Hematology Review Questions - CRASH! Medical Review Series
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- čas přidán 20. 11. 2015
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(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)
Great video and great job... In question 16 you mentioned how LMW heparin was used instead of UFH to reduce instances of HIT. The pathogenesis in HIT is antibodies due to PF4 which is a platelet factor. When HIT develops, there is cross reactivity to LMW heparin too, so we use DTI like bivalirudin and lepirudin. In a normal patient, we could choose between any of the two. However, in patients in Renal failure we choose Bivalirudin since it is hepatically metabolized and in patients in Hepatic failure we choose Lepirudin since it is metabolized in the kidneys.
Very helpful, case studies are the most challenging for us, especially with hematology. Thank you so much.
Question #5: Stool quaiac can lead to false negatives as colon cancers don't always bleed. Would order a colonoscopy and skip the guaiac.
Thank you so much as always!!! I'm a Patreon supporter! You're freaking awesome.
Omg I'm so happy I found channel. Thank you
Thank you for posting this video! Very helpful!
Thank you I needed this for my exam preparation😊
Thanks for your great videos! Extremely beneficial!
thank you so much, these videos are very helpful.
Thank you very helpful, love from Boston!
Thank you Paul. For number 2, I also eliminated BSS based on the fact that it is less common than vWF. But I think BSS is also normally associated with low platelet count (correct me if I'm wrong)
thank u so much for ur time n great work
Thanks paul great work indeed
Amazing video! Thank you very much!
In the UK, with regard to Q5, we would not do a stool guaic test (focal occult blood test) due to high false negative rate, so colonoscopy and endoscopy is usually performed in any older male with IDA. Great video!
Similarly, in the UK with macrocyctic anaemia, we would typically measure directly the B12 and folate levels. Along with antibody screening for pernicious anaemia (anti-intrinsic factor and anti-parietal cells)
very very helpful!!!!!
Thanks alot.
Thank you my dear Paul
thank you so much sir!! you helped very much
Any updates on whether or not to use LMWH in the event of HIT, Dr. Bolin?
Amazing!!! Thank you!
congratulation for contribution to practice medicine
what a great video!
Thank you so much!
Answer to Question # 17 --- D is a better answer . IV Vancomycin + Aztreonam has broader coverage compared to IV Amp+Gent . The latter combination might be good for urosepsis or listeriosis where as the former combination also covers MRSA/MSSA in addition to gram negative rods and is a better empiric choice .
Thanks lot good class 🎉
Can you please explain how the patient in question 3 has TTP????? No CNS symptoms, no clinical thromboses, no ADAMST13 deficiency, he's a young person with infectious diarrhea, a classic setup for HUS, and microangiopathic HA and some renal failure. Nothing points definitively to TTP and since the two are treated differently, how can you call this TTP needing pheresis and not just HUS? Is it the decreased platelet count?
same doubt
I guess it was the fever.
@@eugeniosramos If you think it's HUS - then it has to have past medical history of shigella toxin or ecoli (d/t abx for ecoli) or else it is TTP - they both share similar sx but HUS gotta have more details about Shigella toxin
Valerie Curtis to my understanding, every patient with TTP will have BOTH a microangiopathic HA and thrombocytopenia (kind of obvious). Neuro, renal dysfunction, and fever are the other 3 potential manifestations in the pentad
thank you so much sir god bless you always
I love these videos. I'm not a physician but worked for Oncologists/Hematologists for 4 years and during that time I learnt a lot from them cause I asked a lot of questions about all patients cases I set up appointments for.
in von willebrands it should be elevated PTT.. which is not the thing here..
ref to question 2
I thought only bleeding time would increase since all the factors are normal, no?
ivan damara Not exactly. There's a minor FVIII deficiency in von Willebrand disease. However, PTT may be normal/raised.
The absence of this would not exclude vWD, though its presence would make it even more likely.
Exactly as vWF disease factor 8 stability will be low then intrinsic pathway defected so increase aPTT
Why wouldn't you transfuse pt in #4 before BMB?
Question 9, isn't the most specific test for multiple myeloma plasma cell >10%, because you can have isolated m spike without multiple myeloma?
Thank you
Thanks a lot sir
great lectures Sir. Tq
Thanks alot
In von willebrand's Factor VIII Is low, which causes elevated PTT
Thank you very much! :) I have a small question. In question 3, how do you differentiate whether it is TTP or HUS? As it's a 15 year old who presents with diarrhea, HUS is more likely. So if it's HUS, the answer would be Inpatient observation.
+Sumiththa Mannapperuma i agree. I also believe it to be HUS. Young child with history of GI infection and lack of fever and/or neurological involvement sheers me towards HUS. The child will need inpatient observation and support. 50% of patients require dialysis.
If it was an adult with those labs along with neurological symptoms i would go for TTP and plasmapharesis.
I thought TTP is when there is fever and altered mentation in addition to hemolysis, uremia and thrombocytopenia
#3, how can you tell its TTP HUS and not just HUS?
For question 5, i think an initial test is stool guaiac, but regardless of result, wouldn't you have to still do colonoscopy. If its positive, you do colonoscopy, but if its negative you still do colonoscopy.
Thanks, very helpful :)
Love and Respect from Pakistan!
at question 10, wouldn't it just be easier to test vitamin b12 and folate?
Yes you are correct. Here's, copy/pasted from Medscape, the situation where you would have an application for them:
"The reference range of vitamin B-12 is typically wide. The lower end of the normal level is associated with clinical diseases due to vitamin B-12 deficiency. Therefore, upon clinical suspicion of vitamin B-12 deficiency in the setting of low normal laboratory values, MMA and homocysteine testing should be performed, since these tests are considered to be more sensitive metabolic markers of vitamin B-12 status."
I don't understand question one, can someone please explain it for me
Why did not you choose option B ( homocysteine) instead?
souldn't tibc be low in sideroblastic?
the cause of thrombocytopenia mentioned for TTP is not right they are not clumped causing them being apparantly low by the machine. They are bound to ULVWF and then activated causing microthrombi and they are cleared from circulation..they are truely decreased not falsly counted by the machine...this is very important
For Q6, shouldn't it be vinblastine and not vincristine....
In question 1 ans should be B because intrinsic pathway(factors 2 5 7 10) are produced by liver..
Am I right? Please reply
I could be intrinsic pathway but because factors 2,7,9,10 are vitamin K dependent and are produced the liver. Those factors you listed are all extrinsic pathway and common pathway.
Love u bro😜😍
2020
On question 6 it's not stage IIB, one of nodes is on left the other one is on right side, that's stage IIIB.
No because the diaphragma is the border. Both nodes are above the diaphragma and therefore we stage IIB
From Peru
Question 17 seems a bit outdated, who uses gentamicin nowadays anyways?
ptt can be normal or elevated in von willebrand.
Thank you sir