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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
Q

absent CD55

A

paroxysmal nocturnal hemoglobinuria

26
Q

Increased MCHC and RDW

A

Spherocytosis

27
Q

most common leukemia age >65

A

CLL. shit ton of lymphocytes.

28
Q

Painless lymphadenopathy, splenomegaly, resp infections, lymphocytosis, age >60

A

CLL

29
Q

Peripheral smear for CLL

A

lymphocytosis + smudge cells

30
Q

how do you dx CLL

A

Flow Cytometry

31
Q

False prolongation of PTT and hx of clots

A

Antiphospholipid syndrome (as well as FP syphilis and abortions)

32
Q

criteria that increase pretest probability of DVT: Name and scoring

A

Wells Critera
2 or higher = DVT likely
1 or 0 = DVT unlikely

33
Q

Wells criteria for pretest probability of DVT

A
  • 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
Q

Initial test if suspecting DVT

A

Compression Ultrasound

35
Q

Warfarin inhibits the synthesis of :

A

vit k dependent clotting factors: 2, 7, 9, 10 and Proteins C and S

36
Q

Dx workup of MM

A

-Urine/serum protein electrophoresis (m-spike)
-Peripheral blood smear (rouleux)
-serum free light chain analysis
can confirm w/bone marrow bx

37
Q

chronic anemia following gastrectomy or autoimmune gastritis

A

pernicious anemia = B12 def (loss of intrinsic factor)

38
Q

T/F: B12 deficiency leads to anemia due to abnormal DNA synthesis

A

true. So even though its a production anemia, will see hemolysis labs (indirect bilirubinemia, increased LDH from intramedullary hemolysis)

39
Q

Leukemoid rxn vs CML

A

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
Q

Antibodies that bind to platelet surface causes platelet activation, thrombocytopenia, and a prothrombotic state

A

HIT

41
Q

why are multiple myeloma patients prone to infection?

A

Neoplastic infilt. of bone marrow –> alters normal lymphocytes –> ineffective antibody production and hypogammaglobulinemia

42
Q

recurrent epistaxis, widespread AV malformations and telangiectasias (red blanching papules)

A

Osler-Weber-Rendu aka hereditary telangiectasia

43
Q

how does OSA lead to polycythemia?

A

Get hypoxemia, which results in kidneys increasing EPO

44
Q

hemolysis, cytopenias, venous thrombosis (intraabdominal = abdominal pain). Also, hematuria.

A

PND

45
Q

Use Eculizumab for this patient with hematuria, venous thrombosis and hemolytic anemia

A

PND

46
Q

most common leukemia in the US

A

CLL: dramatic lymphocytosis with smudge cells in the elderly

47
Q

rare lymphocytic leukemia with splenomegaly and pancytopenia and dry tap on BM bx

A

Hairy cell leukemia

48
Q

intense itching after hot shower and facial plethora (ruddy cyanosis) and splenomegaly

A

Polycythemia vera (due to basophils)

49
Q

lab findings in polycythemia vera

A

Inc Hgb, and inc plt and wbc
Low EPO
JAK2 mutation

50
Q

Tx polycythemia vera

A

Phlebotomy and hydroxyurea

51
Q

Low Fe, High Ferritin, Low TIBC, Low Transferrin sat

A

Anemia chronic disease

52
Q

Low Fe, Low Ferritin, High TIBC, Low Transferrin sat

A

Iron def anemia

53
Q

Tx for a patient with DVT/PE and contraindication to anticoagulation (sig active bleeding, recent surgery, hemorrhagic stroke)

A

IVC Filter!

54
Q

Neuropathy, hyperviscosity sxs (diplopia, tinnitus, clots, ) and excessive monoclonal IgM with >10% clonal B cells

A

Waldenstorm macroglobulinemia

55
Q

Patient has folic and b12 deficiency combined. What does replacing folic acid do?

A

Corrects the megaloblastosis, but leads to rapid progression of neuro sxs: loss of vibration/proprioception in LE

56
Q

FAT RN

A 
TTP: 
Fever
Anemia
Thrombocytopenia
Renal Failure
Neuro sxs
57
Q

Adam got high alone to the purp with the fat rn

A

ADAMSTS13
Hyaline clot
TTP
Fever, Anemia, Thrombocytopenia, Renal failure, Neuro sxs

58
Q

Dx step when suspecting TTP

A

Peripheral smear (shows schistocytes)

59
Q

Tx for TTP

A

Plasma exchange/transfusion

60
Q

causes of transfusion rxns (hypotensive)

A
  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
  2. Primary Hypotension rxn
    ->transient hypoT minutes after in pt on ACE-I. Due to bradykinin in blood products
61
Q

Spherocytes on blood smear + anemia

A

Hereditary spherocytosis OR Autoimmune Hemolytic Anemia

Step 2 UWORLD (17 decks)

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