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Medicine > Hematology Oncology I > Flashcards

Hematology Oncology I Flashcards

1
Q

Acute hemolytic transfusion reaction is distinguished from febrile non-hemolytic reaction by the presence of a […] direct antiglobulin (Coomb’s) test.

A

Acute hemolytic transfusion reaction is distinguished from febrile non-hemolytic reaction by the presence of a positive direct antiglobulin (Coomb’s) test.

Coombs test is negative in febrile non-hemolytic transfusion reaction

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2
Q

Acute hemolytic transfusion reaction is distinguished from febrile non-hemolytic reaction by the presence of plasma free hemoglobin > […] mg/dL.

A

Acute hemolytic transfusion reaction is distinguished from febrile non-hemolytic reaction by the presence of plasma free hemoglobin > 25 mg/dL.

may result in a “pink” appearing plasma; plasma free hemoglobin is

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3
Q

Autoimmune hemolytic anemia is differentiated from hereditary spherocytosis by a positive […] test.

A

Autoimmune hemolytic anemia is differentiated from hereditary spherocytosis by a positive Coombs test.

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4
Q

Chronic myeloid leukemia is associated with a […] leukocyte alkaline phosphatase (LAP) score.

A

Chronic myeloid leukemia is associated with a low leukocyte alkaline phosphatase (LAP) score.

helps distinguish CML from leukemoid reaction (high LAP)

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5
Q

CML is distinguished from a leukemoid reaction (benign neutrophilia) by presence of increased […] and/or myelocytes.

A

CML is distinguished from a leukemoid reaction (benign neutrophilia) by presence of increased basophils and/or myelocytes.

presence of basophilia and less mature neutrophil precursors (myelocytes > metamyelocytes) favors diagnosis of CML > leukemoid reaction

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6
Q

Diagnosis of paroxysmal nocturnal hemoglobinuria may be made with flow cytometry, which can detect the absence of the proteins […] and […].

A

Diagnosis of paroxysmal nocturnal hemoglobinuria may be made with flow cytometry, which can detect the absence of the proteins CD55 and CD59.

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7
Q

Does acute myeloid leukemia typically present with lymphadenopathy and hepatosplenomegaly?

A

No (rare)

typically manifests as symptoms related to > 1 cytopenias (e.g. weakness, bleeding, infection)

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8
Q

Heparin-induced thrombocytopenia causes decreased platelet counts with a […]-coaguable state.

A

Heparin-induced thrombocytopenia causes decreased platelet counts with a hyper-coaguable state.

due to IgG antibodies against heparin-platelet factor IV complexes

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9
Q

How do the following laboratory values change with tumor lysis syndrome?

Serum Ca2+: […]

Serum K+: […]

Serum phosphate: […]

Serum uric acid: […]

A

How do the following laboratory values change with tumor lysis syndrome?

Serum Ca2+: Decreased

Serum K+: Increased

Serum phosphate: Increased

Serum uric acid: Increased

K+, phosphate, and uric acid are released from lysed cells; phosphate binds and precipitates Ca2+

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10
Q

Intravascular hemolytic anemias are associated with […] levels of haptoglobin.

A

Intravascular hemolytic anemias are associated with decreased levels of haptoglobin.

haptoglobin is a serum protein that binds free hemoglobin for removal by the reticuloendothelial system

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11
Q

Leukemoid reaction is associated with a […] leukocyte alkaline phosphatase (LAP) score.

A

Leukemoid reaction is associated with a high leukocyte alkaline phosphatase (LAP) score.

helps distinguish leukemoid reaction from CML (low LAP)

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12
Q

Lupus anticoagulant (anti-phospholipid antibody) is associated with […] PTT and a […]-coagulable state.

A

Lupus anticoagulant (anti-phospholipid antibody) is associated with prolonged PTT and a hyper-coagulable state.

PTT will not correct when mixed with normal plasma (mixing study); prolonged PTT is an in vitro artifact

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13
Q

Multiple myeloma is associated with an elevated protein gap (> […] g/dL).

A

Multiple myeloma is associated with an elevated protein gap (> 4 g/dL).

i.e. the difference between serum protein and serum albumin

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14
Q

Patients with infectious mononucleosis are advised to avoid contact sports for at least […].

A

Patients with infectious mononucleosis are advised to avoid contact sports for at least 4 weeks.

due to risk of splenic rupture

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15
Q

Patients with pernicious anemia should be monitored for development of […] cancer.

A

Patients with pernicious anemia should be monitored for development of gastric cancer.

e.g. periodic fecal occult blood testing; pernicious anemia is associated with 2-3x increased risk of gastric cancer compared to the general population due to chronic atrophic gastritis

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16
Q

Pica, especially for ice (pagophagia), may be indicative of […].

A

Pica, especially for ice (pagophagia), may be indicative of iron deficiency anemia.

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17
Q

Polycythemia vera is characterized by […] levels of erythopoietin.

A

Polycythemia vera is characterized by low levels of erythopoietin.

helps differentiate polycythemia vera from secondary forms of polycythemia (e.g. chronic hypoxia, EPO-secreting tumors)

18
Q

The abnormal promyelocytes seen in APML contain numerous primary granules that increase risk for […].

A

The abnormal promyelocytes seen in APML contain numerous primary granules that increase risk for DIC.

Auer rods can activate coagulation cascade; DIC is common presentation

19
Q

The pentad of symptoms seen in thrombotic thrombocytopenic purpura (TTP) may be remembered using the mnemonic FAT RN:

F: […]

A: […]

T: […]

R: Renal symptoms

N: Neurologic symptoms

A

The pentad of symptoms seen in thrombotic thrombocytopenic purpura (TTP) may be remembered using the mnemonic FAT RN:

F: Fever

A: Anemia (MAHA)

T: Thrombocytopenia

R: Renal symptoms

N: Neurologic symptoms

however, only MAHA and thrombocytopenia are required for diagnosis; peripheral blood smear helps aid in diagnosis (e.g. schistocytes suggestive of intravascular hemolysis)

20
Q

The pentad of symptoms seen in thrombotic thrombocytopenic purpura (TTP) may be remembered using the mnemonic FAT RN:

F: Fever

A: Anemia (MAHA)

T: Thrombocytopenia

R: […]

N: […

A

The pentad of symptoms seen in thrombotic thrombocytopenic purpura (TTP) may be remembered using the mnemonic FAT RN:

F: Fever

A: Anemia (MAHA)

T: Thrombocytopenia

R: Renal symptoms

N: Neurologic symptoms

however, only MAHA and thrombocytopenia are required for diagnosis; peripheral blood smear helps aid in diagnosis (e.g. schistocytes suggestive of intravascular hemolysis)

21
Q

The pentad of symptoms seen in […] may be remembered using the mnemonic FAT RN:

F: Fever

A: Anemia (MAHA)

T: Thrombocytopenia

R: Renal symptoms

N: Neurologic symptoms

A

The pentad of symptoms seen in thrombotic thrombocytopenic purpura (TTP) may be remembered using the mnemonic FAT RN:

F: Fever

A: Anemia (MAHA)

T: Thrombocytopenia

R: Renal symptoms

N: Neurologic symptoms

however, only MAHA and thrombocytopenia are required for diagnosis; peripheral blood smear helps aid in diagnosis (e.g. schistocytes suggestive of intravascular hemolysis)

22
Q

What amino acid is likely elevated in a patient with the following peripheral blood smear?

A

Homocysteine

smear is consistent with folate or vitamin B12 deficiency (hypersegmented neutrophils); both vitamins are involved in the conversion of homocysteine to methionine

23
Q

What anticoagulant is associated with decreased levels of proteins C and S?

A

Warfarin

also decreases levels of factors II, VII, IX, and X

24
Q

What blood smear finding is consistent with autoimmune hemolytic anemia?

A

Spherocytes

differentiated from hereditary spherocytosis by a positive Coombs test

25
Q

What cancer is associated with hereditary hemochromatosis?

A

Hepatocellular carcinoma

26
Q

What category of therapy is characterized the following scenario: a patient undergoes radiation therapy prior to having a radical prostatectomy for prostate cancer.

A

Neoadjuvant therapy

treatment given before the standard therapy

27
Q

What category of therapy is characterized the following scenario: a patient undergoes radical prostatectomy and has an undetectable PSA post-surgery. Several months later, the patient’s PSA is elevated again and he undergoes radiation therapy.

A

Salvage therapy

treatment for a disease when standard therapy fails

28
Q

What category of therapy is characterized the following scenario: a patient undergoes radical prostatectomy with concurrent radiation therapy for prostate cancer.

A

Adjuvant therapy

treatment given in addition to standard therapy

29
Q

What chromosomal mutation underlies the pathophysiology of chronic myeloid leukemia (CML)?

A

t(9;22); BCR-ABL fusion

results in constitutively active tyrosine kinase

30
Q

What condition is associated with increased risk for anaphylactic reaction when receiving blood transfusions?

A

IgA deficiency

due to presence of anti-IgA IgG antibodies; RBCs should be washed prior to transfusion

31
Q

What enzyme is typically elevated in patients with hemolytic anemia?

A

Lactate dehydrogenase (LDH)

32
Q

What hepatobiliary complication is associated with hereditary spherocytosis?

A

Pigment gallstones (+/- acute cholecystitis)

splenectomy can reduce risk of gallstones

33
Q

What hereditary disease renders patients prone to warfarin-induced skin necrosis?

A

Hereditary protein C deficiency

due to relative decrease of protein C (anti-coagulant) relative to factors II, IX, and X (pro-coagulant) initially; treatment involves immediate warfarin cessation and administration of protein C concentrate

34
Q

What is an appropriate prophylactic regimen to help prevent tumor lysis syndrome?

A

IV fluids + allopurinol or rasburicase

35
Q

What is the best initial test in a patient found to have a cervical lymph node with metastatic squamous cell carcinoma?

A

Panendoscopy (esophagoscopy, bronchoscopy, laryngoscopy)

helps detect the primary tumor, which can then be biopsied to determine further management

36
Q

What is the diagnostic test of choice for chronic lymphocytic leukemia (CLL)?

A

Flow cytometry

37
Q

What is the drug class of choice for stabilizing bony metastatic lesions and preventing hypercalcemia of malignancy?

A

Bisphosphonates

38
Q

What is the first-line treatment for most patients with chronic myeloid leukemia (CML)?

A

Tyrosine kinase inhibitors (e.g. imatinib)

39
Q

What is the gold standard confirmatory test for heparin-induced thrombocytopenia?

A

Serotonin release assay

40
Q

What is the initial imaging modality used for diagnosis of SVC syndrome?

A

Chest X-ray

abnormalities on CXR warrant follow up with chest CT and histology

Medicine (33 decks)

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