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UWORLD-STEP2 (BA) > IM-Heme/Onco > Flashcards

IM-Heme/Onco Flashcards

1
Q

Hx of gastrectomy, glossitis and anemia

A

Vit B12 deficiency post total or partial gastrectomy - megalobalstic anemia

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2
Q

Microcytic/hypochromic anemia, elevated serum iron, decreased TIBC with patient treated for TB infection? Tx?

A
  • Sideroblastic anemia - vitamin B6 deficiency

- Pyridoxine

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3
Q

Someone from Mediterranean origin like Greece will most commonly have what kind of hemoglobinopathy

A

Beta- Thalassemia

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4
Q

Common manifestations f hemoglobinopathy like Beta- Thalassemia in peripheral smear

A

Hypochromic microcytic anemia

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5
Q

Suspect Multiple myeloma in elderly patient with lab findings (4)

A
  • Hypercalceimia
  • Normocytic anemia
  • Renal insufficiency
  • Protein gap
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6
Q

Define protein gap and what is it’s indication ?

A
  • Difference b/n total protein and albumin >4

- elevated nonablumin protein in the serum, may be seen with polyclonal gamma patties

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7
Q

Name disease that cause polyclonal gammapathies (4)

A
  • Infection
  • connective tissue disease
  • Monoclonal protein (Multiple myloma & Walden storm macroglobulinemia)
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8
Q

How to differenciate polyclonal vs monoclonal cause of protein gap

A

Serum protein electrophoresis (SPEP)

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9
Q

Findings seen in elevated serum protein

A

Rouleaux formation( stocking of RBC like coins)

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10
Q

Majority of head and neck cancers are

A

Squamous cell carcinoma (SCC)

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11
Q

Older, smoker, non-tender lymph node in the submandibular or cervical region

A

Cancer- SCC

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12
Q

Serum haptoglobin is reduced ins intravascular hemolysis due to

A

Hemoglobin released from hemolysis RBCs binds to it and hemoglobin-haptoglobin complex gets removed by liver

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13
Q

Raised serum lactate dehydrogenase (LDH) in RBC hemolysis is due to

A

RBCs releases of LDH

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14
Q

Two reticuloendocthelial systems that phagocytes RBCs

A

Lymph nodes

Spleen

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15
Q

3 Causes of Extravascular hemolysis ( and example of disease)

A
  • antibody-mediated RBC destruction (AIHA- Autoimmune hemolytic anemia)
  • Interinsic RBC enzyme (G6PD definicency)
  • membrane defects (hereditary sphrocytosis)
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16
Q

Negative family history and positive Coombs test that causes extravascular hemolysis

A

Auto immune hemolytic anemia (AIHA)

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17
Q

Positive family history and negative Coombs test that causes extravascular hemolysis

A

Hereditary spherocytosis

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18
Q

Peripheral blood smear with Heinz’s bodies

A

Glucose-6-phosphate dehydrogenase deficiency (x-linked, triggered by medication like sulfa drugs)

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19
Q

Cell membrane anchor that leads to complement-mediated hemolysis

A

Paroxysmal nocturnal hemoglobinuria (PNH)

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20
Q

PNH has positive or negative cooks test?

A

-Negative

But evidence of venous thrombosis or intravasular hemolysis

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21
Q

Autosplenoctomy is seen in

A

Sickle cell anemia

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22
Q

Aquagenic pruritus is?seen in?

A

Itching after bathing

Polycythemia Vera

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23
Q

4 financings in polycythemia vera

A
  • aquagenic pruritus
  • Facial plethora
  • Splenomegaly
  • elevation in all 3 cell lines on CBC
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24
Q

Facial plethora is

A

Ruddy cyanosis

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25
Polyscytmia Vera is caused by
JAK 2 mutation (Tyrosine kinase activated by EPO activities)
26
The difference between primary and secondary polycythemia Vera is
Low EPO level in primary | High EPO level in secondary
27
A myeloproliferative disordering Marked by erythrocytosis
Polycythemia Vera
28
Atrophic glossing is in pernicious anemia the touge looks like
Shiny
29
``` Megalobalstic anemia Atrophied glossitis Vitiligo Thyroid disease Neurological abnormalities Whites of Northern European ancestry ```
pernicious anemia
30
8 causes of macrocytic anemia (MCV >100)
- Folate deficiency - Vit B 12 deficiency - Myelodysplastic syndromes - AML - Drug induced (hydroxyurea, zidovudine, chemo agents) - Liver disease - Alcohol abuse - Hypothyroidism
31
The two types of Autoimmune hemolytic anemia
Cold agglutinatinin AIHA | Warm agglutinatinin AIHA
32
Cause of warm agglutinin AIHA (5)
``` Drugs (PCN) Viral infection Autoimmune (SLE) Immunodeficiency states Lymphoproliferative (CLL) ```
33
Cause of cold agglutinin AIHA (2)
- Infections (Mycoplasma pneumonia infection & Infectious mononucleosis) - Lymphoproliferative disease
34
Direct Coomb’s positive with anti-IgG, anti-C3, or both is which type of AIHA
Warm agglutinin AIHA
35
Direct coomb’s positive with anti-IgM, anti-C3, but NOT IgG is which type of AIHA
Cold agglutinin AIHA
36
Tx for warm Vs cold agglutinin AIHA
Warm- Corticosteroids & splenectomy | Cold- Avoide cold & Ritubimab +/- fludarabine
37
Common complication seen in warm agglutinin AIHA (2)
- Venous thromboembolism | - Lymphoproliferative disorders
38
Common complication seen in cold agglutinin AIHA (2)
- Ischemia & peripheral gangrene | - Lymphoproliferative disorders
39
Common virus that cause thrombocytopenia (3)
- EBV - Hep C - HIV
40
cause of decrease platelet production (6)
- Viral infection (EBV, Hep C, HIV) - Chemotherapy - Myelodysplasia (>60year old) - Alcohol use - Congenital (Fanconi syndrome) - Vit B12 or folate deficiency
41
Cause of increased platelet destruction (4)
- SLE - Medication (heparin) - ITP, DIC, TTP-HUS - Antiphospholipid syndrome
42
Isolated thrombocytopenia without anemia or leukopenia
Idiopathic thrombocytopenia (ITP)
43
Pseudothrombocytopenia due to platelet clumping can happen from (3)
- EDTA - Abciximab - Inadequate anticoagulation of the blood sample
44
Pain, itching, red streaks on arm that is tender, erythematous and palpable cord-like veins on arm and upper chest , Dx? NSIM?
- Trousseau’s syndrome (migratory superficial thrombophlebitis) - CT of abdomin to r/o pancreatic, lung, prostate, stomach, colon and acute leukemia cancers
45
The two most common clinical manifestation in antiphospholipid antibody syndrome are
- Vascular thrombosis | - Pregnancy morbidity
46
The 3 lab findings in antiphospholipd antibody syndrome (APS) are
- Lupus anticoagulant - Anticardiolipin antibody - Anti-Beta-2 glycoproteins 1 antibody
47
APS mostly occurs with women that have
SLE
48
Prolonged ______ is an indirect indicator for the presence of Lupus anticoagulant (LA) and highly suggestive in the correct clinical settings
PTT
49
Specific tests used to diagnose APS (2)
Diluted Russell viper venom test | Kaolin clotting time
50
It is an anti-phospholipid antibody that is a pro-thrombotic immunoglobulin that causes a spuriously prolonged PTT in vitro
Lupus anticoagulant
51
-Hemolytic anemia (elevated LDH, low haptoglobin) with schistocytes - Thrombocytopenia (elevated bleeding time, normal PT/PTT) Dx?
Thrombotic thrombocytopenic purpura (TTP)
52
Tx of TTP (3)
- Plasma exchange - Glucocorticoids - Rituximab
53
Two pathophysiology for TTP
- decreased ADAMTS 13 level (uncleaved vWF multiverses causing platelets trapping and activation - Acquired (autoantibody) or hereditary
54
Classical pentad of TTP
- Thrombocytopenia - Microangiopathic hemolytic anemia (MAHA) - Renal insufficiency - Neurologic changes - Fever
55
Tx of polycythemia Vera (2)
- Phlebotomy | - Hydroxyurea
56
-Increased mean corpuscular hgb concentration (MCHC) - hemolytic anemia - Jaundice - splenomegaly In pt with Northern European decent
Hereditory shperocytosis
57
Why does pt with hereditary spherocytosis have cholecystitis symptoms?
Due to pigment gallstones (from overwhelm conjugation and elimination of bilirubin from the body)
58
The electrolyte imbalance in Tumor lysis syndrome (4)
Increased phosphorus Increased potassium Increased Uric acid Decreased calcium
59
What causes Calcium to be low in Tumor lysis syndrome (TLS)?
Phosphate binds and precipitates calcium reducing IV levels
60
Screening tool for multiple myeloma
Serum protein electrophoresis (SPEP)
61
Abnormal eosin-5- maleimide binding test is seen in
Hereditory spherocytosis
62
What are the 2 forms of HIT?
Type 1- non immune direct effect of heparin on platelet activation, presents 2 days after heparin exposure Type 2- Immune mediated due to antibodies to platelet factor 4 (PF4) complexed with heparin causing >50% drop
63
``` Low hgb and haptoglobin, High bilirubin and LDH Bite cells and Heinz bodies Negative Coombs test Normal G6PD activity ```
``` G6PD deficiency ( G6PD activity is low unless messured during attack) ```
64
Tx for stabilizing bony metastatic lesions to prevent hypercalcemia of malignancy and pathological fractures
Bispohphonates (Zoledronic acid, pamidronate)
65
3 steps in management of Spinal cord compression due to malignancy
- Emergency MRI - IV glucocorticoids - Radiation-oncology and neurosurgery consultation
66
Tx for children with Immune thrombocytopenia (if bleeding) 3
- observe if cutaneous symptoms only | - Glucocorticoid, IVIG or anti-D if bleeding
67
Tx for adult with Immune thrombocytopenia (if bleeding) 3
observation if cutaneous or plt > 30,000 | - Glucocorticoids, IVIG, or anti D if bleeding or plt/30,000
68
Drugs that can cause folic acid deficiency (3)
- Phenytoin (impairs absolution) | - Methotrexate, Trimethoprim (antagonize its physiologic effects)
69
How to diagnosis CLL?
Flow cytometry (clonality of mature B cells)
70
Common complication of CLL
infections

UWORLD-STEP2 (BA) (19 decks)

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