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my NPLEX II > hematology/immunology > Flashcards

hematology/immunology Flashcards

1
Q

Idiopathic Thrombocytopenia Purpura (ITP) labs

A
  • Normal PT and PTT
  • blood smear - enlarged/immature/decreased platelets
  • Thrombocytopenia with normal RBC/WBC
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2
Q

vitamin K deficiency labs

A

PT/INR elevated and normal PTT

decreased factors II, VII, IX and X

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3
Q

von willebrand disease labs

A

increased bleeding time, increased PTT

  • normal platelets
  • decreased factor VIII
  • decreased vW antigen
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4
Q

what symptom in B12 deficiency is not found in folate deficiency

A

neurological sx

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5
Q

sx same in B12 and folate deficiency

A
  • smooth, sore tongue with atrophy of papillae
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6
Q

labs same for alpha thalassemia and beta thalassemia minor

A
  • decreased MCV, Hb and Hct
  • Increased RBC count
  • Normal RDW, ferritin
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7
Q

alpha thalessemia diagnosis

A

DNA analysis with alpha gene probes is the only way to diagnose

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8
Q

alpha thalessemia reticulocytes

A

normal

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9
Q

beta thalassemia major reticulocytes and RDW

A

increased

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10
Q

diagnosis of beta thalassemia

A

Hb electrophoresis

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11
Q

polycythemia vera mutation of what gene

A

JAK2 gene on chromosome 9

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12
Q

polycythemia vera EPO and SAO2 labs

A

decreased EPO, normal SAO2 (O2 saturation)

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13
Q

polycythemia vera labs

A
  • increased RBC count and RBC mass

- decreased EPO, normal SAO2

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14
Q

diagnosis of polycythemia vera

A

3 major criteria OR first 2 major and 2 minor

  • Major criteria:
    1. increased red cell mass
    2. no cause of secondary erythrocytosis
    3. palpable splenomegaly
    4. JAK2 gene
  • Minor:
    1. Absolute leukocytosis
    2. thrombocytosis
    3. leukocytosis
    4. low serum EPO
    4. Bone marrow Bx reveales myelosis w/ megakaryocytes
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15
Q

secondary polycythemia vera can be due to

A
  • high altitude
  • COPD
  • CVD with R->L shunt
  • sleep apnea
  • carbon monoxide exposure
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16
Q

treatment of polycythemia vera

A
  • phlebotomy

- interferon alpha

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17
Q

disseminated intravascular coagulation labs

A
  • increased PT and PTT
  • decreased fibrinogen
  • thrombocytopenia
  • increased bleeding time
  • increased D-dimer
  • normocytic anemia
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18
Q

hemophilia labs

A
  • prolonged PTT, normal INR
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19
Q

anti-HIV antibodies are detectable when

A

3 weeks to 3 months after infection

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20
Q

initial screening test for HIV

A

ELISA (detects anti-gp120 Abs, 100% sensitivity)

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21
Q

Confirmatory test for HIV

A

western blot

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22
Q

What is CD4 T cell count used for in HIV

A

monitoring

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23
Q

What is HIV viral load used for in HIV

A
  • detection of dividing virus, marker of disease progression
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24
Q

Treatment of HIV

A

Zidovudine (nucleoside analog reverse transcriptase inhibitors)

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25
Q

Ankylosing Spondylitis and Reactive Arthritis HLA

A

HLA B27 (95% of AS Pts have this; 80% of Reactive arthritis Pts)

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26
Q

onset of Sx in Ankylosing Spondylitis usually occurs before what age

A

40

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27
Q

Men or women more common in AS

A

Men 5x more

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28
Q

most common Sx of AS

A

Uveitis (aka Iritis) = painful red eyes + photophobia, increased lacrimation, blurred vision

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29
Q

complications of AS

A
  • restrictive lung disease

- neurological complications

30
Q

imaging findings in AS

A
  • bamboo spine (erosion of vertebral bodies)

- Xray of SI joint shows “psuedowidening” of joint d/t sclerosis

31
Q

imaging to detect early AS

A

MRI, can see cartilage changes/bone erosions

32
Q

first line Tx of AS

A

NSAIDS (Celecoxib)

33
Q

pharmacologic Tx for AS

A
  • NSAIDs
  • DMARDs (Sulfasalazine)
  • TNF-alpha agents (Adalimumab)
  • Glucocorticoids
34
Q

Myasthenia Gravis - common age of presentation in women and men

A 
women = 20s yo
men = 60s yo
35
Q

Myasthenia Gravis - autoantibodies created where and against what receptors

A

created in thymus (85% have thymic hyperplasia) and Abs against acetylcholine receptors (destroy or inhibit them)

36
Q

Myasthenia Gravis is what kind of hypersensitivity reaction

A

type 2

37
Q

most common initial Sx in Myasthenia Gravis

A

Ptosis (dipoplia can occur from mm weakness)

38
Q

Sxs in Myasthenia Gravis

A
  • fluctuating mm weakness (worse with exercise, better with rest)
  • Ptosis
  • Dysphagia
39
Q

Why is Myasthenia Gravis emergent?

A

risk of respiratory failure from resp mm weakness

40
Q

Labs for Myasthenia Gravis

A
  • Edrophonium (Tensilon) test – inhibits AChE, then increased ACh reverses Sxs within 2 mins of injection!)
  • Anti-AChE Ab assay (80% sensitivity)
  • CT/MRI to screen for thymic hypoplasia/thymoma
  • EMG - shows increased jitter
41
Q

Tx of Myasthenia Gravis

A
  • AChE inhibitors (Donezepil, Rivastigmine) to relieve Sxs
  • Immunosuppressive medications (steroids)
  • thymectomy
42
Q

Polyarteritis Nodosa diagnostic criteria

A

diagnosed if 3 or more are present:

  1. Weight loss
  2. myalgia/weakness/leg tenderness
  3. livedo reticularis (mottled reticular pattern on skin)
  4. neuropathy
  5. testicular pain
  6. diastolic BP elevated > 90
  7. Elevated Cr or BUN
  8. HEPATITIS B +
  9. Arteriographic abnormality (aneurysm)
  10. Biopsy of artery shows WBCs in artery wall
43
Q

What is Polyarteritis Nodosa

A

necrotizing medium vessel vasculitis involving renal, coronary, & mesenteric arteries

44
Q

5 diseases caused by Necrotizing vasculitis

A
  • polyarteritis nodosa
  • RA
  • Scleroderma
  • SLE
  • Wegener’s granulomatosis
45
Q

Labs in Polymyositis/Dermatomyositis

A
  • serum ANA + sometimes (<30% of cases)
  • elevated enzymes (CK from mm, AST, ALT)
  • muscle Bx shows lymphocytic infiltrate
  • MRI and US may show abnormalities of mm
  • CT scan of chest, Abdomen and pelvis may be warranted to screen for malignancy
46
Q

Physical exams/signs in Polymyositis/Dermatomyositis

A
  • progressive symmetric proximal mm pain and weakness (develops from weeks to months) –> commonly shoulders and hips
  • Heliotrope eyelids or “raccoon eyes” (purple-red eyelid discoloration)
  • Gottron’s patches (purple papules over knuckles and PIPs)
  • Respiratory mm weakness
  • Dysphagia/reflux
47
Q

What MUST the phys exam show in Dermatomyositis

A

typical dermatomyositis rash (heliotrope eyes, purplish burning cheeks, nose, shoulders, upper chest and elbows)

48
Q

does polymyositis have a rash

A

no

49
Q

what cells cause damage in polymyositis

A

T cells mediated damage

50
Q

what cells cause damage in Dermatomyositis

A

antibody mediated damage

51
Q

same Sx in polymyositis and dermatomyositis

A

inflammatory myopathy with symmetrical, proximal muscle weakness

52
Q

body areas affected by dermatomyositis (not poly)

A

joints, esophagus, lungs, and rarely the heart

53
Q

HLA for Rheumatoid arthritis

A

HLA-DR4

54
Q

typical age/gender of Rheumatoid arthritis

A

usually women (3x more than M), 30-50 yo

55
Q

Sxs/Signs of Rheumatoid arthritis

A
  • morning stiffness > 1 hour, better with use, worse with rest
  • symmetric joint involvement of MCPs and PIPs
  • B/L ulnar deviation
  • Boutonniere deformity (extension of DIP, flexion of PIP)
  • Other joints involved (knees, cervical spine, hips, shoulders, elbows)
56
Q

first choice for imaging in Rheumatoid arthritis-

A

radiography (plain film Xray)

57
Q

Disorders with positive RF

A
  • RA, SLE, infections (hepatitis, TB), autoimmune disorders (Sjogrens), and in 1-5% of healthy ppl
58
Q

Tx for Rheumatoid arthritis

A
  • Swimming
  • Pharm:
    1. NSAIDs
    2. Analgesics (acetaminophin w/ or w/o opioid)
    3. Steroids (prednisone)
    4. DMARDs (Adalimumab, sulfasalazine)
59
Q

Sceloderma is what

A

T cell release of cytokines creates excess collagen synthesis (skin, GI, lungs, kidneys) from T cell release of cytokines

60
Q

CREST syndrome of Scleroderma

A 
Calcification
Raynaud's
Esophageal dysmotility
Sclerodactyl (claw like fingers)
Telangietasias (superficial dilated BV)
61
Q

Labs for scleroderma

A
  • Antinuclear antibodies - 95% of cases

- Topoisomerase I Abs (aka Scl-70) in 30%

62
Q

Sjogren is destruction of what

A

minor salivary glands and lacrimal glands, caused by lymphocytic infiltration

63
Q

Common Sxs of Sjogrens

A

xerophthalmia (dry eyes), xerostomia, parotid gland enlargement; dental caries/oral candidiasis/angular chelitis

64
Q

lab positive in Sjogrens

A
  • serum anti-SSA / Ro (and/or)
  • anti-SSB / La
  • (or) + RF and ANA
  • Parotid Salivary gland biopsy shows lymphoid destruction
65
Q

Diagnostic criteria of SLE

A

MD SOAP BRAIN

  • Malar butterfly rash
  • Discoid rash (immunocomplex deposits along basement membrane)
  • Serositis (pleural effusion with friction rub)
  • Oral ulcers
  • ANA
  • Photosensitivity - rash caused by sun
  • Blood
  • Renal - glomerulonephritis
  • Arthritis - osteoperosis
  • Immune
  • Neurologic - seizures, psychosis, H/A, depression
66
Q

labs diagnostic in SLE

A
  • Anti-dsDNA and anti-SMITH are SPECIFIC for SLE
67
Q

other labs in SLE

A
  • ANA
  • anti-dsDNA titer and serum complement to monitor Tx
  • anti-dsDNA and anti-SMITH to confirm dx
68
Q

drugs that can cause SLE

A
  • Anticonvuslants (phenytoin)

- AntiHTN (hydralazine)

69
Q

HLA associated with SLE

A

HLA B8 and HLA DR

70
Q

Dose of Epi IM for anaphylaxis

A

0.3-0.5 mL of 1:1,000 Epi IM to lateral thigh, repeat in 5-15 mins

my NPLEX II (28 decks)

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