Heme/ Onc Flashcards
A child presents with petechiae and low platelets a few weeks after a URI. How would you treat?
observation; if the child is not bleeding no IVIG or steroids are needed because ITP is self-limited in children
what are complications of multiple myeloma
renal failure, hypercalcemia, hyperviscosity syndrome
what are the symptoms of fanconi anemia and how is diagnosis confirmed
sx=aplastic anemia, progressive bone marrow failure, short stature, microcephaly, curved thumbs, hypogonadism, skin pigmentation abnormalities, low-set ears, middle ear hemorrhages/infections/deafness, horseshoe kidney; dx confirmed via chromosomal breaks on genetic analysis
what is the most common complication of sickle cell trait
painless hematuria
what is Diamond-Blackfan anemia
a pure red blood cell aplasia that presents at around 3-12 months, macrocytic anemia, WBC and platelet counts are normal
associated congenital abnormalities include webbed neck, short stature, crested chest and triphalyngeal thumbs
if a patient becomes pancytopenic after drug, toxin or viral exposure you should suspsect what
acquired aplastic anemia
various sites of venous thrombosis in the arms and chest should suggest what condition and what associated disease
Trousseau’s syndrome= hypercoagulable disorder presenting with superficial thrombophlebitis in the chest and upper extremities
Trousseau’s syndrome is associated with occult visceral malignancies
at what size would you want to consider biopsy of a lymph node palpated on physical exam
lymph node greater than 2cm (or firm/immobile)
describe Wiskott-Aldrich syndrome (inheritance pattern and triad of symptoms)
Wiskott-Aldrich is an X-linked disorder characterized by eczema, thrombocytopenia and hypogammaglobulinemia (leading to recurrent bacterial infections)
what is hyposthenuria
inability to concentrate the urine; seen in sickle cell and sickle cell trait; due to sickling of vasa recta of medulla of kidney impairing countercurrent exchange and water reabsorption
“soap bubble”-appearing lesion in the epiphysis of a long bone should make you think of what disease
Giant cell tumor
what happens to calcium, phosphate, potassium and uric acid in tumor lysis syndrome
Ca= decreased (bound up by excess phosphate), Phosphate=elevated; potassium= elevated; uric acid=elevated
what is used to treat DVT caused by homocysteinemia?
vitamin B6 and folate (cofactors for conversion to cysteine)
what is the paraprotein gap usually like for patients with multiple myeloma
increased (i.e. difference between total protein and albumin=greater than 3-4g/dL)
what are the two main manifestations of paroxysymal nocturnal hemoglobinuria
- hemolytic anemia
2. vein thromboses (intraabdominal, intracranial)
what is the most common cause of megaloblastic anemia in chronic alcoholics
folate deficiency (not B12 deficiency)
what is the drug of choice for treating cancer-related cachexia and anorexia
progesterone analogs
what are the symptoms of a pinealoma
- Parinaud’s (ptosis, downward gaze, pupil constriction to accomodation only, upper eyelid retraction)
- obstructive hydrocephalus
- precocious puberty for beta-HCG secreting tumors
what is first-line therapy for chemo-induced vomiting/nausea and what is its mechanism of action
zofran (odansetron): a serotonin 5HT^3 antagonist
after exposure/wound, when should tetanus toxoid vaccine vs. tetanus immunoglobulin
tetanus immunoglobulin should only be given if the wound is severe/dirty AND the patient does not have complete vaccination (>3 toxoid doses), to be given along with toxoid vaccine
just the toxoid vaccine should be given for minor wounds and for patients with incomplete immunization history
how do ACE inhibitors predispose to acquired angioedema
at ANY point in the use of ACE inhibitors angioedema can occur due to inhibition of bradykinin breakdown; bradykinin promotes edema
should vaccines for premature infants be given according to gestational age or chronological age
chronological age; as long as the premature infant is stable and weight >2kg, vaccines should be given by how old the infant is rather than how long the pregnancy was
what is the workup algorithm for a solitary pulmonary nodule
CXR (compare with previous) –> CT scan; if benign do serial CTs to monitor, if indeterminate do biopsy or PET, if highly suspicious for malignancy do surgical excision
which pneumococal vaccine produces immunity via T-cell dependent vs. T-cell independent B cell memory
PCV-13 is conjugated and therefore produces a more robust T-cell dependent B cell response whereas PPSV-23 is just polysaccharide and works via T-cell independent mechanism (not as good for kids/elderly)
is a seizure after DTaP administration a contraindication to subsequent vaccinations
no; only anaphylaxis, encephalopathy and unstable neurologic disorders
what is the cause of hyperIgM syndrome
X-linked defect of CD40 ligand leading to inability to class switch
what factors comprise a high risk solitary pulmonary nodule (these must be surgically excised)
size greater than or equal to 2cm
age older than 60
current smoker or quit less than 5 years ago
corona radiata or spiculated
what are the side effects of erythropoetin therapy
worsening hypertension, headache, flu-like syndrome, red cell aplasia
how can you differentiate between iron deficiency anemia and thalassemia (both are microcytic anemias)
RDW is high in iron deficiency anemia and normal in thalassemias
what two things distinguish Waldenstrom’s macroglobulinemia from multiple myeloma
- IgM spike (vs. IgG or IgA in MM)
2. hyperviscosity (think MACROglobulinemia)
in a patient with malignancy who develops sudden onset severe back pain with neuropathies what is the condition and management algorithm
epidural spinal cord compression
severe vs. not-severe: if severe get emergency MRI and give steroids –> radiation or surgery if indicated by MRI
if not severe get an MRI within 24 hours
if no myelopathy just get an x-ray –> MRI if indicated
characteristic symptoms of graft vs. host disease
can occur at any time and involves activation of donor T lymphoctyes;
sx= maculopapular rash involving face, hands and soles; bloody diarrhea; jaundice
what are the complications of sickle cell trait
gross hematuria due to renal papillary necrosis (which also results from tylenol, diabetes, acute pyelo), UTI’s and renal medullary carcinoma
fever, leukocytosis and left upper quadrant pain with associated splenomegaly and pleural effusion is most likely what?
what are the common etiologies of this condition?
splenic abscess; can be due to infective endocarditis, trauma, IVDU, immunosuppression, hemoglobinopathies
fever, chills, and deep abdominal pain suggest what
retroperitoneal abscess
what are the clinical features of cholesterol emboli
livedo reticularis, blue toe syndrome, gangrene/ulcers, stroke, amaurosis fugax, acute or subacute kidney injury, intestinal ischemia, pancreatitis, Hollenhorst plaques
what are the lab findings for cholesterol emboli
elevated creatinine, eosinophilia, hypocomplementemia
eosinophiluria
what two diseases should a patient with isolated thrombocytopenia be tested for
HIV and Hep C can present as ITP
a child with isolated thrombocytopenia after a viral URI likely has what condition? how do you treat it if it is uncomplicated vs. complicated by active bleeding?
immune thrombocytopenia (ITP)
observation only if uncomplicated (resolves in 6 months)
treat with IVIG or steroids if c/b bleeding
note: adults should get IVIG or steroids for platelets
which drugs cause acute pancreatitis
diuretics (furosemide and HCTZ), antibiotics (metronidazole, tetracyclines), drugs for IBD (mesalamine, sulfasalazine), azathioprine, HIV drugs (didanosine, pentamidine)
what is the classic triad of disseminated gonococcemia
polyarthralgias, tenosynovitis, painless vesicopustular lesions
how do you tell the difference between iron deficiency anemia and thalassemia
RDW: iron deficiency anemia will have a high red cell distribution width due to poikilocytosis as smaller cells are being produced in an iron-deficient state
in thalassemias the RDW is normal
