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1
Q

Heparin to warfarin bridge is necessary because

A

Proteins c and s have shorter half lives than other factors leading to paradoxical hypercoagulability

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2
Q

For rapid reversal of warfarin give

A

Ffp or otherwise vit K

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3
Q

For reversal of heparin give

A

Protamine sulfate

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4
Q

Mech of lmwh (enoxaparin)

A

Mainly inhibits factor Xa

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5
Q

In hemophilia, pt is __, ptt is ___ and bleeding time is ___

A

Ptt is prolonged

Pt and bleeding time is normal

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6
Q

What is cryoprecipitate

A

Mix of factor VIII and fibrinogen more concentrated than ffp

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7
Q

Mild hemophilia can be treated with

A

Desmopressin

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8
Q

How does desmopressin work to tx hemophilia

A

Releases factor VIII from endothelial cells

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9
Q

Best initial test to dx hemophilia

A

Mixing study-mix pt plasma with normal plasma which will correct the ptt

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10
Q

Most accurate test for hemophilia

A

Obtain specific factor assays for factors VII, VIII, IX, XI and XII

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11
Q

Most accurate dx test for vwd

A

Decreased agglutination seen on ristocetin cofactor assay

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12
Q

In vwd, what will happen to bleeding time, pt, ptt, and platelet count

A

Increased bt
Increased ptt (possibly ) due to low factor viii levels
Normal pt and platelet counts

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13
Q

Tx for vwd

A

Desmopressin

Ocps can be used for menorrhagia

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14
Q

Aspirin ___ risk of bleeding in vwd pts

A

Increases

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15
Q

Mech of factor V Leiden

A

Hypercoagulable state

Factor v is resistant to inactivation by protein C

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16
Q

Hypercoagulable state with skin or tissue necrosis following warfarin admin. What am I?

A

Protein c or s deficiency

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17
Q

Aps is often associated with what two conditions

A

Sle and rheumatoid arthritis

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18
Q

What tests confirm aps

A

Lupus anticoagulant and anticardiolipin antibody

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19
Q

Tx of dvt or pe in pts with hypercoagulable state

A

Heparin followed by 3-6 mos warfarin (longer if it’s a repeated event)

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20
Q

Tx of hit

A

Discontinue heparin then start argatroban or lepirudin

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21
Q

Dic is characterized by what two things

A

Thrombosis and hemorrhage

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22
Q

Etiology of dic

A

Deposition of fibrin in small blood vessels leading to thrombosis and end organ damage; also depletion of clotting factors and platelets leading to bleeding diathesis

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23
Q

Three common associations with dic

A

Obstetric complications, sepsis and pancreatitis

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24
Q

In dic factor Viii is

A

Depressed

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25
Q

Three causes of microangiopathic hemolytic anemia

A

Hus
Ttp
Dic

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26
Q

Etiology of ttp

A

Deficiency of vwf cleaving enzyme adamts-13 resulting in large vwf multimers that aggregate platelets and create platelet microthrombi. Rbcs are thus fragmented.

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27
Q

Low plt count, microangiopathic hemolytic anemia, neuro changes (delirium, seizure, stroke), impaired renal function, fever. Think

A

Ttp

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28
Q

Severe increases in creatinine level are more suggestive of hus or ttp

A

Hus

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29
Q

Platelet transfusion in ttp is

A

Contraindicated

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30
Q

Tx for ttp

A

Plasma exchange

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31
Q

Etiology of itp

A

IgG antibodies formed against platelets

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32
Q

In itp, bone marrow production of platelets is __ and there are __ megakaryocytes in the marrow

A

Up

Increased

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33
Q

Differential of thrombocytopenia

A

Hit shoc

Hit or hus
Itp
Ttp or treatment (meds)
Splenomegaly
Hereditary (wiskott Aldrich)
Other (malignancy)
Chemo
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34
Q

Tx of itp if plt count >30,000

A

None

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35
Q

Tx of itp if plt count <30,000

A

Corticosteroids or ivig

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36
Q

Thrombocytopenia, Increassd creatinine and schistocytes acutely in a school aged kid, think

A

Hus

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37
Q

Causes of microcytic anemia

A

Tails

Thalassemia
Anemia of chronic dz
Iron def
Lead poisoning
Sideroblastic anemia
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38
Q

Is tibc high or low in anemia of chronic disease? How about ferritin?

A

Low and high

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39
Q

Is tibc low or high in iron def anemia? How about ferritin?

A

Tibc high

Ferritin low

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40
Q

Etiology of anemia of chronic disease

A

Body hides iron in form of ferritin to limit bacterial proliferation

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41
Q

How does sideroblastic anemia present

A

Low hemoglobin, high serum iron, basophilic stippling (in lead poisoning) and ringed sideroblasts

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42
Q

Hypersegmented neutrophils are a characteristic finding of

A

Megaloblastic anemia

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43
Q

Vit b12 def has __ mma and __ homocysteine; folate def has __ mma and __ homocysteine

A

High and high; normal and high

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44
Q

Hereditary spherocytosis is due to a deficiency in

A

Spectrin or ankyrin

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45
Q

Tx of spherocytosis

A

Splenectomy

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46
Q

Why can sickle pts have polyuria or nocturia

A

Due to sickling happening in inner medulla Of kidneys

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47
Q

Etiology of aplastic anemia

A

Failure of blood cell production due to destruction of bone marrow cells

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48
Q

Cafe au lait spots, short stature, radial/thumb hypoplasia/aplasia. What am I?

A

Fanconi anemia

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49
Q

Tx of aplastic anemia

A

Blood transfusion and stem cell transplantation

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50
Q

How does hydroxyurea work

A

It stimulates production of fetal hemoglobin

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51
Q

Polycythemia Vera is due to

A

Clinal proliferation of a pluripotent marrow stem cell due to a jak2 mutation

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52
Q

Epo in pcv

A

Normal

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53
Q

Tx of pcv

A

Hydroxyurea and ifn

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54
Q

Telltale sign of porphyria

A

Pink urine

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55
Q

What happens to reflexes in porphyria

A

Areflexia

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56
Q

5 ps of acute intermittent porphyria

A

Painful abdomen, port wine colored urine, polyneuropathy, psych disturbances, precipitated by drugs (cyp450 inducers, alcohol, starvation)

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57
Q

Auer rod think

A

AML

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58
Q

Most common childhood malignancy

A

ALL

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59
Q

AML on peripheral smear

A

Large myeloblasts with round or kidney shaped nuclei

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60
Q

Smudge cells are characteristic of

A

CLL

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61
Q

Philadelphia chromosome t(9,22) is associated with

A

CML

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62
Q

Which leukemia tends to present at age <13

A

ALL

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63
Q

Which leukemia tends to present at age 13-40

64
Q

Which leukemia tends to present at age 40-60

65
Q

Which leukemia tends to present at age >60

66
Q

What is a leukomoid reaction

A

Acute inflammatory response to infection with increased neutrophils and a left shift

67
Q

In cml lap is ___ and in leukomoid reaction lap is __

68
Q

Cll shows ___cytosis, cml shows ____cytosis

A

Lymphocytosis (elevation of nk, t or B cells)

Granulocytosis

69
Q

Acute promyelocytic leukemia (apl) a subtype of aml can be treated with

A

All-trans-retinoic acid

70
Q

Tx of cml

A

Imantinib (gleevec)

71
Q

What is more common non-Hodgkin or Hodgkin lymphoma

72
Q

Most nhl cases are _ cell in origin

73
Q

Tx of nhl may be complicated by ___ syndrome, which causes what electrolyte abnormalities

A

Tumor lysis syndrome in which rapid cell death releases intracellular contents and leads to hyperkalemia, hyperphosphotemia, hyperurecemia And hypocalcemia

74
Q

Fever, wt loss and night sweats are the _ sx of

A

B; Hodgkin lymphoma

75
Q

Crab for mm

A

Hypercalcemia
Renal involvement
Anemia
Bone lytic lesions/back pain

76
Q

Hypercalcemia sx

A 
Renal stones
Bone and abdo pain
Confusion
Polyuria
Weakness
Nausea
77
Q

Protein:albumin gap is often __ in multiple myeloma

78
Q

Tx of mm in pts <70? >70?

A

Below 70: bone marrow transplant

Above: melphalan and prednisone

79
Q

What are dutcher bodies? What do you see them in?

A

They are pas+ igm deposits around the nucleus seen in waldenstrom macroglobulinemia

80
Q

Do pts with mm often have renal dysfunction

81
Q

Define neutropenia

82
Q

Tx of mgus

A

None But see regularly to prevent progression to mm

83
Q

Define eosinophilia

A

Absolute eosinophilic count>350

84
Q

Pts with hemolytic anemia have high ___ bilirubin

A

Unconjugated

85
Q

In adult pt with direct hyperbili and high alk phos, what should you do first

86
Q

Elevated c peptide levels and proinsulin levels are seen in pts with ___ tumors

87
Q

Multiple myeloma is a infiltration of the ____ leading to ineffective ___ production

A

Bone marrow

Antibody

88
Q

What is angiodysplasia? What are associated conditions?

A

Painless gi bleeding with dilated submucosal veins and av malformations

Associated with renal dz, vwd, aortic stenosis

89
Q

B thalassemia is a ___opathy

A

Hemoglobinopathy

90
Q

With pts who have a dvt/pe but can’t be anticoagulated what do you do?

A

Inferior vena cava filter

91
Q

Can you get steatorrhea, ftt and vitamin deficiencies in cystic fibrosis

A

Yes

Can see bruising

92
Q

What are the two kinds of acute leukemia’s

A

AML and all

93
Q

Etiology of wiskott Aldrich syndrome

A

Impaired cytoskeleton changes in leukocytes, platelets

94
Q

Eczema, microthrombocytopenia and recurrent infections in a toddler/baby, think

A

Wiskott Aldrich

95
Q

Abscesses due to fungi or cat positive bacteria is the characteristic features of what immunology dz

A

Chronic granulomatous dz

96
Q

Etiology of Chronic granulomatous dz

A

Inability of phagocytes to produce hydrogen peroxide in their lysosomes

97
Q

__ of donor blood can prevent febrile nonhemolytic reaction and reduce risk of __ and ___

A

Leukoreduction

Hla alloimmunization and cmv transmission

98
Q

Reticulocytes are __ in aplastic crisis and ___ in splenic sequestration

A

Decreased

Increased

99
Q

In a pt with scd, an acute drop in hemoglobin and a low retic count without splenomegaly is consistent with

A

Aplastic crisis

100
Q

Which causes pancytopenia, aplastic anemia or aplastic crisis

101
Q

Most common complication in a person with sickle cell trait

A

Renal issues specifically painless hematuria or hyposthenuria (inability to concentrate urine)

102
Q

Are low molecular weight heparin and rivaroxaban recommended in pts with esrd

A

No because they are metabolized in the kidney

103
Q

Is unfractionated heparin contraindicated in pts with esrd

104
Q

Pica is a behavior that sometimes accompanied

A

Iron deficiency anemia

105
Q

What long term meds should you take to prevent stent thrombosis

A

Aspirin and platelet blocker (clopidogrel)

106
Q

Strongest indicator of stent thrombosis in first twelve months after placement

A

Premature discontinuation of antiplatelet therapy

107
Q

Peripheral blood smear in autoimmune hemolytic anemia may show

A

Spherocytes without central pallor

108
Q

Why do you get arterial and venous thrombosis with hit?

A

Hit antibodies activate platelets resulting in platelet aggregation

109
Q

What causes warfarin-induced skin necrosis

A

Rapid decline in protein c levels

110
Q

Scc of the mucosa of head and neck is common in pp with a sig hx of

A

Alcohol and tobacco use

111
Q

Scc positive lymph node in a person with a sig hx of alcohol and tobacco use-what initial test should you do?

A

Triple endoscopy-esophagoscopy, bronchoscopy, laryngoscopy

Aka panendoscopy

112
Q

If a cervical lymph node in a woman shows metastatic adenocarcinoma what cancer should you consider

113
Q

Treatment of mild hypercalcemia in setting of metastatic cancer to the bone

A

Bisphosphonates

Radiation therapy can be used for severe pain

114
Q

You are thinking multiple myeloma. What should you get?

115
Q

Spherocytosis occurs due to defect in

A

Ankyrin gene

116
Q

Coombs rest in hereditary spherocytosis is

117
Q

LAb findings in hereditary spherocytosis

A

Increased mean corpuscular hemoglobin concentration, neg Coombs, increased osmotic fragility and abnormal eosin-5-maleimide binding test

118
Q

In hereditary spherocytosis you have __ mean corpuscular volume and __ mean corpuscular hemoglobin concentration

119
Q

Tx of hit

A

Stop all heparin products, start a direct thrombin inhibitor (argatroban) or fondaparinux

120
Q

Iron and ferritin levels in thalassemia

121
Q

Tibc in thalassemia

122
Q

First finding in peripheral smear of iron def anemia

A

Anisocytosis (rbcs of unequal size) which causes increased red blood cell distribution width

123
Q

Do you see hypochromia in peripheral smear in iron def anemia

124
Q

Abnormal lymph node is bigger than

125
Q

Etiology of factor v Leiden

A

Ad point mutation in gene for factor v that makes it unable to respond to activated protein c

126
Q

Most common cause of liver mass

A

Metastatic diseAse

127
Q

Hepatic angiosarcoma presents in what demographic

A

Old men who have been exposed to toxins

128
Q

Hepatic adenomas present in what demographic?

A

Young women

129
Q

Hepatic adenomas May cause ___ and are associated with ___ use

130
Q

Hepatocellular carcinoma typically emerges from ___ liver

A

Chronically inflamed liver

131
Q

You find rectal cancer. What to do next?

A

Colonoscopy to the cecum

132
Q

In splenic sequestration crisis reticulocyte count in __ and platelet count is __

133
Q

Peripheral blood smear in folate or cobalamin deficiency shows

A

Late rbcs with hypersegmented neutrophils

134
Q

Methylmalonic acid in cobalamin def is __ and in folate def is ___

A

High

Normal

135
Q

Deficiencies in cobalamin and folate will cause ___ homocysteine levels

136
Q

What age range besides Childhood do craniopharyngiomas present?

137
Q

Most significant environmental rf for pancreatic cancer

138
Q

Most common kind of pancreatic cancer

A

Adenocarcinoma

139
Q

Lab findings in pancreatic carcinoma

A

High serum bili and alk phos plus mild anemia

140
Q

Multiple liver lesions on ct. where is the cancer?

A

Likely metastatic diseAse, most commonly from Colon. Do a colonoscopy

141
Q

Red cell distribution width in:
Iron def
Alpha thalassemia
Beta thalassemia

A

Iron def-high

Thalassemias- normal

142
Q

Red blood cell count in:
Iron def anemia
Alpha thalassemia
Beta thalassemia

A

Low in iron def

Normal in thalassemias

143
Q

Peripheral smear in alpha and beta thalassemia

A

Target cells

144
Q

Thalassemias response to iron supplementation

A

No improvement

145
Q

Massive painless hematuria in scd withoht other sx is auspicious for

A

Papillary necrosis

146
Q

Two common complications of hereditary spherocytosis

A

Pigment gallstones and aplastic crisis

147
Q

Splenectomy can cause a dramatic __ in platelets

148
Q

Two common complications of hereditary spherocytosis

A

Pigment gallstones and aplastic crisis

149
Q

Splenectomy can cause a dramatic __ in platelets

150
Q

People without a spleen have what kind of bodies in their rbcs

A

Howell jolly bodies

151
Q

In seminomas, bhcg is __ and afp is ___

A

High

Normal

152
Q

First line tx for chemotherapy induced nausea

A

Serotonin 5ht receptor antagonists (eg ondansetron)

153
Q

Role of haptoglobin

A

Binds to free hemoglobin and promotes its excretion

154
Q

Tibc in anemia of Chronic disease is high or low?

155
Q

High homocysteine levels can be normalized by admin of what two things

A

Pyridoxine b6 and folate

156
Q

Three causes of malignancy in young men

A

Testicular cancer
Lymphoma
Leukemia

157
Q

What kind of contraception should you use in pts with breast cancer

A

NOT hormone containing contraception

Use for example copper iud

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