Myeloproliferative neoplasms (crash cards)

Question 1

Myeloproliferative neoplasms:

Low EPO
Normal SaO2
High RBC#
High WBC#
High Platelet #
Increased plasma volume
Increased MCV

Answer 1

Polycythemia Vera (primary)

A JAK2 mutation that leads to the production of too many RBCs

Signs:
- Aquagenic pruritis
- Erythromelalgia
- Thrombotic episodes

Question 2

Myeloproliferative neoplasms:

Normal EPO
Normal SaO2
Normal MCV
Low Plasma volume

Answer 2

Relative Polycythemia

Caused by dehydration or burns

Question 3

Myeloproliferative neoplasms:

High EPO
High MCV
Normal Plasma volume
Low SaO2

Answer 3

Secondary appropriate polycythemia

Caused by:
- Lung disease
- Congenital heart disease (Right-left shunt)
- High altitude
- Smoking

Question 4

Myeloproliferative neoplasms:

Normal Plasma volume
Normal SaO2
High MCV
High EPO

Answer 4

Secondary Inappropriate Polycythemia

Caused by
- Exogenous EPO (blood doping)
or
- Malignancy (RCC, HCC)

Question 5

Myeloproliferative neoplasms:

AV Malformations
Recurrent epistaxis
Telangiectasias (blanching lesions)
Gi bleeding
Hematuria

Answer 5

Hereditary Hemorrhagic Telangiectasia (Osler-Weber-Rendu)

AUTO DOM mutations in either ENG (Endoglin) or ALK1 which both modulate TGF-B signaling leading to uncontrolled bleeding

Question 6

Shock:

High SVR (afterload)
Low PCWP (preload)
Low CO
Cold + clammy skin

Answer 6

Hypovolemic Shock

Caused by:
- Hemorrhages
- Dehydration
- Burns

Question 7

Shock:

High/Low PCWP (preload)
High SVR (afterload)
Very Low CO
Cold + clammy skin

Answer 7

Cardiogenic shock

Caused by:
- Acute MI
- Valve dysfunction
- Arrythmia

Question 8

Shock:

High/Low PCWP
High SVR (afterload)
Very Low CO
Cold + clammy skin

Answer 8

Obstructive shock

Caused by
- Cardiac tamponade
- Pulmonary embolism
- Tension pneumothorax

Question 9

Shock:

Warm skin
Low PCWP (preload)
Very Low SVR (afterload)
High CO

Answer 9

Distributive shock

Caused by:
- Sepsis
- Anaphylaxis
- CNS injury

Question 10

Shock:

Dry skin
Low PCWP (preload)
Very Low SVR (afterload)
Low CO

Answer 10

Distributive shock

Caused by:
- Sepsis
- Anaphylaxis
- CNS injury

Question 11

Heart:

Low CO
Low QRS
High HR

Answer 11

Cardiac Tamponade

Heart is compressed by fluid (blood & effusions in the pericardial sac)

Signs:
- Pulsus paradox
- Becks triad (Hypotension, Distended Jugular vein, Distant heart sounds)
- Electrican alternans

Question 12

Heart:

ST Elevation
Pathological Q waves
Full thickness of myocardial wall involved
Transmural infarcts

Answer 12

Myocardial infarction

Usually from a ruptured coronary artery atherosclerotic plaque causing acute thrombosis with elevated CKMB & Troponins

Question 13

MI:

Coagulative necrosis
Delineated Myocardium
No nuclei

Answer 13

0-24Hr Mi caused by ventricular arrythmia, Heart failure, & Cardiogenic shock

Question 14

MI:

Heavy neutrophilic infiltrates

Answer 14

24-48Hrs

Question 15

MI:

Macrophages with granulation
&
Angiogenesis

Answer 15

3-5 Days

Question 16

MI:

Some normal myocardium with type 1collagen
&
Macrophage-granulation

Answer 16

1-2 week MI

Question 17

MI:

Low Cellularity
High collagen deposition
Higher risk of balloon aneurysm
Complication is Dressler syndrome

Answer 17

3-4 week MI

Question 18

Heart:

Abnormally fast conduction from the atria to the ventricle (bypasses the AV node)
&
Shortened PR interval
Wide QRS
Delta waves
Supraventricular tachycardia

Answer 18

Wolf-Parkinson White syndrome

Question 19

Wolf-Parkinson White syndrome

Answer 19

Heart:

Abnormally fast conduction from the atria to the ventricle (bypasses the AV node)
&
Shortened PR interval
Wide QRS
Delta waves
Supraventricular tachycardia

Question 20

ECG:

Absent P waves

Answer 20

A fibrillation

Question 21

ECG:

Saw tooth patterns

Answer 21

Atrial flutter

Question 22

ECG:

No discernable rhythm

Answer 22

Ventricular fibrillation

Question 23

Heart failure:

High EDV
Low Ejection fraction
Low Contractility
Poor perfusion

Complications:
- Ischemia
- Dilated cardiomyopathy

Answer 23

Systolic dysfunction

Signs:
- Congestion
- Dyspnea
- Orthopnea
- Fatigue
- Heart sounds
- JVD
- Pitting edema

Question 24

Heart failure:

Normal Ejection fraction
Normal EDV
Low Compliance
High EDP

Complications:
- Myocardial hypertrophy

Answer 24

Diastolic dysfunction

Signs:
- Congestion
- Dyspnea
- Orthopnea
- Fatigue
- Heart sounds
- JVD
- Pitting edema

Question 25

Heart failure: - Pulmonary edema with Hemosiderin laden-macrophages - Orthopnea - Paroxysmal nocturnal dyspnea

Answer 25

Left-sided heart failure

Question 26

Heart failure: - Hepatomegaly with more central venous pressure - Nutmeg liver - Peripheral edema - JVD

Answer 26

Right-sided Heart failure

Question 27

Bleeding disorders: - Hinge pain (arthralgias) - Stomach pain - Palpable purpura on butt/legs - Fever with sudden onset - Arthritis - Hematuria

Answer 27

Henoch-Schönlein purpura (Immunoglobin A vasculitis) A common systemic vasculitis that follows a URI. IgA's are deposited in tissues (skin, gut, renal, & joints)

Question 28

Endothelial injury Turbulent blood flow Hypercoagulability

Answer 28

Virchow's triad

Question 29

Locally invasive (doesn't metastasize) pearly nodule with telangiectasia & rolled borders, non-healing ulcers, & palisading nuclei

Answer 29

Basal cell carcinoma

Question 30

- A chronic non-healing ulcers of the face, lower lip & ears - Locally invasive that can metastasize with keratin pearls

Answer 30

Squamous cell carcinoma

Question 31

- Follows the administration of post fractioned heparin (5-14 days post admin) - Antibodies against heparin complexes & platelet 4 factor on platelets & platelet 4 factor like proteins & heparin like molecules on endothelial cells

Answer 31

Heparin-Induced Thrombocytopenia Platelets activate & aggregate (a prothrombotic state) even with heparin because the low platelet count

Question 32

- Recurrent abortion - Recurrent thrombosis - Cardiac valve vegetations - Thrombocytopenia - False positive syphilis test - Recurrent DVT

Answer 32

Antiphospholipid Antibody Syndrome Usually in SLE Ab's target B2-glycoprotein I (B2GP1) on plasma membranes & endothelial cells

Question 33

Anemia: Short stature Cafe-au-lait spots Absent thumbs/radii High tumor risk Leukemia Aplastic anemia

Answer 33

Fanconi anemia AUTO REC, DNA repair deficiency causing bone marrow failure

Question 34

Anemia: Mutated SPECTRIN causing elliptocytes

Answer 34

Hereditary elliptocytosis

Question 35

Anemia: Deficient intrinsic factor

Answer 35

Pernicious anemia Autoimmune destruction of parietal cells leading to B12 deficiency