7 Heme Onc Flashcards Preview

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Flashcards in 7 Heme Onc Deck (34):
1

B12 deficiency:
think what 4 causes for the test

1. pernicious anemia--no IF
2. crohn's--attacks TI (absorption)
3. pancreatic insuff (need proteases to release from salivary R-binder)
4. Fish tapeworm

2

B12 vs Folate equivocal, get what?

Get MMA. If elevated, then B12 deficiency

3

Schilling's test for B12

1. give IM nonradioactive B12, saturate liver binding sites.
2. give oral radioactive B12, then check if radioactive excreted in urine. If radioactive is present in urine, then it can be absorbed in gut.

3. If not, then add other things to aid absorption: IF, abx if bacterial overgrowth, and pancreatic enzymes

4

Fe deficiency anemia.
-what is normal Fe daily requirement and max?

-how long to replace serum Fe, and how long to replace Fe stores?

-How much Fe in 1 PRBC unit?

1 mg/day, max 3 mg/day

serum Fe: 6 weeks
stores: 6 mo

350g Fe in 1 PRBC unit. So, 1 year's supply.

5

anemia of chronic dz
-tx and decision making

Tx underlying dz. (eg SLE, RA). If can't, can give EPO. helps body utilize Fe stores.

If Hgb>10, f/u labs in 3 mo
If <10, give EPO

6

Pt with microcytic anemia on blood test, but normal Fe studies. Think what. then do what/look for what

Thalassemia.

To dx, get Hgb electrophoresis. Can show B-Thal positive. But if neg, then A-thal is dx of exclusion

Also, LDH normal, but retic count low.

7

Thalassemia: how to think about it.
Classic vignettes

Pt either presents:

MILD: Asx--no tx.
-Asian person with isolated anemia and low retic count, LDH normal. Told couldn't donate blood. (if Hgb electrophoresis negative, must be A-thal)

SEVERE: severe anemia--transfusion required, + deferoxamine
-16yoM comes with Hgb 3.2

8

Pt with microcytic anemia. Fe studies show elevated serum Fe.
do what

Sideroblastic anemia

Get pt away from lead, give B6, Confirm dx with bone marrow bx. (ringed sideroblasts)

9

Sideroblastic anemia:
causes to know (5)

Lead
ETOH
INH
B6 def
AML/myelodysplastic

10

Normocytic hemolytic anemias: (4)
name each, smear, confirm test, tx

1. Spherocytosis
-smear +
-osmotic fragility test
-Folate and Fe if mild, splenectomy if severe

2. PNH
-smear -
-flow cytometry
-steroids, eculizumab

3. G6PD
-Smear: Heinz bodies and Bite cells
-G6PD levels 6-8 wks after attack
-avoid triggers

4. Autoimmune hemolytic anemia
-Smear: spherocytes
-Coombs test (IgG)
-steroids, IVIG, splenectomy

11

Blood smear: you see spherocytes. think what

Either spherocytosis, or AIHA.

Do Coombs. If positive AIHA. negative, spherocytosis.

12

PNH: what to remember

can have venous thrombosis in intra-abdominal veins, causing abd pain.

13

Sickle cell:
what test for avascular necrosis of hip/femur to know

DEXA scan screening

14

Leukemias, ages?

7, 47, 67, 87
ALL, CML, AML (must be older than CML for blast crisis), CLL

15

You suspect AML or ALL. What dx tests to do and not do

CBC not helpful, could be up or down

Blood smear, look for blasts.
Confirm with BM bx, >20% blsts

16

Auer rods
-what associations?

M3 subtype of AML.
Can go into DIC
Tx with ATRA (vit A)

17

Leukemias: what special thing to remember about each?

ALL: CNS PPx with intrathecal Ara-C. Also scrotum

AML: Auer rods, DIC


CML: Blast crisis to AML. imatinib to delay.

CLL: do no harm if old.

18

Lymphoma staging

-how affects tx?

1: 1 group lymph nodes
2: >1 group nodes on same side of diaphragm
3: >1 group nodes, opposite side of diaphragm
4. diffuse dz (blood, bone marrow)

2a or less: radiation (can add chemo IRL)
2b or more: chemo

B means B-sxs present

19

Lymphoma:
-common classic sxs (3)

-uncommon sxs to know (2)

fevers, night sweats, weight loss.

-Pel-Epstein fevers: cyclical over weeks
-ETOH tender LAD

20

chemo tox man (5)

cisplatin: oto and nephrotox

bleomycin: lung fibrosis

doxorubicin, adriamycin: cardiomyopathy

Cyclophosphamide: hemorrhagic cystitis (mesna)

Vincristine, vinblastine--
peripheral neuropathy

21

Multiple Myeloma
-sxs mnemonic

CRAB

Ca, hyper
renal insuff (myeloma kidney)
anemia
bone lesions/pain

22

multiplel myeloma
-3 mechs to know, their sxs, and diagnostic findings

Bad plasma cells make these:

1. bad monoclonal Ab.
-infections
-Protein gap, with M-spike on SPEP

2. Bence Jones proteins (bad Ig's)
-renal failure
-protein gap, UPEP

3. Osteoclast activating factor
-hyperCa, bone lesions
-imaging shows

23

you suspect multiple myeloma. do what tests:

-SPEP: m spike
-UPEP: bence jones proteins
-skeletal survey

-BM Bx to confirm. >10% plasma cells

24

MGUS
-definition
-conversion rate to MM, how often check labs

-SPEP+ but no other MM findings
-Conversion to MM 2%/year. check labs q6mo.

25

Waldenstrom's macroglobulinemia
-classic vignette
-dx finding
-tx

-hyperviscosity syndrome (HA, AMS, blurry vision, mucosal bleeding)+peripheral neuropathy.
62yo male with gum bleeding when brushing teeth, sleeping more. Trouble driving with blurry vision. Feet tingling

->10% lymphs on BM bx

-plasmapheresis to prevent stroke. also chemo.

26

von willebrand's disease
-dx
-tx
-tx in severe acute bleeding

low vWF, also low F8

-vWF assay or platelet fxn test

-desmopressin (vWF)
-acute severe: can give Cryo (F8)

27

general platelet transfusion rules

Transfuse for:
<20k
<50k and bleeding

28

when in thrombocytopenia to NOT give platelets

TTP/HUS. just eats more of it. do plasmapheresis

29

TTP, HIT, DIC, ITP:
-tx

TTP: plasmapheresis, no plt
HIT: stop Hep, do argatroban
DIC: give cryo, FFP, plt, blood
ITP: IVIG, steroids. refractory splenectomy

30

TTP sxs

FAT RN
fever, anemia, thrombocytopenia

renal, neuro sxs

Also think HUS with diarrhea

31

Pt with bleeding because low VitK. causes to know other than warfarin (3)

-cirrhosis
-Abx. killed intestinal K-producing bacteria
-Low PO intake (think ICU pt)

32

always think: If microcytic anemia, then what test?

Iron studies, specifically Ferritin.

high--ACD
low--Fe def
normal--thalassemia

33

Chemo for lymphoma:

Any lymphoma 2b.

(ABC)

Hodgkin's, not severe: ABVD
Hodgkin's severe: BEACOPP
Non-H: Rituximab or CHOP-R, with CNS ppx with MTX

34

NOACs: brand names, indications and contraindications

Lepirudin
Argatroban
Dabigatran
Rivaroxiban
Apixaban

which can be reversed, with what?

Both: HIT, transition to Coumadin.
-HIT, cannot use in renal dz (renally cleared)
-HIT, ok in renal fail. (hepatic)

All 3: nonvalv Afib, DVT
-Pradaxa
-Xarelto
-Eliquis

Pradaxa can be reversed with Praxbind (Idarucixumab)