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MS3 Year > Hematology Oncology > Flashcards

Hematology Oncology Flashcards

1
Q

What is the tx for HIT?

A

stop heparin! and give argatroban then warfarin

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2
Q

What’s the tx for sickle cell chronically, reduce attacks?

A

hydroxyurea (increases HbF)

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3
Q

How do you tx early stage lymphoma? How do you tx late stage (hodgkin vs non-hodg)

A

Radiation; Chemo - hodg: ABVD or BEACOPP; nonhodg: CHOP-R or rituximab alone (CNS ppx)

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4
Q

What one test do you get to separate microcytic anemias?

A

Ferritin

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5
Q

Iron deficiency anemia in an old man, what’s the dx and next step?

A

colon cancer, get a c-scope

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6
Q

Elevated ferritin, decreased TIBC, decreased iron, dx?

A

Anemia of chronic disease

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7
Q

Child, bone pain, frequent infxn, dx?

A

ALL

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8
Q

Two tests you should look at with every anemia?

A

MCV and reticulocyte count

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9
Q

How do you dx sickle cell disease?

A

hgb electrophoresis (first time); sickled cells on smear (for subsequent crises)

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10
Q

What does platelet bleeding look like (problem with primary hemostasis)? Factor bleeding (problem with secondary hemostasis)?

A

Primary: gingiva, skin, vagina
Secondary: hemarthrosis, hematoma

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11
Q

Sickle cell pt with chest pain and fluffy infiltrates on chest XR, dx and next step?

A

acute chest syndrome, exchange transfusion

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12
Q

How do you determine the stage of lymphoma? What defines each stage?

A

CT CAP or PET/CT; Stage 1: 1 LN; 2: gt/= to 2 LNs on same side of diaphragm; 3: LNs on opposite side of diaphragm; 4: mets

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13
Q

Pt has nontender lymphadenopathy, next step?

A

Excisional bx, not FNA

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14
Q

Normocytic anemia, elevated reticulocyte count, differential?

A

hemorrhage and hemolysis

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15
Q

Name 5 destruction causes of thrombocytopenia

A

Alphabet soup: 1) ITP; 2) TTP; 3) DIC; 4) HIT; 5) HUS

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16
Q

Bone marrow bx on Waldenstrom’s macroglobulinemia? MGUS? Multiple myeloma?

A

greater than 10% lymphocytosis; less than 10% plasma cells; greater than 10% plasma cells

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17
Q

Smear on TTP shows what?

A

schistocytes

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18
Q

Normocytic anemia, decreased reticulocyte count, differential?

A

cancer and CKD

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19
Q

What is the best test for hereditary spherocytosis?

A

osmotic fragility

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20
Q

How do you tx iron deficiency anemia?How do you tx anemia of chronic disease? Thalassemia?

A

Iron 2-6 wks (324 mg tid);
EPO in severe cases, tx inflammatory disease
Minor = do nothing
Major = transfusions

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21
Q

Starry sky pattern on bx shows what?

A

Burkitt’s non-hodgkin’s lymphoma

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22
Q

What are 4 causes of microcytic anemia?

A

1) iron deficiency; 2) anemia of chronic disease; 3) thalassemia; 4) sideroblastic

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23
Q

To diagnose pernicious anemia, what’s the best test? What’s the first step?

A

EGD with bx showing atrophy of gastric mucosa;

Anti-IF and Anti-parietal cell antibodies

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24
Q

Most common inherited thrombophilia?

A

Factor V Leiden

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25
Q

What test can you get if the B12 and folate are equivocal?

A

methylmalonic acid (will be elevated in B12 deficiency and not elevated in folic deficiency)

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26
Q

What is splenectomy doesn’t work for ITP

A

rituximab

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27
Q

Less than 10% plasmactyosis in the marrow, but multiple myeloma?

A

MGUS (monoclonal gammopathy of undetermined significance - SPEP is positive but UPEP, skeletal survey and BM bx are negative)

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28
Q

If you have low plts, you give what?

A

platelets

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29
Q

What is the tx for TTP?

A

Plasma exchange (do not give platelets!!)

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30
Q

Pallor, tachycardia, dyspnea on exertion, dx?

A

Anemia

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31
Q

How do you tx multiple myeloma? MGUS?

A

gt 70, no donor: chemo (melphalan + steroids)
lt 70, donor: HSCT (stem cell transplant)
MGUS - watch and wait (converts to MM 2%/yr)

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32
Q

Pt has intracranial hemorrhage, the INR is elevated, what is the next step?

A

Give FFP

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33
Q

T(9;22)?

A

philadelphia chromosome, BCR-ABL, CML

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34
Q

Thalassemia minor, next step?

A

has mild anemia - does not need tx

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35
Q

African American man, anemia, jaundice, joint pain, bone pain, how would you tx?

A

O2, IVF, pain control

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36
Q

80 yo man with fatigue, lymphadenopathy, splenomegaly, and a WBC of 80,000 (99% lymphocytes), dx?

A

CLL

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37
Q

Name 2 categories of causes of sideroblastic anemia and examples within each (6 total)

A

Irreversible: B6 deficiency, cancer
Reversible: Lead, EtOH, Copper, Isoniazid

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38
Q

Compare the presentation of a patient with chronic leukemia to one with acute

A

Chronic: asymptomatic, WBC count gt 60

Acute: infxn, fever, anemic, bleeding, bone pain (SICK!) - they have low blood counts because the blasts are taking up all the bone marrow space

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39
Q

Long stay in the ICU, INR is up, plts and hgb is normal, dx?

A

Vit K deficiency (NPO often)

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40
Q

When do you see bite cells? Heinz bodies?

A

G6PD deficiency for both

41
Q

How do you test for paroxysmal nocturnal hemoglobinuria?

A

flow cytometry (decreased CD55 and CD59)

42
Q

Megaloblastic anemia, differential?

A

B12 deficiency and folate deficiency

43
Q

Nontender lymphadenopathy made worse with alcohol, dx?

A

Hodgkin’s lymphoma

44
Q

What are B symptoms (3)?

A

fever, weight loss, night sweats

45
Q

Which increases your risk for DVT the most: cancer, surgery/trauma, factor V Leiden/prothrombin 20210A?

A

cancer (20x) then surg/trauma (10x) then mutation (1.5x)

46
Q

Normal iron studies in an Asian with microcytic anemia, dx?

A

thalassemia

47
Q

Thalassemia major, next step and what to watch for? How do you tx the what to watch for problem?

A

monthly transfusions to support life; iron overload (hemosiderosis); deferoxamine (not phlebotomy!!)

48
Q

Long term, last resort therapy for ITP?

A

splenectomy

49
Q

What does the bone marrow look like in acute leukemia?

A

gt 20% blasts

50
Q

How can you tx an acute flare of ITP?

A

IVIg

51
Q

Plt bleeding, decreased plt count, dx and three categories?

A

thrombocytopenia - 1) destruction; 2) production; 3) sequestration (spleen, cirrhosis)

52
Q

Decreased ferritin, increased TIBC, decreased iron, dx?

A

iron deficiency anemia

53
Q

How does the presence of an inherited thrombophilia alter your management?

A

It doesn’t

54
Q

Name 3 chronic presentations in sickle cell pts

A

1) asplenia; 2) avascular necrosis; 3) osteomyelitis

55
Q

Anti-phospholipid syndrome can cause __ clots. It can be diagnosed with __. Warfarin goal is __.

A

arterial and venous!; russel viper venom assay; 2-3

causes anticoagulation in vitro and hypercoaguability in vivo

56
Q

Young child that easily bruises with hemarthrosis - dx and next step?

A 
Hemophilia A (8) or B (9)
Give FFP or factors during bleed
57
Q

What separates B12 from folate deficiency? (Not looking for MMA here)

A

Neurologic symptoms (irreversible)

58
Q

Smear on DIC shows what? What about PT/PTT, fibrinogen, platelets, hemoglobin, D-Dimer

A

Schistocytes; INR up, fibrinogen down, plts down, hemoglobin down, D-dimer up

59
Q

Fever, anemia, thrombocytopenia, renal failure, focal deficits, diagnosis?

A

TTP (thrombotic thrombocytopenic purpura (mnemonic: FAT RN)

60
Q

Mediterranean man, salads, and HIV drugs, dx?

A

G6PD deficiency

61
Q

What’s the tx for hereditary spherocytosis?

A

Splenectomy (fixes anemia, not spherocytes) (before it can give folate and iron as support)

62
Q

What are side effects of bleomycin? vincristine/vinblastine? cyclophosphamide? cisplatin? adriamycin/doxorubicin?

A

pulmonary fibrosis; peripheral neuropathy; hemorrhagic cystitis (mesna is antidote!); ototox and renal tox; cardiotox

63
Q

How do you tx hemosiderosis vs hemochromatosis?

A

Both have iron overload, but hemosiderosis tx with deferoxamine, and hemochromatosis tx with phlebotomy (because hemosiderosis is caused by transfusions so you wouldn’t use phlebotomy when they need the blood)

64
Q

How do you test for warm autoimmune hemolytic anemia?

A

Coomb’s test (positive for IgG)

65
Q

Aplastic anemia in a sickle cell pt - causative organism?

A

Parvovirus B19

66
Q

How do you dx thalassemia?

A

hemoglobin electrophoresis (B-thal will have increased HbA2 or HbF, while A-thal is a dx of exclusion)

67
Q

African American man, anemia, jaundice, joint pain, bone pain, priapism, how would you tx?

A

Exchange transfusion (priapism is an acute emergency)

68
Q

Blast crisis?

A

CML conversion into AML

69
Q

What does the iron studies show for sideroblastic anemia? Thalassemia? Anemia of chronic disease? Iron deficiency?

A

Increased iron, normal ferritin and TIBC; Thal: normal for all 3;
ACD: low Fe, high ferritin, low TIBC
Def: low Fe, low ferritin, high TIBC

70
Q

CD55 negative, dx?

A

paroxysmal nocturnal hemoglobinuria

71
Q

If the fibrinogen is down, you give what?

A

cryoprecipitate

72
Q

Who gets warfarin in a DVT and how long?

A

All patients
if provoked - 3 mo
if unprovoked - 6 mo
if recurrence - lifetime

73
Q

Tea and toast diet, diagnosis?

A

folate deficiency

74
Q

TdT+ and __+ are markers for __.

A

cALLa; ALL

75
Q

What is the first step in diagnosing multiple myeloma?

A

SPEP and UPEP (serum and urine electrophoresis - called immunofixation)

76
Q

SPEP is positive, but nothing else in myeloma workup?

A

MGUS

77
Q

What is the tx of ALL?

A

ARA-C intrathecally

78
Q

What is the pathology in paroxysmal nocturnal hemoglobinuria? What is the tx?

A

PIG-A deficiency (ankrin protein) leads to inability prevent complement from binding; eculizumab (terminal complement inhibitor)

79
Q

Auer rods, diagnosis and next step?

A

AML (M3 - promyelocytic leukemia); treat with all trans-retinoic acid

80
Q

What is the underlying pathology in TTP?

A

ADAMTS-13 autoantibody leading to deficiency; ADAMTS-13 normally breaks down vWF

81
Q

Name 3 causes of warm autoimmune hemolytic anemia and how to tx (4)

A

cancer, drugs, rheum

1st line: steroids, recurrent: splenectomy; severe: IVIg; refractory to splenectomy: rituximab

82
Q

70 yo man with hypercalcemia, renal failure, anemia, and bone pain, dx?

A

Multiple myeloma (CRAB = hyperCalcemia, Renal failure, Anemia, Bone pain)

83
Q

Hydrops fetalis diagnosis (thalassemia)

A

4 alpha genes deleted - incompatible with life

84
Q

A picture of a red blood cell with a circle of darkly pigmented iron, what’s the diagnosis?

A

Sideroblastic anemia (ringed sideroblasts)

85
Q

Fevers that come and go, cyclical fevers, diagnosis (not infxn)?

A

Pel-Ebstein fever = Hodgkin

86
Q

How do you tx von Willebrand disease?

A

desmopressin

87
Q

Name 3 production problem causes of thrombocytopenia

A

1) aplastic anemia; 2) MDS (myelodysplastic syndrome); 3) cancer

88
Q

How do you tx cold autoimmune hemolytic anemia (3)?

A

Avoid the cold; tx mycoplasma or mono; refractory: rituximab

89
Q

Plt bleeding normal count, dx (5)?

A

Platelet dysfunction: 1) Iatrogenic (nsaids, aspirin, clopidogrel); 2) von Willebrand disease; 3) uremia; 4) bernard soulier (GpIb); 5) Glanzmann’s (GpIIb-IIIa)

90
Q

Monoclonal expansion of IgG, dx? IgM?

A

Multiple myeloma; Waldenstrom

91
Q

The four tests for diagnosing multiple myeloma?

A

SPEP+, UPEP+, skeletal survey + (lytic lesions), BM bx greater than 10% plasmacytes

92
Q

What are the symptoms of Waldenstrom’s macroglobulinemia?

A

Hyperviscosity syndrome (since IgM is a pentamer)

93
Q

A mixing study fails to correct the bleeding problem, what’s the problem?

A

Patient has factor inhibitors (examples include lupus anticoagulant or spontaneous factor inhibitor)

94
Q

How do you tx CML?

A

imatinib

95
Q

How do you tx recurrent venous thrombosis?

A

life long anticoagulation

96
Q

What’s the tx for a pain crisis in sickle cell?

A

IVF, O2, Pain control

97
Q

What leads to a non-megaloblastic macrocytic anemia (4)?

A

1) Liver disease (cirrhosis); 2) EtOH; 3) medications (AZT, 5-FU, ARA-C); 4) metabolic syndrome (Lesch-Nyhan or hereditary orotic aciduria)

98
Q

Macrocytic anemia, what is the next step?

A

blood smear (not B12 and folate) - checking to see if megaloblastic or non-megaloblastic (aka are there segmented neutrophils or not)

99
Q

Name 3 acute emergencies in patients with sickle cell and how you tx them?

A

1) acute chest (MI, CHF); 2) Acute brain (CVA); 3) Priapism

Tx with exchange transfusion

MS3 Year (18 decks)

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