Heme/Onc Qs

Question 1

Findings diagnostic of paroxysmal nocturnal hemoglobinuria? (including cell markers)

Answer 1

hemolytic anemia, hypocellular bone marrow, and lack of CD55 and CD59.

Question 2

idiopathic Bud-Chiari syndrome - test for?

Answer 2

JAK2 mutation

Question 3

t(9;22)? Treat with?

Answer 3

Philadelphia chromosome. Dasatintib or the imiatinib

Question 4

HLA-matched platelets would only be used if?

Washing of platelets is reserved for?

Answer 4

history of platelet transfusion refractoriness attributed to platelet alloantibodies

history of a severe allergic reaction (anaphylaxis) to a transfused blood product

Question 5

Parvovirus B19 infection in sickle cell can present with?

Answer 5

pure red cell aplasia

Question 6

essential thrombocythemia - treatment? Who gets it?

Answer 6

Hydroxyurea plus low-dose aspirin

Patients older than 60 years, platelet count greater than 1 million/µL, or those with a history of thrombosis.

Question 7

G6PD stain?

Answer 7

cresyl blue

Question 8

cryoprecipitate is typically reserved for?

Answer 8

significant bleeding and a fibrinogen level less than 100 mg/dL

Question 9

Cold agglutinin disease can be confirmed with?

Answer 9

Coombs test

Question 10

Risk factors for progression of monoclonal gammopathy of undetermined significance to multiple myeloma?

Answer 10

non-IgG M protein, an M protein level of at least 1.5 g/dL, and an abnormal serum free light chain ratio

Question 11

Discrepancy between urine dip stick (albumin) and Urine protein ratio suggest?

Answer 11

monoclonal FLCs in the urine (Bence-Jones proteinuria) and potential cast nephropathy

Question 12

classic presentation for CML ?

smear shows?

Answer 12

fatigue; early satiety and progressive weight loss associated with splenomegaly; and a peripheral blood smear demonstrating myelocytes, metamyelocytes, and basophils

Question 13

IGH/CD1 is the mutation associated with?

PML-RAR protein mutation is associated with?

Answer 13

Mantle cell lymphoma

acute promyelocytic leukemia (APL)

Question 14

acute promyelocytic leukemia (APL) is clinically associated with?

Answer 14

DIC and thrombocytopenia and NO SPLENOMEGALY

Question 15

Surgery Hgb goal for sickle cell?

Answer 15

10

Question 16

Parenteral anticoagulant administration must overlap with warfarin for?

Answer 16

5 days and INR>2 for 24 hours

Question 17

5-Azacytidine is appropriate therapy for? Why?

Answer 17

higher risk MDS for the purpose of improving blood counts, delaying AML progression, and extending survival.

Question 18

LGL leukemia is associated with?

Answer 18

RA and Felty’s syndrome

Question 19

Treatment for malignany associated hyperCa?

Answer 19

Hydration, lasix, steroids, IV bisphosphonate

Question 20

key component in the initial evaluation of metastatic nonsquamous non–small cell lung cancer?

Answer 20

epidermal growth factor receptor (EGFR) mutation. (improved survival in patients with EGFR mutations who are treated with EGFR tyrosine kinase inhibitors)

Question 21

Patients receiving long-term immunosuppressive therapy are at greater risk for developing this type of cancer?

Answer 21

NHL

Question 22

estrogen receptor–positive breast cancer who develop metastases limited to bone after a long disease-free interval should be treated initially with?

Answer 22

aromatase inhibitor.

Question 23

Postmenopausal patient with newly diagnosed atypical ductal hyperplasia should be offered breast cancer chemoprophylaxis wiht?

Answer 23

exemestane

Question 24

only chemotherapeutic agent approved for treatment of metastatic melanoma?

Answer 24

dacarbazine

Question 25

translocation [t(14:18)] Translocation cause overexpression of? Cancer type?

Answer 25

BCL2 oncogene.

Follicular lymphoma

Question 26

In patients with aggressive breast cancer who develop severe arthralgia while on antiestrogen therapy due to an aromatase inhibitor - try? If fails?

Answer 26

second aromatase inhibitor should be tried; if the arthralgia fails to resolve, tamoxifen should be started.

Question 27

When to skip imaging despite concern for prostate ca?

Answer 27

Gleason <8, PSA<10

Question 28

entinel lymph node biopsy should be done for melanomas which are how large?

Answer 28

1 mm thick

Question 29

Conversion chemotherapy?

Answer 29

given to patients with unresectable tumors in an attempt to shrink the tumor to a resectable size

Question 30

Women with CUP presenting as abdominal carcinomatosis and ascites - next step?

Answer 30

cytoreductive surgery (assume ovarian cancer)

Question 31

Overexpression of cyclin D1 suggests?

Answer 31

Mantle cell lymphoma

Question 32

Women with a personal and family history of ovarian, endometrial, and colon cancer should undergo testing for genetic mutations caused by?

Answer 32

Lynch-syndrome

Question 33

Agents that are particularly effective in BRCA1-related recurrent ovarian cancers?

Answer 33

PARP inhibitors (-parib)

Question 34

mycosis fungoides is a form of? Treatment?

Answer 34

cutaneous T-cell non-Hodgkin lymphoma

Early - topical steroids If no response? + retinoids (such as bexarotene) and psoralen plus ultraviolet light (PUVA) therapy, +/-interferon alfa If advanced disease (ie organ involvement)? CHOP and stem cell transplant

Question 35

Treat squamous cell carcinoma of the neck with?

Answer 35

chemoradiation therapy following surgical resection

Question 36

Pts with treated cancer of this types should be offered *prophylactic cranial irradiation?

Answer 36

SCLC

Question 37

For men with multifocal bone pain due to metastatic disease - treatment?

Answer 37

radium-223

Question 38

1Women who received chest wall radiation (such as mantle radiation therapy for Hodgkin lymphoma) between the ages of 10 and 30 years are at high risk for developing breast cancer and should be screened ?

Answer 38

annual mammograms and breast MRIs.

Question 39

Patients with a localized gastrointestinal stromal tumor with a relatively higher risk for recurrence should be treated with?

Answer 39

imatinib

Question 40

Treat a high-grade neuroendocrine tumor of unknown primary site with?

Answer 40

platinum

Question 41

patients who have imaging that is characteristic of resectable pancreatic cancer - next step?

Answer 41

tissue sampling prior to potential curative resection is not appropriate, and definitive resection without prior tissue confirmation should be pursued.

Question 42

This is recommended for patients with melanomas of 1- to 4-mm thickness?

Answer 42

Sentinel lymph node biopsy

Question 43

When to give vitamin K for elevated INR without bleeding?

Answer 43

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