Uworld Heme/Onc Flashcards
Febrile neutropenia?
Temperature > 38
Absolute neutrophil count < 1500
Patient with smoking history, hilar fullness, Mediastinal lymphadenopathy, hypertension, hypokalemia?
Cushing’s from small cell lung cancer
Treatment for febrile neutropenic patient?
Monotherapy with antipseudomonal agent (cefepime, Meropenem, Bactrim)
Signs of polycythemia vera?
Increased blood pressure, Increased RBC mass, elevated platelet count
Peptic ulceration, gouty arthritis, splenomegaly, plethoric face
Fibrocystic disease – type of nodule? Draining yields?
Rubbery, firm, mobile and painful during menses. Clear fluid.
Signs of G6PD in smear? Drugs that provoke it?
Heinz bodies. Sulfa drugs, Antimalarial drugs, nitrofurantoin
Tumor lysis syndrome - expected effect on PO4, K, uric acid, Ca?
Hyperphosphatemia, hyperkalemia, hyperuricemia
hypocalcemia
Tumors that cause tumor lysis syndrome?
Burkitt’s lymphoma and ALL
Treatment for HER2 positive cancer? Test needed before treatment?
Herceptin. EKG (can cause cardio toxicity in pts with systolic dysfunction)
Tx for sickle cell pt with stoke-like Sx?
Exchange transfusion (fibrinolytics don’t help because stroke is caused by sickled cells, not thrombus)
Tx of mild, moderate and severe hyperCa?
Mild (<12): none
Moderate (12-14): none unless symptomatic
Severe (14+): saline with calcitonin (no loop diuretics unless CHF). Bisphosphonate for long term.
Anti-PPL - give what false positive? Coags? Platelet count? Tx?
False positive VDRL, prolonged PTT, and thrombocytopenia. Lovanox.
Macro vs micro vascular hemolysis?
Mechanical valves/stenosis vs vessel occlusion
Transferrin saturation?
Iron/TIBC
Drug to increase appetite in cancer patients?
Progesterone analogs (megesteol acetate)
3 basic symptoms of EBV?
Sore throat, fever, maculopapular rash
Mech of spleen in immune response?
Why is the immune system impaired after splenectomy?
- Normally, antigens enter spleen and are phagocytosed by DC cells
- DC cells present antigens to T helper cells, activating them
- T-helper cells migrate to marginal zone of spleen and activate B-cells
- B-cells activation increases germinal centers and antibody production that facilitate phagocytosis of pathogenic organisms
Therefore, no spleen = impaired phagocytosis
Warfarin leads to skin necrosis due to?
Protein C deficiency
Hairy cell leukemia: stain? Effect on bone marrow? Drug to treat?
Tartrate-resistant acid phosphatase (TRAP) stain
Bone marrow fibrosis (dry taps)
Cladribine (Purine analog)
Patient diagnosed with myasthenia gravis. Next test to order?
Chest CT scan to look for thymoma
Waldenström’s versus multiple myeloma: immunoglobulin?
IgM spike vs IgA/IgG spike
Symptoms of Waldenström’s that is not present in multiple myeloma?
Hyperviscosity syndromes – retinal vein engorgement
Patient with HNPCC should also be evaluated for what other cancer?
Endometrial cancer
Signs of lead poisoning?
- Microcytic anemia
- Neurologic abnormalities (difficulty concentrating, myalgias, peripheral neuropathy, extensor weakness)
- Nephropathy
Patient with tumor secreting ADH – treatment?
- Fluid restriction (<800 mL)
2. If still symptomatic/resistant use hypertonic saline
Signs of glucagonoma?
- G.I. symptoms (diarrhea, abdominal pain)
- Diabetes
- Necrolytic migratory erythematous plaques
- Anemia
- Weight loss
Drugs that can impair folate absorption in the gut?
Phenytoin, pentobarbital, primidone
Vitamin deficiency that can cause a microcytic anemia? Mechanism? Common Scenario?
Pyridoxine deficiency causing sideroblastic anemia. Post Isoniazid therapy.
Anisocytosis vs poikilocytosis?
Cells of abnormal sizes vs shapes
Benign vs worrisome lymph nodes?
2 cm, firm and immobile
Senile purpura?
ecchymotic lesion in the elderly (usually dorsum of hands) due to connective tissue atrophy
Test to confirm CLL?
flow-cytometry
Complications of hereditary spherocytosis?
Splenomegaly, jaundice, gallstones
Red blood cells get trapped in fenestrations of spleen (Splenomegaly). Hemolysis leads to jaundice and calcium bilirubinate stones.
Not graft vs. host without?
Skin rash
Leukoreduction? Purpose?
Cell washing?
Depleting leukocytes in transfusions. Prevents febrile reactions caused by pt antibodies reacting with donor leukocyte; reduced CMV transmission
Removes IgA
Diseases with low leukocyte alkaline phosphatase?
- CML
- paroxysmal nocturnal hemoglobinuria
- hypophosphtemia
Laboratory findings in Steroid abuse?
erythrocytosis
Heptatotoxicity
Dyslipidemia
Classic findings in CML?
Leukocytosis with low leukocyte alkaline phosphatase
Management based on CHADS2 score?
0 = no treatment
1 - anticoagulant therapy > aspirin
2+ - Oral anticoagulant therapy
MCHC (mean cell hemoglobin concentration) elevated in?
Spherocytosis
Patient receives blood and becomes:
- febrile with chills. Self limited and resolves within 1 to 6 hours? Prevention?
- Febrile with Flank pain and hemoglobinuria. Progresses to renal failure and DIC. Diagnosis? Tests?
- Non-hemolytic reaction due to cytokines in transfused blood. Luekoreduction
- Acute hemolytic reaction (unmatched blood). Positive Coombs test and free plasma hemoglobin.
Intravascular vs extravsacular hemolysis - haptoglobin?
Very low (lots of Hgb release) versus low-normal (cells phagocytized)
Coombs test in Autoimmune hemolytic anemia vs hereditary spherocytosis?
Positive vs negative
