11. Hematology & Oncology Flashcards
How can bone pain in patients with prostate cancer who have undergone orchiectomy be managed?
Radiation therapy (focal external beam therapy)
How can you differentiate hereditary spherocytosis and autoimmune hemolytic anemia?
Both have spherocytes without central pallor
AIHA: neg family hx and positive Coombs test
HS: pos family hx and negative Coombs test
What microcytic anemia shows target cells on peripheral smear and has normal RBC count?
Tx?
Thalassemia (B thal has elevated HbA2)
No tx for B-thal
Note: Fe def has low RBC count and is microcytic only when Hb <10g/dL
What is the ddx of anterior mediastinal mass?
Eg. male with ant mediastinal mass and elevated AFP and BHCG
4Ts - teratoma (and other germ cell tumors), thymoma, thyroid neoplasm, terrible lymphoma
eg - nonseminomatous germ cell tumor like a mixed germ cell tumor
What pathology can be found in the MIDDLE mediastinum?
Bronchogenic cysts - bengn.
Tracheal tumors, pericardial cysts, lymphoma, LN enlargement and aortic aneurysms of the arch can also be found
How long is there risk of sepsis after splenectomy?
Up to 30 years
Recommend anti-pneumococcal, Haemophilus, and meningococcal vaccines several weeks bf operation. Daily oral penicillin prophy for 3-5 y after splenectomy
Why is a Prussian blue stain done during hemolytic episodes?
positive stain indicates presence of hemoiderin
What are the drugs of choice for stabilizing bony mets to prevent hypercalcemia of malignancy and pathological fractures?
bisphosphonates
What is a common complication of hereditary spherocytosis?
Pigmented gallstones –> acute cholecystitis
Caused by hemolytic anemia
What is the most likely cause of anemia in a patient with prolonged NSAID and aspirin use?
Iron def anemia - NSAIDs and aspirin can cause gastritis and/or gastric ulcers –> chronic GI blood loss and depletion of Fe stores
Confirm dx with upper and lower GI endoscopy
What causes the presence of Howell Jolly bodies in a patient with sickle cell?
Chronic damage and autoinfarction of the spleen leads to functional asplenia by age 5 –> can remove normal nuclear remnants of RBCs.
Patients with CF may develop what heme deficiency?
Vit K def (inc PT and INR, normal aPTT).
CF pts can absorb fats and fat-soluble vit (A,D,E, K) and require pancreatic enzyme replacement and fat-soluble vit supplementation.
DVT in the setting of inc homocysteine should be treated with heparin and warfarin therapy as well as what?
Pyridoxine (B6) - lowers homocysteine levels (cofactor for cystathionine B-synthase) to metabolize homocysteine into cystathionine.
Elevated homocysteine can predispose to VTE
Secondary malignancy is common in pts with Hodgkin lymphoma treated with chemo and radiation. What are a few of the MC secondary solid tumor malignancies?
Lung, breast, thyroid, bone and GI (colorectal, esophageal, gastric)
What can be the earliest manifestation of vaso-occlusive disease in sickle cell disease and presents with the acute onset of bilateral hand and foot swelling and tenderness?
Dactylitis = microvascular occlusion/vaso-oclusive crisis
patients with aggressive heme malignancies are at risk of tumor lysis syndrome when initiated on cytotoxic chemo. What happens to uric acid, phosphate, potassium, and calcium levels? How can you prevent? Consequences of TLS?
HYPER - uricemia, kalemia, phosphatemia
HYPO - calcemia.
Prevent by pretreatment with IV fluids and allopurinal to prevent AKI and cardiac arrhythmias.
Differentiate initial management of suspected DVT vs PE
DVT: wells score and compression US for initial assessment. Confirm dx prior to anticoag
PE: start on anticoag if there are no contraindications while undergoing diagnostic eval.
Fanconi anemia is an autosomal recessive disorder that is the MC congenital cause of what condition? Clinical manifestations of FA? Dx?
Aplastic anemia
Other manifestations: Short, microcephalic, abnormal thumbs, hypogonadism, hypo/hyperpigmented skin, cafe au lait spots, large freckles. Strabismus, low-set ears, middle-ear abnormalities.
Dx: chromosomal breaks o ngenetic analysis
Why might patients with multiple myeloma develop constipation?
Osteolytic bone destruction –> hypercalcemia –> constipation, depression, fatigue.
When on warfarin, the INR should be between 2-3. What does it mean if INR is <2?
What is as equally effective as warfarin in DVT or PE treatment, esp if difficulty in INR monitoring?
Inc risk of clot!
direct factor Xa inhibitors (eg rivaroxaban)
When would whole blood transfusion be indicated rather than packed RBCs?
Whole blood = PRBCs + plasma. Use if pt has severe hemorrhage and needs massive blood transfusion to assist in vol expansion.
PRBCs used in acute GI bleeding for pt with hb <7.
What type of anemia is the MCC of Vit B12 def in whites of norhtern European ancestry. Presents with megaloblatic anemia, atrophic glossitis (shiny tongue), vitiligo, thyroid disease, and neuro abnormalities)
Pernicious anemia (autoimmune condition in which the body’s immune system attacks the actual intrinsic factor protein or the cells in the lining of your stomach that make it.)
All patients with presumed ITP should be tested for what two conditions as platelet counts can be affected by treating the underlying disease?
HIV and hep C.
Thrombocytopenia may be the initial presentation of HIV infection in up to 5-10% of patients.
Differentiate graft vs host disease from graft rejection in a patient with BM transplant
GVHD: activation of donor T lymphocytes (maculopapular rash, diarrhea, abnormal LFTs)
Graft rejection: activation of host T lymphocytes (severe neutropenia and inc risk of infx)
