Heme/Onc

Question 1

Management of acute chest

Answer 1

IVF, analgesics, incentive spirometry, antibiotics. If moderate ( sat >85% and less than or = 2 lobes involved) then transfuse PRBCs. If severe (sat <85% and more than 2 lobes involved) then do exchange transfusion

Question 2

Secondary prophylaxis against strokes in patients with HbSS disease

Answer 2

Simple transfusions every 4-6 weeks wiht goal HbS < 30% and total Hb 9-12.5

Question 3

Peripheral B cell count >5000 with CD5, ,CD19, CD20 and CD23 expression

Answer 3

CLL

Question 4

Type of anemia that can be associated with CLL and is sometimes it’s presentation

Answer 4

Warm autoimmune hemolytic anemia

Question 5

Patient with history of polycythemia vera who has no longer required transfusions and presents with hepatosplenomegaly and consitutional symptoms

Answer 5

Myelofibrosis

Question 6

Things to consider in a patient with peripheral neuropathy, macrocytic anemia and diabetes

Answer 6

Metformin reduces intestinal absorption of B12 by at least 30%

Question 7

Best treatment for solitary brain metastasis

Answer 7

Surgery or sterotactic radiation followed by whole brain radiation. Do chemo after treatment of brain mets as chemo has poor penetration of blood brain barrier

Question 8

Dabigatran use and surgery planning

Answer 8

For planned surgery or non-emergent should wait 48 hours post last dose and then it will be cleared from system. If more emergent, can check thrombin time - if normal, not AC and can proceed. If elevated give idracizumab (antidote) and proceed

Question 9

Constitutional symptoms, flank pain, erythrocytosis and microscopic hematuria

Answer 9

Renal Cell carcinoma

Question 10

Elevated gamma gap with constitutional symptoms, and manifestations secondary to infiltration of hematopoietic tissue (hepatosplenomegaly and cytopenias) and excessive IgM in blood (sensorimotor peripheral neuropathy and hyperviscosity syndrome), can have “sausage link” retinal veins

Answer 10

Waldenstrom macoglobulinemia

Question 11

In patients with bone metastases - how can you delay skeletal-related events (Fracture, skeletal instability/loss, spinal cord compression) and delay symptom onset

Answer 11

Osteoclast inhibiting agents (Denosumab and bisphosphonates).

Question 12

Next step in evaluating a patient with prolonged PTT and normal PT.

Answer 12

Mixing study - this determines between inhibitor or factor deficiency. Deficiency will correct with mixing study, inhibitor will stay abnormal with mixing study

Question 13

Management of mild bleeding or peri-op for minor procedures in patients with mild/moderate VWD

Answer 13

desmopressin

Question 14

Management of severe bleeding episodes or invasive surgeries of those with VWD

Answer 14

VWF preparations

Question 15

Weight loss, long smoking history, shoulder pain with paresthesias

Answer 15

consider superior pulmonary sulcus (pancoast) tumor

Question 16

Clonal myeloproliferative disorder with proliferation of RBCs independent of Epo - thus Epo is typically LOW

Answer 16

Polycythemia vera

Question 17

Treatment in CML

Answer 17

Tyrosine kinase inhibitors (imatinib)

Question 18

Normocytic anemia, massive splenomegaly and tear drop cells with massive hepatosplenomegaly

Answer 18

Primary myelofibrosis