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Medicine Boards Jesse > Heme/Onc > Flashcards

Heme/Onc Flashcards

1
Q

CLL Staging

A

Stg I: Increased lymphocytes, possibly lymphadenopathy
Stg II: splenomegaly
Stg III: anemia
Stg IV: Thrombocytopenia

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2
Q

Bad prognostic signs in CLL

A 
Stg III or IV
B2 microglobulin >3.5
Unmutated heavy gene
ZAP 70 +
deletion of 17p
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3
Q

CLL treatment

A

Start if poor prognostic features or symptomatic
Treatment focus on fludarabine chemo with rituximab
Definitive treatment would be HSCT

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4
Q

Hormone therapy in breast cancer

A

For PRE-menopausal women need to use tamoxifen (blocks ER receptor)
For post-menopausal use aromatase inhibitors (peripheral conversion of androgen to estrogen)

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5
Q

Management of anal cancer

A

If it is Stg I, II or III best managed with radiation and chemotherapy (mitomycin plus 5-FU) rather than surgery

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6
Q

Management of rectal cancer

A

Surgery, if stg II or III treat with radiation and chemo before surgery. After surgery get FOLFOX.

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7
Q

Management of Hodgkin Lymphoma

A

Curable at all stages. Treat with ABVD (Doxo, bleomycin, vinblastine, and dacarbazine) and radiation. Rituximab can be used in lymphocyte predominant CD20+ variants.

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8
Q

Lung mets from CRC

A

If recurrent as a lung mass would resect it!

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9
Q

Treatment of ovarian cancer

A

Stage IA is just surgery alone. IC or higher would get adjuvant chemo. II and III would get intraperitoneal chemo as well.

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10
Q

Treatment of papillary thyroid cancer

A

If Stage III or IV needs treatment with radioactive iodine. Stg III tumors are >4 cm in size and and might have cervical lymph node involvement

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11
Q

Surveillance after Stg III CRC

A

CEA monitoring every 3-6 months
Colonoscopy in 1 year and then every 3-5 years
CT chest/ab/pelvis annually for 3-5 years

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12
Q

HIT management

A

Discontinue heparin

Anticoag with lepirudin, argatroban or danaparoid. Lepirudin is renally cleared. Argatroban is hepatically cleared

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13
Q

Management of Stg IV NSCLC

A

No radiation unless to a targeted met, chemo only

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14
Q

Diagnosis of Lynch syndrome (HNPCC)

A

3-2-1 rule for colon cancer and HNPCC:
3 affected family members
2 generations
1 under the age of 50

These patients should start screening by 20-25 years old or 10 years before first family member dx

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15
Q

Testicular cancer dx tests

A

Obtain:
alpha-fetoprotein (if present it is a NON-seminoma)
B HCG (either)
LDH

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16
Q

Management of gastric carcinoid tumors

A

Type I: Small

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17
Q

Alpha thalassemia trait presents as

A

Mild anemia, microcytosis, hypochromia, target cells and in ADULTS normal hemoglobin electrophoresis. B thalasemia will NOT have a normal hemoglobin electrophoresis

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18
Q

Danazol

A

can be used to treat primary myleofibrosis anemia

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19
Q

Treat acquired factor VIII deficency

A

Can use activated factor VII. Do not need to use FFP or cryo

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20
Q

Management of prostate Ca

A

If it has extended beyond the prostate, PSA >20 or Gleason 8 or 10 NOT a candidate for surgery. Use androgen deprivation and brachy therapy

21
Q

Beta thalassemia trait

A

microcytic, hypochromasia and target cells. Will have normal or slightly increased erythrocyte count

22
Q

Mentzer index

A

Ratio of MCV/erythrocyte count, 13 then iron def

23
Q

Recurrent breast cancer

A

Want to biopsy it to see what the receptor status is to see if they are suitable for hormone therapy, etc

24
Q

B12 v Folate deficency

A

with B12 both homocysteine and methylmalonic levels will be elevated

25
Q

Atra side effect

A

Can have ATRA induced differentiation syndrome which manifests as dyspnea, peripheral edema, wt gain, fever, hypotension, AKI, effusions. Treat with dexamethasone

26
Q

Hemophilia B

A

PT will be normal. aPTT will be prolonged and correct with a mixing study. Lack Factor IX

27
Q

Hemophilia A

A

PT will be normal. aPTT will be prolonged and correct with a mixing study. Lack factor VIII.

28
Q

Acquired factor VIII inhibitor

A

PT will be normal. aPTT will be prolonged and NOT fully correct with a mixing study,

29
Q

Hereditary spherocytosis

A

Will see sphereocytes (red balls), splenomegaly, leg ulcers, gallstones and family history of anemia

30
Q

Small cell lung cancer treatment

A

If patient responds to chemo and radiation would then give whole brain radiation

31
Q

Treatment of MALT

A

If H pylori positive treat for this first. If not responsive than can consider rituximab or chemotherapy

32
Q

Gastric carcinoid treatment

A

Type I and type II gastric carcinoids (associated with hypergastrinemia resulting from chronic atrophic gastritis or gastrinoma, respectively) account for approximately 70% to 80% of these tumors and have a relatively favorable prognosis. Endoscopic resection may be adequate for smaller lesions (≤2 cm)

33
Q

Aplastic anemia treatment

A
  • stem cell transplants for those
34
Q

Iron deficiency versus anemia of chronic disease

A
  • a serum ferritin of >100 rules out iron def
  • serum iron low in both
  • TIBC high in iron def, low in anemia of chronic disease
35
Q

An increased PT with normal aPTT

A

Factor VII deficiency (warfarin)

36
Q

Myelofibrosis and the spleen

A

DO NOT perform a splenectomy

37
Q

Myelodysplastic syndrome

A
  • clonal disorders of hematopoietic stem cells that can progress to leukemia
  • look for clones with chromosomal abnormalities
  • if 5q-deletion syndrome treat with lenalidomide
38
Q

Treatment of CLL (detailed)

A
  • Young patient stg III/IV: fludarabine, cyclophosphamide and rituximab
  • Old patient stg III/IV: chlorambucil
39
Q

Treatment of hairy cell

A

cladribine

40
Q

AML and lymphadenopathy?

A

NO lymphadenopathy with AM

41
Q

Cytogenetics in AML

A

Good: t(8;21), t(15;17), inv(16), or t(16;16)
Bad: loss or deletion of chromosome 7

42
Q

APML

A
  • see t(15;17)

- treat with ATRA

43
Q

HER2 + breast cancer treatment

A

Avoid giving trastuzumab in combination with anthracylines (doxorubicin) d/t increased risk of cardiac toxicity

44
Q

Hyperplastic polyp on colonoscopy?

A

Screen every 10 years as usual

45
Q

Symptoms with endobronchial carcinoid?

A

NO carcinoid syndrome. Carcinoid syndrome can happen when mets are in the liver.

46
Q

BRAF gene mutation

A

Specific for papillary thyroid cancer

47
Q

RET gene mutation

A

Associated with medullary thyroid cancer

48
Q

Radioactive iodine treatment in thyroid cancer?

A

Only works for papillary and follicular as medullary comes from C cells that do NOT take up iodine

49
Q

Elevated calcitonin?

A

Think medullary thyroid cancer

Medicine Boards Jesse (12 decks)

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