Hematology/Oncology Flashcards
1
Q
folate deficiency path
A
leafy greans 3-6 wk stores pregnancy
2
Q
folate deficiency pt
A
tea + toast diet EtOH pregnancy
3
Q
folate deficiency dx
A
folic acid levels decreased normal methylmalonic acid increase homocysteine (not done)
4
Q
folate deficiency tx
A
folate, 1mg po
5
Q
B12 deficiency path
A
3-10 yrs storage animal products neuro symptoms
6
Q
B12 deficiency pt
A
strict vegan pernicious anemia Crohn’s disease gastric bypass
7
Q
B12 deficiency dx
A
B12 levels decreased increase homocysteine (don’t check) increase methylmalonic acid
8
Q
B12 deficiency tx
A
B12 - PO = nutritional - IM = impaired absorption
9
Q
B12 deficiency f/u
A
never choose Schilling test prolonged deficiency is loss of DCMLS (proprioception, Vibration)
10
Q
pernicious anemia path
A
antibodies against parietal cells no intrinsic factor, no B12 absorption
11
Q
pernicious anemia pt
A
weakness, sore tongue, paresthesias
12
Q
pernicious anemia dx
A
Ab-intrinsic factor Ab-Anti-parietal
13
Q
pernicious anemia tx
A
IM B12 cannot treat pernicious anemia
14
Q
pernicious anemia f/u
A
gastric cancer
15
Q
non-megaloblastic anemias
A
liver disease EtOH medications (AZT, HAART, 5-FU, ARA-C) Metabolic syndrome - Lesch-Nyhan - Hereditary orotic aciduria
16
Q
iron deficiency anemia path
A
slow bleed consumption of iron stores
17
Q
iron deficiency anemia pt
A
woman = menorrhagia man = colon cancer
18
Q
iron deficiency anemia dx
A
iron studies - iron decrease - ferritin decrease - TIBC increase best: Bone marrow bx (rarely needed)
19
Q
iron deficiency anemia tx
A
iron 2-6wks for anemia iron 2-6mo for iron stores
20
Q
anemia of chronic disease path
A
chronic inflammatory disease
21
Q
anemia of chronic disease pt
A
anemia
22
Q
anemia of chronic disease dx
A
iron studies - iron decrease - ferritin increase - TIBC decrease best: bone marrow bx (rarely needed)
23
Q
anemia of chronic disease tx
A
give EPO treat inflammatory disease
24
Q
thalassemia path
A
genetic mutations, loss of genes, 4alpha, 2beta
25
thalassemia pt
asx (1 α deleted) minor (2alpha deleted, 1beta deleted) major (3alpha deleted, 2beta deleted) dead (4alpha)
26
thalassemia dx
iron normal ferritin normal TIBC normal Hgb electrophoresis
27
thalassemia tx
minor = do nothing major = transfusion = deferoxamine
28
sideroblastic path
irreversible, B6, cancer Reversible, Lead, EtOH, copper, isoniazid
29
sideroblastic pt
anemia
30
sideroblastic dx
iron increase (done) ferritin normal TIBC normal Best: bone marrow bx (ringed sideroblasts)
31
sideroblastic tx
remove exposure, give back B6, try to treat cancer
32
sickle cell path
autosomal recessive, HgbSS valine for glutamic acid sickle under stress - acidosis - dehydration
33
sickle cell pt
emergency acute - acute chest = MI, CHF - acute brain = CVA - priapism hospitalize acute - vaso-occlusive crisis chronic - asplenia - avascular necrosis - osteomyelitis
34
sickle cell dx
1st: smear = sickled cells - use 1st time and crisis best: Hgb electrophoresis (SC, SS) - use 1st time only
35
sickle cell tx
hydroxyurea = increase HgbF, decrease HgbSS IVF, O2, pain control (hospital) exchange transfusion (emergency)
36
sickle cell f/u
iron overload (deferoxamine)
37
G6PD deficiency path
decrease G6PD hypoxemic = hemolysis
38
G6PD deficiency pt
African American males Dapsone, TMP-SMX, nitrofurantoin
39
G6PD deficiency dx
1st: smear = bite cells, Heinz bodies best: G6PD levels 6-8wks
40
G6PD deficiency tx
supportive avoid stress
41
hereditary spherocytosis path
deficiency in Spectrin, Ankrin, Pallidin
42
hereditary spherocytosis pt
hemolysis, spherocytes
43
hereditary spherocytosis dx
1st smear = spherocytes best = osmotic fragility
44
hereditary spherocytosis tx
folate + Fe splenectomy
45
paroxysmal nocturnal hemoglobinuria path
PIG-A deficiency
46
paroxysmal nocturnal hemoglobinuria pt
paroxysmal (once in a while) nocturnal (happens at night) hemoglobinuria (dark urine) + abdominal vein thrombosis
47
paroxysmal nocturnal hemoglobinuria dx
flow cytometry decrease CD55, decrease CD59
48
paroxysmal nocturnal hemoglobinuria tx
biologics (eculizumab)
49
warm autoimmune hemolytic anemia path
IgG (cancer, drugs, rheum)
50
warm autoimmune hemolytic anemia pt
hemolysis everywhere
51
warm autoimmune hemolytic anemia dx
Coomb's test IgG
52
warm autoimmune hemolytic anemia tx
1st line: steroids recurrent: splenectomy severe: IVIG refractory to splenectomy: rituximab
53
cold autoimmune hemolytic anemia path
IgM (mycoplasma, mono)
54
cold autoimmune hemolytic anemia pt
hemolysis in the cold - tips of digits - tips of nose
55
cold autoimmune hemolytic anemia dx
1st: Coomb's test negative for IgG
56
cold autoimmune hemolytic anemia tx
avoid the cold refractory: rituximab
57
microangiopathic hemolytic anemia path
schistocytes = MAHA
58
microangiopathic hemolytic anemia pt
TTP vs DIC
59
microangiopathic hemolytic anemia dx
decrease Hgb (both) decrease plt (both) decrease fibrinogen (DIC) increase INR (DIC) increase split products (DIC)
60
acute myelogenous leukemia path
acute = blasts myelogenous = neutrophils leukemia = cancer in the blood
61
acute myelogenous leukemia pt
acute, age 67 exposure: benzene radiation CML: blast crisis
62
acute myelogenous leukemia dx
1st: smear = blasts BM bx \> 20% blasts + myeloperoxidase
63
acute myelogenous leukemia tx
M3: Vit A (auer rods on bx) no M3 = chemo
64
acute lymphocytic leukemia path
acute = blasts lymphocytic = leukocytes leukemia = cancer in the blood
65
acute lymphocytic leukemia pt
acute, age 7
66
acute lymphocytic leukemia dx
1st: smear = blasts BM b \>20% blasts + cALLa and + TdT
67
acute lymphocytic leukemia tx
chemo ppx CNS ARA-C+/- radiation
68
chronic myelogenous leukemia path
chronic = mature cells myelogneous = neutrophils leukemia = cancer in the blood
69
chronic myelogenous leukemia pt
chronic, age 47
70
chronic myelogenous leukemia dx
diff (way more cells than should be) BM bx = philadelphia + t(9, 22) + BCR-ABL
71
chronic lymphocytic leukemia path
chronic = mature cells lymphocytic = lymphocytes leukemia = cancer in the blood
72
chronic lymphocytic leukemia pt
chronic, age 87
73
chronic lymphocytic leukemia dx
diff (way more cells than should be) BM bx
74
chronic lymphocytic leukemia tx
\> 65 + asx = nothing \> 65 + sx = chemo \< 65 + donor = HSCT
75
Hodgkin's lymphoma path
contiguous spread usually B sxs Pel-Ebstein fevers painful lymphadenopathy on EtOH
76
Hodgkin's lymphoma pt
nontender lymphadenopathy +/- B sxs
77
Hodgkin's lymphoma dx
excisional biopsy + reed Sternberg cells stage = PET/CT or CT chest/abd/pelvis
78
Non-hodgkin's lymphoma path
hematogenous spread usually NO B sxs Burkett's starry sky extra nodal disease
79
non-hodgkin's lymphoma pt
nontender lymphadenopathy + sxs
80
non-hodgkin's lymphoma dx
excisional biopsy NO Reed-Sternberg cells stage = PET/CT or CT chest/abd/pelvis
81
non-hodgkin's lymphoma tx
IIA or better = radiation IIB or worse = chemo - CHOP-R - CNS ppx
82
cancer staging: I
1 lymph node
83
cancer staging: II
\>/= 2 lymph nodes same side diaphragm
84
cancer staging: III
\>/= 2 lymph nodes opposite side diaphragm
85
cancer staging: IV
mets
86
chemoman
**_C_**isplatin = ototoxicity
**_b_**leomycin = pulmonary fibrosis
**_A_**driamycin/**_D_**oxarubicin = cardiac toxicity
**_V_**incristine/**_V_**inblastine = peripheral neuropathy
**_C_**isplatin = nephrotoxicity
**_Cycl_**ophosphamide = hemorrhagic cystitis
87
multiple myeloma path
IgG
monoclonal expansional plasma cells
- Ig = recurrent infxn
- Bence-Jones = AKI
- osteoclasts = lytic lesions
88
multiple myeloma pt
\>70s (old men)
CRAB
- hyper**C**alcemia
- **R**enal failure
- **A**nemia
- **B**one pain, lytic lesions
89
multiple myeloma dx
Spep +
Upep +
skeletal survey +
BM bx \> 10% plasma
90
multiple myeloma tx
\>70, no donor: chemo
\<70, + donor: HSCT
91
multiple myeloma f/u
melphalan + steroids
- thalidomide
- bortezomib
92
MGUS path
IgG
early myeloma
93
MGUS pt
\>85
no CRAB
94
MGUS dx
Spep +
Upep -
skeletal survey -
BM bx \<10% plasma
95
MGUS tx
watch and wait
converts to multiple myelmoa 2%/yr
96
Waldenstrom's path
IgM
97
Waldenstrom's pt
hyperviscosity syndrome
constitutional symptoms
98
Waldenstrom's dx
Spep +
Upep -
skeletal survey -
BM Bx \> 10% lymphoma
99
Waldenstrom's tx
rituximab - chemo
hyperviscosity = plasmapheresis
100
Waldenstrom's f/u
blast crisis
101
trombophilic disorders
Factor V leiden = mutation
prothrombin 20210A = mutation
Protein C def = level
Protein S def = level
antithrombin def = level
102
who gets warfarin in a DVT: all patients
provoked 3mo
unprovoked 6mo
recurrence lifetime
103
who gets warfarin in DVT: other options
LMWH in cancer
NOACs = warfarin
104
DVT ppx: risk
trauma, surgery (10x)
LMWH ppx
LMWH -\> warfarin
105
DVT ppx: cancer
LMWH ppx
LMWH tx (no warfarin in met cancer)
106
APLA path
lupus 'anticoagulant'
hypercoaguability in artery and veins
107
APLA pt
lupus +
arterial clots AND venous clots
108
APLA dx
russel viper venom assay
109
APLA tx
warfarin goal 2-3
failure meanse increase INR goal
110
TTP path
hyaline clots
ADAMTS-13 deficiency
111
TTP pt
Fever
Anemia
Thrombocytopenia
Renal failure
Neuro symptoms
112
TTP dx
CBC - decrease plt
Smear - schistocytes
PT/PTT - normal
fibrinogen - normal
D-dimer - normal
113
TTP tx
exchange transfusion
114
TTP f/u
NEVER platelets
115
DIC path
fibrin clots
tremendous catastrophic injury
116
DIC pt
sick as shit
sepsis, ICU, shock, then they start bleeding
117
DIC dx
CBC - decrease platelets
smear - schistocytes
PT/PTT - increase
fibrinogen - decrease
D-dimer - increase
118
DIC tx
fix underlying disease
give blood products
- decrease fibrinogin = cryo
- increase INR = FFB
- decrease platelets = platelets
- decrease Hgb = blood
119
HIT path
antibodies to platelets
120
HIT pt
heparin products administered
7-14d
platelets very decreased ~50%
new clots
121
HIT dx
antiplatelet factor 4 ELISA +
confirm with serotonin release assay
122
HIT tx
stop heparin
argatroban -\> warfarin INR 2-3
123
ITP path
antibodies to platelets
splenic destruction
124
ITP pt
woman and autoimmune disease
decrease platelets
125
ITP dx
dx of exclusion
126
ITP tx
steroids
IVIG
splenectomy
rituximab
127
Von Willebrand path
deficiency of vWD
autosomal dominant
most common bleeding disorder
128
Von Willebrand pt
platelet bleed, normal count
| (can have factor VIII def)
129
Von Willebrand dx
1st: CBC = normal count
Best: vWF assay
may have increase PTT from factor VIII deficiency
130
Von Willebrand tx
DDAVP
131
other platelet bleed normal count
Bernard-Soulier - glycoprotein Ib
Glanzmann's - glyco IIb-IIIa
Drugs - ASA, clopidogrel, abciximab
uremia - CKD
132
hemophilia path
x-linked disorder of..
factor VIII (hemophilia A)
factor IX (hemophilia B)
133
hemophilia pt
hemarthrosis
bruises easy
134
hemophilia dx
Increase PTT, can have increase PT or Increase iNR
mixing studies (corrects)
factor levels
135
hemophilia tx
factors whent hey bleed (short term)
136
hemophilia f/u
may develop inhibitors that will not correct with mixing studies
137
antiphoshoplipid antibody syndrome path
lupus
138
antiphospholipid antibody pt
bleeding AND clotting
hemarthrosis (bleeding)
arterial thrombosis (clotting)
139
antiphospholipid antibody dx
PT/PTT/INR
mixing studies (does not correct)
viper venom assay
140
antiphospholipid antibody tx
treat lupus
heparin to warfarin bridge for APLA
141
acquired factor deficiency path
liver dysfunction, warfarin, Vit K deficiency
142
acquried factor deficiency pt
long ICU stay
on warfarin
has cirrhosis
143
acquired factor deficiency dx
PT/PTT/INR
144
acquired factor deficiency tx
vitamin K
