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tsomkapQ > OMED Hematology Oncology > Flashcards

OMED Hematology Oncology Flashcards

1
Q 
Folate deficiency
Path:
Pt:
Dx:
Tx:
A

Path: leafy green, 3-6 week stores, pregnancy
Pt: tea+toast diet, EtOh, pregnancy
Dx: Folic acid levels decreased, but normal methyl malonic acid
Tx: folate, 1 mg po

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2
Q 
B12 deficiency 
Path:
Pt:
Dx:
Tx:
Fu:
A

Path: 3-10 yr storage, animal products, neuro symptoms
Pt: vegan, pernicious anemia, crohn’s, gastric bypass
Dx: B12 levels decreased, increased methyl malonic acid
Tx: B12, PO= nutritional, IM= impaired absorption
Fu: never choose schilling test on exam, prolonged deficiency causes DCMLS

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3
Q 
Pernicious Anemia 
Path:
Pt:
Dx:
Tx:
fu:
A

Path: Antibodies against parietal cells, no intrinsic factor, no B12 absorption

Pt: weakness, sore tongue, paresthesias

Dx: Ab-intrinsic factor, Ab-anti parietal
Tx: IM B12, cannot treat pernicious anemia
F/u: gastric cancer

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4
Q 
non megaloblastic anemia 
Path:
Pt:
Dx:
Tx:
A

Path: liver diz, EtOh, medications: (AZT, HAART, 5 FY, ARA-C), metabolic syndromes (Lesch Nyhan, Hereditary orotic aciduira)

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5
Q 
Iron deficiency anemia 
Path:
Pt:
Dx:
Tx:
A

Path: slow bleed, consumption of iron stores
Pt: women- menorrhagia, older men = colon cancer
Dx: iron studies- ↓iron, ↑TIBH, ↓ Ferritin
Tx: iron 2-6 wks for anemia, iron 2- months for iron stores

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6
Q 
Anemia of chronic disease 
Path:
Pt:
Dx:
Tx:
A

Path: chronic inflammation
Pt: anemic
Dx: iron studies: iron studies- ↓iron, ↓TIBH ↑ Ferritin. bone marrow biopsy, rarely needed.
Tx: treat underlying condition, EPO for severe cases

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7
Q 
Thalassemia 
Path: 
Pt:
Dx:
Tx:
A 
Path: genetic mutations, loss of genes, 4 alpha, 2 beta 
Pt: 
-Asx: 1 alpha deletion (asymptomatic)
-Minor: 2 alpha deletions, 1 beta deletions 
-Major: 3 alpha deletions, 2 beta deletions 
-Dead: 4 alpha deletions 
Dx:
- Fe normal
- Ferritin normal
- TIBC normal 
- Hgb Electrophoresis 
Tx: 
-minor: do nothing 
-major = transfusions = deferoxamine
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8
Q 
sideroblastic anemia 
path:
Pt:
Dx:
Tx:
A

Path:
-irreversible: B6, cancer
-reversible: lead, EtOh, copper, isoniazid
Pt: anemia
Dx:
-Fe ↑, Ferritin normal, TIBC normal
-BEST: bone marrow biopsy showing ringed sideroblasts
Tx: remove exposure, give back B6, try to treat cancer

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9
Q

Sickle Cell

Path:

A

Path:

  • Autosomal recessive
  • HgbSS
  • Valine –> glutamine
  • Sickling under stress (acidosis, dehydration)
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10
Q

Sickle Cell

Pt:

A 
Pt:
Emergency acute-
*acute chest = MI, CHF
*acute brain = CVA 
*priapism

Hospitalized Acute-
*vaso-occlusive crisis

Chronic-

  • asplenia
  • avascular necrosis
  • osteomyelitis
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11
Q

Sickle Cell
Dx:
Tx:
F/u

A

Dx:

*1st- smear = sickled cells –> used on first crisis, not subsequently. if they were diagnosed previously, dont use smear.
*
Best: Hgb electrophoresis (Sc, SS)
-use 1st time only

Tx: hydroxyurea = ↑HgbF, ↓HgbSS, IVF, pain control, exchange transfusion in emergency
f/u: iron overload (deferoxamine)

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12
Q 
G6PD deficiency
Path:
Pt:
Dx:
Tx:
A

Path: ↓ G6PD, hypoxemic = hemolysis
Pt: African American Males, dapsone, TMP-SMX, nitrofurantoin
Dx: 1st smear = bite cells, heinz bodies.
best: G6PD levels 6-8 weeks
Tx: supportive, avoid stressors

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13
Q 
Hereditary spherocytosis 
Path:
Pt:
Dx:
Tx:
A

Path: deficiency in spectrin, ankyrin, pallidin
Pt: hemolysis, spherocytosis
Dx:
smear–>spherocytes –> osmotic fragility test (+)
Tx: folate + Fe, splenectomy

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14
Q 
Paroxysmal Nocturnal Hemoglobinuria 
Path:
Pt:
Dx:
Tx:
A 
Path: PIGA deficiency 
Pt:
Paroxysmal (once in awhile)
Nocturnal (only at night)
Hemoglobinuria (dark urin)

Dx: flow cytometry, ↓CD55, ↓CD59
Tx: Biologics (Eculizumab)

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15
Q 
Warm Autoimmune Hemolytic Anemia 
Path:
Pt:
Dx:
Tx:
A 
Path: IgG (Cancer,Drugs,Rheumatoid)
Pt: Hemolysis Everywhere
Dx: Coombs Test IgG
Tx: 
-First line: steroids
-Recurrent: splenectomy
-Severe: IVIg
-Refractory to splenectomy: rituximab
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16
Q 
Cold autoimmune hemolytic anemia
Path:
Pt:
Dx:
Tx:
A 
Path: IgM (Mycoplasma, mono)
Pt: Hemolysis in the cold
-tips of digits and nose
Dx: First line: Coombs test negative for IgG
Tx: 
-Avoid the cold
-Refractory: rituximab
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17
Q 
Microangiopathic Hemolytic anemia
Path:
Pt:
Dx:
Tx:
A 
Path: Schistocytes = MAHA
Pt: TTP versus DIC
Dx: 
-Decreased hemoglobin (both)
-Decreased PLT (both)
-Decreased fibrinogen (DIC)
-Increased INR (DIC)
-Increased split products (DIC)
Tx: See thrombocytopenia
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18
Q 
Acute myelogenous leukemia
Path:
Pt:
Dx:
Tx:
A 
Path: 
acute = Blasts
Myelogenous= Neutrophils
Leukemia= Cancer in the blood
Pt:
-Acute, age 67
-Exposure: Benzene radiation
-CML: Blast crisis
Dx: 
-First: Smear= blasts
-BM Bx > 20%
Tx: 
M3: Vit A )
auer Rods on bx (-) M3: chemo
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19
Q 
Acute lymphocytic leukemia
Path:
Pt:
Dx:
Tx:
A 
Path:
-acute = blasts 
-lymphocytic = leukocytes 
-leukemia = cancer in the blood
Pt: acute, age 7
Dx: 
-First: smear = blasts
-BM Bx > 20% blasts + cALLa and TdT
Tx:
-chemo
-PPx CNS ARA-C +/- radiation
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20
Q

Chronic myelogenous leukemia

A

Path:

  • Chronic =mature cells
  • Myelogenous =neutrophils
  • Leukemia =cancer in the blood

pt: Chronic, age 47

Dx

  • Dff (way more cells then should be)
  • BM Bx = Philadelphia + t(9, 22) + BCR – ABL

tx: Imatinib (tyrosine kinase)

f/u: blast crisis

21
Q

Chronic lymphocytic leukemia

Path:
Pt:
Dx:
Tx:

A

path:
- Chronic equals mature cells
- Lymphocytic equals lymphocytes
- Leukemia equals cancer in the blood

pt: Chronic, Age 87
dx: diff (Way more cells that should be)

tx:
- 65+ and asx = nothing
- 65+ and Sx = chemo
- < 65 + donor = HSCT

22
Q

Contiguous lymph node spread, B sxs, painful lymphadenopathy with EtOh

Pt:
Dx:
Tx:

A

Hodgkin’s lymphoma

Pt: nontender LAD
Dx:
-excisional biopsy showing Reed Sternberg Cells
-Staging with PET/CT or CT Chest/Abdo/Pelvis

Tx:
IIa or better = radiation
IIb or worse = chemo (ABVD, BEACOPP)

23
Q

Hematogenous spread
usually no B sxs
starry sky on biopsy
Extranodal diz

Pt:
Dx:
Tx:

A

NHL

Pt: nontender LAD +/- sxs

Dx:

  • excisional biopsy
  • NO reed sternberg cells
  • stage PT/CT or CT chest/abdo/pelvis

Tx:

  • IIa or better = chemo
  • IIb or worse, chemo = ABVD or BEACOPP
24
Q

Staging of lymphoma I-IV

A

LNs location relative to diaphragm

I = I = not applicable 
II = 2+ and same side diaphragm 
III = 2+ and opposite side of diaphragm 
IV = Mets = N/A
25
Q

Adverse Effects

cisplatin- 
bleomycin-
adriamycin/doxorubicin-
vincristine/vinblastine-
cisplatin- 
cyclophosphamide-
A

cisplatin- ototoxicity
bleomycin- pulmonary fibrosis
adriamycin/doxorubicin- cardiac toxicity
vincristine/vinblastine- peripheral neuropathy
cisplatin- nephrotoxicity
cyclophosphamide- hemorrhagic cystitis

26
Q

70 yo with hypercalcemia, renal failure, anemia, and bone pain

Path:
Pt:
Dx:
Tx:
f/u
A

Multiple myeloma

Path: IgG, monoclonal expansion of plasma cells

  • Ig = recurrent infections
  • bence jones = AKI
  • osteoclasts = lytic lesions

Pt: 70s+ male with CRAB symptoms (hypercalcemia, renal failure, anemia, and bone pain)
Dx:
Spep+
Upep+
Skeletal survey +
BM Bx > 10 % plasma cells
Tx: above 70 - chemo, no donor. below 70, donor: HSCT
F/u: melphalan + steroids, thalidomide, bortezomib

27
Q

Incidental IgG spike without CRAB symptoms

Path:
Pt:
Dx:
Tx:

A

MGUS, early myeloma

Path: increased IgG
Pt: 85+ yo, no CRAB symptoms
Dx: Spep+, Upep- , skeletal survey - , BM Bx < 10% plasma cells
Tx: watch and wait, converts to MM 2%/yr

28
Q

Constitutional symptoms, hyperviscosity syndrome, IgM

Pt:
Dx:
Tx:
f/u

A

Waldenstrom’s

Path: IgM
Pt: Constitutional symptoms, hyperviscosity syndrome
Dx: Spep + , Upep - , skeletal survey - , BM Bx > 10% lymphoma
Tx:
-Rituximab - chemo
-Hyperviscosity = plasmapheresis
F/u: blast crisis

29
Q

Thrombophilic Disorders listed

A 
Factor V Leiden (mutation)
Prothrombin 20210A (mutation)
Protein C def (level)
Protein S def (level)
Antithrombin def (level)
30
Q

Who gets warfarin in a DVT?

A

All patients except metz cancer pts

“provoked 3 months”
“unprovoked 6 months”
recurrence lifetime

31
Q

DVT prophylaxis

risk
cancer

A

risk:

  • trauma
  • surgery (10x)
  • LWMH PPx
  • LMWH –> warfarin

Cancer
LMWH ppx
LMWH treatment (no warfarin in met cancer)

32
Q

fever, anemia, thrombocytopenia, renal fialure, neuro symptoms

Path:
Pt:
Dx:
Tx:

A

TTP

Path: hyaline clots, adamts-13 deficiency 
Pt ("FAT RN")
Fever
Anemia
Thrombocytopenia 
Renal failure 
Neurological symptoms

Dx:

  • CBC: ↓ platelets
  • Smear: schistocytes
  • PT/PTT: normal
  • fibrinogen: normal
  • D-dimer: normal

Tx:
-exchange transfusion

F/u: NEVER platelets

33
Q

SICK AS SHIT, SEPSIS, ICU SHOCK, THEN THEY START BLEEDING

Path:
Pt:
Dx:
Tx:

A

DIC

Path: fibrin clots, tremendous catastrophic injury

Pt: SICK AS SHIT, SEPSIS, ICU SHOCK, THEN THEY START BLEEDING

Dx:

  • CBC: ↓ platelets
  • Smear: schistocytes
  • PT/PTT: ↑
  • fibrinogen: ↓
  • D-dimer: ↑

Tx:

  • Fix underling disease
  • give blood products
34
Q

thrombocytopenia following heparin exposure

Path:
Pt:
Dx:
Tx:

A

HIT

Path: antibodies to platelets

Pt: heparin –> (7-14 days)–> Plts ↓ by ~50%–> new clots

Dx: antiplatelet factor 4 Elisa +, confirm with serotonin release assay

Tx: stop heparin, argatroban –> warfarin INR 2-3

35
Q

Woman with autoimmune disease and ↓ platelets

Path:
Pt:
Dx:
Tx:

A

Path: antibodies to platelets, splenic destruction
Pt: Woman with autoimmune disease and ↓ platelets

Dx: Diagnosis of exclusion

Tx: steroids, IVIg, splenectomy, rituximab

36
Q

woman with heavy menstrual periods and easy bleeding

Path:
Pt:
Dx:
Tx:

A

Path:

  • MC bleeding disorder
  • Deficiency of vWD
  • autosomal dom

Pt: platelet bleed, normal count, can have factor VIII def

Dx:

  • 1st - CBC = normal count
  • best = vWD assay
  • must have ↑ PTT from factor VIII deficiency

Tx: DDAVP (Desmopressin)

37
Q

Bleeding AND clotting, hemarthrosis (bleeding), arterial thrombosis (clotting)

Path:
Pt:
Dx:
Tx:

A

Antiphospholipid antibody syndrome

Path: LUPUS

Pt: Bleeding AND clotting, hemarthrosis (bleeding), arterial thrombosis (clotting)

Dx: Pt/PTT/INR, mixing studies that do not correct, Vpier Venom Assay

Tx: heparin to warfarin bridge for APLA, treat lupus

38
Q 
Acquired Factor Deficiency 
Path:
Pt:
Dx:
Tx:
A

Path: liver dysfunction, warfarin, Vit K def
Pt: long ICU stay, on warfarin, has cirrhosis
Dx: PT/PTT/INR
Tx: Vitamin K

39
Q

Bleeding Disorders: list them

A 
VWD
ITP
TTP
DIC
Glanzmann's
Bernard-Soulier
Hemophilia 
Liver Disease 
Vit K Deficiency
40
Q

Thrombophilia (over-clotting) diseases: list them

A 
Factor V Leiden
Protein C Deficiency
Protein S Deficiency 
Antithrombin 
Antiphospholipid Syndrome
41
Q

gingival, vaginal, skin bleeding are signs of a problem in which ° of hemostasis?

A

primary hemostasis = platelet bleeding

normal platelet count = platelet function error

low platelet count = platelet destruction/consumption (thrombocytopenia)

42
Q

primary hemostasis with a normal
normal platelet count =

primary hemostasis with a low platelet count =

A

primary hemostasis = platelet bleeding

normal platelet count = platelet function error

low platelet count = platelet destruction/consumption (thrombocytopenia)

43
Q

main causes of thrombocytopenia

A

A. destruction (ITP, TTP, DIC, HIT)

B. production (aplastic, mylodysplastic syndromes, cancer)

C. sequestration -
splenic dysfunction or liver disease

44
Q

Bernard Soulie vs Glanzmann’s

A

BS has one b: problem is Glycoprotein I B

so

GT Glycoprotein II B 3A

45
Q

PT/PTT abnormalities are signs of a problem in which ° of hemostasis?

A 
secondary hemostasis (factors)
 THEN PERFORM 
-mixing study 
         ↓ 
 bleeding continues- indicates presence of inhibitor 
BUT IF
↓
-mixing study:  BLEEDING TIME CORRECTED--> Hemophilia A/B, 
Vitamin K def, Warfarin therapy
DIC, WBD (Factor VIII instability)
46
Q 
Causes of a primary hemostasis dysfunction with a normal
 platelet count =
A

NSAIDs, ASA, clopidigrel

uremia, VWD

47
Q

Causes of a primary hemostasis dysfunction with a low platelet count =

A

Destruction of platelets (ITP, TTP, HTP, DIC)

Underproduction of Platelets (myelodysplastic syndromes, cancer)

Sequestration of platelets
(splenic dysfunction and liver disease)

48
Q

How to diagnose a bleeding disorder

A

CBC

PT/PTT (then mixing study if abnormal)

Platelet count- normal or low?

Hemoglobin-
normal or precipitous drop?

tsomkapQ (117 decks)

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