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202 Cards in this Set
- Front
- Back
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What are some of the causes for normocytic, normochromic anemia?
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Chronic Disease
Hypothyroidism Renal Failure |
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Male pt. has anemia what is the most common cause and what shoud you do?
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GI blood loss--
Do a colonoscoopy |
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In iron deficiency what is the levels of TIBC and ferritin?
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Increased TIBC
Low Ferritin |
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In anemia of chronic disease what is the level of TIBC and ferritin?
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TIBC will be low
Normal or Increased Ferritin |
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What is the most sensitive indicator of iron def?
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Ferritin
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50 y/oman with c/o weakness, exertional SOB, denies CP, BP 130/70, pulse is 100, pallor is present, soft systolic murmur is present, clear lungs, no edema, What is the next best step?
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CBC
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70 y/o male found to have Hb=10; MCV=70, retic index=2, iron is low, TIBC is high, what is the next best step?
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colonoscopy---why? old man with iron deficiency anemia
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Once CBC suggests microcytic anemia, what is the next best step?
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Iron studies
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If iron studies are normal, what is the next best step in a microcytic anemia?
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Hb electrophoresis---why? to R/o thalasemmia
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If iron studies, and Hb electrophoresis study are normal in an microcytic anemia patient; what do you suspect?
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Alpha thalasemmia trait
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A 20 y/o female comes with microcytic anemia, what is your next best thing to do?
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Give iron supplements orally
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You give a young female with microcytic anemia that was given iron supplement and on f/u the iron was normalized. What should you do now?
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continue iron supplement to build up the storage
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18y/o female was started on iron for iron defic. anemia, which test should be ordered after 2 weeks of starting therapy to see if the pt. is respoinding to it?
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Retic count b/c it starts increasing and responding to it in one week.
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You are dealing with a non-compliant pt. and you want to see if the pt. is taking iron...what will you check?
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Retic ct.
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A pt. is started on iron supplement with c/o ab pain, constipation...what should you do.
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tell the pt. this is a common side effect
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If a pt. is taking iron and develops severe abd. cramps, what can you do?
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Switch to ferrous gluconate instead of sulfate b/c it has low elemental iron
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Mother of a young child 1-2 years of age, with easy fatiguability, looks pale, investigation suggests iron def. anemia...what is the most important thing to know in the history? what will be the recommendation?
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What is the dietary regimen of the baby
Recommend: Decrease whole milk, increase whole foods, and give iron supplement |
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What decreases iron absorption?
What should you recommend? |
Calcium and antacid
Recommend: Take 2 hours before calcium or 4 hours after |
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What increases absorption of iron?
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Vit C
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In iron def. pt. can develop a craving for a specific food like clay, ice chips what is the disorder?
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PICA
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Where can you get target cell anemia?
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Thalassemia
Sickle cell SC disease Liver d/o |
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Central density surrounded by the pallor is suggestive of what?
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Target cell
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Basophillic Stippling is seen in what?
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Thalassemia
alcoholic abuse Lead poisoning |
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Where can you see hair on end appearance in skull what do you suspect?
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B-thalassemia major
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What are some causes of sideroblastic anemia/
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Lead poisoning, chronic alcohol abuse
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What is treatment of Sideroblastic anemia?
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Pyrioxine
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When you see foot or wrist drop what should you think of ?
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Lead poisoning
Lyme's disease PAN |
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What is the treatment if the lead level is 25-70?
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Succimer--DMSA oral
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What is the treatment if the lead level is >70?
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EDTA +BAL (Dimercaprol)
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What should you also supplement while trying to chelate lead?
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iron, calcium, mg, zn and multivitamin wiht iron, and take 2 -4 cups of mild.
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Can you get changes in a child with a lead level less than 10?
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YES
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How is BAL (dimercapreol) and EDTA administered?
How is DMSA (Succimer) administered? |
BAL--IM
EDTA--IV DMSA--ORAL |
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Do you do chelation therapy for lead level of 10-24?
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NO
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What is the battery of stuff you should order to monitor or give to a Lead poisioning pt?
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Give: Calcium carbonate
Ferrous sulfate Multivitamin Monitor: CBC BMP LFT Refer to public health dept. |
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What is the most common cause of Vit B12 def?
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Pernicious anemia
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Why do antacids, H2 blockers, and PPI's cause VitB12 defic?
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B/c it removes the acidic nature needed for Intrinsic Factor to bind to Vit B12
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What should you do if in early deficiency the VitB12 is normal and you suspect that it's still VitB12 what is the next step to order?
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Methylmalonic Acid level or
Homocysteine level |
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What can you look at to see if a pt. has folic acid defic?
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homocysteine level is ELEVATed
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How do you find out what the cause of VitB12 defic?
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Schilling test
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What is the exception to doing a Schilling test to determine VitB12 cause?
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If the question refers to some autoimmune deficiency
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What test would you order if you see autoimmune disorder and VitB12 def?
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intrinsic factor antibody to r/o pernicious anemia
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What is the treatment of Vit B12 def. d/t Diphyllobothrium latum?
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Praziquantel
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What is the definitive dx of Diphyllobothrium LATUM?
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Egg in stool had lid like opening
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Alcohol abuser with h/o sz. d/o taking phenytoin with weakness, hct of 25, mcv 110, retic index 0.5?
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Folic acid defic
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What are the drugs that cause folic acid deficiency?
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MTX, Phenytoin, Bactrim, Sulfasalazine
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In Hemolytic anemia what will be for the REtic Index? the LDH? the Indirect BR? and Haptoglobin
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Retic Index is HIGH
LDH is HIGH Indirect BR is HIGH Haptoglobin is LOW |
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What do you think when you see anemia and icterus?
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hemolytic anemia
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What do you think when you see a child, with icterus and splenomegaly?
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Hereditary Spherocytosis
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In Hereditary spherocytosis what will the retic level be? the MCHC?
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Retic level is HIGH
MCHC is high |
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Are Hereditary spherocytes small or big? Do they have central pallor?
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Microcytic, and no they lose the central pallor
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If you spherocytes in the peripheral smear, what are the two things you think of ?
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Hereditary spherocytosis or
Autoimmune hemolytic anemia |
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Why do you do Coomb's test?
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To differentiate Heridary Spherocytosis and AI Hemolytic Anemia
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What does it mean if there is Coomb's Test is positive?
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Coombs + = Autoimmune Hemolytic anemia
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What does it mean if there is Coomb's Test is negative?
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coombs neg= hereditary spherocytosis
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How do you confirm Hereditary Spherocytosis?
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Osmotic Fragility test
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If you diagnose a pt with Hereditary Spherocytosis what is the next best step?
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start folic acid
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What is teh definitive treatment for Hered. Spherocytosis?
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Splenectomy
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60 y/o pt. with Lymphoma came with weakness, exertional SOB, on exam pallor is present, Hb is low, retic is high, LDH is high, Spherocytes are present, Coomb + for IgG...what is most likely diagnosis?
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Warm Ab induced Hemolytic anemia
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What are some of the causes of cold antibody Hemolytic anemia?
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Waldrenstorms,
Mycoplasma Infectious mono |
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Pt. 30y/o with sx of anemia and pt. on methydopa for HTN, recently developed UTI, and started on Ampicillin, on examination pallor is present, Hb is low, retic is high, LDH is increased, and spherocytes present, Coombs +IgG and indirect Coombs + only when drug is added; most likely cause of anemia....is it preg, methyl-dopa, or PCN
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PCN
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What do you think of when you see fragmented RBC in the peripheral smear?
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Microangiopathic Hemolytic anemia
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What are other ways to call fragmented RBC?
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schistocytes, helmet cells
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What causes microangiopathic hemolytic anemia?
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TTP, HUS, DIC, Prosthetic heart valve, HELLP
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What is the difference btwn TTP and HUS?
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TTP have neuro problems that wax and wane.
HUS does NOT have neuro problems |
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What is the treatment of TTP?
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Plasmaphoresis
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What will the PT and PTT levels be in TTP
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PT and PTT will be normal
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Pt. with anemia, thrombocytopenia, peripheral smear has schistocyte present with PT and PTT normal and change in mental status, most likely diagnosis?
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TTP
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Pt. with anemia, thrombocytopenia, peripheral smear has schistocyte present with increased BUN/Creat and recent h/o of diarrhea, most likely diagnosis?
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HUS
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Pt. with prosthetic valve and anemia with schistocyte present, most likely diagnosis?
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Prostheic valve induced microangiopathic anemia
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Pt. with DM admitted with pneumonia got intubated, running high fever,
Developed anemia with thrombocytopenia, schistocytes present and increased PT and PTT |
DIC
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In G6PD do the new cells or older cells get hemolyzed?
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the older cells...and it's a self-limited disease
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What will be seen on peripheral smear for G6PD?
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bite cells aka Hinge bodies
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American black male came with c/o weakness since he was started on dapsone, with increased LDH, increased BR, low Hb, and you suspect G6PD, but the level is normal; what do you do next?
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Repeat G6PD level in a few weeks
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Pt. is Sickle cell and continues to have recurrent crisis...what shoudl you do?
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Give hydroxyurea
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If a recurrent sickle cell pt. is being treated with hydroxyurea, why was that medication started?
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Increase the HbF levels
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Pt. has sickle cell and b-thal is this a good thing or not?
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GOOD---b/c they will have more HbF
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Pt. with pain in the bones, and chronic hemolysis, BR level is high, pt. has anemia and icterus, with pallor , what are you thinking?.
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Sickle cell
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If you have a sickle cell and osteomylitis what is the most likely organism?
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Salmonella
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If a pt. develops osteomyolitis after a punture wound what is most likely organism?
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Pseudomonas
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What does it imply if you have HbS < 40%?
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think of Sickle cell trait
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What is the only cure for Sickle cell?
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HLA-matched sibling donor hematopoietic stem cell transplant for kids <16 y/o
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What drug should be avoided for pain in sickle cell anemia?
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Merperidine
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What is the side effect of meperidine? What type of pt. should this drug be avoided in?
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SZ.
Sz pt. and Renal failure pt. |
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What prophylactic medication should be given to sickle cell pt. less than 5 y/o
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PCN
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If a sickle cell pt. is on PCN prophylaxis and is less than 5 y/o and has a temp <40 then what should you do?
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send blood culture and start
Rocephin IV/IM and oveserve in the ER then do a follow-up |
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If a sickle cell pt. is not on PCN prophylaxis and appears toxic with temp >40 what shoudl you do?
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Blood cultures, Rocephin IV and then Hospitalize the patient
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What the the best prognostic factor of sickle cell?
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HbF levels
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Sickle cell pt. with aplastic crisis is most likely due to what?
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Viral or Folic acid defic
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Sickle cell pt. has hemolytic chronic hemolysis occassionally develop hemolytic crisis secondary to what?
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splenic sequestration or
G6PD |
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Pt. with sickle cell came with SOB, weakness, Hb=5, what next test should you order?
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Retic count
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What does a retic count tell you when sorting out a hemolytic crisis vs. sickle cell
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Retic ct. is LOW in sickle
Retic ct. is HIGH in hemolytic crisis |
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Sickle cell patient came with weakness, Hb is 5, retic index is 0.5 with h/o of febrile illness with rash 1 week ago most likely cause?
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Aplastic crisis d/t parvo infection
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Sickle cell pt. with weakness, Hb=5 and spleen is palpable, retic index is 6%, most likely diagnosis? What is treatment?
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Splenic Sequestration syndrome
Treatment is splenectomy |
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What is the treatment of a sickle cell pt. comes to you with a stroke?
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Exchange transfusion
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How do you prevent a sickle cell pt. from having a recurrent stroke?
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Give Hydroxyurea
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What is the treatment of priaprism?
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Aspiration of of blood from the corpus cavernosum and subsequent irrigation with saline or adrenergic agonist
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Sickle cell pt. came with cough, chest pain, worse with inspiration and lying down. Pt. has fever, infiltrate in the lung, and started on IVF and Abx. After 24 hours there is no improvement and pt. still had severe chest pain most likely diagnosis?
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Acute chest pain syndrome
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How do you treat acute chest pain syndrome?
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exchange transfusion
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Sickle cell pt. with fever, cough, and URI, what should you do?
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Admit
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A new born at 38 weeks was born and during delivery had bloody amniotic test, and pt. developed transient tachypnea, what test do you want to do?
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APT test on neonatal stool
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What does the APT test help distinguish when you see bloody amniotic fluid?
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Maternal adult blood and neonatal GI blood
HbA vs HbF |
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What should you think of when you see an old male, with pancytopenia and splenomegaly?
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Hairy cell leukemia
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What shoud you suspect if you see hypgranular neutrophil nuetrophils(2 lobes) and weakness with pancytopenia?
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Myelodysplastic syndrome
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What will the bone marrow aspiration be in Hairy cell leukemia?
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DRY
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What will the bone marrow aspiration be in Myelodysplastic?
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Hypercellular
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If you see defic. CD55 and CD59 what disease shoudl you think of?
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PNH
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What should you think of if you see pt. c/o dark urine only when they wake up in the morning?
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Paroxysmal Nocturnal HB
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What should you think of if you see pancytopenia and hemolytic anemia.?
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PNH
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What is the screening test for PNH?
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Sucrose lysis test or Ham test
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How do you confirm for PNH?
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Flow cytometry--shows deficient CD59
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What is the treatment for PNH?
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Prednisone and Androgen (Danazol or Danocrine)
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Wharare complications to know with PNH?
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AML, aplastic anemia, or myelodysplasia
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What is the most common cause of death in PNH?
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thrombosis
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if a pt. gets a splenectomy for ITP for how long should you give PCN prophylaxis and until what age?
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for 3-5 years or until 18 y/o
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Pt. in the hospital was started on heparin, next day platelet count went from 150,000 to 110,00, what ws the ost likely diagnosis/...what shoudl you do?
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heparin induced
Do nothing, it is a self-limited disease |
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Pt. was in the hospital for Acute coronary syndrome, and recieved the cocktail, and pt. goes home and returns after 1 week, and c/o swelling of the right lower extermity. Suggest DVT with low platelets is likely...what is the cause?
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HIT type II---b/c they become hypercoaguable problem
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How do you diagnose HIT type II?
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14C seroonin release assay
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What treatment should be done if HIT II is detected?
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Stop all forms of heparin
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What is the difference btwn unfractionated heparin and LMW Heparin as far as action?
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Unfractionated--inactivates thrombin and Factor Xa
LMWH--INActivates Xa |
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20 y.o male came with c/o bleeding significantly after a dental extration; platelet count is normal, PT normal, PTT is increased, bleeding time is increased, what is most likely diagnosis
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vWD...bleeding time is high
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What is the most common inherited bleeding d/o?
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vWF disease
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What is the intial treatment for vWF disease? What if that doesn't work?
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Desmopressin
For severe problem--Factor VIII concentrate |
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A double lumen dialysis pt. found oozing of blood from the exit site, PTT is normal, platelets are normal, bleeding time is elevated; what is most likely diagnosis? What is the treatment?
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abnormal platelet function d/t uremia
Treatment: Desmopressin |
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Pt. with hemolytic anemia needs a blood transfusion, mathing blood is not available? What to do?
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Transfuse O negative blood
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Pt. with anemia getting blood transfusion, develps fever, chills, tachycardia, hypotension, chest pain, flank pain what is most likely diagnosis? /what shoudl be done?
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ABO incompatibility
Stop the transfusion and start IV Hydration to prevent ATN |
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4 hours after a blood transfusion, pt. develops fever, chills, what is the most likely diagnoisis?
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Leukoagglutinin reaction this is not secondary hemolysis. This usually occurs in previously transfused pts. and developed antigen sensitization
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What is the treatment of Leukoagglutin reaction?
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Acetominophen and diphenhydramine
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8 days after transfusion, pt. came with mild fever and findings of hemolysis, what is the most likely diagnosis? What is the treatment?
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Delayed hemolytic transfused reaction d/t minor incompatitibility
Treatment is none, it is self-limiting |
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Pt. with h/o of blood transfusion, needs to be transfused again, what to do?
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Use leukocyte depletion filter
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Blood transfusion causes hives or bronchospasm what is it caused by? and what shoudl you do?
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cause by plasma proteins
Treat with washed RBC |
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Anaphylaxis after blood transfusion; what to do?
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transfuse with A negative blood
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Pt. with lymphoma needs blood transfusion, what to do?
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Transfuse with Gamma radiated blood
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After blood transfusion, pt. develops SOB, bilateral crackles, CXR shows diffuse infiltrate, Pt. got intubated, after 24 hours, he feels better, and gets extubated, most likely diagnosis?
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Donor anti-HLA antibody causing agglutination
Transfusion related lung injury (TRALI) |
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18 y/o black male, pt. is Asx with really low WBC.
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repeat CBC in 3-4 weeks; if WBC are still low called benign neutropenia with no risk of infection
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18 y/o black male, pt. is Asx with really low WBC; and then WBC increases in a few weeks, what shoudl you do?
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repeat CBC in 3-4 weeks
Cyclic Neutropenia |
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Pt. comes with bleeding and platelets are normal, PTT is prolonged, PT is normal, bleeding time normal, what is next step? On repeat test after that step, the PTT became normal
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Mixing study with normal plasma
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Pt. comes with bleeding and platelets are normal, PTT is prolonged, PT is normal, bleeding time normal, and then after mixing study the PTT became normal...what does that mean? What if pt. is Ashkenzi Jew? What if pt is not a JEW? w/hat is teh best treatment?
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Factor defic, but which one?
Jew = Factor IX, Not a jew, order Factor 8 or Factor 9 assay Treat with FFP |
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Pt. comes with bleeding and platelets are normal, PTT is prolonged, PT is normal, bleeding time normal, but after mixing study the PTT did not become normal, then what is the problem?
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Antibody is present
Order factor 8 or Factor 9 antibody level |
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Pt. came after dental extraction came with severe bleeding and platelets are normal; bleeding time is normal; PT and PTT is normal, what is the most likely cause?
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Factor XIII (13) defic.
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How do you confirm a pt. has Factor 13 defic?
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clot solubility test in 5M urea
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Pt. with Vit K defic what are 2 causes you should think of?
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1. Dietary defic
2. You took a broad spectrum antibiotic |
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Post op pt. not eating and getting broad spectrum Abx, is bleeding easily, found to have increased PT and PTT, what should you do?
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Supplement Vit K
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90 y/o male came with c/o multiple ecchymosis over dorsal surface of the hand, platelets are normal, bleeding time normal, PT PTT are both normal, what is the most likely diagnosis?
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Benign Senile purpura
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What type of bleeding is seen in Hemophila?
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Deep; look for bleeding in the joints
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20 y/o male with pain and swelling of RLE, with no signif. PMH, all the routine work is normal, what is the most likely cuase? What is the next thing to order?
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DVT
U/S |
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If there is a young active pt. who develops a DVT, what should you think is the cause?
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Factor V Leiden
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young pt. taking OCP with pain and swelling of RLE, in the lab the platelets are normal, PT, and PTT ARE normal, what is the next test to order? What is the next thing you would like to do before confirmation?
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Doppler U/S
Start IV heparin then send them for the U/S |
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What is the most common finding of EKG in PE?
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EKG will show tachycardia
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If you suspect a PE, what should you do before V/Q scan or CT?
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Start Heparin
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If you do a V/Q scan is indeterminate for a PE, then what should you do?
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Doppler of both legs
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What is the gold standard to diagnose PE?
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pulmonary angiogram
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What is the treatment for PE?
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IV heparin followed by coumadin for 6 months
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What is the level to keep the INR when pt. is being treated for PE?
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INR btwn 2 and 3
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What must you check before you start Heparin/
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Check PT/PTT
Check stool for occult blood |
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When cna you start warfarin when a pt. is on heparin?
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When INR is 1.5
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If a pt. is on warfarin and INR <5 what shoudl you do?
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Devrease the dose and skip one dose
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If the INR if 5-9 and on warfarin, what shoudl you do?
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Sikp one or two doses and take oral LOW dose Vit K
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If INR is >9 and pt. on warfarin, what should you do?
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Hold warfarin, take ORAL
HIGH dose vit K, restart warfarin once level is trherapeutic at low dose. |
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If you have bleeding with increased INR?
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Hold warfarin
Vit K I.V. FFP |
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If a pt. with SLE comes with hypercoaguable state, what must you consider?
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Anti-phospholipid ab
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What lab lmust you order if you see a pt. with DVT and SLE?
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Anti-phospholipid
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What value will be elevated in a pt. with anti-phospholipid antibody?
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elevated PTT
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What is the most common finding for EKG with PE?
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sinus tachy
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What must check before you order heparin?
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Baseline PT/PTT
FOBT |
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What do you do for treatment of chroniv venous insuff?
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1. Leg elevation
2. graduated compression stocking |
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What should yo think of HA, dizziness, increased cell, and itching after a warm bath, and splenomegaly?
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Think of Polycythemia Vera
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What do you do to confirm polycythemia vera? How do you treat?
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Confirm with red cell mass increased
Treat with Phlebotomy to keep Hct < 45% |
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COPD pt with Hct > 60% and WBC and platelets are normal. EPO is increased, oxygen sat 98%, what is the most likely cause of the polycythemia...a)COPD, b.)Polycythemia Vera; c)Hemochromatosis, d) RCC
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Its not COPD, b/c the pt. is not Hypoxic.
it's not polycythemia vera, b/c all 3 cell lines will be high and EPO will be low. Not Hemochromatosis b/c iron levels aren't going up. The answer is Renal cell CA |
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pt. with Hct >60%; what physical exam finding will suggest polycythemia vera?
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splenomegaly
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Athletic pt.on testosterone with Hct >60%, what is the most likely cause of polycythemia?
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androgen stimulated polycythemia
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Polycythemia pt. should be told they are at increased risk of what/
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stroke
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polycythemia pt. came with pain and redness of hands and feet, what is the most likely diagnosis? What is the treatment?
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Erythromyalgia
Treat with Aspirin and phlebotomy |
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pt. with Hb 8 and MCV of 70; platelet count of 800,000, most likely diagnosis?
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Reactive thrombocytosis secondary to iron def. anemia
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8 y.o boy c/o of abdominal pain for 2 day with multiple raidsed red lesions on lower extremity and buttock; which don't blanch with pressure. he has recent h/o of URI, in the lab Hb--normal, platelet--normal, U/A--5-6 RBC, what is most likely diagnosis.
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Henoch-Schonlein Purpura
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Is there any treatment for Henoch Purpura?
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NO
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5 y/o boy with recurrent epitaxis and gum bleeding. he is lethargic and irritable. He has heptosplenomegaly. Hb is low, platelets are low. He has bone pain and recurrent infection.
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ALL
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What will bone marrow have in ALL patients?
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hypercellular with blast cells
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How do you differentiate btwn ALL and AML
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Auer rods--AML
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Which has the worst prognosis with Philadelphia ?
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ALL
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What can you treat all acute AML?
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Cytarabine and Daunorubicin
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What helps differentiate AML and CML?
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AML--will have blast cells and LAP is high
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What do you find on physical exam of CML?
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sternal tenderness
and splenomegaly |
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Does CML with or without Philadelphia chromosome have a better prog?
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CML with Philadelphia chromosome
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15 y/o boy came with swelling in the neck w/ no fever, cough, or SOB, and pt. has cervical LAD, most likely diagnosis? What is the next step?
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Hodgkins lymphoma
Do a LN Bx |
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What do you see on microscopy for hodgkins vs. NHL?
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Reed-Sternberg cells (large binucleate cells)
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What is the most common Hodgkins type?
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Nodular Sclerosing type
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What do you think of when you starry sky appearance?
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Burkitt's
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What drug can cause reactive lymphadenopathy?
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Phenytoin
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70 y/o male came with c/o of LBP; he has anemia, increased BUN/Cr and increased Ca, what is the next best step? What are you trying to R/o
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Protein electrophoresis
To r/o Multiple myeloma |
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How do you diagnose MM?
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SPEP or UPEP
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What should you suspect if you have a disparity btwn the dipstick and 24 urine protein?
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Multiple myeloma
dipstick looks for albumin 24 urine--will show Bence jone proteins |
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What is the next best test to do once you see a monoclonal spike?
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Bone marrow biopsy
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65 y/o with DM, RF, anemia, found to have monoclonal IgG spike with 2g/dl, what is the next best step?
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Bone marrow
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65 y/o with DM, RF, anemia, found to have monoclonal IgG spike with 2g/dl, bone marrow was performed and it was normal, what is the most likely diagnosis?
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Monoclonal gammapathy of Unknown significance (MGUS)
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65 y/o male came with c/o dizziness, visual disturbance, and found to have anemia, protein electrophoresis shows monoclonal immunoglobulin M-spike and no renal failure, renal fxn is normal...bone Xray is normal, most likely diagnosis? What is the treatment?
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Waldrenstorm's macroglobinemia---(Immunoglobulin M-spike)--d/t increased viscosisty.
Treat with immed. Plasmaphoresis |
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What is the side effects of Adriamycin?
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Cardiomyopathy
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What is the side effects of Busulphan
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Pulmonary fibrosis
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What is the side effects of Cyclophosphamide
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Hemmhagic cystitis
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What is the side effects of MTX?
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liver toxicity
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What is the side effects of Vincristine?
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Peripheral neuropathy
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What sholuld be given to a pt recieving cyclphosphamide in order to prevent hmmg cystitis?
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MESNA
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What drug should be given to a pt. recieving chemo to prevent emesis?
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Ondansetron and Granisetron
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