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Hematology And Oncology > UW > Flashcards

UW Flashcards

1
Q

Diagnostic criteria of antiphospholipid antibody syndrome

A
  1. clinical + 1 lab must be met
    lab: lupus anticoagulant, anticardiolipin antibody, anti-beta-2 gp antibody
  2. clinical: arterial or venous vascul thromb, 3 or more consecutive unexpl fetal loses before 10 week, 1 unexplained fetal loss oafter 10 weeks, 1 premature birth of normal neonate befoere 14 week (due to preexlampsia, eclampsia, placental insuf)
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2
Q

lupus anticoagulant - PTT

A

prolonged PTT in vitro –> it will not corect if mixed in a 1:1 dilutionwith normal plasma

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3
Q

lupus anticoagulant test

A
  1. Russel viper venom test

2. kaolin cloating time

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4
Q

polycytemia vera - treatment

A

phlobotomy

hydroxyurea –. decreases thrombus

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5
Q

polycythemia vera - ESR

A

decreased

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6
Q

CLL - lymph node biopsy vs BM biopsy

A

biopsy is not needed

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7
Q

CLL - diagnostic test

A
  • smagde cells on smear
  • flow cytometry
  • lymph node or BM biopsy not needed
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8
Q

possibility of DVT –> ….. (next step)

A

compression U/S

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9
Q

PE vs DVT on the initiation of anticoagulant

A

start in PE

confirm with U/S first in DVT

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10
Q

epidural spinal cord compression 2ry to cancer - management / MC locations / pain worse at

A

first steroids –> then MRI –> then maybe radiation + neurosurgery consultation
MC locations: 60% thoracic, 30% lumbosacral
- pain worse at night at recumbent position

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11
Q

waldestrom vs MM regarding BM biopsy

A

MM: more than 10% clonal plasma cells
Wald: more than 10% clonal B cell

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12
Q

waldestrom major complciations

A

lymphadenopathy, HEPATSPLENOMEGALY, bleeding, neuropathy, hyperviscosity

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13
Q

2 things unexplain on waldestrom

A

lymphadenopathy, hepatosplenomegaly

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14
Q

how to confirm HIT 2

A
  1. Elisa for PF4 antibodies

2. Seretonin release assay

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15
Q

G6PD def - normal G6PD activ level?

A

may be normal during attack

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16
Q

in which leukemia, PCP prophylaxis is indicated

A

CLL

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17
Q

Contraidications of thrombolytics in a massive PE –>

A

consider mechenical thrombectomy
iliac stenting
surgical thrombectomy

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18
Q

contraidications of anticoagulation in PE/DVT –> …

A

IVC filter

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19
Q

Risk factor for PE from thrombus in the renal vein

A

nephrotic syndrom

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20
Q

SVC - next step

A

X-ray

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21
Q

1st choice for cancer related vomiting

A

5-HT3 antagonists

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22
Q

MCC of folate def in USA

A

alcohol

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23
Q

MCC of inadequate response to EPO in patients with renal failure

A

iron def

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24
Q

Leukemoid reaction vs CML regarding leukocyte count and LAP score

A

leukemoid: more than 50, high LAP

CML usually more than 100, low LAP

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25
Q

leukemoid reaction vs CML regarding type of cells

A

leukemoid reaction: more mature: metamyelocytes more than myelocytes / no basophilia
CML: less mature: metamyelo less than myelocytes, absolute basophilia

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26
Q

ITP - treatment

A

A. children: skin manifesatation: observe, bleeding: IVIg OR glucocorticoids
B. Adults: if platelets less than 30 without bleeding: observe, if platelets less than 30 or bleeding: IVIg OR glucocorticoids

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27
Q

hyperspleenism - platelets number

A

usually more than 30 –> no bleeding

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28
Q

other tests required for ITP

A

HIV + HCV

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29
Q

how to treat anemia of chronic disease

A

treat the underlying condition (for example for RA, give methotrexate - not EPO)
iron is not beneficial

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30
Q

hered spheorcytosis with pain at RUQ?

A

acute cholocystitis

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31
Q

treatment of acute PE or DVT - oral factor Xa inh (abixaban rivaroxaban) vs warfarin

A
  1. oral factor Xa inh has 2-4 hours time of onset and they do not need overal or Lab monitorin
  2. Warfarin has 5-7 days onset, need overlap and lab monitorin (PT/INR)
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32
Q

PE/DVT - thrombolysis?

A

only for PE with hemodynamic instability or (rarely) for massive proxima DVT with symptoms and ischemia

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33
Q

Trousseau’s sign?

A

hypercoagulability disorder presenting with recurent superficial thrombophlebitis at unusual sites (eg. arms, chest area). It is usually associated with occult visceral malignancy such as pancreatic (MC), stomach, lung, or prostate carcinoma

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34
Q

when to do extensive testing for an underlying inerited cause of thrombosis

A

when patient’s history is suggestive:

1. yougner than 45 2. Reccurent DVT 3. multiple or unusual sites 4. Family history

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35
Q

Bone scan for the diagnosis of MM

A

not useful: detects only osteoblastic activity (metastatic tumores)

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36
Q

screening test for MM

A
  • serum protein electrophoresis
  • urine protein electrophoresis
  • free light chain analysis
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37
Q

prostate cancer in a patient with bone metastasis with history of orchiectomy

A

radiation (NO FLUTAMIDE)

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38
Q

how to diagnose autoimmune hemolytic anemia

A

coomb: positive for anti-IgG, anti-C3
coomb: positive for IgM, anti-C3

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39
Q

IgM anemia - treatment

A

avoidance of cold

rituximab +/- fludarabine

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40
Q

autoimmune hemolytic anemia - complications

A

IgG: venous thromboembolisms, lymphoproliferative disorder
IgM: ischemia, periphearl gangrene, lymphoproliferative disorder

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41
Q

sideroblastic anemia - size

A

both normal and micro

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42
Q

osteoarthritis - anemia of chronic disease

A

NO –> it is not a systemic infl condition

43
Q

before preganncy test - suspicion for anemia in the family - initial tests?

A

african: Hb elctrophoresis + CBC

non african: CBC at the beginning

44
Q

salvage therapy?

A

treatment when standard therapy fails

45
Q

neoaduvant therapy?

A

treatment given before standard therapy

46
Q

adjuvant therapy ?

A

therapy given in addition to standard therapy

47
Q

induction therapy

A

initial dose of treatment to rapidly kill tumor cells and send the patient into remission

48
Q

consolidation therapy?

A

after induction therapy with multidrug regimens to further reduce tumore burden

49
Q

maintenance therapy?

A

after induction and consolidation therapies (or initial standard therapy) to kill any residual tumor cells and keep the patient in remission (eg. daily androgen in prostate cancer)

50
Q

Hair cell leukemia - genetics / hepatomegaly? / lymphadenopathy / prognosis

A

BRAF mutation
hepatomegaly + lymphadenopathy are both rare
life expectancy is near normal

51
Q

hair cell leukemia - number of WBC

A

decreased due to BM inflitration

a minority has mild leukocytosis

52
Q

Blood transfusion reactions associated with hypotension (and onset and explain)

A
  1. anaphylactic: sec to minutes
  2. sepsis: minutes to hours
  3. primary hypotension reaction: transient, in patients with ACEi: within mins (by bradykynin)
  4. tranfusion related acute lung injury: noncardogenic pul edema: within 6 hours: causef by donor anti-leukocytes antibodies against recipient neutrophils + pulm endothelial cells
53
Q

indications for washed blood trasfusion

A
  1. IgA def
  2. Complement-dependet autoimmune hemolysis
  3. Continued allergic reactions (e.g. hives) with red cell transfusion despite antihistamine treatment)
54
Q

indications for irradiated blood transfusion

A
  1. BM trannplant recipients
  2. Acquired or congenital cellular immunodef
  3. Blood components donated by 1st or 2nd degree relatives
55
Q

indications for leukoreduced blood transfusion

A
  1. Chronically transfused patients
  2. CMV negative at risk patients (eg. AIDS, transplants patients)
  3. potential transplant recipients
  4. previous febrile nonhemolytic reaction
56
Q

MM - renal insuficiency at the time of diagnosis?

A

in 50%

57
Q

MM - protein gap

A

elevated (more than 4): it is the difference between total protein and albumin

58
Q

what is needed in the metabolism of homocysteine to methionine

A
  1. folate
  2. B12
  3. B6
59
Q

HIT 1

A

nonimmune direct effect of heparin on platelet activation and usually presents within the 1st 2 days of heparin –> platelet then normalises with continued heparin therapy and there are no clinical consequences

60
Q

Patients with asplenia are at risk for fulimnant infection with encapsulated bacteia due to deficits in

A

antibody response and antibody-mediated pahgocytosis/complement activation

61
Q

cannabinoids in anorexia?

A

only HIV anorexia

NOT cancer related

62
Q

cancer related anoreia/cachexia syndrome - treatment

A 
progesterone analogues (megestrol acetate + medroxyprogesterone acetate) and corticosterois
(progesterone are preferred due to less SEs)
63
Q

best initial test after suspicion of SCC of head and neck

A

panendoscopy (triple endoscopy: esophagoscopy, bronchoscopy, laryngoscopy)

64
Q

β symptoms in AML

A

only fatigue is common

65
Q

the liver can store vit D for …. (time)

A

30 days

but an acutely ill person with underlying liver disease can become K def in 10 days

66
Q

transplantation graft types and definitions

A
  1. autograft –> from self
  2. synergic graft (isograft) –> from identical twin or clone
  3. allograft (homograft) –> from nonidentical individual of same species
  4. xenograft –> from different species
67
Q

transplant rejection - types and onset (time)

A
  1. hyperacute –> minutes
  2. acute –> weeks to months
  3. chronic –> months to years
  4. graft-vs-host disease –> varies
68
Q

hyperacute transplant rejection - result onset / pathogenesis / treatment

A

widespread thrombosis of graft vessels –> ischemia/necrosis
onset: within minutes
Pre-existing recipient antibodies react to donor antigen and activate complement (type II hypersensitivity
- graft must be removed

69
Q

acute transplant rejection - mechanism

A
  1. Cellular: CD8 T cells activated against donor MHCs (type IV hypersensitivity reaction)
  2. Humoral: antibodies formation (after transplant) –> activate complement
70
Q

acute transplant rejection - results in / onset

A

vasculitis of graft vessels with dense interstitial lymphocytes infiltrate
onset: weeks to months

71
Q

acute transplant rejection - management

A

prevent/reverse with immunosuppresant

72
Q

chronic transplant rejection - mechanism

A

CD4 T cells respond to recipient APCs presentinf donor peptides, including allogenic MCR –> cytokines –> cellular and homural compoments (type II and IV hypersensitivity reactions)

73
Q

chronic transplant rejection - results in / onset

A

cytokines –> proliferation of vascular SMCs, paremchymal atrophy, Interstitial fibrosis
DOMINATED BY ARTERIOSCLEROSIS
onset: month years

74
Q

chronic transplant rejection - example of organs and results

A
  1. lung –> bronchiolitis obliterans
  2. Heart –> accelerated atherosclerosis
  3. Kidney –> chronic graft nephropathy
  4. Liver –> vanishing bile duct syndrome
75
Q

Graft-versus-host-disease - Mechanism / onset

A

grafted immunocompompetent T cells proliferate in the immunocompromised host and reject host cells with “foreign” proteins –> severe organ dysfunction (type IV hypersensitivity reaction)
onset: varies

76
Q

Graft-versus-host-disease - requirements to occur

A
  1. the graft must contain immunocommpoment T cells
  2. the host must be immunocompromised
  3. the recipient must express antigens (eg. MHC or other minor proteins) foreign to the donor
77
Q

Graft-versus-host-disease - clinical manifestation

A
  1. maculopapular rash
  2. jaundice
  3. diarrhea
  4. hepatsplenomegaly
78
Q

Graft versus tumor effect - definition

A

Donor T-cells eliminate malignant residual host T-cells (graft versus leukemia) or eliminates diverse kinds of tumors.

79
Q

transplant rejection - types, onset (time) and hypersensitvity reaction

A
  1. hyperacute –> minutes –> type 2
  2. acute –> weeks to months –> type II (humoral) or IV (cellular)
  3. chronic –> months to years –> both IV and IV (humoral and cellular)
  4. graft-vs-host disease –> varies –> type IV
80
Q

HIT 2 - management

A

stop all heparin products

- start direct thrombin inhibitor (argatroban) or fondaparunix

81
Q

HIT 2 clinical features

A

suspected with heparin exposure more than 5 days + any of the following

  1. platelet reduction more than 50%
  2. arterial or venus thrmbosis
  3. necrotic skin lesions at heparin injection sites
  4. acute systemic (anaphylactoid) reactions after heparin)
82
Q

patients with asplenia are at risk for fulminant infection with encapsulated bacteria due to deficits in

A

antibody response and antibody-mediated phagocytosis/complement activation

83
Q

how to confirm MM

A

bone marrow biopsy: more than 10% clonal plasma cells

84
Q

TTP management

A
  • plasma exchange
  • glucocorticoids
  • rituximab
85
Q

osler weber rendu sundrome - mechanism of polycythemia

A

shunts in the lung

86
Q

vitamin K - store

A

30 days

- in acutely ill with underlying liver disease: 7-10 d

87
Q

delayed hemolytic blood transfusion reaction

A
  1. mild fever + hemol anema
  2. within 2-10 days
  3. (+) direct coombs
  4. by anamnestic antibody response
88
Q

in the absence of any clear provoking factors (recent procedure, immobilization etc), patients with 1st episode of venous thromboembolism should

A

be referred for age appropriate cancer screening

89
Q

CO poisoning

A

high flow 100% O2

- intubation/hyperbaric O2 therapy (sever)

90
Q

giant cell bone tumor - area of the bone

A

epiphysis

91
Q

heparin vs LMWH - PTT

A

heparin it is more likley to prolong it

92
Q

CLL - worse prognosis if

A
  1. hepatosplenomegaly
  2. anemia + thrombocytopenia
  3. multiple chain lymphadenopathy
93
Q

wafarin induced skin necrosis in protein C def - management

A

immediate warfarin cessation and administration of protein C concentrate

94
Q

MM - immunodef

A

bone marrow infiltration by neoplastic cells –> alters normal leukocyte population and causes hypogammaglobulinemia

95
Q

MC mechanism of pancytopenia in SLE

A

peripheral destruction

96
Q

symptomatic patients with autoimmune hemolytic anemia - treatment

A

high dose steroids

97
Q

methionine level in megaloblastic anemia

A

decreased

98
Q

immunologic transfusion reaction types (MC?)

A
  1. allergic reaction
  2. Anaphylactic reaction
  3. Febrile nonhemolytic transfusion reaction (MC)
  4. Acute hemolytic tranfusion reaction
  5. transfusion related acute lung injury
  6. delayed hemolytic
99
Q

tranfusion related acute lung injury

A

noncardogenic pul edema
within 6 hours
caused by donor anti-leukocytes antibodies against recipient neutrophils + pulm endothelial cells

100
Q

delayed hemolytic blood transfusion reaction

A
  1. mild fever + hemol anema
  2. within 2-10 days
  3. (+) direct coombs
  4. by anamnestic antibody response
101
Q

febrile nonhemolytic reaction

A

caused by cytokines accumulation during blood storage

  • 1-6 hours
  • fever + cilld
102
Q

Blood transfusion reaction - acute hemolytic transfusion reaction - intravascular or extravascular hemolysis?

A

both:
hemoglobinuria (intrav hemolysis)
jaundice (extravascular hemolysis)

103
Q

Blood transfusion reaction - acute hemolytic transfusion reaction - mechanism

A

Type II hypersensitivity reaction –> intravascular hemolysis (ABO incompatibility) or extravascular hemolysis (host antibody reaction against foreign antigen on donor RBCs)

Hematology And Oncology (21 decks)

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