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[2a] A ⼀ Step 2 OD USLME > ✅Hematology/Oncology > Flashcards

✅Hematology/Oncology Flashcards

1
Q

Dx test for Iron Deficiency Anemia

________________

why

A

FerriTin < 15

________________

measures iron storage and is specifically for IDA

Iron,TIBC,Transferrin can all be low in Anemia of Chronic Dz as well

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2
Q

Causes of Normocytic Anemia

NON-Hemolytic (normal or low Retic count) -5

A
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3
Q

Causes of Normocytic Anemia

Hemolytic (INC Retic count) - 10

A
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4
Q

Is Haptoglobin ⬆︎ or ⬇︎ in Hemolytic Anemia?

________________

Why?

A

DECREASED

________________

Liberated Hgb (after RBC hemolysis) BINDS to serum Haptoglobin –> HgbHaptoglobin complex –> Cleared by Liver

Haptoglobin picks up Haphazard hgb

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5
Q

Lab markers for Hemolytic Anemia -5

A
  1. ⬇︎Haptoglobin
  2. ⬆︎LDH
  3. ⬆︎UnConjugated bilirubin
  4. Hgbnuria (Reddish brown urine)
  5. DAT (Direct Antiglobulin Coombs Test) -detects antibody-mediated hemolysis
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6
Q

3 main methods of developing iron deficiency

A
  1. ⬇︎ Intake (PO vs GI absorption)
  2. ⬆︎Output (menorrhagia/hematuria/hemorrhage)
  3. ⬆︎ Requirement (pregnancy)
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7
Q

High RDW typically indicates what etx -4

A
  1. Mixed deficiency
  2. Recent Hemorrhage
  3. Iron deficiency Anemia (late - microcytic)
  4. Vit B12/Folate deficiency (Macrocytic)
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8
Q

What about FerriTin makes it non-guaranteed lab value for iron changes?

A

FerriTin is also an acute phase reactant and ⬆︎ with any stress

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9
Q

Spinal Cord Compression can be from DJD, Epidural Abscess or Tumor

Which Cancer metastasis are associated with Tumor Spinal Cord Compression? - 5

A
  1. Prostate
  2. Renal
  3. Lung
  4. Breast
  5. Multiple Myeloma
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10
Q

Which has a longer onset of action: Ibuprofen or Naproxen?

A

Naproxen

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11
Q

T or F: Brain Metastasis from NonSOLC is Chemosensitive

A

FALSE!

NonSOLC is NONSensitive

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12
Q

CP of Acute Intermittent Porphyria - 3

A

AIP causes PAN

  1. Psychosis acute onset
  2. Abd pain acute onset
  3. Neuropathy acute onset

​Fam hx of this is VERY suggestive of AIP

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13
Q

[Acute Intermittent Porphyria] dx

________________

What factor of a pts hx suggest [Acute Intermittent Porphyria] ?

A

[(⬆︎Porphobilinogen) in Urine]

________________

Fam hx of similar sx

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14
Q

Name the substrates for the [heme synthesis enzyme]

<ALAS | Sideroblastic> - 3

A

[(Glycine) + (Succinyl CoA) + (Pyridoxine B6)]

⬇︎

<ALAS | Sideroblastic>

__________________

AAPUF

enzyme is associated with [| x]

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15
Q

Name the substrates for the [final heme synthesis enzyme]

<Ferrochelatase | lead tox> - 3

A

[(CoproPorphobilinogen) ➜ (((Protoporphyrin + Fe2+ )))]

⬇︎

<Ferrochelatase | lead tox>

__________________

  • AAPUF*
  • enzyme is associated with [| x]*
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16
Q

Name the substrate for the [heme synthesis enzyme]

<ALAD | lead tox>

A

(ALA)

⬇︎

<ALAD | lead tox>

__________________

  • AAPUF*
  • enzyme is associated with [| x]*
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17
Q

Name the substrate for the [heme synthesis enzyme]

<PorphoDeam | AIP>

A

(Porphobilinogen)

⬇︎

<PorphoDeam | AIP>

__________________

  • AAPUF*
  • enzyme is associated with [| x]*
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18
Q

Name the substrate for the [heme synthesis enzyme]

<UROPorphoDeam | PCT>

A

(UROPorphobilinogen)

⬇︎

<UROPorphoDeam | PCT>

__________________

  • AAPUF*
  • enzyme is associated with [| x]*
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19
Q

In Order, List the 5 Enzymes involved in Heme Synthesis

A
  • AAPUF*
    1st: <ALAS | Sideroblastic>
    2nd: <ALAD | lead tox>
    3rd: <PorphoDeam | AIP>
    4th: <UROPorphoDeam | PCT>
    5th: <Ferrocheletase | lead tox>

________________

enzyme is associated with [| x]

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20
Q

When is Cryoprecipitate used?

A

ALTERNATIVE tx to replacing fibrinogen and clotting factors in DIC

this is never used first

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21
Q

low Ferritin is specific for what type of anemia

A

iron deficiency anemia

Remember that FerriTin is an acute phase reactant

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22
Q

What does TIBC measure

A

unbound iron sites on transferrin

i.e. will be elevated in IDA but low in Anemia of Chronic Disease

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23
Q

isolated ELEVATED IRON is specific to what type of anemia?

A

Sideroblastic anemia

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24
Q

Anemia with normal iron studies is specific for what type of anemia?

A

Thalassemia (except 3 gene deletion alpha thalassemia)

Dx = Hgb electrophoresis with genetic studies if alpha thalassemia

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25
Q

Tx for iron deficiency anemia?

A

ferrous sulfate 2+

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26
Q

Tx for sideroblastic anemia

A

Pyridoxine B6

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27
Q

Causes of Vitamin B12 deficiency - 6

A
  1. PERNICIOUS ANEMIA = MOST COMMON CAUSE
  2. Vegan/Vegetarian
  3. Blind loop syndrome (Gastrectomy or RYGB)
  4. Diphyllobothrium latum
  5. Pancreatic Insufficiency
  6. Terminal iLeum damage (Crohns)
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28
Q

how do you differentiate Vitamin B12 deficiency from Folate deficiency

A

Vitamin B12 isomerizes methymalonyl coA in the spinal cord myelin —> succinyl coA.

Without it –> suBACute combined degeneration

usually manifest as peripheral neuropathy

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29
Q

Causes of Folate deficiency - 4

A
  1. Goat Milk diet (has no folate)
  2. Psoriasis
  3. Phenytoin
  4. Sulfa drugs
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30
Q

Chronic hemolysis is associated with what type of gallstones?

A

Pigmented bilirubin gallstones

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31
Q

In sickle cell, what causes vasoocclusive crisis -4

A

DICK

  1. Dehydration
  2. Infection
  3. Cold temp
  4. Kant breathe (HYPOXIA)
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32
Q

Sickle Cell Disease dx -2

A

Initially: Peripheral Smear (since SCtrait won’t have sickled cells)

Confirmation: Hgb Electrophoresis

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33
Q

What type of figures are found on smear in Sickle Cell Disease

A

Howell Jolly Bodies (left over nuclear material in pts who don’t have a spleen to remove it)

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34
Q

What disease do you see [Bite keratocyte] cells?

A

G6PD deficiency

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35
Q

What disease do you see Morulae on peripheral blood smear?

A

Ehrlichia infection

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36
Q

How does ParvoB19 affect Sickle Cell Disease pts

A

parvoB19 causes Aplastic Crisis which freezes any further reticulocyte development from marrow. SC pts usually always have high reticuloctye counts but when hit with parvoB19, they suddenly have a drop

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37
Q

MOD for Warm IgG hemolysis

A

Autoimmune Ab in the spleen or liver bind to RBC and remove small amounts of the membrane –> microspherocytes

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38
Q

Tx for [Warm IgG Hemolysis] - 4

A

1st = [** CTS initially ** –> IVIG]

2nd = [Splenectomy —> Rituximab]

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39
Q

What are the triggers of [Cold IgM hemolysis] - 3

A

cold weather is MMMiserable

  1. Mononucleosis EBV
  2. Mycoplasma PNA
  3. Macroglobulinemia Waldenstrom

occurs in colder (peripheral) parts of body and resolve with warming up body

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40
Q

Which [Warm IgG hemolysis] tx can NOT be given to [Cold IgM hemolysis] - 2

A

CTS

SPLENECTOMY

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41
Q

Do NOT confuse Cryoglobulins with Cold IgM hemolysis

What are Cryoglobulins associated with? - 3

A
  1. Hep C
  2. Joint Pain
  3. Glomerulonephritis
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42
Q

List the 4 main characteristics of G6PD deficiency

A

Stress makes me eat bites of fava beans with Heinz ketchup

  1. oxidant Stress on RBC from lack of glutahione reductase –> hemolysis and SUDDEN BACK PAIN
  2. Bite cells
  3. Induced by fava beans, macrobid, sulfa, primaquine, infection
  4. Heinz bodies (RBC inclusions seen after crystal violet staining)

Almost always in Black/Mediterranean Men with sudden Anemia

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43
Q

HUS and TTP etx

A

TTP WILL HAVE MORE NEURO SX and it’s tx = plasma exchange

otherwise, HUS and TTP present the same

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44
Q

TTP is associated with what conditions? - 4

A
  1. Clopidogrel
  2. Ticlopidine
  3. Cyclosporine
  4. AIDS

Unlike HUS, TTP will have neuro sx (confusion/seizures) in addition to Fever

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45
Q

MOD for Paroxysmal Nocturnal Hemoglobinuria

A

[CD55/59 Decay Accelerating factor] (responsible for deactivating complement) of the RBC, WBC and platelets is produced less

so…

nocturnal respiratory acidosis (shallow breathing during sleep) –> complement activation –> complement binds to RBC, WBC and platelets –> nocturnal hgbnuria/⬆︎infection/thrombosis

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46
Q

What is the most common cause of death in Paroxysmal Nocturnal Hemoglobinuria

A

Thrombosis

________________

(Mesenteric or Hepatic veins)

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47
Q

Tx for Paroxysmal Nocturnal Hemoglobinuria -3

A
  1. Prednisone
  2. Bone Marrow Transplant = cure
  3. Eculizumab (inactivates C5 complement)
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48
Q

Treatment for Aplastic Anemia is Bone Marrow Transplant

At what age does [bone marrow transplant] become unavailable?

________________

what are the alternatives then?-2

A

>50 yo

________________

[AntiThymocyte Globulin and Cyclosporine]

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49
Q

“Pt has intense pruritus after a warm shower”

What is the Dx? ; Why does this happen?

A

Polycythemia Vera

________________

Heat ⬆︎Basophils (rare but can become AML) –> ⬆︎Histamine release

________________

Remember: PV ⬆︎ALL 3 cell lines but places focus on RBC more

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50
Q

“Pt has intense pruritus after a warm shower”

What is the Dx?

________________

How do you diagnose this?

A

Polycythemia Vera

________________

Dx = JAK2 mutation

________________

  • Remember: PV ⬆︎ALL 3 cell lines but places focus on RBC more*
  • You must exlude Hypoxia as a cause of ⬆︎RBC*
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51
Q

Tx for Polycythemia Vera - 2

A
  1. phlebotomy
  2. hydroxyurea
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52
Q

When do you treat Essential Thrombocytosis?-2

A

ONLY when

  1. pt>60 yo with sx

OR

  1. pt>60 with [platelets>1.5million]
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53
Q

Tx for Essential Thrombocytosis - 3

A
  1. HYDROXYUREA
  2. Anagrelide when RBC is suppressed from Hydroxyurea
  3. ASA for erythromelagia (painful red hands from ET)
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54
Q

Aplastic Anemia and Myelofibrosis both present as Pancytopenias

What are 2 discerning factors?

A
  1. Myelofibrosis occurs in older people
  2. Myelo = teardrop shaped cells from cells struggling to get out of fibrosed bone marrow
  3. Myelo tx = [Thalidomide and Lenalidomide] = bone marrow production stimulators
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55
Q

Aplastic Anemia and Myelofibrosis both present as Pancytopenias

Tx for Myelofibrosis -2

A

[Thalidomide and Lenalidomide]

________________

( bone marrow production stimulators)

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56
Q

Acute Leukemia will present with signs of ⬜

________________

Which acute leukemia is associated with DIC?

A

PANcytopenia

________________

acute promyelocytic M3 (chromo 1517)

Dx = smear showing blast –> flow cytometry for confirmation

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57
Q

Acute Leukemia will present with signs of _____

Which acute leukemia is associated with Auer rods (eosinophilic inclusions)?

A

PANcytopenia ; promyelocytic M3 (chromo 1517)

Dx = smear showing blast –> flow cytometry for confirmation

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58
Q

Acute Leukemia will present with signs of ⬜

________________

Which acute leukemia is associated with Myeloperoxidase?

A

PANcytopenia

________________

Myelocytic

Dx = smear showing blast –> flow cytometry for confirmation

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59
Q

DDx for pt presenting with pancytopenia - 5

A
  1. Acute Leukemia
  2. Aplastic Anemia
  3. Myelofibrosis (dry tap and tear drop cells)
  4. Myelodysplastic Syndrome (hypercellular bone marrow with ringed sideroblast with Prussian blue )
  5. Hairy Cell Leukemia (dry tap with hypercell bone marrow)
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60
Q

Acute Leukemia will present with signs of ⬜

________________

Which acute leukemia is associated with [ATRA-all trans retinoic acid]?

A

PANcytopenia

________________

[promyelocytic M3 (chromo 1517)]

Dx = smear showing blast –> flow cytometry for confirmation

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61
Q

Which acute leukemia is intrathecal MTX given to prevent relapse?

A

ALL is treated with intrathecal MTX to prevent CNS releapse

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62
Q

How is the [LAP-Leukocyte Alkaline Phosphatase] test used for Heme/Onc diagnostics?

A

Leukemic cells do NOT have high levels of Alkaline Phosphatase so in CML, LAP will be low

if LAP is high = leukemoid rxn (stress rxn)

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63
Q

Other than [LAP-Leukocyte Alkaline Phosphatase] test, what else can be used to diagnose CML?

A

[BCR-ABL 922] PCR

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64
Q

Out of the Myeloproliferative disorders, which has greatest potential for transformation into Acute Leukemia BLAST CRISIS?

A

CML

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65
Q

What are the initial therapies for Chronic Myelogenous Leukemia?-3

________________

What is the ultimate cure?

etx: chromo 922 = BCR ABL gene

A

tx = [tyrosine kinase inhibitors ( x-tinib)] such as ..

  1. imatinib
  2. dasatinib
  3. nilotinib

Cure = Bone marrow transplant (NEVER the first therapy though)

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66
Q

In pt presenting with acute leukostasis reaction, what is the FIRST important thing to do for them?

A

Leukaphresis (establish dx AFTER!)

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67
Q

Myelodysplastic Syndrome is a PreLeukemic disorder

Why do most pts never actually develop AML from Myelodysplastic Syndrome?

A

They die of infection or bleeding FIRST

MDS causes pancytopenia despite hypercellular bone marrow

68
Q

Which chromosomal abnormality is Myelodysplastic Syndrome associated with?

A

5q deletion (these pts have better pgn)

69
Q

What disorder does Pelger Huet cells belong to?

Cell with Bilobed nucleus

A

MyeloDysplastic Syndrome

70
Q

Describe peripheral blood smear for CLL-Chronic Lymphocytic Leukemia

A

proliferation of normal and mature (but dysfunctional) B lymphocytes with smudge cells

71
Q

What is the Richter phenomenon

A

conversion of Chronic Lymphocytic Leukemia –> high grade lymphoma which happens in 5% of patients

________________

CLL = mature lymphocytes and smudge cells

72
Q

What px should be given in Chronic Lymphocytic Leukemia

A

PCP px

73
Q

Tx for Chronic Lymphocytic Leukemia - 2

A

Stage

[0: ⬆︎WBC] and [1: LAD] = no tx

[3: HepatoSplenomegaly], [4: Anemia], [5:Thrombocytopenia] = Fludarabine and Rituximab(if available)

74
Q

Hairy Cell Leukemia dx?-2

B cells with filamentous projections on smear

A

[TRAP-Tartrate Resistant Acid Phosphatase] or CD11c

75
Q

Hairy Cell Leukemia Tx?

B cells with filamentous projections on smear

A

Cladribine

76
Q

Non-Hodgkin Lymphoma and Chronic Lymphocytic Leukemia both involve lymphocyte proliferation

What is the major difference

A

NHL = solid mass (lymph nodes and spleen)

CLL = Circulating liquid mass (so use flow cytometry of peripheral blood to diagnose)

77
Q

NonHodgkin Lymphoma cp - 2

A
  1. painLESS LAD
  2. B sx (Fever, Night sweats, Wt Loss)

Dx = EXCISIONAL bx with staging via CT and BMbx to determine tx

THIS IS THE SAME AS HODGKIN LYMPHOMA - except HD has ReedSternberg owl cells

78
Q

NonHodgkin Lymphoma Dx? -2

A

Dx = [EXCISIONAL bx with staging via CT] and [BMbx to determine tx]

________________

THIS IS THE SAME AS HODGKIN LYMPHOMA - except HD has ReedSternberg owl cells

79
Q

Tx for NonHodgkin Lymphoma with Bsx or ≥ Stage 3 -5

A
80
Q

Tx for NonHodgkin Lymphoma stage 1A and 2A

A
81
Q

For Hodgkin Lymphoma, what are the determinants for prognosis?

A

Lymphocyte Predominant = GOOD Pgn

82
Q

Tx for Hodgkin Lymphoma with Bsx or ≥Stage 3 - 4

A
83
Q

In Heme/Onc what are the MUGA and nuclear ventriculogram used for?

A

Determine cardiotoxicity for Adriamycin/Doxorubicin tx used for Hodgkin Lymphoma

84
Q

What are the toxicities for Cisplatin and Carboplatin? - 2

A
85
Q

What are the toxicities for Vincristine?

A
86
Q

What are the toxicities for Bleomycin and Bulsulfan?

A
87
Q

What are the toxicities for Doxorubicin?

A
88
Q

What are the toxicities for Trastuzumab?

A
89
Q

What are the toxicities for CYclophosphamide?

A
90
Q

What are the toxicities for 5-FU?

A
91
Q

What are the toxicities for 6-MP?

A
92
Q

What are the toxicities for MTX?

A
93
Q

ITP cp - 2

A
  1. isolated thrombocytopenia +/- megakaryocytes on smear (typically after infection)
  2. Normal spleen

Strongly associated with HIV and HepC

94
Q

ITP tx - 5

A

Strongly associated with HIV and HepC

95
Q

What’s the most common inherited bleeding disorder

A

AUTO DOM Von Willebrand Disease

worst after using ASA, detected via Ristocetin cofactor assay

96
Q

What type of bleeding is seen with Factor 11 Deficiency

A

USUALLY NO INCREASED BLEEDING

97
Q

What are the triggers for DIC - 6

A

his DIC SCABS Terribly!

  1. Sepsis
  2. CA
  3. Abruptio placenta or Amniotic fluid embolus
  4. Burns
  5. Snake bites
  6. Trauma –> tissue factor release

DIC activates primary AND secondary coagulation

98
Q

Tx for DIC - 3

A
  1. Platelets if < 50K
  2. FFP (clotting factors)
  3. Cryoprecipitate (replaces fibrinogen if FFP doesn’t work)
99
Q

Which type of clots are more common with HIT?

________________

dx for HIT?-2

A

Venous

________________

[Platelet factor 4 Ab on ELISA] or [Serotonin release assay]

100
Q

Lupus Anticoagulant dx

A

Russel Viper Venom test

101
Q

What is the most common complication for pts with Sickle Cell Trait?

A

Painless hematuria

Sickle cell is auto recessive

102
Q

What prophylaxis regimen should pts who’ve recently had a splenectomy receive afterward?

A

PCN PO QD

x 5 years

103
Q

Bernard Soulier cp - 2

A
  1. Superficial Bleeding out of proportion to the degree of thrombocytopenia
  2. GIANT platelets

etx = absent platelet glycoprotein 1B-9-5 Receptor for von willebrand factor

104
Q

In pts with Factor defects (secondary coagulation dysfunction), the long term effect of blood sitting in joints ➜ Hemophilic arthropathy

________________

explain how this leads to joint pain?

A

iron/hemosiderin desposition –> synovitis and fibrosis of that joint –> chronic worsening joint pain and swelling

105
Q

The vast majority of Head and Neck CA (i.e. submandibular uL hard non-tender LAD) are what type of CA?

A

SQC

106
Q

Why are Bisphosphonates given to CA pts? - 2

A

stabilizes bony metastatic lesions which

  1. prevents hypercalcemia of CA
  2. prevents fx
107
Q

What is the most common cause of [Folate B9] deficiency in the U.S.?

A

EtOH

108
Q

What are the major electrolyte changes in Tumor Lysis Syndrome - 4

A

cytotoxic chemotherapy makes you PUKE

  1. ⬆︎ Phosphate (binds and ⬇︎Ca+ )
  2. ⬆︎ Uric acid (px = allopurinol and IVF)
  3. ⬆︎ K+ ( ➜ cardiac arrhythmias)
  4. Electrolyte ∆
109
Q

What’s the best tx for CA-related anorexia -2

A

Megestrol progesterone analogue >>> CTS

Marijuana is only useful in HIV anorexia

110
Q

**HIGH YIELD**

________________

When is EPO indicated for ESRD pts?

What are the side effects of EPO? - 3

A

Hgb<10 (use EPO with hct goal of 35%)

________________

  1. HTN
  2. HA
  3. Flu-like sx
111
Q

How can you differentiate between Bone Marrow Infiltration and Bone Marrow Aplasia using the spleen?

A

Splenomegaly only occurs in Bone Marrow Infiltration

112
Q

Describe Splenic Sequestration

A

complication of Sickle Cell Disease in which a pooling of RBC AND PLATELETS within the spleen –> splenomegaly, pallor and thrombocytopenia

113
Q

Sickle Cell Disease pts are at risk of having Aplastic Crisis

What is the difference between Aplastic Crisis and Aplastic Anemia?

A

Aplastic Anemia is a/w PANcytopenia and can be congenital (fanconi, drug-induced, autoimmune)

114
Q

Sickle Cell Disease pts are at risk of having Aplastic Crisis

Clinical Presentation of this? -3

________________

What’s the most common cause of this?

A
  1. SUDDEN drop in Hgb with
  2. Reticulocyte < 1%
  3. NO Hepatosplenomegaly

Parvo B19!

115
Q

Fanconi anema is an auto recessive disorder that causes ____(micro/normo/macro) anemia

cp?-3

A

Fanconi MACROcytic anemia

  1. PANcytopenia marrow failure
  2. morphological changes
  3. growth stunt
116
Q

Laboratory results for Chronic Myelogenous Leukemia?-4

A
  1. ⬆︎ABSOLUTE BASOPHILIA
  2. ⬆︎⬆︎⬆︎LEUKOCYTOSIS
  3. shift tward precursor cells (myelocytes or promyelocytes)
  4. ⬇︎Leukocyte Alkaline Phosphatase (LAP)

Cure = Bone marrow transplant (NEVER the first therapy though)

etx = 922 BCRABL philadelphia chromosome

117
Q

Dx for Chronic Myelogenous Leukemia?-3

A

LOW Leukocyte Alkaline Phosphatase score (marker of neutrophil activity and differentiates from leukomoid rxn)

118
Q

lab values for Acute Lymphoblastic Leukemia - 3

A
  1. > 25% Lymphoblast from bone marrow bx (THIS IS HOW YOU DIAGNOSE)
  2. TdT positive (TdT is only expressed by preB and preT lymphocytes)
  3. PAS positive

cp: LAD, hepatosplenomegaly, thrombocytopenia

119
Q

Factor 5 Leiden mod ; how does this affect aPTT and PT/INR

A

AUTO DOM point mutation in Factor 5 gene –> RESISTANCE TO PROTEIN C (which is supposed to inactive Factor 5). This –> Hypercoagulability

aPTT AND PT/INR may both be normal!

120
Q

Dx for Hereditary Spherocytosis - 3

A

E5 with Acid

[Eosin 5 maleimide binding flow cytometry] WITH [Acidified glycerol lysis test]

OR

Osmotic fragility test but it has low sensitvity

Lab findings = ⬆︎Mean Corpuscular Hgb Concentration

121
Q

why are sickle cell patients (both trait and disease) at ⬆︎for benign nocturia

A

HYPOSTHENURIA ; This is when sickles obstruct the vasa rectae of the inner medulla –> inability to concentrate urine

Happens in Sickle Cell pts

122
Q

G6PD deficiency MOD

A

Stress makes me eat bites of fava beans with Heinz ketchup

Triggers –> hemolysis

Almost always in Black/Mediterranean Men with sudden Anemia

123
Q

Hereditary Spherocytosis MOD

A

Defect in RBC membrane (ankyrin, band and spectrin) –> spleen removing the defective parts lil by lil as RBC past which eventually –> spherocytes which have High mean cell hgb concentration and RBC distribution width

Triad = Splenomegaly, Jaundice, Hemolytic Anemia

124
Q

Which type of clots are Heparin Induced Thrombocytopenia pts at risk for, Venous or Arterial?

A

BOTH

125
Q

A pt coming in with GI distress secondary to EColi should be worked up for what heme condition

A

Hemolytic Uremic Syndrome HUS HAT

HUS HAT from EColi O157 H7 shiga toxin

Hemolytic Anemia

Acute renal failure

Thrombocytopenia

126
Q

What are the 3 examples of Microangiopathic Hemolytic Anemia

A

HAT (HemolyticAnemia/AcuteRenalFailure/Thrombocytopenia)

  1. DIC
  2. HUS
  3. TTP (will have more neuro signs)
127
Q

how do anabolic steroids affect hematologic lab values? - 3

A
  1. ⬆︎RBCs
  2. Hepatotoxic
  3. Dyslipidemia
128
Q

what’s the most common cause of anemia in premature infants?

A

Anemia of Prematurity

etx: ⬇︎EPO, shortened RBC life

129
Q

TTP tx

A

TTP will have more neuro sx and it’s tx = plasma exchange

130
Q

DIC tx

A

Cryoprecipitate

(contains clotting factors, fibrinogen and vWF)

131
Q

Which hematological abnormality is Acute Cholecysitis a major complication of?

A

Hereditary Spherocytosis (from pigmented gallstones)

Triad = Splenomegaly, Jaundice, Hemolytic Anemia

132
Q

Although it is a procoagulant, why is lupus anticoagulant called an anticoagulant?

A

because ONLY in the petri dish, it causes prolonged aPTT

133
Q

Describe the peripheral blood smear for Chronic Myeloid Leukemia

A

leukocytosis with shift toward precursor cells (promyelocytes, myelocytes)

Cure = Bone marrow transplant (NEVER the first therapy though)

134
Q

What is Trousseau Syndrome?

________________

What does it indicate?

A

hypercoagulable disorder –> recurrent migratory superficical thrombophlebitis at unusual sites (arm, chest)

________________

Pancreatic Cancer (or sometimes stomach, lung or prostate)

135
Q

When is empiric anticoagulation ok for DVT/PE?

A

ONLY when pt has sx suggesting PE is present . If only DVT sx are present, confirm with US first before anticaogulation

136
Q

How long does it take a vegan to develop macrocytic anemia secondary to vitamin B12 deficiency

A

≥4 years

137
Q

A white male presents with megaloblastic anemia, atrophic glossitis, vitiligo and neuro problems…

all consistent with Vitamin B12 deficiency

What is likely the cause?

A

GENETIC! Whites of Northern European ancestry naturally develop Pernicious Anemia

also, Pernicious Anemia ⬆︎ risk for gastric ADC

138
Q

Describe etx for Warfarin induced skin necrosis

A

Warfarin ⬇︎2, 7, 9, 10, Protein C and S

27910 = ⬆︎Clotting

[Protein C and S] = anti-Clot = Bleeding. But Protein C and S are the first to be affected by warfarin, allowing 27910 to rome freely and ⬆︎Clotting

139
Q

Pernicious Anemia is the most common cause of Vitamin B12 deficiency

Pernicious Anemia ⬆︎ risk for developing what type of cancer?

A

Gastric ADC

140
Q

What is the mangement for when a pt develops Heparin Induced Thrombocytopenia (HIT) - 3

A

1st: STOP HEPARIN OR ENOXPARIN
2nd: initiate alternative (dabigatran, fondaparinux)
3rd: initiate Warfarin once platelet is > 150K

141
Q

An elderly pt has minor trauma and develops ecchymoses

What should be first on the DDx for this particular pt?

A

Senile Purpura (not heme related)

Age-related ⬇︎of elastic fibers in perivascular connective tissue –> purpura

142
Q

What disease should you suspect in a pt with Macrocytic anemia and congenital anomalies?

A

Diamond Blackfan Syndrome (DBS)

intrinsic defect in erythroid progenitor cells –> ⬆︎apoptosis

143
Q

What gene abnormality causes Chronic Myelogenous Leukemia?

A

chromo 922 which forms BCR ABL gene

Cure = Bone marrow transplant (NEVER the first therapy though)

144
Q

Type of Cell? ; Diagnosis?

A

Atypical Reactive CD8 T cells; Infectious Mononucleosis

145
Q

MOD for Hairy cell leukemia? ; How is diagnosis made?

A

B cell neoplasm that infiltrates bone marrow, spleen and peripheral blood; Bone Marrow Biopsy

146
Q

Diagnosis? ; MOD of this disease?

A

Gaucher ; lysosomal storage disease

147
Q

Describe what Transferrin measures?

A

The amount of iron being transferred in the blood

148
Q

Describe what Total Iron Binding Capacity (TIBC) measures?

A

The Capacity of Iron transferrin can actually carry

149
Q

Describe the following values for Iron Deficiency Anemia:

MCV

Iron

Transferrin

TIBC

Ferritin

A
150
Q

Describe the following values for Thalassemia:

MCV

Iron

Transferrin

TIBC

Ferritin

A
151
Q

Describe the following values for Anemia of Chronic Disease:

MCV

Iron

Transferrin

TIBC

Ferritin

A
152
Q

Describe the following values for Sideroblastic Anemia:

MCV

Iron

A

⬇︎MCV

⬆︎Iron

153
Q

How do you diagnose CLL-Chronic Lymphocytic Leukemia?

Suspect this in any elderly with dramatic leukocytosis primarily made of lymphocytes

A

Flow Cytometry of peripheral blood

proliferation of normal and mature (but dysfunctional) B lymphocytes with smudge cells

154
Q

An elderly pt who presents with dramatic leukocytosis primarily made of lymphocytes should always make you suspicious of what disease?

A

Chronic Lymphocytic Leukemia (CLL SLL)

proliferation of normal and mature (but dysfunctional) B lymphocytes with smudge cells

155
Q

MOD for Pica

A

iron deficiency anemia –> desire to eat ice, clay, dirt, paper

156
Q

A pt is newly diagnosed with Head and Neck Squamous cell carincoma

What is the next best step in their diagnostic process?

A

PANendoscopy (esophagoscopy, bronchoscopy, laryngoscopy)

157
Q

Pt has intense pruritus after a warm shower

What is the Dx? ; What is the tx for this?

A

Polycythemia Vera ; Phlebotomy

  • You must exlude Hypoxia as a cause of ⬆︎RBC*
  • Dx = JAK2 mutation*
  • Remember: PV ⬆︎ALL 3 cell lines but places focus on RBC more*
158
Q

Pt has intense pruritus after a warm shower. Polycythemia Vera is diagnosed

What is the difference between Phlebotomy and Plasma exchange?

A

Phlebotomy (tx for PV) removes cells while Plasma exchange only removes substances (Antibodies, immune complexes, toxins)

159
Q

What is the most common type of testicular sex cord stromal tumor? ; What does it secrete?-2

A

Leydig ; Testosterone AND Estrogen

All Solid Testicular Tumor Masses should be treated with Radical Orchiectomy

160
Q

A pt has been diagnosed with a Solid Testicular Tumor Mass via Ultrasound

Tx? -2

A

Radical Orchiectomy –> additional chemoradiation/surgery based on cell type

161
Q

Identify cells ; What disease are they associated with?

A

Spur cell acanthocytes ; Liver disease

162
Q

What blood disorder should be suspected in a pt with ⬆︎Mean Corpuscular Hgb Concentration?

A

Hereditary Spherocytosis

163
Q

cp for Immune Thrombocytopenia ; tx?-3

A

isolated thrombocytopenia after an infection (usually in a child) ;

  1. usually self limited to 6 months = observation
  2. IVIG if bleeding present OR
  3. CTS if bleeding present
164
Q

What type of gallstones are pts with Hereditary Spherocytosis at risk for?

A

Pigmented Bilirubin Gallstones

in Hereditary Spherotycosis, RBC membrane defect can cause intravascular hemolysis

165
Q

Triad for Osler Weber Rendu syndrome

A

Osler Weber likes to EAT

  1. Epistaxis recurrently
  2. AV malformations
  3. Telancietasia
166
Q

Which 2 Vitamins are used to treat Homocystinuria?

A

Pyridoxine B6 with Folate B9

[2a] A ⼀ Step 2 OD USLME (21 decks)

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