New Heme/Onc

If you have a patient you presume is at high-risk for a DVT/PE, what test do you run?

Why not a d-dimer?

-chest x-ray and angiography for PE, US for DVT

-D-dimers are only when there’s no probability of a DVT/PE

Patient has blood smear showing target cells with crystals?

This is a condition swapping glutamic acid to __

-Hemoglobin C disease

-lysine

Chronic use of phenytoin can cause a deficiency of vitamin __, which causes symptoms of __

-A B12 deficiency would cause what kinds of symptoms?

-B9(folate); oral ulcers

-neuro

What cells are seen on histology in patients with Multiple Myeloma?

-plasmacytes

What medication is used for anticoagulation in pregnant women? Why?

MOA?

-heparin; its molecules are too large to cross the placental barrier

-binding to Antithrombin III

What situation is a direct thrombin inhibitor contra-indicated in?

-end-stage renal disease

Gold standard diagnosis for sickle cell disease?

-hemoglobin electrophoresis

If a patient with lupus is presenting with lab work, check the ferritin, iron, and hepcidin. Why?

-in patients with lupus, the chronic inflammation causes increased levels of IL-6, which causes increased hepcidin, binding ferroportin and inhibiting iron transport. So you’ll see increased hepcidin, increased ferritin, low iron, and therefore anemia

If you have a patient with sickle cell, then they get an infections that causes bone infection, it’s safe to assume what pathogen?

-Salmonella

Describe anisocytosis

If a female has this in a blood smear, around her periods, it indicates what?

-great variation in RBC size

-iron-deficiency anemia

First-line management for patients in a sickle cell crisis?

MOA?

Biggest adverse effect?

-hydroxyurea

-increases HbF

-myelosuppression

What medication is used to prevent pathologic fractures, due to metastatic prostate cancer?

MOA?

-Denosumab

-osteoclast inhibitor

What is the mechanism behind physiologic jaundice in newborns?

-deconjugation of bilirubin be beta-glucuronidase and reabsorption into circulation

Skewed vs Normal distribution curves

Remember the order is always mean, median, and mode, and that order climbs the hill

Excessive oozing from an IV line?

Management?

-DIC

-fresh frozen plasma

Hemophilia (A or B) is an (state pattern of inheritance), meaning it’s almost exclusively seen in __

If you have a bleeding disorder in a female, assume it’s __

-x-linked recessive; males

-vWF disease

HUS is generally seen in (children/adults)

TTP is generally seen in (children/adults)

TTP is due to a deficiency of __

-children

-adults

-ADAMTS13

Patient has large vWF multimers?

-TTP

Is vWF classified as a platelet adhesion protein?

YES!

Heinz bodies and bite cells are seen in __

-G6PD deficiency

When are howell-jolly bodies seen?

-asplenia

Bernard-soulier syndrome is a defect in what receptors?

How to distinguish it from vWF disease?

-G Ib receptors

-vWF disease will have normal platelet counts, while this will have decreased platelets

Patients with IM/EBV may develop cold agglutinin disease, which has a Coombs test only positive in __

-this disease pathophysiology involves __

-colder temps(34 Celsius)

-complement C3b

Chronic use of metformin can cause a deficiency of vitamin __, leading to increased levels of what acid?

-B12; methylmalonic