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Clin Med > Heme/Onc > Flashcards

Heme/Onc Flashcards

1
Q

top 3 MC cancers in men

A
  1. prostate. 2. lung. 3. colon
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2
Q

top 3 MC cancers in F

A

1) breast. 2) lung 3) colon

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3
Q

MOA of cytotoxic chemo

A

directly kill dividing cells non-specifically

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4
Q

are mabs curative for CA?

A

no

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5
Q

which class? o Inhibit an inhibitory signal on T-lymphocytes. results in T-cell activation. stimulate immune attack on cancer cells

A

 Immunotherapy – cytokines, checkpoint inhibitors

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6
Q

2 types of cellular therapy for CA

A
  • Hematopoetic Stem Cell Transplants (autologous and allogeneic)
  • Chimeric antigen T-cell therapy / CAR-T
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7
Q

typically don’t try Chimeric antigen T-cell therapy / CAR-T until pt has failed _____

A

chemo

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8
Q

one first degree relative w/ breast cancer is ____risk

A

mod

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9
Q

menarche before ___ is mod risk

A

12

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10
Q

menopause after ___ is mod risk

A

55

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11
Q

2 meds FDA approved for breast cancer prevention

A

o Tamoxifen and raloxifene

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12
Q

 USPSTF recs for mammogram screening

A

biennially (Q2 yrs) ages 50-75

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13
Q

screening test for high risk for breast CA

A

MRI

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14
Q

preferred method to dx breast CA

A

o Core needle biopsy – preferred; done by radiology

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15
Q

__% of breast CAs express either ER or PR or both

A

75

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16
Q

2cm tumor of breast CA is T__

A

T1

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17
Q

> 5cm tumor of breast CA is T__

A

T3

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18
Q

chemo has huge benefits for which 2 intrinsic subtypes of breast CA

A

Her-2 and basal (triple negative)

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19
Q

mab tx for HER-2 breast CA

A

o Trastuzumab (Herceptin)

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20
Q

indication for aromatase inhibitors for breast CA

A

postmenopausal

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21
Q

neo-adjuvant systemic tx benefits which 2 subtypes of breast CA

A

 More effective in aggressive tumors (triple negative, Her-2) w/ pCR (pathologic complete remission)

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22
Q

breast CA prevention (3)

A

exercise, low fat diet; tamoxifen, raloxifene QD X 5 yrs (reduces incidence of ER/PR+ by 50%)

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23
Q

MCC of CA deaths in US

A

lung CA

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24
Q

USPSTF recs for lung CA screening

A
  • USPSTF recommends annual low-dose CT screening (no contrast) for those 50-80 who have no symptoms of lung cancer AND a 20 pack-year history who currently smoke or have quit within 15 years
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25
Q

most common type of lung CA in smokers

A

adenocarcinoma

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26
Q

most common type of lung CA in non-smokers

A

adenocarcinoma

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27
Q

all pts who have SCLC are …..

A

smokers

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28
Q

tx of choice for stage 1 and 2 non-SCLC

A

surgical resection

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29
Q

tx for stage 3 lung CA

A

chemo + radiation, then checkpoint inhibitors

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30
Q

tx for SCLC

A

chemo +/- radiation
checkpoint inhibitors

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31
Q

biggest risk factor for prostate CA

A

age

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32
Q

USPSTF recs for PSA screening

A

o USPSTF recommends discussing risk/benefit. Grade C: offer or provide this service for selected pts 55-69 depending on individual circumstances

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33
Q

predominant presentation of prostate CA

A
  • Elevated PSA w/ no symptoms
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34
Q

dx method for prostate CA

A

TRUS-guided prostate bx

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35
Q

prostate CA only on one side is T__

A

T1

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36
Q

tumor extends through prostatic capsule, bladder neck, or seminal capsule = T___

A

T3

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37
Q

preferred tx for Low risk, localized prostate CA

A

Active surveillance preferred

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38
Q

tx for High risk, localized prostate CA

A

 External beam radiation therapy (EBRT) with 2-3 years of ADT

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39
Q

diet RFs for colon CA (3)

A

red meat, bile salts, low fiber

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40
Q

how to prevent colon CA (2)

A

high fiber, ASA/NSAIDs

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41
Q

Hereditary Nonpolyposis Colorectal Cancer (HNPCC) is aka _____

A

Lynch Syndrome

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42
Q

USPSTF screening for colon CA

A

o Age 45-75

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43
Q

colon CA that goes through muscularis is stage _____ and T__

A

stage 2, T3

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44
Q

surgery for which stages of colon CA

A

1-3

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45
Q

tx for stage 3 resected colon CA

A

 5FU / Oral capecitabine – prodrug of 5-FU, equal to IV 5FU
 Oxaliplatin added to 5FU w/ improved results

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46
Q

chemo for stage 2 colon CA?

A

no, but consider if high risk features

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47
Q

difference in recurrence of rectal vs colon proper CA

A

rectal has much higher risk of local recurrence

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48
Q

imaging for rectal CA

A

MRI

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49
Q

tx for rectal CA

A

o Neo-adjuvant Radiation +5FU or chemo

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50
Q

which esophageal CA is ASW tobacco, alcohol abuse
o ASW achalasia, tylosis, caustic injury (hot drinks), Plummer-Vinson syndrome

A
  • Squamous Cell Esophageal CA
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51
Q

does H pylori increase or decrease risk for esophageal adenocarcinoma?

A

decrease

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52
Q

tx for esophageal CA Early lesions (mucosal, T1)

A

 Endoscopic resection w/ or w/o ablation

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53
Q

tx for esophageal CA Locally advanced (T2/3, N+) but not metastatic

A

Radiation + weekly carboplatin/Taxol (chemo) followed by surgery preferred

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54
Q

does H pylori increase or decrease risk for gastric carcinoma?

A

increase

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55
Q

diet RFs for gastric carcinoma (4)

A

o High salt, nitrite diet
o Low vitamin A/C diet
o Smoked/cured food and lack of refrigeration
o Poor quality drinking water

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56
Q

check for what receptor in gastric carcinoma

A

 20% Her-2 positive

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57
Q

tx for stage 1 and 2 gastric CA

A

surgical resection

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58
Q

most gastric CA found in stage ____

A

3

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59
Q

what stage of gastric CA involves spread to LNs around stomach?

A

3

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60
Q

tx for stage 3 gastric CA

A

surgery + adjuvant chemo +/- radiation

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61
Q

sudden onset of DM in adults, think ____

A

pancreatic CA

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62
Q

Imaging for pancreatic CA

A

CT abd

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63
Q

what stage of pancreatic CA: extends beyond pancreas, but doesn’t involve arteries, +/- LN

A

2

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64
Q

tx choice for local pancreatic CA

A

o Whipple procedure for best outcome (2 yrs) if resectable. Part of liver removed + head of pancreas

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65
Q

character of HA in CNS tumors

A

o New onset HA, daily morning HA (HA that wakes you up in the morning)
o HA w/ nausea, vomiting

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66
Q

imaging choice for CNS tumor

A

MRI

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67
Q

tx for all stages of CNS tumor

A

steroids to decrease swelling

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68
Q

tx for Grade IV Glioblastoma

A

 Surgical debulking
 Radiation w/ continued oral temozolomide

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69
Q

level of PTH in hyperCa of malignancy

A

low

70
Q

most important tx for hypercalcemia

A

rehydration

71
Q

most hyperCa of malignancy ASW production of ______

A

PTH-related peptide (PTHrP; 80%)

72
Q

MC malignancy complicated by SIADH

A

lung CA

73
Q

rate of Na correction for SIADH

A

no more than 10 mEq in 24 hrs

74
Q

trigger for tumor lysis syndrome

A

initiation of chemo

75
Q

CA pt presents w/ hyperuricemia, hyperK, hyperphosphatemia, hypoCa. this is ____

A

tumor lysis syndrome

76
Q

tx for tumor lysis syndrome

A

o Hydration (good urine output)
o Reduce uric acid production w/ allopurinol
o Increase uric acid metabolism w/ rasburicase IV

77
Q
  • Most common life-threatening complication of cytotoxic chemotherapy
A

Neutropenic Fever

78
Q

tx for low risk outpatient w/ Neutropenic Fever

A

cipro + augmentin

79
Q

tx for inpatient w/ Neutropenic Fever

A

antipseudomonal beta-lactam monotherapy:  Cefepime IV
 Piperacillin-tazobactam
 Meropenem

80
Q

neutrophenic fever prevention (4)

A

o Granulocyte colony stimulating factor (GCSF) – pegfilgrastim
o Annual influenza vax
o If high risk: abx prophylaxis (cipro or levofloxacin) if neutrophils drop <1000
o Avoid rare foods: sushi, undercooked steak

81
Q

imaging for suspected spine metastasis

A

o MRI w/ gadolinium is 100% sensitive

82
Q

multiple myeloma is a malignancy of _______ cells

A

plasma cells (differentiated B cells) that produce antibodies

83
Q

CRAB s/s of MM

A

hyperCA, renal insufficiency, anemia, bone pain/lytic lesions

84
Q

SPEP in MM will show ___

A

 Monoclonal protein (M-spike or M-protein) – 3g/dL or greater

85
Q

UPEP in MM will show ___

A

bence jones proteins

86
Q

o M-spike <3 or plasmacytosis <10% (but still >normal) = dx?

A

MGUS (Monoclonal Gammopathy of Undetermined Significance)

87
Q

is MM curable?

A

no

88
Q

dexamethasone + lenalidomide/cyclophosphamide + bortezomib = tx for _____

A

MM

89
Q

how to dx AL amyloidosis

A

Must demonstrate amyloid deposition in tissues (congo red stain, fat pad aspirate, kidney bx)

90
Q

think what 2 things in elevated monocytes

A

infections (mycobacterial), sarcoidosis

91
Q

primary bone marrow dz / leukemia cause what size of anemia?

A

macrocytic

92
Q

order ____ to determine if anemia is acute loss vs hemolytic

A

 Reticulocyte count

93
Q

tx for hereditary spherocytosis and elliptocytosis

A

folate supplements, splenectomy if severe

94
Q

G6PD defic has ___ and ___ on peripheral smear

A
  • Bite cells, Heinz bodies
95
Q

suspect ____ (2) if basophilic stippling on peripheral smear

A

lead poisoning or other heavy metal toxicity, sideroblastic anemia / thalesemia

96
Q

positive direct Coombs test indicates

A
  • Antibody mediated autoimmune hemolytic anemia
97
Q

HUS classic triad

A

o Kidney damage
o Hemolytic anemia
o Thrombocytopenia

98
Q

give platelets in TTP?

A

NO

99
Q

TTP classic pentad

A

o Fever
o Renal failure
o CNS changes
o MAHA (microangiopathic hemolytic anemia)
o Thrombocytopenia

100
Q

most common anemia worldwide

A

Iron Deficiency Anemia

101
Q

results of iron studies in iron defic anemia

A

o Fe low
o TIBC high
o Ferritin low

102
Q

tx for iron deficiency anemia + pt instructions

A

o FeSO4 325mg QOD (take w/ water or OJ on empty stomach)

103
Q

ferritin in anemia of inflammation will be ___

A

normal to high

104
Q
  • Think ________ if microcytic anemia w/ normal or increased serum Fe or no response to tx
A

thalassemia

105
Q

for vit B12 deficiency anemia, order _____ to determine if due to pernicious anemia

A

schilling test

106
Q

B12 vs folate deficiency: homocysteine and methylmalonic acid (MMA) levels

A

B12: both elevated
folate: only homocysteine elevated

107
Q

giving platelets is contraindicated in which 2 conditions

A

TTP, heparin-induced (HIT)

108
Q

MCC of immune thrombocytopenia (ITP)

A

viral infx

109
Q

1st line tx for acute ITP w/ platelets <30k

A

steroids

110
Q

effective surgery for chronic ITP

A

splenectomy

111
Q

what does HIT progress to?

A

HITT (+ thrombosis)

112
Q

timeframe for onset of HIT

A

o Onset 5-14 days (can be 1 day if exposed to heparin in prior 30-100d)

113
Q

how to dx MAHA

A

o Hemolysis w/ schistocytes + thrombocytopenia makes diagnosis

114
Q

pentad for TTP

A

o FAT RN
 Fever
 Anemia – splenomegaly (MAHA)
 Thrombocytopenia – mucocutaneous bleeding
 Renal failure
 Neuro sxs – HA, visual changes, confusion

115
Q

PT and PTT in TTP

A

normal

116
Q

HUS triad

A

o Thrombocytopenia (platelets)
o Hemolytic anemia
o Renal dysfunction (kidney failure)

117
Q

abx to tx HUS?

A

NO!

118
Q

PT and PTT in DIC

A

both increased

119
Q

 Most common inherited coagulopathy

A

VWD

120
Q

in VWD, PTT is prolonged, and mixing study shows ____

A

that PTT corrects

121
Q

1st line prophylaxis for operation in pt w/ VWD

A

o DDAVP (desmopressin

122
Q

hemophilia A = factor ___ deficiency

A

8

123
Q

hemophilia B = factor ____ deficiency

A

9

124
Q

hemophilia A or B more common?

A

A

125
Q

mab for hemophilia

A

o Emicizumab

126
Q

PT and PTT results in vit K deficiency

A

both prolonged

127
Q

tx for vit K deficiency

A

PO supplementation

128
Q

o Most common thrombophilia

A
  • Factor V Leiden Mutation
129
Q

SLE pt w/ VTEs, arterial thrombosis, recurrent spontaneous abortions. think _____ (dx)

A
  • Antiphospholipid Syndrome
130
Q

tx for * Antiphospholipid Syndrome

A

warfarin

131
Q

classic triad for hemochromatosis

A

o Classic Triad:
 Cirrhosis
 DM
 Bronze skin pigmentation

132
Q

type of cell in Hodgkin’s

A

Reed-Sternberg cell
 Malignant cell of Hodgkin’s
 Bilobed, 2 nuclei (owls eyes appearance)

133
Q

how to dx hodgkin’s

A

o Excisional whole lymph node biopsy – Reed-Sternberg cells are pathognomonic

134
Q

Hodgkin’s stage: 2+ lymph node regions on same side of diaphragm, may include localized extra-lymphatic

A

2

135
Q

Hodgkin’s stage: involvement of LN on both sides of diaphragm, may include spleen or localized

A

3

136
Q

tx for stage 1 and 2 Hodgkin’s

A

 2-4 cycles of ABVD +/- radiation
 ABVD = Adriamycin (doxorubicin), bleomycin, vinblastine, dacarbazine

137
Q

Hodgkins is malignancy of germinal or pre-germinal ____ cells

A

B cells

138
Q

these are RFs for _____: o Pesticides and herbicides
o Age
o Viral infections – EBV, Hepatitis C
o Bacterial infections – H. pylori, C. psittaci
o Congenital disorders
o Acquired immunodeficiency – HIV/AIDs, solid organ transplant, SCT

A

NHL

139
Q

which type of lymphoma commonly has Constitutional symptoms (B-symptoms) such as: Cyclical Fevers >38C
 Drenching night sweats
 Weight loss >10%

A

hodgkin’s

140
Q

1st line tx for CLL

A

1st line = BTK inhibitor +/- antiCD20 mab

141
Q
  • Most common type of aggressive NHLs (20-30% of all NHL)
A

 Diffuse Large B Cell NHL

142
Q

tx for Diffuse Large B Cell NHL stage 1 and 2

A

 R-CHOP (chemo) w/ XRT
 Rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine (Oncovin), prednisone

143
Q

rai classification of CLL says splenomegaly is stage ___

A

2

144
Q

rai classification of CLL says platelets <100k is stage ___

A

4

145
Q

peripheral smear in CLL (2)

A

SMUGE cells, mature lymphocytes

146
Q

MC cancer in kids

A

Acute Lymphocytic/Lymphoblastic Leukemia (ALL)

147
Q

tx for ALL

A

aggressive chemo w/ anthracyclines, vincristine, corticosteroids

148
Q

4 y/o presents w/ o Fever + lymphadenopathy + bone pain + bleeding. dx?

A

ALL

149
Q

test + results to dx ALL

A

o Bone marrow aspiration  hypercellular w/ >20% blasts = definitive dx

150
Q

suspect _____ if:
o Too high of things – WBC, H&H, platelets, repeated CBC still elevated
o Unexplained splenomegaly
o Unexplained thrombosis (DVT/VTEs in unexpected places)
o Severe anaphylaxis

A

Myeloproliferative Disorders/Neoplasms (MPN)

151
Q

mutation present in polycythemia vera

A

JAK2 mutation

152
Q

1st test to order if suspected polycythemia vera and expected results

A

EPO (should be low or maybe normal)

153
Q

only cure for polycythemia vera

A

SCT

154
Q

tx for low risk polycythemia vera

A

phlebotomy + ASA

155
Q

tx for high risk polycythemia vera

A

 ASA + phlebotomy + hydroxyurea
 Ruxolitnib (JAK inhibitor) if unresponsive to HU

156
Q

don’t give ASA in polycythemia vera if platelets are >________

A

> 1 mil

157
Q

tx for high risk essential thrombocytosis

A

 ASA + Hydroxyurea

158
Q

1st line tx for symptomatic myelofibrosis

A

JAK inhibitors (o Ruxolitinib )

159
Q

MPN w/ philadelphia chromosome

A

CML - Chronic Myeloid Leukemia

160
Q

how to dx CML

A

Peripheral smear or bone marrow aspirate for karyotype or FISH –looking for t(9;22) OR Quantitative PCR for p210 bcr-abl

161
Q

gold standard tx for CML

A

o Tyrosine kinase inhibitors (imatinib)

162
Q

o Most common acute leukemia in adults

A

AML

163
Q

MC symptom of AML

A

fatigue

164
Q

hallmark finding on peripheral smear for AML

A

Auer Rods (specifically APML)

165
Q

major complication of APML and timeframe

A

o DIC (first 48 hours)

166
Q

induction tx for AML

A

Chemo: cytarabine + anthracycline

167
Q

start what med asap after APML dx?

A

Retinoic acid (ATRA)

168
Q

BBW for Retinoic acid (ATRA)

A

QT prolongation

169
Q

post-remission therapy for AML is allogenic SCT except for which type of AML?

A

APML–auto SCT

170
Q

Which of the following diseases is most commonly associated with a previous history of a hematologic disorder, such as myelodysplastic syndrome, aplastic anemia, or polycythemia vera?

AAcute lymphoblastic leukemia
BAcute myeloid leukemia
CChronic lymphocytic leukemia
DChronic myeloid leukemia
A

AML

171
Q

A 21 year-old male with a diagnosis of type 1 von Willebrand disease undergoes dental extraction of his wisdom teeth. The patient comes to the clinic with continued oozing of the dental sockets despite packing. Treatment should begin with which of the following?

DDAVP

Factor VIII

vWF concentrate

FFP

A

DDAVP causes the release of vWF and factor VIII from storage sites significantly which is needed to complete hemostasis. Factor VIII is indicated for patients with Hemophilia A. Fresh frozen plasma is indicated in Coumadin overdosage and vWF concentrate is indicated in type 2 and 3 patients with von Willebrand disease.

172
Q

Which of the following therapies is recommended for a 13 month-old child with sickle cell disease?

Folic acid and penicillin V

Ferrous sulfate and penicillin V

Folic acid and ferrous sulfate

Folic acid, ferrous sulfate and penicillin V

A

Folic acid and penicillin V. Patients with sickle cell disease should receive prophylactic penicillin V starting at 2 months of age and folic acid starting at 1 year of age. Ferrous sulfate is not globally recommended for patients with sickle cell disease.

Clin Med (14 decks)

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