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Surgery Rotation EORE > Hematology > Flashcards

Hematology Flashcards

1
Q

how do you dx B12 deficiency and pernicious anemia?

A

increased MCV >115, hypersegmented neutrophils, increased serum homocysteine, increased methylmalonic acid, decr. B12 levels

if pernicious anemia - + IF antibody, parietal cell Ab, incr. gastrin levels, + Schilling test

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2
Q

what are the macrocytic anemias?

A

B12 def., folate (vit. B9) def

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3
Q

what is pernicious anemia?

A

autoimmune destruction/loss of gastric parental cells

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4
Q

what’s the tx for B12 def/pernicious anemia?

A

IM B12; watch for signs of hypokalemia w/ tx

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5
Q

what’s the s/s of folate (vit. B9) def.?

A

similar to B12, but NO NEURO SX’s

glossitis***

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6
Q

how do you dx Folate (vit. B9) def?

A

incr. MCV >115, hyperhsegmented neutrophils, decr. folate, normal B12, incr. serum homocysteine

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7
Q

what’s the tx for folate (vit. B9) def?

A

folic acid 1mg PO daily

-if neuro sx’s worsen, then it’s B12 def.

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8
Q

what type of anemia is iron def. anemia?

A

microcytic hypochromic anemia

low MCV, low MCH

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9
Q

what’s the MC cause of iron def. anemia?

A

blood loss

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10
Q

what’s the dx for iron def. anemia?

A

decreased ferritin***, increased TIBC, decr. serum iron

increased RDW, decreased transferrin saturation

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11
Q

what’s the tx for iron def. anemia?

A

iron replacement best on empty stomach (can add vitamin C to increase Fe absorption)

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12
Q

who is alpha thalassemia MC seen in?

A

SE Asian

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13
Q

what is seen on peripheral smear for alpha thalassemia?

A

target cells; Heinz bodies in hemoglobin H disease

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14
Q

what’s the tx for mild alpha-thalassemia (alpha-trait)?

A

no tx

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15
Q

what’s the tx for severe alpha-thalassemia?

A
  1. blood transfusions

2. iron chelating agents

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16
Q

who is beta thalassemia MC seen in?

A

MC in mediterranean

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17
Q

what’s the s/s of beta-thalassemia major?

A

frontal bossing, sx at 6 months

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18
Q

what’s the peripheral smear show for beta-thalassemia?

A

target cells; no HgbA

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19
Q

what type of anemia is anemia of chronic disease?

A

normocytic normochromic anemia

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20
Q

what’s the cause of anemia of chronic disease?

A

chronic inflammatory conditions

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21
Q

what’s the dx for anemia of chronic disease?

A

normal or incr. ferritin* + decr. TIBC* (vs Fe def is incr. TIBC), decr. serum Fe

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22
Q

what type of anemia is B12 def/pernicious anemia and folate (vit. B9) def.?

A

macrocytic normochromic anemia

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23
Q

how do you treat anemia of chronic disease?

A

treat the underlying disease

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24
Q

what’s the MC cause of G6PD deficiency sx’s?

A

infections

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25
Q

what’s the MC medications causing G6PD deficiency sx’s?

A

sulfa drugs (ex. Bactrim), antimalarials

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26
Q

what is G6PD deficiency?

A

episodic hemolytic anemia

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27
Q

what is seen on peripheral smear for G6PD deficiency?

A

normocytic hemolytic anemia with schistocytes (“bite” cells)

-+/- Heinz bodies***

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28
Q

what’s the tx for G6PD deficiency?

A

avoid offending food & drugs

if severe anemia -> Fe/Folic acid supplementation

29
Q

what’s hemophilia A?

A

MC type of hemophilia

x-linked recessive trait

lack of factor 8*** -> AFFECTS THE INTRINSIC PATHWAY

30
Q

what’s the s/s of hemophilia A and B?

A

Hemarthrosis -> arthropathy

excessive hemorrhage in response to trauma & surgery/incisional bleeding

Deep tissue bleeding in hemophilia B

31
Q

how do you dx hemophilia A?

A

low factor 8, prolonged PTT, normal platelet levels

32
Q

what’s the tx for hemophilia A?

A

Factor 8 infusion

Desmopressin (DDAVP) - transiently increases factor 8 & vWF release (used prior to procedures to prevent bleeding)

33
Q

when is Desmopressin used in hemophilia A?

A

prior to procedures to prevent bleeding (b/c transiently increases factor 8 & vWF release)

34
Q

what is hemophilia B?

A

x-linked recessive trait

lack of factor 9

35
Q

how do you dx hemophilia B?

A

decreased serum factor 9, prolonged PTT

36
Q

what’s the tx for hemophilia B?

A

factor 9 infusion (can’t use DDVAP)

37
Q

what hemophilia can you use Desmopressin in? what other d/o is it the tx for?

A

hemophilia A

tx for vWF disease

38
Q

what are the s/s of vWF disease?

A

***Mucocutaneous bleeding: easy bruising, epistaxis, gums, GI menorrhage, bleeding after minor lacerations

39
Q

how do you dx vWF disease?

A

decreased vWF levels, bleeding time & PTT prolongation worse with aspirin

***decreased Ristocetin activity test = GOLD STANDARD

40
Q

what’s the GOLD STANDARD to dx vWF disease?

A

Ristocetin activity test

  • will be decreased
  • no pat aggregation w/ Ristocetin (ristocetin is an abx that causes pat agglutination in vitro)
41
Q

what’s the tx for vWF disease?

A

Type 1 - quantitative def. (MC type)

  • mild -> no tx
  • mod -> DDAVP (Desmopressin)

Type 2 (qualitative def) -> DDAVP (vWF + Factor 8 prior to procedures)

42
Q

what should be given to vWF disease and hemophilia b prior to procedures?

A

DDAVP (desmopressin)

43
Q

what’s vWF disease?

A

ineffective plt adhesion -> d/t deficient/defective vWF

44
Q

what cells are pathognomonic to Hodgkin’s Lymphoma?

A

Reed-Sternberg cells (“owl-eye” appearance)

45
Q

how do you dx Hodgkin’s lymphoma?

A

Excisional bx of LNs (LNs are painless)
-see Reed-Sternberg cells

Mediastinal lymphadenopathy

46
Q

what are s/s of Hodgkin’s lymphoma?

A
  1. Painless lymphadenopathy - alcohol may induce LN pain
  2. Systemic “B” symptoms in advanced disease (night sweats, weight loss, cyclical fever - Pel-Ebstein fever)

Mediastinal lymphadenopathy

47
Q

what LNs are MC affected in Non-Hodgkin’s lymphoma?

A

peripheral LNs

48
Q

what’s the s/s of NHL?

A

painless lymphadenopathy, extra nodal sites common (GI, skin & CNS)

49
Q

what’s the tx for NHL? (follicular and diffuse Large B cell)?

A

Follicular: Rituximab

Diffuse Large B cell: MC type & most aggressive type. treat with R-CHOP (chemo)

50
Q

what is the Philadelphia chromosome a/w?

A

CML (chronic myelogenous leukemia)

51
Q

what are Auer rods a/w?

A

AML

52
Q

what is TTP (thrombotic thrombocytopenia purpura)?

A

Pentad:

  1. Thrombocytopenia (petechiae, mucocutaneoux bleeding)
  2. Microangiopathic hemolytic anemia (anemia, jaundice, schistocyts)
  3. kidney failure/uremia
  4. neurologic sx’s (HA, CVA, AMS)
  5. fever
53
Q

what are the causes of TTP?

A

Primary: idiopathic (autoimmune) -> antibodies against ADAMTS13 -> decr. ADAMTS13

54
Q

what does def. in ADAMTS13 in TTP mean?

A

small vessel thrombosis -> hemolytic anemia

55
Q

what’s the dx for TTP?

A

Labs: thrombocytopenia, NORMAL COAGS (PT/PTT)

56
Q

what’s the TOC for TTP? other tx?

A

Plasmapheresis = TOC

Corticosteroids = other tx

57
Q

what is s/s of DIC?

A

widespread hemorrhage: venipuncture sites

thrombosis, gangrene

58
Q

what’s the dx for DIC?

A

Incr thrombin formation:
-decr. fibrinogen, incr. PTT/PT/INR, severe thrombocytopenia

Increased fibrinolysis: incr. D-dimer

59
Q

what’s the tx for DIC?

A

treat the underlying cause (most impt. step in tx of DIC)

FFP if severe bleeding (replaces coag factors)

60
Q

what is ITP?

A

idiopathic autoimmune thrombocytopenia purpura

isolated thrombocytopenia (low plt count)

61
Q

who is acute ITP vs chronic ITP most common in?

A

acute ITP: MC in children after a viral infection (self-limited)

chronic ITP: MC in adults (recurrent)

62
Q

what’s the cause of ITP?

A

autoimmune antibody rxn vs. plts*** -> with splenic plt destruction following acute infection (ex. viral)

63
Q

what’s the s/s of ITP?

A

increased mucocutaneoux bleeding: purpura, petechiae, bullae, epistaxis (NO SPLENOMEGALY)

64
Q

what’s the dx of ITP?

A

isolated thrombocytopenia with normal coag tests

65
Q

what’s the tx for ITP (children vs adults)

A

children: observation (usu. resolves)
adults: corticosteroids (blunts the immune response) -> IVIG -> splenectomy if refractory

66
Q

what’s the tx after gastric or bariatric surgery if iron deficient?

A

IV iron b/c of inadequate absorption

67
Q

what’s the indications for IV iron repletion?

A

ongoing blood loss, issues with absorption, intolerable GI side effect with PO iron

68
Q

what’s the indications for PO iron repletion?

A

not good absorption for PO with prior bariatric surgery

increased GI adrs

easy to use

Surgery Rotation EORE (10 decks)

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