Heme/Onc

Question 1

When do you need to treat ITP during pregnancy?

Answer 1

Only if they are symptomatic or Platelets fall <30.

And the treatment is IVIG

Question 2

How do you treat recurrent infections in a person with MM? Ex: Recurrent sinusitis

Answer 2

IVIG because they are low on globulins

Question 3

Why use cryo instead of FFP when treating massive bleeding in pt with coagulopathy of liver disease?

Answer 3

Cryo has more Fibrinogen, so if Fibrinogen<100 use cryo instead of Vitamin K + FFP

Question 4

What is the treatment for early stage laryngeal CA?

Answer 4

Radiation ALONE

Question 5

A 65-year-old woman is evaluated 3 weeks postoperatively following right hemicolectomy for colon cancer. Pathology of the surgical specimen revealed a 3-cm adenocarcinoma invading into but not through the colonic wall. Four of 17 local-regional lymph nodes examined contained metastatic cancer. All margins of resection were free of tumor. Contrast-enhanced CT scans of the chest, abdomen, and pelvis were unremarkable. She takes no medications.

On physical examination, vital signs are normal. Surgical incisions are fully healed. The remainder of the examination is normal.

Carcinoembryonic antigen (CEA) is 1.7 µg/L (normal is less than 5.0 µg/L).

What stage?

What is the next step in treatment?

Answer 5

Stage III

FOLFOX

Note: Radiation is not part of the treatment for this.

Question 6

What is the treatment for asymptomatic non-bulky follicular lymphoma?

Answer 6

Observation

These patients may survive many years without treatment

Question 7

What is the next step after a patient with surgically resected colon CA now has diffuse mets?

Answer 7

RAS mutation to determine if they are a candidate for epidermal growth factor receptor inhibitor, such as cetuximab or panitumumab.

Note: No need to biopsy the new metastatic lesion

Question 8

What disease is bcr-abl ass’d with? Why does this matter?

Answer 8

CML

You can use tyrosine kinase inhibitors to treat 1st line it in the CHRONIC phase: imatinib, dasatinib, and nilotinib

Question 9

What are the different phases/treatments for CML?

Answer 9

Chronic phase: <10% blasts in blood and BM: Tx TKI (imatinaib, dasatinib, nilotinib)

Accelerated phase

Blast crisis: >20% blasts: Chemotherapy with idarubicin and cytarabine

Question 10

How do you differentiate Aplastic Anemia from Parvovirus B19 infection in a pt with sickle cell who has low Hb and low reticulocytes?

Answer 10

Aplastic Anemia: Pancytopenia

Parvovirus B19: Preferentially affects Hb -> Transient pure red cell aplasia

Question 11

What is the other agent, besides Epo, used to increase Hb in patients with CKD?

What is the target Hb in CKD patients?

Answer 11

Darbepoetin

Hb>11

Question 12

What cancers to the following markers correspond to?

1. RAS
2. BRAF
3. HER

Answer 12

1. Colorectal
2. Melanoma
3. Upper GI

Question 13

What are the triggers for ITP?

Answer 13

medications

Or associated with other diseases;

• systemic lupus erythematosus
• chronic lymphocytic leukemia
• lymphoma
• Infections: HIV, hepatitis C, or Helicobacter pylori infection.

Question 14

What blood product do you use to treat anemia/thrombocytopenia and low fibrinogen in a pt with DIC just post partum?

Answer 14

Cryo

It has fibrinogen, unlike FFP