Heme/Onc Flashcards
(157 cards)
1
Q
Best initial test for smoker presenting with palpable cervical lymph node
A
Panendoscopy
(esophagoscopy, bronchoscopy, laryngoscopy), then biopsy (suspected SCC of head and neck)
2
Q
Empiric anticoagulation only for suspected ___, not for suspected ___
A
PE; DVT
3
Q
Do not use apixaban (or direct factor Xa inhibitors) in ____
A
ESRD (severe renal disease)
4
Q
Facial plethora (ruddy cyanosis)
A
Polycythemia Vera
+aquagenic pruritus
5
Q
INH side effects
A
INH: Peripheral Neuropathy, Hepatotoxicity
6
Q
Increased RBCs DDx
A
- PV
- Chronic hypoxia (e.g. OSA)
- EPO-producing tumors
7
Q
Smudge cells on smear
A
CLL
8
Q
Excessive bleeding after dental procedure
A
Hemophilia vs. vWF
9
Q
B cell only disorders of immunodeficiency
A
XLA, CVID, IgA
10
Q
B + T cell disorders of immunodeficiency
A
SCID, WAS, Hyper-IgM, Ataxia-telangiectasia
11
Q
No response to vaccination
A
SCID, XLA, CVID
(Absent/low/dysfunctional B cells)
12
Q
Recurrent disseminated bacterial infections (SHiN)
A
Complement deficiency
13
Q
Recurrent GI infections, think these bugs:
A
Salmonella, Campylobacter
14
Q
Blasts on smear
A
ALL
15
Q
Recurrent respiratory infection general examples
A
PNA, sinusitis, otitis
16
Q
T cell only disorders of immunodeficiency
A
- DiGeorge
- IL-12 receptor deficiency
- Hyper-IgE (Job)
- Chronic mucocutaneous candidiasis
17
Q
Phagocyte dysfunction
A
CGD, LAD, Chédiak-Higashi
18
Q
Hematopoietic stem cell transplantation treats:
A
SCID or WAS
19
Q
Triphalangeal thumbs
A
Diamond-Blackfan Anemia
(Congenital pure RBC aplasia that presents within first 3 months of life as pallor, poor feeding, congenital anomalies such as thumbs, webbed neck, cleft lip, short stature, shielded chest)
Tx: Corticosteroids
20
Q
Acquired RBC aplasia in healthy children between 6mo to 5yo
A
TEC (Transient erythroblastopenia of childhood)
(Labs: normocytic normochromic anemia and extremely low reticulocyte count)
21
Q
Most common cause of anemia in preterm infants
A
Anemia of prematurity
(Diminished EPO levels, shortened RBC life span, +/- blood loss)
Path: Premature infant —> Increased O2 concentration in tissues after delivery —> Normal decrease in EPO (erythropoietin) —> decreased BM reticulocyte production —> Expected RBC nadir is worsened due to SHORTER RBC life span (40-50d) from prematurity +/- frequent phlebotomy in NICU —> Early-onset anemia
22
Q
Low iron/high ferritin/low TIBC
A
ACID (Anemia of Chronic [Inflammatory] Disease)
23
Q
Microcytic anemia DDx
A
LIT ASS
- Lead poisoning
- Iron deficiency
- Thalassemias
- Anemia of Chronic Disease
- Sideroblastic anemia
- Spherocytosis (normal to low MCV)
24
Q
RBCs in OSA
A
Elevated (Reactive polycythemia)
(Hypoxemia —> Increased EPO from kidneys —> Elevated H&H)
25
Spinal mets DDx
**Lung/breast/prostate cancer, MM**
26
ABO/Rh risk to fetus:
AB **"O" shit**
**"Rh negative Nancy"** mom
27
Leukocyte alkaline phosphatase (LAP) levels
**CM**_Low_**** vs. **Leuke**_MORE_** reaction**
Low LAP = CML, High LAP = leukemoid reaction
28
Elevated MCHC
**Hereditary spherocytosis**
* AD North European
* Gallstones (pigmented)
* B19 Aplastic anemia
* AGLT (Acidified Glycerol Lysis Test)
* Osmotic fragility on AGLT
* EMA binding test (Eosin-5-Maleimide binding test)
* Tx: Folate, splenectomy, cholecystectomy, +/-transfusion
29
Elevated urinary VMA (vanillylmandelic acid)
**Pheochromocytoma**
30
Upper body edema + weight loss
**SVC syndrome**
(Mediastinal tumor malignancy--SCLC or NHL)
31
Elevated AFP + malignancy
**Nonseminomatous germ cell tumor (4 T's)** vs. **HCC**
* 4 T's = mnemonic for mediastinal mass (**T**eratoma in this case)
32
Increased in B12 deficiency, Normal in folate deficiency
**Methylmalonic acid** (MMA)
33
Absent/hypoplastic thumbs
**Fanconi Anemia**
* AR DNA repair defect presenting 8-16yo with bleeding, fatigue, hearing problems, and absent thumbs
* Other signs: Macrocytic anemia, short stature, absent thumbs, hypogonadism, microcephaly, hypopigmented areas, café au lait spots, large freckles, strabismus, low-set ears, and hearing problems 2/2 conduction abnormalities
* Dx: Chromosomal breaks on genetic analysis
* Tx: HCT
34
Howell-Jolly bodies
**SCD** or **splenectomy**
(_nuclear remnants_ within RBCs that are normally removed by spleen; single/blue/round on Wright stain)
35
Basophilic stippling DDx
* **L**ead poisoning
* Heavy metal poisoning
* **T**halassemias
* **A**lcoholism
36
Recurrent hemarthrosis
**Hemophilia A/B/C**
* A = XR, FVIII
* B = XR, FIX
* C = AR, FXI
37
Fever + hemolysis
**TTP (Thrombotic thrombocytopenic purpura)**
**FAT RN**
* **F**ever
* **A**nemia (MAHA)
* **T**hrombocytopenia
* **R**enal disease
* **N**eurological sx
* Tx: **Emergent plasmapheresis!** (plasma exchange)
38
FFP is used for:
* Warfarin reversal
* Factor V deficiency
* Factor VIII deficiency (Hemophilia A)
* ATIII deficiency
* TTP
39
Vitamin K-dependent coagulation factors
**1972** + **C** & **S**
| (II, VII, IX, X, Proteins C & S)
40
Procoagulant meds
* **TXA**
* **Aminocaproic acid (Amicar)**
41
Hemolysis (LDH/Bili/Haptoglobin) + Thrombosis
**PNH**
(Paroxysmal Nocturnal Hemoglobinuria)
* Genetic absence of CD55 & CD59 protein anchors on RBC surface, allowing complements to attach RBCs --\> hemolysis
* Dx: Absence of CD55/59 on flow
* Tx:
* Iron & Folate supplementation
* **Eculizumab** (mAb that inhibits complement activation)
42
Osteoclast inhibitor
**Bisphosphonates**
(Alendronate, zoledronic acid, pamidronate)
* Tx for hypercalcemia
43
Anemia in ESRD
**EPO deficiency**
* Tx = EPO therapy \*BUT\* _always try iron first_!
44
Drugs that induce folate deficiency
**TMP**
* **T**MP-SMX
* **M**ethotrexate
* **P**henytoin
45
Smudge cells on smear
**CLL**
46
**ALL = lymphoblastic;**
**CLL =lymphocytic**
* ALL = **blasts** on smear;
* CLL = **smudge cells** on smear (+ mature lymphocytes)
47
Pinpoint bruises
**Petechiae** = LOW PLATELETS!!!
48
Excessive bleeding after dental procedure
hemophilia vs. **vWF**
49
Recurrent respiratory
e.g. **PNA,** sinusitis, otitis
50
Recurrent GI
**e.g. Salmonella, Campylobacter**
51
Recurrent disseminated bacterial infections (SHiN)
**Complement deficiency**
52
No response to vaccination
**Absent/low B cells:**
Absent/low B cells:
* **SCID, XLA, or CVID**
53
Primary immunodeficiency:
**SCID, XLA, CVID, IgA, WAS,** Hyper-IgM
54
**B+T d/o:**
* **SCID**
* **WAS** (Wiskott-Aldrich Syndrome)
* Hyper-IgM
* Ataxia-telangiectasia
55
**B only** (humoral):
* XLA
* CVID
* IgA deficiency
56
**T only** (cellular)
* DiGeorge
* IL-12 receptor def
* Hyper-IgE (Job)
* Chronic mucocutaneous candidiasis
57
**Phagocyte dysfunction**
**CGD, LAD**, Chédiak-Higashi
58
HCT Tx:
**SCID or WAS**
59
Triphalangeal thumbs
**Diamond-Blackfan Anemia**
60
Absent/hypoplastic thumbs
**Fanconi Anemia**
61
Howell-Jolly bodies
**SCD** or **splenectomy**
62
Hemarthrosis + easy bleeding + excessive post-dental bleeding
think **hemophilia** **A** or **B** (XR) or **C** (AR)
[VIII, IX, XI respectively]
63
**TTP** —\> Fat nurse pentad (**FAT RN**):
**F**ever, **A**nemia, **T**hrombocytopenia, **R**enal symptoms, **N**eurologic symptoms
64
FFP Tx:
Warfarin reversal, Factor V deficiency, Factor VIII deficiency (Hemophilia A), antithrombin III deficiency, TTP
65
Vitamin K-dependent coag factors:
**1972 + C & S**
66
tPA vs. TXA vs. aminocaproic acid (Amicar)
* tPA = thombolytic
* TXA = clotting promoter
* Aminocaproic acid = clotting promoter
67
Hemolysis (LDH/Bili/Haptoglobin) + Thrombosis
**PNH**
68
Monoclonal antibody that inhibits complement activation
**Eculizumab = Tx for PNH**
69
Complement-mediated hemolysis of RBCs due to genetic defect of CD55 and CD59 on RBC membranes
**PNH**
70
Osteoclast inhibitor
**bisphosphonates**
(e.g. zoledronic acid, alendronate, pamidronate) = **Tx for hypercalcemia**
71
Hypercoagulability disorder associated with occult visceral malignancy
(e.g. pancreatic cancer)
**Migratory superficial thrombophlebitis** (Trousseau’s syndrome)
72
**HIT Tx**
1. Stop heparin
2. Start direct thrombin inhibitor (e.g. argatroban, dabigatran) or fondaparinux (synthetic pentasaccharide)
73
Carboxylates glutamic acid residues on prothrombin complex proteins
**Vitamin K**
74
Anemia in ESRD
**Erythropoietin deficiency**
(Tx: EPO therapy, but always try iron first)
75
Posterior knee pain/swelling/stiffness
**Baker cyst**
| (popliteal cyst)
76
Avulsion of apophysis of tibial tubercle from overuse injury caused by repetitive strain in young children/adolescents w/ recent growth spurt
**Osgood-Schlatter disease**
77
Most common cause of anemia in chronic alcoholics
**Folate** deficiency
78
3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor
**statins**
79
Mediterranean thalassemia
**beta**
80
Southeast Asian thalassemia
**alpha**
81
Antibodies to platelet factor 4 (PF4)
**Type 2 HIT**
(immune-mediated response against PF4 complexed with heparin, leading to DIC-type reaction after \>5d of heparin exposure).
82
Warfarin/Heparin:PT/PTT
**PT prolongation, PTT nl; PT nl, PTT prolongation, respectively**
83
BCR-ABL
**CML t**ranslocation t(9,22) causing constitutively active tyrosine kinase
(tx = TKIs, e.g. imatinib).
84
Converts homocysteine to methionine
**B12 & Folate**
85
Important to rule out ____ before starting folic acid replacement
**B12 deficiency**
| (can be masked until neuro sx begin)
86
Serotonin receptor antagonists treat:
**chemotherapy-induced nausea**
| (e.g. ondansetron; 5HT3-antagonist)
87
Clubbing
**CF, CV** (Cyanotic), **Crohn’s** (IBD), hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome—also due to cyanotic shunt 2/2 pulmonary AVMs)
* Any chronic hypoxemia!
88
Elevations in tumor lysis syndrome
**K+, Phos, Uric acid (KPU)**
89
Hx of abd gunshot wounds
think splenectomy/**SHiN**-prone
90
Warm AIHA causes
**SLE/CLL/PCN**
(drugs)/Viral infections
91
Cold AIHA causes
**Mycobacterial PNA, Mono**
**(EBV, CML/CLL)**
92
High RBCs + low EPO
**Polycythemia vera**
93
Positive Giemsa stain
**Malaria**
| (intraerythrocytic parasites)
94
Auer rods
**AML**
| (40-60yo + acute presentation)
95
Tumor w/ elevated AFP, elevated B-hCG
**Nonseminomatous germ cell tumor**
* Yolk sac
* Choriocarcinoma
* Embryonal carcinoma
* Mixed germ cell
96
Tumor w/ normal AFP, normal to elevated B-hCG
**Seminomatous germ cell tumor**
97
Tumor w/ fat or calcium
**Teratoma**
| (+/- tooth)
98
Mediastinal mass DDx:
**4 T’s** -
## Footnote
**T**hymoma,
**T**hyroid carcinoma,
**T**eratoma (+ seminomatous, nonseminomatous germ cell),
**T**errible lymphoma
99
DDx of Testicular Cancer
**Varicocele, torsion, spermatocele** (cyst), **hydrocele, epididymitis, lymphoma**
100
Hypotensive crisis
think primary adrenal insufficiency
| (**Addison disease**)
101
Hyperpigmentation in Addison disease is due to increased \_\_\_\_
**ACTH**
| (melanocyte precursor)
102
Elevated LFTs + DM + Skin pigmentation
**Hereditary Hemochromatosis**
103
HIT Dx gold standard
**Serotonin release assay**
104
Necrosed (purple/black) lesions on abdomen
**HIT Type** **2**
| (2/2 heparin injection site thrombosis)
105
Microcytic anemia DDx
**LIT ASS**
## Footnote
**L**ead poisoning,
**I**ron deficiency anemia,
**T**halassemias,
**A**CID (anemia of chronic inflammatory disease), **S**ideroblastic anemia, Hereditary **S**pherocytosis (or normal MCV)
106
Levels of this distinguish folate vs. B12 deficiency
**Methylmalonic acid**
(increased in B12 deficiency, normal in folate deficiency)
107
Elevated AFP
**Nonseminomatous germ cell** tumor (**4 T’s**) vs. **HCC**
108
Urinary **VMA** (vanillylmandelic acid)
**Pheochromocytoma**
109
Upper body edema + weight loss
**Superior Vena Cava Syndrome 2/2** mediastinal
tumor malignancy
(SCLC or NHL)
110
Increased mean corpuscular Hb concentration
**Hereditary spherocytosis**
111
LAP in CML vs. Leukemoid Rxn
**CMLow LAP**;
High in Leuke”more” reaction
112
ABO/Rh risk variants in mother
**AB “O”** **shit…; “Rh
negative Nancy” mom**
113
Spine mets DDx
Lung/breast/prostate cancer, MM
114
RBCs in pts with OSA
**RBCs** in pts with **OSA** = Polycythemia (Hypoxemia —\> Increased **EPO** from kidneys —\> Elevated H&H)
115
Increased RBCs DDx
PV, 2/2 chronic hypoxia (e.g. OSA), or EPO-producing tumors
116
**INH** side effects
**Neuropathy, hepatotoxicity**
117
Facial plethora (ruddy cyanosis)
**think PV**
118
Do not use apixaban
(or direct factor Xa inhibitors) in
**ESRD**
119
Empiric anticoagulation only for suspected \_\_\_, not for suspected \_\_\_
**PE; DVT**
120
Best initial test for smoker presenting with palpable cervical lymph node
**Panendoscopy**
(esophagoscopy, bronchoscopy, laryngoscopy) —\> then biopsy (suspected SCC of head/neck)
121
Tx of homocysteinemia
**B6, B12, or folate**
122
Hypocalcemia or hypomagnesemia post-transfusion
**citrate** chelation —\> Treat with calcium gluconate following massive transfusions!
123
Rapid-onset vs. within a few hours post-transfusion reaction
**IgA deficiency anaphylaxis and GVHD,** respectively
124
Treatment of Cancer-related anorexia/cachexia syndrome (CACS)
**progesterone analogue (megestrol acetate) or corticosteroids**
125
**Tx of RA**
methotrexate, hydroxychloroquine, infliximab/etanercept
(**TNF-inhibitors**)
126
Fever + hemolytic anemia
Think TTP
(**FAT RN)**
127
Tx of TTP
**Plasmapheresis**
| (plasma exchange)
128
Time course for transfusion reactions:
* Seconds to minutes - **Anaphylaxis** (IgA deficiency)
* First hour - Acute hemolytic rxn (**GVHD)**
* 1-6 hours - **Febrile nonhemolytic** or **TRALI** (transfusion-related acute lung injury)
* 2-10 days - **Delayed** hemolytic
129
Specialized RBC Tx:
* **Washed**: IgA deficiency; complement-dependent AIHA; Continued allergic rxns w/ RBC transfusion despite antihistamine Tx
* **Irradiated**: BMT; Cellular immunodeficiency (DiGeorge/IL-12/Hyper-IgE); 1st or 2nd degree relative is donor
* **Leukoreduced:** Chronically transfused; CMV seronegative at-risk pts (AIDS, transplant pts); Potential transplant recipients; Previous febrile nonhemolytic transfusion rxn
130
B12 deficiency results in impaired DNA synthesis due to
**decreased purine synthesis**
131
Deficiency following total or partial gastrectomy
**B12 deficiency**
132
Drugs that cause folate deficiency:
* **Phenytoin**
* **Methotrexate**
* **TMP-SMX**
133
Homocysteinemia complication
**hypercoagulability**
**(DVTs)**
134
NSAIDs + anemia
**Iron deficiency anemia**
135
How to diagnose TTP?
**Peripheral blood smear**
**(**schistocytes**)**
136
Normal liver span at R midclavicular line
**6-12cm**
137
**HIV-**associated nephropathy (HIVAN)
**FSGS**
| (focal segmental glomerulosclerosis)
138
SCD nephritis
**MPGN** or **FSGN**
| (long-term)
139
Northern European
**Hereditary spherocytosis; Pernicious anemia**
140
Hypoxia to 85% during anesthetic procedure
**Acquired methemoglobinemia**
**(**oxidization of iron in Hb due to topical anesthetic agents or dapsone.)
141
Shiny tongue + pallor
**B12 deficiency**
142
Megaloblastic
**impaired DNA synthesis**
| (folate or B12 deficiency)
143
Hemolysis + hypercoagulability
**PNH**
(absence of CD55/59; complement-mediated RBC hemolysis)
144
**Anticoagulation in AKI/CKD**
**Heparin only**; AVOID LMWH, fondaparinux, rivaroxaban 2/2 reduced renal clearance.
145
Breast Cancer Screening in Women 50-75
**Mammogram q2years**
146
Cervical Cancer Screening in Women 21-65
**Pap smear q3years**
| (or Pap + HPV testing q5years 30-65yo)
147
Colon Cancer Screening in 50-75yo:
* **Annual FOBT or**
* **Colonoscopy q10years or**
* **Sigmoidoscopy q5years + FOBT q3years**
148
Colon Cancer Screening in high-risk pts:
* **FAP FHx:** age 40 or 10 years before age of relative at CRC dx + colonoscopy q3-5years
* **IBD:** 8 years post-Dx + colonoscopy q1-2years
* **FAP:** Age 10-12 + annual colonoscopy
* **HNPCC** (Lynch Syndrome): Age 20-25 + Colonoscopy q1-2yrs
149
Lung cancer screening
**Low dose CT annually for age 55-80** w/ \>30-pack-year smoking hx + currently smoking or quit in past 15 years.
150
HIV in 15-65yo
**HIV Ab screen 1 time**
151
Hyperlipidemia Screen in Men 35+
**Lipid panel q5years**
152
HTN Screen in 18+
**BP q2years**
153
Bladder cancer screening
**Not currently recommended in anyone**
154
Osteoporosis in Women 65+
**DEXA**
**(**interval uncertain)
155
Lynch Syndrome (HNPCC):
**AD predisposition to CRC, endometrial, & ovarian cancers.**
156
An autoimmune process whereby the body produces IgG antibodies against the platelets
**ITP**
| (Idiopathic Thrombocytopenic Purpura)
157
HIV pt with AMS, EBV DNA in CSF, & solitary, weakly ring-enhancing periventricular mass on brain MRI
Primary CNS Lymphoma
