D\'s Heme_Onc Step 2

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JCremer
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29313
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D\'s Heme_Onc Step 2
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2010-08-08 13:53:48
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USMLE Step
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Heme-Onc
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  1. Left shift OBC
    • Fetal HgB
    • Metabolic Alkalosis
    •  temperature
    •  2,3 DPG
  2. Right shift OBC
    • Metabolic acidosis
    •  temperature
    • High altitude
    • Exercise
    •  2,3 DPG
  3. If CKD and giving EPO hgb should be?
    11-12 g/dL
  4. Mental status changes, cherry red lips, hypoxia. Dx? Tx?
    CO poisioning

    100% O2
  5. Hemolytic anemia & LDH level
     LDH
  6. Schistocytes seen in:
    • DIC
    • TTP
    • HUS
    • Hemolytic Anemia
  7. 4 Microcytic Anemias
    • Iron deficiency
    • Sideroblastic anemia
    • ACD
    • Thalessemia
  8. Do not take supplemental iron with
    Divalent cations (mag, ca)
  9. Causes of sideroblastic anemia
    • Alcohol
    • INH
    • Lead poisoning
  10. Abdominal pain, arthralgia, impaired short term memory, developmental delay, peripheral neuropathy. Dx? Tx?
    Lead poisoning

    • Remove lead source
    • EDTA
    • Succimer
    • Dimercaptosuccinic acid (DMSA)
  11. Basophilic stippling
    • Alcohol abuse
    • Lead poisoning
    • Thalesemia
  12. What are burton's lines
    Gingivial lead lines found in lead poisoning
  13. Chelator of lead poisoning when levels are?
     80 ug/dL
  14. Decreased EPO, increased hepcidin, anemic with hx of RA
    ACD
  15. Causes of drug induced hemolytic anemia
    • Penicillins
    • Quinidine/Quinine
    • Methyldopa
    • Cephlasporins
    • NSAIDs
  16. Blood smear of drug induced hemolytic anemia
    • Burr cella
    • Schistocytes
  17. Pathology behind drug induced hemolytic anemia
    Bind to RBC membrane & cause oxidative destruction

    Produce antidrug antibodies, immune complexes that fix complement or induce anti-Rh antibodiea
  18. Treatment for drug induced hemolytic anemia
    Stop offending agent!
  19. Pathology of immune hemolytic anemia
    • Anti-RBC antibodies
    • Autoimmune dz
    • Drug induced
  20. Types of immune hemolytic anemia
    • Warm: IgG-SLE
    • Cold: IgM-mycoplasma, EBV, HIV
  21. Treatment of immune hemolytic anemia
    • Corticosteriods
    • Avoid cold exposure
    • Stop offending agents
    • Splenectomy if persistent
  22. Pathology of mechanical hemolytic anemia
    RBCs broken down by turbulent flow

    Due to prosthetic heart valves
  23. Blood smear of mechanical hemolytic anemia
    Schistocytes
  24. Pathology of hereditary spherocytosis
    Defect in RBC membrane (ankyrin)
  25. Test for hereditary spherocytosis
    Increased osmotic fragility
  26. Symptoms of hereditary spherocytosis. Treatment
    • Hepatosplenomegaly
    • Calcium bilirubinate stones

    Splenectomy
  27. Pathology of G6PD deficiency
    Deficient enzyme which is required to repair oxidative damage to RBCs.

    Ingesring oxidant causes excessive RBC hemolysis
  28. Triggers for G6PD deficiency
    • Dapsone
    • TMPSMX
    • Primaquine
    • Fava Beans
    • Quinine/Quinidine
    • Sulfa Drugs
    • Nirtofurantoin
    • High dose ASA
  29. G6PD deficiency blood smear
    • Bite cells
    • Heinz bodies
  30. Tests for G6PD deficiency
    • Low G6PD
    • Heinz body prep: screen
    • Enzyme assay: confirm
  31. Treatment of G6PD deficiency
    • Avoid oxidants!
    • Transfusion if severe
  32. Hemolytic anemia with + Coombs test
    • Immune
    • Drug induced
  33. Causes of B12 deficiency
    • PA
    • Inadequate intake
    • Ileal resection
    • Bacterial overgrowth in GI
    • Diphyllobothrium Latum
  34. Treatment of Diphyllobothrium Latum
    Praziquantel
  35. Drugs causing aplastic anemia
    • Chloramphenicol
    • Sulfonamides
    • Phenytoin
    • Chemo
  36. Bone marrow biopsy of aplastic anemia
    • Hypocellularity
    • Fatty infiltrate (adipocyte)
    • Pancytopenia
  37. Triggers of sickling
    • Acidosis
    • Hypoxia
    • Dehydration
  38. Radiology of sickle cell
    • Fish mouthing of vertebrae
    • Lung infiltrates in acute chest syndrome
  39. Sickle cell should be vaccinated against
    • Hep B
    • Flu
    • HiB
    • Pneumoccal
  40. Prophylactic treatment of sickle cell pts till 5 with what?
    Penicillin
  41. Causes of lympopenia
    • Increased cortisol
    • Chemo
    • Radiation
    • Lymphoma
  42. Eosinophilia causes
    • Addisons
    • Neoplasm
    • Asthma
    • Allergic drug rxn
    • Collagen vasc dz
    • Transplant rjxn
    • Parasitic infxn
  43. Types of hypersensitivity rxns:
    • I: Anaphylactic
    • II: Complement mediated
    • III: Immune Complex mediate
    • IV: Delayed
  44. Type I hypersensitivity: mediated by, mechanism, example
    IgE antibody to mast cell

    • Mast cell degranulation
    • Histamine release

    • Anaphylaxis
    • Allergic rhinitis
    • Asthma
  45. Type II hypersensitivity: mediated by, mechanism, example
    IgM & IgG against self

    Allergens react with antibodies to initiate complement cascade

    • Drug induced or immune hemolytic anemia
    • Hemolytic dz of newborn
    • Goodpasture
    • Rheumatic Fever
    • ITP
    • M. Gravis
    • Graves
    • B.P. & P.V.
  46. Type III hypersensitivity: mediated by, mechanism, example
    IgM & IgG complexes

    Antibodies for immune complexes with allergens

    • Arthus rxn
    • Serum sickness
    • Glomerulonephritis
  47. Type IV hypersensitivity: mediated by, mechanism, example
    T cell & macros

    T cells present allergens to macros & secrete lymphokines

    • Allergic contact dermatitis
    • Transplant rejection
    • PPD testing
  48. Monitor LMWH with
    Factor 10 A
  49. Do not start warfarin for a thrombus until after starting LMWH or until PTT is therapeutic on unfractionated heparin bc?
    Warfarin inhibits protein C & S and can cause short period of hypercoagulability immediately after therapy is started
  50. Labs of vWd
    •  PTT,  BT,
    •  vWF  factor 8
    •  ristocetin cofactor activity
  51. Treat vWd
    • Desmopressin
    • Cryo
    • OCP
  52. Vitamin K deficiency labs
    •  PT
    •  INR
  53. Hemophilia labs
    •  PTT
    • Normal PT, normal bleeding time
    •  factor 8 or 9
  54. DIC labs
    •  platelets, fibrinogen
    •  PT, PTT, D-dimer
  55. Treatment for DIC
    • Underlying cause
    • Platelets
    • FFP
    • Cryo
  56. Definition of HIT
    Sudden  in platlet level by more than 50%
  57. Gold standard to dx HIT
    • + serotonin release assay
    • (but not used due to cost)
    • + Heparin induced aggregation assay
  58. Treatment of HIT
    • Dc all heparin
    • Start lepirudin or fondaparinux
  59. Patho ITP & platelet count
    Autoimmune B cell pdxn of antiplatelet antibodies

    50,000
  60. Treatment of ITP
    • Kids: self limited
    • Adults: corticosteriods, delayed splenectomy, IVIG, plasmapheresis, recombinant factor 7a
  61. HUS triad
    • Hemolysis
    • ARF
    • Thrombocytopenia
  62. TTP Pentad
    • Hemolysis
    • ARF
    • Thrombocytopenia
    • Fever
    • AMS
  63. Treatment of TTP-HUS
    • Corticosteriods
    • Plasmapheresis
  64. HELLP treatment
    • Induce delivery if fetus  35wks
    • Anti HTN meds& steriods if preterm
  65. Cause of sepsis in IVDA
    Staph aureus
  66. SIRs criteria
    •  or  Temp
    • Tachypnea
    • Tachycardia
    • Leukocytosis, leukopenia, or bandemia
  67. Pressor for sepsis
    Norepi

    Also give colloid & steriods
  68. Med beneficial for pt with multiorgan failure caused by septic shock
    Human activated protein C
  69. Chills, periodic fever, diaphoresis, HA, myalgia, fatigue. Dx? Test?
    • Malaria
    • PCR for plasmodium
  70. Treatment of malaria
    • Chloroquine
    • Quinine
    • Primaquine
    • Atovaquone-proguanil
    • Mefloquine
  71. Labs with mono
    • + heterophile antibodies
    • + EBV serology
    •  WBC
    •  LFTs
    •  lymphomicytes
    • Hemolytic Anemia
    • Thrombrocytopenia
  72. Mono pts can return to noncontact sports in how long?
    3 wks
  73. Mono pts can return to contact sports in how long?
    4 wks
  74. Screening & confirmatory test for HIV
    ELISA  western blot
  75. Concern for HIV transmission via accidental needle stock. Treatment?
    Prophylactic zidovudine & lamivudine

    HIV antibody tests @ 6 wks, 3 mos, 6 mos
  76. Start antiretroviral treatment for HIV if:
    • 1. CD4 count  350
    • 2. Viral load  20,000
    • 3. Symptomatic development of opportunistic dz
  77. HAART
    2 NRTi's & protease i/NNRTi

    Need 3 drugs!!
  78. Antibiotic prophylaxis cd4  200
    • Bactrim for PCP
    • Clarithromycin or azithromycin for MAC
    • INH when contacts have TB
  79. HIV pathogens at CD4  500
    • Herpes Zoster/Simplex
    • Kaposi's Sarcoma
    • Parasiric diarrhea- isospora, strongyloides, cryptosporidium
  80. See wasting syndrome at what CD4 count
     350
  81. Coccidioidomycosis seen at what CD4 count
    250
  82. HIV pathogens at CD4  200
    • AIDs dementia
    • Bacterial pneumonia
    • Candida esophagitis
    • Cervical Cancer
    • PCP
    • TB
  83. Histoplasmosis seen at what CD4 count?
    150
  84. HIV pathogens at CD4  100
    • Lymphoma
    • PML
    • Cerebral toxoplasmosis
  85. HIV pathogens at CD4  50
    • CMV
    • MAC
  86.  hgb & hct, RBC mass,  EPO, BM shows hypercellular marrow
    Polycythemia Vera
  87. Treatment of Polycythemia Vera
    • Serial phlebotomy
    • Antihistamines
    • ASA
    • Hydroxyurea

    Do not give iron!!
  88. MC type of hodgkins
    Nodular sclerosing
  89. Reed sternberg cells
    Hodgkins lymphoma
  90. (8,14) translocation
    EBV-Burkitts
  91. BM showing blasts of myeloid origin & staining with myeloperoxidsse & Auer rods
    AML
  92. Proliferation of mature B cells, WBC, smudge cells
    CLL
  93. Proliferation of mature myeloid cells, hx radiation exposure. WBC, LAP
    CML
  94. Pathognomonic translocation for CML
    Philadelphia chromosome t(9, 22)

    BCR-ABL fusion gene
  95. BM lymphocytic infiltration
    CLL
  96. BM granulocyte hyperplasia
    CML
  97. Treatment for CML. Complications.
    Imatininb

    Blast crisis
  98. Proliferation of B cells, massive splenomegaly but no lymphadenopathy
    Hairy cell leukemia
  99. Fanconi anemia
    • AR
    • Bone marrow failure-pancytopenia

    • Short stature
    • Abnormal skin pigmentation
    • Horseshoe kidney
    • Cafe au lait
    • Thumb abnormalities

    •  AFP
    • BM-hypocellularity
  100. Diamond blackfan anemia
    • Pure RBC anemia
    • (defect in erythroid progenitor cells)

    • Craniofacial abnormalities
    • Thumb abnormalities
    • MR
    • Hypogonadism
    • Heart murmur

    BM- activity, EPO
  101. Neuroblastoma tumor of?
    Neural crest cells in adrenal glands or sympathetic ganglia
  102. Risk for neuroblastoma
    • NF
    • Tuberous Sclerosis
    • Pheo
    • Beck-Wiedmann
    • Turner's
    • Low folate in mom
  103. Symptoms of neuroblastoma
    • Abd distension & pain
    • Wt loss
    • Bone pain
    • Abd mass
    • HTN
    • Horner's
    • Proptosis
    • Movement disorder
  104. Labs for neuroblastoma
     VMA & HVA in 24hr urine
  105. Rhabdomyosarcoma
    Tumor of striated mm in kids

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