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Step 2 CK > Heme/Onc > Flashcards

Heme/Onc Flashcards

(109 cards)

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1
Q

Increased body temperature, acidosis, and exercise shift the hemoglobin-oxygen dissociation curve in which direction? What effect does this have an oxygen delivery to the tissues?

A

right

more oxygen to tissues

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2
Q

What is the cause of anemia t hat develops after taking a sulfa drug?

A

G6PD deficiency

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3
Q

What lab markers suggest anemia due to hemolysis?

A

decreased H&H, nl MCV, incr indirect bili, decr serum haptoglobin, incr LDH, incr retic count

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4
Q

Hemolytic anemia, why is haptoglobin level decreased? why is the serum lactate dehydrogenase increased?

A

haptoglobin binds free hgb in blood, haptoglobin-hgb removed by spleen, hapttoglobin used up in hemolysis

LDH in RBCs, RBCs lyse and release of LDH

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5
Q

Serum iron, ferritin, transferrin levels in iron deficiency anemia

A

decr serum iron

decr ferritin

incr transferrin

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6
Q

Serum iron, ferritin, transferrin levels in anemia of chronic disease

A

decr serum iron

incr ferritin

decr transferrin

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7
Q

Elderly man has fatigue and SOB. No fever, or sx of infection. On exam his conjunctivae are pale, and stool guaiac is positive. Patient should be considered to have what disease?

A

colon cancer

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8
Q

blood smear of a patient with anemia due to lead poisoning?

A

basophilic stippling

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9
Q

RBC disorder associated with schistocytes (fragmented RBCs)

A

hemolytic anemias

DIC, TTP, HUS

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10
Q

RBC disorder associated with acanthocyte

A

abetalipoproteinemia

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11
Q

RBC disorder associated with bite cell

A

G6PD deficiency

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12
Q

RBC disorder associated with basophilic stippling of RBCs

A

lead

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13
Q

RBC disorder associated with peripheral neuropathy + ringed sideroblasts in bone marrow

A

lead

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14
Q

RBC disorder associated with hypersegmented neutrophils

A

folate/B12

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15
Q

RBC disorder associated with heinz bodies (denatured Hgb in RBC)

A

G6PD deficiency

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16
Q

What type of anemia and MCV with presentation of mental status change, neuropathy, constipation

A

lead tox

MCV decreased

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17
Q

What type of anemia and MCV with presentation of heavy menses, ice pica

A

iron deficiency

MCV decreased

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18
Q

What type of anemia and MCV with presentation of dark urine, jaundice, HSM

A

hemolytic anemia

nl MCV

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19
Q

What type of anemia and MCV with presentation of alcoholic, malnourished

A

B12/folate

incr MCV

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20
Q

virus causing aplastic anemia as well as erythema infectiosum?

A

parvovirus B19

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21
Q

type of thalassemia most commonly associated with patients of mediterranean descent? Thalassemia with patients of african or asian descent?

A

beta thal - mediterranean

alpha thal - african or asian

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22
Q

complications in 10% of patients with sideroblastic anemia?

A

acute leukemia

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23
Q

organism responsible for osteomyelitis in a sickle cell patient?

A

salmonella

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24
Q

vaccines important for sickle cell children?

A

s pneumo, h flu, meningococcal, influenza, hep B

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25
medication used in long term management of sickle cell anemia?
hydroxyurea
26
which drugs cause hemolysis in patients with G6PD deficiency?
"spleen purges nasty inclusions from damaged cells" ``` sulfa primaquine nitrofurantoin INH fava beans dapsone chloroquine ```
27
next step in management of patient with febrile neutropenia due to chemo?
admit pt, blood/urine cx, broad spectrum abx
28
type of infection that causes eosinophilia?
parasitic
29
immunoglobulin class associated with eosinophilia?
IgE
30
Goodpasture glomerulonephritis results from autoantibodies targeting the glomerular basement membrane. Which hypersensitivity reaction is this, and how can it be treated?
Type 2 | tx: antiinflammatory, immuno, plasmapheresis
31
Patient presents with red marks on her ear lobes and left wrist, and is ultimately diagnosed with a nickel allergy. What type of hypersensitivity reaction is this?
type IV hypersensitivity (contact dermatitis)
32
Most important medication in the treatment of anaphylaxis?
epinephrine
33
mechanism of action of streptokinase
cleaves fibrin clots
34
mechanism of action of aspirin
blocks platelet aggregation
35
mechanism of action of clopidogrel
blocks ADP receptor
36
mechanism of action of abciximab
blocks GP2b/3a
37
mechanism of action of tirofiban
blocks GP2b/3a
38
mechanism of action of ticlopidine
blocks ADP receptor
39
mechanism of action of enoxaparin
Xa inhibitor, LMWH
40
mechanism of action of eptifibatide
blocks GP2b/3a
41
Pregnant woman at 24 weeks is diagnosed with a DVT. Which anticoagulants are safe in pregnancy?
heparin, LMWH
42
Mechanism of action of warfarin?
blocks X, IX, VII, II, S, C coagulation factors
43
Lab test is used to monitor warfarin? Heparin? LMWH?
PT/INR PTT no monitoring
44
Management of patient who develops thrombocytopenia while being treated with heparin for a pulmonary embolus?
stop heparin | change to a different anticoag
45
Classic pentad for TTP?
``` hemolytic anemia uremia thrombocytopenia fever neurologic sequelae ```
46
Pregnant woman at 36 weeks gestation who has HTN, proteinuria, elevated AST/ALT, low haptoglobin and platelet count of 70,000?
deliver the baby
47
Platelet count, bleeding time, PT, PTT in HUS/TTP
decr platelet count increased bleeding time nl PT nl PTT
48
Platelet count, bleeding time, PT, PTT in hemophilia A or B
nl platelet count nl bleeding time nl PT incr PTT
49
Platelet count, bleeding time, PT, PTT in von Willebrand disease
nl platelet count incr bleeding time nl PT incr PTT
50
Platelet count, bleeding time, PT, PTT in DIC
decr platelet count incr bleeding time incr PT incr PTT
51
Platelet count, bleeding time, PT, PTT in warfarin use
nl platelet count nl bleeding time incr PT incr PTT
52
Platelet count, bleeding time, PT, PTT in end stage liver disease
nl/decr platelet count nl/incr bleeding time incr PT incr PTT
53
Platelet count, bleeding time, PT, PTT in aspirin use
nl platelet count incr bleeding time nl PT nl PTT
54
treatment for von willebrand disease
desmopressin cyroprecipitate OCPs avoid: aspirin
55
Most common causes of DIC
STOP Making Thrombi ``` sepsis trauma OB complication Pancreatitis Malignancy Transfusion ```
56
Most common mutation that predisposes to venous thrombosis in white patients?
factor 5 leiden
57
what are the criteria for the diagnosis of SIRS?
temp > 38.3, 12,000 10% bandemia HR > 90 RR > 20
58
Man returns from a safari in Africa and now has periodic fevers, chills, diaphoresis, muscle aches and fatigue. How could this man have avoided this illness?
malarial prophylaxis
59
Tumor marker for hepatocellular carcinoma
AFP
60
tumor marker for colon cancer
CEA
61
tumor marker for gastric cancer
CEA
62
tumor marker for pancreatic cancer
CA 19-9
63
tumor marker for ovarian cancer
CA 125
64
HIV positive patient has SOB. Increasing DOE. Cough, fever, and white plaques on tongue and pharynx. Pain with swallowing. What is the CD4 count?
CD4
65
39 year old male HIV patient receives a head CT for headache and new onset confusion and slurring of words. Imaging shows ring enhancing lesions. What is the infection? What lab supports diagnosis?
toxoplasmosis check toxo IgG antibody
66
Rate of transmission of HIV through needle stick. WHat drugs should be given if there is a risk of transmission of HIV in this setting?
0.3% emtricitabne tenofovir raltegravir
67
What is elevated in DIC: fibrin split products, d-dimer, fibrinogen, platelets, hematocrit?
increased fibrin split products, increased d dimer
68
25 year old male diagnosed with HIV must begin HAART regimen. What classes of drugs should his regimen include initially?
2 NRTIs | + NNRTI, protease or integrase inhibitors
69
Antiretroviral class with side effect lactic acidosis
NRTIs
70
Antiretroviral class with side effect GI intolerance
protease inhibitor
71
Antiretroviral class with side effect rash
NNRTIs
72
Antiretroviral class with side effect hyperglycemia, DM, lipid abnormalities
protease inhib
73
Antiretroviral with side effect bone marrow suppression with megaloblastic anemia
zidovudine
74
Antiretroviral with side effect potentially fatal hypersensitivity reaction
abacavir
75
Antiretroviral with side effect neuropsych symptoms (depression and vivid nightmares)
efavirenz
76
Antiretroviral with side effect hyperbilirubinemia, jaundice
atazanavir
77
Antiretroviral with side effect teratogenic, should not be given to women of childbearing age off of contraceptives
efavirenz
78
Antiretroviral with side effect inhibits cytochrome P450, used to boost other drugs
ritonavir
79
66 y/o woman fractures hip. Radiographs show punched out lesions in vertebrae, hips, femurs. Patient says that she has increasing back pain, weakness, fatigue but she has attributed all of that to aging. Labs show anemia, hypercalcemia, increased BUN and creatinine. What studies will help with diagnosis? What would you see? Dx?
SPEP: monoclonal M spike UPEP: Bence Jones protein bone marrow biopsy multiple myeloma
80
21 year old male patient presents with recent weight loss, pruritus and night sweats. Physical exam reveals HSM and nontender cervical LAD. What do you suspect?
Hodgkin lymphoma
81
Blood cell pathology associated with epstein-barr virus in Africa
burkitt lymphoma
82
Blood cell pathology associated with reed sternberg cells, cervical LAD, night sweats
hodgkin lymphoma
83
Blood cell pathology associated with bence jones protein, osteolytic lesions, high calcium
multiple myeloma
84
Blood cell pathology associated with translocation 14;18
follicular
85
Blood cell pathology associated with most common lymphoma in US
diffuse large B cell
86
Blood cell pathology associated with translocation 8; 14
Burkitt
87
Blood cell pathology associated with most common form of Hodgkin lymphoma
nodular sclerosing
88
Blood cell pathology associated with starry sky pattern due to phagocytosis of apoptotic tumor cells
burkitt
89
Blood cell pathology associated with high Hct/Hgb pruritus, burning pain in hands or feet
polycythemia vera
90
Type of leukemia most common neoplasm in children (3-4 years)
ALL
91
Type of leukemia most common leukemia in adults
CLL
92
Type of leukemia philadelphia chromosome is almost always seen
CML
93
Type of leukemia smudge cells on peripheral smear
CLL
94
Type of leukemia with peripheral blasts are PAS (+) and TdT (+)
ALL
95
Type of leukemia with peripheral blasts are pAS (-), myeloperoxidase (+), and have auer rods
AML
96
Type of leukemia with pancytopenia in a down syndrome patiet
ALL
97
Type of leukemia associated with translocation 9;22
CML
98
Type of leukemia white cells with hair like projections
hairy cell
99
medication that cures 95% CML?
imatinib
100
peripheral smear of an asymptomatic patient reveals macrocytosis and hypogranular granulocytes with bilobed nuclei. Dx?
myelodysplastic syndrome
101
5 year old boy has swollen leg. Swollen leg is a mass embedded in muscule of right thigh. Next step?
CT/MRI, then biopsy
102
Most common adrenal tumor in children? What lab studies can be used to diagnose this?
neuroblastoma incr VMA, incr HMA in 24 hour urine
103
4 year old girl brought into the county clinic with URI. The mother reports that this child seems to get sick more often than her friends kids of the same age. Physical exam is remarkable for dangling thumbs, short stature, hypopigmentation of some areas. Labs reveal pancytopenia. Dx?
fanconi anemia
104
3 month old has difficulty breathing, fatigue, and pallor. Heart murmur and abnormal thumbs. Labs reveal anemia,. Dx? EPO?
diamond blackfan anemia incr EPO
105
late lifethreatening complication of CML?
blast crisis
106
conditions associated with a positive p ANCA
pauci immune glomerulonephritis micrscopic polyangiitis eosinophilic granulomatosis with polyangiitis crohn's uC primary sclerosing cholangitis
107
Treatment for TTP?
plasmapheresis steroids
108
What cause of aplastic anemia is associated with thumb abnormalities, diffuse hypo/hyperpigmentation, cafe-au-lait spots and short stature?
fanconi anemia
109
Differential diagnosis for eosinophilia?
CANADA P ``` collagen vasc dx atopic - allergies, asthma, churg strauss neoplasms adrenal insuff (addison) drugs acute interstitial nephritis parasites ```

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