Rx_2.25 (HemOnc)

Question 1

Fatigue, anorexia, weight loss + enlarged lymph nodes + blood smear ==> dx?

Answer 1

• chronic lymphocytic leukemia (CLL) vs. small lymphocytic lymphoma (SLL)
  
  • CLL = >4000cells/mm³ in bloodstream (more than SLL)
• “smudge cell” = characteristics finding on peripheral smear
  
  • fragile lymphocytes (B cells) are flattened in theprocess of examining smear
    
    • CD5
    • CD19
    • CD20
    • CD23

Question 2

Warm-reactive autoimmune hemolytic anemia presentation and tx

Answer 2

• sx/labs
  
  • jaundice
  • anemia sx/lab findings
    
    • increased retic count
  • positive warm-agglutinin test
• tx
  
  • corticosteroids ==> interfere w/immune destruction of erythrocytes
    
    • inhibit Fc receptor-mediated clearance of sensitized RBCs

Question 3

Txs of autimmune hemolytic anemias

Answer 3

• IVIg ==> adult autoimmune hemolytic anemia
• cyclosporine ==> tx of refractory autoimmune hemolytic anemia in children
• splenectomy ==> tx in children w/chronic or refractory autoimmune hemolytic anemia

Question 4

Direct vs. Indirect Coombs test

Answer 4

• direct
  
  • anti-IgM/IgG added to patients serum
  • RBCs agglutinate if IgG/IgM is attached to the surface
• indirect
  
  • normal RBCs added to patient’s serum
  • if pt. has antiRBC antibodies ==> attach to normal RBCs
  • add anti-IgM/IgG; RBCs agglutinate if anti-RBCs have attached

Question 5

Positive Coombs test indicates ==> ?

Answer 5

[most likely] autoimmune hemolytic anemia

Question 6

Tx of acute DVT/PE

Answer 6

• LMWH
  
  • e.g. enoxaparin
  • MOA: subq admin, inhibition of factor Xa
  • does not require monitoring

Question 7

In warfarin tx, monitor…

Answer 7

• PT (prothrombin time) = measure of extrinsic coag pathway
  
  • not standardized between labs
• INR = standardized between labs

Question 8

In heparin tx, monitor…

Answer 8

• PTT (partial thromboplastin time) = measure of intrinsic coagulation pathway

Question 9

Unfractionated Heparin: MOA

Answer 9

• activation of antithrombin III ==> decreased level of available thrombin
• inhibition of factor Xa

Question 10

Serious complications of heparin

Answer 10

• bleeding
• heparin-induced thrombocytopenia )HIT)
  
  • antibodies against heparin-platelet factor 4 complexes ==> clotting
  • ==> MI, stroke, DVT
  • platelets ==> < 50% of prev. level
  • occurs w/in 5-14 days

Question 11

Heparin antidote

Answer 11

protamine sulfate

Question 12

Characteristics of hemophilia

Answer 12

• x-linked recessive hematologic disorders
• A = factor VIII deficiency
• B = factor IX deficiency

Question 13

Translocations assoc. w/hematologic malignancies

Answer 13

• Burkitt’s lymphoma = t(8;14)
  
  • 8 = c-myc
  • 14 = IgG heavy chain locus
  • ==> overexpression of c-myc
• CML = t(9;22)
  
  • BCR-ABL fusion ==> increased tyrosine kinase activity
• Mantle Cell lymphoma = t(11;14)
  
  • 11 = cyclin D1
• Follicular lymphoma = t(14;18)
  
  • 18 = BCL2 ==> inhibits apoptosis
• AML (acute pro-myelocytic leukemia) = t(15;17)
  
  • 17 = retinoic acid receptor

Question 14

fatigue, weight loss + enlarged spleen + peripheral smear ==> dx?

Answer 14

• hairy cell leukemia
  
  • B-cells have “hairy” appearance
• rarely presents w/fevers and night sweats
• 4x more prevalent in men vs. women
• elevation of tartrate-resistant acid phosphatase @ B-lymphs in bone marrow = confirmation
  
  • “TRAP the HAIRY beast”

Question 15

older pt w/central area of necrosis + ring enhancing lesion @ R hemisphere ==> dx?

Answer 15

• Glioblastoma multiforme
• “pseudopalisading necrosis” = central necrosis + hypercellular zone
• most common primary intracrainal neoplasm
  
  • usually @ older patients
• poor prognosis

Question 16

Skin biospy ==> dx?

Answer 16

• basal cell carcinoma
• gross = raised, pearly borders surrounded by fine telangiectasias
• biopsy: palisading nuclei + nests of tumor cells

Question 17

Presentation of acanthosis nigricans

Answer 17

• gross
  
  • thickened hyperpigmented zones
  • velvet-like texture
• assoc. w/ benign or malignant conditions
  
  • DM
  • adenocarcinoma

Question 18

Presentation of actinic keratosis

Answer 18

• most common pre-cancerous dermatosis
• can progress ==> squamous cell carcinoma
• gross = tan-brown, rough lesion <1cm in diameter
• histology = cytologic atypia + intracellular bridging

Question 19

Presentation of squamous cell carcinoma

Answer 19

• patient w/frequent sun exposure
• usually: actinic keratosis ==> SCC
• histologically
  
  • pink, extracell concentration on H&E
• gross
  
  • sharply-defined red, scaling plaques

Question 20

Presentation of lentigo

Answer 20

• benign lesion of childhood
• gross
  
  • 5-10mm oval, tan-brown patches that do not darken w/sunlight
• histo
  
  • linear basal hyperpigmentation from melanocyte hyperplasia