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Step 2 Rotation Cards > Heme/Onco > Flashcards

Heme/Onco Flashcards

1
Q

causes of non megaloblastic macrocytic anemia

A

liver disease - cirrhosis
alcohol
drugs - 5-FU, Ara C, zidovidine
lesch nylan

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2
Q

folate

A

3-6wk supply, green leafy veggies
pt with tea and toast diet

decreased methymalonic acid and increased homocysteine
mcv >100

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3
Q

b12

A

3-10 years, animal products
tingling, numbness - DCMLS affected - 2pt discrimination, proprioception, numbness

strict uneducated vegan or compromised absorption

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4
Q

b12 absorption causes

A

pernicious anemia - IgA attacks parietal cells –> no intrinsic factor

crohns dz - terminal ileum predilection

gastric bypass - bypass parietal cells absorption of b12

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5
Q

dx of b12 def

A

increased methylmalonic acid
increased homocysteine
increased MCV

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6
Q

tx of b12 def

A

PO - nutritionally def pts

IM - impaired absorption pts

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7
Q

schilling test interpretation

A

po b12 given after b12 receptors saturated –>

urine b12 (+) = nutritional issue 
urine b12 (-) = malabsorption
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8
Q

types of microcytic anemia

A

iron def
anemia of chronic dz
sideroblastic
thalassemias

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9
Q

ferritin =

TIBC =

A

ferritin = stored iron

TIBC = potential storage

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10
Q

sideroblastic anemia basics

A

increased Iron

ringed sideroblast on biopsy - iron gets stuck in mitochondria

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11
Q

reversible causes of sideroblastic anemia

A

drugs
etoh
lead poisoning

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12
Q

irreversible causes of sideroblastic anemia

A

b6 def

myelodysplastic syndrome

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13
Q

iron def anemia pt presentation

A

old guy colon cancer +fecal occult blood test

young women with menometrorrhagia

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14
Q

dx of iron def anemia

A

decreased Fe
decreased Ferritin
increased TIBC

bone marrow biopsy = gold standard

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15
Q

tx of iron def anemia

A

iron 324mg TID + stool softeners for constipation side effects

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16
Q

anemia of chronic inflammatory disease

A

RA pts
Lupus pts
asymptomatic anemia

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17
Q

dx and tx of anemia of chronic inflammatory disease

A

increased ferritin
decreased Fe
decreased TIBC

tx - nothing - EPO if severe - better to tx underyling dz

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18
Q

thalassemias

A

problem with globin

minor thal - asymptomatic - no tx
major thal - transfusion dependent - tx = transfusions - with deforaxamine for iron overload

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19
Q

dx of thalassemias

A

nml Fe, nml ferritin, nml TIBC

hemoglobin electrophoresis
alpha 1 - asymptomatic, alpha 2 - mild anemia, alpha 3 - severe anemia, alpha 4- hydrops
beta 1 mild and beta 2 severe

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20
Q

next step after finding anemia that is normocytic

A

LDH
Haptoglobin
Bilirubin
Smear

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21
Q

normocytic anemia with
increased LDH
decreased haptoglobin
increased bilirubin

A

hemolysis

  • sickle cell
  • g6pd def
  • hereditary spherocytosis
  • PNH
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22
Q

normocytic anemia with + smear

A

cancer

  • myelodysplastic
  • leukemia
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23
Q

sickle cell dz

A

cells sickle - HgbSS - AR
vasocclusive crisis –> pain
- acidosis, hypoxemia, dehydration

Acute chest, acute brain, priaprism

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24
Q

dx and tx sickle cell

A

dx - hgb electrophoresis - smear - sickle cells = crisis

tx - hydroxyurea - increased Hgb F, IVF, O2, pain control

exchange transfusion for acute crisis
iron overload - deforaxamine

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25
Q

G6PD def

A

blacks and oxidative crisis with meds:

  • dapsone
  • TMP -SMX
  • Nitrofurantoin
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26
Q

dx of G6PD

A

smear - heinz bodies, bite cells,
during crisis G6PD level nml - check 6-8wks later

tx - remove stressor

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27
Q

hereditary spherocytosis

A

RBC membrane protein problems - ankrin, spectrin, pallidum

dx - smear - best test - osmotic fragility

tx - splenectomy - folate and iron

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28
Q

autoimmune hemolytic anemia

A

+ coombs test
–> IgM - cold myeloplasma, mono –> tx - avoid cold

–> IgG - warm - autoimmune (spherocytes) dz, cancer –> tx –> steroids, rituximab, splenectomy

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29
Q

PNH

A

def of PIGA gene - easier complement formation

shallow breathing at night -> acidotic state -> easier complement formation

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30
Q

PNH dx and tx

A

dx - flow cytometry CD55

tx - supportive if severe Eculizumab

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31
Q

AML basics

A

67 y/o
exposure hx - benzene, radiation, CML hx
acute presentation - infection, fever, weight loss, bone pain, anemia, etc

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32
Q

AML dx and tx

A

dx - smear - blasts - BM biopsy > 20% blasts
- (+) myeloperoxidase and auer rods

tx - M3 - all trans retinoic acid (vit A)
- not M3 = chemo

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33
Q

ALL basics

A

acute presentation

kids - 7 y/o

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34
Q

dx and tx of ALL

A

dx - smear - blasts BM >20% blasts
- (+) tdt and (+) cALLa

tx - chemo and prophylaxis CNS ARA-c (+/- radiation)

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35
Q

CML basics

A

asymptomatic
high high WBC >60,000
middle age 47 y/o

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36
Q

dx of CML

A

BM biopsy - > philadelphia chromosome, t(9:22) BCR-ABL fusion protein, tyrosine kinase

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37
Q

tx of CML

A

imatinib and complication can be ALL crisis

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38
Q

CLL basics

A

asymptomatic
87 y/o

BM biopsy showing lymphocytes

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39
Q

tx of CLL

A

old > 65 + no symptoms –> do nothing
old > 65 + symptoms (hyperviscosity syndrome - HA) –> chemotherapy

young + donor –> stem cell transplant

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40
Q

hodgkin lymphoma

A

reed sternberg cells
night sweats, fever, weight loss

dx = 2a or better
tumor burden = local

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41
Q

hodgkin lymphoma - odd presentations and tx

A

pel epstein fevers (cyclical)
etoh –> painful LN

tx - ABVD or BEACOPP (if severe)

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42
Q

non hodgkin lymphoma

A

(-) B symptoms
2b or worse at dx

spreads hematogenously –> everywhere
burkitt lymphoma - starry sky, extra nodal dz

tx - rutiximab - CHOP

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43
Q

staging of lymphoma

A

I - 1 LN - same side as diaphragm
II - >1 LN - same side as diaphragm
III - >1 LN - opposite side as diaphragm
IV - metastatic disease

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44
Q

presentation of non tender lymphadenopathy –> next step =

A

excisional biopsy

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45
Q

vincristine
vinblastine
ADR

A

Peripheral neuropathy

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46
Q

bleomycin ADR

A

pulmonary fibrosis

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47
Q

cyclophosphamide ADR

A

hemorrhagic cystitis

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48
Q

adriamycin
doxorubicin
danurubicin

ADR

A

cardiomyopathy

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49
Q

cisplatin ADR

A

ototoxicity

nephrotoxicity

50
Q

Multiple myeloma

path

A

produce incomplete IgG –> M spike
make osteoclast stimulating factor –> osteolytic lesions

make bence jones proteins –> AKI

infections and protein gap

51
Q

MM presentation

A 
older 70 y/o 
hypercalcemia 
renal failure 
anemia 
bone pain
52
Q

dx of MM

A

M spike
spep +
skeletal survey +
upep +

53
Q

tx of MM

A

> 70 + no donor = chemo - melphagon + steroids + either thalidimide or bortezumub

< 70 + donor = stem cell transplant

54
Q

MGUS

A 
early myeloma (2% convert to MM) 
asymptomatic, old pts >85 y/o

spep + but (-) upep and (-) skeletal survey –> BM <10% plasma cells

monitor no tx

55
Q

waldenstroms

A

secretes IgM –> M spike
hyperviscosity syndrome
fever night sweats weight loss

56
Q

dx and tx of waldenstroms

A

spep + but (-) upep and skeletal survey (-) BM biopsy –> (>10% lymphoma)

tx - Rituximab based chemo
hyperviscosity tx = plasmaphoresis

57
Q

primary hemostasis

A

endothelial injry -> vWF attaches to glycoprotein on platelet -> adhesion -> activation –> release of TXA2 and ADP -> platelets aggregate –> fibrinogen mesh -> platelet plug

58
Q

secondary hemostasis

A 
Ip     Ep
    10
   5 
   2
   1 --> 1a (fibrinogen) found on platelet plug --> fibrin clot ---> dimers (via plasmin)

plasminogen –> plasmin (via TPA)

59
Q

signs/symptoms of bleeding
superficial, vaginal, skin - petechiae
workup –> CBC (platelet count) –>

A

low –> thrombocytopenia –> destruction, production sequestration

nml –> platelet dysfunction –> NSAIDs, aspirin, clopridogrel, Von Willebrands dz, bernard dz, glanzman dz

60
Q

thrombocytopenia destruction causes

A

ITP
TTP
DIC
HIT

61
Q

thrombocytopenia production causes

A

aplastic anemia

myelodysplastic syndrome

62
Q

Von Willebrands Dz

A

decreased vWF
decreased factor 8
nml plt count

dx - vWF assay

tx - DDAVP, factor 8 infusion

63
Q

bernard soulier dz

glanzman dz

A

bernand - def of glycoprotein 1b

glanzman - def of glycoprotein IIb/IIIa

64
Q

signs/symptoms of bleeding
deep bleeding, hematoma, arthrosis
workup –> PT/PTT –>

A

mixing study –> if no correction –> inhibition

                     --> if corrects ----> 
factor def 
- hemophilia A/B 
- vit K def 
- warfarin 
- von willebrands dz 
- DIC
65
Q

TTP path

A 
hylaine clot 
def of ADAMS T13
66
Q

presentation of TTP

A 
F - fever
A - anemia - MAH 
T - Thrombocytopenia 
R - renal failure
N - neuro symptoms
67
Q

dx and tx of TTP

A

dx - cbc - low plts –> smear - schisocytes - nml PT/PTT - nml fibrinogen - nml d-dimer

tx - exchange transfusion

68
Q

DIC

A

fibrin clot - basically use up all clotting factors and bleed
sick as shit - sepsis, icu, shock –> bleed

69
Q

dx and tx of DIC

A

dx - cbc - low plts -> smear - schistocytes - high PT/PTT
- low fibrinogen - high d-dimer

tx - supportive - fix underlying problem

70
Q

HIT

path and dx

A

antibodies to plts
7-14 days on heparin –> plts drop

dx - HIT abs

71
Q

tx of HIT

A

stop heparin

start argatroban bridge to warfarin

72
Q

ITP

A

abs to plts
women with autoimmune disorder with low plts

dx of exclusion
tx - steroids, if critically low IV Ig –> splenectomy –> if that fails then rituximab

73
Q

APS

antiphospholipid antibody syndrome

A

lupus pt or pt with multiple miscarriages
arterial and venous clots

dx - russel viper venom assay

tx - warfarin 2-3 INR if not working 4-5 range

74
Q

fresh frozen plasma contents

A

contains all the clotting factors
contains RBCs/WBCs/ Platelets

use for - coagulopathy, def of factors,

cant be given if pt vit K def

75
Q

cryoprecipitate

A

contains factor VIII and fibrinogen

for hemophilia A - DIC - and VWDz

76
Q

reticulocyte index
> 2%
< 2%

A

> 2% = excessive RBCs destruction or blood loss and bone marrow is responding

< 2% = inadequate RBC production by bone marrow

77
Q

MCC of thalessemia

A

beta thalessemia minor

78
Q

patho phys of anemia of chronic disease

A

the release of inflammatory cytokines has a suppressive effect on erythopoisesis

79
Q

causes of aplastic anemia

A

idiopathic
radiation exposure
meds - chloramphenicol, sulfonamidses, gold carmbazepine

chemicals - benzene

80
Q

presentation of aplastic aneia

A

pancytopenia
anemia
petechia
increased incidence of infection due to neutropenia

81
Q

other cause of b12 def

A

diphyllobthrium atum infection

82
Q

other causes of folate def

A

MTX

phenytoin

83
Q

causes of warm AIHA

A 
lymphomas - CLL
leukemias
SLE 
Collagen vascular disease 
alpha methyldopa
84
Q

causes of cold AIHA

A

mycoplasma pneumonia

infectious mononucleosis

85
Q

HIT
type 1
type 2

A

type 1 - <48hrs - heparin causes direct platelet aggregation

type 2 - 3-12 days - heparin induced antibody mediated injury to platelets

86
Q

signs of thrombocytopenia

A

petechia
mucosal bleding
epistaxis

ecchymosis at sites of minor trauma

itnracranial hemorrhagen and heavy GI bleeding can occur <5,000

87
Q

TTP basics

A

HUS
Fevere
AMS

88
Q

HUS basics

A

MAE
Thrombocytopenia
Renal failure

89
Q

main complications of HIT

A

venous thrombosis

DVT

90
Q

function of vWF

A

enhances platelet aggregation and adhesion

91
Q

dx of vWD

A

increased bleeding time
nml plts
nml PT/PTT

decreased plasma vWF
decreased factor VIII activity

92
Q

first line tx of vWD

A

desmopressin

if no response then give factor VIII

93
Q

therapeutic range for
heparin
warfarin

A

heparin PTT 60-90

Warfarin INR 2-3 (if mechanical dz - INR 2.5-3.5)

94
Q

DIC tx

A

cryoprecipitates - replace clotting factors and fibrinogen

FFP replaces all clotting factors

give platelets if <30,000

95
Q

vit K basics

A

II VII IX X
Protein C and S
Post translational modification - gamma carboxylation

96
Q

Factor VII

A

shortest half life of all clotting factors so a prolonged PT is what you will see first

97
Q

pts with antithrombin III deficiency

A

do not respond to heparin

98
Q

heparin MOA

A

potentiates the action of AT to primarily inhibit clotting factors IIa and Xa
prolong PTT

99
Q

cholestatsis and affects vit K

A

leads to decreased Vit K absoprtion –> vitamin K deficiency

100
Q

contraindications for heparin use

A

previous HIT
active bleeding - GI bleed, intracranial bleed
hemophilia, thrombocytopenia

severe HTN
recent surgery on eyes, spine or brain

101
Q

antidote for heparin

A

protamine sulfate

102
Q

ADR of warfarin

A

skin necrosis - cause by rapid decrease in protein C

teratogenic

103
Q

clopidogrel MOA

A

blocks the binding of ADP to P2Y12 receptor which reduces platelet activation and aggregation

increases the bleeding time

104
Q

risk factors for breast cancer

A

prior hx of cancer
pts age
family hx
female

unopposed estrogen (early menarche, late menopause, nulliparity)
thoracic radiation
smoking, alcohol consumption

105
Q

Multiple myeloma basics

A

low Hgb
high Ca
poor renal function

106
Q

walden macroglobulinemia

A

hyperviscosity syndrome
can lead to retinal dilation with hemorrhaging and possible blindness

M spike

107
Q

MM tx

A

hematopoietic stem cell transplantation if pt is:
young
asymptomatic
has NOT had chemo before

108
Q

HL with worse prognosis

A

lymphocyte depleted hodgkin lymphoma

109
Q

Rituximab MOA

A

monoclonal antibody against CD20

110
Q

risk factors for NHL

A

HIV/AIDs
immunosuppression
EBV, HTLV-1
H pylori

111
Q

follicular lymphoma basics

A

most common form of NHL
t(14;18)
55 y/o
painless peripheral lymphadenopathy

112
Q

diffuse large cell B lymphoma

A

locally invasive
presents as large extranodal mass

85% cured with CHOP therapy

113
Q

burkitt lymphoma basics

A

B cell lymphoma
african link with jaw and EBV infection
t(8;14)
starry sky night

114
Q

lymphocytic lymphoma

A

t cell lymphoma
may progress to T-ALL
aggressive with rapid dissemination

115
Q

mycosis fungoides

A

t cell lymphoma of skin
eczemoid skin lesions
cribriform shape of lymphocytes

if hematogenous - sezary syndrome

116
Q

CHOP therapy for lymphomas

A

C - cyclophosphamide
H - hydroxydanomycin
O - Oncovin (vincristine)
P - Prednisone

117
Q

Auer rods =

A

AML

118
Q

tumor lysis syndrome

A 
chemo complication 
rapid cell death with release of intracellular contents causes: 
hyperkalemia 
hyperphosphatemia 
hyperuricemia
119
Q

polcythemia vera

A

Jak2 kinase mutation
severe pruritus after hot bath or shower

hyperviscosity syndrome - HA, dizzy, weak
thrombotic bleeding

120
Q

dx criteria of polycthemia vera

A

major

  • elevated RBCs: Men >36, Women > 32
  • O2 sat > 92
  • splenomegaly

Minor

  • thrombolysis
  • leukocytosis
  • LAP > 100
  • B12 > 900
121
Q

tx of polcythemia vera

A

repeated phlebotomy to lower HCT

Step 2 Rotation Cards (14 decks)

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