Rx_2.26 (HemOnc)

Question 1

Most common supratentorial tumor in children….

Answer 1

• craniopharyngioma <== Rathke’s pouch
  
  • ==> H/A, BTH
  • ==> deficiency of ant. pituitary hormones
    
    • e.g. GH
• cystic tumor lined by stratified squamous and filled w/viscous yellow, cholesterol rich fluid

Question 2

Warfarin: MOA, toxocity

Answer 2

• MOA =
  
  • inhibits vit K epoxide reducatase ==>
  • inability to carboxylate factors II, VII, IX, X and proteins C & S
• Toxicity
  
  • bleeding
  • teratogenic
  • skin/tissue necpsis

Question 3

Classic signs & sx of Hodgkin’s Lymphoma

Answer 3

• night sweats
• fever
• weight loss
• **presence of Reed-Sternberg cell

Question 4

Tx of Hodgkin’s lymphoma

Answer 4

• ​ABVD regimen:
  
  • Adriamycin (doxorubicin)
  • Bleomycin
  • Vinblastine
  • Dacarbazine

Question 5

Vinblastine: MOA, SE

Answer 5

• MOA:
  
  • inhibits MT formation of mitotic spindle
• SE:
  
  • alopecia
  • constipation
  • myelosuppression
  • neurotoxicity (rare)

Question 6

abnormal monoclonal immunoglobulin level + no other signs of malignancy ==> dx? tx?

Answer 6

• monoclonal gammopathy of undeterined significance (MGUS)
• tx = monitoring @ regular intervals for progression

Question 7

Cancer drugs that act in the M phase of the cell cycle

Answer 7

• vinca alkaloids=inhibit MT fxn/spindle formation
  
  • vincristine
  • vinblastine
• paclitaxel
  
  • binds to tubulin and hyperstabilizes MTs that have already polymerized ==> prevents spindle breakdown

Question 8

5-fluorouracil: MOA, use

Answer 8

• anti-metabolite
• prevents formation of thymidine vua inhibition of thymidylate synthase
• use = cancer drug

Question 9

6-mercaptopurine: MOA, use

Answer 9

• anti-metabolite
• inhibits formation of purines
• use = cancer drug

Question 10

Methotrexate: MOA, use

Answer 10

• anti-metabolite
• inhibts dihydrofolate reductase ==> inhibition of DNA synthesis (via same pathway as 5-fluorouracil)
• use = cancer drug

Question 11

Busulfan: MOA, use

Answer 11

• DNA alkylating agent (cell cyle nonspecific)
• use = CML

Question 12

Bleomycin: MOA

Answer 12

• inhibit replication by inducing DNA strand breaks via free radical formation
• strand breakage interrupts G2 phase of cell cycle (after DNA synthesis)

Question 13

Cyclophosphamide: MOA

Answer 13

• DNA alkylating agent (cell cycle nonspecific)

Question 14

Hematologic consequences of colon cancer

Answer 14

• carcinoma of colon ==> chronic blood loss
• ==> iron deficiency anemia
  
  • hypochromic, microcytic anemia

Question 15

Iron toxicity presentation & tx

Answer 15

• N/V + abdominal pain w/in 4 hours of ingestion
• tx = deferoxamine = chelating agent
  
  • also tx for aluminum toxicity

Question 16

Deferoxamine: uses, SE

Answer 16

• use
  
  • iron toxicity
  • aluminum toxicity
• SE
  
  • hypotensive shock 2^o to histamine release
  • allergic rxn
  • (rare) neural/renal toxicity

Question 17

Dimercaprol use

Answer 17

• tx poisoning by arsenic, mercury, gold

Question 18

Penicillamine uses

Answer 18

• tx of lead and arsenic toxicity
• chelating agent in Wilson’s disease (disorder of copper metabolism)

Question 19

“WEPT”

Answer 19

• Warfarin Extrinsic, PT
  
  • Warfarin ==I extrinsic pathway
    
    • TF + 7 => 10 + 5 => 2 => 1
  • Monitor PT

Question 20

Characteristics of Ehrlichiosis

Answer 20

• cause = Ehrlichia chaffeensis
  
  • carried by a tick on dogs/deer in Americas
  • member of the order Rickettsia
• presentation
  
  • fever, H/A malaise
  • truncal rash
  • blood = berry-like cytoplasmic inclusion in macs or PMNs
• tx
  
  • doxycycline

Question 21

Histologic feature + possible causes?

Answer 21

• target cell
• HALT:
  
  • ​Hemoglobin C disease
  • Asplenia
  • Liver disease
  • Thalassemia

Question 22

Presentation of thalassemias

Answer 22

• microcytic, hypochromic anemia
• alpha-thalassemia
  
  • alpha globin chain is underproduced
  • severity = ~#/4 genes mutated
  • loss of all four alpha genes ==> hydrops fetalis
• beta-thalassemia
  
  • beta globin chain underproduced
  • major = absence
  • minor = underproduction