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ABIM > Heme 2 > Flashcards

Heme 2 Flashcards

1
Q

Pt NOT taking any medications. Does not have any Medical Problems. B12 is normal. Patient does not Drink. He has evidence of Anemia, leukopenia, thrombocytopenia, elevated MCV. Blood Smear shows Ovalmacrocystosis and HYPOsegmentated Neutrophils. Bone marrow biopsy/Aspirate Hypercellular Marrow with dysplasia. Normal B12 and folate levels.

Dx?
Test?
Rx?

A

MDS

Elevated MCV but normal B12 and Folate, No drugs, No ETOH.

Bone marrow biopsy (hypercellular marrow with dysplastic erythroid precursors) to confirm.

Supportive infusions.
STEM Cell Transplant < 50 years age.

Lenalidomide for older.

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2
Q

Abdominal cramping, bloody diarrhea, haptoglobin undetectable, hgb 6.1, plt 34, retic count 9.8%, Cr 3.6, 3+ blood on UA, Coombs test negative.

Dx?
Rx?

A

Hemolytic Uremic Syndrome.
(Shiga toxin producing Ecoli)

Supportive

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3
Q

Common cause of Heparin Resistance? ( failure of the aPTT to increase)

A

Antithrombin deficiency

(Heparin- Antithrombin complex Inactivates thrombin)
so they keep clotting

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4
Q

Pt presenting with prolonged bleeding from venipuncture sites, new ecchymoses, poor oral intake on abx and has C. diff diarrhea. Dx?

A

Vit K deficiency

Give oral or IV Vit K

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5
Q
  1. Low ferritin, low iron, high TIBC, low % saturation ?
  2. High ferritin, low iron, low TIBC , low sat?
A
  1. Iron deficiency anemia
  2. Anemia of inflammation
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6
Q

Mild intramedullary hemolysis, elevated lDH, decrease haptoglobin, degreased reticulocyte count, increased indirect billi

  1. Increased MMA and Homocysteine levels?
  2. Normal MMA levels and Increased homocysteine levels.
A

B12 deficiency

Folate deficiency

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7
Q

Similar to SS pt present with elevated reticulocyte count and tender abdomen?

A

Splenic Sequestration complication of hemoglobin SC disease.

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8
Q

Main hemoglobin Elevated B thalassemia?

A

A2

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9
Q

What diseases are important to rule out for ITP?

Management platelets > 30,000 ?
Management of platelets < 30,000 ?

A

Drugs,HIV, HCV, SLE, CLL, Lymphoma.

> 30,000 Observe

< 30,000 Steroids or IVIG or splenectomy

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10
Q

Microangiopathic hemolytic anemia, Thrombocytopenia, FEVERS, Renal dysfunction.

Dx?
Test?
Rx?

A

TTP (FAT-RN)

Inherited gene defect in ADAMTS 13 or anti-ADAMTS13 from infection/drugs/preg/cancer

Plasmapharesis/Plasma exchange

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11
Q

Difference from TTP and HUS?

A

HUS has more Renal involvement

Both can be caused by Shiga toxin

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12
Q

Difference btw TTP and DIC?

A

PT and PTT are prolonged in DIC because the ALL clotting factors are affected

TTP will just have Prolonged Bleeding Time

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13
Q

Life threatening bleeds, associated with solid tumors, CLL, post part, hemophiliacs. Mixing study does not correct PTT.

A

Factor 8 inhibitor

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14
Q

Elevated PTT, Normal PT but No clinical bleeding disorder?

A

Factor 12 deficiency

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15
Q

Bleeding, prolonged PTT, Corrects with mixing study, X-linked disorder?

A

Factor 8 deficiency

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16
Q

Bleeding, decreased absorption in diet, associated Decreased levels 27910CS ?

A

Vit K deficiency

17
Q

Name the times you will use each:
1. Massive PE, unstable, renal failure, MI

  1. HIT?
  2. Malignancy and Pregnancy
  3. Renal disease?
A
  1. IV UFH (Heparin)
  2. Agatroban, Bivalirudin
  3. LMWH
  4. LMWH, fondaparinux
18
Q

Pancytopenia due to Idiopathic, Drugs (phenytoin, sulfa) or Viral infection (Parovirus B19).
Pt presents with bleeding, infection, anemia.

Dx?
Test?
Rx?

A

Aplastic Anemia

Bone Marrow Tap is hypocellular

STEM Cell Transplant in Younger
Immunosuppression in Older patients

19
Q

Pt presenting with DIC, Auerods present.

Dx?
Rx?
Why to treat immediately?

A

APL with 15/17 translocation a subset of AML.

Rx with ATRA

Rx immediately, high mortality from hemorrhage

20
Q

Pt present with CNS symptoms, Cranial nerve Defects, associated with 9/22 BCR-ABL translocation.

Dx?

A

ALL

21
Q

Increased WBC in comparison to RBCs. Associated with thrombocytosis, early satiety, hepatosplenomegaly, 9/22 translocation, BCR/ABL .

Dx?
Rx?

A

CML

Imatinib, Tyrosine Kinase Inhibitor turn off tyrosine kinase to induce apoptosis

22
Q

Associated with very rapid growth, Tumor Lysis Syndrome, EBV in Africa?

A

Burkitt lymphoma (High Grade Lymphomas)

23
Q

Hairy cells seen on bone marrow biopsy. Associated with dry tap. Dx? Rx?

A

Hairy Cell leukemia

Cladribine

24
Q

Platelet Transfusion Threshold:

  1. No other risk factors for bleeding.
  2. Intracranial bleeding ?
  3. Bleeding for planned surgery?
A
  1. Transfuse < 10,000- 20,000 (Lowest Threshold)
  2. < 100,000 (Higher threshold)
  3. < 50,000

ABIM (45 decks)

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