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Heme/onc > high yield > Flashcards

high yield Flashcards

1
Q

vitamin K dependent coagulation factors

A

Factors 7, 9, 10 and prothrombin

protein C and protein S

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2
Q

important details of coagulation cascade

A
  • major site of synthesis of factors is liver (liver disease=bleeding)
  • Factor 7 has a very short half-life
  • vitamin K dependent factors: 2, 7, 9, 10 (procoag) protein C and S (anticoag.)
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3
Q

plasma cell neoplasm def

A

expansion of a clone of plasma cells (terminally differentiated Ig secreting B cells) that typically secrete a monoclonal Ig (paraprotein/M protein)

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4
Q

cancers that produce parathyroid hormone and result in hypercalcemia

A

kidney cancer

lung cancer

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5
Q

treatment of tumor lysis syndrome

A

hydration + allopurinol

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6
Q

signs and symptoms of superior vena cava syndrome

A
  • venous dilatation of arms and chest
  • facial flushing and swelling
  • dyspnea
  • cerebral edema
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7
Q

signs of spinal cord compression

A

back pain followed by leg weakness
evere back pain in radicular, band-like pattern which precedes motor or sensory deficit
• Weakness in distribution below dermatomal level of pain
• Sensory defect below same dermatomal level
• Hyerreflexia and pathologic long tract signs
• Urinary and rectal incontinence

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8
Q

treatment of hypercalcemia in lymphomas and plasma cell neoplasms

A

steroid responsive

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9
Q

signs/symptoms of hypercalcemia

A
  • CNS changes
  • Polyuria
  • Constipation and dysphagia
  • Anorexia
  • Severe bone pain
  • Rarely pancreatitis and kidney stones
  • Shortened QT-interval
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10
Q

pericardial tamponade

A

depends on rapidity of accumulation of pericardial fluid

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11
Q

t(9;22)

A

philadelpha chromosome; BCR-ABL
CML
small % ALL (poor prognosis; adult form)
treat w/ imatinib

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12
Q

t(8;14)

A

burkitt lymphoma

myc activation

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13
Q

t(11;14)

A

mantle cell lymphoma

cyclin D1 activation

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14
Q

t(14;18)

A

follicular lymphoma

BCL-2 activation

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15
Q

t(15;17)

A

APL subtype of AML

PML-RAR fusion (treat w/ ATRA)

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16
Q

most common aggressvie lymphoma

A

diffuse large B cell

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17
Q

most common indolent lymphoma

A

follicular lymphoma

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18
Q

therapy for diffuse large B cell lymphoma

A

R CHOP (cyclophosphadmide=alkylating agent, doxorubicin (topo II inhib), vincristine (inhibts MT polymerization), prednisone)

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19
Q

follicular lymphoma vs follicular hyperplasia

A

follicular lymphoma express BCL2 t(14;18)

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20
Q

symptoms of polycythemia vera

A

persistent leukocytosis, thrombocytosis, splenomegaly, generalized pruritus (usually after bathing), thrombosis and erythromelagia

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21
Q

Which diseases have JAK2 mutations?

A

polycythemia vera, essential thrombocythemia, primary myelofibrosis

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22
Q

Which acute leukemia more commonly presents w/ adenopathy?

A

ALL (and also Burkitt’s lymphoma)

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23
Q

APL key facts

A

more likely to present with DIC
t(15;17)=PML-RAR fusion
treated w/ ATRA + chemo or arsenic

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24
Q

Which chemotherapy drug is most likely to be later associated with secondary AML?

A

akylating agents

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25
Q

myelophtisic anemia

A

• replacement of marrow by infiltrative process→fragmented RBCs in peripheral blood

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26
Q

symptoms of MM

A 
CRAB
hyperCalcemia
Renal insufficiency
Anemia
Bone lesions
27
Q

Anisocytosis

A

blood cells of unequal size

28
Q

GI bleed, ulcer, menstrual irregularities

A

iron deficiency anemia

29
Q

What do you think of w/ aplastic anemia

A

parvovirus B19

30
Q

hyposegmented neutrophils

A

pegler heut anomaly

31
Q

African american pt limping

A

avascular necrosis femoral head

32
Q

hydroxyurea

A

treatment sickle cell

inc. HbF

33
Q

COLD AIHA

A

IgM, intravascular hemolsys

34
Q

Warm AIHA

A

pt has lupus–warm autoimmune hemolytic anemia

35
Q

pt w/ recurrent miscarriages

A

antiphospholipid antibody syndrome

labs: paradoxically elevated PTT w/ lupus anticoagulant

36
Q

ALL

A

median age onset 10; lymphoblasts occupy > 20% marrow space; TdT+; CD2, 3, 7 positive; mets can occur to the CNS so you want to look for CNS disease in these patients by doing an LP +/- CT, MRI

37
Q

CLL

A

median age onset 65 years; functionally incompetent mature b-lymphocytes; CD19, 20, 22, 23 positive;
SMUDGE CELLS
pts asymptomatic, discovered on routine blood smear

38
Q

AML

A

median age onset is 60 years old; POSITIVE FOR MYELOPEROXIDASE

39
Q

APL

A

= rare disease, t(15;17) PML-RARa fusion protein; treat with All-trans retinoic acid; release of auer rods can lead to DIC

40
Q

CML

A

Philadelphia chromosome t(9;22); three course disease→ chronic phase → accelerated phase → blast phase (counts can get so high that cells cause infacts, stroke); NOTE: You can distinguish this from leukemoid reaction because CML has low levels of leukocyte alkaline phosphatase

41
Q

Burkitt lymphoma

A

starry sky appearance on pathology (know this); t(8;14); EBV associated; you can also see this in people with HIV

42
Q

Lung cancer

A

: small cell is the most deadly; squamous cell can produce PTHrP causing hypercalcemia; small cell can secrete ACTH (leading to cushings) and ADH (causing SIADH); know that small cell cancer is treated with chemotherapy and not surgery

43
Q

adenocarcinoma of the lung

A

located peripherally in the lung (pleural puckering seen on path…google image this) and can result in hypertrophic osteoarthropathy (polyarthritis and periostosis of long bones) → so if you get a patient with PAIN IN HIS SHINS, think of this
**MOST COMMON TYPE OF LUNG CANCER IN NON-SMOKERS

44
Q

colon cancer screening in brief

A

a. NormalL colonoscopy @ 50 then every 10 yrs if normal; every 3-5 years if abnormal findings
b. Strong Family Hx of Colon Ca: colonoscopy @ age 40 or 10 years before diagnosis in relative, then every 5 years
c. Ulcerative colitis: colonoscopy 8-10 years after diagnosis , then every 1-2 years.

45
Q

clopidogrel side effect

A

clopidogrel can cause neutropenia

46
Q

target cells assoc. w/

A 
HALT
HbC
Asplenia
Liver disease
Thalassemia
47
Q

basophilic stippling assoc w/

A 
TAIL
thalassemia
anemia chronic disease
iron deficiency
Lead poisoning
48
Q

tear drop cell

A

infiltrative d/o of bone marrow

49
Q

howell-jolly body in rbc

A

asplenia

50
Q

TTP

A

autoimmune attack on ADAMTS13–>large vWF–>platelet overactivation
Dx: dec. PC (normal PT, PTT, D-dimer)
systemi sx>renal sx
low ADAMTS13 activity

51
Q

HUS

A

caused by E. coli O157:H7
dec. PC (normal PT, PTT, D-dimer)
renal sx>systemic Sx
normal ADAMTS13 activity

52
Q

DIC

A

widespread endothelial damage, overactivation of both platelets and coagulation cascade
dec. PC, inc. PT/PTT/D-dimer
clotting and bleeding at same time

53
Q

bloody discharge from nipple in premenopausal woman

A

intraductal papilloma=benign

54
Q

pancreatic cancer staging

A

o T-stage:
• T1: limited to pancreas 2cm
• T3: extends beyond pancreas, not to celiac axis, SMA
• T4: involves celiac axis or SMA

o N-stage:
• N0: no regional LN
• N1: + regional LN

o M-stage: M0 (no mets) M1 (mets)

55
Q

criteria for surgical resection pancreatic cancer

A
  • No distant mets
  • Clear fat plane around celiac artery and SMA
  • Patent SMV/portal vein
56
Q

screening for HCC

A

for high risk pts (HBV, HCV, cirrhotics)
serial US and AFP testing every 6-12months
follow up w/ CT/MRI if abnormal

57
Q

radiographic Diagnosis of HCC

A

lesions 1-2cm w/ classic appearance on 2 imaging modalites,

lesions >2cm w/ one imaging modality,

AFP>200 w/ classic arterial enhancement

58
Q

peutz jeghers syndrome

A

perioral pigmentation; AD; STK11/LKB1 gene mutation; small intestinal hamartomas w/ increased risk other GI cancers

59
Q

amsterdam criteria to identify HNPCC kindred

A
  • 3 or more relatives w/ an associated cancer (CRC, small bowel, endometrial, renal, gastric, ovarian)
  • 2 successive generations involved
  • 1 of cancers diagnosed before age 50
  • **criteria misses 50% of HNPCC families
60
Q

follow-up surveillance for resected CRC

A

o H&P w/ digital rectal exam q3-6months for 2 years then q6 months for 3 years
o CEA testing q3-6months for 2 years, then q6months for 3 years
o Colonoscopy at 1 year, repeat in 1 year if abnormal or if negative then 5 years
o CT chest, abdomen, pelvis annually x 5 years for high risk patients
o No evidence for routine CBC, LFT, CXR, PET scan

61
Q

squamous cell lung cancer

A 
most common cancer in smokers
central
hypercalcemia due to PTH-like substance
bone mets
CK5/6+, P63+
62
Q

adenocarcinoma of the lung

A

most common in nonsmokers
peripheral
brian mets, hypertrophic osteoarthropathy (shin pain)
TTF-1+, CK7+, CK20-, NAPSIN A+

63
Q

large cell lung cancer

A

giant cell, clear cell, spindle cell

brain mets

64
Q

smal cell lung cancer

A

most deadly
neurosecretory granules, chromogranin+, synaptophysin+
central (hilar/mediastinal adenopathy)
paraneoplastic syndrome (SIADH, cushings, eaton lambert)
brain mets–>must image!

Heme/onc (5 decks)

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