Heme Onc DIT Flashcards
1
Q
next step in mgmt:
25 y/o man dx’d with a solitary testicular mas by US
A
orchiectomy
2
Q
classic findings of HSP
A
palpable purpura
GI sx’s (e.g. abd’l pain, vomiting, guaiac+, intussusception)
renal disease
transient arthritis/arthralgias
3
Q
What variables shift the Hb-O2 dissociation curve to the right
A
“CADET-face RT”
C: incr'd A: incr'd altitiude/acid (i.e. decr' pH) D: incr'd DPG3 E: exercise T: incr'd temp
4
Q
what effect does a right shift on Hb-O2 curve have
A
Incr’d delivery of O2 to peripheral tissues
5
Q
what is cause of anemia that develops after taking a sulfa drug
A
G6PD deficiency
6
Q
what lab markers suggest anemia due to hemolysis
A
decr'd H&H with incr'd retics normal MCV decr'd haptoglobin incr'd indirect bilirubin incr'd LDH
7
Q
in hemolytic anemia, why is serum haptoglobin level der’d & serum LDH increased
A
Haptoglobin binds free Hb in blood
LDH spills out of hemolyzed RBC’s
8
Q
characteristic findings in hereditary spherocytosis
A
jaundice & gallstones (2nd/2 elevated bilirubin)
splenomegaly
anemia with incr’d retics & MCHC
spherocytes on peripheral smear
positive osmotic fragility test
9
Q
spherocytosis is a/w higher incidence of what lab abnormality
A
pseudohyperkalemia
2nd/2 K+ spilling into blood when RBC’s lyse after blood draw
10
Q
tx of hereditary spherocytosis
A
folic acid 1mg qD
splenectomy (moderate to severe cases)
RBC transfusion (extreme cases)
11
Q
Rx for diarrhea 2nd/2 E. histolytica
A
metronidazole (+ hydration)
12
Q
Rx for diarrhea 2nd/2 G. Lamblia
A
metronidazole (+ hydration)
13
Q
Rx for diarrhea 2nd/2 salmonella
A
quinolones or TMP-SMX (+ hydration)
14
Q
Rx for diarrhea 2nd/2 shigella
A
quinolones or TMP-SMX (+ hydration)
15
Q
Rx for diarrhea 2nd/2 campylobacter
A
erythromycin (+ hydration)
16
Q
Rx for mild persistent asthma
A
ACUTE TX: short-acting B2-agonist (i.e. albuterol) IV corticosteroids (for persistent sx's)
LONG-TERM CONTROL:
albuterol, prn
inhaled glucocorticoid
+/- leukotriene inhibitor (e.g. cromolyn)
17
Q
what is charcots triad indicative of & what are the components
A
Dx: cholangitis
TRIAD:
jaundice
RUQ pain
Fever
18
Q
what is reynold’s pentad indicative of & what are the components
A
Dx: cholangitis
PENTAD: jaundice RUQ pain Fever hypotension AMS
19
Q
Iron Def Anemia: serum iron ferritin transferrin Fe/TIBC
A
serum iron: decr’d
ferritin: decr’d
transferrin: incr’d
Fe/TIBC: < 12%
20
Q
Anemia of chronic disease: serum iron ferritin transferrin Fe/TIBC
A
serum iron: decr’d
ferritin: incr’d
transferrin: decr’d
Fe/TIBC: > 18%
21
Q
what is seen on blood smear of a patient with lead poisoning
A
microcytic
hypochromic
basophilic stippling
22
Q
RBC disorder a/w:
schistocyte (fragmented RBC)
A
hemolytic anemia
DIC
TTP
HUS
23
Q
RBC disorder a/w:
acanthocyte (spur cell)
A
abetalipoproteinemia
24
Q
RBC disorder a/w:
bite cell
A
G6PD def
25
RBC disorder a/w:
| basophilic stippling
lead poisoning
B-thalassemia
alcohol
26
RBC disorder a/w:
| peripheral neuropathy and ringed sideroblastic in BM
lead poisoning
27
RBC disorder a/w:
| hypersegmented neutrophils
folate/B12 def
28
```
RBC disorder a/w:
heinz bodies (denatured Hgb in RBC)
```
G6PD def
29
RBC disorder a/w:
| burr cells
uremia
30
MCV & anemia a/w:
| mental status changes, neuropathy, constipation
microcytic
lead poisoning
31
MCV & anemia a/w:
| heavy menses, strict vegetarians, ice pica
microcystic
iron def
32
MCV & anemia a/w:
| dark urine, jaundice, hepatosplenomegaly
normocytic
hemolytic anemia
33
MCV & anemia a/w:
| alcoholic, malnourished
macrocytic
folate/B12 def
34
what virus can cause aplastic anemia as well as erythema infectiosum disease (i.e. "fifth disease")
Parvovirus B19
35
what test is used to rule out urethral injury
retrograde cystourethrogram
36
lipid-lowering agent:
| SE = facial flushing
niacin
37
lipid-lowering agent:
| SE = elevated LFT's, myositis
statins
fibrates
38
lipid-lowering agent:
| SE = GI discomfort, bad taste
bile acid sequestrants
| e.g. cholestyramine
39
lipid-lowering agent:
| best effect on HDL
niacin
40
lipid-lowering agent:
| best effect on TG's
fibrates
41
lipid-lowering agent:
| best effect on LDL/cholesterol
statins
42
lipid-lowering agent:
| binds C. Diff toxin
cholestyramine
43
which types of thalassemias are most commonly a/w pts of Mediterranean & AA/Asian descent
MEDITERRANEAN: B-Thal
AA/ASIAN: a-Thal
44
What complication occurs in 10% of pts with sideroblastic anemia
```
myelodysplastic syndrome (aka "refractory anemia)
--> acute leukemia
```
45
Besides Staph Aureus, which organism may be responsible for osteomyelitis in a sickle cell pt
salmonella
46
Which vaccines are particularly important in children with sickle cell disease
HiB
Pneumoccal
Meningococcal
Influenza
Hep B
47
What medication is used in the long-term management of sickle cell anemia
Hydroxyurea
48
drugs a/w elevated prolactin levels
METHYLDOPA
PSYCHIATRIC DRUGS
phenothiazines
haloperidol
risperidone
49
what substances cause hemolysis in px with G6PD def
```
primaquin
dapsone
sulfonamides
fava beans
isoniazid
nitrofurantoin
high-dose ASA
```
50
when would you expect eosinophillic casts in urine
acute interstitial nephritis, AIN
| i.e. allergic interstitial nephritis
51
differential dx for eosinophilia
"DNAAACP"
```
D = drugs (e.g. NSAIDS, PCN's/Ceph's)
N = neoplasms
A = allergies/asthma (churg-strauss), allergic bronchopulmonary aspergillosis
A = adrenal insufficiency (Addison's)
A = AIN (allergy-induced)
C = CVD's (e.g. PAN, dermatomyositis)
P = parasites (e.g. strongyloides, Ascaris --> Loeffler's eosinophilic pneumonitis)
```
52
what is the management in a px with febrile neutropenia due to chemo
admit
culture
start broad-spectrum antibiotics
(e.g. cefepime/ceftazidine)
53
what type of infection causes eosiniphilia
parasitic
54
immunoglobulin a/w eosinophilia
IgE
55
what type of hypersensitivity is good pasture
type II HSN
56
what is the treatment for type II hypersensitivity
anti-inflammatories
immunosuppressives (e.g. corticosteroids)
possibly plasmaphoresis
57
most important medication for anaphylaxis
epinephrine
58
Tx for anaphylaxis
```
ABC's
stop offending agent
epinephrine IM or IV (for AW obstruction)
H1/H2 blockers (for cutaneous sx's)
bronchodilators
steroids
IVF's (for hypotension)
```
59
Dx
| 45 yo with acute flank pain and hematuria
nephrolithiasis
60
MCC of aortic stenosis in 50 y/o
congenital bicuspid aortic valve
61
MOA:
| streptokinase
activates tissue plasminogen --> cleaves fibrin clots
62
MOA:
| aspirin
Cox-2 inhibitor --> blocks plt aggregation
63
MOA:
| clopidogrel
inhibits ADP receptor
64
MOA:
| abciximab
Gp2b3a Inhibitor
65
MOA:
| tirofiban
Gp2b3a Inhibitor
66
MOA:
| ticlopidine
inhibits ADP receptor
67
MOA:
| enoxaparin
LMWH --> inhibits CF Xa
68
MOA:
| eptifibatide
Gp2b3a Inhibitor
69
classic triad of HUS
hemolytic anemia
uremia
thrombocytopenia
70
what is the pentad of TTP
```
hemolytic anemia
uremia
thrombocytopenia
neurologic sequelea
fever
```
71
lab test to monitor:
| warfarin
PT/INR
72
lab test to monitor:
| heparin
PTT
73
lab test to monitor:
| LMWH
doesn't need monitoring
| h/w it can be monitored with anti-CF Xa
74
drugs known to cause thrombocytopenia
heparin (HIT)
abciximab (GP2b3a inhibitor)
carbamazepine, phenytoin, valproate
cimetidine
acyclovir, rifampin
sulfonamides
(e.g. sulfasalazine, TMP-SMX)
procainamide, quinidine
quinine, gold compounds
75
1st line Rx for vWD
desmopressin, DDAVP (increases vWF secretion)
76
Rx for vWD that is severe or refractory
cryoprecipitate or Factor VIII
77
Rx for vWD with menorrhagia
OCP
78
MCC's of DIC
"STOP Making Thrombi"
```
S = sepsis
T = trauma
O = OB complications
P = pancreatitis
```
M = malignancy
T = transfusions
79
PLT's, BT, PT, PTT:
| HUS/TTP
PLT's: decr'd
BT: incr'd
PT: normal
PTT: normal
80
PLT's, BT, PT, PTT:
| hemophilia A or B
PLT's: normal
BT: normal
PT: normal
PTT: incr'd
81
PLT's, BT, PT, PTT:
| vWD
PLT's: normal
BT: incr'd
PT: normal
PTT: incr'd
82
PLT's, BT, PT, PTT:
| DIC
PLT's: decr'd
BT: incr'd
PT: incr'd
PTT: incr'd
83
PLT's, BT, PT, PTT:
| warfarin use
PLT's: normal
BT: normal
PT: incr'd
PTT: incr'd
84
PLT's, BT, PT, PTT:
| aspirin
PLT's: normal
BT: incr'd
PT: normal
PTT: normal
85
PLT's, BT, PT, PTT:
| end stage liver disease
PLT's: normal/decr'd
BT: normal/incr'd
PT: incr'd
PTT: incr'd
86
what is the MC mutation that predisposes white pt's to venous thrombosis
Factor V Leiden mutation
87
Dx & Tx:
| post-op pt with poor urine output, BUN 85, Cr 3 & clear lungs
Dx: Prerenal azotemia (2nd/2 dehydration)
Tx: IVF's
88
what infection causes aplastic crisis in sickle cell pt's
Parvovirus B19
89
Dx:
| pt presents with glomerulonephritis plus b/l sensorineural deafness
Alport's Syndrome
90
Tx of shock
IVF's & pressors
blood, urine, & sputum cultures (BEFORE starting antibiotics)
CXR
empiric antibiotics
insulin drip
continuous cardiac monitoring & central venous pressure measurments
91
man returns from African safari c/o periodic fevers, chills, diaphoresis, muscle aches, & fatigue; how could he have avoided illness
prophylactic anti-malarials
92
Tx for infectious mononucleosis
rest & plenty of fluids
NSAIDS or Tylenol (for fever, sore throat, & malaise)
gradual return to sports
(incr'd risk of splenic rupture):
NONCONTACT: 3 wks after sx onset
CONTACT: 4 wks after sx onset
93
what is the spectrum of conditions related to blood infections
bacteremia
SIRS
sepsis
severe sepsis
septic shock
multiple organ dysfxn syndrome
94
definition:
| bacteremia
bacteria of any amount in the blood that does not meet criteria for SIRS
95
definition:
| SIRS
Systemic Inflammatory Response Syndrome (SIRS) WITHOUT an identified source of infection
(NOTE: criteria may be met due to other causes independent of infection or source may never be found)
96
what are the 4 categories for SIRS criteria
temperature
tachycardia
tachypnea
WBC's
97
how many of the SIRS categories must be present to meet the SIRS criteria
2 or more
98
What is the SIRS "temperature" criteria
> 38.3C or < 36.0C
99
What is the SIRS "tachycardia" criteria
HR > 90 bpm
100
What is the SIRS "tachypnea" criteria
RR > 20 bpm or PaCO2 < 32
101
What is the SIRS "WBC's" criteria
ANY 1 OF THE FOLLOWING:
> 12,000
> 10% bands
< 4,000
102
Criteria:
| SIRS
CRITERIA: 2 or more of the following:
```
TEMPERATURE:
> 38.3C
< 36.0C
TACHYCARDIA:
HR > 90
TACHYPNEA:
RR > 20 bpm
PaCO2 < 32
WBC'S:
> 12,000
> 10% bands
< 4,000
```
103
definition:
| sepsis
SIRS WITH an identified source of infection;
(FYI: if SIRS criteria met & there is no obvious source of infection, w/u should include urine, blood, & sputum cultures)
104
definition:
| severe sepsis
SEPSIS + 1 OF THE FOLLOWING:
organ dysfxn
hypotension
hypoperfusion
105
what signs are evidence of organ dysfxn, hypotension &/or hypoperfusion seen in severe sepsis
lactic acidosis
SBP < 90 mmHg
SBP drop > 40 mmHg
106
definition:
| septic shock
SEVERE SEPSIS + hypotension , despite adequate fluid resuscitation
107
definition:
| multiple organ dysfxn syndrome
SEPTIC SHOCK + evidence of 2 or more organs failing
108
SUMMARIZE the spectrum of conditions related to blood infections with definition of each
BACTEREMIA: bacteria in the blood that does not meet criteria for SIRS
SIRS: 2+ criteria met WITHOUT source of infection identified
SEPSIS: SIRS + source of infection identified
SEVERE SEPSIS: sepsis + organ dysfxn, hypotension, or hypoperfusion
SEPTIC SHOCK: severe sepsis + hypotension, despite adequate fluid resuscitation
MULTIPLE ORGAN DYSFUNCTION SYNDROME:
septic shock + evidence of 2+ organs failing
109
classic EKG finding in PE
"S1Q3T3"
wide S in Lead I
large Q in lead III
inverted T wave in lead III
110
Dx:
| post op px with pain presents with hyponatremia and normal volume status
SIADH (2nd/2 stress)
111
Rx for mild unconjugated hyperbilirubinemia
phototherapy
112
Rx for severe unconjugated hyperbilirubinemia
exchange transfusion
113
what is the initial HAART regimen
2 NRTI's + EITHER:
1 protease inhibitor
1 NNRTI
may be add ritonavir
114
antiretroviral a/w:
| SE of lactic acidosis
NRTI'S
115
antiretroviral a/w:
| SE of GI intolerance
protease inhibitors
116
antiretroviral a/w:
| SE pancreatitis
zalcitibine
didanosine
stavudine
ritonavir
117
antiretroviral a/w:
| SE of peripheral neuropathy
zalcitibine
didanosine
stavudine
118
antiretroviral a/w:
| SE of megaloblastic anemia
zidovudine
119
antiretroviral a/w:
| SE of rash
NNRTI's
120
antiretroviral a/w:
| SE of hyperglycemia, DM, lipid abnormalities
protease inhibitors
| e.g. indinavir, sequinavir, amprinavir
121
antiretroviral a/w:
| SE of BM suppression
zidovudine
122
antiretroviral a/w:
| given to pregnant woman with HIV
HAART regimen with zidovudine
123
antiretroviral a/w:
| regimen for occupational HIV exposure
LOW-RISK: zidovudine + lamivudine
HIGH-RISK: 3-drug HAART regimen
124
what bugs are tx prophylactically in AIDS pt's with CD4+ < 200 and what is rx is given
PCP: TMP-SMX
TOXOPLASMOSIS: TMP-SMX
MAC: Macrolide (e.g. clarithromycin or azithromycin)
125
Tx for acute toxoplasmosis in AIDS pt
pyrimethamine or sulfadiazine
126
HIV prophylaxis for TB
INH
127
AIDS criteria
ANY OF THE FOLLOWING:
HIV+ with CD4+ < 200
HIV+ with CD4+ < 15% of total lymphocytes
HIV+ with "AIDS-defining illness"
128
what are some examples of "AIDS-defining illness"
THERE ARE MANY (refer to SU p.144-145):
esophageal candidiasis
PCP
toxoplasmosis
MAC
129
tumor marker:
| hepatocellular carcinoma
AFP
130
tumor marker:
| colon cancer
CEA
131
tumor marker:
| gastric cancer
CEA
132
tumor marker:
| pancreatic cancer
CA 19-9
CEA
133
tumor marker:
| ovarian cancer
CA-125
134
dx:
| young black man with painless hematuria
sickle cell trait
135
MCC of aortic stenosis in a 70 y/o
senile (i.e. degenerative) calcifications
136
labs in DIC
ELEVATED:
fibrin-split products
D-dimers
DECREASED:
fibrinogen
platelets
hematocrit
137
which type of RTA is a/w abnormal H+ secretion & nephrolithiasis
RTA I
138
what is the classic presentation of polycythemia vera
thrombosis
erythromelalgia (i.e. burning pain in hands & feet)
pruritis (esp after warm bath/shower)
facial plethora
hepatosplenomegaly
visual disturbances
abnormal labs
139
what visual distrubances are seen with polycythemia vera
blurred vision
amaurosis fugax
scintillating scotoma
ophthalmic migraine
140
what lab abnormalities are seen with polycythemia vera
elevated H&H
elevated red cell mass
basophilia
leukocytosis
thrombocytosis
141
what is the Rx for polycythemia vera
phlebotomy
| FYI: induces a desirable iron def anemia --> DO NOT supplement with iron
142
what is used in px with polycythemia vera with high risk of thrombosis; which pts are considered "at risk"
hydroxyurea
```
"AT RISK":
h/o thrombosis
plts > 1,500,000
CV RF+
> 70 y/o
```
143
what is used in px with polycythemia vera with refractory pruritis or refractory erythrocytosis
IFN-a
144
what tests will help in dx of MM
SPEP: monoclonal AB spike
UPEP: bence-jones proteins
BM BX: incr'd plasma cells
145
Dx
| px with weight loss, pruritis, night sweats, hepatosplenomegaly, nontender cervical lymphadenopathy
Hodgkin's lymphoma
146
Dx:
| 3 y/o girl presents with abd'l mass, hematuria, & HTN
Wilm's tumor
147
Dx & Tx:
| recent Cuban immigrant with sx's of malabsorption is found to also have megaloblastic anemia
Dx: Tropical sprue
Tx: folate & antibiotics (e.g. tetracycline or sulfa)
148
cell pathology a/w:
| EBV
Burkitt's lymphoma
149
cell pathology a/w:
| reed sternberg cell, cervical lymphadenopathy, night sweats
Hodgkin's lymphoma
150
cell pathology a/w:
| bence jones proteins, osteolytic lesions, high Ca2+
MM
151
cell pathology a/w:
| translocation 14:18
follicular lymphoma
152
cell pathology a/w:
| MC lymphoma in US
diffuse large B cell lymphoma
153
cell pathology a/w:
| translocation 8:14
burkitt's lymphoma
154
cell pathology a/w:
| translocations 9:22
philadelphia (CML or ALL)
155
cell pathology a/w:
| MC hodgkin lymphoma
nodular sclerosing
156
cell pathology a/w:
| starry sky pattern due to phagocytosis of apoptotic tumor cells
burkitt's lymphoma
157
cell pathology a/w:
| high H&H, pruritis (esp after hot bath or shower), burning pain in hands or feet
polycythemia vera
158
cell pathology a/w:
| white cells with hair-like projections & splenomegaly
hairy-cell leukemia
159
cell pathology a/w:
| macrocytosis, hypogranular granulocytes with bilobed nuclei
myelodysplastic syndrome
160
Rx for CML
imatinib
161
leukemia a/w:
| MC in children (peak age 3-4 y/o)
ALL
162
leukemia a/w:
| MC in adults (avg age of onset 50 y/o)
CLL
163
leukemia a/w:
| philadelphia Chromosome is always present
CML
164
leukemia a/w:
| smudge cells
CLL
165
leukemia a/w:
| peripheral blasts are PAS+ and TdT+
ALL
166
leukemia a/w:
| peripheral blasts are PAS-, MPO+ and have Auer rods
AML
167
leukemia a/w:
| pancytopenia in a down syndrome px
ALL
168
lung cancer a/w:
| elevated ACTH --> glucocorticoid excess --> Cushing's
small cell lung cancer
169
lung cancer a/w:
| elevated PTH related peptide --> hypercalcemia
squamous cell lung cancer
170
lung cancer a/w:
| elevated ADH --> SIADH --> hyponatremia
small cell lung cancer
171
lung cancer a/w:
| antibodies to presynaptic Ca2+ channels --> Lambert-Eaton syndrome
small cell lung cancer
172
disease that causes glomerulonephritis with deafness
Alport's syndrome
173
MC adrenal tumor in children; lab study used to dx
MC = neuroblastoma
Dx'c = 24-hr urine --> incr'd VMA & HVA
174
Dx:
| 4 y/o girl with URI & dangling thumbs, short stature, & hypopigmentation of some skin areas; labs reveal pancytopenia
fanconi's anemia
