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PANCE Exam Review > Heme > Flashcards

Heme Flashcards

1
Q

CRAB: hyperCalcemia, Renal insufficency, Anemia and Bone/Back lesion pain. Dx?

A

Multiple Myeloma

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2
Q

What is Thrombocytosis?

A

Too many platelets

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3
Q

What is the Vitamin for Folate?

A

B9

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4
Q

What is RDW? Explain.

A
  • Degree of variation in RBC size.

- Normal is <15% variation.

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5
Q

What does TIBC stand for?

A

Total Iron Binding Capacity

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6
Q

Explain importance of TIBC

A

Carton of eggs →

  • If carton is full (high) of eggs (Fe), binding capacity is low
  • If carton is empty (low), binding capacity is high
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7
Q

2 MC types of microcytic anemia

A
  • Iron Deficiency Anemia

- Thalassemia

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8
Q

What is leukocytosis?

A

Too many WBCs

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9
Q

Pt. presents with headache, dizziness, pruritus after showering. He has HTN and splenomegaly. Dx?

A

Polycythemia Vera

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10
Q

Pt. was treated for iron deficiency anemia 6 weeks ago. Today she presents with normal values. What should be done next? Why?

A
  • Check serum ferritin level

- It takes 4-6 mo to replenish so Rx should continue for a 4-6 mo.

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11
Q

Labs seen with Von Willebrand Disease (VWD):

A

Prolonged bleed time ± prolonged PTT

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12
Q

In what population of pts. must a PA be aggressive with spotting and treating anemia? Why?

A
  • Elderly

- They won’t survive a large GI bleed.

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13
Q

What virus is Hodgkin’s associated with?

A

EBV

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14
Q

How do we know the difference of Iron Deficiency Anemia vs. Thalassemia?

A
  • Iron studies

- Normal RDW (USE THIS ONE), Serum Fe, TIBC and serum Ferritin in Thalassemia.

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15
Q

MC presentation (color, size) of Anemia of Chronic Disease

A

Normocytic, Normochromic

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16
Q

How do we Tx Anemia of Chronic Disease?

A

Tx underlying cause

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17
Q

In a 45yo vs. 75 yo with B12 and Folate Deficiencies, what are the differences in presentation?

A
  • Both: Unexplained weakness
  • Younger: Paresthesias
  • Elderly: Cognitive changes
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18
Q

How do we check/Dx B12 Deficiency?

A
  • Dx: Serum cobalamin levels
  • ↑ Serum Homocysteine
  • ↑Methyl-Malonic Acid (MAA)
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19
Q

What presents with splenomegaly, gingival hyperplasia and Auer rods?

A

Acute Myelogenous Leukemia

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20
Q

RDW in Chronic (>3 mo) would show what and why?

A
  • Normal at <15 % variation in size.

- All RBCs are small and don’t vary like they would in acute.

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21
Q

Tx for Polycythemia Vera

A
  • Phlebotomy
  • Hydroxyurea
  • ASA
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22
Q

What is thrombocytopenia?

A

Low platelet count

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23
Q

What does it mean to have petechiae and purpura?

A

Bleeding under the skin.

-Many petechiae lead to purpura.

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24
Q

If Polys and Lymphs are numerically nearby, think _____

A

Viral infection

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25
Q

Reed-Sternberg Cell pathognomonic in:

A

Hodgkin’s

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26
Q

What is seen on x-ray for Multiple Myeloma?

A

Lytic lesions

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27
Q

Bariatric surgery is an RF for ____ D/T ____:

A
  • Iron Deficiency Anemia

- ↓ iron absorption

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28
Q

Oral Tx for Lead poisoning

A

Succimer

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29
Q

Tx for Sickle Cell

A

Hydroxyurea

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30
Q

Painless supraclavicular or anterior cervical triangle lymph node mass. Sxs: F, night sweats, wt. loss. Dx?

A

Hodgkin’s

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31
Q

BEST Dx lab test for Thalassemia

A

Hemoglobin Electrophoresis

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32
Q

What does it mean infection-wise when the Monocytes are elevated?

A

Infection >24 hr bc that’s when Monos come out.

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33
Q

What iron is usually given Rx and why?

A
  • Ferrous Sulfate

- GI issues with highest and too many pills to take with lowest.

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34
Q

MC gene in Polycythemia Vera

A

Janus kinase 2 gene (JAK2)

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35
Q

What is the expected duration to treat for B12 deficiency?

A

Usually life-long

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36
Q

Koilonychia is seen in:

A

Iron Deficiency Anemia

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37
Q

If Polys and Lymphs are numerically REALLY far apart, think _____

A

Bacterial infection

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38
Q

MC marker of Thrombotic Thrombocytopenic Purpura (TTP). High or low?

A

Severe ↓ ADAMTS13

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39
Q

What is seen in Protein electrophoresis of Multiple Myeloma?

A

Bence-Jones proteins

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40
Q

What is the name of B12?

A

Cobalamin

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41
Q

2 MC conditions associated with Eosinophils

A
  • Allergic reactions

- Parasitic infections

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42
Q

What is seen on peripheral blood smear for Multiple Myeloma?

A

Rouleaux

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43
Q

Why is RDW normal in Thalassemia?

A

-There is no iron problem, the problem is making Hemoglobin.

44
Q

What type of hemoglobin does hydroxyurea increase?

A

HbF (fetal hemoglobin)

45
Q

What is the only vitamin deficiency to result in neuro symptoms?

A

B12 (Cobalamin)

46
Q

What presents with splenomegaly and Philadelphia chromosome t(9;22)?

A

Chronic Myelogenous Leukemia (CML)

47
Q

What makes a RBC red?

A

Hemoglobin

48
Q

Tx for Primary Immune Thrombocytopenia

A
  • Kids: observe ± IVIG (severe w/bleed)

- Adults: Steroids > IVIG; Platelets <20K - transfusion, splenectomy

49
Q

Pt. on chemo presents with temp >101 F and neutrophil < 500. Dx?

A

Neutropenic Fever

50
Q

An elderly pt. is being treat for Iron Deficiency Anemia. After 1 mo of Tx, her Hgb and Hct haven’t changed much. What is the next step? Why?

A
  • Check Reticulocyte count

- To see if bone marrow is producing RBCs.

51
Q

Peripheral smear: spherocytes and Howell-Jolly body. Dx?

A

Hereditary Spherocytosis

52
Q

Hyperdense lines at metaphyses (“lead lines”) seen in:

A

Lead poisoning

53
Q

How long does it take total WBC count to react to infection?

A

At least 12 hrs

  • So polys and lymphs are already circulating in this time.
  • Immunocompromised might not even show a difference.
54
Q

↑ hemoglobin, ↑ RBC mass, leukocytosis, and thrombocytosis. Dx?

A

Polycythemia Vera

55
Q

What does “chromic” mean in Anemia? What terms are used to differentiate?

A
  • Color

- Hypo, normo, hyper

56
Q

What is MCH?

A

RBC color AKA Hemoglobin content

57
Q

What Dx is complicated by Minimal Change Disease?

A

Hodgkin’s lymphoma

58
Q

Tx for Thrombotic Thrombocytopenic Purpura (TTP)

A

ASAP Plasma exchange + IV corticosteroids + Rituximab

59
Q

What antipsychotic causes agranulocytosis (severely dangerous leukopenia/neutropenia)?

A

Clozapine

60
Q

Tx for Tumor Lysis Syndrome

A

IVF + ER dialysis (with multiple electrolyte abnormalities)

61
Q

How many days after chemo should nadir be in absolute neutrophil count?

A

7 days

62
Q

Thrombocytopenia is usually the ONLY lab abnormality seen in:

A

Primary Immune Thrombocytopenia

63
Q

What labs are seen in Aplastic Crisis?

A

↓ Hb + reticulocytopenia

64
Q

Schistocytes are seen in what 2 Dx’s?

A

Disseminated intravascular coagulation (DIC) and Thrombotic Thrombocytopenic Purpura (TTP)

65
Q
  • Platelet 10-20K + mucosal bleeding OR

- Platelet < 10K and no bleeding are treated with:

A

Steroids or IVIG (or both)

66
Q

In what Dx can we find recurrent DVTs, spontaneous abortions, or CV events?

A

Antiphospholipid Antibody Syndrome

67
Q

Mgmt of Red Man Syndrome

A
  • Antihistamine (Diphenhydramine) and stop offending agent.

- Can restart med slower without true anaphylaxis and resolved Sxs.

68
Q

Tx for Neutropenic Fever

A

PCN (or 4th gen. Ceph) + Vanco

69
Q

What lab would be affected by Hemophilia A, B, C?

A

PTT

70
Q

What is the ONLY D/O causing increase in mean corpuscular hemoglobin concentration (MCHC)?

A

Hereditary Spherocytosis

71
Q

Which lab tests platelet function and health?

A

Bleed time

72
Q

Tx for Hereditary Spherocytosis

A

Daily Folic Acid

73
Q

Dx for Sickle Cell Disease

A

↑ reticulocytes, ↓ Hct, Hgb

74
Q

What risk does a high INR on Warfarin have?

A

Bleed risk

75
Q

If INR is <5, what is the mgmt?

A

Lower dose or omit

76
Q

Tx for Acute Chest Syndrome in SCD

A

Broad-spectrum antibiotics admit to ICU

77
Q

Difference between Disseminated intravascular coagulation (DIC) and Thrombotic Thrombocytopenic Purpura (TTP):

A
  • DIC has LOW Fibrinogen

- TTP has normal Fibrinogen

78
Q

Recurrent DVTs and pulmonary embolism. Dx?

A

Factor V Leiden

79
Q

Labs seen in Beta Thalassemia

A
  • ↑ HgbF

- Codocytes (target cells)

80
Q

Tx for severe Iron Deficiency Anemia

A

PO Ferrous Sulfate (unless showing Sxs CHF)

81
Q

What is ESR?

A

Nonspecific marker of inflammation

82
Q

MCC of mortality in sickle cell patients

A

Acute Chest Syndrome (ACS)

83
Q

What anticoagulation med is CI in pregnancy?

A

Warfarin

84
Q

Pt.: Short stature, deaf, skin hyper/hypopigmentation, cafe-au-lait spots, renal abnormalities. Labs: Macro anemia and↑ fetal hemoglobin (HgF). Dx?

A

Fanconi Anemia

85
Q

Young kid with lymphadenopathy*, limping, bone pain. Lymphoblasts on peripheral smear. Dx?

A

Acute Lymphocytic Leukemia (ALL)

86
Q

What PE is seen with Von Willebrand Disease (VWD)?

A

Mucosal bleeding

87
Q

MC heme manifestation in chronic alcoholics

A

Macrocytosis

88
Q

Dx for Hereditary Spherocytosis

A

Osmotic fragility test

89
Q

What Dx presents post URI with thrombocytopenia?

A

Primary immune thrombocytopenia

90
Q

What mandates antibiotic treatment for Neutropenic Fever?

A

Single oral temp. of 101F (38.3C) or 100.4 for >1 hr

91
Q

Labs seen in Aplastic Crisis

A

↓ Hemoglobin and ↓Reticulocyte count

92
Q

Dx for Polycythemia Vera

A

CBC

93
Q

Hodgkin vs. Non-Hodgkin

A

H: Localized, single group of nodes
NH: Multiple, peripheral nodes

94
Q

Post chemo initiation. HyperUricemia, HyperK, HyperPhos, HypoCa+. Dx?

A

Tumor Lysis Syndrome

95
Q

In a person with normal marrow function, what is the mean life span of platelets?

A

7-10 days

96
Q

What is a potential adverse effect associated with unfractionated heparin?

A

Thrombocytopenia

97
Q

AA man is placed on Primaquine for travel to Africa. Within 5 wks he presents complaining of fatigue. CBC shows anemia. What diagnostic study should be performed? Why?

A
  • G6PD assay

- Antimalarials, sulfas, nitro cause oxidative stress

98
Q

Your patient has been treated for Fe deficiency anemia. What do you check to see if treatment is working?

A

↑ Reticulocyte (immature/new RBCs)

99
Q

Tx for Pernicious Anemia

A

Steroids + B12

100
Q

Tx of choice for mild Hemophilia A Deficiency and for severe bleed

A

Mild: DDAVP daily
Severe: Factor VIII infusion

101
Q

Pregnant pt. presents with sudden onset bleeding and severe pain (placenta abrupto). She has an elevated PT and PTT. How would you treat this?

A
  • FFP/packed RBCs

- D/T DIC

102
Q

Pt. presents for routine check-up. He has ↓ serum iron, ↓ total iron binding capacity (TIBC), and ↑ ferritin. Dx?

A

Anemia of chronic disease (Normocytic, Normochromic)

103
Q

Pt. presents for routine check-up. He has ↓ serum iron, ↓ total iron binding capacity (TIBC), and ↑ ferritin. What is the Tx?

A
  • Monthly Erythropoietin (EPO) injections

- Dx: Anemia of chronic disease

104
Q

Pt. presents with labs showing target cells (ringed sideroblasts) and basophilic stippling. Also has ↑ serum iron. What would be the diagnosis?

A

Lead poisoning

105
Q

What is the next step in mgmt with Fe deficiency in adults >60yo and microcytic hypochromic anemia? Why?

A
  • Colonoscopy

- Worry about colon CA until proven otherwise

106
Q

What is the best treatment for a pt. with CKD and labs showing Cr 21, HgB 6.8?

A

-Transfusion (HgB <7, anytime)

107
Q

47 yo female presents to the ED. She has Hx of DM and CHF and has darkening skin with elevated liver enzymes. What is the Dx?

A

Hemochromatosis “Bronze Diabetes”

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