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elmaya > Heme/onc > Flashcards

Heme/onc Flashcards

1
Q

List red flags associated with lymphadenopathy (6)

A

Constitutional sx, arthralgias, bruising, petechiae, supraclavicular, large nodes, chronic / non-resolving

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2
Q

List the electrolyte findings seen in tumor lysis syndrome

A

hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia

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3
Q

Bacterial causes of lymphadenitis, and usual antibiotic choice

A

GAS or S. aureus (including MRSA)

Treat with Keflex, amox-clav or clindamycin for MRSA for 10-14 days

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4
Q

What is Parinaud (oculoglandular) syndrome

A

Conjunctivitis and ipsilateral pre-auricular adenopathy

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5
Q

Initial lab work-up of anemia

A

CBC+diff, reticulocyte count, type and cross, coagulation studies, FOBT, bilirubin, haptoglobin, pregnancy test as indicated

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6
Q

Symptoms and lab findings seen in hemolysis

A

Symptoms: jaundice, splenomegaly, dark urine, + symptoms of anemia (fatigue, pallor, syncope, shortness of breath)

Labs would show high retic count, dec haptoglobin, inc LDH, unconjugated bili and heme in the urine

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7
Q

Lab work-up of hemolytic anemia

A

CBC+diff, peripheral blood smear, reticulocyte count, type and cross, antibody screen (indirect Coombs test), DAT, electrolyte, urea/Cr, indirect and direct bilirubin, haptoglobin, LDH

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8
Q

Differential diagnosis of hemolytic anemia

A

DDx: intrinsic (enzyme, Hg, membrane/) vs. extrinsic

Infections – mycoplasma, EBV, CMV, parvovirus
Toxins/meds – lead, naphthalene , quinidine, rifampin, antibiotics, IVIG
Autoimmune – SLE, thyroiditis
Malignancy- lymphoma
Immune disorders- CVID
Mechanical fragmentation – heart valves, HUS, TTP

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9
Q

Management of autoimmune hemolytic anemia (AIHA)

A
  • Transfuse slowly is symptomatic or severe anemia
  • Steroids
  • IVIG, Plasmapheresis, splenectomy
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10
Q

List acquired causes of methemoglobinemia

A

benzocaine, dapsone, chloroquine, nitrates, paraquat, rasbirucase, lidocaine, EMLA, sulfonamide, methylene blue, phenytoin, well-water (high nitrates)

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11
Q

At what level to treat methemoglobinemia, and what is the treatment

A

Treatment: if > 20% MetHg (or > 10% if underlying cardiopulmonary disease)

  • give 1-2 mg/kg of methylene blue (not to give in G6PD)
  • Discontinue any offending agents
  • ascorbic acid
  • Exchange transfusion if failed methylene blue or G6PD
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12
Q

2 causes of pure RBC aplasia

A

Diamond Blackfan anemia

TEC (transient erythroblastopenia of childhood)

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13
Q

DDx of neutropenia (list 6)

A
  • Differential: congenital/ inherited vs. acquired
  • Congenital: cyclic neutropenia, Schwachman-Diamond syndrome, various other syndromes
  • Acquired:
  • Drugs (anticonvulsants – VPA, antibiotics – penicillins, chemotherapy, radiation, etc.)
  • Infectious (viral suppression)
  • Bone marrow infiltrate/failure
  • Nutritional
  • Auto-immune (or neonatal allo-immune NAIT)
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14
Q

Treatment options of ITP

A

Treatment: Depends on degree of bleeding

o Absent to mild bleeding (petechiae, mild epistaxis): observation (or IVIG or steroids)

o Moderate (more severe skin lesions, non-severe mucosal bleeding – epistaxis, menorrhagia): steroids or IVIG (Rhogam is an option if Rh+, risk of hemolysis)

o Severe (bleeding episodes requiring admission or blood transfusions, Intracranial hemorrhage): steroids, IVIG, platelet transfusion, ?urgent splenectomy

All patients: avoid aspirin, NSAIDs, activities that can cause head trauma

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15
Q

IVIG side effects (list 4)

A

risk hypersensitivity reaction, headache, aseptic meningitis, fever/chills, hemolysis, hypotension (and ++expensive)

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16
Q

DDx of RUQ abdominal pain in sickle cell disease

A
  • DDX RUQ pain: liver infarction from sickling, cholelithiasis (chronic hemolysis), hepatitis from infectious cause, pancreatitis, peptic ulcer disease and biliary obstruction
17
Q

Emergency management of priapism in sickle cell

A
  • Oral or IV hydration and pain control
  • Pseudoephedrine orally; terbutaline orally or SC (beta-2 receptor agonist)
  • Urology consultation if no improvement within 3 hours –> may need aspiration
18
Q

Low-risk criteria for discharge home in sickle cell patients with fever

A 
> 6 months 
immunization UTD
less than 5% drop in baseline hemoglobin
Hg greater 60 g/L
stable patients
live close to hospital
reliable caregiver 
- cultures + give 1 dose of ceftriaxone in ED, then levofloxacin or azithromycin or clindamycin x 3 days; follow up within 24 hours
19
Q

Definition of acute chest syndrome

A

1) new infiltrate on CXR
AND
2) chest pain, fever, cough, tachypnea or hypoxemia

20
Q

List 6 complications of sickle cell

A
  • Vaso-occlusive crisis
  • Acute chest syndrome
  • Bacteremia/ sepsis
  • Osteomyelitis
  • Dactylitis
  • Priapism
  • Gallstones
  • Stroke
  • Splenic sequestration
21
Q

4 conditions that can cause an isolated increase in PTT

A

hemophilia type A (VIII), hemophilia type B (IX), von Willebrand disease, heparin administration, factor XI deficiency

22
Q

4 conditions that can cause an isolated increase in INR (PT)

A

warfarin, factor VII deficiency, early liver disease, early vitamin K deficiency

23
Q

Labs for work-up of suspected von willebrand disease

A 
INR/PTT initially normal (apart from type 3 which has prolonged INR)
vWF antigen (quantity) and ristocetin cofactor (quality or function), factor VIII and blood group (vWF lower with type O)
24
Q

Management of bleeding in Von Willebrand Disease

A

DDAVP
TXA
if does not responds to DDAVP- factor VIII-vwF concentration (Humate P)

25
Q

General steps in managing a transfusion reaction

A
  • Stop the transfusion
  • Alert blood bank
  • Make sure blood given to correct patient
  • Supportive care + specific management depending on the cause
  • Investigations (ABO blood type and cross match, DAT, CBC, haptoglobin, urinalysis, creatinine, urea, LDH)
26
Q

List 3 non life-threatening transfusion reactions

A
  1. Allergic transfusion reaction (most common)
  2. Febrile Non-Hemolytic Transfusion Reaction (diagnosis of exclusion - rule out hemolysis, TRALI, sepsis)
  3. Delayed hemolytic transfusion reaction
27
Q

List 5 transfusion reactions that can present with fever

A

Acute hemolysis, anaphylactic, TRALI, septic, febrile non-hemolytic, delayed hemolytic

28
Q

What two things, other than recurrent infections/sepsis, would cause you to consider splenic dysfunction? (prev. question)

A
  • Presence of Howell-Jolly bodies in circulating RBCs
  • “pitted” erythrocytes and Heinz Bodies
  • Mild thrombocytosis and leukocytosis
  • Splenomegaly or splenic atrophy/decreased uptake of radioactive RBCs on imaging
  • Low immune response to vaccines
  • Recurrent Splenic sequestration crises
29
Q

Acute hemolytic transfusion reaction:

List 4 signs/symptoms, 3 lab tests, 4 steps in management.

A

Signs/Symptoms: triad of fever, flank pain, and red/brown urine is rare. Chest tightness, hypotension, apnea

Labs: Coombs (DAT), CBC, urine, LDH, haptoglobin, bili

  1. Stop the transfusion
  2. ABC, complete VS
  3. IVF with NS. No dextrose as this worsens the RBC hemolysis. Titrate IVF to UO of 100-200ml/L to prevent oliguric RF
  4. Vasopressors
30
Q

Hemophilia/vit k deficiency/DIC - list what the changes are to all of INR/PTT/fibrinogen/plts hematology

A

Hemophilia: Normal INR, prolonged PTT, N fibrinogen, N platelets

Vit K def: Prolonged INR, N/inc PTT, N fibrinogen, N platelets

DIC: inc INR/PTT, low fibrinogen, low platelets

31
Q

Common presenting sx of ALL

A

fever, weight loss/FTT, anorexia, lymphadenopathy, hepatomegaly, splenomegaly, pallor, petechiae, epistaxis, back pain, limp, bone pain, CN palsies, headache, head/neck mass

32
Q

Emergency work-up of new leukemia diagnosis

A

Labs: CBC plus differential (blasts, atypical lymphocytes or monocytes), peripheral blood smear (blasts greater 20%), electrolytes including calcium/magnesium/phosphate (TLS), uric acid, renal function (urea, Cr), coagulation studies (INR, PTT), blood group and type, antibody screen, liver function tests and liver enzymes, blood culture if febrile

Imaging: chest xray to assess for mediastinal mass, neuroimaging as needed

33
Q

Treatment of tumor lysis syndrome

A
  • Hyperhydration
  • Allopurinol
  • Rasburicase (not in G6PD)
  • Treatment of hyperphosphatemia: Aluminum hydroxide
  • Alkalinize the urine (not always done, unclear efficacy)
  • No calcium replacement unless symptomatic
  • Hyperkalemia management
34
Q

Hyperkalemia management

A
  • stabilize cardiac membranes: Calcium carbonate if severe ECG changes
  • shift: Ventolin, Insulin/glucose, bicarb (if acidosis)
  • eliminate: Furosemide, Kayexalate
  • ECG
35
Q

Bloodwork findings in HLH

A

high serum ferritin, cytopenias, hypertriglyceridemia, hypofibrinogenemia, transaminitis

36
Q

List 4 tumors in the anterior mediastinum

A

4 T’s: terrible lymphoma, thymoma, thyroid carcinoma, teratoma

37
Q

List 4 complications of mediastinal masses

A
  • SVC syndrome (plethora, facial edema, jugular venous distension)
  • Tracheal obstruction
  • Tumor lysis syndrome
  • Pleural or pericardial effusion
38
Q

common xray findings of bone tumors

A

Xray signs: periosteal elevation (codman triangle), sunburst pattern, lytic lesions,

  • Osteosarcoma: metaphyseal end of long bones (often the knee) –> “sunburst pattern”
  • Ewing sarcoma: diaphysis, ribs –> “Onion skin”

elmaya (5 decks)

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