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1

What can cause a left shift of the hgb-O2 dissociation curve?

Metabolic alkalosis
Decreased body temp
Increased Hgb F

2

What can cause a right shift of the Hgb-O2 dissociation curve?

Metabolic acidosis
Increased body temp
High altitude
Exercise

3

A patient presents with AMS, cherry lips, and hypoxia despite normal pulse ox reading. What is going on?

CO poisoning

4

What causes microcytic anemias?

Iron deficiency
Lead poisoning
Chronic disease
Sideroblastic
Thalassemias

5

What causes normocytic anemia?

Hemolytic
Chronic disease
Hypovolemia

6

What causes macrocytic anemia?

Folate deficiency
B12 deficiency
Liver disease
Booze

7

What does agglutination with direct Coombs test indicate?

Presence of IgG and complement on RBC membranes (warm and cold agglutinin disease)

8

What does agglutination with indirect Coombs test indicate?

Anti-RBC antibodies in serum

9

Patient develops fatigue, pallor, and icterus after being treated with penicillin. What happened? What would be seen on a smear?

Drug induced hemolytic anemia (Direct Coombs +)

Burr cells and shistocytes

10

Patient has a microcytic anemia with the following labs: low iron, normal/high ferritin, low TIBC, normal iron:TIBC (>18). What is this?

Anemia of chronic disease

11

Patient has a microcytic anemia with the following labs: normal/high iron, normal ferritin, normal TIBC, and stippled, microcytic RBCs on smear. What is this?

Lead poisoning

(Stippled means dotted)

12

Patient has a microcytic anemia with the following labs: low iron, low ferritin, high TIBC, and low iron:TIBC (

Iron deficiency anemia

13

Patient has a microcytic anemia with the following labs: high iron, high ferritin, low TIBC and ringed sideroblasts. What is this? What can cause this? What can it progress to?

Sideroblastic anemia (cells of different sizes may be seen on smear)

Congenital: X-linked most common
Reversible: alcohol is most common; B6 deficiency (isoniazid); Cu deficiency; Pb poisoning

Acute leukemia

14

What causes target cells? Basophilic stippling?

Thalassemia alpha --> microcytic target cells

Thalassemia beta --> variably sized target cells; basophilic stippling

15

RECAP: how can iron deficiency anemia and ACD be differentiated?

TIBC...high in Fe deficiency and low in ACD

16

Besides anemia symptoms, what else is seen with lead poisoning?

Gingival lead lines
Peripheral neuropathy

17

Which one, folate or B12 deficiency, causes a sore tongue?

Folate deficiency

18

Which one, folate or B12 deficiency, causes neurologic symptoms?

B12 deficiency

symmetric paresthesias, ataxia, possible psychosis

19

What kind of anemias can phenytoin cause?

Folate deficiency (macro)
Aplastic anemia

20

A patient comes in with persistent infections, poor clotting, pallor, systolic murmur, and increased pulse pressure. What could be going on?

Aplastic anemia

Worse in old people

Caused by parvovirusB19 in sickle cell patients

21

A smear shows target cells, sickle cells, and nucleated RBCs. What does the person have?

Sickle cell anemia...only deoxygenated cells would be sickled

22

How does hydroxyurea help with sickle cell disease?

Increases HgB F

23

An African patient with a history of recurrent infections comes in with bone pain. What could be going on?

Salmonella osteomyelitis...sickle cell patients are more susceptible to it

24

What can cause neutropenia w/o immune deficiency (agranulocytosis)?

Viral infections: hepatitis, HIV, EBV
Drugs: clozapine, antithyroids, sulfasalzine, TMP-SMX
Chemo
Aplastic anemia

25

Asthma, allergic rhinitis, and anaphylaxis are examples of? which is mediated by?

Type I hypersensitivity reaction

IgE antibodies attached to mast cells --> mast cell and histamine release

26

Drug-induced or immune hemolytic anemia are examples of? which is mediated by?

Type II hypersensitivity reaction

IgM and IgG antibodies --> complement cascade

27

Arthus reaction, serum sickness, and glomerulonephritis are examples of? which is mediated by?

Type III hypersensitivity reaction

IgM and IgG immune complexes --> deposit in tissue --> complement cascade

28

Allergic contact dermatitis, transplant rejection, and PPD testing are examples of? which is mediated by?

Type IV hypersensitivity reaction

T cells and macrophages

29

Warfarin is tracked with INR (normalized PT). How is heparin tracked? LMWH?

Heparin is monitored with PTT

LMWH does not need to be monitored

30

What are the genetics of vWF disease? What labs are seen with it?

vWF disease is autosomal dominant

Increased PTT and bleeding time; decreased factor VIII antigen, decreased vWF antigen, decreased ristocetin cofactor activity

31

How is vWF disease treated?

minor bleed --> desmopressin (increases factor VIII)
Major bleed/surgery --> vWF and factor VIII concentrate
Avoid ASA

32

Patient comes in because of uncontrolled bleeding. Testing shows increased PTT, normal PT, and normal bleeding time. What could be going on?

Hemophilia A (VIII) or B (IX)

33

How do thienopyridines work?

Clopidogrel and ticlopidine work by blocking ADP receptors

34

Besides increased risk of hemorrhage, what else can be caused by GP IIb/IIIa inhibitors?

nausea, back pain, hypotension

35

How does heparin work?

Binds to antithrombin to increase activity...decreasing clot formation

36

How does LMWH work?

Binds to factor Xa to prevent clot formation

37

How do direct throbbing inhibitors work?

Lepirudin and argatroban are highly selective inhibitors of thrombin to suppress activity of factors V, IX, and XIII and clot formation

38

What causes Heparin-Induced Thrombocytopenia (HIT)? What is seen on labs? How is it treated?

Development of antiplatelet antibodies

Sudden >50% drop in platelets

Stop heparin
Start direct thrombin inhibitor (Lepirudin or argatroban)

39

A patient has a platelet count

Idiopathic Thrombocytopenic Purpura...autoimmune B-cell directed production of anti-platelet antibodies

Adults...steroids, delayed splenectomy, IVIG, plasmapheresis, or recombinant factor VIIa

40

E. coli O157:H7 can cause TTP-HUS. What is the path? What are the symptoms?

Diffuse platelet aggregation d/t autoantibodies against preventative enzyme

Hemolytic anemia
ARF
Thrombocytopenia
W/O severe bleeding
Neurologic sequela

41

How is HIV diagnosed?

Positive ELISA --> repeat ELISA also positive --> positive Western Blot

ELISA = sensitive
Western Blot = specific

42

What is a possible complication of polycythemia vera? How is PCV treated?

Leukemia

Serial phlebotomy
Antihistamines (for pruritus)
ASA (thrombus prophylaxis)
Hydroxyurea (bone marrow suppression)

43

In what disease do IgA and IgG produce an abnormal monoclonal protein (M protein) and Bence Jones proteins? What can be seen on x-rays?

Multiple Myeloma...poor prognosis

Punched out bone lesions on skull and long bones

44

Hodgkin Lymphoma originates in what kind of cells?

B cells

45

What is the most common Hodgkin lymphoma?

Nodular sclerosis (low grade)

46

A hodgkin lymphoma is found to have a lot of lymphocytes in it. Is that good or bad? Depleted of lymphocytes?

Lymphocyte rich is best prognosis

Lymphocyte depleted is worst prognosis

47

Lymph node biopsy shows 'owl-eyes' (Reed-Sternberg cells). What is this?

Hodgkin lymphoma

48

Is Hodgkin lymphoma generally fatal?

No, 80% cure rate...unless too far progressed

49

Non-Hodgkin Lymphoma originates in what kind of cells?

Lymphocytes (mostly B cells)
Natural killer cells

50

What is the most common NHL?

Diffuse large B cell

51

Which NHL is relate to EBV? What is seen on biopsy?

Burkitt lymphoma t[8;14]

Starry sky

52

Which type of NHL is of T cell origin?

Peripheral

53

Besides EBV, what are other risk factors for NHL?

HIV
Congenital immunodeficiencies
Rheumatic disease

54

An NHL shows cleaved cells. What kind is this?

Follicular small cell variant t[14;18]

55

Which NHL is basically the same as CLL?

Small lymphocytic

56

Is the prognosis as good for NHL as it is for HL?

NO...poor prognosis...palliative treatments

57

Who commonly gets ALL? what is the cell of origin?

White kids (2-5yo)

B-cell precursor is most common

58

What can be present in adult ALL? What is this usually found in?

Philadelphia chromosome (t[9;22])...carries poor prognosis

CML

59

A bone marrow biopsy shows blasts of MYELOid origin and staining with MYELOperoxidase. What is it? What would be seen on a blood smear? What is the prognosis

Acute MYELOgenous Leukemia (AML)

Large myeloblasts with notched nuclei and Auer rods

Poor...multiple remissions, but relapse is common

60

An older patient is in for a regular exam and CBC shows a really fuckin high WBC. What is a possible diagnosis? What is the cell of origin? What would be seen on smear?

This is possibly Chronic Lymphocytic Leukemia (CLL)

Which is a proliferation of mature B cells

Could see numerous small lymphocytes and smudge cells

61

What is the survival with CLL?

Some > 10 years
some less than 4

62

A middle aged patient with a history of radiation exposure is found to have a really freakin high WBC with high proportion of neutrophils. Cytogenic analysis shows t[9;22]. What is the likely disease? What is the progression?

Chronic Myeloid Leukemia

Doing fine for a while...start to have some fatigue, sweats, weight loss...gets worse (blast crisis) and bone pain...death

63

A middle aged guy comes in because he's lost some pep and has noticed a mass in his LUQ. A blood smear shows numerous lymphocytes with hair projections. What is this?

Hair cell leukemia...proliferation of B cells

64

A child comes in for an infection and is found to have pancytopenia. On exam, cafe-au-lait spots are found. What does this kid likely have? What else could be seen? What is the prognosis?

This is likely Fanconi Anemia

Could find a horseshoe kidney on imaging

Death in childhood d/t bone marrow failure or leukemia

65

A kid is found to have a microcytic anemia with decreased Hgb, Hct, and retic count, but increased erythropoietin. What could be going on?

Diamond-Blackfan anemia (pure RBC anemia)

66

Where do neuroblastomas present? What are risk factors? What is the prognosis?

Adrenal glands or sympathetic ganglia

Turner syndrome
Low maternal folate intake

Found 1yo...bad, metastasize to brain and bone

67

What is the most common soft tissue sarcoma in kids?

Rhabdomyosarcoma