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PANRE review > Hematology > Flashcards

Hematology Flashcards

1
Q

What is the kids leukemia?

A

ALL

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2
Q

What is the median age of onset of AML?

A

60

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3
Q

What are the most common pathogens in patients with leukemia induced neutropenia?

A

Gram-negatives and fungi

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4
Q

Young patient with lymphadenopathy, hepatosplenomegaly and chronic fatigue, what do you suspect?

A

ALL

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5
Q

What type of blood dyscrasia causes Auer rods to be seen in the cell cytoplasm?

A

AML

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6
Q

What is the definitive diagnostic finding for ALL?

A

terminal deoxynucleotidyl transferase

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7
Q

What additional treatment is commonly needed in acute leukemia to combat a side effect of chemotherapy?

A

Allopurinol and diuretics d/t increased uric acid blood levels

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8
Q

What are the greatest indicators of prognosis for the acute leukemias?

A

WBC count and age at diagnosis

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9
Q

What are the cure rates for ALL and AML with current therapies?

A

> 50% with ALL, > 70% at < 60 years with AML

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10
Q

Which leukemia is a malignancy of the B lymphocytes?

A

CLL

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11
Q

What is the most prevalent leukemia?

A

CLL

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12
Q

What are the typical characteristics of a CLL patient?

A

median age 65, twice as common in men as women

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13
Q

50 yo F presents with episodes of excessive sweating, low-grade fevers, anorexia, weight loss and chronic fatigue. Which leukemia do you suspect?

A

CML

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14
Q

What are the three phases of CML?

A

chronic, accelerated and blast crisis - you need to catch it before stage 3 for prognosis

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15
Q

Which leukemia has a mild course but is resistant to cure? Average survival?

A

CLL - median survival 6 years or 10-15 with stage 0-1

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16
Q

Which blood dyscrasia should be suspected with isolated lymphocytosis and leukocytosis greater than 20k?

A

CLL

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17
Q

Which blood dyscrasia should be suspected with keukocytosis with median WBC count of 150k?

A

CML

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18
Q

What is the new test that has replaced the test for the philadelphia chromosome?

A

BCR-ABL

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19
Q

Which blood dyscrasia shows smudge cells on peripheral smear?

A

CLL

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20
Q

What is the standard therapy of choice in CML?

A

imatinib mexylate (gleevee) then likely bone marrow transplant

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21
Q

Pt presents with fatigue, anemia, elevated corrected reticulocyte count, elevated indirect bilirubin and LDH. What work up is needed?

A

work up for hemolysis

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22
Q

What is the typical cause of sideroblastic anemia?

A

lead toxicity

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23
Q

What is the work up for microcytic anemia?

A

Lead levels, TIBC and FeSat, hemoglobin electrophoresis for Hgb A2 and F will be abnormal in thalassemia

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24
Q

What should you think of if Burr cells are seen on smear? (4)

A

Peptic ulcer, cancer of stomach, Uremia, Vitamin K deficiency

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25
Q

What should you think of if Spur cells are seen on smear (1)?

A

post splenectomy

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26
Q

What should you think of if stomatocytes are seen on smear (1)?

A

alcoholic liver disease

27
Q

What should you think of if shistocytes (helmet cells) are seen on smear?

A

TTP, DIC, glomerulonephritis, heart valve, burns

28
Q

If you see bite cells on smear, what should you think?

A

G6PD deficiency

29
Q

If you see basophilic stippling on smear, what should you think?

A

lead toxicity

30
Q

If you see rouleaux on smear, what should you think?

A

multiple myeloma

31
Q

If you have a patient with microcytic anemia who is not responding to iron treatment, what is the most likely alternative diagnosis?

A

thalassemia

32
Q

Patient with alpha thalassemia who has been symptomatic should receive what advice about how to stave off symptoms?

A

folic acid supplementation and avoid oxidative medications (quins, sulfonimides, nitro, dapsone)

33
Q

What is the treatment for beta thalassemia?

A

Bone marrow transplant possible splenectomy

34
Q

Patient presents with chronic fatigue, brittle nails, cheilosis, smooth tongue and esophageal webs. diagnosis?

A

iron deficiency anemia

35
Q

Patient with serum iron < 30, elevated TIBC and transferrin sat < 15 has what?

A

iron deficiency anemia

36
Q

What additional supplement may increase iron absorption?

A

Vitamin C

37
Q

What does prussian blue staining of bone marrow test for?

A

sideroblastic anemia

38
Q

What type of anemia is anemia of chronic inflammatory disease?

A

typically (70%) normochromic normocytic, 30% hypochromic microcytic

39
Q

What conditions cause pancytopenia?

A

aplastic anemia, leukemia and myelofibrosis

40
Q

What is the most common cause of vitamin B12 deficiency?

A

Pernicious anemia (lack of intrinsic factor to absorb)

41
Q

Hypersegmented neutrophils on smear of anemic patient. diagnosis?

A

Vitamin B12 deficiency

42
Q

A patient with anemia is found to have an elevated indirect bilirubin, elevated LDH on labs. What is the cause?

A

hemolysis

43
Q

What does a direct Coombs test identify?

A

antibodies to the RBCs

44
Q

What does an indirect Coombs test identify?

A

antibodies in the patient’s serum

45
Q

Howell-jolly bodies are seen on peripheral smear, diagnosis?

A

sickle cell anemia

46
Q

What is the treatment of an acute pain episode of sickle cell disease?

A

analgesics, hypotonic fluids and rest

47
Q

what prophylaxis is indicated for sickle cell patients (6)?

A

low-dose PCN daily until age 6, pneumococcal vaccine, transcranial dopplers for stroke prevention, pulmonary function testing for restrictive disease screening, folate supplementation, hydroxyurea orally to increase Hgb F production

48
Q

Young male african american patient presents with acute fatigue after taking aspirin. His h/h is low and indirect bilirubin high. Smear reveals bite cells and Heinz bodies. What should you test to confirm the diagnosis? Treatment?

A

G6PD level should be low, tell patient to avoid oxidative drugs (like aspirin) and fava beans

49
Q

What are the causes of an IgG positive direct Coombs test? (4)

A

lymphoma, SLE, UC drugs, transfusion reaction

50
Q

What are the causes of an IgM positive direct Coombs test? (3)

A

Viral infections, antibiotics, transfusion reactions

51
Q

What conditions are patients with polycythenia vera at risk for?

A

CML or AML

52
Q

Patient presents with generalized pruritus after bathing, what is the diagnosis? diagnostic criteria?

A

polycythenia vera, hematocrig >54 in males, > 51 in females

53
Q

what is the most common cause of morbidity and mortality in patients with polycythenia vera?

A

thrombosis

54
Q

A patient with painless supraclavicular and cervical lymphadenopathy until injestion of alcohol has Reed-Sternberg cells on biopsy. Diagnosis?

A

Hodgkins lymphoma

55
Q

Patient presents with painless lymphadenopathy and abdominal fullness as well as vague GI symptoms. Likely cancer type?

A

Burkett’s lymphoma

56
Q

Which lymphoma has a better cure rate?

A

Hodgkin’s

57
Q

Patient has Bence Jones proteinuria. diagnosis?

A

Multiple myeloma

58
Q

Patient has a monoclonal spike on serum protein electrophoresis. diagnosis?

A

Multiple myeloma

59
Q

Female patient with severe anemia inducing menses, first hematologic test?

A

vWF

60
Q

Treatment of acute bleeding for someone with vWF deficiency?

A

DDAVP, factor VIII

61
Q

a 5 yo boy presents with hemarthrosis, his mother’s brother had bleeding problems as well. PTT is prolonged. Next test to confirm dx? dx? tx?

A

factor VIII for deficiency, Hemophilia A, treat with factor VIII recombinant

62
Q

What is another name for Christmas disease?

A

Hemophilia B

63
Q

A post operative patient who is NPO and receiving post operative antibiotics begins to have soft tissue bleeding. PT/PTT are mildly prolonged. LFTs are elevated. Clotting factors II, VII, IX and X are decreased. What is the cause? Treatment?

A

Vitamin K deficiency, downgrade antibiotics if possible, supplement vitamin K

PANRE review (14 decks)

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