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MRCPI 2 Adult Med > Haematology/Oncology > Flashcards

Haematology/Oncology Flashcards

1
Q

When is platelet transfusion indicated in ITP

A

In the setting of a catastrophic bleed - given alongside high dose steroids and IV Ig

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2
Q

Bacterial contamination of plts is rare T/F

A

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

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3
Q

Mechanism of febrile non hemolytic platelet transfusion rxn

A

leukocyte cytokine presence

Note: common enough, rapid rise in temp following/during tranfusion. Not shocked

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4
Q

In venous sinus thrombosis with evidence of intracranial bleeding anticoagulation should be d/c T/F

A

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

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5
Q

Cornerstone of mgmt of DIC

A

Treat underlying condition

Note: transfusion of plts or plasma components is reserved for those that present with bleeding

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6
Q

First line tx for CML

A

Glivec/imatanib

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7
Q

In a pt on warfarin starting on co-trimoxazole what action is needed?

A

Decreased dose of warfarin

As the abx will increase warfarin levels

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8
Q

In a patient who has been exposed to asbestos what is the latent period to developing mesothelioma?

A

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

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9
Q

In pts with CRC what histopath is needed to use Cetuximab

A

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.

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10
Q

Hypercalcaemia and elevated parathyroid hormone related peptide levels are most commonly associated with which lung malignancy

A

Squamous cell carcinomas

Note: these lesions often necrotic and cavitation

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11
Q

First line treatment of met RCC

A

Sunitinib

NB: often over interferon alpha as superior in improving progression free survival and also less side effects

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12
Q

Inheritance of G6PD

A

X linked

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13
Q

Differiate DIC vs TTP on labs

A

TTP has normal coag and d dimer

Note: decreased fibrinogen and elevated fibrin degradation products is classic in DIC

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14
Q

In the treatment of malignant hyperCa with panidronate when should Ca be rechecked for effect?

A

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

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15
Q

Thrombophilia screen is indicated after first episode of portal vein thrombosis T/F

A

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.

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16
Q

Thrombophilia screen is indicated after skin necrosis on initiation of warfarin therapy T/F

A

T

Skin necrosis on institution of warfarin therapy is indicative of underlying protein C or protein S deficiency

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17
Q

Protein C/S deficiency leads to thrombocytopenia.

A

F - it does not need lead to thrombocytopenia

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18
Q

The presence of splenomegaly in the setting of a raised platelet count suggests a diagnosis of ___

A

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

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19
Q

Microcytic hypochromic red cells are seen on blood film in thalassaemia T/F

A

T

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20
Q

What blood products are used pre op in pts with VWD

A

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

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21
Q

TTP is associated with what?

A

pregnancy
HIV-1 infection
carcinomas

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22
Q

Gold std for diagnosis of pleural malignancy

A

VATS biopsy

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23
Q

5 yr survival in a patient with Dukes C CRC

A

40-50%

Note: C = LN involvement

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24
Q

What are indications for tx for CLL and what is 1st line treatment?

A

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

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25
Q

In DIC what is expected of protein C levels?

A

Circulating levels of activated protein C (aPC) will be reduced

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26
Q

Most common malignancies associated with dermatomyositis

A

bronchogenic
pancreatic
gastrointestinal
breast

27
Q

CA 125 to monitor?

A

Ovarian Ca

28
Q

Ca 19 9 to monitor

A

Pancreatic Ca

29
Q

CEA to monitor

A

CRC or breast Ca

30
Q

Beta-HCG and AFP to monitor

A

Testicular Ca

Note: AFP alone to monitor liver Ca

31
Q

Trastuzumab is used for what type of maligancy?

A

HER 2+

AKA herceptin

32
Q

MEN 1 is associated with phaeochromocytomas

A

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

33
Q

What is the most common presentation of MEN1?

A

HyperCa due to hyperparathyroidism

Note: this is the presentation in about 80%

34
Q

Classic features of MEN1

A

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

35
Q

Features of MEN2a and b

A

MEN2a
Phaeochromocytoma
Medullary thyroid Ca
Parathyroid tumor

MEN2b
Phaeochromocytoma
Medullary thyroid Ca
Marfanoid appearance
Mucosal neuromas

36
Q

Target cells on a blood film in typically found in ___

A

hyposplenism

37
Q

Antimicrobial prophylaxis should a pt receive before starting chemotherapy (for CLL) with fludarabine

A

Septrin AKA co-trimoxazole

Note: prophylaxis against PJP. Continued after chemotherapy until the CD4 counts exceeds 200 cells/mm3

38
Q

Raloxifene is indicated only for primary prevention of breast cancer in postmenopausal women T/F

A

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.

39
Q

Tx of asymptomatic patient follicular lymphoma (grade 1 and 2)?

A

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.

40
Q

In a patient with breast cancer found to have lytic lesion what treatment is indicated to prevent fractures

A

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.

41
Q

What is the anticoagulant recommended for tx of DVT or PE in maligancy/palliative setting?

A

Daily LMWH

42
Q

Most sensitive marker for iron deficiency?

A

Serum ferritin (in the absence of inflammation)

43
Q

Initial investigation of myelofibrosis?

A

Trephine (bone) biopsy

NB: bone marrow aspiration often results in a dry tap.

44
Q

Beta-2-microglobulin has been shown to be predictive of risk of progression of disease in ___

A

myeloma
myelodysplastic syndrome
chronic myeloid leukaemia

45
Q

A common RF for both breast and nasopharyngeal Ca?

A

Alcohol consumption

46
Q

Tx options in SCV obstruction

A

IV steroids
Radiotherapy
Endovascular stenting

47
Q

von Hippel-Lindau syndrome increases the risk of ovarian Ca T/F

A

F

Note: Hereditary non-polyposis colorectal cancer (HNPCC) does increase risk of ovarian Ca

48
Q

Tx of gut associated lymphoid tissue (GALT) lymphoma or gastric MALToma.

A

1st line is Helicobacter eradication therapy

49
Q

Tx of BCR-ABL + ALL

A

Chemotherapy + rituximab + Tyrosine Kinase Inhibitor

50
Q

In transfusion related acute lung injury patients are usually afebrile T/F

A

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.

51
Q

Timing of HIT 1 vs 2

A

HIT 1: within 2 days of starting heparin

HIT 2: 4 to 10 days after starting heparin therapy.

52
Q

MOA fulvestrant?

A

Selective oestrogen receptor down regulator

53
Q

MOA tamoxifen?

A

Partial agonist and antagonist of oestrogen

54
Q

MOA exemestane?

A

Aromatase inhibitor

Note: as is anastrazole

55
Q

4 cancers most frequently associated with hypercalcaemia

A
  1. Myeloma (most commonly)
  2. Breast cancer
  3. Lung cancer
  4. Renal cell carcinoma
56
Q

CD117 (c-KIT) positivity implies what malignancy?

A

Gastrointestinal stromal tumour (GIST)

57
Q

Which is the cell of origin of GISTs?

A

Interstitial cells of Cajal within Auerbach’s plexus

58
Q

About 10% of patients with lymphoma present with autoimmune haemolysis.T/F

A

F

Note: About 10% of patients with CLL present with autoimmune haemolysis.

59
Q

1st line tx of GVHD

A

Good nutrition, weight maintenance and immunosuppression with methylprednisone and cyclosporin.

60
Q

What tumor makes help differentiate seminomatous and nonseminomatous testicular tumours?

A

AFP
It is increased only in patients with nonseminomatous tumours.

Note: beta HCG can be elevated in both

61
Q

Features of von Hippel Lindau

A

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).

62
Q

3 malignancies that most commonly met to brain?

A

Lung cancer
Melanoma
Breast cancer

63
Q

Tx of carcinoid syndrome?

A

Somatostatin analog

Note: after somatostatin (if liver involvement) hepatic artery embolisation

64
Q

How is Pancoast tumor diagnosed?

A

CT thorax

Note: too peripheral to biopsy usually (via bronch for example)

MRCPI 2 Adult Med (15 decks)

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