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Medicine > ITE Heme/Onc > Flashcards

ITE Heme/Onc Flashcards

1
Q

What is PRCA caused by?

A

parvo typically

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2
Q

How to treat PRCA?

A

IVIG

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3
Q

Initial imaging modalities used for patients with monoclonal gammopathy ?

A

Low-dose CT

then PET-CT

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4
Q

A whole-body low dose CT scan negative for smoldering myeloma should be followed by what?

A

whole-body MRI

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5
Q

Guidelines state that patients treated for Multiple Myeloma with proteasome inhibitors (bortezomib) should receive what type of prophylaxis?

A

Antiviral (acyclovir, valacyclovir) to avoid herpes zoster

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6
Q

What is acute chest syndrome?

A

SS anemia; where pulmonary vasculature is occluded by sickled cells

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7
Q

What is the treatment for acute chest syndrome in SS patient’s?

A

erythrocyte exchange transfusion

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8
Q

Most appropriate long-term treatment for high risk antiphospholipid syndrome?

A

Warfarin

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9
Q

What should patients with diagnosed Polycythemia Vera (PV) always be treated with?

A

Phlebotomy and aspirin (goal hematocrit should be 45%)

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10
Q

High Risk Polycythemia Vera with additional risk factors including older age (>60) or a hx of thromboembolic event should receive what?

A

cytoreductive therapy: hydroxyurea or interferon-alpha in addition to phlebotomy

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11
Q

What is the treatment of choice for red blood cell aplasia related to parvovirus?

A

IVIG

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12
Q

Should you always scan a pregnant patient that you suspect a PE in the setting of an elevated D-Dimer? Why or why not?

A

No. D-dimer elevation is common in pregnancy and you do not want to subject patient to unnecessary radiation

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13
Q

What other drug would you want to add if patient was started on Bortezomib? (Hint: think prophylaxis)

A

Herpes Zoster prophylaxis: Valacyclovir

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14
Q

If you suspect Acute Chest Syndrome (ACS) in someone with sickle cell anemia, what is the first thing to do for management?

A

Erythrocyte Exchange Transfusion

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15
Q

What treatment should patients with anti-phospholipid be placed on?

A

Warfarin

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16
Q

What is the most appropriate initial management for PV patients when first diagnosed (especially if they are not exhibiting signs/symptoms)?

A

Low dose aspirin and phlebotomy

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17
Q

What are medicinal options for patients with PV and symptoms (or frequent phlebotomy)?

A

Hydroxyurea and interferon-alpha

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18
Q

What agent is indicated in PV when patient is symptomatic and has resistant symptoms (1st line therapy failed)?

A

Ruxolitinib

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19
Q

Characterized by anemia, reticulocytosis, elevated LDH, low haptoglobin and an indirect bilirubinemia

A

Hemolytic Anemia

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20
Q

How to confirm diagnosis of Warm Autoimmune Hemolytic Anemia?

A

Direct Antiglobulin Test (DAT)

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21
Q

How to reduce risk of febrile neutropenia when initiating chemotherapy?`

A

Start G-CSF at the time of chemotherapy

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22
Q

Increased aPTT pathway in setting of common post-surgical bleeding could indicate what?

A

Factor level decrease (Factor 8, 9 and 12)

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23
Q

Difference between alpha thal trait and carrie?

A

Alpha trait: elevated MCV and anemia

Alpha carrier: no anemia and normal or decreased MCV

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24
Q

Difference between alpha-thal and beta-thal?

A

Alpha-thal: normal hemoglobin electrophoresis

Beta-thal: abnormal hemoglobin electrophoresis

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25
Q

Difference between beta thal minor and Hemoglobin E trait?

A

Beta thal: decreased Hgb A components

Hemoglobin E trait: elevated Hgb E (>50%)

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26
Q

Patients with mild forms of hereditary spherocytosis should be monitored and placed on what medication?

A

folate

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27
Q

If patient, who has hereditary spherocytosis, develops transfusion dependence, symptomatic anemia, and massive splenomegaly, what is the indicated treatment?

A

Splenectomy

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28
Q

Platelet levels of gestational thrombocytopenia and ITP?

A

Gestational: rare and rarely go under 100k

ITP: first trimester low platelets and less than 70k

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29
Q

(9;22) mutation is associated with what cancer?

A

CML

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30
Q

What’s the treatment for CML?

A

Imatinib which is a TKI

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31
Q

Fever, dyspnea, hypotension, flank pain, and pink colored urine appearing shortly after blood transfusion

A

Acute hemolytic transfusion reaction; tx is volume expansion and supportive care

32
Q

Prolonged aPTT time should prompt what diagnostic test?

A

Mixing Study

33
Q

How to additionally treat HIGH-RISK acute myeloid leukemia after completing induction chemotherapy?

A

Stem Cell transplant

34
Q

How to treat anemia of chronic inflammation?

A

Treat the source; for instance, if PMR is suspected, start prednisone

35
Q

How to manage minimally symptomatic ITP?

A

glucocorticoids; only give platelet transfusion if platelets are between 10-20k

36
Q

Sepsis patient who then develops low platelets, prolonged coag studies, low fibrinogen, and elevated D-Dimer

A

DIC

37
Q

What level of platelets require a transfusion if patient is about to undergo an invasive procedure?

A

less than 50,000

38
Q

How much should one unit of platelets transfused increase the total count?

A

20-30k

39
Q

What drugs cause neutropenia?

A

Methimazole and thionamides

40
Q

In older patients with splanchnic vein thrombosis or Budd-Chiari syndrome, what should be tested?

A

Myeloproliferative disorders; order a JAK-2 tyrosine Kinase test

41
Q

What should you do in a patient with supratherapeutic INR less than 10 and is asymptomatic?

A

just watch and wait; follow up with INR weekly

42
Q

INR greater than 10

A

Vitamin K

43
Q

INR greater than 10 and life-threatening BLEEDING

A

Vitamin K and PCC should be administered

44
Q

Patients with essential thrombocythemia who have JAK2V617F mutation, what treatment regimen should be started?

A

aspirin and hydroyxurea

45
Q

The initial tests you should order with immune thrombocytopenic purpura should include what?

A

HIV and Hep C = early signs are low platelets

46
Q

What medication do you use for life-threatening bleeding on dabigatran?

A

Idarucizumab

47
Q

What medication do you use to reverse Factor Xa inhibitors (Eliquis, Xarelto)?

A

Andexanet alfa

48
Q

What vaccines are indicated for a patient starting chemotherapy for MM?

A

13-valent pneumococcal
23-valent pneumococcal
yearly influenza vaccine

49
Q

What are some underlying causes of erythrocytosis?

A

Hypoxia = smoking and OSA must be treated first

50
Q

Young age onset of bleeding symptoms and family history of bleeding; typically mucocutaneous, and menorrhagia and bleeding after minor procedures; aPTT would be normal or prolonged

A

vWD disease

51
Q

Macrocytic anemia with MCV of 110-115 would commonly include what differential?

A
  1. B12/folate deficiency
  2. treatment of HIV infection with anti-retrovirals
  3. Hydroxyurea
52
Q

How to treat DIC?

A

Treat the underlying disorder (ie. sepsis)

Also, platelet transfusions, cryoprecipitate, and fresh frozen plasma are provided as needed

53
Q

How to treat Warm autoimmune hemolytic anemia when patient has Hgb less than 7 and is symptomatic and hemodynamically unstable?

A

HAVE TO STABILIZE; use cross type erythrocyte transfusion therapies to get blood counts up; think about autoimmune treatments after

54
Q

What disease causes an IgM monoclonal gammopathy?

A

Waldenstroms macroglobulinemia (hyper IgM syndrome); can cause hyperviscosity

55
Q

How to immediately treat hyperviscosity syndrome associated with Waldenstrom?

A

Plasmapheresis

56
Q

Middle aged patient with headache, altered mentation, change in vision and hearing, nystagmus and ataxia

A

Hyperviscosity syndrome

57
Q

Patient with hemolytic anemia with a positive direct antiglobulin test to anticomplement (C3) but, not IgG

A

Cold agglutinin

58
Q

Cold agglutinin can arise as a primary process or secondary to what?

A

infection, lymphoproliferative disorder, autoimmune disease

59
Q

What is the management of upper extremity DVT associated with central venous catheter?

A

Left in: continue AC until cath is removed up to 3 months

removed: 3 months of AC

60
Q

Which anticoagulant has lowest renal elimination?

A

Eliquis

61
Q

Treatment of acute TTP?

A

Plasma Exchange with rituximab and glucocorticoids

62
Q

How to reverse warfarin bleeding?

A

4-factor PCC

63
Q

Protamine sulfate is used to reverse what?

A

heparin

64
Q

Heterozygous C282Y mutation of HFE gene without H63D or S65C in hemachromatosis

A

No treatment

65
Q

Management of superficial DVT that measures greater than 5cm?

A

6 weeks of oral DOAC

66
Q

Patients requiring chronic blood transfusions should be monitored for what?

A

evidence of iron overload with serial ferritin measurements; consider MRI to evaluate if iron deposition is suspected in heart/liver

67
Q

Patients requiring chronic blood transfusions should be monitored for what?

A

evidence of iron overload with serial ferritin measurements; consider MRI to evaluate if iron deposition is suspected in heart/liver

68
Q

What is the treatment for secondary iron overload?

A

iron chelation therapy

69
Q

What is the treatment for secondary iron overload?

A

iron chelation therapy

70
Q

What factor is most specific to the liver when evaluating for coagulopathy of liver disease?

A

Factor 8

71
Q

What are one of the medications that can cause hemolytic anemia associated with G6PD deficiency?

A

Nitrofurantoin

72
Q

Patient who has newly diagnosed triple positive anti-phospholipid disorder should be initiated with what therapy in the hospital? What oral medication should be initiated after discharge?

A

Heparin bridge to warfarin

73
Q

In patients taking DAP following coronary revascularization with significant hemorrhage, the best strategy is what?

A

discontinue Plavix and continue aspirin at least

74
Q

How to treat Hemophilia A patients who are bleeding?

A

Factor 7; PCC; or porcine derived factor 8 concentrate

75
Q

What medication can you give patient with MDS with 5q-cytogenic abnormality who are transfusion dependent?

A

Lenalidomide

Medicine (7 decks)

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