heme/onc misc

Question 1

What 2 things will be low in von willibrand disease

which factor will be low?

Answer 1

low von Willebrand factor and low factor VIII

Question 2

antiphospholipid syndrome is associated with what other disease?

Answer 2

SLE

Question 3

How do you dx antiphospholipid syndrome (5)

Answer 3

• w/ lupus anticoagulant
• prolonged dilute Russell viper venom time (DRVVT) test
• prolonged PTT
• anti-B2 glycoprotein
• anticardiolipin (IgG and IgM)
  *

Question 4

MC genetic hypercoagulable state

Answer 4

Factor V leiden mutation

Question 5

MC genetic bleeding disorder, autosomal dominant

Answer 5

Von Willebrand Disease

Question 6

what is LMWH dosed based on

Answer 6

patients weight

Question 7

1. what is used to monitor anticoagulant medications?
2. What is used to monitor warfarin efficacy
3. What is used to monitor heparin use (but not to determine dosage?

Answer 7

1. monitor anticoags- INR
2. Monitor warfarin efficacy- PT
3. Monitor heparin use- PTT

Question 8

What is virchows triad

Answer 8

• blood stasis
• hypercoagulable state
• vascular injury

Question 9

how do you dx Factor V Leiden

Answer 9

activated protein C resistance assay (Factor V Leiden specific functional assay)- if positive confirm w/ DNA testing

Normal PT/PTT

Question 10

Patients with Protein C deficiency are at an increased risk of what on warfarin

Answer 10

skin necrosis

Question 11

What is the name of the condition:

autoimmune rxn to platelets usually after a viral illness (onset is insidious and chronic)

Answer 11

Idiopathic thrombocytopenic purpura (ITP)

Question 12

How do you diagnose idopathic thrombocytopenic purpura

Answer 12

Dx of exclusion

CBC normal except low platelets (+ direct coombs test)

Question 13

ITP is associated with what 4 conditions

Answer 13

HIV

HCV

SLE
CLL

Question 14

Is direct Coombs test positive or negative in ITP

Answer 14

positive

Question 15

Differency b/w ITP and TTP

Answer 15

ITP-

• insidious and chronic
• CBC nml except low plts
• • direct coombs

TTP-

• acute, F, multi-organ thrombosis
• decr. plt + anemia + schistocytes
• • coombs

Question 16

which 2 drugs cause TTP

Answer 16

Quinidine, cyclosporine & pregnancy

Question 17

presentation of what?

Purpura and “FAT RN” (Fever, anemia, thrombocytopenia, renal failure, neuro sxs)

Answer 17

TTP

Question 18

child

low plts

anemia

renal failure

post-infection (E.coli or shigella

Answer 18

Hemolytic uremic syndrome

Question 19

is coombs test positive or negative in immunologic hemolytic anemia

Answer 19

positive

Question 20

anemia of chronic disease: low or high?

ferritin

serum Fe

TIBC

Answer 20

high ferritin

low serum Fe

Low TIBC

Question 21

which anemia has + osmotic fragility test

Answer 21

hereditary spherocytosis

Question 22

low Microcytic, hypochromic

normal TIBC and ferritin

elevated iron

Answer 22

Thalassemia

Question 23

macrocytic andemia

hypersegmented neutrophils

decreased vibratory position sense

elevated homocysteine

Answer 23

vitamin B12 deficiency

Question 24

What are the 2 MCC of anemia of chronic disease

Answer 24

chronic renal failure

connective tissue disorders

also: RA, SLE, HIV, CA, Cirrhosis, chronic infections, etc

Question 25

Normal or ↓ MCV ↓ TIBC Normal or ↑ Ferritin (because it is not being transported and utilized) +/- decreased EPO

Answer 25

Anemia of chronic disease decr. EPO in anemia of renal failure

Question 26

What 5 drugs can aplastic anemia

Answer 26

ACE-I **sulfonamides** (busulfan) **chloramphenicol** Azathioprine **phenytoin**

Question 27

is reticulocytosis seen in aplastic anemia

Answer 27

no you see reticulocytoPENIA

Question 28

what is the only anemia where all 3 lines are decreased (WBC, RBC, plt)

Answer 28

aplastic anemia

Question 29

what is the most accurate test for aplastic anemia? what is seen

Answer 29

bone marrow bx: normal cell morphology **hypocellular bone marrow** with **fatty infiltration**

Question 30

methylmalonic acid and homocysteine are elevated in which anemia?

Answer 30

Vitamin B12 deficiency

Question 31

What 4 laboratory findings are seen in all hemolytic anemias

Answer 31

↑ Retic, ↑ LDH, ↓ Haptoglobin, and ↑ Bilirubin (indirect)

Question 32

What 6 drugs commonly cause hemolysis in patients with G6PD deficiencyt

Answer 32

antimalarials: primaquine, pamaquine phenacetin, ASA, sulfonamides, dapsone

Question 33

Ferritin less than what is diagnositc for iron deficiency anemia

Answer 33

15

Question 34

At what 3 ages should you check hgb and hct for iron def anemia

Answer 34

12mo, 18mo and 12y/o (female)

Question 35

iron deficiency anemia- how long does it take to correct anemia? to replete iron stores? how often should you recheck blood counts?

Answer 35

how long does it take to correct anemia? **_6 weeks_** to replete iron stores? **_6 months_** how often should you recheck blood counts? **_q3mo x1yr_**

Question 36

What is the most useful test to initially monitor the response of a pt w/ iron deficiency anemia to iron therapy is

Answer 36

retic count (retic response to iron therapy is usualy evident w/in a wk)

Question 37

T/F: iron deficiency anemia can be caused by zinc deficiency

Answer 37

true

Question 38

is the retic count in iron def. anemia low, normal or high

Answer 38

low or inappropriately normal

Question 39

what are 2 common neuro findings in pernicious anemia

Answer 39

loss of position and vibratory sensation

Question 40

What mutation is found in polycythemia vera

Answer 40

Jak2

Question 41

pruritis after hot baths rubor of hands and feet

Answer 41

polycythemia vera

Question 42

What are secondary causes of polycythemia

Answer 42

altitude related COPD sleep apnea genetic neoplasms (pheochromocytoma, liver tumors)

Question 43

patients with polycythemia vera may also have what other condition

Answer 43

gout due to hyperuricemia