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Flashcards in Uworld Heme/Onc Deck (43):
0

Patient with smoking history, hilar fullness, Mediastinal lymphadenopathy, hypertension, hypokalemia?

Cushing's from small cell lung cancer

1

Febrile neutropenia?

Temperature > 38
Absolute neutrophil count < 1500

2

Treatment for febrile neutropenic patient?

Monotherapy with antipseudomonal agent (cefepime, Meropenem, Bactrim)

3

Signs of polycythemia vera?

Increased blood pressure, Increased RBC mass, elevated platelet count

Peptic ulceration, gouty arthritis, splenomegaly, plethoric face

4

Fibrocystic disease – type of nodule? Draining yields?

Rubbery, firm, mobile and painful during menses. Clear fluid.

5

Signs of G6PD in smear? Drugs that provoke it?

Heinz bodies. Sulfa drugs, Antimalarial drugs, nitrofurantoin

6

Tumor lysis syndrome - expected effect on PO4, K, uric acid, Ca?

Hyperphosphatemia, hyperkalemia, hyperuricemia

hypocalcemia

7

Tumors that cause tumor lysis syndrome?

Burkitt's lymphoma and ALL

8

Treatment for HER2 positive cancer? Test needed before treatment?

Herceptin. EKG (can cause cardio toxicity in pts with systolic dysfunction)

9

Tx for sickle cell pt with stoke-like Sx?

Exchange transfusion (fibrinolytics don't help because stroke is caused by sickled cells, not thrombus)

10

Tx of mild, moderate and severe hyperCa?

Mild (<12): none

Moderate (12-14): none unless symptomatic

Severe (14+): saline with calcitonin (no loop diuretics unless CHF). Bisphosphonate for long term.

11

Anti-PPL - give what false positive? Coags? Platelet count? Tx?

False positive VDRL, prolonged PTT, and thrombocytopenia. Lovanox.

12

Macro vs micro vascular hemolysis?

Mechanical valves/stenosis vs vessel occlusion

16

Transferrin saturation?

Iron/TIBC

17

Drug to increase appetite in cancer patients?

Progesterone analogs (megesteol acetate)

18

3 basic symptoms of EBV?

Sore throat, fever, maculopapular rash

19

Mech of spleen in immune response?

Why is the immune system impaired after splenectomy?

1. Normally, antigens enter spleen and are phagocytosed by DC cells
2. DC cells present antigens to T helper cells, activating them
3. T-helper cells migrate to marginal zone of spleen and activate B-cells
4. B-cells activation increases germinal centers and antibody production that facilitate phagocytosis of pathogenic organisms

Therefore, no spleen = impaired phagocytosis

20

Warfarin leads to skin necrosis due to?

Protein C deficiency

21

Hairy cell leukemia: stain? Effect on bone marrow? Drug to treat?

Tartrate-resistant acid phosphatase (TRAP) stain

Bone marrow fibrosis (dry taps)

Cladribine (Purine analog)

22

Patient diagnosed with myasthenia gravis. Next test to order?

Chest CT scan to look for thymoma

23

Waldenström's versus multiple myeloma: immunoglobulin?

IgM spike vs IgA/IgG spike

24

Symptoms of Waldenström's that is not present in multiple myeloma?

Hyperviscosity syndromes – retinal vein engorgement

25

Patient with HNPCC should also be evaluated for what other cancer?

Endometrial cancer

26

Signs of lead poisoning?

1. Microcytic anemia
2. Neurologic abnormalities (difficulty concentrating, myalgias, peripheral neuropathy, extensor weakness)
3. Nephropathy

27

Patient with tumor secreting ADH – treatment?

1. Fluid restriction (<800 mL)
2. If still symptomatic/resistant use hypertonic saline

28

Signs of glucagonoma?

1. G.I. symptoms (diarrhea, abdominal pain)
2. Diabetes
3. Necrolytic migratory erythematous plaques
4. Anemia
5. Weight loss

29

Drugs that can impair folate absorption in the gut?

Phenytoin, pentobarbital, primidone

30

Vitamin deficiency that can cause a microcytic anemia? Mechanism? Common Scenario?

Pyridoxine deficiency causing sideroblastic anemia. Post Isoniazid therapy.

31

Anisocytosis vs poikilocytosis?

Cells of abnormal sizes vs shapes

32

Benign vs worrisome lymph nodes?

2 cm, firm and immobile

33

Senile purpura?

ecchymotic lesion in the elderly (usually dorsum of hands) due to connective tissue atrophy

34

Test to confirm CLL?

flow-cytometry

35

Complications of hereditary spherocytosis?

Splenomegaly, jaundice, gallstones

Red blood cells get trapped in fenestrations of spleen (Splenomegaly). Hemolysis leads to jaundice and calcium bilirubinate stones.

36

Not graft vs. host without?

Skin rash

37

Leukoreduction? Purpose?

Cell washing?

Depleting leukocytes in transfusions. Prevents febrile reactions caused by pt antibodies reacting with donor leukocyte; reduced CMV transmission

Removes IgA

38

Diseases with low leukocyte alkaline phosphatase?

1. CML
2. paroxysmal nocturnal hemoglobinuria
3. hypophosphtemia

39

Laboratory findings in Steroid abuse?

erythrocytosis
Heptatotoxicity
Dyslipidemia

40

Classic findings in CML?

Leukocytosis with low leukocyte alkaline phosphatase

41

Management based on CHADS2 score?

0 = no treatment
1 - anticoagulant therapy > aspirin
2+ - Oral anticoagulant therapy

42

MCHC (mean cell hemoglobin concentration) elevated in?

Spherocytosis

43

Patient receives blood and becomes:

1. febrile with chills. Self limited and resolves within 1 to 6 hours? Prevention?

2. Febrile with Flank pain and hemoglobinuria. Progresses to renal failure and DIC. Diagnosis? Tests?




1. Non-hemolytic reaction due to cytokines in transfused blood. Luekoreduction

2. Acute hemolytic reaction (unmatched blood). Positive Coombs test and free plasma hemoglobin.

44

Intravascular vs extravsacular hemolysis - haptoglobin?

Very low (lots of Hgb release) versus low-normal (cells phagocytized)



45

Coombs test in Autoimmune hemolytic anemia vs hereditary spherocytosis?

Positive vs negative

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