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Boards Studying > Heme/Onc > Flashcards

Heme/Onc Flashcards

1
Q

Excessive exposure to oxidizing agents (dapsone, nitrites, local/topical anesthetics) can lead to

A

Methemoglobinemia

  • ferrous Fe converted to ferric Fe
  • pulse ox sat is low & not corrected with O2
  • PaO2 is normal
  • Tx with methylene blue or ascorbic acid if CI (G6PD)
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2
Q

microcytic anemia, constipation (GI), forgetfulness, sensory neuropathy, fatigue and unsteady gait. Worked with cars and drinks home distilled whiskey

A

Lead toxicity - impaired heme synthesis

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3
Q

Febrile nonhemolytic transfusion reaction

A

1-6 hours after beginning transfusion

  • Caused by residual plasma/leukocyte debris releasing cytokines in storage
  • Prevent with leukoradiation
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4
Q

gamma tetramers on hemoglobin electrophoresis, tired infant with mild scleral icterus

A

alpha thalassemia - microcytic anemia, elevated erythrocyte count, and target cells

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5
Q

Pt with recent URI tx with amox develops normocytic anemia with reticulocytosis, splenomegaly, mild scleral icterus

A

Warm agglutinin autoimmune hemolytic anemia

  • due to drugs (penicillin), viral infection, autoimmune (SLE), immunodef, lymphoproliferative (CLL)
  • anti IgG-Ab, anti C3 or both
  • treat with corticosteroids or splenectomy
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6
Q

Infection with mycoplasma pneumoniae or infectious mono or lymphoproliferative
Livido reticularis and acral cyanosis with cold exposure, Improves with warming
Anemia

A

Cold agglutinin AIHA

  • anti-IgM and anti-C3 antibodies
  • avoid cold
  • tx with Rituximab
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7
Q

Pt starts dapsone for dermatitis herpetiformis and develops scleral icteris, anemia, dark urine with blood on UA

A

G6PD deficiency - after starting dapsone, TMP/SMX, primaquine

  • erythrocytes unable to produce enough NADPH to protect from oxidative injuries
  • leads to hemolytic anemia
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8
Q

5 year old with bone pain, diffuse LAD, and pancytopenia

A

ALL (>25% lymphoblasts)

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9
Q

Testing for hereditary spherocytosis

A

Autosomal dominant
Coombs negative hemolytic anemia, jaundice, splenomegaly
-eosin-5-malemide (EMA) binding test
-acidified glycerol test

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10
Q

Blood smear finding of a patient with multiple myeloma

A

Rouleaux formation - due to elevated serum protein

Sx of MM: systemic systems, bone pain, normocytic anemia, renal insufficiency, protein gap, hypercalcemia

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11
Q

Side effect of glucocorticoids on CBC

A

leukocytosis due to mobilization of marginated neutrophils into the bloodstream

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12
Q

How to distinguish iron deficiency anemia from thalassemia with CBC

A

iron deficiency: low MCV, increased RDW, low RBCs

  • Mentzer index (MCV/RBC) >13
    thalassemia: low MCV, normal RDW and RBCs
  • Mentzer index <13
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13
Q

66 year old man with constipation, low back pain, and lab evidence of anemia, renal insufficiency, and hypercalcemia

A

Multiple myeloma

- hypercalcemia (from osteolytic bone destruction) –> constipation

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14
Q

Pt receives a blood transfusion. Within minutes starts to wheeze

A

Anaphylactic

  • due to anti-IgA antibodies
  • within a few seconds to minutes
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15
Q

TRALI

A
  • respiratory distress and signs of noncardiogenic pulmonary edema
  • within six hours of transfusion
  • caused by donor anti-leukocyte antibodies
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16
Q

Pt with progressively worsening tingling and burning in the hands and feet. Refinished antique furniture as a hobby. Also has hyper and hypo pigmentation of the skin on the back of the neck. Hyperkeratosis on palms and soles. Plantar and dorsiflexion weak. 1+ DTRs in UE and LE. Anemic

A

Arsenic poisoning

- pressure treated wood

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17
Q

Pt with viral URI sx and pancytopenia

A

Aplastic anemia due to hematopoietic stem cell deficiency

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18
Q

Child presents with splenomegaly, jaundice, and anemia. Multiple family members have had splenectomy in the past.

A

Hereditary spherocytosis

- increased MCHC

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19
Q

Aplastic crisis vs. aplastic anemia

A

Crisis: sudden halt in RBC production, usually due to parvovirus

Anemia: pancytopenia due to bone marrow failure

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20
Q

Homeless man with chronic alcoholism presents with delayed wound healing. He has poor dentition and his gums bleed easily. Why is his wound not healing appropriately?

A

Scurvy - vitamin C deficiency

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21
Q

Tx for HIT

A

stop heparin and start direct thrombin inhibitor (agatroban)

22
Q

side effect of EPO

A

hypertension

23
Q

Pt with increasingly heavy periods, myalgias, arthralgias, petechiae, increased fatigue, and platelets 24,000

A

Immune thrombocytopenic purpura

  • ANA testing is advisable
  • dx of exclusion
  • normal coag studies with platelets <100,000
24
Q

Complications of sickle cell trait

A
  • hgbA (50-60%), hgbS (35-45%), hgbF (<2%)
  • hematuria, hyposthenuria (impairment in concentrating ability)
  • UTIs and splenic infarctions less common
25
Q

Findings on peripheral smear in patient with sickle cell disease with functional asplenia due to autoinfarction

A

Howell-Jolly bodies = nuclear remnants of RBCs that are usually removed by a functional spleen

26
Q

Tx for ITP (child 2-5 with petichiae and low platelets, often preceded by a URI)

A

no mucosal bleeding: observe

w/ mucosal bleeding: IVIG

27
Q

What is elevated in a patient’s blood who has colbalamin (B12) deficiency

A

homocysteine and methylmalonic acid

28
Q

Pt with sickle cell has three weeks of progressive hip pain. X-rays and ESR are normal. Restricted in abduction and internal rotation

A

`Osteonecrosis of femoral head

- disruption of microcirculation

29
Q

managment of elevated lead

A

check venous lead level

chelate if lead >45

30
Q

most common cause of sepsis in SCD

A

Strep pneumo

31
Q

Tx for Burkitt lymphoma

A

Rituximab - CD20 antibody which is on the surface of all B cells

32
Q

26 year old construction worker with irritability, fatigue, muscle aches and microcytic anemia. Peripheral smear shows nucleated erythrocytes surrounded by groups of blue dots.

A

Lead poisoning - basophilic stippling

- order a DMSA

33
Q

NSAIDs can cause `

A

iron deficiency anemia through chronic blood loss from GI tract

34
Q

Tx for warfarin induced intracerebral hemorrhage

A

Prothrombin concentrate complex - contains vitamin K dependent clotting factors

35
Q 
MOA of:
Heparin
LMWH
Abciximab (ReoPro), tirofiban (Aggrastat), and eptifibatide (Integrilin)
Aspirin
A
  • binds to anti-thrombin III (AT III) and increases the rate of AT III inactivation of thrombin and Factor Xa.
  • same as above but has preference for Xa
  • both require significant dose reduction in CKD - don’t use!
  • GPIIb/IIIa inhibitors – decrease platelet aggregation
  • irreversibly inhibits COX-1 in platelets
36
Q

Tumor markers:

  • pancreatic ca
  • ovarian
  • hepatocellular
  • colon
  • medullary thyroid
A
  • Ca 19-9
  • Ca 125
  • AFP
  • CEA
  • Calcitonin
37
Q

normal platelet count, normal PT, prolonged aPTT, increased bleeding time, and a low ristocetin cofactor assay

A

von willebrand disease

-tx is DDAVP

38
Q

Pathophys of ITP

A

autoantibody targeting the platelet glycoprotein IIb/IIIa or platelet glycoprotein Ib/IX

type 2 hypersensitivity

sx: epistaxis, gingival bleeding, petechiae, and ecchymosis with isolated thrombocytopenia
tx: high dose prednisone

39
Q

How to tx HIT

A

stop heparin

- initiate alternate anticoagulation (argatroban, fondaparinux)

40
Q

Tumor Lysis Syndrome electrolytes

A 
Hyperkalemia, hyperuricemia, hyperphosphatemia (inner cell contents)
secondary hypocalcemia (from hyperphosphatemia)
41
Q

Organophosphate poisoning

A

inhibits acetylcholinesterase - build up of ACh - hypermotility and hypersecretions with bradycardia
tx: atropine (sx) and pralidoxime (definitive)

42
Q

Cancer associated with radon

A

lung cancer

43
Q

Rash, GI sx (diarrhea), and liver dysfunction 15 days after a transplant

A

GVHD (CD8 t-lympocyte mediated injury)

- tx: methylprednisolone

44
Q

Burkitt lymphoma translocation/gene

A

t (8;14) c-myc

45
Q

pentad of neurological symptoms, acute renal failure, microangiopathic hemolytic anemia (with the presence of schistocytes), thrombocytopenia, and fever

A

TTP

- tx: plasma exchange

46
Q

Patient’s with APL (subtype of AML with Auer rods) are at extremely high risk of

A

catastrophic hemorrhage due to tumor-induced consumptive coagulopathy
- give all-trans retinoic acid

47
Q

Beta thalassemia major

A

Patients have increased hemoglobin A2 and F
Transfusion dependent
Require chelation due to iron overload

48
Q

6 year old boy with pancytopenia, bleeding gums, short stature, hypopigmented macules, hypoplastic thumbs, flat thenar eminences

A

fanconi anemia

- dna repair defect

49
Q

drugs to avoid in G6PD

A 
nitrofurantoin
dapsone
isobutyl nitrate
primaquine
rasburicase
50
Q

sideroblastic anemia

A

Acquired causes include exposure to lead, drugs (isoniazid, alcohol, chloramphenicol), collagen vascular disease, and neoplasm.

  • abnormality in iron metabolism
  • microcytic anemia
  • increased ferritin and iron with normal or elevated TIBC
  • anisocytosis and siderocytes
51
Q

35 year old male presents with recurring fevers that wake him up at night. He also noticed an enlarging mass in his neck that hurts after he goes out with his friends and has a few drinks. He also notices an enlarged cervical LN with several other palpable ones

A

Hodgkin lymphoma

  • Pel-Ebstein fevers
  • pain with alcohol
  • pruritis

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