Test 3 Flashcards

1
Q

What is sweet syndrome associated with?

A

myelodysplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is sweet’s syndrome?

A

acute neutrophilic dermatosis, pyoderma gangrenosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

is latency for AML longer for alkylating agents or topoisomerase inhibitors?

A

alkylating agents - 3-7yrs

topoisomerase inhibitors - 1-2 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

response to tx for ppl who have MDS after being on alkylating agents?

A

highly resistant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what growth factors can be used to tx MDS?

A

G-CSF, GM CSF

EPO (can only use it epo level

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what type of chemotx agent is azacytidine and what does it tx?

A

hypomethylating agent

tx MDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

benefits of azacytidine?

A
  1. decr transfusion dependence 50%

2. prolonge time to leukemia: 21 months vs 12 mon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which phase of CML is this? peripheral and bone marrow blasts

A

chronic phase of CML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which phase of CML is this? Progressive splenomegaly, weight loss, fevers, bone pain. Blood or bone marrow blasts >10%, increasing peripheral counts or cytopenias unresponsive to therapy

A

accelerated phase of CML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

which phase of CML is this? Blood or marrow blasts >20%

A

blast phase of CML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

why does imatinib most often fail in tx of CML?

A

resistance to ABL kinase domain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the 1st drug of choice of rtx of polycytheia vera?

A

hydrea (reduces thrombosis rate–>can normalize platelet and spleen size)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how to tx smoldering multiple myeloma?

A

watch and wait

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what characteristics indicates that a patient with palsmacytoma will have a graeter of chance?

A

disappearance of M protein and NO active disease = longest stability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

is there a correlation b/w amt of amyloid & degree of impairment of organ fxn?

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what disease do 10% myeloma patients concurrently have?

A

amyloidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is the greatest predictor of poor outcome in amyloidosis?

A

cardiac involvement = median survival of 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

when is the risk of waldenstroms most likely to progress?

A

within 1st 5 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

difference b/w tx’ing waldenstroms asymptomatic vs symptomatic?

A

asymptomatic: observe
sx: chemo, plasmapheresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

which familial/genetic diseases are assc’d with incr cancer risk?

A

neurofibromatosis, familial polyposis, li-fraumeni syndrome

immune deficiencies, metabolic disorders, disorders of chromosome stability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is a common sx that a kid with a brain tumor presents with?

A

wakes up in the middle of the night with a HA, then vomits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

when are lymph nodes considered large?

A

when >10 mm
exceptions:
epitrochlear >5 mm; inguinal >15 mm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what type of adenopathy is more likely malignant?

A
  1. generalized
  2. regional not involving the head or neck
  3. medistinal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

describe the texture of lymph nodes that are more likely to be more malignant?

A

hard/rubbery, non-tender, matted, non-mobile

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

when is biopsy recommended for LN?

A
  1. if nodes are enlarging after 2-3 weeks of antibiotic tx
  2. nodes that are not enlarging, but have not shrunk in 6-8 weeks
  3. when present with abnormal CXR
  4. when present with weight loss, hepatosplenomegaly, fevers, NS
  5. if LN is posterior auricular, epitrochlear, supraclavicular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

is bone pain and early or late presentation?

A

late sx of cancer (unless Eqings sarcoma or osterosarcoma in which bone pain presents earleir in course of disease)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

when to evaluate bone pain?

A
  1. persistent pain
  2. associated swelling/mass
  3. limited mobility
  4. wakes at night
  5. no relief from NSAIDS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

which kids are at increased risk for developing ALL?

A
  1. Downs
  2. prenatal exposure to xray
  3. postnatal exposure to high doses radiation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is the best predictor of outcome in ppl with ALL?

A

poor response within 28 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

high WBC (>50k) is prognostic of what?

A

prognostic in precursor B-ALL, not t-ALL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what age grps have a prognosis of higher risk in ALL?

A

> 10 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

when to do f/u after chemotx for ALL?

A

5 yrs post-chemo, then annually for 10 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what % of malignancies do brain tumors comprise?

A

20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is the most common brain tumor?

A

astrocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

parinaud syndrome is associated with what?

A

incr ICP “setting sun”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

which type of brain tumor can you not use surgery for?

A

optic glioma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

can use surgery to tx which types of brain tumors?

A

medulloblastoma, low grade astro (cerebral), high grade astro, ependymoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

can use XRT to tx what types of brain tumors?

A

brain stem glioma, ependymoma, germ cell tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

can use chemo for what types of brain tumors?

A

medulloblastoma, ependymoma, germ cell tumor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

which types of brain tumors do you not need to use surgrery for diagnosis?

A

GCT, BSG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

what type of radiation to use if tumor disseminates to CSF?

A

neuro axis prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

what disease are astrocytomas associated with?

A

NF-1, li-fraumeni syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

what is the leading cause of morbidity & mortality in pediatric cancers?

A

brain tumors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

what is the 2nd most common abdominal malignant tumor in children?

A

wilms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

in staging wilms tumor, when there is tumor spill at the time of surgery, what stage is it?

A

stage III

46
Q

what stages of wilms tumor do you not tx with radiotx?

A

stage I, II with FH

stage I with anaplasia

47
Q

raccoon eyes are associated with what malignancy?

A

neuroblastoma

48
Q

horner’s syndrome can present with which malignancy?

A

neuroblastoma

49
Q

miosis, ptosis, anhydrosis characterize what?

A

horners syndrome

50
Q

what is the most common extra cranial solid tumor in children?

A

neuroblastoma

51
Q

what factors predict poor prognosis in neuroblastoma?

A

> 18 months old, Myc-N amplification

52
Q

periorbital swelling can present with which types of cancer?

A

neuroblastoma,

soft tissue sarcomas of orbit

53
Q

can you use radiation to get rid of ewings sarcoma?

A

NOT radiosensitive

54
Q

if you find cancer in long bones, which type of cancer is likely (ie. distal femur, proximal tibia, proximal humerus, pelvis)?

A

osteogenic sarcoma

55
Q

if you find cance in all bones (long or flat or pelvis, skull, ribs), what can it be?

A

ewing sarcoma

56
Q

hodgkins is more common in adolescents or young kids?

A

adolescents

57
Q

what causes more rapid progression with hodgkins?

A

with medistinal masses, compression of airways is the only thing that causes more rapid presentation

58
Q

what is the most common leukemia in adults?

A

CLL

59
Q

what classification is acute progranulocytic leukemia?

A

M3 (of M0-M7 scale in AML)

60
Q

AML auer rodes are found in which types of AML?

A

M2, M3, MDS

61
Q

where to withdraw BM for biopsy?

A

posterior iliac crest

62
Q

ATRA is used to tx what?

A

APL

63
Q

FAB classification L1 means what?

A

ALL with lymphoblast small to intermediate size (most common)

64
Q

who made the claim that specific gene translocations caused specific diseases?

A

Jane Rowley

65
Q

Jane Rowley showed the link of Philly chrom to what cancer?

A

CML (9:22 translocation)

66
Q

case: 78 y/o WF c/o fatigue. BP = 110/80, P = 80, R = 18, T = 36.6, Pox = 98%. Alert. Aleve + ASA use for arthritis. Eyes with Pale palpebral mucosa, pallor. Low Hgb, small MCV, stool guiac +, low serum ferritin, serum iron, transferrrin sat; high retic count, high TIBC

A

iron deficiency anemia (ASA + aleve use)

67
Q

central pallor >33% on RBC indicates what?

A

microcytic anemia

68
Q

when to start blood transfusions in patients with upper GI bleed?

A

wait until hgb drops below 7

69
Q

case: 78 y/o WF c/o fatigue. BP = 110/80, P = 80, R = 18, T = 36.6, Pox = 98%. presents 5 yrs after iron deficieny anemia secondary to GI bleed. LE paresthesias, short term memory loss, on PPI long term. mild abdominal tenderness, pallor, low hgb, high MCV, low retic, low B12, high methylmalonic acid, high homocysteine

A

B12 deficient anemia (chronic PPI use)

70
Q

case: Burundian immigrant, infected burn (tx’d w/ bactrim), sudden oset fatigue, generalized weakness, jaundice, dark urine. high pulse, icteric eyes, spleen palpable, low hgb, high retic count, LFT test abnormal, heinz bodies

A

G6PD deficiency

71
Q

case: 49 yo female nurse with dyspnea upon climbing stairs, smoker, obese, irregular menses. on depo, has chronic urticaria, mildly elevated bp, hih hr, low O2 sat, venous duplex bilateral legs negative for DVT

A

pulmonary embolism

72
Q

case: 65 yo male, frequent chest colds, smoker, dizziness, tinnitis, gums bleed, stomach pain post meals, skin is darker, incr AP diameter, splenomegaly, hepatomegaly, decr dorsalis pedis pulses, elevated WBC, elevated platelets, JAK2 mutation

A

polycythemia vera

73
Q

what is the major type of lymphoid neoplasm?

A

B cell lymphomas

74
Q

greater than 15 centroblasts/hpf is what grade of follicualr lymphoma?

A

high grade

75
Q

BCL2 is assc’ d with with NHL?

A

follicular lymphoma

76
Q

cyclin D1?

A

mantle cell lymphoma

77
Q

which type of Burkitts involves the jaw?

A

endemic burkitts

78
Q

what is teh most common childhood malignancy in equitorial Africa?

A

burkitts

79
Q

which type of lymphoma presents with hypercalcemia?

A

adult t-cell lymphoma

80
Q

which lymphoma presents with highly folded nuclear membrane?

A

mycosis fungiodese/sezary syndrome

81
Q

is the plaque phase of tumor phase of mycosis fungioses in the epidermis?

A

plaque phase

tumor phase is in the dermis

82
Q

which lymphoma has sheets of blasts in LN, CD34+ TdT, CD1a+?

A

T lymphoblastic leukemia/lymphoma

83
Q

are t-ALL or B-ALL considered higher risk?

A

T-ALL

84
Q

what factors predict poor prognosis for T-ALL?

A

age 100k

85
Q

which type of lymphoma has bimodal age variation?

A

hodgkins

affects 20-30 yo & >50 yo

86
Q

does hodgkins or NHL present with contigious lymphadenopathy?

A

hodgkins

87
Q

which type of histologic subtype of HD is most common in US?

A

nodular sclerosis

88
Q

which type of histologic subtype of HD is predominant?

A

lymphocyte

89
Q

which type of histologic subtype of HD is in lower SES countries?

A

mixed cellularity

90
Q

what indicates that HD is in the BM?

A

Hb 15k

91
Q

what are the most common causes of NHL?

A

chemotx and radiation

92
Q

what is the prototype NHL that is indolent (low grade)?

A

follicular lymphoma

93
Q

what is the prototype NHL that is aggressive (intermediate grade)?

A

diffuse large cell lymphoma

94
Q

what is the prototype NHL that is very aggressive (high grade)?

A

burkitts

95
Q

what is rituximab?

A

anti-CD20 antibody

used to tx DLCL

96
Q

what is richter’s transformation?

A

1/3 follilcular transforms to DLCL at 10 yrs of disease

97
Q

when would it be appropriate to use BM/stem cell transplant in tx of lymphoma?

A
  1. relapse after CHOP
  2. DLCL and very aggressive lymphomas
    NOT follicular lymphoma
98
Q

causes of malignant lymphocytosis?

A
  1. chronic lymphocytic leukemia

mantle cell, hairy cell, splenic lymphoma, prolymphocytic leukemia

99
Q

Which lymphomas are assc’d with HIV?

A

DLCL, burkitts, CNS

100
Q

chronic lymphocytic leukemia is assc’d with B or T cells?

A

B cells

101
Q

why use SVC endovascular stent for SVC syndrome?

A

alleviates sx

may be necessary prior to tissue dx

102
Q

which types of cancers would be expected to show positive effects with stenting?

A

small cell lung cancer, lymphoma, germ cell tumors show rapid response

103
Q

case: high fever, metastatic breast cancer tx’d 1 week ago, hypotension, high hr, chills, mucus membranes with some purulence

A

neutropenic fever

104
Q

what type of imaging for neutropenic fever?

A

CXR

105
Q

cancer patients are more likely of get neutropenic fever from gram+ or gram-?

A

gram +

106
Q

which pathogens cause the most invasive neutropenic fever?

A

candida and aspergillus

107
Q

what is it called when pulse disappears with inspiration, re-appears with expiration?

A

pulsus paradoxus

108
Q

what is lhermittes sign ass’cd with?

A

malignant spinal cord compression

109
Q

what is Decr sensation over buttocks, posterior thigh, perineum; low back pain, bladder & bowel dysfxn, decr patella & Achilles reflexes, LE weakness?

A

cauda equina syndrome

110
Q

what imagign technique can differentiate b/w extradural tumor & intramedullary or leptomeningeal tumor?

A

mri

111
Q

Hyper K, Hyperuricemia, Hyper P, Hypocalcemia after tx with intensive induction chemo is?

A

tumor lysis syndrome

112
Q

what is the most common disease related emergency in ppl with hematologic malignancy?

A

tumor lysis syndrome