Hemonc Flashcards
(157 cards)
1
Q
Heparin to warfarin bridge is necessary because
A
Proteins c and s have shorter half lives than other factors leading to paradoxical hypercoagulability
2
Q
For rapid reversal of warfarin give
A
Ffp or otherwise vit K
3
Q
For reversal of heparin give
A
Protamine sulfate
4
Q
Mech of lmwh (enoxaparin)
A
Mainly inhibits factor Xa
5
Q
In hemophilia, pt is __, ptt is ___ and bleeding time is ___
A
Ptt is prolonged
Pt and bleeding time is normal
6
Q
What is cryoprecipitate
A
Mix of factor VIII and fibrinogen more concentrated than ffp
7
Q
Mild hemophilia can be treated with
A
Desmopressin
8
Q
How does desmopressin work to tx hemophilia
A
Releases factor VIII from endothelial cells
9
Q
Best initial test to dx hemophilia
A
Mixing study-mix pt plasma with normal plasma which will correct the ptt
10
Q
Most accurate test for hemophilia
A
Obtain specific factor assays for factors VII, VIII, IX, XI and XII
11
Q
Most accurate dx test for vwd
A
Decreased agglutination seen on ristocetin cofactor assay
12
Q
In vwd, what will happen to bleeding time, pt, ptt, and platelet count
A
Increased bt
Increased ptt (possibly ) due to low factor viii levels
Normal pt and platelet counts
13
Q
Tx for vwd
A
Desmopressin
Ocps can be used for menorrhagia
14
Q
Aspirin ___ risk of bleeding in vwd pts
A
Increases
15
Q
Mech of factor V Leiden
A
Hypercoagulable state
Factor v is resistant to inactivation by protein C
16
Q
Hypercoagulable state with skin or tissue necrosis following warfarin admin. What am I?
A
Protein c or s deficiency
17
Q
Aps is often associated with what two conditions
A
Sle and rheumatoid arthritis
18
Q
What tests confirm aps
A
Lupus anticoagulant and anticardiolipin antibody
19
Q
Tx of dvt or pe in pts with hypercoagulable state
A
Heparin followed by 3-6 mos warfarin (longer if it’s a repeated event)
20
Q
Tx of hit
A
Discontinue heparin then start argatroban or lepirudin
21
Q
Dic is characterized by what two things
A
Thrombosis and hemorrhage
22
Q
Etiology of dic
A
Deposition of fibrin in small blood vessels leading to thrombosis and end organ damage; also depletion of clotting factors and platelets leading to bleeding diathesis
23
Q
Three common associations with dic
A
Obstetric complications, sepsis and pancreatitis
24
Q
In dic factor Viii is
A
Depressed
25
Three causes of microangiopathic hemolytic anemia
Hus
Ttp
Dic
26
Etiology of ttp
Deficiency of vwf cleaving enzyme adamts-13 resulting in large vwf multimers that aggregate platelets and create platelet microthrombi. Rbcs are thus fragmented.
27
Low plt count, microangiopathic hemolytic anemia, neuro changes (delirium, seizure, stroke), impaired renal function, fever. Think
Ttp
28
Severe increases in creatinine level are more suggestive of hus or ttp
Hus
29
Platelet transfusion in ttp is
Contraindicated
30
Tx for ttp
Plasma exchange
31
Etiology of itp
IgG antibodies formed against platelets
32
In itp, bone marrow production of platelets is __ and there are __ megakaryocytes in the marrow
Up
| Increased
33
Differential of thrombocytopenia
Hit shoc
```
Hit or hus
Itp
Ttp or treatment (meds)
Splenomegaly
Hereditary (wiskott Aldrich)
Other (malignancy)
Chemo
```
34
Tx of itp if plt count >30,000
None
35
Tx of itp if plt count <30,000
Corticosteroids or ivig
36
Thrombocytopenia, Increassd creatinine and schistocytes acutely in a school aged kid, think
Hus
37
Causes of microcytic anemia
Tails
```
Thalassemia
Anemia of chronic dz
Iron def
Lead poisoning
Sideroblastic anemia
```
38
Is tibc high or low in anemia of chronic disease? How about ferritin?
Low and high
39
Is tibc low or high in iron def anemia? How about ferritin?
Tibc high
| Ferritin low
40
Etiology of anemia of chronic disease
Body hides iron in form of ferritin to limit bacterial proliferation
41
How does sideroblastic anemia present
Low hemoglobin, high serum iron, basophilic stippling (in lead poisoning) and ringed sideroblasts
42
Hypersegmented neutrophils are a characteristic finding of
Megaloblastic anemia
43
Vit b12 def has __ mma and __ homocysteine; folate def has __ mma and __ homocysteine
High and high; normal and high
44
Hereditary spherocytosis is due to a deficiency in
Spectrin or ankyrin
45
Tx of spherocytosis
Splenectomy
46
Why can sickle pts have polyuria or nocturia
Due to sickling happening in inner medulla Of kidneys
47
Etiology of aplastic anemia
Failure of blood cell production due to destruction of bone marrow cells
48
Cafe au lait spots, short stature, radial/thumb hypoplasia/aplasia. What am I?
Fanconi anemia
49
Tx of aplastic anemia
Blood transfusion and stem cell transplantation
50
How does hydroxyurea work
It stimulates production of fetal hemoglobin
51
Polycythemia Vera is due to
Clinal proliferation of a pluripotent marrow stem cell due to a jak2 mutation
52
Epo in pcv
Normal
53
Tx of pcv
Hydroxyurea and ifn
54
Telltale sign of porphyria
Pink urine
55
What happens to reflexes in porphyria
Areflexia
56
5 ps of acute intermittent porphyria
Painful abdomen, port wine colored urine, polyneuropathy, psych disturbances, precipitated by drugs (cyp450 inducers, alcohol, starvation)
57
Auer rod think
AML
58
Most common childhood malignancy
ALL
59
AML on peripheral smear
Large myeloblasts with round or kidney shaped nuclei
60
Smudge cells are characteristic of
CLL
61
Philadelphia chromosome t(9,22) is associated with
CML
62
Which leukemia tends to present at age <13
ALL
63
Which leukemia tends to present at age 13-40
AML
64
Which leukemia tends to present at age 40-60
CML
65
Which leukemia tends to present at age >60
CLL
66
What is a leukomoid reaction
Acute inflammatory response to infection with increased neutrophils and a left shift
67
In cml lap is ___ and in leukomoid reaction lap is __
Low
| High
68
Cll shows ___cytosis, cml shows ____cytosis
Lymphocytosis (elevation of nk, t or B cells)
Granulocytosis
69
Acute promyelocytic leukemia (apl) a subtype of aml can be treated with
All-trans-retinoic acid
70
Tx of cml
Imantinib (gleevec)
71
What is more common non-Hodgkin or Hodgkin lymphoma
NHL
72
Most nhl cases are _ cell in origin
B
73
Tx of nhl may be complicated by ___ syndrome, which causes what electrolyte abnormalities
Tumor lysis syndrome in which rapid cell death releases intracellular contents and leads to hyperkalemia, hyperphosphotemia, hyperurecemia And hypocalcemia
74
Fever, wt loss and night sweats are the _ sx of
B; Hodgkin lymphoma
75
Crab for mm
Hypercalcemia
Renal involvement
Anemia
Bone lytic lesions/back pain
76
Hypercalcemia sx
```
Renal stones
Bone and abdo pain
Confusion
Polyuria
Weakness
Nausea
```
77
Protein:albumin gap is often __ in multiple myeloma
Elevated
78
Tx of mm in pts <70? >70?
Below 70: bone marrow transplant
Above: melphalan and prednisone
79
What are dutcher bodies? What do you see them in?
They are pas+ igm deposits around the nucleus seen in waldenstrom macroglobulinemia
80
Do pts with mm often have renal dysfunction
Yes
81
Define neutropenia
Anc<1500
82
Tx of mgus
None But see regularly to prevent progression to mm
83
Define eosinophilia
Absolute eosinophilic count>350
84
Pts with hemolytic anemia have high ___ bilirubin
Unconjugated
85
In adult pt with direct hyperbili and high alk phos, what should you do first
Abdo us
86
Elevated c peptide levels and proinsulin levels are seen in pts with ___ tumors
Beta cell
87
Multiple myeloma is a infiltration of the ____ leading to ineffective ___ production
Bone marrow
| Antibody
88
What is angiodysplasia? What are associated conditions?
Painless gi bleeding with dilated submucosal veins and av malformations
Associated with renal dz, vwd, aortic stenosis
89
B thalassemia is a ___opathy
Hemoglobinopathy
90
With pts who have a dvt/pe but can’t be anticoagulated what do you do?
Inferior vena cava filter
91
Can you get steatorrhea, ftt and vitamin deficiencies in cystic fibrosis
Yes
| Can see bruising
92
What are the two kinds of acute leukemia’s
AML and all
93
Etiology of wiskott Aldrich syndrome
Impaired cytoskeleton changes in leukocytes, platelets
94
Eczema, microthrombocytopenia and recurrent infections in a toddler/baby, think
Wiskott Aldrich
95
Abscesses due to fungi or cat positive bacteria is the characteristic features of what immunology dz
Chronic granulomatous dz
96
Etiology of Chronic granulomatous dz
Inability of phagocytes to produce hydrogen peroxide in their lysosomes
97
__ of donor blood can prevent febrile nonhemolytic reaction and reduce risk of __ and ___
Leukoreduction
| Hla alloimmunization and cmv transmission
98
Reticulocytes are __ in aplastic crisis and ___ in splenic sequestration
Decreased
| Increased
99
In a pt with scd, an acute drop in hemoglobin and a low retic count without splenomegaly is consistent with
Aplastic crisis
100
Which causes pancytopenia, aplastic anemia or aplastic crisis
Anemia
101
Most common complication in a person with sickle cell trait
Renal issues specifically painless hematuria or hyposthenuria (inability to concentrate urine)
102
Are low molecular weight heparin and rivaroxaban recommended in pts with esrd
No because they are metabolized in the kidney
103
Is unfractionated heparin contraindicated in pts with esrd
No
104
Pica is a behavior that sometimes accompanied
Iron deficiency anemia
105
What long term meds should you take to prevent stent thrombosis
Aspirin and platelet blocker (clopidogrel)
106
Strongest indicator of stent thrombosis in first twelve months after placement
Premature discontinuation of antiplatelet therapy
107
Peripheral blood smear in autoimmune hemolytic anemia may show
Spherocytes without central pallor
108
Why do you get arterial and venous thrombosis with hit?
Hit antibodies activate platelets resulting in platelet aggregation
109
What causes warfarin-induced skin necrosis
Rapid decline in protein c levels
110
Scc of the mucosa of head and neck is common in pp with a sig hx of
Alcohol and tobacco use
111
Scc positive lymph node in a person with a sig hx of alcohol and tobacco use-what initial test should you do?
Triple endoscopy-esophagoscopy, bronchoscopy, laryngoscopy
Aka panendoscopy
112
If a cervical lymph node in a woman shows metastatic adenocarcinoma what cancer should you consider
Breast
113
Treatment of mild hypercalcemia in setting of metastatic cancer to the bone
Bisphosphonates
| Radiation therapy can be used for severe pain
114
You are thinking multiple myeloma. What should you get?
Spep
115
Spherocytosis occurs due to defect in
Ankyrin gene
116
Coombs rest in hereditary spherocytosis is
Negative
117
LAb findings in hereditary spherocytosis
Increased mean corpuscular hemoglobin concentration, neg Coombs, increased osmotic fragility and abnormal eosin-5-maleimide binding test
118
In hereditary spherocytosis you have __ mean corpuscular volume and __ mean corpuscular hemoglobin concentration
Low
| High
119
Tx of hit
Stop all heparin products, start a direct thrombin inhibitor (argatroban) or fondaparinux
120
Iron and ferritin levels in thalassemia
High
121
Tibc in thalassemia
Low
122
First finding in peripheral smear of iron def anemia
Anisocytosis (rbcs of unequal size) which causes increased red blood cell distribution width
123
Do you see hypochromia in peripheral smear in iron def anemia
Yes
124
Abnormal lymph node is bigger than
2cm
125
Etiology of factor v Leiden
Ad point mutation in gene for factor v that makes it unable to respond to activated protein c
126
Most common cause of liver mass
Metastatic diseAse
127
Hepatic angiosarcoma presents in what demographic
Old men who have been exposed to toxins
128
Hepatic adenomas present in what demographic?
Young women
129
Hepatic adenomas May cause ___ and are associated with ___ use
Ruq
| Ocp
130
Hepatocellular carcinoma typically emerges from ___ liver
Chronically inflamed liver
131
You find rectal cancer. What to do next?
Colonoscopy to the cecum
132
In splenic sequestration crisis reticulocyte count in __ and platelet count is __
Up
| Down
133
Peripheral blood smear in folate or cobalamin deficiency shows
Late rbcs with hypersegmented neutrophils
134
Methylmalonic acid in cobalamin def is __ and in folate def is ___
High
| Normal
135
Deficiencies in cobalamin and folate will cause ___ homocysteine levels
High
136
What age range besides Childhood do craniopharyngiomas present?
Age 55-66
137
Most significant environmental rf for pancreatic cancer
Smoking
138
Most common kind of pancreatic cancer
Adenocarcinoma
139
Lab findings in pancreatic carcinoma
High serum bili and alk phos plus mild anemia
140
Multiple liver lesions on ct. where is the cancer?
Likely metastatic diseAse, most commonly from Colon. Do a colonoscopy
141
Red cell distribution width in:
Iron def
Alpha thalassemia
Beta thalassemia
Iron def-high
| Thalassemias- normal
142
Red blood cell count in:
Iron def anemia
Alpha thalassemia
Beta thalassemia
Low in iron def
| Normal in thalassemias
143
Peripheral smear in alpha and beta thalassemia
Target cells
144
Thalassemias response to iron supplementation
No improvement
145
Massive painless hematuria in scd withoht other sx is auspicious for
Papillary necrosis
146
Two common complications of hereditary spherocytosis
Pigment gallstones and aplastic crisis
147
Splenectomy can cause a dramatic __ in platelets
Rise
148
Two common complications of hereditary spherocytosis
Pigment gallstones and aplastic crisis
149
Splenectomy can cause a dramatic __ in platelets
Rise
150
People without a spleen have what kind of bodies in their rbcs
Howell jolly bodies
151
In seminomas, bhcg is __ and afp is ___
High
| Normal
152
First line tx for chemotherapy induced nausea
Serotonin 5ht receptor antagonists (eg ondansetron)
153
Role of haptoglobin
Binds to free hemoglobin and promotes its excretion
154
Tibc in anemia of Chronic disease is high or low?
Low
155
High homocysteine levels can be normalized by admin of what two things
Pyridoxine b6 and folate
156
Three causes of malignancy in young men
Testicular cancer
Lymphoma
Leukemia
157
What kind of contraception should you use in pts with breast cancer
NOT hormone containing contraception
Use for example copper iud
