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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
Q

Polyscytmia Vera is caused by

A

JAK 2 mutation (Tyrosine kinase activated by EPO activities)

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26
Q

The difference between primary and secondary polycythemia Vera is

A

Low EPO level in primary

High EPO level in secondary

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27
Q

A myeloproliferative disordering Marked by erythrocytosis

A

Polycythemia Vera

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28
Q

Atrophic glossing is in pernicious anemia the touge looks like

A

Shiny

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29
Q 
Megalobalstic anemia
Atrophied glossitis
Vitiligo
Thyroid disease
Neurological abnormalities
Whites of Northern European ancestry
A

pernicious anemia

30
Q

8 causes of macrocytic anemia (MCV >100)

A
  • Folate deficiency
  • Vit B 12 deficiency
  • Myelodysplastic syndromes
  • AML
  • Drug induced (hydroxyurea, zidovudine, chemo agents)
  • Liver disease
  • Alcohol abuse
  • Hypothyroidism
31
Q

The two types of Autoimmune hemolytic anemia

A

Cold agglutinatinin AIHA

Warm agglutinatinin AIHA

32
Q

Cause of warm agglutinin AIHA (5)

A 
Drugs (PCN)
Viral infection
Autoimmune (SLE)
Immunodeficiency states
Lymphoproliferative (CLL)
33
Q

Cause of cold agglutinin AIHA (2)

A
  • Infections (Mycoplasma pneumonia infection & Infectious mononucleosis)
  • Lymphoproliferative disease
34
Q

Direct Coomb’s positive with anti-IgG, anti-C3, or both is which type of AIHA

A

Warm agglutinin AIHA

35
Q

Direct coomb’s positive with anti-IgM, anti-C3, but NOT IgG is which type of AIHA

A

Cold agglutinin AIHA

36
Q

Tx for warm Vs cold agglutinin AIHA

A

Warm- Corticosteroids & splenectomy

Cold- Avoide cold & Ritubimab +/- fludarabine

37
Q

Common complication seen in warm agglutinin AIHA (2)

A
  • Venous thromboembolism

- Lymphoproliferative disorders

38
Q

Common complication seen in cold agglutinin AIHA (2)

A
  • Ischemia & peripheral gangrene

- Lymphoproliferative disorders

39
Q

Common virus that cause thrombocytopenia (3)

A
  • EBV
  • Hep C
  • HIV
40
Q

cause of decrease platelet production (6)

A
  • Viral infection (EBV, Hep C, HIV)
  • Chemotherapy
  • Myelodysplasia (>60year old)
  • Alcohol use
  • Congenital (Fanconi syndrome)
  • Vit B12 or folate deficiency
41
Q

Cause of increased platelet destruction (4)

A
  • SLE
  • Medication (heparin)
  • ITP, DIC, TTP-HUS
  • Antiphospholipid syndrome
42
Q

Isolated thrombocytopenia without anemia or leukopenia

A

Idiopathic thrombocytopenia (ITP)

43
Q

Pseudothrombocytopenia due to platelet clumping can happen from (3)

A
  • EDTA
  • Abciximab
  • Inadequate anticoagulation of the blood sample
44
Q

Pain, itching, red streaks on arm that is tender, erythematous and palpable cord-like veins on arm and upper chest , Dx? NSIM?

A
  • Trousseau’s syndrome (migratory superficial thrombophlebitis)
  • CT of abdomin to r/o pancreatic, lung, prostate, stomach, colon and acute leukemia cancers
45
Q

The two most common clinical manifestation in antiphospholipid antibody syndrome are

A
  • Vascular thrombosis

- Pregnancy morbidity

46
Q

The 3 lab findings in antiphospholipd antibody syndrome (APS) are

A
  • Lupus anticoagulant
  • Anticardiolipin antibody
  • Anti-Beta-2 glycoproteins 1 antibody
47
Q

APS mostly occurs with women that have

A

SLE

48
Q

Prolonged ______ is an indirect indicator for the presence of Lupus anticoagulant (LA) and highly suggestive in the correct clinical settings

A

PTT

49
Q

Specific tests used to diagnose APS (2)

A

Diluted Russell viper venom test

Kaolin clotting time

50
Q

It is an anti-phospholipid antibody that is a pro-thrombotic immunoglobulin that causes a spuriously prolonged PTT in vitro

A

Lupus anticoagulant

51
Q

-Hemolytic anemia (elevated LDH, low haptoglobin) with schistocytes
- Thrombocytopenia (elevated bleeding time, normal PT/PTT)
Dx?

A

Thrombotic thrombocytopenic purpura (TTP)

52
Q

Tx of TTP (3)

A
  • Plasma exchange
  • Glucocorticoids
  • Rituximab
53
Q

Two pathophysiology for TTP

A
  • decreased ADAMTS 13 level (uncleaved vWF multiverses causing platelets trapping and activation
  • Acquired (autoantibody) or hereditary
54
Q

Classical pentad of TTP

A
  • Thrombocytopenia
  • Microangiopathic hemolytic anemia (MAHA)
  • Renal insufficiency
  • Neurologic changes
  • Fever
55
Q

Tx of polycythemia Vera (2)

A
  • Phlebotomy

- Hydroxyurea

56
Q

-Increased mean corpuscular hgb concentration (MCHC)
- hemolytic anemia
- Jaundice
- splenomegaly
In pt with Northern European decent

A

Hereditory shperocytosis

57
Q

Why does pt with hereditary spherocytosis have cholecystitis symptoms?

A

Due to pigment gallstones (from overwhelm conjugation and elimination of bilirubin from the body)

58
Q

The electrolyte imbalance in Tumor lysis syndrome (4)

A

Increased phosphorus
Increased potassium
Increased Uric acid
Decreased calcium

59
Q

What causes Calcium to be low in Tumor lysis syndrome (TLS)?

A

Phosphate binds and precipitates calcium reducing IV levels

60
Q

Screening tool for multiple myeloma

A

Serum protein electrophoresis (SPEP)

61
Q

Abnormal eosin-5- maleimide binding test is seen in

A

Hereditory spherocytosis

62
Q

What are the 2 forms of HIT?

A

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
Q 
Low hgb and haptoglobin, 
High bilirubin and LDH
Bite cells and Heinz bodies 
Negative Coombs test
Normal G6PD activity
A 
G6PD deficiency
( G6PD activity is low unless messured  during attack)
64
Q

Tx for stabilizing bony metastatic lesions to prevent hypercalcemia of malignancy and pathological fractures

A

Bispohphonates (Zoledronic acid, pamidronate)

65
Q

3 steps in management of Spinal cord compression due to malignancy

A
  • Emergency MRI
  • IV glucocorticoids
  • Radiation-oncology and neurosurgery consultation
66
Q

Tx for children with Immune thrombocytopenia (if bleeding) 3

A
  • observe if cutaneous symptoms only

- Glucocorticoid, IVIG or anti-D if bleeding

67
Q

Tx for adult with Immune thrombocytopenia (if bleeding) 3

A

observation if cutaneous or plt > 30,000

- Glucocorticoids, IVIG, or anti D if bleeding or plt/30,000

68
Q

Drugs that can cause folic acid deficiency (3)

A
  • Phenytoin (impairs absolution)

- Methotrexate, Trimethoprim (antagonize its physiologic effects)

69
Q

How to diagnosis CLL?

A

Flow cytometry (clonality of mature B cells)

70
Q

Common complication of CLL

A

infections

UWORLD-STEP2 (BA) (19 decks)

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