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Hemato onco Flashcards

1
Q

Une femme de 53 ans souhaite discuter avec vous de son traitement de cancer du sein. Il y a quelques mois, elle a subit une chirurgie + chimio pour un néo du sein, ganglions +, hormono+. Qu’en est-il au sujet du tamoxifène?
a) Diminue le risque cardiovasculaire
b) Diminue les bouffées de chaleur
c) Réduit le risque de cancer de l’endomètre
d) Augmente la densité minérale osseuse

A

D) augmente la densité minérale osseuse

Higher risk of endometrial cancer, thrombosis, arthalgias, hot flashes

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2
Q

2 causes of agglutination on blood film?

A

Cold AI hemolytic anemia (IgM)
Paroxysmal cold hemoglobinuria

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3
Q

2 lung cancer with often molecular targets?

A

NSCLC only
ADK : PDL1 + molecular targets like EGFR
Squamous : PDL1

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4
Q

3 causes of spherocytes on blood film?

A

Warm AI hemolytic anemia (IgG)
Hereditary spherocytosis
Delayed hemolytic transfusion reaction

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5
Q

5 DDX of primary pancytopenia ?

A

PNH
Aplastic anemia
Leukemia
MDS
Myelofibrosis

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6
Q
  1. Homme dans la 60aine, diagnostic ADK œsophage à la biopsie. Lequel est un facteur de risque de son cancer.?
    A. RGO
    B. ROH
    C. ATCD néoplasie tête et cou dans la famille
    D. Tabac
A

FDR ADK a/n oesophage distal
- Barrett, GERD
- Obesity
- Smoking

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7
Q

50F with Diffuse Large B Cell Lymphoma, recently received prednisone 4 days. She comes into ER feeling unwell. HR is 132, BP 90/68, Temp 38.5, RR 20. Bloodwork: Neutorphils 5, K 6.3, Ca 2.1, Cr 180, PO4 2.2, Uric acid 380, LFT normal. CT shows shrinking lymph nodes compared to the scan a month ago . She has no other significant past medical history and takes no medications. What should you do next?
A. Start IV fluids and send off G6PD testing
B. Start IV fluids and start Allopurinol
C. Start IV fluids and start Rasburicase
D. Start IV fluids and Piptazo

A

IV fluids and Rasburicase
She’s a female so not likely G6PD. She’s unwell, hemodynamic unstable, there’s signs of treatment response with biochemical features of TLS. Treat!

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8
Q

72M PO12 from CABG, bilateral thrombus of superficial femoral vein. On Heparin 5000u sc TID. Hb 107 and PLT 118.
Which of the following would not be an appropriate empiric anticoagulant choice?

a) Enoxaparin 100 mg sc BID
b) Rivaroxaban 15 mg po BID
c) Fondaparinux 10 mg sc OD
d) Apixaban 10 mg po BID

A

ENOX should be avoided as suspected case of HIT

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9
Q

A 34 premenopausal female with breast cancer on tamoxifen recently presented to clinic for routine check-up. She is having intermittent vaginal bleeding that is not part of her period. She wants to switch over to Letrozole. What would you advise her, assuming her medical oncologist is not available?
A. Switch to letrozole.
B. Stop the tamoxifen. Organize an endometrial biopsy
C. Reassure her that tamoxifen confers cardiovascular benefit, and to continue the tamoxifen
D. Stop the tamoxifen. Organize a pap smear

A

C)
High risk of endometrial cancer with tamoxifen

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10
Q

A 34F with triple negative breast cancer on chemotherapy. She came into ER with dizziness, vomiting and ataxia. On brain MRI she was found to to have a left cerebellar lesion and bilaterally enlarged ventricles with obstructive hydrocephalus. What is the next best step?
A. Lumbar puncture to relieve the pressure B. Dexamethasone
C. Acetazolamide
D. Neurosurgery for shunt

A

B) Leptomeningeal disease is deadly and often occurs with breast cancer and lung cancer. Shunting doesn’t work well as the cancer cells just plug up the shunt. LP will cause herniation. Dexamethasone would be first line to help reduce some swelling and buy time for chemo.

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11
Q

A 35M plumber presents with flushing, and a new left leg pain and swelling. HR 95, BP 165/85, O2 100%RA, 37.3 degrees Celsius. CBC shows Hb of 175, WBC 9, Plt 230. Na 132, K 4.2, Cr 250. Ca 2.9, Mg 0.74, PO4 1.25. He reports feeling tired over the last 1 year with 15 lb weight loss. He denies any SOB, cough, hematuria, but does have some back ache that is sustained in the last 3 months which he attributed to mechanical back pain. What is the next best test to assess his potential malignancy?
A. CT Abdomen and Pelvis with contrast
B. Ultrasound KUB
C. CT chest
D. PET scan
E. Upper Endoscopy with Colonoscopy

A

B)

While CT scan would be ideal, he has a kidney injury so it’s best to at least get an ultrasound first to rule out hydro but also evaluate for the culprit- Likely an RCC, an internist’s tumor given the thrombosis, HTN, hypercalcemia, and the polycythemia

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12
Q

A 55M with recently identified large RUL lung mass, with a small right pleural effusion presents to your clinic for further workup. He is currently asymptomatic. What is the next best step?
A. Thoracic surgery for thoracentesis
B. Consult early palliative care as early referral has survival advantage.
C. Urgent referral to medical oncology to get opinion on treatment.
D. IR for lung mass biopsy

A

Need bx of primary to identify the malignancy first (Effusion can wait. May be reactive). In addition, thoracic surgery doesn’t do paracentesis

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13
Q

A 62 year old man presents with a new right leg iliac vein thrombosis. He has a known history of JAK2 positive polycythemia vera and has been on ASA 81mg daily and intermittent phlebotomies. His hemoglobin is 162 g/L with normal renal function. His ferritin is 12. He is started on weight-based tinzaparin for management of the DVT and ASA is stopped. In addition, the following should be done:
a) Start hydroxyurea
b) ContinueASA
c) Continue ASA and start hydroxyurea
d) Increasefrequencyofphlebotomies

A

A)

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14
Q

ABIRATERONE tx side effects in prostate cancer ?

A
  • Hyperaldosteronism : HTN, hyperglycemia, hypoK
  • CV disease
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15
Q

AL amyloid and abnormal coags ?

A

Possible as can cause an acquired FX deficiency

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16
Q

Androgen deprivation therapy side effects ?

A

OP
Decreased libido
Gynecomastia
Hot flashes
Fatigue

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17
Q

Anticoagulant choice in HIT ?

A

IV : argatroban, danaparoid
SC : fondaparinux
PO : warfarin, DOACs
Pregnancy : danaparoid preferred

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18
Q

Aplastic anemia presentation ?

A

Previous healthy pt with pancytopenia, low retics +/- high LFTs
Can be 2e to pregnancy, AI disease, drugs (NSAIDs, PTU, carbamazepine)
BM bx is hypocellular

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19
Q

B12 deficiency : should you tx orally or IM ?

A

Oral B12 as effective as IM supplementation
If need to urgently replace (pregnant w sx) : IM

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20
Q

Blast cells + Auer rods + DIC : think ?

A

APL which is subtype of AML
Most curable AML type but early mortality from DIC
Urgent tx : ATRA

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21
Q

Blood film of myelodysplastic syndrome ?

A

Hypolobated / hypogranular neutrophils, hypogranular platelets, macrocytosis, low retics

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22
Q

Breast cancer staging and needing imaging post surgery ?

A

Stage I : small tumor and no nodes, no imaging
Stage II : nodes < 3 and no further tests unless sx
Stage III : skin/chest wall, nodes ≥ 4, staging post op with bone scan and CT TAP

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23
Q

Can you biopsy testicular cancer ?

A

NO NEVER BIOPSY TESTICULAR MASS due to risk of tumor seeding
Radical orchietoctomy !!

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24
Q

Can you test for vWF during pregnancy ?

A

Yes but level AND activity increases during pregnancy so need to be repeated following pregnancy if suspected

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25
Q

Cancer associated VTE : outpatient prophylaxis for who ?

A

Consider DVT prophylaxis (apix 2.5 BID, rivarox 10 OD, LMWH) for high risk ambulatory cancer patients : Khorana score ≥ 2

Khorana score : BMI ≥ 35, prechemo PLT > 350, Hb < 100 or eprex, prechemo WBC > 11
Very high risk (brain stomach, pancreas)

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26
Q

Cancer dx if AFP elevated and mass ?

A

If AFP elevated, non seminoma will always be present
AFP never elevated in seminoma tumor

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27
Q

Cancer médullaire de la thyroïde, autre cancer a rechercher ?

A

Rechercher la mutation RET dans tout les cas car 25% des medullaires sont familiaux
2A : Eliminer pheo et hyperpara primaire
2B : Eliminer pheo + neurome / ganglioneurome

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28
Q

Cancer staging : malignant fluid is stage IV in all cancer except ?

A

OVARIAN, malignant ascites with peritoneal deposits is stage III

However malignant pleural effusion is stage IV

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29
Q

CLL presentation ?

A
  • isolated HIGH lymphocytes ++ samll mature lymphocytes and smudge cells
  • lymphadenopathy / splenomegaly
  • cytopenias, ITP/AIHA
  • Richers transformation
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30
Q

Colorectal cancer staging ?

A

Stage 2 : through muscle layer
Stage 3 : lymph nodes

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31
Q

Criteria for screening for lung cancer ?

A
  • Age 55-74
  • ≥ 30 pack year smoking history
  • Current smoker or quit within 15 years

Screen with annual low dose CT every year up to 3 consecutive years

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32
Q

Cyclophosphamide toxicity side effects ?

A

Secondary malignancies (MDS, AML, bladder Ca)
Hemorrhagic cystitis, bladder CA
Infertility

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33
Q

Diagnosis of acute leukemia ?

A

> 20% blasts in peripheral blood or marrow
Auer rods only in myeloid neoplasms

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34
Q

Difference between tamoxifen and AI ?

A

Tamox decreases OP and CV risk but AI increases OP/CV risk
Tamox increases endometrical cancer and thrombosis
Both increase hot flashes

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35
Q

DOAC and amiodarone ? paxlovid/ritonavir ?

A

Aimodarone increases levels of all DOACs
Ritonavir CI to use w apix and riva

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36
Q

DOAC and min DFG ?

A

Caution if CrCl < 30 : apix < 25; up to < 15 but limited data

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37
Q

DOAC and pregnancy ?

A

CI in pregnancy AND breastfeeding

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38
Q

Duration of anticoagulation in HIT ?

A

If no thrombosis : min until PLT recovery > 150, max 3 months
If thrombosis : 3-6 months

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39
Q

Equivalence morphine / oxycodone / hydromorphone ?

A

Morphine 30
Oxycodone 20 -> 1.5x for PO morphine
Hydromorphone 6 -> 5x for PO morphine

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40
Q

Etiology of warm vs cold AI hemolytic anemia ?

A

Warm : LYMPHOproliferative disease like CLL, AI, drugs (methyldopa, NSAIDs)
Cold : Infection (mycoplasma pneumonia, EBV), lymphoprolif (MGUS, Wald)

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41
Q

EtOH associated with wich gastroesophageal cancer ?

A

Squamous cell : upper mid esophagus

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42
Q

Femme de 41 ans avec gène BRCA1. Quel test est le plus SENSIBLE pour détecter des ‘‘petits’’ cancers ?
1. écho
2. Mammo
3. IRM
4. Thermographie

A

IRM

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43
Q

HbSc common presentation ?

A

Persistent microcytic anemia despite iron replacement
Less anemua and pain crises than HbSS
But MORE OCULAR and BONE complications
Ex : non proliferative retinopathy

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44
Q

Heparin Induced Thrombocytopenia diagnosis ?

A
  • low PLT : 50% drop and nadir > 20
  • Day 5-14days or <1days with recent exposure ( 1 point if > 14 days)
  • Proven thrombosis
  • Other causes excluded

NO POINT IF
- Timing < 4 days and no recent heparine
- Nadir < 10 or < 30% drop

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45
Q

How do differentiate B12 deficiency from syphilis ?

A
  • BOTH mental status change/dementia
  • PUPILS : N if b12 / Argyle Robertson if syphilis (small, no reaction to light but does accomodate)
  • Dec vibration and proprioception in BOTH
  • B12 : increased tone, weaknes, hyperreflexia/clonus
  • Syphilis : TABES DORSALIS : ABSENT REFLEXES with tone/power N
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46
Q

How do you diagnose PNH ?

A

Peripheral blood flow cytometry : loss of CD55 and CD59
Overalp w aplastic anemia possible if pancytopenia : perform BM bx/aspirate

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47
Q

How do you reverse LMWH or heparin?

A

Protamin 25-50 for LMWH
Protamin based on last admin for hepatin

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48
Q

How do you reverse warfarin if bleeding ?

A

If life threatening bleed/imminent procedure:
IV vit K + PCC dosing per INR
(3000 U if INR > 5)

If non life threatening : vit K + supportive

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49
Q

How do you reverse warfarin if non bleeding and INR > 9 vs > 4.5-9 ?

A

NOT BLEEDING
If > 9 : hold warfarin and vit K 2.5-5
If > 4.5-9 : hold + decrease dose

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50
Q

How do you treat distal calf DVT ?

A
  • Severe symptoms, multiple deep veins - involved, active cancer, ≥5 cm long, close to popliteal vein, irreversible risk factor, +D- dimer, or progression on repeat U/S : consider full dose anticoagulation
    (treat as proximal DVT)
  • If high bleeding risk or no indication to treat: monitor with serial U/S
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51
Q

How do you treat subsegmental PEs w negative leg dopplers ?

A
  • Controversial, but favor treatment
  • Consider treatment if: active cancer/other thrombotic risk, symptomatic, high D-dimer
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52
Q

How do you treat superficial vein thrombosis ?

A

1) ≤3 cm from saphenofemoral junction or saphenopopliteal jxn : FULL dose anticoagulation x 3 months
2) >3cm from SFJ/SPJ and ≥5 cm long à PROPHYLACTIC anticoagulation x 45d (fondaparinux 2.5 mg sc daily or rivaroxaban 10 mg po daily or LMHW proph/intermed dose)
- >3cm from SFJ/SPJ + <5cm long : NSAIDs and monitor with serial U/S. ** Exceptions:
prophylactic anticoagulation in pregnancy, cancer, surgery, trauma, prior hx of SVT/DVT

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53
Q

Hypersegmented neutrophils on bloodfilm?

A

Think megaloblastic anemia : folate or B12 deficiency
Hypersegmented is > 6 lobes

54
Q

Immune colitis tx ?

A

If no response to steroids after 72h : infliximab

55
Q

Indications for irradiated blood to prevent transfusion associated GVHD ?

A

Ø Intra-uterine or neonatal exchange transfusion.
Ø CongenitalT-cellimmunodeficiency.
Ø Autologous stem cell transplant recipients until 3mo post-transplant
Ø Allogeneic stem cell transplant until at least 6 months post-transplant (indefinite if GVHD or on immunosuppression)
Ø CAR-T cell until 3mo post-infusion
Ø All patients with Hodgkin’s Disease.
Ø T-cell depleting therapies

56
Q

Indications for washed platelets ?

A

Ø Anaphylaxis to transfusion NYD
Ø Recurrent/severe allergic transfusion reactions
Ø IgA deficiency with no IgA deficient donor available

57
Q

Isolated elevated aPTT ?

A

If corrects on mixing study : think of factor deficiency VIII, IX, XI, XII

58
Q

Isolated eleveted INR ?

A

Extrinsic pathway : if PT corrects think of FVII deficiency if < 50%

59
Q

Management and presentation of cardiomyopathy 2e chemo ?

A

Anthracycline : irreversible and delayed
Tx with routine management of HF
Trastuzumab : reversible and early onset
Tx HF, repeat TTE in 1 mo to ensure recovering

60
Q

Masse médoastinale antéroeire : 5 T’s ?

A

Thymoma (plus fréquent, myasthénie grave)
Teratoma (si mature lisse, si immature nécrotique, trouvaille fortuite)
Tumeur germinale non séminomateuse (AFP et Bhcg +)
Terrible lymphoma

61
Q

Minor dx criteria in MF ?

A

Minor criterias :
- Leukoerythroblastic film
- LDH > ULN
- Anemia
- Leukocytosis > 11
- Palpable splenomegaly

62
Q

Most common acute leukemia in adults vs peds ?

A

AML in adults
ALL in peds

63
Q

NSCLC : metastatic management ?

A

ECGR + : osimertinib first line
Other drive mutation : chemo / immuno
Driver mutation negative : immuno +/- chemo
Early referral to palliative care have mortality benefit

64
Q

NSCLC : treatment ?

A

Stage 1 : surgery and no adjuvant
Stage 2 : surgery and adjuvant chemo
Stage 3 unresectable : chemoradiation then immunotherapy durvalumab x 1yr

65
Q

NSCLC staging ?

A

Stage 2 if hilar lymph node
Stage 3 if mediastinal lymph node
Stage 4 if malignant effusion

66
Q

On blood film:
HbSc vs HbSS vs sickle cell trait ?
G6PD ?

A
  • HbSc: target cells and several dense contracted and folded red cells
  • HbSS : sickle cells
  • Sickle cell trait : no target cells
  • G6PD : bite cells
67
Q

Outpatient ATB regimen for febrile neutropenia ?

A

Cipro + amox/clav or clinda if pen allergic

68
Q

Para neoplastic syndromes with SCLC ?
Name 4.

A
  • SIADH
  • Lamber Eaton Myasthenic Syndrome (anti VGCC Ab, absent/decreased reflexes)
  • Encephalomyelitis and sensory neuropathy (anti Hu Ab)
  • Cushing syndrome
69
Q

Paraneoplastic syndromes associated with ADK / squamous cell ?

A

ADK : hypertrophic osteoarthropathy
Squamous : hypercalcemia via PTHrP

70
Q

PNH definition ?

A

Clocal stem cell disorder characterized by:
- BM failure
- Chronic intravascular and extravascular hemolysis with uncontrolled complement activation
- Thrombosis atypical sites (splanchnic, hepatic)

71
Q

Presentation of non small cell ?

A

SQUAMOUS
- Central lesions with strong link with smoking. Unlikely mutated.
ADK
- Peripheral lesions. Most common. Has driver mutations.

72
Q

Presentation of small cell lung cancer ?

A

Central lesions
Strong link with smoking
Non EGFR/ALK mutated
Rapidly growing

73
Q

Prostate cancer associated with which heme anormality ?

A

Associated with coagulopathy. DIC is most common in metastatic setting / post op

74
Q

PTI treatment : onset of response to IvIg cortico or ritux ?

A

IvIG is fastest in 1-3d
Cortico takes 2-14d
Ritux takes 7-56d

75
Q

PV diagnosis criteria ?

A

Hb>165/160 (M/F) or HCT > 49/48
with JAK + mutation
Low serum EPO

76
Q

Radiation pneumonitis presentation and tx ?

A

1-3 months post radiation, mimics pneumonia with ground glass and interstitial changes
Treat with steroids

77
Q

Reduced breast cancer mortality in lifestyle modifications after breast cancer ?

A

Exercise 150min/wk

78
Q

Right supraclavicular nodes dx ?
Left supraclavicular nodes dx ?

A

Right : lung, esophageal
Left is Virchow node : abdo malignancies (pancreas, testicles…) amd ipsi breast and lung

79
Q

Screening for breast cancer ?

A

50-74 yrs mammogram q2-3 yrs
≥ 75y no evidence of benefits/harms to make formal recommendation

80
Q

Screening for cervical cancer ?

A
  • Anyone with cervix ages 25-69 :
    Screen with pap test q3yrs
  • STOP screening at age 70 and ≥ 3 negative tests in last 10yrs
81
Q

Screening for colorectal cancer : if increased risk ?

A

≥ 1 first degree relative with colon cancer OR advanced adenoma
- Age 40-50 or 10yrs before earliest age of relative’s dx
- COLO q 5-10yrs

82
Q

Screening for colorectal cancer :average risk ?

A

Age 50-74
FIT q2yrs or Flex sigmoidoscopy q10yrs
DO NOT USE colonoscopy

83
Q

Screening for hepatocellular carcinoma ?

A

All patients with cirrhosis (against childs pugh C unless transplant candidate)
Hep B carrier sAg + and certain criterias

US q6 month / US + AFP q6months

84
Q

SIADH as paraneoplastic syndrome associated with which lung cancer ?

A

SCLC

85
Q

Side effect of anthracyclines ?

A

IRREVERSIBLE cardiomyopathy
Secondary leukemia

Eg : Doxorubicin (adriamycin), epirubicin

86
Q

Side effect of bleomycin
?

A

Pulmonary fibrosis
Typical chemo regimen for testicular cancer BEP : bleomycin, etoposide, cisplatin

87
Q

Side effect of platinums chemotherapies ?

A

Cisplatin, carboplatin, oxaliplatin
- Peripheral neuropathy
- Cisplatin specific highly emetogenic nephrotoxic, ototoxic
- Oxaliplatin specific cold induced neuropathy

88
Q

Small Cell lung cancer staging ?

A

Limited stage if confined to 1 hemithorax or 1 radiation field
Extensive stage if beyong 1 radiation field OR malignant effusion

89
Q

Staging of bladder and prostate cancer : what if LN ?

A

Any positive lymph nodes in bladder or prostate cancer is stage IV

90
Q

Survival benefit of biphosphonates in breast cancer tx ?

A

Increases survival as adjuvant
No survival benefit if metastatic but improves pain/QOL,prolongs time to 1st skeletal related event

91
Q

T cell large granular lymphocyte leukemia (LGL) presentation ?

A

Associated with AI dx esp RA
Often present like Felty seyndrome with splenomegaly and neutropenia

92
Q

Teardrops cells on blood film?

A

Think myelofibrosis

93
Q

The 4 S’s of Lung Ca ?

A

Smokers get Squamous and the Speedy Small Cell
Adeno I don’t know which i got cancer

94
Q

Timing du risque de neutropénie fébrile post chimio ?

A

Entre le J7 et pour 2 semaines

95
Q

Trastuzumab/Herceptin side effects ?

A

HER 2 drug
REVERSIBLE cardiomyopathy

96
Q

Treatment of PTI ?

A

1) Not bleeding or mild-mucocutaneous bleeding PLT > 30 : watch and wait

2) NOT bleeding and PLT < 30
1st line : pred or dex 40 x 4d, IvIg if C/I to pred

3) ACTIVE BLEEDING
Steroids + tranexamic acid +/- IvIg
If life threatening : PLT tranfusion +/- splenectomy

97
Q

Treatment of PTI in pregnancy ?

A

Tx if bleed, PLT< 30, delivery or PLT < 50 + ≥ 36wk GA
Steroids or IvIg (pred > dex as dex crosses placenta)
PLT > 50 for delivery, > 50-80 for neuraxial anesthesia
Check baby’s platelet count

98
Q

TTP treatment ?

A

PLEX WITHIN 4-8 H
FFP to bridge : 3-4u then 1u q2h
Steroids Pred / solumedrol IV
Folic acid 5 daily
ASA IF high trop/CNS sx once PLT > 50
DVT proph when PLT > 50

NO PLT transfusion unless life threatening bleed

99
Q

Two heme malignant dx with dysplastic myeloid cells ?

A

CMML
MDS

100
Q

Tx of polycythemia vera ?

A

ASA for everyone
Hct < 45% with phlebotomy for everyone
Increase to ASA BID if arterial thrombosis history
High risk (≥ 60y or thrombosis) get cytoreduction

101
Q

Tx of secondary ITP ?

A

IF SIGNIFIANT BLEEDING
and HCV : IvIg
and HIV : steroids or IvIg

102
Q

Tx of small cell lung cancer ?

A

Limited stage : concurrent chemo radiation +/- prophylactic cranial irraditation

Extensive stage : palliative chemo + immuno + prophylactic cranial radiation

HIGHLY chemo/radio sensitive but frequently relapse
Usually no chx

103
Q

Tx of warm vs cold AI hemolytic anemia ?

A

Warm : prednisone 1st line then splenectomy / ritux
Cold : WARM pt, no role for steroids, ritux if refractory

104
Q

Typical EGFR+ profile ?

A

Elderly, female, asian, non smoker, adenocarcinoma

105
Q

Umbilical nodes dx ?

A

Sister Mary Joesph Node : intra abodminal / pelvic metastases
- GI gastrin, colon, pancreas
- Gyneco : ovarian, endometrial

106
Q

Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT) diagnosis ?

A
  1. COVID vaccine 4 to 42 days prior to symptom onset
  2. Any venous or arterial thrombosis (often cerebral or abdominal)
  3. Thrombocytopenia (platelet count < 150 x 109/L)
  4. Positive PF4 “HIT” (heparin-induced thrombocytopenia) ELISA
  5. Markedly elevated D-dimer (> 4 times upper limit of normal)
107
Q

What are the implications of BRCA 1 vs 2 ?

A

• BRCA 1 = ↑ Lifetime risk of Breast ca (70%) and Ovarian ca (45%)
• BRCA 2 = ↑ Lifetime risk of Breast CA (70%), Ovarian Ca (20%), Prostate Ca,
Pancreatic Ca, Gastric Ca

108
Q

What are the neurological manifestations of vitamine B12 deficiency ?

A
  • Subacute, combined degeneration of cord = posterior columns and corticostpinal tract
  • Peripheral neuropathy
  • Dementia
109
Q

What are the three types of vWD ?

A
  1. quantitative deficiency
    ↓VWF:Ag [<30%] = ↓VWF Rco [<30%] ie. concordant; ratio>0.7)
  2. qualitative deficiency
    ↓/↔ VWF Ag [<30-200%], ↓↓VWF:Rco [<30%] ie. discordant; ratio<0.7
  3. no vWF produced : f VIII low
    ↓VWF:Ag [<5%] = ↓VWF:Rco [<5%]; ↓↓ factor VIII = Behaves like Hemophilia A
110
Q

What causes 50% of SVC syndrome cases ?

A

NSCLC
but SCLC, lymphoma, metastatic possible too

111
Q

What is a high risk MGUS ?

A
  1. M protein ≥ 15g/L
  2. Non IgG M protein
  3. Abnormal free light chain FLC ratio
112
Q

What is Chronic Myeloid Leukemia ?

A

CML : one of the MPNs
- Philadelphia Chromosome BCR:ABL t:9;22
- Has a chronic + accelerated + blast phase
- BASOPHILS

Chronic : high WBC + splenomegaly + blasts < 10 + basos
Tx with TLI

Accelerated : 10-19% blasts and BASO > 20%

Blast : > 20% tx as per acute leukemia and TKi

113
Q

What is CMML : chronic myelomonocytic leukemia?

A

Features of both MPN and MDS
Too many monocytes : MONOCYTOSIS FOR 3 MONTHS
Myeloids cells are dysplastic
Blasts < 20%

Prognosis : 15-30% get AML

114
Q

What is the PLT tranfusion thresholds for non APL vs APL in acute leukemia cytopenias?

A

Non APL PLT<10 if not bleeding > < 50 if bleeding
APL PLT < 30-50 as RISK of bleeding

115
Q

When should you admit PTI patient ?

A

If new diagnosis and PLT < 20 : admission

116
Q

When should you prescribe or not prescribe rasburicase ?

A

Prescribe if AKI or very high uric acid > 535 or no response to allopurinol
NOT in G6PD DEF

117
Q

When should you suspect G6PD deficiency ?

A

X linked recessive*, more common in Africa, Middle East, certain parts of Mediterranean and Asia.
*If MCQ says a woman, no FamHx, assume no G6PD defic!

NOT rasburicase if G6PD

118
Q

When to use warfarin ?

A
  • Breastfeeding
  • CKD stage 4-5
  • Antiphospholipid
  • LV thrombus
  • FRAIL ELDERLY that likes warfarin
  • Mechanical valve
119
Q

Which breast cancer patients need adjuvant therapy?

A

ENDOCRINE THERAPY
Everyone stage 2 to 3 with HR+/HER2+
Stage 1 HR+ only also
Post menopause TAM or AI
Pre menopause TAM

CHEMO
for triple negative, HER2+ or triple positive stage 2 to 3

120
Q

Which cancer associated with PTHrP production ?

A

Squamous cell NSCLC
Head and neck cancers

121
Q

Which opiods should you use if renal or hepatic dysfunction ?

A

Renal : hydromorphone, METHAdone, fentanyl
No morphine with no urine
Hepatic dysfunction : hydromorphone, MORphine, fentanyl
No meth with failing heps

122
Q

Which opioids can cause excess itching/urticaria ?

A

fentanyl

123
Q

Which splanchnic thrombosis is the MOST symptomatic ?

A

Hepatic vein thrombosis : fulminant liver failure

124
Q

Which supplementation is necessary if patient on androgen deprivation therapy for prostate cancer ?

A

Calcium if needed , vit D and a biphosphonate for metastatic disease or low bone mineral density

125
Q

Work up for carcinoid suspicion ?

A

echo preop
serum chromogranin A
Urine 24 hr urine 5 HIAA
GALLIUM PET scan (not regular PET)

126
Q

Workup for lung cancer ?

A

ALL patients : CT TAP +/- MRI brain +/- bone scan if sx
If negative : PET scan / mediastinal staging

127
Q

Comment diagnostiquer PNH ?

A

Cytometrie de flux

128
Q

Pronostic de la LMC ?

A

Survie de plus de 7 ans avec inhibiteur de tyrosine kinase

129
Q

Anémie hémolytique AI anticorps chauds : coombs ? vs froid ?

A

Chaud : Coombs mixte IgG +/- C3d
Froid : Coombs + C3d

130
Q

Vous voyez en consultation un homme africain de 25 ans avec masse faciale de 12x12 cm. Il rapporte des nausées, vomissementsd et diarrhées depuis 2 jours. Signes vitaux normaux. Au niveau des laboratoires, vous notez hyperphosphorémie, hyperkaliémie, hypocalcémie, augmentation des LDH. Qu’est-ce qui devrait être inclus dans sa prise en charge initiale?
3) Rasburicase 4) Febuxostat

A

Febuxostat car a risque G6PD vu africain

131
Q

Acute thoracic syndrome : Hb s target ?

A

Exchange transfusion targeting HbS < 30

132
Q

Description d’un frottis mégaloblastique ?

A

Neutrophiles hypersegmentés
Macro ovalocytes

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