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Internal Medicine > Hematology & Oncology > Flashcards

Hematology & Oncology Flashcards

1
Q

Name the Blood transfusion Rxn occur within seconds to minutes of transfusion.

A

Anaphylactic

-Caused By recipient anti IgA Ab

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2
Q

Name the Blood transfusion Rxn occur within 1 hour of transfusion.

A

Acute Hemolytic

-Caused by ABO incompatibility

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3
Q

Name the Blood transfusion Rxn occur with 1-6 hours of transfusion.

A

Febrile Non Hemolytic

-Caused by cytokine accumulation during blood storage

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4
Q

Name the Blood transfusion Rxn occur within 6 hours of transfusion.

A

Transfusion related Acute lung Injury

-Caused By Dono anti leukocyte Ab

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5
Q

Name the Blood transfusion Rxn occur within 2-10 days after transfusion.

A

Delayed Hemolytic

-Caused by anamnestic antibody response

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6
Q

Name the Blood transfusion Rxn causing Hypotension

A

Bacterial sepsis

Primary Hypotension Rxn

Transfusion Related Acute lung Injury

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7
Q

Name the specialized RBC treatment for Febrile non Hemolytic Rxn

A

Leukoreduced Blood

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8
Q

Washed is the specialized RBC treatment in given in ;

A

IgA deficiency

Complement dependent autoimmune hemolytic Anemia

Continue allergic Rxn with red cell transfusion despite antihistamines t/m

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9
Q

Name the indication to irradiated blood

A

A) Bone marrow transplant recipients

B) Acquired Or Congenital cellular immunodeficiency

C) Blood components donated by first Or Second degree Relatives

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10
Q

Name the condition which show Tear drop cells (Dacrocytes)

A

Thalassemia

Bone Marrow infiltration

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11
Q

Name the condition which show burr cells (Echinocytes)

A

ESRD

Pyruvate kinase deficiency

Liver Diseases

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12
Q

Name the condition which shows Ringed sideroblast (Seen inside bone marrow)

A

Sideroblastic anemia

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13
Q

Name the condition which shows target cells

A 
HALT
H Hbc
A asplenia 
L Liver disease
T Thalassemia
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14
Q

Name the condition which shows Basophilic stippling

Seen in peripheral smear

A

Sideroblastic anemia due to lead

Thalassemia

Alcohol

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15
Q

Important information

A

Basophilic stippling in which there is aggregation of ribosomal precipitates

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16
Q

Important information

A

Single blue dot in RBC = Howell jolly body

Multiple Blue Dots in RBC= Basophilic stippling

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17
Q

What is Pappenheimer Bodies?

A

Siderocytes containing Basophilic granules of iron in sideroblastic anemia

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18
Q

Name the condition which shows Howell jolly bodies

-Nuclear Remnants In RBC

A

All those conditions in which spleen get removed or becomes dysfunctional

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19
Q

Name the condition which causes non megaloblastic macrocytic anemia

A

Diamond blackfan anemia

Liver Diseases

Alcoholism

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20
Q

Name the condition which causes megaloblastic macrocytic anemia

A

Defective DNA synthesis

  • Folate and B12 Deficiency
  • Orotic aciduria

Defective DNA Repair
-Fanconi anemia

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21
Q

Name the condition which causes microcytic anemia

A

Defective Globin Chain
-Thalassemia (High Ret count)

Defective Heme Synthesis

  • Anemia of Chronic Disease
  • Iron Deficiency
  • Lead poisoning
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22
Q

Name the normocytic conditions which shows non Hemolytic (Ret count less than normal)

A

Aplastic anemia
CKD
Early Iron Deficiency

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23
Q

Most common cause of iron deficiency in adult male and post menopausal female

A

Chronic GI bleeding

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24
Q

What is the most earliest finding in iron deficiency anemia

A

RDW more than normal
-RDW≥20 suggest iron deficiency anemia
Normal in thalassemia is 12-14%

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25
Q

Beside increase in RDW in iron deficiency anemia what other parameters help in d/f it from thalassemia?

A

1) Decrease RBC and (2) increase HgB after iron supplements in iron deficiency anemia
2) Normal RBC count and (2) no change in Hb level even after iron supplements
3) Mentzer Index <13 in thalassemia and >13 in iron deficiency anemia

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26
Q

How to confirm Beta thalassemia minor?

A

Increase HbA2>3.5% on electrophoresis

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27
Q

What is the common cause of iron deficiency anaemia before age 1 yr?

A

Introduction of cow, goat Or Soy milk

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28
Q

Triad of Lead poisoning induced anaemia

A

Anaemia

Abdominal pain

neurological sign

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29
Q

Name the enzymes inhibit by lead in gene synthesis

A

1) ALA Dehydratase

2) Ferrochelatase

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30
Q

What is the reason behind basophilic stippling in lead poisoning?

A

Lead inhibits rRNA degradation result RBC retain aggregates of rRNA

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31
Q

What is the specific dx in Sideroblastic anaemia?

A

Ringer sideroblast in bone marrow sampling

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32
Q

How pernicious anaemia causes B12 deficiency?

A

1) By the presence of anti-IF Ab

2) Pt develop chronic atrophic gastritis—>Decreases production of IF by gastric parietal cells

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33
Q

Important information

A

Chronic atrophic gastritis increases the risk of intestinal type gastric Ca and gastric carcinoid tumors

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34
Q

Name the cause of megaloblastic anaemia in children

A

Orotic aciduria B/c of defect in UMP synthase

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35
Q

Triad of Diamond blackfan anaemia

A

Non megaloblastic macrocyctic anaemia

Short stature with upper extremity malformation (triphalangeal thumb)

Craniofacial deformities

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36
Q

Laboratory markers of Normocytic anaemia

A

Increase of following

1) LDH
2) Unconjugated Bilirubin (If haemolytic)

3) Urobilinogen in urine
4) Pigmented gallstones

5) Increase reticulocyte if haemolytic
6) Decrease Haptoglobin if intravascular haemolysis

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37
Q

Triad of Hereditary Spherocytosis

A

1) Hemolytic anemia
2) Inherited gallstones
3) Splenomegaly

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38
Q

Most important finding in cbc of Hereditary Spherocytosis

A

Increase MCHC

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39
Q

Name the gold standard test for Hereditary Spherocytosis

A

Acidified glycerol lysis test along with eosin 5 Maleimide binding test (Flow cytometry)

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40
Q

Triad of Paroxysmal nocturnal Hemoglobinuria

A
  • Haemolytic anaemia
  • pancytopenia*
  • Venous thrombosis*
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41
Q

Name the monoclonal antibody used in t/m of PNH

A

Eculizumab inhibits terminal complement protein C5

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42
Q

Important information

A

All patients with haemolytic anaemia have a tendency for venous thromboembolism but PNH patients are at particular risk esp Intra Abdominal and cerebral vein

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43
Q

Name the complications of sickle cell anaemia

Think of sickle cell

A

1) Hematuria due to sickling in renal medulla
2) Vaso occlusive crisis like stroke, Chest pain, pain swelling of hands, pain erection and avascular crisis

3) Aplastic crisis
4) Autosplenectomy
5) splenic infarct

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44
Q

How to prevent stroke in sickle cell anaemia?

A

Exchange transfusion

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45
Q

What is the main side effect of Hydroxyurea?

A

Myelosuppression

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46
Q

Main renal finding in pts with sickle cell trait

A
  • Painless microscopic Or Gross Hematuria

- Hyposthenuria due to impairment of counter current exchange and free water reabsorption by sickle cell

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47
Q

Name the causes of acute sever anaemia in sickle cell disease

A

Aplastic crisis in which ret count less than normal

Splenic sequestration crisis in which ret count more than normal

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48
Q

Name the MCC of bacteremia in sickle cell disease patients

A

S pneumonia usually from non vaccine aero types

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49
Q 
Hb Electrophoresis patterns is 
* HbA is 0%
*HbA is 85-95%
*HbF 5-15%
What’s the diagnosis?
A

Sickle cell disease

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50
Q 
Hb Electrophoresis patterns is 
* HbA is 50-60%
*HbA is 35-45%
*HbF <2%
What’s the diagnosis?
A

Sickle cell trait

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51
Q

Why is it necessary to check iron store before giving erythropoietin in CKD?

A

Erythropoietin supplements—>Increases New RBCs production—>Iron utilised—>Rapid Depletion of body iron stores

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52
Q

Important information

A

All patients with CKD and Ht<30% or Hb<10g/dl are candidates for recombinant erythropoietin therapy after iron deficiency has been rule out

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53
Q

Triad of aplastic anaemia

A

Pancytopenia

Decrease Ret count

Dry bone marrow tap

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54
Q

Triad of fanconi anaemia

A

Aplastic anaemia

Thumb/radial defect

Short height with macules

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55
Q

How much count to consider for neutropenia?

A

Absolute neutrophil count <1500

Severe infection typical when <500celle/mm3

56
Q

How much count to consider for lymphopenia?

A

Absolute lymphopenia count <1500

But <3000cells/mm3 in children

57
Q

How much count to consider for Eosinopenia?

A

<30cell/mm3

58
Q

What is the major cause of Eosinopenia?

A

Steroids
And Cushing syndrome

Steroids sequester eosinophils in lymph nodes and cause apoptosis of lymphocytes

59
Q

Name the enzymes inhibit by lead in heme synthesis

A

ALA dehydratase

Ferrochelatase

60
Q

Name the substrate accumulated in blood if lead inhibit the enzymes in heme synthesis

A

ALA if ALA dehydratase inhibit

Protoporphyrin if ferrochelatase inhibit

61
Q

Name the enzymes inhibit in acute intermittent porphyria and substrate accumulated

A

Prophobilinogen deaminase

Prophobilinogen and ALA

62
Q

Triad of Acute Intermittent porphyria

A

Port wine urine

Abdominal pain

Polyneuropathy

Condition can precipitate if cytochrome p450 inducers drugs/ starvation/ alcohol

63
Q

Name the porphyria associated with HCV

A

Porphyria cutanea tarda

- Uroporphyrinogen Decarboxylase deficiency or inhibit

64
Q

Name the clotting factors whose deficiency wouldn’t increase PTT

A

Factor 7 and 13

65
Q

After mixing stuides, PT get normal name the clotting factors which were deficient

A

Factors 7 (mainly) 1,2,5 and 10

66
Q

After mixing stuides, PT doesn’t get normal what could be the reason?

A

Factor 7 inhibitor present in patients plasma

67
Q

PTT normalised after mixing study what are factors deficient?

A

Factor 8,9,11 and 12

68
Q

If PTT initially shortener then prolonged after mixing study what could be the reason?

A

Factor 8 inhibitor

69
Q

If PTT not normalised even after mixing study what could be the reason?

A

Factor 9 inhibitor

Most commonly due to lupus anti coagulant

70
Q

What is the t/m of ITP in children if skin manifestation only?

A

Just observed

71
Q

What is the t/m of ITP in children if there is bleeding?

A

Give IVIg

Or Steroid

72
Q

T/m of ITP in adult if PLT count ≥30k without bleeding

A

Observed

73
Q

T/m of ITP in adult if PLT count ≤30k Or bleeding

A

IVIg

Or Steroid

74
Q

What will be seen in peripheral smear in Bernard Soulier syndrome?

A

Large platelets

Also abnormal ristocetin test

75
Q

What will be seen in peripheral smear in Glanzmann Thrombasthenia?

A

No platelets clumping

76
Q

Difference between FFP and PCC

A

FFP contains all the clotting factors and plasma proteins

Whereas PCC contains clotting factors which are reduced by vitamin K

77
Q

Causes of thrombophilias

A

Either mutations Viz Factor V Leiden Or Prothrombin mutation

Or Deficiency if Antithrombin or Protein C / S

78
Q

Indication for Rivaroxaban in DVT

A

Acute DVR Or PE

Recurrent Or Refractory DVT

PT doesn’t want daily injection Or Has d/f with dietary restriction and frequent INR monitoring

79
Q

Important information regarding DVT

A

Warfarin and IV Unfractionated Heparin prefer long term anticoagulant for patients with ESRD

(very HY HY)

LMWH and Rivaroxaban are contraindications in ESRD

80
Q

Name the subtypes of Hodgkin lymphoma

A

Nodular Sclerosis

Lymphocyte rich

Mixed cellularity

Lymphocytes deplete

81
Q

Important information regarding Mixed cellularity

A

Seen in immunocompromised with eosinophilia

82
Q

Triad of Hodgkin lymphoma

A
  • B symptoms with painless lymphadenopathy
  • Normal peripheral blood smear with normal CBC
  • Massive lymphocytes is not seen
83
Q

Name the neoplasm of Mature B cells non Hodgkin lymphoma

A

Burkitt lymphoma

-Diffuse large B cell lymphoma

Follicular lymphoma

-Mantle cell lymphoma

Marginal Zone Lymphoma

-Primary CNA lymphoma

84
Q

Name the neoplasm of Mature T cells non Hodgkin lymphoma

A

Adult T cell lymphoma

Mycosis Fungoides/Sezary Syndrome

85
Q

Triad of Adult T cell lymphoma

A

Lytic bone lesion

Increase Sr Ca2+

Cutaneous lesion

86
Q

MC type of non Hodgkin lymphoma in adult

A

Diffuse large B cell lymphoma

87
Q

Triad of Follicular Lymphoma

A

Translocation of 14;18

BCL2 inhibits apoptosis

Painless waxing and waning lymphadenopathy

88
Q

Name the mature neoplasm of B cell non Hodgkin lymphoma associated with chronic inflammation like sjogren syndrome or MALTOMA

A

Marginal Zone lymphoma

89
Q

Name the mature neoplasm of B cell non Hodgkin lymphoma associated with HIV/AIDs

A

Primary CNS lymphoma

90
Q

Triad of Hairy Cell leukaemia

A

Dry tap with massive splenomegaly

Pancytopenia

No lymphadenopathy

91
Q

Markers specific for Hairy Cell leukaemia

A

TRAP

And CD11c

92
Q

Name the types of polycythemia

A

Relative

Absolute appropriate

Absolute inappropriate

Polycythemia Vera

93
Q

Name the types of polycythemia where plasma volume decrease

A

Relative

94
Q

Name the types of polycythemia in which plasma volume increases

A

Polycythemia Vera

95
Q

Name the types of polycythemia in which RBC mass increases

A

Except relative

All types have increased RBC mass

96
Q

Triad Of MGUS

A

CRAB -ve

SPAP +ve whereas UPEP -ve

BM biopsy show less than 10% plasma cells

97
Q

Triad of Waldenstrom’s Macroglobulinemia

A

Peripheral Neuropathy with Hyperviscosity syndrome

SPEP+ve whereas UPEP-ve

BM biopsy shows lymphocytes

98
Q

Name the bony condition occur due to Sickle cell disease

A

If Afebrile without inflammation::
Avascular Necrosis

If febrile:
Osteomyelitis only focal pain
Vaso occulsive crisis more than 1 side involved

99
Q

How to dx and manage HIT?

A

Dx via HIT-Ab Or Serotonin release assay

Tx:
Don’t wait for result and stop all heparin product

Give direct thrombin inhibitor meds (BAD)
Or
fondaparinux

100
Q

Why allopurinol given in tumor lysis syndrome?

A

Allopurinol prevent acute urate nephropathy but not tumor lysis syndrome

101
Q

How to manage CANCER RELATED ANOREXIA/CACHEXIA SYNROME (CACS)?

A

1) nutritional counselling and supplementation with enteral or parenteral feeding
2) progesterone analogues (eg megestrol acetate or medroxyprogesterone acetate) or glucocorticoids
3) Synthetic cannabinoids are useful in HIV cachexia but not CACS

102
Q

How to manage CHEMOTHERAPY INDUCED NAUSEA AND VOMITING?

A

First hydrate and then control N/V

First line med—-> Serotonin receptor antagonists (eg ondansetron)

2nd or3rd line for refractory vomiting Is Dopamine receptor antagonists like metoclopramide and prochlorperazine

103
Q

D/f b/w CML and Leukemoid reaction

A

CML::
Low LAP with Presence of absolute basophilias

Less mature neutrophils dominate like promyelocytes, myelocytes more than metamyelocytes

Leukemoid Reaction::
High LAP with Absence of absolute basophilias

More mature neutrophils dominate like metamyelocyte more than myelocytes

104
Q

Triad of POLYCYTHEMIA VERA (PV)

A

Elevate Hb with low erythropoietin level

Viscous blood leads to HTN, headache , burning cyanosis in hand / feet

Aquagenic pruritus

105
Q

What are examination findings and complications of POLYCYTHEMIA VERA (PV)?

A

O/E there is facial plethora and splenomegaly

Complications are thrombosis, myelofibrosis and acute leukaemia

106
Q

How to manage POLYCYTHEMIA VERA (PV) ?

A

Phlebotomy
And
Hydroxyurea if there is risk of thrombosis

107
Q

Triad of ANDROGEN ABUSE in Male

A

Gynecomastia with low testicular volume

Aggressive mood almost

Increase Ht, Hb and LDL with low HDL

108
Q

What bacteria could attack HEMOCHROMATOSIS patient?

A

Listeria

Vibrio vulnificus

Yersinia

109
Q

What are the parameters of iron in ANEMIA OF CHRONIC DISEASES?

A

Body will store iron so there will be:
Low serum iron and TIBC
Ferritin will be increase or normal

MCV and transferrin saturation will be normal or low

110
Q

What are the parameters of iron in Thalassemia?

A

Lots of iron
So
Serum iron and ferritin, saturation
increases

TIBC decreases

111
Q

What are the lab values of leads induced poisoning?

A

CBC-> microcytic anemia With basophilic stippling on peripheral smear

Elevated venous lead level
Elevated serum zinc proptoporphyrin level

112
Q

What are d/f lab patterns in TTP?

A

Hemolytic anemia (decreases haptoglobin but increases LDH)

Low Platelets result increases bleeding time but normal PT/PTT

Schistocytes on blood smear

Deranged Urea/cr

113
Q

Important point of CO poisoning dx

A

pulse oximetry cannot differentiate oxyHb from carboxyHb.

Diagnosis is made on ABGs with cooximetry

114
Q

What are the clinical features of frost bite?

A

There will be superficial pallor and anaesthesia

Formation of blister and Eschar

Deep tissue necrosis and mummification

115
Q

How to manage frost bite?

A

1) Rapid rewarming in water bath temp should be 37-39*c with analgesics

116
Q

Name the condition which shows protein gap

Protein gap (difference between total protein and albumin >4g/dl): means increase non-albumin proteins in serum

A

polyclonal gammopathies(infection, connective tissue diseases)

excess monoclonal proteins (MM, Waldenstrom gammopathy)

117
Q

Name the chemotherapeutic agents for d/f leukaemia and lymphoma

A

Chlorambucil and prednisone—for CLL

CHOP regimen—for non-Hodgkin lymphoma

cladribine for hairy cell Leukaemia

118
Q

How to manage G6PD patient?

A

Remove or treat the responsible cause

Supportive care

119
Q

What are the causes of warm agglutinin AIHA?

V-DIAL

A

V viral

D drug like penicillin
I immunodeficiency
A autoimmune like SLE
L lymphoproliferative CLL

120
Q

Triad of warm agglutinin AIHA

A

Life threatening anemia but asymptomatic

Positive coomb test with Anti IgG, anti C3 or both

Rx is steroid or removal of steroid if refractory

121
Q

What are the complications of warm and cold agglutinin AIHA?

A

Warm
Venous thromboembolism
Lymphoproliferative disorder

Cold:
Ischemia and peripheral gangrene

Lymphoproliferative disorder

122
Q

What are the causes of cold agglutinin AIHA and How to manage it ?

A

Causes are infection like EBV, mycoplasma and lymphoproliferative diseases

Rx is avoidance of cold temperature
Rituximab and fludarabine

123
Q

Triad of Cold agglutinin AIHA

A

Anemia SxS

Livedo reticularis and acral cyanosis with cold exposure which disappear with warm

Positive coomb test with anti C3 or anti IgM but not IgG usually

124
Q

Triad of Acute intermittent porphyria

A

Abdominal pain with peripheral neuropathy

Autonomic disruption ± psychiatric sxs

Red color urine on air exposure

125
Q

What are lab findings of Acute intermittent porphyria?

A

Increase Serum and urine porphobilinogen ALA and porphyrin, urobilinogen

Deranged LFT ± Hyponatremia

126
Q

How to manage Acute intermittent porphyria?

A

Glucose and Hemin

127
Q

How to Approach proximal DVT treatment along with pulmonary embolism with unstable vitals OR Massive proximal DVT with severe swelling or limb threatening ischemia?

A

Give Thrombolytics if no CI

If contraindications or no response—>mechanical or surgical thrombectomy OR iliac stenting

128
Q

How to Approach proximal DVT treatment WITHOUT pulmonary embolism with unstable vitals OR Massive proximal DVT with severe swelling or limb threatening ischemia?

A

Give anticoagulant If no CI

If CI or no response—-> IVC filter

129
Q

How to manage Acute Splenic Sequestration?

A

Isotonic fluid infusion

Blood transfusion for low Hb
± Removal of spleen

130
Q

How to manage painful Erection due to Sickle cell disease?

A

Aspiration of blood from Corpora Cavernosa

Intracavernous injection of Phenylephrine

131
Q

How to manage Stroke due to Sickle cell disease?

A

Tx —> Exchange transfusion Or simple transfusion if former not available

132
Q

Important point of AML

A

1) Seen in adult
2) sxs of pancytopenia and RARELY seen HSM/LAD

4) DIC if subtype APML which shows Atypical promyelocytes on bone marrow bx

133
Q

Name the vaccine given in Spenlectomy patient

A

1) Strep pnemonia
2) H influ

3) N meningitis
4) HAV HBV and TDap

134
Q

How transfusion Transmitted bacteria occur and how does it present?

A

Due to platelets transfusion

Fever with low BP and tachycardia around 30 minutes after transfusion

135
Q

When to consider HIT type 2?

Remember 4 indicators

A

If PLTs count reduce to ≥50% from baseline

Or
Arterial or Venous thrombosis

Or
Necrotic skin lesion at heparin injection sites

Or
Systematic Anaphylactic rxn after heparin

Internal Medicine (14 decks)

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