Haematology/Oncology Flashcards
When is platelet transfusion indicated in ITP
In the setting of a catastrophic bleed - given alongside high dose steroids and IV Ig
Bacterial contamination of plts is rare T/F
F - bacterial contamination is actually common due to need to store at 22 degrees
Note: would not expect a rapid rise in temp like you would with an acute febrile non haemolytic rxn
Mechanism of febrile non hemolytic platelet transfusion rxn
leukocyte cytokine presence
Note: common enough, rapid rise in temp following/during tranfusion. Not shocked
In venous sinus thrombosis with evidence of intracranial bleeding anticoagulation should be d/c T/F
F - should be continued, need to prevent propagation of further clots
Note: features of venous sinus thrombosis - headache, photophobia and emesis. Bleeds can occur due to venous congestion
Cornerstone of mgmt of DIC
Treat underlying condition
Note: transfusion of plts or plasma components is reserved for those that present with bleeding
First line tx for CML
Glivec/imatanib
In a pt on warfarin starting on co-trimoxazole what action is needed?
Decreased dose of warfarin
As the abx will increase warfarin levels
In a patient who has been exposed to asbestos what is the latent period to developing mesothelioma?
Typically within 20 yrs of exposure
Note: same for development of asbestosis. Hence if a person has pleural plaques on xray but exposure was > 20 yrs ago not likely to develop mesothelioma or asbestosis
In pts with CRC what histopath is needed to use Cetuximab
K-Ras wild type proven patients
Note: Cetuximab is licensed by NICE in metastatic colorectal cancer for who require downstaging prior to surgical resection of liver metastatic disease.Always given in combination with chemotherapy and causes an acne type rash as its major side effect.
Hypercalcaemia and elevated parathyroid hormone related peptide levels are most commonly associated with which lung malignancy
Squamous cell carcinomas
Note: these lesions often necrotic and cavitation
First line treatment of met RCC
Sunitinib
NB: often over interferon alpha as superior in improving progression free survival and also less side effects
Inheritance of G6PD
X linked
Differiate DIC vs TTP on labs
TTP has normal coag and d dimer
Note: decreased fibrinogen and elevated fibrin degradation products is classic in DIC
In the treatment of malignant hyperCa with panidronate when should Ca be rechecked for effect?
5 -7 days
Note: takes 5-7 days for the drug to take effect. Max dose is 90mg. Use IV fluids in meantime while waiting for bisphosphonate to work
Thrombophilia screen is indicated after first episode of portal vein thrombosis T/F
F
Testing for heritable thrombophilia after a first episode of intra-abdominal vein thrombosis has uncertain predictive value for recurrence; decisions regarding duration of anticoagulant therapy in relation to the results of testing are not evidence based.
Thrombophilia screen is indicated after skin necrosis on initiation of warfarin therapy T/F
T
Skin necrosis on institution of warfarin therapy is indicative of underlying protein C or protein S deficiency
Protein C/S deficiency leads to thrombocytopenia.
F - it does not need lead to thrombocytopenia
The presence of splenomegaly in the setting of a raised platelet count suggests a diagnosis of ___
A myeloproliferative disorder.
Note: the most useful diagnostic test is bone marrow biopsy with ancillary studies. Flow cytometry findings are usually not specific in these disorders
Microcytic hypochromic red cells are seen on blood film in thalassaemia T/F
T
What blood products are used pre op in pts with VWD
Factor VIII concentrate is used to increase the concentration of vWF.
Note:
Purified or recombinant preparations are avoided since they contain only small concentrations of vWF.
In minor trauma, desmopressin (DDAVP) can be used to increase the concentration of VWF
TTP is associated with what?
pregnancy
HIV-1 infection
carcinomas
Gold std for diagnosis of pleural malignancy
VATS biopsy
5 yr survival in a patient with Dukes C CRC
40-50%
Note: C = LN involvement
What are indications for tx for CLL and what is 1st line treatment?
Lymphocyte doubling time of <6 months
Bone marrow compromise ( anaemia, thrombocytopenia, neutropenia)
Autoimmune complications ( immune thrombocytopenia or autoimmune haemolysis)
Disabling B symptoms (weight loss or night sweats).
Tx:chlorambucil
In DIC what is expected of protein C levels?
Circulating levels of activated protein C (aPC) will be reduced
Most common malignancies associated with dermatomyositis
bronchogenic
pancreatic
gastrointestinal
breast
CA 125 to monitor?
Ovarian Ca
Ca 19 9 to monitor
Pancreatic Ca
CEA to monitor
CRC or breast Ca
Beta-HCG and AFP to monitor
Testicular Ca
Note: AFP alone to monitor liver Ca
Trastuzumab is used for what type of maligancy?
HER 2+
AKA herceptin
MEN 1 is associated with phaeochromocytomas
F - MEN 1 is associated with pancreatic tumors ( insulimomas, gastrinomas, VIPomas), parathyroid adenoma and pituitary tumors (mostly prolactinoma)
Note: gastrinoma is most common pNET
MEN 2 and von Hippel Lindau are both assoc with phaeochromocytomas
What is the most common presentation of MEN1?
HyperCa due to hyperparathyroidism
Note: this is the presentation in about 80%
Classic features of MEN1
Associated with 3 Ps
Pancreatic NET
Parathyroid hyperplasia
Pit adenomas
Also Angiofibromas
Note: the hyperparathyroidism is usually due to 4 gland hyperplasia rather than a solitary adenoma
Features of MEN2a and b
MEN2a
Phaeochromocytoma
Medullary thyroid Ca
Parathyroid tumor
MEN2b
Phaeochromocytoma
Medullary thyroid Ca
Marfanoid appearance
Mucosal neuromas
Target cells on a blood film in typically found in ___
hyposplenism
Antimicrobial prophylaxis should a pt receive before starting chemotherapy (for CLL) with fludarabine
Septrin AKA co-trimoxazole
Note: prophylaxis against PJP. Continued after chemotherapy until the CD4 counts exceeds 200 cells/mm3
Raloxifene is indicated only for primary prevention of breast cancer in postmenopausal women T/F
T
Note: not used to treat DCIS. Oestrogen receptor-positive DCIS, tamoxifen therapy for five years in addition to lumpectomy decreases the risk of a new breast cancer event.
Tx of asymptomatic patient follicular lymphoma (grade 1 and 2)?
Can be observed closely
Note: this describes a low grade lymphoma. Intensive chemotherapy is questionable in asymptomatic patients. No long term survival benefit has been demonstrated with this approach. If symptomatic or end organ damage tx would be indicated.
In a patient with breast cancer found to have lytic lesion what treatment is indicated to prevent fractures
IV bisphosphonates (such as zoledronic acid)
Note: evidence demonstrating benefit of oral bisphosphonate therapy such as alendronate in the treatment of bone metastases is conflicting.
What is the anticoagulant recommended for tx of DVT or PE in maligancy/palliative setting?
Daily LMWH
Most sensitive marker for iron deficiency?
Serum ferritin (in the absence of inflammation)
Initial investigation of myelofibrosis?
Trephine (bone) biopsy
NB: bone marrow aspiration often results in a dry tap.
Beta-2-microglobulin has been shown to be predictive of risk of progression of disease in ___
myeloma
myelodysplastic syndrome
chronic myeloid leukaemia
A common RF for both breast and nasopharyngeal Ca?
Alcohol consumption
Tx options in SCV obstruction
IV steroids
Radiotherapy
Endovascular stenting
von Hippel-Lindau syndrome increases the risk of ovarian Ca T/F
F
Note: Hereditary non-polyposis colorectal cancer (HNPCC) does increase risk of ovarian Ca
Tx of gut associated lymphoid tissue (GALT) lymphoma or gastric MALToma.
1st line is Helicobacter eradication therapy
Tx of BCR-ABL + ALL
Chemotherapy + rituximab + Tyrosine Kinase Inhibitor
In transfusion related acute lung injury patients are usually afebrile T/F
F
Note: characterised by respiratory distress, severe hypoxia, fever and a CXR showing perihilar and nodular shadowing in the mid and lower zone, soon after transfusion with no other apparent cause.
Timing of HIT 1 vs 2
HIT 1: within 2 days of starting heparin
HIT 2: 4 to 10 days after starting heparin therapy.
MOA fulvestrant?
Selective oestrogen receptor down regulator
MOA tamoxifen?
Partial agonist and antagonist of oestrogen
MOA exemestane?
Aromatase inhibitor
Note: as is anastrazole
4 cancers most frequently associated with hypercalcaemia
- Myeloma (most commonly)
- Breast cancer
- Lung cancer
- Renal cell carcinoma
CD117 (c-KIT) positivity implies what malignancy?
Gastrointestinal stromal tumour (GIST)
Which is the cell of origin of GISTs?
Interstitial cells of Cajal within Auerbach’s plexus
About 10% of patients with lymphoma present with autoimmune haemolysis.T/F
F
Note: About 10% of patients with CLL present with autoimmune haemolysis.
1st line tx of GVHD
Good nutrition, weight maintenance and immunosuppression with methylprednisone and cyclosporin.
What tumor makes help differentiate seminomatous and nonseminomatous testicular tumours?
AFP
It is increased only in patients with nonseminomatous tumours.
Note: beta HCG can be elevated in both
Features of von Hippel Lindau
Diagnosis is based on haemangioblastomas of CNS or retina, and the presence of one associated VHL tumour (renal cell carcinoma, islet cell tumours and adenomas).
3 malignancies that most commonly met to brain?
Lung cancer
Melanoma
Breast cancer
Tx of carcinoid syndrome?
Somatostatin analog
Note: after somatostatin (if liver involvement) hepatic artery embolisation
How is Pancoast tumor diagnosed?
CT thorax
Note: too peripheral to biopsy usually (via bronch for example)
