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UWorld > Hematology / Oncology > Flashcards

Hematology / Oncology Flashcards

1
Q

Henoch-Schonlein Purpura (HSP) is a type of pediatric vasculitis that results from …

A

IgA deposition

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2
Q

2 early clinical manifestations of HSP?

A

Palpable purpura, Abdominal pain

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3
Q

What accounts for abdominal pain in setting of HSP?

A

Intussusception

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4
Q

2 late clinical manifestations of HSP?

A

Arthralgias, IgA nephropathy

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5
Q

Most common prognosis for HSP?

A

Spontaneous resolution

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6
Q

Best treatment for mild cases of HSP?

A

Supportive care, Hydration

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7
Q

Best treatment for severe cases of HSP?

A

Systemic steroids

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8
Q

Common UA findings for HSP?

A

Hematuria + RBC casts

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9
Q

Common antecedent event in setting of HSP?

A

URI

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10
Q

5 aspects of clinical presentation for multiple myeloma?

A

CRAB – hypercalcemia, renal insufficiency, anemia, bone pain (fractures)

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11
Q

3 aspects of workup for patients with suspected multiple myeloma?

A

Serum protein electrophoresis, Urine protein electrophoresis, Bone marrow biopsy

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12
Q

Appearance of bone marrow biopsy in setting of multiple myeloma?

A

> 10% plasma cells

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13
Q

Best way to evaluate possible pathologic fractures in patients recently diagnosed with multiple myeloma?

A

Skeletal survey (XR)

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14
Q

Complication of multiple myeloma?

A

Hyperviscosity syndrome

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15
Q

What accounts for development of Hyperviscosity syndrome in setting of multiple myeloma?

A

Increased protein count, Abnormal Ig shape

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16
Q

6 aspects of clinical presentation for Hyperviscosity syndrome?

A

HA, dizziness, nystagmus, hearing loss, vision changes, gingival bleeding

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17
Q

Best treatment for Hyperviscosity syndrome?

A

Plasmapheresis

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18
Q

Initial treatment for patient with vaso-occlusive episode in setting of sickle cell disease?

A

IV opioids

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19
Q

Additional treatment for patient with vaso-occlusive episode in setting of sickle cell disease?

A

Rehydration

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20
Q

In setting of sickle cell disease, diagnosis of Acute Chest Syndrome always requires …

A

Presence of new pulmonary infiltrate on CXR

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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

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22
Q

Best treatment for Acute Chest Syndrome in sickle cell disease (only 1 needed)?

A

Ceftriaxone + Macrolide

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23
Q

Value of treating Acute Chest Syndrome with Ceftriaxone?

A

Covers Strep pneumoniae

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24
Q

Value of treating Acute Chest Syndrome with Macrolide?

A

Covers Mycoplasma pneumonia

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25
Q

Most common cause of hereditary thrombophilia?

A

Factor V Leiden

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26
Q

Clinical consequence of hereditary thrombophilia in Factor V Leiden?

A

Increased risk of venous thromboembolism

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27
Q

Anemia in patients with ESRD is usually due to …

A

Decreased EPO secretion

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28
Q

ESRD patients with transferrin saturation <30% and ferritin <500 require which treatment?

A

IV iron supplementation

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29
Q

Best imaging modality for detection of osteolytic bone metastases?

A

XR, PET

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30
Q

Best imaging modality for detection of osteoblastic bone metastases?

A

Radioisotope bone scan

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31
Q

3 medications that most commonly cause macrocytic anemia due to folate deficiency?

A

TMP-SMX, Methotrexate, Phenytoin

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32
Q

Best treatment for “rescue” of RBCs that are deficient in folic acid, causing macrocytic anemia?

A

Folinic Acid … more potent that folic acid

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33
Q

6 “red flag” features of lower back pain?

A

Constitutional symptoms (fever, weight loss); Age > 55 yo; IVDU; Immunosuppression; Nocturnal pain; HX of malignancy

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34
Q

Next step in management of patient with lower back pain with “red flag” symptoms?

A

Spinal XRs, serum ESR

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35
Q

Role of spinal XRs in management of patient with lower back pain with “red flag” symptoms?

A

Identify lytic bone lesions

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36
Q

Role of serum ESR in management of patient with lower back pain with “red flag” symptoms?

A

Elevated in infection, malignancy, inflammatory conditions

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37
Q

Next step of management of patient with lower back pain with “red flag” symptoms … (+) spinal XR or ESR?

A

MRI

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38
Q

Thalassemia represents a type of ___ anemia

A

Microcytic

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39
Q

Change to ferritin in Thalassemia?

A

Increased

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40
Q

Change to RBC turnover in Thalassemia?

A

Increased

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41
Q

Change to MCV in Thalassemia?

A

Very low

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42
Q

Diagnostic test for Thalassemia?

A

Maternal hemoglobin electrophoresis

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43
Q

Change to hemoglobin electrophoresis in Thalassemia?

A

Elevated hemoglobin A2 levels

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44
Q

Appearance of peripheral smear in Thalassemia?

A

Target cells

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45
Q

Normal INR value for patient on warfarin?

A

2-3

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46
Q

Best management of popliteal DVT that is inadequately treated with warfarin, then develops into femoral DVT?

A

IV heparin

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47
Q

___ presents in young children with sickle cell disease as symmetric swelling and pain of the hands + feet

A

Dactylitis

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48
Q

Best management of Dactylitis?

A

NSAIDs, Oral opioids (oxycodone)

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49
Q

2 non-pharmacologic treatments of Dactylitis?

A

Heat application, hydration

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50
Q

Clinical presentation of TTP (thrombotic thrombocytopenic purpura)?

A

FTKCS – Fever, Thrombocytopenia, Kidney damage, CNS impairment, Schistocytes (from hemolytic anemia)

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51
Q

Etiology of TTP?

A

Formation of antibodies against ADAMST13

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52
Q

Role of ADAMST13?

A

Plasma metalloproteinase that cleaves VWF

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53
Q

Treatment of TTP?

A

Plasma exchange

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54
Q

Role of plasma exchange in treatment of TTP?

A

Removes the anti-ADAMST13 Ig … and replaces ADAMST13 from donor plasma

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55
Q

Characteristic lab finding for patients with CLL?

A

Significant lymphocytosis

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56
Q

CLL represents leukemia of …

A

Monoclonal B cells

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57
Q

2 physical exam findings that indicate poor prognostic factor for CLL?

A

Organomegaly, LAD

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58
Q

2 lab findings that indicate poor prognostic factor for CLL?

A

Anemia, Thrombocytopenia

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59
Q

What is the primary goal of treatment for patients with metastatic prostate CA?

A

Palliation

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60
Q

Best step of palliative treatment for patients with metastatic prostate CA, pain is unresponsive to narcotic analgesics?

A

External beam radiation therapy

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61
Q

Clinical presentation of acute sickle cell hepatic crisis?

A

Fever, jaundice, RUQ pain

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62
Q

2 lab values seen in acute sickle cell hepatic crisis?

A

Anemia (hemolysis), Elevated LFTs

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63
Q

Common trigger for acute sickle cell hepatic crisis?

A

Persistent N/V … leading to dehydration … vaso-occlusive trigger

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64
Q

Prognosis for acute sickle cell hepatic crisis?

A

Self-limited with resolution typically within 2 weeks

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65
Q

Therapeutic onset of direct factor Xa inhibitors?

A

2-4 hours

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66
Q

Overlap needed for direct factor Xa inhibitors?

A

No

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67
Q

Lab monitoring for direct factor Xa inhibitors?

A

No

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68
Q

MOA of direct factor Xa inhibitors?

A

Vitamin K antagonism

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69
Q

Therapeutic onset of direct factor Xa inhibitors?

A

5-7 days

70
Q

Overlap needed for direct factor Xa inhibitors?

A

Yes, overlap with Heparin + LMWH for 5 days

71
Q

Lab monitoring for direct factor Xa inhibitors?

A

PT/INR

72
Q

Best treatment for DVT in a patient without CA?

A

Oral factor Xa inhibitor

73
Q

Duration of Oral factor Xa inhibitor treatment for DVT in patient without CA?

A

3 months

74
Q

Best treatment for DVT or PE in a patient with CA?

A

LMWH

75
Q

Best management of DVT for female on menopausal hormonal therapy (MHT)?

A

Cessation of MHT, begin SSRIs

76
Q

Clinical presentation immune thrombocytopenia (ITP)?

A

Platelet count < 100,000; sudden onset bleeding, recent viral infection

77
Q

Best management of ITP for patients with mild or no bleeding?

A

Observation

78
Q

Best management of ITP for patients with mucosal bleeding, platelet count < 30,000?

A

IVIG

79
Q

Clinical prognosis for ITP?

A

Spontaneous resolution

80
Q

Appearance of iron deficiency anemia on peripheral smear?

A

Hypochromic microcytic RBCs

81
Q

3 factors that may lead to iron deficiency anemia during pregnancy?

A

Fetal hematopoiesis, Placental development, Expansion of maternal RBC mass

82
Q

Best management for patient on warfarin with INR 2-4.5?

A

Hold warfarin for 1-2 days

83
Q

Best management for patient on warfarin with INR 4.5-10?

A

Hold warfarin, resume when INR returns to NML

84
Q

Best management for patient on warfarin with INR >10?

A

Hold warfarin, administer 2.5-5mg oral Vitamin K

85
Q

Best management for patient on warfarin with active bleeding?

A

Hold warfarin, administer 10mg oral Vitamin K + PCC

86
Q

2 parts of spinal cord affected by Pernicious Anemia?

A

Dorsal columns + Lateral columns

87
Q

Clinical presentation of Pernicious Anemia effect on dorsal columns?

A

Loss of proprioception + vibration

88
Q

Clinical presentation of Pernicious Anemia effect on lateral columns?

A

Brisk reflexes

89
Q

Complication of B12 supplementation in patients with pernicious anemia?

A

Hypokalemia

90
Q

What accounts for development of Hypokalemia in treatment of pernicious anemia?

A

Uptake of K+ by newly-formed RBCs

91
Q

Inheritance pattern of G6PD deficiency?

A

X-linked recessive

92
Q

Clinical presentation of G6PD deficiency?

A

Hemolytic anemia

93
Q

Diagnostic lab value for G6PD deficiency?

A

Low G6PD

94
Q

Appearance of blood smear in G6PD deficiency?

A

Bite cells with Heinz bodies

95
Q

What is the role of G6PD?

A

Formation of NADPH

96
Q

Most common cause of polycythemia?

A

Chronic hypoxia

97
Q

Best initial test for polycythemia?

A

Serum EPO level

98
Q

Change to EPO in polycythemia vera?

A

Low

99
Q

Change to EPO in polycythemia caused by chronic hypoxia?

A

High

100
Q

Additional pathology that might cause polycythemia with high EPO?

A

Renal cell CA

101
Q

Which lab value may indicate CO poisoning?

A

Carboxyhemoglobin

102
Q

Most common cause of chronic hypoxia causing polycythemia?

A

Sleep apnea

103
Q

Best test for suspected Sleep apnea?

A

Nocturnal oximetry

104
Q

Microcytic, hypochromic RBCs with anisocytosis suggests …

A

Iron deficiency anemia

105
Q

Typical change to ferritin levels in Iron deficiency anemia?

A

Decreased

106
Q

Major source of blood loss in male with Iron deficiency anemia?

A

GI tract

107
Q

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?

A

Microvascular cryoglobulin precipitation from MM … causing microvascular occlusion

108
Q

Diseases associated with Type 1 cryoglobulins?

A

B cell malignancies (MM)

109
Q

Diseases associated with Type 2 cryoglobulins?

A

Hepatitis C, SLE

110
Q

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?

A

Alloantibodies

111
Q

___ are typically responsible for difficulties in finding cross-matched bloos in patients with history of multiple blood transfusions

A

Alloantibodies

112
Q

How do you calculate Mentzer index?

A

MCV/RBC

113
Q

What is the value of Mentzer index?

A

Distinguishes between IDA and Thalassemia

114
Q

Mentzer index that suggests IDA?

A

> 13

115
Q

Mentzer index that suggests Thalassemia?

A

< 13

116
Q

When should iron-rich food be introduced to breast-fed babies to prevent IDA?

A

6 mo

117
Q

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?

A

Normal finding in children 2-3 mo to have HGB 11

118
Q

What accounts for physiologic anemia of infancy?

A

Transient down-regulation of EPO

119
Q

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?

A

CT chest for staging

120
Q

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?

A

Repeat exam in 3 months

121
Q

Best management of ocular melanoma that is <10mm diameter, < 3 mm thickness?

A

Follow-up in 3 months, then every 6 months thereafter

122
Q

Best management of ocular melanoma that is > 10mm diameter, > 3 mm thickness?

A

XRT

123
Q

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?

A

Radionucleotide ventriculography

124
Q

Role of Radionucleotide ventriculography?

A

Measures EF

125
Q

30 yo female presents for preconception counseling; Currently on warfarin for mitral valve replacement - what is recommendation regarding anti-coagulation during pregnancy?

A

Warfarin should be replaced with LMWH during 1st trimester, then with unfractionated heparin before delivery

126
Q

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?

A

Wait for platelet count recovery before starting warfarin

127
Q

Best approach to HIT?

A

Stop ALL forms of heparin, start alternative anticoagulants (direct thrombin inhibitor)

128
Q

Example of a direct thrombin inhibitor?

A

Argatroban

129
Q

When is warfarin started in setting of HIT?

A

After treatment with non-heparin anticoagulant, with PL recovery to 150+

130
Q

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?

A

Reticulocyte count

131
Q

Best initial step in investigation of normocytic anemia?

A

Ret count

132
Q

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?

A

Biopsy of LN and culture

133
Q

Etiology of chronic granulomatous disease?

A

X-linked recessive mutation of NADPH oxidase

134
Q

Clinical presentation of chronic granulomatous disease?

A

Infection of skin, lung, LNs

135
Q

3 DOC for prophylaxis against chronic granulomatous disease?

A

TMP-SMX, itraconazole, IFN-gamma

136
Q

Which bacteria are patients with chronic granulomatous disease susceptible to?

A

Catalase (+)

137
Q

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?

A

Tumor lysis syndrome

138
Q

Electrolyte abnormalities associated with Tumor Lysis Syndrome?

A

Hyperkalemia, Elevated uric acid, Elevated phosphate

139
Q

1 yo male presents with severe microcytic + hypochromic anemia; PE reveals hepatosplenomegaly - diagnosis?

A

Thalassemia major

140
Q

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 …

A

Hypertransfusion regimen

141
Q

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?

A

Chronic granulomatous disease

142
Q

What is best infection prophylaxis against Chronic granulomatous disease?

A

TMP-SMX, Itraconazole

143
Q

Inheritance pattern of Chronic granulomatous disease?

A

X-linked recessive

144
Q

Mutation in Chronic granulomatous disease?

A

NADPH oxidase

145
Q

Clinical presentation of TTP?

A

FTKCS – fever, thrombocytopenia, kidney dysfunction, CNS, schistocytes (hemolytic anemia)

146
Q

When does HELLP syndrome typically present?

A

3rd trimester

147
Q

When does acute fatty liver of pregnancy typically present?

A

3rd trimester

148
Q

15 mo male presents with iron deficiency anemia; Started on ferrous sulfate – which lab change will occur first after initiation of ferrous sulfate?

A

Increase in reticulocyte count

149
Q

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?

A

Iron Deficiency Anemia; Sickle Cell trait

150
Q

IDA is typically diagnosed by …

A

Clinical history, low HGB

151
Q

In patients with family history of hemoglobinopathy, what is another step necessary in diagnosis of IDA?

A

HGB electrophoresis

152
Q

HGB electrophoresis that shows 40% HB-S, 60% HB-A is consistent with …

A

Sickle Cell trait

153
Q

Clinical presentation of Sickle Cell trait?

A

Asymptomatic, does not cause anemia

154
Q

___ refers to interdisciplinary intervention that seeks to reduce unnecessary medical interventions and improve quality of life for patients with serious/terminal illness

A

Palliative Care

155
Q

How do Palliative Care and Hospice differ?

A

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
Q

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?

A

Symptomatic hypocalcemia

157
Q

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 …

A

Calcium gluconate, Calcium chloride

158
Q

Association between massive blood transfusion and acute hypocalcemia?

A

Patients with renal/hepatic disease often fail to clear citrate quickly … citrate binds ionized calcium … free calcium levels decrease

159
Q

Diagnosis for acute hypocalcemia in setting of multiple transfusions requires …

A

Ionized calcium level … (serum calcium level may be normal)

160
Q

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?

A

Aplastic crisis

161
Q

Most common etiology of aplastic crisis in SCD?

A

Parvovirus B19 infection

162
Q

Ret count change in aplastic crisis in SCD?

A

<1%

163
Q

Ret count change in splenic sequestration in SCD?

A

> 2%

164
Q

Etiology of aplastic anemia (vs. aplastic sequestration)?

A

Aplastic anemia – occurs in non-SCD patients, characterized by pancytopenia

165
Q

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?

A

IV desmopressin

166
Q

What is the most common cause of bleeding in patients with chronic kidney disease?

A

Platelet dysfunction

167
Q

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?

A

Decreased platelet adhesion due to time regulated von Willebrand factor

168
Q

MONA of desmopressin?

A

Stimulates release of von Willebrand factor from endothelial cells and reduces bleeding time

169
Q

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?

A

Leukoreduction

170
Q

What is the most common AE of transfusion?

A

Febrile non-hemolytic transfusion reaction

UWorld (21 decks)

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