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CK Heme Onc > Heme Onc DIT > Flashcards

Heme Onc DIT Flashcards

1
Q

next step in mgmt:

25 y/o man dx’d with a solitary testicular mas by US

A

orchiectomy

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2
Q

classic findings of HSP

A

palpable purpura

GI sx’s (e.g. abd’l pain, vomiting, guaiac+, intussusception)

renal disease

transient arthritis/arthralgias

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3
Q

What variables shift the Hb-O2 dissociation curve to the right

A

“CADET-face RT”

C:  incr'd 
A:  incr'd altitiude/acid (i.e. decr' pH)
D:  incr'd DPG3
E:  exercise
T:  incr'd temp
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4
Q

what effect does a right shift on Hb-O2 curve have

A

Incr’d delivery of O2 to peripheral tissues

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5
Q

what is cause of anemia that develops after taking a sulfa drug

A

G6PD deficiency

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6
Q

what lab markers suggest anemia due to hemolysis

A 
decr'd H&H with incr'd retics
normal MCV
decr'd haptoglobin
incr'd indirect bilirubin
incr'd LDH
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7
Q

in hemolytic anemia, why is serum haptoglobin level der’d & serum LDH increased

A

Haptoglobin binds free Hb in blood

LDH spills out of hemolyzed RBC’s

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8
Q

characteristic findings in hereditary spherocytosis

A

jaundice & gallstones (2nd/2 elevated bilirubin)

splenomegaly

anemia with incr’d retics & MCHC

spherocytes on peripheral smear

positive osmotic fragility test

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9
Q

spherocytosis is a/w higher incidence of what lab abnormality

A

pseudohyperkalemia

2nd/2 K+ spilling into blood when RBC’s lyse after blood draw

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10
Q

tx of hereditary spherocytosis

A

folic acid 1mg qD

splenectomy (moderate to severe cases)

RBC transfusion (extreme cases)

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11
Q

Rx for diarrhea 2nd/2 E. histolytica

A

metronidazole (+ hydration)

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12
Q

Rx for diarrhea 2nd/2 G. Lamblia

A

metronidazole (+ hydration)

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13
Q

Rx for diarrhea 2nd/2 salmonella

A

quinolones or TMP-SMX (+ hydration)

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14
Q

Rx for diarrhea 2nd/2 shigella

A

quinolones or TMP-SMX (+ hydration)

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15
Q

Rx for diarrhea 2nd/2 campylobacter

A

erythromycin (+ hydration)

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16
Q

Rx for mild persistent asthma

A 
ACUTE TX:
 short-acting B2-agonist (i.e. albuterol)
 IV corticosteroids (for persistent sx's)

LONG-TERM CONTROL:
albuterol, prn
inhaled glucocorticoid
+/- leukotriene inhibitor (e.g. cromolyn)

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17
Q

what is charcots triad indicative of & what are the components

A

Dx: cholangitis

TRIAD:
jaundice
RUQ pain
Fever

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18
Q

what is reynold’s pentad indicative of & what are the components

A

Dx: cholangitis

PENTAD:
jaundice 
RUQ pain
Fever
hypotension
AMS
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19
Q 
Iron Def Anemia:
serum iron
ferritin
transferrin
Fe/TIBC
A

serum iron: decr’d
ferritin: decr’d
transferrin: incr’d
Fe/TIBC: < 12%

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20
Q 
Anemia of chronic disease:
serum iron
ferritin
transferrin
Fe/TIBC
A

serum iron: decr’d
ferritin: incr’d
transferrin: decr’d
Fe/TIBC: > 18%

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21
Q

what is seen on blood smear of a patient with lead poisoning

A

microcytic

hypochromic

basophilic stippling

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22
Q

RBC disorder a/w:

schistocyte (fragmented RBC)

A

hemolytic anemia
DIC
TTP
HUS

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23
Q

RBC disorder a/w:

acanthocyte (spur cell)

A

abetalipoproteinemia

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24
Q

RBC disorder a/w:

bite cell

A

G6PD def

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25
Q

RBC disorder a/w:

basophilic stippling

A

lead poisoning
B-thalassemia
alcohol

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26
Q

RBC disorder a/w:

peripheral neuropathy and ringed sideroblastic in BM

A

lead poisoning

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27
Q

RBC disorder a/w:

hypersegmented neutrophils

A

folate/B12 def

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28
Q 
RBC disorder a/w:
heinz bodies (denatured Hgb in RBC)
A

G6PD def

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29
Q

RBC disorder a/w:

burr cells

A

uremia

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30
Q

MCV & anemia a/w:

mental status changes, neuropathy, constipation

A

microcytic

lead poisoning

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31
Q

MCV & anemia a/w:

heavy menses, strict vegetarians, ice pica

A

microcystic

iron def

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32
Q

MCV & anemia a/w:

dark urine, jaundice, hepatosplenomegaly

A

normocytic

hemolytic anemia

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33
Q

MCV & anemia a/w:

alcoholic, malnourished

A

macrocytic

folate/B12 def

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34
Q

what virus can cause aplastic anemia as well as erythema infectiosum disease (i.e. “fifth disease”)

A

Parvovirus B19

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35
Q

what test is used to rule out urethral injury

A

retrograde cystourethrogram

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36
Q

lipid-lowering agent:

SE = facial flushing

A

niacin

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37
Q

lipid-lowering agent:

SE = elevated LFT’s, myositis

A

statins

fibrates

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38
Q

lipid-lowering agent:

SE = GI discomfort, bad taste

A

bile acid sequestrants

e.g. cholestyramine

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39
Q

lipid-lowering agent:

best effect on HDL

A

niacin

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40
Q

lipid-lowering agent:

best effect on TG’s

A

fibrates

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41
Q

lipid-lowering agent:

best effect on LDL/cholesterol

A

statins

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42
Q

lipid-lowering agent:

binds C. Diff toxin

A

cholestyramine

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43
Q

which types of thalassemias are most commonly a/w pts of Mediterranean & AA/Asian descent

A

MEDITERRANEAN: B-Thal

AA/ASIAN: a-Thal

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44
Q

What complication occurs in 10% of pts with sideroblastic anemia

A 
myelodysplastic syndrome (aka "refractory anemia)
--> acute leukemia
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45
Q

Besides Staph Aureus, which organism may be responsible for osteomyelitis in a sickle cell pt

A

salmonella

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46
Q

Which vaccines are particularly important in children with sickle cell disease

A

HiB

Pneumoccal

Meningococcal

Influenza

Hep B

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47
Q

What medication is used in the long-term management of sickle cell anemia

A

Hydroxyurea

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48
Q

drugs a/w elevated prolactin levels

A

METHYLDOPA

PSYCHIATRIC DRUGS
phenothiazines
haloperidol
risperidone

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49
Q

what substances cause hemolysis in px with G6PD def

A 
primaquin
dapsone
sulfonamides
fava beans
isoniazid
nitrofurantoin
high-dose ASA
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50
Q

when would you expect eosinophillic casts in urine

A

acute interstitial nephritis, AIN

i.e. allergic interstitial nephritis

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51
Q

differential dx for eosinophilia

A

“DNAAACP”

D = drugs (e.g. NSAIDS, PCN's/Ceph's)
N = neoplasms
A = allergies/asthma (churg-strauss), allergic bronchopulmonary aspergillosis
A = adrenal insufficiency (Addison's)
A = AIN (allergy-induced)
C = CVD's (e.g. PAN, dermatomyositis)
P = parasites (e.g. strongyloides, Ascaris --> Loeffler's eosinophilic pneumonitis)
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52
Q

what is the management in a px with febrile neutropenia due to chemo

A

admit
culture
start broad-spectrum antibiotics
(e.g. cefepime/ceftazidine)

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53
Q

what type of infection causes eosiniphilia

A

parasitic

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54
Q

immunoglobulin a/w eosinophilia

A

IgE

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55
Q

what type of hypersensitivity is good pasture

A

type II HSN

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56
Q

what is the treatment for type II hypersensitivity

A

anti-inflammatories

immunosuppressives (e.g. corticosteroids)

possibly plasmaphoresis

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57
Q

most important medication for anaphylaxis

A

epinephrine

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58
Q

Tx for anaphylaxis

A 
ABC's
stop offending agent
epinephrine IM or IV (for AW obstruction)
H1/H2 blockers (for cutaneous sx's)
bronchodilators
steroids
IVF's (for hypotension)
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59
Q

Dx

45 yo with acute flank pain and hematuria

A

nephrolithiasis

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60
Q

MCC of aortic stenosis in 50 y/o

A

congenital bicuspid aortic valve

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61
Q

MOA:

streptokinase

A

activates tissue plasminogen –> cleaves fibrin clots

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62
Q

MOA:

aspirin

A

Cox-2 inhibitor –> blocks plt aggregation

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63
Q

MOA:

clopidogrel

A

inhibits ADP receptor

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64
Q

MOA:

abciximab

A

Gp2b3a Inhibitor

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65
Q

MOA:

tirofiban

A

Gp2b3a Inhibitor

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66
Q

MOA:

ticlopidine

A

inhibits ADP receptor

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67
Q

MOA:

enoxaparin

A

LMWH –> inhibits CF Xa

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68
Q

MOA:

eptifibatide

A

Gp2b3a Inhibitor

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69
Q

classic triad of HUS

A

hemolytic anemia
uremia
thrombocytopenia

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70
Q

what is the pentad of TTP

A 
hemolytic anemia
uremia
thrombocytopenia
neurologic sequelea
fever
71
Q

lab test to monitor:

warfarin

A

PT/INR

72
Q

lab test to monitor:

heparin

A

PTT

73
Q

lab test to monitor:

LMWH

A

doesn’t need monitoring

h/w it can be monitored with anti-CF Xa

74
Q

drugs known to cause thrombocytopenia

A

heparin (HIT)

abciximab (GP2b3a inhibitor)

carbamazepine, phenytoin, valproate

cimetidine

acyclovir, rifampin

sulfonamides
(e.g. sulfasalazine, TMP-SMX)

procainamide, quinidine

quinine, gold compounds

75
Q

1st line Rx for vWD

A

desmopressin, DDAVP (increases vWF secretion)

76
Q

Rx for vWD that is severe or refractory

A

cryoprecipitate or Factor VIII

77
Q

Rx for vWD with menorrhagia

A

OCP

78
Q

MCC’s of DIC

A

“STOP Making Thrombi”

S = sepsis
T = trauma
O = OB complications
P = pancreatitis

M = malignancy

T = transfusions

79
Q

PLT’s, BT, PT, PTT:

HUS/TTP

A

PLT’s: decr’d
BT: incr’d
PT: normal
PTT: normal

80
Q

PLT’s, BT, PT, PTT:

hemophilia A or B

A

PLT’s: normal
BT: normal
PT: normal
PTT: incr’d

81
Q

PLT’s, BT, PT, PTT:

vWD

A

PLT’s: normal
BT: incr’d
PT: normal
PTT: incr’d

82
Q

PLT’s, BT, PT, PTT:

DIC

A

PLT’s: decr’d
BT: incr’d
PT: incr’d
PTT: incr’d

83
Q

PLT’s, BT, PT, PTT:

warfarin use

A

PLT’s: normal
BT: normal
PT: incr’d
PTT: incr’d

84
Q

PLT’s, BT, PT, PTT:

aspirin

A

PLT’s: normal
BT: incr’d
PT: normal
PTT: normal

85
Q

PLT’s, BT, PT, PTT:

end stage liver disease

A

PLT’s: normal/decr’d
BT: normal/incr’d
PT: incr’d
PTT: incr’d

86
Q

what is the MC mutation that predisposes white pt’s to venous thrombosis

A

Factor V Leiden mutation

87
Q

Dx & Tx:

post-op pt with poor urine output, BUN 85, Cr 3 & clear lungs

A

Dx: Prerenal azotemia (2nd/2 dehydration)

Tx: IVF’s

88
Q

what infection causes aplastic crisis in sickle cell pt’s

A

Parvovirus B19

89
Q

Dx:

pt presents with glomerulonephritis plus b/l sensorineural deafness

A

Alport’s Syndrome

90
Q

Tx of shock

A

IVF’s & pressors

blood, urine, & sputum cultures (BEFORE starting antibiotics)

CXR

empiric antibiotics

insulin drip

continuous cardiac monitoring & central venous pressure measurments

91
Q

man returns from African safari c/o periodic fevers, chills, diaphoresis, muscle aches, & fatigue; how could he have avoided illness

A

prophylactic anti-malarials

92
Q

Tx for infectious mononucleosis

A

rest & plenty of fluids

NSAIDS or Tylenol (for fever, sore throat, & malaise)

gradual return to sports
(incr’d risk of splenic rupture):
NONCONTACT: 3 wks after sx onset
CONTACT: 4 wks after sx onset

93
Q

what is the spectrum of conditions related to blood infections

A

bacteremia

SIRS

sepsis

severe sepsis

septic shock

multiple organ dysfxn syndrome

94
Q

definition:

bacteremia

A

bacteria of any amount in the blood that does not meet criteria for SIRS

95
Q

definition:

SIRS

A

Systemic Inflammatory Response Syndrome (SIRS) WITHOUT an identified source of infection

(NOTE: criteria may be met due to other causes independent of infection or source may never be found)

96
Q

what are the 4 categories for SIRS criteria

A

temperature

tachycardia

tachypnea

WBC’s

97
Q

how many of the SIRS categories must be present to meet the SIRS criteria

A

2 or more

98
Q

What is the SIRS “temperature” criteria

A

> 38.3C or < 36.0C

99
Q

What is the SIRS “tachycardia” criteria

A

HR > 90 bpm

100
Q

What is the SIRS “tachypnea” criteria

A

RR > 20 bpm or PaCO2 < 32

101
Q

What is the SIRS “WBC’s” criteria

A

ANY 1 OF THE FOLLOWING:

> 12,000
10% bands
< 4,000

102
Q

Criteria:

SIRS

A

CRITERIA: 2 or more of the following:

TEMPERATURE:   
     > 38.3C
     < 36.0C
TACHYCARDIA:
     HR > 90
TACHYPNEA:  
     RR > 20 bpm
     PaCO2 < 32
WBC'S:
     >  12,000
     >  10% bands
     <  4,000
103
Q

definition:

sepsis

A

SIRS WITH an identified source of infection;

(FYI: if SIRS criteria met & there is no obvious source of infection, w/u should include urine, blood, & sputum cultures)

104
Q

definition:

severe sepsis

A

SEPSIS + 1 OF THE FOLLOWING:

organ dysfxn
hypotension
hypoperfusion

105
Q

what signs are evidence of organ dysfxn, hypotension &/or hypoperfusion seen in severe sepsis

A

lactic acidosis

SBP < 90 mmHg

SBP drop > 40 mmHg

106
Q

definition:

septic shock

A

SEVERE SEPSIS + hypotension , despite adequate fluid resuscitation

107
Q

definition:

multiple organ dysfxn syndrome

A

SEPTIC SHOCK + evidence of 2 or more organs failing

108
Q

SUMMARIZE the spectrum of conditions related to blood infections with definition of each

A

BACTEREMIA: bacteria in the blood that does not meet criteria for SIRS

SIRS: 2+ criteria met WITHOUT source of infection identified

SEPSIS: SIRS + source of infection identified

SEVERE SEPSIS: sepsis + organ dysfxn, hypotension, or hypoperfusion

SEPTIC SHOCK: severe sepsis + hypotension, despite adequate fluid resuscitation

MULTIPLE ORGAN DYSFUNCTION SYNDROME:
septic shock + evidence of 2+ organs failing

109
Q

classic EKG finding in PE

A

“S1Q3T3”

wide S in Lead I

large Q in lead III

inverted T wave in lead III

110
Q

Dx:

post op px with pain presents with hyponatremia and normal volume status

A

SIADH (2nd/2 stress)

111
Q

Rx for mild unconjugated hyperbilirubinemia

A

phototherapy

112
Q

Rx for severe unconjugated hyperbilirubinemia

A

exchange transfusion

113
Q

what is the initial HAART regimen

A

2 NRTI’s + EITHER:

1 protease inhibitor

1 NNRTI

may be add ritonavir

114
Q

antiretroviral a/w:

SE of lactic acidosis

A

NRTI’S

115
Q

antiretroviral a/w:

SE of GI intolerance

A

protease inhibitors

116
Q

antiretroviral a/w:

SE pancreatitis

A

zalcitibine
didanosine
stavudine
ritonavir

117
Q

antiretroviral a/w:

SE of peripheral neuropathy

A

zalcitibine
didanosine
stavudine

118
Q

antiretroviral a/w:

SE of megaloblastic anemia

A

zidovudine

119
Q

antiretroviral a/w:

SE of rash

A

NNRTI’s

120
Q

antiretroviral a/w:

SE of hyperglycemia, DM, lipid abnormalities

A

protease inhibitors

e.g. indinavir, sequinavir, amprinavir

121
Q

antiretroviral a/w:

SE of BM suppression

A

zidovudine

122
Q

antiretroviral a/w:

given to pregnant woman with HIV

A

HAART regimen with zidovudine

123
Q

antiretroviral a/w:

regimen for occupational HIV exposure

A

LOW-RISK: zidovudine + lamivudine

HIGH-RISK: 3-drug HAART regimen

124
Q

what bugs are tx prophylactically in AIDS pt’s with CD4+ < 200 and what is rx is given

A

PCP: TMP-SMX

TOXOPLASMOSIS: TMP-SMX

MAC: Macrolide (e.g. clarithromycin or azithromycin)

125
Q

Tx for acute toxoplasmosis in AIDS pt

A

pyrimethamine or sulfadiazine

126
Q

HIV prophylaxis for TB

A

INH

127
Q

AIDS criteria

A

ANY OF THE FOLLOWING:

HIV+ with CD4+ < 200
HIV+ with CD4+ < 15% of total lymphocytes
HIV+ with “AIDS-defining illness”

128
Q

what are some examples of “AIDS-defining illness”

A

THERE ARE MANY (refer to SU p.144-145):

esophageal candidiasis
PCP
toxoplasmosis
MAC

129
Q

tumor marker:

hepatocellular carcinoma

A

AFP

130
Q

tumor marker:

colon cancer

A

CEA

131
Q

tumor marker:

gastric cancer

A

CEA

132
Q

tumor marker:

pancreatic cancer

A

CA 19-9

CEA

133
Q

tumor marker:

ovarian cancer

A

CA-125

134
Q

dx:

young black man with painless hematuria

A

sickle cell trait

135
Q

MCC of aortic stenosis in a 70 y/o

A

senile (i.e. degenerative) calcifications

136
Q

labs in DIC

A

ELEVATED:
fibrin-split products
D-dimers

DECREASED:
fibrinogen
platelets
hematocrit

137
Q

which type of RTA is a/w abnormal H+ secretion & nephrolithiasis

A

RTA I

138
Q

what is the classic presentation of polycythemia vera

A

thrombosis

erythromelalgia (i.e. burning pain in hands & feet)

pruritis (esp after warm bath/shower)

facial plethora

hepatosplenomegaly

visual disturbances

abnormal labs

139
Q

what visual distrubances are seen with polycythemia vera

A

blurred vision

amaurosis fugax

scintillating scotoma

ophthalmic migraine

140
Q

what lab abnormalities are seen with polycythemia vera

A

elevated H&H

elevated red cell mass

basophilia

leukocytosis

thrombocytosis

141
Q

what is the Rx for polycythemia vera

A

phlebotomy

FYI: induces a desirable iron def anemia –> DO NOT supplement with iron

142
Q

what is used in px with polycythemia vera with high risk of thrombosis; which pts are considered “at risk”

A

hydroxyurea

"AT RISK":
h/o thrombosis
plts > 1,500,000
CV RF+
> 70 y/o
143
Q

what is used in px with polycythemia vera with refractory pruritis or refractory erythrocytosis

A

IFN-a

144
Q

what tests will help in dx of MM

A

SPEP: monoclonal AB spike

UPEP: bence-jones proteins

BM BX: incr’d plasma cells

145
Q

Dx

px with weight loss, pruritis, night sweats, hepatosplenomegaly, nontender cervical lymphadenopathy

A

Hodgkin’s lymphoma

146
Q

Dx:

3 y/o girl presents with abd’l mass, hematuria, & HTN

A

Wilm’s tumor

147
Q

Dx & Tx:

recent Cuban immigrant with sx’s of malabsorption is found to also have megaloblastic anemia

A

Dx: Tropical sprue

Tx: folate & antibiotics (e.g. tetracycline or sulfa)

148
Q

cell pathology a/w:

EBV

A

Burkitt’s lymphoma

149
Q

cell pathology a/w:

reed sternberg cell, cervical lymphadenopathy, night sweats

A

Hodgkin’s lymphoma

150
Q

cell pathology a/w:

bence jones proteins, osteolytic lesions, high Ca2+

A

MM

151
Q

cell pathology a/w:

translocation 14:18

A

follicular lymphoma

152
Q

cell pathology a/w:

MC lymphoma in US

A

diffuse large B cell lymphoma

153
Q

cell pathology a/w:

translocation 8:14

A

burkitt’s lymphoma

154
Q

cell pathology a/w:

translocations 9:22

A

philadelphia (CML or ALL)

155
Q

cell pathology a/w:

MC hodgkin lymphoma

A

nodular sclerosing

156
Q

cell pathology a/w:

starry sky pattern due to phagocytosis of apoptotic tumor cells

A

burkitt’s lymphoma

157
Q

cell pathology a/w:

high H&H, pruritis (esp after hot bath or shower), burning pain in hands or feet

A

polycythemia vera

158
Q

cell pathology a/w:

white cells with hair-like projections & splenomegaly

A

hairy-cell leukemia

159
Q

cell pathology a/w:

macrocytosis, hypogranular granulocytes with bilobed nuclei

A

myelodysplastic syndrome

160
Q

Rx for CML

A

imatinib

161
Q

leukemia a/w:

MC in children (peak age 3-4 y/o)

A

ALL

162
Q

leukemia a/w:

MC in adults (avg age of onset 50 y/o)

A

CLL

163
Q

leukemia a/w:

philadelphia Chromosome is always present

A

CML

164
Q

leukemia a/w:

smudge cells

A

CLL

165
Q

leukemia a/w:

peripheral blasts are PAS+ and TdT+

A

ALL

166
Q

leukemia a/w:

peripheral blasts are PAS-, MPO+ and have Auer rods

A

AML

167
Q

leukemia a/w:

pancytopenia in a down syndrome px

A

ALL

168
Q

lung cancer a/w:

elevated ACTH –> glucocorticoid excess –> Cushing’s

A

small cell lung cancer

169
Q

lung cancer a/w:

elevated PTH related peptide –> hypercalcemia

A

squamous cell lung cancer

170
Q

lung cancer a/w:

elevated ADH –> SIADH –> hyponatremia

A

small cell lung cancer

171
Q

lung cancer a/w:

antibodies to presynaptic Ca2+ channels –> Lambert-Eaton syndrome

A

small cell lung cancer

172
Q

disease that causes glomerulonephritis with deafness

A

Alport’s syndrome

173
Q

MC adrenal tumor in children; lab study used to dx

A

MC = neuroblastoma

Dx’c = 24-hr urine –> incr’d VMA & HVA

174
Q

Dx:

4 y/o girl with URI & dangling thumbs, short stature, & hypopigmentation of some skin areas; labs reveal pancytopenia

A

fanconi’s anemia

CK Heme Onc (13 decks)

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