Heme/Onc

Question 1

Plt activation, prothrombosis, thrombocytopenia 5-10 d after anticoag

Answer 1

HIT (abs to hep-plt factor 4)

Question 2

Paraprotein gap (ptn-alb >3-4), increased risk for infection because decreased functional abs, maybe leukopenia.

Answer 2

multiple myeloma

Question 3

Nuclear remnants within RBCs, blue inclusions, s/p splenectomy

Answer 3

Howell-Jolly bodies

Question 4

DDx for anterior mediastinal mass

Answer 4

Terrible Ts
Thymoma,
Teratoma (and other germ cell tumors)
Terrible lymphomas 
Thyroid

Question 5

MMA and homocystine with b12 and folate

Answer 5

b12: MMA and homocystine both increased
folate: ml MMA, elevated homochysteine

Question 6

MCV in hemolytic anemia

Answer 6

NL

Question 7

Thalassemia MCV

Answer 7

typically very very low. Nl iron studies

Question 8

Risks for polycythemic infants infants

Answer 8

respiratory distress, poor feeding and nn probs (not hyperglycemia)

Question 9

hyposthenuria

Answer 9

inability to concentrate urine. sickle cell trait

Question 10

Salvage therapy

Answer 10

Therapy when standard therapy fails

Question 11

Infections in sickle cell asplenia

Answer 11

s pneumo most common

Question 12

Anabolic steroid use effect on hct

Answer 12

increase hct

Question 13

Sx dvts

Answer 13

from iliofemoral vv (calf vv often asx)

Question 14

Thrombocytopenia in Wiskott Aldrich

Answer 14

from impaired production

Question 15

HIV is a RF for TTP

Answer 15

schistocytes, hemolytic anemia. nl mcv. increased retic

Question 16

Hairy cell leukemia

Answer 16

TRAP +, tx with cladrabine

Question 17

Smudge cells

Answer 17

Seen with CLL. From fragile cells and smear preparation. Low PLT is a poor prognostic sign.

Question 18

Sunburst pattern on XRAY/codmans triangle. PE - large, tender mass

Answer 18

Osteosarcoma

Question 19

Onion skin on XRAY (osteolytic lesion with a periosteal reaction that produces layers of reactive bone). Concurrent flu-like symptoms

Answer 19

Ewings Sarcoma - 22:11

Question 20

How to treat decreased appetite in cancer patients

Answer 20

Progesterone analogues. Cannabanoids dont have eough research behind them. Or steroids, but prog analogues have fewer side effects

Question 21

Middle Mediastinal Mass?

Answer 21

Bronchogenic cyst

Question 22

Posterior Mediastinal Mass?

Answer 22

Neurogenic tumors - meningocele, enteric cyst, lymphoma, diaphragmatic hernia, esophageal tumors, aortic aneurysm

Question 23

Elderly patient, painless LAD, smudge cells. Thrombocytopenia and hemolytic anemia also maybe present

Answer 23

CLL - tx with CD20 MAB

Question 24

Most common causes of malignant pleural effusion?

Answer 24

Breast and Lung CA. MM isnt common

Question 25

MSK pain in sickle cell - caused by?

Answer 25

Vaso-occlusion. Can manifest as spinal and nn pain

Question 26

Renal damage in MM cause by ?

Answer 26

Renal tubular damage more common than glom pathology

Question 27

A Thalassemia - located on what chromosome ? What is minor look like?

Answer 27

11 - minor can be cis or trans. Only one deletion (a,a,a,-) shows no clinical dz.

Question 28

Elevated PTT, petechiea, bruising in hospital/post op setting?

Answer 28

think HIT - remove offending agent

Question 29

Anemia s/p gastrectomy. What type of anemia?

Answer 29

Think B12def - megaloblastic. IF isn't produced as much

Question 30

Breast cancer, most important prognostic factor?

Answer 30

TNM. More important than ER+/PR+

Question 31

EBV infection can cause what hematologic abnormality?

Answer 31

Autoimmune hemolytic anemia. usually 2-3 weeks after onset of sxs

Question 32

Spherocytes on peripheral smear. Low haptoglobin, high ldh, anemia. Coombs positive. dx?

Answer 32

AIHA. Can be warm (igG) or cold (IgM) mediated. Hereditary spherocytosis has a negative coombs.

Question 33

ALWAYS check cbc/diff for eosinophils. It really narrows potential dx.

Answer 33

SErz. Makes it a lot easier. DNAAACP

Question 34

HIT is thrombogenic and you need to monitor closely for aa or vv clots

Answer 34

truth

Question 35

Hematuria in a patient who recently took medication?

Answer 35

Think G6PD def

Question 36

Stroke in sickle cell patients. Treatment?

Answer 36

Do exchange transfusion to decrease percentage of sickled cells. Fibrinolytic therapy won't work because it's not a true embolus.

Question 37

VERY high WBC with lots of granulocyte forms. Also has low leukocyte alk phos.

Answer 37

CML. PHL chromosome

Question 38

fever, chills, malaise 1-6 h after blood products

Answer 38

TRALI. Tx is to irradiate cells (wash cells with IgA def)

Question 39

Young patient with cervical LAD <2.0 cm, mobile. Otherwise no sx. What do you do?

Answer 39

Observe. no need to bx in this patient. Only bx if >2.0 cm or sx

Question 40

Tx for sarcoid

Answer 40

steroids

Question 41

Treatment for TTP/HUS?

Answer 41

emergent plasmapheresis

Question 42

eczematous rash over nipple. does not respond to topical treatment. bx shows large cells surrounded by clear halos

Answer 42

PAget's disease of breast/adenoCa