Heme/Onc Emergencies

Question 1

Effect of steroids for acute chest crisis?

Answer 1

Reuce deteroriation & transfucion requirement, but increase recurrence rate.

Question 2

Role for hydroxyurea in acute chest crisis?

Answer 2

None, only in chronic disease

Question 3

Treatment of acute chest crisis?

Answer 3

Abx targeting encapsulated organisms & atypicals. Simple / exchange transfusions.

Question 4

Classic findings of AML?

Answer 4

Gingival hyperplasia, rash, LAD

Question 5

Classic findings of APL?

Answer 5

Bleeding, thrombosis (DIC, fibrinolysis). Auer rods.

Question 6

Classic findings of ALL?

Answer 6

LAD, organomegaly, CNS dysfunction, bone pain, tumor lysis

Question 7

Classic findings of T Cell Leukemia?

Answer 7

Hypercalcemia, bone lesions

Question 8

Age incidence of APL?

Answer 8

Teens - 60s.

Question 9

Translocation of APL?

Answer 9

t(15;17)

Question 10

Treatment of APL?

Answer 10

ATRA (all-trans-retinoic-acid). Diffferentiates promyelocytes to neutrophils.
2nd line is Arsenic Trioxide. Preferred if WBC < 10k.

Question 11

What is Differention Syndrome?

Answer 11

side effect of ATRA treatment for APL? Cytokine release, increase APL adhesion via beta-2 integrins. Fever, leukocytosis, pulm infiltrates, effusion. Looks like HF, PNA, Sepsis.

Question 12

Treatment of differention Syndrome?

Answer 12

Dexamethasone.

Question 13

Treatment of hyperleukocytosis in AML?

Answer 13

Leukapharesis. Cyrotreduction w/ chemo preferred if not emergent. Cranial irridiation.

Question 14

Symptoms of hypercalcemia?

Answer 14

Lethargy, confusion, constipation, hypovoleumia, bradyarrhythmias

Question 15

Treatment of hypercalcemia?

Answer 15

1. IVF, loop diuretics.
2. HD if Ca > 18, HF, severe AKI, AMS.
3. Bisphosphnates (zolendronic acid, pamidronate)
4. Steroids
5. Calcitonin (tachyphylaxis)

Question 16

Indications for HD in hypercalcemia?

Answer 16

Ca < 18, severe AKI, AMS.

Question 17

Most Common cancers to met to bone?

Answer 17

Lung, breast, prostate.

Consider MM, NHL, RCC.

Question 18

Indication for steroids for bony mets?

Answer 18

focal neuro changes due to spine mets

Question 19

Pathophysiology of hyperviscoscity syndrome?

Answer 19

Elevated IgG. Can be due to aggressive IVIG treatment.

Question 20

Classic triad of hyperviscosity syndrome?

Answer 20

Mucosal bleeds, neuro changes, vision changes.

Question 21

Rouleaux formation on peripheral blood smear indicative of what?

Answer 21

Hyperviscosity syndrome

Question 22

Treatment of hyperviscosity syndrome?

Answer 22

Plasmapharesis, chemotherapy

Question 23

Classic underlying cancers causing tumor lysis syndrome when treated? (5)

Answer 23

Burkitt’s lymphoma, NHL, ALL, DLBCL, AML

Question 24

Treatment of tumor lysis syndrome?

Answer 24

Rasburicase. HD possibly, for normal indications.

Question 25

Prophylaxis for tumor lysis syndrome?

Answer 25

Allopurinol. Febuxostat is 2nd line.

Question 26

Contraindication to giving rasburicase?

Answer 26

G6PD-Deficiency.

Question 27

MCC of SVC syndrome? 3 others?

Answer 27

MCC is NSCLC (50%). Others are SCC, lymphoma, mets.

Question 28

MCC of mets to CNS?

Answer 28

melanoma, lung, breast.

Question 29

Size of brain met which indicates neurosurgery?

Answer 29

> 4-5cm