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USMLE Step 2 > Heme > Flashcards

Heme Flashcards

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USMLE® Step 1 flashcards
1
Q

effect of PTT in lupus anticoag

A

prolonged

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2
Q

first dx step towards SVC syndrome?

A

CXR

-most commonly caused by malignancy

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3
Q

trousseaus sign

A

migratory thrombophblebitis most highly assoc with pancreatic cancer but can be others as well

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4
Q

CML vs leukomoid reaction

A

CML has a low LAP and more myelocytes

  • CML has absolutely basophilia
  • CML has extreme leukocytosis*****
  • philadelphia csome

polycycthemia vera and leukomoid reaction both show elevated LAP score

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5
Q

features of CLL

A
  • 70
  • fatigue, splenomegaly
  • mature lymphocytsis and smudge cells on smear
  • if found incidentally and asx, don’t treat –> very slow growing
  • thrombocytopenia –> late finding, poor px because shows impaired BM fx
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6
Q

tumor lysis syndrome labs, tx

A
  • INC K, Phos
  • dec Ca
  • AKI

first line is IV fluids, then allopurinol

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7
Q

physical exam signs of hemolysis

A

splenomegally
jaundice
scleral icterus

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8
Q

AML

A

age ~60

  • can have variable white count
  • inc myeloblasts with pancytopenia
  • myeloperoxidase +
  • auer rods
  • 15;17
  • all trans retinoic acid
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9
Q

Young guy with no clot risk develops DVT. You give high dose heparin for DVT in patient with prolonged aPTT but nothing changes, including aPTT. What’s happening?

A

ATIII deficiency

  • AD
  • heparin requires ATIII to work –> then deactivates II, X
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10
Q

first diagnostic steps in malaria?

A

thick smear –> followed by thin smear

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11
Q

exercise hemoglobinuria is what type of hemolysis?

A

intravascular

***of note, haptoglobin is usu normal in extravascular hemolysis

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12
Q

Kehr’s sign

A

referred left shoulder pain from splenic rupture

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13
Q

philadelphia csome

A

9;22
tx with imatinib (tyrosine kinase inhibitor)

> 90% in CML but can be in ALL with kiddos so watch out

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14
Q

acute trauma coagulopathy

A

admin pRBC, FFP and plt in 1:1:1

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15
Q

dactylitis

A

swelling of hand or feet assoc with vasoocclussive crisis

also seen in RA, sarcoid

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16
Q

p falciparum proph

A

atovoquone-proguanil

Falcip is resistant to chloraquine in endemic areas

***ring inclusions in RBC

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17
Q

Coombs results

A

positive= HS!

Negative= AIHA

**they both have spherocytes on smear

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18
Q

bilateral patchy infiltrates on CXR, dry cough, hemolysis labs? dx? test?

A

cold, IgM, AIHA

positive direct coombs

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19
Q

isolated fever within hour or two of recieving blood products

A

normal labs = non hemolytic transfusion rxn, can give acetaminophen

next step–> check coombs

20
Q

parvovirus B19

A

pancytopenia

hypocellular, fatty marrow on biopsy

21
Q

thrombocytopenia in cirhossis most likely caused by?

A

hypersplenism

spleen gets large due to inc portal pressures –> sequestrs platelets

22
Q

tx for refractory ITP that does not respond to IVIG/ steroids

A

splenectomy

23
Q

PTT is what pathway

A

intrinsic

*affected by heparin

24
Q

what is THE BEST TEST EVER for hereditary spherocytosis

  • also, what should you give them as proph?
  • what pathology are that at risk for at a younger age then usual?
A

ema (eosin-5-m…) binding test, it uses flow

characteristics of HS: inc RDW, inc MCHC, hemolysis signs

  • proph with folic acid to prevent megaloblastic anemia
  • gallstones
25
Q

safe malaria proph in pregnancy

A

mefloquin

atovaquone- proguanil

26
Q

paroxysmal nocturnal hemoglobinuria

A

genect defect in anchoring protein

at risk form thrombosis in atyplica locations

test= CD55/CD59

27
Q

polycythemia vera

A

hyperviscosity sx

  • can cause essetnail thrombocytosis
  • can cause 2nd gout

tx= phlebotomy

28
Q

characteristics of hodgkins (don’t forget the paraneoplastic syndrome)

A
  • reed sternberg cells= polynuclear giant cell, CD15/30+
  • EBV
  • alcohol induced pain in lymph nodes
  • painless cervical lymphadenopathy
  • elevated ESR is assoc with poor px
  • paraneoplastic syn: inc Ca++ via ectopic 1a-OH production

tx with chemo

29
Q

malarial endemic regions

A

asia, africa, south america

signs can look like hemolysis so look at history

30
Q

diamond blackfin anemia

A
  • dx at <1 year –> definitive is bone marrow bx
  • macrocytic anemia (lack other cytopenias)
  • triphalangeal thumbs
31
Q

tx of CLL

A

if asyx –> observe and monitor progression

if sx –> rituximab (anti CD20)

32
Q

PE signs assoc with Fe deficiency

A

koilonychia- SCOOPED NAILs

angular chelitis

33
Q

tx of ALL

A

(ab= CD10, CD19, tdt)

  • aggressive chemo with vincristine, imatinib if 9;22
  • CNS proph with intrathecal chemo
34
Q

differentiate megaloblastic from simply macrocytic

A

megaloblastic = hypersegmented neutrophils

-can only be caused by b12/ folate defi

35
Q

antibiotics in sickle cell crisis/ sepsis?

A

IV ceft –> improved mortality

think of coverage for staph, salmonelloa, e coli, s pneumo (functional asplemia)

36
Q

presentatin seems consistent with G6pd and HS. How do you differentiate?

A

G6PD is more acute, 2-3 days after oxidative stress insult, like abx

HS happens a few weeks later and has ** inc MCHC**

37
Q

hair cell luekemia

A

common in older men with similar presentation to CLL

  • massive splenomegaly
  • TRAP+ (tart tresistant acid phos), CD11c
  • dry BM tap
  • tx= cladribine
38
Q

vWD labs and tx

A

inc PTT (dec factor VIII) **hemophilia will also have long ptt
inc bleeding time
nl plt

tx with desmopressin

(VIII is part of extrinsic pathway, requires vwb)

39
Q

more rare side effect of TMP-SMX that you don’t think of as often?

A

agranulocytosis

40
Q

lab disturbances that can be seq of gestational dm in newborns?

A

hypoglycemia
hypocalcemia
polycythemia

41
Q

ringed sideroblasts, microcytic vs macrocytic anemia

A

microcytic= lead poisoning

macrocytic= myelodysplastic syn

42
Q

warf vs DOAC in acute DVT?

A

DOAC acts instantly

43
Q

warf induced skin necrosis

A

due to relative Prot C deficiency which is the first factor to decrease

44
Q

heme effect of isoniazid

A

acq sideroblastic anemia that ,masquerades as fe def.

  • inhibits pyridoxine req for protoporphyrin synth
  • dimorphic rbcs
  • INC fe, DEC tibc
45
Q

lab values in vaso-occlusive crisis

A

aka splenic sequestration

  • reticulocytosis
  • thrombocytopenia
  • normocytic anemia

USMLE Step 2 (18 decks)

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