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MKSAP > Hematology/Oncology > Flashcards

Hematology/Oncology Flashcards

1
Q

Treatment for aplastic anemia

A

Immunosuppression w/ antithymocyte globulin, cyclosporine, and prednisone

Younger than 50? =» Allogeneic hematopoietic stem cell transplantation

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2
Q

Achrocordon

A

Skin tag

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3
Q

Patient w/ ESRD who suddenly quits responding to their EPO shots

A

Check for anti-EPO antibodies

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4
Q

Infectious causes of neutropenia

A

Typhoid, TB, Brucellosis

HIV, hepatitis, parvovirus, EBV

Histoplasmosis

Malaria, lesihmaniasis

Ehrlichiosis, RMSF

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5
Q

Leukemia that can be associated w/ the clinical features of Felty Syndrome

A

Large Granular Lymphocyte Leukemia

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6
Q

Patients w/ poor MDS prognostic factors

A

Severe pancytopenia

Hgb<8, Plt <50, ANC <800

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7
Q

Unique adverse effects of TKIs (like imatinib)

A

QT prolongation

Fluid retention

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8
Q

Heme/onc side effect of testosterone supplements

A

Polycythemia; should be monitored at initiation, 3 and 6 months, then annually

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9
Q

Management of polycythemia vera (4 things)

A
  1. Phelobotomy w/ goal Hcrt <45%
  2. Low dose ASA
  3. Hydroxyurea in patients w/ high risk of thrombosis (pts >60 years old or hx of thrombosis)
  4. Ruxolitinib (JAK1/2 inhibitor) `
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10
Q

Patients w/ extreme ET are at increased risk for what?

A

Hemorrhage; thought to cause acquired vWF dysfunction

Levels > 1.5 million

Level >1 million w/ hx of thrombosis or age >60 =» Treat w/ hydroxyurea

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11
Q

Hypereosinophilic syndrome (HES)

A

Sustained eosinophil counts >1500/uL w/ end-organ damage; could be lungs, skin, heart, GI tract.

Tx: Glucocorticoids

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12
Q

Bad mutation w/ AML but still has normal cytogenetics

A

FLT3-ITD; needs transplant for cure

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13
Q

AML treatment

A

Induction therapy: Antracyclines (daunorubicin) + cytarabine =» bone marrow ablation

Consolidation chemotherapy follows

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14
Q

Other TKI used for Philadelphia Chromosom

A

Dasatinib

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15
Q

ALL Treatment

A

Variable but includes:

Vincristine + Anthracyclines (doxo/daunorubacin)+ Corticosteroids + L-asparaginase

***Needs CNS prophylaxis as well w/ Oral mercaptopurine and MTX weekly for up to 2 years

Prognosis remains poor due to 11% recurrence of cancer at 30 years; also develop cardiac dysfunction, metabolic syndrome compared to age-matched individuals after treatment

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16
Q

L-asaparinase ADRs

A

Allergic reactions common
Hypofibrinogenemia
Hypertriglyceridemia

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17
Q

POEMS

A 
Polyneuropathy (sensorimotor)
Organomegaly (liver, spleen)
Endocrinopathy (adrenals, gonads, trichosis)
Monoclonal protein 
Skin changes (hyperpigmentation)
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18
Q

Initial eval of plasma cell disorders

A 
CBC, CMP 
B2-microglobulin
SPEP
Serum/urine immunofixation 
Serum free light chain testing (should be abnormal k-l ratio) 
Skeletal survery
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19
Q

Patient w/ MGUS + kidney disease

A

“Monoclonal gammopathy of renal significance”

Patients must be treated like MM to prevent renal failure

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20
Q

Rough estimate of risk for smoldering MM to become full blown MM

A

10% year; other poor factors include M protein >3g/dL, BM plasma cells >10%, Serum FLC ration <0.125

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21
Q

Mainstay of MM therapy if possible

A

Induction chemotherapy followed by:

AUTOLOGOUS BM transplant

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22
Q

Medication to give all patients w/ MM

A

Bisphosphonates; improves survival and prevents skeletal events

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23
Q

Treatment of Waldenstrom’s Macroglobulinemia

A

Rituximab + Chemotherapy (cyclophosphamide or bortezomib) + glucocorticoids

Ibrutinib ? A bruton’s TK inhibitor now approved too

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24
Q

Treatment of metastatic basal cell carcinoma

A

Oral hedgehog inhibitors

Vismodegib, sonidegib

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25
Q

Management of superficial basal cell carcinoma

A

Topical chemo w/ 5-fluorouracil or imiquimod

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26
Q

Reason every-other-day dosing is better for iron

A

Every day dosing =» Increased hepcidin production Decreased ferroportin=» decreased absorption

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27
Q

Iron goals in patients on EPO therapy

A

Ferritin > 100

Transferrin saturation >20%

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28
Q

Test to order for suspected folate deficiency

A

Homocysteine level; should be elevated

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29
Q

Supplement for patients w/ elevated hemolysis and hereditary spherocytosis

A

Folate

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30
Q

L-glutamine in sickle cell disease

A

Precursor of NAD =» decreases number of pain crises

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31
Q

Crizanlizumab

A

P-selectin inhibitor that reduces SCD pain crises by preventing cellular adhesion

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32
Q

Medications associated with increased number of SCD pain crises

A

PDE inhibitors like viagra

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33
Q

Moyamoya disease

A

Irregular perforating vascular networks near stenotic vessels in SCD in the regions corresponding to lenticulostriate and thalamoperforate arteries

=» Cerebral bleeding in 3rd and 4th decades of life

-Can cause early cognitive dysfunction likely 2/2 to chronic anemia

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34
Q

Post CVA management in SCD patients

A

Monthly transfusion

35
Q

Post treatment f/up for rectal/colon cancer

A

6 month interval physical exam and CEA

CT scan every year; colonoscopy after one year, then in 3 years, then q5years

Do this for at least 5 years
*Need rectal sigmoidoscopy q3-6months for rectal cancer patients for 2-3 years after surgery

36
Q

What do you check all colon cancers for?

A

Microsatellite instability; if present, do NOT treat w/ adjuvant chemotherapy after surgery

37
Q

Molecular testing to order on metastatic colon cancer

A

KRAS, NRAS, BRAF, MSIs

38
Q

Role of bevacizumab in colon cancer treatment

A

When given concurrently w/ FOLFOX, therapy is potentiated and a modest increased in PFS is gained

39
Q

Immunotherapy for KRAS, NRAS, BRAF pos colon cancers

A

Panitumumab or cetuximab; block EGFR

-May only have activity in left sided colon tumors

Major ADR: Acneiform rash
***Actually good because if you don’t have the rash, it may not be working

40
Q

Anal cancer chemo regimen

A

Mitomycin + 5-FU

41
Q

Chemotherapy for pancreatic cancer

A

Post-resection ? =» gemcitabine + capecitabine (better in RCTs when combined)

No surgery? =» FOLFIRINOX

42
Q

Molecular testing for gastroesophageal cancer

A

HER-2; add to chemotherapy if positive for modest but statistically significant survival benefit

43
Q

Origins of gastrointestinal NETs and pancreatic NETs

A 
GI = Endocrine cells 
Pancreatic = Langerhan's cells
44
Q

Management for poorly differentiated, highly aggressive NETs

A

Etoposide + Cisplatin

-Similar for lung Small Cell Carcinoma

45
Q

F/up for indolent GI NET

A

CT scan q3months; can space to 6 months after approximately one year

46
Q

Treatment for NET w/ somatostatin receptor

A

Octreotide

-Can also consider hepatic arterial embolization, radiofrequency ablation, or surgical debulking if symptoms of carinoid are debilitating

47
Q

Treatment of GIST tumor

A

Low risk => Surgery alone

High risk =» Surgery + adjuvant imatinib for 3 years

48
Q

Surgical candidacy eval of non-small cell carcinoma

A

FEV1 and DLCO measurement

  • If one variable is unfavorable, an expected post-surgical level is calculated
  • If candidates can get surgery, 5 year survival for Stage I = 60-70% and Stage II = 40% w/ radiation therapy or stereotactic radiation if tumor was small
49
Q

Sleeve resection (pulmonary)

A

Performed on lung cancer patients w/ proximal mass; involves resecting lung and part of bronchus

50
Q

Postsurgical therapy for Stage I-III lung cancers

A

Cisplatin + one of the followgin: gemcitabine (SCC), docetaxel, pemetrexed (adenocarcinoma), vinorelbine

51
Q

Resectable T4 non-small cell lung cancer characteristic

A

No invasion to surrounding vital structures
No mediastinal involvement
No CONTRAlateral spread
-*Occasionally, w/ single contralateral mass can be resected under assumption this is new, independent secondary tumor

In some cases, single ipsilateral mediastinal node positive and nonbulky disease can have surgery

-Basically treated as Stage III disease

52
Q

Metastatic annotation to the contralateral lung in non-small cell lung cancer

A

M1a

M1b = farther met

53
Q

Molecular testing for non-squamous, non-small cell lung cancer

A

EGFR (w/ transolacations for ALK, ROS)

  • If identified, patients need early tx w/ erlotinib
  • If w/ TRANSLOCATION, crizotinib
54
Q

Standard chemo for metastatic lung cancer

A

Carboplatin (more favorable ADR proflie) + bevacizumab
AND ONE OF THE FOLLOWING:

pemetrexed (if adenocarcinoma)

or

gemcitabine (if squamous cell carcinoma)

55
Q

New immunotherapy for lung cancer

A

Pembrolizumab (PD-L1 inhibitor)

-Superior as 1ST LINE THERAPY if expression of PD-L1 >50%

56
Q

PERC (there are 8 of them)

A 
Age <50
HR <100 
O2 Sat <95%
No hemoptysis 
No estrogen use 
No previous DVT/PE
No unilateral leg swelling 
No surgery or trauma requiring hospitalization within the last 4 weeks
57
Q

Treatment of an acquired factor VIII deficiency

A

Activated factor VII

58
Q

Standard therapy for nonresectable non small cell carcinoma

A

Platinum + taxol + daily radiation for 6 weeks

Then darvolumab for one year

59
Q

Indication for pemetrexed in NsCc lung cancer

A

Adenocarcinoma

Gemcitabine for squamous

60
Q

Treatment of diarrhea 2/2 to immunotherapy

A

< 4 episodes : Symptomatic

4-6 episodes/day; Antimotility agents, prednisone 1mg/kg/day

> 6 episodes daily: Admit, stool studies, prednisone 2mg/kg/day, GI for scoping
-Infliximab if all else fails

61
Q

Patient on immunotherapy w/ headache, dizziness, nausea

A

Suspect hypophysitis

Test ACTH, TFTs, cort stim, MRI brain

May require steroids and thyroid replacement

62
Q

Difference between carboplatin and cisplatin for NSCC

A

Cisplatin = CURATIVE INTENT

63
Q

Erdheim-Chest disease

A

Non-Langherhan’s histocytosis malignancy characterized by osseous involvement w/ bilateral symmetric osteosclerosis of the long bones, cardiac imaging/conduction abnormalities (requires MRI imaging of ENTIRE aorta) potential diabetes insipidus, and periocular infiltration manifesting as proptosis

Malignant cells negative for S100 or CD1a (unlike in Langerhans)

Tx: BRAF + =» Vemurafenib

  BRAF - =>> INF-a
64
Q

Cytarabine MOA and ADRs

A

Pyrimidine analog that inserts itself into DNA and inhibits DNA polymerase

ADRs: BM suppression, fever, myalgia, bone pain, GI toxicity, pancreatitis, tumor lysis

65
Q

Idarubicin MOA and ADRs

A

Inserts itself into DNA double helix? also inhibits DNA topoisomerase III inhibiting DNA repairs

ADRs: BM suppression, CARDIOMYOPATHY, hyperuricemia, skin necrosis if extravasation occurs

66
Q

Differentiation Syndrome

A

Second severe manifestation of APML that consists of high fever, peripheral edema, pulmonary infiltrates, hypoxia, hypotension, renal/hepatic dysfunction, and serositis; more likely in patients w/ WBC >10,000

Tx: Stop ATRA + ATO; start dexamethasone 10mg IV BID

67
Q

Diamond-Blackfan anemia

A 
Erythroid aplasia characterized by: 
Macrocytic anemia in childhood
No reticulocyte response 
Decreased RBC precursors in BM 
Triphalangeal thumbs 
Increased risk of malignancy and endocrine dysfnxn
68
Q

Most common gene mutation w/ Diamond Blackfan anemia

A

RBS 19; affects ribosome synthesis

*Disease has incomplete penetrance meaning, although it may seem to skip familial generations, it is an inherited condition

69
Q

Abnormalities associated w/ Diamond-Blackfan other than triphalangeal thumbs

A 
High arched or cleft palate 
Flat nose bridge 
Hypertelorism 
Cardiac/renal abnormalities 
   ***Cardiac and renal imaging required in workup
70
Q

Therapy for Diamond-Blackfan anemia

A

Steroids at 2mg/kg/day versus Leukoreduced RBC transfusions

71
Q

Ivosidenib

A

IDH-1 inhibitor; this leads to increased levels in cancer cells causing decreased blast production and increased hematopoetic differentiation

Indications: Treatment of AML in patients >75 years of age w/ comorbidities excluding them from chemotherapy OR refractory AML

ADRs: DIFFERENTIATION SYNDROME, Guillan-Barre, QT prolongation, edema, transaminitis,

72
Q

Low-risk management therapies of MDS

A

Anemia: EPO for 3 months if EPO levels <500

Thrombocytopenia: Plt <20000 or <50 w/ bleeding =»TPO-RA (avoid if >5% blasts in marrow)

5q deletion: Linalidomide

Ringed Sideroblasts: Luspatercept

IDH: Ivodesenib

73
Q

Immunosuppressive therapy for MDS

A

Azacitidine or Decitabine: DNA methylating agents as they INHIBIT DNA methyltransferase

Neither one superior to the other

74
Q

Fostamatinib

A

Therapy for chronic ITP resistant to rituxan, ivig, and splenectomy

Acts as a small molecule spleen tyrosine kinase inhibitor affecting the differentiation and survival of antibodies via igG Fc receptor signaling

75
Q

Enzalutamide

A

Medication for castration resistant prostrate cancer associated with ischemic heart disease, PRESS, lower seizure threshold

76
Q

Stauffer syndrome

A

Hepatic dysfunction in the absence of liver Mets with RCC

RCC also can cause anemia, thrombocytosis, hypercalcemia, AA anylodosis, and polymyalgia rheumatica

77
Q

Stage IV breast cancer therapy that recurs after previous adjuvant aromatase therapy

A

Letrozole + Palbociclib

-Cdk4 and Cdk 6 inhibitor

78
Q

Abiraterone

A

CYP17-inhibitor Medication used in metastatic castrate-resistant prostate cancer; blocks androgen synthesis in tumor tissues, tested, and adrenal glands. *must administer with prednisone due to adrenal suppression

79
Q

Muir-Torre Syndrome

A

AD inherited MMR mutation in genes of MLH1- MSH-2, or MSH-6; same genes as HNPCC

Associated w/ one sebaceous gland malignancy and one visceral malignancy

80
Q

Treatment for metastatic melanoma that has progressed on PDL-1 inhibitor therapy

A

BRAF + MEK inhibitor therapy

MEKs include: , Trametinib, Cobemitinib

-Potentially reduced toxicity of BRAF inhibitors when use in combination

81
Q

Complete Thrombophilia Lab Test Profile

A 
Activated protein C (APC) resistance (FVL test) 
Prothrombin G20210A genetic teset 
Lupus anticoagulant 
anticardiolipin antibody
anti-B2 microglobulin
Antithrombin activity
Protein C, S activity
Fibrinogen levels (elevation is bad)
PAI-1
82
Q

Acquired antithrombin deficiency

A

Occurs in liver disease and nephrotic syndromes BUT can also occur w/ OCPs, prolonged heparin, asparaginase therapy, and DIC

**If patient gets a clot while on heparin, may need to think of this

83
Q

One mechanism of action for clots in chronic inflammation

A

Increased C4bBP binds protein S, thereby lowering free protein S that cannot form with activated protein C and complex to break down Factor Va and VIIIa

84
Q

Capecitabine

A

MoA: prodrug of 5-FU that is a pyrimidine antimetabolite that inhibits thimidylate synthetase which blocks the methylation of deoxyuridylic acid to thimidylic acid

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