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Clincial Medicine > Heme-Onc > Flashcards

Heme-Onc Flashcards

1
Q

Blood donations are collected in plastic bags containing the anticoagulants:

A

ACD (Acid-Citrate-Dextrose) or CPD (Citrate-Phosphate-Dextrose)

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2
Q

PRBCs are stored at what temperature? How long is the shelf life?

A

0 - 6 degrees, 42 days

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3
Q

At what temperature are platelets stored? Shelf life?

A

Room temperature with 5 day shelf life.

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4
Q

RBC transfusions generally indicated when Hb drops below

A

7

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5
Q

The restrictive RBC transfusion policy aims at a lower target Hb around:

A

7 - 8 Gms

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6
Q

In an actively bleeding patient, goal of platelet transfusion is to keep platelets:

A

Above 50k in most cases, above 100k if evidence of DIC or CNS bleeding

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7
Q

Platelet transfusions are also given to patients in preparation for invasive procedures. Major surgery and endoscopies aim for __k while a spinal tap with a heme malignancy aims for __k.

A

50k

20k

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8
Q

Prophylactic platelet transfusions are generally above 10k, but may be higher in patients with:

A

Fever, sepsis, APL

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9
Q

Prophylactic platelet transfusions should not be given to patients with

A

TTP/HIT

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10
Q

For a massive transfusion, a 1:1:1 ratio of what should be given?

A

PRBCs:FFP:Platelets

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11
Q

What are some major concerns with a massive transfusion?

A

Citrate toxicity, hypothermia, hyperkalemia, hypocalcemia, metabolic alkalosis, coagulation parameters

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12
Q

A transfusion reaction wherein antibodies to donor leukocytes cause a release of cytokines and result in symptoms of fever, chills, dyspnea

A

Febrile, nonhemolytic RBC or platelet transfusion reaction

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13
Q

A transfusion reaction wherein ABO incompatibility leads to rapid destruction of donor erythrocytes and results in DIC, shock, acute renal failure, fever, bakc pain, hemoglobinuria.. May only see fever and chills in comatose or anesthetized pt!

A

Acute hemolytic transfusion reaction

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14
Q

What is the appropriate response to an AHTR?

A

Stop transfusion, ABCs, saline, diuretics, blood sample for DAT, Hb, type and cross

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15
Q

A transfusion reaction wherein ABO incompatibility results in shock, hypotension, angioedema, respiratory distress. IgA deficient patients at high risk.

A

Anaphylactic transfusion reaction to RBCs, platelets, cryoppt, granulocytes, or gamma globulin.

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16
Q

A transfusion reaction wherein allergenic substances in donor plasma react with recipient antibodies with mast cell and basophil histamine release.

A

Urticarial transfusion reaction, give benadryl

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17
Q

A transfusion complication more common in elderly patients, pediatric patients, patients with compromised cardiac function (seen in ICU)

A

Transfusion associated circulatory overload

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18
Q

A transfusion complicated associated with two hit theory of neutrophil sequestration, priming, and activation paired with donor Abs vs HLA1, 2, and human neutrophil antigens.

A

Transfusion related acute lung injury

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19
Q

TRALI occurs how long after transfusion?

A

1 - 6 hours

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20
Q

A transfusion complication occurring days or weeks after transfusion, presenting with anemia, hyperbilirubinemia as a result of extravascular hemolysis.

A

Delayed hemolytic transfusion reaction

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21
Q

A transfusion complication that occurs days to weeks after transfusion and presents with fever, rash, anorexia, vomitting, abd pain, diarrhea, pancytopenia, abnormal LFTs

A

Graft vs Host disease

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22
Q

Most common mortality in travelers:

A

Cardiovascular disease

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23
Q

What percentage of travelers will develop some type of diarrhea?

A

20 - 60%

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24
Q

What questions might you want to ask someone who is planning to travel?

A

Country, duration, accommodations, purpose, travel history, allergies, current illnesses

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25
Q

What treatment is recommended for altitude sickness?

A

Descent, oxygen. Prevention: avoid alcohol and sedatives, high carb diet, sildenafil and acetazolamide.

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26
Q

Catfish that ascends the urethra, attracted by urea.

A

Candiru

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27
Q

Prophylaxis for traveler’s diarrhea is not recommended, but may recommend _____ before a high-risk meal

A

Peptobismol

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28
Q

Treatment for traveler’s diarrhea with blood in stool:

A

Fluids, zithromax

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29
Q

Three R’s of travel immunization

A

Routine childhood
Required for crossing borders
Recommended: according to risk (Hep A, typhoid, etc)

30
Q

Routine travel immunizations:

A

Diphtheria, tetanus, Polio, MMR, Influenza, Pneumococcal

31
Q

Recommended travel vaccines:

A

Hep A, Hep B, typhoid, japanese encephalitis, rabies

32
Q

DEET concentration that is sufficient for repellent for travelers:

A

40%

33
Q

Clotting in the arterial system generally results in ____ clots of platelets.

A

White

34
Q

Clotting in the venous system generally results in ____ clots of red blood cells.

A

Red

35
Q

Risk factors for arterial thrombosis include:

A

Vascular injury (#1), lipoproteins decreasing fibrinolysis, inflammatory changes, homocysteine

36
Q

An anti-coagulant that decreases thromboxane and lasts for the lifespan of a platelet

A

Aspirin

37
Q

Most commonly used inhibitor of ADP-induced platelet aggregation

A

Clopidogrel (Plavix)

38
Q

Thrombin inhibitors for VTE prophylaxis and atrial fib

A

Dabigatran (Pradaxa) and Apixaban (Eliquis)

39
Q

Bone marrow has the capacity to increase production ______ x the normal production

A

5 - 10

40
Q

RBC lifespan can reach as low as __ days before marrow cannot compensate and anemia develops.

A

18 days

41
Q

A person can lose up to __% of their blood without clinical signs at rest.

A

20%

42
Q

A loss of __ - __% of blood can lead to circulatory collapse and shock

A

30 - 40%

43
Q

Anemia as a result of _______ may present with signs of malnutrition and neurological changes

A

B12 deficiency

44
Q

Anemia as a result of _______ may present with severe pallor, a smooth tongue, and esophageal webs.

A

Iron deficiency

45
Q

Anemia as a results of ______ may present with jaundice

A

Hemolysis

46
Q

A CBC includes:

A 
RBC count (n = 3.8-5.2, 3.9-5.9)
Hct/PCV (n = 38-46%, 41-53%)
Hb (n = 12 0 16, 13.5-17.5)
RBC indices
47
Q

RBC indices on a CBC are:

A

MCV (mean corpuscular volume)
MCHC (Mean corpuscular hb concentration)
MCH (Mean corpuscular hb)
RDW (Red cell distribution width)

48
Q

MCV =

A

(Hct%/RBC) x 10

n = 80 - 100 fL

49
Q

MCHC =

A

(Hb/Hct%)x100

n = 31 - 37

50
Q

MCH =

A

(Hb/RBC) x 10

n = 26 - 34

51
Q

RDW =

A

(Standard dev/mean MCV) x 100

n = 11.5 - 14.5%

52
Q

What stain is used on PBS to visualize remaining ribosomes and ER of reticulocytes?

A

Methylene blue

53
Q

Special considerations in treating a patient for HIV include:

A

Adolescents, pregnant patients, IV drug users, older patients, HIV-2, coinfection with HBV/HCV/TB

54
Q

The best predictor of disease progression, indicator of immune function, and key factor in determining urgency of ART:

A

CD4+ cell count

55
Q

An adequate response to ART is

A

Increase in CD4 cells by 50 - 1500 /uL/year

56
Q

How often should a patient have their CD4 count checked during first two years of ART?

A

Every 3 - 6 months

57
Q

How often should a patient have their CD4 count checked after two years of adequate and consistent suppression? (300 - 500 cells/uL)

A

Every 12 months

58
Q

A factor to consider in the decision to start ART and the goal of art with regard to this factor:

A

HIV RNA, goal to achieve undetectable levels (

59
Q

How often should HIV RNA be checked?

A

Every 2 - 4 weeks after starting or changing the ART regimen, then every 4 - 8 weeks until levels are

60
Q

Drug resistance testing is indicated in HIV patients with:

A

Acute HIV infection, chronic infection at entry into care, virologic failure during ART, suboptimal suppression, pregnancy

61
Q

Drug resistance testing is not usually indicated in HIV patients:

A

After discontinuation of ARVs, if plasma HIV RNA

62
Q

Patients with this HLA should not receive ABC and should be recorded as an ABC allergy.

A

HLA-B*5701

63
Q

Current recommendations for initiating ART with the intention of preventing transmission:

A

HIV infected pregnant women, patients at risk of transmitting HIV to a sexual partner

64
Q

Current 6 categories of ARV medications:

A

NRTI, NNRTI, PI, Integrase inhibitors, fusion inhibitors, PK boosters

65
Q

3 categories of regimens for ART:

A

1 Integrase inhibitor + 2 NRTIs
1 PK-boosted PI + 2 NRTIs
1 NNRTI + 2 NRTIs

66
Q

In the 3 main categories for ART regimens, each includes 2 NRTIs, one of which should include:

A

3TC (Lamivudine) or FTC (Emtricitabine)

67
Q

In patients with CD4

A

RPV-based

DRV/r +RAL

68
Q

In patients with HIV RNA >100k, it is not recommended to use _____, _____, or _____ due to high rate of virologic failure.

A

RPV-based
ABC/3TC + EFC or ATV/r
DRV/r + RAL

69
Q

In patients with chronic kidney disease and ostoporosis, one should avoid ____ in ART regimen:

A

TDF

70
Q

In patients with a psychiatric illness, one should consider avoiding ____ in ART regimen

A

EFV

Clincial Medicine (10 decks)

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