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Flashcards in UW Deck (103):
1

Diagnostic criteria of antiphospholipid antibody syndrome

1. clinical + 1 lab must be met
lab: lupus anticoagulant, anticardiolipin antibody, anti-beta-2 gp antibody
2. clinical: arterial or venous vascul thromb, 3 or more consecutive unexpl fetal loses before 10 week, 1 unexplained fetal loss oafter 10 weeks, 1 premature birth of normal neonate befoere 14 week (due to preexlampsia, eclampsia, placental insuf)

2

lupus anticoagulant - PTT

prolonged PTT in vitro --> it will not corect if mixed in a 1:1 dilutionwith normal plasma

3

lupus anticoagulant test

1. Russel viper venom test
2. kaolin cloating time

4

polycytemia vera - treatment

phlobotomy
hydroxyurea --. decreases thrombus

5

polycythemia vera - ESR

decreased

6

CLL - lymph node biopsy vs BM biopsy

biopsy is not needed

7

CLL - diagnostic test

- smagde cells on smear
- flow cytometry
- lymph node or BM biopsy not needed

8

possibility of DVT --> ..... (next step)

compression U/S

9

PE vs DVT on the initiation of anticoagulant

start in PE
confirm with U/S first in DVT

10

epidural spinal cord compression 2ry to cancer - management / MC locations / pain worse at

first steroids --> then MRI --> then maybe radiation + neurosurgery consultation
MC locations: 60% thoracic, 30% lumbosacral
- pain worse at night at recumbent position

11

waldestrom vs MM regarding BM biopsy

MM: more than 10% clonal plasma cells
Wald: more than 10% clonal B cell

12

waldestrom major complciations

lymphadenopathy, HEPATSPLENOMEGALY, bleeding, neuropathy, hyperviscosity

13

2 things unexplain on waldestrom

lymphadenopathy, hepatosplenomegaly

14

how to confirm HIT 2

1. Elisa for PF4 antibodies
2. Seretonin release assay

15

G6PD def - normal G6PD activ level?

may be normal during attack

16

in which leukemia, PCP prophylaxis is indicated

CLL

17

Contraidications of thrombolytics in a massive PE -->

consider mechenical thrombectomy
iliac stenting
surgical thrombectomy

18

contraidications of anticoagulation in PE/DVT --> ...

IVC filter

19

Risk factor for PE from thrombus in the renal vein

nephrotic syndrom

20

SVC - next step

X-ray

21

1st choice for cancer related vomiting

5-HT3 antagonists

22

MCC of folate def in USA

alcohol

23

MCC of inadequate response to EPO in patients with renal failure

iron def

24

Leukemoid reaction vs CML regarding leukocyte count and LAP score

leukemoid: more than 50, high LAP
CML usually more than 100, low LAP

25

leukemoid reaction vs CML regarding type of cells

leukemoid reaction: more mature: metamyelocytes more than myelocytes / no basophilia
CML: less mature: metamyelo less than myelocytes, absolute basophilia

26

ITP - treatment

A. children: skin manifesatation: observe, bleeding: IVIg OR glucocorticoids
B. Adults: if platelets less than 30 without bleeding: observe, if platelets less than 30 or bleeding: IVIg OR glucocorticoids

27

hyperspleenism - platelets number

usually more than 30 --> no bleeding

28

other tests required for ITP

HIV + HCV

29

how to treat anemia of chronic disease

treat the underlying condition (for example for RA, give methotrexate - not EPO)
iron is not beneficial

30

hered spheorcytosis with pain at RUQ?

acute cholocystitis

31

treatment of acute PE or DVT - oral factor Xa inh (abixaban rivaroxaban) vs warfarin

1. oral factor Xa inh has 2-4 hours time of onset and they do not need overal or Lab monitorin
2. Warfarin has 5-7 days onset, need overlap and lab monitorin (PT/INR)

32

PE/DVT - thrombolysis?

only for PE with hemodynamic instability or (rarely) for massive proxima DVT with symptoms and ischemia

33

Trousseau's sign?

hypercoagulability disorder presenting with recurent superficial thrombophlebitis at unusual sites (eg. arms, chest area). It is usually associated with occult visceral malignancy such as pancreatic (MC), stomach, lung, or prostate carcinoma

34

when to do extensive testing for an underlying inerited cause of thrombosis

when patient's history is suggestive:
1. yougner than 45 2. Reccurent DVT 3. multiple or unusual sites 4. Family history

35

Bone scan for the diagnosis of MM

not useful: detects only osteoblastic activity (metastatic tumores)

36

screening test for MM

- serum protein electrophoresis
- urine protein electrophoresis
- free light chain analysis

37

prostate cancer in a patient with bone metastasis with history of orchiectomy

radiation (NO FLUTAMIDE)

38

how to diagnose autoimmune hemolytic anemia

coomb: positive for anti-IgG, anti-C3
coomb: positive for IgM, anti-C3

39

IgM anemia - treatment

avoidance of cold
rituximab +/- fludarabine

40

autoimmune hemolytic anemia - complications

IgG: venous thromboembolisms, lymphoproliferative disorder
IgM: ischemia, periphearl gangrene, lymphoproliferative disorder

41

sideroblastic anemia - size

both normal and micro

42

osteoarthritis - anemia of chronic disease

NO --> it is not a systemic infl condition

43

before preganncy test - suspicion for anemia in the family - initial tests?

african: Hb elctrophoresis + CBC
non african: CBC at the beginning

44

salvage therapy?

treatment when standard therapy fails

45

neoaduvant therapy?

treatment given before standard therapy

46

adjuvant therapy ?

therapy given in addition to standard therapy

47

induction therapy

initial dose of treatment to rapidly kill tumor cells and send the patient into remission

48

consolidation therapy?

after induction therapy with multidrug regimens to further reduce tumore burden

49

maintenance therapy?

after induction and consolidation therapies (or initial standard therapy) to kill any residual tumor cells and keep the patient in remission (eg. daily androgen in prostate cancer)

50

Hair cell leukemia - genetics / hepatomegaly? / lymphadenopathy / prognosis

BRAF mutation
hepatomegaly + lymphadenopathy are both rare
life expectancy is near normal

51

hair cell leukemia - number of WBC

decreased due to BM inflitration
a minority has mild leukocytosis

52

Blood transfusion reactions associated with hypotension (and onset and explain)

1. anaphylactic: sec to minutes
2. sepsis: minutes to hours
3. primary hypotension reaction: transient, in patients with ACEi: within mins (by bradykynin)
4. tranfusion related acute lung injury: noncardogenic pul edema: within 6 hours: causef by donor anti-leukocytes antibodies against recipient neutrophils + pulm endothelial cells

53

indications for washed blood trasfusion

1. IgA def
2. Complement-dependet autoimmune hemolysis
3. Continued allergic reactions (e.g. hives) with red cell transfusion despite antihistamine treatment)

54

indications for irradiated blood transfusion

1. BM trannplant recipients
2. Acquired or congenital cellular immunodef
3. Blood components donated by 1st or 2nd degree relatives

55

indications for leukoreduced blood transfusion

1. Chronically transfused patients
2. CMV negative at risk patients (eg. AIDS, transplants patients)
3. potential transplant recipients
4. previous febrile nonhemolytic reaction

56

MM - renal insuficiency at the time of diagnosis?

in 50%

57

MM - protein gap

elevated (more than 4): it is the difference between total protein and albumin

58

what is needed in the metabolism of homocysteine to methionine

1. folate
2. B12
3. B6

59

HIT 1

nonimmune direct effect of heparin on platelet activation and usually presents within the 1st 2 days of heparin --> platelet then normalises with continued heparin therapy and there are no clinical consequences

60

Patients with asplenia are at risk for fulimnant infection with encapsulated bacteia due to deficits in

antibody response and antibody-mediated pahgocytosis/complement activation

61

cannabinoids in anorexia?

only HIV anorexia
NOT cancer related

62

cancer related anoreia/cachexia syndrome - treatment

progesterone analogues (megestrol acetate + medroxyprogesterone acetate) and corticosterois
(progesterone are preferred due to less SEs)

63

best initial test after suspicion of SCC of head and neck

panendoscopy (triple endoscopy: esophagoscopy, bronchoscopy, laryngoscopy)

64

β symptoms in AML

only fatigue is common

65

the liver can store vit D for .... (time)

30 days
but an acutely ill person with underlying liver disease can become K def in 10 days

66

transplantation graft types and definitions

1. autograft --> from self
2. synergic graft (isograft) --> from identical twin or clone
3. allograft (homograft) --> from nonidentical individual of same species
4. xenograft --> from different species

67

transplant rejection - types and onset (time)

1. hyperacute --> minutes
2. acute --> weeks to months
3. chronic --> months to years
4. graft-vs-host disease --> varies

68

hyperacute transplant rejection - result onset / pathogenesis / treatment

widespread thrombosis of graft vessels --> ischemia/necrosis
onset: within minutes
Pre-existing recipient antibodies react to donor antigen and activate complement (type II hypersensitivity
- graft must be removed

69

acute transplant rejection - mechanism

1. Cellular: CD8 T cells activated against donor MHCs (type IV hypersensitivity reaction)
2. Humoral: antibodies formation (after transplant) --> activate complement

70

acute transplant rejection - results in / onset

vasculitis of graft vessels with dense interstitial lymphocytes infiltrate
onset: weeks to months

71

acute transplant rejection - management

prevent/reverse with immunosuppresant

72

chronic transplant rejection - mechanism

CD4 T cells respond to recipient APCs presentinf donor peptides, including allogenic MCR --> cytokines --> cellular and homural compoments (type II and IV hypersensitivity reactions)

73

chronic transplant rejection - results in / onset

cytokines --> proliferation of vascular SMCs, paremchymal atrophy, Interstitial fibrosis
DOMINATED BY ARTERIOSCLEROSIS
onset: month years

74

chronic transplant rejection - example of organs and results

1. lung --> bronchiolitis obliterans
2. Heart --> accelerated atherosclerosis
3. Kidney --> chronic graft nephropathy
4. Liver --> vanishing bile duct syndrome

75

Graft-versus-host-disease - Mechanism / onset

grafted immunocompompetent T cells proliferate in the immunocompromised host and reject host cells with "foreign" proteins --> severe organ dysfunction (type IV hypersensitivity reaction)
onset: varies

76

Graft-versus-host-disease - requirements to occur

1. the graft must contain immunocommpoment T cells
2. the host must be immunocompromised
3. the recipient must express antigens (eg. MHC or other minor proteins) foreign to the donor

77

Graft-versus-host-disease - clinical manifestation

1. maculopapular rash
2. jaundice
3. diarrhea
4. hepatsplenomegaly

78

Graft versus tumor effect - definition

Donor T-cells eliminate malignant residual host T-cells (graft versus leukemia) or eliminates diverse kinds of tumors.

79

transplant rejection - types, onset (time) and hypersensitvity reaction

1. hyperacute --> minutes --> type 2
2. acute --> weeks to months --> type II (humoral) or IV (cellular)
3. chronic --> months to years --> both IV and IV (humoral and cellular)
4. graft-vs-host disease --> varies --> type IV

80

HIT 2 - management

stop all heparin products
- start direct thrombin inhibitor (argatroban) or fondaparunix

81

HIT 2 clinical features

suspected with heparin exposure more than 5 days + any of the following
1. platelet reduction more than 50%
2. arterial or venus thrmbosis
3. necrotic skin lesions at heparin injection sites
4. acute systemic (anaphylactoid) reactions after heparin)

82

patients with asplenia are at risk for fulminant infection with encapsulated bacteria due to deficits in

antibody response and antibody-mediated phagocytosis/complement activation

83

how to confirm MM

bone marrow biopsy: more than 10% clonal plasma cells

84

TTP management

- plasma exchange
- glucocorticoids
- rituximab

85

osler weber rendu sundrome - mechanism of polycythemia

shunts in the lung

86

vitamin K - store

30 days
- in acutely ill with underlying liver disease: 7-10 d

87

delayed hemolytic blood transfusion reaction

1. mild fever + hemol anema
2. within 2-10 days
3. (+) direct coombs
4. by anamnestic antibody response

88

in the absence of any clear provoking factors (recent procedure, immobilization etc), patients with 1st episode of venous thromboembolism should

be referred for age appropriate cancer screening

89

CO poisoning

high flow 100% O2
- intubation/hyperbaric O2 therapy (sever)

90

giant cell bone tumor - area of the bone

epiphysis

91

heparin vs LMWH - PTT

heparin it is more likley to prolong it

92

CLL - worse prognosis if

1. hepatosplenomegaly
2. anemia + thrombocytopenia
3. multiple chain lymphadenopathy

93

wafarin induced skin necrosis in protein C def - management

immediate warfarin cessation and administration of protein C concentrate

94

MM - immunodef

bone marrow infiltration by neoplastic cells --> alters normal leukocyte population and causes hypogammaglobulinemia

95

MC mechanism of pancytopenia in SLE

peripheral destruction

96

symptomatic patients with autoimmune hemolytic anemia - treatment

high dose steroids

97

methionine level in megaloblastic anemia

decreased

98

immunologic transfusion reaction types (MC?)

1. allergic reaction
2. Anaphylactic reaction
3. Febrile nonhemolytic transfusion reaction (MC)
4. Acute hemolytic tranfusion reaction
5. transfusion related acute lung injury
6. delayed hemolytic

99

tranfusion related acute lung injury

noncardogenic pul edema
within 6 hours
caused by donor anti-leukocytes antibodies against recipient neutrophils + pulm endothelial cells

100

delayed hemolytic blood transfusion reaction

1. mild fever + hemol anema
2. within 2-10 days
3. (+) direct coombs
4. by anamnestic antibody response

101

febrile nonhemolytic reaction

caused by cytokines accumulation during blood storage
- 1-6 hours
- fever + cilld

102

Blood transfusion reaction - acute hemolytic transfusion reaction - intravascular or extravascular hemolysis?

both:
hemoglobinuria (intrav hemolysis)
jaundice (extravascular hemolysis)

103

Blood transfusion reaction - acute hemolytic transfusion reaction - mechanism

Type II hypersensitivity reaction --> intravascular hemolysis (ABO incompatibility) or extravascular hemolysis (host antibody reaction against foreign antigen on donor RBCs)