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MCCQE1 > Hemato Oncology > Flashcards

Hemato Oncology Flashcards

1
Q

↓Hb, ↓MCV. Dx and next step?

A

Microcytic Anemia.

• Iron studies: ferritin, Fe, TIBC, % of saturation

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2
Q

↓Hb, ↑MCV. Dx and next step?

A

Macrocytic Anemia. Next step = smear to classify in:
• Megatloblastic (B12 or folate deficiency)
• Non-megaloblastic (liver disease, ETOH, drugs, metabolic)

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3
Q

↓Hb, normal MCV, Reticulocyte index > 2%. Dx and next step?

A

Destruction Normocytic anemia. Get LDH, bilirrrubin, haptohemoglobin

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4
Q

↓Hb, normal MCV, Reticulocyte index < 2%. Dx a possible cuases?

A

Production Normocytic anemia. Possible causes:
o Leukemia / myelodysplastic syndrome
o Kidney disease

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5
Q

↓Hb, ↑MCV, smear with segmentation. Next step?

A

Measure B12 and folate

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6
Q

↓Hb, ↑MCV, smear with segmentation, normal B12 and folate. Next step?

A

Get methyl malonic acid
o normal in folate deficency
o elevated in B12 deficency

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7
Q

↓Hb, ↑MCV, normal smear. Dx?

A

Non-megaloblastic anemia

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8
Q

Cuases of Non-megaloblastic anemia

A 
•	Non-megaloblastic causes:
o	Cirrhosis
o	Alcohol (even if not cirrhosis)
o	Drugs 
	5 fluorouracil
	HAART (AZT) 
o	Metabolic inherited conditions
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9
Q

Causes of folate deficency

A

Not ingestion of leafy greens (malnourish alcoholic, extreme diets)

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10
Q

Absorption of B12

A
  • Parietal cells produce intrinsic factor

* Intrinsic factor + ingested B12 = absorption in the terminal ileum

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11
Q

Cuses of B12 deficency

A

Strict uneducated vegan
Compromised absorption of B12
• Pernicious anemia: Auto-antibodies (IgA) attack parietal cells –> ↓ intrinsic factor
• Crohn’s disease: Inflammation of terminal ileum –> no absorption of B12
• Gastric bypass

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12
Q

Complication of B12 megalobastic anemia

A

subacute combined degeneration of the posterior cord: Loss of 2-point discrimination, vibration and proprioception

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13
Q

Schilling test

A

Discriminate between malabsorption and deficiency of B12
• IM B2 + PO B12 (saturation)
• Check B12 in the urine. If (+) : malnutrition -> Tx: PO B12; if (-) : absorption -> Tx: IM B12

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14
Q

↓Hb, ↓MCV, ↓Fe, ↓Ferritin, ↑TIBC. Dx and next step?

A

Iron deficiency anemia. Iron replacement 324 mg TID + stool softeners AND look for the source of slow bleeding.

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15
Q

↓Hb, ↓MCV, ↓Fe, ↑Ferritin, ↓TIBC. Dx and next step?

A

Anemia of Chronic inflammatory disease. Control underlying disease, but nothing for anemia +/- EPO in severe cases. Don’t give Fe replacement!

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16
Q

ASx patient, ↓Hb, ↓MCV, normal Fe, normal Ferritin, normal TIBC. Dx, next step?

A

Minor thalasemia, get a Hb electrophoresis, but wont neet Tx

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17
Q

Symptoms of anemia,↓Hb, ↓MCV, normal Fe, normal Ferritin, normal TIBC. Dx, next step?

A

Major thalasemia, get a Hb electrophoresis to differentiate between alfa and beta, monthly transfussion + de-ferox-amine if hemosiderosis (iron overload)

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18
Q

↓Hb, ↓MCV, ↑ Fe, normal Ferritin, normal TIBC. Dx, next step?

A

Sideroblastic anemia. Next step, get a bone marrow Bx to see Ring sideroblasts (RBC with dark centre)

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19
Q

Ring sideroblasts (RBC with dark centre) on bone marror Bx. Dx?

A

Sideroblastic anemia

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20
Q

↓Hb, normal MCV. Next step?

A 
Look for hemolysis
o	↓Haptoglobin
o	↑Bilirubin
o	↑LDH
o	Smear
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21
Q

Bite cells and Heinz bodies on blood smear. Dx?

A

G6DP deficiency

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22
Q

↓Hb, normal MCV, ↓Haptoglobin, ↑Bilirubin, ↑LDH, Spherocytes on blood smear. Dx and next step?

A

Two possible Dx: Hereditary spherocytosis or autoimmune hemolytic anemia.

Next step: Osmotic fragility and Coombs test to differentiate between the two

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23
Q

↓Hb, normal MCV, normal smear, normal haptoglobin, normal bolirrubin, normal LDH. Possible Dx

A

Hemorrhage or CKD

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24
Q

Male, afican american, with anemia, priapism/stroke/MI. Next step, possible Dx and Tx?

A

Next step: Smear with sickle cells, Hemoglobin electrophoresis (one time as a child).

Possible Dx: Sickle cell disease

Tx: Hydroxyurea (induces formation of HbF), folic acid
o In acute setting: IVF, O2, pain killers, and underlying condition, transfusion

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25
Q

Male, africanamerican, taking dapsone / TMP-SMX / nitrofurantoine, who has jaundice.
o Smear with Bite cells and Heinz bodies

Next step, possible Dx and Tx?

A

Next step:
o G6PD level (check it 6-8 weeks after the attack)

Dx: G6PD deficiency

Tx: Supportive, folic acid, and avoid stress

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26
Q

Greek man who eats fava beans, who has jaundice.

↓Hb, normal MCV
↓Haptoglobin
↑Bilirrubin
↑LDH
Smear with Bite cells and Heinz bodies

Next step, possible Dx and Tx?

A

Next step:
o G6PD level (check it 6-8 weeks after the attack)

Dx: G6PD deficiency

Tx: Supportive, folic acid, and avoid stress

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27
Q

Tx of Hereditary spherocytosis ?

A

splenectomy, folate, Fe

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28
Q

↓Hb, normal MCV, ↓Haptoglobin, ↑Bilirubin, ↑LDH, Spherocytes on blood smear, Coombs test (+) for IgM. Dx?

A

Cold Autoimmune hemolytic anemia (associated with Mycoplasma)

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29
Q

↓Hb, normal MCV, ↓Haptoglobin, ↑Bilirubin, ↑LDH, Spherocytes on blood smear, Coombs test (+) for IgG. Dx?

A

Warm Autoimmune hemolytic anemia (associated with • Autoinmune disease and cancer)

• Tx: steroids, rituximab, splenectomy

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30
Q

Patient with dark urine during night. Dx, next step, and tx?

A

Paroxysmal nocturnal hemoglobinuria

o Dx: Flow cytometry CD55 (-)

o Tx: Supportive, but in refractory cases use Eculizumab

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31
Q

47-y-o patient, ASx, ↑↑WBC, ↑↑Polys. Possible Dx and next step?

A

Chronic myelocytic leukemia (CML).

Next step: BM Bx and cytogenetics

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32
Q

47-y-o patient, ASx, ↑↑WBC, ↑↑Polys, : Philadelphia chromosome: a t(9,22) translocation with overactive activity of a tyrosine kinase BCR-Abl. Dx, Tx and complication?

A

Chronic myelocytic leukemia (CML).
Tx: Imatinib
Complication: Blast crisis, i.e., when CML becomes resistant to Tx and turns into AML

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33
Q

87-y-o patient, ASx, ↑↑WBC, ↑↑Lymphocites. Dx and treatment?

A

Chronic lymphocytic leukemia
Because of the age and ASx, no Tx is needed

But if
• > 65 + Sx (hyperviscocity syndrome); Tx= ChemoTx
• Young + donor; Tx = Stem cell transplant

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34
Q

67-y-o patient with fever, bone pain, anemia, bleeding, petechiae, and infections. Has history of exposure to bezene or radiation +/- history of CML. Dx and next step?

A

Acute myelocytic leukemia (AML)

Next step: Smear and BM Bx

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35
Q

67-y-o patient with fever, bone pain, anemia, bleeding, petechiae, and infections. Has history of exposure to bezene or radiation +/- history of Chronic myelogenous leukemia (CML).

Blood Smear shows blasts of polys and Auer rots
BM Bx with > 20% blasts
Marker: (+) Myeloperoxidase

Dx and Tx?

A

Acute myelocytic leukemia (AML) – M3 variant

Tx: Vitamin A

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36
Q

67-y-o patient with fever, bone pain, anemia, bleeding, petechiae, and infections. Has history of exposure to bezene or radiation +/- history of CML.

BM Bx with > 20% blasts
Marker: (+) Myeloperoxidase
Blood smear blasts

Dx and Tx?

A

Not M3 Acute myelocytic leukemia (AML)

Tx: ChemoTx

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37
Q

7-y-o patient with fever, bone pain, anemia, bleeding, petechiae, and infections.

  • BM Bx > 20% blasts
  • Markers: (+) cALL, (+) TDT

Dx and Tx?

A

Acute lymphocytic leukemia (ALL)

Tx:
• ChemoTx
• Intrathecal prophylaxis chemoradiation with Ara-C or Methotrexate

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38
Q

Non-tender fixed lymph node +/- B symptoms (fever, night sweats, weight loss). Next step?

A

Excisional Bx

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39
Q

Non-tender fixed lymph node. Reed Stenberg cell on Excisional Bx. Dx?

A

Hodgkin’s Lymphoma

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40
Q

Workup for staging lymphoma.

A
  1. CxR
  2. CT chest, abdomen, pelvis or PET
  3. Bone Marrow Bx
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41
Q

Stages of lymphoma

A

I: One group of lymph nodes
II: > one group of lymph nodes; one side of diaphragm
III: > one group of lymph nodes; opposide sides of diaphragm
IV: Difusse disease, in blood or bone marrow

A: No B Sx
B: (+) B Sx

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42
Q

Pel-Epstein fevers (cyclical fever)
Alcohol lymph nodes (lymph node becomes painful after consumption of alcohol)

Associated with?

A

Hodgkin’s Lymphoma

43
Q

Burkitt’s lymphoma.
Extranodal disease

Associated with?

A

Non-Hodgkin’s Lymphoma

44
Q

Side effects of Cisplatin

A

Ototoxicity, nephrotoxicity

45
Q

Side effects of Bleomycin

A

Pulmonary fibrosis

46
Q

Side effects of Adriamycin/Doxorubicin

A

Cardiac (CHF)

47
Q

Side effects of Vincristine/Vinblastine

A

Peripheral neuropathy

48
Q

Side effects of Cyclophosphamide

A

Hemorrhagic cystitis

49
Q

70-y-o patient, recurrent infections, hyperCa, anemia, renal failure, pathologic fractures. Possible Dx and next step?

A

Multiple myeloma.

Next steps:

  • Serum electrophoresis showing an M spike (because of the excess of protein)
  • Urine electrophoresis showing an M spike (Bence Jones protein)
  • Skeletal surveys (xRs) with litic lessions
  • Bone marrow Bx to confirm de Dx (> 10% plasma cells)
50
Q

Bence Jones protein in urine electrophoresis. Dx?

A

Multiple myeloma.

51
Q

Mutiple myeloma Tx

A

> 70, no donor  ChemoTx: melphalan + prednisone + (thalidomide or bortezomib)

<70 with donor  stem cell transplant

52
Q

> 85, ↑protein gap, ASx,

Serum electrophoresis showing an M spike, but…
Negative urine electrophoresis
Negative skeletal surveys
BM Bx < 10% of plasma cells

Dx and Tx?

A

Monoclonal Gammopathy of Uncertain Significance

o Tx: observe, watch for conversion to MM

53
Q

> 65 years, Hyperviscosity syndrome, constitutional Sx (sweets, weight loss), anemia, CHF

Serum electrophoresis showing an M spike, but…
Negative urine electrophoresis
Negative skeletal surveys
BM Bx > 10% lymphocytosis

Dx and Tx?

A

Waldenstorm’s (a form of Plasma cell dyscrasia of secretion of IgM)

Tx:
Rituximab-based chemoTx
If Hyperviscosity –>plasmapheresis

54
Q

Factor II is called

A

Prothrombine

55
Q

Factor IIa is called

56
Q

Factor I is called

A

Fibrinogen

57
Q

Factor Ia is called

58
Q

Example of thombophilias and treatment

A

Factor V Leiden
Prothrombin 20210A
Protein C deficiency / Protein S deficiency
Antithrombin deficiency

Tx: After a second episode of DVT, thrombophilia is suspected and Tx with heparin-to-warfarin-bridge

59
Q

Why Heparin-to-warfarin-bridge is done?

A

Warfarin initially inhibits protein C and S –> More risk of cloth
Then once Proteins C and S are depleted, it inhibits factors 1972 –> Less risk of cloth

60
Q

Women, history of autoimmune disease, Multiple miscarriages, Arterial and venous cloths. Possible Dx, cuase of that Dx, next step and tx?

A

Antiphospholipid antibody syndrome

Cause by the lupus anticoagulant (in vivo is procoagulant)

Next step: Russel’s viper venom test

Tx: warfarin (INR 2-3)

61
Q

Patient with Fever, Anemia (micro angiopathic hemolytic), Thrombocytopenia, Renal failure, and Neuro Sx (stroke).

CBC: low Plts
Smear: Schistocytes 
PT/PTT: normal
Fibrinogen: normal
D-dimer: normal

Dx and tx?

A

Thrombotic thrombocytopenic Purpura (TTP)

Tx: Exchange transfusion

62
Q

Patient at the ICU who is critically ill, in sepsis and starts bleeding

CBC: low Plts
Smear: Schistocytes 
PT/PTT: elevated
Fibrinogen: low
D-dimer: elevated

Dx and tx?

A

Disseminated Intravascular Coagulation (DIC)

Tx: Supportive (e.g., transfusion), fix underlying disease

63
Q

Patient who is hospitalized on heparin and after 7-14 days , platelets rapidly decrease. Dx and tx?

A

Heparin-induced thrombocytopenia

Stop heparin
Start argatroban
Bridge-to-warfarin

64
Q

Woman with lupus and low platelets. Dx and management?

A

Immune thrombocytopenic purpura

Steroids
IV Ig in acute setting if plts are really low
Splenectomy
If splenectomy fails, Rituximab

65
Q

Patient with superficial bleeding (epistaxis, gingival bleeding, menorrhagia). Is it primary or secondary bleeding?

A

Primary bleeding (platelets)

66
Q

Patient with deep bleeding (hemarthrosis, hematoma, prolomged bleeding). Is it primary or secondary bleeding?

A

Secondary bleeding (factors)

67
Q

Patient with superficial bleeding (epistaxis, gingival bleeding, menorrhagia). Not on clopidogrel, ASA or NSAIDS
Normal plt count

Dx, next step, and tx?

A

Von Willebrand Disease

Next step: Von Willebrand factor assay

Tx: DDAVP (desmopressin)

68
Q

Four causes of microcytic anemia.

A

TICS—Thalassemia, Iron defi ciency, anemia of Chronic

disease, and Sideroblastic anemia.

69
Q

An elderly man with hypochromic, microcytic anemia is

asymptomatic. Diagnostic tests?

A

Fecal occult blood test and sigmoidoscopy; suspect

colorectal cancer.

70
Q

Precipitants of hemolytic crisis in patients with G6PD deficiency.

A

Sulfonamides, antimalarial drugs, fava beans.

71
Q

The most common inherited cause of hypercoagulability.

A

Factor V Leiden mutation.

72
Q

The most common inherited bleeding disorder.

A

von Willebrand’s disease.

73
Q

The most common inherited hemolytic anemia.

A

Hereditary spherocytosis.

74
Q

Diagnostic test for hereditary spherocytosis.

A

Osmotic fragility test.

75
Q

Pure RBC aplasia.

A

Diamond-Blackfan anemia.

76
Q

Anemia associated with absent radii and thumbs, diffuse
hyperpigmentation, café au lait spots, microcephaly, and
pancytopenia.

A

Fanconi’s anemia.

77
Q

Medications and viruses that lead to aplastic anemia.

A

Chloramphenicol, sulfonamides, radiation, HIV,

chemotherapeutic agents, hepatitis, parvovirus B19, EBV.

78
Q

How to distinguish polycythemia vera from 2° polycythemia.

A

Both have ↑ hematocrit and RBC mass, but polycythemia vera should have normal O2 saturation and low erythropoietin levels.

79
Q

Thrombotic thrombocytopenic purpura (TTP) pentad?

A

“FAT RN”: Fever, Anemia, Thrombocytopenia, Renal

dysfunction, Neurologic abnormalities.

80
Q

Hemolytic uremic syndrome (HUS) triad?

A

Anemia, thrombocytopenia, and acute renal failure.

81
Q

Treatment for TTP.

A

Emergent large-volume plasmapheresis, corticosteroids,

antiplatelet drugs.

82
Q

Treatment for idiopathic thrombocytopenic purpura (ITP) in children.

A

Usually resolves spontaneously; may require IV Ig and/or

corticosteroids.

83
Q

Which of the following are ↑ in DIC: fi brin split products,

D-dimer, fi brinogen, platelets, and hematocrit.

A

Fibrin split products and D-dimer are elevated; platelets,

fi brinogen, and hematocrit are ↓.

84
Q

An eight-year-old boy presents with hemarthrosis and ↑ PTT with normal PT and bleeding time. Diagnosis? Treatment?

A

Hemophilia A or B; consider desmopressin (for hemophilia A) or factor VIII or IX supplements.

85
Q

A 14-year-old girl presents with prolonged bleeding after dental surgery and with menses, normal PT, normal or ↑ PTT, and ↑ bleeding time. Diagnosis? Treatment?

A

von Willebrand’s disease; treat with desmopressin, FFP, or cryoprecipitate.

86
Q

A 60-year-old African-American man presents with bone pain. Workup for multiple myeloma might reveal?

A

Monoclonal gammopathy, Bence Jones proteinuria, “punched-out” lesions on x-ray of the skull and long bones.

87
Q

Reed-Sternberg cells.

A

Hodgkin’s lymphoma.

88
Q

A 10-year-old boy presents with fever, weight loss, and night sweats. Exam shows an anterior mediastinal mass.

Suspected diagnosis?

A

Non-Hodgkin’s lymphoma.

89
Q

Microcytic anemia with ↓ serum iron, ↓ total iron-binding

capacity (TIBC), and normal or ↑ ferritin.

A

Anemia of chronic disease.

90
Q

Microcytic anemia with ↓ serum iron, ↓ ferritin, and ↑ TIBC.

A

Iron defi ciency anemia.

91
Q

An 80-year-old man presents with fatigue,
lymphadenopathy, splenomegaly, and isolated
lymphocytosis. Suspected diagnosis?

A

Chronic lymphocytic leukemia (CLL).

92
Q

The lymphoma equivalent of chronic lymphocytic leukemia (CLL).

A

Small lymphocytic lymphoma.

93
Q

A late, life-threatening complication of chronic myelogenous

leukemia (CML).

A

Blast crisis (fever, bone pain, splenomegaly, pancytopenia).

94
Q

Auer rods on blood smear.

A

Acute myelogenous leukemia (AML).

95
Q

AML subtype associated with DIC.

96
Q

Electrolyte changes in tumor lysis syndrome.

A

↓ Ca2+, ↑ K+, ↑ phosphate, ↑ uric acid.

97
Q

Treatment for AML M3.

A

Retinoic acid.

98
Q

A 50-year-old man presents with early satiety, splenomegaly, and bleeding. Cytogenetics show t(9,22). Diagnosis?

A

Chronic myelogenous leukemia (CML).

99
Q

Heinz bodies?

A

Intracellular inclusions seen in thalassemia, G6PD deficiency, and postsplenectomy.

100
Q

An autosomal-recessive disorder with a defect in the GPIIbIIIa platelet receptor and ↓ platelet aggregation.

A

Glanzmann’s thrombasthenia.

101
Q

Virus associated with aplastic anemia in patients with sickle cell anemia.

A

Parvovirus B19.

102
Q

A 25-year-old African-American man with sickle cell anemia has sudden onset of bone pain. Management of pain crisis?

A

O2, analgesia, hydration, and, if severe, transfusion.

103
Q

A significant cause of morbidity in thalassemia patients.

Treatment?

A

Iron overload; use deferoxamine.

MCCQE1 (19 decks)

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