LE6 Flashcards

Question

5. The most frequent causes of metastatic tumors involving the vertebral column are: A. Lung, breast, and prostate cancer B. Myxoma, cervical, and pancreatic cancer C. Lymphoma, colonic, and gastric cancer D. Myxoma, lung, and breast cancer

Answer 1

A. Lung, breast, and prostate cancer These cancers frequently metastasize to the vertebral column due to their high bone marrow blood supply.

Answer 2

D. Trastuzumab is the most notorious anthracycline Trastuzumab is NOT an anthracycline but a monoclonal antibody; doxorubicin and daunorubicin are anthracyclines known for dose-dependent cardiotoxicity.

Answer 3

A. Cardiotoxicity is difficult to reverse and causes high mortality. Unlike anthracycline-induced toxicity, trastuzumab-induced cardiotoxicity is often reversible and does not cause permanent structural damage. ✅ Anthracyclines → IRREVERSIBLE CHF. ✅ Trastuzumab → REVERSIBLE CHF. ✅ Radiation → PERICARDIAL DISEASE & VALVULAR DISEASE. ✅ Tyrosine Kinase Inhibitors → BLACK BOX WARNING for CV toxicity. ✅ Surveillance should be done EVERY 5 YEARS post-exposure. ✅ Prevention is key (Dexrazoxane, Radiation shielding, Lifestyle).

Answer 4

A. Diffusing capacity of the lungs for carbon monoxide (DLCO) DLCO is the best measure of pulmonary impairment after chemotherapy, particularly in bleomycin-induced lung toxicity. DLco (Diffusion Capacity of Lungs for CO₂) is the most sensitive test for detecting early impairment. ✅ Radiation Pneumonitis → 4 weeks post-radiation ✅ Bleomycin Pneumonitis → Dose-related, Lower Lobes ✅ DLco = Most Sensitive Test for Early Detection ✅ Prednisone 1mg/kg/day → Main Treatment for Pneumonitis ✅ Fibrosis = Irreversible, No Effective Treatment ✅ Prevention is Key → Monitor DLco, Avoid Smoking & High Oxygen in Bleomycin Patients

Answer 5

B. Vinca alkaloids Vincristine and vinblastine cause "stocking-glove" peripheral neuropathy, starting with numbness and tingling and progressing to motor dysfunction. Peripheral neuropathy: Stocking-glove neuropathy (Vinca alkaloids, Cisplatin). Hearing loss (Cisplatin). Lhermitte’s Sign (Electric shock sensation down the spine on neck flexion).

Answer 6

A. Cisplatin Cisplatin-induced neurotoxicity causes sensorimotor neuropathy and ototoxicity (hearing loss) due to damage to the cochlear hair cells. Peripheral neuropathy: Stocking-glove neuropathy (Vinca alkaloids, Cisplatin). Hearing loss (Cisplatin). Lhermitte’s Sign (Electric shock sensation down the spine on neck flexion).

Answer 7

D. It is irreversible and always progresses to fibrosis. Radiation pneumonitis is often reversible and does not always lead to pulmonary fibrosis, which occurs in a subset of patients. Acute Radiation Pneumonitis (4 weeks post-treatment). Pulmonary Fibrosis (Late-stage complication).

Answer 8

C. It is a specific sign of radiation-induced myelopathy. Lhermitte’s sign is not specific to radiation-induced myelopathy; it is also seen in multiple sclerosis and cervical spondylosis. Myelopathy (Radiation-Induced) Lhermitte’s Sign → Electric shock sensation down the spine with neck flexion Diffuse Radiation Injury → White matter changes on MRI, global dysfunction Chronic Radiation Myelopathy → Occurs 9 months to 10 years post-treatment

Answer 9

D. Erosion of the pedicles ("winking owl sign") Earliest radiologic finding of vertebral tumors due to pedicle destruction, appearing as a missing or asymmetric pedicle on X-ray.

Answer 10

C. In young adults, the most common cause of SVCS is tuberculous lymphadenopathy. Lung cancer (85%) and lymphoma are the most common causes of superior vena cava syndrome (SVCS), not tuberculosis.

Answer 11

B. Uncontrolled generation of thrombin by blood exposure to pathologic tissue factors DIC is caused by excessive thrombin generation, leading to widespread clotting and secondary fibrinolysis, consuming platelets and clotting factors.

Answer 12

A. Prolongation of PT Vitamin K deficiency leads to decreased clotting factor activity (II, VII, IX, X), prolonging PT (early finding) before APTT is affected.

Answer 13

C. All of the above Chronic DIC is associated with dead fetus syndrome, malignancies (metastasis), and chronic inflammation leading to low-grade coagulation activation.

Answer 14

D. Factor VIII and IX Hemophilia A (Factor VIII deficiency) and Hemophilia B (Factor IX deficiency) are X-linked disorders.

Answer 15

D. None of the above Rationale: All the listed drugs—Warfarin, Amphetamines, and Fibrinolytic agents—are associated with disseminated intravascular coagulation (DIC) as per the provided table.

Answer 16

A. Von Willebrand factor vWF mediates platelet adhesion to the subendothelial matrix at sites of vascular injury.

Answer 17

B. Amlodipine Rationale: Amlodipine, a dihydropyridine calcium channel blocker (CCB), has been reported to cause immune-mediated thrombocytopenia. The mechanism is likely drug-induced immune thrombocytopenia (DITP), where drug-dependent antibodies target platelets. Verapamil (C) and Nifedipine (D) are also calcium channel blockers but are not commonly associated with isolated thrombocytopenia. Atorvastatin (A) is a statin, which can cause drug-induced myopathy, but thrombocytopenia is rare.

Answer 18

A. Sickle cell disease Sickle cell disease (HbS mutation) is the most common structural hemoglobinopathy, while thalassemias are disorders of hemoglobin synthesis.

Answer 19

D. None of the above All listed factors (infection, puberty, hypersplenism) can aggravate anemia in alpha-thalassemia due to increased hemolysis and erythropoietic stress.

Answer 20

D. All of the above Sickle cell disease complications include: Acute chest syndrome (leading cause of death) Chronic pulmonary crises → pulmonary hypertension & cor pulmonale Avascular necrosis of femoral/humeral head due to vaso-occlusion

Answer 21

C. Deferoxamine Deferoxamine is an iron chelator used to treat transfusion hemosiderosis (iron overload from repeated blood transfusions). 🔍 What is Transfusion Hemosiderosis? Hemosiderosis is iron overload caused by repeated blood transfusions, where excess iron accumulates in organs, leading to severe complications. 🩸 How Does it Happen? 1 unit of PRBC (Packed Red Blood Cells) = 250-300 mg of iron (1 mg/mL). 2 units of PRBC provide the same iron as 1-2 years of dietary iron intake. >100 units of PRBC transfusions → Leads to iron overload.

Answer 22

C. Vitamin C can be given to augment iron absorption. FALSE. Vitamin C is contraindicated in iron overload because it increases free radical formation and oxidative stress, worsening tissue damage.

Answer 23

A. True Unexplained anemia in males or postmenopausal females should be assumed to be due to GI blood loss (e.g., ulcers, malignancies) until proven otherwise.

Answer 24

B. False Oral iron should be taken on an empty stomach for better absorption; food reduces iron absorption, especially dairy, tea, and coffee.

Answer 25

B. Higher incidence among Asians. Chronic lymphocytic leukemia (CLL) is most common in Western populations and rare in Asians, unlike some other leukemias.

Answer 26

A. True Many cases of CLL are asymptomatic and diagnosed incidentally on CBC showing lymphocytosis.

Answer 27

C. Stage C Binet Stage C: Hemoglobin ≤10 g/dL and/or platelets <100,000/μL due to bone marrow involvement.

Answer 28

B. The cancer cell of Hodgkin's lymphoma Reed-Sternberg cells (large, multinucleated "owl-eye" cells) are pathognomonic for Hodgkin’s lymphoma.

Answer 29

A. Non-Hodgkin's lymphoma Non-Hodgkin's lymphoma (NHL) is the most common lymphoid malignancy, with various B-cell, T-cell, and NK-cell subtypes.

Answer 30

A. Epstein-Barr virus EBV is strongly linked to Hodgkin's lymphoma, particularly mixed cellularity and lymphocyte-depleted subtypes.

Answer 31

D. All of the above Non-Hodgkin's lymphoma (NHL) arises from B cells (most common), T cells, or NK cells, with varying clinical presentations.

Answer 32

C. Helicobacter pylori Mucosa-associated lymphoid tissue (MALT) lymphoma, especially in the stomach, is strongly associated with chronic infection by Helicobacter pylori. Eradication of H. pylori can lead to regression of early-stage gastric MALT lymphomas.

Answer 33

A. None of the above This implies that the listed options (B, C, and D) are all associated with the development of lymphoma: B. Radiation and prior radiation therapy – Prior therapeutic radiation can increase the risk of secondary malignancies, including lymphomas. C. Prior chemotherapy – Certain chemotherapeutic agents are associated with an increased risk of secondary malignancies, including lymphomas. D. Phenytoin – Though more famously linked to a “pseudolymphoma” syndrome, phenytoin has been reported in association with true lymphomas as well.

Answer 34

A. Chediak-Higashi syndrome Chediak–Higashi syndrome is a congenital (inherited) disorder, not an acquired one. The other conditions—HIV infection, iatrogenic immunosuppression (e.g., post-transplant), and acquired hypogammaglobulinemia—are all acquired immunodeficiencies that increase the risk of developing lymphoma.

Answer 35

C. Stage III Briefly: Stage I: Single lymph node region/lymphoid structure Stage II: Two or more lymph node regions on the same side of the diaphragm Stage III: Lymph node regions on both sides of the diaphragm (may include spleen) Stage IV: Diffuse or disseminated involvement of one or more extralymphatic organs

Answer 36

A. Mature B lymphocytes The Reed–Sternberg cells (characteristic of Hodgkin lymphoma) are derived almost invariably from B cells (even though they often have crippled or minimal typical B-cell surface markers).

Answer 37

A. Stage IA “A” indicates absence of “B symptoms” (fever, night sweats, weight loss). “I” indicates involvement of only one lymph node region (or lymphoid structure).

Answer 38

D. Palpable lymph nodes in the neck and inguinals “B” symptoms are specifically: Unexplained fever >38°C Unexplained weight loss >10% of body weight in the preceding 6 months Drenching night sweats Having palpable lymph nodes (neck, inguinal, etc.) is not a “B” symptom; it is simply a clinical finding of lymphadenopathy.

Answer 39

A. Female sex Poor prognostic factors in Hodgkin’s lymphoma (e.g., per the International Prognostic Score) include: Prognostic Factors (International Prognostic Score - IPS) Unfavorable features: Male sex. Age >45 years. Stage IV disease. Albumin <4 g/dL. Hemoglobin <10.5 g/dL. WBC ≥15,000/μL. Lymphocytes <600/μL or <8% of WBC.

Answer 40

C. Cisplatin Rationale: The standard ABVD regimen for Hodgkin's lymphoma includes Adriamycin, Bleomycin, Vinblastine, and Dacarbazine. Cisplatin is not part of this regimen.

Answer 41

B. False Rationale: Although ABVD is the chemotherapy regimen used for both early-stage and advanced-stage Hodgkin's lymphoma, the number of cycles differs. Early-stage (low-risk) patients often receive 4 cycles of ABVD (sometimes with involved-field radiation therapy for unfavorable cases), rather than the standard 6 cycles used for advanced-stage disease.

Answer 42

B. False Rationale: Patients with relapsed Hodgkin's lymphoma are usually treated with salvage chemotherapy followed by high-dose chemotherapy with stem cell transplantation, rather than reusing the same standard-dose regimen.

Answer 43

C. All of the above Rationale: Both the Ifosfamide, Carboplatin, and Etoposide regimen and the Gemcitabine, Navelbine, and Doxorubicin regimen are used as salvage chemotherapy options in relapsed Hodgkin's lymphoma.

Answer 44

True Rationale: Hodgkin's lymphoma has a high cure rate, particularly when diagnosed early.

Answer 45

D. None of the above Rationale: Long-term complications following treatment for Hodgkin's lymphoma can include hypothyroidism, breast tumors, and Lhermitte's syndrome, all potentially related to thoracic radiotherapy.

Answer 46

True Rationale: Acute lymphoid leukemia (ALL) most commonly occurs in children, with a notable incidence peak at ages 3–4 years.

Answer 47

True Rationale: Down syndrome is associated with a significantly increased risk of leukemia—up to a twentyfold increase compared to children without Down syndrome.

Answer 48

B. HTLV-1 Rationale: Adult T-cell leukemia is etiologically linked to infection with HTLV-1.

Answer 49

D. None of the above Rationale: Bone marrow examination in ALL is used to differentiate between AML and ALL, confirm the diagnosis, and evaluate immunologic, cytogenetic, and genomic markers.

Answer 50

False Rationale: Lumbar puncture is performed early in the treatment of ALL as a prophylactic measure to prevent central nervous system involvement, rather than after complete remission.

Answer 51

C. >5% ALL cells in bone marrow/blood Rationale: Hematologic relapse in ALL is defined by having more than 5% leukemic blasts in the bone marrow or peripheral blood.

Answer 52

A. True Rationale: Chemotherapy regimens for elderly ALL patients were modified to remove anthracyclines and alkylating agents, leading to an improved overall survival rate of 42%, an increased complete remission rate of 73%, and a reduction in early mortality to 13%.

Answer 53

A. True Rationale: Allogeneic stem cell transplant is a curative option in CML, but 10–15% of patients die within 1–2 decades due to subtle long-term complications, including chronic graft-versus-host disease (GVHD), organ dysfunction, and the development of secondary cancers.

Answer 54

D. All of the above Rationale: Long-term complications following allogeneic stem cell transplant in CML include chronic graft-versus-host disease, organ dysfunction, and an increased risk of second cancers.

Answer 55

C. High performance status Rationale: A high performance status is a favorable prognostic factor in AML, while the other factors listed are associated with a poorer prognosis.

Answer 56

E. Weight gain and increased appetite Rationale: AML typically presents with systemic symptoms like fatigue, weight loss, and anorexia, not weight gain or increased appetite.

Answer 57

A. Blood neutrophil count ≥1000/uL and platelet count ≥100,000/uL Rationale: Complete remission in AML is defined by a blood neutrophil count of ≥1000/uL, a platelet count of ≥100,000/uL, the absence of circulating blasts, and bone marrow blasts <5%. Hemoglobin levels are not a primary criterion for defining remission.

Answer 58

a. Alkylating agents Rationale: Alkylating agents are the leading cause of therapy-associated AML, often occurring years after chemotherapy for other malignancies. These agents cause DNA damage and chromosomal abnormalities, increasing leukemia risk.

Answer 59

b. False Rationale: AML is typically associated with normocytic normochromic anemia, not a microcytic hypochromic picture. The anemia results from bone marrow infiltration by leukemic blasts, leading to decreased RBC production rather than increased RBC destruction.

Answer 60

b. Fatigue Rationale: Fatigue is the most frequent symptom in AML due to anemia and marrow failure. Other common symptoms include fever, infection, bruising, and bleeding due to leukopenia and thrombocytopenia, but fatigue remains the most prominent.

Answer 61

C. All of the above Prolongation of both PT and aPTT suggests a defect in the common pathway (Factors V, X, II, or fibrinogen). Factor V or Factor X deficiency affects both pathways since they are part of the common pathway. Factor II (Prothrombin) and Fibrinogen deficiency also lead to prolongation of both PT and aPTT because they are essential in the final clot formation. Therefore, all of the above are correct.

Answer 62

C. Hemophilia The most common acquired coagulation factor deficiencies result from liver disease, DIC, and Vitamin K deficiency. Hemophilia is an inherited disorder, not acquired. Liver disease affects multiple clotting factors since the liver synthesizes most of them (II, VII, IX, X, fibrinogen, etc.).

Answer 63

D. None of the above All listed drugs can contribute to DIC: Amphetamines → Can trigger vasoconstriction & endothelial damage. Fibrinolytic agents → Can disrupt normal clot formation, leading to consumption of clotting factors. Warfarin → Inhibits Vitamin K-dependent clotting factors (II, VII, IX, X), increasing bleeding risk. Since all three drugs are associated with DIC or coagulopathy, the correct answer is none of the above.

Answer 64

A. vWF (Von Willebrand Factor) vWF is crucial for platelet adhesion to subendothelial collagen during vascular injury. Other options are incorrect: Immunoglobulin → Involved in immune response, not coagulation. Transferrin → Iron transport protein. Ceruloplasmin → Copper-carrying protein.