PPP ROSH- Psych/Heme Flashcards by brandon lovin

Polycythemia Vera’s presentation

This is d/t ? mutation

What abnormal c/c can they have

Splenomegaly
Abnormal proliferation of all 3 lines
Thrombosis

JAK-2

Aquagenic pruritus: pruritus after warm bath

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How is Polycythemia Vera Dx and Tx

MC nutritional deficiency in Peds

? is the MC inherited bleeding d/o

CBC; Hydroxyurea, ASA, Phlebotomy

Fe deficiency

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

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How do Pts w/ VW Dz present

How are Pts Tx

MC hemolytic anemia

Mucosal bleeds

Desmopressin- DDAVP

Hereditary spherocytosis- RBC membrane defect

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What lab results are seen w/ Hereditary Spherocytosis

What is the MC complication from this Dx

What characteristics differentiates TRALI from TACO

Howell Jolly body

Billirubin gallstones

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

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Reed Sternberg cells indicate ? Dx

What is the MC nephrotic syndrome in Peds

What is the MCC of nephrotic syndrome in adults

Minimal change dz

Focal segmental glomerulosclerosis

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What are the B-Sxs of HL

MC inherited hypercoagulability d/o

How are these Pts Tx

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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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

Koilonychia- spooning of nails

Megaloblastic anemia w/ inc serum methylmalonic/homocysteine

Folic acid

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MCC of Megaloblastic anemia

What can cause Methemoglobinemia and how is it Tx

What would be seen on blood draw

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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Define Fanconi Anemia

What may be noted on PE

How are Pts Tx

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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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

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

Hydroxyurea w/ support

ABX w/ exchange transfusions

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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

P-RBC transfusions

Terbutaline and exchange transfusion

Chlamydia, Mycoplasma

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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

5-14d later

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

Multiple platelet/PRBCs

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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

LMWH/UFH, Warfarin is C/i

Phlegmasia ceruelea dolens

Ferritin

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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

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

Knee/Wrist

Basophilic stippling; Succimer

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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

HFlu, N meningitides, Strep Pneumo

Acute chest syndrome: admit, broad spectrum ABX, O2

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What lab result would be seen during B-Thalassemia

What 3 lab results are seen during thalassemia

N-HL presentation

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

Microcytosis, Hypochromic, Basophilic stippling

Persistent, painless adenopathy w/ B-Sxs

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

Primary Immune Thrombocytopenia is AKA

How are PTs Tx

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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Define Multiple Myeloma

How do Pts present w/ this

How is this Tx

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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MC leukemia in Western country adults

What may be seen on lab results

Define Tumor Lysis Syndrome

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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? syndrome can cause multiple spontaneous abortions

This is commonly seen w/ ? Dz

What markers are used for Dx

Antiphospholipid Ab syndrome- acquired hypercoagulability

Lupus

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

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What do blood samples look like under microscopy during Multiple Myeloma

How are PTs Tx

B12 Deficiency will have ? increased lab result

Rouleaux formation

Chemo, Stem cell transplant

Methylmalonic acid

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? is the hallmark finding for multiple myeloma

Philadelphia chromosome is found w/ ? Dx

What is the staging system for N/HL

Bence Jones proteins

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

Ann Arbor system

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

This hemophilia is AKA and d/t ?

How are Pts Tx

aPTT

Christmas Dz d/t deficiency of Factor 9

Recombinant Factor 9

Define TTP

How are Pts Tx

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

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

? Dx is associated w/ Auer Rods When is Clozapine used What lab needs to be ordered when using Clozapine

AML- MC leukemia in adults; clonal proliferation of myeloid precursor cells Schizo w/ SI WBC monitoring for agranulocytosis

# Define Muehrckes Lines MCC of non-solid organ Ca-related death Leading cause of death world wide

Transverse bands that disappear w/ pressure N-HL Adeno lung Ca

? is the only dz modifying therapy for Sickle Cell MCC of hemolytic transfusion reactions How are these Tx

Hydroxyurea- inc levels of Hb F (fetal hgb) ABO incompatability d/t human error Stop infusion, Crystalloid infusions, Diuretics

ALL AML CLL CML

MC childhood leukemia Adults > kids w/ Auer rods MC adult leukemia w/ smudge cells; worst prognosis Philadelphia chromosome w/ basophilic smears

How can CML be differed from reactive leukocytosis d/t infection 2nd Gen antipsychs need to have ? monitoring Cluster A, B, and C personalities

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

C/i for using Buproprion ? presenting c/c suggest panic attack How is PCP use differed on PE from cocaine

Anorexia nervosa, Seizure d/o Chest pain PCP- aggressive/violent behavior or flat, catatonic stare

Opiate withdrawal Sxs How is GAD/o Tx Blocking ? receptors decreases risk for EPS

Mydriasis- dilated N/V/D Tachy/Tachy/HTN Yawning/lacrimation Venlafaxine (SNRI) Muscarinic Ach receptors

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

Olanazpine- atypical antipsych Matchbox- sample of skin/infestation CBT w/ psychotherapy

# Define Kaposi Sarcoma MC head/neck Ca in Peds What lab result aids w/ Dx

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

? virus is associated w/ Burkitt Lymphoma How does Hereditary Spherocytosis present and how is it Tx Unique fact to isolate this Dx

EBV Spherical microcytic, Inc retic/MCV, +osmotic fragility test, -Coombs; Tx: Splenectomy Inc mean corpuscular hgb concentration (MCHC)

What RBC membrane protein is defected in spherocytosis Define HIT How is it Tx

Sprectrin or Actrin Heparin Induced Thrombocytopenia- 5-7d post initiation drop in platelets >50% D/c heparin, start Fondaparinux, FXa inhibitors

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

<10K Fanconi Anemia <12mon; Ferrous sulfate 2mon after Hgb normalizes

Name of triad contributors to thrombosis development Population for the pentad presentations for TTP and HUS What will be seen on PE

Virchow: Stasis Hypercoag Injury HUS: kids, TTP: adults Fever Anemia Thrombocytopenia Neuro Kidney injury Purpura, Petechiae, Bleeding

How is TTP Tx MC hereditary bleeding d/o 3 common findings for clotting factor deficiency and not platelet insufficiency

Plasmapheresis- remove plasma, replace w/ FFP Von Willebrand dz- Tx w/ DDAVP Delayed bleeding, Hemearthrosis, Soft tissue hematomas

What PE finding is most consistent w/ thrombocytopenia MCC of Secondary Polycythemia MC location for spontaneous bleeds d/t hemophilia A

Wet purpura- occurs on mucosal surfaces Hypoxia Peds: Ankle, Adult: Knee > Elbow > Ankle

Anesthetic allergy and next option algorithm Max dose of Lidocaine w/out Epi What is found in cryoprecipitate

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

# Define Neutropenic Fever How is this Dx How are Pts Tx

Fever w/ neutropenia (absolute neutrophils) <1500 MC d/t Pseudomonas Blood and Urine cultures Vanc + Cefepime (4th Gen)

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

RDW elevation South Asia/Chinese PCN

Antiplatelets Anticoagulants What temp defines a neutropenic fever

Clopidogrel ASA Prasugrel Dabi/Edox/Apixa/Riva-aban, Warfarin PO temp of 101* taken once

Warfarin inactivates ? factors Reversal agent is ? MCC of bacterial infection in neutropenic fever Pts

2 7 9 10, Protein C, S Vit K Gram pos

How is antiphospholipid syndrome tested for Dx What is used for primary thrombotic prevention Most Pts are put on life long ? for anticoagulation

Lupus anticoagulant, Anti-cardiolipin Low dose ASA Warfarin

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

Hydroxychloroquine Parvovirus B19 Aminocaproic acid

? 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

Typicals Doxepin- TCA Omalizumab PO Antihistamines Post exertion/head in Sickle Cell Pts

What do Howel Jolly bodies look like What does their presence indicate What will ALL look like on PE

Basophilic nuclear remnant in RBCs Damage/absent spleen Peds 3-7y/o w/ bone pain, adenopathy, hepatosplenomegaly and CNS involvement, lymphoblasts on peripheral smear

Initial lab test for Dx B12 deficiency MC presentation for ALL How is a Dx of Multiply Myeloma confirmed

Serum cobalamin Adenopathy Serum/Urine protein electrophoresis

How is a Dx of TTP confirmed How are PTs Tx What lab results are seen w/ vWDz

ADAMTS13 deficiency w/ inhibitor (cleaves vWF) Plasma exchange (platelets <10K), Rituximab, GCCS Prolonged bleeding time; Normal PT, PTT, INR

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

D/c infusion, Push diphenhydramine Folic Acid Thiamine w/ no anemia

B12 deficiency can be associated w/ ? infection Philadelphia chromosome is associated w/ ? Dx and w/ ? gene How to differ Fe Deficient, ACDz, and Thalassemia

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

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

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