Mksap 16 Q&a Hem/onc

Front 1

cornerstone of treatment for SCLC (limited-stage and extensive-stage)

Back 1

Combination chemotherapy

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define limited-stage disease SCLC

Back 2

disease limited to one hemithorax, with hilar and mediastinal LAD that can be encompassed within one radiotherapy portal

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thalassemia that presents with normal hemoglobin electrophoresis results

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α-thalassemia trait

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pentad of findings in TTP

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fever, neurologic deficits, thrombocytopenia, microangiopathic hemolytic anemia, kidney impairment

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how is mantle cell lymphoma diagnosis confirmed?

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presence of overexpression of cyclin D1 and a t(11;14) translocation in the malignant lymphoid cells

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CD4-positive T-cell leukemia characterized by major skin involvement

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mycosis fungoides

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what is Sézary syndrome?

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cutaneous lymphoma with prominent leukemic phase; sometimes considered a late stage of mycosis fungoides with lymphadenopathy

Front 8

provides independent prognostic information in CLL

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β2-microglobuin level, heavy gene mutational status, and cytogenetics

Front 9

test to establish diagnosis of CML

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fluorescence in situ hybridization (FISH) assay for t(9;22)

Front 10

conditions where JAK 2 is positive

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polycythemia vera (95%) and essential thrombocythemia and primary myelofibrosis (50-60%)

Front 11

heterophile antibody test

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infectous mononucleosis

Front 12

useful in the management of the hormonal symptoms of neuroendocrine tumors when they are present and may slow progression of metastatic carcinoid tumors

Back 12

octreotide, a somatostatin analogue

Front 13

when is R hemicolectomy indicated in carcinoid tumors of ileocecal area

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large carcinoid tumors (≥2 cm) of appendix or tumors of appendix of any size with aggressive histology (high-grade neuroendocrine tumors or adenocarcinomas)

Front 14

treatment of locally advanced anal cancer

Back 14

RT + 5FU and mitomycin

Front 15

is surgery indicated in anal cancer?

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stages I, II, and III potentially cured with RT + chemo, without disfiguring operation

Front 16

how to confurm adherence to hydroxyurea therapy in sickle patients

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check MCV (should show macrocytosis)

Front 17

treatment of acute chest syndrome

Back 17

(ABx, O2, pain meds, don't overhydrate, transfusion) empiric broad-spectrum antibiotics, supplemental oxygen, pain meds (diminish chest splinting), and avoid overhydration; transfusion if hypoxic despite o2

Front 18

appropriate breast cancer follow-up

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H&P + mammography

Front 19

causes of PRCA (4)

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parvovirus B19 infection, myelodysplasia, large granular lymphocytosis, thymoma

Front 20

??diagnostic of large granular lymphocytosis

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Flow cytometry revealing CD57+ T cells and clonality on T-cell receptor gene rearrangement studies

Front 21

lab findings in PRCA caused by parvovirus infection

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giant pronormoblasts in bone marrow biopsy, and no large granular lymphocytes on PBS

Front 22

poor prognostic features of melanoma (3)

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thickness greater than 0.75 mm, a positive deep margin, or lymphovascular invasion

Front 23

most common complication of sickle cell trait

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hematuria due to papillary necrosis

Front 24

purpose of γ-irradiation of erythrocytes

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eradicates lymphocytes (minimizes GVHD)

Front 25

advantages of leukoreduction of blood product

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less febrile nonhemolytic transfusion reactions, CMV transmission, and alloimmunization (but not anaphylaxis)

Front 26

Young men with a predominant tumor location in the mediastinum and retroperitoneum

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extragonadal germ cell cancer syndrome, (check HCG and AFP)

Front 27

monoclonal antibody against vascular endothelial growth factor

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Bevacizumab

Front 28

a monoclonal antibody that interferes with the HER2/neu receptor

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trastuzumab or Herceptin

Front 29

side effects of traztuzumab

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Heart failure (esp when used with anthracycline)

Front 30

side effects of tamoxifen

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increased risk for thromboembolic disease and endometrial cancer

Front 31

agent used for ER-positive breast cancer

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tamoxifen

Front 32

mutation in severe congenital neutropenia

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neutrophil elastase gene

Front 33

work up for autoimmune neutropenia

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antineutrophil antibody assay

Front 34

Diagnosis of APS

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venous or arterial thromboembolism or pregnancy morbidity (3 or + first-trimester miscarriages or one fetal death) and positive laboratory results ([dRVVT], ACL Ab, β2 GPI) on two occasions 12 weeks apart

Front 35

mutations associated with mild to moderate hyperhomocysteinemia

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Methylene tetrahydrofolate reductase mutations

Front 36

how to minimize risk of alloimmnization in patients with SCD

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phenotypically matched for the C, E, and K antigens

Front 37

who should undergo yearly mammography and breast MRI

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patients who received mantle radiation, carriers of the BRCA1 or BRCA2 mutation

Front 38

side effect of bevacizumab

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disrupt normal vasculature, resulting in POOR WOUND HEALING and vascular catastrophes, including bleeding or thromboses

Front 39

diagnostic of hairy cell leukemia

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dry aspirate on bone marrow sampling and finding of lymphoid cells with hair-like projections

Front 40

treatment of hairy cell leukemia

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cladribine, highly curable

Front 41

describe headache of brain mets

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maximum intensity on waking up, severe and persistent despite analgesia

Front 42

How to manage pregnant with SCD in a painful crisis

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Fluids, O2, morphine (not teratogenic)

Front 43

low risk prostate cancer

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T1 or T2 cancer with Gleason score <8 and PSA <20

Front 44

when is antiandrogen therapy considered in prostate cancer?

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newly diagnosed + high-risk + received radiation therapy OR hormone-sensitive metastatic cancercancer

Front 45

when is radical prostatectomy indicated in prostate cancer?

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younger patients with organ-confined disease and a life expectancy greater than 10 years

Front 46

treatment of diffuse large B cell lymphoma

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R-CHOP (rituximab plus cyclophosphamide, doxorubicin, vincristine, prednisone) x six cycles, high-dose chemotherapy and autologous HSCT for recurrent

Front 47

Treatment of newly diagnosed acute lymphoblastic leukemia.

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induction chemo with daunorubicin, vincristine, L-asparaginase, prednisone

Front 48

BCR-ABL inhibitor used for the treatment of chronic myeloid leukemia

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imatinib

Front 49

Anticoagulants approved for the treatment of HIT

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argatroban + lepirudin (direct thrombin inhibitors) and danaparoid (heparinoid)

Front 50

Pulmo nodule vs lung mass

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pulmo NODULE = nodule up to 3 cm diameter surrounded by normal lung and no LAD vs. MASS = >3 cm

Front 51

when should lung nodules be followed?

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low risk </=4mm, follow-up not required; highi risk <4mm, follow up in 1 year. low-risk (never smokers, no first-degree relative with lung cancer, or significant radon or asbestos exposure); high-risk (smoking history, environmental exposure)

Front 52

treatment of CUPS in woman with axillary LAD

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axillary LAD without other findings = treat as stage II breast cancer

Front 53

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.

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Kidney cancer

Front 54

diagnosis of multiple myeloma

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bone marrow biopsy showing 10% or more clonal plasma cells

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diagnosis of symptomatic myeloma

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requires evidence of end-organ damage (hypercalcemia, kidney dysfunction, anemia, and/or bone disease) related to myeloma

Front 56

greatest reduction in cancer risk for patients who are (+) for BRCA

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bilateral salphingo-oophorectomy and bilateral mastectomy

Front 57

chronic myeloproliferative disorder characterized by overproduction of megakaryocytes and bone marrow stromal cell-mediated collagen deposition

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primary myelofibrosis

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high risk features of primary myelofibrosis

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age >65; fever, night sweats, and weight loss >/=10%; Hb <10 g/dL (100 g/L);WBC > 25,000/µL (25 × 109/L); and circulating blasts of >/=1%

Front 59

what is SEVERE aplastic anemia?

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>/=2 of: ANC 200 to 500/µL, Plt <20,000/µL, and retic <0.2%

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VERY SEVERE aplastic anemia

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ANC <200/µL

Front 61

aplastic anemia in young man occurs after viral infection. which viral infections can cause this?

Back 61

EBV, CMV

Front 62

define limited stage SCLC

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disease limited to one hemithorax, with hilar and mediastinal LAD that can be encompassed within one radiotherapy portal.

Front 63

treatment of SCLC

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limited stage - RT and chemo; extensive - chemo only

Front 64

patient on tamoxifen develops menopausal symptoms - what is your treatment?

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venlafaxine

Front 65

What is retinoic acid syndrome?

Back 65

In APL patients who receive ATRA, 25% develope syndrome of fever, hypotension, dyspnea, peripheral edema, weight gain, AKI due to ATRA-induced differentiation; MECHANISM is due to release of cytokines from promyelocytes leading to capillary leak

Front 66

manifestations of tumor lysis syndrome

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hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, AKI, DIC

Front 67

how to treat a pregnant patient with DVT?

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LMWH throughout pregnancy + 6 weeks after delivery

Front 68

4 side effects of Tamoxifen

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VTE, endometrial cancer, hot flushes, cataracts.

Front 69

warfarin reversal for life-threatening bleeding (2)

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vitamin K, 10 mg IV over 1 hour, plus prothrombin complex concentrate (PCC)

Front 70

what is prothrombin complex concentrate (PCC)?

Back 70

lyophilized plasma products that contain each of the vitamin K-dependent coagulation factors

Front 71

associated with increased RDW

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iron, folate, or vitamin B12 deficienty

Front 72

treatment of head and neck cancer in general

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locoregionally advanced (stages III and IVA and IVB without mets) combination of radiation, chemo and surgery. early-stage (stages I and II) head and neck cancer receive surgery or radiation with curative intent

Front 73

when is iron chelation indicated in beta thalassemia?

Back 73

high ferritin and transferrin saturation, even without SSx of iron overload

Front 74

what are bite cells?

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cells with eccentrically located hemoglobin confined to one side of the cell seen in g6pd

Front 75

differentiate WAIHA from cold agglutinin disease

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direct Coombs (antiglobulin) test is frequently strongly positive for IgG and negative or weakly positive for complement in WAIHA,

Front 76

diagnostic test to establish PNH

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cytometric analysis for CD55 and CD59

Front 77

how to prevent DVT in pregnant?

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LMWH

Front 78

how to prevent DVT in pregnant with APAS?

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LMWH or UFH + ASA

Front 79

rare NMJ transmission disorder caused by antibodies directed against presynaptic voltage-gated P/Q-type calcium channels

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Lambert-Eaton myasthenic syndrome

Front 80

how to diagnose Lambert-Eaton myasthenic syndrome

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EMG and assays for P/Q-type calcium channel antibodies

Front 81

differentiate cobalamin from folate deficiency

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cobalamin deficiency presents with neuro symptoms + elevated MMA and homocysteine; folate does not have neuro symptoms

Front 82

findings in smear of MDS

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leukoerythroblastic picture, nucleated RBCs and a left shift in WBC; megathrombocytes, teardrop cells

Front 83

treatment for acquired hemophilia with severe bleeding

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rFVIIa

Front 84

treatment for DIC with severe bleeding

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FFP and CP

Front 85

what is the pathophysiology of TRALI?

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caused by antileukocyte antibodies in the donor blood product directed against recipient leukocytes, which then sequester in the lungs, usually during or within 6 hours of a transfusion

Front 86

etiology of acute hemolytic transfusion reaction

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most commonly caused by a clerical error leading to ABO incompatibility. hypotension and DIC develop very early in the transfusion

Front 87

surveillance for stage III colon cancer, post op and adjuvant chemo

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PE + CEA q 3-6m; CT chest, abd, pelv q1y for 3-5y; colonoscopy 1y after resection the q3-5y

Front 88

when is exchange transfusion or RBC transfusion indicated in sickle cell disease?

Back 88

acute management of stroke and acute chest syndrome.

Front 89

most common forms of cutaneous T-cell non-Hodgkin lymphoma.

Back 89

Mycosis fungoides (affects skin) and Sézary syndrome (affects skin and blood)

Front 90

treatment for progressing mycosis fungoides/Sézary syndrome.

Back 90

alemtuzumab (anti-CD52)

Front 91

What is the Mentzer index?

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MCV/RBC; <13 = β-thalassemia.

Front 92

treatment of High-risk, early-stage lesions bladder cancer

Back 92

BCG immunotherapy (intravesicular)