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HEMATOLOGY/ONCOLOGY ROSH REVIEW EXAM 2024
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HEMATOLOGY/ONCOLOGY ROSH REVIEW EXAM 2024
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HEMATOLOGY/ONCOLOGY ROSHREVIEW EXAM 2024
What is the standard INR range for those on warfarin therapy?
What is the standard INR range for those with valve replacement? - CORRECT
ANSWERS-Warfarin therapy:
2.0-3.0
Replaced valves:
2.5-3.5
What is tx for those with elevated INRs? - CORRECT ANSWERS-<5 w/ no significant bleeding:
Hold warfarin therapy until regulates, start at lower dose when back to therapeutic range
<10 and asymptomatic:
Oral Vitamin K should bring INR down w/in 24 hours
>10 or severe risk for major bleed:
Hold warfarin, give IV Vitamin K
Life threatening bleed:
Fresh Frozen Plasma
What significant complication can result from heparin therapy? - CORRECT ANSWERS-Heparin-induced Thrombocytopenia (HIT)
What are factors that promote sickling in sickle cell disease? - CORRECT ANSWERS-Cold, dehydration, hypoxia, infection, stress, menses, alcohol consumption.
PAROVIRUS B19* can induce aplastic crisis!
What is the most common presentation of sickle cell disease in infants? - CORRECT ANSWERS-Dactylitis!
Infants may be more symptomatic than adults with sickle cell due to their increased levels of HgF early on Which of the following types of hemoglobin does hydroxyurea increase? - CORRECT ANSWERS-HgF! HbF inhibits HbS polymerization, its concentration within each cell and its distribution among all cells influence cell heterogeneity.
Wh/ reduced incidence of painful occlusive crises and needs for transfusion
What is the most common cause of death in adults with sickle cell disease? - CORRECT ANSWERS-Acute Chest Syndrome! Fever, Chest pain, Chest Xray shows pulmonary infiltrate
What is the most common complication of hereditary spherocytosis? - CORRECT ANSWERS-Bilirubin gallstones.
What presents with hx of phototherapy during neonatal period, presenting presently with icteric sclera, jaundice, splenomegaly, Elevated LDH, Elevated
Indirect Bilirubin, and presence of spherocytes on peripheral smear, and negative Coombs test? - CORRECT ANSWERS-Hereditary Spherocytosis
Howell-Jolly bodies also seen on smear; Dense and hyper chromic autoimmune hemolytic anemia
What results in hemolysis after exposure to drugs with oxidant properties that result in oxidative damage to hemoglobin in circulating red cells? - CORRECT ANSWERS-Glucose-6-phosphate dehydrogenase deficiency!
What would a positive Coombs test indicate? - CORRECT ANSWERS-
Autoimmune Hemolytic Anemia! That you have antibodies fighting against RBCs in your blood!
What is one of the most common causes of symptomatic thrombocytopenia in children? - CORRECT ANSWERS-Immune Thrombocytopenia (ITP)
signs of cutaneous bleeding that include petechiae, purpura, and ecchymoses. Mucosal bleeding that involves the nasal passages, buccal and gingival surfaces may also be present. Other than mucocutaneous bleeding, patients usually appear well
What presents in 2-6 year old with recent viral infection and now with petechiae, epistaxis, gingival bleeding, menorrhagia, GI bleed, intracranial bleed?
Tx? - CORRECT ANSWERS-Immune Thrombocytopenia (ITP) Tx:
Supportive --> for children
Platelets (only for severe active bleed or extremely low platelet count)
Corticosteroids
IVIG
Splenectomy
At what age does immune thrombocytopenia present? - CORRECT ANSWERS-
Any age!
What presents with 2-6 year old with recent viral infection, complaining of red spots on skin or easy bruising, petechiae, purpura, and gingival bleeding on exam, platelets <50,000?
Tx? - CORRECT ANSWERS-Idiopathic Thrombocytopenia (ITP)
Tx:
Observation, steroids, IVIG (anti platelet antibodies are the usual causative factors of dx)
What components are contained in cryoprecipitate? - CORRECT ANSWERS-
Factor VIII, XIII, von Willebrand factor (vWF), fibrinogen and fibronectin.
What presents with history of minor trauma causing large amounts of bleeding/hemarthrosis; complaining of spontaneous bleeding episodes involving skin, mucous membranes, and joints?
Labs:
aPTT: Prolonged
PT:
Normal
Tx? - CORRECT ANSWERS-Hemophilia B (Factor IX Deficiency)!
Christmas disease
Tx:
Exogenous Factor IX Concentrate
What presents with depression, irritability, psychosis, anemia (megaloblastic), sensory & motor deficits (absent reflexes and paresthesias),
dementia, nausea, vomiting, diarrhea?
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