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HEME ONC Flashcards

1
Q

acidified glycerol lysis test is used to dx…

A

hereditary spherocytosis

defect in spectrin and ankyrin

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2
Q

which lung cancers are peripheral and which are central?

A

peripheral = adenocarcinoma and large cell carcinoma

central = squamous cell and small cell

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3
Q

what syndromes are associated with squamous cell lung ca and which with small cell carcinoma?

A

squamous = hypercalcemia

small cell = cushing syndrome, SIADH, or lambert eaton

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4
Q

which lung ca is the most common type of primary lung cancer in both smokers and nonsmokers?
predominant type in nonsmokers?

A

adenocarcinoma

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5
Q

what tx is given to sickle cell patient with recurrent vasoocclusive crises?

its side effect?

A

hydroxyurea to boost amount of fetal hgb

can cause myelosuppression

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6
Q

auer rods are specific for which leukemia?

A

AML

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7
Q

aflatoxin is ass w what?

ebv reactivation ass w what?

A

hepatocellular carcinoma

nasopharyngeal carcinoma

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8
Q

normal reticulocyte count?`

what raises it?

A

0.5-2.5%

blood loss and hemolysis

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9
Q

at what hematocrit do i transfuse?

A

if patient is symptomatic or if patient is elderly or has heart disease

do NOT if patient is young and asx

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10
Q

each unit prbcs should raise the hct by

A

3

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11
Q

when do you transfuse cryoprecipitate first?

A

never.

never first line

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12
Q

only microcytic anemia with HIGH iron

A

sideroblastic anemia (cant incorporate iron with heme)

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13
Q

TIBC

in chronic disease and iron deficiency?

A

low in anemia of chronic disease

high in iron def

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14
Q

test used to look for ringed sideroblasts?

A

prussian blue stain

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15
Q

most accurate test for thalassemia?

A

electrphoresis

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16
Q

megaloblastic anemia + hypersegmented neutrophils

A

either B12 or folate def!

get B12 and folate levels!!

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17
Q

methotrexate can lead to __ deficiency

A

folate

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18
Q

both B12 and folate deficiency increase ____ but onlu B12 is associated with increased ___

A

homocysteine

methylmalonic acid

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19
Q

what decreases mortality in sickle cell disease?

A

hydroxyurea in prevention and antibiotics with fever

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20
Q

exchange transfusion for sickle cell vasoocclusive crisis is used when..

A 
acute chest syndrome
priapism
stroke
or
visual disturbance from retinal infarction
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21
Q

what is the diagnosis? best test?

recurrent hemolysis, intermitternt jaundice, splenomegaly, family hx of anemia or hemolysis, and bilirubin gallstones

A

spherocytosis

osmotic fragility test

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22
Q

most accurate test for autoimmune hemolysis?

A

coombs +

detects IgG on rbc surface

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23
Q

colder parts of body showing mottling that resolves on warming?

tx?

A

cold agglutinin disease

steroids dont work with cold agglutinins…give rituximab and warm patient

24
Q

warm agglutinins are Ig__ and cold are Ig___

A

warm are igG

cold are IgM

25
holly jowell bodies? heinz bodies?
HJ = sickle cell heinz = g6pd
26
in g6pd deficiency, g6pd level will be __ after acute event.....when to dx?
normal get g6pd level after 1-2 months
27
HUS vs TTP similarities and differences
both present with hemolysis with schistcytes, thrombocytopenia, and renal insufficiency hus is due to e coli 0517h7 and is usually in kids ttp is usually in adults due to meds or dz, and has neuro sx
28
paroxysmal nocturnal hemoglobinuria
decreased cd55 and cd59 episodic dark urine pancytopenia clots in weird places
29
aplastic anemia
pancytopenia fatigue infections bleeding dx: bone marrow biopsy tx: young patient = bone marrow transplant,,,old patient = antithymocyte globulin and cyclosporine
30
polycycthemia vera
overproduction of all 3 cell lines but mostly rbcs! despite a low epo hyperviscosity sx (htn, ha, thrombosis, fatigue) hct high, plat and wbc high, rbc mass high, oxygen normal, epo low dx;;;;JAK2 mutation most accurate tx: phlebotomy and aspirin, hydroxyurea, allopurinol, antihistamines
31
essential thrombocytosis
plat count >1 mil leading to thrombosis and bleeding
32
myelofibrosis
panytopenia and bone marrow fibrosis -- blood prodution shifts to sleen and liver (hepatosplenomegaly) + tear drop shaped cells and nucleated rbcs
33
APL (acute promyelocytic leukemia)
``` type of ALL 15:17 translocation auer rods associated with DIC blasts on blood smear + myeloperoxidase ``` tx: chemo + ATRA
34
philadelphia chromosome?
bcrabl 9:22 translocation | CML
35
Non hodgkin lymphoma presentation? dx? tx?
painless LAD, nodes are NOT warm red or tender, fever, weightloss, sweats best initial test is exisional biopsy (CBC is often normal) stage with CT chest abd pelvis and bone marrow biopsy DO NOT DO NEEDLE ASPIRATION of LN tx for advanced dz: CHOP therapy ccyclophosphamide doxorubicin (hydroxydaunorubiin) or adriamycin vincrisine (oncovine) prednisone
36
staging for non hodgkins lymphoma
1 1 LN group 2 2 or more LN groups on same side of diaphragm 3 both sides of diaphragm 4 widespread
37
MALT
mucosal associated lymphoid tissue =lymphoma of the stomach associated with H pylori tx with clarithromycin and amoxicillin
38
reed sternberg cells?
hodgkins disease
39
hodgkins versus NH lymphoma
hodgkins = local usually, centers around cervical area, reed sternberg cells on path, lymphocyte predominant = best prognosis, lymphocyte depleted = worst prognosis NHL = usually found in late stage, widespread, no reed sternberg cells, burkitt and immunoblastic have worst prognosis
40
late hodgkins lymphoma tx
``` ABVD adriamycin (doxorubicin) bleomycin vinblastine dacarbazine ```
41
what do you use to determine cardiac toxicity from chemo?
MUGA (nuclear ventriculogram)
42
``` adverse effect of these chemo agents: 1 doxorubicin 2 vincristine 3bleomycin 4 cyclophosphamide 5 cisplatin ```
``` 1 cardiomyopathy 2 neuropathy 3 pulm fibrosis 4 hemorrhagic cystitis 5 renal and ototoxicity ```
43
Multiple myeloma
hypercalcemia, hyper uricemia, renal failure (due to Ig and bence jones protein), anemia, and bone pain (lytic lesions) ``` xray --> punched out lesions smear --> reauloux formations serum electrophoresis (SPEP) --> IgG or IgA spike = monoclonal M spike UPEP --> bence jones proteins biopsy >10% plasma cells ```
44
most accurate test for myeloma?
bone marrow biopsy
45
waldenstrom macroglobulinemia
overproduction of IgM from malignant B cells --> hyperviscosity lethargy, blurry vision, engorged eye vessels, mucosal bleeding, and raynauds IgM spike tx: plasmapheresis
46
ITP
isolated thrombocytopenia (normal ht, normal wbc, normal spleen) mild bleeding tx = glucocorticoids severe bleeding = IVIG, antiRho
47
before splenectomy, what do you need to vaccinate for?
neisseria meningitisis haemophilus influenzae pneumococcus
48
VWD
von willibrand mc inherited bleeding disorder (AD) gum bleeding with normal platelet count (decreased functioning, not count) dx: low vWF, + ristocetin assay longer bleeding time tx: DDAVP (desmopressin) to release vWF stores OR vWF replacement
49
DIC labs and tx
elevated PT and aPTT low platelets elevated d dimer and fibrin split products decreased fibrinogen (it was consumed) if plat <50k and serious bleeding --> FFP (to replace plats and clotting factors)
50
do not transfuse platelets into HIT patient,, why?
it may worsen thrombosis
51
BRCA cancer
breast ovarian pancreatic
52
lumpectomy w radiation vs modified radical mastectomy
equal in effectiveness lumpectomy is less deforming (not for multifocal dz though)
53
radical mastectomy when?
never the right answer
54
all ER or PR + breast ca pt should get...
tamoxifen, raloxifene or an aromatase inhibitor (anastrozole)
55
side effects 1) tamoxifen 2) aromatase inhibitors (anastrozole)
1 enodmetrial ca risk and clots | 2 osteoporosis
56
trastuzumab
given in her2neu + breast ca antibodies that decrease risk of recurrence and improve survival
57
in prostate ca which is more likely to cause erectile dysfunction surgery or radiation
surgery

step 2 ck (16 decks)

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