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231 Cards in this Set
- Front
- Back
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What is the best treatment for patients with acute venous thromboembolism and metastatic cancer?
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Chronic low-molecular-weight heparin at therapeutic doses
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Which patients should have an IVC filter?
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high risk for recurrent thrombosis who have sustained major bleeding and cannot undergo anticoagulation
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What changes can be seen on peripheral blood smear with iron-deficiency anemia?
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microcytic, hypochromic red cells; abnormalities in erythrocyte size (anisocytosis) and shape (poikilocytosis); and, occasionally, red blood cells of bizarre shapes, such as cigar-shaped cells. (increases reported red cell distribution width)
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How is TTP treated?
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plasmapheresis
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How do you treat warm antibody-mediated autoimmune hemolytic anemia?
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corticosteroids
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How does antibody-mediated autoimmune hemolytic anemia manifest itself on blood smear?
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spherocytes on the peripheral blood smear
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What will you see on a blood smear of a patient with microangiopathic hemolytic anemia?
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nucleated red blood cells and low platelet counts
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What is the primary manifestation of transfusion-related acute lung injury?
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hypoxemia
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What causes transfusion-related acute lung injury?
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Antileukocyte antibodies in donor plasma react with antigens on the surface of patients' leukocytes, chiefly neutrophils, leading to neutrophil aggregation and leukostasis in the pulmonary vasculature
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How is TRALI treated?
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supportively, avoid diuretics
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What are the major diagnostic criteria of polycythemia vera?
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- Elevated red blood cell mass
- Normal blood oxygen saturation - Presence of splenomegaly. |
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How do you treat polycythemia vera?
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phlebotomy & low-dose aspirin
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What causes the iron deficiency with PCV?
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reflects the increased use of endogenous iron stores as a consequence of increased bone marrow erythroid activity rather than iron deficiency caused by blood loss or decreased dietary iron consumption
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When should hydroxyurea be used in PCV patients?
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When patient's platelet count were increased to >600,000/μL
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What is the hematocrit goal for patients being phlebotomized for PCV?
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< 45%
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How would sickle cell trait appear on Hb electrophoresis?
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Dark A (fast) band and Dark S band
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How would hemoglobin SC appear on Hb electrophoresis?
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Dark A2 (slow) band and Dark S band
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How would hemoglobinS/B+ thalassemia on Hb electrophoresis?
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Dark S band and faint A and A2 bands
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What characterizes MGUS?
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- Presence of serum monoclonal gammaglobulin without the clinical features of multiple myeloma
- paraprotein level <3.5 g/dL (35 g/L), and - less than 10% plasmacytosis in the bone marrow |
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How should MGUS be managed?
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routine follow-up to identify signs of progression to multiple myeloma and periodic measurement of serum monoclonal protein concentration
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What can be done to minimize the need for donor blood transfusion during surgery?
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Intraoperative acute normovolemic hemodilution
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What is the treatment for multiple myeloma?
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thalidomide and dexamethasone
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What is a common side effect of bortezomib therapy for multiple myeloma?
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peripheral neuropathy (~30% of patients). Typically sensory. but can be mixed motor & sensory.
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80 yr patient with DM and multiple myeloma treated with bortezomib presents with stocking-glove neuropathy. What is the cause?
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Drug toxicity from bortezomib
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What is seen clinically with POEMS syndrome?
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- Polyneuropathy,
- Organomegaly - Endocrine abnormalities - Monoclonal gammopathy - Skin findings |
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What is POEMS syndrome?
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rare plasma cell dyscrasia
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How should patients with HIT be managed?
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stopped and alternative anticoagulation with a direct thrombin inhibitor (argatroban or lepirudin) instituted immediately
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Which direct thrombin inhibitor should be used in patients with HIT and thrombosis?
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lepirudin
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Young female with antithrombin heterozygosity or Factor V leiden presents requesting OCP. What should be prescribed?
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She should be prescribed oral progestin-only–containing contraceptives
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How should delayed hemolytic transfusion reaction be treated?
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avoidance of the incompatible antigen. No role for steroids in alloimmunity.
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What are signs suggestive of disease transformation from myelodysplastic syndrome to acute myeloid leukemia (AML)?
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severe pancytopenia and circulating myeloid blasts on peripheral blood smear
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What is the induction chemotherapy for AML?
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cytarabine and anthracycline
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If suspecting conversion of myelodysplastic syndrome to AML, what diagnostic test should be performed?
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Bone marrow aspirate and biopsy (confirms diagnosis and gives cytogenic info)
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Which has better response to chemo, transformed AML or de novo AML?
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transformed AML
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What do patients with α-thalassemia trait have on blood smear?
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- Mild microcytic anemia with
- Pominent target cells |
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What type of defect do patients with alpha-thalassemia trait have? What chromosome is it on?
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2 gene defect (a,--)/(a, --)
Chromosome 16 |
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Are RBC counts elevated, reduced or normal in pateints with thalassemia?
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preserved or increased
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Are RBC counts elevated, reduced or normal in pateints with tiron deficiency anemia?
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reduced
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Do asymptomatic, pregnant sickle cell patients require transfusions?
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No, not unless she has cardiovascular difficulties or low retic count
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When can patients with delayed-onset heparin-induced thrombocytopenia (HIT) present?
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3-4 wks after heparin exposure
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How is acute chest syndrome (ACS) characterized in sickle patients?
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- fever
- chest pain, - shortness of breath - hypoxia, and a - radiographically detected chest infiltrate |
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How should acute chest syndrome be treated?
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erythrocyte transfusion (simple or exhange) to achieve a target hemoglobin of 10 g/dL (100 g/L).
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How should transfusion-dependent myelodysplastic disorder be treated?
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Erythropoietin therapy
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What is Imatinib mesylate used for?
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bcr-abl chromosomal translocation typically found in chronic myeloid leukemia and in some cases of acute lymphoblastic leukemia
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Describe the iron stores of patients with myelodysplastic syndrome
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adequate or elevated
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Patient admitted with infection treated with cephalosporine and receives blood transfusion. He later becomes anemic with weakly positive DAT. How do you differentiate drug-induced from warm autoantibody reaction?
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Patients with a drug-induced antibody reaction do not have indications of hemolysis or evidence of complement activation on direct antibody testing
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Cold reactive autoantibodies are IgM antibodies or IgG antibodies?
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IgM antibodies
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What do you see with cold autoantibody reaction?
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Positive DAT positive for complement but not IgG
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Which mutations are the most common mutations predisposing to venous thrombosis in white populations?
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Factor V Leiden and prothrombin G20210A
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Which factor is low in pregnancy and can make testing for thrombophilic disorder difficult?
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Protein S
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If a patient has slight anemia, thrombocytopenia and not responding to prednisone. What should be done next?
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Bone marrow aspiration and biopsy
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How would you describe the bone marrow of AML?
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hypercellular
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What can be used to decrease the need for transfusions in aplastic anemia?
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antithymocyte globulin and cyclosporine
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What treatment can be curative for aplastic anemia?
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Allogeneic stem cell transplantation (consider age and if has living siblings)
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What characterizes inflammatory anemia (anemia of chronic disease)?
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- low or normal serum iron concentration
- reduced serum total iron-binding capacity, - serum ferritin that is not decreased |
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What is diagnostic of multiple myeloma?
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- Hypercalcemia,
- Bone pain - Anemia - Clusters of large plasma cells on bone marrow aspirate smear |
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What do you think of when you hear perinuclear halo?
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multiple myeloma
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Which leukemia is associated with Philadelphia chromosome (Ph)-positive?
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CML
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What leads to suppression of CML?
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Imatinib mesylate
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What is thrombotic thrombocytopenia purpura (TTP) is characterized by?
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-Fever
- Neurologic abnormalities - Thrombocytopenia - Microangiopathic hemolytic anemia - Renal insufficiency |
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What do you see with microangiopathic hemolytic anemia?
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- anemia
- schistocytes - elevated serum lactate dehydrogenase concentration |
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What is the treatment for TTP?
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emergent plasma exchange, followed by plasma infusion
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Patient with warm autoimmune hemolytic anemia on corticosteroid treatment develops heart failure and full blood serologic evaluation not yet complete. How should the patient be treated?
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immediate transfusion, even when only incompatible blood (hemolysis may worsen)
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When is splenectomy indicated for corticosteroid warm autoimmune hemolytic anemia?
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when refractory to corticosteroid treatment
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What are the causes of Autoimmune hemolytic anemia (AIHA)?
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- Idiopathic
- Drugs - Lymphoproliferative disorders - Collagen vascular diseases, - malignancies |
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What do you see on peripheral smear with autoimmune hemolytic anemia?
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polychromatic red blood cells and spherocytes
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Patient presents short of breath, anemic, elevated reticulocytes, spherocytes. What is the diagnosis?
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Autoimmune hemolytic anemia
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How should patients with corticosteroid-refractory autoimmune hemolytic anemia?
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splenectomy, raises hemoglobin in 2/3 of people
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When does thrombocytopenia in pregnancy need to be evaluated?
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when platelet values decrease to lower than 70,000/μL
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What should be done with incidental thrombocytopenia found during prenancy?
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careful follow-up
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What are the characteristics of the HELLP syndrome?
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- Hemolysis with a microangiopathic blood smear
- Elevated liver enzymes - Low platelet count |
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What is the most likely diagnosis for a patient with sepsis, severe neutropenia, and relatively well-preserved hematocrit and platelet counts after ingestion of trimethoprim–sulfamethoxazole?
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Drug-induced agranulocytosis
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How can you treat drug-induced agranulocytosis if the patient is septic?
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granulocyte colony-stimulating factor - can shorten her recovery period and may be helpful in the treatment of her severe infection
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Patient presents with history of mucosal bleeding (as do other family members) and mildly prolonged activated partial thromboplastin time. What is this consistent with?
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von Willebrand's disease
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When you do typically see bleeding in patients with essential thrombocytosis?
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with really high platelet counts
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Where does bleeding usually occur with hemophilia A? What is the laboratory abnormality?
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- Bleeding into joints
- markedly prolonged aPTT |
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What can improve the response to erythropoietin in patients receiving dialysis?
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Vitamin C (mobilizes iron stores for erythropoeisis)
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What can erythropoietin failure in patients receiving dialysis?
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- Iron deficiency
- Folate deficiency - Ongoing blood loss - Iron overload |
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54 yo female with lower extremity edema, proteinuria, and monoclonal gammopathy in serum or urine. What should be suspected?
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amyloidoisis (AL)
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How can amyloidoisis AL be diagnosed?
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kidney biopsy
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What causes bleeding symptoms and hematologic abnormalities in patients with autoimmune disorders, malignancy, or in the postpartum setting?
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acquired factor VIII inhibitor
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What can be tested to confirm acquired factor VIII inhibitor?
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inhibitor screen and factor VIII level
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What malignancy is associated with acquired Factor VIII inhibitor?
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lymphoma
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What is characteristically seen with hereditary spherocytosis?
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- hemolytic anemia
- Coomb's negative - elevated mean hemoglobin concentration - predominantly spherocytes on peripheral smear |
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What conditions should you think of when you see spherocytic red blood cells on peripheral smear?
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- Hereditary spherocytosis
- Warm-antibody hemolytic anemia |
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Is a new alloantibody is not always detectable in patients with sickle cell disease who have adverse transfusion reactions?
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NO
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What condition should you think of if you see teardrop erythrocytes on peripheral smear?
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myelofibrosis
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What is the clinical presentation for patients with myelofibrosis?
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- Fatigue
- Weight loss - Massive splenomegaly - Teardrop-shaped erythrocytes on peripheral blood |
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How do you treat myelofibrosis?
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chronic blood transfusion
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When is treatment for ITP generally initiated?
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when platelets drop < 30.000
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Is bone marrow examination required in the diagnosis of ITP?
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NO
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What is the likely diagnosis of isolated thrombocytopenia in an otherwise-healthy young patient?
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ITP
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What treatment provides disease-free and overall survival advantage for patients with multiple myeloma?
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high-dose chemotherapy and autologous stem cell transplantation
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Which treatment should be avoided in multiple myeloma patients that are candidates for autologous stem cell transplantation?
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Melphalan
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What is a side effect of melphalan?
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cumulative myelotoxicity
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What are some of the adverse events with Thalidomide?
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- major fetal malformations
- increase the risk of thromboembolism - cause somnolence - debilitating neuropathy. |
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What treatment can be used for relapsed and refractory myeloma?
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Bortezomib
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What are potential adverse effects of long-term parenteral bisphosphonate therapy?
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Renal dysfunction and osteonecrosis of the jaw
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What additional treatment should be started in patients with multiple myeloma?
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Monthly parenteral bisphosphonate therapy
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What is the appropriate treatment for a patient with HELLP?
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delivery of the fetus
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What can be given to hasten fetal lung maturity?
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betamethasone
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In whom should inherited thrombocytopenic disorder be suspected?
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otherwise-healthy patients with
- low platelet count - giant platelets on peripheral blood smear - family history of thrombocytopenia, and -who are refractory to corticosteroids |
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What laboratory study abnormalities are seen in patients with B12 deficiency?
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- elevated serum lactate dehydrogenase
-elevated unconjugated bilirubin -elevated serum methylmalonic acid -homocysteine concentrations -may have increased forgetfulness |
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What laboratory differences are seen with B12 and folate deficiencies?
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folate deficiency only has elevated homocysteine concentration
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In patients without hemorrhagic risk factors, at what platelet level should phrophylactic transfusions of platelets begin?
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< 10,000
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What platelet level should be maintained for patients with pulmonary hemorrhage and those undergoing most types of major surgery?
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40,000-50,000
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What are symptoms of symptoms of serotonin syndrome?
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- Tachycardia
- Hypertension - Hyperthermia - Mydriasis - Hyperactive bowel sounds, - Diaphoresis - Hyperreflexia - Clonus - Changes in mental status. |
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What do you see with neuroleptic malignant syndrome?
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- Slow-onset bradykinesia
- Muscular rigidity - Hyperthermia - Fluctuating consciousness - Autonomic instability |
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What is a major difference between symptom onset of neuroleptic malignant syndrome and serotonin syndrome?
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NMS symptoms evolve over days and within hours for serotonin syndrome
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What treatment can be used for patients with thalassemia with iron overload?
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Deferoxamine - parenteral iron chelator
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If a pateint is pregnant and needs a blood transfusion, but her CMV status is unknown what kind of special blood product requirement is needed?
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Leukoreduction
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What will CMV transmission to a pregnanct female do to the fetus?
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- Teratogenicity
- Mental retardation or the so-called TORCH syndrome (toxoplasmosis, other [syphilis], rubella, cytomegalovirus, and herpes simplex virus). |
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What does leukocyte reduction do?
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decreases primary HLA alloimmunization and many nonhemolytic, febrile transfusion reactions, but it also prevents CMV transmission because the donor blood lacks free viremia and contains leukocytes with a reservoir of latent virus
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What is Sweets syndrome?
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neutrophilic dermatosis associated with blood neutrophilia and occurs in the setting of acute myeloid leukemia and other myeloid disorders, and during treatment with trans-retinoic acid and granulocyte colony-stimulating factor
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How are all stages of Hodgkins lymphoma treated?
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systemic chemotherapy with curative intent
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What malignancy is associated with Reed-Steinberg cell?
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Hodgkin's lymphoma
(CD20−, CD15+, and CD30+ expression) |
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What are the distinctive qaulities of Hodgkin lymphoma?
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- the malignant Reed-Steinberg cell (CD20−, CD15+, and CD30+ expression)
- Disease spread is commonly contiguous, usually emanating from a cervical lymph node; - More than 75% of patients with newly diagnosed disease can be cured with combination chemotherapy, with or without radiotherapy |
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How is Hodgkin's lymphoma staged?
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- blood tests (including erythrocyte sedimentation rate)
- CT scans of the chest, abdomen, and pelvis - Occasionally, bone marrow biopsy or aspirate. |
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What does ABVD therapy consist of for Hodgkin's lymphoma?
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- Doxorubicin
- Bleomycin - Vinblastine - dacarbazine |
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How should patients with Hodkins lymphoma be treated if have early-stage disease and a favorable prognosis?
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- Four cycles of ABVD alone or
- Two cycles of ABVD plus involved-field radiation therapy at 20 Gy |
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How should patients with Hodkins lymphoma be treated if have early-stage disease and a unfavorable prognosis?
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Four cycles of ABVD plus involved-field radiation therapy at 20 Gy
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How should patients with Hodkins lymphoma be treated if have advanced-stage disease and a favorable prognosis?
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six cycles of ABVD
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What are late complications for patients with Hodgkin's lymphoma?
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- solid tumors (15-25 yrs later due to radiation)
- AML or myelodysplastic syndrome (if received akylating agents - mechlorethamine or procarbazine OR topoisomerase II inhibitors such as etoposide) - MI (>5 yrs) |
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What are potential adverse events associated with akylating treatment (mechlorethamine or procarbazine) for Hodkin's lymphoma?
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- Azospermia (males)
- amenorrhea (women > 30) |
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What are the chemo regimens for colon cancer?
|
- 5-flourauracil plus leucovorin (FU/LV standard)
- oxaliplatin plus FU/LV (FOLFOX) : Stage III cancer |
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What is a side effect of leuprolide (Gonadotropin-releasing hormone agonists)?
|
bone loss & osteoprosis
(reduced levels of testosterone result in less conversion of testosterone to estradiol, which is needed to protect and strengthen bones) |
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What is the management of patients with localized prostate cancer?
|
- radical prostatectomy
- External-beam radiotherapy - Ccryotherapy, or - Watchful waiting |
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What are useful prognostic factors for prostate cancer?
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- Serum PSA concentration
- Clinical stage - Gleason score - Number of positive biopsy specimens at diagnosis |
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How are patients with with metastatic prostate cancer usually treated?
|
- Bilateral orchiectomy or Gonadotropin-releasing hormone agonists (GnRH-As) with or without antiandrogen therapy
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What types of symptoms do GnRH-agonists cause?
|
- Hot flushes
- Gynecomastia - loss of libido - impotence - tumor flare |
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Descrube tumor flare reactions and how they can be prevented?
|
- treatment with GNRH agonists causes an increase in FSH & LH leading to an increase in testosterone & worsening of prostate ca symptoms.
- use of antiandrogen therapy can reduce reaction |
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What are some anitandrogen agents?
|
- bicalutamide
- nilutamide - flutamide |
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What treatment should be considered in patients receiving long-term androgen-deprivation therapy?
|
Calcium with vitamin D supplementation
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Which drug should be avoided in patients who smoke or have an elevated risk of lung cancer?
|
beta-carotene
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What should be monitored after orchiectomy for testicular cancer?
|
serial measurements of AFP & B-hCG levels
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What is the half-lives of AFP & b-hCG?
|
AFP: 5-7 days
B-hCG: 24 hrs |
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How can you detect recurrent or persistent tumor with testicular cancer?
|
- reappearance of tumor markers or
- the failure of tumor marker concentrations to decline |
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How are Stage I disease or nonbulky (tumor size <5 cm) stage II seminomas treated?
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orchiectomy followed by retroperitoneal radiation therapy
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How are bulky stage II seminoma generally managed?
|
cisplatin-based combination chemotherapy after orchiectomy
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How is Stage II nonseminoma managed?
|
orchiectomy and retroperitoneal lymph node dissection, with or without two courses of cisplatin-based chemotherapy
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How are Stage II nonseminomas with large retroperitoneal lymph nodes treated?
|
three courses of chemotherapy after orchiectomy and not retroperitoneal lymph node dissection
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Is Stage 1 nonseminoma highly curable?
|
Yes, >95% with surgery alone
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What is the cornerstone of successful treatment in patients with stage III seminoma and nonseminoma?
|
Chemotherapy
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Which testicular cancer patients are candidates for high-dose chemotherapy with autologous stem cell transplantation?
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Patients who have an incomplete response to first-line therapy and those requiring third-line salvage therapy
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What is curative for patients with early-stage ovarian cancer?
|
surgery alone
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How should patients with Stage III or IV ovarian cancer be treated?
|
With six to eight cycles of platinum- or taxane-based chemotherapy
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Which stages of ovarian cancer should be treated with surgery alone?
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Stage IA or IB
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When would observation for 1 month before performing biopsy be appropriate only in patients with cervical lymph nodes?
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When the node is <2 cm
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What must be considered in patients who have lymphoplasmacytic lymphoma (Waldenström's macroglobulinemia) with an elevated serum IgM concentration?
|
hyperviscosity syndrome
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What should be checked in patients suspected of having hyperviscosity syndrome and evidence of heart failure?
|
serum viscosity level
|
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How should patients with hyperviscosity syndrome be treated?
|
- emergent plasmaphoresis PLUS
- administration of immediate systemic treatment, such as rituximab–fludarabine or rituximab–cyclophosphamide–vincristine–prednisone combination therapy |
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When should plasmaphoresis and systemic treatment be started for hyperviscosity syndrome?
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- serum viscosity >3.0 with suspicious symptoms
OR - a value of >4.0 without suspicious symptoms |
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Who should consider prophylactic oopherectomy?
|
Only women who are at high risk for ovarian cancer
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What should females at high risk for ovarian cancer do if they want to preserve child-bearing potential?
|
undergo routine screening for the circulating serum tumor maker, CA-125, in addition to pelvic ultrasonography
|
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Which serum marker is elevated in pancreatic cancer?
|
CA 19-9 (this tumor marker's role has not been proved in the diagnosis or management of pancreatic cancer)
|
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How is pancreatic cancer staged?
|
- Stage I - tumor limited to the pancreas
- Stage II - tumor extending into the duodenum, bile duct, or peripancreatic tissues - Stage III - regional lymph node involvement - Stage IV disease by tumor extending directly into the stomach, spleen, colon, or adjacent large vessels, or by the presence of metastatic disease |
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What is the first-line therapy of choice for patients with metastatic pancreatic cancer and good performance status?
|
gemcitabine
|
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In patients at risk for tumor lysis syndrome, how can hyperuricemia be treated if unable to tolerate oral intake?
|
IV rasburicase (if can tolerate orals, use allopurinol)
|
|
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How do you treat tumor lysis syndrome?
|
- IV hydration
- urinary alkalinization (bicarb) - Xanthine oxidase inhibitor (allopurinol) OR (rasburicase if cannot tolerate orals) |
|
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When is re-excision indicated in patients with breast cancer?
|
In patients with positive tumor margins detected after breast-conserving surgery
|
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Which breast cancer patients are better served with mastectomy than breast-conserving therapy?
|
When
- Complete excision cannot be achieved unless mastectomy is performed - Tumor cannot be accessed by radiation - Radiation is contraindicated |
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What are patients with ductal carcinoma in situ at increased risk for?
|
New or locally recurrent breast cancer in the contralateral or ipsilateral breast
|
|
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Does use of sunscreen decrease risk of melanoma?
|
NO, decreases risk of squamous cell carcinoma
|
|
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How should patients with testicular cancer metastatic to the brain be treated?
|
whole-brain radiation therapy and combination chemotherapy
|
|
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What can be done to facilitate sphincter-preserving surgery in patients with distal rectal tumors?
|
Treat with preoperative radiation therapy plus chemotherapy to reduce tumor size
|
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What chemotherapy is used to treat colon cancer?
|
- 5-fluorouracil and leucovorin
- oxaliplatin with 5-fluorouracil and calcium leucovorin |
|
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Which cancer has a higher rate of local recurrence, rectal or colon cancer?
|
rectal
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What tumor location prevents low anterior resection?
|
tumors within 6 cm of the anal verge
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How are tumors within 6 cm of the anal verge treated surgically?
|
wide surgical resection with abdominoperineal resection (removing the anus and sphincter muscle) and permanent colostomy
|
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What infectious agent is associated with Gastric mucosa-associated lymphoid tissue (MALT) lymphoma?
|
Helicobacter pylori
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|
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How is remission of MALT lymphoma achieved?
|
With eradication of H. pylori with antibiotics and PPI therapy.
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How is MALT lymphoma monitored?
|
repeated endoscopies every 3-4 months
|
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What virus is Marginal-zone lymphoma (lymph node and splenic types) associated with?
|
Hep C
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What other diseases do patients with MALT usually have?
|
autoimmune diseases such as Hashimoto's thyroiditis and Sjogren's syndrome
|
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How is progression of MALT lymphoma treated?
|
- Radiotherapy
- Rituximab - Gastrectomy, - Chemotherapy or a combination of these modalities |
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What is MALT lymphoma of the small bowel also known as?
|
- immunoproliferative small intestinal disease
- Heavy-chain disease |
|
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Where is MALT lymphoma of the small bowel usually seen? Who gets it? and what infectious agent is it associated with?
|
- Middle east
- young adults - camplylobacter jejuni |
|
|
Do patients with small cell cell lung cancer and poor performance status respond well to chemo and whole-brain radiation?
|
YES
|
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|
What helps reduce skeletal-related events in patients with metastatic lung cancer?
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Bisphosphonates such as pamidronate or zolendronate
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What suggests low risk of metastatic prostate cancer?
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- Low gleason score
- PSA < 10 - Disease stage - # of positive biopsies |
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Besides 5-fluorouracil and oxaliplatin, what other agents can be used to treat colorectal cancer?
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irinotecan
bevacizumab cetuximab |
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How should patients with histologically confirmed adenocarcinoma of the axillary lymph nodes but no clinically or radiologically detected breast abnormalities be treated?
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As Stage II breast canver (radiation therapy of the breast and chemo therapy)
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How should patients with advanced-stage follicular lymphoma be managed?
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watchful waiting
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What would indicate reasons for starting therapy for advanced-stage follicular lymphoma?
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- fever
- soaking night sweats - weight loss (>10% baseline weight within 6 months) - leukopenia - thrombocytopenia - severe anemia that is refractory to treatment with growth factors - hydronephrosis - biliary obstruction - very bulky (>10 cm) lymphadenopathy that causes discomfort. |
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what is the median survival for patients with advanced-stage follicular lymphoma?
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10-14 years
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How may localized follicular lympphoma (stage I) may be cured?
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radiotherapy alone may cure patient
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What laboratory abnormalities are seen with tumor lysis syndrome?
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elevated potassium, phosphorus and uric acid
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What therapy decreases breast cancer risk by approximately 50% in pre- and postmenopausal women who have an elevated risk for this disease?
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tamoxifen
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What are potential harms of tamoxifen therapy?
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- hot flushes
- endometrial cancer - thromboembolic disease - ocular problems |
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What type of cancer is EBV associated with?
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non-Hodgkin's lymphoma
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What does the Gleason score for prostate cancer represent?
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histologic scoring system, tumors are graded from 1 to 5 based on the degree of glandular differentiation and structural architecture
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How do you interpret the Gleason score for prostate cancer?
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Total Gleason scores of;
- 2 to 4 represent well-differentiated tumors - 5 to 6 represent moderately differentiated tumors - 7 represents moderately poorly differentiated tumors - 8 to 10 represent poorly differentiated tumors |
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Which of the 2 Gleason score is most predictive of outcome?
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the first
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How should mixed seminomatous germ cell tumors be managed?
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As nonseminomatous germ cell tumors & with chemotherapy
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What is the best way to establish a diagnosis in patients with suspicious lymphocytosis?
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flow cytometry of peripheral blood
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What decreases a male's risk for prostate cancer?
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Finasteride
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What are some side effects of finasteride?
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- reduced volume of ejaculate
- loss of libido - gynecomastia - erectile dysfunction **lower incidence of urinary obstructive symptoms ** higher gleason scores |
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How should patients with squamous cell carcinoma (SCC) of unknown primary site and upper or midcervical lymph node involvement be treated?
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As if they had locally advanced SCC of the head and neck
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How is locally advanced SCC of the head and neck treated?
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- radiation therapy to the pharyngeal acid and bilteral neck
- radical neck dissection - combination of these two therapies |
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What is more effective than tamoxifen against breast cancer in postmenopausal women with hormone receptor–positive breast cancer?
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aromatase inhibitors
(anastrozole, exemestane, or letrozole) |
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How should patients with marginal-zone B-cell lymphoma be treated if Hep C not detected?
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Splenectomy
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Young, male patients with poorly differentiated midline carcinoma containing germ cell cancer markers and isochromosome 12p. What is the likely diagnosis and how should he be treated?
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- extragonadal germ cell cancer
- cisplatin-based chemo |
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What improves survival in men with metastatic prostate cancer refractory to hormonal ablation therapy?
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Docetaxel and prednisone
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Should aromatase inhibitors be used in premenopausal women with hormone receptor negative breast cancer?
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NO
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What is used to treat metastatic HER2-positive breast cancer?
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trastuzumab and chemotherapy
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How should patients with early-stage resectable non–small-cell lung cancer be treated/
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adjuvant chemotherapy
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What is curative for most patients with diffuse large B-cell lymphoma?
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Combination of:
- Rituximab - CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) - with or without radiation therapy |
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What does bronchioloalveolar cell carcinoma respond to?
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epidermal growth factor receptor inhibitors (Erlotinib or gefitinib)
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What does combination hormone replacement therapy increase the risk of?
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breast cancer
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What does unopposed estrogen therapy increases the risk of?
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uterine cancer
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When does testicular cancer usually relapse?
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within 2 years after definitive therapy
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Where does ovarian cancer usually metastasize to?
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Pleura and peritoneum
(rarely to bone or liver, and almost never to breast) |
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Where does breast cancer usually metastasize to?
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pleura, peritoneum, liver and bone
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What is the tumor marker for ovarian cancer?
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CA-125
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What malignancies are associated with HHV8 with HIV?
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- Primary effusion B-cell lymphoma (very rare)
- Castleman's disease (plasmablastic multi-centric) (very rare) - Kaposi's sarcoma (HIV-related) |
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What malignancy is associated with HTLV?
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Adult T-cell leukemia/lymphoma (very rare)
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What malignanies are associated with Hep C?
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- Lymphoplasmacytic lymphoma (Waldenström's macroglobulinemia)
- Nodal marginal zone B-cell lymphoma - Splenic marginal zone B-cell lymphoma (splenic lymphoma with villous lymphocytes) |
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How is the diagnosis of chronic lymphocytic leukemia established?
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flow cytometry
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What are adverse prognostic factors for follicular lymphoma?
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- age > 60
- Hb < 12 - increased # of involved lymph nodes - increased disease stage - elevated LDH |
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How is CLL characterized?
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abnormal accumulation of morphologically mature-appearing lymphocytes with a characteristic immunophenotype (CD5+, CD20+, CD23+)
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What is a major cause of death in patients with CLL?
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hemorrhage & infection (due to pancytopenia)
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Which CLL mutation portends a more indolent course?
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somatic mutations of the immunoglobulin heavy-chain
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What disease is associated with a monoclonal serum paraprotein of immunoglobulin M?
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lymphoplasmacytic lymphoma (Waldenstrom's macroglobulinemia)
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What disease is characterized by splenomegaly, varying degrees of leukopenia or pancytopenia and bone marrow infiltration by atypical lymphoid cells with cytoplasmic projections>
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Hairy cell leukemia
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What treatment causes prolonged remission with hairy cell leukemia?
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pentostatin or cladribine
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Of the two types of testicular cancer (seminoma and nonseminoma), which is more radiosensitive?
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seminoma
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Where do nonseminomas metastasize?
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retroperotineal lymph nodes and lung parenchyma
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In which tumor type is AFP elevated, seminoma or nonseminoma?
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nonseminomatous tumors (if elevated in seminomatous, should treat as nonseminomatous)
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What is a potential adverse event to retroperitoneal dissection for testicular ca?
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retrograde ejaculation
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What is a side effect of cisplatin therapy?
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peripheral neuropathy and subclinical nephropathy
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What is a side effect of etoposide-containing treatments?
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acute nonlymphoblastic leukemia (with chromosomal 11q23 translocation)
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