HemeOnc Flashcards
1
Q
High TIBC
A
Iron deficiency
2
Q
> 24oz/d cow’s milk + anemia, pica, fatigue, inc RDW
A
Iron deficiency –> oral iron therapy
3
Q
Iron deficiency tx in baby
A
Cows milk b4 9mo
4
Q
High Ferritin
A
Chronic disease –> EPO
5
Q
Low iron, Low TIBC anemia
A
Chronic disease
- high ferritin
6
Q
Low TIBC
Everything else normal or high
A
Thalessemias (Inc A1)
7
Q
High Hb A2
A
B-Thal trait
8
Q
MCV <75, normal RDW, Target cells, Normal iron, ferritin, no response to iron
A
B-Thal trait (inc A2), alpha-thal (normal)
9
Q
Target cells anemia
A
Thal minor
10
Q
Hct >30, RDW NORMAL, RBC count normal to Inc, normal to inc iron, Ferritin, anemia
A
Thal minor
11
Q
Basophilic stippling
A
Thalessemia & heavy metal poisoning
12
Q
RUQ pain w/ inspiration, splenomegaly, same thing in brother
A
Hereditary spherocytosis –> Ca-bilirubin gall stones –> folate & splenectomy
13
Q
Tx for hereditary spherocytosis
A
Folate & tranfusions –> 30+ yr strep risk = vaccination b4 splenectomy + daily PCN
14
Q
Multiple small round dense, hyperchromic (no pallor) RBCs, RUQ pain, Coombs -
A
Hereditary spherocytosis = ankyrin defect –> high MCHC & RDW
15
Q
High retic, hyperUNconjugated bilirubinemia, spherocytes, schistiocytes, osmotic fragility
A
Hereditary spherocytosis
16
Q
High retic, inc MCHC, normal or low MVC, anemia, jaundice
A
Hereditary spherocytosis
17
Q
Thrombocytopenia –> pancytopenia, absent radius/thumb, café-au-lait, microcephaly
A
Fanconi anemia (TAR)
18
Q
Pancytopenia, hypopigmented spots, short, abn thumbs, deafness, strabismus, 7 y/o
A
Fanconi anemia = DNA breaks –> stem cell transplant
19
Q
Swelling of hand/feet, fever, pale, poor feeding
A
Hand-foot syndrome = Sickle Cell
20
Q
85% HbS, 15% HbF
A
Sickle cell disease
21
Q
Management of Sickle cell
A
Vaccinations, PCN until 5, folic acid, HU for vasoocclusive events
22
Q
Sickle cell disease complications
A
ACS, dacylitis, stroke, osteomyelitis, splenic infarction
23
Q
Hx severe arm pain, now weakness, clumsy in right hand, 3 y/o A.A boy
A
Sickle cell stroke = get peripheral smear, retic
24
Q
40%HbS, 60% HbA
A
Sickle cell Trait –> Hematuria, can’t concentrate urine –> polyuria, nocturia, inc UTIs
25
Anemia + high retic, A.A boy, hx hematuria, Abd pain, no vaccines --> death
Sickle cell --> bacterial infection d/t asplenia = PCN until 5 y/o
26
#1 bacteremia bug in sickle cell
Strep pneumo (encapsulated)
27
Howell-Jolly bodies
Sickle cell - sign of aplenia
28
Severe drop in Hb, retic <1%, sudden onset fatigue, dyspnea, NO HSM
Aplastic crisis
29
Retic <1%, BM HYPOCELLULAR, fatty infiltrate, bleeding, petechiae, lethargy, weakness
Acquired aplastic anemia - drugs, chemicals, CCl4, insecticides
30
Hypoplastic, fat-filled marrow
Aplastic Anemia
31
High F Hb (HU increases this)
Sickle cell, beta thal, aplastic anemia
32
Reticulocytosis w/ sickle cell
Hyperhemolytic crisis
33
African American 17 y/o male w/ painless hematuria
Sickle cell trait - d/t papillary ischemia
34
Heinz bodies & bite cells
G6PD deficiency and thalessemias = Hb precipitation
35
Bite cells, RBC inclusions (Heinz bodies), inc indirect bili, inc LDH, dec haptoglobin, jaundice, back pain, DARK urine
G6PD deficiency
| - activity level may be NORMAL during an attack
36
Inc marrow cellularity + megakaryocyte hyperplasia
Essential thrombocytosis
37
Shiny tongue, palmar crease, Hb 7.5, WBC 3500, Hx gastric bypass
B12 deficiency d/t bypass/no IF
38
Everything inc but TIBC dec
Hemochromatosis
39
Absent CD55
Paroxysmal Nocturnal Hemoglobinuria
| - destruction by complement
40
Hemarthroses, epistaxis, joint swelling, young age, family bleeding disorder
Hemophilia A (VIII) or B (IX)
41
Easy bruising, knee swelling after fall, skin ecchymoses, bruising at waistband
Hemophilia (A = VIII, B= IX) --> platelet count and Coag
42
Cause of hemophilia arthropathy
Iron/hemosiderin deposition --> synovitis & fibrosis
43
Normocytic, normochromic anemia, low retic, Hb 7-10, normal platelet, WBC, bilirubin
Anemia of prematurity - FTT, tachypnea, lethargy, cyanosis, tachycardia
44
Weak, abd pain, inc urine prophobilinogen
Acute intermittent porphyria
45
Purpura, large joint arthritis, N/V, melena, normal PT, PTT, Comp & IgA N-Inc
Anaphylactoid purpura
46
Bruising, bloody stool, IVH, baby born at home, inc PT
Hemorrhagic disease of newborn = vit K def (II, VII, IX, X)
47
Venous Hct >65 risk
NEC --> partial exchange transfusion
48
Washing cells/removing WBCs
Prevent febrile transfusion
49
HPT w/ acute monoarthritis, chondrocalcinosis
Pseudogout - CPPD = rhomboid crystal, +
50
Helmet cells
Trauma - DIC, HUS, TTP
51
Drugs that cause folic acid deficiency
TMP-SMX, MTX, Phenytoin, phenobarbital
52
Platelet dysfunctions
vWD, renal failure (uremic coagulopathy)
53
Inc PT (INR) >> aPTT
Vit K deficiency
54
CF + prolonged PT deficiency
Vit K --> low factor VII
55
Lupus anti-coagulant prolongs?
PTT
56
Drop of >50% platelets on heparin
HIT --> stop all heparin & use direct thrombin inhibitor + serotonin release assay
57
Absent Ib-IX-V, mild thrombocytopenia but profuse bleeding, giant platelets
Bernard-soulier
58
Anemia, thrombocytopenia, HS megaly, BONE PAIN/erosions, PAS+ inclusions
Gaucher's
59
Blood transfusions before 1986 and 1992 screened for what?
HBV and HCV, respectively
60
Paresthesias & hypoCa, hypoMag after receiving several PRBC units
Citrate anti-coagulant in whole blood chelates serum Ca
61
Pancytopenia, young A.A female, joint pain, rash, 1+ proteinuria, FPGN
SLE --> peripheral immune destruction of all 3 cell lines
62
Isolated thrombocytopenia, no infections
Immune thrombocytopenia (ITP) ---> steroids then splenectomy or rituximab
BM shows inc MEGAkaryocytes
63
URI weeks ago --> sudden petechiae, epistaxis, thrombocytopenia >30,000
ITP --> Observation; steroids if <30,000
64
Hemolytic anemia, thrombocytopenia, renal failure, HA, fragmented RBCs
TTP-HUS (ADAMTS-13) ---> plasma exchange
65
Painless blisters on dorsal hand (sun-exposed area),fragility, facial hyperpigment, hypertrichosis, inc uroporphyrins, *HCV,* estrogen use or iron overload
Porphyria cutanea tarda --> phlebotomy, hydroxychloroquine or IF-a
66
Deficiency in urobilinogen decarboxylase --> urine porphyrin inc
Porphyria cutanea tarda
67
#1 inherited disorder causing hypercoagulability
Factor V Leiden
68
HCV, palpable purpura, hematuria, proteinuria, low complement
Mixed cryoglobulinemia = Hep C
69
Palpable purpura on butt of kid
Henoch-Schonlein
70
Purpura, normal platelet count, arthralgia, abd pain/bleeding, scrotal swelling
Henoch-Schonlein purpura --> intussusception = IVFs, NSAIDs or steroids --> SURGERY
71
Hematuria, abd pain, purple non-blanching rash on lower legs, normal platelets
Vasculitis/HSP
72
Senile purpura
Perivascular CT atrophy
73
Therapy for iron overload in B-thal or sickle cell
Deferoximine
74
Ruby papules on lips, high Hct, recurrent nosebleeds, digital clubbing
Osler-Weber-Rendu --> AVMs (lungs --> shunt --> polycythemia, hemoptysis)
75
Delayed clamping of umbilical cord --> ?
Polycythemia --> Resp distress
76
Resp distress, poor feeding, neuro sx
Polycythemia
77
Pruritus after warm shower, ulcers, facial plethora, Low EPO
PCV
78
JAK2 mutation
PCV
79
PNA sx but lymphocytosis, smudge cells, how to confirm Dx?
CLL --> flow cytometry
80
Most common leukemia in Western countries
CLL
81
Elderly, lymphocytosis, smudge cells (breakdown/inc fragility)
CLL
82
Reed-Sternberg cells
Hodgkins lymphoma
83
Leukocytosis with neutrophilia, marked splenomegaly, low leukocyte alkaline phosphatase
CML
84
Pt got chemo & rad for Hodgkin lymphoma --> CXR density dx?
Secondary malignancy - also breast, bone, thyroid, GI cancers
85
Numerous infections, weight loss, HSM, LAD, petechiae
ALL = higher in boys, Down
86
Pale, petechiae, fever, fatigue, rubbery non-tender LNs, anemia, widened mediastinum
ALL --> BM Bx
87
LAD, splenomegaly, 80% blasts, Inc prolymphocytes, (-) PAS (+) Tdt
ALL
88
Starry sky appearance
Burkitt lymphoma
89
Tx for acute limb ischemia
Heparin --> surgery --> intra-arterial fibrinolysis
90
Anti-cardiolipin Abs, recurrent thromboses
Antiphospholipid Ab syndrome
91
Poor prognostic indicator in CLL
Thrombocytopenia
92
Cause of death in CLL pts
Infection
93
Temp 101.3, neutrophils 850
Neutropenic fever --> PA --> Zosyn
94
Dry tap, TRAP stain, CD11c
Hairy cell leukemia (B) --> Cladribine (purine)
95
NHL Tx
CHOP
96
CLL tx
Chlorambucil & Prednisone
97
BCR/ABL
CML
| - Hx of radiation exposure
98
9;22 activity
TK in CML, tx = Imatinib
99
Hypocellular + Fibrotic marrow
Myelofibrotic disorders
100
Retinoic Acid receptor
AML (promyelocytic)
101
Excess bone resorption in cancer
PTHrP - Breast CA
102
Excess Ca reabsorption in cancer
Lymphoma (Vit D)
103
Anterior mediastinal masses
Thymoma - Teratoma - Thyroid - Terrible lymphoma
104
Mediatinal mass w/ high b-HCG, normal AFP
Seminoma
105
Mediastinal mass w/ elevated b-HCG, elevated AFP
Mixed germ cell/Non-seminomatous - yolk, chorio
106
Back pain, anemia, renal dysfxn, elevated ESR, constipation
MM --> hyperCa
107
Plasmacytosis, monoclonal proteins, lytic lesions
MM (IgG or IgA)
108
High serum protein, normal albumin (gamma gap) disorders
MM, amyloidosis, waldenstroms, MGUS
109
Gamma gap, anemia, pancytopenia, hyperCa, renal disease
MM
110
MM SPEP
>3g M protein, >10% plasma cells in BM
111
MGUS SPEP
need sketelal x-rays to monitor for --> MM
112
IgM spike, anemia, bruises, night sweats, dizzy, blurry vision, numbness
Waldenstroms
113
Metabolic/electrolyte abnormalities w/ tumor lysis syndrome
HypoCa, HyperPhos, Uric acid, K
114
Frequency of brain mets by cancer type
Lung > Breast > Melanoma > Colon
115
Solitary brain mets
Breast, Colon, RCC
116
Multiple brain mets
Lung, Melanoma
117
Pappenhiemer bodies
Sideroblastic anemia - phagocytes ingest excessive iron
118
LOW Hb and haptoglobin
Inc LDH and bilirubin
*Portal vein thrombosis*
PNH
- no GP1 --> cant bind CD55 or 59 --> destruction by complement
- Dx by flow cytometry
119
Signs and sx of polycythemia in newborn
RESPIRATORY DISTRESS
Poor feeding, hypoglycemia, hypoCa
Tx = hydration or partial exchange transfusion
