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20 Cards in this Set
- Front
- Back
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161. treatment of essential thrombocythemia (ET)?
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a. Hydroxyurea to lower the platelet count
b. Anagrelideis an agent specific to the treatment of ET, but is not as strong as hydroxyurea. c. Daily aspirin should also be given if patient is thrombosing. |
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162. Presentation of multiple myeloma?
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a. Bone pain caused by a fracture occurring under normal use (most common).
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163. The most common causes of death from multiple myeloma?
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a. Infection: patients with multiple myeloma are effectively immunodeficient.
b. Real failure |
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164. What initial testing should you order for multiple myeloma?
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a. Skeletal survey- to detect punched out osteolytic lesions. (Osteoblastic lesions suggest metastatic prostate cancer).
b. Serum protein electrophoresis (SPEP)-you are looking for elevated levels of monoclonal antibody ( usually IgG). c. Urine protein electrophoresis (UPEP)-detects Bence-Jones protein. d. Peripheral smear: shows “Rouleaux” formation of blood cells. e. Elevated calcium level: makes sense with the osteolytic lesions f. beta-2 microglobulin level. This is a prognostic indicator. g. BUN and creatinine: this is to detect frequent occurrence of renal insufficiency. |
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165. Which test for multiple myeloma is a prognostic indicator?
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a. Beta-2 microglobulin level.
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166. What is the single most specific test for multiple myeloma?
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a. Bone marrow biopsy, which detects high numbers of plasma cells (10%).
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167. treatment of multiple myeloma (2 drugs)?
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a. Melphalan and steroids.
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168. Alternative medications, which may be added in the treatment of multiple myeloma?
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a. Thalidomide
b. Lenalidomide c. Bortezomib. |
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169. MOA of Thalidomide?
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a. Thalidomide is an inhibitor of tumor necrosis factor that has the same efficacy as chemotherapy,
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170. what is the most effective therapy for multiple myeloma?
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a. Autologous stem cell bone marrow transplantation.
b. This is reserved for patients who are relatively young (<70) WITH ADVANCED DISEASE. |
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171. What else should we remember to treat multiple myeloma?
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a. Hypercalcemia- hydration/diuresis
b. bone fractures- biz phosphonates c. renal failure- hydration d. anemia- erythropoietin e. prophylactic against infections with vaccinations (e.g., flu, Pneumovax, tetanus). |
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172. Presentation of Monoclonal Gammopathy of Unknown Significance (MGUS)?
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a. MGUS presents with an asymptomatic elevation of IgG on SPEP.
b. The SPEP is done because of elevated total protein level found in an elderly patient, typically over 70. |
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173. treatment of MGUS?
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a. There is no treatment
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174. Presentation of Waldenstrom's Macrglobulinemia?
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a. Hyper-viscosity from IGM overproduction.
b. The question will describe blurry vision, confusion, and headache. c. Enlarged nodes and spleen can be found!! |
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175. Diagnostic testing for Waldenstrom's Macrglobulinemia?
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a. There is no specific finding on CBC.
b. The best initial tests is a serum viscosity level, which will be markedly elevated. c. And d. SPEP, which will show an elevated IgM level. |
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176. Treatment of Waldenstrom's Macrglobulinemia: best initial therapy?
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a. Plasmapheresis
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177. further treatment of Waldenstrom's Macrglobulinemia?
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a. Use the agency reviews for CLL, such as fludarabine or chlorambucil.
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178. Presentation of aplastic anemia?
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a. Pancytopenia with no identified ideology.
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179. Treatment of aplastic anemia?
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a. When the patient is young (< 50) and has a match, the best possible therapy is bone marrow transplantation.
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180. Treatment of aplastic anemia. If the patient is greater than 50 and/or no match?
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a. Anti-thymocyte globulin and cyclosporine.
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