Hematology Review Questions - CRASH! Medical Review Series 

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.

Question #5: Stool quaiac can lead to false negatives as colon cancers don't always bleed. Would order a colonoscopy and skip the guaiac.

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?

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!

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)

in von willebrands it should be elevated PTT.. which is not the thing here.. ref to question 2

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 .

Very helpful, case studies are the most challenging for us, especially with hematology. Thank you so much.

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 so much as always!!! I'm a Patreon supporter! You're freaking awesome.

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.

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.

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

Omg I'm so happy I found channel. Thank you

Thank you I needed this for my exam preparation😊

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.

#3, how can you tell its TTP HUS and not just HUS?

Any updates on whether or not to use LMWH in the event of HIT, Dr. Bolin?

thank u so much for ur time n great work

In question 1 ans should be B because intrinsic pathway(factors 2 5 7 10) are produced by liver.. Am I right? Please reply

In von willebrand's Factor VIII Is low, which causes elevated PTT

Thank you for posting this video! Very helpful!

Thanks for your great videos! Extremely beneficial!

Thanks lot good class 🎉

thank you so much, these videos are very helpful.

Amazing video! Thank you very much!

very very helpful!!!!! Thanks alot.

Why did not you choose option B ( homocysteine) instead?

Thank you my dear Paul

Thank you very helpful, love from Boston!

Thanks paul great work indeed

Why wouldn't you transfuse pt in #4 before BMB?

congratulation for contribution to practice medicine

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.

thank you so much sir!! you helped very much

Thank you

For Q6, shouldn't it be vinblastine and not vincristine....

I don't understand question one, can someone please explain it for me

Thank you so much!

thank you so much sir god bless you always

Thank you sir

Amazing!!! Thank you!

what a great video!

2020

Thanks alot

great lectures Sir. Tq

souldn't tibc be low in sideroblastic?

Thanks, very helpful :) Love and Respect from Pakistan!

Question 17 seems a bit outdated, who uses gentamicin nowadays anyways?

ptt can be normal or elevated in von willebrand.

From Peru

Love u bro😜😍

Thanks a lot sir