Heme/Onc Flashcards
What does the S score in testicular cancer staging refer to?
Elevated serum tumor markers
How many stages are there for testicular cancer?
3
What is classic triad for renal cell carcinoma presentation?
Hematuria
Pain
Upper abdominal mass
What size of renal mass should always be treated as malignant?
> 3-4 cm
What histological type of renal cell carcinoma tends to have the better prognosis?
Papillary cell - tends to be lower stage at diagnosis
What size RCC can a partial nephectomy be considered over a total?
4 cm
What are primary immunotherapy agents for RCC?
Sunitinib, sorafenib, or bevacizumab
Or mTOR inhibitors such as everolimus or temairolimus
What is main chemotherapy agent used for treatment of CLL?
Fludarabine based chemo plus rituximab
What is main treatment of hairy cell leukemia?
Cladribine
What lymphoma is associated with a cyclin D1 and t(11;14) translocation?
Mantle cell lymphoma
What chemo regimen is now used to treat mantle cell lymphoma?
R-HYPERCVAD
What is chemo for Hodgkin lymphoma?
ABVD
Does elevated AFP in testicular cancer indicated seminoma or nonseminoma?
Nonseminoma
What is mycosis fungoides and Sezary syndrome forms of?
Cutaneous T cell non Hodgkin lymphoma
What is the most likely origin of tumor in a male with poorly differentiated carcinoma with bulky retro peritoneal or mediastinal LAD?
Likely unrecognized germ cell tumor - treat like testicular cancer with platinum based therapy
What cancer should be assumed if a woman presents with CUP involving single axillary lymph node?
Breast cancer
If a woman with abdominal carcinomatosis and ascites with CUP, what cancer is it assumed it is?
Ovarian
What thickness of melaninoma requires sentinel lymph node biopsy?
> 1 mm
What immunolomodulatory agent can be used for metastatic melanoma is BRAF gene mutation is positive?
Vemurafenib
What are two main chemo agents used for primary CNS tumors?
Carmustine
Temozolomide
Which type of cancer accounts for 65% of superior vena cava syndromes?
Lung
What are the most common cancers that cause spinal cord compression?
Breast
Lung
Prostate
Which cancers have the highest risk for developing hypercalcemia?
Multiple myeloma
Breast
Kidney
Lung
What valvular heart disease can cause an acquired form of Von willebrands disease?
Severe aortic stenosis
What factor deficiency is associated with isolated elevation in PT and normal PTT?
Factor 7
What does the thrombin clotting time differentiate between?
If concern for heparin contamination (prolonged time)
Also by low fibrinogen levels
Which type of hemophilia does desmopressin sometimes help?
Hemophilia A (factor 8 deficiency)
What conditions can give an acquired hemophilia?
Postpartum state
Malignancy
Autoimmune conditions
- due to an acquired inhibitor
What is normal lifespan of a platelet?
7-10 days
What skin finding on exam for thrombocytopenia confers higher risk of intracranial hemorrhage?
Wet purpura (petechia on mucous membranes)
What are common drugs that can induce ITP?
B lactam antibiotics Sulfa Vancomycin Quinine Cephalosporins
What test has mostly replaced the bleeding time in most hospitals?
Platelet Function Analyzer - 100
What herbal supplements impair platelet function?
Garlic
Ginseng
Chinese black tree fungus
What is Virchow’s triad?
Stasis
Vessel wall integrity
Hypercoagulability
What type of thrombosis does factor V Leiden predispose to - arterial or venous?
Venous
Which thrombophilia tests can be done at any time even if on anticoagulation?
Factor V Leiden
G20210A gene mutation
How long should anticoagulation be discontinued in patients who need thrombophilia testing?
2-4 weeks
Which factors does prothrombin complex concentrate have?
2, 9, 10
What type of DVT prophylaxis is preferred with trauma surgery?
LMWH
What is typical oral replacement dose for vitamin B12 deficiency?
1000-2000 ug/d
What is the most common form of congenital aplastic anemia?
Fanconi anemia
What cell ligands are deficient in PNH?
CD55 and CD59
What is primary treatment of aplastic anemia if older than age 40?
Antithymocyte globulin and cyclosporine
What common virus can cause a pure red cell aplasia?
Parvo B19
What tumor in the chest can cause a pure red cell aplasia?
Thyoma
What condition has pure red cell aplasia with CD57+ T cell clonality?
Large granular lymphocytosis
What syndrome is characterized by:
Rheumatoid arthritis
Splenomegaly
Neutropenia
Felty syndrome
What syndrome can have hypolobulated neutrophils?
Muelodysplastic syndrome
What is chemo agent used to treat MDS?
Azacitidine
An elevated hematocrit with microcytosis is pathognomonic for what disorder?
Polycythemia Vera
Is epo level high or low in PV?
Low or undetectable
What are potential treatment agents for essential thrombocytosis?
Anagrelide - watch for side effect of heart failure and arrhythmias
Hydroxyurea -1st line
What leukemia is Sweet syndrome associated with?
AML
What form of AML has increased association with DIC?
APL
What additional chemo agent is added to APL treatment?
ATRA
What is chemo regimen for AML?
7-3 treatment
7 days cytarabine followed by 3 days anthraxycline
What leukemia is associated with a t(15:17) translocation?
APL
What complication of AML/APL treatment presents with pulmonary infiltrates, edema, hypotension, dyspnea and fever?
Differentiation syndrome - treat with dexamethasone
What percent of lymphoblasts on bone marrow biopsy gives diagnosis of ALL?
> 25%
What is typical chemo treatment for ALL?
Anthracycline
Vincristine
L-asparginase
Prednisone
What size of renal mass is usually treated with just observation?
What platelet count in pregnancy requires further monitoring or work up?
What is goal platelet count in ITP and pregnancy?
30-40,000 until delivery then >50000 to prevent bleeding complications
When does the increased risk of VTE due to pregnancy resolve after delivery?
6-12 weeks post partum
What trimester MUST warfarin be avoided?
1st avoid weeks 6-12!
What drug can be added to lung adenomacinoma if EGFR mutation positive?
Erlotinib
What chemo agent can treat GIST?
Imatinib (gleevac)
Which is more likely to cause hyperviscosity syndrome - MM or waldenstroms macroglobinemia?
Waldenstroms - IgM is pentamer which is bigger immunoglobulin
What percent clonal cells are needed to diagnosis MM?
> 10%
What M protein level is consistent with MGUS?
1.5-3.0 g/dL
What agents are used to treat multiple myeloma?
Thalidomide
Lenalidode
Melphalan
Bortezomib
Which drug used to treat MM is contraindicated if HSCT is being considered in future?
Melphalan- stem cell toxicity
What clotting factor deficiency can be seen with amyloidosis?
10
What is typical chemo treatment for ALL?
Anthracycline
Vincristine
L-asparginase
Prednisone
What platelet count in pregnancy requires further monitoring or work up?
What is goal platelet count in ITP and pregnancy?
30-40,000 until delivery then >50000 to prevent bleeding complications
What is main treatment of amyloidosis?
Melphalan and dexamethasone
What immunoglobulin is elevated in Waldenstroms macroglobulinemia?
IgM
What conditions cause target cells on peripheral smear?
Liver disease
Thalassemias
Splenectomy
What causes teardrop cells in peripheral smear?
Myelofibrosis/marrow infiltration
What causes bite cells on peripheral smear?
G6PD deficiency
What causes burr cells?
Kidney disease
What causes spur cells?
Severe liver disease
How do you calculate reticulocyte count?
Percent reticulocyte count x patient hematocrit/45 x0.5
What condition commonly has low hepcidin levels?
Iron deficiency anemia
What is major complications of treatingn with erythropoietin stimulating agents?
Hypertension
Thrombosis
What type of immunoglobulin causes warm hemolytic anemia?
IgG
What immunoglobulin causes cold hemolytic anemia?
IgM
When does the increased risk of VTE due to pregnancy resolve after delivery?
6-12 weeks post partum
What trimester MUST warfarin be avoided?
1st avoid weeks 6-12!
What drug can be added to lung adenomacinoma if EGFR mutation positive?
Erlotinib
What chemo agent can treat GIST?
Imatinib (gleevac)
Which is more likely to cause hyperviscosity syndrome - MM or waldenstroms macroglobinemia?
Waldenstroms - IgM is pentamer which is bigger immunoglobulin
What percent clonal cells are needed to diagnosis MM?
> 10%
What M protein level is consistent with MGUS?
1.5-3.0 g/dL
What clotting factor deficiency can be seen with amyloidosis?
10
Which drug used to treat MM is contraindicated if HSCT is being considered in future?
Melphalan- stem cell toxicity
What agents are used to treat multiple myeloma?
Thalidomide
Lenalidode
Melphalan
Bortezomib
What monoclonal antibody can be used to treat paroxysmal nocturnal hemoglobinuria?
Eculizumab
What infection is increased risk if using eculizumab to treat PNH?
Neisseria - needs meningitis vaccine!
What is The most sensitive test for hemochromatosis?
Transferrin saturation - if > 60% in men or 50% in women suggestive
What pre-treatment to blood products can help prevent febrile transfusion reactions?
Leukoreduction
What pre-treatment of blood products can help prevent allergic reactions?
Washing of cellular blood products
What pre-treatment can help prevent anaphylaxis to blood products?
Washing cellular products
IgA deficient donor
Which type of donors of blood products may cause increased risk of TRALI?
Multifarious women as blood donor
What pre treatment of blood products can help prevent t-GVHD?
Gamma irradiation
How much should 1 unit of platelets raise the platelet count?
20-30,000
What is the best way to dose FFP?
10-15 ml/kg. there are 200-300 ml per unit FFP
What is recommended dose of cryoprecipitate?
1-2 units per 10 kg
What factors are in cryoprecipitate?
8, vWF, 13, fibronectin, fibrinogen
How long after blood product transfusion do you expect a delayed hemolytic transfusion reaction?
5-10 days
What is a TACO?
Transfusion associated circulatory overload - dyspnea, cough, tachycardia, cyanosis and Pulm edema within 1-2 hrs of transfusion
What are indications for using erythrocytapheresis?
Sickle cell acute chest syndrome
Malaria
Babesia infections
What 2 drugs have been studied as prophylaxis for primary invasive breast cancer?
SERMs - tamoxifen and raloxifene
SE - increased endometrial cancer, thrombosis, cataracts
What is primary treatment for DCIS breast cancer?
Lumpectomy plus radiation or mastectomy
Plus hormone therapy x 5 years with tamoxifen
What tumor size characterized stage 1 breast cancer?
What is standard drug treatment added for hormone receptor positive breast cancer tumors in pre menopausal women?
Tamoxifen
What is standard drug treatment added for hormone receptor positive breast cancer tumors in post menopausal women?
aromatase inhibitor such as anastrozole
What is treatment alternative for premenopausal women with breast CA if tamoxifen is contraindicated (ie h/o VTE or endometrial CA)?
Ovarian ablation
What chemo agent is the single most effective agent in colorectal cancer?
5-FU
Usually use FOLFOX regimen
What is primary chemo agents for anal cancer?
Mitomycin plus 5-FU
Plus radiation
What is most common agent used for pancreatic cancer?
Gemcitabine +/- FOLFIRINOX
What is the most common site of carcinoid tumor?
Appendix
What kind of lung cancer is associated with hypercalcemia and PTHrP?
NSCLC
Which type of lung cancer tends to be located peripherally?
NSCLC
What change in FEV1 is associated with a positive bronchodilator challenge test?
Falls 20% from baseline
What are the main adverse side effects of theophylline?
Cardiac arrhythmias and seizures
What part of the lungs is primarily affected by alpha 1 anti trypsin deficiency?
Bases
What is the most common cause of a macrocytic anemia with MCV >115?
Megaloblastic diseases ie MDS
Is MCV typically normal, elevated, or low in hemolytic anemia?
Elevated
When should you check for G6PD activity following an acute hemolytic event?
2-3 months later, can be falsely normal right after a hemolytic event
What is potential complication of using meperidine in sickle cell disease?
Accumulation of metabolites that lead to seizures
What platelet count in pregnancy requires further monitoring or work up?
What condition is a contraindication for using lepirudin?
Kidney disease
What condition is a contraindication to using argatroban?
Hepatic dysfunction
What is treatment of Sezary syndrome (t cell lymphoma of blood/bone marrow?)
Alemtuzumab
What size of renal mass is usually treated with just observation?
What is standard chemo regimen for anal cancer?
Mitomycin plus 5-FU
What chemo agent is the single most effective agent in colorectal cancer?
5-FU
Usually use FOLFOX regimen
What is primary chemo agents for anal cancer?
Mitomycin plus 5-FU
Plus radiation
What is most common agent used for pancreatic cancer?
Gemcitabine +/- FOLFIRINOX
What is the most common site of carcinoid tumor?
Appendix
What kind of lung cancer is associated with hypercalcemia and PTHrP?
NSCLC
Which type of lung cancer tends to be located peripherally?
NSCLC
What change in FEV1 is associated with a positive bronchodilator challenge test?
Falls 20% from baseline
What are the main adverse side effects of theophylline?
Cardiac arrhythmias and seizures
What part of the lungs is primarily affected by alpha 1 anti trypsin deficiency?
Bases
What is the most common cause of a macrocytic anemia with MCV >115?
Megaloblastic diseases ie MDS
Is MCV typically normal, elevated, or low in hemolytic anemia?
Elevated
When should you check for G6PD activity following an acute hemolytic event?
2-3 months later, can be falsely normal right after a hemolytic event
What is potential complication of using meperidine in sickle cell disease?
Accumulation of metabolites that lead to seizures
What platelet count in pregnancy requires further monitoring or work up?
What condition is a contraindication for using lepirudin?
Kidney disease
What condition is a contraindication to using argatroban?
Hepatic dysfunction
What is treatment of Sezary syndrome (t cell lymphoma of blood/bone marrow?)
Alemtuzumab
