Heme Onc

Question 1

Monitor heparin vs warfarin

Answer 1

heparin: PTT (intrinsic via antithromb III)
warfarin: PT (extrinsic via vit K)

Question 2

Hemophelia A, B, C factor deficiencies and tx

Answer 2

A: VIII
B: IX
C: XI
Tx: transfusion of cryoprecipitate (VIII, fibrinogen)
DDAVP for mild (+ fluid restriction)

Question 3

Ristocetin assay

Answer 3

test for vWF, measures ability to agglutinate platelets

Question 4

Deficiencies: Bernard soulier, glanzmann thormbasthenia

Answer 4

Bernard Soulier: GpIb

Glanzmann: GpIIb/IIIa

Question 5

Long term tx of DVT

Answer 5

1st: 3-6mo warfarin
2nd: 6-12 mo
3rd+: lifelong warfarin

Question 6

DIC vs severe liver disease

Answer 6

Factor VIII depressed in DIC

Question 7

3 causes microangiopathic hemolytic anemia

Answer 7

HUS (incr creat)
TTP
DIC (abn clotting, incr PT/PTT/ d-dimer)

Question 8

Tx: TTP vs ITP

Answer 8

TTP: plasmapheresis, plasma replacement, steroids
ITP: corticosteroids, IVIG, splenectomy

Question 9

B12 vs folate deficiency: labs

Answer 9

B12: incr MMA and homocysteine
folate: normal MMA, incr homocysteine

Question 10

cafe au lat spots, short stature, thumb hypoplasia, anemia

Answer 10

fanconi anemia

Question 11

health maintenance for sickle cell

Answer 11

folate suppl, pneumo vax,

Question 12

Tx: acute chest syndrome

Answer 12

hydration, incentive spirometry, sickle variant

Question 13

Tx of polycythemia vera

Answer 13

cytoreductive drugs (eg hydroxyurea, IFN), ASA for prothrombotic

Question 14

How distinguis leukemoid rxn vs leukemia

Answer 14

LAP: high in leukemoid rxn, low in leukemia

Question 15

photodermatitis, neuropsych, colicky abd pain: dx and tx

Answer 15

porphyria

glucose to decr heme synth

Question 16

Auer rod on smear: dx and tx

Answer 16

AML type M3, ATRA

Question 17

WBC >100,000 with TIA/ other blood vessel occlusion: dx and tx

Answer 17

leukostasis

hydroxyurea +/- leukopheresis

Question 18

smudge cells: dx, workup, tx

Answer 18

CLL
CD5+CD20/21+
Tx when symptomatic: chemo, radiation

Question 19

TRAP + staining: dx and tx

Answer 19

hairy cell leukemia

Tx: cladribine (nucleoside analog), IFNa, spelectomy

Question 20

Dx and classification of NHL

Answer 20

excisional bx of LN
# of nodes and sides of diaphragm involved

Question 21

B symptoms, pruritis, hepatosplenomegaly, weekly fevers, alcohol-induced pain: dx and tx, prognostic factors

Answer 21

Hodgkin’s disease
excisional LN biopsy: Reed-sternberg cells
Chemo and/or radiation; lymphocyte predominant= best prognosis

Question 22

Anemia, renal failure, bone pain: what must be ruled out, tx

Answer 22

multiple myeloma (>10% plasma cells in BM, M protein, lytic bone lesions)
Tx: melphalan, prednisone

Question 23

Marrow shows dutcher bodies (PAS+ deposits around nucleus)

Answer 23

Waldenstrom’s

tx: remove excess Ig with plasmapheresis

Question 24

Common causes sepsis for neutropenia, tx

Answer 24

S. aureus, Psuedomonas, E coli, proteus, klebsiella

tx: cefepime

Question 25

Hematuria and eosinophilia

Answer 25

shcistosomiasis

Question 26

Neoplasms assoc with tuberous sclerosis

Answer 26

astrocytoma

cardiac rhabdomyoma

Question 27

Neoplasm assoc with plummer-vinson

Answer 27

SCC of esophagus