Exam 1: Must know

Question 1

What is considered severe aplastic anemia? (want lab values)

Answer 1

Neutrophils: (ANC) less than 500

Platelets less than 20K

Retic (ARC) less than 60K

Question 2

What is considered VERY severe aplastic anemia? (want lab values)

Answer 2

Neutrophils: (ANC) less than 200

Platelets less than 20K

Retic (ARC) less than 60K

Question 3

What are the SE of Epoetin / Darbepoetin? What is the CI?

Answer 3

HTN and thrombosis

uncontrolled HTN

Question 4

What is the most form of inherited sideroblastic anemia?

Answer 4

x-linked

Question 5

What are some common ways for acquired sideroblastic anemia? What syndrome is it associated with?

Answer 5

Often part of a general myelodysplastic syndrome

Chronic alcoholism
Lead poisoning
Copper deficiency
Chronic infection/inflammation
Medications - mostly antimicrobials
isoniazid, linezolid, chloramphenicol

Question 6

What does erythroid hyperplasia indicate?

Answer 6

ineffective erythropoiesis

Question 7

You must order ____ to diagnosis sideroblastic anemia

Answer 7

bone marrow aspirate

Question 8

What are the ringed sideroblasts made up of?

Answer 8

erythroid cells with IRON deposits in mitochondria encircling the nucleus

Question 9

What is the MC cause of anemia worldwide?

Answer 9

Iron deficiency anemia

Question 10

What is Plummer-Vinson Syndrome? What is it associated with?

Answer 10

esophageal webs leading to dysphagia

iron deficiency anemia

Question 11

What is the recommended oral iron replacement dose? What is the alternative?

Answer 11

Ferrous sulfate 325 mg orally three times per day on an empty stomach

Ferrous gluconate

Question 12

When would you want to give parenteral iron?

Answer 12

If pt cannot tolerate or absorb oral iron, or anemia is refractory to it

Hx of bariatric surgery, GI malabsorption

May also be used for late-stage renal disease, later in pregnancy

Question 13

Name a way you can differentiate Iron def. anemia from anemia of chronic disease

Answer 13

iron def anemia: ferritin is DECREASED

anemia of chronic disease: ferritin is normal or INCREASED

Question 14

What is the anemia of endocrine disorders caused by?

Answer 14

Decreased EPO secretion → normocytic, normochromic anemia

Question 15

What is anemia of chronic liver disease caused by?

Answer 15

Cholesterol deposits in RBC membrane → shortened RBC survival and inadequate EPO secretion to compensate

Question 16

What is anemia of starvation caused by?

Answer 16

Decreased protein intake → decreased metabolism → decreased EPO

Question 17

What is anemia of the elderly caused by?

Answer 17

resistance to EPO, decreased EPO secretion, and chronic low-level inflammation

Question 18

____ is the cyanide anitdote

Answer 18

Hydroxocobalamin

Question 19

When can you use oral B12 therapy?

Answer 19

May use oral or sublingual B12 if mild (Hgb >8) and no neuro s/s, or for maintenance
and if absorption is adequate orally

Question 20

What is the MC of folic acid deficiency?

Answer 20

Anorexia, alcoholism, no fruits/vegetables, overcooked fruits/vegetables

Question 21

What is the classic difference between B12 and folate def?

Answer 21

B12 will have NUERO s/s and folate will not

Question 22

When will B12 and folate deficiency begin to respond to treatment?

Answer 22

retic: 1 week
CBC: approx. 2 months

Question 23

______ excessive production of all hematopoietic cells, especially RBCs

Answer 23

Polycythemia vera

Question 24

_____ excessive platelet production

Answer 24

essential thrombocytosis

Question 25

_____ excessive production of collagen or fibrous tissue in the marrow

Answer 25

myelofibrosis

Question 26

_____ excessive production of granulocytes

Answer 26

Chronic myelogenous leukemia (CML)

Question 27

In what condition does the patient have ruddy facial features?

Answer 27

polycythemia vera

Question 28

What is the classic traid of hemochromatosis?

Answer 28

hyperpigmentation, DM, cirrhosis

Question 29

What is the most common x-Linked genetic disease?

Answer 29

Hemophilia A

Question 30

Should give hemophilia patients ____ for mild pain relief

Answer 30

Celebrex

Question 31

____ is the most common inherited bleeding disorder

Answer 31

vWD

Question 32

What are the platelets counts associated with bleeding risks?

Answer 32

<10,000 = spontaneous hemorrhage <50,000 = increased bleeding during invasive procedures and in trauma (non-CNS) <100,000 = increased bleeding/complications during invasive procedures in closed spaces (CNS, eye)

Question 33

You have a pt with ITP, when is it necessary to start pharmcotherapy?

Answer 33

Severe thrombocytopenia (platelets <10,000/microL) with signs of substantial cutaneous bleeding Moderate thrombocytopenia (platelets <20,000/microL) with mucosal bleeding Past or anticipated factors that increase bleeding risk (such as recent head trauma)

Question 34

You have a pt with ITP, when do they need to go the hospital?

Answer 34

Patients with major bleeding or very severe thrombocytopenia (<10,000) should be admitted to the hospital for management/monitoring

Question 35

When is a splenectomy indicated for a pt with ITP?

Answer 35

thrombocytopenia persists for 6 months or more with medical therapy

Question 35

qualitative PLT disorders manifest as _____

Answer 35

mucous membrane bleeding

Question 36

How do you stop the bleeding caused by qualitative plt disorders?

Answer 36

transfusion of normal donor platelets

Question 37

severe deficiency of enzyme ADAMTS13 molecule what disease are you thinking?

Answer 37

Thrombotic Thrombocytopenic Purpura

Question 38

What is the role of ADAMTS13?

Answer 38

breaks down vWF when it is no longer needed aka small blood clots form more frequently

Question 39

____ is the most common cause of acute renal failure in children

Answer 39

HUS

Question 40

_____ is the most common cause of inherited thrombophilia, accounting for 40 to 50 percent of cases

Answer 40

Factor V Leiden

Question 41

____ pts are at risk for warfarin-induced skin necrosis. What is the treatment?

Answer 41

Protein C deficiency stop warfarin, start vit K, heparin and protein C concentrate/FFP

Question 42

The probability of a DVT Wells score, what is high?

Answer 42

3 or greater moderate: 1-2 low: 0 or less

Question 43

The probability of a PE Wells score, what is high?

Answer 43

hight is greater than 4 low: 0-4

Question 44

_____ you cannot use if the CrCl >95`

Answer 44

Savaysa

Question 45

What DOACs should if you avoid if your patient LOVES grapefruits juice?

Answer 45

Eliquis and Xarelto

Question 46

What are the dosing instructions for a pt who is on ASA and NSAIDs at the same time?

Answer 46

take ASA 60 minutes before or 8 hours after taking NSAIDs

Question 47

Name all the IRREVERSIBLE P2Y12

Answer 47

Plavix Effient Ticlid

Question 48

Is ASA reversible or irreversible?

Answer 48

irreversible

Question 49

Do not give ___ and omeprazole together

Answer 49

Plavix

Question 50

What are the CI of Effient?

Answer 50

Hx of TIA or CVA

Question 51

What is the major SE of Ticlid?

Answer 51

life threating hematologic reaction must monitor CBC every 2 weeks for the first 3 months

Question 52

What are the REVERSIBLE P2Y12 medications?

Answer 52

Brilinta: Ticagrelor Kengreal: cangrelor

Question 53

What is a major SE shown in clinical trials with Brilinta?

Answer 53

dypsnea

Question 54

What is the BBW with Brilinta?

Answer 54

CI when taking ASA 100mg or higher daily

Question 55

____ is the IV only form of P2Y12 class of medication.

Answer 55

Kengreal : Cangrelor normally found in the cath lab