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Heme/onc > Heme/Onc > Flashcards

Heme/Onc Flashcards

1
Q

TTP

A

Suspect in patient with:

  1. MAHA –> Schistocytes
  2. Increase LDH
  3. Thrombocytopenia

Diagnosis: Peripheral smear

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2
Q

CTEPH

A

Criteria:

  • Mean pulmonary artery pressure of greater than 25 mm Hg
  • With normal pulmonary capillary wedge pressure, left atrial pressure, and left ventricular end-diastolic pressure

Diagnosis: V/Q scan- obstruction of medium sized or larger pulmonary arteries

+ V/Q scan warrants: Right heart cath

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3
Q

PNH

A

Suspect in patients with:

  • Hemolytic anemia
  • Pancytopenia
  • Unprovoked atypical thrombosis

Diagnosis: flow cytometry results, which can detect CD55 and CD59 deficiency on the surface of peripheral erythrocytes or leukocytes

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4
Q

Budd-Chiari syndrome

A

Defintion: acute portal hypertension caused by thrombosis of the hepatic veins

Presentation: fulminant hepatic failure or subacutely with tender hepatomegaly and rapid-onset ascites

Mutation: JAK2 activating mutation

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5
Q

ITP association

A
  • Idiopathic
  • SLE
  • CLL
  • Lymphoma
  • HIV
  • Hepatitis C
  • H. Pylori infection

Think about this with low platelet count and platelet type bleeding in young person.

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6
Q

Acquired platelet dysfunction

A

Can be caused by SSRI or gingko biloba

Test: Platelet function analyzer 100 to check for platelet function

When to test: normal platelet count and platelet type bleeding

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7
Q

Inflammatory anemia

A 
Labs:
Low iron
Low TIBC
Low transferrin saturation 
High Ferritin

Treatment: No specific therapy

Associated with:

  • Malignancy
  • Pregnancy
  • Tuberculosis
  • Osteomyelitis
  • Rheumatological disorders (inflammatory)
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8
Q

Myelodysplastic syndrome treatment

A

Lenalidomide: improve quality of life and decrease transfusion-associated iron overload and alloimmunization

When to use: Multiple transfusion

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9
Q

Hypereosinophilia

A

Causes:

  • Collagen vascular disease
  • Helminthic infection
  • Idiopathic
  • Neoplasia
  • Allergy/Atopy/Asthma
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10
Q

Acute aplastic crisis in hereditary spherocytosis

A

Trigger: by viral infection
Labs: Elevated bilirubin with low reticulocyte count
Treatment: Observation

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11
Q

Warfarin reversal

A

Four-factor prothrombin complex in serious GI or neurosurgical bleeds

Contraindicated: History of HITT (contains heparin)

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12
Q

Idarucizumab

A

Dabigatran reversal agent: binds non-vitamin K antagonist, decreases for 24 hours

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13
Q

Unprovoked DVT

A

10% of people will find malignancy within 1 year

To do: Age appropriate screening

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14
Q

Acute promyelocytic leukemia

A

Reduced total leukocyte count and features of disseminated intravascular coagulation

If DIC: Urgent cyroprercipiate, FFP and Platelets

Diagnosis: Bone Marrow Biopsy

Treatment: All-trans RA

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15
Q

MGUS cutoff

A

M spike of < 1.5 with normal SPEP and UPEP does not warrant any further evaluation

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16
Q

Delayed hemolytic transfusion reaction

A

Time period: 7-14 days after transfusion

Symptoms: Low grade fever and feature of hemolytic anemia

Diagnosis: Direct Antiglobulin (Coombs) test

17
Q

Pure red cell aplasia

A

Cause: Parvovirus B19, affects erythrocyte precursors in bone marrow

Diagnosis: Just Hb decreased without decrease in WBC and platelets
- Decrease erythrocyte count

18
Q

Essential thrombocytosis

A

Genes:

  • JAK2
  • Calreticulin
  • MPL

Bone marrow biopsy: hypercellularity with increased numbers of enlarged megakaryocytes

Indication for treatment: Age > 60 with thromboembolic complications

Treatment: Hydroxyurea and ASA

19
Q

Benign Ethnic Neutropenia

A

Isolated, mild neutropenia (1000-1500/µL [1-1.5 × 109/L]) found on routine testing in asymptomatic black persons or certain other ethnic groups (jews, west indians, arabs)

20
Q

Anemia of Chronic Disease

A

Labs:

  • Normocytic anemia
  • Low reticulocyte count
  • Normal erythrocyte morphology

Cause: Epo deficiency

Treatment: Erythropoiesis stimulating agents

21
Q

Amylodosis

A

Symptoms:

  • Proteinuria (nephrotic range)
  • Cardiomyopathy
  • Orthostatic hypotension
  • Macroglossia

Labs: IgG gamma monoclonal gammopathy

Diagnosis: Abdominal fat pad biopsy (apple-green birefringence with Congo red staining)

22
Q

Hemochromatosis lab findings

A

Transferrin saturation > 45% warrant additional testing

Imaging findings: Hook like osteophytes (especially in 2nd and 3rd MCP)

23
Q

Waldenström macroglobulinemia

A

B-cell lymphoma with clonal lymphoplasmacytic infiltration of the bone marrow

Labs: IgM spike

Diagnosis: Bone marrow biopsy

Complications:
- Hyperviscosity: AMS, H/A, hearing loss, tinnitus, dizziness, nystagmus. If M protein level < 400 and no symptoms no need for testing

24
Q

Patient with ALL are at risk for:

A
  • Metabolic syndrome
  • Truncal obesity
  • Dyslipidemia
  • ## High BMI
25
Q

Isolated axillary lymph adenocarcinoma

A
  • Should be treated as primary breast cancer until proven otherwise
26
Q

Tumor lysis syndrome- Burkitts

A

Burkitts commonly presents with spontaneous tumor lysis syndrome

Other cancers:

  • Leukemia
  • CLL
  • Large B cell lymphoma

Treatment: Rasburicase and IV hydration and Lasix

27
Q

Tx in patients high risk, early stage, ER PR + that are premenopausal post chemotherapy

A

Ovarian suppression along with antiestrogen therapy
= increased surviva benefit

Tx: Leuoprolide with aromatase inhibitor (exemestane)

28
Q

Optimally debulked stage III Ovarian CA Tx

A

IV/IP chemotherapy

Tumor size has to < 1 cm

29
Q

Neuroendocrine tumors

A

If well differentiated, low mitotic grade usually are indolent and asymptomatic thus do not require treatment

30
Q

Treatment Hairy Cell Leukemia

A

Cladribine or Pentostatin.

31
Q

Follicular lymphoma progression

A

Look for:

  • LDH elevation
  • Increased uptake on PET scan

*** NEED TO RE-BIOPSY as it may have progressed

32
Q

Isolated Inguinal lymph node

A

Prompt checking of:

  • Vagina
  • Vulva
  • Cervix
  • Anus
  • Penis
33
Q

Asymptomatic Follicular Lymphoma

A

Do not need to treat because they “live FOOOO ever”

34
Q

Chest wall radiation age < 30, guidelines for breast cancer screening

A

Start Mammograms at age 25 or 8 years after radiation therapy is complete

35
Q

Bladder cancer

A

RF: advanced age, white ethnicity, various occupational exposures, and cigarette smoking

Symptoms: Hematuria

Treatment: TURBT with six rounds of intravesical chemotherapy (BCG or Mitomycin)

Heme/onc (1 decks)

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