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DIT STEP 2 > HEM&ONC > Flashcards

HEM&ONC Flashcards

1
Q

Shift oxy-hemoglobin curve to left

A

Metabolic alkalosis Decreased body temp Increased Hgb F

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2
Q

Shift oxy0hemoglobin curve to the right

A

Metabolic acidosis Increased body temp High altitude Exercise

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3
Q

5 causes of microcytic anemia

A

Iron deficiency Lead poisoning Anemia of chronic disease Sideroblastic anemia Thalassemias

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4
Q

3 causes of normocytic anemia

A

Hemolytic anemia Anemia of chronic disease Hypovolemia

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5
Q

Normal MCV Increased retake count Increased indirect bill Increased LDH Decreased serum haptoglobin

A

Hemolytic anemia

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6
Q

Pathology of G6PD deficiency

A

Deficiency of G6PD (enzyme required to repair oxidative damage to RBCs) Ingestio nof an oxidant causes excessive hemoylsis

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7
Q

Heinz bodies

A

Small densities of Hgb in RBC seen in GG6PD deficiency

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8
Q

Oxidants that exacerbate G6PD deficiency

A

Fava beans High dose ASA Sulfa Dapsone Quinine/quinidine Primaquine Nitrofurantoin

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9
Q

Serum iron and ferritin in sideroblastic anemia

A

Increased

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10
Q

Which thalassemia shows basophilic stippling

A

Beta

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11
Q

Gingival lead lines, peripheral neuropathy, decreased MCV

A

Lead poisoning anemia (acquired sideroblastic anemia)

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12
Q

Treamtnet for lead poisoning

A

EDTA or Dimercaptosuccinic acid

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13
Q

Drugs that can cause aplastic anemia

A

Chloramphenicol, sulfonamides, phenytoin, chemotherapeutics

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14
Q

H/P of aplastic anemia

A

Persistent infections Poor clotting Easy brusiing

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15
Q

Defective heme synthesis

A

Sideroblastic anemia

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16
Q

Causes of sideroblastic anemia (3) - acquired

A

Alcohol Isoniazid Lead poisoning

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17
Q

Tx of hereditary sideroblastic anemia

A

Vitamin B6. Significant iron overload requires therapeutic phlebotomy or chelation with deferoxamine.

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18
Q

Complication in 10% of sideroblastic anemia patients

A

Acute leukemia

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19
Q

SORE tongue points to what kind of anemia

A

folate deficiency

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20
Q

How many abnormal genes do pts with alpha thalassemia minor have

A

Two

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21
Q

What kind of Hb increases in pts with B-thalassemia minor

A

HbA2

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22
Q

What kind of Hb is increased in pts with B-thalassemia major

A

HbA2 and F

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23
Q

Complications of thalassemias

A

Chronic iron overload from repeat transfusions causes damage to heart and liver.

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24
Q

Diff between sickle cell anemia and beta thalassemia

A

SCD causes production of DEFECTIVE beta chains. In B-thalassemia, decreased production of NORMAL beta chains.

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25
Q

“fish mouth vertebrae”

A

sickle cell disease

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26
Q

Encapsulated organisms

A

S pneumo H influenzae N. meningitidis Klebsiella

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27
Q

What type of hypersensitivity is drug-induced hemolytic anemia

A

Type II

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28
Q

Increased PT/INR indicates decreased function of which factors

A

Factors II, VII, IX, X

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29
Q

Increased PTT indicates decreased function of which factors

A

IIa, IXa, Xa, XIa, XIIa

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30
Q

Monitoring required in LMWH

A

None :)

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31
Q

Only factors not synthesized by the liver

A

VWF and VIII therefore they remain normal in liver failure

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32
Q

vWD labs

A

Increased PTT Increased bleeding time decreased ristocetin cofactor assay

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33
Q

Name 3 GPIIb/IIIa inhibitors

A

Abciximab Tirofiban Eptifibatide

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34
Q

Name 2 drugs you can use for HIT patients

A

lepirudin Argatroban Direct thrombin inhibitors

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35
Q

MOA of dipyridamole

A

Inhibit activity of adenosine deaminase and phosphodiesterase to inhibit platelet aggregation

36
Q

4 things increased in DIC

A

increased PT Increased PTT Increased fibrin split products Increased D-dimer

37
Q
A

Plasmodium infection. Ntote enlarged size, intracellular ring and eosinophilic Schuffners granules

38
Q

Prophylactic regimen for HIV in needle stick injury

A

Lamivudine + zidovudine for 4 weeks.

39
Q

At what CD4 count is Kaposi sarcoma seen

A

<500

40
Q

Tx of toxoplasmosis

A

Pyrimethamine

Sulfadiazene

Clindamycin

Chronic tx may be needed.

41
Q

3 infections seen at CD4<50

A

MAC

CMV

Cryptococcal meningitis

42
Q

Complication of polycythemia vera

A

Leukemia

43
Q

Most common form of Hodgkin lymphoma

A

Nodular sclerosing

44
Q

“Starry sky pattern”

A

Burkitt lymphoma

45
Q

t14:18

A

Follicular lymphoma

46
Q

t8;14

A

Burkitt lymphoma

47
Q

Staining with myeloperoxidase

A

AML

48
Q

Smudge cells

A

CLL

49
Q

Philadelphia chromosome (t9;22 BCR-ABL)

A

CML. Also associated with 15% of adult ALL cases.

50
Q

massive splenomegaly and NO lymphadenopathy is what leukemia?

A

Hairy cell

51
Q

Features of Fanconi anemia

A

Short stature

ABnormal skin pigmentation

Horsehoe kidney

Thumb abnormalities

Its bone marrow failure + pancytopenia + increased risk of leukemia

52
Q

Congenital pure RBC anemia

A

Diamond-Blackfan

53
Q

Elevated megakaryocytes

A

ITP

54
Q

Giant platelets, abnormal ristocetin assay, thrombocytopenia

A

Bernard-Soulier

55
Q

Labs in hereditary spherocytosis

A

Anemia with reticulocytosis and increased MCHC

Higher incidence of PSEUDO HYPERKALEMIA as RBCs lyse after blood draw and intracellular potassium leaks.

56
Q

Tx of hereditary spherocytosis

A

Folic acid, 1 mg daily.

RBC transfusion if extreme anemia.

Splenectomy in moderate to severe disease.

57
Q

What lab markers suggest anemia due to hemolysis

A

Low H & H

Normal MCV

High reticulocyte count

Indirect bilirubinemia

High LDH

LOW haptoglobin.

58
Q

Name 4 things that cause schistocytes

A

DIC

HUS

TTP

Hemolytic anemia

59
Q

What disease do you see acanthocytes in?

A

Abetalipoproteinemia

60
Q

3 times you’d see basophilic stippling of RBCs

A

Lead poisoning

Thalassemia

Alcohol use

61
Q

Heinz bodies

A

G6PD

62
Q

Ddx for serum eosinophilia

A

D NAAACP

Drugs (NSAIDs, pcn/cephs)

Neoplasms

Allergies, Arthma (Churg Strauss), Allergic bronchopulonary aspergillosis

AIN

Collagen vasc disease (PAN, dermatomyosities)

Parasites (Such as strongyloides, ascaris lofflers eosinophilic pneumonitis)

63
Q

What drugs are known for causing thrombocytopenia

A

Heparin, abciximab

Carbamazepine, phenytoin, valproate

Cimetidine

Acyclovir, rifampin

Sulfonamides

Procainamide

Quinine, gold compounds

64
Q

You gave a von willebrand pt DDAVP but theyre still bleeding. Now what.

A

Cryo or Factor VIII concentrates.

65
Q

MOA of clopidogrel

A

ADP blocker

66
Q

MOA of eptifibatide

A

GPIIb/IIIa

67
Q

MOA of ticlopidine

A

ADP blocker

68
Q

MOA of tirofiban

A

GPIIb/IIIa

69
Q

Labs in HUS or TTP

A

Decreased platelets

Increased bleeding time

Nml PT, nml PTT

70
Q

Labs in Hemophilia A or B

A

Isolated elevation in PTT

71
Q

Labs in Von Willebrand

A

Normal platelets

Increased bleeding time

Normal PT

Increased PTT (Due to factor VIII)

72
Q

Labs in end stage liver disease

A

Platelet count: decreased or normal

Bleeding time : increased or normal

PT: Increased

PTT: increased

73
Q

Labs in ASA use

A

Increased bleeding time ONLY!

74
Q

Erythromelalgia – what is it and what dz is it classically seen in

A

Burning pain in hands/feet with erythema, pallor or cyanosis that is relieved by ASA. Seen in polycythemia vera

75
Q

Treatment of polycythemia vera

A

PHlebotomy to keep hct below 45% in men, 42% in women

76
Q

What can you add to therapy for a polycythemia vera patient if at high risk for thrombosis

A

Hydroxyurea. Can also take ASA daily to help prevent thrombosis

77
Q

What can you add to therapy if a patient has refractory pruritis or refractory erythrocytosis in polycythemia vera

A

IFN alpha

78
Q

What medication is associated with remission in 95% of patients with CML

A

Imatinib

79
Q

Peripheral blasts are PAS + and TdT+

A

ALL

80
Q

21 y/p/ with recent weight loss, pruritis and night sweats. PE reveals hepatosplenomegaly and nontender cervical lymphadenopathy. What do you immediately suspect

A

Hodgkins

81
Q

Which anti retroviral causes lactic acidosis

A

NRTI

82
Q

4 anti retrovirals that cause pancreatitis

A

Didanosine!!!

Zalcitabine

Stavudine

Ritonavir

83
Q

Which anti retroviral causes megaloblastic anemia and bone marrow suppression

A

zidovudine

84
Q

Regimen for HIV exposure ppx

A

AZT plus lamivudine

85
Q

At CD4 <200, add what meds prophylactically? for waht organisms?

A

TMP-SMX or dapsone for PCP and toxoplasmosis

86
Q

At CD4 <100, add what meds prophylactically and for what organism

A

Erythro or clarithromycin for MAC

DIT STEP 2 (17 decks)

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