Heme/Onc

Question 1

Most causes of microcytic anemia have what kind of reticulocyte count

Answer 1

Low reticulocyte count, implies production problem

Macrocytic anemia has a low reticulocyte count as well

Question 2

Causes of macrocytic anemia

Answer 2

B 12/folate deficiency,Sideroblastic anemia, alcoholism, anti-metabolite medications, liver disease or hypothyroidism, zidovudine, phenytoin, Milo dysplastic syndrome, cold agglutinin’s

Question 3

FFP versus cryoprecipitate

Answer 3

FFP replace his clotting factors, used in those with elevated PT, PTT it, INR and bleeding, used as replacement with plasmapheresis
Cryoprecipitate is used to replace fibrinogen, used in DIC, provides clotting factors in smaller classroom about you, has high levels of factor 8 and VWF

Question 4

Causes of sideroblastic anemia

Answer 4

Can be associated with Milo dysplasia, most common cause is alcohol – suppressing bone marrow, other causes: blood poisoning, INH, vitamin B6 deficiency

Question 5

Unique features on iron studies of microcytic anemias:
Low ferritin
Hi iron
Normal

Answer 5

Low ferritin: iron def
Hi iron: sideroblastic
Normal: thalassemia

Question 6

Difference between anemia of chronic disease and iron deficiency anemia

Answer 6

TIBC will be hi in iron deficiency, but low in anemia chronic disease

Question 7

Thalassemia diagnosis

Answer 7

Alpha: DNA analysis
Beta: hemoglobin electrophoresis
RDW will be normal as well iron studies

Question 8

Labs in vitamin B 12 and folate deficiency

Answer 8

Increased LDH and indirect Billy Rubin, decreased reticulocyte count, hypercellular bone marrow, increased homocysteine levels, only vitamin B 12 will have an elevated MMA
Both may cause pan cytopenia

Question 9

Diagnosing sickle cell disease

Answer 9

Best initial test: peripheral smear

Most accurate test: hemoglobin electrophoresis

Question 10

Sickle cell disease treatment

Answer 10

Oxygen, hydration, analgesia, if fever or high white count: antibiotics: ceftriaxone, Levofloxacin, moxifloxacin
Folate replacement, pneumococcal vaccination,
Exchange transfusion: ACS, Priya prism, stroke, visual disturbance from retinal infection

Question 11

Features of sickle cell trait

Answer 11

Isothenuria: defect and ability to concentrate urine

Occasionally hemateria

Question 12

Causes of autoimmune hemolysis – warm or IgG

Answer 12

CLL, lymphoma, SLE, penicillin, methyldopa, Ray famine, funny tone
Coombs test is most accurate, will have spherocytes on peripheral smear
Treat with steroids, if re current: splenectomy, severe/acute hemolysis not responding to steroids: I VIG
Rituximab, other immunosuppressant

Question 13

Cold agglutinin disease

Answer 13

Most accurate test is cold agglutinin titer, direct Coombs’ test was positive only for complement
Treat by staying warm, rituximab, sometimes plasmapheresis, anti-metabolites/immunosuppressive’s – steroids in splenectomy do not work in cold

Question 14

TTP is associated with?

Answer 14

Ticlodipine, cyclosporine, Plavix, AIDS, SLE

Question 15

Episodic dark urine, pancytopenia, clots in unusual places think?

Answer 15

Paroxysmal nocturnal hemoglobinuria – PNH
MCC OD: thrombosis
Treat,with prednisones, eculizumab, bone marrow transplant, give folate

Question 16

If a patient with a plastic anemia is too old for bone marrow transplant – about 50 or there’s no match donor treat with?

Answer 16

Antithymocyte globulin and cyclosporine/tacrolimus

Question 17

Treatment for polycythemia vera

Answer 17

Phlebotomy, aspirin: prevent thrombosis, hydroxyurea: lowers cell count, allopurinol, rasburicase: protects against Uric acid road, anti histamines

Question 18

Essential thrombocytosis will have platelet count around? Very difficult to distinguish from?

Answer 18

Platelet count above 1 million, difficult to distinguish from reaction to another stress: infection, cancer, iron deficiency
Will have both bleeding and thrombosis
Treat with hydroxyurea

Question 19

Treatment for myelo fibrosis

Answer 19

Thalidomide, lenalidonide, bone marrow transplant under age 50 to 55
ruxolitibib inhibits JAK2

Question 20

Leukemia associated with the DAC

Answer 20

AML M3 subtype: acute promyelocytic leukemia
15:17 translocation
Best initial test: blood smear showing blast
Most accurate: flow cytometry
Myeloperoxidase characteristic of AML
Add all trans retinoic acid to Tx for M3
If ALL add mtx - intrathecal

Question 21

Pruritis after shower, splenomegaly, high WBC think?

Answer 21

CML
Diagnosed with BCR-ABL on pcr or fish
Most likely to transform into acute leukemia – blast crisis, differentiate from leukemoid reaction with low LAP

Question 22

Myelodysplastic syndrome

Answer 22

Pre-leukemic disorder in older patients over 60 – pancytopenia with hypercellular bone marrow, increased MCV, nucleated red cells in small number of blasts, ring sideroblasts, severity based on percentage a blast, 5q deletion has excellent response to a lenalidomide
Pelger-Huet cells: bilobed nucleus
Azacitidine

Question 23

Treatment for CLL

Answer 23

Stage 3/4: fludarabine, cyclophosphamide, rituximab
Mild: chlorambucil
Infections: IVIG
Prednisone for autoimmune thrombocytopenia or hemolysis
PCP prophylaxis

Question 24

Radiation increases the risk of?

Answer 24

Solid tumors: breast, direct, long, also increases chance of premature coronary artery disease
Chemotherapy increases the risk of acute leukemia, MDS, NHL

Question 25

Best diagnostic test for MM

Answer 25

Bone marrow biopsy with greater than 10% plasma cells

Question 26

Blurry vision, vertigo, engorge blood vessels in the eye, mucosal bleeding, Ray nods, think?

Answer 26

Walden Strom macroglobulinemia: hyperviscosity, no bone lesions, best therapy is plasmapheresis to remove the IgM and decrease viscosity

Question 27

Immune thrombocytopenic Purpera will have? How to treat?

Answer 27

Isolated thrombocytopenia, normal sized spleen, Megakaryocytes are elevated, Platelets are large
If platelets under 30,000: steroids, if severe bleeding in less than 10,000: I VIG, anti-Rho, with recurrent episodes/steroid dependent: splenectomy, if still refactory: immunosuppressants
Give meningitis, pneumococcus, H. Flu vaccination before splenectomy

Question 28

Superficial bleeding, elevated bleeding time with normal platelet count possibly elevated PTT, worsened after use of aspirin think?

Answer 28

VWD: AD
No platelet aggregation with ristocetin assay
Treat with desmopressin

Question 29

Hemophilia’s have what PT/PTT?

Answer 29

Normal PT, elevated PTT implying intrinsic pathway defect, factor 8/9, May have prolonged bleeding time, treat with DDAVP or factor replacements

Question 30

DIC risk factors and labs?

Answer 30

Risks: sepsis, burns, placenta abruption, amniotic fluid embolism, snakebites, trauma, cancer
Bleeding related to clotting factor deficiencies and thrombocytopenia
Elevated PT, PTT, BT, low platelets, elevated D dimer, decreased fibrinogen

Question 31

DIC treatment

Answer 31

If platelets are under 50,000in the patient has serious bleeding: use FFP – replace his platelets and clotting factors, use cryoprecipitate if bleeding not controlled with FFP

Question 32

Platelets drop more than 30%, Venus more than arterial thrombosis, think? How do you diagnose and treat?

Answer 32

HIT – confirm with ELISA. For platelet factor 4 Abs or serotonin release essay

Question 33

APL Dx

Answer 33

Best initial test: mixing study, will not correct, PTT will remain elevated (paradoxical)
Best: Russell viper venom test

Question 34

Testicular cancer

Answer 34

Alpha fetal protein: only in nonseminomatous cancers, hCG up in all of them
Staging performed with CT of abdomen pelvis chest, as his cancer metastasizes up through lymphphatic channels and the retroeritoneum moves into the chest
Seminoma: sensitive to chemo and radiation, non-seminoma: just chemo

Question 35

If low or high-grade dysplasia is seen on Pap smear what to do next?

Answer 35

Colposcopy and biopsy

Question 36

If ASCUS on pap, what to do next?

Answer 36

Get HPV testing, if positive get colposcopy, if negative: repeat Pap smear in six months