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First Aid/
First Aid for the USMLE Step 2 CK (8th Ed.)/
7 - Hematology/Oncology - Page 151Ace Your First Aid for the USMLE Step 2 CK (8th Ed.) Classes and Exams with Picmonic: #1 Visual Mnemonic Study Tool for Medicine (MD/DO) Students
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First Aid for the USMLE Step 2 CK (8th Ed.) | Medicine (MD/DO) School Study Aid
Coagulation Cascade Overview
- Secondary Hemostasis
- Intrinsic Pathway
- Partial Thromboplastin Time (PTT)
- Heparin
- Extrinsic Pathway
- Prothrombin Time (PT)
- Warfarin
- Common Pathway
- Thrombin
- Convert Fibrinogen to Fibrin
- Stabilizes the Platelet Plug
2 mins
Heparin Mechanisms
- Mechanism of Action
- Short Half-life
- Antithrombin Activation Cofactor
- Decrease Thrombin, Factor Xa
- Side Effects
- Bleeding
- Heparin Induced Thrombocytopenia (HIT)
- Antidote
- Protamine Sulfate
2 mins
Heparin Induced Thrombocytopenia (HIT)
- Pathophysiology
- 5-10 Days After Heparin Exposure
- Heparin-Platelet Factor 4 Complex
- Autoantibodies Form Against Complex
- Heparin-Platelet Factor 4-Antibody Complex Binds Platelets
- Platelet Aggregation
- Procoagulant Release
- Symptoms
- Thrombocytopenia
- Diagnosis
- Serotonin Release Assay (SRA)
- Treatment
- Stop Heparin, Start Direct Thrombin Inhibitor
2 mins
INR Lab Value
- 0.8-1.2 Normal Range
- Warfarin
- 2.0-3.0
1 min
Warfarin Antidotes
- Antidotes
- Vitamin K
- Fresh Frozen Plasma
59 secs
Enoxaparin (Lovenox)
- Mechanism of Action
- Inhibits Clotting Factors
- Factor Xa
- Indications
- Clot Formation Prevention
- Side Effects
- Heparin Induced Thrombocytopenia (HIT)
- Bleeding
- Considerations
- Medication Education
- Subcutaneous Injection
- 2 Inches from Umbilicus or Incisions
- Antidote
- Protamine Sulfate
2 mins
Heparin Indications
- Indications
- Acute Coronary Syndrome (ACS)
- Prophylaxis
- Pulmonary Embolism
- Atrial Fibrillation
- Used during Pregnancy
1 min
Warfarin
- Mechanism of Action
- Interferes with Vitamin K-dependent Clotting Factors
- Extrinsic Pathway
- Bridge with Heparin
- Indications
- Chronic Anticoagulation
- Side Effects
- Bleeding
- Necrosis
- Cytochrome P450
- Contraindications
- Pregnancy
- Antidote
- FFP + Vitamin K
2 mins
PT/PTT Lab Values
- Prothrombin Time (PT)
- 10-14 seconds
- Activated Partial Thromboplastin Time (PTT or aPTT)
- 25-35 seconds
1 min
Von Willebrand Disease
- Mixed platelet and coagulation disorder
- Mechanism
- Autosomal Dominant Condition Leading to Reduced vWF
- Defect in platelet plug formation
- Labs
- Increased Bleeding Time
- PTT increased
- Factor VIII decreased
- Normal platelet count
- Treatment
- DDAVP (synthetic vasopressin)
1 min
Disseminated Intravascular Coagulation (DIC)
- Pathophysiology
- Bleeding State
- Activation of Clotting Factors
- Deficiency of Clotting Factors
- Causes
- Sepsis
- Trauma
- Obstetric Complications
- Acute Pancreatitis
- Malignancy
- Nephrotic Syndrome
- Transfusion
2 mins
Hemolytic Uremic Syndrome (HUS)
- Children
- Pathophysiology
- Preceded by Acute Diarrheal Illness
- Endothelial Damage
- Classic Triad of Symptoms
- Microangiopathic Hemolytic Anemia (MAHA)
- Thrombocytopenia
- Renal Failure
- Labs
- Helmet cells
- LDH
- Treatment
- Dialysis
- Supportive
2 mins
Anemia Lab Values
- Iron Deficiency Anemia
- Serum Iron Decreased
- Transferrin Increased
- Ferritin Decreased
- % Transferrin Saturation Decreased
- Pregnancy and OCP Use
- Serum Iron Normal
- Transferrin Increased
- Ferritin Normal
- % Transferrin Saturation Decreased
- Anemia of Chronic Disease
- Serum Iron Decreased
- Transferrin Decreased
- Ferritin Increased
- % Transferrin Saturation Decreased or Normal
- Hemochromatosis
- Serum Iron Increased
- Transferrin Decreased
- Ferritin Increased
- % Transferrin Saturation Increased
3 mins
Iron Deficiency Anemia
- Causes
- Malnutrition/Malabsorption
- Hemorrhage
- Signs
- Microcytic, Hypochromic Anemia
- Decreased Heme Synthesis
- Labs
- Decreased Reticulocytes
- Decreased Ferritin
- Increased Red Cell Distribution Width (RDW)
- Poikilocytosis
- Anisocytosis
- Increased Central Pallor
2 mins
Vitamin B12 (Cobalamin) Deficiency Causes
- Causes
- Vegans
- Pernicious Anemia
- Gastric Bypass Surgery
- Malabsorption
- Sprue
- Enteritis
- Crohn's Disease
- Diphyllobothrium latum
4 mins
G6PD Deficiency
- X-linked Recessive
- Hemolytic Anemia
- Inflammatory Response
- Fava Beans
- Sulfonamides
- Primaquine
- Anti TB Drugs
- Heinz Bodies
- Bite Cells
- Prevalent Among African Americans due to Increased Malarial Resistance
2 mins
G6PD Mechanism
- Turns NADP+ to NADPH
- NADPH Used by Glutathione Reductase
- Detoxifies Free Radicals and Peroxides
- X-linked Recessive
2 mins
Hereditary Spherocytosis Disease
- Northern Europeans
- Mechanisms
- Autosomal Dominant
- Spectrin/Ankyrin Deficiency
- Spherocyte Formation
- Hemolytic Anemia
- Symptoms
- Bilirubin Gallstones
- Jaundice
- Splenomegaly
3 mins
Hereditary Spherocytosis Diagnosis & Treatment
- Labs
- Increased MCHC
- Spherocytes
- Normocytic Anemia
- Diagnosis
- Eosin-5-Maleimide (EMA) Binding Test
- Osmotic Fragility Test
- Glycerol Lysis Test
- Treatment
- Folic Acid
- Splenectomy
2 mins
Folate Deficiency
- Clinical Features
- Macrocytic Anemia
- Megaloblastic Anemia
- Etiologies
- Malabsorption
- Dietary
- Tea and Toast
- Alcoholics
- Medication-induced
- Methotrexate
- Trimethoprim
- Increased Requirement
- Hemolytic Anemia
- Pregnancy
2 mins
Sickle Cell Anemia (Management)
- Long Term Treatment
- Hydroxyurea
- Bone Marrow Transplant
- Folate
- Acute Treatment
- Exchange Transfusion
- Prophylaxis
- Penicillin Prophylaxis
1 min
Sickle Cell Anemia (Mechanism)
- Intrinsic Normocytic Hemolytic Anemia
- Point Mutation
- Autosomal Recessive
- African American
- Dehydration or Decreased O2
- Newborns Asymptomatic
- Heterozygote Malarial Resistance
2 mins
Sickle Cell Anemia (Signs and Complications)
- Signs
- Crew-cut on Skull X-ray
- Complications
- Auto-splenectomy
- Painful Crisis
- Aplastic Crisis
- Splenic-sequestration Crisis
- Hyper-hemolytic Syndrome
- Renal Papillary Necrosis
- Salmonella osteomyelitis
- Pulmonary Hypertension
- Hyposthenuria
2 mins
Beta Thalassemia
- Mechanism
- Microcytic, Hypochromic Anemia
- Mediterranean Populations
- Decreased Beta-Globin
- Beta-Thalassemia Minor
- Increased HbA2
- No Intervention
- Beta-thalassemia Major
- Blood Transfusions
- Hemochromatosis
- Crew-cut on Skull X-Ray
- Diagnosis
- Electrophoresis
2 mins
Transfusion Reactions
- Acute Hemolytic
- Febrile, Non-Hemolytic
- Mild Allergic
- Anaphylactic
- Circulatory Overload
- Sepsis Reaction
- Transfusion-Related Acute Lung Injury (TRALI)
- Massive Blood Transfusion
2 mins
Polycythemia Vera Labs
- Lab Findings (The 4 H's)
- Hypervolemia
- Histaminemia
- Hyperviscosity
- Hyperuricemia
- Diagnosis
- Elevated Hemoglobin or Hematocrit
- Positive Jak2 Mutation
1 min
Polycythemia Vera Disease
- Pathophysiology
- JAK2 Mutation leading to increased red blood cells
- Tyrosine Kinase
- Symptoms
- Erythromelalgia
- Pruritus
- Often After Hot Shower
- Headache
- Treatment
- Phlebotomy
- Aspirin
1 min
Acute Lymphoblastic Leukemia (ALL)
- Ages < 15
- May Present with Bone Marrow Involvement in Children
- Mediastinal Mass in Adolescents
- TdT Positive
- CALLA Positive
- t(12;21) Better Prognosis
- Spread to CNS and Testes
- Most Responsive to Chemotherapy
2 mins
Acute Myelogenous Leukemia (AML)
- Myeloblasts Increase on Peripheral Smear
- Median Onset 60 Years
- T 15;17 M3 Subtype
- Auer Rods
- Disseminated Intravascular Coagulation (DIC) is a Common Presentation
- M5 Gum Infiltration
- Responds to Vitamin A
3 mins
Chronic Lymphocytic Leukemia (CLL)
- Signs and Symptoms
- Age > 60 Years
- B Cell Neoplasm
- Smudge Cells
- Often Asymptomatic
- Cold IgM Autoimmune Hemolytic Anemia
- Warm IgG Autoimmune Hemolytic Anemia
- Richter's Transformation
3 mins
Chronic Myelogenous Leukemia (CML)
- Pathophysiology
- BCR-ABL
- 9;22 Translocation
- Philadelphia Chromosome
- Signs & Symptoms
- Tyrosine Kinase
- Low Alkaline Phosphatase
- Splenomegaly
- Considerations
- Blast Crisis
- Age 30 to 90 Years
- Responds to Imatinib
3 mins
Hairy Cell Leukemia
- Pathophysiology
- Mature B Cell Tumor
- Signs and Symptoms
- Splenomegaly
- Diagnosis
- Flow Cytometry
- Cells Have Filamentous Hair-Like Projections
- Stains TRAP Positive
- Dry Tap on Bone Marrow Aspiration
- Treatment
- Cladribine
- Pentostatin
2 mins
Hodgkin Lymphoma Pathophysiology
- Pathophysiology
- Reed-Sternberg Cells
- Binucleate
- Owl's Eyes Appearance
- CD 15 and CD 30
- B Cell Origin
- Bimodal Age Distribution
2 mins
Hodgkin Lymphoma Signs & Symptoms
- Signs and Symptoms
- Localized Single Group of Lymph Nodes
- Contiguous Spread
- Constitutional B Symptoms
- Low-Grade Fever
- Night Sweats
- Weight Loss
2 mins
Multiple Myeloma Pathophysiology
- Pathophysiology
- Monoclonal Plasma Cell Cancer
- Clock Face Chromatin
- Diagnosis
- M Spike on Protein Electrophoresis
- Increased IgG and IgA
- Fried Egg Appearance (BM Biopsy)
- Rouleaux Formation
- Stacked RBC's
- Bence Jones Protein
2 mins
Multiple Myeloma Signs and Symptoms
- Signs and Symptoms
- Increased Susceptibility to Infection
- Back/Bone Pain
- Punched Out Lytic Bone Lesions
- Hypercalcemia
- Primary Amyloidosis
- Renal Insufficiency
- Anemia
2 mins
Amyloidosis
- Etiologies
- Primary
- Multiple Myeloma
- Secondary
- Tuberculosis (TB)
- Rheumatoid Arthritis
- Pathology
- Congo Red Stain
- Apple Green Birefringence
- Complications
- Nephrotic Syndrome
2 mins
Antithrombin Deficiency
- Characteristics
- Autosomal Dominant
- Increased Thrombin and Factor X
- Heparin Resistance
- Hypercoagulability
- Diagnosis
- Family History
- Normal PT, PTT, and Bleeding Time
- Antithrombin-Heparin Cofactor Assay
- Management
- Factor Xa Inhibitors
- Direct Thrombin Inhibitors
- Low Molecular Weight Heparin
- Antithrombin Replacement
3 mins
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