Heme- UWORLD Flashcards

1
Q

94- Q1. What class of Ig is Anti-D antibody? Explain the principle of injecting RhoGAM to prevent erythroblastosis fetalis

A

IgG

First Rh+ fetus may produce Anti-D IgG in Rh- mom, and for second Rh+ fetus this antibody can CROSS PLACENTA and attack fetus RBC. By injecting RhoGAM during third trimester, it sqeusters fetal D antigen, preventing synthesis of Anti-D IgG in mom

  • Don’t have to worry about erythroblastosis fetalis for ABO because it is IgM, which is too big to cross placenta
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2
Q

94- Q 9. Signs of sepsis (low BP, systemic infection signs). What hematologic condition should I think first?

A

DIC

Shistocytes: RBC gets sheared by thrombi.

  • In fact, ONLY ONE abnormal RBC form on blood smear in DIC is shistocytes, no others are noticed in DIC
  • sepsis is S in STOP Making Thrombi
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3
Q

95- Q 1. What is pathophysiology of DIC in obstetrics?

A

placenta damage -> release of tissue factor (enriched in placental trophoblast) -> initiation of extrinsic coagulation cascade

  • obstetrics is O in STOP Making New Thrombi
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4
Q

95- Q 5. mucosal bleeding, which is platelet defect, can be seen in both ITP and von-willebrand disease. What would patient’s history differ between these two?

A
  • ITP: associated with viral illness, NOT chronic
  • von-willebrand disease: decreased vWF, chronic
    => pt may present history of epistaxis even in childhood
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5
Q

95- Q 25. Hepcidin is released from where?

A

liver

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6
Q

95- Q 30. erythroblastosis fetalis vs. hydrops fetalis: they both present similarly ( immediate death, generalized edema, hepatosplenomegaly). What lab test can differentiate these two?

A

coombs test

  • eryrthroblastosis fetalis: positive direct coombs test (maternal anti-D IgM )
  • hydrops fetalis: negative coombs test, no antibody mediated RBC destruction. Barts Hb (gamma4) is just not compatible with life.
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7
Q

95- Q 35. JAK2 mutation is associated with myeloproliferative disorders. What is JAK2

A

CYTOPLASMIC NON-RECEPTOR tyrosine kinase

  • EPO has its own receptor
  • EPO binds to EPO receptor -> cytoplasmic JAK2-STAT binds to ligand bound EPO receptor, stimulating erythropoeisis
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8
Q

96- Q 28. Aplastic crisis vs. Aplastic anemia: what is major difference?

A

aplastic crisis: primarily affecting RBC ONLY. Occurs after parvovirus B19 (naked single stranded DNA)

aplastic anemia: bone marrow issue. Affects all lineages- RBC, platelet, WBC
*aplastic anemia is mismonomer

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9
Q

97- Q 10. smaller and fewer platelets on blood smear, itchy red rash. DIagnosis?

A

Wiskott-Aldrich syndrome

WA
Thrombocytopenia
Eczema (atopic dermatitis)
Recurrent infection

*buzzword: smaller and fewer platelets on blood smear

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10
Q

97- Q 20. 3 week yo baby. Intracranial hemorrhage with signs of increased ICP (abnormal gaze, bulging head). No apparent signs of trauma. Diagnosis?

A

neonatal vitamin K deficiency

  • > vitamin K is synthesized by gut flora (also folate), neonates take time to develop gut flora. Also, vitamin K is not in breast milk as well.
  • tx is intramuscular vitamin K injection
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11
Q

98- Q 7. What is normal liver span?

A

6-15 cm

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12
Q

98- Q 7. Where is major site of platelet squestration?

A

spleen

  • so does RBC
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13
Q

98 - Q 8. Through what surface molecule does cancer cells evade immune destruction by CD8 T cell?

A

PD-1 Ligand (programmed death)

  • PD-1 ligand in cancer cells binds to PD-1 receptor on CD8 T cells, inhibiting CD8 T cell and evade cell mediated cytotoxicity. Targeting PD-1 by drug thus can be used as anti-cancer agent
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14
Q

98- Q 13. MOA of Bortezomib, proteosome inhibitor, in treating multiple myeloma?

A

Bortezomib is a proteosome inhibitor, resulting in accumulation of damaged/cytotoxic/misfolded proteins within plasma cells, leading to APOPTOSIS

  • this drug is NOT in FA
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15
Q

98 -Q25. How does kidney releases EPO?

A

peritubular cells in RENAL CORTEX sense O2 sense hypoxia

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16
Q

98- Q28. Why is asplenic patient has increased risk for encapsulated organism infection?

A

splenic OPSONIZING ANTIBODY is important for SYSTEMIC CLEARANCE of encapsulated bacteria

17
Q

98- Q 36. numerous lymphocytes are observed in lymph node. What finding will ensure that this is cancer?

A

MONOCLONAL expansion of lymphocytes

- commonly checked with T cell receptor rearrangement

18
Q

98- Q 39. What is primarily responsible for excessive bleeding in patients with chronic renal disease?

A

uremic toxin that impairs platelet aggregation
only bleeding time will be increased in lab studies

  • even platelet count is normal
19
Q

99- Q 10. Which vitamin deficiency is associated with megaloblastic anemia in alcoholic patients

A

Folate deficiency

alcoholics= poor nutrition

  • I picked B12 as it is liver that B12 has a storage. But unless patient shows really severed liver disease, liver still have a large reserve of B12. Thus, in alcoholics in general, it is folate deficiency.
20
Q

99- Q 24. Basophilic cytoplasm with high proliferation fraction, Ki-67 fraction. what cancer is this

A

Burkitt lymphoma

  • buzzword: Ki-67 fraction
21
Q

100- Q4. painless lymphadenopathy and lymph node size fluctuates (gets bigger and smaller) over time. Diagnosis?

A

Follicular lymphoma

  • waxing and wanning lymphadenopathy
22
Q

100- Q6. Pure red cell aplasia

  • what is this
  • lab findings
  • associated with what? (2)
A
  • Shit I never heard before
  • normal erythrocyte precursor, normal WBC and platelet. Only RBC is affected: low RBC count, low reticulocytes
  • associated with thymic tumor, parvovirus B19