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35 Cards in this Set
- Front
- Back
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A teenage African American male presents to the ER with right hip pain and a hematocrit of 25%. What is the most likely diagnosis?
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Sickle cell disease causing osteonecrosis of the femoral head.
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What is the next step in the management of a patient with febrile neutropenia due to chemotherapy?
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Admit patient to hospital
Blood, urine culture CXR Broad spectrum IV antibiotics |
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What is the most common cause of anemia in elderly patients?
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Iron deficiency anemia
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What would you see on a blood smear of a patient with anemia due to lead poisoning?
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Microcytic hypochromic with basophillic stippling
Sideroblasts |
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What is the cause of anemia in an alcoholic patient with an elevated MCV?
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Folate deficiency
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What is the cause of anemia that develops after taking a sulfa drug?
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G6PD Deficiency
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What medication is used in the long-term management of sickle cell anemia?
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Hydroxyurea
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Compare the serum iron, ferritin, and transferrin levels in iron deficiency anemia to anemia of chronic disease.
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Serum Iron:
IDA: Decreased ACD: Decreased Ferritin: IDA: Decreased ACD: Normal or increased Transferrin: IDA: Increased ACD: Decreased |
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What lab markers suggest anemia due to hemolysis?
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Decreased Hb and Hct
MCV normal Increased reticulocytes Increased indirect bilirubin Decreased Haptoglobin LDH high |
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Identify which RBC disorders would have the following findings:
- Schistocytes - Acanthocyte (spur cell) - Bite cell - Basophilic stippling - Peripheral neuropathy + sideroblastic RBCs - Hypersegmented neutrophils - Heinz bodies (denatured Hb in RBC) |
Schistocytes
- DIC, hemolytic anemia, HUS, TTP Acanthocyte (spur cell) - Abetalipoprotienemia Bite cell - G6PD Deficiency Basophilic stippling - Lead poisoning, thalassemias, alcohol use Peripheral neuropathy + sideroblastic RBCs - Lead poisoning Hypersegmented neutrophils - B12, folate deficiency Heinz bodies (denatured Hb in RBC) - G6PD deficiency |
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Which vaccines are particularly important in children with sickle cell disease?
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Pneumococcus, Flu vaccine, H. influenza type B, HBV
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Other than vaccination, how is pneumococcal infection prevented in children with sickle cell disease?
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Penicillin prophylaxis until 5 years of age
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What complication occurs in 10% of patients with sideroblastic anemia?
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Acute leukemia
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What is the treatment for anaphylaxis?
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ABCs
Epinephrine (DOC) Intubation (if closed airway) Antihistamines Bronchodilators Recumbent positioning IV Hydration Vasopressors for severe hypotension |
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What is the treatment for the most common inherited bleeding disorder?
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Von Willebrand disease treatments
- Desmopressin (which increases vWF secretion) is first-line for acute bleeding - Cryoprecipitate or Factor VIII concentrations for severe or refractory bleeding - OCPs for menorrhagia - Avoid aspirin and other platelet inhibitors |
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What are the most common causes of DIC?
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Mnemonic: STOP Making new Thrombi
Sepsis, trauma, obstetric complications, pancreatitis Malignancy Transfusions |
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What are the criteria for the diagnosis of Systemic Inflammatory Response Syndrome (SIRS)?
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SIRS = at least 2 of the following
- Fever > 38C or hypothermia < 35C - Tachypnea (RR > 20 bpm or PaCO2 < 32 mmHg) - Tachycardia(HR > 90 bpm) - Leukocytosis (WBC > 12,000), Leukopenia (WBC < 4,000), or bandemia (> 10% bands) |
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What is the classic pentad for thrombotic thrombocytopenia purpura?
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Fever
Neurologic: Altered mental status, seizures Uremia Hemolytic anemia Thrombocytopenia |
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What is the most common mutation in white patients that predisposes to venous thrombosis?
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Factor V Leiden
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What is the mechanism of action of the following drugs?
- Streptokinase - Aspirin - Clopidigrel - Abciximab - Tirofiban - Ticlopidine - Enoxaparin - Eptifibatide |
Streptokinase
- Cleaves fibrin clots Aspirin - COX-inhibitor Clopidigrel - ADP receptor antagonist Abciximab - GP IIb/IIIa receptor antagonist Tirofiban - GP IIb/IIIa receptor antagonist Ticlopidine - ADP receptor antagonist Enoxaparin - Binds Factor Xa Eptifibatide - GP IIa/IIIb Inhibitor |
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What lab test is used to monitor warfarin? Heparin? LMWH?
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Warfarin: PT/INR
Heparin: PTT LMWH: Anti-factor Xa |
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What is the treatment for von Willebrand's disease?
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Desmopressin/DDAVP
Cryoprecipitate Factor VIII Women: OCPs Avoid aspirin |
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What lab changes (Platelet count, Bleeding time, PT, PTT) would you see in the following diseases?
- HUS or TTP - Hemophilia A or B - von Willebrand disease - DIC - Warfarin use - End stage liver disease - Aspirin use |
HUS or TTP
Low Plt, High BT, normal PT and PTT Hemophilia A or B Normal Plt, BT, and PT, High PTT von Willebrand disease Normal Plt and PT, High BT, High PTT DIC Low Plt, High BT, PT, PTT Warfarin use Normal Plt and BT, High PT and PTT End stage liver disease Low or normal Plt, High or normal BT, High PT and PTT Aspirin use Normal Plt, High BT, normal PT and PTT |
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What are the criteria for the diagnosis of SIRS?
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SIRS = at least 2 of the following
- Fever > 38C or hypothermia < 35C - Tachypnea (RR > 20 bpm or PaCO2 < 32 mmHg) - Tachycardia(HR > 90 bpm) - Leukocytosis (WBC > 12,000), Leukopenia (WBC < 4,000), or bandemia (>10% bands) |
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What is the most important medication in the treatment of anaphylaxis?
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Epinephrine
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What are the most common causes of DIC?
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STOP Making new Thrombi
Sepsis Trauma (extensive surgery) Obstetric complications Pancreatitis Malignancy Transfusions |
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What is the treatment for polycythemia vera?
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- Phlebotomy to keep hematocrit < 45% in men, <42% in women
- Add hydroxyurea if at high-risk for thrombosis (age > 70, prior thrombosis, platelets > 1,500,000, presence of cardio risk factors) - Aspirin daily to help prevent thrombosis (MI, CVA, PE, DVT) - If refractory pruritis or refractory erythrocytosis -> interferon alpha - If symptomatic hyperuricemia, give allopurinol |
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What type of leukemia matches the following description?
- Most common neoplasm in children (peak age 3-4 years) - Most common leukemia in adults (average age 50) - Philadelphia chromosome is almost always seen - Smudge cells on peripheral smear - Peripheral blasts are PAS+ and TdT+ - Peripheral blasts are PAS-, myeloperoxidase+ and have Auer rods - Pancytopenia in a Down syndrome patient |
Most common neoplasm in children (peak age 3-4 years)
- ALL Most common leukemia in adults (average age 50) - CLL Philadelphia chromosome is almost always seen - CML Smudge cells on peripheral smear - CLL Peripheral blasts are PAS+ and TdT+ - ALL Peripheral blasts are PAS-, myeloperoxidase+ and have Auer rods - AML Pancytopenia in a Down syndrome patient - ALL |
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What medication is associated with remission in 95% of patients with CML?
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Imatinib
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A 21 year old male patient presents with recent weight loss, pruritis, and night sweats. Physical exam reveals hepatosplenomegaly and a nontender cervical lymphadenopathy. What do you immediately suspect?
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Hodgkin's lymphoma
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Which blood cell pathology matches the following description?
- Associated with Epstein-Barr virus (in Africa) - Reed-sternberg cell, cervical lymphadenopathy, night sweats - Bence-Jones proteins, osteolytic lesions, high calcium - Translocation 14;18 - Most common lymphoma in the US - Translocation 8;14 |
Associated with Epstein-Barr virus (in Africa)
- Burkitt's lymphoma Reed-sternberg cell, cervical lymphadenopathy, night sweats - Hodgkin's lymphoma Bence-Jones proteins, osteolytic lesions, high calcium - Multiple myeloma Translocation 14;18 - Follicular lymphoma Most common lymphoma in the US - Diffuse large B cell (non-Hodgkin's) Translocation 8;14 - Burkitt's lymphoma |
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Which blood cell pathology matches the following description?
- Translocation 9;22 - Most common form of Hodgkin's lymphoma - "Starry-sky pattern" due to phagocytosis of apoptotic tumor cells - High hematocrit/hemoglobin, pruritis (especially after hot bath), burning pain in hands or feet - Blood smear (hair-like projections), splenomegaly |
Translocation 9;22
- CML Most common form of Hodgkin's lymphoma - Nodular sclerosis "Starry-sky pattern" due to phagocytosis of apoptotic tumor cells - Burkitt's lymphoma High hematocrit/hemoglobin, pruritis (especially after hot bath), burning pain in hands or feet - Polycythemia vera Blood smear (hair-like projections), splenomegaly - Hairy cell leukemia |
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Which antiretroviral or antiretroviral class matches the following statement?
- SE: lactic acidosis - SE: GI intolerance - SE: Pancreatitis - SE: Peripheral neuropathy - SE: Megaloblastic anemia |
SE: lactic acidosis
- NRTIs SE: GI intolerance - Protease inhibitors SE: Pancreatitis - Zalcitabine, Stavudine, Didanosine, Ritonavir SE: Peripheral neuropathy - Zalcitabine, Stavudine, Didanosine SE: Megaloblastic anemia - Zidovudine |
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Which antiretroviral or antiretroviral class matches the following statement?
- SE: Rash - SE: Hyperglycemia, DM, and lipid abnormalities - SE: Bone marrow suppression - Given to pregnant women with HIV - Regimen for occupational HIV exposures |
SE: Rash
- NNRTIs SE: Hyperglycemia, DM, and lipid abnormalities - Indinavir, Amprenavir SE: Bone marrow suppression - Zidovudine Given to pregnant women with HIV - HAART therapy, Zidovudine (for labor) Regimen for occupational HIV exposures - Zidovudine, Lamivudine |
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Regarding antibiotic prophylaxis in HIV patients, when, with what, and for what organisms?
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CD4 < 200
TMP-SMX, dapsone: PCP pneumonia, Toxoplasmosis CD4 <100 Erythromycin, Clarithromycin: MAC |
