1
Q
- TIP- HEMATOCRIT:>30-35% SYMPTOMS
- TIP- HEMATOCRIT:25-30% SYMPTOMS
- TIP- HEMATOCRIT: 20-25% SYMPTOMS
- TIP- HEMATOCRIT: <20-25% SYMPTOMS
- TI- MI CAUSES?
A
- NONE
- DYSPNEA (WORSE ON EXERTION), FATIGUE
- LIGHTHEADEDNESS, ANGINA
- SYNCOPE, CHEST PAIN
- ANEMIA, HYPOXIA, CAD, CARBON MONOXIDE POISONING
2
Q
TARGET CELLS; LOW HEMOGLOBIN, LOW RETICULARCYTE COUNT, DYSPNEA, FATIGUE, LOW MCV (N:80-100)
- DIAGNOSIS/ IS A RESULT OF?
- INITIAL TEST
- INITIAL TREAT- IF SEVERE?
A
*MICROCYTOSIS
ANEMIA CAUSED BY: IRON DEF, BETA-THAL, SIDEROBLASTIC ANEMIA, ANEMIA OF CHRONIC DISEASE
- CBC AND (IRON STUDIES)FERRITIN: LOW=IRON DEFICIENCY; IRON: HIGH SIDEROBLASTIC ANEMIA; NORMAL IRON STUDIES: THALASSEMIA
- SEVERE: PACKED RBC (W/DISEASE OR OLD PT. OR SYMPTOMATIC: SHORTNESS OF BREATH, LIGHTHEADED, CONFUSED, SYNCOPE, BP)
3
Q
B12 AND FOLATE DEF, SIDEROBLASTIC, ALCOHOLISM, ANTI-PUR.PHARM, LIVER/HYPOTHYROID,ZIDOVUDINE OR PHENYTOIN, MYEKODYSPLATIC SX.
- DIAGNOSIS/ ALL CAUSE?
- INITIAL TREAT- IF SEVERE?
A
- MACROCYTIC ANEMIA
* SEVERE: PACKED RBC (W/DISEASE OR OLD PT. OR SYMPTOMATIC: SHORTNESS OF BREATH, LIGHTHEADED, CONFUSED, SYNCOPE, BP)
4
Q
TIP- MACRO AND MICRO ANEMIA GIVE?
A
LOW RETICULOCYTE COUNT
5
Q
TIP- NORMOCYTIC ANEMIA CAUSED BY?
A
BLOOD LOSS OR HEMOLYSIS (AT FIRST: FAST LOSS NO TIME FOR MCV CHANGE; THEN MACRO)
6
Q
- TIP- PACKED RBC; HEMATOCRIT? HOW MANY POINT RISE PER UNIT?
- TIP- FRESH FROZEN PLASMA; WHAT IS IT? WHAT LEVELS DOES IT HELP WITH?
- TIP- CRYOPRECIPITATE; WHAT IS IT? WHAT LEVELS DOES IT HELP WITH? [NEVER USED FIRST]
- TIP- WHEN TO USE WHOLE BLOOD?
A
- 70-80% RISES 3 POINTS PER UNIT
- CLOTTING FACTORS OF PLASMA; LOWERS PT, PTT, INR AND BLEEDING TIME (MAYBE USED AS REPLACEMENT WITH PLASMAPHERESIS
- REPLACE FIBRINOGEN, CLOTT FACTORS; (GOOD IN DIC), INCREASES FACTOR VIII AND VWF LEVELS
- NEVER
7
Q
5ML LOSS OF BLOOD A DAY; FROM SLOW GI BLEED OR MENSTRUATION, [HIGH TIBC]
- DIAGNOSIS
- INITIAL TEST
- ACC TEST
- INITIAL TREAT
A
- MICROCYTIC IRON DEFICIENCY
- (IRON STUDIES)FERRITIN: LOW=IRON DEFICIENCY; IRON: HIGH SIDEROBLASTIC ANEMIA; NORMAL IRON STUDIES: THALASSEMIA
- BONE MARROW BIOPSY
- REPLACE IRON(FERROUS SULFATE) THEN IM-IRON
8
Q
DISEASE DOES NOT MOVE IRON; OR NO ERYTHROPIETIN; CANCER OR CRHONIC INFECTION (e.g. RA), [LOW TIBC]
- DIAGNOSIS
- INITIAL TEST
- INITIAL TREAT
A
- MICROCYTIC ANEMIA OF CHRONIC DISEASE (INITIALLY NORMAL MCV)
- (IRON STUDIES)FERRITIN: LOW=IRON DEFICIENCY; IRON: HIGH SIDEROBLASTIC ANEMIA; NORMAL IRON STUDIES: THALASSEMIA
- TX. CAUSE, IF END STAGE RENAL FAILURE: ERYTHROPOIETIN
9
Q
ALCOHOL SUPPRESSIVE; LEAD; ISONIAZID AND VIT B6 HAVE MAJOR EFFECT; [ALCOHOLIC; IRON:HIGH WITH LOW MCV]
- DIAGNOSIS
- INITIAL TEST
- ACC. TEST
- INITIAL TEST
A
- SIDEROBLASTIC ANEMIA ( MACRO OR MICROCYTIC)
- (IRON STUDIES)FERRITIN: LOW=IRON DEFICIENCY; IRON: HIGH SIDEROBLASTIC ANEMIA; NORMAL IRON STUDIES: THALASSEMIA
- PRUSSIAN BLUE (RINGED SIDEROBLASTS) BASOPHILIC STIPPLING MAY OCCUR
- TX. CAUSE + VIT B6 (PYRIDOXINE)
10
Q
ASYMPTOMATIC LOW MCV AND [NORMAL IRON]
- DIAGNOSIS
- INITIAL TEST
- ACC. TEST
- INITIAL TREAT
A
- THALASSEMIA MICROCYTIC
- (IRON STUDIES)FERRITIN: LOW=IRON DEFICIENCY; IRON: HIGH SIDEROBLASTIC ANEMIA; NORMAL IRON STUDIES: THALASSEMIA
- HEMOGLOBIN ELECTROPHOESIS (FOR ALFA-GENETIC)
- MAJOR: TRANSFUSION LIFELONG; IRON OVERLOAD: DEFERASIROX OR DEFERIPRONE IRON CHELATORS
TIP- ALPHA THALASSEMIA ELECTROPHORESIS: 1D=NORM;2D=MILD ANEMIA, NORM ELEC.PH.; 3D=MODRT ANEMIA, Hb-H(BETA TETRADS), HIGH RETIC,4D=GAMMA-4 OR BART Hb,CHF, STILL BIRTH
TIP-BETA THALASSEMIA ELECTROPHORESIS: 1D=INC. Hb F AND A2; 2D=N/A;3D=NORMAL HbF NO TRANSFUSION DEPENDENCE; 4D=N/A
11
Q
TIP-LOW MCV: IRON DEF VS ANEMIA OF CHRONIC DISEASE
A
BOTH LOW FERRITIN; BUT, TIBC IS HIGH IN IRON DEF. AND LOW IN CHRONIC DISEASE
12
Q
TIP- RED CELL DISTRIBUTION OF WIDTH IS INCREASED
A
IRON DEFICIENCY RDW(SMALLER TO BIGGER CELLS ACCOUNTS TO WIDTH)
13
Q
MACROCYTIC ANEMIA+DIETARY DEF OR PSORIASIS AND SKIN LOSS; DRUGS: PHYNYTOIN, SULFA
- DIAGNOSIS
- INITIAL TREAT
A
- FOLATE DEFICIENCY MACROCYTIC ANEMIA
* TREAT WHAT IS DEF.=B12 NEURO, FOLATE=HEME (TREATMENT MAY RESULT IN HYPOKAKEMIA FROM FAST CELL PRODUCTION)
14
Q
MACRO.ANEMIA+ PERNICIOUS ANEMIA,PANCREATIC INSUFF,LOW MEAT,DISEASE DAMAGE TO TERMINAL ILEUM OR STOMACH,DIPHYLLOB.,HIV
- DIAGNOSIS
- P.ASS.
- INITIAL TREAT
A
- VIT B 12 DEFICIENCY
- PERIPHERAL NEUROPATHY, P.COLUMN DAMAGE(VIBRATORY SENSATION)=ATAXIA; AND RARE DEMENTIA, INC. METHYLMALONIC (MMA)
- TREAT WHAT IS DEF.=B12 NEURO, FOLATE=HEME (TREATMENT MAY RESULT IN HYPOKAKEMIA FROM FAST CELL PRODUCTION)
15
Q
HYPERSEGMENTATION OF NEUTROPHILS, HIGH MCV ANEMIA
- DIAGNOSIS
- INITIAL TEST
- INITIAL TREAT
A
- MEGALOBLASTIC ANEMIA: VIT B12 OR FOLATE DEF.
- B12 AND FOLATE LEVELS; INC. LDH AND INDIRECT BILIRUBIN, DEC. RETICULOCYTES, HYPERCELLULAR BONE MARROW, MACROOVALOCYTES, INC. HOMOCYCTEINE
- TREAT WHAT IS DEF.=B12 NEURO, FOLATE=HEME (TREATMENT MAY RESULT IN HYPOKAKEMIA FROM FAST CELL PRODUCTION)
16
Q
- TIP- ALWAYS CONFIRM B12 IF NEAR NORMAL WITH?
- TIP-SCHILLING TEST IS NEVER THE RIGHT ANSWER; PERNICIOUS ANEMIA IS TESTED WITH ANTI INTRINSIC FACTOR AND ANTI PERIETAL ANTIBODIES
- TIP- WHY IS RETICULOCYTE LOW IF CELLS ARE BIG?
- TIP-B12 AND FOLATE CAN ALSO CAUSE?
- TIP- PANCREATIC ENZYMES ARE NEEDED TO?
- TIP- NEUROLOGICAL SYMPTOMES ARE REVERSABLE AT FIRST?
A
- MMA
- TRUE
- THEY ARE DESTROYED AS THET LEAVE THE MARROW
- PANCYTOPENIA
- BREAK CARRIER PROTEINS AND ABSORB B12
- TRUE
17
Q
DEC. Hct, HAPTOGLOBIN; INCREASED:LDH,IND.BILI,RET:HYPERKALEMIA, FOLATE DEF., SLIGHT INCR. IN MCV
*DIAGNOSIS
A
*HEMOLYTIC ANEMIA
18
Q
HEMOLYTIC ANEMIA+AFRICAN,(PAIN:CHEST,BACK,THIGHS) FEVER YOUNGER
- DIAGNOSIS
- P.ASS.
- INTIAL TEST
- ACC TEST
- INITIAL TREAT
A
- SICKLE CELL HEMOLYTIC ANEMIA
- BILE G. STONES, INFECT: ENCAPS, OSTEOMYELITIS(SAL),RETINOPATHY,STROKE,BIGHEART,SKIN ULCERS, AVASCULAR NECROSIS, DACTYLITIS,PAPILLARY NECROSIS
- PERIPHERAL SMEAR(AS DISEASE DOES NOT HAVE SICKLED CELLS)
- Hb ELECTROPHORESIS
- O2,HYDRATION,ANALGESIA; FEVER: ANTIBIOTICS (CEFTRIAXONE,LEVOFLOX); FOLATE; PNEUMCOCCAL VAC.; PHARM: HYDROXYUREA (INC. Hb-F); SEVERE: TRANSFUSE
19
Q
TIP- ASPLEENIC SICKLE CELL SMEAR
TIP- SICKLE TRAIT (AS)
TIP- LOOK FOR APLASTIC CRISIS IN SICKLE CELL
A
- SICKLED CELL, TARGET CELLS, HOWELL JOLLY BODIES
- DOES NOT HAVE SICKLED CELLS, BUT CANNOT CONCENTRATE URINE(ISOSTHENURIA) AND HEMATURIA: NO TX.
- RETICULOCYTE COUNT: PARVO B-19
20
Q
HEMOLYTIC ANEMIA+ INTERMITTENT JAUNDICE, SPLENOMEGALY,FAMILY HX,B.GALLSTONES
- DIAGNOSIS
- INTIAL TEST
- ACC. TEST
- INITIAL TREAT
A
- HEREDITARY SPHEROCYTOSIS
- LOW MCV,INC. MEAN CORPUSCULAR HEMOGLOBIN CONCENTRATION(MCHC), NEG. COOMBS
- OSMOTIC FRAGILITY
- FOLATE, SPLENECTOMY
21
Q
HEMOLYTIC ANEMIA+ CLL,LYMPHOMA,SLE,OR DRUGS: PENICILLIN, ALPHA, METHYLDOPA, RIFAMPIN, PHENYTOIN
- DIAGNOSIS
- INITIAL TEST
- ACC TEST
- INITIAL TREAT
A
- AUTOIMMUNE (WARM OR IgG) HEMOLYSIS
- COOMBS (INDIRECT GETS MORE ANTIBODIES), SMEAR: MICROSPHEROCYTES, NO SCHYSTOCITYS (B.C.- THEY STAY IN SPLEEN)
- COOMBS
- GLUCOCORTICOIDS, IF RECURRENT:SPLENECTOMY,SEVERE ACUTE:IVIG, RITUXIMAB,AZATHIOPRINE, CYCLOPHOSPHAMIDE OR CYCLOSPORINE AFTER SPLENECTOMY
22
Q
TIP- ALTERNATE TX IN AUTOIMMUNE HEMOLYSIS
A
CYCLOPHOSPHAMIDE,CYCLOSPORINE, AZATHIOPRINE, MYCOPHENOLATE MOFETIL
23
Q
HEMOLYTIC ANEMIA+ COLDER PARTS OF BODY WITH SYMPTOMS OF NUMBNESS; BETTER BY WARMING
- DIAGNOSIS
- P.ASS.
- INITIAL TEST
- ACC. TEST
- INITIAL TREAT
A
- COLD AGGLUTININ DISEASE
- EBV, WALDENSTROM MACROGLOBULINEMIA OR MYCOPLASMA PNEUMONIAE
- DIRECT COOMBS
- COLD AGGLUTININ TITER
- STAY WARM, RITUXIMAB THEN PLASMAPHERESIS, PHARM: CYCLOPHOSPHAMIDE, CYCLOSPORINE, OR OTHER IMMUNOSUPPRESSIVE AGENTS
TIP- WHAT DOES NOT WORK FOR COLD AGGLUTININ DISEASE=[STEROIDS AND SPLENECTOMY]
TIP-CRYOGLOBULINS ARE P.ASS.= [COLD AGGLUTININS AND DO NOT RESPOND TO STEROIDS EITHER; HEP-C, JOINT PAIN,GLOMERULONEPHRITIS]
24
Q
X-LINKED, OXIDANT STRESS INFECTION, AFRICAN AMERICAN/MEDITERRANEAN, ANEMIA, JAUNDICE,PHARM USE
- DIAGNOSIS
- INITIAL TEST
- ACC. TEST
- INITIAL TREAT
A
- G6PDD
- SMEAR/METHYLENE BLUE STAIN (HEINZ BODIES AND BITE CELLS), G6PD LEVEL AFTER 1-2 MONTHS OF HEMOLYTIC EVENT
- G6PD LEVEL AFTER HEMOLYTIC EVENT
- AVOID OXIDANT STRESS
25
CHILD INTRAVASCULAR HEMOLYSIS, SCHISTOCYTES,THROMBOCYTOPENIA, RENAL INSUFFICIENCY
* DIAGNOSIS
* INITIAL TEST
* INITIAL TREAT
* (HUS) HEMOLYTIC UREMIC SYNDROME
* PT/PTT ARE NORMAL, NEGATIVE COOMBS, ECOLI 0157:H7 TITERS
* SEVERE: FFP THEN PLASMAPHERESIS, ANTIBIOTICS
26
ADULT, INTRAVASCULAR HEMOLYSIS, SCHISTOCYTES,THROMBOCYTOPENIA, RENAL INSUFFICIENCY, SEIZURES, CONFUSION
* DIAGNOSIS
* INITIAL TEST
* INTIAL TREAT- TTP
* TTP (METALLOPROTEINASE DEFICIENCY) ADAMTS 13
* PT/PTT ARE NORMAL, NEGATIVE COOMBS
* SEVERE: FFP THEN PLASMAPHERESIS, STERIODS
27
EPISODIC DARK URINE IN THE MORNING,PANCYTOPENIA AND IRON DEFICIENCY ANEMIA
* DIAGNOSIS
* INTIAL TEST
* ACC TEST
* INITIAL TREAT
* (PNH) PAROXYSMAL NOCTURNAL HEMOGLOBINURIA (CD 55&59[DECAY ACCELERATING FACTOR ON RBC] DEFICIENCY)
* CBC: PANCYTOPENIA (ANEMIA), FLOW CYTOMETRY (CD55&59)
* FLOW CYTOMETRY
* PREDNISONE (HEMOLYSIS), BONE MARROW TRANSPLANT (CURE), ECULIZUMAB (INACTIVATES C5); THEN FOLIC ACID IF TRANSFUSED
TIP- P.ASS PNH=APLASTIC ANEMIA, MYELODYSPLASIA, ACUTE LEUKEMIA, THROMBOISIS: LARGE VESSELS, HEPATIC VEINS
28
PANCYTOPENIA ANEMIA, HX.-C. INFECTION:HIV,HEP,CMV,EBV, CANCER, RADIATION, CHEMO, B12 DEF.,THYROID:PTU/METHIMAZOLE,SLE,PNH
* DIAGNOSIS
* INITIAL TEST
* ACC. TEST
* INTIAL TREAT
* APLASTIC ANEMIA
* CBC: PANCYTOPENIA, MARROW BIOPSY
* BONE MARROW BIOPSY
* S.THERAPY: TRANSFUS,ANTIBIOTIC AND PLATELETS, BMT(ALLO) <50, ABOVE 50YRS OF NO DONOR: ANTITHYMOCITE GLOBUILIN AND CYCLOSPORINE/TACROLIMUS
TIP- APLASTIC ANEMIA=COULD BE AUTOIMMUNE; HENCE, THE CYCLOSPORINE
29
HEADACHE,BLURRED VISION, TINNITUS, HYPERTENSION, FATIGUE,SPLENOMEGALY, BLEEDING, THROMBOSIS
* DIAGNOSIS
* INTIAL TEST
* ACC. TEST
* P.ASS.
* INTIAL TREAT
* POLYCYTHEMIA VERA
* CBC: HEMATOCRIT >60%, RBC HIGH ALL CELLS HIGH (JAK2 PROTEIN MUTATION DOES NOT REGULATE); LOW ERYTHROPIETIN LEVEL, HIGH:B12
* JAK2 MUTATION TEST
* AML, RENAL CELL CANCER: HIGH Hct + ERYTHROPOIETIN, PRURITIS:AFTER HOT SHOWERS(BASOPHILES), LOW MCV
* PHLEBOTOMY, ASPIRIN (FOR THROMBUS), HYDROXYUREA (LOWERS CELL COUNT), ALLOPURINOL/RASBURICASE, ANTIHISTAMINES
30
BLEEDING, ELEVATED PLATELET COUNT;EXCLUDE:INFECTION,CANCER, IRON DEF.;JAK2 50% OF THE TIME
* DIAGNOSIS
* INITIAL TREAT
* ESSENTIAL THROMBOCYTOSIS
* 60YRS, >1.5MIL=HYDROXYUREA THEN ANAGRELIDE IF LOW RBC RESULT; ASPIRIN(ERYTHRMOMELALGIA)
TIP- ERYTHROMOMELALGIA=PAINFUL, RED HANDS IN ET
31
BLOOD PRODUCTION: IN LIVER&SPLEEN (MEGALY), NUCLEATED TEARDROP RBC; PANCYTOPENIA; MARROW BIOPYS: FIBROSIS
* DIAGNOSIS
* INITIAL TREAT
* MYELOFIBROSIS
| * THALIDOMIDE AND LENALIDOMIDE (TNF-INH)= INCR. MARROW PRODUCTION, TRANSPLANT UNDER 50-55YRS
32
FATIGUE, INFECTION, BLEEDING (WBC NORMAL OR INCREASED) YET INFECTIONS, DIC (MAYBE)
* DIAGNOSIS
* INTIAL TEST
* ACC. TEST
* INITIAL TREAT
TIP- FATIGUE, INFECTION AND BLEEDING SYMPTOMS ARE?
* ACUTE LEUKEMIA
* BLOOD SMEAR SHOWING BLASTS
* FLOW CYTOMETRY (DIFFERENT SUBTYPES ARE DETECTED:CD MARKER CONTROLLED)
* LEUKAPHERESIS; CHEMO(REMOVE BLASTS FROM SMEAR)=INDUCING REMISSION; THEN BMT(IF POOR PROGNOSIS) OR CHEMO AGAIN(IF GOOD PROG.)
TIP=MYELODYSPLASTIC SYNDROME
TIP- AML-M3 P.ASS.?=CHROM 15-17; AUER RODS(EOSINOPHILIC INCLUSION)
33
INITIAL TREAT- AML AND ALL
TIP- PROGNOSIS OF AML OR ALL IS?
INITIAL TREAT- AML M3 SPECIFIC
INITIAL TREAT- ALL
P.ASS. AML-M3?
LEUKAPHERESIS;CHEMO(REMOVE BLASTS FROM SMEAR)=INDUCING REMISSION; THEN BMT(IF POOR PROGNOSIS) OR CHEMO AGAIN(IF GOOD PROG.)
CYTOGENTICS(CHROMOSOMAL CHARACTERISTICS) GOOD=LESS RELAPSE=CHEMO;BAD=MORE RELAPSE=BMT
ALL TRANS RETINOIC ACID(ATRA)
ADD INTRATHECAL CHEMO (MTX) PREVENTS CNS RELAPSE
DIC
34
HIGH WBC-ALL NEUTROPHILS, PRURITUS (BASOPHILS), SPLENOMEGALY(SATIETY), FATIGUE NIGHT SWEATS, AND FEVER
* DIAGNOSIS
* INITIAL TEST
* ACC. TEST
* INITIAL TREAT
* CML
* EXCLUDE(LEUKOMOID REACTION) FROM HIGH NEUTROPHILS, LEUKOCYTE ALKALINE PHOSPHATASE SCORE(LAP) IS LOW; HIGH BASOPHILS;PCR/FISH:BCR-ABL
* PCR/FISH: BCR-ABL (9:22)
* TYROSINE KINASE INHIBITORS (IMATINIB), DASATINIB, OR NILOTINIB; THEN BMT IF POSIBLE (MOST EFFECTIVE)
TIP- CML CBC:=HIGH: NEUTROPHILS, BASOPHILS NORMAL: BLASTS (LESS THAN 5%)
TIP-P.ASS. ACUTE LEUKEMIA (BLAST CRISIS)=CML
35
PANCYTOPENIA; HYPERCELLULAR BONE MARROW; SEVERE INFECTIONS AND BLEEDING, OLDER >60YRS
* DIAGNOSIS
* INTIAL TEST
* INTIAL TREAT
* MYELODYPLASTIC SYNDROME
* CBC: MACROCYTIC ANEMIA WITH NUCLEATED CELLS, LOW BLASTS MARROW: HYPERCELLULAR; SMEAR/STAIN: PELGER-HUET CELLS/RINGED SIDEROBLASTS
* TRANSFUSION;ERYTHROPOIETIN;LENALIDOMIDE(5q DELETE); AZACITIDINE (DECREASES TRANSFUSION)
TIP- BLASTS IN MYELODYSPLASTIC SYNDROME=SEVERITY
36
AGE:>50YRS, BAD B LYMPHOCYTES; SLIGHTLY HIGH WBC, FATIGUE,LYMPHADENOPATHY, SPLEEN/LIVER ENLARGE, INFECTION
* DIAGNOSIS
* INTIAL TEST
* P.ASS.
* INITIAL TREAT
* CLL
* CBC: WBC (~20,000) MOSLTY LYMPH-B&LOW GAMMAGLOB; PARADOXICAL EVENTS:ANEMIA/LOW PLATELETS WHEN LYMPH IS NEEDED*;SMEAR:SMUDGE
* HIGH-GRADE LYMPHOMA (MOST DIE BEFORE)
* INTIAL TREAT- CLL STAGE 0 (ELEVATED WBC) AND STAGE 1 (LYMPHADENOPATHY)=NOTHING
INTIAL TREAT- CLL STAGE 2 (HEPATOSPLENOMEGALY), 3 (ANEMIA), 4 (THROMBOCYTOPENIA)=FLUDARABINE AND RITUXIMAB
INITIAL TREAT- CLL REFRACTORY? MILD? SEVERE INFECTION? AND AUTOIMMUNE:HEMOLYSIS/LOW P.?=CYCLOPHOSPHAMIDE(EFFICACY), CHLORAMBUCIL, IV IMMUNOGLOBULINS, PREDNISONE
TIP- IN CLL ANEMIA/LOW PLATELETS CAN BE FROM CLL OR AUTOIMMUNE, WHICH IS MORE DANGER?=AUTOIMMUNE
37
PANCYTOPENIA, MASSIVE SPLENOMEGALY, MONOCYTOPENIA, DRY MARROW WITH HYPERCELL, MIDDLE AGED MAN
* DIAGNOSIS
* INITIAL TEST
* ACC TEST
* INITIAL TREAT
* CD 11c HAIRY CELL LEUKEMIA
* SMEAR: FILAMENTOUS PROJECTIONS; FLOW CYTOMETRY(CD11c)
* FLOW CYTOMETRY
* CLADRIBINE OR PENTOSTATIN
38
PAINLESS LYMPHADENOPATHY, MAY INVOLVE PELVIC, RETROPERITONEAL, MESENTERIC STRUCTURES, NODES, "B"SX
* DIAGNOSIS
* INITIAL TEST
* INTIAL TREAT
* NON-HODGKIN LYMPHOMA
* EXISIONAL BIOPSY; CBC: NORMAL (LDH MAYBE HIGH=WORSE SEVERITY); STAGING:CT SCAN(CHEST,ABDOMEN&PELVIS),BONE MARROW BIOPSY
* STAGE 1(1LYMPH NODE) 2(2 OR MORE ON SAME SIDE OF DIAPHRAGM) 3. BOTH SIDES OF DIAPH. 4 WIDESPREAD=1&2= LOCAL RADIATION AND SMALL DOSE/COURSE OF CHEMO; 3&4("B"SX)=C.H.O.P+RITUXIMAB(CD20)
TIP- NHL VS CLL=CLL (IS "LIQUID/CIRCULATING IN VESSELS) VS NHL (IS A SOLID MASS)
TIP-NHL (BURKITT AND IMMUNOBLASTIC HAVE THE WORST PROGNOSIS)=TRUE
39
* TIP-COLD NODE=CANCER; WARM NODE=INFECTION(RED AND TENDER)
* TIP- C.H.O.P IS?
* TIP- NHL IS DIAGNOSED AT STAGE: 3&4 80-90% OF THE TIME?
* TRUE
* CYCLOPHOSPHAMIDE; HYDROXYDAUNORUBICIN(ADRIAMYCIN)/DOXORUBICIN; ONCOVIN (VINCRISTIN); PREDNISONE
* TRUE
40
GERD, PEPTIC ULCER FOR YEARS TREATED WITH PEPTOBISMOL; FATIGUE, FEVER, NIGHT SWEATS & WEIGHT LOSS
* DIAGNOSIS
* INTIAL TREAT
* MUCOSAL ASSOCIATED LYMPHOID TISSUE
| * CLARITHROMYCIN AND AMOXICILLIN
41
PAINLESS LYMPHADENOPATHY, CERVICAL AREA NODES, "B" SX, REED-S.CELLS
* DIAGNOSIS
* INTIAL TEST
* INTIAL TREAT
* HODGKIN DISEASE
* EXISIONAL BIOPSY; CBC: NORMAL; STAGING:CT SCAN(CHEST,ABDOMEN&PELVIS),BONE MARROW BIOPSY
* STAGE:1&2 LOCAL RAD/LITTLE CHEMO; 3&4ABVD: ADRIAMYCIN(DOXORUBICIN), BLEOMYCIN, VINBLASTINE, DACARBAZINE
INTIAL TREAT- RELAPSED HODGKIN=
AFTER RADIATION: CHEMO; AFTER CHEMO: EXTRA HIGH CHEMO AND BONE MARROW TRANSPLANT
42
TIP- HODGKIN=REED STERNBERG AND HIGH AMOUNT IS BAD(LYMPHOCYTE PREDOMINANT IS THE BEST PROGNOSIS)
TIP- SIDE EFFECTS OF RADIATION AND CHEMOTHERAPY?
TIP- CHEMO DOSING?
TIP- SIDE EFFECT: DOXORUBICIN
TIP-SIDE EFFECT: VINCRISTINE
TIP-SIDE EFFECT: BLEOMYCIN
TIP-SIDE EFFECT: CYCLOPHOSPHAMIDE
TIP-SIDE EFFECT: CISPLATIN
TRUE
CHEMO=HEART: CAD, (LEUKEMIA,MDS,NHL ONLY 1% PER YEAR) RADATION: RISK OF FUTURE SOLID TUMORS(BREAST,THYROID, LUNG-SCREEN AFTER 8YRS)
TEST HEART WITH (MUGA) MULTI-GATED-ACQUISITION SCAN OR NUCLEAR VENTRICULOGRAM MOST ACC. TEST-FOR EF OF LEFT VENT.
CARDIOMYOPATHY
NEUROPATHY
LUNG FIBROSIS
HEMORRHAGIC CYSTITIS
RENAL AND OTOTOXICITY
43
BONE PAIN, FRACTURES, HYPERURICEMIA, ANEMIA(FULL MARROW WITH PLASMA), RENAL FAILURE(BENCE-JONES), HYPERCALCEMIA
```
DIAGNOSIS
P.ASS.
INITIAL TEST
ACC TEST
INITIAL TREAT
```
* MULTIPLE MYELOMA
* P.ASS.-OSTEOCLAST ACTIVATING FACTOR (OAF) HYPERCALCEMIA; BAD PLASMA CELLS(INFECTIONS/LOW GLOBUILINS)
* XRAY(LYTIC "PUNCHED OUT LESIONS"); SERUM PROTEIN ELECTROPHORESIS(SPEP) SHOWS AN IgG(60%) OR IgA(25%) SPIKE="M" OR CLONE; URINE:BENCE-JONES
HYPERCALCEMIA;BETA2MICRGLOBULIN(SEVERITY);SMEAR(ROULEAUX);INC. BUN/Cr; BMB(PLASMA CELLS >10%) INC. TOTAL PROTEIN; DEC. ANION GAP/INC. CL&BICARB
* BMB: >10% PLAMA CELLS
* 70 USE MELPHALAN;
44
TIP- CAUSE OF DEATH MULTIPLE MYELOMA
TIP- ROULEAUX
TIP- M SPIKE DOES NOT MEAN IgM SPIKE
TIP- TECHNETIUM BONE SCAN=RADIONUCLIDE BONE SKAN AND DOES NOT PICK LYTIC LESIONS; THEY ARE FOR?
TIP- DIPSTICK ANALYSIS IS LIMITED TO REACT WITH ALBUMIN AND WILL NOT SHOW BENCE-JONES; YOU NEED WHAT?
TIP- MGUS (MONOCLONAL GAMMOPATHY OF UNKNOWN SIGNIFICANCE) ALSO GIVES M SPIKE AND IS BENIGN IN OLDER PP. BUT?
INFECTION/RENAL FAILURE
IgG ADHERES RBS TOGETHER
TRUE
INDICATION OF INCREASED UPTAKE WITH OSTEOBLASTIC ACTIVITY
IMMUNOELECTROPHORESIS
1% TRANSFORM INTO MYELOMA AND THE MORE MGUS THE MORE THE CHANCE
45
LETHARGY,BLURRY VISION/VERTIGO, ENGORGED BLOOD VESSES IN THE EYE, MUCOSAL BLEEDING,RAYNAUD PHENOMENON
* DIAGNOSIS
* INITIAL TEST
* INTIAL TREAT
* WALDENSTROM MACROGLOBULINEMIA
* IGM SPIKE (MALIGNANT B CELLS/ HYPERVISCOSITY); CBC:ANEMIA
* ACUTE: PLASMAPHERESIS; CHRONIC: RITUXIMAB OR PREDNISONE&CYCLOPHOS. (PRODUCTION IGM) + BORTEZOMIB OR LENALIDOMIDE (CONTROL CELLS)
46
SUPERFICIAL BLEEDING-EPISTAXIS,GINGIVAL,PETECIAE,PURPURA,MUCOSAL SURFACE:GUMS,VAGINAL BLEED
* DIAGNOSIS
* INITIAL TEST-
* INITIAL TREAT-
* PLATELET BLEEDING: ITP
* EXCLUSION: ANTIPLATELET ANTBODIES(NOT SPECIFIC),ULTRASOUND OR CT EXCLUDES:HYPERSPLENISM, MEGAKARYOCYTES ARE ELEVATED
* 1.NO BLEED,CT:>30000=NOTHING; 2. MILD BLEED,CT:<30000=STEROIDS;
3. RECURRENT:SPLENECTOMY; 4.IF FAILED:ROMIPLOSTIMOR ELTROMBOPAG,RITUXIMAB,AZATHIOPRINE,CYCLOSPORIN,MYCOPHENOLATE
47
TIP-(ISOLATED THROMBOCYTOPENIA:NORMAL HEMATOCRIT&WBC) NORMAL SPLEEN
TIP- ROMIPLOSTIM AND ELTROMBOPOIETIN ARE FOR? AND DOES WHAT?
TIP- ALWAYS VACCINATE: FOR? IN TIP
TIP- BRAIN AND GI COULD BE BOTH PLATELET OR/AND FACTOR BLEED
TRUE
ITP AND IS A THROMBOPOIETIN
NEISSERIA MENINGITIDIS, HAEMOPHILUS INFLUENZAE,
PNEUMOCOCCUS
TRUE
48
HX. OF PARENT+SX W/ BLEEDING-EPISTAXIS,GINGIVAL,PETECIAE,PURPURA,MUCOSAL SURFACE:GUMS,VAGINAL BLEED
* DIAGNOSIS
* INTIAL TEST-
* INTIAL TREAT-
* ONLY FACTOR BLEEDING WITH PLATELET SYMPTOMS ALONE: VON WILLEBRAND DISEASE (AD)
* VWF LEVEL (MAYBE 50%), RISTOCETIN COFACTOR ASSAY: VWF DYSFUNCTION/ACTIVITY;FACTOR VIII ACTIVITY; BLEEDING:INCREASED(RARE)
* DDAVP(DESMOPRESSIN)-RELEASES SUBENDOTHELIAL STORES OF VWF, FACTOR VIII OR VWF CONCENTRATE
49
DEEP BLEEDING- JOINTS AND MUSCLES+ MALE CHILD
* DIAGNOSIS
* INITIAL TEST
* ACC TEST
* INITIAL TREAT
* HEMOPHILIA
* PT&PTT- PTT PROLONGED+MIXING WILL CORRECT PTT; ASSAY FACTOR VIII&IX
* ASSAY FACTOR VIII&IX
* MILD: DDAVP; SEVERE: WITH LOW LEVELS OF FACTOR VIII OR IX
50
PROLONGED BLEEDING WITH TRAUMA OR SURGERY ONLY
* DIAGNOSIS
* INTIAL TEST
* INITIAL TREAT
* FACTOR XI DEFICIENCY
* PT/PTT=PROLONGED PTT; MIXING ASSAY FACTOR XI (GETS BETTER)
* FRESH FROZEN PLASMA (ONLY WITH ACUTE TRAUMA/SURGERY)
51
PROLONGED PTT AND NORMAL BLEEDING TIME BEFORE SURGERY LAB EXAMS
DIAGNOSIS-
INITIAL
FACTOR XII DEFICIENCY
NOTHING
52
DEEP BLEEDING+SUPERFICIAL BLEEDING+(SEPSIS/BURNS/ABRUPTIO PLACENTAE OR AMNIOTIC FLUID EMBOLUS/SNAKE BITE/CANCER/TRAUMA)
DIAGNOSIS-
INITIAL TEST-
INITIAL TREAT-
DISSEMINATED INTRAVASCULAR COAGULATION (DIC)
ELEVATED PT AND PTT; LOW PLATELETS; ELEVATED D-DIMER&FIBRIN SPLIT PRODUCTS; DEC. FIBRINOGEN LEVEL
<50000=PLATELETS AND CLOTTING FACTORS (FFP); THEN CRYOPRECIPITATE IF FFP DOES NOT HELP
53
HYPERCOAGULABLE STATE/THROMBOPHILIA
DIAGNOSIS-
INITIAL TEST-
INITIAL TREAT-
FACTOR LEIDEN MUTATION
ANTIPHOSPHOLIPID & COAGULATION TEST
WARFARIN: TO INR 2-3 FOR 6 MONTHS
54
USE OF UNFRACTIONATED HEPARIN OR LOW MOLECULAR HEPARIN(RARE) 5-10 DAYS AFTER STARTS; VENOUS CLOTS
DIAGNOSIS-
INITIAL TEST-
INITIAL TREAT-
* HIT
* ELISA FOR PLATELET FACTOR IV (PF4) ANTIBODIES OR SEROTONIN RELEASE ASSAY
* STOP ALL HEPARIN; THROMBIN INH:ARGATROBAN,LEPIRUDIN,BIVALIRUDIN; WARFARIN(AFTER DIRECT THROMBIN INH)
55
TIP- DO NOT TRANSFUSE PLATELETS INTO HIT; IT MAY WORSEN THROMBOSIS
TIP- HIT MAY PRESENT WITH BLEEDING(LOW Pt)
TRUE
TRUE
USMLE Step 2 CK
flashcards
Decks in class (9)
# Cards
