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- Med School Review 🔥 > Heme/Onc > Flashcards

Heme/Onc Flashcards

1
Q

Best initial test for smoker presenting with palpable cervical lymph node

A

Panendoscopy

(esophagoscopy, bronchoscopy, laryngoscopy), then biopsy (suspected SCC of head and neck)

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2
Q

Empiric anticoagulation only for suspected ___, not for suspected ___

A

PE; DVT

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3
Q

Do not use apixaban (or direct factor Xa inhibitors) in ____

A

ESRD (severe renal disease)

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4
Q

Facial plethora (ruddy cyanosis)

A

Polycythemia Vera

+aquagenic pruritus

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5
Q

INH side effects

A

INH: Peripheral Neuropathy, Hepatotoxicity

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6
Q

Increased RBCs DDx

A
  • PV
  • Chronic hypoxia (e.g. OSA)
  • EPO-producing tumors
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7
Q

Smudge cells on smear

A

CLL

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8
Q

Excessive bleeding after dental procedure

A

Hemophilia vs. vWF

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9
Q

B cell only disorders of immunodeficiency

A

XLA, CVID, IgA

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10
Q

B + T cell disorders of immunodeficiency

A

SCID, WAS, Hyper-IgM, Ataxia-telangiectasia

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11
Q

No response to vaccination

A

SCID, XLA, CVID

(Absent/low/dysfunctional B cells)

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12
Q

Recurrent disseminated bacterial infections (SHiN)

A

Complement deficiency

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13
Q

Recurrent GI infections, think these bugs:

A

Salmonella, Campylobacter

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14
Q

Blasts on smear

A

ALL

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15
Q

Recurrent respiratory infection general examples

A

PNA, sinusitis, otitis

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16
Q

T cell only disorders of immunodeficiency

A
  • DiGeorge
  • IL-12 receptor deficiency
  • Hyper-IgE (Job)
  • Chronic mucocutaneous candidiasis
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17
Q

Phagocyte dysfunction

A

CGD, LAD, Chédiak-Higashi

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18
Q

Hematopoietic stem cell transplantation treats:

A

SCID or WAS

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19
Q

Triphalangeal thumbs

A

Diamond-Blackfan Anemia

(Congenital pure RBC aplasia that presents within first 3 months of life as pallor, poor feeding, congenital anomalies such as thumbs, webbed neck, cleft lip, short stature, shielded chest)

Tx: Corticosteroids

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20
Q

Acquired RBC aplasia in healthy children between 6mo to 5yo

A

TEC (Transient erythroblastopenia of childhood)

(Labs: normocytic normochromic anemia and extremely low reticulocyte count)

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21
Q

Most common cause of anemia in preterm infants

A

Anemia of prematurity

(Diminished EPO levels, shortened RBC life span, +/- blood loss)

Path: Premature infant —> Increased O2 concentration in tissues after delivery —> Normal decrease in EPO (erythropoietin) —> decreased BM reticulocyte production —> Expected RBC nadir is worsened due to SHORTER RBC life span (40-50d) from prematurity +/- frequent phlebotomy in NICU —> Early-onset anemia

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22
Q

Low iron/high ferritin/low TIBC

A

ACID (Anemia of Chronic [Inflammatory] Disease)

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23
Q

Microcytic anemia DDx

A

LIT ASS

  • Lead poisoning
  • Iron deficiency
  • Thalassemias
  • Anemia of Chronic Disease
  • Sideroblastic anemia
  • Spherocytosis (normal to low MCV)
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24
Q

RBCs in OSA

A

Elevated (Reactive polycythemia)

(Hypoxemia —> Increased EPO from kidneys —> Elevated H&H)

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25
Q

Spinal mets DDx

A

Lung/breast/prostate cancer, MM

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26
Q

ABO/Rh risk to fetus:

A

AB “O” shit

“Rh negative Nancy” mom

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27
Q

Leukocyte alkaline phosphatase (LAP) levels

A

CMLow** vs. LeukeMORE reaction**

Low LAP = CML, High LAP = leukemoid reaction

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28
Q

Elevated MCHC

A

Hereditary spherocytosis

  • AD North European
  • Gallstones (pigmented)
  • B19 Aplastic anemia
  • AGLT (Acidified Glycerol Lysis Test)
    • Osmotic fragility on AGLT
  • EMA binding test (Eosin-5-Maleimide binding test)
  • Tx: Folate, splenectomy, cholecystectomy, +/-transfusion
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29
Q

Elevated urinary VMA (vanillylmandelic acid)

A

Pheochromocytoma

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30
Q

Upper body edema + weight loss

A

SVC syndrome

(Mediastinal tumor malignancy–SCLC or NHL)

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31
Q

Elevated AFP + malignancy

A

Nonseminomatous germ cell tumor (4 T’s) vs. HCC

  • 4 T’s = mnemonic for mediastinal mass (Teratoma in this case)
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32
Q

Increased in B12 deficiency, Normal in folate deficiency

A

Methylmalonic acid (MMA)

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33
Q

Absent/hypoplastic thumbs

A

Fanconi Anemia

  • AR DNA repair defect presenting 8-16yo with bleeding, fatigue, hearing problems, and absent thumbs
  • Other signs: Macrocytic anemia, short stature, absent thumbs, hypogonadism, microcephaly, hypopigmented areas, café au lait spots, large freckles, strabismus, low-set ears, and hearing problems 2/2 conduction abnormalities
  • Dx: Chromosomal breaks on genetic analysis
  • Tx: HCT
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34
Q

Howell-Jolly bodies

A

SCD or splenectomy

(nuclear remnants within RBCs that are normally removed by spleen; single/blue/round on Wright stain)

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35
Q

Basophilic stippling DDx

A
  • Lead poisoning
  • Heavy metal poisoning
  • Thalassemias
  • Alcoholism
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36
Q

Recurrent hemarthrosis

A

Hemophilia A/B/C

  • A = XR, FVIII
  • B = XR, FIX
  • C = AR, FXI
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37
Q

Fever + hemolysis

A

TTP (Thrombotic thrombocytopenic purpura)

FAT RN

  • Fever
  • Anemia (MAHA)
  • Thrombocytopenia
  • Renal disease
  • Neurological sx
  • Tx: Emergent plasmapheresis! (plasma exchange)
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38
Q

FFP is used for:

A
  • Warfarin reversal
  • Factor V deficiency
  • Factor VIII deficiency (Hemophilia A)
  • ATIII deficiency
  • TTP
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39
Q

Vitamin K-dependent coagulation factors

A

1972 + C & S

(II, VII, IX, X, Proteins C & S)

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40
Q

Procoagulant meds

A
  • TXA
  • Aminocaproic acid (Amicar)
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41
Q

Hemolysis (LDH/Bili/Haptoglobin) + Thrombosis

A

PNH

(Paroxysmal Nocturnal Hemoglobinuria)

  • Genetic absence of CD55 & CD59 protein anchors on RBC surface, allowing complements to attach RBCs –> hemolysis
  • Dx: Absence of CD55/59 on flow
  • Tx:
    • Iron & Folate supplementation
    • Eculizumab (mAb that inhibits complement activation)
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42
Q

Osteoclast inhibitor

A

Bisphosphonates

(Alendronate, zoledronic acid, pamidronate)

  • Tx for hypercalcemia
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43
Q

Anemia in ESRD

A

EPO deficiency

  • Tx = EPO therapy *BUT* always try iron first!
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44
Q

Drugs that induce folate deficiency

A

TMP

  • TMP-SMX
  • Methotrexate
  • Phenytoin
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45
Q

Smudge cells on smear

A

CLL

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46
Q

ALL = lymphoblastic;

A

CLL =lymphocytic

  • ALL = blasts on smear;
  • CLL = smudge cells on smear (+ mature lymphocytes)
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47
Q

Pinpoint bruises

A

Petechiae = LOW PLATELETS!!!

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48
Q

Excessive bleeding after dental procedure

A

hemophilia vs. vWF

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49
Q

Recurrent respiratory

A

e.g. PNA, sinusitis, otitis

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50
Q

Recurrent GI

A

e.g. Salmonella, Campylobacter

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51
Q

Recurrent disseminated bacterial infections (SHiN)

A

Complement deficiency

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52
Q

No response to vaccination

A

Absent/low B cells:

Absent/low B cells:

  • SCID, XLA, or CVID
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53
Q

Primary immunodeficiency:

A

SCID, XLA, CVID, IgA, WAS, Hyper-IgM

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54
Q

B+T d/o:

A
  • SCID
  • WAS (Wiskott-Aldrich Syndrome)
  • Hyper-IgM
  • Ataxia-telangiectasia
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55
Q

B only (humoral):

A
  • XLA
  • CVID
  • IgA deficiency
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56
Q

T only (cellular)

A
  • DiGeorge
  • IL-12 receptor def
  • Hyper-IgE (Job)
  • Chronic mucocutaneous candidiasis
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57
Q

Phagocyte dysfunction

A

CGD, LAD, Chédiak-Higashi

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58
Q

HCT Tx:

A

SCID or WAS

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59
Q

Triphalangeal thumbs

A

Diamond-Blackfan Anemia

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60
Q

Absent/hypoplastic thumbs

A

Fanconi Anemia

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61
Q

Howell-Jolly bodies

A

SCD or splenectomy

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62
Q

Hemarthrosis + easy bleeding + excessive post-dental bleeding

A

think hemophilia A or B (XR) or C (AR)

[VIII, IX, XI respectively]

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63
Q

TTP —> Fat nurse pentad (FAT RN):

A

Fever, Anemia, Thrombocytopenia, Renal symptoms, Neurologic symptoms

64
Q

FFP Tx:

A

Warfarin reversal, Factor V deficiency, Factor VIII deficiency (Hemophilia A), antithrombin III deficiency, TTP

65
Q

Vitamin K-dependent coag factors:

A

1972 + C & S

66
Q

tPA vs. TXA vs. aminocaproic acid (Amicar)

A
  • tPA = thombolytic
  • TXA = clotting promoter
  • Aminocaproic acid = clotting promoter
67
Q

Hemolysis (LDH/Bili/Haptoglobin) + Thrombosis

A

PNH

68
Q

Monoclonal antibody that inhibits complement activation

A

Eculizumab = Tx for PNH

69
Q

Complement-mediated hemolysis of RBCs due to genetic defect of CD55 and CD59 on RBC membranes

A

PNH

70
Q

Osteoclast inhibitor

A

bisphosphonates

(e.g. zoledronic acid, alendronate, pamidronate) = Tx for hypercalcemia

71
Q

Hypercoagulability disorder associated with occult visceral malignancy

(e.g. pancreatic cancer)

A

Migratory superficial thrombophlebitis (Trousseau’s syndrome)

72
Q

HIT Tx

A
  1. Stop heparin
  2. Start direct thrombin inhibitor (e.g. argatroban, dabigatran) or fondaparinux (synthetic pentasaccharide)
73
Q

Carboxylates glutamic acid residues on prothrombin complex proteins

A

Vitamin K

74
Q

Anemia in ESRD

A

Erythropoietin deficiency

(Tx: EPO therapy, but always try iron first)

75
Q

Posterior knee pain/swelling/stiffness

A

Baker cyst

(popliteal cyst)

76
Q

Avulsion of apophysis of tibial tubercle from overuse injury caused by repetitive strain in young children/adolescents w/ recent growth spurt

A

Osgood-Schlatter disease

77
Q

Most common cause of anemia in chronic alcoholics

A

Folate deficiency

78
Q

3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor

A

statins

79
Q

Mediterranean thalassemia

A

beta

80
Q

Southeast Asian thalassemia

A

alpha

81
Q

Antibodies to platelet factor 4 (PF4)

A

Type 2 HIT

(immune-mediated response against PF4 complexed with heparin, leading to DIC-type reaction after >5d of heparin exposure).

82
Q

Warfarin/Heparin:PT/PTT

A

PT prolongation, PTT nl; PT nl, PTT prolongation, respectively

83
Q

BCR-ABL

A

CML translocation t(9,22) causing constitutively active tyrosine kinase

(tx = TKIs, e.g. imatinib).

84
Q

Converts homocysteine to methionine

A

B12 & Folate

85
Q

Important to rule out ____ before starting folic acid replacement

A

B12 deficiency

(can be masked until neuro sx begin)

86
Q

Serotonin receptor antagonists treat:

A

chemotherapy-induced nausea

(e.g. ondansetron; 5HT3-antagonist)

87
Q

Clubbing

A

CF, CV (Cyanotic), Crohn’s (IBD), hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome—also due to cyanotic shunt 2/2 pulmonary AVMs)

  • Any chronic hypoxemia!
88
Q

Elevations in tumor lysis syndrome

A

K+, Phos, Uric acid (KPU)

89
Q

Hx of abd gunshot wounds

A

think splenectomy/SHiN-prone

90
Q

Warm AIHA causes

A

SLE/CLL/PCN

(drugs)/Viral infections

91
Q

Cold AIHA causes

A

Mycobacterial PNA, Mono

(EBV, CML/CLL)

92
Q

High RBCs + low EPO

A

Polycythemia vera

93
Q

Positive Giemsa stain

A

Malaria

(intraerythrocytic parasites)

94
Q

Auer rods

A

AML

(40-60yo + acute presentation)

95
Q

Tumor w/ elevated AFP, elevated B-hCG

A

Nonseminomatous germ cell tumor

  • Yolk sac
  • Choriocarcinoma
  • Embryonal carcinoma
  • Mixed germ cell
96
Q

Tumor w/ normal AFP, normal to elevated B-hCG

A

Seminomatous germ cell tumor

97
Q

Tumor w/ fat or calcium

A

Teratoma

(+/- tooth)

98
Q

Mediastinal mass DDx:

A

4 T’s -

Thymoma,

Thyroid carcinoma,

Teratoma (+ seminomatous, nonseminomatous germ cell),

Terrible lymphoma

99
Q

DDx of Testicular Cancer

A

Varicocele, torsion, spermatocele (cyst), hydrocele, epididymitis, lymphoma

100
Q

Hypotensive crisis

A

think primary adrenal insufficiency

(Addison disease)

101
Q

Hyperpigmentation in Addison disease is due to increased ____

A

ACTH

(melanocyte precursor)

102
Q

Elevated LFTs + DM + Skin pigmentation

A

Hereditary Hemochromatosis

103
Q

HIT Dx gold standard

A

Serotonin release assay

104
Q

Necrosed (purple/black) lesions on abdomen

A

HIT Type 2

(2/2 heparin injection site thrombosis)

105
Q

Microcytic anemia DDx

A

LIT ASS

Lead poisoning,

Iron deficiency anemia,

Thalassemias,

ACID (anemia of chronic inflammatory disease), Sideroblastic anemia, Hereditary Spherocytosis (or normal MCV)

106
Q

Levels of this distinguish folate vs. B12 deficiency

A

Methylmalonic acid

(increased in B12 deficiency, normal in folate deficiency)

107
Q

Elevated AFP

A

Nonseminomatous germ cell tumor (4 T’s) vs. HCC

108
Q

Urinary VMA (vanillylmandelic acid)

A

Pheochromocytoma

109
Q

Upper body edema + weight loss

A

Superior Vena Cava Syndrome 2/2 mediastinal

tumor malignancy

(SCLC or NHL)

110
Q

Increased mean corpuscular Hb concentration

A

Hereditary spherocytosis

111
Q

LAP in CML vs. Leukemoid Rxn

A

CMLow LAP;

High in Leuke”more” reaction

112
Q

ABO/Rh risk variants in mother

A

AB “O” shit…; “Rh
negative Nancy” mom

113
Q

Spine mets DDx

A

Lung/breast/prostate cancer, MM

114
Q

RBCs in pts with OSA

A

RBCs in pts with OSA = Polycythemia (Hypoxemia —> Increased EPO from kidneys —> Elevated H&H)

115
Q

Increased RBCs DDx

A

PV, 2/2 chronic hypoxia (e.g. OSA), or EPO-producing tumors

116
Q

INH side effects

A

Neuropathy, hepatotoxicity

117
Q

Facial plethora (ruddy cyanosis)

A

think PV

118
Q

Do not use apixaban

(or direct factor Xa inhibitors) in

A

ESRD

119
Q

Empiric anticoagulation only for suspected ___, not for suspected ___

A

PE; DVT

120
Q

Best initial test for smoker presenting with palpable cervical lymph node

A

Panendoscopy

(esophagoscopy, bronchoscopy, laryngoscopy) —> then biopsy (suspected SCC of head/neck)

121
Q

Tx of homocysteinemia

A

B6, B12, or folate

122
Q

Hypocalcemia or hypomagnesemia post-transfusion

A

citrate chelation —> Treat with calcium gluconate following massive transfusions!

123
Q

Rapid-onset vs. within a few hours post-transfusion reaction

A

IgA deficiency anaphylaxis and GVHD, respectively

124
Q

Treatment of Cancer-related anorexia/cachexia syndrome (CACS)

A

progesterone analogue (megestrol acetate) or corticosteroids

125
Q

Tx of RA

A

methotrexate, hydroxychloroquine, infliximab/etanercept

(TNF-inhibitors)

126
Q

Fever + hemolytic anemia

A

Think TTP

(FAT RN)

127
Q

Tx of TTP

A

Plasmapheresis

(plasma exchange)

128
Q

Time course for transfusion reactions:

A
  • Seconds to minutes - Anaphylaxis (IgA deficiency)
  • First hour - Acute hemolytic rxn (GVHD)
  • 1-6 hours - Febrile nonhemolytic or TRALI (transfusion-related acute lung injury)
  • 2-10 days - Delayed hemolytic
129
Q

Specialized RBC Tx:

A
  • Washed: IgA deficiency; complement-dependent AIHA; Continued allergic rxns w/ RBC transfusion despite antihistamine Tx
  • Irradiated: BMT; Cellular immunodeficiency (DiGeorge/IL-12/Hyper-IgE); 1st or 2nd degree relative is donor
  • Leukoreduced: Chronically transfused; CMV seronegative at-risk pts (AIDS, transplant pts); Potential transplant recipients; Previous febrile nonhemolytic transfusion rxn
130
Q

B12 deficiency results in impaired DNA synthesis due to

A

decreased purine synthesis

131
Q

Deficiency following total or partial gastrectomy

A

B12 deficiency

132
Q

Drugs that cause folate deficiency:

A
  • Phenytoin
  • Methotrexate
  • TMP-SMX
133
Q

Homocysteinemia complication

A

hypercoagulability

(DVTs)

134
Q

NSAIDs + anemia

A

Iron deficiency anemia

135
Q

How to diagnose TTP?

A

Peripheral blood smear

(schistocytes)

136
Q

Normal liver span at R midclavicular line

A

6-12cm

137
Q

HIV-associated nephropathy (HIVAN)

A

FSGS

(focal segmental glomerulosclerosis)

138
Q

SCD nephritis

A

MPGN or FSGN

(long-term)

139
Q

Northern European

A

Hereditary spherocytosis; Pernicious anemia

140
Q

Hypoxia to 85% during anesthetic procedure

A

Acquired methemoglobinemia

(oxidization of iron in Hb due to topical anesthetic agents or dapsone.)

141
Q

Shiny tongue + pallor

A

B12 deficiency

142
Q

Megaloblastic

A

impaired DNA synthesis

(folate or B12 deficiency)

143
Q

Hemolysis + hypercoagulability

A

PNH

(absence of CD55/59; complement-mediated RBC hemolysis)

144
Q

Anticoagulation in AKI/CKD

A

Heparin only; AVOID LMWH, fondaparinux, rivaroxaban 2/2 reduced renal clearance.

145
Q

Breast Cancer Screening in Women 50-75

A

Mammogram q2years

146
Q

Cervical Cancer Screening in Women 21-65

A

Pap smear q3years

(or Pap + HPV testing q5years 30-65yo)

147
Q

Colon Cancer Screening in 50-75yo:

A
  • Annual FOBT or
  • Colonoscopy q10years or
  • Sigmoidoscopy q5years + FOBT q3years
148
Q

Colon Cancer Screening in high-risk pts:

A
  • FAP FHx: age 40 or 10 years before age of relative at CRC dx + colonoscopy q3-5years
  • IBD: 8 years post-Dx + colonoscopy q1-2years
  • FAP: Age 10-12 + annual colonoscopy
  • HNPCC (Lynch Syndrome): Age 20-25 + Colonoscopy q1-2yrs
149
Q

Lung cancer screening

A

Low dose CT annually for age 55-80 w/ >30-pack-year smoking hx + currently smoking or quit in past 15 years.

150
Q

HIV in 15-65yo

A

HIV Ab screen 1 time

151
Q

Hyperlipidemia Screen in Men 35+

A

Lipid panel q5years

152
Q

HTN Screen in 18+

A

BP q2years

153
Q

Bladder cancer screening

A

Not currently recommended in anyone

154
Q

Osteoporosis in Women 65+

A

DEXA

(interval uncertain)

155
Q

Lynch Syndrome (HNPCC):

A

AD predisposition to CRC, endometrial, & ovarian cancers.

156
Q

An autoimmune process whereby the body produces IgG antibodies against the platelets

A

ITP

(Idiopathic Thrombocytopenic Purpura)

157
Q

HIV pt with AMS, EBV DNA in CSF, & solitary, weakly ring-enhancing periventricular mass on brain MRI

A

Primary CNS Lymphoma

- Med School Review 🔥 (23 decks)

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