Heme/Onc

Question 1

Myelofibrosis

Answer 1

Collagen/reticulin deposition in bone marrow –> hepatosplenomegaly from extramedullary hematopoiesis

Peripheral blood cell counts can be either increased or decreased.

Question 2

Common cause of bleeding in setting of chronic renal failure?

Answer 2

Platelet dysfunction –> platelets do not degranulate in uremic environment

Prolonged bleeding time with normal PT/aPTT
DDAVP (desmopressin) is treatment of choice, by increasing release of factor VIII:vWF from endothelial storage sites

Question 3

Most common secondary causes of ITP?

Answer 3

HIV and hepatitis C –> testing for these two is generally performed in setting of suspected ITP

Question 4

MALT lymphoma - cause and management?

Answer 4

Low grade B cell lymphoma of mucosa-associated lymphoid tissue.

H. pylori infection critical role in pathogenesis –> those with MALT lymphomas should be tested for H. pylori infection and those with positive results should under eradication [quadruple] therapy. Majority of those on Abx will achieve complete remission.

Question 5

Appetite stimulants in cancer-related anorexia/cachexia syndrome (CACS)

Answer 5

Progesterone analogues (eg megestrol acetate) preferred over corticosteroids due to decreased incidence of side effects.

Synthethic cannabinoids like dronabinol useful in advanced HIV cachexia but large studies have demonstrated little benefit in anorexia and weight gain in CACS.

Question 6

NOAC advantage over warfarin?

Answer 6

Rapid onset of action
No requirement for lab monitoring (e.g. INR)
No requirement for overlap therapy

Question 7

Hodgkin Lymphoma

Answer 7

Epidemiology: Bimodal peak incidence: 15-35 and > 60
A/w EBC in immunosuppressed

Manifestations: painless lymphadenopathy (esp cervical and supraclavicular chains), mediastinal mass, B symptoms (fevers, night sweats, weight loss), pruritus

Dx: LN bx, RS cells on histology

Question 8

Lupus anticoagulant

Answer 8

An IgM or IgG immunoglobulin that prolongs aPTT by binding to phospholipids used in the assay. The prolonged aPTT is an artifact–the lupus anticoagulant is NOT a physiologic anticoagulant but actually INCREASES the risk of thrombosis.

Question 9

Management of polycythemia vera

Answer 9

Serial phlebotomy is mainstay treatment –> creates relative Fe deficiency and reduces HCT to normal range. BM suppressive drugs may be added in pt with high risk thrombosis.

Question 10

Leukocyte alkaline phosphatase score

Answer 10

Marker of neutrophil activity. Can differentiate b/w leukemoid reaction (high) and CML (low).