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Flashcards in HemeOnc Deck (119)
1

High TIBC

Iron deficiency

2

>24oz/d cow's milk + anemia, pica, fatigue, inc RDW

Iron deficiency --> oral iron therapy

3

Iron deficiency tx in baby

Cows milk b4 9mo

4

High Ferritin

Chronic disease --> EPO

5

Low iron, Low TIBC anemia

Chronic disease
- high ferritin

6

Low TIBC
Everything else normal or high

Thalessemias (Inc A1)

7

High Hb A2

B-Thal trait

8

MCV <75, normal RDW, Target cells, Normal iron, ferritin, no response to iron

B-Thal trait (inc A2), alpha-thal (normal)

9

Target cells anemia

Thal minor

10

Hct >30, RDW NORMAL, RBC count normal to Inc, normal to inc iron, Ferritin, anemia

Thal minor

11

Basophilic stippling

Thalessemia & heavy metal poisoning

12

RUQ pain w/ inspiration, splenomegaly, same thing in brother

Hereditary spherocytosis --> Ca-bilirubin gall stones --> folate & splenectomy

13

Tx for hereditary spherocytosis

Folate & tranfusions --> 30+ yr strep risk = vaccination b4 splenectomy + daily PCN

14

Multiple small round dense, hyperchromic (no pallor) RBCs, RUQ pain, Coombs -

Hereditary spherocytosis = ankyrin defect --> high MCHC & RDW

15

High retic, hyperUNconjugated bilirubinemia, spherocytes, schistiocytes, osmotic fragility

Hereditary spherocytosis

16

High retic, inc MCHC, normal or low MVC, anemia, jaundice

Hereditary spherocytosis

17

Thrombocytopenia --> pancytopenia, absent radius/thumb, café-au-lait, microcephaly

Fanconi anemia (TAR)

18

Pancytopenia, hypopigmented spots, short, abn thumbs, deafness, strabismus, 7 y/o

Fanconi anemia = DNA breaks --> stem cell transplant

19

Swelling of hand/feet, fever, pale, poor feeding

Hand-foot syndrome = Sickle Cell

20

85% HbS, 15% HbF

Sickle cell disease

21

Management of Sickle cell

Vaccinations, PCN until 5, folic acid, HU for vasoocclusive events

22

Sickle cell disease complications

ACS, dacylitis, stroke, osteomyelitis, splenic infarction

23

Hx severe arm pain, now weakness, clumsy in right hand, 3 y/o A.A boy

Sickle cell stroke = get peripheral smear, retic

24

40%HbS, 60% HbA

Sickle cell Trait --> Hematuria, can't concentrate urine --> polyuria, nocturia, inc UTIs

25

Anemia + high retic, A.A boy, hx hematuria, Abd pain, no vaccines --> death

Sickle cell --> bacterial infection d/t asplenia = PCN until 5 y/o

26

#1 bacteremia bug in sickle cell

Strep pneumo (encapsulated)

27

Howell-Jolly bodies

Sickle cell - sign of aplenia

28

Severe drop in Hb, retic <1%, sudden onset fatigue, dyspnea, NO HSM

Aplastic crisis

29

Retic <1%, BM HYPOCELLULAR, fatty infiltrate, bleeding, petechiae, lethargy, weakness

Acquired aplastic anemia - drugs, chemicals, CCl4, insecticides

30

Hypoplastic, fat-filled marrow

Aplastic Anemia

31

High F Hb (HU increases this)

Sickle cell, beta thal, aplastic anemia

32

Reticulocytosis w/ sickle cell

Hyperhemolytic crisis

33

African American 17 y/o male w/ painless hematuria

Sickle cell trait - d/t papillary ischemia

34

Heinz bodies & bite cells

G6PD deficiency and thalessemias = Hb precipitation

35

Bite cells, RBC inclusions (Heinz bodies), inc indirect bili, inc LDH, dec haptoglobin, jaundice, back pain, DARK urine

G6PD deficiency
- activity level may be NORMAL during an attack

36

Inc marrow cellularity + megakaryocyte hyperplasia

Essential thrombocytosis

37

Shiny tongue, palmar crease, Hb 7.5, WBC 3500, Hx gastric bypass

B12 deficiency d/t bypass/no IF

38

Everything inc but TIBC dec

Hemochromatosis

39

Absent CD55

Paroxysmal Nocturnal Hemoglobinuria
- destruction by complement

40

Hemarthroses, epistaxis, joint swelling, young age, family bleeding disorder

Hemophilia A (VIII) or B (IX)

41

Easy bruising, knee swelling after fall, skin ecchymoses, bruising at waistband

Hemophilia (A = VIII, B= IX) --> platelet count and Coag

42

Cause of hemophilia arthropathy

Iron/hemosiderin deposition --> synovitis & fibrosis

43

Normocytic, normochromic anemia, low retic, Hb 7-10, normal platelet, WBC, bilirubin

Anemia of prematurity - FTT, tachypnea, lethargy, cyanosis, tachycardia

44

Weak, abd pain, inc urine prophobilinogen

Acute intermittent porphyria

45

Purpura, large joint arthritis, N/V, melena, normal PT, PTT, Comp & IgA N-Inc

Anaphylactoid purpura

46

Bruising, bloody stool, IVH, baby born at home, inc PT

Hemorrhagic disease of newborn = vit K def (II, VII, IX, X)

47

Venous Hct >65 risk

NEC --> partial exchange transfusion

48

Washing cells/removing WBCs

Prevent febrile transfusion

49

HPT w/ acute monoarthritis, chondrocalcinosis

Pseudogout - CPPD = rhomboid crystal, +

50

Helmet cells

Trauma - DIC, HUS, TTP

51

Drugs that cause folic acid deficiency

TMP-SMX, MTX, Phenytoin, phenobarbital

52

Platelet dysfunctions

vWD, renal failure (uremic coagulopathy)

53

Inc PT (INR) >> aPTT

Vit K deficiency

54

CF + prolonged PT deficiency

Vit K --> low factor VII

55

Lupus anti-coagulant prolongs?

PTT

56

Drop of >50% platelets on heparin

HIT --> stop all heparin & use direct thrombin inhibitor + serotonin release assay

57

Absent Ib-IX-V, mild thrombocytopenia but profuse bleeding, giant platelets

Bernard-soulier

58

Anemia, thrombocytopenia, HS megaly, BONE PAIN/erosions, PAS+ inclusions

Gaucher's

59

Blood transfusions before 1986 and 1992 screened for what?

HBV and HCV, respectively

60

Paresthesias & hypoCa, hypoMag after receiving several PRBC units

Citrate anti-coagulant in whole blood chelates serum Ca

61

Pancytopenia, young A.A female, joint pain, rash, 1+ proteinuria, FPGN

SLE --> peripheral immune destruction of all 3 cell lines

62

Isolated thrombocytopenia, no infections

Immune thrombocytopenia (ITP) ---> steroids then splenectomy or rituximab

BM shows inc MEGAkaryocytes

63

URI weeks ago --> sudden petechiae, epistaxis, thrombocytopenia >30,000

ITP --> Observation; steroids if <30,000

64

Hemolytic anemia, thrombocytopenia, renal failure, HA, fragmented RBCs

TTP-HUS (ADAMTS-13) ---> plasma exchange

65

Painless blisters on dorsal hand (sun-exposed area),fragility, facial hyperpigment, hypertrichosis, inc uroporphyrins, *HCV,* estrogen use or iron overload

Porphyria cutanea tarda --> phlebotomy, hydroxychloroquine or IF-a

66

Deficiency in urobilinogen decarboxylase --> urine porphyrin inc

Porphyria cutanea tarda

67

#1 inherited disorder causing hypercoagulability

Factor V Leiden

68

HCV, palpable purpura, hematuria, proteinuria, low complement

Mixed cryoglobulinemia = Hep C

69

Palpable purpura on butt of kid

Henoch-Schonlein

70

Purpura, normal platelet count, arthralgia, abd pain/bleeding, scrotal swelling

Henoch-Schonlein purpura --> intussusception = IVFs, NSAIDs or steroids --> SURGERY

71

Hematuria, abd pain, purple non-blanching rash on lower legs, normal platelets

Vasculitis/HSP

72

Senile purpura

Perivascular CT atrophy

73

Therapy for iron overload in B-thal or sickle cell

Deferoximine

74

Ruby papules on lips, high Hct, recurrent nosebleeds, digital clubbing

Osler-Weber-Rendu --> AVMs (lungs --> shunt --> polycythemia, hemoptysis)

75

Delayed clamping of umbilical cord --> ?

Polycythemia --> Resp distress

76

Resp distress, poor feeding, neuro sx

Polycythemia

77

Pruritus after warm shower, ulcers, facial plethora, Low EPO

PCV

78

JAK2 mutation

PCV

79

PNA sx but lymphocytosis, smudge cells, how to confirm Dx?

CLL --> flow cytometry

80

Most common leukemia in Western countries

CLL

81

Elderly, lymphocytosis, smudge cells (breakdown/inc fragility)

CLL

82

Reed-Sternberg cells

Hodgkins lymphoma

83

Leukocytosis with neutrophilia, marked splenomegaly, low leukocyte alkaline phosphatase

CML

84

Pt got chemo & rad for Hodgkin lymphoma --> CXR density dx?

Secondary malignancy - also breast, bone, thyroid, GI cancers

85

Numerous infections, weight loss, HSM, LAD, petechiae

ALL = higher in boys, Down

86

Pale, petechiae, fever, fatigue, rubbery non-tender LNs, anemia, widened mediastinum

ALL --> BM Bx

87

LAD, splenomegaly, 80% blasts, Inc prolymphocytes, (-) PAS (+) Tdt

ALL

88

Starry sky appearance

Burkitt lymphoma

89

Tx for acute limb ischemia

Heparin --> surgery --> intra-arterial fibrinolysis

90

Anti-cardiolipin Abs, recurrent thromboses

Antiphospholipid Ab syndrome

91

Poor prognostic indicator in CLL

Thrombocytopenia

92

Cause of death in CLL pts

Infection

93

Temp 101.3, neutrophils 850

Neutropenic fever --> PA --> Zosyn

94

Dry tap, TRAP stain, CD11c

Hairy cell leukemia (B) --> Cladribine (purine)

95

NHL Tx

CHOP

96

CLL tx

Chlorambucil & Prednisone

97

BCR/ABL

CML
- Hx of radiation exposure

98

9;22 activity

TK in CML, tx = Imatinib

99

Hypocellular + Fibrotic marrow

Myelofibrotic disorders

100

Retinoic Acid receptor

AML (promyelocytic)

101

Excess bone resorption in cancer

PTHrP - Breast CA

102

Excess Ca reabsorption in cancer

Lymphoma (Vit D)

103

Anterior mediastinal masses

Thymoma - Teratoma - Thyroid - Terrible lymphoma

104

Mediatinal mass w/ high b-HCG, normal AFP

Seminoma

105

Mediastinal mass w/ elevated b-HCG, elevated AFP

Mixed germ cell/Non-seminomatous - yolk, chorio

106

Back pain, anemia, renal dysfxn, elevated ESR, constipation

MM --> hyperCa

107

Plasmacytosis, monoclonal proteins, lytic lesions

MM (IgG or IgA)

108

High serum protein, normal albumin (gamma gap) disorders

MM, amyloidosis, waldenstroms, MGUS

109

Gamma gap, anemia, pancytopenia, hyperCa, renal disease

MM

110

MM SPEP

>3g M protein, >10% plasma cells in BM

111

MGUS SPEP

need sketelal x-rays to monitor for --> MM

112

IgM spike, anemia, bruises, night sweats, dizzy, blurry vision, numbness

Waldenstroms

113

Metabolic/electrolyte abnormalities w/ tumor lysis syndrome

HypoCa, HyperPhos, Uric acid, K

114

Frequency of brain mets by cancer type

Lung > Breast > Melanoma > Colon

115

Solitary brain mets

Breast, Colon, RCC

116

Multiple brain mets

Lung, Melanoma

117

Pappenhiemer bodies

Sideroblastic anemia - phagocytes ingest excessive iron

118

LOW Hb and haptoglobin
Inc LDH and bilirubin
*Portal vein thrombosis*

PNH
- no GP1 --> cant bind CD55 or 59 --> destruction by complement
- Dx by flow cytometry

119

Signs and sx of polycythemia in newborn

RESPIRATORY DISTRESS
Poor feeding, hypoglycemia, hypoCa

Tx = hydration or partial exchange transfusion