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Hematology/Oncology Flashcards

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1
Q

Normal MCV size? What does it tell us?

A
  • 80-100
  • The size of the RBC
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2
Q

What does Mean Corpuscular Hgb (MCH) mean?

A
  • Average amount of hgb in RBC
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3
Q

What does Mean Corpuscular Hgb Concentration mean? (MCHC)

A
  • Color
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4
Q

What is the reticulocyte count?
What does it tell you?
What if it stays low?

A
  • # of young RBCs in the blood
  • Tells us bone marrow’s ability to create new RBCs
  • Low: may want to eval for malignancy
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5
Q

Condition where there is too many RBCs?

A
  • Polycythemia Vera
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6
Q

Normochromic Anemias (4)

A
  • Sickle Cell
  • Anemia of Chronic Disease/Cancer
  • B12 and Folic Acid deficiency
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7
Q

Hypochromic Anemias (2)

A
  • IDA
  • Thalassemia
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8
Q

What are 2 bone marrow disorders?

A
  • Aplastic anemia
  • Myelodysplastic Anemia
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9
Q

3 conditions people might have with anemia?

A
  • Cheilitis
  • Glossitis (beefy red tongue)
  • Koilonychia (spoon shaped nails)
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10
Q

Conditions that can increase H&H?

A
  • Living at high altitudes
  • Testosterone use
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11
Q

How to evaluate if you have 2 kinds of anemia at once?

A
  • Peripheral smear
  • Ex: IDA and B12 deficiency
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12
Q

How long for H&H to start increasing after supplementing the deficient substance? (iron, B12, folate)

How long to be back to normal?

A
  • 1-2 weeks
  • up to 2 months
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13
Q

What 2 tests to check for B12 deficiency with normal B12 levels?

A
  • Anti-parietal antibodies
  • Methylmalonic Acid (MMA)
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14
Q

How many AA in the US have sickle cell?

A
  • 1 out of 500
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15
Q

What are 3 normocytic anemias?

A
  • Sickle Cell
  • Anemia of chronic Disease
  • G6PD Deficiency
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16
Q

What conditions are associated with normocytic anemias? (2)

A
  • Chronic autoimmune or inflammatory disorders
    (polymyalgia rheumatica and RA)
  • Chronic infection
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17
Q

Anemia of Chronic Disease
Mild vs. long-standing

A
  • Mild: normocytic normochromic
  • Longstanding: Microcytic, hypochromic
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18
Q

Normal RBC lifespan?
Lifespan in ACD?

A
  • 100-120 days
  • 60-90 days
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19
Q

Initial tests for ACD? (6)

A
  • CBC
  • Serum ferritin, Serum transferrin (TIBC)
  • B12, folate
  • reticulocyte count
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20
Q

What newborn screening is required for sickle cell?

A
  • Sickledex
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21
Q

What are 3 microcytic anemias?
MCV?

A
  • LIT: Lead intox, IDA, Thalassemia
  • MCV <80
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22
Q

What MCV/MCHC in IDA?

A
  • Low MCV (microcytic)
  • Low MCHC (hypochromic)
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23
Q

What is the RDW in IDA?
New onset vs. long standing

A
  • > 15% if new onset (new deficiency = new donut holes)
  • < 15% if long standing (all we get are donut holes)
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24
Q

Serum ferritin vs. Serum iron

A
  • Ferritin: Measure of iron in storage (iron stores)
  • Iron: Measure of iron in circulation
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25
What does Total Iron Binding Capacity (TIBC) tell us? Other name? Why would it be high?
- Capacity to take in iron - Transferrin - High when there is not enough iron to fill the storage containers in IDA
26
Most common cause of IDA? Common times to experience during lifetime?
- Blood loss - 12-24mo, starting menses, during pregnancy
27
How long are the effects of aspirin?
- 7-10 days
28
Unique symptoms of IDA? (3)
- Nail spooning - PICA - Angular cheilitis
29
Why do we want patients to avoid iron supplements before rechecking labs?
- Can affect TIBC and serum iron
30
What should we limit in kids < 1 to prevent IDA?
- Cow’s milk and cow’s milk products because they are low in iron and inhibit absorption from other sources
31
Diet high in iron?
- Red meats, liver - Leafy greens - Beans/peas -Whole grains
32
How much elemental iron do we need per day? Which form is good for pregnant patients to prevent?
- 150-200mg per day - Ferrous gluconate d/t low dose
33
How long does it take to replace iron stores?
- 4-6 months
34
Normal increase in H&H 1 month after starting iron replacement?
- 3 points HCT - 1 point Hgb
35
What do we need to check before stopping iron supplements? When?
- Serum ferritin (stores) in 4-6 months
36
How to take iron? What if it upsets our stomach?
- On empty stomach - Take with vitamin C drink
37
How to prevent botulism in kids? When should we start giving PB and eggs?
- No honey before 12mo - 6mo to prevent allergy and atopic disease
38
What is happening in Thalassemia? Is it inherited?
- The body isn’t making enough hgb so they have too much IRON - Body makes defective alpha or beta chains - YES need to screen the whole family
39
Where do we see thalassemia?
- beta: Mediterranean - alpha: SE Asian countries
40
MCV/RDW/MCHC in thalassemia?
- Microcytic, normal RDW, hypochromic - Not enough hgb, so cells will be pale
41
What happens when the body absorbs too much iron? How do we treat it?
- Hemochromatosis - Regular phlebotomy
42
What organ is affected by too much iron?
- Excess iron stored in liver, and it doesn’t work when it gets too full
43
Which anemia has glossitis?
- B12 deficiency
44
Meds that can cause Folic Acid deficiency?
- Methotrexate - Bactrim - Dilantin
45
Tests for B12/folic acid anemias?
- MMA 24hr urine (high in b12) - Homocysteine level (high in both)
46
Antibody tests for B12 deficiency?
- Anti-parietal and anti-intrinsic factor
47
Medications that cause B12 deficiency (4)
- Antacids - PPIs, H2 blockers - Metformin
48
When should neuro symptoms improve after starting B12 replacement?
- 5-10 days
49
How does B12 deficiency present in older adults? (6)
- Cognitive changes - unexplained weakness and unsteady gait - paresthesia - Decreased reflexes, abnormal Romberg
50
B12 injections regimen?
- SQ daily x1 week, weekly x1 mo, monthly for life
51
When to check retic count and CBC after starting B12 supplements?
- 2 weeks
52
Most common cause of B12 deficiency? Other causes? (3)
- Pernicious anemia - Vegan diet, gastric surgery, IBD
53
What does intrinsic factor do?
- Allows the body to absorb B12
54
What is pernicious anemia? How to Dx?
- Autoimmune destruction of parietal cells resulting in intrinsic factor destruction - Dx: anti-parietal antibodies
55
Diet causes of Folic Acid deficiency?
- Overcooking veggies, low citrus
56
What conditions cause folic acid deficiency?
- Gastrectomy - Celiac disease (sprue)
57
What is happening in aplastic anemia? Causes? (3)
- Destruction of stem cells in the bone marrow - Radiation, drugs, viral infection
58
Labs of aplastic anemia? Dx?
- Pancytopenia - Bone marrow biopsy
59
How to diagnose thalassemia and Sickle cell?
- Hgb electrophoresis
60
How is Thalassemia managed?
- Regular transfusions, which also increase amount of iron
61
2 main causes of SC crisis? Tx?
- Illness and dehydration - Refer to ED most of the time
62
What is happening is Polycythemia Vera? High risk for what?
- Bone marrow makes too many RBCs, making the blood thick and sticky - High risk for blood clots
63
Polycythemia Vera Common with what 2 things? Treatment?
- COPD and high altitudes - Tx: regular phlebotomy
64
How is Hep B transmitted?
- Blood, semen, body fluids
65
When do we get the Hep B vaccine?
- 3 dose series - Birth, 2mo later, 6mo
66
Symptoms of Hep B (5)
- Vague abdominal pain - Dark urine, fever, fatigue, jaundice
67
HBsAg indicates what?
- Acute or chronic infection
68
IgM means?
- Positive the minute someone is infected - Acute Hep B
69
What does IgG mean? (2) + findings mean?
It’s gone or never there - Positive: resolved or chronic
70
What does Anti-HBc tell is?
- C= Core - Whether patient has Hep B now or had it at some point - Tells us whether IgG or IgM is positive
71
What will Anti-HBc be if the patient is vaccinated?
Negative
72
What is Anti-HBs? (HBsAB) Positive vs. negative
-surface antibody tells us about immunity - +Anti-HBs = immunity from past infection or vaccine - -Anti-HBs = not immune and susceptible to infection
73
+HBc +HBs with -HBsAg?
- Immunity due to natural infection
74
+ HBsAg with +IgG means what? - HbsAg with +IgG means what?
- + HBsAg, +IgG = Chronic Hep B - - HBsAg with +IgG = Resolved Hep B
75
Does Hep B go away?
- Usually resolves on its own
76
What to do when patient exposed to Hep B and are unvaccinated
- Give them Hep B vaccine AND IgG within 24 hours
77
What to do if patient exposed to Hep B and are vaccinated
- Give them IgG within 24 hours
78
Can pregnant patients get Hep B?
- Yes – one of the first vaccines that babies get
79
How to stage CA?
- TNM: Tumor, Nodes, Mets
80
Which lymph nodes are biopsied first in CA?
- Virchow’s (sentinels) nodes - Found at left supraclavicular area of chest
81
2 most common lymphomas? Age groups?
- Hodgkins- adolescents and young adults - Non-Hodgkins – Older adults
82
Which lymphoma has Reed Sternberg cells?
- Hodgkins
83
Symptoms of lymphoma? (5) What to order?
- Enlarged LN, night sweats, fever, weight loss, fatigue - CBC
84
Symptoms with CLL/CML (6) Fast or slow?
- Slow progression - Night sweats, fever, fatigue, weight loss - Easy bruising, lymphadenopathy
85
CBC findings in CLL and CML?
- Very high WBC > 60,000
86
CLL vs. CML distinguishing factors?
- CLL: less symptoms, may not need tx - CML: abdominal complaints d/t enlarged spleen and liver, anemia
87
Treatments for CML/CLL if bad enough?
- Bone marrow transplant, C/R
88
Most common type of leukemia in adults? Survival rate?
- Acute Myeloid Leukemia - 5-year survival 30%
89
What is multiple myeloma? Age group?
- Cancer of plasma cells (B cells) - Adults > 60
90
Symptoms of multiple myeloma?
- Bone pain, fractures, hypercalcemia
91
Average size of spleen? Palpable?
- 6-12cm - Usually not in healthy people
92
Causes of enlarged spleen?
- Mono, sickle cell, CML
93
What is the treatment for Hep C?
- Direct-acting anti-viral tablets
94
What does HIV 1/2 antibody test look at?
- suggestive of acute infection but not confirmatory
95
What do to if HIV 1/2 antibody test is positive? Then what?
- Positive: order HIV1/2 differentiation immunoassay - If that is negative, may need RNA or nucleic acid test
96
Older tests to diagnose HIV?
- Elisa and western Blot
97
HIV at risk for what? (3) Do we vaccinate these people?
- Kaposi Sarcoma, PJP, TB - Don’t give vaccines to these people
98
What to do if patient’s partner is HIV positive?
- PrEp (pre-exposure prophylaxis) - Partner takes anti-retrovirals to prevent getting HIV - Can reduce chance of getting HIV by 99%
99
What meds are in PrEp?
- Tenofovir disoproxil plus Truvada (men and women) - Tenofovir alafenamide plus descovy (men)
100
What to do after HIV exposure?
- HIV test in 3 days - PEP (post-exposure prophylaxis): Give anti-retroviral therapy within 3 days
101
Catch up vaccines pneumonic
- Its Time for Many Happy Happy Vaccines - IPV, Tdap, MMR, Hep B, HPV, Varicella
102
Who gets DTaP vs. Tdap?
- DTaP if < 7 - Tdap if > 7
103
What age for HIB?
< 5
104
What age for HPV?
- 9-14: 2 dose series - > 15: 3 dose series
105
Most common cause of epiglottitis?
Hib
106
What to do if child is exposed to pertussis?
- Give prophylactic azithromycin
107
Labs found with malaria (4)
- Anemia, thrombocytopenia - low Na from vomiting - Elevated bili (unconjugated, can’t get rid of until conjugated)
108
Incubation period for malaria? Diagnosis?
- 6-18 days - Blood test for the parasite
109
How to take malarone? Safe for pregnant women? Kids? What else might work?
- Start 1-2 day before travel and continue until 7 days after return - NO - Can’t give to children < 5kg - Doxy
110
How to take Chloroquine? -quine drugs
- Start 1-2 weeks before travel
111
Treatment for malaria?
- Malarone or Chloroquine or Doxy
112
TB test >/= 5mm Positive with who?
- Immunocompromised patient - Immigrants with exposure
113
TB test >/= 10 Positive with who?
- Immigrants
114
TB test >/= 15 Positive with who?
- General public and healthy adults
115
Causes of thrombocytopenia? (3)
- Recent infection - Drugs - Leukemia
116
Treatment for thrombocytopenia
- Refer hematology - Prednisone 4-6 weeks
117
Most common bleeding disorder in the US?
- Von Willebrand disease
118
First responder WBCs in infection?
- Neutrophils and lymphocytes
119
Leukocytes/WBCs also called what?
- Segs, polys
120
What do monocytes tell us?
- About how long the patient has been sick - Don’t increase for 24 hours
121
What do eosinophils tells us?
- Allergic or parasitic in nature
122
WBCs in a viral vs. bacterial infection Neutrophils and Lymphocytes
- Viral: neutrophils and lymphocytes CLOSE in number - Bacterial: neutrophils and lymphocytes BIG difference
123
What are bands? What do bands tell us?
- Immature WBCs – bone marrow things it’s bad - Released when infection seems to be bad according to the bone marrow
124
Mechanical valve replacement target INR
- 2.3-3.5
125
What does a Coombs Test look for? What is this condition has increased risk for this condition?
- Hemolytic anemia - SLE
126
Symptoms of polycythemia vera?
- Facial plethora, distended retinal veins - HA, blurry vision - Frequent nosebleeds - Fatigue, pruritis
127
What medication is used for polycythemia vera? What does it help with?
- Hydroxyurea - Reduced risk of clots
128
When are phlebotomies indicated in polycythemia vera? How are they done?
- When the hct > 45% - 500ml blood removed weekly until levels are down
129
What is hemochromatosis?
- Overload of iron
130
Complications of hemochromatosis? (4)
- Severe organ damage - Diabetes - Skin hyperpigmentation - Arthritis
131
Beta thalassemia vs. alpha thalassemia regions?
- Beta: Mediterranean - Alpha: Asian SE
132
Foods high in vitamin K?
- Potatoes, greens, lentils
133
Foods high in vitamin d?
- OJ nonorganic, milk, salmon
134
Foods high in iron?
- Red meat, tuna, eggs
135
What is G6PD deficiency? Which genre most affected?
- Condition where RBCs are broken down in response to meds, illness - boys
136
What medications cause G6PD Deficiency to worsen?
Salicylates - aspirin and pepto bismol Fava beans

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