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ABIM > Heme 3 > Flashcards

Heme 3 Flashcards

1
Q

Name (4) Long-term Complications of NonHodgkin Lymphoma and how to screen for them.

A
  1. Breast Cancers (Due to chest radiation) Annual Mammograms age 40
  2. CAD- Minimize Risk Factors (HTN, HLD Obesity)
  3. Hypothyroidism - Check TSH, neck radiation
  4. Depression, PTSD.- Screen
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2
Q

Patients with BRCA 1 or 2 mutations should be offered

A

Prophylactic Mastectomy.

Salpingo-oophorectomy for women > 35-40

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3
Q
  1. 26 yo Women presents with dry cough, low grade fever, night sweats and weightloss. She has lymphadenopathy in the supraclavicular area, cervical and axillary region. What is the next step in management?
  2. Management of a patient presenting with generalized Lymphadenopathy?
  3. Localized > 4 weeks. Next Step in Management?
A
  1. Excisional (take full node out) Biopsy of Supraclavicular Lymph Nodes.
  2. CBC and CXR. If normal RPR, HIV, HBsAg, PPD, Heterophile testing.
    If all negative then biopsy.
  3. Excisional Biopsy
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4
Q

61 yo M with 20 minutes of Slurred Speech, Episode of Blurry vision. Active 35 pack year Smoking hx.
Spleen tip Palpable on inspiration. Hematocrit 64%
Dx? Test?
Rx for Low risk and High risk thrombosis patients ?

A

Polycythemia Vera

Jak-2, low EPO levels (Suppressed Epo)

Rx: Phlebotomy and Aspirin

Those that are high risk require (old)

Myelosuppression with Hydroxyurea.
PV can convert to Myeloproliferative disorders/AML.

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5
Q

60 yo MAN, presents with Vague abdominal pain, fatigue, hepatosplenomegaly. WBC 45,000, Platelets 550,000 and there is evidence of Basophilia (9%)and Eosinophilia (10%).

Dx?

A

CML (Myeloproliferative Disorders have Basophilia and Eosinophilia

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6
Q
  1. Pt presents with Spherocytes, Anemia, Jaundice and Splenomagly?
    What is next step in Management and Why?
  2. What test confirms HS?
  3. Rx?
A

DAT or Coombs test to differentiate from Hereditary Spherocystosis and Autoimmune Hemolytic Anemia.

DAT is negative in HS

  1. Eosin-5-Maleimide Binding (Flow Cytometry) or Acidified Glycerol Lysis test
  2. Transfusion or if needed Splenectomy
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7
Q

Pt with 35 year smoking hx presents with Right Shoulder pain, Horner Syndrome and Paraesthesias of the of the C8-T2 region causing tingling in 4th and fiifth digit on the Right side. Dx?

A

Pancosat Tumor

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8
Q

Differential diagnosis of Thrombocytopenia:

  1. Preceding Viral Infection. No Microangiopathic hemolytic Anemia. No fever, No Neurological changes and No AKI. No increase in LDH, Bili. Dx?
  2. Microangiopathic Hemolytic Anemia, AKI, Neurological Changes, Increase in LDH, BIli
  3. Prodromal illness of Diarrhea, Abdominal Vomiting, Microangiopathic Hemolytic Anemia, AKI, increase in LDH, and Bili. No neuro Symptoms.
A
  1. ITP
  2. TTP
  3. HUS
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9
Q

Pt presents with Heavy Menstrual Bleeding and Epitaxis. Platelet Counts and Coagulation studies are normal.

Dx?
Test?
Rx for Mild Cases?
Rx for Severe Cases or patients under going surgery?

A

Von Willebrand disease (Muocutaneous bleeding)

Check Plasma von Willebrand Factor Antigen and Activity assays (Risoetin)

Rx is Desmopressin

Rx for Severe Cases give vWF

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10
Q
  1. Mild Thrombocytopenia within the first 2 days of Heparin Exposure. Dx? Management?
  2. Mild or Moderate Thrombocytopenia with or without DVT 5-10 days AFTER Heparin initiation. Dx?
  3. Develop of High-titer antibodies against Heparin-PF4 Complexes in ABSENCE of circulating Heparin. Occurs 5-19 days AFTER Heparin Cessation. Dx? Rx? Test?
A
  1. HIT Type 1 Non-immune. It resolves spontaneously. Plt count does not drop < 100,000. Do not discontinue Heparin.
  2. HIT Type 2 Immune Mediated due to PF4
    at least 50% drop
  3. Delayed-Onset HIT immune mediated due to high-titer Heparin PF4 complexes.

Direct thrombin inhibitor. (Agatroban), Blivirudin, Fondapurinux

Test: Serotonin Release Assay
Heparin Induced Platelet Aggregation
Assay

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11
Q
  1. Pt with Hodgkin lymphoma receiving chemotherapy receives emergency blood transfusion after an MVA and develops Fever, Rash, Profuse Diarrhea, Elevated LFTs and Lymphopenia. Dx? How to prevent this?
  2. Pt with IgA deficiency should receive what kind of red blood cells?
A
  1. Graft-Versus Host Disease.
    Immunocompromised patients need to receive Irradiated Blood Products to Inactivate donor Lymphocytes BEFORE transfusion. - exclusion is HIV patients.
  2. Washed red blood cells.
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12
Q

Pt presents with Recurrent Acute abdominal Pain with Constipation, Attacks of Dark Urine, Peripheral Neuropathy and Hyponatremia.

Dx?
Test?
Rx?

A

Acute Intermittent Porphyria (Attacks Precipitated by Starvation, Stress, Infection) Elevated Urinary Porphobilinogen (PBG) During an ACUTE ATTACK, And Alpha Aminoevulinic Acid

Rx: Glucose Loading and IV Hemin (Reconstitutes Heme in Liver.)

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13
Q

Pt treated for Breast Cancer 6 years with Anthracycline Develops Anemia, Thrombocytopenia and WBC 17,000. Smear Shows Polychromasia With Nucleated RBCs, Metamyelocytes and Large Nuclei, Prominenet Nucleoi with scant Cytoplasm. Dx?

A

Chemotherapy Induced Acute Myeloid Leukemia.

Pt treated with Chemotherapy agents are at risk for developing Myelodysplastic/Myeloproliferative Neoplasms and AML.

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14
Q

Rx for Bone Metastases ?

A

Denosumab (Osteonecrosis of Jaw, Hypocalcemia, Safe in Renal Function) and IV Bisphosphenates (Zoledronic Acid or Pamidronate).

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15
Q

Rx for Triple negative Invasive ductal Carcinoma with 4 involved Lymph Nodes.

A

Chemotherapy Followed by Radiation.

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16
Q

70 Y Male presents with B symptoms. He has evidence of Hepatosplenomegaly. Leukocytes are 25,000 with 80% Lymphocytes. Smear Shows Small Mature Lymphocytes. Flow Cytometry Shows CD5, C19, CD23, CD38. Dx? What does the Flow Cytometry Mean? Management ?

A

CLL Chronic Lymphocytic Leukemia. Flow Cytometry shows the Clonal Population of Circulating B cells.

Management is observation.

Treatment is initiated when there is signs of disease progression

17
Q
  1. What Labs Composed of TLS (4)?
  2. What is the management for Low Risk of TLS Cancers (Germ Cell, Small Cell)?
  3. High Risk of TLS Cancers (Burkitt Lymphoma- High Grade)
A
  1. Uric Acid, Calcium, Phosphorous, Potassium
  2. IV hydration 80-100ml/hr+ Allopurinol.
  3. IV hydration + Rasburicase.
18
Q

Name the side effects of the Chemotherapy:

  1. Blemoycin
  2. Anthracyclines/Trastuzumab
  3. Methotrexate
  4. Cisplatin
  5. Cyclophosphamide
  6. 5-Fluorouracil
  7. EGFR Inhibitor (Erlotinib & Cetuximab)
A
  1. Pulmonary Fibrosis
  2. Cardiomyopathy
  3. Liver Toxicity, Nephrotoxicity, Hypersensitivity Pneumonitis
  4. Nephrotoxicity, Otoxicity, Peripheral neuropathy
  5. Hemorrhagic Cystitis, Bladder Cancer
  6. Severe Diarrhea
  7. Skin Rash
19
Q

Next Step in Management after a patient presents with Elevated PTT? > 35s

A

Mixing Study to test for inhibitor

If it corrects then its a factor deficiency

20
Q
  1. When ITP is incidentally Found on Blood Work. Plt count of 50,000, What is the next step in management?

2.What if patient is > Age 60?

  1. What if PLT are < 30,000?
  2. What is 2nd Line treatment ?
  3. What is 3rd Line treatment?
A
  1. Observation
  2. If Age > 60 then Bone Marrow Aspirate to r/p Myelodysplastic Syndromes.
  3. If Plt < 30,000 then given Corticosteroids and/or IVIG
  4. Splenectomy or Rituxumab
  5. Thromboeisis Stimulating Agent
21
Q
  1. What are the common Organs that Carcinoid Tumors Can Occur?
  2. Test?
  3. Rx?
A
  1. Heart (JVD, Edema) , Lung (Bronchospasm. and GI (Diarrhea), Flushing, Telangiectasis
  2. 5-HIAA then CT to localize Tumor
  3. Give Octreotide (Somatostatin Analog) to provide symptom relief and before surgery
22
Q

Management of a Sickle Cell Disease patient with hx of Acute Strokes?

A

Chronic Simple Transfusion

23
Q

Name the Factors levels Decreased or Increased in Each State:

  1. Liver Failure
  2. DIC
  3. Vit K Deficiency
A
  1. Factor V and VIII decreased, Factor VIII Increased
  2. All Clotting Factors decreased including Factor VIII
  3. Factor & first then 2,9, 10.
24
Q

SS patient presents with Cough, Chest pain, Pulmonary infiltrates, Hypoxemia, Fever and Lung Crackles.

Dx?
Rx?

  1. Mild (1 lobe, Sat >90%)?
  2. Moderate?
  3. Severe (> 2 lobes, Sat < 85%)?
A

Acute Chest Syndrome

  1. IV fluids, Pain control, Abx, Supplemental 02 and Incentive Spirometry.

Mild 0-2 Units RBCs

Moderate 2-3 units

Severe needs Exchange Transfusion.

25
Q

Name the 5 causes of Secondary Polycythemia

A
  1. Hypoxemia (OSA, Cardiopulomonary, High Altitude)
  2. Congenital (High affinity Hemoglobin)
  3. Renal Transplant
  4. Epo Tumor
  5. Testosterone
26
Q

Hematocrit 54%, Pt presents with Abdominal pain, Weight loss, Fevers and Microscopic Hematuria.

Dx?

A

Rencal Cell Carcinoma

27
Q
  1. Management of Extensive Small Cell Carcinoma?
  2. Management of Limited Disease?
  3. Management of Non Small Cell Carcinoma?
A
  1. Chemotherapy Alone (Cisplatin+ Etoposide) + Chest Radiation.
  2. Chemotherapy (6 cycles) if they respond well then Chest and Prophylactic Brain is Next.
  3. Molecular Profiling to determine best Treatment ( Endothelial Growth Factor Tyrosine Kinase Inhibitors.)
28
Q
  1. Patient develops Maculopapular rash which can progress to TEN, Elevated LFTs, Diarrhea, Vomiting, Thrombocytopenia WITHIN 100 DAYS of Transplant. Dx? Risk Factors? Rx?
  2. This can occur at Anytime After Transplant. Pt presents with Lichen Planus/Scleroderma type rash, Elevated LFTs, Vaginal inflammation, Esophageal Webs, Bronchiolitis, Joint Tractures. Dx? Risk Factors Rx?
A
  1. Acute-Graft-Versus Host-Disease. ( More Inflammatory)
    Risk Factors: Unrelated Patients, Different Gender, HLA mismatch, No PRE-TREATMENT.

Rx: Steroids + Cyclosporine + Methotrexate (Liver, Nephro, Hypersensitivity Pneumonitis)

  1. Chronic Graft Versus Host Disease (More Autoimmune)
    Risk Factors: Older people, Prior Acute GVD, Positive Cytomegalovirus (Donor Or Recipient)

Rx: Localized Therapy (topical)

29
Q

What are the 2 common Secondary Malignancies of ALL?

A

Meningioma (due to Intracranial Radiation - 20 year Prolong Latency Period) and AML.

30
Q
  1. Treatment of limited-stage SCLC?
  2. Treatment of Extended-stage SCLC?
A
  1. Cisplatin-Based Chemotherapy + Thoroacic Radiation
  2. 6 Cycles of chemo alone…..then possibly radiation

ABIM (45 decks)

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