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step 2 ck > HEME ONC > Flashcards

HEME ONC Flashcards

1
Q

acidified glycerol lysis test is used to dx…

A

hereditary spherocytosis

defect in spectrin and ankyrin

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2
Q

which lung cancers are peripheral and which are central?

A

peripheral = adenocarcinoma and large cell carcinoma

central = squamous cell and small cell

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3
Q

what syndromes are associated with squamous cell lung ca and which with small cell carcinoma?

A

squamous = hypercalcemia

small cell = cushing syndrome, SIADH, or lambert eaton

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4
Q

which lung ca is the most common type of primary lung cancer in both smokers and nonsmokers?
predominant type in nonsmokers?

A

adenocarcinoma

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5
Q

what tx is given to sickle cell patient with recurrent vasoocclusive crises?

its side effect?

A

hydroxyurea to boost amount of fetal hgb

can cause myelosuppression

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6
Q

auer rods are specific for which leukemia?

A

AML

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7
Q

aflatoxin is ass w what?

ebv reactivation ass w what?

A

hepatocellular carcinoma

nasopharyngeal carcinoma

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8
Q

normal reticulocyte count?`

what raises it?

A

0.5-2.5%

blood loss and hemolysis

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9
Q

at what hematocrit do i transfuse?

A

if patient is symptomatic or if patient is elderly or has heart disease

do NOT if patient is young and asx

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10
Q

each unit prbcs should raise the hct by

A

3

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11
Q

when do you transfuse cryoprecipitate first?

A

never.

never first line

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12
Q

only microcytic anemia with HIGH iron

A

sideroblastic anemia (cant incorporate iron with heme)

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13
Q

TIBC

in chronic disease and iron deficiency?

A

low in anemia of chronic disease

high in iron def

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14
Q

test used to look for ringed sideroblasts?

A

prussian blue stain

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15
Q

most accurate test for thalassemia?

A

electrphoresis

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16
Q

megaloblastic anemia + hypersegmented neutrophils

A

either B12 or folate def!

get B12 and folate levels!!

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17
Q

methotrexate can lead to __ deficiency

A

folate

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18
Q

both B12 and folate deficiency increase ____ but onlu B12 is associated with increased ___

A

homocysteine

methylmalonic acid

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19
Q

what decreases mortality in sickle cell disease?

A

hydroxyurea in prevention and antibiotics with fever

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20
Q

exchange transfusion for sickle cell vasoocclusive crisis is used when..

A 
acute chest syndrome
priapism
stroke
or
visual disturbance from retinal infarction
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21
Q

what is the diagnosis? best test?

recurrent hemolysis, intermitternt jaundice, splenomegaly, family hx of anemia or hemolysis, and bilirubin gallstones

A

spherocytosis

osmotic fragility test

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22
Q

most accurate test for autoimmune hemolysis?

A

coombs +

detects IgG on rbc surface

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23
Q

colder parts of body showing mottling that resolves on warming?

tx?

A

cold agglutinin disease

steroids dont work with cold agglutinins…give rituximab and warm patient

24
Q

warm agglutinins are Ig__ and cold are Ig___

A

warm are igG

cold are IgM

25
Q

holly jowell bodies?

heinz bodies?

A

HJ = sickle cell

heinz = g6pd

26
Q

in g6pd deficiency, g6pd level will be __ after acute event…..when to dx?

A

normal

get g6pd level after 1-2 months

27
Q

HUS vs TTP

similarities and differences

A

both present with hemolysis with schistcytes, thrombocytopenia, and renal insufficiency

hus is due to e coli 0517h7 and is usually in kids

ttp is usually in adults due to meds or dz, and has neuro sx

28
Q

paroxysmal nocturnal hemoglobinuria

A

decreased cd55 and cd59
episodic dark urine
pancytopenia
clots in weird places

29
Q

aplastic anemia

A

pancytopenia
fatigue infections bleeding

dx: bone marrow biopsy
tx: young patient = bone marrow transplant,,,old patient = antithymocyte globulin and cyclosporine

30
Q

polycycthemia vera

A

overproduction of all 3 cell lines but mostly rbcs! despite a low epo

hyperviscosity sx (htn, ha, thrombosis, fatigue)

hct high, plat and wbc high, rbc mass high, oxygen normal, epo low

dx;;;;JAK2 mutation most accurate

tx: phlebotomy and aspirin, hydroxyurea, allopurinol, antihistamines

31
Q

essential thrombocytosis

A

plat count >1 mil leading to thrombosis and bleeding

32
Q

myelofibrosis

A

panytopenia and bone marrow fibrosis – blood prodution shifts to sleen and liver (hepatosplenomegaly) + tear drop shaped cells and nucleated rbcs

33
Q

APL (acute promyelocytic leukemia)

A 
type of ALL
15:17 translocation
auer rods
associated with DIC
blasts on blood smear + myeloperoxidase

tx: chemo + ATRA

34
Q

philadelphia chromosome?

A

bcrabl 9:22 translocation

CML

35
Q

Non hodgkin lymphoma
presentation?
dx?
tx?

A

painless LAD, nodes are NOT warm red or tender, fever, weightloss, sweats

best initial test is exisional biopsy (CBC is often normal)
stage with CT chest abd pelvis and bone marrow biopsy

DO NOT DO NEEDLE ASPIRATION of LN

tx for advanced dz: CHOP therapy

ccyclophosphamide
doxorubicin (hydroxydaunorubiin) or adriamycin
vincrisine (oncovine)
prednisone

36
Q

staging for non hodgkins lymphoma

A

1 1 LN group
2 2 or more LN groups on same side of diaphragm
3 both sides of diaphragm
4 widespread

37
Q

MALT

A

mucosal associated lymphoid tissue
=lymphoma of the stomach

associated with H pylori

tx with clarithromycin and amoxicillin

38
Q

reed sternberg cells?

A

hodgkins disease

39
Q

hodgkins versus NH lymphoma

A

hodgkins = local usually, centers around cervical area, reed sternberg cells on path, lymphocyte predominant = best prognosis, lymphocyte depleted = worst prognosis

NHL = usually found in late stage, widespread, no reed sternberg cells, burkitt and immunoblastic have worst prognosis

40
Q

late hodgkins lymphoma tx

A 
ABVD
adriamycin (doxorubicin)
bleomycin
vinblastine
dacarbazine
41
Q

what do you use to determine cardiac toxicity from chemo?

A

MUGA (nuclear ventriculogram)

42
Q 
adverse effect of these chemo agents:
1 doxorubicin
2 vincristine
3bleomycin
4 cyclophosphamide
5 cisplatin
A 
1 cardiomyopathy
2 neuropathy
3 pulm fibrosis
4 hemorrhagic cystitis
5 renal and ototoxicity
43
Q

Multiple myeloma

A

hypercalcemia, hyper uricemia, renal failure (due to Ig and bence jones protein), anemia, and bone pain (lytic lesions)

xray --> punched out lesions
smear --> reauloux formations
serum electrophoresis (SPEP) --> IgG or IgA spike = monoclonal M spike
UPEP --> bence jones proteins
biopsy >10% plasma cells
44
Q

most accurate test for myeloma?

A

bone marrow biopsy

45
Q

waldenstrom macroglobulinemia

A

overproduction of IgM from malignant B cells –> hyperviscosity

lethargy, blurry vision, engorged eye vessels, mucosal bleeding, and raynauds

IgM spike

tx: plasmapheresis

46
Q

ITP

A

isolated thrombocytopenia (normal ht, normal wbc, normal spleen)

mild bleeding tx = glucocorticoids
severe bleeding = IVIG, antiRho

47
Q

before splenectomy, what do you need to vaccinate for?

A

neisseria meningitisis
haemophilus influenzae
pneumococcus

48
Q

VWD

A

von willibrand
mc inherited bleeding disorder (AD)

gum bleeding with normal platelet count (decreased functioning, not count)

dx: low vWF, + ristocetin assay longer bleeding time
tx: DDAVP (desmopressin) to release vWF stores OR vWF replacement

49
Q

DIC labs and tx

A

elevated PT and aPTT
low platelets
elevated d dimer and fibrin split products
decreased fibrinogen (it was consumed)

if plat <50k and serious bleeding –> FFP (to replace plats and clotting factors)

50
Q

do not transfuse platelets into HIT patient,, why?

A

it may worsen thrombosis

51
Q

BRCA cancer

A

breast
ovarian
pancreatic

52
Q

lumpectomy w radiation vs modified radical mastectomy

A

equal in effectiveness

lumpectomy is less deforming (not for multifocal dz though)

53
Q

radical mastectomy when?

A

never the right answer

54
Q

all ER or PR + breast ca pt should get…

A

tamoxifen, raloxifene or an aromatase inhibitor (anastrozole)

55
Q

side effects

1) tamoxifen
2) aromatase inhibitors (anastrozole)

A

1 enodmetrial ca risk and clots

2 osteoporosis

56
Q

trastuzumab

A

given in her2neu + breast ca

antibodies that decrease risk of recurrence and improve survival

57
Q

in prostate ca which is more likely to cause erectile dysfunction

surgery or radiation

A

surgery

step 2 ck (16 decks)

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