Step Up: Heme/onc

Front 1

describe the direct coombs test and what it tests for

Back 1

pt blood is mixed with coombs reagent

agglutination is positive

this means RBCs are actively being attacked in the body and the coombs reagent revealed it

usually tests for anti-RBC antibodies (warm and cold reacting antibodies against RBCs.. warm IgG...cold IgM)

Front 2

describe the indirect coombs test and what it tests for

Back 2

pt SERUM is mixed with DONOR blood and added to coombs reagent

agglutination is positive

this means the pt has antibodies in the serum that will attack this donor's blood if added into pt's body

usually tests for Rh and blood typing

Front 3

what determines the severity of alpha or Beta- thalassemias?

Back 3

number of genes involved (4 for alpha, 2 beta)

Front 4

if you have a microcytic anemia and you have normal iron, ferritin, TIBC (transferrin)...what are the differentials and their points to distinguish them and lab values that may be helpful?

Back 4

lead poisoning- basophilic stippling on blood smear, lead level

thalassemia- target cells, Hgb elctrophoresis

Front 5

what do sickle cell patients want to avoid exposure to that will cause and aplastic crisis?

Back 5

parvo b19

Front 6

sickle cell pts are at risk for what conditions?

Back 6

autosplenectomy
stroke
osteomyelitis
multiple organ ischemia
acute chest syndromes- emboli, pneumonia
infection by encapsulated bacteria (strep pneumo, h.flu, n.meningitidis, klebsiella)

Front 7

presentation of sickle cell crisis

Back 7

priapism, deep bone pain, dactylitis, tachypnea, dyspnea

Front 8

what can cause sickle cell crisis?

Back 8

acidosis, hypoxia, stress, dehydration

Front 9

when is the earliest presentation of sickle cell dz?

Back 9

6 months when fetal Hgb is going away

Front 10

is a low hgb in a 3-6 mo old baby normal?

Back 10

yes bc fetal hgb is going away

Front 11

treatment of sickle cell crisis? management of sickle cell normally?

Back 11

hydration, O2, analgesics

hydroxyurea, pneumococcal vaccine, prophylactic pennicillin in kids to protect against asplenic infxns

Front 12

what is sideroblastic anemia and expected labs to aid in Dx? tx?

Back 12

anemia d/t a failure of heme synthesis.

leads to increased serum iron levels b/c it cannot be utilized in heme production. ringed sideroblasts present (blue dots surrounding rbcs) microcytic anemia

tx- B6 to normalize Hgb conc.; erythropoetin supplementation, phlebotomy/transfusion to stabilize iron

Front 13

aplastic anemia caused by what?

Back 13

bone marrow failure (pancytopenia)

Front 14

presentation of aplastic anemia?

Back 14

repeated infections, clotting failure (platelets) easy bleeding and bruising, PANCYTOPENIA

Front 15

lab values showing a decrease in Hgb, Hct, RBCs, WBCs, decreased platelets requires what next step?

Back 15

bone marrow bx

(aplastic anemia shows hypocellularity)

Front 16

what causes a right shift in the oxygen dissociation curve?

Back 16

acidosis, increased temp, exercise, increased altitude,

Front 17

pt suspected of carbon monoxide poisoning tx?

Back 17

100% O2

Front 18

types of hemolytic anemia?

key presenting buzz word on blood smear?

Back 18

drugs
immune- warm/cold anti-RBC antibodies
mechanical- heart valve
hereditary spherocytosis- defect in rbc membrane
G6PD def- G6PD repairs oxidative damage

schistocytes!!!!

Front 19

what tests will differentiate the types of hemolytic anemias?
a)drugs
b) immune-
c) mechanical
d) hereditary spherocytosis
e) G6PD def

Back 19

a) H&P (quinidines, L-dopa)
b) coombs test (DIRECT...warm and cold Ab's)
c) H&P
d) spherocytes and hepatosplenomegaly
e) Heinz bodies, bite cells, low G6PD

Front 20

iron deficiency in elderly is considered what until proven

Back 20

colon CA

Front 21

pluripotent stem cells develop into myeloid and lymphoid cells...lymphoid cells develop into what?

Back 21

B-cell> plasma cells> Ab's

T-Cell > CD4, CD8

Front 22

iron studies in iron def anemia are as follows?
a) serum Fe
b) Ferritin
c) TIBC (Transferrin)

cause? presentation? labs?

Back 22

a) low
b) low
c) high

low in diet, blood loss, poor absorption
fatigue, cheilitis, pale, PICA, tachypnea, tachycardia
microcytic anemia

Front 23

iron studies in chronic disease anemia are as follows?
a) serum Fe
b) Ferritin
c) TIBC (Transferrin)

why these studies and what diseases are present?

Back 23

a) low
b) normal high
c) low

iron is trapped in macrophages, decreased erythropoetin. iron in serum is low, but iron is in body just not available for blood use (up ferritin low tibc)

DM, neoplasia, kidney disease

Front 24

iron studies in sideroblastic anemia are as follows?
a) serum Fe
b) Ferritin
c) TIBC (Transferrin)

Back 24

high
high
low

Front 25

why does anemia of any type present with tachycardia and tachypnea?

Back 25

decrease oxygen delivery to tissues and decreased percieved cardiac output

Front 26

presentation of lead poisoning? labs?

Back 26

child
**peripheral neuropathy- motor in extremities
**gingival lead lines

labs: microcytic anemia, blood smear has **basophilic stippling and increased lead levels

Front 27

a CBC showing increased MCV and decreased Hgb is what?
etiology?
blood smear?

Back 27

megaloblastic anemia

folate/B12 deficiency

big RBCs and HYPERsegmented PMNs

Front 28

how to differentiate B12 def from folate def

Back 28

B12 will have peripheral neuropathy and/or psychosis

NEURO SYMPTOMS with B12 NOT folate

Front 29

any B12 def will need what next?

Back 29

Schilling test

Front 30

what is the schilling test?

Back 30

1) 1st load up B12 transporters that could possible be empty with an IM injection
2) give oral radioactive labeled B12
3) if decreased labeled B12 is seen administer more labeled B12 with intrinsic factor

decreased B12 with IF administered= bad intestinal absorption
NORMAL B12 with IF administered= pernicious anemia d/t absence of IF

Front 31

causes of B12 def?

Back 31

diet
ILEUM resection
Diphyllobothrium latum (tapeworm fish?)
Gastritis- decreased Intrinsic Factor
immune attack against parietal cells (produce IF)

Front 32

describe hemolytic disease of the newborn and the Tx.

Back 32

Rh + fetus and Rh - mom

mother anti-Rh IgG against Rh + fetus can cross placenta and cause fetal hydrops in subsequent babies. in first baby can cause an anemia d/t RBC destruction in baby.

Tx- RhoGAM

Front 33

kids with short stature, abnormal skin pigment, THUMB abnormality and horseshoe kidney is presentation of what? etiology? labs?

Back 33

Fanconi anemia

bone marrow failure

labs: pancytopenia

Front 34

kids with increased VMA in 24 hr urine collection and a large abdominal mass, suspect what?

Back 34

neuroblastoma

(pheochromocytomas are VERY similar but present later in life and are rarely mets associated and also appear in slightly different cells. neuroblastomas attack immature cells.)

Front 35

describe adverse effects of these chemo drugs?
a) cyclophosphamide
b) doxyrubicin
c) bleomycin

Back 35

a) hemorrhagic cystitis
b) cardiotoxic
c) pulmonary fibrosis

Front 36

what causes eosinophilia?

Back 36

parastitic infxn
asthma
Addison's dz
neoplasm
allergic reaction

Front 37

what meds can cause agranulocytosis (neutropenia)?

Back 37

clozapine
TMP-SMX
sulfasalazine

Front 38

define the 4 types of hypersensitivity reactions

Back 38

1-IgE
2- IgM, IgG complement cascade
3- immune complexes
4- T-cell mediated

Front 39

Tx of anaphylaxis?

Back 39

Epinephrine
antihistamines
bronchodilators
IVF
pressors?

Front 40

monitor heparin tx with what?
warfarin?

Back 40

PTT (intrinsic pathway)

PT/INR (extrinsic pathway)

Front 41

when starting warfarin tx, what must you do first until INR reaches therapeutic?

Back 41

start on LMWH b/c of protein C/S inhibition causes a hypercoaguable state

Front 42

mucosal bleeding and bruising, suspect what?

Back 42

vWF or thrombocytopenia

Front 43

hemarthroses presentation, suspect what?

Back 43

hemophilia A- VIII
hemophilia B- IX

X-linked recessive

Front 44

work up vWF with a PTT study why? tx?

Back 44

because factor VIII is usually involved

desmopressin

Front 45

warfarin therapy patients should avoid what food?

Back 45

green leafy veggies b/c high in vit K

Front 46

babies have bleeding and increased PT times why?

Back 46

gut flora is not matured enough to help with Vit. K production

Front 47

what can cause DIC?

Back 47

Sepsis
trauma
OB complications
neoplasm

Front 48

what labs aid in Dx of DIC?

Back 48

thrombocytopenia
increased PT/PTT
increased d-dimer and fibrin-split products
decreased fibrinogen (b/c being used to make fibrin clots)

Front 49

what is ITP?

Back 49

autoimmune destruction of platelets

Front 50

what is TTP-HUS?

Back 50

diffuse platelet aggregation d/t antibodies against a preventative enzyme
HUS- associated with E.coli 0157:H7

Front 51

How does TTP-HUS present?

Back 51

neuro deficits
Renal failure
fever
hemolytic anemia
thrombocytopenia

Front 52

Pt develops thrombocytopenia after being admitted to ICU for isolated DVT. He was started on Heparin per protocol. CBC remarkable for low platelets, increased PTT but normal PT. Dx?

Back 52

HIT

Front 53

palpable lower extremity purpura in a child is what usually?

Back 53

Henoch-Schonlein purpura (IgA vasculitis)

Front 54

Pt presents to ER with chills, n/v, fever of 102.3, and altered mental status. He is found to have hypotension, tachycardia and tachypnea. Labs reveal an increased WBC, and hematuria. what is among the infectious etiology differential?

Back 54

SEPSIS

Front 55

in sepsis, when do you start antibiotics? tx of sepsis?

Back 55

after 1st blood culture draw

hydration, broad spec abx, pressors, O2, tight glycemic control

Front 56

pt presents to ER after African mission trip with fever and headache. he admits to myalgias and a periodic episodes of normal temp and high grade fever. what should top differentials? plan?

Back 56

malaria

tx with chloroquine or mefloquine

Front 57

m/c agent causing mononucleosis? presentation? labs? complication?

Back 57

EBV

fatigue, sore throat with exudates, cervical lymphadenopathy, spleomegaly

labs: increased lymphocytes

splenic rupture with physical activity

Front 58

risk of transmission of HIV (i.e. needlestick) should be started on what prophylactically?

Back 58

Zidovudine and lamivudine

Front 59

how do you definitively rule in HIV?

Back 59

2 positive ELISA (screen)
Positive WESTERN Blot rules in HIV

Front 60

monitor HIV therapy with what 2 tests?

Back 60

CD4 count and viral loads

Front 61

when do you start prophylactic abx in HIV patients?

Back 61

CD4 < 200

Front 62

these agents require what abx coverage prophylactically?

a) PCP pneumonia
b) histoplasmosis
c) Mycobacterium Avian Complex
d) TB

Back 62

a) TMP-SMX
b) TMP-SMX
c) Clarithromycin
d) Isoniazid

Front 63

to keep viral load low, pregnant moms with HIV should take what during labor?

Back 63

Zidovudine

Front 64

features of these point to what HIV opportunistic condition?
a) neuro sx including memory loss
b) odynophagia (pain swallowing)
c) focal neuro sx. specific sx -MRI shows lesion
d) vision loss
e) gradual onset non productive cough
f) purple subQ nodules

Back 64

a) AIDS dementia
b) Candida esophagitis
c) histoplasmosis
d) CMV retinitis
e) PCP pneumonia
f) Kaposi's sarcoma

Front 65

can HIV mothers breastfeed?

Back 65

NO

Front 66

pt presents with itching and burning in hands and feet, fatigue and headache. Splenomegaly also noted. CBC shows increased Hgb and Hct. Dx? tx?

Back 66

polycythemia vera
phlebotomy

Front 67

pt presents with back pain, weakness, fatigue, and multiple fractures. Lumbar XRs show punched out lesions. CBC shows low Hgb and Hct and decreased WBCs. BMP show increased BUN and mild increase in Cr. serum and urine protein electrophoresis show M-spike in Gamma globulin region and presence of Bence Jones proteins. How do you make a definitive Dx?

Back 67

increased plasm cells on bone marrow biopsy

Front 68

in terms of lymphadenopathy, describe hodgkins and nonhodgkins lymphoma

Back 68

Hodg--- CERVICAL lymphadenopathy

non-hodg--- diffuse lymphadenopathy

Front 69

lymph node bx shows presence of Reed-Sternberg cells. Dx?

Back 69

Hodgkin's lymphoma

Front 70

hodgkins or nonhodgkins is related to EBV infection?

Back 70

nonhodgkins

Front 71

describe cells of:
a) ALL
b) AML
c) CLL
d) CML

Back 71

a) immature lymphoid cell origin
b) immature myeloid cell origin
c) mature lymphoid cell origin
d) mature myeloid cell origin

Front 72

this leukemia is common in children and usually presents as bone pain and pancytopenia (possible normal RBCs). Dx and explain labs.

Back 72

ALL

pancytopenia b/c all the cells are blasts. smear will show lymphoid blast cells

Front 73

this leukemia presents in kids and adults. presents as fatigue, easy bruising, dyspnea, real nonspecific findings. CBC shows pancytopenia (possible normal RBCs). next step? then give dx on next card

Auer rods seen on Bone marrow Bx

Back 73

bone marrow biopsy- myeloid immature cells with auer rods

AML

Front 74

this leukemia presents in elderly population. presents as fatigue and frequent infections. CBC reveals >100K WBCs (increased) and hepatosplenomegaly noted. Bone marrow bx shows smudge cells. Dx?

Back 74

CLL

Front 75

this leukemia presents in middle age population usually as fatigue. CBC reveals >100,000 WBCs (increased). presence of Philadelphia Chromosome is present. Dx?

Back 75

CML

Front 76

mature leukemias will have what kind of WBCs?
immature?

Back 76

increased WBCs
decreased WBCs