Heme/Onc

Question 1

Triad of paroxysmal nocturnal hemoglobinuria

Answer 1

Hemolysis, cytopenias, and a hypercoagulable state (e.g. PVT)

Question 2

CYP450 inducers that lead to decreased warfarin levels

Answer 2

1. OCPs
2. AEDs: carbamezepine, phenytoin, phenobarbital
3. Rifamping
4. Ginseng and St. John’s Wort

Question 3

CYP450 inhibitors that lead to increased warfarin levels

Answer 3

1. Acetaminophen and NSAIDs
2. Some antibiotics and antifungals (e.g. metronidazole)
3. SSRIs
4. Amiodarone
5. Cimetidine and omeprazole
6. Thyroid hormone
7. Gingko, cranberry juice, vitamin E

Question 4

Reversal of warfarin

Answer 4

IV vitamin K plus prothrombin complex concentrate (or FFP if that is unavailable)

Question 5

What is LMWH CI that unfractionated heparin is not?

Answer 5

ESRD

Question 6

When do you treat ITP, and what with?

Answer 6

Bleeding or platelets <30k. Give steroids or IVIG

Question 7

Triad of GVHD

Answer 7

1. Dermatitis (maculopapular rash)
2. Gastroenteritis (bloody diarrhea)
3. Hepatitis (jaundice and elevated LFTs)

Question 8

Marker for ALL

Answer 8

TdT

Question 9

Transient visual disturbances, burning cyanosis in hands and feet, and itching in the shower

Answer 9

PV (can also see HTN and thrombosis)

Question 10

Hyperviscosity syndrome in Waldenstrom macroglobulinemia

Answer 10

Diplopia, tinnitus, HA, and dilated/segmented fundoscopic findings
(Elevated IgM can also lead to neuropathy and cryogloblinemia).
(Infiltration can lead to hepatosplenomegaly, anemia, and thrombocytopenia)

Question 11

Smudge cells

Answer 11

Pathognomonic for CLL

Question 12

High mitotic index and “starry sky” appearance

Answer 12

Burkitt lymphoma

Question 13

VHL syndrome

Answer 13

1. Hemangioblastomas
2. Clear cell RCC
3. Phochromocytoma

Question 14

Anterior mediastinal masses

Answer 14

1. Thymoma
2. Thyroid tumor
3. Teratoma and germ cell tumors
4. Terrible lymphoma

Question 15

Middle mediastinal masses other than lymphomas and lymph nodes

Answer 15

Bronchogenic cysts and tracheal tumors

Question 16

Posterior mediastinal masses other than lymphomas and lymph nodes

Answer 16

Neurogenic tumors

Question 17

Test required before starting rituximab

Answer 17

PPD

Question 18

Work-up for first provoked unprovoked thromboembolism

Answer 18

CXR and age-appropriate cancer screening

Question 19

Macrocytic anemia with elevated bilirubin

Answer 19

Intramedullary hemolysis in megaloblastic anemia

Question 20

Who is at risk for primary hypotensive transfusion reaction?

Answer 20

Patients on ACEIs (bradykinin accumulation in blood products leads to hypotension, ACE breaks down bradykinin)

Question 21

What do you do for the next transfusion for a patient who had anaphylaxis after an RBC transfusion?

Answer 21

Washed RBCs (to wash away IgA)

Question 22

What do you do for the next transfusion for a patient who had febrile non-hemolytic transfusion reaction after an RBC transfusion?

Answer 22

Leukoreduced RBCs (FNHTR due to antibodies against donor WBC or breakdown of donor WBC releasing cytokines)

Question 23

Finding on exam in X-linked agammaglobulinemia

Answer 23

Absent lymphoid tissue (tonsils and lymph nodes)

Will present with recurrent sinopulmonary infections after 6 months of age

Question 24

Recurrent infections, eczema, and thrombocytopenia.

What is the underlying defect?

Answer 24

Wiskott-Aldrich syndroe. Due to defect in regulation of actin cytoskeleton

Question 25

Test for chronic granulomatous disease

Answer 25

Dihydrorodamine or nitroblue tetrazolium for lack of oxidative burst

Question 26

Most common organism causing sepsis in sicklers

Answer 26

Pneumococcus (even if vaccinated)

Question 27

Key side effect(s) of cyclophosphamide

Answer 27

Hemorrhagic cystitis and bladder cancer

Present with hydration and mesna

Question 28

Key side effect(s) of platinum-based chemotherapies

Answer 28

Cochlear dysfunction

Question 29

Electrolyte changes in tumor lysis syndrome

Answer 29

Elevations in phosphate, potassium, and uric acid, but hypocalcemia (precipitates with phosphate).