Kanis

Question 1

INR

Answer 1

GOAL INR is between 2-3

higher INR is assocaited with warfarn (coumadin)

lower INR is assocaited with lower INR

IF INR above 9 = OMIT DOSE and GIVE VITAMIN K

Question 2

what do you do if you if you suspect HIT

Answer 2

• Diagnosis
  
  • ELISHA for anti PF4/Heparin antibodies
• Treatment
  
  • discontinue Heparin
  • start another anticoagulant

Question 3

thombocytopenia - Disseminated intravascular coagulation

Answer 3

• Thrombocytopenia
• Schistocytes form (within blood vessels –> get ripped apart)
• Prolonged PT, PTT, Thrombin time and reduced fibrinogen level
  
  • because coagualtion proteins are depleted
• Elevated fibin degradation products
• D-Dimer increased

Question 4

Thrombocytopenia - TTP and HUS

Answer 4

• PT, PTT and fibrinogen NORMAL
  
  • because coagualtion proteins are NOT depleted
• ANEMIA, THROMBOCYTOPENIA, LDH ELEVATION are SEEN
• HUS –> like TTP, but SEEN IN CHILDREN (abdominal pain, diarrhea, E.COLI)
• TTP –> adults, multi-organ failure b/c of diffuse platelets plugs and neurological manifestations

Question 5

What is the most frequent cause of inherited thrombophilia

Answer 5

Factor V leiden mutation

Question 6

Prophylaxis

Answer 6

• patient is hopsilized beacuse of…
• prophylaxis should be give for patients with immobility infections, history of thombus, malignancy, and CHF –> risk for developing thomboembolism
• PROPHYLACTIC DEVICES
  
  • sequential compression devices
  • compression stockings
  • ambulation
  • LMWH
  • NOT STRICT BED REST

Question 7

Diagnostic testing for DVT

Answer 7

• D-dimer
• Ct-Chest
• pulmonary angiogram
• blood tests to look for clotting abnormaltiies

Give heparin (procoagulant properties initially) and then warfarin

Question 8

Multiple Myeloma

Answer 8

• CRAB pneumonic for symptoms
  
  • Calcium (hypercalcium)
  • Renal failure
  • Anemia (beta2 microglobulin)
  • Bone Lesions
• Test of choice is Serum Proetein Electrophoresis P
• Diagnosis is suggested by presence of M protein, plasmacytosis, and myeloma related organ or tissue involvement

Question 9

diagnosis of amyloidosis

Answer 9

• challenge
• BIOPSY WITH CONGO RED STAINING
  
  • rectal or subcutaneous fat

Question 10

MGUS

Answer 10

• Benign disorder
• Absence of organ or tissue involvement
• Plasmacytosis < 10%
• < 2.5mg/dL M proteina nd few or no monoclonal light chains in urine

Question 11

Waldenstrom

Answer 11

monoclonal gammopathy involving IgM

assocaited with hypervisconsity syndrome

Question 12

hodgkin lymphome

Answer 12

• REED STERNBER CELL
  
  • OWL’S EYE APPEARANCE
  • 2= NUCLEAR LOBES
  • B cell linage
• CONTINGOUS LYMPH NODE SPREAD
• High cure rates with tx
• significant morbidity and mortality ass with tx
• B-symptoms have worse prognosis

Question 13

Non-Hodgkin lymphoma

Answer 13

• More Non-CONTIGUOUS SPREAD
• B symptoms –> worse prognosis
• Treatment depends on subtype
  
  • MALT –> treat H. pylori with antibiotics in early disease