heme/onc 4 Flashcards
What causes blockage of iron release from macrophages?
Chronic liver disease and an elevated serum alpha-fetoprotein level.
What are the characteristic imaging findings of HCC?
They are sufficiently specific and obviate the need for tissue diagnosis.
What is LCIS nearly always positive for?
Estrogen receptor.
What does chemoprevention usually rely on?
The use of tamoxifen, a selective estrogen receptor modulator.
What is Tumor Lysis Syndrome (TLS) caused by?
Release of the contents of malignant cells into the bloodstream.
What electrolyte abnormalities may result from TLS?
Hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.
What can iron overload from transfusion-related etiologies lead to?
End-organ dysfunction, especially in the liver and myocardium.
How often should patients with smoldering MM managed with observation undergo surveillance testing?
Every 2 to 3 months after initial diagnosis.
What should be monitored for stable patients with smoldering MM?
Every 4 to 6 months for one year.
What should be administered to patients on hemodialysis?
Iron should be administered (IV/PO).
What findings are consistent with pseudothrombocytopenia?
Thrombocytopenia, lack of bruising or bleeding, and a peripheral-blood smear showing platelet clumping.
What causes pseudothrombocytopenia?
Naturally occurring antibodies.
What causes naturally occurring antibodies directed against an epitope on glycoprotein IIb/IIIa?
They are caused by naturally occurring antibodies directed against an epitope on glycoprotein IIb/IIIa that is exposed by the anticoagulant ethylenediaminetetraacetic acid.
What is the recommended target hemoglobin level for anemic patients on dialysis?
Most clinicians recommend a target hemoglobin level no higher than 11.5 g/dL for anemic patients on dialysis.
From where can squamous-cell carcinomas originate?
Squamous-cell carcinomas can originate from the skin, the mucosa of the upper aerodigestive tract, and the cervix.
What does pancytopenia without peripheral blood smear evidence suggest?
Pancytopenia without peripheral blood smear evidence of dysplasia or circulating blasts in an otherwise healthy patient is suggestive of aplastic anemia.
When should orchiopexy be performed for patients with cryptorchidism?
Orchiopexy before puberty reduces the risk for testicular cancer to a greater extent than orchiopexy after puberty.
Is orchiopexy necessary immediately after birth?
Orchiopexy is not necessary immediately after birth because about half of cryptorchid testicles will descend spontaneously within the first 6 months of life.
What is the best approach to breast cancer screening for young women with a high lifetime risk?
The best approach for breast cancer screening for young women who have a lifetime breast cancer risk of at least 20% to 25% is annual MRI in addition to annual mammography.
What is the sensitivity of MRI compared to mammography in young women with increased mammographic density?
MRI has better sensitivity in young women with increased mammographic density, while mammography is superior in detecting microcalcifications associated with ductal carcinoma in situ.
How long is anticoagulation extended for patients undergoing total hip arthroplasty?
For major ortho surgery, anticoagulation is extended for up to 6 weeks for patients undergoing total hip arthroplasty.
What does beta-thalassemia lead to?
Beta-thalassemia leads to abnormal erythrocytes that express procoagulant phospholipids, activated clotting factors, and activated platelets, all of which predispose patients to thrombosis.
What are the symptoms of chronic radiation proctitis?
Chronic radiation proctitis commonly has the symptoms of fecal urgency, tenesmus, and anal bleeding.
What are the symptoms associated with TTP?
TTP is associated with a pentad of symptoms: thrombocytopenia, microangiopathic hemolytic anemia, neurologic abnormalities, acute kidney injury, and fever.
What is the appropriate colorectal surveillance option after a partial colectomy for stage I colon cancer?
The appropriate colorectal surveillance option for a patient who has undergone a partial colectomy for stage I colon cancer is colonoscopy one year after the colectomy.
What is the test used in the workup of prolonged PTT?
The test used in the workup of prolonged PTT is a mixing study where the patient’s plasma is mixed with normal plasma in vitro.
How is aplastic anemia confirmed?
Aplastic anemia is confirmed with a bone marrow biopsy.
What effect does the addition of eltrombopag have on aplastic anemia therapy?
The addition of eltrombopag to standard aplastic anemia therapy has been shown to increase the efficacy.
What do IgM antibodies bind to on erythrocytes?
IgM antibodies bind to polysaccharides on erythrocytes.
What binds to polysaccharides on erythrocytes?
Cold agglutinin
Causes cold agglutinin hemolytic anemia.
What is a tumor marker typically elevated in patients with seminoma?
Human chorionic gonadotropin.
What does the presence of new monoclonal gammopathy suggest?
An infiltrating disorder, particularly AL amyloidosis.
What does the diagnostic workup for squamous-cell carcinoma of the head and neck include?
Direct laryngoscopy, examination under anesthesia, and concurrent bilateral tonsillectomy.
What may a persistently low platelet count despite repeated platelet transfusions indicate?
Immunologically mediated refractoriness, warranting screening for human leukocyte antigen antibodies.
What should therapeutic phlebotomy for a patient with hereditary hemochromatosis continue until?
Ferritin level is brought into the lower end of the normal range.
What is the most appropriate treatment for a patient with transfusion-induced iron overload with evidence of end-organ dysfunction?
Iron chelation therapy with a treatment such as deferasirox.
What should patients newly diagnosed with adenocarcinoma of the lung and who have never smoked be tested for?
Epidermal growth factor receptor mutations and certain other important driver mutations.
What are absolute basophilia and eosinophilia often present together with?
True.
What results from hereditary spherocytosis?
Diminished compliance of the cell and degradation by the spleen, resulting in splenomegaly, anemia, and jaundice.
When should first-degree relatives of patients who develop colorectal cancer before age 60 start screening?
At either age 40 or 10 years before the age at which the index case was diagnosed, whichever comes first.
What are the most common malignant tumors in men aged 25 to 35?
Testicular tumors.
What level is elevated in folate deficiency?
Homocysteine level, but not the methylmalonic acid level.
What are gastrointestinal stromal tumors (GIST)?
A type of tumor that occurs in the digestive tract.
Where can cancer occur in the gastrointestinal tract?
Cancer can occur throughout the gastrointestinal tract, most commonly in the stomach.
At what age is cancer most often diagnosed?
Cancer is most often diagnosed in adults aged 50 or older.
What is the cancer typically associated with parathyroid hormone-related peptide?
The cancer typically associated with parathyroid hormone-related peptide is squamous-cell carcinoma of the lung.
What is Gaucher disease?
Gaucher disease is the most common lysosomal storage disease.
What type of genetic disorder is Gaucher disease?
Gaucher disease is an autosomal recessive disorder.
What causes Gaucher disease?
Gaucher disease is caused by a deficiency of the glucocerebrosidase enzyme, leading to the accumulation of glycolipids.
What is included in the diagnostic workup for squamous-cell carcinoma of the head and neck?
The diagnostic workup includes direct laryngoscopy examination under anesthesia and concurrent bilateral tonsillectomy.
What should be suspected in a patient with pulmonary symptoms who has been recently irradiated?
Radiation pneumonitis should be suspected.
What is von Willebrand disease?
Von Willebrand disease is diagnosed by lifelong mucosal bleeding in a patient with a prolonged activated partial-thromboplastin time.
What is commonly associated with TRALI?
TRALI is more commonly associated with hypotension and normal central venous pressure.
What should be done for a patient with von Willebrand disease who continues to bleed despite prophylaxis?
The patient should be treated with von Willebrand factor concentrate.
What is chronic radiation proctitis?
Chronic radiation proctitis is one of the most common toxicities of radiation therapy for prostate cancer.
What anticoagulants are effective in preventing recurrent venous thromboembolism in cancer patients?
Low-molecular-weight heparin and direct oral factor Xa inhibitors have the most evidence to support their efficacy.
What is required for a diagnosis of acute lymphoblastic leukemia?
A diagnosis of acute lymphoblastic leukemia generally requires the presence of at least 20% blasts in the bone marrow.
What is required for a diagnosis of acute lymphoblastic leukemia?
The presence of at least 20% bone-marrow lymphoblasts.
What is characteristically seen in patients of certain ethnicities regarding neutrophil counts?
Asymptomatic isolated absolute neutrophil counts below the laboratory reference range.
Which ethnicities typically do not express the Duffy allele?
People of African descent.
What condition may occur in patients with persistently positive lupus anticoagulant?
A thrombotic event.
What antibodies are associated with antiphospholipid syndrome?
Anticardiolipin antibody and β2-glycoprotein antibody.
What is the recommended screening for people aged 50 to 80 with a history of smoking?
Annual screening with low-dose chest CT.
What defines TACO in relation to transfusion reactions?
It may be distinguished from transfusion-related acute lung injury (TRALI) by the presence of hypertension and distended neck veins.
What is the most appropriate management of hypercalcemia of malignancy?
Aggressive volume repletion followed by either an intravenous bisphosphonate or denosumab.
What is the most common medical problem associated with G6PD deficiency?
Hemolytic anemia.
What is the appropriate management for severe abdominal pain in a patient with pancreatic cancer?
Neurolysis, such as a celiac plexus block.
What is the metaphysis in relation to bone structure?
It is the transitional zone at which the diaphysis (shaft) and epiphysis (end) of a bone come together.
What is a common side effect of radiotherapy for head and neck cancers?
Hypothyroidism within 5 years.
What should a unilateral right-sided varicocele raise concern for?
The possibility of obstruction from a retroperitoneal mass.
What is the most likely cause of new thrombocytopenia that develops during or shortly after hospitalization?
Drug-induced thrombocytopenia.
What is the use of topoisomerase inhibitors associated with?
No back content.
What are topoisomerase inhibitors?
Topoisomerase inhibitors, such as doxorubicin, can lead to leukemia occurring even earlier after treatment.
What is Beck’s triad?
Beck’s triad for pericardial effusion includes low systolic blood pressure, jugular venous distention, and muffled heart sounds.
What medications are used for bone pain from metastatic lesions?
Anti-inflammatory medications such as glucocorticoids and nonsteroidal anti-inflammatory drugs (NSAIDs) target the inflammatory component of this pain.
How does myelofibrosis differ from myelodysplasia?
Myelofibrosis is typically associated with splenomegaly and leukoerythroblastosis, with a low-grade reticulocytosis.
What is thrombotic thrombocytopenic purpura associated with?
Thrombotic thrombocytopenic purpura is classically associated with microangiopathy, thrombocytopenia, renal insufficiency, mental status changes, and fever.
What is secondary hemostasis?
Secondary hemostasis is the stabilization of the platelet plug (white thrombus) by creating a fibrin network.
What is recommended for patients receiving primary therapy for multiple myeloma with skeletal lesions?
They should be considered candidates for at least 2 years of treatment with an osteoclast inhibitor such as an intravenous bisphosphonate (e.g., zoledronic acid or pamidronate) or denosumab.
What does the National Comprehensive Cancer Network recommend after neck irradiation?
They recommend monitoring thyroid-stimulating hormone levels every 6 to 12 months.
What is Felty syndrome?
About 1% of patients with rheumatoid arthritis develop Felty syndrome, characterized by its classic triad of rheumatoid arthritis, splenomegaly, and neutropenia.
What mediates platelet aggregation?
Platelet aggregation is mediated by GpIIb/IIIa-receptor and fibrinogen.
What is the initial treatment for primary CNS lymphoma?
Once the diagnosis of primary CNS lymphoma has been established, initial treatment for most patients involves high-dose systemic chemotherapy.
What should be done for patients at high risk for lung cancer?
In patients at high risk for lung cancer, appropriate screening and monitoring should be conducted.
What can reduce mortality in patients at high risk for lung cancer?
Annual screening with low-dose CT can reduce mortality.
Example: In patients at high risk for lung cancer, mortality can be reduced by annual screening with low-dose CT.
What is characterized by a very low mean corpuscular volume?
Beta-thalassemia trait is characterized by a very low mean corpuscular volume.
Example: It is often in the 60s μm3.
What is the most appropriate treatment strategy in patients on hemodialysis with anemia?
To start an erythropoiesis-stimulating agent.
Example: This is particularly relevant for patients with anemia secondary to chronic kidney disease.
What types of cancers are associated with the lowest risk?
Smaller solid cancers and indolent lymphomas are associated with the lowest risk.
Example: These are contrasted with aggressive leukemias and cancers with large tumors.
