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[h] Hematology & Oncology System Flashcards

[i] Master this session in just 5 minutes.

[q] What is the most likely diagnosis?

32 years old male presenting with vertebrae (Back pain), hypercalcemia with increased susceptibility to infections + x-ray shows: o Lytic, ‘punched-out’ in the vertebrae + Serum protein electrophoresis (SPEP) shows Monoclonal M protein spike of IgG + peripheral blood smear shows Rouleaux formation of RBCs + dipstick of urinalysis shows Proteinuria.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==

Cg==

[Qq]

[f]IE11bHRpcGxlIG15ZWxvbWEu

Cg==

Cg==

JiM4MjExOyBUaGluayBDUkFCOg==
[Qq] HyperCalcemia.
Renal involvement.
Anemia.
Bone lytic lesions/Back pain.

[q] ……. is a patient with increased serum protein with M spike on SPEP; but other features of multiple myeloma are absent (no lytic bone lesions, hypercalcemia, AL amyloid, or Bence jones proteinuria).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE1vbm9jbG9uYWwgZ2FtbW9wYXRoeSBvZiB1bmRldGVybWluZWQgc2lnbmlmaWNhbmNlIChNR1VTKS4=[Qq]

[q] What is the most likely diagnosis?

43 years old male with painless generalized lymphadenopathy with Visual and neurologic deficits, Serum protein electrophoresis (SPEP) shows Monoclonal M protein spike of IgM.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFdhbGRlbnN0b3JtIG1hY3JvZ2xvYnVsaW5lbWlhLg==[Qq]

[q] What is the most likely diagnosis?

5 years old child presenting with lytic bone lesions in his skull and skin rash + Histology shows Cells that express S-100 (mesodermal origin) and CD1a, Birbeck granules (“tennis rackets” or rod shaped on EM).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IExhbmdlcmhhbnMgY2VsbCBoaXN0aW9jeXRvc2lzLg==[Qq]

[q] What is the most likely diagnosis?

9 years old child presenting with fever, pancytopenia, hepatosplenomegaly, ↑↑↑ serum ferritin levels + Bone marrow biopsy shows macrophages phagocytosing marrow elements.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEhlbW9waGFnb2N5dGljIGx5bXBob2hpc3Rpb2N5dG9zaXMuIFN5c3RlbWljIG92ZXJhY3RpdmF0aW9uIG9mIG1hY3JvcGhhZ2VzIGFuZCBjeXRvdG94aWMgVCBjZWxscyDihpIgZmV2ZXIsIHBhbmN5dG9wZW5pYSwgaGVwYXRvc3BsZW5vbWVnYWx5LCDihpHihpHihpEgc2VydW0gZmVycml0aW4gbGV2ZWxzLg==[Qq]

[q] What is the most likely diagnosis?

59 years old patient presenting with abnormal venous dilation of his legs, skin discoloration, lipodermatosclerosis, skin ulceration on the medial aspect of the lower leg, and pain, swelling that is typically worse in the evening or following prolonged standing and improves after walking or leg elevation.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENocm9uaWMgdmVub3VzIGluc3VmZmljaWVuY3kgKENWSSku[Qq]

[q] Chronic venous insufficiency is most commonly caused by ……  leading to venous hypertension in the deep venous system of the legs.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGluY29tcGV0ZW5jZSBvZiB2ZW5vdXMgdmFsdmVzLg==[Qq]

[q] Patients who receive the equivalent of more than one body blood volume (5-6 liters) of whole blood transfusions or packed red blood cells over a period of 24 hours may develop paresthesias due to hypocalcemia, why?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENpdHJhdGUgY2hlbGF0ZXMgY2FsY2l1bSBhbmQgbWFnbmVzaXVtIGFuZCBtYXkgcmVkdWNlIHRoZWlyIHBsYXNtYSBsZXZlbHMsIGNhdXNpbmcgcGFyZXN0aGVzaWFzIGR1ZSB0byBoeXBvY2FsY2VtaWEu[Qq]

[q] …… inhibits epoxide reductase which interferes with γ-carboxylation of vitamin K-dependent clotting factors II, VII, IX, and X, and proteins C and S.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFdhcmZhcmluLg==[Qq]

[q] – The target INR for therapeutic warfarin anticoagulation is ….

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IDItMy4=[Qq]

[q] What is the most likely diagnosis?

45 years old patient on warfarin as anticoagulant for treatment of DVT presenting with intracranial hemorrhage, he was using omeprazole for treatment of GERD for along time.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IERydWctZHJ1ZyBpbnRlcmFjdGlvbiBiZXR3ZWVuIHdhcmZhcmluIGFuZCBvbWVwcmF6b2xlIChDWVAgNDUwIGluaGliaXRvciku

Cg==

Cg==[Qq]

 

[q] For reversal of warfarin, we give ……..

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHZpdGFtaW4gSyBhbmQgRm9yIHJhcGlkIHJldmVyc2FsLCB3ZSBnaXZlIGZyZXNoIGZyb3plbiBwbGFzbWEgdW50aWwgdml0YW1pbiBrIHN0YXJ0IHRvIHdvcmtzLg==[Qq]

[q] ……. enhances the activity of antithrombin → Lowers the activity of thrombin and factor Xa.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEhlcGFyaW4u[Qq]

[q] …….. has equal activity against Factor Xa and thrombin, while ….. has greater activity against Factor Xa than thrombin.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFVuZnJhY3Rpb25hdGVkIGhlcGFyaW4sIExNV0gu

Cg==

Cg==

JiM4MjExOyBPbmx5IHVuZnJhY3Rpb25hdGVkIGhlcGFyaW4gKG5vdCBMTVdIKSBoYXMgYSBwZW50YXNhY2NoYXJpZGUgY2hhaW4gbG9uZyBlbm91Z2ggKCZndDsxOCBzYWNjaGFyaWRlIHVuaXRzKSB0byBiaW5kIHRvIGJvdGggYW50aXRocm9tYmluIGFuZCB0aHJvbWJpbi4gQXMgYSByZXN1bHQsIHVuZnJhY3Rpb25hdGVkIGhlcGFyaW4gaGFzIGVxdWFsIGFjdGl2aXR5IGFnYWluc3QgRmFjdG9yIFhhIGFuZCB0aHJvbWJpbiwgd2hpbGUgTE1XSCBoYXMgZ3JlYXRlciBhY3Rpdml0eSBhZ2FpbnN0IEZhY3RvciBYYSB0aGFuIHRocm9tYmluLg==

[Qq]

[q] What is the most likely diagnosis?

Patient who was on heparin as anticoagulant for long time present with thrombosis although low platelet count?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEhlcGFyaW4taW5kdWNlZCB0aHJvbWJvY3l0b3BlbmlhIChISVQpLg==

Cg==

RGV2ZWxvcG1lbnQgb2YgSWdHIGFudGlib2RpZXMgYWdhaW5zdCBoZXBhcmluLWJvdW5kIHBsYXRlbGV0IGZhY3RvciA0IChQRjQpLiBBbnRpYm9keS1oZXBhcmluLVBGNCBjb21wbGV4IGFjdGl2YXRlcyBwbGF0ZWxldHMgJiM4MjExOyZndDsgdGhyb21ib3NpcyBhbmQgdGhyb21ib2N5dG9wZW5pYS4=

Cg==

[Qq]

[q] Antidote of heparin is ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFByb3RhbWluZSBzdWxmYXRlIGlzIGEgcGVwdGlkZSB0aGF0IGJpbmRzIHRvIGhlcGFyaW4gZm9ybWluZyBhIGNvbXBsZXggdGhhdCBoYXMgbm8gYW50aWNvYWd1bGFudCBhY3Rpdml0eSAoY2hlbWljYWwgaW5hY3RpdmF0aW9uKS4=

Cg==

Cg==[Qq]

[q] ….. is a form of low molecular weight heparin that, like heparin, functions by binding and activating antithrombin III.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEVub3hhcGFyaW4sIGRhbHRlcGFyaW4u[Qq]

[q] Low molecular weight heparin is more widely used than unfractionated heparin. Why?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]

Cg==

TE1XSCBoYXZlIGJldHRlciBiaW9hdmFpbGFiaWxpdHksIGFuZCAyLTQgdGltZXMgbG9uZ2VyIGhhbGYtbGlmZTsgY2FuIGJlIGFkbWluaXN0ZXJlZCBzdWJjdXRhbmVvdXNseSBhbmQgd2l0aG91dCBsYWJvcmF0b3J5IG1vbml0b3Jpbmcu

Cg==

74KnIE9jY3VycmVuY2Ugb2YgaGVwYXJpbi0gaW5kdWNlZCB0aHJvbWJvY3l0b3BlbmlhIChISVQpIGlzIG11Y2ggbW9yZSBjb21tb24gd2l0aCB0aGUgdXNlIG9mIHVuZnJhY3Rpb25hdGVkIGhlcGFyaW4gY29tcGFyZWQgdG8gbG93IG1vbGVjdWxhciB3ZWlnaHQgaGVwYXJpbi4=

[Qq]

Enoxaparin has been shown to cause a statistically significant reduction in death and recurrent myocardial infarction when used in the acute treatment of myocardial infarction as compared with unfractionated heparin (ESSENCE, TIMM 1 trials).

[q] Upon clinical suspicion of HIT, the most important initial step in treatment is to stop ……. and give ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IHN0b3AgYWxsIGZvcm1zIG9mIGhlcGFyaW4sIERpcmVjdCB0aHJvbWJpbiBpbmhpYml0b3JzIChoaXJ1ZGluLCBsZXBpcnVkaW4gYW5kIGFyZ2F0cm9iYW4sIGRhYmlnYXRyYW4pIGRvIG5vdCByZXF1aXJlIGFudGl0aHJvbWJpbi1sbGwgZm9yIHRoZWlyIGFjdGlvbiBhbmQgYXJlIGRydWdzIG9mIGNob2ljZSBpbiB0aGUgdHJlYXRtZW50IG9mIEhJVC4=[Qq]

[q] The mainstay of DVT treatment in pregnancy is ….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGhlcGFyaW4gKENvdW1hZGluIGlzIG5vdCB1c2VkIGJlY2F1c2UgaXQgaXMgdGVyYXRvZ2VuaWMpLg==[Qq]

[q] …… directly or indirectly aid conversion of plasminogen to plasmin, which cleaves thrombin and fibrin clots. ↑ PT, ↑ PTT, no change in platelet count.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFRocm9tYm9seXRpY3MgKEFsdGVwbGFzZSAodFBBKSwgcmV0ZXBsYXNlIChyUEEpLCB0ZW5lY3RlcGxhc2UgKFROSy10UEEpLCBzdHJlcHRva2luYXNlKS4=[Qq]

[q] We treat Thrombolytics toxicity with ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IGFtaW5vY2Fwcm9pYyBhY2lkIGFuZCB0cmFuZXhlbWljIGFjaWQgKGFudGktZmlicmlub2x5dGljcyku

Cg==

Cg==[Qq]

[q] ….. inhibit platelet aggregation by blocking P2Y12 receptors → Prevent expression of glycoproteins IIb/IIIa on platelet surface?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEFEUCByZWNlcHRvciBpbmhpYml0b3JzLiBDbG9waWRvZ3JlbCwgcHJhc3VncmVsLCB0aWNhZ3JlbG9yIChyZXZlcnNpYmxlKSwgdGljbG9waWRpbmUgKGlycmV2ZXJzaWJsZSku[Qq]

[q] In patients with an aspirin allergy, aspirin can cause bronchoconstriction with shortness of breath and wheezing. In such patients, the best alternative antiplatelet agent is ……?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENsb3BpZG9ncmVsLg==[Qq]

[q] – Ticlopidine is rarely used due to the occurrence of serious side effects. ……. is seen in about 1 percent of patients on ticlopidine and typically presents with fever and mouth ulcers

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE5ldXRyb3BlbmlhLiBUaG91Z2ggdGhpcyBpcyByYXJlLCBpdCBpcyBhIHNlcmlvdXMgY29tcGxpY2F0aW9uIGFuZCBjb21wbGV0ZSBibG9vZCBjb3VudCBzaG91bGQgYmUgbW9uaXRvcmVkIGJpd2Vla2x5IGZvciB0aGUgZmlyc3QgdGhyZWUgbW9udGhzLg==[Qq]

[q] ……. bind to the glycoprotein receptor IIb/IIIa (fibrinogen receptor) on activated platelets, preventing aggregation.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEdseWNvcHJvdGVpbiBJSWIvSUlJYSBpbmhpYml0b3JzIChBYmNpeGltYWIsIGVwdGlmaWJhdGlkZSwgdGlyb2ZpYmFuKS4=[Qq]

[q] …….. is a Phosphodiesterase III inhibitor → ↑ cAMP in platelets → resulting in inhibition of platelet aggregation; vasodilators.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENpbG9zdGF6b2wsIGRpcHlyaWRhbW9sZS4=[Qq]

[q] ……. is a folic acid analog that competitively inhibits dihydrofolate reductase –> ↓ dTMP –> ↓ DNA synthesis.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE1ldGhvdHJleGF0ZS4=

Cg==

Cg==[Qq]

[q] What is the chemotherapeutic drug that cause these side effects?

– Myelosuppression, which is reversible with leucovorin “rescue”.

– Toxic to 2L (Lung, Liver) → Pulmonary fibrosis, Hepatotoxicity.

– Mucositis (mouth ulcers).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE1ldGhvdHJleGF0ZS4=[Qq]

[q] Pyrimidine analog bioactivated to 5-FdUMP, which covalently complexes folic acid. This complex inhibits thymidylate synthase –> ↓ dTMP –> ↓ DNA synthesis.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEZsdW9yb3VyYWNpbC4=

Cg==

Cg==[Qq]

[q] What is the chemotherapeutic drug that cause these side effects?

Myelosuppression, worsened with the addition of leucovorin (folinic acid).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IDUtZmx1b3JvdXJhY2lsLg==[Qq]

[q] …… is a Purine (thiol) analogs —> ↓ de novo purine synthesis. Activated by HGPRT.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEF6YXRoaW9wcmluZSwgNi1tZXJjYXB0b3B1cmluZS4=

Cg==

Cg==[Qq]

[q] …….. is the drug of choice for hairy cell leukemia.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENsYWRyaWJpbmUu[Qq]

[q] …… is an alkylating agent that cause pulmonary fibrosis as a side effect.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFB1bG1vbmFyeSBmaWJyb3Npcy4=

Cg==

Cg==[Qq]

[q] …… is an alkylating agent that cause hemorrhagic cystitis as a side effect that can prevented with …… or …….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEN5Y2xvcGhvc3BoYW1pZGUsIHByZXZlbnRlZCB3aXRoIG1lc25hICh0aGlvbCBncm91cCBvZiBtZXNuYSBiaW5kcyB0b3hpYyBtZXRhYm9saXRlcykgb3IgTi1hY2V0eWxjeXN0ZWluZS4=

Cg==

Cg==[Qq]

[q] …… is an alkylating agent that can Cross blood-brain barrier –>  CNS + used in Brain tumors (including glioblastoma multiforme) + and cause CNS toxicity (convulsions, dizziness, ataxia) as a side effect?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IE5pdHJvc291cmVhcyAoQ2FybXVzdGluZSwgbG9tdXN0aW5lLCBzZW11c3RpbmUsIHN0cmVwdG96b2Npbiku[Qq]

[q] ……. is a chemotherapeutic drug that induces free radical formation —> breaks in DNA strands and cause pulmonary fibrosis as a side effect.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEJsZW9teWNpbi4=

Cg==

Cg==[Qq]

[q] …….. is a chemotherapeutic drug that causes Cardiotoxicity (dilated cardiomyopathy) as a side effect.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IERveG9ydWJpY2luLg==

Cg==

Cg==[Qq]

[q] The most effective method of preventing doxorubicin cardiomyopathy is ……..?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IERleHJhem94YW5lLiBJdCBpcyBhbiBpcm9uLWNoZWxhdGluZyBhZ2VudCB0aGF0IGRlY3JlYXNlcyBmb3JtYXRpb24gb2Ygb3h5Z2VuIGZyZWUgcmFkaWNhbHMgYnkgZG94b3J1YmljaW4gYW5kIG90aGVyIGFudGhyYWN5Y2xpbmVzLg==[Qq]

[q] ……. is a microtubule inhibitors that bind β-tubulin and inhibit its polymerization into microtubules —> prevent mitotic spindle formation (M-phase arrest)?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFZpbmNyaXN0aW5lLCB2aW5ibGFzdGluZS4=[Qq]

[q] …….. is a vinca alkaloid that causes neurotoxicity (areflexia, peripheral neuritis).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFZpbmNyaXN0aW5lLg==

Cg==

Cg==[Qq]

[q] ….. is a microtubule inhibitors that hyperstabilize polymerized microtubules in M phase so that mitotic spindle cannot break down (anaphase cannot occur).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFBhY2xpdGF4ZWwu[Qq]

[q] …… is a platinum-containing compound that cause – Nephrotoxicity as a side effect that can prevented with …… and …….?

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENpc3BsYXRpbi4gUHJldmVudCBuZXBocm90b3hpY2l0eSB3aXRoIGFtaWZvc3RpbmUgKGZyZWUgcmFkaWNhbCBzY2F2ZW5nZXIpIGFuZCBjaGxvcmlkZSAoc2FsaW5lKSBkaXVyZXNpcy4=

Cg==

Cg==[Qq]

[q] ……. is a chemotherapeutic drug that inhibits topoisomerase II.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEV0b3Bvc2lkZS4=[Qq]

[q] ……. is a chemotherapeutic drug that – Inhibits ribonucleotide reductase →↓ DNA Synthesis (S-phase specific) and (↑ HbF).

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEh5ZHJveHl1cmVhLg==[Qq]

[q] …… is a Monoclonal antibody against VEGF.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEJlVmFjaXp1bWFiLiAoQmVWYWNpenVtYWIgaW5oaWJpdHMgQmxvb2QgVmVzc2VsKS4=[Qq]

[q] ……. is a monoclonal antibody against EGFR.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IENldHV4aW1hYi4=[Qq]

[q] ……. is a EGFR tyrosine kinase inhibitor.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IEVybG90aW5pYi4=[Qq]

[q] ……. is a tyrosine kinase inhibitor of BCR-ABL (Philadelphia chromosome fusion gene in CML) and c-kit (common in GI stromal tumors).

[c]IFNob3fCoCBtZS B0aGUgYW5zd2Vy[Qq]

[f]IEltYXRpbmliLg==[Qq]

[q]  …….. is a monoclonal antibody against CD20, which is found on most B-cell neoplasms.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFJpdHV4aW1hYi4=[Qq]

[q] ….. is a small molecule inhibitor of BRAF oncogene ⊕ melanoma.

[c]IFNob3cgbWUgdG hlIGFuc3dlcg==[Qq]

[f]IFZlbXVyYWZlbmliLg==[Qq]

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