Heme/onc Uworld

Question 1

anemia of chronic disease pathogenesis:

Answer 1

increased inflammatory cytokines (hepcidin)

Question 2

pt with ESRD on HD, now receiving Erythropoietin therapy for anemia but still has anemia, what next to improve sxms?

Answer 2

Iron supplementation: MCC of inadequate response to Erythropoietin tx on dialysis

Question 3

pt on phenytoin + increased MCV

Answer 3

folic acid deficiency

Question 4

G6PD flaire, bite cells, but normal limits on assay of g6pd activity

Answer 4

G6PD ;; takes a week for it to show, low sensitivity
XR

Question 5

mechanical aortic valve s/p severe aortic stenosis, now has hepatosplenomegaly, low platelets and elevated reticulocytes

Answer 5

mechanical aortic valve causing traumatic injury to RBCs –> schistocytes
next step: echocardiogram

Question 6

spherocytes without central pallor:

Coombs positive:

Coombs negative:

Answer 6

Autoimmune hemolytic Anemia (AIHA)

Hereditary Spherocytosis

Question 7

Coombs negative, positive eosin-5 maleimide, positive osmotic fragility

Answer 7

Hereditary Spherocytosis

Question 8

evaluation of anemia

Answer 8

Question 9

aquagenic pruritis, facial plethora, splenomegaly
elevated hemoglobin, thrombocytosis

Answer 9

LOW EPO!
POLYCYTHEMIA VERA
tx: PHLEBOTOMY

Question 10

pt with polycythemia vera symptoms, and now has hepatomegaly, splenomegaly, flank dullness and distension
what next?

Answer 10

budd chiari: abdominal doppler ultrasound!!

Question 11

isoniazid induced syderoblastic anemia:
tx:

Answer 11

pyridoxine

Question 12

Scleroderma blood cells:

Answer 12

schistocytes and microangiopathic hemolytic anemia, and thrombocytopenia

Question 13

pt with microcytic anemia, gets iron therapy but with no response

Answer 13

thalassemia
hemoglobin defect

Question 14

MACRO-cytic anemia, mild thrombocytosis, glossitis(smooth, shiny tongue)
and happens to have vitiligo

Answer 14

vitamin b-12 deficiency
has more auto-immune diseases

can cause gastric cancer** (gastric atrophy)

Question 15

Prolonged PTT with mixing study correcting PTT
vs
Prolonged PTT with mixing study NOT correcting PTT

Answer 15

Von willebrand disease

Antiphospholipid antibody (lupus) can also present with arthralgia

Question 16

isolated thrombocytopenia

Answer 16

Question 17

hypercalcemia with normocytic anemia

Answer 17

multiple myeloma

Question 18

pt with headaches, confusion, mild fever, renal (creatinine elevated), hemolytic anemia, low platelets (thrombocytopenia), fragmented red blood cells
dx
tx

Answer 18

TTP
plasma exchange

Question 19

DIC
dx
tx?

Answer 19

acute Pro-myelocytic leukemia associated with DIC
**TUMOR induced consumptive coagulopathy –> can cause hemorrhage –> activation of tissue factor (DIC), and increased plasmin
tx: all trans retinoid acid

Question 20

traumatic accident got shot several times years ago and now has pancytopenia (all 3 blood lines low leukocytes, erythrocytes, platelets)

Answer 20

acquired deficiency of hematopoietic stem cells
aplastic anemia

Question 21

65F with mature lymphocytes with lymphocytosis and cervical and supcralavicular large lymph nodes

Answer 21

Question 22

CML

Answer 22

abnormal fusion of BCR-ABL t:9,22 causing leukemogenesis d/t lots of active tyrosine kinase

tx: tyrosine kinase inhibitor : IMAN-tinib

Question 23

leukemia reaction vs CML

Answer 23

LAP score: high and more metamyelocytes (mature)

vs

lap score: LOW and more myelocytes

Question 24

Answer 24

Question 25

17M with pruritus, fever, cervical and supraclavicular painless lymph nodes
dx

Answer 25

hodgkin lymphoma
excision lymph node biopsy

Question 26

follicular lymphoma

Answer 26

elderly patients
non-hodgkin lymphoma type
painless lymphadenopathy
t:14,18
over expression of BCL-2

Question 27

CHRONIC autoimmune diseases like SLE and elevated LDH and weight loss

Answer 27

non-hodgkin lymphoma

Question 28

pt gets shot and then lots of abdominal surgeries – years later gets severe fever, and septic shock presentation with gram positive cocci in blood

Answer 28

impaired antibody facilitated phagocytosis (OPSONIZATION)
pt probably had a splenectomy and now is more affected by encapsulated organisms like Strep Pneumonia, H- influenza, and Neisseria Meningitidis

Question 29

nausea with chemotherapy
tx?

Answer 29

serotonin 5-HT-3 receptor antagonist (ondansetron)

Question 30

gets cytotoxic chemotherapy: what to Also give to reduce Aki?

different case: pt gets chemo and now has hyperuricemia

Answer 30

normal saline

tumor lysis syndrome:
hyperuricemia, hyperphosphatemia, hyperkalemia
but hypo-calcemia