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NURP532 > Week 10 Hematology/Oncology > Flashcards

Week 10 Hematology/Oncology Flashcards

1
Q

Platelet

A

small, colorless, disc shaped cell fragment without nucleus, found in large numbers in blood and involved in clotting

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2
Q

Eosinophil

A

WBC type; granulocyte that is release during infections, allergic reactions, and asthma

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3
Q

Basophil

A

WBC type; least common granulocyte; plays a role in allergy induced inflammation

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4
Q

Leukocyte

A

Colorless cell that circulates int eh blood and body fluids and is involved in counteracting foreign substances and disease

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5
Q

Neutrophil

A

Most abundant WBC; phagocyte and a granulocyte

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6
Q

Monocyte

A

Large, phagocytic WBC with a simple oval nucleus and clear, grayish cytoplasm; becomes a macrophage to surround and kill microorganisms

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7
Q

Lymphocyte

A

Form of a small leukocyte (WBC) with single round nucleus, occurring especially in the lymphatic system

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8
Q

The primary care pediatric nurse practitioner sees a 12-month-old infant who is being fed goat’s milk and a vegetarian diet. The child is pale and has a beefy-red, with sore tongue and oral mucous membranes. Which tests will the nurse practitioner order to evaluate this child’s condition?

A. Hemoglobin electrophoresis
B. RBC folate, iron, and B12 levels

C. Reticulocyte levels​

D. Serum lead levels

A

B. RBC folate, iron, and B12 levels

Infants and children who are fed goat’s milk or who are on a strict vegetarian diet are at risk for folic acid and vitamin B12 deficiency. These should be evaluated, along with iron, to rule out IDA. Hemoglobin electrophoresis is used to evaluate diseases associated with altered hemoglobin, such as beta-thalassemia and sickle cell anemia, neither of which is indicated by this child’s history. Reticulocyte levels are evaluated to evaluate transient erythroblastopenia of childhood, a condition that frequently follows a viral infection. Serum lead levels are not indicated based on this history.

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9
Q

A patient reports recent mild fatigue and palpitations. A complete blood count reveals a decreased hemoglobin level and a normal ferritin level. What other findings are likely to be present?

​A. Decreased hematocrit

B. Decreased MCV, MCH, and MCHC

C. Elevated total iron-binding capacity
D. Paresthesias, koilonychia, and pica

A

A. Decreased HCT

This patient has signs of milder iron-deficiency anemia and will also have a low hematocrit level. The RBC indexes are the last to change as the anemia becomes more severe. When the ferritin level drops, the TIBC will become elevated. Paresthesias, koilonychia, and pica occur with more severe anemia.

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10
Q

The primary care pediatric nurse practitioner evaluates a 5-year-old child who presents with pallor and obtains labs revealing a hemoglobin of 8.5 g/dL and a hematocrit of 31%. How will the nurse practitioner manage this patient?

​A. Prescribe elemental iron and recheck labs in 1 month

B. Reassure the parent that this represents mild anemia

C. Recommend a diet high in iron rich foods

D. refer to hematologist for further evaluation

A

A. Prescribe Elemental iron and recheck labs in 1 month

The child has mild to moderate iron-deficiency anemia and will need iron supplementation. The hemoglobin, hematocrit, and reticulocytes should be reevaluated in 4 weeks after initiation of treatment. The child needs iron supplementation, so reassurance alone is not indicated. It is difficult to get iron from foods, so supplementation will be needed. Children with hemoglobin levels less than 4 g/dL and some children with hemoglobin levels less than 7 g/dL must be referred.

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11
Q

A complete blood count on a 12-month-old infant reveals microcytic, hypochromic anemia with a hemoglobin of 9.5 g/dL. The infant has mild pallor with no hepatosplenomegaly. The primary care pediatric nurse practitioner suspects what disorder?

​A. Hereditary spherocytosis

B. Iron-deficiency anemia​

C. Lead Intoxication

D. Sickle-cell anemia

A

B. Iron Deficiency Anemia

Iron-deficiency anemia is the most common type of anemia in infants and children, accounting for approximately 90% of cases. It is characterized by decreased hemoglobin, with microcytic, hypochromic RBCs. Hereditary spherocytosis is characterized by pallor and jaundice with splenomegaly. Lead intoxication is accompanied by neurobehavioral problems. Sickle-cell anemia involves the presence of HgbS.

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12
Q

During a well-child examination of a 2-year-old child, the primary care pediatric nurse practitioner palpates a unilateral, smooth, firm abdominal mass which does not cross the midline. What is the next course of action?

​A. Order a CT scan of the chest, abdomen, and pelvis

B. Perform urinalysis, CBC, and renal function tests
C. Reevaluate the mass in 1–2 weeks

D. Refer the child to an oncologist immediately

A

D. refer to oncologist immediately

The finding is consistent with Wilms tumor, and referral, diagnosis, and treatment are urgent. Palpating a mass too vigorously could lead to the rupture of a large tumor into the peritoneal cavity so care should be taking in conducting the physical examination. The other tests may be ordered by the oncology team. Treatment and diagnosis must occur immediately.

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13
Q

A patient reports a neck mass that has been present intermittently for 5 or 6 weeks, which varies in size. The provider palpates a lymph node that measures 1.25 cm. Which test will provide proper histologic diagnosis for this patient?

A Bone marrow aspirate

B Computed tomography (CT) scan with intravenous (IV) contrast

C Lymph node biopsy,

D Positron emission tomography (PET) scan

A

C. Lymph node biopsy

The lymph node biopsy is used to provide proper histologic diagnosis and precise classification. Bone marrow aspirate identifies the presence of dysplastic cells. PET and CT scans will identify the presence of other lesions.

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14
Q

Which situations are considered oncologic emergencies in a patient diagnosed with cancer and require urgent referral to an oncologist? Select all that apply.

response - incorrect

A Bone marrow suppression

B Metastasis of cancer cellsMetastasis of cancer cells

C Superior vena cava syndrome,

D Syndrome of inappropriate antidiuretic hormone

E Tumor lysis syndrome

A

C, D, E

Superior vena cava syndrome, SIADH, and tumor lysis syndrome are all oncologic emergencies requiring urgent referral to the oncologist. Bone marrow suppression and metastasis occur with cancer but are not emergencies.

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15
Q

What is the most important role of the primary care provider in cancer management?

A Counseling about healthy practices to reduce risk factors

B Performing regular screenings to detect cancer

C Referring patients for genetic testing to identify those at risk

D Teaching patients about cancer management once diagnosed

A

A. Counseling

About three-fourths of cancer risks are related to elements that patients can control themselves and include diet, tobacco, alcohol, sun exposure, physical activity, and risky sexual behaviors. Emphasizing healthy lifestyle practices is a principle component of primary care. Screenings are next in importance and should be performed according to guidelines based on risk and age. Genetic testing is useful in a small percentage of patients; a good family history is important before referral for testing. The primary care provider may assist oncology specialists in teaching patients about cancer management.

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16
Q

The primary care pediatric nurse practitioner is examining a 5-year-old child who has had recurrent fevers, bone pain, and a recent loss of weight. The physical exam reveals scattered petechiae, lymphadenopathy, and bruising. A complete blood count shows thrombocytopenia, anemia, and an elevated white blood cell count. The nurse practitioner will refer this child to a specialist for what diagnostic testing?

A A bone marrow biopsy,

B Corticosteroids and intravenous immunogloblin (IVIG)

C Hemoglobin electrophoresis

D Immunoglobulin testing

A

A. Bone marrow biopsy

This child has symptoms and initial lab tests consistent with leukemia and should be referred to a pediatric hematologist-oncologist for a bone marrow biopsy for a definitive diagnosis. Corticosteroids and IVIG are given for severe idiopathic thrombocytopenic purpura (ITP). Hgb electrophoresis is used to diagnose sickle cell anemia (SCA). Immunoglobulins are evaluated when immune deficiency syndromes are suspected.

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17
Q

A patient being treated for cancer has had chemotherapy within the past 2 weeks and comes to the primary care clinic with a fever of 38.5 °C. What is the initial action?

A Obtain a STAT complete blood count (CBC) with differential

B Order a chest radiograph

C Order blood and urine cultures

D Prescribe empirical antibiotics

A

A. STAT CBC w/diff

Patients receiving chemotherapy who have a temperature >38°C and an absolute neutrophil count (ANC) of less than 500/mm3 require immediate hospitalization and treatment. The primary provider should order a CBC to determine this risk and plan immediate hospitalization and referral to the oncologist. Once hospitalized, the patient will have further workup to determine the cause of the infection and then antibiotics to treat the infection.

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18
Q

Most common causes of anemia in elderly are…

A

anemia of chronic disease

nutritional deficiency (iron, b12, folate)

decreased bone marrow response erythropoeitin

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19
Q

What are the 3 etiologies of anemia?

A

RBC production disorders

RBC destruction disorders

Blood loss (acute or chronic)

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20
Q

What are the RBC production disorders

A

Iron deficiency anemia (IDA)

anemia of chronic kidney disease (ACKD)

vitamin B12 & folate deficiency

Anemia of chronic disease

aplastic anemia (bone marrow stem cell failure)

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21
Q

The most important factor in the body’s ability to increase RBC production is…

A

iron

without adequate iron stores, the marrow cannot increase erythropoeisis

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22
Q

_____ is a glycoprotein secreted by the kidney that induces erythroid precursor cells to differentiate, thereby increasing new RBC production.

A

Erythropoietin

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23
Q

What are the RBC destruction disorders?

A

Sickle cell

RBC membrane defects (hereditary spherocytosis; hereditary elliptocytosis)

RBC enzyme defects (G6PD)

Autoimmune antibody production (autoimmune hemolytic anemia)

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24
Q

What does MCV indicate?

A

Mean Corpusular volume

The average size of RBC

Can be microcytic, normocytic or macrocytic

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25
Q

What is a reticulocyte?

What does it evaluate?

A

Immature RBC

Larger than mature RBC d/t nucleus

Evaluates:

  • bone marrow production of RBC
  • if causative factor is decreased production or loss
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26
Q

What is reticulocytosis?

What condition causes this?

A

an increased number of reticulocytes

Usually in response to decreased numbers of RBCs

>100,000 = bone marrow is responding to anemia conditions

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27
Q

What is reticulocytopenia?

A

Poor marrow function/failure

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28
Q

What does the reticulocyte index calculate?

What does a low RI mean? Examples?

Elevated RI meaning?

A

calculates bone marrow response

low RI = bone marrow unable to account for anemia

EX: IDA, ACD, B12, folate deficiency

Elevated RI = marrow attempting to recover from anemia or hemolysis

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29
Q

In the presence of anemia with significant reticulocytes, hemolysis needs to be in the differential…What would you order to rule out hemolysis and why?

A

Serum bilirubin: r/o hyperbilirubinemia (conjugaed bilirubin is marker of hemoglobin catabolism)

Increased serum lactate dehydrogenase (LDH) - indicative of direct cellular injury

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30
Q

A low reticulocyte count with anemia points to…

A

impaired erythropoiesis indication a reduction in RBC precursors or ineffective production

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31
Q

A bone marrow biopsy and aspiration report says erythroid hyperplasia….what does this mean?

A

RBCs are being produced but are not viable and usually do not leave the marrow

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32
Q

What are the size of RBCs in iron deficiency anemia?

A

microcytic and can be seen on peripheral blood smear before indices change

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33
Q

Define anisocytosis

define poikilocytosis

A
  1. significant variations of size
  2. significant variation of shape
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34
Q

What labs should be evaluated with a low MCV/microcytic anemia?

A
  • Ferritin,
  • serum iron,
  • total iron bindng capacity
  • transferrin saturation percetage

Help differentiate between iron def anemia and anemia of chronic disease

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35
Q

____ is the first lab value to be abnormal when iron stores are becoming depleted even before IDA is reflected in morphology

What could cause Ferritin to be falsely elevated?

A

Ferritin

<12 = absence iron stores

acute-phase reactant,

  • liver damage and other iron rich sources,
  • iron overload,
  • inflammatory disorders &
  • ETOH
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36
Q

What are common causes of microcytic anemia

A

Iron deficiency

Anemia of chronic disease

thalassemia

sideroblastic anemia

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37
Q

What should be suspected as a cause of IDA in adult men and postmenopausal women?

A

Chronic GI blood loss

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38
Q

What will iron studies show in a person with IDA?

A

low ferritin

high TIBC

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39
Q

What are common complaints with IDA 4

Physical exam findings of severe IDA 4

A
  • paresthesias
  • pica for starch, clay, ice
  • sore tongue
  • brittle/spoon shaped nails

Physical exam

  • more forceful apical pulse
  • tachycardia on exertion
  • systolic flow murmur
  • CHF in older patient
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40
Q

What is the first change on a CBC in IDA?

A

HgB drop

…with increasing severity/duration RBCs become microcytic and hypochromic

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41
Q

What lab values would you expect in Thalassemia minor?

hgB

MCV

MCHC

RDW

A

Hgb low end of normal

MCV = low

MCHC = low

RDW = normal

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42
Q

What lab values would you expect for anemia of chronic disease?

A

hgB = low end of normal

MCV = low

MCHC = low

RDW = normal

Serum iron = low

ferritin = high

TIBC = low

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43
Q

what lab values would you expect in sideroblastic anemia?

hgB

MCV

MCHC

RDW

A

hgB = low

MCV = low

MCHC = low

RDW = varies

Serum Iron = high

Ferritin = high

TIBC = normal

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44
Q

When is iron absorption optimum?

When should there be an improvement in blood work?

A

before meals with ascorbic acid

Improvement = 1 to 2 weeks; MCV corrected in 2 months

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45
Q

Universal screening for IDA begins at age ___

A

all children 1 year old should be screened

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46
Q

What changes are important in the diagnosis of thalassemia?

A

changes in the normal amount of adult hemoglobin

Normally predominantly hemoglobin A1, then small amounts hgb A2 & F

47
Q

What is Cooley anemia?

A

B-thalassemia major

Severe, life-threatening during 1st year of life

Associated with developmental problems, decreased life expectancy

Lifelong chronic RBC transfusions

48
Q

What labs would you order for determining the presence of thalassemia?

A

CBC w/diff

serum iron studies

hemoglobin electrophoresis

49
Q

Hemoglobin electrophoresis shows Bart’s hemoglobin. what does this mean?

A

A-thalassemia

50
Q

A child presents with severe microcytic, hypochromic anemia, jaundice, and hepatosplenomegaly…what diagnosis are you going to consider?

A

Thalassemia major

51
Q

When should you refer a patient with thalassemia intermedia to a hematologist?

A
  • abnormal facies
  • growth retardation
  • pathologic fractures
52
Q

What is Deferoxamine?

complications

A

chelating agent that removes iron from tissues and allowed excretion of iron in urine and stools

IV

given weekly for life

complications

  • if high dose with low ferritin
    • toxic eye effects
    • hearing loss
    • skeletal lesions
53
Q

what is Deferasirox?

complication

A

Oral iron chelator

daily dose with adjustment Q3 months

complications:

  • Renal toxicity = electrolyte dysfx
54
Q

What are the complications of iron overload? 8

A

Endocrine

  • Growth retardation
  • DM
  • Hypothyroidism
  • Hypoparathyroidism
  • Disturbed pubertal development

Cardiac

  • Arrhythmias
  • Pericarditis
  • Cardiac Failure
55
Q

What is macrocytic macrocytic anemia and what does it look like on a peripheral smear?

What are its common causes?

A

oval shaped; hypersegmented neutrophils, elevated RDW

Causes: vitamin B12 & folate deficiency

56
Q

What are causes of folate deficiency?

causes of B12 deficiency?

A

Folate

  • ETOH #1
  • goat’s milk feeding in infants

B12

  • Vegan diet long term
  • BF by mother with pernicious anemia
  • Pernicious anemia (loss of intrinsic factor in stomach cells)
57
Q

pernicious anemia onset

A

after 50 years

58
Q

Folate and B12 deficiency

symptoms (early and late)

Symptoms specific to B12

A

Symptoms

  • decreased vibratory sensation
  • propioception loss
  • peripheral neuropathy
  • ataxia
  • LATE: spasticity, hyperractive reflexes, +Romberg

B12 only: sore mouth & taste loss, beefy red toungue

59
Q

Myelodysplastic syndromes

What

Clinical presentation

Diagnosis

Population

A

What: Bone marrow defect where cells produced do not mature into functional RBCs, WBCs & PLTs

Clinical Presentation

  • depends on which cells aren’t maturing EX RBCs immature = anemia
  • Usually found incidentally

Diagnosis

  • Bone marrow biopsy = gold standard

Population: >65

60
Q

Folate and B12 deficiency

Diagnostics:

  • find on CBC? (hgb, mcv, rdw, retic, ri)
  • peripheral smear
  • other labs
A

CBC:

  • low hgb; MCV >100; elevated RDW;
  • low reticulocyte count & RI

Peripheral smear

  • Oval macrocytes *earliest signs*
  • hypersegmented neutrophils *earliest signs

Other labs

  • serum cobalamine (b12)
  • folate level
  • vit b12 metabolites of methylmalonic acid
  • homocysteine (elevated in both)
61
Q

How would you differentiate between vitamin b12 deficiency caused by malabsorption VS lack of intrinsic factor?

What medication can cause malabsorption

A

anti-IF assay

anti-parietal cell antibodies **highly specific for pernicious anemia

long term H2 blockers

62
Q
A
63
Q

Acute Lymphoblastic Leukemia (ALL)

Patho

WHO

S/S

A

Patho: originates in lymphoblasts >>> invade/replace healthy bone marrow. >>> production of RBCs prevented

Who: <5 yrs & >50 years

Symptoms

  • fever
  • infection
  • bleeding
  • bone pain
  • swelling extremities or face
  • unexplained blood clots
64
Q

Acute Myeloid Leukemia (AML)

symptoms 6

risk factors

who

A

*most common type of leukemia in adults*

Symptoms:

  • weakness
  • Dyspnea
  • infection
  • bruising/bleeding
  • unexplained H/A
  • blood dyscrasias

Risk factors

  • Environmental irritants: smoking, radiation, chemo etc

Who:

  • mostly older men
65
Q

AML

Patho

A
  1. hematopoietic precursor cells (stem cells) don’t fully turn into mature RBC
  2. stem cells rapidly replicate & spread in bone marrow
  3. RBC production prevented
66
Q

Chronic Lymphocytic Leukemia (CLL)

what

s/s

A

What: abnormal/dysfunctional lymphocyte production, “crowds out” healthy cells

Symptoms

  • fever/chills
  • persistent fatigue
  • frequent infection
  • weight loss
  • swollen lymph nodes
  • easy bleeding
  • bone pain/tenderness
67
Q

Colorectal cancer

Risk factors

A

Risk factors

  • high fat diet
  • low fiber
  • sedentary lifestyle
  • FMH
  • obesity
  • diabetes
  • smoking
  • advanced age
68
Q

Gallbladder cancer

symptoms

A

symptoms

  • Jaundice
  • pain above stomach
  • fever
  • n/v
  • bloat
  • abdomen lumps
69
Q

What are the most common organs for liver cancer to spread to?

A

lungs

bones

adrenal glands

70
Q

what is the most common type of lung cancer?

What are the 3 most common forms?

A

non small cell lung cancer (NSCLC)

Common forms:

  • Adenocarcinoma
  • SCC
  • Large cell carcinoma
71
Q

common places for lung cancer to metasize?

A

liver

bones

brain

72
Q

Non-Hodgkin’s lymphoma

Patho

s/s 5

A

Patho:

  1. Arise from B lymphocytes originating in lymph nodes and spread through lymph system
  2. Lymphocytes are abnormal, replicate rapidly and avoid programmed death
  3. Out number healthy lymphocytes & body can no longer fight infection

Symptoms

  • Abdomen pain
  • fever
  • weight loss
  • appetite loss
  • fatigue
73
Q

Pancreatic cancer

most common type & describe

A

Adenocarcinoma: arises from exocrine cells in pancreas

74
Q

How would you describe an anemia of chronic disease?

A

normocytic (normal MCV)

normochromic (normal MCH/MCHC)

Hgb >9

insidious onset

normally affects elderly & hospitalized patients

75
Q

Anemia of Chronic Disease

Diagnostics

A

Diagnostics

  • CBC
    • normocytic, hgb 10-11, decreased retic,
  • Bone marrow exam
    • normal - increased bone marrow stores
  • CRP; ESR
  • Ferritin/TIBC/Transferrin/serum iron (r/o IDA)
  • LFT
  • Renal function

**want to find underlying cause**

76
Q

What is the treatment of ACKD?

A

Recombinant human erythropoietin (rHuEPO)

or

Darbepoetin alfa

77
Q

how to diagnose sickle cell disease

A

hemoglobin electrophoresis

78
Q

What would you see on the CBC with sickle cell?

peripheral blood smear?

A
  • Evidence of hemolytic anemia
    • low hgb
    • reticulocytosis
    • hyperbilirubinemia
    • elevated LDH

Peripheral blood smear

  • anisocytosis
  • poikilocytosis
  • Howell-Jolly bodies (shows fxal asplenia)
  • target cells
79
Q

Causes of hemolytic anemia

A

sickle cell

hereditary spherocytosis

hypersplenism

autoimmune hemolysis

delayed hemolytic transfusion reaction

80
Q

Hydroxyurea

Indication 4

Monitoring

A

Indication

  • >3 sickle crisis/year
  • pain interferes with ADLs
  • Hx severe/recurrent chest syndrome
  • Offer >9months to reduce sickle disease complications

Monitoring

  • Q2weeks toxicity signs (low neut & plt; hgb drop 2)
81
Q

Hematopoietic stem cell transplantation indication

A

Indication: sickle cell curative therapy

82
Q

complications of sickle cell in children

A

Dactylitis:

  • infants and toddlers
  • painful swelling hands&feet r/t bone marrow expansion from ^erythropoeisis

Acute Splenic Sequestration

  • Life threatening emergency
  • RBCs trapped in splenic sinuses
  • Progresses to hypovolemic shock
83
Q

What is the leading cause of morbidity and mortality in sickle cell?

A

pulmonary HTN

Dx w/ echocardiogram

84
Q

Acute Chest Syndrome

what

s/s/ 5

progression

A

Acute pulmonary event in sickle cell; infectious or non infectious cause

S/S

  • Fever
  • dyspnea
  • cough
  • pulmonary infiltrates
  • severe CP

Progression

  • 1st hospitalized for vaso occlusive crisis then develops respiratory distress
85
Q

what is the most common cause of death in children with sickle cell?

What vaccinations/schedule should these children receive for prevention?

A

s. pneumoniae sepsis d/t splenic malfunction & inability to make IgG antibodies to antigens

Prevention

  • PNA Vaccine
    • 2 months = PCV 13
    • 2 years = PPV23
    • 7 years = 2nd dose PPV23 (5 years after 1st)
  • Prophylactic PCN
    • newborn to 5 years old
86
Q

Aplastic Anemia

Patho

s/s 5

Diagnostics

A

Patho: damage to bone marrow’s ability to generate stem cells d/t infection/autoimmune/exposure

Symptoms

  • Sudden onset
  • Recent viral infection/chronic disease/exposure
  • petechiae/ecchymosis/abnormal bleeding
  • pallor
  • mild lymphadenopathy

Diagnostics

  • CBC (pancytopenia, normochronic/normocytic)
    • low retic = lack of bone marrow activity
  • Bone marrow biopsy for diagnosis****
87
Q

Lymphoma

What

Clinical Presentation

A

What: Arise from lymphocytes

Presentation

  • Lymphadenopathy >4 weeks & >1.5cm
  • Lymph nodes wax & wane
  • “B symptoms”= disseminated disease
    • >38C
    • night sweats
    • weight loss >10% body weight
88
Q

Which of the following is the most sensitive test to assess for iron deficiency?

Select one:

a. Mean corpuscular volume (MCV)
b. Serum iron
c. Total iron binding capacity
d. Ferritin

A

d. Ferritin

89
Q

A low reticulocyte count can be seen with which of the following?

Select one:

a. Thalassemia minor
b. Iron or vitamin B12 deficiency
c. Acute blood loss
d. Hemolytic anemia

A

b. Iron or vitamin B12 deficiency

90
Q

A 25-year-old female with mild microcytic anemia is diagnosed with beta thalassemia minor. Which of the following should be included in the patient management plan?

Select one:

a. A referral to a hematologist for further evaluation and treatment
b. Treatment with iron therapy indefinitely
c. Referral to a genetic counselor if considering conceiving
d. Check a serum haptoglobin level

A

c. Referral to a genetic counselor if considering conceiving

91
Q

A patient has a CBC showing a pancytopenia (low hemoglobin, decreased leukocytes and platelets). Which of the following should be included in the differential diagnosis?

Select one:

a. Idiopathic thrombocytopenia
b. Von Willebrand disease
c. Aplastic anemia
d. Anemia of chronic disease

A

c. Aplastic anemia

92
Q

An adult patient who is currently receiving treatment for lymphoma presents for swelling of the neck and face along with a cough. There are signs of venous distention in the upper body on physical exam. The nurse practitioner suspects which of the following?

Select one:

a. Tumor lysis syndrome
b. Hyperviscosity syndrome
c. Malignant spinal cord compression
d. Superior vena cava syndrome

A

d. Superior vena cava syndrome

93
Q

What is the most common leukemia?

A

Chronic lymphocytic leukemia

94
Q

Presentation of acute leukemia

What is more common in ALL vs AML?

A
  • Symptoms r/t anemia
    • weakness
    • fatigue
    • pallow
    • dyspnea
  • Thrombocytopenia symptoms (bleeding)
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Bone pain r/t expanded bone marrow
  • Joint pain/swelling
  • CNS symptoms

Lymphadenopathy, hepatosplenomegaly, testicular invovlement

95
Q

Chronic Leukemia presentation

cardinal finding on physical exam?

A
  • Asymptomatic in beginning
  • PROGRESSION DISEASE =
    • Bone pain
    • bleeding problems
    • infection
    • fatigue
    • pallor
    • adenopathy
    • fever/night sweats

Cardinal finding = splenomegaly (sensation fullness LUQ)

  • compresses surrounding organs, weight loss, leg edema
96
Q

Acute Leukemia Diagnostics

Other diagnostics

A
  • CBC
  • Blood smear
    • ^blast cells
    • decrease granulocytes, RBC & PLT
    • Blast cells 20% total
  • Bone marrow aspirate *definitive diagnosis*
    • Blast cells >20% total cell population

Other diagnostics

  • Hyperuricemia
  • LDH: elevated
  • PT/INR/APTT: r/o DIC in bruising patients
  • Myeoblast count: ^^^ = leukostasis
97
Q

What is leukostasis?

A

Complication of Acute Leukemias

Affects lungs and brains primarily

Seen with ^^^ myeloblast count

98
Q

Chronic Leukemia Diagnostics

CML specific 1

CLL specific findings 7

A
  • Normal RBC
  • Slight anemia
  • ^^myelocytes & basophils

CML specific (does not make masses)

  • ^uric acid

CLL specific

  • non tender adenopathy (lymph nodes wax and wane)
  • splenomegaly
  • fatigue, night sweats, fever, malaise
  • sustained lymphocytosis
  • decreased IgG
  • Peripheral blood smear **diagnosis
  • CXR: detects hilar & mediastinal adenopathy
99
Q

Tumor Lysis Syndrome

What

Prevent

Findings

Cancers associated with

A

What:

  • Rapid release of intracellular products
  • Occurs within 7 days of treatment

Prevention:

  • Hydration
  • limit electrolytes during high risk period

Findings:

  • ^Phos, K, Uric Acid
  • hypocalcemia
  • with or w/o renal failure
  • fluid overload

Associated with: Leukemia, Lymphoma, solid tumors

100
Q

Leukostasis

A

What: blood stasis when blood vessels overcrowded with blast cells

101
Q

Neutropenia is worst _____ after chemotherapy and recovers _____ after chemo therapy

Neutropenic patients with a fever is a sign of ______

A

Neutropenia is worst 10-14 days after chemotherapy and recovers 4 months after chemo therapy

Neutropenic patients with a fever is a sign of life threatening sepsis

102
Q

Hodgkin Lymphoma

Patho

Presentation

A

Patho: germinal B cells, “Reed-Sternberg cells”

Presentation

  • Painless adenopathy to neck
  • Mediastinal mass
  • Pruritus
  • “b symptoms”
  • hepatosplenomegaly

Diagnosis

  • Lymph node biopsy
103
Q

How would you treat a patient with persistent, unexplained lymphadenopathy for 1 month?

A

Referral for biopsy to r/o malignant disease

104
Q

When would you prescribe prophylactic antibiotic therapy in severe neutropenia?

What would you prescribe?

A

Neutropenia = ANC <500

Fluoroquinolones

105
Q

Superior Vena Cava syndrome

What?

Common Cause 2

S/S (hallmark)

How to diagnose

A

What: SVC obstruction by external compression, invasion or thrombosis

Common cause: lung cancer & lymphoma

Symptoms: (usually insidious)

  • Facial & neck edema ***hallmark****
  • Chest & shoulder pain
  • cough
  • hoarsness
  • dysphagia

Diagnosis: CT scan

106
Q

most patients with myelodysplastic syndromes become ______ dependent for the rest of their lives

A

blood transfusion-dependent and will need chelation therapy to avoid iron overload

107
Q

For a patient with myelodysplastic syndrome, what are the indications for urgent referral/emergency care? 4

A
  1. with neutropenia <1000 and Fever
  2. Any bleeding that does not resolve with 15 mins pressure
  3. Increasing trend of peripheral blasts (r/o transformation to acute leukemia)
  4. Nodular or flat diffuse rash (r/o acute leukemia)
108
Q

Malignant Spinal Cord Compression

Symptoms

Diagnosis

A

Symptoms:

  • New onset back pain (constant dull ache)
  • worse when lying down
  • Rapid progression to paraplegia

Diagnosis: MRI or CT (if MRI contraindicated)

109
Q

Hypercalcemia of Malignancy

cause

s/s 6

Diagnosis

Treatment

Prognosis

A

Cause: stimulated osteoclast activity release ca+ from bone

Symptoms:

  • Ca >10
  • AMS/lethargy/confusion
  • weakness
  • hypovolemia
  • polyuria, polydipsia
  • Hyporeflexia

Diagnosis: Ionized serum calcium & total serum calcium & albumin

Treatment:

  • Rehydration & refer
  • Hospitalize Ca+ >14 or more than mild symptoms

Prognosis <1 month

110
Q

Tumor Lysis Syndrome

WHAT

WHEN

PREVENTION

S/S

A

What: Rapid release of intracellular products

When: within 7 days of treatment

Prevention: Hydration, limit K & phos during high risk period

Symptoms:

  • Cairo Bishop
  • Azotemia/ elevated electrolytes
  • ARF
  • Symptoms r/t electrolyte imbalance N/V/D cramps
  • low UO
111
Q

Malignancy associated SIADH

A

Symptoms:

  • na <135
  • concentrated urine
  • N/V CONSTIPATION
  • muscle weaknesss
    • Babinkski
  • Edema

Treatment: Fluid restriction, raise Na, hospital

112
Q

hemophilia typically has low levels of

A

factor 8

113
Q

in what conditions would you see basophil stippling?

A

thalassemia

Lead intoxication

Myelodysplasia

NURP532 (11 decks)

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