Heme/Onc Flashcards
1
Q
top 3 MC cancers in men
A
- prostate. 2. lung. 3. colon
2
Q
top 3 MC cancers in F
A
1) breast. 2) lung 3) colon
3
Q
MOA of cytotoxic chemo
A
directly kill dividing cells non-specifically
4
Q
are mabs curative for CA?
A
no
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
6
Q
2 types of cellular therapy for CA
A
- Hematopoetic Stem Cell Transplants (autologous and allogeneic)
- Chimeric antigen T-cell therapy / CAR-T
7
Q
typically don’t try Chimeric antigen T-cell therapy / CAR-T until pt has failed _____
A
chemo
8
Q
one first degree relative w/ breast cancer is ____risk
A
mod
9
Q
menarche before ___ is mod risk
A
12
10
Q
menopause after ___ is mod risk
A
55
11
Q
2 meds FDA approved for breast cancer prevention
A
o Tamoxifen and raloxifene
12
Q
USPSTF recs for mammogram screening
A
biennially (Q2 yrs) ages 50-75
13
Q
screening test for high risk for breast CA
A
MRI
14
Q
preferred method to dx breast CA
A
o Core needle biopsy – preferred; done by radiology
15
Q
__% of breast CAs express either ER or PR or both
A
75
16
Q
2cm tumor of breast CA is T__
A
T1
17
Q
> 5cm tumor of breast CA is T__
A
T3
18
Q
chemo has huge benefits for which 2 intrinsic subtypes of breast CA
A
Her-2 and basal (triple negative)
19
Q
mab tx for HER-2 breast CA
A
o Trastuzumab (Herceptin)
20
Q
indication for aromatase inhibitors for breast CA
A
postmenopausal
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)
22
Q
breast CA prevention (3)
A
exercise, low fat diet; tamoxifen, raloxifene QD X 5 yrs (reduces incidence of ER/PR+ by 50%)
23
Q
MCC of CA deaths in US
A
lung CA
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
25
most common type of lung CA in smokers
adenocarcinoma
26
most common type of lung CA in non-smokers
adenocarcinoma
27
all pts who have SCLC are …..
smokers
28
tx of choice for stage 1 and 2 non-SCLC
surgical resection
29
tx for stage 3 lung CA
chemo + radiation, then checkpoint inhibitors
30
tx for SCLC
chemo +/- radiation
checkpoint inhibitors
31
biggest risk factor for prostate CA
age
32
USPSTF recs for PSA screening
o USPSTF recommends discussing risk/benefit. Grade C: offer or provide this service for selected pts 55-69 depending on individual circumstances
33
predominant presentation of prostate CA
* Elevated PSA w/ no symptoms
34
dx method for prostate CA
TRUS-guided prostate bx
35
prostate CA only on one side is T__
T1
36
tumor extends through prostatic capsule, bladder neck, or seminal capsule = T___
T3
37
preferred tx for Low risk, localized prostate CA
Active surveillance preferred
38
tx for High risk, localized prostate CA
External beam radiation therapy (EBRT) with 2-3 years of ADT
39
diet RFs for colon CA (3)
red meat, bile salts, low fiber
40
how to prevent colon CA (2)
high fiber, ASA/NSAIDs
41
Hereditary Nonpolyposis Colorectal Cancer (HNPCC) is aka _____
Lynch Syndrome
42
USPSTF screening for colon CA
o Age 45-75
43
colon CA that goes through muscularis is stage _____ and T__
stage 2, T3
44
surgery for which stages of colon CA
1-3
45
tx for stage 3 resected colon CA
5FU / Oral capecitabine – prodrug of 5-FU, equal to IV 5FU
Oxaliplatin added to 5FU w/ improved results
46
chemo for stage 2 colon CA?
no, but consider if high risk features
47
difference in recurrence of rectal vs colon proper CA
rectal has much higher risk of local recurrence
48
imaging for rectal CA
MRI
49
tx for rectal CA
o Neo-adjuvant Radiation +5FU or chemo
50
which esophageal CA is ASW tobacco, alcohol abuse
o ASW achalasia, tylosis, caustic injury (hot drinks), Plummer-Vinson syndrome
* Squamous Cell Esophageal CA
51
does H pylori increase or decrease risk for esophageal adenocarcinoma?
decrease
52
tx for esophageal CA Early lesions (mucosal, T1)
Endoscopic resection w/ or w/o ablation
53
tx for esophageal CA Locally advanced (T2/3, N+) but not metastatic
Radiation + weekly carboplatin/Taxol (chemo) followed by surgery preferred
54
does H pylori increase or decrease risk for gastric carcinoma?
increase
55
diet RFs for gastric carcinoma (4)
o High salt, nitrite diet
o Low vitamin A/C diet
o Smoked/cured food and lack of refrigeration
o Poor quality drinking water
56
check for what receptor in gastric carcinoma
20% Her-2 positive
57
tx for stage 1 and 2 gastric CA
surgical resection
58
most gastric CA found in stage ____
3
59
what stage of gastric CA involves spread to LNs around stomach?
3
60
tx for stage 3 gastric CA
surgery + adjuvant chemo +/- radiation
61
sudden onset of DM in adults, think ____
pancreatic CA
62
Imaging for pancreatic CA
CT abd
63
what stage of pancreatic CA: extends beyond pancreas, but doesn’t involve arteries, +/- LN
2
64
tx choice for local pancreatic CA
o Whipple procedure for best outcome (2 yrs) if resectable. Part of liver removed + head of pancreas
65
character of HA in CNS tumors
o New onset HA, daily morning HA (HA that wakes you up in the morning)
o HA w/ nausea, vomiting
66
imaging choice for CNS tumor
MRI
67
tx for all stages of CNS tumor
steroids to decrease swelling
68
tx for Grade IV Glioblastoma
Surgical debulking
Radiation w/ continued oral temozolomide
69
level of PTH in hyperCa of malignancy
low
70
most important tx for hypercalcemia
rehydration
71
most hyperCa of malignancy ASW production of ______
PTH-related peptide (PTHrP; 80%)
72
MC malignancy complicated by SIADH
lung CA
73
rate of Na correction for SIADH
no more than 10 mEq in 24 hrs
74
trigger for tumor lysis syndrome
initiation of chemo
75
CA pt presents w/ hyperuricemia, hyperK, hyperphosphatemia, hypoCa. this is ____
tumor lysis syndrome
76
tx for tumor lysis syndrome
o Hydration (good urine output)
o Reduce uric acid production w/ allopurinol
o Increase uric acid metabolism w/ rasburicase IV
77
* Most common life-threatening complication of cytotoxic chemotherapy
Neutropenic Fever
78
tx for low risk outpatient w/ Neutropenic Fever
cipro + augmentin
79
tx for inpatient w/ Neutropenic Fever
antipseudomonal beta-lactam monotherapy: Cefepime IV
Piperacillin-tazobactam
Meropenem
80
neutrophenic fever prevention (4)
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
imaging for suspected spine metastasis
o MRI w/ gadolinium is 100% sensitive
82
multiple myeloma is a malignancy of _______ cells
plasma cells (differentiated B cells) that produce antibodies
83
CRAB s/s of MM
hyperCA, renal insufficiency, anemia, bone pain/lytic lesions
84
SPEP in MM will show ___
Monoclonal protein (M-spike or M-protein) – 3g/dL or greater
85
UPEP in MM will show ___
bence jones proteins
86
o M-spike <3 or plasmacytosis <10% (but still >normal) = dx?
MGUS (Monoclonal Gammopathy of Undetermined Significance)
87
is MM curable?
no
88
dexamethasone + lenalidomide/cyclophosphamide + bortezomib = tx for _____
MM
89
how to dx AL amyloidosis
Must demonstrate amyloid deposition in tissues (congo red stain, fat pad aspirate, kidney bx)
90
think what 2 things in elevated monocytes
infections (mycobacterial), sarcoidosis
91
primary bone marrow dz / leukemia cause what size of anemia?
macrocytic
92
order ____ to determine if anemia is acute loss vs hemolytic
Reticulocyte count
93
tx for hereditary spherocytosis and elliptocytosis
folate supplements, splenectomy if severe
94
G6PD defic has ___ and ___ on peripheral smear
* Bite cells, Heinz bodies
95
suspect ____ (2) if basophilic stippling on peripheral smear
lead poisoning or other heavy metal toxicity, sideroblastic anemia / thalesemia
96
positive direct Coombs test indicates
* Antibody mediated autoimmune hemolytic anemia
97
HUS classic triad
o Kidney damage
o Hemolytic anemia
o Thrombocytopenia
98
give platelets in TTP?
NO
99
TTP classic pentad
o Fever
o Renal failure
o CNS changes
o MAHA (microangiopathic hemolytic anemia)
o Thrombocytopenia
100
most common anemia worldwide
Iron Deficiency Anemia
101
results of iron studies in iron defic anemia
o Fe low
o TIBC high
o Ferritin low
102
tx for iron deficiency anemia + pt instructions
o FeSO4 325mg QOD (take w/ water or OJ on empty stomach)
103
ferritin in anemia of inflammation will be ___
normal to high
104
* Think ________ if microcytic anemia w/ normal or increased serum Fe or no response to tx
thalassemia
105
for vit B12 deficiency anemia, order _____ to determine if due to pernicious anemia
schilling test
106
B12 vs folate deficiency: homocysteine and methylmalonic acid (MMA) levels
B12: both elevated
folate: only homocysteine elevated
107
giving platelets is contraindicated in which 2 conditions
TTP, heparin-induced (HIT)
108
MCC of immune thrombocytopenia (ITP)
viral infx
109
1st line tx for acute ITP w/ platelets <30k
steroids
110
effective surgery for chronic ITP
splenectomy
111
what does HIT progress to?
HITT (+ thrombosis)
112
timeframe for onset of HIT
o Onset 5-14 days (can be 1 day if exposed to heparin in prior 30-100d)
113
how to dx MAHA
o Hemolysis w/ schistocytes + thrombocytopenia makes diagnosis
114
pentad for TTP
o FAT RN
Fever
Anemia – splenomegaly (MAHA)
Thrombocytopenia – mucocutaneous bleeding
Renal failure
Neuro sxs – HA, visual changes, confusion
115
PT and PTT in TTP
normal
116
HUS triad
o Thrombocytopenia (platelets)
o Hemolytic anemia
o Renal dysfunction (kidney failure)
117
abx to tx HUS?
NO!
118
PT and PTT in DIC
both increased
119
Most common inherited coagulopathy
VWD
120
in VWD, PTT is prolonged, and mixing study shows ____
that PTT corrects
121
1st line prophylaxis for operation in pt w/ VWD
o DDAVP (desmopressin
122
hemophilia A = factor ___ deficiency
8
123
hemophilia B = factor ____ deficiency
9
124
hemophilia A or B more common?
A
125
mab for hemophilia
o Emicizumab
126
PT and PTT results in vit K deficiency
both prolonged
127
tx for vit K deficiency
PO supplementation
128
o Most common thrombophilia
* Factor V Leiden Mutation
129
SLE pt w/ VTEs, arterial thrombosis, recurrent spontaneous abortions. think _____ (dx)
* Antiphospholipid Syndrome
130
tx for * Antiphospholipid Syndrome
warfarin
131
classic triad for hemochromatosis
o Classic Triad:
Cirrhosis
DM
Bronze skin pigmentation
132
type of cell in Hodgkin's
Reed-Sternberg cell
Malignant cell of Hodgkin’s
Bilobed, 2 nuclei (owls eyes appearance)
133
how to dx hodgkin's
o Excisional whole lymph node biopsy – Reed-Sternberg cells are pathognomonic
134
Hodgkin's stage: 2+ lymph node regions on same side of diaphragm, may include localized extra-lymphatic
2
135
Hodgkin's stage: involvement of LN on both sides of diaphragm, may include spleen or localized
3
136
tx for stage 1 and 2 Hodgkin's
2-4 cycles of ABVD +/- radiation
ABVD = Adriamycin (doxorubicin), bleomycin, vinblastine, dacarbazine
137
Hodgkins is malignancy of germinal or pre-germinal ____ cells
B cells
138
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
NHL
139
which type of lymphoma commonly has Constitutional symptoms (B-symptoms) such as: Cyclical Fevers >38C
Drenching night sweats
Weight loss >10%
hodgkin's
140
1st line tx for CLL
1st line = BTK inhibitor +/- antiCD20 mab
141
* Most common type of aggressive NHLs (20-30% of all NHL)
Diffuse Large B Cell NHL
142
tx for Diffuse Large B Cell NHL stage 1 and 2
R-CHOP (chemo) w/ XRT
Rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine (Oncovin), prednisone
143
rai classification of CLL says splenomegaly is stage ___
2
144
rai classification of CLL says platelets <100k is stage ___
4
145
peripheral smear in CLL (2)
SMUGE cells, mature lymphocytes
146
MC cancer in kids
Acute Lymphocytic/Lymphoblastic Leukemia (ALL)
147
tx for ALL
aggressive chemo w/ anthracyclines, vincristine, corticosteroids
148
4 y/o presents w/ o Fever + lymphadenopathy + bone pain + bleeding. dx?
ALL
149
test + results to dx ALL
o Bone marrow aspiration hypercellular w/ >20% blasts = definitive dx
150
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
Myeloproliferative Disorders/Neoplasms (MPN)
151
mutation present in polycythemia vera
JAK2 mutation
152
1st test to order if suspected polycythemia vera and expected results
EPO (should be low or maybe normal)
153
only cure for polycythemia vera
SCT
154
tx for low risk polycythemia vera
phlebotomy + ASA
155
tx for high risk polycythemia vera
ASA + phlebotomy + hydroxyurea
Ruxolitnib (JAK inhibitor) if unresponsive to HU
156
don't give ASA in polycythemia vera if platelets are >________
>1 mil
157
tx for high risk essential thrombocytosis
ASA + Hydroxyurea
158
1st line tx for symptomatic myelofibrosis
JAK inhibitors (o Ruxolitinib )
159
MPN w/ philadelphia chromosome
CML - Chronic Myeloid Leukemia
160
how to dx CML
Peripheral smear or bone marrow aspirate for karyotype or FISH --looking for t(9;22) OR Quantitative PCR for p210 bcr-abl
161
gold standard tx for CML
o Tyrosine kinase inhibitors (imatinib)
162
o Most common acute leukemia in adults
AML
163
MC symptom of AML
fatigue
164
hallmark finding on peripheral smear for AML
Auer Rods (specifically APML)
165
major complication of APML and timeframe
o DIC (first 48 hours)
166
induction tx for AML
Chemo: cytarabine + anthracycline
167
start what med asap after APML dx?
Retinoic acid (ATRA)
168
BBW for Retinoic acid (ATRA)
QT prolongation
169
post-remission therapy for AML is allogenic SCT except for which type of AML?
APML--auto SCT
170
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
AML
171
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
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
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
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.
