heme/onc 1 Flashcards

1
Q

What is the possibility of pure red cell aplasia being reversed sometimes by what procedure

A

Thymectomy

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2
Q

What should a patient have to evaluate for thymoma?

A

A chest radiograph.

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3
Q

What is the typical cause of pure red cell aplasia?

A

It is typically idiopathic but can occur in patients with hematologic malignancies.

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4
Q

Which hematologic malignancy is associated with pure red cell aplasia?

A

Chronic lymphocytic leukemia.

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5
Q

What viral illnesses can lead to pure red cell aplasia?

A

Parvovirus, HIV, and hepatitis C.

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6
Q

What medications are associated with pure red cell aplasia?

A

Phenytoin and trimethoprim–sulfamethoxazole.

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7
Q

What activates factor X and factor IX in the extrinsic pathway of coagulation?

A

TF-FVIIa complex.

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8
Q

What is a common finding in a patient with iron deficiency anemia?

A

Severe anemia by the time the MCV has reached the mid- to low 60s.

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9
Q

How does aortic stenosis cause acquired von Willebrand disease?

A

Increased shear stress at the defective valve leads to unfolding of the von Willebrand factor (VWF) polymer and subsequent proteolytic cleavage by ADAMTS13.

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10
Q

What type of cancer can produce a variety of ectopic hormones?

A

Small-cell lung cancer.

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11
Q

What hormones can small-cell lung cancer produce?

A

Adrenocorticotropic hormone and antidiuretic hormone.

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12
Q

What syndrome can develop due to ectopic hormone secretion from small-cell lung cancer?

A

Paraneoplastic Cushing syndrome and the syndrome of inappropriate diuretic hormone secretion.

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13
Q

What is the most likely diagnosis in a person with HIV showing thrombocytopenia?

A

Immune thrombocytopenia.

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14
Q

What is the typical timeline for HIT to occur after heparin exposure?

A

5 to 14 days after exposure.

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15
Q

What are the major criteria for Polycythemia Vera (PV)?

A
  1. Elevated hemoglobin level (>16.0 g/dL in women; >16.5 g/dL in men). 2. Elevated hematocrit (>48% in women; >49% in men). 3. Bone-marrow biopsy consistent with PV.
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16
Q

What genetic mutation is associated with Polycythemia Vera?

A

Presence of the JAK2 V617F mutation.

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17
Q

What is the JAK2 V617F mutation?

A

The JAK2 V617F mutation is a specific mutation in the JAK2 gene associated with certain blood disorders.

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18
Q

What is a minor criterion for diagnosing certain blood disorders?

A

A serum erythropoietin level below the normal reference range.

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19
Q

What is important to rule out before further diagnostics in isolated thrombocytopenia?

A

It is important to rule out pseudothrombocytopenia.

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20
Q

What can cause pseudothrombocytopenia?

A

EDTA altered platelet autoantibodies resulting in clumping.

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21
Q

What is a common consequence of radiotherapy for head and neck cancers?

A

Development of hypothyroidism within 5 years.

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22
Q

What is PNH?

A

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare acquired bone-marrow disorder caused by mutations in the phosphatidylinositol glycan anchor gene.

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23
Q

What INR level is associated with an increased risk for bleeding?

A

An INR greater than 4.0.

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24
Q

How does the risk for intracranial hemorrhage change with INR levels?

A

The risk increases approximately twofold for every one-unit increase in INR.

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25
Q

What do guidelines recommend for patients with liver cirrhosis?

A

Patients should undergo surveillance ultrasound with or without alpha-fetoprotein testing every 6 months.

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26
Q

Who are candidates for treatment with rasburicase?

A

Patients at high risk for tumor lysis syndrome or with uric acid levels >8 mg/dL despite aggressive volume expansion.

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27
Q

What percentage of GISTs have mutations in the PDGFRA gene?

A

Up to 10% of GISTs have mutations in the PDGFRA gene.

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28
Q

What are common culprits for drug-induced immune-mediated thrombocytopenia?

A

Trimethoprim-sulfamethoxazole, quinine, vancomycin, and penicillin.

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29
Q

How can low-risk neutropenia and fever be managed?

A

With ciprofloxacin and amoxicillin-clavulanate.

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30
Q

What is the next step in a patient with parasthesias and borderline-low vitamin B12 level?

A

Measurement of serum methylmalonic acid and homocysteine levels.

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31
Q

What should patients with essential thrombocythemia who have risk factors be monitored for?

A

They should be monitored for complications related to their condition.

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32
Q

What should patients with risk factors for complications (age >60 years, presence of a JAK2 mutation, or a history of bleeding or thrombosis) be treated with?

A

They should be treated with cytoreductive therapy with hydroxyurea.

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33
Q

What is the best diagnostic test for a patient with a history of prostate cancer who develops microcytic anemia and fatigue with a positive fecal occult-blood test?

A

The best diagnostic test is colonoscopy.

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34
Q

Where do osteosarcomas generally arise?

A

Osteosarcomas generally arise in the metaphysis of the bone.

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35
Q

What are essential features of the cancer-associated hypercoagulable state?

A

Venous thrombophlebitis and arterial thromboembolism.

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36
Q

What does a prolonged activated partial-thromboplastin time that is not corrected by a mixing study suggest?

A

It suggests the presence of a factor inhibitor, most commonly a factor VIII inhibitor.

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37
Q

What is the best strategy for managing intractable cancer-related pain despite intermittent opioids?

A

The best strategy is intravenous opioids administered as patient-controlled analgesia.

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38
Q

What is the standard immunosuppressive therapy for aplastic anemia?

A

Standard immunosuppressive therapy includes antithymocyte globulin and calcineurin inhibition.

39
Q

What should patients receiving primary therapy for multiple myeloma with skeletal lesions be considered for?

A

They should be considered candidates for at least 2 years of treatment with an osteoclast inhibitor.

40
Q

What is the most likely diagnosis in a patient who presents with bone-marrow failure 5 years after receiving chemotherapy and radiotherapy?

A

The most likely diagnosis is secondary malignancy or treatment-related myelodysplastic syndrome.

41
Q

What is therapy-related myelodysplastic syndrome associated with?

A

It is associated with chemotherapy and radiotherapy.

42
Q

Which virus infection is associated with Burkitt lymphoma?

A

Epstein-Barr virus infection.

43
Q

What is thrombotic thrombocytopenic purpura classically associated with?

A

It is classically associated with microangiopathy, thrombocytopenia, renal insufficiency, mental status changes, and fever.

44
Q

What is the most common serious adverse event associated with the use of bevacizumab?

A

Severe hemorrhage.

45
Q

What are features associated with increased risk for progression of MGUS?

A
  1. A serum monoclonal protein level >1.5 g/dL
  2. Non–immunoglobulin G monoclonal protein
  3. A markedly abnormal free-light-chain-kappa-to-lambda ratio.
46
Q

What is the perioperative management for a patient with prolonged partial-thromboplastin time and low factor XII level?

A

To proceed with surgery without additional treatment.

47
Q

Do patients with deficiency of factor XII exhibit an increased bleeding diathesis?

A

No, they do not exhibit an increased bleeding diathesis despite the in vitro partial-thromboplastin time assay being prolonged.

48
Q

What infections commonly cause cold agglutinin hemolytic anemia?

A

Typical infections include mycoplasma and Epstein–Barr virus.

49
Q

Where do osteosarcomas generally arise?

A

They generally arise in the metaphysis of the bone.

50
Q

What does a CT scan of radiation pneumonitis typically show?

A

It shows areas of consolidation in a nonanatomical distribution that does not conform to lobes or bronchopulmonary segments, but rather to the radiation port.

51
Q

What are the major clinical manifestations of mixed cryoglobulinemic vasculitis?

A

They include palpable purpura, kidney disease, arthralgia, myalgia, and peripheral neuropathy.

52
Q

What is the significance of hypocomplementemia in TLS?

A

It is significant for smaller solid cancers and indolent lymphomas.

53
Q

What is hypocomplementemia associated with?

A

Hypocomplementemia is associated with smaller solid cancers and indolent lymphomas.

54
Q

What cancers are associated with the highest risk?

A

Aggressive leukemias and cancers with large tumor burdens are associated with the highest risk.

55
Q

What is the typical duration for pharmacologic prophylaxis after major orthopedic surgery?

A

Pharmacologic prophylaxis is typically continued for at least 14 days or until the patient regains ambulatory function with full weight-bearing.

56
Q

What are the most common solid tumors in adolescents and young adults?

A

Germ-cell tumors are the most common solid tumors in adolescents and young adults.

57
Q

What are examples of extracranial germ-cell tumors?

A

Extracranial germ-cell tumors include yolk sac tumors, embryonal carcinomas, choriocarcinomas, and mixed tumors.

58
Q

What symptoms do germ-cell tumors often manifest with?

A

Germ-cell tumors often manifest with abdominal pain and distention associated with a palpable pelvic-abdominal mass.

59
Q

What does Vitamin A deficiency cause?

A

Vitamin A deficiency causes night blindness but is not associated with anemia.

60
Q

What is polycythemia vera?

A

Polycythemia vera is a myeloproliferative neoplasm characterized by increased red-cell mass and elevated hemoglobin.

61
Q

What are common symptoms of polycythemia vera?

A

Common symptoms include erythromelalgia (red, hot, painful extremities), pruritus, and a low serum erythropoietin level.

62
Q

What is Ewing sarcoma most common in?

A

Ewing sarcoma is most common in children and adolescents.

63
Q

Is inflammatory breast cancer often detected by imaging modalities?

A

Inflammatory breast cancer is often not detected by imaging modalities.

64
Q

What is the first line drug for management of chemotherapy-induced neuropathic pain?

A

The first line drug for management of chemotherapy-induced neuropathic pain is duloxetine.

65
Q

What is the most likely diagnosis in a patient with leukocytosis above 100,000 cells per mm3 with absolute basophilia, thrombocytosis, and splenomegaly?

A

The most likely diagnosis is chronic myeloid leukemia.

66
Q

What system estimates the risk of progression from asymptomatic to symptomatic multiple myeloma?

A

The Mayo Clinic 2018 risk stratification system estimates the risk of progression from asymptomatic to symptomatic multiple myeloma.

67
Q

What are the three risk factors considered in the Mayo Clinic 2018 risk stratification system?

A

The three risk factors are: M protein >2 g/dL, bone marrow clonal plasma cells >20%, and involved–uninvolved free-light-chain ratio >20.

68
Q

What is the risk classification for patients with no risk factors for smoldering multiple myeloma?

A

Patients with no risk factors are considered to be at low risk for smoldering multiple myeloma.

69
Q

What is the risk classification for patients with one risk factor for smoldering multiple myeloma?

A

Patients with one risk factor are considered to be at intermediate risk for smoldering multiple myeloma.

70
Q

What is the risk classification for patients with two or three risk factors for smoldering multiple myeloma?

A

Patients with two or three risk factors are considered to be at high risk for smoldering multiple myeloma.

71
Q

What is the association of squamous-cell carcinoma of the oropharynx in non-smokers?

A

It is most often associated with human papillomavirus infection.

72
Q

What do guidelines from the American Association for the Study of Liver Diseases recommend for patients with liver cirrhosis?

A

They recommend undergoing surveillance ultrasound with or without alpha-fetoprotein testing every 6 months.

73
Q

What condition is myelofibrosis typically associated with?

A

It is typically associated with splenomegaly and leukoerythroblastosis.

74
Q

What can iron overload from transfusion-related etiologies lead to?

A

It can lead to end-organ dysfunction, especially in the liver and myocardium.

75
Q

What are the most common primary tumors that metastasize to the brain?

A

Lung cancer, melanoma, renal-cell carcinoma, and breast cancer.

76
Q

What is Ewing sarcoma typically associated with?

A

It is typically associated with an onion-skin periosteal reaction.

77
Q

What is the likely diagnosis in a patient with recurrent epistaxis, telangiectasia, and anemia?

A

It is hereditary hemorrhagic telangiectasia.

78
Q

What is Beck triad associated with?

A

It is associated with pericardial effusion and includes low systolic blood pressure, jugular venous distention, and muffled heart sounds.

79
Q

What is pancytopenia in association with splenomegaly indicative of?

A

It can be indicative of B symptoms, monocytopenia, and atypical lymphocytes.

80
Q

What is characteristic of hairy-cell leukemia?

A

It is characterized by projections.

81
Q

What results from hereditary spherocytosis?

A

It results in diminished compliance of the cell and degradation by the spleen, leading to splenomegaly, anemia, and jaundice.

82
Q

What is hereditary hemorrhagic telangiectasia?

A

It is a genetic disorder that leads to abnormal blood vessel formation.

83
Q

What is the most likely diagnosis in a patient with a monoclonal gammopathy?

A

Heart failure.

84
Q

What is renal failure?

A

A condition where the kidneys fail to filter waste from the blood.

85
Q

What condition is associated with periorbital purpura?

A

Amyloid light-chain amyloidosis.

86
Q

What is the most likely diagnosis in a patient with pancytopenia?

A

Auer rods.

87
Q

What is disseminated intravascular coagulation?

A

A serious condition involving the formation of blood clots throughout the small blood vessels.

88
Q

What is acute promyelocytic leukemia associated with?

A

Chromosomal translocation t(15;17).

89
Q

What does acute radiation proctitis refer to?

A

Rectal bleeding that occurs during radiation treatment or within 6 weeks.

90
Q

What are meningiomas?

A

Tumors that are adjacent to bone and anchored to the dura.

91
Q

What classic appearance do meningiomas render on imaging?

A

The classic appearance of the ‘dural tail’.

92
Q

What is likely to cause tenesmus and significant anemia?

A

Anal fissure.

93
Q

Is it true that anal fissure is likely to cause tenesmus and significant anemia?