Ou Im Absolutes Set 6

Front 1

pt presents with palpitations, fatigue, HA, glossitis, flat thin nails.
1.What is the most likely dx?

Back 1

iron deficiency anemia

Front 2

in FE def what will the TIBC ans % st and ferritin levels be?

Back 2

TIBC is high
% sat is low
Ferritin is low

Front 3

what is the most specific test of iron deficiency?

Back 3

a low MCV.
only seen with Fe def and thalassemia

Front 4

what is the best test to distinguish between Fe def and anemia of chronic disease?

Back 4

ferritin

Front 5

what is the bone marrow storage form of iron?

Back 5

ferritin

Front 6

what does transferrin do?

Back 6

made in liver and transports iron to bone marrow to be used so it is high in Fe def.

Front 7

what is the mcc of massive lower GI bleeding in adults?

Back 7

diverticulosis

Front 8

what does elevated CEA tell you

Back 8

coon cancer with mets to liver?

Front 9

what are the 3 risks for polyps becoming cancer?

Back 9

villous component
2 cm or greater
sessile

Front 10

pt has a megaloblastic anemia with hypersegmented neutraphils. what is the cause?

Back 10

B12/folate def

Front 11

what anemia is associated with LDH, high indirect bili, and pancytopenia

Back 11

B12/folate

Front 12

pt presents with neuropathy, ataxia, +rhomberg, dementia and anemia. what is the cause?

Back 12

B12 deficiency

Front 13

what are causes of b12 def?

Back 13

1. pernicious anemia with anti-pareital factor and intrinsic factor antibodies
2. partial gastrectomy with removal of ileum.
3. metformin

Front 14

treatment of pernicious anemia? what are the side effects of treatment?

Back 14

Im or SubQ B12
side effects are thrombocytosis so have to give ASA also and hypokalemia because the new RBCs are using it up.

Front 15

what are causes of folate deficiency ?
how to dx it?

Back 15

causes: alcohol, pregnancy, jejunal probs like crohns and celiac, drugs (sulfasalzine, mtx, 5-FU), hemolysis

dx with RBC folate levels not serum folate

Front 16

Sickle cell complications and causes:
1. What causes aplastic crisis?
2. what causes chest syndrome?
3. what causes sickle cell crisis?
4. what causes osteomyelitis typically?

Back 16

1. parvovirus B19 with retic count of zero
2. plugging of vasculature and requiring transfusion
3. infection/dehydration/hypoxia
4. salmonella

Front 17

Sickle cell
1. how it is passed?
2. what are typical WBC, Hgb, platelets?
3. what is treatment?
4. when do you see howell jolly bodies?

Back 17

1. autosomal recessive, have Hgb S
2. elevated WBC, low Hgb, elevated platelets
3. hydroxyurea to increase fetal hgb
4. spleen autoinfarction

Front 18

pt has low MCV with no anemia an target cells. Dx?

Back 18

thalassemia

Front 19

Who has alpha thal?
Who has beta thal minor?

Back 19

Alpha is asians (will hav normal hgb electrophoresis)
beta is greeks, Mediterranean

Front 20

Hemolytic anemia. What is the dx?
1. high MCHC, abnormal osmotic fragility test 2/2 loss of spectrin on RBC membrane?
2. +Ham's test, and budd chiari is associated with it. only hemolytic anemia without iron overload seen
3. heinz bodies?

Back 20

1. spherocytosis
2. paroxysmal noctural hemoglobinuria
3. G6PD def

Front 21

in hemolytic anemia...
1. what is haptoglobin level?
2. bilirubin level?
3. LDH?
4. retic count?

Back 21

1. low
2. high indirect
3. high
4. high

Front 22

what causes ITP?
what is treatment in adults?

Back 22

caused by IgG antibody against platelets
tx with steroids, IVIG, splenectomy, rituximab, thromboplastin receptor agonists

Front 23

what vaccines should be given before splenectomy?

Back 23

pneumovax
H flu
meningococcal

Front 24

What is the typical presentation of TTP?

Back 24

FAT RN
fever, anemia, thrombocytopenia, renal failure, neurologic changes

see LOW ADAMTS13 levels

Front 25

what is tx of TTP?

Back 25

plasmaphereis or rituximab

Front 26

in a mixing study if pt labs normalize what is the cause?

Back 26

factor def

if not its an inhibitor

Front 27

what is the most common bleeding disorder?

Back 27

von willebrands

Front 28

1. how is VWF def passed?
2. what is bleeding time, PTT, and PT/INR?
3. how to treat it?

Back 28

1. autosomal dominant
2. prolonged bleeding time and PTT but NORMAL PT/INR
3. treat with DDVAP if mild but cryoprecipitate or factor 8 concentrate if more severe.

Front 29

what meds can cause platelet problems?

Back 29

ASA, NSAIDS, H-2 blockers and heparin

Front 30

what is the treatment for HIT?

Back 30

argotroban or hirudin before test results of HIT antibodies come back. Can also used fondaparinux now

Front 31

in DIC-- what will fibrinogen, platelets, d-dimer and Pt/PTT be?

Back 31

low fibrinogen
low platelets
prolonged PtPTT
and high d dimer.

tx with FFP and underlying condition

Front 32

if pt has abnormal ristocetin assay what should you think of on test?

Back 32

von willebrands

Front 33

how long after stopping heparin after an acute thrombotic event should Antithrombin level be checked and why?

Back 33

2 week drug free can check AT because heparin lowers AT, and lowers protein C and S

Front 34

which clotting disorder has the highest thrombotic risk?

Back 34

antithrombin deficiency -very rare

Front 35

if pt has true protein C or S deficiency what are they are risk for when starting coumadin?

Back 35

coumadin skin necrosis

Front 36

What two disorders will cause BOTH arterial and venous clots?

Back 36

anticardiolipin antibody syndrome and hyperhomocysteinemia

Front 37

pt presets after multiple second trimester spontaneous abortions. what labs should be checked?
What is the treatment?

Back 37

check anti-cardiolipin antibodies and lupus anticoagulant for anticardiolipin antibody syndrome

treat with coumadin lifelong with INR 2-2.5 for first and 3-3.5 for recurrent or arterial clot

Front 38

what is mechanism for factor V leiden and how to dx?

Back 38

activated prot C resistance and dx by PCR which picks up the mutation

Front 39

how to dx prothrombin gene mutation G20210A?

Back 39

DNA test

Front 40

what is treatment of hyperhomocysteinemia?

Back 40

folate 1mg/day

Front 41

how do OCPs increase risk of VTW 4 fold?

Back 41

lowers prot c/s and icnreases fibrinogen and prothrombin

Front 42

pt presents complaining of puritis and hives after a warm shower.
dx?
labs?
tx?
complications?

Back 42

1. polycythemia vera
2. high LAP score, low EPO levels, high RBC mass, pancytosis
3. phlebotomy weekly until hct below 45 and ASA, and myelosupressives later.
4. splenic infarct and AML risk

Front 43

what diseases have the JAK 2 mutation?
how can you treat it?

Back 43

polycythemia vera, myelofibrosis, essential thrombocytopenia

tx with ruxolitinib

Front 44

what is alloimmunuztion?

Back 44

development of antibodies to foreign RBC antigens- ocurs in 10% of transfusions

Front 45

how much should one unit of blood increase hgb?

Back 45

one hgb

Front 46

pt presents in respiratory failure 6 hours after a blood transfusion. what is the dx and cause?

Back 46

TRALI due to donor WBC antibodies binding iwth host WBC and sequestering in the lung

Front 47

pt presents with leukocytosis, night sweats, splenomegaly, philedelphia crhomosome and LOW LAP score (key!)
what is dx and tx?

Back 47

CML and treat with imatinib (first line) or hydroxyurea+interferon

Front 48

how does imatinib work?

Back 48

protein tyrosine kinase inhibitor of Bcr-Abl tyrosine kinase gene

Front 49

elderly person presents with elevated lymphocytes and smudge cells.
what is dx and when should treatment be started and what is tx?

Back 49

CLL usually b cell.
treat at stage 3 or 4 when anemia or thrombocytopenia with fludarabine.

Front 50

auer rods and 30% blasts in BM think what kind of cancer

Back 50

AML

Front 51

what is treatment for M3 (promyelocytic) AML?

Back 51

all-trans retinoic acid (ATRA)

Front 52

what will uric acid level, K, phos, and ca levels be in tumor lysis syndrome and what is treatment?

Back 52

high uric acid, K, phos,
low ca
give allopurinol plus hydration

Front 53

what cancer to think of in kids with bone pain?

Back 53

ALL- 85% cure rate
CALLA CD 10+ has best prognosis

Front 54

pt presents with pancytopenia, massive splenomegaly and TARTRATE- RESISTANT ACID PHOSPHATASE. what is dx? and tx?

Back 54

hairy cell leukemia (an indolent b cell non-hodgkins lymphoma

treat with interferon

Front 55

what are side effects of interferon?

Back 55

depression and thyroid problems?

Front 56

what is a leukemoid rxn and what can cause it?

Back 56

persisten WBC of 30-50,000 that are mature and not clonally derived due to C. diff colitis, alcoholic hepatitis, and TB

Front 57

pt presents with fevers, night sweats, weight loss, painful nodes with etoh ingestion and reed sternberg cells
Dx?
tx?

Back 57

nodular sclerosing hodgkins lymphoma

tx stage 3 adn 4 with chemo ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) and XRT to involved nodes

Front 58

is hodgkins or non hodgkins better survival?

Back 58

hodgkins

Front 59

older pt presents with bone pain and high LDH and hx of crohns (or other autoimmune disease). what is dx and tx?

Back 59

non-hodgkins most liley burkitts (t 8:14)
tx with XRT and rituximab

Front 60

black pt presents with renal failure, bone pain, high calcium, thrombocytopenia.
1. what is dx?
2. what are the classic findings in urine
3. what type of cells are involved?
4. what type of antibodies are involved?
5. what test should be ordered?
6. what is treatment

Back 60

1. Multiple myeloma
2. bence-jones protiens in urine
3. b cell malignancy
4. IgG usually invovled (if IgM it is Waldenstroms)
5. order a skeletal survey not a bone scan
6. melphalan and prednisone

Front 61

what does POEMS syndrome stand for?

Back 61

polyneuropathy that is usually distal and symmetric and papilledema
organomegaly
endocrinopathy or edema
m-protien (myeloma variant)
skin hyperpigmentation

it is a plasma cell disorder

Front 62

50 year old african american male presents with low back pain and no hx of trauma. what should be ruled out?

Back 62

prostate cancer

mets are blastic with high alk phos

Front 63

what drug can decrease prostate cancer risk by 40% and how does it work?

Back 63

finasteride- a 5a reductase inhibitor that inhibits conversion of testosterone to dihydrotestosterone and shrinks prostate tissue

Front 64

what is the number 1 cause of Ca death in men and women

Back 64

lung cancer

Front 65

what are lung cancer risk factors?

Back 65

smoking, passive smoke, asbestos, arsenic, radon, genetics

Front 66

where is squamous cell and small cell (oats) and adenocarcinoma seen in the lung?

Back 66

squamous and small cell are central and adeno is peripheral

Front 67

what is seen on CXR in adenocarcinoma?

Back 67

cannonball mass

Front 68

ectopic hormones : name the cancer is comes from
1. ADH
2. ACTH
3. erythropoietin
4. hcG
5 calcitonin
6. AFP
7. CEA
8. pth related peptide
9. serotonin

Back 68

1. small cell
2. small cell
3. squamous cell lung cancer, renal cell CA, hepatomas
4. choriocarcinoma
5. medullary cancer of thyroid
6. hepatoma
7. colon cancer with liver mets
8. squamous of lung, breast and renal
9. carcinoid

Front 69

pt presents with myasthenia like illness and is diagnose by EMG with eaton-lambert syndrome. what should you look for next?

Back 69

small cell lung cancer or lymphoma

Front 70

if pt has DVT associated with a malignancy what should anticoagulation be?

Back 70

LMWH - not warfarin!

Front 71

if pt presents with acanthosis nigricans and is not found to have DM what else should you look for?

Back 71

gastric cancer

Front 72

who is most at risk for breast cancer?

Back 72

nulliparous women, late first pregnancy, and family history

Front 73

if pt has breast cancer with HER2 protein expression what should be the treatment?

Back 73

herceptin

Front 74

what is most common finding on bx of breast cancer?

Back 74

infiltrating ductal cell cancer

Front 75

staging breast cancer.
stage 1?
stage 2?
stage 3?
stage 4?

Back 75

1. <2cm
2. 2-5cm
3. >5cm
4. chest wall, skin, mets

Front 76

breast cancer treatment
1. if positive lymph nodes what should be treatment?
2. if ER/PR what should be treatment?
3. what are risks of the treatment for question 2?

Back 76

1. chemo
2. tamoxifen
3. risks are endometrial cancer, cataracts, and DVTs

Front 77

pt has colon polyps and osteomas and soft tissue tumors. what is syndrome?

Back 77

gardners syndrome

Front 78

what cancer is strep bovis endocarditis associated with?

Back 78

colon cancer

Front 79

for pain in cancer pt on exam what should you give?

Back 79

acetaminophen first then long acting narcs sooner than later