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Step 2 CK > Heme/Onc > Flashcards

Heme/Onc Flashcards

1
Q

Increased body temperature, acidosis, and exercise shift the hemoglobin-oxygen dissociation curve in which direction? What effect does this have an oxygen delivery to the tissues?

A

right

more oxygen to tissues

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2
Q

What is the cause of anemia t hat develops after taking a sulfa drug?

A

G6PD deficiency

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3
Q

What lab markers suggest anemia due to hemolysis?

A

decreased H&H, nl MCV, incr indirect bili, decr serum haptoglobin, incr LDH, incr retic count

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4
Q

Hemolytic anemia, why is haptoglobin level decreased? why is the serum lactate dehydrogenase increased?

A

haptoglobin binds free hgb in blood, haptoglobin-hgb removed by spleen, hapttoglobin used up in hemolysis

LDH in RBCs, RBCs lyse and release of LDH

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5
Q

Serum iron, ferritin, transferrin levels in iron deficiency anemia

A

decr serum iron

decr ferritin

incr transferrin

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6
Q

Serum iron, ferritin, transferrin levels in anemia of chronic disease

A

decr serum iron

incr ferritin

decr transferrin

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7
Q

Elderly man has fatigue and SOB. No fever, or sx of infection. On exam his conjunctivae are pale, and stool guaiac is positive. Patient should be considered to have what disease?

A

colon cancer

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8
Q

blood smear of a patient with anemia due to lead poisoning?

A

basophilic stippling

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9
Q

RBC disorder associated with schistocytes (fragmented RBCs)

A

hemolytic anemias

DIC, TTP, HUS

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10
Q

RBC disorder associated with acanthocyte

A

abetalipoproteinemia

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11
Q

RBC disorder associated with bite cell

A

G6PD deficiency

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12
Q

RBC disorder associated with basophilic stippling of RBCs

A

lead

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13
Q

RBC disorder associated with peripheral neuropathy + ringed sideroblasts in bone marrow

A

lead

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14
Q

RBC disorder associated with hypersegmented neutrophils

A

folate/B12

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15
Q

RBC disorder associated with heinz bodies (denatured Hgb in RBC)

A

G6PD deficiency

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16
Q

What type of anemia and MCV with presentation of mental status change, neuropathy, constipation

A

lead tox

MCV decreased

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17
Q

What type of anemia and MCV with presentation of heavy menses, ice pica

A

iron deficiency

MCV decreased

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18
Q

What type of anemia and MCV with presentation of dark urine, jaundice, HSM

A

hemolytic anemia

nl MCV

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19
Q

What type of anemia and MCV with presentation of alcoholic, malnourished

A

B12/folate

incr MCV

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20
Q

virus causing aplastic anemia as well as erythema infectiosum?

A

parvovirus B19

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21
Q

type of thalassemia most commonly associated with patients of mediterranean descent? Thalassemia with patients of african or asian descent?

A

beta thal - mediterranean

alpha thal - african or asian

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22
Q

complications in 10% of patients with sideroblastic anemia?

A

acute leukemia

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23
Q

organism responsible for osteomyelitis in a sickle cell patient?

A

salmonella

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24
Q

vaccines important for sickle cell children?

A

s pneumo, h flu, meningococcal, influenza, hep B

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25
Q

medication used in long term management of sickle cell anemia?

A

hydroxyurea

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26
Q

which drugs cause hemolysis in patients with G6PD deficiency?

A

“spleen purges nasty inclusions from damaged cells”

sulfa
primaquine
nitrofurantoin
INH
fava beans
dapsone
chloroquine
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27
Q

next step in management of patient with febrile neutropenia due to chemo?

A

admit pt, blood/urine cx, broad spectrum abx

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28
Q

type of infection that causes eosinophilia?

A

parasitic

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29
Q

immunoglobulin class associated with eosinophilia?

A

IgE

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30
Q

Goodpasture glomerulonephritis results from autoantibodies targeting the glomerular basement membrane. Which hypersensitivity reaction is this, and how can it be treated?

A

Type 2

tx: antiinflammatory, immuno, plasmapheresis

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31
Q

Patient presents with red marks on her ear lobes and left wrist, and is ultimately diagnosed with a nickel allergy. What type of hypersensitivity reaction is this?

A

type IV hypersensitivity (contact dermatitis)

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32
Q

Most important medication in the treatment of anaphylaxis?

A

epinephrine

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33
Q

mechanism of action of streptokinase

A

cleaves fibrin clots

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34
Q

mechanism of action of aspirin

A

blocks platelet aggregation

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35
Q

mechanism of action of clopidogrel

A

blocks ADP receptor

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36
Q

mechanism of action of abciximab

A

blocks GP2b/3a

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37
Q

mechanism of action of tirofiban

A

blocks GP2b/3a

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38
Q

mechanism of action of ticlopidine

A

blocks ADP receptor

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39
Q

mechanism of action of enoxaparin

A

Xa inhibitor, LMWH

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40
Q

mechanism of action of eptifibatide

A

blocks GP2b/3a

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41
Q

Pregnant woman at 24 weeks is diagnosed with a DVT. Which anticoagulants are safe in pregnancy?

A

heparin, LMWH

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42
Q

Mechanism of action of warfarin?

A

blocks X, IX, VII, II, S, C coagulation factors

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43
Q

Lab test is used to monitor warfarin? Heparin? LMWH?

A

PT/INR
PTT
no monitoring

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44
Q

Management of patient who develops thrombocytopenia while being treated with heparin for a pulmonary embolus?

A

stop heparin

change to a different anticoag

45
Q

Classic pentad for TTP?

A 
hemolytic anemia
uremia
thrombocytopenia
fever
neurologic sequelae
46
Q

Pregnant woman at 36 weeks gestation who has HTN, proteinuria, elevated AST/ALT, low haptoglobin and platelet count of 70,000?

A

deliver the baby

47
Q

Platelet count, bleeding time, PT, PTT in HUS/TTP

A

decr platelet count

increased bleeding time

nl PT

nl PTT

48
Q

Platelet count, bleeding time, PT, PTT in hemophilia A or B

A

nl platelet count

nl bleeding time

nl PT

incr PTT

49
Q

Platelet count, bleeding time, PT, PTT in von Willebrand disease

A

nl platelet count

incr bleeding time

nl PT

incr PTT

50
Q

Platelet count, bleeding time, PT, PTT in DIC

A

decr platelet count

incr bleeding time

incr PT

incr PTT

51
Q

Platelet count, bleeding time, PT, PTT in warfarin use

A

nl platelet count

nl bleeding time

incr PT

incr PTT

52
Q

Platelet count, bleeding time, PT, PTT in end stage liver disease

A

nl/decr platelet count

nl/incr bleeding time

incr PT

incr PTT

53
Q

Platelet count, bleeding time, PT, PTT in aspirin use

A

nl platelet count

incr bleeding time

nl PT

nl PTT

54
Q

treatment for von willebrand disease

A

desmopressin
cyroprecipitate
OCPs
avoid: aspirin

55
Q

Most common causes of DIC

A

STOP Making Thrombi

sepsis
trauma
OB complication
Pancreatitis
Malignancy
Transfusion
56
Q

Most common mutation that predisposes to venous thrombosis in white patients?

A

factor 5 leiden

57
Q

what are the criteria for the diagnosis of SIRS?

A

temp > 38.3, 12,000 10% bandemia
HR > 90
RR > 20

58
Q

Man returns from a safari in Africa and now has periodic fevers, chills, diaphoresis, muscle aches and fatigue. How could this man have avoided this illness?

A

malarial prophylaxis

59
Q

Tumor marker for hepatocellular carcinoma

A

AFP

60
Q

tumor marker for colon cancer

A

CEA

61
Q

tumor marker for gastric cancer

A

CEA

62
Q

tumor marker for pancreatic cancer

A

CA 19-9

63
Q

tumor marker for ovarian cancer

A

CA 125

64
Q

HIV positive patient has SOB. Increasing DOE. Cough, fever, and white plaques on tongue and pharynx. Pain with swallowing. What is the CD4 count?

A

CD4

65
Q

39 year old male HIV patient receives a head CT for headache and new onset confusion and slurring of words. Imaging shows ring enhancing lesions. What is the infection? What lab supports diagnosis?

A

toxoplasmosis

check toxo IgG antibody

66
Q

Rate of transmission of HIV through needle stick. WHat drugs should be given if there is a risk of transmission of HIV in this setting?

A

0.3%

emtricitabne
tenofovir
raltegravir

67
Q

What is elevated in DIC: fibrin split products, d-dimer, fibrinogen, platelets, hematocrit?

A

increased fibrin split products, increased d dimer

68
Q

25 year old male diagnosed with HIV must begin HAART regimen. What classes of drugs should his regimen include initially?

A

2 NRTIs

+ NNRTI, protease or integrase inhibitors

69
Q

Antiretroviral class with side effect lactic acidosis

A

NRTIs

70
Q

Antiretroviral class with side effect GI intolerance

A

protease inhibitor

71
Q

Antiretroviral class with side effect rash

A

NNRTIs

72
Q

Antiretroviral class with side effect hyperglycemia, DM, lipid abnormalities

A

protease inhib

73
Q

Antiretroviral with side effect bone marrow suppression with megaloblastic anemia

A

zidovudine

74
Q

Antiretroviral with side effect potentially fatal hypersensitivity reaction

A

abacavir

75
Q

Antiretroviral with side effect neuropsych symptoms (depression and vivid nightmares)

A

efavirenz

76
Q

Antiretroviral with side effect hyperbilirubinemia, jaundice

A

atazanavir

77
Q

Antiretroviral with side effect teratogenic, should not be given to women of childbearing age off of contraceptives

A

efavirenz

78
Q

Antiretroviral with side effect inhibits cytochrome P450, used to boost other drugs

A

ritonavir

79
Q

66 y/o woman fractures hip. Radiographs show punched out lesions in vertebrae, hips, femurs. Patient says that she has increasing back pain, weakness, fatigue but she has attributed all of that to aging. Labs show anemia, hypercalcemia, increased BUN and creatinine. What studies will help with diagnosis? What would you see? Dx?

A

SPEP: monoclonal M spike
UPEP: Bence Jones protein
bone marrow biopsy

multiple myeloma

80
Q

21 year old male patient presents with recent weight loss, pruritus and night sweats. Physical exam reveals HSM and nontender cervical LAD. What do you suspect?

A

Hodgkin lymphoma

81
Q

Blood cell pathology associated with epstein-barr virus in Africa

A

burkitt lymphoma

82
Q

Blood cell pathology associated with reed sternberg cells, cervical LAD, night sweats

A

hodgkin lymphoma

83
Q

Blood cell pathology associated with bence jones protein, osteolytic lesions, high calcium

A

multiple myeloma

84
Q

Blood cell pathology associated with translocation 14;18

A

follicular

85
Q

Blood cell pathology associated with most common lymphoma in US

A

diffuse large B cell

86
Q

Blood cell pathology associated with translocation 8; 14

A

Burkitt

87
Q

Blood cell pathology associated with most common form of Hodgkin lymphoma

A

nodular sclerosing

88
Q

Blood cell pathology associated with starry sky pattern due to phagocytosis of apoptotic tumor cells

A

burkitt

89
Q

Blood cell pathology associated with high Hct/Hgb pruritus, burning pain in hands or feet

A

polycythemia vera

90
Q

Type of leukemia most common neoplasm in children (3-4 years)

A

ALL

91
Q

Type of leukemia most common leukemia in adults

A

CLL

92
Q

Type of leukemia philadelphia chromosome is almost always seen

A

CML

93
Q

Type of leukemia smudge cells on peripheral smear

A

CLL

94
Q

Type of leukemia with peripheral blasts are PAS (+) and TdT (+)

A

ALL

95
Q

Type of leukemia with peripheral blasts are pAS (-), myeloperoxidase (+), and have auer rods

A

AML

96
Q

Type of leukemia with pancytopenia in a down syndrome patiet

A

ALL

97
Q

Type of leukemia associated with translocation 9;22

A

CML

98
Q

Type of leukemia white cells with hair like projections

A

hairy cell

99
Q

medication that cures 95% CML?

A

imatinib

100
Q

peripheral smear of an asymptomatic patient reveals macrocytosis and hypogranular granulocytes with bilobed nuclei. Dx?

A

myelodysplastic syndrome

101
Q

5 year old boy has swollen leg. Swollen leg is a mass embedded in muscule of right thigh. Next step?

A

CT/MRI, then biopsy

102
Q

Most common adrenal tumor in children? What lab studies can be used to diagnose this?

A

neuroblastoma

incr VMA, incr HMA in 24 hour urine

103
Q

4 year old girl brought into the county clinic with URI. The mother reports that this child seems to get sick more often than her friends kids of the same age. Physical exam is remarkable for dangling thumbs, short stature, hypopigmentation of some areas. Labs reveal pancytopenia. Dx?

A

fanconi anemia

104
Q

3 month old has difficulty breathing, fatigue, and pallor. Heart murmur and abnormal thumbs. Labs reveal anemia,. Dx? EPO?

A

diamond blackfan anemia

incr EPO

105
Q

late lifethreatening complication of CML?

A

blast crisis

106
Q

conditions associated with a positive p ANCA

A

pauci immune glomerulonephritis

micrscopic polyangiitis

eosinophilic granulomatosis with polyangiitis

crohn’s

uC

primary sclerosing cholangitis

107
Q

Treatment for TTP?

A

plasmapheresis

steroids

108
Q

What cause of aplastic anemia is associated with thumb abnormalities, diffuse hypo/hyperpigmentation, cafe-au-lait spots and short stature?

A

fanconi anemia

109
Q

Differential diagnosis for eosinophilia?

A

CANADA P

collagen vasc dx
atopic - allergies, asthma, churg strauss
neoplasms
adrenal insuff (addison)
drugs
acute interstitial nephritis
parasites

Step 2 CK (16 decks)

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