Heme/Onc - UWorld

Question 1

In patients with Medullary Thyroid Cancer, what do Elevated Calcitonin levels AFTER a Thyroidectomy indicate?

Answer 1

Metastatic Disease

Question 2

In patients with Suspected Metastatic Medullary Thyroid Cancer (elevated calcitonin post-thyroidectomy), what is the Next Step in Management?

Answer 2

CT Scan (Neck & Chest)

Question 3

Why is a Total Body Iodine Scan NOT useful in the Diagnosis of Medullary Thyroid Cancer?

Answer 3

Medullary Thyroid Cancer cells do NOT take-up iodine.

Question 4

Rh(d) Incompatibility is ONLY possible in what genetic Mother/Father Rh(d) combination?

Answer 4

Rh(d)- Mother / Rh(d)+ Father

Question 5

What Disease can be caused by Rh(d) Incompatibility in the Newborn?

Answer 5

Hemolytic Disease of the Newborn

Question 6

Describe (2) Steps in the Pathophysiology of Hemolytic Disease of the Newborn?

Answer 6

1. Rh(D) Incompatibility occurs when an Rh(D)-Negative Mother is exposed to the Rh(D) Antigen (typically from fetomaternal hemorrhage in a prior pregnancy with an Rh(D)-Positive fetus).
2. The Mother then produces IgG Anti-D Antibodies that Cross the Placenta and Destroy Rh(D)-Positive Fetal RBCs (eg, hemolysis) in a subsequent pregnancy.

Question 7

What are (3) typical Clinical Presentation findings in patients with suspected Immune Thrombocytopenia (ITP)?

Answer 7

1. Antecedent Viral Infection (no evidence of systemic disease; no fever, malar rash, or joint stiffness)
2. Asymptomatic Petechiae & Purpura
3. Mucous Membrane Bleeding

Question 8

What are (2) Lab Findings in patients with Immune Thrombocytopenia (ITP)?

Answer 8

1. Isolated THROMBOCYTOPENIA (Platelets < 100,000/mm³)
2. NEGATIVE Direct COOMBS (Antiglobulin) Test

Question 9

What Clinical Manifestation of Immune Thrombocytopenia (ITP) signifies a MILD form of Disease?

Answer 9

Asymptomatic or Cutaneous bleeding (eg, Petechiae, Purpura)

Question 10

Which (2) Clinical Manifestations of Immune Thrombocytopenia (ITP) signify a MODERATE/SEVERE form of Disease?

Answer 10

1. Mucosal bleeding (eg, gingival, epistaxis)
2. Internal hemorrhage (eg, hematochezia, intracranial hemorrhage)

Question 11

What is the Treatment for patients with MILD Immune Thrombocytopenia (ITP)?

Answer 11

Observe (eg, mild or no bleeding)

Question 12

What is the Treatment for patients with MODERATE/SEVERE Immune Thrombocytopenia (ITP)?

Answer 12

IVIG Pharmacotherapy (eg, moderate/severe bleeding)

Question 13

In patients taking Warfarin who are suffering Life-Threatening Hemorrhage which (2) Treatments should they receive for reversal?

Answer 13

1. Prothrombin Complex Concentrate (contains Vitamin K Clotting Factors and Normalizes INR in < 10 minutes)
2. IV Vitamin K (results in Sustained Reversal BUT takes 12 - 24 hours for full effect)

Question 14

What is the Mechanism of Action (MOA) for Warfarin used in the treatment of A-Fib and Venous Thromboembolism?

Answer 14

Inhibits Vitamin K Recycling ⇒ Decreased Vitamin K ⇒ Decreased circulation Vitamin K Dependent Clotting Factors (II, VII, IX, X)