Hematology / Oncology Flashcards
1
Q
Henoch-Schonlein Purpura (HSP) is a type of pediatric vasculitis that results from …
A
IgA deposition
2
Q
2 early clinical manifestations of HSP?
A
Palpable purpura, Abdominal pain
3
Q
What accounts for abdominal pain in setting of HSP?
A
Intussusception
4
Q
2 late clinical manifestations of HSP?
A
Arthralgias, IgA nephropathy
5
Q
Most common prognosis for HSP?
A
Spontaneous resolution
6
Q
Best treatment for mild cases of HSP?
A
Supportive care, Hydration
7
Q
Best treatment for severe cases of HSP?
A
Systemic steroids
8
Q
Common UA findings for HSP?
A
Hematuria + RBC casts
9
Q
Common antecedent event in setting of HSP?
A
URI
10
Q
5 aspects of clinical presentation for multiple myeloma?
A
CRAB – hypercalcemia, renal insufficiency, anemia, bone pain (fractures)
11
Q
3 aspects of workup for patients with suspected multiple myeloma?
A
Serum protein electrophoresis, Urine protein electrophoresis, Bone marrow biopsy
12
Q
Appearance of bone marrow biopsy in setting of multiple myeloma?
A
> 10% plasma cells
13
Q
Best way to evaluate possible pathologic fractures in patients recently diagnosed with multiple myeloma?
A
Skeletal survey (XR)
14
Q
Complication of multiple myeloma?
A
Hyperviscosity syndrome
15
Q
What accounts for development of Hyperviscosity syndrome in setting of multiple myeloma?
A
Increased protein count, Abnormal Ig shape
16
Q
6 aspects of clinical presentation for Hyperviscosity syndrome?
A
HA, dizziness, nystagmus, hearing loss, vision changes, gingival bleeding
17
Q
Best treatment for Hyperviscosity syndrome?
A
Plasmapheresis
18
Q
Initial treatment for patient with vaso-occlusive episode in setting of sickle cell disease?
A
IV opioids
19
Q
Additional treatment for patient with vaso-occlusive episode in setting of sickle cell disease?
A
Rehydration
20
Q
In setting of sickle cell disease, diagnosis of Acute Chest Syndrome always requires …
A
Presence of new pulmonary infiltrate on CXR
21
Q
In addition to Presence of new pulmonary infiltrate on CXR, what are 3 other criteria for diagnosis of Acute Chest Syndrome in sickle cell disease (only 1 needed)?
A
Fever, Hypoxemia, CP, Respiratory distress
22
Q
Best treatment for Acute Chest Syndrome in sickle cell disease (only 1 needed)?
A
Ceftriaxone + Macrolide
23
Q
Value of treating Acute Chest Syndrome with Ceftriaxone?
A
Covers Strep pneumoniae
24
Q
Value of treating Acute Chest Syndrome with Macrolide?
A
Covers Mycoplasma pneumonia
25
Most common cause of hereditary thrombophilia?
Factor V Leiden
26
Clinical consequence of hereditary thrombophilia in Factor V Leiden?
Increased risk of venous thromboembolism
27
Anemia in patients with ESRD is usually due to …
Decreased EPO secretion
28
ESRD patients with transferrin saturation <30% and ferritin <500 require which treatment?
IV iron supplementation
29
Best imaging modality for detection of osteolytic bone metastases?
XR, PET
30
Best imaging modality for detection of osteoblastic bone metastases?
Radioisotope bone scan
31
3 medications that most commonly cause macrocytic anemia due to folate deficiency?
TMP-SMX, Methotrexate, Phenytoin
32
Best treatment for “rescue” of RBCs that are deficient in folic acid, causing macrocytic anemia?
Folinic Acid … more potent that folic acid
33
6 “red flag” features of lower back pain?
Constitutional symptoms (fever, weight loss); Age > 55 yo; IVDU; Immunosuppression; Nocturnal pain; HX of malignancy
34
Next step in management of patient with lower back pain with “red flag” symptoms?
Spinal XRs, serum ESR
35
Role of spinal XRs in management of patient with lower back pain with “red flag” symptoms?
Identify lytic bone lesions
36
Role of serum ESR in management of patient with lower back pain with “red flag” symptoms?
Elevated in infection, malignancy, inflammatory conditions
37
Next step of management of patient with lower back pain with “red flag” symptoms … (+) spinal XR or ESR?
MRI
38
Thalassemia represents a type of ___ anemia
Microcytic
39
Change to ferritin in Thalassemia?
Increased
40
Change to RBC turnover in Thalassemia?
Increased
41
Change to MCV in Thalassemia?
Very low
42
Diagnostic test for Thalassemia?
Maternal hemoglobin electrophoresis
43
Change to hemoglobin electrophoresis in Thalassemia?
Elevated hemoglobin A2 levels
44
Appearance of peripheral smear in Thalassemia?
Target cells
45
Normal INR value for patient on warfarin?
2-3
46
Best management of popliteal DVT that is inadequately treated with warfarin, then develops into femoral DVT?
IV heparin
47
___ presents in young children with sickle cell disease as symmetric swelling and pain of the hands + feet
Dactylitis
48
Best management of Dactylitis?
NSAIDs, Oral opioids (oxycodone)
49
2 non-pharmacologic treatments of Dactylitis?
Heat application, hydration
50
Clinical presentation of TTP (thrombotic thrombocytopenic purpura)?
FTKCS – Fever, Thrombocytopenia, Kidney damage, CNS impairment, Schistocytes (from hemolytic anemia)
51
Etiology of TTP?
Formation of antibodies against ADAMST13
52
Role of ADAMST13?
Plasma metalloproteinase that cleaves VWF
53
Treatment of TTP?
Plasma exchange
54
Role of plasma exchange in treatment of TTP?
Removes the anti-ADAMST13 Ig … and replaces ADAMST13 from donor plasma
55
Characteristic lab finding for patients with CLL?
Significant lymphocytosis
56
CLL represents leukemia of …
Monoclonal B cells
57
2 physical exam findings that indicate poor prognostic factor for CLL?
Organomegaly, LAD
58
2 lab findings that indicate poor prognostic factor for CLL?
Anemia, Thrombocytopenia
59
What is the primary goal of treatment for patients with metastatic prostate CA?
Palliation
60
Best step of palliative treatment for patients with metastatic prostate CA, pain is unresponsive to narcotic analgesics?
External beam radiation therapy
61
Clinical presentation of acute sickle cell hepatic crisis?
Fever, jaundice, RUQ pain
62
2 lab values seen in acute sickle cell hepatic crisis?
Anemia (hemolysis), Elevated LFTs
63
Common trigger for acute sickle cell hepatic crisis?
Persistent N/V … leading to dehydration … vaso-occlusive trigger
64
Prognosis for acute sickle cell hepatic crisis?
Self-limited with resolution typically within 2 weeks
65
Therapeutic onset of direct factor Xa inhibitors?
2-4 hours
66
Overlap needed for direct factor Xa inhibitors?
No
67
Lab monitoring for direct factor Xa inhibitors?
No
68
MOA of direct factor Xa inhibitors?
Vitamin K antagonism
69
Therapeutic onset of direct factor Xa inhibitors?
5-7 days
70
Overlap needed for direct factor Xa inhibitors?
Yes, overlap with Heparin + LMWH for 5 days
71
Lab monitoring for direct factor Xa inhibitors?
PT/INR
72
Best treatment for DVT in a patient without CA?
Oral factor Xa inhibitor
73
Duration of Oral factor Xa inhibitor treatment for DVT in patient without CA?
3 months
74
Best treatment for DVT or PE in a patient with CA?
LMWH
75
Best management of DVT for female on menopausal hormonal therapy (MHT)?
Cessation of MHT, begin SSRIs
76
Clinical presentation immune thrombocytopenia (ITP)?
Platelet count < 100,000; sudden onset bleeding, recent viral infection
77
Best management of ITP for patients with mild or no bleeding?
Observation
78
Best management of ITP for patients with mucosal bleeding, platelet count < 30,000?
IVIG
79
Clinical prognosis for ITP?
Spontaneous resolution
80
Appearance of iron deficiency anemia on peripheral smear?
Hypochromic microcytic RBCs
81
3 factors that may lead to iron deficiency anemia during pregnancy?
Fetal hematopoiesis, Placental development, Expansion of maternal RBC mass
82
Best management for patient on warfarin with INR 2-4.5?
Hold warfarin for 1-2 days
83
Best management for patient on warfarin with INR 4.5-10?
Hold warfarin, resume when INR returns to NML
84
Best management for patient on warfarin with INR >10?
Hold warfarin, administer 2.5-5mg oral Vitamin K
85
Best management for patient on warfarin with active bleeding?
Hold warfarin, administer 10mg oral Vitamin K + PCC
86
2 parts of spinal cord affected by Pernicious Anemia?
Dorsal columns + Lateral columns
87
Clinical presentation of Pernicious Anemia effect on dorsal columns?
Loss of proprioception + vibration
88
Clinical presentation of Pernicious Anemia effect on lateral columns?
Brisk reflexes
89
Complication of B12 supplementation in patients with pernicious anemia?
Hypokalemia
90
What accounts for development of Hypokalemia in treatment of pernicious anemia?
Uptake of K+ by newly-formed RBCs
91
Inheritance pattern of G6PD deficiency?
X-linked recessive
92
Clinical presentation of G6PD deficiency?
Hemolytic anemia
93
Diagnostic lab value for G6PD deficiency?
Low G6PD
94
Appearance of blood smear in G6PD deficiency?
Bite cells with Heinz bodies
95
What is the role of G6PD?
Formation of NADPH
96
Most common cause of polycythemia?
Chronic hypoxia
97
Best initial test for polycythemia?
Serum EPO level
98
Change to EPO in polycythemia vera?
Low
99
Change to EPO in polycythemia caused by chronic hypoxia?
High
100
Additional pathology that might cause polycythemia with high EPO?
Renal cell CA
101
Which lab value may indicate CO poisoning?
Carboxyhemoglobin
102
Most common cause of chronic hypoxia causing polycythemia?
Sleep apnea
103
Best test for suspected Sleep apnea?
Nocturnal oximetry
104
Microcytic, hypochromic RBCs with anisocytosis suggests …
Iron deficiency anemia
105
Typical change to ferritin levels in Iron deficiency anemia?
Decreased
106
Major source of blood loss in male with Iron deficiency anemia?
GI tract
107
56 yo male presents for pain, paresthesia, black discoloration of several fingers; Also reports fatigue, back pain for several months; PE shows livedo reticularis; Labs show anemia, elevated creatinine, elevated protein, hypercalcemia, high ESR; XR shows lytic lesions in vertebrae - etiology of patient’s hand findings?
Microvascular cryoglobulin precipitation from MM … causing microvascular occlusion
108
Diseases associated with Type 1 cryoglobulins?
B cell malignancies (MM)
109
Diseases associated with Type 2 cryoglobulins?
Hepatitis C, SLE
110
55 yo female presents with HGB 5.7; Hx of myelodysplasia, requiring multiple blood transfusions; Labs calls to say that blood grouping and cross-matching are complete, but are unable to find suitable blood for transfusion - what is reason for this incompatibility?
Alloantibodies
111
___ are typically responsible for difficulties in finding cross-matched bloos in patients with history of multiple blood transfusions
Alloantibodies
112
How do you calculate Mentzer index?
MCV/RBC
113
What is the value of Mentzer index?
Distinguishes between IDA and Thalassemia
114
Mentzer index that suggests IDA?
> 13
115
Mentzer index that suggests Thalassemia?
< 13
116
When should iron-rich food be introduced to breast-fed babies to prevent IDA?
6 mo
117
8 wo male presents for fever; Drinks soy-based formula; T 100.4, HR 120, RR 30; HGB 11.5 (decreased from 18 at birth), Reticulocytes 0.8% - what is best explanation for HGB drop?
Normal finding in children 2-3 mo to have HGB 11
118
What accounts for physiologic anemia of infancy?
Transient down-regulation of EPO
119
58 yo male presents with cough, weight loss; Long smoking HX; CXR shows 3.2cm mass in RUL; Sputum cytology consistent with SCC; What is best next step in management?
CT chest for staging
120
54 yo male presents for ophthalamic exam for newly diagnosed T2DM; Fundoscopic exam shows densly-pigmented lesion in choroid; Size = 8mm with height 1mm - what is best next step of workup?
Repeat exam in 3 months
121
Best management of ocular melanoma that is <10mm diameter, < 3 mm thickness?
Follow-up in 3 months, then every 6 months thereafter
122
Best management of ocular melanoma that is > 10mm diameter, > 3 mm thickness?
XRT
123
34 yo female with ALL prepares for induction CTX with vincristine, doxorubicin, prednisone; Which test is appropriate for monitoring patient’s condition while on CTX?
Radionucleotide ventriculography
124
Role of Radionucleotide ventriculography?
Measures EF
125
30 yo female presents for preconception counseling; Currently on warfarin for mitral valve replacement - what is recommendation regarding anti-coagulation during pregnancy?
Warfarin should be replaced with LMWH during 1st trimester, then with unfractionated heparin before delivery
126
64 yo male develops PE after R total knee replacement; (was on LMWH as DVT PPX); CBC after positive CTPE shows PL 45, down from 170 preop - what is best approach?
Wait for platelet count recovery before starting warfarin
127
Best approach to HIT?
Stop ALL forms of heparin, start alternative anticoagulants (direct thrombin inhibitor)
128
Example of a direct thrombin inhibitor?
Argatroban
129
When is warfarin started in setting of HIT?
After treatment with non-heparin anticoagulant, with PL recovery to 150+
130
43 yo male presents for fatigue, palpitations; 3 recent episodes of URI; Smokes 2 PPD, sexually active with several partners; Labs show Hgb 6.7, MCV 85 - what is best next step in management?
Reticulocyte count
131
Best initial step in investigation of normocytic anemia?
Ret count
132
15 yo male presents with fever, fatigue, neck pain; PE shows tender, erythematous BL cervical LAD; PE shows T100.6; HX of chronic granulomatous disease; Current prophylaxis included TMP-SMX, itraconazole - best next step?
Biopsy of LN and culture
133
Etiology of chronic granulomatous disease?
X-linked recessive mutation of NADPH oxidase
134
Clinical presentation of chronic granulomatous disease?
Infection of skin, lung, LNs
135
3 DOC for prophylaxis against chronic granulomatous disease?
TMP-SMX, itraconazole, IFN-gamma
136
Which bacteria are patients with chronic granulomatous disease susceptible to?
Catalase (+)
137
62 yo male with Diffuse Large B-Cell Lymphoma presents for R-CHOP chemotherapy; HX of HFREF, T2DM, HTN; Develops NV, treated with anti-emetics; Next morning, patient develops loss of pulse; EKG shows widening of QRS complex, patient late develops cardiac arrest - what is underlying etiology of cardiac arrest?
Tumor lysis syndrome
138
Electrolyte abnormalities associated with Tumor Lysis Syndrome?
Hyperkalemia, Elevated uric acid, Elevated phosphate
139
1 yo male presents with severe microcytic + hypochromic anemia; PE reveals hepatosplenomegaly - diagnosis?
Thalassemia major
140
1 yo male presents with severe microcytic + hypochromic anemia; PE reveals hepatosplenomegaly; If this child survives years after initial diagnosis, severe organ damage due to iron overload will be best explained by …
Hypertransfusion regimen
141
30 mo male presents with fever, cough, SOB; Hx of recurrent infections, including 4 episodes of cervical lymphadenitis; T 100.8; CXR reveals patchy infiltrate in LLL and moderate pleural effusion; Labs show LDH 1100, WBC 70, PMN predominence; Pleural fluid culture grows GNB within neutrophils, and Burkholderia - diagnosis?
Chronic granulomatous disease
142
What is best infection prophylaxis against Chronic granulomatous disease?
TMP-SMX, Itraconazole
143
Inheritance pattern of Chronic granulomatous disease?
X-linked recessive
144
Mutation in Chronic granulomatous disease?
NADPH oxidase
145
Clinical presentation of TTP?
FTKCS – fever, thrombocytopenia, kidney dysfunction, CNS, schistocytes (hemolytic anemia)
146
When does HELLP syndrome typically present?
3rd trimester
147
When does acute fatty liver of pregnancy typically present?
3rd trimester
148
15 mo male presents with iron deficiency anemia; Started on ferrous sulfate – which lab change will occur first after initiation of ferrous sulfate?
Increase in reticulocyte count
149
16 mo female presents with parents for concerns about slow development; Born to Greek mother, AA father; Drinks cow’s milk; Father has Sickle Cell Trait; PE shows pallor; Labs show HGB 9.2, MCV 64, RDW 16.5%; HGB electrophoresis shows 40% HB-S, 60% HB-A – diagnosis?
Iron Deficiency Anemia; Sickle Cell trait
150
IDA is typically diagnosed by …
Clinical history, low HGB
151
In patients with family history of hemoglobinopathy, what is another step necessary in diagnosis of IDA?
HGB electrophoresis
152
HGB electrophoresis that shows 40% HB-S, 60% HB-A is consistent with …
Sickle Cell trait
153
Clinical presentation of Sickle Cell trait?
Asymptomatic, does not cause anemia
154
___ refers to interdisciplinary intervention that seeks to reduce unnecessary medical interventions and improve quality of life for patients with serious/terminal illness
Palliative Care
155
How do Palliative Care and Hospice differ?
Palliative care = can be offered to patients concurrently with disease-modifying treatments; Hospice = offered to patients when life-prolonging therapy is no longer indicated
156
40 yo male with HX of cirrhosis presents with perioral paresthesia, cramping of both hands; Admitted recently for hematemesis, requiring multiple pRBC transfusions + FFP; Labs show Na 132, HCO3 20, Ca2+ 9.2 – diagnosis?
Symptomatic hypocalcemia
157
40 yo male with HX of cirrhosis presents with perioral paresthesia, cramping of both hands; Admitted recently for hematemesis, requiring multiple pRBC transfusions + FFP; Labs show Na 132, HCO3 20, Ca2+ 9.2 – patients symptoms would likely improve after IV administration of …
Calcium gluconate, Calcium chloride
158
Association between massive blood transfusion and acute hypocalcemia?
Patients with renal/hepatic disease often fail to clear citrate quickly … citrate binds ionized calcium … free calcium levels decrease
159
Diagnosis for acute hypocalcemia in setting of multiple transfusions requires …
Ionized calcium level … (serum calcium level may be normal)
160
4 yo female with sickle cell disease presents with fatigue, loss of appetite; HR 120, O2 sat 95% on RA; PE shows conjunctival pallor; Labs show HGB 5.0, MCV 85, Ret 0.1% - diagnosis?
Aplastic crisis
161
Most common etiology of aplastic crisis in SCD?
Parvovirus B19 infection
162
Ret count change in aplastic crisis in SCD?
<1%
163
Ret count change in splenic sequestration in SCD?
>2%
164
Etiology of aplastic anemia (vs. aplastic sequestration)?
Aplastic anemia – occurs in non-SCD patients, characterized by pancytopenia
165
46-year-old female presents for upper GI hemorrhage; reports 2 episodes of coffee ground emesis, along with intermittent passage of black stools; 2 days ago, patient underwent EGD, revealing erosive gastritis; prescribed omeprazole; what is next best step in management?
IV desmopressin
166
What is the most common cause of bleeding in patients with chronic kidney disease?
Platelet dysfunction
167
In a patient with chronic kidney disease, normal platelet count and coagulation labs are seen; what is the problem that leads to abnormalities in hemostasis in patients with chronic CKD?
Decreased platelet adhesion due to time regulated von Willebrand factor
168
MONA of desmopressin?
Stimulates release of von Willebrand factor from endothelial cells and reduces bleeding time
169
45 yo female presents for elective hysterectomy; Preop Hgb is 7; Patient transfused with 2u pRBCs; 2 hours after transfusion begins, patient develops fever, chills, malaise; Transfusion is stopped and patient is treated with acetaminophen - what could have prevented this transfusion reaction?
Leukoreduction
170
What is the most common AE of transfusion?
Febrile non-hemolytic transfusion reaction
