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INTERNAL MED IP/OP > Heme/Onc > Flashcards

Heme/Onc Flashcards

1
Q

What are the macrocytic anemias? What would we see on a blood smear with these anemias?

A

B12 and Folate deficiency

Megaloblastic (hypersegmented neutrophils)

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2
Q

What would a pt have with B12 deficiency?

A

Peripheral neuropathy

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3
Q

What type of anemia may be secondary to alcoholism?

A

Folate deficiency

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4
Q

What type of anemia is associated with glossitis?

A

Folate (can also occur in B12)

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5
Q

What are the microcytic anemias? What consititues as microcytic?

A 
*TICS* MCV is less than 80
Anemia or chronic disease
Iron def anemia
Thalassemia
Sideroblastic
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6
Q

What are the differences between Anemia of chronic dz and iron def anemia?

A

Both have LOW Serum Iron
Ferritin is NORMAL in ACD
Ferritin is LOW in IDA
IDA will also have a high iron binding capacity

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7
Q

What is the max amount of ferrous sulfate a person absorb/day?

A

Max = 4mg
Males require 1mg
Females require 2mg (more if preggo)

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8
Q

If the iron levels are normal but the MCV is still less than 80, what should you think of?

A

Thalassemia or sideroblastic

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9
Q

What is thalassemia?

A

Reduced or absent beta or alpha chain

*Normal hemoglobin is made up of two alpha globin & two beta globin chains

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10
Q

How do you diagnose a thalassemia?

A

Electrophoresis (Hgb A2 and F)

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11
Q

When would we see Beta thalassemia diagnosed?

A

Intermediate and Major occur between 4-6months when the switch from fetal hemoglobin to adult occurs

Minor is asymptomatic

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12
Q

How do we treat alpha vs beta thalassemia?

A

Alpha H – folic acid supplements, avoid iron supplements

Beta = transfusions, iron chelation

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13
Q

What is the MC cause of sideroblastic anemia? Dx?

A

Lead toxicity

Lead level followed by bone marrow biopsy

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14
Q

What would normocytic anemia be caused from? What are the MCV levels?

A

Acute blood loss, organ failure, or impaired marrow function.

MCV 80-100

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15
Q

What is hemolytic anemia?

A

HIT (hereditary, immune attack, and trauma to the RBCs); characterized by decreased RBC survival and increased cell lysis

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16
Q

What are some of the causes of hemolytic anemias?

A

spherocytosis, elliptocytosis, G6PD, thalassemias, and sickle cell

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17
Q

How might a patient present with hemolytic anemia?

A

Jaundice, delayed puberty (from sickle cell), hepatosplenomegaly, and petechiae and purapura

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18
Q

Target cells are associated with what?

A

Thalassemias

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19
Q

Heinz body or bite cells are associated with what?

A

G6PD

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20
Q

What would we see on labs for G6PD?

A

Increased indirect bilirubin, reticulocyte count, LDH

Decreased Haptoglobin

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21
Q

What causes G6PD?

A

oxidative stress = Infection, meds, and fava beans

22
Q

What meds have to be avoided with G6PD?

A

oxidant drugs = nitrofurantoine, sulfa, TMP-SMX, antimalarials

23
Q

Howell-Jolly cells are associated with what?

A

Folate def (can also be seen in a Sickle cell smear)

24
Q

What is the classification system for leukemias?

A

Acute or Chronic

Myelocytic or Lymphocytic

25
Q

What do you see on labs in a pt with leukemia?

A

Pancytopenia (decreased RBC, platelets, and WBC) OR elevated WBC

Blasts seen on smear = Acute Leukemia

Flow cytometry distinguishes the classification of acute leukemia

26
Q

What type of leukemia MC occurs in young children?

A

ALL – MC form of childhood cancer

27
Q

What type of leukemia typically occurs in adults over the age of 60?

A

AML

28
Q

What type of leukemia presents in young to middle aged adults?

A

CML

29
Q

What type of leukemia has the worst prognosis and occurs in those over the age of 70?

A

CLL

30
Q

Auer rods are associated with what type of leukemia?

A

AML

31
Q

The Philadelphia chromosome is associated with what?

A

CML

32
Q

Smudge cells are associated with what?

A

CLL

33
Q

What is the standard of treatment for acute leukemias?

A

Chemotherapy

*better prognosis in AML if under the age of 60

34
Q

How do we treat CML? CLL?

A

CML = tyrosine kinase inhibitors Imatinib and allogeneic bone marrow transplantation

CLL is palliative care

35
Q

Reed-Sternberg cells are associated with what?

A

Hodgkin disease (along with enlarged spleen and liver)

36
Q

What type of hodgkin’s is found in patients aged 15-45?

A

Hodgkin’s disease

37
Q

How do we treat Hodgkin’s?

A

chemo and radiation

38
Q

Which type of hodgkin’s has a better prognosis?

A

Hodgkin’s

39
Q

What are the B symptoms?

A

Fever, night sweats, weight loss

40
Q

A pt presents with bone pain and anemia – what dx? Workup?

A 
Multiple myeloma
 
Monoclonic spike on serum protein electrophoresis
 
*Bence-Jones protein in urine
 Lytic lesions on xray
41
Q

How do we treat multiple myeloma?

A

chemotherapy, dexamethasone

42
Q

What is the cause of sickle cell anemia?

A

abnormal hemoglobin S

43
Q

What’s worse – sickle cell homozygous or heterozygous?

A

homozygous (heterozygous means they carry the trait)

44
Q

What are some risk factors to vasoocclusive disease in sickle cell?

A

infection with parvovirus B19

COLD, dehydration, hypoxia, stress, menses, and alcohol

45
Q

What are the sxs of vaso-occlusion in sickle cell?

A

sudden pain, commonly chest, back, abdomen, and extremities

46
Q

What are some of the complications of sickle cell?

A

growth issues, Asplenia + recurrent infection, increased risk of stroke, retinopathy

47
Q

How do we diagnose sickle cell?

A

CBC shows hemolysis

Confirmed with hemoglobin electrophoresis

48
Q

How do we treat the chronic form of sickle cell?

A

Folic Acid for ALL!!!

Vaccines: pneumococcal, influenza, and meningococcus

Children under 5: Prophylactic PCN to prevent infection

Hydroxyurea (to increase level of HgF)

49
Q

How do we treat an acute vaso-occlusive episode?

A

O2, hydration, and opioids

If a fever is present give ceftriaxone (cephalosporin allergy = clinda or levo)

50
Q

If a pregnant woman has a DVT can you give warfarin?

A

NO

INTERNAL MED IP/OP (9 decks)

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