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Flashcards in Hem Onc Deck (231):
1

Manifestation of initial seroconversion of HIV

Mono type syndrome with fever, malaise, pharyngitis, rash, lymphadenopathy

Neonate: oral thrush, FTT< lymphadenopathy.

2

Dx HIV

ELISA confirmed with Western

3

When to start retrovirals for HIV

CD 4<350
Pregnant
Nephropathy
Hep B conifection

4

CD 4< 200 prophy

PCP: TMP-SMX, daponse, or pentamidine

5

CD4<50 prophy

MAC: Azithromycin or Clarithromycin/ or Rifabutin as alternative

Consider cryptococcal and candida prophy with fluconazole

6

Vaccine must give with CD 4 >200

MMR - because is live

7

Vaccine to give to all HIV pts

Pneumo
Hep B
Inactivated polio
Annual flu
Tetanus booster q 10 yrs
Annual PPD, CXR if anergic

8

AIDS associated malignancies

Kaposi - HHV 8
nonHogkin lymphpma (esp primary B cell of CNS)

9

Positive India Ink

Cryptococcus

10

Ring enhancing lesion

Toxoplasmosis
Cysticerosis/Taenia solium in Latin America

11

Meds to reduce mom-child transmission HIV

Mom: AZT/ZDV, no breastfeeding
Kid: ZDV for 6 weeks after birth

12

CMV retinitis Tx

Valganciclovir
Alt: foscarnet or cidofovir

13

Stains to detect PCP

Silver - Wright Giemsa, Giemsa, methanemine silver

14

Needle stick - what to do

HIV testing
Start HAART immediately - lamivudine, zidovudine
Restest 6 wks, 3 months, 6 months

15

Four causes microcytic anemia

TICS-
Thalessemia
Iron def
anemia of Chronic disease
Sideroblastic anemia

16

Elderly man with hypochromic microcytic anemia and no Sx, Dx test?

FOBT and sigmoidoscopy
Suspect colorectal Ca

17

Precipitants of hemolytic crisis in pts with G6PD def

Sulfonamides
Antimlalarial Rx
Fava beans

18

Most common inherited cause of hypercoagulability

Factor V Leiden

19

Most common inherited bleeding disorder

von Wilebrand's

20

Most common inherited hemolytic anemia

Hereditary spherocytosis

21

Dx test for hereditary spherocytosis

Osmotic fragility test

22

Pure RBC aplasia

Diamond Blackfan anemia

23

Anemia associated with absent radii and thumbs, diffuse hyper-pigmentation, cafe au lait, microcephaly, pancytopenia

Fanconi's

24

Meds and viruses that lead to aplastic anemia

Chloramphenicol, sulfonamides, radiation, chemo
Hepatitis, HIV, Parvovirus B19, EBV

25

How to distinguish polycythemia vera from secondary polycythemia

Both have inc HCT and RBC mass
Polycythemia vera: normal O2 sats and low EPO

26

TTP pentad

FAT RN
Fever
Anemia
Thrombocytopenia
Renal dysfunction
Neuro abnormalities

ADAMTS13

27

HUS triad

Anemia
Thrombocytopenia
Acute renal failure

28

Tx TTP

Emergent large volume plasmapheresis
Corticosteroids
Antiplatelet drugs
NO PLATELET TRANSFUSION - CI!!!!

29

Tx ITP in children

Resolves spontaneously, may require IVIG and/or corticosteroids

30

Which of following are inc in DIC, fibrin split products, D-dimer, fibrinogen, plts, HCT

Inc: fibrin split and D- dimer
Dec: plts, fibrinogen, Hct

31

8 yr boy presents with hemarthrosis and inc PTT with normal PT and bleeding time. Dx? Tx?

Hemophilia A or B
Consider desmopressin for hemophilia A or factor VIII or IX supplements

32

14 yr girls with prolonged BT after dental surgery and with menses, normal PT, normal or inc PTT, inc BT
Dx?
Tx

von Willebrand's
Tx desmopression, FFP, or cryoprecipitate

33

60 yr AA man with bone pain. What would a workup for MM reveal?

Monoclonal gammopathy
Bence Jones proteinuria
Punched out lesions on x-ray of skull and long bones

34

Reed Sternberg cells

Hodgkin's lymphoma

35

10 yr boy with fever, weight loss, night sweats. Exam shows ant mediastinal mass. Dx?

Non Hodgkins

36

Microcytic anemia with dec serum Fe, dec TIBC, normal or inc ferritin

Anemia of chronic disease

37

Microcytic anemia with dec serum Fe, dec ferritin, inc TIBC

Fe def anemia

38

80 yr man with fatigue, lymphadenopathy, splenomegaly, isolated lymphocytosis
Dx?

CLL

39

Lymphoma equivalent of CLL

Small lymphocytic lymphoma

40

Late life threatening complication of CML

Blast crisis- fever, bone pain, splenomegaly, pancytopenia

41

Auer rods

AML

42

AML subtype associated with DIC
Tx

M3
Retinoic acid

43

Electrolyte changes in tumor lysis syndrome

Dec Ca
Inc K
Inc Phosphate
INc uric acid

44

50 yr man presents with early satiety, splenomegaly, bleeding, t(9,22)
Dx

CML

45

Heinz bodies

Intracellular inclusions seen in thalessemia, G6PD def, postsplenectomy

46

Virus - aplastic aneima in sickle cell

Parvovirus B19

47

25 yr AA man with sickle cell anemia has sudden onset bone pain
Management?

O2, analgesia, hydration, transfusion if sever

48

Significant cause of morbidity in thalassemia its
Tx

Fe overload
Tx with deferoxamine

49

Shift Hb-O2 curve to left - what does it mean and causes

Mean- increased affinity for O2
Metabolic alkalosis
Dec body T
Increased HbF
Dec CO2
Dec 2,3, BPG

50

Shift Hb-O2 curve to right - what does it mean and causes

Mean: lower affinity for O2
Metabolic acidosis
increased body T
High altitude
Inc CO2
Inc 2,3 BPG
Exercise

51

Cherry red lips, hypoxia despite normal pulse ox

CO poisoning

Tx: O2

52

Hg Bart

Hydrops fetalis with 4 mutated alpha globin genes = fetal death

53

Ringed sideroblast + basophilic stippling

Pb poisoning anemia

54

Tx Pb poisoning

EDTA or DMSA
Dimercaprol if severe
Succimer in kids

55

Microcytic anemia: Fe def vs thalessemia
-MCV: RBC >13
-MCV: RBC <13

>13: Fe def
<13: thal

56

If microcytic anemia, essential test before Fe administration

R/O thalassemia because adding Fe will cause Fe overload

57

Components of Coombs reagent

Rabbit IgM against human IgG and complement

58

Direct agglutination
What?
Meaning?

Coombs reagent + RBC
Agglutinate: presence of IgG and complement on RBC membrane

59

Indirect agglutination
What?
Meaning

Serum + Type O RBC + Coombs reagent
Agglutinate: anti RBC Ab - Rh Alloimmunization

60

Schistocytes, spherocytes, Burr cells

Hemolytic anemia

61

2 types of hemolytic anemia with + direct coombs

Drug
Immune

62

Cold agglutinin

IgM

63

Warm agglutinin

IgG

64

Bite cells and Heinz bodies (dots of Hg in RBC)

G6PD def

65

Megaloblastic anemia- most common cause

Folate def

66

Hypersegmented neutrophils

B12 or folate def

67

Fatty infiltrate in BM

aplastic anemia

68

Aplastic anemia in sickle cell

Parvovirus B 19

69

Function hydroxyurea in sickle cell

Inc HbF

70

Fish mouth vertebrae, lung infiltrates in acute chest syndrome

Sickle cell

71

Heterozygous carriers sickle cell

ASX
more resistance to malaria

72

Sickle cell increases susceptibility to

Salmonella osteomyelitis
SEpsis by encapsulated organisms: Strep pneumo, H flu, N meningitidis, Klebsiella

73

4 types hypersensitivity reactions

ACID
Anaphylactic
Complement mediated
Immune complex mediated
Delayed

74

Test to measure heparin
What factors

PTT
II, IX, X, XI, XII - intrinsic

75

Test to measure warfarin
What factors

PT
Vit K dep: II, VII, IX, X, c ans d s- extrinsic

76

Proper way to anticoagulate

Start LMWH or until PTT therapeutic on unfractionated heparin then start warfarin
Because warfarin inhibits protein C and S - cause short period of hypercoagulability after starting

77

Only clotting factors not made by liver

vWF and VIII

78

Food with lots of Vit K

green veggies

79

Signs of TTP HUS

Nasty Fever Torched His Kidneys
Neuro
Fever
Thrombocytopenia
Hemolytic anemia
Kidney failure

80

ASA mechanisms

Inhibits plt aggergation by inhibiting COX activity to suppresses TXA2 synthesis

81

Thienopyridines (clopidogrel, ticlopidine) mechanism

Block ADP receptors to suppress fibrinogen binding to injury and plt adhesion

82

GP IIb/IIIA inhibitors (abciximab, tirofiban, eptifibatide)

Inhibit plt aggregation by binding GP IIB/IIIA receptors

83

Adenosine reuptake inhibitors (dipyridamole) mechanism

Inhibit adenosine deaminase and PDE to inhibit plt aggregation

84

Heparin mechanisms

Bind to antithrombin to increase activity and prevent clot

85

LMWH (enoxaparin, dalteparin) mechanism

Bind factor Xa to prevent clot formation
SAFEST DURING PREGNANCY

86

Direct thrombin inhibitors (lepirudin, argatroban)

Highly selective inhibitors of thrombin to suppress factors V, IX, XIII and plt aggregation

87

Direct factor Xa inhibitors (fondaparinux)

Highly selective inhibition factor Xa without thrombin activity

88

Use direct thrombin vs factor Xa inhibitors

Thrombin: alternative to heparin if pt has had HIT
Xa: DVT, PE anticoag, DVT prevention

89

Warfarin mechanism

Antagonizes Vit K dep carboxylation of factors II, VII, IX, X

90

Cause sepsis asplenic pts

Encapsulated bugs

91

Sepsis IVDU

Staph aureus

92

Common place malaria

Sub-Saharan Africa

93

Prophy for malaria

Chloroquine, Mefloquine

94

Stain for Plasmodium

Giemsa - shows ring and Schuffers granules

95

Criteria sepsis

2 of following
-RR > 20 or PaCOR 90
-WBC >12,000 or 10%
-T >38 or 90

96

NRTI mechanisms, adverse

Abacavir, Didanosine, Lamivudine, Zidovudine (AZT)

-Inhibit production of viral genome, block incorporation of viral DNA via reverse transcriptase inhibition

-BM, neuropathy, pancreatitis, hypersensitivity

97

NNRTI mechanisms, adverse

Delavuridine, Efavirenz, Nevirapine

-Inhibit reverse transcriptase

-Liver, neuro, rash

98

PI mechanisms and adverse

"-navir"

-Interfere with viral replication - produce nonfcnal virus

-Hyperglc, hyperTG, drug interactions, lipodystrophy

99

Integrase inhibitor mechanisms and adverse

Raltegravir

-Inhibits final step in integration of viral DNA into host

-Neutropenia, pancreatitis, liver, hyperglc

100

Fusion inhibitor mechanisms and adverse

enfuvirtide

-Inhibits viral ability to fuse with CD4 cell - cannot enter

-hypersesntivity at injection site, bacterial pneumo

101

CCR5 antag mechanisms and adverse

Maraviroc

-Inhibits viral CCR5 coreceptor -->no entry into host

-URI infections, peripheral neuro, dizzy

102

Combos

Combivir
Trizivir
Epzicom

Good if regimen is confusing and causing noncompliance

103

Complication Polycythemia vera

Progress to leukemia

104

bence Jones proteins, M protein, punched out lesion on rad

Multiple myeloma

105

Reed Sternberg cells

Hodgkin lymphoma- B cells

106

Prognosis Hodgkin vs Non

Hodgkin good
Non not good

107

8:14 vs 14:18

8:14 Burkitt
14:18 follicular small cell

108

Starry sky

Burkitt

109

Cleaved cells

Follicular small cell

110

Most common leukemia kids

ALL

111

bad prognosis ALL

Adult of Phl chr

112

Phl chr

ALL
CML

9:22 BCR-ABL - imitinab

113

Blood smear shows notched nuclei and Auer rods; stains with myeloperoxidase

AML

114

Smudge cells and CD5

CLL

115

Possibly due to radiation exposure

CML

116

Irregular cytoplasmic projection

Hairy cell
Like CML

117

Blast crisis

CML

118

Radiation induced malignancies

Thyroid
CML
Sarcoma

119

Fatigue, DOE< infections, short, abnormal skin pigmentation (cafe au lait or hypopigment), mutated thumbs, horseshoe kidney - chromosome breakages, AR

Fanconi anemia - 2/2 BM failure

120

Fatigue, DOE< cyanosis, pallor, craniofacial abnormalities, thumb abnormalities, heart murmur, mental retardation, hypogonadism = pure RBC anemia

Diamond Blackfan

121

Antidote heparin

Protamine sulfate

122

Antidote warfarin

Vit K

123

What is increased in hemophilia PT or PTT

PTT

124

Factors in cryoprecipitate

VIII and fibrinogen
Some Factor XIII, vWF, fibronectin

125

Function of DDVAP in hemophilia Tx

Release more factor VIII

126

Prolonged PTT and BT

von Willebrands disease IF factor VIII def as well

127

Causes of hypercoaguable states

ATIII def
Protein C or S def
Factor V leiden
Hyperhomocysteinemia
Dysfibrinogenemia
Plasminogen def
Prothrombin G20210A mutation
MTHFR mutation

128

5 S/S of TTP

Low plt
Microangiopathic hemolytic anemia
Neuro changes - delirium, seizure, stroke
Impaired kidney
Fever

Need 3 of 5

129

HUS vs TTP

HUS: severe elevation Creatinine

130

3 causes microangiopathic hemolytic anemia

HUS
TTP
DIC

131

LAP in heme malignancy vs leukemoid reaction (EBV)

LAP elevated in leukemoid and low in malignancy

132

College kid consumes alcohol and barbs then has episode abd pain and brown urine next day

porphyria

133

Tx nonhemolytic febrile transfusion reaction

Acetaminophen

134

Ages Leukemias

ALL60

135

Tumor lysis syndrome labs

Hyper K
HyperPhos
Hyperuricemia
HypoCa

136

Dutcher bodies
What
Disease

IgM that stain with PAS

Waldenstroms

137

Congo red shows apple birefringence

amyloidosis

138

Amyloidosis of Mult myeloma and Waldenstroms

AL

139

Amyloidosis of chronic inflammatory disease

AA

140

Causes secondary eosinophilia

NAACP
Neoplasm
Allergies
ASthma
Collagen vascular disease
Parasites

141

Hematuria with eosinophilia

Possibibly schostosomiasis

142

Neoplasm: Down syndrome

ALL

143

Neoplasm: Xeroderma pigmentosum

SCC and basal cell of skin

144

Neoplasm: chronic atrophic gastritis, pernicious anemia, postsurg gastric remnants

Gastric adenocarcinoma

145

Tuberous sclerosis (facial angiofibroma, seizures, mental retardation)

Astrocytoma and cardiac rhabdomyoma

146

Actinic keratosis

SCC of skin

147

Barrett's

Esophageal adenocarcinoma

148

Plimmer Vinson (atrophic glossitis, esophageal wbs, anemia - due to Fe def)

SCC of esophagus

149

Cirrhosis (Etoh, HBV or HCV)

Hepatocellular CA

150

UC

Colonic adenocarcinoma

151

Paget's disease of bone

Secondary osteosarcoma and fibrosarcoma

152

Immunodef states

Malignant lymphomas

153

AIDS

Aggressive malignant NHL and Kaposi

154

AI (MG)

Benign and malingnant thymomas

155

Acanthosis nigricans

Visceral malignancy - stomach, lung, breast, uterus

156

Multiple dysplastic nevi

Malignant melanoma

157

Methyldopa, penicillins, and sulfonamides cause

RBC Ab and hemolysis

158

Chloroquine and sulfa drugs cause

Hemolysis in G6PD

159

Phenytoin causes

Megaloblastic anemia by interfering with folate metabolism

160

Chloramphenical, chemo, zidovudine cause

aplastic anemia and BM suppression

161

Acanthocytes or spur cells

Abetalipoproteinemia

162

Echinocytes, burr cells

Uremia

163

Howell Jolly bodies

Asplenia,

164

Hypersegmented neutrophils

B12 or folate def

165

Fe inclusions in RBC of BM

Sideroblastic

Tx: pyridoxine

166

Parasites inside RBC

Malaria
Babesiosis

167

Polychromasia

Reticulocytosis

168

Rouleaux

Multiple Myeloma

169

Schistocytes, helment cell, fragmented RBC

Intravascular hemolysis

170

Target cells

Thalassemia or liver dis

171

Teardrop shaped RBC

Myelofibrosis

172

Cows milk before 1 yr of age

Anemia via bleeding in GI tract

173

Type of lung cancer that mets early

Small cell

174

Paraneoplastic syndrome of small cell lung ca

SIADH
Cushing
Hypercalcemia 2.2 PTH

175

Plaque like itchy skin rash that does not improve with Tx, blood smear shows cerebriform nuclei ("butt cells"), Pautrier abscess in epidermis

Mycosis fungoides, Sezary syndrome

176

EBV in Africa

Burkitt

177

HTLV-1 is a cause

T cell leukemia

178

Best and worst prognosis subtypes NHL

Best: small follicular
Worst: large diffuse

179

Anemia, teardrop cell, dry tap on BM biopsy, high MCV and RBC distribution, assoc w/ CML

Myelodysplasia/Myelofibrosis

180

Osteolytic, Bence Jones, High calcium

Multiple Myeloma- cannot see on PET scan becuase lytic not blastic

181

Hyperviscosity, IgM spike, cold agglutinins

Waldenstrom

182

Pruritis after hot bath, high Hg, Tx phlebotomy

Polycythemia vera

183

Plt >1,000,000, pts might have bleeding or thormbosis

Primary thrombocytopenia

184

Cancer highest mortality

Lung

185

Highest incidence cancer

Male: prostate
Female: breast

186

Familial polyposis plus osteomas and soft tissue tumors

Gardner

187

MEN I

Parathyroid
Pituitary
Pancreas- islet cell

188

MEN IIA

Medullary thyroid
Parathyroid
Pheo

189

MEN II B

Medullary
Pheo
Mucosal neuromas

190

Perioral freckles, multiple noncancerous GI polyps, increased incidence noncolon cancer (stomach, breast, ovaries)

Peutz Jeghers

191

Neurofibromas, cafe au lait, inc pheo, bone cyst, Wilms, leukemia

NF1

192

BIlat acuoustic schwanoma

NF2

193

Adenoma sebaceum, seizures, mental retardation, glial nodules in brain, increased renal angiomyolipomas, cardiac rhabdomyomas

Tuberous sclerosis

194

Hemangiomas in cerebellum, renal cell cancer, cyst in liver or kidney

Von Hippel Lindau

195

Increased risk skin cancer - genetic

Xeroderma pigmentosum, albinism

196

Vinyl chloride cancer

Liver angiosarcoma

197

AFP tumor marker

Liver, yolk sac testicular

198

Bladder tumor antigen, NMP 2 tumor marker

Bladder

199

CA 15-5, CA 27.29

Breast

200

CA 19-9

Pancreas, lung

201

Ca-125

Ovarian

202

CEA

colon, ancreas, GI

203

Chromagrnain A

Carcinoid, neuroblastoma

204

hCG

hyaditaform moles, choriocarcinoma

205

Beta 2 microglobulin

multiple myeloma, CLL

206

PSA

Prostate

207

S-100

Melanoma, CNS, nerve tumors

208

Thyroglobulin

Thyroid

209

Most common breast cancer

Invasive ductal

210

Good Tx if hormone sensitive breast ca in postmenopausal

Aromatase inhibitor- Anastrazole,

Not for premenopausal

211

Good for premenopausal with ER + breast cancer

Tamoxifen or Raloxifene

212

Her2/neu Rx

Trastuzuma

213

Trousseau sign

Migratory thrombophlebitis
Could indicate pancreatic ca- adenoCA

214

Courvoisier sign

Palpable nontender GB- may be pancreatic CA- adenoCA

215

4 types pancreatic cancer

Insulinoma - beta cell
Gastrinoma
Glucagonoma- alpha cell
VIPoma

216

Whipple triad

Hypoglycemia <50
CNS Sx 2/2 hypoglycemia

Give glc to relieve Sx

Think Insulinoma = C peptide will be high (not high with DM)

217

Dx gastrinoma

Eleavated fasting serum gastrin or secretin stimulation test

218

Hyperglycemia with high glucagon and migratory necrotizing skin erythema

Glucagonoma - alpha cell

219

Watery diarrhea, hypoK, achlorhydria

VIPoma

220

Tumor that has skin/teeth/hair/bone
can show up as pelvic calcification on rads

Dermoid cyst/teratoma

221

Tumor causes virilization - hirsutism, receding hairline, deepening voice, clitoromegaly

Sertoli-Leydig (ovarian cell)

222

Causes feminization and precocious puberty tumor

Granulosa theca cell tumor (ovarian tumor)

223

Meigs syndrome

Ovarian fibroma, ascites, right hydrothorax, pleural effusion

224

Krukenberg tumor

Stomach or other GI ca with mets to ovaries

225

Increased 5HIAA

Carcinoid tumor- most commonly in GI - appendix

226

CD1 positive cells + birbeck granules

Histiocytosis

227

Liver flukes like Clonorchis

Cholangiosarcoma

Also caused by IBD

228

Most common tumor of liver

Hemangioma- benign and left alone

229

OCP, benign liver tumor

Hepatic adenoma

230

Main primary liver in kids, malignant

Hepatoblastoma

231

EBV and Asian and nose

Nasopharyngeal cancer