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heme Flashcards

1
Q

mechanism of polycythemia vera

EPO: high/low

A

jak2 mutation causing proliferation of bone marrow stem cells

EPO low( jak2 mutation don’t care about EPO

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2
Q

high Hb, pain in fingertips, pruritus with exposure to hot water: Dx & treatment

A

Phlebotomy
Polycythemia vera

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3
Q

old, fatigue, Hb low: cause

A

GI bleed

diverticular bleed
colorectal cancer
angiodysplasia

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4
Q

smoker, COPD+high Hb mechanism?

EPO level?

A

2nd polycythemia

high EPO d/t low O2

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5
Q

smoker, Polycythemia , hypercalcemia, high creatinine

A

Renal cell carcinoma
d/t paraneoplastic PTHrP secretion

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6
Q

Bleed Time increase (2-7min)
Bleeding on surfaces

A

vWF
platelet adhesion

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7
Q

school age kids with viral infection
+epistaxis, bruising/petechiae, low platelet.

A

ITP

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8
Q

Low platelet, high bleeding Time, random bruising 30-40F

A

ITP

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9
Q

30F random bruise+BT 6,

A

domestic abuse

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10
Q

40F bruise +BT 9

A

ITP(idiopathic/immune thrombocytopenia purpura

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11
Q

35F +viral infection+epistaxis ITP DX confirm with:

A

low platelet

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12
Q

13M + epistaxis +BT 9

A

ITP

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13
Q

Teen cough, coryza, epistaxis

A

antibodies against
glycoproteins IIB/IIIA
HS type II

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14
Q

Teen nose bleed, very low platelet manage with
Initial treatment?
No response?

A

steroid
Non responsive: IVIG

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15
Q

Teen nose bleed, very low platelet , effective way to decrease recurrence

A

splenectomy
NOT steroid (only initial treatment)

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16
Q

Teen +viral infection+ low neutrophil

next best step

A

viral induced neutropenia

immediate IV broad-spectrum antibiotic

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17
Q

Teen +viral infect. Neutropenia, fever +antibiotics. Restore Neutrophill with?

A

GM-CSF (IL3)

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18
Q

child +pancytopenia+low platelet+viral DX

A

B19
aplastic anemia

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19
Q

32F+ arthritis+ Hb 9+WBC 3k+ Platelet 90k mechanism

note no viral infection

A

increased peripheral destruction
autoantibodies
antiphospholid

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20
Q

overactive thyroid treatment low WBC(neutrophil 5%

A

Drug-induced neutropenia
methimazole & propylthiouracil

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21
Q

drug causing agranulocytosis

A

ganciclovire (CMV)
Clozapine (anti-psychotic0)
methortrexat(DMARD)
ticlopidine(anti-platelet )

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22
Q

child with absent or hypo plastic thumb low Hb, WBC, platelet

A

falconi anemia
AR aplastic anemia

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23
Q

pure RBC aplasia

A

triphalangeal thumb (Diamond-blackfan anemia

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24
Q

Thymoma associated with anemia

A

pure RBC aplasia

(myasthenia gravis)

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25
Q

daycare worker with lacy rash, no aplastic anemia, check

A

Parvo IgM titers

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26
Q

44F chemotherapy low RBC, WBC, platelets next step

A

bone marrow aspiration

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27
Q

chemo with all cell line low (neutropenia)

A

IG broad spectrum antibiotic

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28
Q

PT high

PTT high

BOTH high

A

extrinsic (III, 7,5,10

intrinsic( 12,9,8, 10

common (10,5, prothrombin(II), thrombin(IIa)–>fibrinogen(1)–>fibrin(1a)

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29
Q

Bleeding time high with aspirin why?

A

lower platelet function
inhibit CoX1/2
decrease thromboxane A2 production

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30
Q

Increase fibrin degradation product seen with

A

DIC and PE

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31
Q

treatment for BT9, petechiae, PTT 42 , Normal platelet

A

DDAVP (desmopressin) increases vWF

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32
Q

Hemarthrosis in school age boy

A

Hemophilia A/B

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33
Q

the child with hemarthrosis, PTT 90

A

Hemophilia A/B

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34
Q

inheritance pattern for vWF

A

AD

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35
Q

hemophilia inheritance

A

X-LR

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36
Q

cause of Hemophilia A/B

A

deficient production of factor 8/9
Hemophilia A mc

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37
Q

Hemophilia A treatment

A

IV desmopressin/factor 8 replacement

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38
Q

Hemophilia B

A

factor 9 replacement

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39
Q

repeated factor replacement(like repeated antibody venom treatment)

A

PTT very high
factor 8/9 less effective

40
Q

Low HbA, high HBA2 and HbF in 8 month old boy

A

Insufficient production of Beta globin
symptomatic after 6 month

41
Q

How is Nephrotic syndrome associated with acquired clotting state

A

loss of natural anticoagulants
antithrombin III

42
Q

antithrombin III function

A

natural anticoagulant
inhibit factors IIa (thrombin) and 10a

43
Q

Restocitin neg dz , normal platelet

A

vWF and Bernard-Soulier ds

44
Q

BT high with pos Restocitin, Normal platelet

A

Glanzmann thrombasthenia

45
Q

AoCD mechanism
inflammatory state –>high IL6 liver–>___hepcidin–>dec ferroportin activity–>___iron released by gut enterocytes and macrophages—> iron transport___—->ferritin level____—–>Transferrin and TIBC____

A

elevated hepcidin
decrease all others

46
Q

12F+chronic renal failure +epistaxis, Hb low? explain epistaxis

A

renal failure cause uremic platelet dysfunction
high BUN

Note: epistaxis is seen with platelet dysfunction

47
Q

82M+ M spike IgG+epistaxis. explain epistaxis?

A

uremic platelet dysfunction 2nd to MM(renal amyloidosis)

48
Q

effect of imatinib and dihydropyridine Calcium channel blocker(nifedipine, amlodipine)

A

fluid retention
Imatinib treats CML(9:22 bcr/abl)

49
Q

10M + lytic bone lesion with pos CD1a,S100

A

Langerhan Cell histiocytosis
Birbeck granules

50
Q

MOA of rituximab

Indication

A

CD20 inhibitor on B cells

RA, ITP, MS, AIHA, B cell Non-hodgkin(CLL)

51
Q

Rituximab reactivate

52
Q

Toxicity of ___________ mitigated with saline (NaCl-) infusion and amifostine

53
Q

important side effect with cisplatin

A

Oto and Neurotoxicity

54
Q

decrease IL-2 responsiveness+ no effect on calcineurin

55
Q

decrease calcineurin

A

cyclosporine +tacrolimus

56
Q

MOA of cyclosporine and tacrolimus

A

dec calcineurin+dec IL-2 transcription +nephrotosic

57
Q

Sirolimus(mTOR) is save in

A

kidney failure, not nephrotoxic

58
Q

gingival hyperplasia +nephrotoxicity +BP

A

cyclosporine

59
Q

antagonist at cyclophilin receptor

A

cyclosporine

60
Q

antagonist at FK506 receptor to decrease calcineurin

important side effect

A

Tacrolimus

Type II diabetes

61
Q

Mesna is use to

A

reduce cyclophosphamide toxicity using thiol-SH group

62
Q

hemorrhagic cystic due to acrolein

A

cyclophosphamide

63
Q

guanine N7 alkylating agent

A

MOA of cyclophosphamide

64
Q

inhibitor
topo I

Topo II

A

irinotecan/topotecan

etoposide/teniposide

65
Q

HER-2/New(ERBB2) treatment

A

trastuzumab

66
Q

trasTUzumab toxicity

67
Q

partial agonist in endometrium increasing endometrial cancer

68
Q

SERMs

A

Tamoxifene and raloxifene

Both antagonists at ER receptors in the breast
agonist on bone

69
Q

fluid retention in CML treatment

70
Q

bar/abl tyrosine kinase inhibitor for CML

71
Q

Ab against EGFR

72
Q

MOA of erlotinib

A

EGFR tyrosine kinase inhibitor

73
Q

Notable indicator of erlotinib

A

non-small cell lung cancer

74
Q

dexrazoxane chelation of free radicals

A

toxicity of doxorubicin/daunorubicin

75
Q

dilated cardiomyopathy with a DNA intercalator

A

doxorubicin/daunorubicin

76
Q

DNA intercalates + cause free radical

A

doxorubicin(Adriamycin)/daunorubicin

77
Q

pulmonary fibrosis Drug?
Free radical formation

A

Bleomycine

78
Q

vincristine toxicity

79
Q

hyper stabilize microtubules

A

paclitaxel/docetaxel

80
Q

inhibit microtubules formation

A

cochicine, -bendazoles (mebendazole, albendazole)
vincristine
vinblastine,
griseofulvin

81
Q

Inhibits IMP dehydrogenase (purine synthesis)

A

mycophenolate mofetil

82
Q

pyrimidine synthesis inhibitor (ribonucleotide reductase inhibitor

A

hydroxyurea
produces more fetal Hb
sickle cell pt

83
Q

converted to 6-MP

A

inhibits purine synthesis
azothioprine

84
Q

MOA of 6-mercaptopurine

A

PRPP amidotransferase inhibitor(purine synthesis inhibitor)

85
Q

MOA of 5- fluorouracil

A

thymidylate synthase inhibitor

86
Q

leucovorin rescue use in

A

methotrexate toxicity

87
Q

reversible, competitive inhibitor of dihydrofolate reductase; 1st line DMARD for RA

A

Methotrexate

88
Q

Methotrexate side effect

A

pulmonary fibrosis, hepatotoxicity, neutropenia

89
Q

antifibrinolytic drugs (tPA: stroke)

A

tranexamic acid, aminocaproic acid

90
Q

tPA fibrinolytic should be given

A

in ischemic stroke within 3-4.5 hr

91
Q

MOA of apixaban

A

factor Xa inhibitor(band)

92
Q

MoA of fondaparinux

A

inhibits factor Xa (activate antithrombin)

93
Q

treatment for heparin induce thrombocytopenia

A

Bivalirudin,
lepirudin
dabigatran
argatroban

94
Q

Both anti-platelet agents and vasodilators

A

dipyridamole +cilostazol, both cAMP and cGMP phosphodiesterase inhibitors

95
Q

Gp2b/3a inhibitor

A

abciximab
eptifibatide
tirofiban

96
Q

MOA of
clopidogrel
prasugrel
ticagrelor
ticlopidine

A

ADP2Y 12 receptor blockers
inhibit aggregation by dec expression of Gp2b/3a

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