Hematology/ Oncology

Question 1

From Alison Houchin: what is the differential for anemia?

Answer 1

Think destruction, production, loss.

Either there is blood loss, a problem with production, or a problem with destruction (i. e. hemolysis).

Question 2

From Epic, what is the normal range for serum total protein?

Answer 2

6.3 - 8.2 g/dL

Question 3

What are the 3 types of granulocytes?

Answer 3

neutrophils, eosinophils, and basophils

from MedicineNet.com

Question 4

What is MCV and what is its significance?

Answer 4

Mean corpuscular volume….

Question 5

What is the most common lethal cancer worldwide?

Answer 5

Primary bronchogenic carcinoma

Retrieved from: “The Microbiology of Postobstructive Pneumonia in Lung Cancer Patients
Hsu-Kim, Cynthia MD; Hoag, Jeffrey B. MD, MS; Cheng, Guang-Shin MD; Lund, Mark E. MD”

Question 6

What is a paraneoplastic syndrome?

Answer 6

Paraneoplastic syndromes are signs or symptoms that occur as a result of organ or tissue damage at locations remote from the site of the primary tumor or metastases.

Question 7

What are the two most common paraneoplastic syndromes?

Answer 7

Humoral hypercalcemia of malignancy in squamous cell carcinoma and the syndrome of inappropriate antidiuretic hormone secretion in small cell lung cancer

[Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4127595/]

Question 8

What is carcinoma?

Answer 8

a cancer arising in the epithelial tissue of the skin or of the lining of the internal organs

Question 9

What is RCHOP?

Answer 9

RCHOP is a chemotherapy regimen used to treat non-Hodgkin lymphoma:

R - rituximab
C - cyclophosphamide
H - doxorubicin, (hydroxydaunomycin)
O - vincristine (Oncovin)
P - prednisolone

Question 10

What diagnosis should be considered in a patient with a ferritin level >2,000?

Answer 10

HLH (hemophagocytic lymphohistiocytosis)

[from Williams Hematology, Ch 71]

Question 11

What is Hutchinson sign in dermatology?

Answer 11

Refers to pigmentation in the paronychial area suggesting subungual melanoma.

[Retrieved from https://radiopaedia.org/articles/hutchinson-sign-disambiguation]

Question 12

Gastrointestinal stromal tumors (GISTs) may be _________ or ______. They are most common in the _______ and small intestine but may be found anywhere in or near the GI tract. Some scientists believe that GISTs begin in cells called interstitial cells of Cajal (ICC), in the wall of the GI tract.

Answer 12

malignant or benign
stomach

[Retrieved from https://www.cancer.gov/types/soft-tissue-sarcoma/patient/gist-treatment-pdq]

Question 13

The neutrophil series matures in an orderly fashion, from __________ to ____________ to _________ to _____________ to ____ form to ______ neutrophil.

Answer 13

myeloblast
promyelocyte
myelocyte
metamyelocyte
band
mature

[From UpToDate: “Evaluation of the peripheral blood smear”]

Question 14

Metamyelocytes, and rarely myelocytes, may be seen during ______, _____, _____ reactions, and recovery from _____. Forms less mature than the myelocyte (e.g. promyelocytes, myeloblasts) are almost exclusively present in the peripheral blood in _____ malignancies.

Answer 14

infections
pregnancy
leukemoid
myelosuppression

hematologic

[From UpToDate: “Evaluation of the peripheral blood smear”]

Question 15

The combined presence of early neutrophil forms, nucleated red blood cells, and tear drop-shaped red blood cells is called a “_____-______” blood picture, and suggests the presence of bone marrow invasion and/or fibrosis.

Answer 15

leuko-erythroblastic

[From UpToDate: “Evaluation of the peripheral blood smear”]

Question 16

What is carcinoma/ adenocarcinoma?

Answer 16

Carcinoma is a malignant tumor arising from epithelia.

Adenocarcinoma is a malignant tumor arising from a gland.

Question 17

Plasmacytomas are tumors composed of plasma cells of variable maturity, which are histologically identical to those seen in ________ _______. If they occur solely in the bone, they are designated solitary plasmacytoma of bone. If they arise outside bone in soft tissues, they are called solitary ______________ _____________.

Answer 17

multiple myeloma

extramedullary plasmacytoma

Question 18

Small cell lung cancer (SCLC) is distinguished from non-small cell lung cancer (NSCLC) by its _____ ________ time, high growth fraction, and the early development of widespread __________. Although the cancer is initially highly responsive to chemotherapy and radiotherapy, the majority of patients will relapse with broadly resistant disease within a few months to a year from initial therapy.

Answer 18

rapid doubling

metastases

[“Pathobiology and staging of small cell carcinoma of the lung”, UpToDate]

Question 19

What is transferrin?

In terms of total body content of iron, how much iron is bound to transferrin?

Answer 19

The iron transport protein. Transferrin is a bi-lobed glycoprotein with two iron-binding sites.

3 mg (estimated to be about the same whether you are an 80 kg male or 60 kg female)

[From Harrison’s, Ch 93]

Question 20

Because almost all of the iron transported by transferrin is delivered to the erythroid marrow, the clearance time of transferrin-bound iron from the circulation is affected most by the plasma iron level and the erythroid marrow activity. When erythropoiesis is markedly stimulated, the pool of erythroid cells requiring iron increases, and the clearance time of iron from the circulation decreases. The half-clearance time of iron in the presence of iron deficiency is as short as __-__ ___. With suppression of erythropoiesis, the plasma iron level typically increases, and the half-clearance time may be prolonged to several hours. Normally, the iron bound to transferrin turns over 6–8 times per day. Assuming a normal plasma iron level of 80–100 μg/dL, the amount of iron passing through the transferrin pool is 20–24 mg/d.

Answer 20

10–15 min

[From Harrison’s, Ch 93]

Question 21

Normally 80% of iron passing through the plasma transferrin pool is recycled from senescent red cells. Absorption of ∼1 mg/d is required from the diet in men, and __ mg/d in women to maintain homeostasis. As long as transferrin saturation is maintained between 20 and 60% and erythropoiesis is not increased, use of iron stores is not required. However, in the event of blood loss, dietary iron deficiency, or inadequate iron absorption, up to 40 mg/d of iron can be mobilized from stores.

Answer 21

1.4 mg/d

[From Harrison’s, Ch 93]

Question 22

The principal iron regulatory hormone is….

Answer 22

…hepcidin.

[From Harrison’s, Ch 93]

Question 23

By definition, marrow iron stores are absent when the serum ferritin level is

Answer 23

<15
synthesis

[From Harrison’s, Ch 93]

Question 24

Once the ___________ ___________ falls to 15–20%, hemoglobin synthesis becomes impaired. This is a period of iron-deficient erythropoiesis. Careful evaluation of the peripheral blood smear reveals the first appearance of microcytic cells, and if the laboratory technology is available, one finds hypochromic reticulocytes in circulation. Gradually, the hemoglobin begins to fall, reflecting iron-deficiency anemia. The transferrin saturation at this point is <10–15%.

Answer 24

transferrin saturation

[From Harrison’s, Ch 93]

Question 25

Echinocytes (also known as ____ ______) are spiculated red cells with the spikes ______ spaced; they can represent an artifact of abnormal drying of the blood smear or reflect changes in stored blood. They also can be seen in renal failure and malnutrition and are often reversible.

Answer 25

burr cells
evenly

[Harrison’s: Ch 62: Interpreting Peripheral Blood Smears]

Question 26

What is the Warburg effect?

Answer 26

The increased uptake of glucose and fermentation of glucose to lactate by cancer cells. It is observed even when oxygen is available and mitochondria are functioning.

Question 27

What is the mechanism of action for eltrombopag (Promacta)?

Answer 27

Thrombopoietin (TPO) nonpeptide agonist which increases platelet counts by binding to and activating the human TPO receptor

Often used for treating chronic ITP.

Question 28

What should be given alongside factor VII for maximum effect?

Answer 28

FFP