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hem/onc Flashcards

1
Q

Surveillance for cervical cancer

A
  • H&P q3 months for first 2 years, then q6 months for years 2-5
    (most recurrences are symptomatic. There’s no indication that routine imaging with CT or US results in better outcomes than clinical monitoring)
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2
Q

Management of locally advanced anal cancer

A

Combined chemoradiotherapy (often curable, avoiding surgery)

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3
Q

Management of pt with DLBCL and residual mass that has responded well to chemo

A
  • observation with serial CT scanning (probably represents scar tissue rather than viable tumor. Also – bulky lymphoma masses often don’t show complete resolution by CT)
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4
Q

Duration of increased risk for infection after HSCT

A

6-12 months after (compromised function of neutrophils and lymphocytes)

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5
Q

GVHD occurs in which transplant type

A

Allo NOT auto’s

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6
Q

Management of a rapidly enlarging lymph node in patient with history of follicular lymphoma

A
  • biopsy (rule out transformation. Transformation to DLBCL occurs in 30% of patients with follicular lymphoma)
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7
Q

Indication for olaparib in ovarian cancer

A
  • patients with germline BRCA-mutated advanced ovarian cancer previously treated with 3 or more lines of chemo
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8
Q

To watch out for with weight based lovenox dose

A

DON”T exceed max dose for obese patients

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9
Q

Warfarin reversal in patients experiencing severe bleeding or requiring urgent surgery

A

Four-factor PCC + vitamin K

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10
Q

Potential adverse effect of 4-factor PCC

A

VTE

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11
Q

What to think when sickle cell patient presents with isolated anemia

A

Parvovirus (preferentially affects erythrocyte precursors in the bone marrow, causing transient pure red cell aplasia)

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12
Q

When vitamin k deficient patients see improvement in coagulopathy following vitamin k administration

A

Within 1 day

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13
Q

Management of metastatic hormone receptor-positive, HER2-negative breast cancer

A

anti-estrogen therapy + palbociclib

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14
Q

Management of MDS requiring frequent transfusions

A

Lenalidomide

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15
Q

What are the goals of MDS treatment

A
  • Relieve transfusion dependence

- Prevent transformation to AML

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16
Q

Caveats to know about using hypomethylaging agents for MDS

A
  • both azacitidine and decitabine worsen blood counts initially
  • may take up to 6 months to show an effect
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17
Q

When essential thrombocythemia needs to be treated

A

1) Patients older than 60

2) VTE

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18
Q

Treatment of essential thrombocythemia

A

Aspirin + hydroxyurea

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19
Q

Most significant complications of ET

A

1) Thrombosis (arterial more common than venous)
2) Hemorrhage
3) Progression to myelofibrosis
4) Transformation to acute leukemia

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20
Q

Drugs that are frequently the cause of drug-induced hemolytic anemia

A

Antibiotics (CTX commonly) (Thought that ceftriaxone may become affixed to the erythrocyte membrane, leading to an immune reaction resulting in erythrocyte hemolysis)

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21
Q

Positive direct antiglobulin test indicates

A

Autoimmune hemolysis

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22
Q

Spherocytes on peripheral blood smear indicate

A
  • Hereditary spherocytosis

- *Autoimmune hemolysis

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23
Q

G6PD heme effect

A

Acute hemolysis

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24
Q

G6PD inheritance and clinical relevance

A
  • x-linked recessive (thus it is uncommon in women)
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25
Q

What is cold agglutinin disease?

A
  • autoimmune hemolytic anemia that is positive for C3

- read

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26
Q

Cold agglutinin disease triggers

A
  • lymphoproliferative disorders
  • Mycoplasma pneumonia
  • EBV
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27
Q

When to NEVER perform hereditary thrombophilia evaluation

A
  • Never in acute setting (during VTE diagnosis)
  • Never while on anticoagulant therapy (delay at least 2 weeks after discontinuation of anticoagulant therapy)
  • (except for testing for genetic mutations)
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28
Q

Indications for hereditary thrombophilia evaluation

A
  • VTE in unusual sites
  • recurrent idiopathic thrombosis
  • patients younger than 45 with unprovoked VTE
  • clear family history of VTE
  • patients with warfarin-induced skin necrosis
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29
Q

Kidney sequelae of TLS

A

Uric acid nephropathy

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30
Q

Rasburicase efficacy

A
  • rapid onset

- can rapidly lower urate levels

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31
Q

Pre-operative management of anemia

A
  • Iron studies (anemia predicts perioperative blood transfusion requirements)
    (should be treated with oral iron prior to surgery and source needs to be determined and corrected before surgery)
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32
Q

Term for DVT associated with acute limb ischemia

A

Massive DVT

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33
Q

Management of suspected pseudothrombocytopenia

A

Repeat platelet count in a heparinized blood specimen

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34
Q

Cause of psuedothrombocytopenia

A

Antibodies directed against the anticoagulant ethylenemdiaminetetraaacetic acid

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35
Q

Management of lobular carcinoma in situ

A

Chemoprophylaxis with antiestrogens (tamoxifen or raloxifen or AI)

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36
Q

Problem with severe autoimmune hemolytic anemia

A
  • autoantibody typically reacts against all erythrocytes so a completely crossmatch-compatible unit may be impossible to find
37
Q

Blood transfusion in autoimmune hemolytic anemia

A

Transfuse crossmatch-incompatible blood (The autoantibody typically reacts against all erythrocytes so a completely crossmatch-compatible unit may be impossible to find, even O negative)

38
Q

Workup of patient presenting with mucocutaneous bleeding (epistaxis, gum bleeding) and normal CBC

A

Platelet Function Analyzer-100 to evaluate for acquired platelet dysfunction

39
Q

Fibrinogen deficiency is typically seen in

A

1) DIC

2) Liver disease

40
Q

Hemoglobin electrophoresis in SCD

A
  • Pretty much all HbS (Greater than 90% HbS)

- no HbA

41
Q

How to test for hereditary thrombophilia in someone on lifelong AC

A
  • Temporarily stop AC and test 2 weeks later

* Never test in acute setting or while pt is on AC

42
Q

Alpha-thalassemia trait on hemoglobin electrophoresis

A
  • normal electrophoresis pattern (electrophoresis isn’t a measure of quantity, it’s of hemoglobin function – with trait there is inadequate production but hemoglobin A is otherwise normal and thus will migrate in a normal pattern)
43
Q

Alpha-thalassemia trait lab features

A
  • chronic microcytic anemia

- Hgb around 10

44
Q

Management of thalassemia in general

A
  • supplemental folate

- NO iron (they have increased ability to absorb iron, which can lead to iron overload)

45
Q

Radiation in general for NSCLC

A
  • adjuvant used after surgery with negative margins
  • combined CRT is used as primary treatment for stage III with mediastinal involvement because these patients typically don’t fare well with surgery
46
Q

Transferrin saturation threshold for HH screening

A

45%

47
Q

RILI is

A

Radiation-induced lung injury

48
Q

2 main types of RILI

A

Radiation pneumonitis + radiation fibrosis

49
Q

Incidence of RILI depends

A
  • area radiated
  • technique (SBRT less likely, proton beam therapy)
  • concurrent chemo (several chemo drugs are known sensitizers to radiotherapy)
50
Q

Difference in presentation between acute radiation pneumonitis and fibrotic radiation pnumonities

A
  • acute radiation pneumonitis = 4-12 weeks following irradiation
  • symptoms of late or fibrotic radiation pneumonitis = 6-12 months after
51
Q

Presentation of radiation pneumonitis

A

nonproductive cough + dyspnea + fever + chest pain

52
Q

Physical exam for radiation pneumonitis

A

Can hear crackles + skin erythema

53
Q

Next step after suspected radiation pneumonitis

A
  • CT chest (compare to pretreatment CT images prior to radiation)
54
Q

Treatment of RILI

A
  • supportive care for fibrosis

- some experts recommend oral steroids for subacute

55
Q

Indications for irradiated RBCs

A

1) BMT recipients
2) Acquired or congenital
cellular immunodeficiency
3) blood components donated by first or second degree relatives

56
Q

Indications for leukoreduced blood products

A
  • chronically transfused patients
  • CMV seronegative at risk patients (AIDS, transplant recipients)
  • potential transplant recipients
  • previous febrile non hemolytic transfusion reaction
57
Q

Indications for washed blood products

A
  • IgA deficiency

- Complement-dependent autoimmune hemolytic anemia

58
Q

Why you need to wash PRBC’s prior to giving to IgA deficient patient

A

When RBCs and plasma are separated from whole blood, small amounts of residual plasma remain in the RBC concentrate, which includes IgA. Washing removes as much plasma as possible.

59
Q

Management of ED in patient with contraindication to PDE inhibitor

A

intraurethral alprostadil OR vacuum assist device

60
Q

Major contraindication to PDE inhibitors (sildenafil) for ED

A

Nitrates

61
Q

primary myelofibrosis clinical features

A
  • MASSIVE hepatomegaly + splenomegaly (extra medullary hematopoiesis can also cause hepatomegaly)
  • hallmark of PMF
62
Q

CBC in primary myelofibrosis

A
  • initial leukocytosis (greater than 30K) followed by leukopenia (due to marrow proliferation but then marrow becomes anemic/leukopenic as fibrosis replaces the marrow)
  • initial thrombocytosis, followed by thrombocytopenia
63
Q

primary myelofibrosis pathophys

A
  • chronic myeloproliferative disorder characterized by an overproduction of megakaryocytes and bone marrow stroll cells, which release fibrosis-promoting cytokines into the marrow
64
Q

Management of patient with high pretest for DVT but negative US

A

Repeat US within 24 hours (false negatives are rare but can happen)

65
Q

Management of xerostomia (dry mouth) following radiation for head and neck cancer

A
  • DC meds that can worsen xerostomia (anticholinergics and antidepressants)
  • nonpharmacologic interventions (saline rinses, water-soluble mouth lubricants, regular dental care, frequent chewing of sugarless gum)
  • cholinergic medications (pilocarpine, cevimeline) (stimulate salivary muscarinic receptors and increase saliva production
66
Q

Presentation of severe xerostomia

A

oral pain, dental carries, oral infections, dysphagia, anorexia

67
Q

How to monitor direct thrombin inhibitor

A

Thrombin time

68
Q

Management of patient needing urgent surgery who’s on a direct thrombin inhibitor

A

Check thrombin time:
IF normal –> proceed directly to surgery
IF elevated –> idarucizimab if life-threatening bleeding or requiring urgent or emergency surgery

69
Q

Initial step in workup of polycythemia

A

Differentiate primary (low epo) from secondary (normal or elevated epo) with Epo

70
Q

Differential for secondary polycythemia

A

1) Hypoxemia (OSA, high altitude, cardiopulmonary disease)
2) EPO-producing tumors
3) congenital (high-affinity hemoglobin)
4) Following renal transplantation
5) androgen supplementation

71
Q

Polycythemia definition

A

Hemoglobin greater than 16 in women and 16.5 in men

72
Q

Presentation of sickle cell trait + potential complications

A

Just: usually asymptomatic but can have complications:

  • hematuria (infarction of renal medullary blood vessels)
  • splenic infarction from strenuous exercise or exposure to hypoxic conditions
  • Renal medullary carcinoma
  • Increased UTI
  • VTE
  • Priapism
73
Q

splenic infarction presentation

A
  • acute onset LUQ pain + nausea, vomiting
74
Q

Management of prostate nodule + why

A

BIOPSY (REGARDLESS OF PSA)
*A significant number of men with prostate cancer have PSA values less than 4.0 and a small but significant percentage have values less than 2.0

75
Q

indications for prostate biopsy

A
  • nodule

- rising PSA level (usually over 4) OR rate of change

76
Q

diagnosis of ABPA

A
  • skin testing for aspergillus
77
Q

strongest RF for critical illness myopathy

A
  • use of IV steroids
78
Q

critical illness myopathy presentation

A
  • flaccid quadriparesis
  • difficulty weaning from mechanical ventilation
  • can have decreased reflexes
  • can have myopathy with loss of myosin on muscle biopsy
79
Q

critical illness myopathy treatment

A
  • stop or reduce steroids ASAP

- PT

80
Q

other common cause of weakness in ventilated patients in ICU

A
  • prolonged neuromuscular blockade from prolonged paralytics
81
Q

Management of acute chest syndrome

A

Mild (no significant desaturation) = simple transfusion
Moderate (desatting but not less than 85%) = simple transfusion
Severe (desatting below 85% or 2 lobes involved) = exchange transfusion

82
Q

GVHD presentation

A
  • maculopapular rash (that often becomes generalized)
  • RUQ abdominal pain
  • hepatomegaly
  • LFT abnormalities
  • profuse watery diarrhea
83
Q

Other type of GVHD aside from HSCT-associated GVHD

A

ta-GVHD (transfusion-associated)

84
Q

Difference in presentation from GVHD and ta-GVHD

A
  • ta-GVHD causes bone marrow destruction leading to progressive pancytopenia
  • treatment is typically ineffective and most cases are fatal
85
Q

How to prevent ta-GVHD

A
  • transfuse irradiated blood products to patients at risk (this inactivates donor lymphocytes prior to transfusion)
86
Q

presentation of CMV from transfusion

A
  • typically mono-like like syndrome (fever, maculopapular rash, LFT abnormalities, systemic symptoms)
87
Q

Major long-term complications of PV

A
  • myelofibrosis (“post-PV myelofibrosis”) and AML
88
Q

Presentation of marginal-zone lymphoma

A

Splenomegaly + lymphocytosis + cytopenias

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