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Shelves > Heme/Onc > Flashcards

Heme/Onc Flashcards

1
Q

Pentad of: thrombocytopenia, microangiopathic hemolytic anemia (anemia + schistocytes), neurologic signs, renal insufficiency, and fever

A

TTP

Schistocytes on smear (microangiopathic hemolytic anemia) is required, usually LDH is also elevated due to hemolysis

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2
Q

Factor VIII deficiency

A

Hemophilia A

Long PTT

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3
Q

Factor IX

A

Hemophilia B

Long PTT

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4
Q

When do you get concerned about thrombocytopenia?

A

<50,000

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5
Q

Pt has a hard and immobile lymph node. Now what?

A

Get surgery to excise

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6
Q

Middle aged male, gradual onset of fatigue, Inaspirable BM, BM bx reveals CD11c/CD22

A

Hairy cell leukemia

Cancer of B lymphocytes

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7
Q

BM bx with high IgM and lymphoblastic infiltrate

A

Waldenstrom macroglobulinemia
Monoclonal IgM causes hyperviscosity (dizziness, HA, Hearing/vision problems)
Roleaux formation

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8
Q

Diagnostic test for Hemophelia?

A

1:1 mixing studies

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9
Q

Pt with recurrent infections, hepatic fibrosis. Low IgG, IgA but very high IgM

A

Hyper IgM syncrome

X linked deficiency in CD40

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10
Q

Overproduction of RBC, WBC, and plates with chr translocation of 22 and 9

A

CML
Philadelphia chromosome
Fatigue, night sweats, low fever

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11
Q

Insidious bone pain and osteolytic lesion on Xray

A

Multiple myeloma
Need a Sr protein electrophoresis, Urine protein electrophogesis, free light chain analysis
Confirm dx with BM bx

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12
Q

Marked leukocytosis (>50K) after an infection

A

Leukemoid reaction (LR)
High alk phosphatase score
Greater proportion of late PMN precursors (metamyelocytes, bands)
No basophils

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13
Q

Back pain in a pt with suspected malignancy

A

Epidural spinal cord compression
Give IV steroids
May or may not have bowel/bladder dysfunction

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14
Q

Work up for possible SVC syndrome

A

CXR

Suspect small cell lung cancer, non Hodgkins, fibrosing mediastinis, thrombosis.

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15
Q

Hemolysis after taking bacrim. NL G6PD activity

A

G6PD deficiency

Often have NL enzyme activity during hemolytic episode b/c rets will have NL G6PD levels

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16
Q

Management of thrombotic thrombocytopenic purpura (TTP)

A

Plasma exchange
TTP can be life threatening hemoltic anemia and thrombocytopenia
Caused by autoantibodies to plasma protease ADAMTS13

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17
Q

Genetic finding in polycythemia vera

A

JAK2
Tend to have low epo levels (vs. other causes of polycythemia)
Aquagenic pruritis

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18
Q

Initial screening test for thalassemia

A

CBC

Microcytic anemia warrants further testing

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19
Q

Why are MM pts more prone to infection?

A

Impaired effective Ab production

this is d/t BM infiltration by neoplastic cells which alter the NL WBC population leading to hypogammablovulinemia

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20
Q

Microcytic anemia d/t hemolysis in otherwise healthy pt

A

Look for calcific heart valve

“Macrovascular traumatic hemolysis”

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21
Q

Alcoholic with bleeding at venopuncture site

A

Vit K deficiency

d/t inadequate dietary intake, malabsorption, hepatocellular dz

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22
Q

PE most commonly comes from a clot in the?

A

Femoral v.

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23
Q

HD pt has crazy high HTN. Why?

A

Erythropeoietin therapy

Those that receive large doses experience a rapid rise in Hgb leading to HTN

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24
Q

If you suspect TTP (thrombocytopenia, hemolytic anemia) order a?

A

Blood Smear

Look for schistocytes

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25
Q

What lab findings are present in anti phospholipid Ab syndrome

A

Prolonged PTT
Diluted Russell viper venom test
kaolin clotting time

26
Q

Most common cause of B12 deficiency

A

Pernicious anemia

2x risk of gastric cancer

27
Q

Why do multiple myeloma pts get constipation?

A

Hypercalcemia

Fatigue, constipation, depression

28
Q

What are potential infectious causes of ITP?

A

HCV and HIV

29
Q

Macrocytic anemia

hypersegmented PMN’s

A

Folic acid and/or B12 (cobalamine deficiency)

Causes increased homocysteine levels d/t both vitamins being needed in homocysteine metabolism

30
Q

Increased methylmalonic acid concentration is specific to

A

Cobalamin (B12) deficiency

31
Q

Anemia after partial gastrectomy

A

Vit B12 deficiency

Necessary cofactor in purine synthesis -> deficiency leads to defective DNA synthesis

32
Q

Thrombocytopenia after heparin use

A

HIT
Ab mediated platelet activation
heparin -> conformational change on platelet surface exposes a neoantigen -> Ab binds -> platelet activation, thrombocytopenia, prothrombotic state
Type 2 = 5-10 days after heparin

33
Q

Pain, decreased ROM at a joint. X ray w/ osteolytic lesions

“soap bubble” on radiograph in the epihpyseal region of the long bone

A

Giant cell tumor

Benign but locally aggressive

34
Q

Pt works in parking garage presents with HA, nausea, dizziness, polycythemia

A

CO poisoning
Dx - Carboxyhemoglobinemia on ABG
Tx - high flow 100% O2

35
Q

Elevated LFTs
DM
skin hyperpigmentation

A

Hereditary hemochromatosis
“bronze diabetes”
Can progress to cirrhosis, HCC

36
Q

RFs for DVT

A

Immobilization
Surgery
Malignancy
Medication

37
Q

CBC findings in hereditary spherocytosis

A

High Hgb
High RBC distribution width
Triad: hemolytic anemia, jaundice, splenomegaly

38
Q

Tx for CML

A

Tyrosine kinase inhibitors (imatinib)

9;22 forms BCR-ABL fusion creates a constitutively active tyrosine kinase -> leukomogenesis

39
Q

Fatigue
1 or more cytopenias
presents with DIC

A 
APML
AML will look similar but no DIC
Smear = Auer rods
BM bx = hypercellular and premyeloid blasts
Most common adult leukemia
40
Q

Young guy
Hemolytic anemia
Jaundice
splenomegaly

A

HEreditary spherocytosis
RBC membrane fragility
high risk of cholecystitis d/t pigmented gallstones

41
Q

Fever jaundice, abd pain, dark urine
Blood Smear - bite cells, RBC inclusion after crystal violet staining
Dx?

A 
G6PD deficiency
bite cells and Heinz bodies
X linked
Black men
episodic hemolysis in response to oxidant durgs, infection, fava beans
42
Q

Pt with lytic bone mets has hypercalcemia. tx?

A

Bisphosphonates

Stabilize the bone

43
Q

Warfarin inhibits synthesis of vit K dependent factors

A

1972
II, VII, IX, X
Protein C
protein S

44
Q

Best way to improve a patient’s anorexia d/t chronic dz?

A

Progesterone analogue (megestrol acetate, medroxygrogeserone acetate) and steroids

45
Q

When starting chemo, pts are at risk of tumor lysis syndrome. What metabolic abnormalities are seen?

A 
Hyperuricemia
Hyperkalemia
hyperphosphatemia
hypocalcemia (binds phosphate)
Causes ARI, cardiac arrhythmias
Tx fluids, allopurinal
46
Q

How do you manage anticoagulation if you suspect HIT?

A

Stop Heparin
Start DOAC
Once plts return to >150k pt can be switched to warfarin

47
Q

A PE pt cannot tolerate anticoagulation. They need a?

A

IVC filter

48
Q

DVT pt has been taking warfarin since discharge but his diet is inconsistent. His DVT has grown since discharge. How do you manage?

A

Stop warfarin

Start DOAC

49
Q

How do you tx anemia of chronic disease?

A

Treat the underlying disorder

50
Q

Recurrent nose bleeds
Oral lesions
Young pt

A

Hereditary telangiectasia (Osler-Weber-Rendu syndrome)
Develop pulmonary AVMs -> hemoptysis, right to left shunting.
Get an increased HCT d/t shunting

51
Q 
Elderly pt (60) with weight loss, fatigue
Peripheral blood smear -> leukocytosis w/ mature lymphocytes and smudge cells
A

CLL
most common leukemia in the US
median age = 70
Hallmark = lymphocytosis

52
Q

Pt develops fever 2 hours after receiving blood transfussion. What could have prevented this?

A

Leukoreduction of donor blood

This can prevent febrile nonhemolytic reaction by reducin the risk of HLA alloimmunization and CMV transmission

53
Q

Hyperviscosity syndrome (diplopia, tinnitus, HA, dilated funduscopic findings)
Neuropathy
Cryoglobulinemia
serum electrophoresis -> sharp IgM spike

A

Waldenstrom macroglobulinemia
Monoclonal expansion of IgM
(Mult Myeloma would have expansion of IgA, IgG, light chains)
Both W and MM have rouleaux bodies
BM - >10% clonal B cells (MM, plasma cells)

54
Q

Fatigue, dyspnea 2 weeks after amoxicillin tx

Splenomegaly, anemia, high ret count

A

Autoimmune hemolytic anemia d/t abx therapy
+ Direct Coomb’s test with anti-IgG, anti C3
Tx - steroids, splenectomy
Complications - VTE, lymphoproliferative disorders

55
Q

Pain management for a pt with metastatic prostate cancer to the bone that is s/p orchiectomy?

A

Radiation therapy

56
Q

Why are splenectomy pts at increased risk of infection to encapsulated organisms (Strep pneumo, H. flu)?

A

Deficit in Ab response and ab-mediated phagocytosis/complement activation

57
Q

PNA pt has a marked leukocytosis with 85% lymphocytes. What should you do next?

A

Start Abx, fluids
Flow cytometry of the peripheral blood (suspicious for CLL)
Flow will reveal clonality of B cells

58
Q

Pt with significant EtOH and smoking hx and Bx of LN reveals squamous cell carcinoma. CT is NL. Now what?

A

Panendoscopy (esophagoscopy, bronchoscopy, laryngoscopy)

59
Q 
Anemia
High total Bili
High serum lactate
Low serum haptoglobin
Direct Coombs +
A

Autoimmune hemolytic anemia

If + Fhx, and - Coombs think Hereditary Spherocytosis

60
Q

Tx for B-thalassemia minor?

A

Reassurance

Usually mild anemia

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