Hematology/ Oncology Flashcards
Pulmonary embolism is heralded
“abrupt onset of dyspnea, chest pain, apprehension, hemoptysis, or syncope”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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good initial screening tool for DVT in moderate- to high-risk patients;
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Venous Duplex ultrasound with compression
If negative and suspicion is high repeat in 5–7 days
“the gold standard for the diagnosis of DVT”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Venography
What Arterial blood gases along with respiratory alkalosis are seen in PE.”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Low PO2, low PCO2
“this is the preferred test for diagnosis of PE. It allows direct visualization of emboli and detection of parenchymal abnormalities”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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CT angiogram
“CT angiography has mostly replaced invasive pulmonary angiography as the gold standard for the diagnosis of PE in the presence of an equivocal ventilation/perfusion scan” in many facilities
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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In treatment of DVT how long should anticoagulation be maintained
3-6 month for unprovoked proximal DVT or PE
TREAT provoked DVT or PE no more than 3 months
Treat unprovoked calf DVT 3 months
First study to perform in evaluating VTE during pregnancy
Cxr
If CXR normal order v/q scan
If abnormal order CT SCAN
During anticoagulation in pregnancy convert from LMWH in the month to?
Easier to stop quickly Un fractionated heparin
Compression stockings until anticoagulation resumed after delivery
Vaginal- restart 4-6 hours
C-section restart after 6-12 hours
MCV >100
Macrocytic anemia
Causes be-12 deficiency
Myelodysplasia
Reticulocytosis
Hypersegmented PMNs, elevated LDH, HIGH methylmalonic acid levels low b12
Megaloblastic anemia
I “Reed-Sternberg cells present (these are large binucleate cells with single distinct nucleoli) is pathognomonic of”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Hodgkins lymphoma
“One or two unexplained, enlarged lymph nodes in a young person indicates Hodgkin disease until it is proved otherwise”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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“Weight loss
b. Bleeding from skin and mucous membranes
c. Bone marrow biopsy: dry tap, normal bone marrow replaced by fibrotic material”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Myelofibrosis
“Plethora, sometimes cyanosis
b. Proliferation of all hematopoietic cell lines
c. Elevated hemoglobin, red blood cell mass, and thrombocytosis”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Polycythemia vera
65 yo male presents complaint constant back pain unrelieved by positioning. Plain film reveals compression fracture T-12
Pathology: plasma cell malignancy or plasma cell proliferation
3. Signs and symptoms: (a) bone pain (sternum, skull, ribs, and back); (b) anemia (normochromic, normocytic); (c) immune suppression (history of bacterial infections); (d) renal failure; (e) hypercalcemia; and (f) weakness, confusion, depression, fatigue
4. Diagnosis: (a) serum protein electrophoresis, (b) bone marrow biopsy of 10% plasma cells (c) Bence Jones protein in the urine, qualitative immunoglobulins, and skeletal survey
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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MULTIPLE myeloma
“Reed-Sternberg cells are pathognomonic”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Hodgkins disease
“Lymph node enlargement in the supraclavicular area is common for”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Hodgkin’s disease
“The most common sign/symptom is solitary or nonsolitary lymph node enlargement.
b. The presence or absence of systemic symptoms is not only a staging phenomenon (A or B) but also prognostic.
c. The most common systemic symptoms include weight loss, night sweats, fevers, and pain.”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Lymphoma
“Disease is associated with excessive proliferation of erythroid, granulocytic, and megakaryocytic precursors.
• Splenomegaly is almost universal in this disease.
• Disease has significantly elevated red blood cell mass.
• Patient presents with plethora.
• Disease characteristically has thrombocytosis”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Polycythemia rubra vera
“Disease produces a major disorder of the bone marrow.
• Splenomegaly is present in all patients.
• As the disease progresses, patients experience weight loss, skin and mucous membrane bleeding, bone pain, jaundice, and lymphadenopathy.
• Bone marrow tap is almost always unsuccessful; it is known as a dry tap.
• Bone marrow biopsy reveals fibrosis of marrow spaces and osteoscleros”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Myelofibrosis
“a. Atomic bomb survivors (or other radiation victims
disease has the presence of the Philadelphia chromosome.
• When this disease is diagnosed, the total white blood cell count often exceeds 200,000 cells/mm3.
• The disease usually follows this course: (a) chronic phase of variable duration, (b) blastic transformation, with (c) some patients experiencing a distinct intermediate accelerated phase.
• The most consistent physical finding is splenomegaly.”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Chronic myelogenous leukemia
“This form of leukemia is the most common form of leukemia in the United States.
• The disease is usually seen in patients older than 50years.
• The abnormal cells morphologically resemble mature, small lymphocytes of the peripheral blood and accumulate in the bone marrow, blood, lymph nodes, and spleen in large numbers.
• This disease has an “indolent nature.”
• Median survival exceeds 10 years, and many patients require no treatment.”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Chronic lymphocytic leukemia
“This disease has characteristic cells that exhibit cytoplasmic projections on their surfaces.
• This disease is the result of an expansion of neoplastic type B lymphocytes.
• This disease usually presents in male patients older than 40years.
• Approximately 30% of patients with this disease have a vasculitis-like disorder.
• The treatment of choice for this disease is cladribine.”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Hairy cell leukemia
“This disease has characteristic cells that exhibit cytoplasmic projections on their surfaces.
• This disease is the result of an expansion of neoplastic type B lymphocytes.
• This disease usually presents in male patients older than 40years.
• Approximately 30% of patients with this disease have a vasculitis-like disorder.
• The treatment of choice for this disease is cladribine.”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Hairy cell leukemia
“a. Most common acute leukemia of adults
b. Auer rods pathognomonic
c. Immature myeloblasts on smear
d. Infections common
e. Bone marrow transplantation essential for survival (10% to 30%)
f. May follow myelodysplastic disorder or preleukemia”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Acutely myelogenous leukemia
“Acute onset after viral exanthem or viral infection
b. Rapid drop in platelet count
c. Corticosteroids treatment of choice; splenectomy in resistant cases”
Most common in children 2-4 years old
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Idiopathic thrombocytic purpura
“Most common inherited bleeding disorder
b. Results from a factor VIII deficiency
c. Often manifested as severe menorrhagia in women
d. Factor VIII concentrates treatment of choice”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Von Willebrands
“Follows obstetric catastrophes, major trauma, metastatic malignant neoplasms, or bacterial sepsis
b. Microemboli or microthrombi in vasculature, elevated fibrin degradation products
c. Profuse bleeding from many sites
d. Treatment: fresh frozen plasma for severe bleeding”
PT/INR elevated fibrinogen low
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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DIC
Wells criteria
active cancer/treatment (treatment within last 6 months), immobilization/paralysis, recent major surgery/bedridden 3 or more days, localized tenderness along deep vein, entire leg swelling, calf swelling greater than 3cm compared with other leg, pitting edema in symptomatic leg, collateral superficial veins, and history of previous DVT”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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X-linked factor VIII deficiency associated with hemarthrosis and hematomas
Hemophilia A
Platelet count that is usually adequate for appropriate clotting
20,000 to50,000
Factors V,II, X alOng with DIC causes prolonged
PT & PTT
In a nonbleeding patient, the transfusion of one unit PRBCs can be expected to raise hematocrit by
3-4% (1g/dL of Hb)
What is the INR of FFP
1.5
Patient presents with acute abdomen has been taking warfarin. What is preoperative management?
Administer FFP
Over 50% of people with a history of chest radiation require replacement of this hormone
Thyroid
I patients with tumor lysis necrosis have renal failure secondary to
Uric acid nephropathy
Coarse basophilic stippling on RBCs, irritability,insomnia signs of
Lead poisoning
Lead chelator used to treat elevated lead levels
Dimercaprol
Infant presents with history of recurrent bouts of jaundice splenomegaly MCV 60, target cells on peripheral smear. Diagnosis
test to confirm diagnosis
Thalassemia
Hb electrophoresis
When a sickle cell patient presents with fever, cough, chest pain and pulmonary infiltrates on cxr Suspect
Acute chest syndrome
Macrocytic anemia with normal B-12 and only homocysteine elevated. Diagnosis
Folate deficiency
Associated w phenytoin, malabsorption i.e. Celiac
Caused by immune destruction of parietal cells in the stomach, resulting in decreased absorption of B-12
Pernicious anemia
An autosomal recessive defect in cellular copper transport resulting in DECREASED CERULOPLASMIN levels, kayser fleisher rings
Diagnosis
Treatment
Wilson’s disease
Treat with penicillamine or trientine (cheating agent)
“Most common acute leukemia of adults
b. Auer rods pathognomonic
c. Immature myeloblasts on smear
d. Infections common
e. Bone marrow transplantation essential for survival (10% to 30%)
f. May follow myelodysplastic disorder or preleukemia”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Chronic myelogenous leukemia
“a. Disease of children
b. Immature lymphoblasts
c. Infections common
d. Up to a 70% cure rate at present”
Excerpt From: Alfred F. Tallia, Joseph E. Scherger & Nancy Dickey. “Swanson’s Family Medicine Review.” Saunders, 2013. iBooks.
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Acute lymphocytic leukemia
