Flashcards in Hem Onc Deck (231)
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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
