Hematology Oncology I Flashcards
Acute hemolytic transfusion reaction is distinguished from febrile non-hemolytic reaction by the presence of a […] direct antiglobulin (Coomb’s) test.
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
Acute hemolytic transfusion reaction is distinguished from febrile non-hemolytic reaction by the presence of plasma free hemoglobin > […] mg/dL.
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
Autoimmune hemolytic anemia is differentiated from hereditary spherocytosis by a positive […] test.
Autoimmune hemolytic anemia is differentiated from hereditary spherocytosis by a positive Coombs test.
Chronic myeloid leukemia is associated with a […] leukocyte alkaline phosphatase (LAP) score.
Chronic myeloid leukemia is associated with a low leukocyte alkaline phosphatase (LAP) score.
helps distinguish CML from leukemoid reaction (high LAP)
CML is distinguished from a leukemoid reaction (benign neutrophilia) by presence of increased […] and/or myelocytes.
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
Diagnosis of paroxysmal nocturnal hemoglobinuria may be made with flow cytometry, which can detect the absence of the proteins […] and […].
Diagnosis of paroxysmal nocturnal hemoglobinuria may be made with flow cytometry, which can detect the absence of the proteins CD55 and CD59.
Does acute myeloid leukemia typically present with lymphadenopathy and hepatosplenomegaly?
No (rare)
typically manifests as symptoms related to > 1 cytopenias (e.g. weakness, bleeding, infection)
Heparin-induced thrombocytopenia causes decreased platelet counts with a […]-coaguable state.
Heparin-induced thrombocytopenia causes decreased platelet counts with a hyper-coaguable state.
due to IgG antibodies against heparin-platelet factor IV complexes
How do the following laboratory values change with tumor lysis syndrome?
Serum Ca2+: […]
Serum K+: […]
Serum phosphate: […]
Serum uric acid: […]
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+
Intravascular hemolytic anemias are associated with […] levels of haptoglobin.
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
Leukemoid reaction is associated with a […] leukocyte alkaline phosphatase (LAP) score.
Leukemoid reaction is associated with a high leukocyte alkaline phosphatase (LAP) score.
helps distinguish leukemoid reaction from CML (low LAP)
Lupus anticoagulant (anti-phospholipid antibody) is associated with […] PTT and a […]-coagulable state.
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
Multiple myeloma is associated with an elevated protein gap (> […] g/dL).
Multiple myeloma is associated with an elevated protein gap (> 4 g/dL).
i.e. the difference between serum protein and serum albumin
Patients with infectious mononucleosis are advised to avoid contact sports for at least […].
Patients with infectious mononucleosis are advised to avoid contact sports for at least 4 weeks.
due to risk of splenic rupture
Patients with pernicious anemia should be monitored for development of […] cancer.
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
Pica, especially for ice (pagophagia), may be indicative of […].
Pica, especially for ice (pagophagia), may be indicative of iron deficiency anemia.
Polycythemia vera is characterized by […] levels of erythopoietin.
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)
The abnormal promyelocytes seen in APML contain numerous primary granules that increase risk for […].
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
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
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)
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: […
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)
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
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)
What amino acid is likely elevated in a patient with the following peripheral blood smear?
Homocysteine
smear is consistent with folate or vitamin B12 deficiency (hypersegmented neutrophils); both vitamins are involved in the conversion of homocysteine to methionine
What anticoagulant is associated with decreased levels of proteins C and S?
Warfarin
also decreases levels of factors II, VII, IX, and X
What blood smear finding is consistent with autoimmune hemolytic anemia?
Spherocytes
differentiated from hereditary spherocytosis by a positive Coombs test
What cancer is associated with hereditary hemochromatosis?
Hepatocellular carcinoma
What category of therapy is characterized the following scenario: a patient undergoes radiation therapy prior to having a radical prostatectomy for prostate cancer.
Neoadjuvant therapy
treatment given before the standard therapy
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.
Salvage therapy
treatment for a disease when standard therapy fails
What category of therapy is characterized the following scenario: a patient undergoes radical prostatectomy with concurrent radiation therapy for prostate cancer.
Adjuvant therapy
treatment given in addition to standard therapy
What chromosomal mutation underlies the pathophysiology of chronic myeloid leukemia (CML)?
t(9;22); BCR-ABL fusion
results in constitutively active tyrosine kinase
What condition is associated with increased risk for anaphylactic reaction when receiving blood transfusions?
IgA deficiency
due to presence of anti-IgA IgG antibodies; RBCs should be washed prior to transfusion
What enzyme is typically elevated in patients with hemolytic anemia?
Lactate dehydrogenase (LDH)
What hepatobiliary complication is associated with hereditary spherocytosis?
Pigment gallstones (+/- acute cholecystitis)
splenectomy can reduce risk of gallstones
What hereditary disease renders patients prone to warfarin-induced skin necrosis?
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
What is an appropriate prophylactic regimen to help prevent tumor lysis syndrome?
IV fluids + allopurinol or rasburicase
What is the best initial test in a patient found to have a cervical lymph node with metastatic squamous cell carcinoma?
Panendoscopy (esophagoscopy, bronchoscopy, laryngoscopy)
helps detect the primary tumor, which can then be biopsied to determine further management
What is the diagnostic test of choice for chronic lymphocytic leukemia (CLL)?
Flow cytometry
What is the drug class of choice for stabilizing bony metastatic lesions and preventing hypercalcemia of malignancy?
Bisphosphonates
What is the first-line treatment for most patients with chronic myeloid leukemia (CML)?
Tyrosine kinase inhibitors (e.g. imatinib)
What is the gold standard confirmatory test for heparin-induced thrombocytopenia?
Serotonin release assay
What is the initial imaging modality used for diagnosis of SVC syndrome?
Chest X-ray
abnormalities on CXR warrant follow up with chest CT and histology
