Usmle Ck - Heme/onc 3

Front 1

anemia with decreased retic count?

Back 1

aplastic anemia

Front 2

pt with metastatic mass bleeding inside the brain?

Back 2

- metastatic melanoma!

Front 3

pt with hg 8, cr 2.1, ca11?

Back 3

- pt with anemia, renal disease, and hypercalcemia = MM
- do serum immunoelectrophoresis

Front 4

how to interpret iron studies?

Back 4

- see booook

Front 5

pt with hemophilia?

Back 5

- will most likely have hx of joint swelling b/c of hemarthroses as most common site of bleeding is in joints

Front 6

pt with solid testicular mass?

Back 6

- do radical orchiectomy
- do not do FNA or biopsy b/c risk of cancer cell spillage

Front 7

role of folate and B12?

Back 7

- convert homocysteine to methionine, thus B12/folate deficiency = high homocysteine
- if you see high methylmalonic acid, then B12 and not folate deficiency

Front 8

VMA?

Back 8

pheos

Front 9

**drugs that cause folic acid deficiency?

Back 9

phenytoin, trimethoprim, methotrexate

Front 10

which lung ca not associated with smoking?

Back 10

- adenocarcinoma bronchoalveolar type, located in periphreal
- met early to adrenals, bone, CNS

Front 11

sx in pt with TTP-HUS?

Back 11

- normocytic hemolytic anemia with increased indirect bili, thrombocytopenia and renal failure
- e.g. low Hg, normal MCV, increased retic, low platelet, high Cr, high t. bili w/ normal direct bili
- DO PERIPHERAL SMEAR to check for schistocytes = TTP-HUS

Front 12

schisotcytes

Back 12

- diagnostic of microangiopathic hemolytic anemia which can be 2/2 TTP-HUS, DIC, malignant HTN
- normal PT,PTT would r/o DIC

Front 13

HIV increases risk for DIC vs TTP vs HUS vs ITP?

Back 13

- TTP

Front 14

pt with peptic ulcer and high calcium?

Back 14

- MEN type
- have zollinger-Ellison syndrome = gastrin producing tumor called gastrinoma = refractory peptic ulcer dz
- primary hyper PTH: increased Ca and decreased hpos

Front 15

vit D toxicity?

Back 15

elevated phos and ca

Front 16

femur with sunburst appearance?

Back 16

- osteosarcoma

Front 17

ewings vs osteosarcoma vs giant cell vs chondrosarcoma vs glomus tumor vs fibrosarcoma?

Back 17

ewings: v. malignant, onion skinning on xray, diaphyseal tumor
- osteosarcoma: sunburst
- giant cell: soap bubble
- chondrosarcoma: older, fusiform defect with scallopping
- glomus tumor:common vascular benign tumor, triad: intermitten pain, tenderness, sensitivity to touch, in subungual area
- fibrosarcoma: malignant spindle cell neoplasm, painful mass

Front 18

howell jolly bodies?

Back 18

- nuclear remnants on RBCs that are typically removed by spllen
- so person with splenectomy will have howell-jolly bodies: RBCs with round, blue inclusions on Wright stain

Front 19

RBC:
- wright stain
- cystal violet stain
- methylene blue stain?
- prussian blue stain?

Back 19

- wright: howel-jolly bodies in asplenic pt
- crystal violet: oxidizes hemoglobin in RBCs in G6PD deficiency
- methylene blue = reticulocytes
- prussian blue: presence of hemosiderin = hemolysis

Front 20

what commonly occurs with pulm HTN?

Back 20

- polycythemia vera

Front 21

signs of AV shunting?

Back 21

papules
- e.g. hereditary telangiectasia: epistaxis, ruby papules on lips, GI, lungs
- can causes increased Hct 2/2 chronic hypoexmia if shunting in lung

Front 22

tx of hairy cell?

Back 22

- cladribine
SE: neurological,, kidney damage

Front 23

pt with intravascular hemolysis... what would suggest PNH?

Back 23

- hepatic vein thrombosis
- PNH 2/2 abnormal cell marker = attacked by complement
- occurs in paroxysms so may occur randomly at an old age

Front 24

presentation of fanconi's anemia?

Back 24

- young boy with aplastic anemia, macrocytic, hypoigmentation, poor growth
- problem of DNA repair
- tx: hematopoietic stem cell transplant
- increased cancer and congenital abnormalities: microcephaly, abnormal thumbs, hypogonasim

Front 25

metabolic abnormalities of tumor lysis syndrome?

Back 25

- low ca, high phos, high K, high uric acid
- occurs with tumors with high cell turnover: poorly diff lymphomas and leukemias

Front 26

pt with submandibular or cervial lympho node?

Back 26

SCC of head and neck

Front 27

tx of antiphospholipid ab syndrome?

Back 27

heparin

Front 28

tx of basal cell ca?

Back 28

- 1-2 cm margins

Front 29

triad of glucagonoma?

Back 29

- hyperglycemia, necrotizing dermatitis (erythematous, scaly plaques on face and buttock), weight loss
- confirm dx with elevated fasting glucose, serum glucaogon, CT scan showing pancreatic tumor
- surgery, doesn't need chemo