Onc - MDS and Leukemias Flashcards Preview

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Flashcards in Onc - MDS and Leukemias Deck (22):
0

Features of polycythemia vera?

#Headache, blurred vision, tinnitus
#Hypertension
#Splenomegaly
#Thrombosis and bleeding

1

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

Low versus high erythropoietin

2

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

#Elevated B12
#Low iron

JAK2 mutation

Conversion to AML

3

Treatment for polycythemia vera?

#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

Essential thrombocytosis – clinical sign? Treatment?

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

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

Anagrelide (inhibits platelet maturation)

6

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

Myelofibrosis

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

7

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

Acute leukemia

Blood smear will show blasts

Flow cytometry

8

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

AML (auer rods)

Translocation between chromosomes 15 and 17

9

Best indicator of prognosis in acute leukemia?

Cytogenetics (specific chromosomal characteristics)

10

Treatment for patients with promyelocytic leukemia?

All-trans-retinoic acid

11

Complication of promyelocytic (M3) leukemia?

DIC

12

ALL treatment?

Chemotherapy + intrathecal methotrexate to prevent CNS relapse

13

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?

CML

PCR or FISH for BCR-ABL

Tyrosine kinase inhibitors (imantinib)

Bone marrow transplant

Blast crisis

14

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

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

15

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

Myelodysplastic syndrome (pre- leukemia disorder)

#Increased MCV
#Nucleated RBCs
#ringed sideroblasts

Bleeding and infection




16

Myelodysplastic syndrome – treatment?

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

17

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

CLL

Abnormal B-cells

18

Stages of CLL? (And treatment?)

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

Patient with refractory CLL – treat with?

Mild CLL?

Severe infection?

Autoimmune thrombocytopenia or hemolysis?

Cyclophosphamide

Chlorambucil

IVIg

Prednisone

20

Antibiotic prophylaxis in CLL?

PCP

21

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

Hairy cell leukemia

Smear showing hairy cells

Flow cytometry for CD11c

Cladribine, pentostatin

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