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STEP 3 > HEME-ONC > Flashcards

HEME-ONC Flashcards

1
Q

What is the preferred imaging for monoclonal gammopathys?

A

Low dose CT & PET-CT because of increased sensitivity for detection of lytic lesions. If whole body low dose CT negative for smoldering myeloma then get whole-body MRI.

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2
Q

How to treat pure red cell aplasia in immunocompromised pt?

A

IVIG

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3
Q

What to do when d-dimer is elevated in pregnancy and pt has SOB?

A

Determine YEARS Criteria before ordering imaging since d-dimer will be elevated in pregnancy.

YEARS: 1 point for DT, Hemopytsis, PE.

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4
Q

Why do you give antiviral ppx in multiple myeloma?

A

To prevent herpes zoster reactivation. Ppx should be given regardless of previous immunization against herpes.

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5
Q

Why is TMP-SMX or Levaquin given during induction chemo?

A

Ppx against high rate of infection with gram (-) and encapsulated bacteria w/I first 3 months of therapy.

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6
Q

What is acute chest syndrome?

A

Sickle cell anemia pts with fever, hypoxia, chest pain and consolidation on lung imaging. Result of vaso-occlusion in the pulmonary microvasculature.

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7
Q

What is the treatment for severe acute chest syndrome?

A

Erythrocyte exchange transfusion. With post transfusion target Hgb = 10

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8
Q

What is the most common cause of acquired neutrophilia?

A

Smoking. Leukocytosis seen with smoking can persist for a prolonged time even after cessation.

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9
Q

DIC Labs?

A

Prolonged PTT, PT, INR, Elevated Fibrin degradation productions
Low fibrinogen

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10
Q

What is high risk antiphophoslipid syndrome?

A

Triple positive: Lupus anticoagulant, anticardiolipin ab, anti-b2-glycoprotein ab measures two occasions 12 weeks apart.

Tx: Warfarin

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11
Q

Treatment for polycythemia vera?

A

Low-dose aspirin and phlebotomy to a target hematocrit of less than 45% to reduce the risk of adverse cardiovascular events.

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12
Q

Treatment for polycythemia vera? With additional risk factors such as age > 60 years, hx of thromboembolic event?

A

Hydroxyurea/interferon a + phlebotomy > ruxolitinib + phlebotomy

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13
Q

Hallmark of immune-mediated hemolysis?

A

Positive direct antiglobulin test that detects IgG, complement (C3), or both on the erythrocyte surface.

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14
Q

When should screening for heart failure be done for cancer survivors?

A

Echo 3-5 years in those that have received high-dose anthracycline, or chest irradiation.

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15
Q

Post-surgical bleeding, PTT prolonged, platelet normal, mixing study corrects PTT?

A

Factor 11 Deficiency - Hemophilia C.

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16
Q

How to reverse heparin?

A

Give Protamine Sulfate at 1 mg per 100 U of Heparin.

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17
Q

How to replace fibrinogen in DIC?

A

Cryoprecipitate

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18
Q

How to reverse Argatroban?

A

Idarucizumab FDA-approved monoclonal antibody fragment that binds free and thrombin-bound dabigatran and neutralizes its activity.

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19
Q

Reverse Warfarin?

A

Vit K. Give to pt taking warfarin when INR > 10 without any bleeding.

If life threatening bleed then also give PCC.

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20
Q

Alpha thalassemia trait?

A

Deletions of two or more of the four α-globin genes and present with mild, microcytic and hypochromic anemia (hemoglobin level approximately 10 g/dL [100 g/L]) and a normal or elevated iron level.

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21
Q

Beta thalassemia?

A

A reduced hemoglobin A level and elevated levels of hemoglobin F (α2/γ2), and hemoglobin A2(α2/δ2) are seen on hemoglobin electrophoresis.

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22
Q

Treatment for mild hereditary spherocytosis?

A

Folate vs severe: transfusion dependent, symptomatic anemia, massive splenomegaly

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23
Q

ITP in pregnancy?

A

First trimester, Platelets < 70 K, hx of thrombycotpenia before pregnancy even is mild. If put > 30 K no risk fr pregnancy.

If plts < 30 K. Give IVIG/Gluccocorticoids

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24
Q

Gestational thrombocytopenia?

A

Plts don’t decrease until last pregnancy 7 are between 70-100

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25
CML?
< 10% Blasts in the bone marrow
26
Treat low risk neutropenia fever?
Empiric outpatient abx; levaquin + amoxicillin & clavulanate
27
Warm autoimmune hemolytic anemia
Steroids vs cold; avoid cold + rituximab
28
Tx low grade MALT lymphoma involving the lung?
Rituximab
29
High risk prostate cancer?
High Gleason score; lymph mode metastasis, or other metastasis) —> Screen for Brca (genetic counseling)
30
Tx stage 2 non small cell lung cancer?
Cisplatin based chemotherapy (after resection)
31
Manage incidentally discovered neuroendocrine tumors?
Do nothing unless symptoms, F/U in 3 months; if symptoms then somatostatin analogue
32
Tx of anal cancer?
Irradiation & chemo; no surgery
33
Tx of inflammatory breast cancer?
Preop chemo, mastectomy, irradiation
34
What anti depressants to give pt with breast cancer?
Venlafaxine, avoid others because of cypd inhibition. (bupropion & fluoxetine)
35
B symptoms?
Fever, night sweats, weight loss
36
vWF?
PTT ELEVATED, PT NORMAL (EXTRINSIC)
37
Waldenstrom Macroglubenmeia?
IgM, end organ damage, > 10% clonal lymphocytes by bone marrow biopsy. Hyperviscosity syndrome & cryoglobunemia Tx: plasmapheresis + chemotherapy
38
Hemolytic dx of newborn?
Incompatibility due to RhD negative mother & RhD positive father.
39
Iron therapy labs?
Increase in reticulocyte production then increase in Hct & Hgb
40
Worse prognosis associated with CLL?
Anemia/Thrombocytopenia
41
AC during pregnancy?
Use LMWH in 1st trimester, if high risk can use warfarin in 2 and 3rd but transition to UH in 3rd.
42
Ferrtin < 15?
IDA
43
Anthracylcin vs Radiation Heart Toxicity?
Dilated vs Restrictive Cardiomyopathy
44
Tx of sickle cell crisis?
NSAIDS > Oral Opioids, Hydration & Heat
45
Exchange Transfusion?
Removal of bilirubin & ab with replacement of RBC for neonates with bilirubin > 20-25.
46
Common brain metastasis sites?
Lung > Breast > Unknown Primary > Melanoma
47
Tx of limited small cell lung cancer?
After chemo: ppx cranial irradiation
48
Treatment for secondary AML (therapy-related AML or (AML after another cancer)?
Stem cell transplantation since more likely to relapse.
49
ITP Treatment?
If symptomatic and plts < 30 K then give steroids. If asymptomatic and plts < 10 K give plts. If symptomatic and < 50 then transfuse plts.
50
Management of hyadiform mole?
Suction curettage & weekly b-hcg levels until undetectable for 6 months with contraception.
51
What to do when b-hcg in hydatid mole despite treatment?
Get transvaginal US & CXR and give methotrexate.
52
FAT RN?
TTP: Fever, Anemia, Thrombocytopenia, Renal, Neurologic & Schitocytes. Acquired def in ADAMTS13. Treatment: Plasma exchange
53
G6PD def in neonates?
Presents on Day 2-3 of life with unconjugated hyperbilirubenmia and anemia. X-linked seen in African American, middle eastern * SE Asia.
54
SE of antipsychotics, prochlorperazine & metoclopramide?
Acute dystonia as they are dopamine antagonists. Treat with IV diphenhydramine or benztropine.
55
What to do when peripheral venous hematocrit > 65%? In neonates?
Obtain hematocrit levels from serum since heel prick (capillary) is unreliable.
56
Neutropenia?
ANC < 1500 & severe is < 500
57
What score to use in Heparin induced Thrombocytopenia?
4T: Platelet count decrease > 50% = 2 points, onset > 1 day with previous exposure w/I 30 days = 1 point, no other likely cause of thrmobytopenia = 2 points.
58
Treatment for aplastic anemia in younger patients with HLA matched donor?
Stem cell transplant
59
Treatment for aplastic anemia in older pts?
Immunosuppression with antithymocyte globulin, cyclosporine, and prednisone. Since pathogenesis related to autoimmunity.
60
Treatment for essential thrombocytopenia with JAK2 mutation?
Hydroxyurea + aspirin. But pts > 60 should be treated with hydroxyurea and aspirin regardless of mutation status.
61
VTE prevention and treatment in patients with cancer?
Calculate Khorana Score: > 2 then give apixaban, rivaroxaban LMWH
62
Anemia with elevated LDH, indirect bilirubin, and AST levels without an elevated reticulocyte count?
Infeffective erythropoiesis.
63
Reverse Argatroban?
Idarucizumabi n pts with life-threatening bleeding or who require an urgent invasive procedure. If not available then can do urgent HD (Removes upto 68% in 4 hours).
64
Reverse Apixiban/Rivaroxaban 7 Edoxaban?
4PCC or andexanet alfa.
65
Multiple myeloma pts vaccine?
Pneumococcal vaccination with the 20-valent pneumococcal conjugate vaccine alone or the PCV15 followed by PPSV23 min 8 weeks apart & annual flu vaccine.
66
Treatment for pts with unprovoked proximal DVT?
Extended anticoagulation.
67
vWF?
Young age of onset of bleeding symptoms and family history of bleeding in both sexes; mucocutaneous, and menorrhagia and bleeding after minor procedures. Platelet function testing abnormal. Reduction in vWF ag & reduced vWF ristocetin cofactor activity.
68
Wells criteria?
DVT: Previous DVT, Active cancer or tx of cancer w/I 6 months, paralysis, paresis, immbolization, bedridden status & surgery.
69
Chimeric ag receptor (CAR)?
Given in ALL that has relapsed/refractory, targets CD19 ag on leukemic cells.
70
Cytokine release syndrome?
IL-6 mediated immune reaction to CAR T cells.
71
MGUS?
M protein level < 3 or < 500/24hr of urinary monoclonal freight chains, clinical plasma cells < 10% of bone marrow cellularity & absence of end organ damage.
72
Waldenstrom macroglobuenmia?
IgM: Fevers, night sweats, weight loss, hepatosplenomegaly, lymphadenopathy, GI dysfunction from serum viscosity. Treatment: plasmapheresis for hypervelocity syndrome, but overall disease need chemo.
73
Mentor Index?
MCV/RBC >13 = IRON DEFICINECY. Elevated Red cell distribution width seen as well.
74
Medication that help improves Anemia of CD in rheum arthritis?
ANTI-TNF-A
75
Hgb A & HbS In 60:40 ration?
Sickle cell trait. Mild normocytic anemia.
76
IVC filter SE?
Doubles risk for recurrent DVT. Only use when there is an absolute CI to AC.
77
Acute hemolytic transfusion reaction ?
Fever, dyspnea, hypotension, flank pain, and pink-colored urine appearing during or shortly after a transfusion. (15 min)
78
Treatment for acute hemolytic transfusion reaction?
immediate discontinuation of the transfusion, volume expansion, and supportive care.
79
Symptoms of neonatal polycythemia?
Hyeprviscoity, hypoglycemia, hyperbilibrunemia & respiratory compromise. Treatment: hydration & correct hypoglycemia >>> partial exchange transfusion (removing blood and giving saline) if failing to improve.
80
New bone pain at night w/ hx of prostate enlargement or pending confirmation of cancer?
Supect metastasis and get radioisotope bone scan. (Looks for osteoblastic lesions)
81
How much does one unit of platelets increase by transfusion?
20-30 K
82
If undergoing invasive procedures and platelets less than 50 K?
Give platelet transfusion
83
What score for pulmonary embolism?
PESI Score: 1 point for age > 80, Hx of cardiopulmonary disease, hx of cancer, HR > 110, SBP < 100 & SpO2 < 90%. If none met, low risk if 30 day mortality of 1.1%. Give home tx with rivaroxaban or apixaban.
84
Tx for VTE?
Apixiban in pts with kidney injury. Rivaroxban can’t be used in kidney injury. Dabigatran & Edoxaban can’t use in kidney injury but requires bridging >>> Warfarin can be used but require bridging.
85
Thromboylytic therapy in massive PE with hemodynamic instability.
Cold agglutinin hemolytic anemia? IgM ab that cause erythrocyte agg. And hemolytic anemia with extravascular hemolysis by complement fixation. (Positive for anticomplemement C3 & neg for IgG) Tx: Rituximab
86
Management of peri-operative complications in sickle cell?
Goal target of Hgb 10
87
What happens if you give iron 2-3 times a day?
Increases hepcidin -> dcreases iron absorption
88
TTP tx?
Plasma exchange with FFP to remove autoab and replace deficient ADAMSTS13. Prednisone decreases autoab production and Rituximab surpresses autab production and recurrence.
89
Iron overload in hemochromatosis?
Rare in heterzygous. No need to monitor if iron stores normal.
90
Dosing of abixiban in VTE?
10mg BID for one week & then 5 mg BID thereafter
91
Bridging with heparin?
For min 5 days before Dabigatran & Edoxaban & Warfarin. For Warfarin INR should be > 2 for 24 hours.
92
First step if pt has thrombotypenia?
Peripheral blood smear and confirm platelt count.
93
Tx of superficial vein thrombosis?
Lesser Saphenous Vein, cord palpated on PE, thrombus > 5 cm. 6 weeks with AC.
94
When does iron overload happen in thalassemia?
> 15-20 transfusion units of blood. Iron chelation is tx and get MRI to see deposition in liver & Heart.
95
DIC & Liver disease presentation, what to get to differentiate between the two?
Factor 8. Consumed in DIC, normal or elevated in liver disease.
96
Tx of anit-phoshpolipid syndrome and VTE?
LMWH followed by Warfarin
97
Tx for MDS with 5q subtype?
Lenalidomde: decreases transfusion dependence and leukemic transformation >>> Azacytidine & Decitabine.
98
Prolonged aPTT that does not correct with mixing study & low Factor 8?
Hemophilia A (Factor 8 def). Tx: Factor 7 or PCC or porcine derived Factor 8 concentrate.
99
Tx for advanced metastatic adenocarcinoma of colon and debilitating status with no prior co-morbidities?
Fluorouracil and Oxaliplatin
100
Imaging studies for staging in asymptomtic pts with newly diagnosed breast cancer?
Not recommended in Stage 0 to 2 Breast Cancer. Get CT if symptoms or if ALP/ ALT elevated. Brain metastasis occurs rarely and later in disease course.
101
Folfox?
5-Fluorouracil/Capecitabine Leucovorin, Oxaliplatin. Tx for Stage 3 (Mets to local-regional lymph nodes) Colon Cancer. Adjuvant Radiation not part of routine management (unlike rectal).
102
Elevated Calcitonin in medullary thyroid cancer s/p thyroidectomy?
Metastatic disease. Get CT scan of neck and chest. This cancer does not take up iodine therefore today body iodine scan not useful.
103
Painless abdominal mass in children?
Neuroblastomas: HTN b/c of mass compressing renal artery and activating RAA -> flushing & sweating. Age < 2 yrs. Periorbital ecchymoses. Opsoclonus myoclonus. Small round blue cells on histology.
104
Wilms Tumor?
Age < 5 yrs -> unilateral, painful abd mass -> HTN & Hematuria. Flushing and sweating not seen vs Neuroblastoma.
105
Risk Factors for Colon Cancer?
Family hX, FAP, IBD, African-American. Alcohol > Smoking > Obesity. Protective: High Fiber, Regular NSAID use, HRT, Regular Exercise.
106
Physiological anemia of infancy?
Normal expected decline in Hgb in 1st month of life. O2 increases after delivery in comparison to utero -> decrease in EPO. Fall from > 14 to 9-11. Usually happens around 2-3 months.
107
Tx for TLS?
IVF & Rasburicase (Metabolizes uric acid to allantoin) . Not allopurinol/febuxostat b/c only prevents formation of additional uric acid. Rasburicase C/I in G6PD def -> methemoglobenmia & hemolysis
108
Stage newly diagnosed large B cell lymphoma?
LDH
109
VTE + bad kidneys?
Apixiban & UFH
110
Which cancer is associated with breast implants?
Anaplastic T-cell lymphoma
111
Treatment for early stage Hodkin Lymphoma?
ABVDR. Unfavorable = large mediastinal mass, elevated ESR, multiple modal sites, extranodal involvement, age > 50 y/older, mastic splenic disease.
112
When to repeat biopsy in prostate cancer screening?
If PSA doubles in < 3 years.
113
Tx of nausea in chemotherapy that causes severe N/V?
Four-drug combination of an NK1 receptor antagonist, a 5-hydroxytryptamine-3 receptor antagonist, dexamethasone, and olanzapine.
114
Tx is side effects of immunotherapy?
Steroids IV
115
Tx of testicular cancer?
Surgery. Dx: US
116
What to biopsy in newly diagnosed metastatic breast cancer?
Lesion that upstages the pt to the greatest degree
117
Tx for treatment refractory metastatic mismatch repair deficient colon cancer?
Immunotherapy
118
How often to have dexa scan while on aromatase inhibitors?
Q2y
119
Women with brca mutation who achieves response with platinum chemo?
Give maintenance therapy with poly adp ribose polymerase inhibitor
120
Tx of pt with DCIS after BL mastectomy?
Nothing; no radiation or hormonal therapy Only if ER+ then give hormone therapy
121
Tx of non-mutated BRAF melanoma?
Immunotherapy + anti-CTLA-4
122
Chemo therapy to prevent breast cance in pt with VTE?
Aromatase inhibitors
123
When to use immunotherapy in non-small lung cancer?
First line i n absence of driver mutation (ALK, ROS2, EGF) but > 50% PD-1 expression absence of driver mutation (ALK, ROS2, EGF) and no PD-1 expression, use alongside chemotherapy

STEP 3 (14 decks)

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