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74 Cards in this Set
- Front
- Back
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pt with decreased platelets, rest of CBC is normal? path?
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- isolated acquired thrombocytopenia i.e. autoimmune platelet destruction (not bone marrow related b/c owther cell lines would be involved)
- ddx path: increased consumption, sequestration, destruction - dx: ITP: atibplatelet ab destroy platelets |
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pt with pancytopenia and hepatosplenomegaly?
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- malignant infiltration of bone marrow; hepatosplenomegaly 2/2 extramedullary hematopoiesis
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etiology of bone marrow aplasia?
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- pancytopenia 2/2 EBV, chemo, radiation
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lab values of vWD?
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- factor that helps plt bind to endothelium is impaired ==> normal plt number, increased BT, PTT
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what is splenic sequestration? labss?
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- d/o that causes splenomegaly that then causes plts to sequester in spleen
- plts > 30,000, no abnormal bleeding |
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labs in DIC?
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- accelerated plt consumption ==> decreased fibrinogen, increased PT, PTT, BT
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what causes ineffective erythropoiesis?
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B12 and folic acid deficiencies ==> erythroid precursors die ==> megaloblastic anemia
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germ cell tumors?
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- nonseminomatous (increased hCG, AFP) = yolk sac, choriocarcinoma, embryonal, or mixed cell type of these
- seminomatous (increased bhCG) |
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young pt with nocturia, normal urinalysis, no other sx
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- hyposthenuria (kidney unable to concentrate urine) 2/2 sickle cell dz/trait
- path: RBC sickling in vasa recta of inner medulla ==> impairs counter exhcange and water absorption |
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major causes of vit K deficiency? labs? reserve? labs? tx?
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- diet, intestinal malabsorption (abx use), hepatocellular dz
- reserve: 30d unless sick then 7-10d - labs: decreased K+ => decreased prothrombin copmlex proteins (factor 2, 7, 9, 10, C, S) => increased PT => increased PTT; increased PT>PTT - tx: give K+, if acute hemorrhage give FFP |
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pt with thrombocytopenia, microangiopathic hemolytic anemia, fever, + neuro signs?
- if neg neuro signs, + renal failure, following diarrhea? |
1. TTP: platelet consumption 2/2 thrombi formation in microcirculation
2. HUS |
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pt with increased PTT early in life?
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factor VIII, IX deficiency
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MCC inherited bleeding dx in adults?
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vWD
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pt with hereditary spherocytosis? labs? tx?
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see polychromatophys, give folic acid, take out spleen
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low B6 (pyridoxine) is seen when? sx?
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- INH for TB. see peripheral neuropathy.
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pt with acute bleeding of gums, weight loss, fatigue, see leukocytosis w/ high blast forms. labs?
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- acute monocytic leukemia (FAB M5)
- lab: + alpha naphtyl esterase, high monoblasts, promonoblasts, monocytes |
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pt with increased myeloblasts?
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acute myeloblastic leukemia
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auer rods?
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acute promyelocytic leukmeia, AML
- see hypergranular promyelocytes |
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predominance of lymphoblasts, PAS+? epi? sx? labs?
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- ALL
- young kids (2-10y.o.) - most present with infx (ear infx), lymphadenopathy, splenomegaly - labs: >25% lymphoblasts is dx, +TdT (preB, preT lymphobasts) |
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erythroblasts with irregular outline and high nuclear cytoplasmic ratio?
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- M6
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pt with PICA w/ hx duodenal ulcer? ddx PICA?
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- chronic bleeding 2/2 duodenal ulcer
- decreased iron due to diet |
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labs of SIADH? which ca?
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- low Na, low serum osm, high urine osm
- small cell ca |
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tx of small cell ca?
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- CHEMO, no surgery (unlike other lung ca)
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pt with hypercalcemia, tx if 2/2 sarcoid vs cancer vs hypercalcemic crisis?
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1. sarcoid: extra renal vit D production; tx: CS
2. Bisphos 3. IV fluids, furosemide |
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pt with hx prostate ca, now with met to spine tx?
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- radiation therapy relieves pain
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pt with limited prostate ca tx?
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- flutamide (non-steroidal anti-androge ==> blocks androgen by binding to dihydrotestosterone receptors) + LHRH agonist
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abd pat bad biopsy is to dx what?
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amyloidosis ( may also see increased monoclonal protein)
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dx of MGUS
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- monoclonal protein level < 3g/dL
- no anemia, lytic bone lesions, increased ca, renal insufficiency - do bone biopsy if above are positive to ddx MGUS vs MM |
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what is the schililng's test?
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- ddx vit B12 (cobalamin) deficiency 2/2 pernicious anemia (ab to intrinsic factor) vs malabsoprtion
- oral radiolabeled B12 and IM unlabeled B12 ==> measure urinary excreation B12. If normal urine excretion ==> poor intake. if decreased then impaired absorption - to ddx P.A and malabsorption give 2nd dose radiolableld with IF ==> if normal urine then dx of pernicious anemia. If decreased then r/o prenicious anemia and suggest malabsorption (pancreatic insufficiency, bact overgrowht, short gut syndrome) |
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dx criteria for lynch syndrome?
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1. 3 relatives w/ CRC, one must be first degree relative
2. involves 2 or more generations 3. one case dx <50y.o. 4. r/o FAP - note: increase endometrial ca |
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starry sky appearance? etiology?
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burkitt's lymphoma = B cell neoplasm, increased mitosis index, aggressive but responds to chemo
- associated with EBC, mass of mandible, abd viscera |
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mass in mandible?
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Burkitt's
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elderly with pancytopenia?
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myelodysplasitc syndrome = clonal stem cell d/o, progresses to acute leukemia
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splenomegaly =
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extravascular hemolysis
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pt with spherocytes, neg fhx, and+ coombs?
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- autoimmune hemolytic anemia! not hereditary spherocytosis b/c would see +fhx and -coombs
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labs and signs of AHA (autoimmune hemolytic anemia?)
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- pallor, jaundice, splenomegaly
- increased indirect bili, retic, LDH |
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intravascular vs extravascular hemolytic anemia?
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intravascular = paroxysmal nocturnal hemoglobinuria = decraesed serum haptoglobin
- extravascular = autoimmune hemolytic anemia = nl haptoglobulin |
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heinz body?
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G6PD
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tx of pain in pts with terminal ca?
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1. try using non-narcotics first unless sure it's severe pain
2. do not be afriad to give narcotics 3. give short term to titrate then change to long acting w/ short acting for breakthrough |
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at what size lymph node to be worried if no sx?
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- >2 cm = malignancy or granulomatous
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chemo agents that cause peripheral neuropathy? other drugs?
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- vincristine, cisplatin, taxanes
- phenytoin, isoniazid, amiodarone, hydralazine |
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+ coombs test?
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IgG in blood attaching to RBC ==> spleen removes
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pt with dark ruine, back pain, fatigue after taking bactrim? labs? other precipitating factors?
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think G6PD
- labs: +LDH, decreased haptoglobin = acute hemolysis - bite cells - note G6PD acitivity is measured normal during acute crisis - other precipitating factors: infx, fava bean |
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schistocytes, etiology?
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- intravascular hemolysis (excludes spleen so CLL is extravascular)
- prosthetic valves, DIC, TTP, HUS, paroxysmal nocturnal hemoglobinuria |
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ddx bone marrow infiltration vs bone marrow aplasia?
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- splenomegaly = infiltration = leukemia or lymphoma replace RBC progentiro type
- no splenomegaly = aplasia |
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detection of HER2 oncogene overexprestion? tx?
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- FISH, immunohistochemical stinaing
- tx: trastuzumab/herceptin |
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prophylaxis for splenectomy?
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- anti-pneumococcal, hemophilus, meningococcal vaccines several weeks before the operation
- daily oral PCN ppx for 3-5 yeras - risk for pneumococcal sepsis is > 30yrs |
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pt with lung mass and hyerCa2+?
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- squamous cell carcinoma = sCa++mous
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adenocarcinoma of lung is associated with?
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- hypertrophic pulm osteoarthropathy
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**tx of solitary brain met?
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- usually found in grey-white matter junction
- surgical resection followed by radiation (whole brain) - can tx w/ chemo if from chemosensitive tumor e.g. small cell lung ca, lymphoma, choriocarcinoma |
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pt with thrombocytopenia?
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if no anemia, ddx includes HIV
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pt on warfarin now w/ bleeding?
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check diet, if taking vitamins of other foods that increase warfarin: alcohol, vit E garlic, ginko, ginseng, st john's wort, abx
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what decreases warfarin effectiveness?
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diet high in vit K, leafy greens
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elderly pt with WBC 42 and majority are lymphocytes? next step? epi?
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CLL
- do flow cytometry to confirm dx - older pts 70y.o. |
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smudge cells?
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CLL
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pt with sx of pruritus after bathing? increased RBC? other labs/sx?
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- polycythemia vera
- granulocytosis, thrombocytosis, splenomegaly, increased leuk alkaline phos, nl O2 sat - DECREASED erythropoetin level |
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labs of hairy cell leukemia?
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- B-lymphocytic chronic leukemia
- fibrotic bone marrow ==> unsuccessful tap - tartrate resistant acid phosphatase (TRAP) stain and + CS11c marker - benign course |
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left shift? left shift and decreased leuk alk phos?
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- neutrophilic leukocytosis
- CML |
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reed sterbern cells?
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- owl eyes = hodgkins
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incrased blast cells?
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lymphoblastic leukemia
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pt with CF now with bleed? labs?
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- fat malabsortipn ==> K+ deficiency, decreased factor 2, 7, 9, 10 C, s,
- increased PT 2/2 decreased vit K |
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non-healing, painless ulcer (may be at site of old scar?)
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squamous cell ca
- do punch biopsy to confirm |
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most important prognostic consideration in breast ca? other facotrs?
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tumor burder= TNM (no histological grade)
- ER+, PR+ = good - HER-2 /neu oncogene = bad |
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MCC thrombocytopenia in hospitalized pts?
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heparin
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ITP?
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dx of exlcusion, all other cell lines, PT, PTT are normal
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DIC?
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thrombocytopenia, increased PT, PTT, thrombin time, decreased fibrinogen level, coag proteins
- increasd fibrin, degradation products life threatening |
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increased PTT and normal plt vs low plt?
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1. vWD
2. HIT |
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pt newly started on warfarin now with skin necrosis?
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- pro-coag effects of warfarin 2/2 decreased protein C
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how to dx myasthenia gravis? next step?
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- EMG, ACh receptor Ab test
- CT chest to screen for thymoma |
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antijo
anti-RNP |
polymyositis
CT dz |
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pt with fever and 91% neutrophils, WBC 690? tx?
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- febrile neutropenia - emergency
- common in chemo - tx empirically w/ g- coverage (esp for pseudomonas, MCC cause is seeding from GI) = 3rd gen and 4th gen ceph = ceftazidine or cefepime |
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pt with hepatomegaly, arthropathy, newly dx dM?
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- hemochromatosis
- check iron - then do liver biopsy |
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pt with lupus and VTE?
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antipho syndrome, viper venom is prolonged
- see increasd PTT b/c IgM or IgG prolongs PTT by binding phospholipids in the assay = artifact |
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pt receives blood tx now with tingling?
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- check Ca2+, low 2/2 chelation from citrate
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