Uworld Heme/Onc

Question 0

Febrile neutropenia?

Answer 0

Temperature > 38

Absolute neutrophil count < 1500

Question 1

Patient with smoking history, hilar fullness, Mediastinal lymphadenopathy, hypertension, hypokalemia?

Answer 1

Cushing’s from small cell lung cancer

Question 2

Treatment for febrile neutropenic patient?

Answer 2

Monotherapy with antipseudomonal agent (cefepime, Meropenem, Bactrim)

Question 3

Signs of polycythemia vera?

Answer 3

Increased blood pressure, Increased RBC mass, elevated platelet count

Peptic ulceration, gouty arthritis, splenomegaly, plethoric face

Question 4

Fibrocystic disease – type of nodule? Draining yields?

Answer 4

Rubbery, firm, mobile and painful during menses. Clear fluid.

Question 5

Signs of G6PD in smear? Drugs that provoke it?

Answer 5

Heinz bodies. Sulfa drugs, Antimalarial drugs, nitrofurantoin

Question 6

Tumor lysis syndrome - expected effect on PO4, K, uric acid, Ca?

Answer 6

Hyperphosphatemia, hyperkalemia, hyperuricemia

hypocalcemia

Question 7

Tumors that cause tumor lysis syndrome?

Answer 7

Burkitt’s lymphoma and ALL

Question 8

Treatment for HER2 positive cancer? Test needed before treatment?

Answer 8

Herceptin. EKG (can cause cardio toxicity in pts with systolic dysfunction)

Question 9

Tx for sickle cell pt with stoke-like Sx?

Answer 9

Exchange transfusion (fibrinolytics don’t help because stroke is caused by sickled cells, not thrombus)

Question 10

Tx of mild, moderate and severe hyperCa?

Answer 10

Mild (<12): none

Moderate (12-14): none unless symptomatic

Severe (14+): saline with calcitonin (no loop diuretics unless CHF). Bisphosphonate for long term.

Question 11

Anti-PPL - give what false positive? Coags? Platelet count? Tx?

Answer 11

False positive VDRL, prolonged PTT, and thrombocytopenia. Lovanox.

Question 12

Macro vs micro vascular hemolysis?

Answer 12

Mechanical valves/stenosis vs vessel occlusion

Question 16

Transferrin saturation?

Answer 16

Iron/TIBC

Question 17

Drug to increase appetite in cancer patients?

Answer 17

Progesterone analogs (megesteol acetate)

Question 18

3 basic symptoms of EBV?

Answer 18

Sore throat, fever, maculopapular rash

Question 19

Mech of spleen in immune response?

Why is the immune system impaired after splenectomy?

Answer 19

1. Normally, antigens enter spleen and are phagocytosed by DC cells
2. DC cells present antigens to T helper cells, activating them
3. T-helper cells migrate to marginal zone of spleen and activate B-cells
4. B-cells activation increases germinal centers and antibody production that facilitate phagocytosis of pathogenic organisms

Therefore, no spleen = impaired phagocytosis

Question 20

Warfarin leads to skin necrosis due to?

Answer 20

Protein C deficiency

Question 21

Hairy cell leukemia: stain? Effect on bone marrow? Drug to treat?

Answer 21

Tartrate-resistant acid phosphatase (TRAP) stain

Bone marrow fibrosis (dry taps)

Cladribine (Purine analog)

Question 22

Patient diagnosed with myasthenia gravis. Next test to order?

Answer 22

Chest CT scan to look for thymoma

Question 23

Waldenström’s versus multiple myeloma: immunoglobulin?

Answer 23

IgM spike vs IgA/IgG spike

Question 24

Symptoms of Waldenström’s that is not present in multiple myeloma?

Answer 24

Hyperviscosity syndromes – retinal vein engorgement

Question 25

Patient with HNPCC should also be evaluated for what other cancer?

Answer 25

Endometrial cancer

Question 26

Signs of lead poisoning?

Answer 26

1. Microcytic anemia
2. Neurologic abnormalities (difficulty concentrating, myalgias, peripheral neuropathy, extensor weakness)
3. Nephropathy

Question 27

Patient with tumor secreting ADH – treatment?

Answer 27

1. Fluid restriction (<800 mL) | 2. If still symptomatic/resistant use hypertonic saline

Question 28

Signs of glucagonoma?

Answer 28

1. G.I. symptoms (diarrhea, abdominal pain) 2. Diabetes 3. Necrolytic migratory erythematous plaques 4. Anemia 5. Weight loss

Question 29

Drugs that can impair folate absorption in the gut?

Answer 29

Phenytoin, pentobarbital, primidone

Question 30

Vitamin deficiency that can cause a microcytic anemia? Mechanism? Common Scenario?

Answer 30

Pyridoxine deficiency causing sideroblastic anemia. Post Isoniazid therapy.

Question 31

Anisocytosis vs poikilocytosis?

Answer 31

Cells of abnormal sizes vs shapes

Question 32

Benign vs worrisome lymph nodes?

Answer 32

2 cm, firm and immobile

Question 33

Senile purpura?

Answer 33

ecchymotic lesion in the elderly (usually dorsum of hands) due to connective tissue atrophy

Question 34

Test to confirm CLL?

Answer 34

flow-cytometry

Question 35

Complications of hereditary spherocytosis?

Answer 35

Splenomegaly, jaundice, gallstones Red blood cells get trapped in fenestrations of spleen (Splenomegaly). Hemolysis leads to jaundice and calcium bilirubinate stones.

Question 36

Not graft vs. host without?

Answer 36

Skin rash

Question 37

Leukoreduction? Purpose? Cell washing?

Answer 37

Depleting leukocytes in transfusions. Prevents febrile reactions caused by pt antibodies reacting with donor leukocyte; reduced CMV transmission Removes IgA

Question 38

Diseases with low leukocyte alkaline phosphatase?

Answer 38

1. CML 2. paroxysmal nocturnal hemoglobinuria 3. hypophosphtemia

Question 39

Laboratory findings in Steroid abuse?

Answer 39

erythrocytosis Heptatotoxicity Dyslipidemia

Question 40

Classic findings in CML?

Answer 40

Leukocytosis with low leukocyte alkaline phosphatase

Question 41

Management based on CHADS2 score?

Answer 41

0 = no treatment 1 - anticoagulant therapy > aspirin 2+ - Oral anticoagulant therapy

Question 42

MCHC (mean cell hemoglobin concentration) elevated in?

Answer 42

Spherocytosis

Question 43

Patient receives blood and becomes: 1. febrile with chills. Self limited and resolves within 1 to 6 hours? Prevention? 2. Febrile with Flank pain and hemoglobinuria. Progresses to renal failure and DIC. Diagnosis? Tests?

Answer 43

1. Non-hemolytic reaction due to cytokines in transfused blood. Luekoreduction 2. Acute hemolytic reaction (unmatched blood). Positive Coombs test and free plasma hemoglobin.

Question 44

Intravascular vs extravsacular hemolysis - haptoglobin?

Answer 44

Very low (lots of Hgb release) versus low-normal (cells phagocytized)

Question 45

Coombs test in Autoimmune hemolytic anemia vs hereditary spherocytosis?

Answer 45

Positive vs negative