Hematology / Oncology Flashcards by AS W

What treatment can be used for bony lesions in multiple myeloma?

Zoledronic acid

Zoledronic acid has been shown to prevent new skeletal-related events and improve survival in patients with multiple myeloma requiring therapy.

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What is the preferred treatment of iron deficiency

ferrous sulfate

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Should Epo be used for patients with CKD not on HD who have a Hgb greater than 10?

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Should you test for G6PD during an acute hemolytic episode?

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Do asymptomatic patients with factor XI deficiency need intervention prior to surgery?

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Should patients with newly diagnosed stage 0-2 breast cancer get add’l imaging (PET, CT, bone scan)?

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should you ever offer ovarian ca screening?

no, not even in high risk women

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head and neck cancer patient with negative post treatment scan - do they need routing imaging?

no, only if there are signs and symptoms of recurrent disease

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can you treat febrile neutropenia as an outpatient?

yes if patient lacks significant comorbidities and has reliable home care and follow-up

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older men with early stage prostate cancer, limited life expectancy or sig medical comorbidity - what’s the best approach?

observation

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evaluation for a patient with pancytopenia?

bone marrow and biopsy -> hypocellular and increased fat
cytogenetics to exclude other bone marrow disorders like MDS
PNH screening flow cytometry
vit b12 and folate levels, hepatitis serologies, HIV testing

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What is the treatment for aplastic anemia

withdraw causative agents

immunosupporession with cyclosporine and antithymocyte globulin -> leads to control in 70% of patients

allogenic HSCT in patients <50

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What is the treatment for PNH

eculizumab in symptomatic patients

allogenic HSCT can lead to long term survival

ppx anticoagulation and iron and folic acid supplementation in all patients

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lenalidomide is the treatment for what syndrome?

-5q syndrome, type of MDS, more than 2/3rds patients will respond to this treatment

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treatment for CML

palliative: hydroxyrea to alleviate leukocytosis and HSM

- Imatinib, dasatinib, nilotinib

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what is a side effect of all tyrosine kinase inhibitors?

QtC prolongation

don’t be tricked!

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What is the treatment for essential thrombocythemia

ASA for low risk patients

hydroxyurea + ASA in high risk non pregnant patients

plateletpheresis in emergent, life threatening situations to reduce platelets quickly

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what are the most common causes of thrombocythemia?

iron deficiency anemia

infection

usually improve within a few weeks

don’t be tricked!

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does a negative JAK2 test exclude essential thrombocythemia?

don’t be tricked!

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What is the treatment for P vera

therapeutic phlebotomy

hydroxyurea for patients at high risk for thrombosis

low dose ASA unless other contraindications

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hepatic vein thrombosis should prompt evaluation for what condition?

p vera

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What is the treatment for ALL

chemo + allo HSCT + CNS intrathecal chemo +/- radiation

+ dasatinib if + for phl chromosome

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how diagnose AML

bone marrow bx with >20% blasts

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leukostasis in AML is typically a risk above what leukocyte count?

50k

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MM with IgM gammopathies: what's the next step?

CT chest/ab/pelvis if B symptoms since more likely to be associated with B cell lymphoma

MM with non-IgM gammopathy - next step?

skeletal survey to assess for bony lesions

mult myeloma patient with back pain - next step?

MRI to assess for spinal cord impingement

Should you use bone sacnes in patients with suspected multiple myeloma?

no, not as sensitive as skeletal survey

What is the treatment for multiple myeloma

proteasome inhibitor - bortezomib immunomodulatory agent - ex. thalidomide or lenalidomide glucocorticoid alkylating agent-ex cyclophosphamide for non-transplant candidates

ferritin above what level rules out iron deficiency anemia?

100

ferritin below what level is effectively diagnostic for iron deficiency anemia

What is the treatment for iron deficiency anemia

oral iron EOD for 6 months

in malabsorptive conditions can you treat with PO folate or b12?

yes to folate, no to b12

bite cells are suggestive of what disease

G6PD

target cells are suggestive of what disease

thalassemia, other hemoglobinopathy or liver dz

What is the treatment for warm autoimmune hemolytic anemia

glucocorticoids

What is the treatment for cold agglutinin dz

cold avoiddance ritux for persistent symptoms

What is the treatment for TTP

emergent plasma exchange

What is the treatment for hereditary spherocytosis

splenectomy

What is the treatment for severe thalassemia

HSCT

What is the treatment for severe PNH

eculizumab or HSCT

What is the treatment for ITP

prednisone IVIG if plts <30k or bleeding IVIG is first line in pregnancy

What is the treatment for melanoma with a solitary brain metastasis?

surgical resection

What is Four-factor prothrombin complex concentrate used for?

warfarin toxicity and life threatening bleeding

elderly man with poor po intake and prolonged PT but normal PTT

vitamin K deficiency tx: vitamin K, FFP if acute need

what thyroid cancer is associated with a childhood history of radiation

papillary thyroid cancer

sickle cell with a sudden drop in Hct?

aplastic crisis

Sickle cell patient with: chronic exertional dyspnea What is the diagnosis?

HF or pHTN

Sickle cell patient with infection with encapsulated organism What is the diagnosis?

functional asplenia

Sickle cell patient with: liver dz What is the diagnosis?

viral hepatitis iron overload from transfusions ischemic induced hepatic crisis

What is the treatment for vaso-occulsive crisis

hydration, supp o2, tx for any precipitating event, opioids

when should you use exchange transfusion for a patient with sickle cell

acute stroke fat embolism acs can use as ppx for patients with a history of stroke

pt with sickle cell with severe symptoms unresponsive to transfusions and hydroxyurea- what's the best tx?

HSCT

should you transfuse a patient with simple vaso-occlusive pain

can you use meperidine to treat painful sickle crises?

no because the metabolite normeperidine can build up and lead to seizures

how can you distinguish a thalassemia trait from iron deficiency anemia

RDW will be low in thalassemia trait but elevated in iron deficiency anemia

when should you pursue chelation therapy for beta thalassemia?

ferritin >1000 ng/mL

tx for INR >9

vit K 2.5 -5 mg PO

What is the treatment for bleeding at any INR

vit K 10mg IV and 4f-PCC

normal PT, prolonged aPTT What is the diagnosis?

deficiency of factor VIII, IX, XI or XII vWD if severe and low factor VIII level heparin

hemophilia a is a deficiency in what factor

factor VIII

hemophilia b is a deficiency in what factor

factor IX

how diagnose a hemophilia?

prolonged PTT that improves with a mixing study (because its a deficiency of a factor)

how diagnose vWD

prolonged bleeding time normal or prolonged aPTT definitive dx with vWF antigen level, activity assay, factor VIII level and multimer study to diagnose subtypes

What is the treatment for vWD?

OCPs in women with mild dz DDAVP for mild to moderate bleeding or before dental procedures

should you use cryo for patients with vWD

no because of increased transfusion infection risk

How do you diagnose ITP?

peripheral smaer with reduced numbers of large platelets and normal erythroid and myeloid cells

What is the treatment for HUS

supportive tx

What is the treatment for TTP

stop causative drug | plasma exchange

should you give platelets in TTP - HUS?

no, can exacerbate the microvascular occlusion don't be tricked!

How diagnose HIT?

PF4/heparin Ab and serotonin release assay

Each plt transfusion should raise the plt count by how much?

20k

What does cryo have that FFP doesn't?

fibrinogen, mainly used in DIC also has vWF

what is the platelet transfusion threshold for intracranial bleeding

100k

which patients need prolonged VTE ppx

up to 5 weeks of VTE ppx s/p - hip and knee replacement - hip fracture - major cancer surgery

If a DVT is diagnosed do you need a CTA?

no, same treatment

parenteral anticoagulation has to overlap with warfarin for how many days?

at least 5 or until the INR is >2 for 24 hours

Which patients should not receive a NOAC?

BMI >40 GFR <30

How diagnose PNH

flow cytometry!

how treat patients with RCC and 1 pulm met?

Debulking nephrectomy improves survival in patients diagnosed with metastatic kidney cancer, particularly in those with limited metastatic disease.

what are survivors of ALL at risk for?

metabolic syndrome

What is the workup for a postmenopausal woman with asictes and a pelvic mass

paracentesis with cytology

What is the treatment for ER, PR positive breast cancer that is not metastatic

pre-menopausal: tamoxifen 5-10 years and radiation post-menopausal: aromatase inhibitor: anastrozole, letrozole, exemestane, need periodic DEXA scans

What is the treatment for HER-2 positive breast cancer?

trastuumab *need to evaluate LV before starting

What is the treatment for DCIS

lumpectomy + radiation

do patients with metastatic breast ca need mastectomy?

no unless required for local cancer control don't be tricked!

who needs lung cancer screening?

anyone with a 30 pack years smoking history aged 55 to 74 years needs a low dose CT ANNUALLY

What is the diagnosis? lung mass and hypercalcemia

non small cell lung cancer

What is the treatment for limited SCLC

chemo and radiation

What is the treatment for SCLC with brain mets

whole brain radiation

What is more useful in workup of gastric cancer - CT or EUS?

EUS is better to evaluate depth of tumor invasion and LN involvement

What is the treatment for FAP

prophylactic colectomy EGD to assess for duodenal cancer

when should you start with colonoscopy in patients with FAP or FAP risk

age 10-12 and then q1-2 years

how often should you do colonoscopies on patients with UC or crohn's

8 years after diagnosis and then every 1-2 yeras

what cancer screening should patients with PSC have?

colo at time of diagnosis

What is the treatment for anal cancer

radiation therapy and mitomycin + 5-FU

should you treat anal cancer with surgery?

no don't be tricked!

What is the treatment for cholangiocarcinoma

surgery

patients in high risk categories for prostate cancer should have what as part of their workup

bone scan CTAP

men with prostate cancer who progress despite androgen deprivation therapy should have what added to their treatment regimen

docetaxel bicalutamide (anti-androgen)

elevated serum calcitonin is seen in what type of thyroid cancer?

medullary

BRAF mutation is specific to what type of thyroid cancer

papillary

smudge cells are characteristic of what disease

CLL

What is the treatment for hairy cell leukemia

cladribine

What is the treatment for hodgkin's

ABVD + radiation

What is the treatment for DLBCL

R-CHOP

side effect of tamoxifen

VTE, endometrial cancer