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Step 2 > Heme/Onc > Flashcards

Heme/Onc Flashcards

1
Q

pRBC

A

1 unit raise Hb 3 points

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2
Q

FFP

A

Replaces clotting factors
elevated PT, aPTT, INR
FFP is used as a replacement with plasmapheresis

NO FFP in IgA deficiency (must be IgA deficient donor)- anaphylactic reaction

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3
Q

Cryopreciptate

A

Replace fibrinogen
High levels of Factor VIII and vWF
Useful in DIC
NEVER the first choice

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4
Q

Sideroblastic anemia

A 
Micro/Macrocytic 
Most accurate test: Prussian blue stain for ringed sideroblasts. Basophilic stippling 
Myelodysplasia 
Alcohol's suppressive effects on BM 
Lead poisoning 
INH 
Pyroxidine deficieny
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5
Q

Microcytic anemia

low ferritin on iron study

A

Iron deficiency

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6
Q

Microcytic anemia and high iron

A

Sideroblastic anemia

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7
Q

Microcytic anemia and normal iron studies

A

Thalassemia

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8
Q

Most accurate test for B-thalssemia

A

Hb electrophoresis

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9
Q

Most accurate test for A-thalessemia

A

genetic studies

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10
Q

Alpha thal

A

One gene deletion- nomral

two gene deletion- mild anemia, normal electrophoresis

three gene deletion- moderate anemia with HbH (beta tetrads)

Four gene deletion- gama-4 tetrads (HbBart), CHF and death in utero

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11
Q

Beta thal

A

One gene deletion: Increased HbF and HbA2

Two gene deletion: beta thal intermedia, normal HbF, no transfusion dependence

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12
Q

Differentiating between folate and B12 deficiency?

A

B12- elevated methylmalonic acid

Both will have elevated homocysteiene levels

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13
Q

How to diagnose pernicious anemia?

A

Anti-intrinsic factor and anti-parietal cell Ab

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14
Q

Sickle cell mutation

A

Point mutation at position 6 in beta chain-valine replaces glutamic acid

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15
Q

Parvovirus B19 with sickle cell

A

Aplastic crisis
Look for sudden drop in retic count

Most accurate test: Parvovirus B19 PCR for DNA

TX: IVIG

(BM Bx-giant pronormoblasts)

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16
Q

Causes of Warm/IgG hemolysis

A

CLL
Lymphoma
SLE
Penicillin, alpha-methyldopa, rifampin, and phenytoin

17
Q

Causes of Cold/IgM hemolysis

A

EBV
Waldenstrom macroglobulinemia
M. pneumoniae

18
Q

Best initial test for G6PD

A

Smear: Heinz bodies (methylene blue) and bite cells

Most accurate: G6PD level 1-2mo after acute episode

19
Q

Pathophys of PNH

A

Clonal stem cell defect with increased sensitivity of red cells to complement in acidosis

Mutation of PIG-A gene- leads to deficiency in CD55 and CD59 (decay accelerating factors) cause over activation of complement while sleeping

Test by decreased CD55 and CD59 activity

Treat with Prednisone

20
Q

Treatment for aplastic anemia

A

Transfusion/abx/platelets

Allogenic bone marrow transplant

Too old for BM transplant: antithymocyte globulin and cyclosporine/tacrolimus

21
Q

Myelofibrosis

A

Pancytopenia associated with bone marrow fibrosis

Blood production in spleen and liver- tear drop shaped cells and nucleated RBC

Talidomide and lenalidomide- TNF inhibitors, increase BM production

22
Q

AML M3

A

15:17, most associated with Auer rods (eosinophilic inclusions)
DIC, initial presentation

23
Q

Treatment for AML/ALL

A

Chemotherapy first- remove blasts

Bad prognosis=bad cryogenics=immediate BMT

Good prognosis=good cryogenics=more chemo

ATRA for M3/promyelocytic leukemia

Add intrathecal MTX to ALL to prevent relapse in CNS

24
Q

Persistently high WBC-neutrophils
Pruritus
Spenomeagly- early satiety, abdominal fullness, LUQ pain

A

CML

Dx: low leukocyte alkaline phosphatase score

Most accurate test: BCR-ABL (9:22, Philadelphia chromosome) by PCR or FISH

Tx: Tyrosine kinase inhibitors- imatinib

BMT curative

Most likely to transform into blast crisis.

25
Q

Myelodysplastic syndrome

A

preleukemic condition

Associated with 5q deletion (better prognosis)

Pancytopenia with hyper cellular marrow
Increased MCV, nucleated RBC, small number for blasts
Ringed sideroblasts

Tx:
Transfusions
EPO
Lenalidomide-especially in 5q deletion

26
Q

Elevated WBC in person >50yo

Fatigue
Lympahdenopathy
Hepatosplenomeagly
Infection

A

CLL

Dx:
Elevated WBC- predominantly lymphocytes 
Hypogammaglobulinemia 
Anermia or thrombocytopenia- warm IgG/ BM infiltration 
Smudge cells on smear
27
Q

CLL treatment

A

0/elevated WBC or 1/lymphadenopathy- no treatment

2/hepatosplenomagly, 3/anemia, 4/thrombocytopenia- fludarabine (purine analog)

Refractory cases- cyclophosphamide

Mild cases- chlorambucil (mustard gas/alkylating agent)

Severe infection- IVIG
Autoimmune thrombocytopenia/hemolysis- prednisone

PCP prophylaxis in CML

28
Q

Pancytopenia
Massive splenomeagly
Inaspiratly dry tap- hypercellularity

A

Hairy cell leukemia

Dx:
Initial- Smear showing hairy cells
Best- flow cytometry for CD11c

Tx: clardribine and pentostatin

29
Q

Painless lymphadenopathy involving pelvic, retoperitoneal, or mesenteric stuctures

Lymph nodes not warm, red, or tender

Fever, weight loss, drenching sweat

A

Non-hodgkin lymphoma

Dx:
initial- excisional bx
CBC normal

Stage: CT C/A/P and BM Bx

30
Q

NHL treatment

A

1-lymph node group
2- 2+ lymph node groups on same side of diaphragm
3- both sides of diaphragm
4- widespread disease

1+2- local radiation and small course chemo

3+4+any B sx- CHOP and rituximab 
C-cylchophosphamide 
H-adriamycin 
O-vincristine 
P-prednisone
31
Q

Hodgkin lymphoma treatment

A

A-adriamycin- nuclear ventriculogram prior to determine EF
B-bleomycin
V-vinblastine
D-darbazine

32
Q

Doxirubicin toxicity

A

Cardiomyopthat get MUGA or nuclear ventriculogram first

33
Q

Vincristine toxicity

A

Neuropathy

34
Q

Bleomycin toxicity

A

Lung fibrosis

35
Q

Cyclophosphamide

A

Hemorrhagic cystitis

36
Q

Cisplatin

A

Renal toxicity and ototoxicity

37
Q

Diagnosis of Multiple Myeloma

A

X-ray of affected bone showing lytic lesion (radionuclide scan is normal in lytic lesions)

Serum electrophoresis IgG or IgA spike

Most accurate: >10% BM with plasma cells

38
Q 
Lethargy
Blurry vision, vertigo 
Engorged blood vessels in the eye 
Mucosal bleeding 
Raynaud phenomenon
A

Waldenstrom Macroglobulinemia

Dx: IgM spike on SPEP (cause hyperviscosity

Tx: plasmapheresis

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