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Step 2 UWORLD > Heme onc > Flashcards

Heme onc Flashcards

1
Q

Redness/tenderness/migratory thrombophlebitis at unusual sites i.e. arms and chest

A

Trousseau syndrome: hypercoag disorder ass. with visceral malignancy (usually pancreatic cancer)

“pain, itching, and red streaks on arm and chest. tender, erythematous, palpable cord-like veins on arm and chest”

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2
Q

Tx for HIT

A

STOP Heparin, give Argatroban or Fondaparinux. Switch to warfarin once platelet >150k

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3
Q

what causes thrombocytopenia/leukopenia in SLE pt?

A

Peripheral auto-immune destruction

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4
Q

Woman with menorrhagia

A

vWD!! (not hemophilia)

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5
Q

Hemophilia: PT, PTT, BT, Platelet count

A

All normal except for increased PTT

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6
Q

Hemarthrosis w/ +FHx

A

Hemophilia

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7
Q

Tx of hemophilia

A

Give Factor 8/9

Desmopressin for mild Hem A

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8
Q

T/F: HIT is highly thrombogenic

A

True–>high risk of arterial and venous clots

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9
Q

Thrombosis and hx of miscarriage in SLE pt

A

Anti-phospholipid syndrome

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10
Q

Tumor lysis syndrome electrolytes

A

Hyper: Uricemia, Kalemia, Phosphatemia
Hypo: Calcemia

Contents of cell is released. Low calcium b/c it gets bound by phosphate

  • AKI from uric/phosphate
  • Arrythmia from potassium
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11
Q

Tx for ITP

A

Platelets <30K: IVIG or Glucocorticoids

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12
Q

Features of androgen (steroid) abuse (athletes)

A
  • Mood changes, gynecomastia, aggressive behavior

- Polycythemia (so don’t be a peasant and pick EPO abuse if they have above changes)

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13
Q

CML translocation and tx

A

9,22 = BCR-ABL

–>Tyrosine Kinase inhibitor = Imatinib

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14
Q

wbc and LAP in CML vs Leukomoid Rxn

A

CML: wbc&raquo_space;> (up to over 100k). LAP low
Leukomoid: wbc&raquo_space; (up to 50k). LAP high.

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15
Q

what increases appetite in cancer/cachetic pt with anorexia?

A

Progesterone analog (megestrol acetate), Corticosteroids

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16
Q

Why are asplenic patients at increased risk of encapsulated organism infection?

A

Splenic macrophages make opsonizing antibodies, which facilitiates phagocytosis of encapsulated organisms. These capsules protect against innate phago and req antibody-mediated complement activation

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17
Q

Drugs that cause megaloblastic anemia

A

*have BLAST with PMS
Phenytoin (impair folic acid absorption), Methotrexate, Sulfa’s (including trimethoprim) (these impair folates physiologic effect)

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18
Q

Tx for TTP

A

PLEX
Not platelets
will present with hemolytic anemia and
thrombocytopenia, possibly renal failure, neuro manifestations, and dfever

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19
Q

What is the mechanism of developing skin necrosis at abdominal injection site/thrombocytopenia in patients on heparin?

A

HIT = IgG against heparin-bound platelet factor 4 (PF4)

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20
Q

What kind of anemia do CKD/ESRD patients have?

A

EPO deficiency!!!!!!!!

–>Normocytic normochromic anemia

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21
Q

Most common side effects of EPO injections (i.e. dialysis patient with anemia)

A
  1. Hypertension (duh, increased volume)
  2. HA
  3. flu-like syndrome
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22
Q

PT and PTT in Factor V Leiden

A

Normal sonny boy!
“the assembly line is fine, and that’s what we are measuring”. the factor 5 functions straight, you make fibrin normal speed. problem is you can’t turn it off, so once the fibrin comes off the line its piling up you aren’t turning it off as fast.

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23
Q

b12 deficiency in whites of eastern european descent

A

Pernicious anemia

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24
Q

Anemia of lymphoproliferative disorders:

A

this means leukemia/lymphoma

–>Bone marrow infiltration by cancer cells

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25
absent CD55
paroxysmal nocturnal hemoglobinuria
26
Increased MCHC and RDW
Spherocytosis
27
most common leukemia age >65
CLL. shit ton of lymphocytes.
28
Painless lymphadenopathy, splenomegaly, resp infections, lymphocytosis, age >60
CLL
29
Peripheral smear for CLL
lymphocytosis + smudge cells
30
how do you dx CLL
Flow Cytometry
31
False prolongation of PTT and hx of clots
Antiphospholipid syndrome (as well as FP syphilis and abortions)
32
criteria that increase pretest probability of DVT: Name and scoring
Wells Critera 2 or higher = DVT likely 1 or 0 = DVT unlikely
33
Wells criteria for pretest probability of DVT
- prior dvt - active cancer - recent immobilization (including bedridden >3 days) - localized pain (along vein dist) - swollen leg - calf swelling >3cm more than other leg - Pitting Edema - non varicose veins
34
Initial test if suspecting DVT
Compression Ultrasound
35
Warfarin inhibits the synthesis of :
vit k dependent clotting factors: 2, 7, 9, 10 and Proteins C and S
36
Dx workup of MM
-Urine/serum protein electrophoresis (m-spike) -Peripheral blood smear (rouleux) -serum free light chain analysis can confirm w/bone marrow bx
37
chronic anemia following gastrectomy or autoimmune gastritis
pernicious anemia = B12 def (loss of intrinsic factor)
38
T/F: B12 deficiency leads to anemia due to abnormal DNA synthesis
true. So even though its a production anemia, will see hemolysis labs (indirect bilirubinemia, increased LDH from intramedullary hemolysis)
39
Leukemoid rxn vs CML
Leuk: wbc>50k, caused by severe infx, HIGH LAP, METAMYELO>MYELO (mature) CML: wbc >100k sometimes, caused by BCR-ABL fusion, LOW LAP, Myelo>Metamyelo (immature), Absolute basophilia
40
Antibodies that bind to platelet surface causes platelet activation, thrombocytopenia, and a prothrombotic state
HIT
41
why are multiple myeloma patients prone to infection?
Neoplastic infilt. of bone marrow --> alters normal lymphocytes --> ineffective antibody production and hypogammaglobulinemia
42
recurrent epistaxis, widespread AV malformations and telangiectasias (red blanching papules)
Osler-Weber-Rendu aka hereditary telangiectasia
43
how does OSA lead to polycythemia?
Get hypoxemia, which results in kidneys increasing EPO
44
hemolysis, cytopenias, venous thrombosis (intraabdominal = abdominal pain). Also, hematuria.
PND
45
Use Eculizumab for this patient with hematuria, venous thrombosis and hemolytic anemia
PND
46
most common leukemia in the US
CLL: dramatic lymphocytosis with smudge cells in the elderly
47
rare lymphocytic leukemia with splenomegaly and pancytopenia and dry tap on BM bx
Hairy cell leukemia
48
intense itching after hot shower and facial plethora (ruddy cyanosis) and splenomegaly
Polycythemia vera (due to basophils)
49
lab findings in polycythemia vera
Inc Hgb, and inc plt and wbc Low EPO JAK2 mutation
50
Tx polycythemia vera
Phlebotomy and hydroxyurea
51
Low Fe, High Ferritin, Low TIBC, Low Transferrin sat
Anemia chronic disease
52
Low Fe, Low Ferritin, High TIBC, Low Transferrin sat
Iron def anemia
53
Tx for a patient with DVT/PE and contraindication to anticoagulation (sig active bleeding, recent surgery, hemorrhagic stroke)
IVC Filter!
54
Neuropathy, hyperviscosity sxs (diplopia, tinnitus, clots, ) and excessive monoclonal IgM with >10% clonal B cells
Waldenstorm macroglobulinemia
55
Patient has folic and b12 deficiency combined. What does replacing folic acid do?
Corrects the megaloblastosis, but leads to rapid progression of neuro sxs: loss of vibration/proprioception in LE
56
FAT RN
``` TTP: Fever Anemia Thrombocytopenia Renal Failure Neuro sxs ```
57
Adam got high alone to the purp with the fat rn
ADAMSTS13 Hyaline clot TTP Fever, Anemia, Thrombocytopenia, Renal failure, Neuro sxs
58
Dx step when suspecting TTP
Peripheral smear (shows schistocytes)
59
Tx for TTP
Plasma exchange/transfusion
60
causes of transfusion rxns (hypotensive)
1. Anaphylactic ->resp distress w/in minutes. recipient anti-IgA 2 . Transfusion-related acute lung injury ->resp distress and pulm edema within 6 hours. Donor anti-leukocyte 3. Primary Hypotension rxn ->transient hypoT minutes after in pt on ACE-I. Due to bradykinin in blood products
61
Spherocytes on blood smear + anemia
Hereditary spherocytosis OR Autoimmune Hemolytic Anemia

Step 2 UWORLD (17 decks)

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