paracentesis: Doesn’t matter
Central Venous: <20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Transfusion fever dx and management

A

Stop transfusion
- Acute hemoltyic
- Sepsis
- Febrile, non-hemolytic transfusion reaction
- TRALI (resp distress, usually several hours later)

Stop
Full set vitals
RE-check: Call transfusion medicine - clerical check
Hemolytic workup
If mild: give acetaminophen and continue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Transfusion fever dx and management

A

Stop transfusion
- Acute hemoltyic
- Sepsis
- Febrile, non-hemolytic transfusion reaction
- TRALI (resp distress, usually several hours later)

Stop
Full set vitals
RE-check: Call transfusion medicine - clerical check
Hemolytic workup
If mild: give acetaminophen and continue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Hemolytic Anemia Diagnosis and DDx

A

Diagnosis:
- CBC, smear, retics, haptoglobin, LDH, bili (total and direct), DAT, fibrinogen

DDx:
-Hereditary: Sickle, G6PD, Spherocytosis
-Acquired: Autoimmune warm / cold (IgG, bind at body temp, usually a malignancy caused / EBV or Mycoplasma pneumonia, lymphoma or Waldenstroms), Alloimmune (newborn, transfuse), drug induced (cephalosproins, sulfa, levodopa, penicillin..)

-Framentation:
DIC - sepsis, meningococcemia, bacteremia, trauma, etc. - Supportive mgmt

TTP - Congenital or acquired ADAMSTS13 deficiency. Bicytopenia, ALTERED MENTAL STATUS, renal failure, neuro issues). Treatment: PLEX +/- steroids

HUS - Post β hemolytic (Shiga toxin producing) E.coli.

Pregnancy
Malignant HTN
Malignancies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anemia causes by MCV

A

Microcytic < 80
- Thalassemia
- Anemia of chronic disease
- Iron Deficiency
- Lead poisoning
- Sideroblastic

Normocytic 80-100
- Hemolysis (sometimes macro)
- Bleeding (sometimes macro)
- Anemia of chronic disease (sometimes micro)
- Marrow failure (aplastic anemia, myeloproliferative disorders)
- Infectious (EBV)
- Hypothyroid
- Hypoadrenal / Hypopit
- Renal failure

Macrocytic:
- B12
- Folate
- Reticulocytosis
- EtOH
- Hypothyroisd

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is sideroblastic anemia

A

Disorder of porphyrin leads to iron deposition in mitochondria of RBC precursors
- Genetic in kids
- Acquired in adults: infections, carcinoma, leukemia, RA, EtOH, lead poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Drugs that can trigger hemolysis in G6OD

A

Aspirin
Antimalarials (Quinine, Plaquenil)
Nitrofurans
Sulfa
FAVA beans

16
Q

6 Diagnostic lab tests for hemolytic anemia

A

Peripheral smear
DAT
Haptoglobin
unconjugated bili
LDH
Serum free Hgb

17
Q

Types of intravascular hemolysis

A

Intra: MAHA(s), burn, infections, autoimmune, transfusion
Extra: Malignancy, enzyme deficiency, hemoglobin defects, hypersplenism, toxins

18
Q

Causes of Leukocytosis / Lymphocytosis

A

Leuko:
- Infection
- Medications - Steroids
- Trauma
- Pregnancy
- Lymphoproliferative (CML, PV)
- hereditary neutrophilia
- Eosinophilia
- DKA
- Thyrotoxicosis
- Seizures

Lymphocytosis:
- Viral (mono, rubeola, rubella, varicella), CLL, graft rejection

19
Q

Things affecting O2 dissociation curve

A

Right shift: acidosis, increased CO2, fever/hyperthermai, increased 2,3 BPG

Left Shift: alkalosis, cold,

20
Q

Hemostasis steps

A

Endothelial injury
Platelet plug
Activation of cascade
Clot formation
Fibrinolysis

21
Q

10 causes of thrombocytopenia

A

Production:
- Aplastic anemia / Marrow failure
- Liver failure
- Drugs: chemo, EtOH, septra, digoxin, ASA

Destruction:
- ITP
- Collagen vascular disease
- Transfusion reactions
- TTP
- HIT
- DIC
- HUS
- Vasculitis
- Massive transfusion
- Infection - Rubeola, Varicella

Sequestration:
- Hypersplenism

22
Q

6 causes of thrombocytosis

A

Reactive:
- Infection
- Iron deficiency
- Trauma
- Non heme malignancy
- Post splenectomy
- Rebound from deficiency

PV
Primary

23
Q

HIT vs ITP

A

HIT:
- Usually 5-7 days post exposure
- Present with bleeding and thrombocytopenia or thrombosis
- Isolated thrombocytopenia

ITP:
Acute: usually in age 2-6.
- Preceded by viral prodrome-
- Self limited
- Can use IVIG, steroids and plamapheresis
- Platelets < 20

Chronic: Women>men, insidious onset
- Plt 30-100 k

24
Q

TTP vs HUS

A

TTP: ADAMTS-13
- MAHA
- Typically adults age 10-40 years. F > M
- Mnemonic “FAT-RN” with more neuro involvement
“Fever
Anemia
Thrombocytopenia
Renal impairment
Neurologic impairment”
- Most common onset after quinine or plavix
- Tx: Plasma exchange +/- ritux/steroid/ASA

HUS: Usually post infectious
- Autoimmune abdominal vasculitis
- Typically pediatric patients
- Supportive case

25
Q

PT vs PTT abnormality

A

PT:
- Rare genetics. Usually warfarin, Vit K deficiency or liver disease

PTT:
- More common, hemophilia A and B
- Factor 8, 9, 11
For PTT inherited disorders:
Tx - FFP 15 ml/kg or factor concentrate at 50U /kg

26
Q

Hemophilia A and B

A

Factor VIII and IX
Sex linked recessive M 4x F
Severity based on VIII activity assay

Mgmt with factor replacement or FFP if needed.
Demopressin may be helpful

27
Q

vWF deficiency

A

Most common inherited coagulopathy
- lack of vwF.
- presents with mucosal bleeding and menorrhagia
- For severe dsiease fiver factor VIII
For mild give demopressin +/- TXA

28
Q

DIC Coagulopathy Mgmt

A

Treat underlying cause
Manage the primary issue:
- Bleeding - platelets, FFP, cryoprecipitate
- Clotting IV heparin

29
Q

Febrile Neutropenia Def’. and Mgmt

A

ANC < 0.5 or anticipated to drop within 48 hrs with fever > 38.3 or 38 for > 1 hr
Most common infections:
- Pneumonia, UTI, skin, anorectal, pharyngitis

Tx:
Low Risk: Oral cipro or amox clav
High Risk: Pip-tazo +/- vanco if known MRSA, cellulitis, severe sepsis, severe mucositis, Blood culture with gram +ve cocci

30
Q

Signs of spinal cord compression

A

Back pain
Leg weakness
Saddle parasthesia
Autonomic dysfunction

31
Q

Causes of pericardial effusion in malignancy

A

Malignancy
Hypoalbuminemia
Radiation
Chemotherapy

32
Q

Hypercalcemia symptoms and management and causes

A

Bone pain / fractures
Nephrolithiaisis
Abdo pain / constipation
Altered mental status

ECG: short QT
Ca2+ > 3.0 for symptoms

Mgmt:
- IV fluids resus
- Loop Diuretics
- Dialysis
- Bisphosphonate
- Consider calcitonin

Causes:
Paraneoplastic - PTHrP
PTH producing tumor
Bone resorption

33
Q

Electrolyte abnormalities in TLS and Mgmt

A

Hyper K+
Hyperphosphatemia
Hyperuricemia
Hypocalcemia

34
Q

Treatment of TLS

A

IVF 5-6 L / day (200-250 /hr)
Hyperkalemia mgmt
Hyperuricemia:
- Allopurinol as preventative, not in acute
- Rasburicase
Hypocalcemia: Give calcium only if cardiac or neuro abnormalities

35
Q

What is leukostasis

A

Hyperviscosity syndrome 2nd to markedly elevated WBC in hematologic malignancies
Usually WBC > 100

Symptoms primarily in neuro and pulmonary

36
Q

Conditions associated with hyperviscosity syndrome, symptoms and mgmt

A

AML/ALL/PV
Multiple myeloma
Waldenstrom’s
Sickle cell
Malaria or babeiosis

Presents with visual changes, AMS and mucosal bleeding

Mgmt: PLEX, phlebotomy and IV fluids replacement

37
Q

Presentation of SVC syndrome

A

Red plethoric face or UE caused by compression of the SVC
- +/- CP, dyspnea or cough
JVD and cyanosis of upper trunk
Pemberton’s sign.
Collateral veins often present

38
Q

Cancers that met to bone

A

Prostate
Testes
Breast
Lung
Multiple myeloma
Kidney

CCFP-EM (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions