heme/onc 3 Flashcards
What is the elevated hemoglobin level for women?
> 16.0 g/dL
What is the elevated hemoglobin level for men?
> 16.5 g/dL
What is the elevated hematocrit level for women?
> 48%
What is the elevated hematocrit level for men?
> 49%
What is a major criterion for Polycythemia Vera (PV)?
Bone-marrow biopsy consistent with PV
What mutation is associated with Polycythemia Vera?
Presence of the JAK2 V617F or another similar JAK2 mutation
What is a minor criterion for Polycythemia Vera?
Serum erythropoietin level below the normal reference range
What assays test the ability of a patient’s HIT antibodies?
Heparin-induced platelet aggregation (HIPA) assay and the serotonin release assay (SRA)
What should a unilateral right-sided varicocele raise concern for?
Possibility of obstruction from a retroperitoneal mass
What is the most likely diagnosis in a patient with recurrent epistaxis?
Hereditary hemorrhagic telangiectasia
What can the erythrocyte count indicate in beta-thalassemia trait?
It is often high (>5 million per mm3)
What is the erythrocyte count in patients with iron deficiency?
It is often low
What is characteristic of hairy-cell leukemia?
Pancytopenia in association with splenomegaly, monocytopenia, and atypical lymphocytes with projections
What are the usual immunophenotypic markers for Chronic lymphocytic leukemia?
CD5, CD19, and CD23 positivity with dim positivity for CD20
What are the most common malignant tumors in males aged 15 to 35?
Testicular tumors
What should squamous-cell carcinoma isolated to a cervical lymph node be considered?
Head and neck cancer until proven otherwise
What is acute promyelocytic leukemia sensitive to?
Vitamin A derivative all-trans retinoic acid and arsenic
What does pancytopenia without peripheral blood smear evidence suggest?
Aplastic anemia
What is the first-line management of chemotherapy?
Not specified in the provided text.
What is suggestive of aplastic anemia?
Pancytopenia without peripheral blood smear evidence of dysplasia or circulating blasts in an otherwise healthy patient.
What is the first-line management of chemotherapy-induced neuropathic pain?
Duloxetine.
What is a common cause of mild leukocytosis?
Cigarette smoking.
True or False: Cigarette smoking is a common cause of mild leukocytosis.
True.
When is the coadministration of low-molecular-weight heparin appropriate?
When bridging warfarin with heparin until the international normalized ratio is therapeutic, typically 2-3.
What condition is indicated by a patient presenting after an atypical lung infection with hemolytic anemia?
Cold agglutinin hemolytic anemia, with a positive Coombs test for anti-C3 and negative for anti-immunoglobulin G.
What are common symptoms of chronic radiation proctitis?
Fecal urgency, tenesmus, and anal bleeding.
Is mild neutrophilia seen with inhaled glucocorticoids?
No, it is rarely seen.
True or False: Mild neutrophilia is rarely seen with inhaled glucocorticoids.
True.
Where can squamous-cell carcinomas originate?
From the skin, the mucosa of the upper aerodigestive tract, and the cervix.
What is the best strategy for managing intractable cancer-related pain despite intermittent opioids?
Intravenous opioids administered as patient-controlled analgesia.
What is the continuous infusion rate for patient-controlled analgesia?
50% to 100% of the patient’s 24-hour opioid intake, divided by 24 to determine the hourly rate.
What activates factor X and factor IX in the extrinsic pathway of coagulation?
TF-FVIIa complex.
What is the appropriate colorectal surveillance option for a patient who has undergone a partial colectomy for stage I colon cancer?
Colonoscopy one year after the colectomy.
What is the most appropriate management for a young man with a heterogeneous hypoechoic testicular mass on ultrasound?
Radical inguinal orchiectomy.
What is the treatment for patients at high risk for tumor lysis syndrome?
Patients who have uric acid levels >8 mg/dL despite aggressive volume expansion are considered candidates for treatment with rasburicase.
What should be done when a family member asks to withhold diagnostic information from a patient?
The most appropriate action is to ask the patient how much information she would like to know about her condition and the results of her tests.
Which vitamin deficiency is indicated by an elevated homocysteine level?
An elevated homocysteine level — but not the methylmalonic acid level — is elevated in folate deficiency.
What does irregular vaginal bleeding in a postmenopausal woman raise concern for?
Irregular vaginal bleeding in a postmenopausal woman should raise concern for endometrial cancer.
What does a combination of personal and family history of mucosal bleeding suggest?
It is suggestive of an inherited bleeding disorder such as von Willebrand disease.
What is the most appropriate test to confirm a suspected diagnosis of hepatocellular cancer in a patient with cirrhosis?
Dynamic contrast-enhanced MRI or multiphasic CT of the liver.
What is the most appropriate investigation for a patient with a periventricular brain tumor that has features of a lymphoma?
Lumbar puncture.
When is stereotactic biopsy indicated?
Stereotactic biopsy is indicated only when the analysis of cerebrospinal fluid is not diagnostic.
What does an elevated serum methylmalonic acid level indicate in a patient with severe macrocytic anemia?
It is very specific for identifying vitamin B12 deficiency.
Does iron deficiency anemia have elevated RDW?
True, iron deficiency anemia has elevated RDW.
What happens to PNH cells in the intravascular space?
PNH cells are susceptible to complement-mediated lysis that occurs in the intravascular space and causes hemoglobinuria and episodes of dark urine.
What is the most appropriate test for monitoring unfractionated heparin therapy?
The most appropriate test is the anti-factor Xa assay.
What is the appropriate diagnostic step for a man with a new nondiminishing right-sided varicocele?
CT of the abdomen and pelvis.
What is the diagnosis for a thrombotic event occurring in the context of persistently positive lupus anticoagulant?
Antiphospholipid syndrome.
What is polycythemia vera?
Polycythemia vera is a myeloproliferative neoplasm.
What is ‘Polycythemia vera’?
It is a myeloproliferative neoplasm (MPN) characterized by increased red-cell mass, elevated hemoglobin, erythromelalgia (red hot painful extremities), pruritus, and a low serum erythropoietin level.
What are the common symptoms of Polycythemia vera?
Common symptoms include increased red-cell mass, elevated hemoglobin, erythromelalgia (red hot painful extremities), pruritus, and a low serum erythropoietin level.
What percentage of cervical cancer cases are squamous-cell carcinomas?
Squamous-cell carcinomas comprise about 80% of all cervical cancer cases.
What is the most common initial test for Heparin-Induced Thrombocytopenia (HIT)?
The most common initial test for HIT is an enzyme-linked immunosorbent immunoassay (ELISA) that identifies the presence of antiplatelet factor 4 antibodies in serum.
What are the functional assays used to test HIT antibodies?
The functional assays used to test HIT antibodies are the heparin-induced platelet aggregation (HIPA) assay and the serotonin release assay (SRA).
What is Felty syndrome?
Felty syndrome is a condition that can develop in about 1% of patients with rheumatoid arthritis, characterized by the classic triad of rheumatoid arthritis, splenomegaly, and neutropenia.
How can low-risk neutropenia and fever be managed?
Low-risk neutropenia (lasting no more than 7 to 10 days in the absence of other underlying conditions) and fever can be managed with ciprofloxacin and amoxicillin-clavulanate.
What is the recommended management for a patient taking apixaban with life-threatening bleeding?
The recommended management is reversal with andexanet alfa or prothrombin complex concentrate.
In what clinical settings is reversal of anticoagulant recommended?
Reversal of the anticoagulant is recommended in clinical settings such as bleeding at a critical site where there is a high risk that the function of a vital organ will be compromised with resulting disability or death.
What are examples of critical sites for bleeding?
Examples of critical sites for bleeding include intracranial, thoracic, airway, pericardial, intra-abdominal (nongastrointestinal), and retroperitoneal.
What is intra-abdominal bleeding?
Bleeding that occurs within the abdominal cavity but is not related to the gastrointestinal tract.
What is retroperitoneal bleeding?
Bleeding that occurs in the retroperitoneal space, which is the area behind the peritoneum.
What is intra-articular bleeding?
Bleeding that occurs within a joint space.
What is major bleeding?
Bleeding that is life-threatening and fails to respond to initial control measures.
What is a serum tryptase level indicative of?
A serum tryptase level >20 ng/mL in the absence of an associated myeloid disorder is one of the minor diagnostic criteria for systemic mastocytosis.
What is the target urine output for TLS management?
A loop diuretic can be added to achieve a target urine output of around 150–200 mL/hour for most adults.
What treatment may help ITP patients who relapse or are unresponsive to dexamethasone?
They may respond to intravenous immunoglobulin stimulation of platelet production.
What are eltrombopag and romiplostim used for?
They are used for stimulating platelet production in patients with ITP.
What is the role of immunosuppression in ITP treatment?
Immunosuppression with agents like rituximab may be used for ITP patients.
When is splenectomy reserved?
Splenectomy is reserved for patients refractory to medical management.
What infections are associated with Burkitt lymphoma?
Epstein-Barr virus infection is associated with Burkitt lymphoma.
What is characterized by plasma cells in the bone marrow?
Multiple myeloma is characterized by plasma cells in the bone marrow.
What is usually associated with multiple myeloma?
It is usually associated with an Ig(G/M) paraproteinemia.
What are the first-line treatments for symptomatic anemia in low-risk myelodysplastic syndrome?
The most appropriate first-line treatments are erythropoietin and transfusion support.
What is the management for cancer pain crisis with opioid-induced neurotoxicity?
The most appropriate management is opioid rotation with dose reduction to account for incomplete cross-tolerance.
What are essential features of the cancer-associated hypercoagulable state?
Venous thrombophlebitis and arterial thromboembolism are essential features.
What is related to chronic DIC?
Cancer-associated hypercoagulable state is related to chronic DIC.
What does CHOP stand for?
CHOP stands for cyclophosphamide, doxorubicin, vincristine, and prednisone.
What chemotherapy agents are appropriate for large-cell lymphomas?
Doxorubicin, vincristine, and prednisone with or without rituximab.
What is not appropriate for CLL?
Chemotherapy with doxorubicin, vincristine, and prednisone.
What condition is indicated by tenderness of the breast one month into adjuvant radiation therapy?
Radiation-induced dermatitis.
What assays test the ability of a patient’s HIT antibodies to activate test platelets?
Heparin-induced platelet aggregation (HIPA) assay and the serotonin release assay (SRA).
What is the next step in a patient with borderline-low vitamin B12 and high-normal folate levels?
Measurement of serum methylmalonic acid and homocysteine levels.
What are the most common primary tumors that metastasize to the brain?
Lung cancer, melanoma, renal-cell carcinoma, and breast cancer.
How is suspected heparin-induced thrombocytopenia managed?
Discontinuation of heparin and initiation of anticoagulation with a direct thrombin inhibitor such as argatroban.
What is the first-line treatment for immune thrombocytopenia?
Steroids or alternatively IVIG.
What is contraindicated in a patient with thrombosis using warfarin alone?
Because acute depletion of protein C can precipitate a thrombotic event.
What is the first-line therapy for hairy-cell leukemia?
Cladribine.
What is secondary hemostasis?
Stabilization of the platelet plug (white thrombus) by creating a fibrin network.
What characterizes TTP?
Deficiency of ADAMTS13.
What is TTP characterized by?
TTP is characterized by deficiency of ADAMTS13.
What is ADAMTS13?
ADAMTS13 is a plasma protease that normally cleaves ultra-large von Willebrand factor multimers.
Why is iron deficiency common in dialysis patients?
Iron deficiency is common in dialysis patients because of frequent blood testing and blood lost from the procedure.
What is the most appropriate management for a patient with symptomatic chemotherapy-induced anemia?
The most appropriate management is transfusion of packed red cells.
Are there specific hemoglobin and hematocrit thresholds for red-cell transfusion in patients with asymptomatic anemia?
Yes, there are specific thresholds for red-cell transfusion in patients with asymptomatic anemia.
Are there thresholds for red-cell transfusion in patients with symptomatic anemia?
No, there are no such thresholds for those with symptomatic anemia.
What has Bevacizumab been associated with?
Bevacizumab has been associated with significant improvements in overall survival among patients receiving carboplatin and paclitaxel for metastatic non-small-cell lung cancer.
How can TACO be treated?
TACO can be treated with oxygen and diuretics.
How can TACO be prevented?
TACO can be prevented by reducing the infusion rate.
What is required for further characterization of a poorly differentiated neoplasm diagnosed on fine-needle aspiration biopsy?
A core biopsy and immunohistochemical analysis are required.
What must be ruled out before considering malignancy in cases of reactive monocytosis?
Autoimmune conditions must be ruled out before malignancy is considered.
What causes Tumor Lysis Syndrome (TLS)?
TLS is caused by the release of the contents of malignant cells into the bloodstream, resulting in electrolyte abnormalities.
What electrolyte abnormalities may occur in TLS?
Electrolyte abnormalities may include hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.
What happens to hepatic production of hepcidin in patients with chronic inflammation?
Hepatic production of hepcidin is increased, which causes reduced iron absorption in the duodenum.
