Abim Hem/onc

Front 1

Tx of DCIS

Back 1

Lumpectomy/Radiation or Mastectomy -- lumpectomy preferred

Front 2

AFP >200 + Liver mass

Back 2

Dx of Hepatocellular Carcinoma

Front 3

SSRIs and Tamoxifen

Back 3

Best to avoid SSRIs (esp paroxetene, fluocetene, buproprion) -- SSRIs lower Tamoxifen levels

Venlefaxine can be used for hot flashes

Front 4

Gail Model >1.66%

Back 4

Tx with Tamoxifen

Front 5

Colon Cancer Tx

Back 5

Stage I --> SGY
Stage II --> SGY
Stege III --> SGY + Adjuvant ChemnoTx (5FU based)
Stage IV --> systemic chemotx (5FU based; cetuximab in KRAS -ve patients; bevacuzimab)

Front 6

Increased AFP + Testicular Mass

Back 6

Nonseminomatous Cancer

Front 7

Onset of thrombocytopenia 5-10 days after transfusion

Back 7

Post-transfusion Purpura
- usually occurring in women who were sensitized during pregnancy
- Caucasian women
- PLA1-Ag (HPL-1A positive on platelets (Women who do not have PLA1 Ag are susceptible)
- Preferred Tx = IVIG

Front 8

Dx test for Post-transfusion Purpura

Back 8

Anti-HPL1a or PLA1

Front 9

Tx for Post-transfusion purpura

Back 9

IVIG

Front 10

Patient with HITT and CKD, next step?

Back 10

Argatroban and stop Heparinoid

Front 11

INR 4-10 on coumadin

Back 11

No need for Vitamin K unless active bleeding; hold warfarin

Front 12

INR >10 on coumadin

Back 12

Needs Vitamin K and holding of warfarin

Front 13

INR 3-4 on coumadin

Back 13

No dose change if single high reading and previously stable

Front 14

Afib in a patient with Graves' disease with low CHADS2 score, what next? Anticoagulate?

Back 14

Anticoagulate --- Afib nin Graves disease is associted with higher embolic rates

40% of pts with Afib with hyperthyroidism will stay in Afib even when euthyroid

Thyrotoxicosis in 12-18% of all pts presenting with Afib

CHADS 2 criteria were developed in nonvalvular Afib pts based on trials with few hyperthyroid patients

Front 15

A 45 yo man has the following lesion on the leg. Biopsy shows Melanoma with Breslow depth 2.5mm. What is the next step?

Back 15

Wide excision with sentinal lymph
node sampling

Front 16

Screening for Melanoma

Back 16

Insufficient evident to recommend for or against routine screening by PCPs or counseling for pt self-exams


But consider HARMM CRITERIA for referral

• History of previous melanoma
• Age >50 yrs
• Regular dermatologist absent
• Mole changing
• Male gender

Malignant Melanoma (Rigel, 2007, HARMM criteria)

• 0-1 risk factors = 1.0
• 2 risk factors = 1.7
• 3 risk factors = 2.5
• 4-5 risk factors = 4.4

Front 17

Most common skin cancer associated with other malignancies

Back 17

Squamous Cell Cancer

Front 18

Gamma-irradiation of erythrocytes

Back 18

minimizes the incidence of graft-versus-host disease by eradicating lymphocytes but would not decrease the risk for anaphylaxis

Front 19

Leukoreduction of Erythrocytes

Back 19

Leukoreduction of erythrocytes decreases the incidence of febrile nonhemolytic transfusion reactions, cytomegalovirus transmission, and alloimmunization but not anaphylaxis.

Front 20

Minimizes the risk for transfusion-associated anaphylaxis

Back 20

Using washed erythrocytes and platelets

Front 21

Goal Platelets in acute neurosurgical patients either with a head bleed or planned CNS surgery

Back 21

Platelet transfusion to maintain the platelet count at 100,000/µL (100 × 10^9/L) for the first few days after central nervous system bleeding or immediately prior to and after a planned central nervous system surgery is recommended.

Front 22

Universal donor

Back 22

O- blood

Front 23

Anemia in Pregnancy

Back 23

Anemia in pregnancy predominantly results from a dramatic increase in plasma volume that is proportionally larger than the increase in erythrocyte production.

Front 24

Major Side Effect of Lanalidomide + Dexamethosone

Back 24

Lenalidomide in combination with high-dose dexamethasone is associated with an increased risk for venous thromboembolism in patients with multiple myeloma. VTE may occur even despite giving subcutaneous prophylaxis heparin.

Front 25

Duration of anticoagulation for venous thromboembolism in a pregnant patient?

Back 25

The duration of anticoagulation for venous thromboembolism in a pregnant patient is at least 6 months and should extend 6 weeks beyond parturition.

Front 26

Tx of bleeding episodes in patients with evidence of acquired inihibitor (prolonging PTT on mixing study).

Back 26

Recombinant activated factor VIIa is approved for treating bleeding episodes in patients with acquired factor VIII inhibitors.

Front 27

Inflammatory Anemia

Back 27

Patients with inflammatory anemia typically have normal or low serum iron levels, a low total iron-binding capacity and elevated serum ferritin level, and normal findings or microcytic hypochromic erythrocytes on the peripheral blood smear.

Front 28

Characteristic CBC of beta-thalassemia

Back 28

Microcytic anemia associated with an abnormal or slightly increased erythrocyte count is characteristic of β-thalassemia.

The Mentzer index is a ratio of the mean corpuscular volume (MCV) in fluid liters divided by the erythrocyte count. Values less than 13 are associated with β-thalassemia.

Front 29

Definition of MGUS

Back 29

</= 3 g/dL of M progtein

<10% BM plasma cells

No symptoms or e/o End organ damage

Front 30

Myeloma

Back 30

>/= 3 g/dL or >10% plasma cells

Front 31

Why are pregnant women hypercoagulable

Back 31

The most likely laboratory findings in a pregnant patient with no family or personal history of thrombophlebitis are decreased protein S activity, decreased free protein S antigen, and normal total protein S antigen.

Pregnancy is associated with a dramatic increase in factor VIII activity, von Willebrand factor, and C4b binding protein.

Protein S exists in the plasma in two forms, an unbound free form that is more functionally active and a bound and less functionally active protein that circulates in a complex with C4b binding protein. During pregnancy, the concentration of C4b binding protein rises, peaking in the third trimester.

This rise drives the equilibrium between bound and free protein S toward an increasing proportion of the bound form of protein S, resulting in a reduction in protein S activity.

This temporal reduction in protein S activity contributes to the hypercoagulable state of pregnancy. Congenital protein S deficiency is most commonly caused by mutations in the protein S gene or regulatory elements that reduce protein S synthesis, producing equivalent reductions in protein S antigen and activity.

Although not all patients with inherited thrombophilia have a positive family history, congenital protein S deficiency is relatively rare.

Front 32

Most common complication of Sickle Cell Trait

Back 32

Hematuria occurs with increased incidence in patients with sickle cell trait, which was previously diagnosed in this patient and is confirmed by his normal complete blood count and hemoglobin electrophoresis results. Sickle cell trait is generally considered a benign condition, although hematuria, renal medullary carcinoma, risk of splenic rupture at high altitudes, venous thromboembolism, and sudden death during extreme conditions have been reported. Hematuria is by far the most common complication of sickle cell trait, and up to half of cases are due to renal papillary necrosis. Although the exact mechanism of papillary necrosis is not entirely understood, several factors contributing to this process have been described. Renal papillary necrosis results from local microinfarctions in the renal medulla. The hypoxemia, hypertonicity, acidosis, and hyperthermia of arterial blood passing through the long vasa recta of the renal medulla, a consequence of the countercurrent exchange in the renal medulla, promote polymerization of deoxyhemoglobin S. Renal papillary necrosis often presents with painless gross hematuria.

Front 33

Tx of 5q- syndrome

Back 33

Lenalidomide

Front 34

Anticoagulation recommendations for pregnant women with a h/o idiopathic VTE

Back 34

Pregnant women with a history of idiopathic venous thromboembolism should receive antepartum and postpartum prophylactic anticoagulation.

Although outcomes data are limited, it is currently recommended that pregnant women at moderate to high risk of recurrent VTE (as in this patient with a single unprovoked pulmonary embolism) receive prophylactic-dose or intermediate-dose low-molecular-weight heparin (LMWH) during pregnancy and for 6 weeks postpartum.

Front 35

Characterized by microcytosis, normal iron studies, target cells on the peripheral blood smear, and normal hemoglobin electrophoresis results.

Back 35

Alpha-thalassemia


***In beta-thalassemia - hgb electrophoresis is abnormal***

Front 36

What % of patients w/ budd chiari syndrome (Thrombosis of hepatic veins) is associated with PV or ET

Back 36

50-60%

Front 37

Standard of care for patients with higher-risk MDS

Back 37

Azacitadine

Front 38

CD34, CD10, CD20, and TdT positive

Back 38

B-cell ALL -- start induction chemotherapy

Front 39

Asymtomatic mild neutropenia in an "ethnic person"

Back 39

Mild congenital asymptomatic neutropenia is characterized by absolute neutrophil counts of 1000/µL to 1500/µL (1.0-1.5 × 10^9/L); is common among blacks, Yemenite Jews, and Jordanian Arabs; is not associated with increased infections; and requires no therapy

Front 40

Iron chelator of choice for patients with multiple transfusions

Back 40

The oral iron chelator, deferasirox, is often used because of its ease of administration and efficacy. Deferasirox is generally well tolerated, but it can cause rare, serious side effects, including agranulocytosis and kidney failure.

Front 41

lymphoplasmacytic lymphoma characterized by production of monoclonal IgM antibodies

Back 41

Waldenstrom's Macroglobulinemia

Be aware of hyperviscosity syndrome (increased Total Protein and dizziness, segmented retinal veins, etc.) --> give plasmapharesis to treat.

Front 42

CD57-positive T cells and clonality on T-cell receptor gene rearrangement studies are diagnostic of _______

Back 42

Pure red cell aplasia

look for parvo b19, thymomas, or large cell granular lymphocytosis

Front 43

Characterized by insidious symptoms and findings of anemia or jaundice and a peripheral blood smear showing spherocytes, which are erythrocytes that have lost their central pallor. In addition, the direct Coombs (antiglobulin) test is frequently strongly positive for IgG and negative or weakly positive for complement.

Back 43

Warm Autoimmune Hemolytic Anemia

Front 44

Direct Coombs test is negative for IgG and positive for complement

Back 44

Cold Agglutinin Disease

In cold agglutinin disease, the direct Coombs test is negative for IgG and positive for complement, reflecting the properties of the pathogenic IgM antibody.

Front 45

Constitute the warfarin-reversal therapy in patients with life-threatening bleeding.

Back 45

Intravenous vitamin K and prothrombin complex concentrate constitute the warfarin-reversal therapy in patients with life-threatening bleeding.

Front 46

Asymptomatic follicular lymphoma, next step?

Back 46

Regardless of the stage at presentation, patients with asymptomatic follicular lymphoma can be followed without therapeutic intervention until they experience symptoms.

Front 47

Symptomatic follicular lymphoma, next step?

Back 47

Rituximab, combination chemotherapy, and prednisone

Front 48

Patients with average-risk prostate cancer who achieve remission after radiation therapy, next step?

Back 48

Should receive follow-up with serial digital rectal examinations and serum prostate-specific antigen measurement every 6 to 12 months.

Front 49

Patients with cervical cancer who have high-risk features identified at surgery (large primary tumor, deep stromal invasion, lymphovascular invasion, or positive lymph nodes)....

Back 49

Should receive adjuvant treatment with a combination of chemotherapy and radiation.

Front 50

Can cause hypertension, poor wound healing, and vascular catastrophes, including bleeding or thromboses.

Back 50

Bevacizumab

Front 51

Overexpression of cyclin D1 and a t(11:14) translocation are diagnostic

Back 51

Mantle Cell Lymphoma

Front 52

Cerebriform nucleus morphology

Back 52

Mycosis Fungoides

Front 53

Cancer of unknown primary site presenting as axillary lymphadenopathy in women

Back 53

Should be managed as stage II breast cancer -- Mastectomy with Axillary Lymph Node Dissection

Front 54

The only malignancy in which removing the primary tumor in the setting of metastatic disease can improve overall outcome rather than just reduce local symptoms.

Back 54

Kidney Cancer --- do a nephrectomy

Front 55

Patients with high-risk prostate cancer, tx?

Back 55

are optimally managed with a combination of androgen deprivation therapy and radiation.

Front 56

When is radical prostatectomy recommended in patients with prostate cancer?

Back 56

Radical prostatectomy is recommended for patients with organ-confined disease and a life expectancy greater than 10 years.

Front 57

Tx of patients with low grade gleason score and confined prostate cancer

Back 57

watchful waiting

Front 58

Asymptomatic patients with indolent, well-differentiated metastatic carcinoid tumors, tx?

Back 58

can often be managed with expectant observation and serial imaging studies.

Front 59

Stage II non-small cell lung cancer, tx?

Back 59

Potentially curable with surgical resection and adjuvant postoperative chemotherapy to reduce the recurrence risk.

Front 60

Stage III non-small cell lung cancer, tx?

Back 60

Chemotherapy + Radiation

Front 61

Stage IV non-small cell lung cancer, tx?

Back 61

Chemotherapy only

Front 62

Tx of organ involved mycosis fungoides

Back 62

Alemtuzemab

Mild disease can be treated with IVA/Psoralen or corticosteroids

Front 63

Most appropriate diagnostic strategy for a postmenopausal woman who presents with ascites and a pelvic mass.

Back 63

Paracentesis with cytologic analysis is recommended as the most appropriate diagnostic strategy for a postmenopausal woman who presents with ascites and a pelvic mass.

Front 64

When is a sentinal lymph node bx done in patients with melanoma

Back 64

Sentinel lymph node biopsy is generally recommended for patients with tumors greater than 1 mm thick; however, it has not consistently been shown to benefit long-term survival.

Front 65

Ovarian cancer f/u

Back 65

H/P, pelvic exam, and CA-125 measurement every 4 months for the first 2 years

Front 66

Tx of Anal Cancer

Back 66

Mitomycin plus 5-fluorouracil used in conjunction with radiation therapy is the preferred treatment of anal cancer.

stages I, II, and III anal cancer can be potentially cured with radiation therapy plus chemotherapy, without the need for a disfiguring operation.

Front 67

Tx of Brain Mets in Melanoma

Back 67

Resection

Front 68

When do you give BCG in bladder cancer?

Back 68

High-risk, early-stage bladder cancer is treated with intravesicular medication, typically bacillus Calmette-Guérin immunotherapy.

Front 69

In patients with CLL, these tests provide independent prognostic information on appropriate follow-up monitoring and time to initiate treatment.

Back 69

β2-microglobuin level, heavy gene mutational status, and cytogenetics (molecular testings)

Front 70

Review of the peripheral blood smear reveals numerous small lymphoid cells. Flow cytometry of the peripheral blood shows monoclonal B cells expressing CD20, CD10, and CD5.

Back 70

Think: CLL