Hemato oncologie Flashcards Preview

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Flashcards in Hemato oncologie Deck (409):
1

Hyperglycemia and skin findings(2)

glucagonoma
hemochromatosis

2

Skin findings in glucagonoma

NME necrolytic migratory erythema

3

Zone bastion de NME(3)

Face
extremities
perineum

4

Neurologic Manif of glucagonoma(3)

Demencia
ataxia
Proximal mx weakness

5

Confirmatory test of glucagonoma

Glucagon > 500pg/ml

6

Why anemia in glucagonoma(2)

Anemia of chronic disease
Glucagon directly affects erythropoiesis

7

Malt Lymphoma management(3)

Omeprazole
clarythro
Amox

8

Failure of antibio in Malt Lymphoma what to do?

CHOP + bleomycine

9

Quid for CHOP(4)

Cyclophosphamide
adryamycine
vincristine
Prednisone

10

classification of hyper ca++

Mild 10-12
Moderate 12-14
severe >14

11

Management of asymptomatic Mild Hyperca++

No rx needed

12

What to avoid in Mild hypercalcemia(4)

Hctz
Lithium
prolonged bed rest
volume depletion

13

rx of severe hyperca++(2)

Normal saline plus calcitonin
Biphosphonate

14

what's the long term rx for hyper ca++

Biphosphonate

15

When to rx moderate hypercalcemia(2)

if symptomatic
rx similar to severe hyper ca++

16

Quid of Hairy celle leukemia

B cell tumor

17

Marker for Hairy cell leukemia

TRAP(Tartrate resistant acid phosphatase)

18

Rx of hairy cell leukemia

cladribine

19

What's cladribine

Purine analog

20

clue for waldenstrom macroglobulinemia(3)

invasion of reticuloendothelial system
Sensory deficit
visual problems

21

quid for Waldenstrom

plasma cell proliferation

22

What's the only blood cells to be normal or elevated in Waldenstrom

WBC

23

What explains the sensory deficit in Waldenstrom

demyelinating sensorimotor neuropathy

24

Physiopatho of Hyperviscosity in waldenstrom

excess of production of IGM

25

Disease causing gamma gap (4)

Amyloidosis
Multiple Myeloma
MGUS
waldenstrom

26

next step in in presence of isolated trombocytopenia

Test for HIV

27

What are the 2 main causes ot low platelet

Decrease production
Peripheral destruction

28

What virus could decrease platelet production(3)

HIV
epstein Barr
Hep C

29

What chemicals could cause decrease platelet production?(2)

Chemotherapy
Alcohol use

30

Congenital disease causing decreased platelet production

Fanconi syndrome

31

What carence could cause decreased platelet production(2)

B12
folate

32

What other disease can cause decreased platelet production

Myelodysplasia

33

Disease causing increased platelet destruction

Lupus
antiphospholipid syndrome
Idiopathic thrombocytopenic purpura
TTP-HUS
DIC

34

Drugs causing increased platelet destruction

Heparin

35

Non tender nodes in neck in older patient and smoker?

Squamous cell carcinoma of Head matastasis

36

Management of antiphospholipid syndrome in pregnant women

Low molecular weight Heparin

37

workup of antiphospholipid syndrome

prolonged PTT
thrombocytopenia
VDRL false positive

38

causes of anemia

RBC destruction
decrease red blood cell production
blood loss

39

cause of anemia in lymphoproliferative disorder

invasion of moelle osseuse

40

Cause of decreased red blood cell production(2)

Carence
Moelle osseuse problem

41

Physio patho of senile purpura

perivascular connective tissue atrophy

42

findings in senile purpura

dark ecchimosis in elderly
in area of trauma

43

People at risk for B12 anemia

Vegetarians

44

Symptoms of B12 anemia(2)

Memory loss
Balance problem

45

Megaloblastic anemia in alcoholic

B9 deficiency

46

if you give b9 to correct the megalobalstic anemia in a Veg what will happen?(2)

No more anemia
persistence of neurologic symtoms

47

Quid of polycythemia vera

erythropietin independent red blood cells overproduction

48

Hmg in polycythemia vera

Everything is high

49

why pruritus after bath in polycyhemia vera(2)

release of Histamine
and Prostaglandine

50

What causes release of histamine in Polycythemia vera

Mast cell degranulation

51

what cause release of prostaglandine

stimuli comming from red blood cells

52

How to explain the HTA

because of increase blood volume

53

How to explain face plethora in polycythemia vera

because of vasodilation(Histamine and prostaglandine)

54

Confirmatory test of polycythemia vera(2)

Low erythropoietin
JAK2V617F Mutation

55

Digestive problem in Polycthemia vera

Peptic ulceration

56

How to explain peptic ulceration in Polycythemia vera

Massive release of histamine

57

why abortion in antiphospholipid syndrome

because of thrombosis
arterial and veinous

58

why anemia in paroxystic nocturnal hemoglobinuria

hemolysis

59

what will be low in intra vxar hemolytic anemia(2)

Hb
Haptoglobin

60

What will be high in intra vxar hemolytic anemia

Bilirubin
LDH

61

why hemolytic anmemia in PNH

Absence of CD55 CD59 on RBC
Attack by complement

62

clue for PNH

Hepatic vein thrombosis

63

confirmatory DX for PNH(2)

Flow cytometry
Absence CD55 CD59

64

What explain absence of CD55 and 59 in PNH

GP1 abnormality

65

role of GP1

Help CD55 and CD59 to bind to RBC surface

66

Confirmatory test of Myastenia Gravis MG(2)

antibody to acethylcholine receptor
Electromyogram

67

If you confirm MG what will be the next step

Ct scan of chest for Thymoma

68

lung cancer in non smoker and smoker

adenocarcinoma

69

lung cancer with central localisation(2)S

Scc small cell carcinoma
SCC squamous cell carcinoma

70

Lung cancer with peripheral localisation(2)

adenocarcinoma
Large cell carcinoma

71

Paraneoplastic syndrome in Small cell carcinoma(3)

SiADH
Cushing syndrome
Lambert eaton syndrome

72

Paraneoplastic syndrome in squamous cell carcinoma

hypercalcemia

73

Paraneoplastic syndrome in Large cell carcinoma(2)

galactorrhea
gynecomastia

74

Paraneoplastic syndrome in adenocarcinoma(2)

clubbing
hypertrophic osteoarthropathy

75

Antibody produced in waldenstrom

IGM

76

Antibody mostly produced in MM

IGG

77

What cells are incriminated in MM

Plasma cells

78

Why reccurrent infection in MM

Inability to produce effective antibody
leukopenia

79

Clue for MM(CRAB)

High Calcium
ranal impairement
anemia
bone pain

80

What gamma gap

Protein total-albumin>3 a 4

81

Why renal impairement

IGG or paraprotein produced by myeloma cells collect in glomeruli and cause renal impairement

82

Why leukopenia and anemia in MM

Malignant cells invade moelles osseuse

83

Bone pain in MM

bone invasion and Lysis

84

Hypercalcemia in MM why?

Because of bone invasion

85

management of prostate cancer with metastasis

orchiectomy

86

Despite of orchiectomy pain persist in prostate cancer what 's the next step?

radiation

87

why orchiectomy in advanced prostatic cancer?

because androgen plays a key role prostactic cancer

88

workup for Hemachromatosis(3)

serum iron
HFE gene marker
Liver biopsy

89

What are the six organs targeted by hemochromatosis

Liver
Pancreas
Heart
Pituitary gland
skin
Musculoskeletic system

90

quid of cardiac problem(3) in hemochromatosis

restrictive cardiomyopathy
dilated cardio
trouble de conduction

91

Quid of pancreas problem in hemochromatosis

Diabetes

92

Skin problem in hemochromatosis

Hyperpigmentation of skin

93

Pituitary problem in Hemochromatosis

Hypoptuitarism

94

quid Hypopituitarism(2)

sexual organ problem (amenorrhee femme,impotence sexuelle pour homme)
Hypothyroidism

95

quid of articular pain in hemochromatosis

Pseudo gout

96

cause of pseudogout

deposit of calcium pyrophosphate dihydrate in articulation

97

radiologic hallmark of pseudogout

chondrocalcinosis

98

cause of chondrocalcinosis(3)

Hypomagnesemie
Hyperparathyroidism
Hemochromatosis

99

confirmatory test for hemochromatosis(2)

HFE gene
liver biopsy

100

rx of hemochromatosis

phlebotomy

101

clue for TTP HUS(4)

Hemolytic anemia
low platelet
renal impairement
neurologic symptoms

102

rx of TTPHUS

Plasma exchange(plasmapheresis)

103

why plasma pherseis works

Because the disease in caused by antibody

104

what antibdy cause TTP-HUS

ADAMTS-13,antibody against von willebrand cleaving protease factor

105

explain low platelet in TTP-HUS(2)

accumulation ao von willebrand factor
and aggregation of platelets

106

Peripheral smear of TTP-HUS

fragmented cells

107

What's the hallmark of fragmented cells

Microangiopathic hemolytic anemia

108

What's trastuzumab

Monoclonal antibody

109

indication of trastuzumab

breast cancer with HER2 receptor

110

What to before beginning tratuzumab

echocardiographie

111

Breast cancer with progesterone and oestrogene receptor,rx?

chemotherapy

112

Thrombosis and low platelets days after initiating Heparin DX

thrombocytopenia induced by heparin

113

How to explain thrombosis in HIT

because the complexe Heparin -PF4-IGG activates platelets

114

sideroblastic anemia

inability to produce heme

115

What anemia can develop patients on anti TB drugs

sideroblastic anemia

116

why patient on anti TB can develop sideroblatic anemia

because of lack of B6

117

what 's the role of pyridoxine in erytropoiesis

protoporphyrin synthesis

118

cause of b6 deficiency(2)

alcohol
isoniazid

119

what's salvage therapy

failure of standards rx
begin a second to eliminate the metastasis

120

adjuvant therapy

rx given in addition to the standard therapy

121

Neoadjuvant therapy

rx given before the standard therapy

122

cancer of esophagus associated with reflux disease

adenocarcinoma

123

ca of esophagus associated with cigarettes and alcohol

squamous cell carcinoma

124

workup of esophageal cancer(2)

baryum swallow
endoscopy and biopsy

125

work up for sqamous cell carcinoma of the skin

Punch biopsy

126

staging for esophageal cancer

Pet scan

127

most common cause of matastasis in brain

lung cancer

128

Multiple brain metastasis(2)

Lung
Malignant melanoma

129

solitary brain metastasis(3)

breast cancer
colon cancer
renal cancer

130

MEN 1 syndromes(3)

Pancreatic tumor
Pituatary adenoma
parathyroid hyperplasia

131

pancreatic tumor in MEN 1(4)

gastrinoma
vipoma
glucagonoma
insulinoma

132

quid zollinger ellisson syndrome

Multiple peptique ulcer rebelious to rx

133

management of sickle cell disease complicated by stroke

exchange transfusion

134

Long term treatment of sickle cell disease

hydroxyurea

135

action of hydroxyurea

Increase of HB F

136

Rx anorexia induced by cancer(2)

progesterone analog

137

Quid of progesterone analog(2)

Medroxy progesterone or
megestrol acetate

138

quid for amsterdam criteria

useful for lynch syndrome diagnosis

139

Criteria for Lynch syndrome(4)

at least 3 relatives with colon cancer ,one of them is first degree relative with the two others
two or more generation involved
at least one dx before 50
FAP has been excluded

140

quid of lynch

Hereditary non polyposis colorectal cancer

141

Quid of lynch 1

only colon is involved

142

quid of Lynch 2

colon plus extra colon involvement

143

The most common extra colon site for lynch 2

endometrial carcinoma

144

Ovarian cancer screening

BRCA 1
BRCA 2

145

Si BRCA genes positive what's the next step in case of ovarian cancer workup(2)

CA-125
Pelvis ultrasound

146

Complication of EPO

iron deficiency anemia

147

why anemia in administration of EPO

rapid depletion of body's iron store

148

Treatment of iron deficiency anemia in dyalisis patient

iron dextran

149

Population involved in G6PD deficiency

Afro american(black)

150

Peripheral smear of G6PD(2)

Heinz bodies
Bite cells

151

Physiopatho of Heinz bodies

oxydation of hB

152

Why Hb is easily oxydized in G6PD deficiency

because of lack of glutathione

153

role of G6PD

formation of NADPH

154

role of NADPH

cofactor in formation of gluthatione

155

what can cause hemolysis in G6PD deficiency(4)

fava beans
sulfa drugs
antimalaric drugs
nitrofurantoin

156

Next step iron deficinecy anemia in Men >40 ans

fecal occult blood

157

Next step iron deficiency anemia in menopause woman

fecal occult blood

158

what's the most common cause of iron deficiency anemia in male or post menopausal women

chronic gastrointestinal blood loss

159

Best confirmatory test for HIT

serotonin release assay

160

Rx of HIT(2)

stop heparin
Direct thrombin inhibitor or
Fondaparinux

161

after how many day can begin HIT

after 5 days or more after the beginning of heparin treatment

162

Microcytic anemia non responsive to iron therapy

Thalassemie

163

epidemio of thalassemia

Europe descendant

164

Physiopatho of thalassemia(2)

Hemoglobinopathy
globin problem synthesis

165

Marker for mononucleosis

Heterophile antibody

166

Vit K deficiency cause(3)

Dietary
Malabsorbtion
storage problem in liver

167

Lab in Vit K deficiency(3)

Pt prolonged
Ptt prolonged
but PT>PTT

168

role of Vit k

play key role 2, 7 ,9, 10 synthesis

169

molecular action of vit K

cofactor in carboxylation of glutamic residues

170

in case of acute bleeding with vit k deficiency what to do

fresh frozen plasma

171

PICA quid

appetite for other things than food

172

quid of Pagophagia

craving for ice

173

Cause of PICA

iron deficiency anemia

174

key problem in hereditary spherocytosis

Spectrin problem

175

role of spectrin

scallfolding protein of RBC
if absent RBC is not deformable anymore

176

clue for spherocytosis(2)

Hemolysis
pigmented gallstones

177

epidemio of hereditary spherocytosis

Mediteraneen

178

work up of herediatary spherocytosis(2)

osmotic fragility test
Eosin 5maleinide binding test

179

rx of spherocytosis(2)

acid folic
splenectomy

180

hemogram of hereditary spherocytosis(2)

High mean cell hb concentration
high red blood cell distribution width

181

transmission of herediatary spherocytosis

autosomal dominant

182

peripheral smear of spherocytosis

spherocytes

183

knee pain ,lytic lesion in distal femur with soap bubble appearance

giant cell tumor

184

rx of giant cell tumor

curettage

185

what's trousseau syndrome

superficial thrombophlebitis

186

Physical exam in superficial thrombophlebitis

cord like veins on chest and arm

187

ca associated with trousseau(6)

pancreas
Lung
prostate
colon
stomach
acute leukemias

188

first thing to do devant un trousseau syndrome

ct scan of abdomen to rule out pancreatic ca

189

Physio patho of thrombophlitis in trousseau syndrome

Mucin production
causes aggregation of platelet

190

complication of hyperhmocysteinemia

Venous thrombosis
atheroclerosis

191

cause of hyperhomocysteinemia

B6
B12/foalte deficiency

192

role of folate and b12 in homocysteine metabolism

cofactors in tansformation of homocysteine in methionine

193

role of B6 in homocysteine metabolism

cofactor in transformation of homocysteine in cysteine

194

risk in HIT(2)

arterial clot
vein clot

195

rx of Polycythemia vera

phlebotomy to keep hmt

196

triad of pernicious anemia(3)

Macrocytic anemia
glossitis
neurologic changes

197

Physio patho of b12 deficiency in pernicious anemia(2)

antibody against intrinsic factor
atrophic gastritis,low parietal cells ,no intrinsic factor

198

Long term complication of pernicious anemia

gastric cancer

199

Patient eating only preccoked food whay substance will be deficient

folate

200

patient eating precooked food what substance will be high

Homocysteine

201

Wquid of megalobaste/dx(2)

Hypersegmented neutrophiles
MEGALOBALSTIC anemia

202

Cause of megalobalstic anemia

Folate
B12 deficiency

203

How to differentiate B9 and B12 deficiency

high methyl malonic acid ---->B12 deficiency

204

role of B12

transforms methylmalonyl co A en succinyl co A

205

what marker is important in the future management of breast adenocarcinoma(ductal carcinoma)

HER2

206

Why Her 2 so important(2)

because it's determinant for
Prognosis
treatment of breast adenocarcinoma

207

How to determine the presence of HER2(2)

FISH or (fluorescent in situ hybridization)
IHC (immuno histo chemical staining)

208

If Her2 is positive what will be the next step(2)

trastuzumab or
antracycline

209

cause of pancytopenia in lupus

autoimmune peripheral destruction of the 3 types of blood cells

210

cause of anemia in lupus(4)

auto immune hemolytic anemia
gastrointestinal blood loss
renal insufficiency
anemia of chronic disease

211

breast ca associated with paget disease

adenocarcinoma

212

prurit in nipple in paget why?

migration of cancer cells

213

Mechanical valve and hemolysis

microangipathic hemolytic anemia

214

peripheral smear in microangiopathic hemolytic anemia

schistocytes

215

ulcerative colitis when to begin surveillance

after 8 years with the disease

216

surveillance of ulcerative colitis

colonoscopy q1 -2 year

217

Patient with adenopathy cerciv]cale ,biopsy shows metastasis od squamous celle carcinoma what to do?

Panendoscopy
-laryngoscopy
-esophagoscopy
-brochoscopy

218

HIT management(2)

stop heparin
start argatroban

219

Management of fibrocystic disease

aspiration
follow during 4-6 weeks

220

work up of MM

serum electrophoresis
M spike

221

urine of MM

bence jones protein

222

cause of cell damage in G6PD

oxidative stress

223

prussian blue stain of urine,role?

detecting hemosiderrin(hemolysis)

224

cause of microcytic anemia

iron deficiency
lead poisonning
thalassemia
chronic disease

225

what are the 4 indicaors used to work up microcytic anemia

serum iron
ferritin
TIBC
% saturation

226

how will be the 4 indicators in iron deficiency anemia

everything is low except TIBC(high)

227

how will be the 4 indicators in thalassemia

everything is high except TIBC(low)

228

how will be the indicators in anemia of chronic disease (2)

everything is low except ferritin (normal or High)
could also be normal MCV,saturation

229

Normal MCV,Normal % saturation, normal ferritin but low fer and TIBC

anemia of chronic disease

230

characteristic of immune thrombocytopenic purpura(2)

isolated low platelet

231

other name of ITP

idiopathic thrombocytopenic purpura

232

cause thromcytopenia in ITP

auto antibody IGG directed aaginst platelet membrane glycoprotein

233

What the first step in front of isolated thrombocytopenia(2)

test for HIV
Hep C

234

what 's the clue for rx of isolated thrombocytopenia

platelet level
30000

235

ITP with platelet >30000 no bleeding

observe

236

ITP platelet

Rx

237

First line regimen for ITP

corticosteroids

238

second line regimen for ITP

rituximab

239

bad prognosis for CLL

low platelet

240

stage 0 CLL

Lymphocytosis

241

stage 1 CLL

Lymphocytosis and adenopathy

242

stage 2 CLL

splenomegaly

243

stage 3 CLL

anemia

244

stage 4 CLL

Low platelet

245

stage 1 and 2 CLL prognosis

fair

246

stage 3 CLL prognosis

intermediate

247

smudges cells Quid

partial breakdown of leucocytes during preparation because fragility

248

disease with smudge cells

CLL

249

cause of hypotension during transfusion(4)

anaphylactic reaction
transfusion related acute lung injury
primary hypotension reaction
sepsis

250

cause of anaphylactic reaction during transfusion

caused by recipient anti IGA antibodies

251

when anaphylactic reaction can occur during transfusion

seconds to minutes after the transfusion

252

cause of transfusion related acute lung injury

donor anti leucocytes antibody

253

when does the reaction start(acute lung injury)

whitin 6 hours of transfusion

254

Symptoms of tranfusion related acute pulmonary injury

pulmonary edema

255

primary hypotension cause?

bradikinin in blood products

256

people at risk for Primary hypotension and why

People receiving ACE inhibitor
bradikinin is normally degraded by ACE

257

when does primary hypotension develops(2)

Minutes after the transfusion
transient

258

when patient will develop sepsis after transfusion

minutes to hours after transfusion

259

people at risk of anaphylactic reaction and why(2)

people with IGA deficiency
presence of anti IGA antibody

260

whats the rx for anaphylactic reaction induced by transfusion

intra mxar epinephrine

261

how to prevent anaphylactic transfusion reaction

washed red cells products

262

Testicular mass management

remove without bilan d'extension

263

the only cured even with metastasis

testicular cancer

264

Immunologic blood transfusion reaction (6)

Febrile non hemolytic
acute hemolytic
delayed hemolytic
anaphylactic
allergic
acute lung injury

265

cause of febrile non hemolytic reaction

cytokine accumualation in blood products

266

time for development of febrile non hemolytic reaction

1-6 hres

267

cause of acute hemolytic reaction

ABO mismatching

268

time for development of acute hemolytic rx

within one hour

269

symptoms of acute hemolytic reaction(3)

flank pain
fever
hemolysis

270

Delayed hemolytic reaction cause

anmnestic antibody response

271

time for development of delayed hemolytic reaction

2-10 jours

272

cause of allergic reaction during blood transfusion(2)

IGE
mast cells activation

273

time for development allergic reaction

within 2-3 hours

274

what's the five ways to diferentiate B12 deficiency caused by pernicious anemia from folate deficiency

High LDH
achlrydria
schilling test +
Methylmalonyl co A in urine
neurological symptoms
all favor B12 deficiency

275

cause of macrotic anemia en dehros de B12 and folate deficiency(3)

hypothyroidism
severe liver disease
anti metabolites

276

traffic controller with polycythemia dx?

secondary polycythemia induced by co poisonning

277

why co poisonning causes secondary polycythemia(2)

co has high affinity for HB
compensatory mechanism --->increase of RBC

278

how will be PTT in lupus anti coagulant and why

prolonged
IGG or IGM is responsible for that

279

rouleux appearance of RBC

MM

280

management of solitary brain metastasis(2)

surgery
whole brain radiation

281

Management of multiple brain metastasis

radiation

282

Most common brain tumor

Metastatic brain tumor

283

lung cancer involved mostly in solitary brain metastasis

Non small cell lung carcinoma

284

whay t is impaired in splenectomised patient?

phagocytosis

285

why splenectomised patients are prone to infection

because they can opsonised encapsulated bugs

286

infection in patient with splenectomy(3)

S pneumonia
hi flu
Neisseria

287

disease with spherocytes with central pallor(2)

hereditary spherocytosis
autoimmune hemolytic anemia

288

disease causing extra vascular hemolysis

hereditary spherocytosis
autoimmune hemolytic anemia (warm agglutinin)

289

2 types of autoimmune hemolytic anemia

warm agglutinin
cold agglutinin

290

cause of warm agglutunin

autoimmune disease

291

rx of warm agglutinin(3)

corticosteroids
rituximab
splenectomy

292

Lieu of hemolysis in warm agglutinin

extra vascular

293

cause of cold agglutinin(2)

infection or
auto immune disease

294

Lieu of hemolysis in cold agglutinin

intra vascular

295

rx of cold agglutinin

supportive care
red blood cell transfusion

296

Hb extra vasculaire

destruction exageree des globules rouges dans le system reticuloendothelial(foie rate moelle osseuse)

297

clue for autoimmune hemolytic anemia

direct test coombs positif

298

athlete with polycythemia why?

steroid s use

299

side effect of steroids on athlete(4)

infertility/decrease libido/gynecomastia
psychiatric problem
left ventricular hypertrophy
Increase LDL and decrease HDL

300

hypocalcemie induced by tumor lysis syndrome why

cells explode
phosphate binds to ca++

301

workup for tumor lysis syndrome(4)

K+ high
ca++ low
phosphate low
aci uric high

302

mechanism of macrocytosis in B12 deficiency

B12 is cofactor for demethylation Methyl THF

303

role of THF

Purine synthesis

304

role purine

gives DNA

305

quid rituximab

CD 20 antibody

306

Ca in tamoxifen(2)

endometrial carcinoma
uterine sarcoma

307

other risk with tamoxifen

DVT

308

quid of MGUS

high serum monoclonal protein without any symptom

309

work up for MGUS(2)

-serum monoclonal protein

310

MM work up(3)

serum monoclonal protein> 3 g
>10 % plasma cells
elevated B2 microglobulin

311

management of all patients with MGUS

skletal bone survey to rule out MM

312

Is there a risk for MGUS to become MM

1% per year

313

anterior mediastinal mass with high AFP and BHCG

Mixed germ cell tumor(non seminomatous teratoma)

314

anterior mediastinal mass(4)

teratoma
thyroid mass
terrible lymphoma
thymoma

315

ant mediastinal mass producing BHCG

seminoma

316

confirmatory diagnostic of CLL

flow ctometry showing clonalityof cells.

317

disease with low leukocyte alkaline phosphatase(3)

CML
PNH
Hypophosphatemia

318

High WBC and high leukocyte alkaline phosphatase dx?(2)

leukemoid reaction
infection

319

clue for CML

philadelphia chromosome

320

cardiovascular risk for traumatic hemolytic anemia(2)

calcified aorta
artificial cardiac valves

321

peripheral smear in traumatic hemolytic anemia

Helmet cells or fragmented cells

322

TTP-HUS peripheral smear finding and why(2)

fragmented RB cells or schistocytes
microangiopathic hemlolytic anemia

323

calcified aorta or mechanical heart valve par psmear finding and why?(2)

Fragmented RBC or Helmet cells
Macroangiopathic hemolytic anemia

324

hallmark of TTP-HUS

Schistocytes(Microangiopathic hemolytic anemia)

325

rx of anemia chronic disease

rx the chronic disease

326

what's the target in treating CML

Non-receptor tyrosine kinase

327

Quid philadelphia chromosome

translocation 9,22

328

consequence of translocation 9,22(2)

abnormal BCR-Abl
Abnormal tyrosine kinase

329

action of gleevec(imatinib)

tyrosine kinase inhibitor
inhibition of abnormal BCR-ABL gene

330

prognosis factor inbreast cancer

TNM stage

331

Marker for future management of breast cancer

HER2

332

Patient with breast cancer ,HER2 positive with EFs the next step

can't use trastuzumab

333

Principle of pain management in ca(2)

begin with non narcotics
failure,short acting narcotics

334

Patient with axillary adenopathy develops anemia normochromic with high reticulocytes and will WBC Dx

(WARM)autoimmune hemolytic anemia caused by non hogkin Lymphoma or CLL

335

rx of warm hemolytic anemia(2)

Prednisone
if failure splenectomy

336

what are the factors involved in Hemophilia(2)

8-hemophilia A
9-hemophilia B

337

first site of bleeding in hemophilia

Joint

338

weils criteria for DVT 1ant

previous DVT

339

weils criteria 3 causes

Bedridden > 3 days
immobilization
cancer

340

weils criteria 5 sign symptoms

localised tenderness over vein distribution
swollen leg
pitting edema
collateral superficialnon varicoses vein
calf swelling >3 cm

341

weils criteria exclusion

other dx possible _2 pts

342

interpretation of weils criteria

/ 2 DVT Likely

343

if DVT unlikely what will be the next step

D-dimer

344

DVT likely

Compressive US

345

weils criteria for DVT pointage

1 pt per criterion

346

why arterio veinous shunting can cause secondary polycythemia

because of chronic hypoxemia

347

quid of hereditary telengiectasia

osler weber rendu syndrome

348

clue for osler weber rendu syndrome(2)

Nosebleeding
oral lesions

349

cause of secondary polycythemia(3)

arterioveinous shunt
steroids
co poisonning
sleep apnea

350

Why macrocytic anemia in Sickle cell disease

Folate deficiency
hydroxyurea use

351

why folate deficiency in SCD

increase RBC turn over
increase consumption of folate in bone marrow

352

cause macrocytic anemia MCV>100(8)

folate deficiency
B12 deficiency
Myelodysplastic syndrome
AML
drugs induced
liver disease
alcohol abuse
hypothyroidism

353

Drugs causing macrocytic anemia(5)

Zidovudine
hydroxyurea
chemo agents
TMS
Phenytoin

354

what's the two type of HIT(2)

Non immune mediated
immune mediated

355

criteria to differentiate the two types(2)

time of occuring
Platelet count

356

Type 1(non immune mediated) HIT(2)

1-4 days after initiation of heparin
Platelet count more than 100000

357

Quid type 2HIT(2)

5-10 jours after initiation of heparin
platelet count less than 100 000

358

what's the clinical outcome for type 1 HIT

none

359

what's the management of type 1 HIT(2)

Continue heparin
observation

360

What's the clinical outcome for type 2 HIT(3)

risk of thrombosis
Necrolytic skin lesions at heparin injections site
acute systemic reaction

361

Management of type 2 HIT(2)

stop heparin
use alternative anticoagulant to prevent thrombosis(direct thrombin inhibitor , argatroban)

362

Physiopatho of TMS induced macrocytosis

Inhibition of dihydro folate reductase

363

Risk with high dose TMS

Pancytopenia

364

Physiopatho of metrotrexate induced Macrocytosis

Inhibition of dihydrofolate reductase

365

rx macrocytic anemia induced by by metrotrexate

folinic acid(Leucovorin)

366

the most common threat in splenectomy

s Pneumo sepsis

367

How long last the threat for S Pneumo sepsis

More than 30 years after the splenectomy

368

Management before splenectomy(3)

3 vaccines
Anti pneumoccocal
Hi flu
Meningoccoque

369

Management after splenectomy

PNC for 2 to 5 years

370

drug causing a false positive result for protin S deficiency

warfarin

371

Why microcytic anemia in lead poisonning and sideroblastic anemia

reduced heme synthesis

372

cause of reduced heme synthesis

Lead poisonning
sideroblastic anemia(B6 deficiency)

373

how are Iron and ferritin in sideroblastic anemia

Normal

374

physio patho of sleep apnea induced secondary polycythemia

Increase production of erythropoietine

375

first line regimen of chemotherapy induced vomiting

ondansetron

376

what's ondansetron(2)

5HT3 receptor blocker
serotonin antagonist

377

why sulfa drugs and primaquine cause hemolysis in G6PD deficiency?

because they have high redox potential

378

two forms of G6PD deficiency

G6PD A
Mediterranean G6PD

379

Quid G6PD A

Moderate form

380

Quid of Mediteranean G6PD

The severe form

381

clue for hairy cell leukemia(3)

dry tap during bone marrow biosy
TRAP +
cd 11 c marker

382

quid of TRAP

strong phosphatase reaction not inhibited by acid tartaric

383

during hemolysis how is G6PD level

normal

384

approach of pulmonary nodule in less than 40 years non smoker(2)

ask for an old xray
obtain chest xray q 3 months for 12 months

385

pulmonry nodule in smoker

CT
FNA
for peripheral lesion

386

why brochoscopy is not good for peripheral lesion workup

because you wont reach the lesion with brochoscopy

387

what category of patient is at risk of warfarin induced skin necrosis

patient with protein C deficiency

388

why during the first days of warfarin initiation procoagulant activity is increased

because warfarin does not block all the factors at the same time,in the beginning only protein C and S are blocked

389

management of back pain in patinet with malignancy first step

determine if Myelopathy by physical exam

390

If no Myelopathy what to do in case of back pain in Malignancy

Xray lumbar

391

no myelopathy in back pain xray - next step

bone scan

392

No myelopathy in back pain induce d by malignancy xray +,next step

MRI of the spine within 24 hours

393

severe myelopathy in patient having back pain caused by malignancy(2)

urgent MRI
IV glucocorticoids

394

If myelopathy is not severe next step

MRI within 24 hours

395

back pain in malignancy plus myelopathy Dx?

epidural spinal cord compression

396

paresthesia after blood transfusion

hypocalcemia

397

why blood transfusion can cause hypocalcemia?

because of chelation calcium by citrate
NB citrate can also chelate Mg

398

BCC of ear management

excision 1-2 mm of clear margins whre microscopic
shaving can be done

399

BCC in perioral region management

excision 1-2 mm of clear margins

400

BCC in nose or lips,management

excision 1-2mm of clear margins

401

the most common skin cancer in the US

BCC

402

BCC characteristics

sore that bleeds oozes and remain open for more than 3 weeks

403

clue for febrile non hemolytic reaction(2)

fever gone away with acetaminopen and stopping transfusion
no sigh of hemolysis

404

prevention of non hemolytic febrile reaction

Leukoreduction

405

Timeline of transfusion reactions(4)

sec to min-ananphylaxis
min to 1 hour-acutehemolysis
1 hour to 6 hour-non hemolytic febrile reaction/TRALI
2 days-10 days delayed hemolytic reaction

406

anti infectious effect of leukoreduction(2)

prevent CMV infection
because this virus is living inside of white cells

407

dx differentiel of High glucagon level(4)

hypoglycemia
cushing
pancreatitis
sepsis

408

glucagon level more than 500 pg /ml

glucagonoma

409

peripheral smear in thalassemia

target cells