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USMLE STEP 2 > UW - Med/HemeOnc > Flashcards

UW - Med/HemeOnc Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the signs of acute and chronic lead poisoning?

A

Acute: GI-ab pain/constipation, Neuro-HA, cog defects, periph neuropathy, MSK-joint pain, aches, Heme-anemia, basophilic stippling, anorexia

Chronic: Similar to acute PLUS Fatigue/insomnia, HTN, Neuropsych sx, Nephropathy, miscarriages/stillbirths

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2
Q

What are the clinical features associated w/ Giant Cell Tumor?

A

Pain, swelling, decreased range of joint motion in involved site, pathological fractures from thinning of bone cortex in weight bearing areas
Loc: distal femur and proximal tibia around knee joint
XRay: expansile and eccentric lytic area (soap buble appearance)

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3
Q

What hematological problem is associated w/ chronic kidney failure? How do you treat and what precautions should be taken?

A
  1. Normocytic, hypoproliferative anemia from decreased erythropoietin
  2. Tx = Epo which leads to surge in iron usage for new RBCs
  3. Provide iron supplementation to prevent microcytic anemia
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4
Q

What are the clinical features of CLL?

A

Pneumonia w/ extreme WBC elevation and 85% lymphocytes, atypical lymphocytes w/ smudge appearance (flow cytometry to confirm clonality), median age 70, recurrent infections

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5
Q

What is a major complication of Heparin induced thrombocytopenia and why? What should be done?

A

Thrombosis - because Heparin-platelet-Ab bound immune complexes activate adjacent platelets to release pro-coagulant factors causing platelet aggregation, thrombin formation and thrombosis
-Can also activate endothelium to release prothrombotic cytokines (vWF)

Monitor closely for Arterial/Venous clots

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6
Q

What are the clinical features of autoimmune hemolytic anemia and how can you differentiate from hereditary spherocytosis?

A
  • Auto-Abs to RBCs cause Extravascular hemolysis (anemia, indirect hyperBR, low-normal haptoglobin and slightly elevated LDH)
  • Sx: Jaundice, pallor, splenomegaly, spherocytes w/o central pallor
  • Negative family history and POSitive Coombs test (unlike HS w/ which has strong genetic link and -coombs)
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7
Q

What lab test and clinical presentation can distinguish warm vs. cold agglutinin?

A

Warm: Asymptomatic to life threatening anemia, Direct Coombs + w/ anti-IgG, anti-C3 or both

Cold: Sx of anemia, livedo reticularis, acral cyanosis w/ cold exposure disappears w/ warmth; direct Coombs + w/ anti-C3 or anti-IgM, but not anti-IgG usually

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8
Q

How can you distinguish intravascular vs. extravascular hemolysis?

A

Intra: Significant RBC structural damage (PNH, DIC), lots of Hb released, bound/excreted w/ Haptoglobin at very high levels (undetectable hapto), elevated indirect BR, elevated LDH

Extra: RBCs mainly destroyed by phagocytes in reticuloendothelial system (lymph nodes, spleen), less Hb release leads to Norma/low haptoglobin, slightly elevated LDH, elevated indirect BR (usually Ab mediated, G6PD def, or membrane defects)

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9
Q

What is a typical presentation for patients w/ multiple myeloma?

A
  • Back pain, anemia, renal dysfxn, elevated ESR (70%)

- Hypercalcemia in 28% of patients leading to constipation and polyuria (HyperCa from bone lysis by plasma cells)

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10
Q

What is the most common cause of malignancy associated hypercalcemia? Which cancers is this associated w/?

A

PTH related peptide (PTHrP) in 80% of cases - SCC, Renal/bladder, ovarian/endometrial, breast

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11
Q

What causes bone resorption in 20% of metastasized breast cancers?

A

Secretion of factors that activate osteoclasts leading to direct bone resorption

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12
Q

In which situations do you most often see hypercalcemia from extra-renal production of calcitriol?

A

Granulomatous disease and lymphoma

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13
Q

What is the preferred anti-emetic used in chemotherapy induced nausea? What is less effective but can also be used?

A
  1. Seratonin antagonists (target 5HT3-R) are first line (e.g. Ondansetron)
  2. Anti-dopamine antagonists (metoclopromide and prochlorperazine
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14
Q

What lab values/markers are elevated w/ choriocarcinoma? Non-seminomatous GCTs? Hepatocellular carcinoma?

A

Chorio - beta-HCG
HCCa - AFP
NSGCT - both b-hCG and AFP

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15
Q

What can be used to help patients w/ cancer related anorexia/cachexia syndrome?

A

Progesterone analogs (megestrol acetate, medroxyprogesterone acetate) and corticosteroids -> increase appetite, cause weight gain, provide sense of well being

-Also can use Mirtazepine (TCA)

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16
Q

What are the symptoms/clinical features of hereditary telangiectasia (Osler-Weber-Rendu syndrome)?

A

AD dz -> diffuse telangiectasias, recurrent epistaxis, and widespread AVMs

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17
Q

What can result from lung AVMs that shunt blood from the right to left side of the heart?

A

Chronic hypoxemia, reactive polycythemia

Risk of massive fatal hemoptysis

18
Q

What clinical features are useful for diagnosing multiple myeloma and how can you confirm?

A
  • Normocytic anemia, hypercalcemia, renal failure, elevated total protein w/ normal albumin (monoclonal protein release)
  • Presents in old age, back pain common
  • Labs show increased ESR, Bence jones proteins in urine
  • Serum immunoelectrophoresis confirms
19
Q

What organ is at great risk of damage in multiple myeloma and how does this develop?

A

50% get renal insufficiency from Hypercalcemia, Hyperuricemia, amyloid deposition, and pyelonephritis

20
Q

What should all patients w/ isolated thrombocytopenia be tested for?

A
  • HIV and Hep C virus

- Bone marrow bx if tests negative

21
Q

What can cause decreased platelet production leading to thrombocytopenia?

A

-Viral infections (HIV, HCV, EBV), Chemo, Myelodysplasia, Alcohol use, Congenital (Fanconi), Vitamin B12 or Folate deficiency

22
Q

What conditions cause increased platelet destruction leading to thrombocytopenia?

A

SLE, Meds (heparin), Idiopathic thrombocytopenic purpura, DIC, thrombotic thrombocytopenia purpura-hemoytic uremic syndrome, Antiphospholipid syndrome

23
Q

At what point would lymph nodes warrant a biopsy?

A
  • Size >2cm

- Hard nodules (esp older pts w/ smoking history)

24
Q

What exam should patients w/ newly diagnosed BPH get?

A

UA to r/o hematuria (cancer, stones) and infection

25
Q

Which cells are affected in CLL?

A

B-cells

26
Q

What is the overall prognosis for CLL? What worsens prognosis?

A
  • 8-10 median survival

- Anemia and thrombocytopenia worsen prognosis

27
Q

What electrolyte abnormalities develop from tumor lysis syndrome?

A
  • Destruction of cells release large amounts of potassium and phosphate
  • released phos binds calcium –> hypocalcemia
  • Degradation of cell proteins causes elevation of uric acid
28
Q

What are the signs of a delayed hemolytic transfusion reaction and what causes it?

A
  • Mild fever and hemolytic anemia, 2-10 days after transfusion, + direct Coombs test
  • Caused by anamnestic antibody response
29
Q

What causes anaphylactic transfusion reactions?

A

Recipient anti-IgA Abs

30
Q

What type of anemia results from lead poisoning?

A

Microcytic anemia

31
Q

What is a side effect of hydroxyurea?

A

Macrocytosis

32
Q

What is the classic tetrad of multiple myeloma? What deficiency will these patients have?

A

CRAB - Calcium (hypocalcemia), Renal impairment, Anemia, and bones (bone pain, lytic lesions, fractures)
-Inability to produce effective antibodies

33
Q

What are the risks of cyclophosphamide therapy? How can you overcome?

A
  • Acute hemorrhagic cystitis, bladder ca,

- Excess fluid intake, voiding frequently, take MESNA

34
Q

How do you manage progressive pain and boney Mets in patients w/ prostate cancer who got orchiectomy?

A

Radiation therapy

35
Q

What is the hematological finding in basal cell carcinoma?

A

Invasive clusters of spindle cells, surrounded by palisaded basal cells,

36
Q

What is the most common cause of macrocytic anemia in patients w/ Sickle?

A

Folate deficiency (from overuse of folate w/ increased RBC production 2/2 increased RBC destruction)

37
Q

What is hyperhemolytic crisis in SCD?

A

Acute severe anemia w/ reticulocytosis

38
Q

How often should women from 50-74 be screened w/ mammograms?

A

Every 2 years

39
Q

How does anemia result in patients w/ lymphoma/leukemia?

A

Bone marrow infiltration by cancerous cells leading to replacement of RBC progenitors

40
Q

What drugs can cause megaloblastic anemia?

A

Phenytoin, primidone, phenobarbital, trimethoprim, methotrexate

USMLE STEP 2 (21 decks)

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