Heme/Urology

Question 1

Normal or ↓ MCV, ↓ TIBC, ↑ Ferritin (high iron stores), ↓ serum erythropoietin

Answer 1

Anemia of chronic disease

Question 2

Tx of anemia of chronic dz

Answer 2

Treatment:

• Erythropoietin 50-150 U/kg IV 3 × weekly
  
  • Treat the underlying disease

Question 3

The only anemia where all three cell lines are decreased ↓ WBC ↓ RBC ↓ Platelets - will have normal MCV and ↓ Retic

Answer 3

Aplastic anemia

Question 4

• (+) osmotic fragility test
• ↑ Retic, ↑ LDH, ↓ Haptoglobin, and ↑ Bilirubin (indirect) and the presence of spherocytes

Answer 4

Hereditary spherocytosis

Question 5

• Very ↓ MCV (microcytic and hypochromic) with a normal TIBC and Ferritin
• Elevated iron and family history of blood cell disorder

Answer 5

Thalassemia

Question 6

↓ MCV (microcytic), ↓ MCH (hypochromic), ↑ TIBC, ↓ Ferritin (best test, low iron stores), Target cells, pica, and nail spooning

Answer 6

Iron deficiency

Question 7

• Chinese and southeast Asians
• Hemoglobin electrophoresis: Hemoglobin H (H disease), Hemoglobin Bart’s (hydrops fetalis), Hemoglobin A (trait)

Answer 7

Alpha thal

Question 8

↑ MCV (macrocytic anemia), Hypersegmented Neutrophils and normal folate, decreased vibratory and position sense

Answer 8

Vitamin B12

Question 9

What is the Differential Diagnosis of Bleeding in the Postoperative Setting?

Answer 9

• Surgical bleeding: Bleeding from a major artery or vein that was missed during surgery must be ruled out first, especially in the immediate postoperative period
• Medications: Inquire about aspirin, clopidogrel, heparin, warfarin, or any other antiplatelet or anticoagulant medication
• Inherited coagulation disorders: Patients with von Willebrand disease may have a history of excessive bleeding after minor procedures or very heavy menses; hemophilia A and B usually present in childhood with spontaneous hemorrhage into joints (hemarthrosis)
• Liver disease: Reduced production of clotting factors
• Renal failure: Uremia impairs platelet function
• Disseminated intravascular coagulation (DIC): Seen with severe sepsis, malignancy, and childbirth complications; leads to bleeding and microthrombi; manifests with diffuse bleeding from wounds and surgical sites, hematemesis, digital cyanosis, renal insufficiency, and stroke

Question 10

An 8-year-old boy with hemophilia A with spontaneous bruising and nosebleed

Answer 10

Factor VIII

Question 11

A 7-year-old boy with hemophilia B with large right knee hemarthrosis

Answer 11

Factor IX

Question 12

A 23-year-old woman with von Willebrand’s disease who develops bleeding complications

Answer 12

First try DDAVP; then cryoprecipitate prn

Question 13

Patient with liver failure and poor nutrition with elevated PT that is refractory to multiple transfusions of FFP

Answer 13

Vitamin K

Question 14

Painless hematuria in a smoker

Answer 14

Bladder cancer = transitional cell carcinoma is the most common type

Question 15

How to classify 5 stages of kidney disease

Answer 15

• Stage 1: normal GFR (≥ 90 mL/min/1.73 m2) plus either persistent albuminuria or known structural or hereditary renal disease
• Stage 2: mild GFR 60 to 89 mL/min/1.73 m2
• Stage 3: moderate GFR 30 to 59 mL/min/1.73 m2
• Stage 4: severe GFR 15 to 29 mL/min/1.73 m2 (symptomatic stage)
• Stage 5: kidney failure GFR < 15 mL/min/1.73 m2

Question 16

What kind of castas are found in renal failure?

Answer 16

Broad waxy casts in urinary sediment are a specific finding in chronic renal failure

Question 17

A 31-year-old man with right flank pain radiating into the scrotum, gross hematuria, right-sided hydronephrosis, and normal abdominal x-ray

Answer 17

Nephrolithiasis

Question 18

• Colicky flank pain radiating to the groin, hematuria, CVA tenderness, and nausea and vomiting

Answer 18

Nephrolithiasis

Question 19

Four main types of kidney stones

Answer 19

• Calcium oxalate (80%): Most common, excess oxalate, hyperparathyroidism, radiopaque - avoid grapefruit juice (makes calcium oxalate stones worse)
• Struvite (10%): Associated with chronic UTI with Klebsiella and Proteus species, radiopaque
• Uric Acid (7%): Form in individuals with persistently acidic urine - Excess meat/alcohol, gout, radiolucent
• Cystine (1%): Rare genetic, radiolucent (young boy with kidney stones)

Question 20

What size stones will pass spontaneously vs needing stent or nephrostomy

Answer 20

Stones < 5 mm will have an 80% chance of spontaneous passage

• Stones > 10 mm are not likely to pass spontaneously. Ureteral stent or percutaneous nephrostomy (gold standard) should be used if renal function is jeopardized. Urgent treatment with extracorporeal shock wave lithotripsy can be used for renal stones of less than 2 cm or for ureteral stones of less than 10 mm

Question 21

Dx imaging of renal vascular disease (1st line vs gold standard)

Answer 21

DX: ultrasound = first imaging in age <60

• Renal Arteriography is Gold Standard for diagnosis
• May hear a renal artery bruit on auscultation

Question 22

A 22-year-old male who develops a right scrotal hydrocele with elevated serum β-HCG

Answer 22

Testicular cancer

Question 23

MCC testicular carcinoma

Answer 23

• Seminoma is the most common type (60%)

Question 24

Postop urinary retention (POUR) causes

Answer 24

• Obstructive causes: Urethral stricture, bladder calculi or neoplasm, foreign body
• Neurogenic causes: Multiple sclerosis, Parkinson disease, CVA, postoperative retention
• Traumatic causes: Urethral, bladder, or spinal cord injury
• Extraurinary: Fecal impaction, AAA, rectal or retroperitoneal mass
• Infectious: Local abscess, cystitis, genital herpes, zoster

Question 25

Acute urinary retention is painful or painless?

Answer 25

Acute = Painful

Chronic = Painless

Question 26

Acute urinary retention has how much in the bladder?

Question 27

Child < 4 years of age with an abdominal tumor that does NOT cross the midline

Answer 27

Wilms tumor

Question 28

Child with painless, unilateral abdominal mass with no other signs or symptoms, also known as

Answer 28

Wilms tumor → nephroblastoma

Question 29

Average age of Wilms tumor

Answer 29

Mean age is 3.5 years