Heme/Onc Flashcards

1
Q

What situation with gross hematuria would trigger exploration with further imaging?

A

Trick question, one episode is all it takes –> imaging or cystoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the treatment for Stage III colon cancer? When in colon cancer treatment might you use bevacizumab or cetuximab?

A

FOLFOX, no radiation as local recurrence is rare. Bev and Cet may be more helpful in metastatic disease.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If you have a patient with metastatic adenocarcinoma below the diaphragm with unknown primary, what are the considerations of further diagnosis if male or female? What is the caviat if a female has abdominal carcinomatosis and ascites?

A

Male: best presumed GI cancer without additional testing for primary
Female: do breast exam, mammography, gynecologic exam and if negative can presume GI as well.
*Female with abdominal carcinomatosis and ascites has ovarian cancer most likely unless evidence for GI source

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Female presents for heme onc evaluation after discovered ascites with abdominal carcinomatosis and adenocarcinoma of unknown primary on fluid/biopsy evaluation. What should be further done to evaluate for primary?

A

No further evaluation. Presume ovarian and treat.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

In Large B-cell lymphoma, what lab elevation indicates poor prognosis?

A

Elevated LDH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How does Large B-cell lymphoma usually present?

A

Enlarging neck or abdominal LAD (lymph nodes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When does cervical cancer need chemorad?

A

Stage III, involving pelvic side wall or lower 1/3 vagina or pelvic LAD

*high risk for distant recurrence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is used to reduce infectious events in patients with CLL who have hypogammaglobulinemia?

A

IVIG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do you determine where to biopsy someone with previously treated or new breast cancer who comes to you with several new mets?

I.E. do you biopsy the local lymph node or do you biopsy the lung nodule?

A

Biopsy the lesion that would upstage the cancer the most –> lung nodule in this situation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What condition is defined by serum M protein >3 g or >500/24h urinary monoclonal free light chain or bone marrow plasma clonal cells 10-59% w/o evidence multiple myeloma symptoms or signs.

A

Smoldering multiple myeloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What imaging should be done in smoldering MM?

A

Low-dose CT or PET-CT then if negative do whole body MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What should be done in smoldering MM if PET-CT is negative?

A

Whole body MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Do bone scans catch lytic or blastic lesions?

A

blastic (so not great for smoldering MM which has lytic lesions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the criteria for smoldering MM based off of?

A

elevated levels of M protein in serum (3g) or 24 h urinary monoclonal free light chains (500) or bone marrow plasma clonal cell population percentage (10-50%) w/o evidence of MM by symptoms or signs.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Match these drugs to their respective conditions in regards to a low Hgb and name the caviat* with IVIG: Prednisone and IVIG.

A

Hemolytic anemia –> Prednisone

Parvovirus pure red cell aplasia –> IVIG (*if immunocompromised - prolonged viremia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MM receiving treatment need what kind of prophylaxis if on a proteasome inhibitor?

A

Zoster –> Valgancyclovir

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What lab criteria makes someone high risk anti phospholipid antibody syndrome?

A

Triple positive (lupus anticoagulant, anticardiolipin, anti-B2-glycoprotein antibodies) x 2 tested 12 weeks apart

*regular APLAS just needs mod to high titer of any of those 12 weeks apart with clinical criteria (obstetric issues or VTE or cardiac valve vegetation or arterial thrombosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how is polycythemia vera usually treated?

A

low dose ASA + phlebotomy to goal Hct <45%. If >60 or VTE will need hydroxyurea or interferon-a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What cell results when the spleen phagocytizes IgG and parts of RBC membranes in AIHA?

A

Spherocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When are fluoroquinolones to prevent febrile neutropenia? When might you bring in GCSF?

A

Anticipated PROLONGED neutropenia (such as with acute leukemia induction chemo or allogeneic stem cell transplant.)

GCSF can be good in HIGH RISK CHEMO of inducing neutropenia and also for SECONDARY PREVENTION in someone who already had febrile neutropenia with chemo.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Between alpha-thalassemia trait and beta-thalassemia minor, do one or both have abnormal Hgb electrophoresis?

A

Only Beta thalassemia minor. (has reduced hemoglobin A level, and elevated levels of hemoglobin F and hemoglobin A2 on hemoglobin electrophoresis).

*Avoid iron supplementation in both as they absorb iron better than those without these conditions. Folate can be helpful.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What condition should you suspect in someone with Hgb 10 with chronic microcytosis and target cells on blood smear with family history of anemia and normal Hgb electrophoresis?

A

Alpha-thalassemia trait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

how do you treat mild and severe hereditary spherocytosis?

A

Mild: folate
Severe: Splenectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do MMR deficient and MMR proficient metastatic colon cancer differ in treatment?

A

MMR deficient have substantial benefit from PD-1 inhibitors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Does pregnancy increase risk of ER+ breast cancer recurrence?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

In tx of inflammatory breast cancer, which is done first, radiation, chemo, or surgery?

A

First, chemo to make smaller and ensure success of surgical removal, then possibly radiation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is the treatment for anal cancer (surgery, radiation, chemo, immunotherapy, etc) and what is the cancer associated with?

A

HPV. Treatment is radiation and chemo.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

True or False: well-differentiated neuroendocrine tumors can be observed with serial imaging.

A

True (very indolent)

*if poorly differentiated, there is chemo and other options, and if symptomatic there are options too.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

In metastatic NSCLC, is treatment better for those with or without driver mutations?

A

driver mutation is better, can target the mutation even if have poor functional status

30
Q

what happens to urate, calcium, potassium, and phosphorus in TLS?

A

urate, K, and phos go up while calcium decreases

31
Q

when beginning inpatient chemo induction in patients with acute leukemia or high grade lymphoma, should allopurinol or rasburicase be given with IV hydration?

A

Rasburicase for high risk TLS.

32
Q

when is radiation needed for Stage II or III NSCLC?

A

if not resectable, treated with chemo/rad. Radiation not needed if able to resect and then give just chemo.

33
Q

True or False: melanoma with a solitary met is treated with resection and immunotherapy?

A

True, unless BRAF or MEK mutation in which case may get targeted therapy instead of immunotherapy

34
Q

Is a MALT cancer treated with chemo/rad?

A

No. May only need rituximab, add H pylori eradication if gastric.

35
Q

What antibiotic regimen is given to low-risk neutropenic fever without symptoms?

A

[Ciprofloxacin or Levofloxacin] + Amoxicillin/clavulanate

36
Q

what medication should be added for patients with breast cancer and bone mets?

A

Zoledronic acid or denosumab

37
Q

What medication class improves metastasis-free survival in patients already on leuprolide with prostate cancer and rapidly rising PSA if testosterone remains suppressed?

A

Androgen-receptor blockers (i.e. enzalutamide, darolutamide)

38
Q

how do you treat acute hemolytic transfusion rxn?

A

Stop transfusion, administer fluids and other supportive care, send hemolysis labs and DIC panel to confirm diagnosis, as well as new type and screen and DAT to ensure safety in further transfusions.

39
Q

What is the risk of relapse in therapy-related AML?

A

high. indication for HSCT.

40
Q

what do ferritin, iron levels, and TIBC do in anemia of inflammation?

A

Ferritin is high
Iron is low
TIBC is low

41
Q

what level do platelets need to be at for invasive procedures?

42
Q

what is Budd-Chiari syndrome and does it include portal vein thrombosis?

A

hepatic venous outflow obstruction, no.

43
Q

What do half of Budd-Chiari patients have as the cause?

A

MPN including potentially JAK2 tk mutation or essential thrombocythemia so should test for JAK2

44
Q

What is used to treat essential thrombocytopenia? does age matter?

A

If < 60 - aspirin only

if >60 or previous clot - ASA + hydroxyurea

45
Q

What does the Khorana score tell you in cancer patients?

A

if 2 or higher may need DVT prophylaxis.

46
Q

what sort of monitoring may be needed for patients with transfusion-dependent thalassemia?

A

iron panels, echo/ekg, and MRI to assess cardiac and liver iron overload

47
Q

treatment for secondary iron overload

A

desferrioxamine, deferasirox, deferiprone (iron chelation)

48
Q

What might you test in someone with ITP?

A

HIV, Hep C, ANA/complement for SLE, APLS antibodies, H pylori if abdominal symptoms. CMV and Varicella zoster are also common causes.

if other signs of deficiency could test for B12 or folate but this is less commonly associated with ITP (more non immune thrombocytopenia).

49
Q

What antibiotics may cause ITP?

A

beta lactams, sulfas, vanc, rifampin, linezolid

50
Q

How would you reverse dabigatran?

A

Idarucizumab, HD

51
Q

How would you reverse Apixaban?

A

Andexanet alfa or 4-factor PCC

52
Q

What is treatment for CRS (cytokine release syndrome)?

A

if mild, supportive care. if severe, high dose steroids and tocilizumab and evaluate for sepsis.

53
Q

what imaging is needed for MGUS?

A

gotcha! just observe, would only need therapy if they have significant kidney disease

54
Q

how do you risk stratify in smoldering myeloma?

A

skeletal imaging - Low-dose CT (preferred) and PET-CT are recommended as the initial imaging procedure for patients with a monoclonal gammopathy because of increased sensitivity for the detection of lytic lesions.
A whole-body low-dose CT scan negative for smoldering myeloma should be followed by a whole-body MRI.

55
Q

what makes smoldering myeloma and MGUS different from multiple myeloma requiring treatment?

A

MM has CRAB

56
Q

diagnostic tests for MM?

A

Diagnostic tests for multiple myeloma include CBC; serum chemistries; SPEP; 24-hour UPEP; serum and urine immunofixation assays; serum free light chain testing; and serum IgG, IgA, and IgM measurements

57
Q

what should be done for a sickle cell patient before major surgery?

A

transfusion preop to Hgb of 10 to reduce adverse outcomes including acute chest syndrome.

58
Q

True or false, PICC/CVC line associated DVT requires immediate removal of the line. How much AC is needed?

A

False - may leave in if functioning well, total 3 months AC (not from line removal).

59
Q

What should be considered before giving allopurinol to person of Korean, Han Chinese, Thai, and African descent?

A

HLA-B 58:01 allele testing, increased risk of severe cutaneous reaction if positive.

60
Q

Why not give allopurinol along with azathioprine or 6-MP?

A

allopurinol will decrease breakdown and could lead to toxicity of aza or 6-MP.

61
Q

What type of imaging is done after curative resection in colorectal cancer and why?

A

CT scan chest/abdomen/pelvis annually for up to 5 years to look for oligometastatic disease in lung or liver mostly which can be easily resected, also 1 year colonoscopy

62
Q

at what point in ckd should you stop treating with bisphosphonates like the normal population?

A

once GFR <30-35, need expert to comment as bisphosphonates are usually avoided in this population

63
Q

In a young man with poorly differentiated carcinoma near the midline, what is the most probable cancer?

64
Q

what treatment is good for metastatic NSCLC with ALK translocation? what if they did not have a driver mutation?

A

Alectinib, if no driver - chemo + pembro

65
Q

What should be checked in GE (gastroesophageal) tumor which might mean they could respond to trastuzumab?

66
Q

what is the treatment for local lung adenocarcinoma?

A

surgical resection +/- radiation

67
Q

what separates exemestane from tamoxifen and raloxifene?

A

E has no increased risk for DVT while T and R do. (some women benefit from risk reduction therapy with these if high risk for breast cancer for example hx of atypical hyperplasia or lobular carcinoma)

68
Q

what does an aromatase inhibitor do? Why isn’t it good as sole therapy for premenopausal women?

A

prevents conversion of androgens to estrogen. premenopausal still have estrogen coming straight from ovaries.

69
Q

What therapy do premenopausal women with hormone responsive breast cancer need in addition to aromatase inhibitor?

70
Q

what does tamoxifen do?

A

selective estrogen receptor modulator (SERM); blocks estrogen uptake by breast cells

71
Q

What kind of lung cancer has increased risk intracranial mets and should have MRI brain at initial staging?

A

SCLC. (if they respond to initial chemo, need prophylactic cranial irradiation).