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Boards > Hematology / Oncology > Flashcards

Hematology / Oncology Flashcards

1
Q

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

A

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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2
Q

What is the preferred treatment of iron deficiency

A

ferrous sulfate

high value care

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3
Q

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

A

no

high value care

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4
Q

Should you test for G6PD during an acute hemolytic episode?

A

no

high value care

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5
Q

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

A

no

high value care

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6
Q

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

A

no

high value care

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7
Q

should you ever offer ovarian ca screening?

A

no, not even in high risk women

high value care

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8
Q

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

A

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

high value care

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9
Q

can you treat febrile neutropenia as an outpatient?

A

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

high value care

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10
Q

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

A

observation

high value care

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11
Q

evaluation for a patient with pancytopenia?

A
  1. bone marrow and biopsy -> hypocellular and increased fat
  2. cytogenetics to exclude other bone marrow disorders like MDS
  3. PNH screening flow cytometry
  4. vit b12 and folate levels, hepatitis serologies, HIV testing
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12
Q

What is the treatment for aplastic anemia

A

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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13
Q

What is the treatment for PNH

A

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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14
Q

lenalidomide is the treatment for what syndrome?

A

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

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15
Q

treatment for CML

A

palliative: hydroxyrea to alleviate leukocytosis and HSM

- Imatinib, dasatinib, nilotinib

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16
Q

what is a side effect of all tyrosine kinase inhibitors?

A

QtC prolongation

don’t be tricked!

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17
Q

What is the treatment for essential thrombocythemia

A

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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18
Q

what are the most common causes of thrombocythemia?

A

iron deficiency anemia

infection

usually improve within a few weeks

don’t be tricked!

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19
Q

does a negative JAK2 test exclude essential thrombocythemia?

A

no

don’t be tricked!

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20
Q

What is the treatment for P vera

A

therapeutic phlebotomy

hydroxyurea for patients at high risk for thrombosis

low dose ASA unless other contraindications

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21
Q

hepatic vein thrombosis should prompt evaluation for what condition?

A

p vera

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22
Q

What is the treatment for ALL

A

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

+ dasatinib if + for phl chromosome

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23
Q

how diagnose AML

A

bone marrow bx with >20% blasts

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24
Q

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

A

50k

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25
Q

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

A

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

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26
Q

MM with non-IgM gammopathy - next step?

A

skeletal survey to assess for bony lesions

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27
Q

mult myeloma patient with back pain - next step?

A

MRI to assess for spinal cord impingement

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28
Q

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

A

no, not as sensitive as skeletal survey

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29
Q

What is the treatment for multiple myeloma

A

proteasome inhibitor - bortezomib

immunomodulatory agent - ex. thalidomide or lenalidomide

glucocorticoid

alkylating agent-ex cyclophosphamide for non-transplant candidates

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30
Q

ferritin above what level rules out iron deficiency anemia?

A

100

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31
Q

ferritin below what level is effectively diagnostic for iron deficiency anemia

A

14

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32
Q

What is the treatment for iron deficiency anemia

A

oral iron EOD for 6 months

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33
Q

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

A

yes to folate, no to b12

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34
Q

bite cells are suggestive of what disease

A

G6PD

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35
Q

target cells are suggestive of what disease

A

thalassemia, other hemoglobinopathy or liver dz

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36
Q

What is the treatment for warm autoimmune hemolytic anemia

A

glucocorticoids

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37
Q

What is the treatment for cold agglutinin dz

A

cold avoiddance

ritux for persistent symptoms

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38
Q

What is the treatment for TTP

A

emergent plasma exchange

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39
Q

What is the treatment for hereditary spherocytosis

A

splenectomy

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40
Q

What is the treatment for severe thalassemia

A

HSCT

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41
Q

What is the treatment for severe PNH

A

eculizumab or HSCT

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42
Q

What is the treatment for ITP

A

prednisone

IVIG if plts <30k or bleeding

IVIG is first line in pregnancy

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43
Q

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

A

surgical resection

44
Q

What is Four-factor prothrombin complex concentrate used for?

A

warfarin toxicity and life threatening bleeding

45
Q

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

A

vitamin K deficiency

tx: vitamin K, FFP if acute need

46
Q

what thyroid cancer is associated with a childhood history of radiation

A

papillary thyroid cancer

47
Q

sickle cell with a sudden drop in Hct?

A

aplastic crisis

48
Q

Sickle cell patient with: chronic exertional dyspnea

What is the diagnosis?

A

HF or pHTN

49
Q

Sickle cell patient with infection with encapsulated organism

What is the diagnosis?

A

functional asplenia

50
Q

Sickle cell patient with: liver dz

What is the diagnosis?

A

viral hepatitis

iron overload from transfusions

ischemic induced hepatic crisis

51
Q

What is the treatment for vaso-occulsive crisis

A

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

52
Q

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

A

acute stroke
fat embolism
acs

can use as ppx for patients with a history of stroke

53
Q

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

A

HSCT

54
Q

should you transfuse a patient with simple vaso-occlusive pain

A

no

55
Q

can you use meperidine to treat painful sickle crises?

A

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

56
Q

how can you distinguish a thalassemia trait from iron deficiency anemia

A

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

57
Q

when should you pursue chelation therapy for beta thalassemia?

A

ferritin >1000 ng/mL

58
Q

tx for INR >9

A

vit K 2.5 -5 mg PO

59
Q

What is the treatment for bleeding at any INR

A

vit K 10mg IV and 4f-PCC

60
Q

normal PT, prolonged aPTT

What is the diagnosis?

A

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

61
Q

hemophilia a is a deficiency in what factor

A

factor VIII

62
Q

hemophilia b is a deficiency in what factor

A

factor IX

63
Q

how diagnose a hemophilia?

A

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

64
Q

how diagnose vWD

A

prolonged bleeding time
normal or prolonged aPTT

definitive dx with vWF antigen level, activity assay, factor VIII level and multimer study to diagnose subtypes

65
Q

What is the treatment for vWD?

A

OCPs in women with mild dz

DDAVP for mild to moderate bleeding or before dental procedures

66
Q

should you use cryo for patients with vWD

A

no because of increased transfusion infection risk

67
Q

How do you diagnose ITP?

A

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

68
Q

What is the treatment for HUS

A

supportive tx

69
Q

What is the treatment for TTP

A

stop causative drug

plasma exchange

70
Q

should you give platelets in TTP - HUS?

A

no, can exacerbate the microvascular occlusion

don’t be tricked!

71
Q

How diagnose HIT?

A

PF4/heparin Ab and serotonin release assay

72
Q

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

A

20k

73
Q

What does cryo have that FFP doesn’t?

A

fibrinogen, mainly used in DIC

also has vWF

74
Q

what is the platelet transfusion threshold for intracranial bleeding

A

100k

75
Q

which patients need prolonged VTE ppx

A

up to 5 weeks of VTE ppx s/p

  • hip and knee replacement
  • hip fracture
  • major cancer surgery
76
Q

If a DVT is diagnosed do you need a CTA?

A

no, same treatment

77
Q

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

A

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

78
Q

Which patients should not receive a NOAC?

A

BMI >40

GFR <30

79
Q

How diagnose PNH

A

flow cytometry!

80
Q

how treat patients with RCC and 1 pulm met?

A

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

81
Q

what are survivors of ALL at risk for?

A

metabolic syndrome

82
Q

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

A

paracentesis with cytology

83
Q

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

A

pre-menopausal: tamoxifen 5-10 years and radiation

post-menopausal: aromatase inhibitor: anastrozole, letrozole, exemestane, need periodic DEXA scans

84
Q

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

A

trastuumab

*need to evaluate LV before starting

85
Q

What is the treatment for DCIS

A

lumpectomy + radiation

86
Q

do patients with metastatic breast ca need mastectomy?

A

no unless required for local cancer control

don’t be tricked!

87
Q

who needs lung cancer screening?

A

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

88
Q

What is the diagnosis?

lung mass and hypercalcemia

A

non small cell lung cancer

89
Q

What is the treatment for limited SCLC

A

chemo and radiation

90
Q

What is the treatment for SCLC with brain mets

A

whole brain radiation

91
Q

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

A

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

92
Q

What is the treatment for FAP

A

prophylactic colectomy

EGD to assess for duodenal cancer

93
Q

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

A

age 10-12 and then q1-2 years

94
Q

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

A

8 years after diagnosis and then every 1-2 yeras

95
Q

what cancer screening should patients with PSC have?

A

colo at time of diagnosis

96
Q

What is the treatment for anal cancer

A

radiation therapy and mitomycin + 5-FU

97
Q

should you treat anal cancer with surgery?

A

no

don’t be tricked!

98
Q

What is the treatment for cholangiocarcinoma

A

surgery

99
Q

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

A

bone scan

CTAP

100
Q

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

A

docetaxel

bicalutamide (anti-androgen)

101
Q

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

A

medullary

102
Q

BRAF mutation is specific to what type of thyroid cancer

A

papillary

103
Q

smudge cells are characteristic of what disease

A

CLL

104
Q

What is the treatment for hairy cell leukemia

A

cladribine

105
Q

What is the treatment for hodgkin’s

A

ABVD + radiation

106
Q

What is the treatment for DLBCL

A

R-CHOP

107
Q

side effect of tamoxifen

A

VTE, endometrial cancer

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