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IPAP > PPP ROSH- Psych/Heme > Flashcards

PPP ROSH- Psych/Heme Flashcards

1
Q

Polycythemia Vera’s presentation

This is d/t ? mutation

What abnormal c/c can they have

A

Splenomegaly
Abnormal proliferation of all 3 lines
Thrombosis

JAK-2

Aquagenic pruritus: pruritus after warm bath

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2
Q

How is Polycythemia Vera Dx and Tx

MC nutritional deficiency in Peds

? is the MC inherited bleeding d/o

A

CBC; Hydroxyurea, ASA, Phlebotomy

Fe deficiency

VwF- supports platelet adhesion by bridging platelet w/ endothelial structures

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3
Q

How do Pts w/ VW Dz present

How are Pts Tx

MC hemolytic anemia

A

Mucosal bleeds

Desmopressin- DDAVP

Hereditary spherocytosis- RBC membrane defect

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4
Q

What lab results are seen w/ Hereditary Spherocytosis

What is the MC complication from this Dx

What characteristics differentiates TRALI from TACO

A

Howell Jolly body

Billirubin gallstones

TACO has no fever, TALI- Fever, HOTN, Tachycardia

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5
Q

Reed Sternberg cells indicate ? Dx

What is the MC nephrotic syndrome in Peds

What is the MCC of nephrotic syndrome in adults

A

HL

Minimal change dz

Focal segmental glomerulosclerosis

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6
Q

What are the B-Sxs of HL

MC inherited hypercoagulability d/o

How are these Pts Tx

A

Fever, Night sweats, Weight loss

Factor V Leiden- needed to generate fibrin mesh of clots, Dz causes resistance to degradation by Protein C

Anticoagulation, FFP

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7
Q

Name of nail changes seen during Fe Deficient Anemia

? lab result suggests Vit B12 deficiency

What other supplement Tx is recommended during first months of Tx

A

Koilonychia- spooning of nails

Megaloblastic anemia w/ inc serum methylmalonic/homocysteine

Folic acid

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8
Q

MCC of Megaloblastic anemia

What can cause Methemoglobinemia and how is it Tx

What would be seen on blood draw

A

Chronic alcoholism: B12 deficiency, Folate deficiency

Benzocaine:
Methylene blue- aids w/ Fe3 (ferric) conversion to Fe2 (ferrous)

Chocolate colored arterial blood

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9
Q

Define Fanconi Anemia

What may be noted on PE

How are Pts Tx

A

Defected DNA repair causing macrocytic anemia and inc AF-protein; increased risk for AML/tumors

Absent/Small thumbs, Short, Mental delays

Marrow transplant

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10
Q

How are Peds/Adults going through Sickle Crisis induced cerebrovascular events Tx

How are vaso-occlusive pain crisis’ Tx

How are acute chest syndromes Tx

A

P: Exchange transfusion to dec Hgb S level <30%
A: tPA

Hydroxyurea w/ support

ABX w/ exchange transfusions

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11
Q

How are Sickle Cell induced Aplastic Crisis Tx

How are Sickle Cell induced priapisms Tx

What are the MCC of Acute Chest syndrome in Sickel Pts

A

P-RBC transfusions

Terbutaline and exchange transfusion

Chlamydia, Mycoplasma

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12
Q

How long after completion of chemo will Nadir in absolute neutrophil count occur

MCC of aplastic crisis in Sickle Cell Pts

Sickle Pts should receive ? type of blood products

A

5-14d later

Parvovirus B19 d/t suspension of erythropoiesis (undetectable retic count)

Multiple platelet/PRBCs

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13
Q

How are DVTs in pregnancy Tx

What is the name of the blue-ish hue the leg appears as

Best lab test for indicator of stored iron

A

LMWH/UFH, Warfarin is C/i

Phlegmasia ceruelea dolens

Ferritin

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14
Q

What lab result is used to differ Fe Deficient Anemia from Thalassemia

? type of x-rays are ordered for suspected lead poisoning

What lab result is pathognemonic to this poisoning and how are they Tx

A

RDW- inc w/ Fe Deficient, normal w/ Thalassemia

Knee/Wrist

Basophilic stippling; Succimer

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15
Q

Sickle Cell Dz affects ? Hgb chain

What microbes are these Pts particularly susceptible to

? is the leading cause of death in these Pts and how are they Tx

A

B

HFlu, N meningitides, Strep Pneumo

Acute chest syndrome: admit, broad spectrum ABX, O2

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16
Q

What lab result would be seen during B-Thalassemia

What 3 lab results are seen during thalassemia

N-HL presentation

A

Codocytes: target cells; abnormal B-cahin causes hypochromic appearance

Microcytosis, Hypochromic, Basophilic stippling

Persistent, painless adenopathy w/ B-Sxs

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17
Q

What meds are used pre/acutely for chemo s/e when treating N-HL

Primary Immune Thrombocytopenia is AKA

How are PTs Tx

A

Pre: Benzos Acute: 5-hydroxytryptamine antagonist

Idioapthic Thrombocytopenia Purpura- Abs to platelets causing mucocutaneous bleeds

CCS+IVIG; <10K= spontaneous bleeds- Platelet transfusion

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18
Q

Define Multiple Myeloma

How do Pts present w/ this

How is this Tx

A

Malignant proliferation of plasma cells producing excess monoclonal paraproteins

CRAB:
Inc Ca, Renal insufficiency (Bence Jones protein), Anemia, Bone lesion (HyperCa)

CCS, Pamidronate, Chemo

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19
Q

MC leukemia in Western country adults

What may be seen on lab results

Define Tumor Lysis Syndrome

A

CLL- monoclonal proliferation of mature B-cells

Smudge cells- fragile lymphocytes
>10% clonal marrow plasma cells =Dx

Hyper-K/Uric/Phosph, HypoCa, Inc Cr d/t cell death from chemo for heme malignancies; Tx: aggressive fluids and dialysis

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20
Q

? syndrome can cause multiple spontaneous abortions

This is commonly seen w/ ? Dz

What markers are used for Dx

A

Antiphospholipid Ab syndrome- acquired hypercoagulability

Lupus

Anticardiolipin Abs, Anti-beta 2 glycoprotein Abs, Lupus anticoagulant

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21
Q

What do blood samples look like under microscopy during Multiple Myeloma

How are PTs Tx

B12 Deficiency will have ? increased lab result

A

Rouleaux formation

Chemo, Stem cell transplant

Methylmalonic acid

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22
Q

? is the hallmark finding for multiple myeloma

Philadelphia chromosome is found w/ ? Dx

What is the staging system for N/HL

A

Bence Jones proteins

CML- WBC 150K, peripheral smear w/ L-shifted myeloids, Splenomegaly, <5% blast cells; Tx: Imatinib mesylate

Ann Arbor system

23
Q

? lab test will be abnormal in Pts w/ hemophilia B

This hemophilia is AKA and d/t ?

How are Pts Tx

A

aPTT

Christmas Dz d/t deficiency of Factor 9

Recombinant Factor 9

24
Q

Define TTP

How are Pts Tx

? is the MCC of hyperviscosity syndrome and how are they Tx

A

Dec VWF cleaving protease leading to inc LDH, indirect bili and normal coag studies

Plasma exchange w/ CCS

Inc serum protein 2/2 Waldenstrom macroglobulinemia; Phoresis/Phlebotomy

25
Q

? Dx is associated w/ Auer Rods

When is Clozapine used

What lab needs to be ordered when using Clozapine

A

AML- MC leukemia in adults; clonal proliferation of myeloid precursor cells

Schizo w/ SI

WBC monitoring for agranulocytosis

26
Q

Define Muehrckes Lines

MCC of non-solid organ Ca-related death

Leading cause of death world wide

A

Transverse bands that disappear w/ pressure

N-HL

Adeno lung Ca

27
Q

? is the only dz modifying therapy for Sickle Cell

MCC of hemolytic transfusion reactions

How are these Tx

A

Hydroxyurea- inc levels of Hb F (fetal hgb)

ABO incompatability d/t human error

Stop infusion, Crystalloid infusions, Diuretics

28
Q

ALL

AML

CLL

CML

A

MC childhood leukemia

Adults > kids w/ Auer rods

MC adult leukemia w/ smudge cells; worst prognosis

Philadelphia chromosome w/ basophilic smears

29
Q

How can CML be differed from reactive leukocytosis d/t infection

2nd Gen antipsychs need to have ? monitoring

Cluster A, B, and C personalities

A

CML- Phili chromosome
RL: lower WBC <50K and w/out splenomegaly

Lipids d/t acquired metabolic syndrome

A: Schizotypal, Schizoid, Paranoid
B: Boderline Antisocial Histrionic Narcissistic
C: Dependent, OCD, Avoidant

30
Q

C/i for using Buproprion

? presenting c/c suggest panic attack

How is PCP use differed on PE from cocaine

A

Anorexia nervosa, Seizure d/o

Chest pain

PCP- aggressive/violent behavior or flat, catatonic stare

31
Q

Opiate withdrawal Sxs

How is GAD/o Tx

Blocking ? receptors decreases risk for EPS

A

Mydriasis- dilated
N/V/D
Tachy/Tachy/HTN
Yawning/lacrimation

Venlafaxine (SNRI)

Muscarinic Ach receptors

32
Q

What med can be used in Anorexia Nervosa to aid w/ weight gain

Pts w/ delusional parasitosis can present w/ ? sign

First line therapy for borderline personality d/o

A

Olanazpine- atypical antipsych

Matchbox- sample of skin/infestation

CBT w/ psychotherapy

33
Q

Define Kaposi Sarcoma

MC head/neck Ca in Peds

What lab result aids w/ Dx

A

Systemic tumor d/t co-infection w/ HHV-8; presents w/ ecchymotic macules/tan plaques in Eastern European males w/ purple/brown lesions on feet

HL- painless, rubbery mass in supraclavicular/anterior cervical triangle w/ B-Sxs

Reed Sternberg cells

34
Q

? virus is associated w/ Burkitt Lymphoma

How does Hereditary Spherocytosis present and how is it Tx

Unique fact to isolate this Dx

A

EBV

Spherical microcytic, Inc retic/MCV, +osmotic fragility test, -Coombs; Tx: Splenectomy

Inc mean corpuscular hgb concentration (MCHC)

35
Q

What RBC membrane protein is defected in spherocytosis

Define HIT

How is it Tx

A

Sprectrin or Actrin

Heparin Induced Thrombocytopenia- 5-7d post initiation drop in platelets >50%

D/c heparin, start Fondaparinux, FXa inhibitors

36
Q

Platelet levels below ? should initiate transfusions

MC form of inherited Aplastic Anemia

Infants drinking cows mild before ? age are at risk for Fe Anemia and what is Tx

A

<10K

Fanconi Anemia

<12mon; Ferrous sulfate 2mon after Hgb normalizes

37
Q

Name of triad contributors to thrombosis development

Population for the pentad presentations for TTP and HUS

What will be seen on PE

A

Virchow: Stasis Hypercoag Injury

HUS: kids, TTP: adults
Fever Anemia Thrombocytopenia Neuro Kidney injury

Purpura, Petechiae, Bleeding

38
Q

How is TTP Tx

MC hereditary bleeding d/o

3 common findings for clotting factor deficiency and not platelet insufficiency

A

Plasmapheresis- remove plasma, replace w/ FFP

Von Willebrand dz- Tx w/ DDAVP

Delayed bleeding, Hemearthrosis, Soft tissue hematomas

39
Q

What PE finding is most consistent w/ thrombocytopenia

MCC of Secondary Polycythemia

MC location for spontaneous bleeds d/t hemophilia A

A

Wet purpura- occurs on mucosal surfaces

Hypoxia

Peds: Ankle, Adult: Knee > Elbow > Ankle

40
Q

Anesthetic allergy and next option algorithm

Max dose of Lidocaine w/out Epi

What is found in cryoprecipitate

A

Amide: have two I’s, Esters: have one I; allergy to one, pick from other class

3-5mg/kg

Factor 8, 9, vWF, fibrinogen, fibronectin

41
Q

Define Neutropenic Fever

How is this Dx

How are Pts Tx

A

Fever w/ neutropenia (absolute neutrophils) <1500 MC d/t Pseudomonas

Blood and Urine cultures

Vanc + Cefepime (4th Gen)

42
Q

Lab result characteristic for Fe Deficient Anemia

Alpha-Thalassemia is associted w/ ? ancestry

What medication is started in Peds at age 5 w/ Dx of Sickle Cell

A

RDW elevation

South Asia/Chinese

PCN

43
Q

Antiplatelets

Anticoagulants

What temp defines a neutropenic fever

A

Clopidogrel ASA Prasugrel

Dabi/Edox/Apixa/Riva-aban, Warfarin

PO temp of 101* taken once

44
Q

Warfarin inactivates ? factors

Reversal agent is ?

MCC of bacterial infection in neutropenic fever Pts

A

2 7 9 10, Protein C, S

Vit K

Gram pos

45
Q

How is antiphospholipid syndrome tested for Dx

What is used for primary thrombotic prevention

Most Pts are put on life long ? for anticoagulation

A

Lupus anticoagulant, Anti-cardiolipin

Low dose ASA

Warfarin

46
Q

What med is used for prophylactic Tx for Pts w/ antiphospholipid syndrome and SLE

Hereditary spherocytosis are at increased risk for infections by ?

What med is used for Pts w/ hemophilia prior to dental procedures to prevent clot breakdown

A

Hydroxychloroquine

Parvovirus B19

Aminocaproic acid

47
Q

? types of antipsychotics are more likely to have EPS Sxs

What med is used for medical Tx failure, chronic and recurrent urticaria

Howel Jolly bodies may be seen in ? population w/ ? Dx

A

Typicals

Doxepin- TCA
Omalizumab
PO Antihistamines

Post exertion/head in Sickle Cell Pts

48
Q

What do Howel Jolly bodies look like

What does their presence indicate

What will ALL look like on PE

A

Basophilic nuclear remnant in RBCs

Damage/absent spleen

Peds 3-7y/o w/ bone pain, adenopathy, hepatosplenomegaly and CNS involvement, lymphoblasts on peripheral smear

49
Q

Initial lab test for Dx B12 deficiency

MC presentation for ALL

How is a Dx of Multiply Myeloma confirmed

A

Serum cobalamin

Adenopathy

Serum/Urine protein electrophoresis

50
Q

How is a Dx of TTP confirmed

How are PTs Tx

What lab results are seen w/ vWDz

A

ADAMTS13 deficiency w/ inhibitor (cleaves vWF)

Plasma exchange (platelets <10K), Rituximab, GCCS

Prolonged bleeding time; Normal PT, PTT, INR

51
Q

How is an anaphylactoid reaction to Vanc Tx

Alcoholic w/ generalized weakness needs ? supplementation

Alcoholics are commonly deficient in ? but will have ? associated lab result

A

D/c infusion, Push diphenhydramine

Folic Acid

Thiamine w/ no anemia

52
Q

B12 deficiency can be associated w/ ? infection

Philadelphia chromosome is associated w/ ? Dx and w/ ? gene

How to differ Fe Deficient, ACDz, and Thalassemia

A

D latum tapeworm

CML, BCR-ABL gene

Fe: micro/hypo w/ dec ferritin, inc TIBC
ACDz: inc ferritin, dec TIBC
Thal: norm ferritin, norm/inc serum Fe

53
Q

How to differ aplastic crisis from splenic sequestration

How to differ Primary/Secondary Erythroctyosis (polycythemia vera)

Opposition defiant d/o commonly co-exists w/ ? other Dx

A

Aplastic; dec retic, mild neutropenia
Sequest: splenomegaly, hypovolemia, thrombocytopenia

1: normal o2 sat, dec EPO, inc WBC/platelet
2: dec o2 sats, inc EPO, normal WBC/platelet

ADHD

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