Hemo mehlman 1st. 12-09 (1)

Question 1

Pale RBC –> think what?

Answer 1

iron deficiency

Question 2

iron deficiency + elderly –> loss via what?

Answer 2

blood loss per rectum

Question 3

elderly, 3 causes blood loss per rectum HY?

Answer 3

diverticular bleed, CRC, and angiodysplasia are HY for elderly.

Question 4

MCC bleeding via rectum in elderly?

Answer 4

diverticular bleed

Question 5

Do colonoscopy to rule out CRC in elderly patient with fatigue, especially if fecal occult blood is positive.

Answer 5

.

Question 6

Angiodysplasia definition?

Answer 6

tortuous superficial intraluminal colonic vessels

Question 7

DDx like ulcerative colitis are of course also possible cause of bleeding per rectum, but previous three are more common and HY

Answer 7

.

Question 8

Fecal ocult positive + elderly + fatigue –> what to do?

Answer 8

Do colonoscopy to rule out CRC

Question 9

Angiodysplasia + ….. = Heyde syndrome.

Answer 9

aortic stenosis

Question 10

Angiodysplasia + aortic stenosis = ?

Answer 10

Heyde syndrome.

Question 11

thalasemia - what cells?

Answer 11

Thalassemia has target cells classically.

Question 12

thalasemia in children?

Answer 12

major

Question 13

thalasemia in young adults?

Answer 13

minor

Question 14

Think demographics. For instance, USMLE Q likely won’t give you thalassemia in elderly patient, the same way they won’t give you diverticulitis in younger patient

Answer 14

.

Question 15

Red cell distribution width (RDW) in thalassemia?

Answer 15

decreased

Question 16

Red cell distribution width (RDW) in iron deficiency?

Answer 16

increased

Question 17

The RBCs are uniformly small in thalassemia due to Hb production problem, whereas in iron deficiency you have a larger range of RBC size due to non-uniformity of how iron deficiency can affect bone marrow production.

Answer 17

.

Question 18

Microcytic + low iron + ferritin normal + RDW low –>?

Answer 18

thalassemia

Question 19

Microcytic + low iron + ferritin low + RDW high –>?

Answer 19

iron deficiecy

Question 20

Thalassemia Qs will classically give decreased serum iron (same as iron deficiency), but ferritin is normal in thalassemia. Both have microcytic anemia.

Answer 20

.

Question 21

Thalassemia (notably alpha thalassemia trait; 1 out of 4 mutations) - what HY????

Answer 21

presents as a microcytic hypochromic anemia that doesn’t respond to iron supplementation.

Question 22

That is, pregnant woman has low iron scrutinized at first appointment; she’s started on standard pregnancy vitamins (include iron), then a few weeks later her ferritin is normal but iron is still low –> what is next evaluation test?

Answer 22

do hemoglobin electrophoresis to diagnose thalassemia.

Question 23

Increased HbA2 = ….2, ….2. what chains?

Answer 23

Increased HbA2 = alpha2, delta2

Question 24

Increased HbA2 = alpha2, delta2 –> in what disease?

Answer 24

in thalassemia

Question 25

CML - what translocation?

Answer 25

CML is caused by t(9;22) translocation (Philadelphia chromosome; bcr-abl)

Question 26

CML treatment? drug and group

Answer 26

treatment = imatinib, a tyrosine kinase inhibitor;

Question 27

imatinib most common adverse?

Answer 27

imatinib causes fluid retention (peripheral edema)

Question 28

trastuzumab (Herceptin) used for…..

Answer 28

ER/PR+ breast cancer

Question 29

ER/PR+ breast cancer, what drug?

Answer 29

trastuzumab (Herceptin)

Question 30

trastuzumab (Herceptin) adverse?

Answer 30

cardiotoxic

Question 31

Tacrolimus group?

Answer 31

Tacrolimus (FK506 binder; decreases intracellular calcineurin)

Question 32

Tacrolimus is an immunosuppressant that causes what 2 common adverse?

Answer 32

causes diabetes + nephropathy (increased BUN and Cr).

Question 33

Ticlopidine, what group drug?

Answer 33

ADP2Y12 blocker

Question 34

Ticlopidine (ADP2Y12 blocker); anti-platelet agent known to…… advers

Answer 34

agranulocytosis (low neutrophils).

Question 35

Ticagrelor also an ADP2Y12 blocker.

Answer 35

.

Question 36

Aplastic anemia - cause by what?

Answer 36

can be caused by viral infection, eg Parvo B19

Question 37

For aplastic anemia = mechanism?

Answer 37

defective bone marrow production

Question 38

aplastic anemia –> what next step confirm?

Answer 38

do bone marrow aspiration (sounds overly invasive but it’s the next best step USMLE wants).

Question 39

Chemo-induced pancytopenia, if they want next best step to diagnose –>?

Answer 39

bone marrow aspiration

Question 40

SLE causes antibodies against …..

Answer 40

hematologic cell lines

Question 41

SLE classically what hemo finding?

Answer 41

thrombocytopenia

but also can cause antibodies against RBCs and WBCs.

Question 42

SLE case: SLE vignette with all cell lines down, the answer is NOT aplastic anemia - why?

Answer 42

i.e., bone marrow production problem is WRONG answer

Question 43

SLE vignette with all cell lines down, the answer is NOT aplastic anemia, what correct answer?

Answer 43

the correct answer is “increased peripheral destruction” due to antibodies. Hard Q there.

Question 44

Fanconi anemia is AR aplastic anemia seen in what population?

Answer 44

Ashkenazi Jewish population

Question 45

Fanconi anemia. what weird finger finding?

Answer 45

causes aplastic/hypoplastic thumbs or radii (weird detail at first but pathognomonic)

Question 46

Diamond-Blackfan anemia is ….

Answer 46

pure-RBC aplasia that causes triphalyngeal thumbs. step 3 Q.