Hematology Oncology Flashcards
What labs might indicate hemolysis?
increased retic count, increased unconjugated bilirubin, increased LDH, decreased haptoglobin
What are the different types of MAHA syndromes?
TTP, HUS, DIC, Prosthetic valves, eclampsia, HELLP, malignant HTN, vasculitis
How does lupus anticoagulant affect clotting facts/times?
PTT is prolonged, bleeding time normal
What is the presentation of acute hemolytic transfusion reaction?
flank pain, fever, chills, positive coombs, pink plasma
What is the presentation of autoimmune hemolytic anemia?
jaundice, hepatosplenomegaly, pallor,
What PNH and its presentation?
defect in cell membrane - intravascular hemolysis, thrombosis,
G6PD deficiency - How does it appear on pathology?
Heinz bodies
What is the presentation of Hodgkin’s lymphoma?
painless lymphadenopathy, sometimes fever, night sweats, cough
How is HL diagnosed?
lymph node biopsy demonstrating reed sternberg cells
What is the presentation of NHL?
enlarg lymph nodes, recurrent infections, possibly superior edvena cava obstruction, respiratory involvement, bone pain, etc
Who tends to be affected by AML?
adults, often exposed to radiation, myeloproliferative syndromes
Who tends to be affected by ALL? How bad is it?
children under 15; most responsivie to therapy, has poor prognosis if in really young or older children, elevated white count or CNS involvment
How can ALL be pathologically separated from AML?
Auer rods - granules and eosinophilic rods inside malignant cells
Who tends to be affected by CLL? How bad is it?
people over 50; not so bad (least aggressive)
What is the classic pathology of CLL?
smudge cells
What is a common presentation of polycythemia vera?
severe pruritis after a shower; facial plethora, splenomegaly
When do you get BRCA a screening?
over 50 1st degree relative 2 or more relatives Ovarian and breast cancers Ashkenazi jews
How does a vitamin K deficiency present in terms of clotting factors and bleeding times?
prolonged PT, prolonged PTT, greater PT than PTT
Describe the classic presentation of HUS
follows infectious disease, especially diarrheal
thrombocytopenia, microangiopathic hemolytic anemia, fever, renal failure
Describe the presentation of DIC. how does it present in terms of clotting factors and clotting times?
initial thrombosis followed by procoagulant consumption
thrombocytopenia, prolonged PT, prolonged PTT, prolonged thrombin time
Describe the classic presentation of TTP
hemolytic anemia, fever, neurological signs, thrombocytopenia
Describe the presentation of von Willebrand’s disease in terms of bleeding times and coags
prolonged bleeding time, increase in PTT; PT would be normal
Describe the side effect profile of tacrolimus
calcinuerin inhibitor - nephrotoxicity, hyperkalemia, glucose intolerance
Describe the side effect profile of cyclosporine
calcineurin inhibitor - nephrotoxicity, hyperkalemia, gingitival hypertrophy, hirsuitism, gout
Describe the side effect profile of azathioprine
dose related diarrhea, leukopenia, hepatotoxicity
Describe the side efect profile of mycophenolate
bone marrow suppression
Describe the characteristic presentation of squamous cell cancer
often location on the lip
invasive cords of squamous cells with keratin pearls
What are the cancers that frequently metastasize into the brain?
lung, breast, melanoma, colon
Distinguish between iron deficiency anemia and thalassemia
thalassemia: hematocrit increased, RDW is normal (increased in iron deficiency), target cells, normal iron studies, no response to iron
What is the best initial test for a patient with squamous cell carcinoma in the head and neck?
panendoscopy followed by biopsy
A patient comes in with focal back pain, a history of malignancy and bowel/bladder dysfunction. What is the best course of treatment?
glucocorticoids - this is epidural spinal cord compression
What is the diagnostic test for PNH?
sugar water test, flow cytometry to test for CD55 and CD59
What is the diagnostic test of choice for sideroblastic anemia?
prussian blue test
Distinguish between pernicious anemia and folic acid defiiciency
pernicious - increased LDH, achlorhydria present, schilling test positive, methyl malonyl coA present, neurological signs present
How is diagnosis of PV confirmed?
low erythropoeitin levels and presence of JAK2 mutation
How can CML be distinguished from a leukamoid process?
low leukocyte alk phosphatatase and presence of philadelphia chromosome. Often basophilia
What are the two MAHA syndromes for which you do not give platelets?
HIT and TTP
Describe the utility of the mixing study
if PT normalizes after mixing, indicates clotting factor deficiency
If PT does not normalize, indicates antibody issue
An African american patient presents with fever, jaundice, abdominal pain, and dark urine. There are small RBC inclusions on smear This is
G6PD deficiency - occurs in response to infection and oxidant drugs.
What is one possible side effect of warfarin if not bridged?
skin necrosis because protein C levels drop, inducing a procoagulant state.
What is the mechanism of G6PD deficiency?
needed to make NADPH which is used to reduce glutathione, which is used to protect RBCs from injury
What is the classic quatrand of multiple myeloma?
calcium, renal impairment, anemia, bones
What drugs have been shown to improve appetite in patients with advanced cancer?
progesterone analogs (megestrol acetate) and corticosteroids
When should blood be irradiated?
BMT, acquired or congenital cellular immunodeficiency, blood components from a first or second degree relative
What is the purpose of leukoreducing blood?
leukocytes release cytokines that can cause non-hemolytic fever
When should cells be washed?
IgA deficiency patients, complement dependent autoimmune hemolytic anemia, continued allergic reactions
What is the presentation of B12 deficiency?
macrocytic anemia, glossitis, neurologic changes
What findings on pathology smear indicate multiple myeloma?
rouleax and plasma cells
How do you distinguish MGUS from multiple myeloma?
MGUS < 3ug protein and <10% plasma cells
What is the presentation of pancoast tumors?
horner’s syndrome, shoulder pain, C8-T2 involvement
What is the difference between type 1 and type 2 HIT?
type 2 is immune mediated (antibodies against heparin platelet factor 4)
A patient presents with rubbery, mobile lymph nodes. What is the next step?
observation
What are some of the side effects of EPO shots?
worsening of hypertension, headaches, flu like syndrome
What are the side effects of trastuzumab (herceptin)?
cardiotoxicity
What is the best screening tool for a virilizing neoplasm? What can it tell you?
serum testosterone and DHEAS levels
if primarily elevated testosterone, indicates ovarian tumor. if primarily elevated DHEAS, adrenal source
If a patient presents at random with ITP, what test should be done?
HIV, HepC
What are the pathological findings associated with sickle cell?
Howell Jolly bodies
A North European patient presents with increased mean corpuscular hemoglobin concentration, hemolytic anemia, jaundice, and splenomegaly. He starts to have pain after eating (gallstones) This is…
hereditary spherocytosis
What antibiotic regimen should be offered to a patient with febrile neutropenia?
broad spectrum, cover pseudomonas -
e.g. cefipime
A patient presents with constant nose bleeds and ruby colored papules on the lips as well as clubbing and an enlarged liver. What is the likely cause of elevated hematocrit in this patient?
this is HHT - AVMS in liver, lungs, brain. AVMs in lungs shunt blood from right to left
What are possible side effects of cyclophosphamide?
bladder cancer, bone marrow suppression, sterility
What are potential side effects of cisplatin and carboplatin
cochlear dysfunction
What are the side effects of hydroxychloroquine?
optic neuritis
What is one of the acute treatments for stroke in a sickle cell patient?
exchange transfusion
A patient presents with tetany after a car accident in which he received blood transfusions. This is likely due to
calcium chelation by citrate in the blood
What techniques can be used to assess if an oncogene is responsible for driving a cancer?
FISH, immunohistochemical staining
What should be one of your top concerns for gross painless hematuria?
bladder malignancy
A patient being treated for Burkitt’s lymphoma presents with tetany, prolonged QT intervals. What will be the levels of Ca, PO4, K+, and uric acid?
decreased Ca, increased PO4, increased K+, increased uric acid
How does pernicious anemia lead to B12 deficiency?
body makes antibodies against intrinsic factor
What long term complication should patients with intrinsic factor be monitored for?
gastric cancer resulting from atrophic gastritis
An older patient presents with fatigue, lymphadenopathy, splenomegaly. The anemia is likely due to
bone marrow infiltration due to lymphoproliferative disorder
What is the most common presentation of hemophilia?
joint swelling
A person of greek descent presents with microcytic anemia. Think
beta thalessemia
A patient with RA presents with normal MCV, low iron, low TIBC, normal ferritin. This is..
anemia of chronic disease
An alcoholic presents with elevated MCV and decreased serum hemoglobin. This is likely…
folate deficiency
A patient presents with pallor, enlarged spleen and lymphocytes with fine, irregular cytoplasmic projections. This is.. (and how do you treat?)
hairy cell leukemia - treat with cladribine
An older smoking patient presents with ear pain and a lump in the neck as well as a submandibular mass. This is likely…
squamous cell carcinoma
A patient presents with mild thrombocytopenia, giant platelets and bleeding out or proportion to the thrombycytopenia. This is..
Bernard Soulier syndrome
A patient presents with swelling and pain in the leg. What is the next step?
ultrasound
A patient has smudge cells on smear. What treatment would you initiate?
chlorambucil and prednisone
A pregnant patient with a hx of 3 miscarriages comes in with thrombocytopenia and a prolonged PTT. This is..
antiphospholipid antibody syndrome - treat with low molecular weight heparin
How often should patients with UC undergo screening?
every year
Shortly after having a DVT, a patient presents with a cold arm and thrombocytopenia. This is..
HIT; stop heparin and start arbatroban
What is “salvage therapy”
therapy done if the initial therapy doesn’t work
What is consolidation therapy?
therapy given after induction to reduce tumor burden
A patient presents with a tumor in the anterior mediastinum in addition to elevated AFP and elevated beta HCG. This is..
mixed germ cell tumor - seminomas can have elevated beta HCG, but not usually elevated AFP
A patient presents with easy fatiguiability, difficulty concentrating, insomnia, myalgia and right hand clumsiness and memory loss. Labs show microcytic anemia, elevated creatinine and peripheral blood smear shows basophilic stippling. This is..
lead poisoning
A patient presents with numbness and weakness in his feet, difficulty walking. He has multiple bruises and eye exam shows dilated segmented tortuous veins. Labs show an IgM spike. This is..
Waldenstrom’s macroglobulinemia
A patient who works at an underground parking lot presents with headaches, dizziness and nausea with elevated hematocrit. This is..
CO poisoning
Causes of polycythemia can include…
pulmonary hypertension, plasma volume loss, polycythemia vera, AV shunting, pulmonary conditions that cause hypercarbia
What therapy can be used in SIADH if a patient is unresposive to fluid restriction and hypertonic saline?
demeclocycline - decreases responsiveness to ADH
What disease is a risk factor for the development of TTP?
HIV
A patient with diabetes presents with weight loss, diarrhea and a rash around the mouth and on her thighs. This is..
glucagonoma (With necrolytic migratory erythema)
What medication is used in the long term tx of hypercalcemia?
zoledronic acid (bisphosphonates)
A patient presents with fatigue, sore throat, fever and malaise in addition to lymphadenopathy and palatal petichiae. This is..
mono
When are CA125 and pelvic US used for ovarian cancer?
diagnose in patients with symptoms or screen for patients with hereditary history (BRCA)
The presence of ___ is a poor prognostic indicator in CLL
thrombocytopenia
A patient presents with fever,malaise, weight loss, kidney disease and levido reticularis. Suspect..
polyarteritis nodosa
