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Heme/Onc Fellowship > Miscellaneous > Flashcards

Miscellaneous Flashcards

1
Q

AC trial at Medstar

A

RCT double blind study comparing ASA vs placebo for 3 years w/ end goal monitoring of decreased recurrence of breast cancer following standard chemotherapy regimens

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2
Q

Palbociclib benefit for breast cancer

A

When combined w/ endocrine therapy, increased PFS

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3
Q

Consideration of long term anastrazole for post chemotherapy breast cancer

A

If patient is post menopausal and had low grade disease, unlikely to have great benefit

If high grade disease or premenopausal, recommend continuation for 10 years

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4
Q

Mondoor’s disease

A

Superficial thrombophlebitis of the veins of the anterior chest wall

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5
Q

Capecitabine cycles for metastatic breast cancer

A

Oral regimen taken for 14 days followed by 7 day break

Total cycle length is 21 days

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6
Q

Stauffer’s Syndrome

A

Signs of cholestasis unrelated to tumor infiltration of the liver that resolves after RCC resection

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7
Q

Sarcoma that requires full body scanning

A

Myeloid lipoid sarcoma; requires full body CT, MRI spine, MRI brain

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8
Q

Merkel Cell Cancer general concept for therapy

A

Carboplatin + Etopiside (like small cell lung cancer); additionally, they are now trying PD-1 inhibitor therapies

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9
Q

Ravulizumab

A

Anti-C5 antibody used to atypical HUS, PNH in the US; associated with increased risk for meningococcal infections due to decrease formation of C5-9 complex

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10
Q

Anticoagulant w/ the best bleeding profile

A

Eliquis

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11
Q

Thrombin positively feedbacks what factors in the coagulation cascade?

A

II, V, XI, XIII

-Is partly why Factor XII, PK, and HMWK deficiencies don’t bleed since XI can still be activated

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12
Q

Antithrombin inhibits what molecules?

A

Thrombin (duh), Factor IXa, and Xa; irreversibly binds

-Also factors XIa and XIIa to a small extent

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13
Q

Protein C function

A

Cleaves cofactors Va and VIIIa to reduce their function; free protein S is a cofactor for activated protein C function

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14
Q

What are some of our natural anticoagulant pathways?

A

Antithrombin
Protein C, S
Tissue Factor Pathway Inhibitor (TFPI)
Plasminogen

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15
Q

Treatment for Factor VIII inhibitor

A

Activated Factor VII

Additionally, steroids + cyclophosphamide to eliminate the inhibitor

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16
Q

Antiphospholipid antibodies will prolong with coagulation time?

A

PTT

17
Q

When is the PFA inaccurate?

A

When platelet count is <100 or if Hcrt is <30

18
Q

Causes of acquired vWD

A

MGUS - treatable w/ IVIG
Hypothyroidism - type I due to decreased production
MPNs - type II due to sticky platelets that don’t bind vWF
Valvular disorders (Heide’s)
LVADs
Wilm’s tumors

19
Q

Cause of acquired Factor X deficiency

A

Amyloidosis - actively removes Factor X from plasma; fix with replacement

20
Q

What can patient’s with a lupus inhibitor also have?

A

Anti Factor II antibody

21
Q

What lab can be increased with SS crisis?

A

AST; due to reserve in RBCs

22
Q

Bendamustine ADRs

A

Fever at night, increased Cr NOT DUE TO TLS, hair loss, nausea

23
Q

Rituxan infusion rate

A

It is slowly increased every 30minutes to ensure no reaction; typically, this won’t occur until the 2nd or 3rd increase

24
Q

Patient with a provoked DVT who still gets tested and has a positive hypercoagulable screen

A

Does not change management; repeat testing after 3 months of treatment for provoked DVT and test when off anticoagulation

25
Q

Labs to check for thrombophilia

A 
LA
ACL
Anti-B2 glycoprotein
FVL
Prothombin G20201A
Protein S
Free s antigen
Protein C
Antithrombin III activity
26
Q

What to do with patient who is heterozygous for BOTH FVL and prothrombin mutations?

A

Anticoagulate; if positive for just one, don’t

27
Q

Acquired hemophilia deficiencies

A 
Acquired deficiency:
• Liver disease (C, S, AT)
• Warfarin therapy (C, S)
• Estrogens, pregnancy (S)
• Inflammatory diseases (S)
• Heparin therapy (AT)
• Acute thrombosis (S, AT)
28
Q

Bleeding disorder that is usually benign but most commonly presents as excessive intraoperative bleeding

A

Factor XI deficiency

Diagnosis: Prolonged aPTT, low Factor XIa level

Tx: Antifibrinolytics, FFP prior to surgery

29
Q

Factor VII deficiency

A

Mucocutaneous or surgical bleeding but rarely presents as thrombosis

Tx with rVIIa

30
Q

Plasma dyscrasias can be associated with a deficiency of which coagulation factor?

A

Factor X

Can also be AR inherited (1:500k)

Levels are well associated with symptoms

Tx: FX concentrate, PCC, FFP, treatment of plasma cell disorder

31
Q

Factor V deficiency

A

Has prolonged aPTT, PT, normal thrombin time

Can treat with platelets because platelet granules contain factor V

32
Q

Bleeding from umbilical stump or sudden ICH

A

Factor XIII deficiency; AR genes coding for catalytic A subunit

Can also present as poor wound healing or pregnancy loss

Dx: Clot solubility test, Factor XIII assay, genetic testing

33
Q

Treatment for Factor XIII deficiency

A

Recombinant Factor XIIIa subunit OR pdFXIII if known to have B subunit mutation

Can also use FFP if not available

*****Give monthly prophylactic Factor XIII treatment in patients with FXIII level <10% to decrease risk of spontaneous ICH

34
Q

Prothrombin deficiency

A

Poor correlation with levels and clinical bleeds

Dx: Same to factor V deficiencies; confirm with prothrombin activity assay, prothrombin antigen level, genetic testing

**Need to rule out acquired deficiency and check for antiprothrombin antibodies

Tx: PCC q2-3days, pts only need prophylaxis with history of severe bleeding, prothrombin levels <10%

35
Q

Hypofibrinogenemia

A 
Homozygous = No fribrinogen 
Heterozygous= Hypofibrinogenemia

Tx: Cryo, FFP, prophylaxis in only severe cases

36
Q

Dysfibrinogenemia

A

Actually associated w/ increase risk of thrombosis (20-25%)

37
Q

Second most common inheritable bleeding disorder

A

HHT; AD inherited

95% have severe recurrent mucocutaneous bleeding; many patients also have liver, lung, brain vascular malformations that are at increased risk for hemorrhage

Tx: Iron infusions + Antifibrinolytics + Local ablative procedures + Antiangiogenic therapies (bevacizumab)

Heme/Onc Fellowship (8 decks)

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