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Online Med Ed > Hematology/Oncology > Flashcards

Hematology/Oncology Flashcards

1
Q

folate deficiency path

A

leafy greans 3-6 wk stores pregnancy

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2
Q

folate deficiency pt

A

tea + toast diet EtOH pregnancy

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3
Q

folate deficiency dx

A

folic acid levels decreased normal methylmalonic acid increase homocysteine (not done)

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4
Q

folate deficiency tx

A

folate, 1mg po

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5
Q

B12 deficiency path

A

3-10 yrs storage animal products neuro symptoms

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6
Q

B12 deficiency pt

A

strict vegan pernicious anemia Crohn’s disease gastric bypass

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7
Q

B12 deficiency dx

A

B12 levels decreased increase homocysteine (don’t check) increase methylmalonic acid

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8
Q

B12 deficiency tx

A

B12 - PO = nutritional - IM = impaired absorption

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9
Q

B12 deficiency f/u

A

never choose Schilling test prolonged deficiency is loss of DCMLS (proprioception, Vibration)

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10
Q

pernicious anemia path

A

antibodies against parietal cells no intrinsic factor, no B12 absorption

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11
Q

pernicious anemia pt

A

weakness, sore tongue, paresthesias

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12
Q

pernicious anemia dx

A

Ab-intrinsic factor Ab-Anti-parietal

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13
Q

pernicious anemia tx

A

IM B12 cannot treat pernicious anemia

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14
Q

pernicious anemia f/u

A

gastric cancer

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15
Q

non-megaloblastic anemias

A

liver disease EtOH medications (AZT, HAART, 5-FU, ARA-C) Metabolic syndrome - Lesch-Nyhan - Hereditary orotic aciduria

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16
Q

iron deficiency anemia path

A

slow bleed consumption of iron stores

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17
Q

iron deficiency anemia pt

A

woman = menorrhagia man = colon cancer

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18
Q

iron deficiency anemia dx

A

iron studies - iron decrease - ferritin decrease - TIBC increase best: Bone marrow bx (rarely needed)

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19
Q

iron deficiency anemia tx

A

iron 2-6wks for anemia iron 2-6mo for iron stores

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20
Q

anemia of chronic disease path

A

chronic inflammatory disease

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21
Q

anemia of chronic disease pt

A

anemia

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22
Q

anemia of chronic disease dx

A

iron studies - iron decrease - ferritin increase - TIBC decrease best: bone marrow bx (rarely needed)

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23
Q

anemia of chronic disease tx

A

give EPO treat inflammatory disease

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24
Q

thalassemia path

A

genetic mutations, loss of genes, 4alpha, 2beta

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25
Q

thalassemia pt

A

asx (1 α deleted) minor (2alpha deleted, 1beta deleted) major (3alpha deleted, 2beta deleted) dead (4alpha)

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26
Q

thalassemia dx

A

iron normal ferritin normal TIBC normal Hgb electrophoresis

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27
Q

thalassemia tx

A

minor = do nothing major = transfusion = deferoxamine

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28
Q

sideroblastic path

A

irreversible, B6, cancer Reversible, Lead, EtOH, copper, isoniazid

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29
Q

sideroblastic pt

A

anemia

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30
Q

sideroblastic dx

A

iron increase (done) ferritin normal TIBC normal Best: bone marrow bx (ringed sideroblasts)

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31
Q

sideroblastic tx

A

remove exposure, give back B6, try to treat cancer

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32
Q

sickle cell path

A

autosomal recessive, HgbSS valine for glutamic acid sickle under stress - acidosis - dehydration

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33
Q

sickle cell pt

A

emergency acute - acute chest = MI, CHF - acute brain = CVA - priapism hospitalize acute - vaso-occlusive crisis chronic - asplenia - avascular necrosis - osteomyelitis

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34
Q

sickle cell dx

A

1st: smear = sickled cells - use 1st time and crisis best: Hgb electrophoresis (SC, SS) - use 1st time only

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35
Q

sickle cell tx

A

hydroxyurea = increase HgbF, decrease HgbSS IVF, O2, pain control (hospital) exchange transfusion (emergency)

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36
Q

sickle cell f/u

A

iron overload (deferoxamine)

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37
Q

G6PD deficiency path

A

decrease G6PD hypoxemic = hemolysis

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38
Q

G6PD deficiency pt

A

African American males Dapsone, TMP-SMX, nitrofurantoin

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39
Q

G6PD deficiency dx

A

1st: smear = bite cells, Heinz bodies best: G6PD levels 6-8wks

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40
Q

G6PD deficiency tx

A

supportive avoid stress

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41
Q

hereditary spherocytosis path

A

deficiency in Spectrin, Ankrin, Pallidin

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42
Q

hereditary spherocytosis pt

A

hemolysis, spherocytes

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43
Q

hereditary spherocytosis dx

A

1st smear = spherocytes best = osmotic fragility

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44
Q

hereditary spherocytosis tx

A

folate + Fe splenectomy

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45
Q

paroxysmal nocturnal hemoglobinuria path

A

PIG-A deficiency

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46
Q

paroxysmal nocturnal hemoglobinuria pt

A

paroxysmal (once in a while) nocturnal (happens at night) hemoglobinuria (dark urine) + abdominal vein thrombosis

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47
Q

paroxysmal nocturnal hemoglobinuria dx

A

flow cytometry decrease CD55, decrease CD59

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48
Q

paroxysmal nocturnal hemoglobinuria tx

A

biologics (eculizumab)

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49
Q

warm autoimmune hemolytic anemia path

A

IgG (cancer, drugs, rheum)

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50
Q

warm autoimmune hemolytic anemia pt

A

hemolysis everywhere

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51
Q

warm autoimmune hemolytic anemia dx

A

Coomb’s test IgG

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52
Q

warm autoimmune hemolytic anemia tx

A

1st line: steroids recurrent: splenectomy severe: IVIG refractory to splenectomy: rituximab

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53
Q

cold autoimmune hemolytic anemia path

A

IgM (mycoplasma, mono)

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54
Q

cold autoimmune hemolytic anemia pt

A

hemolysis in the cold - tips of digits - tips of nose

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55
Q

cold autoimmune hemolytic anemia dx

A

1st: Coomb’s test negative for IgG

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56
Q

cold autoimmune hemolytic anemia tx

A

avoid the cold refractory: rituximab

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57
Q

microangiopathic hemolytic anemia path

A

schistocytes = MAHA

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58
Q

microangiopathic hemolytic anemia pt

A

TTP vs DIC

59
Q

microangiopathic hemolytic anemia dx

A

decrease Hgb (both) decrease plt (both) decrease fibrinogen (DIC) increase INR (DIC) increase split products (DIC)

60
Q

acute myelogenous leukemia path

A

acute = blasts myelogenous = neutrophils leukemia = cancer in the blood

61
Q

acute myelogenous leukemia pt

A

acute, age 67 exposure: benzene radiation CML: blast crisis

62
Q

acute myelogenous leukemia dx

A

1st: smear = blasts BM bx > 20% blasts + myeloperoxidase

63
Q

acute myelogenous leukemia tx

A

M3: Vit A (auer rods on bx) no M3 = chemo

64
Q

acute lymphocytic leukemia path

A

acute = blasts lymphocytic = leukocytes leukemia = cancer in the blood

65
Q

acute lymphocytic leukemia pt

A

acute, age 7

66
Q

acute lymphocytic leukemia dx

A

1st: smear = blasts BM b >20% blasts + cALLa and + TdT

67
Q

acute lymphocytic leukemia tx

A

chemo ppx CNS ARA-C+/- radiation

68
Q

chronic myelogenous leukemia path

A

chronic = mature cells myelogneous = neutrophils leukemia = cancer in the blood

69
Q

chronic myelogenous leukemia pt

A

chronic, age 47

70
Q

chronic myelogenous leukemia dx

A

diff (way more cells than should be) BM bx = philadelphia + t(9, 22) + BCR-ABL

71
Q

chronic lymphocytic leukemia path

A

chronic = mature cells lymphocytic = lymphocytes leukemia = cancer in the blood

72
Q

chronic lymphocytic leukemia pt

A

chronic, age 87

73
Q

chronic lymphocytic leukemia dx

A

diff (way more cells than should be) BM bx

74
Q

chronic lymphocytic leukemia tx

A

> 65 + asx = nothing > 65 + sx = chemo < 65 + donor = HSCT

75
Q

Hodgkin’s lymphoma path

A

contiguous spread usually B sxs Pel-Ebstein fevers painful lymphadenopathy on EtOH

76
Q

Hodgkin’s lymphoma pt

A

nontender lymphadenopathy +/- B sxs

77
Q

Hodgkin’s lymphoma dx

A

excisional biopsy + reed Sternberg cells stage = PET/CT or CT chest/abd/pelvis

78
Q

Non-hodgkin’s lymphoma path

A

hematogenous spread usually NO B sxs Burkett’s starry sky extra nodal disease

79
Q

non-hodgkin’s lymphoma pt

A

nontender lymphadenopathy + sxs

80
Q

non-hodgkin’s lymphoma dx

A

excisional biopsy NO Reed-Sternberg cells stage = PET/CT or CT chest/abd/pelvis

81
Q

non-hodgkin’s lymphoma tx

A

IIA or better = radiation IIB or worse = chemo - CHOP-R - CNS ppx

82
Q

cancer staging: I

A

1 lymph node

83
Q

cancer staging: II

A

>/= 2 lymph nodes same side diaphragm

84
Q

cancer staging: III

A

>/= 2 lymph nodes opposite side diaphragm

85
Q

cancer staging: IV

A

mets

86
Q

chemoman

A

Cisplatin = ototoxicity

bleomycin = pulmonary fibrosis

Adriamycin/Doxarubicin = cardiac toxicity

Vincristine/Vinblastine = peripheral neuropathy

Cisplatin = nephrotoxicity

Cyclophosphamide = hemorrhagic cystitis

87
Q

multiple myeloma path

A

IgG

monoclonal expansional plasma cells

  • Ig = recurrent infxn
  • Bence-Jones = AKI
  • osteoclasts = lytic lesions
88
Q

multiple myeloma pt

A

>70s (old men)

CRAB

  • hyperCalcemia
  • Renal failure
  • Anemia
  • Bone pain, lytic lesions
89
Q

multiple myeloma dx

A

Spep +

Upep +

skeletal survey +

BM bx > 10% plasma

90
Q

multiple myeloma tx

A

>70, no donor: chemo

<70, + donor: HSCT

91
Q

multiple myeloma f/u

A

melphalan + steroids

  • thalidomide
  • bortezomib
92
Q

MGUS path

A

IgG

early myeloma

93
Q

MGUS pt

A

>85

no CRAB

94
Q

MGUS dx

A

Spep +

Upep -

skeletal survey -

BM bx <10% plasma

95
Q

MGUS tx

A

watch and wait

converts to multiple myelmoa 2%/yr

96
Q

Waldenstrom’s path

A

IgM

97
Q

Waldenstrom’s pt

A

hyperviscosity syndrome

constitutional symptoms

98
Q

Waldenstrom’s dx

A

Spep +

Upep -

skeletal survey -

BM Bx > 10% lymphoma

99
Q

Waldenstrom’s tx

A

rituximab - chemo

hyperviscosity = plasmapheresis

100
Q

Waldenstrom’s f/u

A

blast crisis

101
Q

trombophilic disorders

A

Factor V leiden = mutation

prothrombin 20210A = mutation

Protein C def = level

Protein S def = level

antithrombin def = level

102
Q

who gets warfarin in a DVT: all patients

A

provoked 3mo

unprovoked 6mo

recurrence lifetime

103
Q

who gets warfarin in DVT: other options

A

LMWH in cancer

NOACs = warfarin

104
Q

DVT ppx: risk

A

trauma, surgery (10x)

LMWH ppx

LMWH -> warfarin

105
Q

DVT ppx: cancer

A

LMWH ppx

LMWH tx (no warfarin in met cancer)

106
Q

APLA path

A

lupus ‘anticoagulant’

hypercoaguability in artery and veins

107
Q

APLA pt

A

lupus +

arterial clots AND venous clots

108
Q

APLA dx

A

russel viper venom assay

109
Q

APLA tx

A

warfarin goal 2-3

failure meanse increase INR goal

110
Q

TTP path

A

hyaline clots

ADAMTS-13 deficiency

111
Q

TTP pt

A

Fever

Anemia

Thrombocytopenia

Renal failure

Neuro symptoms

112
Q

TTP dx

A

CBC - decrease plt

Smear - schistocytes

PT/PTT - normal

fibrinogen - normal

D-dimer - normal

113
Q

TTP tx

A

exchange transfusion

114
Q

TTP f/u

A

NEVER platelets

115
Q

DIC path

A

fibrin clots

tremendous catastrophic injury

116
Q

DIC pt

A

sick as shit

sepsis, ICU, shock, then they start bleeding

117
Q

DIC dx

A

CBC - decrease platelets

smear - schistocytes

PT/PTT - increase

fibrinogen - decrease

D-dimer - increase

118
Q

DIC tx

A

fix underlying disease

give blood products

  • decrease fibrinogin = cryo
  • increase INR = FFB
  • decrease platelets = platelets
  • decrease Hgb = blood
119
Q

HIT path

A

antibodies to platelets

120
Q

HIT pt

A

heparin products administered

7-14d

platelets very decreased ~50%

new clots

121
Q

HIT dx

A

antiplatelet factor 4 ELISA +

confirm with serotonin release assay

122
Q

HIT tx

A

stop heparin

argatroban -> warfarin INR 2-3

123
Q

ITP path

A

antibodies to platelets

splenic destruction

124
Q

ITP pt

A

woman and autoimmune disease

decrease platelets

125
Q

ITP dx

A

dx of exclusion

126
Q

ITP tx

A

steroids

IVIG

splenectomy

rituximab

127
Q

Von Willebrand path

A

deficiency of vWD

autosomal dominant

most common bleeding disorder

128
Q

Von Willebrand pt

A

platelet bleed, normal count

(can have factor VIII def)

129
Q

Von Willebrand dx

A

1st: CBC = normal count

Best: vWF assay

may have increase PTT from factor VIII deficiency

130
Q

Von Willebrand tx

A

DDAVP

131
Q

other platelet bleed normal count

A

Bernard-Soulier - glycoprotein Ib

Glanzmann’s - glyco IIb-IIIa

Drugs - ASA, clopidogrel, abciximab

uremia - CKD

132
Q

hemophilia path

A

x-linked disorder of..

factor VIII (hemophilia A)

factor IX (hemophilia B)

133
Q

hemophilia pt

A

hemarthrosis

bruises easy

134
Q

hemophilia dx

A

Increase PTT, can have increase PT or Increase iNR

mixing studies (corrects)

factor levels

135
Q

hemophilia tx

A

factors whent hey bleed (short term)

136
Q

hemophilia f/u

A

may develop inhibitors that will not correct with mixing studies

137
Q

antiphoshoplipid antibody syndrome path

A

lupus

138
Q

antiphospholipid antibody pt

A

bleeding AND clotting

hemarthrosis (bleeding)

arterial thrombosis (clotting)

139
Q

antiphospholipid antibody dx

A

PT/PTT/INR

mixing studies (does not correct)

viper venom assay

140
Q

antiphospholipid antibody tx

A

treat lupus

heparin to warfarin bridge for APLA

141
Q

acquired factor deficiency path

A

liver dysfunction, warfarin, Vit K deficiency

142
Q

acquried factor deficiency pt

A

long ICU stay

on warfarin

has cirrhosis

143
Q

acquired factor deficiency dx

A

PT/PTT/INR

144
Q

acquired factor deficiency tx

A

vitamin K

Online Med Ed (18 decks)

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