Heme/Onc

Question 1

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

Answer 1

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

Question 2

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

Answer 2

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

Question 3

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?

Answer 3

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

Question 4

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?

Answer 4

No further evaluation. Presume ovarian and treat.

Question 5

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

Answer 5

Elevated LDH

Question 6

How does Large B-cell lymphoma usually present?

Answer 6

Enlarging neck or abdominal LAD (lymph nodes)

Question 7

When does cervical cancer need chemorad?

Answer 7

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

*high risk for distant recurrence

Question 8

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

Answer 8

IVIG

Question 9

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?

Answer 9

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

Question 10

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.

Answer 10

Smoldering multiple myeloma

Question 11

What imaging should be done in smoldering MM?

Answer 11

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

Question 12

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

Answer 12

Whole body MRI

Question 13

Do bone scans catch lytic or blastic lesions?

Answer 13

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

Question 14

What is the criteria for smoldering MM based off of?

Answer 14

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.

Question 15

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

Answer 15

Hemolytic anemia –> Prednisone

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

Question 16

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

Answer 16

Zoster –> Valgancyclovir

Question 17

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

Answer 17

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)

Question 18

how is polycythemia vera usually treated?

Answer 18

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

Question 19

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

Answer 19

Spherocytes

Question 20

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

Answer 20

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.

Question 21

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

Answer 21

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.

Question 22

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?

Answer 22

Alpha-thalassemia trait

Question 23

how do you treat mild and severe hereditary spherocytosis?

Answer 23

Mild: folate
Severe: Splenectomy

Question 24

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

Answer 24

MMR deficient have substantial benefit from PD-1 inhibitors

Question 25

Does pregnancy increase risk of ER+ breast cancer recurrence?

Answer 25

no

Question 26

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

Answer 26

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

Question 27

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

Answer 27

HPV. Treatment is radiation and chemo.

Question 28

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

Answer 28

True (very indolent)

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

Question 29

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

Answer 29

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

Question 30

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

Answer 30

urate, K, and phos go up while calcium decreases

Question 31

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

Answer 31

Rasburicase for high risk TLS.

Question 32

when is radiation needed for Stage II or III NSCLC?

Answer 32

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

Question 33

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

Answer 33

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

Question 34

Is a MALT cancer treated with chemo/rad?

Answer 34

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

Question 35

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

Answer 35

[Ciprofloxacin or Levofloxacin] + Amoxicillin/clavulanate

Question 36

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

Answer 36

Zoledronic acid or denosumab

Question 37

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

Answer 37

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

Question 38

how do you treat acute hemolytic transfusion rxn?

Answer 38

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.

Question 39

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

Answer 39

high. indication for HSCT.

Question 40

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

Answer 40

Ferritin is high
Iron is low
TIBC is low

Question 41

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

Answer 41

> 50k

Question 42

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

Answer 42

hepatic venous outflow obstruction, no.

Question 43

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

Answer 43

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