Heme/onc Mksap 16 Q&a

Front 1

Cornerstone of treatment for small cell lung cancer (limited-stage and extensive-stage)

Back 1

Combination chemotherapy

Front 2

Define limited-stage disease small cell lung cancer:

Back 2

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

Front 3

Thalassemia that presents with normal hemoglobin electrophoresis results?

Back 3

Alpha-thalassemia trait

Front 4

Pentad of findings in TTP

Back 4

-fever

-neurologic deficits

-thrombocytopenia

-microangiopathic hemolytic anemia

-kidney impairment

Front 5

How is mantle cell lymphoma diagnosis confirmed?

Back 5

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

Front 6

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

Back 6

Mycosis fungoides

Front 7

What is Sézary syndrome?

Back 7

Cutaneous LYMPHOMA with prominent leukemic phase; sometimes considered a late stage of mycosis fungoides with lymphadenopathy.

Front 8

Provides independent prognostic information in chronic lymphocytic lymphoma (CLL)?

Back 8

-β2-microglobuin level
-heavy gene mutational status

-cytogenetics

Front 9

Test to establish diagnosis of chronic myelogenous lymphoma (CML):

Back 9

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

Front 10

Conditions where JAK 2 is positive:

Back 10

-Polycythemia vera (95%)

-Essential thrombocythemia

-Primary myelofibrosis (50-60%)

Front 11

Heterophile antibody test if for diagnosis of:

Back 11

infectous mononucleosis

Front 12

This agent is 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 right hemicolectomy indicated in carcinoid tumors of ileocecal area?

Back 13

With large carcinoid tumors (greater than or equal to 2 cm) of appendix or tumors of appendix of any size with aggressive histology (high-grade neuroendocrine tumors or adenocarcinomas).

Front 14

What is the treatment of locally advanced anal cancer?

Back 14

Radiation + 5FU and mitomycin

Front 15

When is surgery indicated in anal cancer?

Back 15

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

Front 16

Best way to confurm adherence to hydroxyurea therapy in sickle patients?

Back 16

Check MCV (should show macrocytosis)

Front 17

What is the treatment of acute chest syndrome?

Back 17

-Antibiotics: empiric broad

-oxygen

-pain meds: to diminish chest splinting

-hydration (but don't overhydrate)

-transfusion: if hypoxic despite supplemental oxygen

Front 18

What is appropriate breast cancer follow-up?

Back 18

H&P + mammography

Front 19

causes of PRCA (4)

Back 19

parvovirus B19 infection, myelodysplasia, large granular lymphocytosis, thymoma

Front 20

How to diagnose large granular lymphocytosis:

Back 20

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:

Back 21

Giant pronormoblasts in bone marrow biopsy, and no large granular lymphocytes on peripheral blood smear.

Front 22

Poor prognostic features of melanoma:

Back 22

-Thickness greater than 0.75 mm

-a positive deep margin, or

-lymphovascular invasion

Front 23

What is the most common complication of sickle cell trait?

Back 23

Hematuria due to papillary necrosis

Front 24

What is the purpose of doing γ-irradiation of erythrocytes:

Back 24

Eradicates lymphocytes (minimizes graft versus host disease)

Front 25

The advantages of leukoreduction of blood product:

Back 25

-Less febrile nonhemolytic transfusion reactions, -Less CMV transmission, and

-Less alloimmunization (but not anaphylaxis)

Front 26

What condition to think of in young men with a predominant tumor location in the mediastinum and retroperitoneum?

Back 26

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

Front 27

What is the man-made monoclonal antibody against vascular endothelial growth factor?

Back 27

Bevacizumab

Front 28

What is the man-made monoclonal antibody that interferes with the HER2/neu receptor?

Back 28

Trastuzumab or Herceptin

Front 29

What are the side effects of Traztuzumab (Herceptin):

Back 29

Heart failure (esp when used with anthracycline)

Front 30

What are the side effects of tamoxifen

Back 30

Increased risk for thromboembolic disease and endometrial cancer

Front 31

Agent used for ER-positive breast cancer:

Back 31

tamoxifen

Front 32

What is the mutation in severe congenital neutropenia?

Back 32

neutrophil elastase gene

Front 33

The best test for work up for autoimmune neutropenia?

Back 33

Antineutrophil antibody assay

Front 34

Diagnosis of antiphopholipid antibody syndrome:

Back 34

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

The mutations associated with mild to moderate hyperhomocysteinemia:

Back 35

Methylene tetrahydrofolate reductase mutations

Front 36

How to minimize risk of alloimmnization in patients with sickle cell disease:

Back 36

Phenotypically matched for the C, E, and K antigens

Front 37

Who should undergo yearly mammography and breast MRI:

Back 37

1. Patients who received mantle radiation

2. Carriers of the BRCA1 or BRCA2 mutation

Front 38

Side effect of bevacizumab (used to treat glioblastoma and NCLC)

Back 38

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

Front 39

Diagnostic of hairy cell leukemia:

Back 39

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

Front 40

Treatment of hairy cell leukemia:

Back 40

Cladribine, highly curable

Front 41

Describe headache of brain mets:

Back 41

maximum intensity upon waking up, severe and persistent despite analgesia

Front 42

How to manage pregnant with sickle cell disease in a painful crisis

Back 42

Fluids, O2, morphine (not teratogenic)

Front 43

What is considerd low risk prostate cancer:

Back 43

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

Front 44

When is antiandrogen therapy considered in prostate cancer?

Back 44

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

Front 45

when is radical prostatectomy indicated in prostate cancer?

Back 45

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

Front 46

Treatment of diffuse large B cell lymphoma:

Back 46

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

Front 47

Treatment of newly diagnosed acute lymphoblastic leukemia.

Back 47

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

Front 48

BCR-ABL inhibitor used for the treatment of chronic myeloid leukemia (CML)?

Back 48

imatinib

Front 49

Anticoagulants approved for the treatment of HIT

Back 49

-Argatroban: direct thrombin inhibitor

-Lepirudin: direct thrombin inhibitors

-Danaparoid (heparinoid)

Front 50

Difference in the definition of pulmonary nodule vs lung mass:

Back 50

Pulm 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?

Back 51

-Low risk: less than or equal to 4mm, follow-up not required

-High risk: less than 4mm, follow up in 1 year.

Low-risk is defined as never smokers, no first-degree relative with lung cancer, or significant radon or asbestos exposure); high-risk is defined as smoking history, environmental exposure.

Front 52

Treatment of cancer of unknown primary (CUP) in woman with axillary LAD:

Back 52

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

Front 53

What is 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?

Back 53

Kidney cancer

Front 54

Best way to diagnose of multiple myeloma:

Back 54

bone marrow biopsy showing 10% or more clonal plasma cells

Front 55

diagnosis of symptomatic myeloma

Back 55

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

Front 56

What is the greatest reduction in cancer risk for patients who are (+) for BRCA:

Back 56

bilateral salphingo-oophorectomy and bilateral mastectomy

Front 57

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

Back 57

Primary myelofibrosis

Front 58

What are the high risk features of primary myelofibrosis:

Back 58

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 considered SEVERE aplastic anemia?

Back 59

Greater than or less than 2 of:

-ANC 200 to 500

-Plt <20,000

-Retic <0.2%

Front 60

What is VERY SEVERE aplastic anemia:

Back 60

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

Treatment of small cell lung cancer:

Back 62

-Limited stage: radiation and chemo

-Extensive: chemo only

Front 63

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

Back 63

Venlafaxine (Effexor)

Front 64

What is retinoic acid syndrome?

Back 64

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 65

Manifestations of tumor lysis syndrome:

Back 65

hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia, AKI, DIC

Front 66

How to treat a pregnant patient with DVT?

Back 66

LMWH throughout pregnancy + 6 weeks after delivery

Front 67

4 side effects of Tamoxifen

Back 67

VTE, endometrial cancer, hot flushes, cataracts.

Front 68

warfarin reversal for life-threatening bleeding (2)

Back 68

-Vitamin K: 10 mg IV over 1 hour, plus prothrombin complex concentrate (PCC)

Front 69

what is prothrombin complex concentrate (PCC)?

Back 69

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

Front 70

associated with increased RDW

Back 70

iron, folate, or vitamin B12 deficienty

Front 71

treatment of head and neck cancer in general

Back 71

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 72

When is iron chelation indicated in beta thalassemia?

Back 72

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

Front 73

What are bite cells?

Back 73

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

Front 74

Differentiate warm autoimmune hemolytic anemia from cold agglutinin disease:

Back 74

Direct Coombs (antiglobulin) test is frequently strongly positive for IgG and negative or weakly positive for complement in warm.

Front 75

Diagnostic test to establish proxysmal nocturnal hemoglobinuria (PNH):

Back 75

Cytometric analysis for CD55 and CD59

Front 76

how to prevent DVT in pregnant?

Back 76

LMWH

Front 77

how to prevent DVT in pregnant with APAS?

Back 77

LMWH or unfractionated heparin + ASA

Front 78

Rare neuromuscular junction transmission disorder caused by antibodies directed against presynaptic voltage-gated P/Q-type calcium channels

Back 78

Lambert-Eaton myasthenic syndrome

Front 79

how to diagnose Lambert-Eaton myasthenic syndrome

Back 79

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

Front 80

differentiate cobalamin (b12) from folate deficiency

Back 80

cobalamin deficiency presents with neuro symptoms + elevated methylmolonic acid and homocysteine; folate does not have neuro symptoms.

Front 81

Describe findings in smear of myelodysplastic syndrom:

Back 81

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

Front 82

What is the treatment for acquired hemophilia with severe bleeding:

Back 82

rFVIIa

Front 83

Treatment for DIC with severe bleeding:

Back 83

FFP and cyropercipitate

Front 84

What is the pathophysiology of transfusion related acute lung injury?

Back 84

Caused by anti-leukocyte 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 85

Likely etiology of acute hemolytic transfusion reaction:

Back 85

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

Front 86

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

Back 86

-Physical exam + CEA q 3-6m

-CT of chest, abd, pelvis q1year for 3-5years;

-Colonoscopy 1y after resection then q3-5years

Front 87

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

Back 87

Acute management of stroke and acute chest syndrome.

Front 88

What are the most common forms of cutaneous T-cell non-Hodgkin lymphoma:

Back 88

-Mycosis fungoides (affects skin)

-Sézary syndrome (affects skin and blood)

Front 89

Treatment for progressing mycosis fungoides/Sézary syndrome.

Back 89

alemtuzumab (anti-CD52)

Front 90

What is the Mentzer index?

Back 90

MCV/RBC; <13 = β-thalassemia.

Front 91

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

Back 91

BCG immunotherapy (intravesicular)