Step 2 Hem/onc

Front 1

Prostate CA:
Work Up?
Dx?
MCC?

Back 1

perform transrectal US if PSA >10ng/ml or PSA velocity >.75,
o Dx: gold standard US guided biopsy
- MC adenocarcinoma

Front 2

Heyde’s syndrome:

Back 2

combo of Angiodisplasia colon bleeding and aortic stenosis from calcifications

Front 3

radiation sialadenitis:

Back 3

dry mouth after treatment CA tx w/ radiation (especially thyroid),

Front 4

Breast CA risk factors:

Back 4

older age
- nulliparity (no offspring)
- early onset menarche
- late onset menopause
- first pregnancy after 35
- high fat low fiber diet
- fam. Hx 1st degree relative
- BRCA1 and 2 mutations

Front 5

Breast CA tumor Markers?

Back 5

tumor markers CA 27-29
- BRCA1 and 2 mutations

Front 6

Tx for Anal Squamous Cell CA?

Back 6

chemo followed by external beam radation

Front 7

Pancreatic CA:
Presentation?

Back 7

Classically weight loss, dull chronic epi pain, and jaundice in middle age Pancreatic CA until proven otherwise

Front 8

Pancreatic CA:
Dx?

Back 8

o Dx w/ CT abd, ERCP for CA head of Pancreas

Front 9

Pancreatic CA:
Prognostic Factors?
Risk Factors?

Back 9

- sister mary josephs nodule = poor prognosis
- CA of head (gastroduodenal artery involvement)= best prognosis
- RF: smoking, age, obesity, fam hx, NOT ALCOHOL

Front 10

ITP:
Presentation?
Cause?

Back 10

isolated thrombocytopenia, usually following acute infx
- due to IgG binding to platelets
o Purpura, petachia, mucosal bleeding, meno/metorrhagia

Front 11

ITP:
Tx?

Back 11

o Tx w/ prednisone if platelet <30,000 or symptomatic
- IVIG then splenectomy if no resolvment

Front 12

TTP:
Presentation?
Complications?
Tx?

Back 12

- thrombocytopenia, petechial bleeding,
- Complications: neurological involvement, renal failure, hemolytic anemia
o Tx w/ Steroids

Front 13

neutropenic fever:
Presentation?
Tx?

Back 13

- fever above 101 w/ neutrophil count <500 in a pt on chemo
- Tx w/ cefepime as a monotherapy, as it covers for pseudomonas

Front 14

Neutropenic Fever on chemo for solid tumor w/o mets, Tx?

Back 14

send home w/ PO cipro and ampacillin

Front 15

MC Malignant tumor of the urinary tract?

Back 15

Bladder CA, MC transitional cell

Front 16

RF for Bladder CA?

Back 16

- smoking (MC)
- diet rich in meat/fat
- schistosomiasis
- chronic cyclophosphamide treatment and exposure to aniline dyes (not ACUTE exposure)

Front 17

At what point do you transfuse platelets?

Back 17

If count is <50,000 and pt actively bleeding or <30,000

Front 18

What tx is contraindicated in Thalassemia and why?

Back 18

iron, will cause overload

Front 19

Leukomoid reaction:

Back 19

leukocytosis, fever
- increased leukocyte alkaline phosphatase

Front 20

What Lymphoma has similar presentation to Leukomoid reaction and how are they different?

Back 20

CML
- CML has decreased leukocyte alkaline phosphatase, while Leukomoid reaction has increased leukocyte alkaline phosphatase

Front 21

MC infectious cause of aplastic crisis in sickle cell pts?

Back 21

parvovirus B19

Front 22

Tx for aplastic crisis in sickle cell pt?

Back 22

blood transfusion

Front 23

What medication can decrease the incidence of aplastic crisis in sickle cell pts?
what mechanism?

Back 23

- Hydroxyurea can be used to decrease incidence of crisis
- increasing HbF levels

Front 24

What hemolytic anemia has a + fragility test?

Back 24

Hereditary spherocytosis

Front 25

4 types of Microcytic Anemias?

Back 25

TICS:
- Thalassemia
- Iron-deficiency
- Chronic Disease
- Sideroblastosis

Front 26

What factor deficiencies are associated w/ each Thalassemai?

Back 26

A=factor VIII
B=factor IX
C= factor XI
D= factor XII

Front 27

What is in Cryoprecipate and when is it used?

Back 27

Factor VIII, XIII, vWF, fibrinogen and fibronectin
• Only given DIC

Front 28

Multiple Myeloma (MM):
Presenation?
Cause?

Back 28

- Back pain, pathologic fractures, fatigue, weight loss
- Proliferation of Plasma Cells, causing abnormal Protein M from heavy IgG and IgA chance (Bence Jones Proteins)

Front 29

Multiple Myeloma (MM):
Radiologic Findings?
Electrolyte Changes?
Tx?

Back 29

- Punch-out lesions in skull and long bones
- High protein M and Bence Jones proteins
- Hypercalcemia, hypophosphotemia
- Tx w/ ration/chemo, bone marrow transplant

Front 30

what EKG changes can occur from Hypercalemia?

Back 30

short QT interval (opposite is true)

Front 31

Waldenstrom’s Macroglobulinemia:
Cause?
Lab values?
Tx?

Back 31

B cell disorder that leads to monoclonal gammopathy
- elevated IgM, elevated ESR, uric acid, LDH,
- kidney failure and Dutcher bodies (PAS staining IgM around nucleus)
o Tx w/ plasmapheresis

Front 32

What Organ is most affected by Waldenstrom's Macroglobulinemia and what is found on Histo?

Back 32

kidney failure and Dutcher bodies (PAS staining IgM around nucleus)

Front 33

Polycycthemia Vera:
Cause?
Presenation?
Labs?

Back 33

myeloproliferative disorder of bone marrow increasing production of RBC, WBC, and platelets
- HA, Burning in Feet/Hands, Pruritis, Splenomegaly
- Increased HbG, Hct, RBC mass, WBC, and Platelets

Front 34

Polycycthemia Vera:
Histo findings?
Tx?

Back 34

- hypercellular bone marrow
- Tx w/ serial phlebotomy, ASA, Hydroxurea

Front 35

What med should all pt's on Chemo be given and why?

Back 35

- allopurinol
- prevent tumor lysis syndrome and decrease chance of uric acid stones from breakdown of bodies cells

Front 36

MC CA present in areas of chronic would drainage/inflammation?

Back 36

Squamous Cell CA

Front 37

RF for Cervical CA?

Back 37

early age of coitus, increased sexual partners

Front 38

2 MC testicular CA?

Back 38

MC is seminoma, followed by non-seminoma

Front 39

MC megoblastic anemia?

Back 39

• Folate deficiency MCC megoblastic anemia
o Folate def comes up quicker, B12 has larger store

Front 40

Screening Regimen for Colon CA?

Back 40

screen 50 w/ no family hx and no sx’s
o + fam. Hx, 10 years before initial diagnosis in first degree relative

Front 41

ALL:
Age?
Presentation?
Classic Finding?

Back 41

- 2-5, MC CA in children
- anemia (pallor, fatigue), thrombocytopenia (petachia), neutropenia (fever)
o Look for blasts on peripheral smear

Front 42

AML:
Age?
Presentation?
Classic Finding?

Back 42

- 5-30
- fatigue, hx chronic infx, fever, easy bruising, hepatosplenomegaly, Painless Lymphadenopathy
o Pancytopenia on labs, w/ large myeloblasts w/ notched nuclei (Auer Rods)

Front 43

CML:
Age?
Classic Finding?
Tx?

Back 43

- 30-45
- t(9,22) philidelphia chromosome
- Tx w/ Imatinib

Front 44

CLL:
Age?
Presentation?
Classic Finding?

Back 44

- >60
- smudge cells that are CD5 +
o CML has decreased leukocyte alkaline phosphatase

Front 45

Burkitt’s Lymphoma:
Genetic Finding?
Histo Finding?
Common Presentation?
Associated disease?
Tx?

Back 45

- t(8,14) c-myc
- starry night sky on histo (sheets of lymphocytes w/ macrophages)
o Found in young adults, presents w/ jaw lesion or abd/pelvic mass
- associated w/ EBV in AIDS pt’s
o Tx w/ rituximab

Front 46

Hodgkins lymphoma:
Histo Finding?
Common Presentation?
Associated disease?
Dx?

Back 46

- B-cell malignancy
- reed-sternberg cells (bilobar nuclei)
o MC presents w/ painless lymphadenopathy, sometimes weight loss and night sweats
- associated w/ EBV, third or sixth decade
o Dx w/ excisional biopsy of lymph node

Front 47

MC type of Hodgkins Lymphoma:

Back 47

o Nodular sclerosing subtype MC

Front 48

Hairy Cell Leukemia:
Common Finding?

Back 48

Malignant B-cell disorder
- + Tartrate resistant acid phosphatase (TRAP)

Front 49

Ewing Sarcoma:
Presentation?
Cell Origin?
Radiologic Finding?
Genetic Finding?

Back 49

2nd MC childhood bone CA
- usually found around 15 and has a neural crest origin
o “Onion-skin” layering of new bone
- associated w/ t(11;22) genetic translocation

Front 50

Osteosarcoma:
Radiologic Finding?
MC area found?

Back 50

- MC malignant bone tumor
- sunburst radiological pattern,
- found in distal femur, proximal tibia, proximal humerus most commonly

Front 51

B12 vs folate deficiency:
Similarities and Differences?

Back 51

- Both will have increased homocysteien,
- B12 has increased methylmalonic acid levels

Front 52

Hereditary Spherocytosis:
Cause?
Smear Findings?
Other Findings?
Tx?

Back 52

- Caused by Genetic defect in RBC membrane
- Spherocytes on Smear
- + osmotic fragility test
- Tx w/ Splenectomy

Front 53

Mechanical Hemolytic Anemia:
Cause?
Smear Findings?

Back 53

- due to turbulent flow, MC from prosthetic heart valve
- Schistocytes on Smear

Front 54

G6PD Deficiency:
Cause?
Smear Findings?
Tx?

Back 54

- Caused by deficiency of G6PD, brought on by ingestion of oxidants (fava beans, ASA, Sulfa drugs)
- Bite cells and Heinz Bodies on Smear
- Tx w/ avoidance of precipitating cause

Front 55

What diseases are Sickle Cell Pt's more susceptible to?

Back 55

- Salmonella Osteomyelitis
- Encapsulated Organisms such as S. Pneumo, H. Influenza, N. Meningitides, Klebsiella

Front 56

What pathway do Heparin and Warfarin affect?

Back 56

Heparin= Intrinsic pathway, monitored w/ PTT
Warfarin= Extrinsic pathway, monitored w/ PT and INR

Front 57

Causes of Hypercalcemia in Malignancy?

Back 57

- In cases of mets to bone, osteolysis by Cytokines
- Solid tumors w/o mets can produce parathyroid hormone related peptide (PTHrP), causing hypercalcemia and decreased PTH
- Ectopic PTH production can come from Ovarian, Lung, and Neuroectodermal tumors
- Hodgins disease can cause hypercalcemia due to production of Calcitriol

Front 58

Hemophilia can cause joint swelling/pain (hemoarthroses) w/ what mechanism?

Back 58

- Causes synovial thickening and fibrosis due to iron deposition (2nd to hemosiderin deposition), causing cytokine release and cartilage injury
- chronically leads to hemophilic arthropathy

Front 59

What will be seen on peripheral smear in sickle-cell pt and what does it mean?

Back 59

- Howell-Jolly bodies, normally removed by spleen
- Shows that pt spleen isn’t functioning

Front 60

Neurofibromatosis type 2, what is best way to visualize (Dx) acoustic Neuroma’s?

Back 60

- MRI w/ gadolinium

Front 61

Poor prognostic factor in CLL?

Back 61

- Presence of thrombocytopenia

Front 62

MCC death in CLL?

Back 62

- infx

Front 63

What is the Tx for coagulopathy in liver failure pt’s?

Back 63

- FFP's

Front 64

Elderly pt w/ bone pain, renal failure and hypercalcemia is?
What causes the renal failure?

Back 64

- MM until proven otherwise
- Renal failure from obstruction in the tubules due to paraproteinemia (mainly Bence-Jones protiens)

Front 65

MC presentation of Sickle Cell Trait?

Back 65

Painless gross hematuria

Front 66

Salvage Chemotherapy?

Back 66

Extra Tx for a disease when standard therapy fails
- (Ex. Radical Prostatectomy for Prostate CA, w/ PSA recurrence later on that requires Radiation)

Front 67

Adjuvant therapy?

Back 67

Given in addition to standard therapy at the same time

Front 68

Neoadjuvant therapy?

Back 68

Given before standard therapy (radiation before Prostatectomy)

Front 69

Why are people w/ MM at an increased risk for infx?

Back 69

Inability to produce effective antibodies as bone marrow is destroyed by malignant plasma cells

Front 70

How to Dx von Willabrand disease?
Tx?

Back 70

- PTT and bleeding time prolonged
- Ristocetin cofafactor assay measures capacity of vWF to agglutinate platelets
- Tx w/ Desmopressin (DDAVP)

Front 71

vWF vs. Hemophilia?

Back 71

vWF will have prolonged PTT and bleeding time, while Hemophilia only has prolonged PTT

Front 72

What diseases predipose to Thrombotic Thrombocytopenic Purpura (TTP)?

Back 72

- HUS and HELLP

Front 73

What are the 5 signs/Sx's of TTP?

Back 73

- low platelet count
- microangiopathic hemolytic anemia
- neurologic changes
- impaired renal function
- fever

Front 74

Tx for TTP?
What should be avoided?

Back 74

- Tx w/ steroids and in extreme cases splenectomy
- avoid platelet transfusion

Front 75

Cause of ITP?
Presentation?
Dx?
Tx?

Back 75

- IgG anti-bodies form against platelets
- usually asymptomatic, can have minor bleeding/bruising, hematuria, hematochezia, melena
- Dx of exclusion
- Steroids, IVIG, or splenectomy (not platelet transfusion)

Front 76

Waldenstrom's Macroglobulinemia:
Dx?

Back 76

- elevated levels of IgM
- Bone marrow biopsy shows abnormal plasma cells w/ Dutcher Bodies (PAS + IgM deposits around nucleus)

Front 77

Transplant Tissue:
Autologous?
Allogeneic?
Syngeneic?

Back 77

- Autologous: from pt to himself
- Allogeneic: from donor to different pt
- Syngeneic: from identical twins