Onc - MDS and Leukemias Flashcards Preview

Medicine > Onc - MDS and Leukemias > Flashcards

Flashcards in Onc - MDS and Leukemias Deck (22)
Loading flashcards...
0
Q

Distinguishing between polycythemia vera and renal cell carcinoma as a cause for increased hematocrit?

A

Low versus high erythropoietin

1
Q

Features of polycythemia vera?

A
#Headache, blurred vision, tinnitus
#Hypertension
#Splenomegaly
#Thrombosis and bleeding
2
Q

Suspected polycythemia vera – non-CBC lab findings? Most accurate test? Increased risk to develop which cancer?

A
#Elevated B12
#Low iron

JAK2 mutation

Conversion to AML

3
Q

Treatment for polycythemia vera?

A
#Phlebotomy and aspirin (to prevent thrombosis)
#Hydroxyurea (to lower cell count)
#allopurinol or rasburicase (to protect against uric acid rise)
#Antihistamines (to prevent pruritis following warm showers)
4
Q

Essential thrombocytosis – clinical sign? Treatment?

A

Erythromelalgia – Painful red hands

If under 60, asymptomatic, and platelet count under 1.5 million no treatment

If patients over 60, thromboses or platelet count over 1.5 million:
#Hydroxyurea
#aspirin for Erythromelalgia
5
Q

Patient with essential thrombocytosis presents after beginning hydroxyurea – now has red blood cell suppression. Switch to which medication?

A

Anagrelide (inhibits platelet maturation)

6
Q

Teardrop shaped cells and nucleated RBCs suggest what diagnosis? Treatment?

A

Myelofibrosis

Thalidomide and Lenalidomide (TNF-a inhibitors that increase bone marrow production)

7
Q

Patient presents with infection and pancytopenia after a long history of myelodysplastic syndrome – need to rule out? Best initial test? Most accurate test?

A

Acute leukemia

Blood smear will show blasts

Flow cytometry

8
Q

Leukemia patient presents with Eosinophilic inclusions in white blood cells – type of leukemia? Associated associated with what genetic mutation?

A

AML (auer rods)

Translocation between chromosomes 15 and 17

9
Q

Best indicator of prognosis in acute leukemia?

A

Cytogenetics (specific chromosomal characteristics)

10
Q

Treatment for patients with promyelocytic leukemia?

A

All-trans-retinoic acid

11
Q

Complication of promyelocytic (M3) leukemia?

A

DIC

12
Q

ALL treatment?

A

Chemotherapy + intrathecal methotrexate to prevent CNS relapse

13
Q

Patient presents with pruritis, splenomegaly, night sweats, fever and high WBC count with increased basophils - suspected diagnosis? Most accurate test? Best initial treatment? Can be cured with? If untreated, can result in?

A

CML

PCR or FISH for BCR-ABL

Tyrosine kinase inhibitors (imantinib)

Bone marrow transplant

Blast crisis

14
Q

Patient presents with acute leukostasis reaction (extremely high white blood cell count) – Next step?

A

Leukapheresis to remove excess WBCs (more important than getting a diagnosis)

15
Q

Patient over 60 presents with asymptomatic pancytopenia on CBC. CBC shows bi-lobed neutrophils – suspected diagnosis? Other lab findings? Usual cause of death?

A

Myelodysplastic syndrome (pre- leukemia disorder)

#Increased MCV
#Nucleated RBCs
#ringed sideroblasts

Bleeding and infection

16
Q

Myelodysplastic syndrome – treatment?

A
#Transfusions (azacitadine decreases transfusion dependence)
#Erythropoietin
#lenalidomide if patients have 5Q deletion (better prognosis)
17
Q

Smudge cell seen on smear – suspected diagnosis? Clonal proliferation of?

A

CLL

Abnormal B-cells

18
Q

Stages of CLL? (And treatment?)

A

Stage 0 – elevated WBC (none)
Stage 1 – lymphadenopathy. (None)

Stage 2 – Hepatosplenomegaly (fludarabine + rituximab)
Stage 3 – anemia (fludarabine + rituximab)
Stage 4 – thrombocytopenia (fludarabine + rituximab)

19
Q

Patient with refractory CLL – treat with?

Mild CLL?

Severe infection?

Autoimmune thrombocytopenia or hemolysis?

A

Cyclophosphamide

Chlorambucil

IVIg

Prednisone

20
Q

Antibiotic prophylaxis in CLL?

A

PCP

21
Q

Middle aged man presents with pancytopenia, massive splenomegaly. BM tapped is attempted but dry. Suspected diagnosis? Best initial test? Most accurate test? Treatment?

A

Hairy cell leukemia

Smear showing hairy cells

Flow cytometry for CD11c

Cladribine, pentostatin

Decks in Medicine Class (106):