Anemia/Thrombocytopenia
MDS/Solid Tumors
Leukemia/Lymphomas
Cancer Screening
H/O Potpourri
100
These are the 4 variables accounted for in the "4T Score" when HIT is being considered.
What are: 1) Degree of Thrombocytopenia, 2) Timing of onset, evidence of Thrombosis or other sequelae, and 4) likelihood of other causes for Thrombocytopenia
100
Name three tumor types that classically spread to the bone.
What are lung, breast, prostate, Myeloma, renal and bladder?
100
This physical exam finding is the most common sign of lymphoma.
What is lymphadenopathy?
100
Lung cancer is recommended for patients aged ____ with a ____ pack year smoking history and should be discontinued in patients who have not smoked for ____ years.
Lung cancer is recommended for patients aged 50-80 years with a 20 pack year smoking history and should be discontinued in patients who have not smoked for 15 years.
100
These are the platelet transfusion thresholds for the following conditions:
1) No active bleeding (prevent spontaneous bleeds)
2) Fever/sepsis, DIC, chemotherapy-induced thrombocytopenia
3) Active bleeding or planned surgery
4) Neurosurgery or intracranial bleeding
What is:
1) No active bleeding (prevent spontaneous bleeds): <10,000
2) Fever/sepsis, DIC, chemotherapy-induced thrombocytopenia: <20,000
3) Active bleeding or planned surgery: <50,000
4) Neurosurgery or intracranial bleeding: <100,000
200
A 41yo F with unremarkable PMHx presents with concerns for intermittent fever, easy bruising, and bleeding from the gums when brushing her teeth over the last few weeks. Workup in ED notable for Plt 22, MCV 82, INR 1.1, Cr 1.3. Retics 4.5%, haptoglobin undetectable, indirect bili 3.4. Plasmic score of 7.
This is the first-line treatment while awaiting further confirmatory/clarifying laboratory analysis.
What is therapeutic plasma exchange (PLEX) +/- glucocorticoids to decrease autoantibody production.
PLEX to remove the high-molecular-weight vWF multimers and replace the deficient ADAMTS13 (plasma infusion, although not a definitive treatment, can be started if PLEX is delayed)
200
Name 2 treatment/management options for JAK2-positive primary polycythemia vera.
What are:
- Therapeutic phlebotomy to hematocrit level <45%
- Low-dose aspirin for all patients unless strong contraindications exist
- Hydroxyurea or interferon-α for patients at highest risk for thrombosis (age >60 years; history of MI, CVA, VTE)
200
This genetic transformation is classically seen with Chronic Myeloid Leukemia.
What is (9:22) translocation, or the Philadelphia Chromosome?
200
Per ACS recommendations, cervical cancer screening for females older than 25 years can be either HPV testing along every __ years, HPV testing with cytology (PAP smear) every __ years, or cytology alone every __ years.
Per ACS recommendations, cervical cancer screening for females older than 25 years can be either HPV testing along every 5 years, HPV testing with cytology (PAP smear) every 5 years, or cytology alone every 3 years.
200
This Greek physician described tumors with spreading, "crab-like" veins leading to the crab symbol used to symbolize cancer today.
Who is Hippocrates?
300
When differentiating between iron deficiency anemia and anemia of inflammation/chronic disease, the levels of serum iron, ferritin, TIBC, and transferrin saturation can be helpful.
Provide levels (high/low/normal) of serum iron, ferritin, TIBC, and transferrin saturation for BOTH iron deficiency anemia and anemia of chronic disease.
300
Name the SLIM-CRAB criteria for signs and symptoms of multiple myeloma.
What are >60% clonal plasma cells on bone marrow examination (Sixty), serum FLC ratio >100c (Light chains), > 1 focal lesion on MRI (MRI), Serum Calcium > 11 or > 1 higher than than the upper level limit of normal (HyperCalcemia), Serum Creatinine >2 (Renal Failure), Hgb <10 (Anemia), >1 lytic bone lesions on imaging studies (Bone disease)?
300
This disease process classically responds well to All-Trans Retinoic Acid (ATRA).
What is Acute Promyelocytic Leukemia (APML)?
300
For females with a suspicious mass on clinical breast exam, ultrasound is preferred as first line imaging over mammography for females under the age of ____.
What is 30 years old?
Due to dense breast tissue. It is also preferred in pregnant patients to reduce radiation exposure.
300
This chemotherapy medication is classically related to delayed onset of pulmonary toxicity and fibrosis.
What is Bleomycin?
400
An 18yo M from Pakistani descent presents to establish cares with a new PCP, initial lab work notable for Hgb 7.6, MCV 61, Plt 334. Iron level WNL, ferritin WNL, retics 2%. Peripheral smear with microcytosis and target cells present. Hgb electrophoresis with decreased HbA, increased HbA2, and increased HbF -- determined to be B-thalassemia intermedia.
This supplementation is encouraged for these patients, while this supplementation is generally avoided.
What is folate supplementation is encouraged for management, while iron supplementation is generally avoided.
Patients with β-thalassemia trait should receive genetic counseling, and folate supplementation may be helpful if they are anemic. As with α-thalassemia, supplemental iron should be avoided -- concern for overload.
400
In the Keynote 407 trial, treatment of metastatic NSCLC with this anti PD-L1 immunotherapy has been shown to reduce mortality regardless of PD-L1 status of the cancer.
What is Pembrolizumab?
For those with low PD-L1 expression Pembrolizumab should be used in combination with platinum-based chemotherapy
400
Approximately 30% of Follicular lymphomas can undergo histologic transformation into this alternative disease.
What is Diffuse Large B-Cell Lymphoma?
Typically very aggressive and have much worse outcomes for patients
400
ACS recommends screening for breast cancer in high risk women (eg those with BRCA, lifetime risk of breast cancer >25%, those who had chest wall radiation as a child) with what test(s) and time interval?
What is annual mammography and breast MRI?
Prophylactic bilateral mastectomy can be considered for those with BRCA mutations. Chemoprophylaxis with SERMs or aromatase inhibitors can be considered with an 5-year risk of breast cancer.
400
In a patient with severe hypercalcemia of malignancy (Ca >14) and acute kidney injury (eGFR < 30), this medication should be used in addition to calcitonin and intravenous fluids.
What is Denosumab?
Bisphosphonates should be avoided when possible in renal dysfunction.
500
In those symptomatic patients with PNH, these (either/or, name one) therapies can be offered to reduce intravascular hemolysis, hemoglobinuria, and the need for transfusion.
What is/are: eculizumab or ravulizumab
500
For a patient who is diagnosed with Stage IIa (or any non-metastatic) colorectal cancer and is successfully treated with surgical resection, what are the recommended post-procedure surveillance intervals and strategies?
CEA levels every 6 months, CT scans of the chest, abdomen and pelvis annually for 5 years, and colonoscopy 1 year post op, then in 3 years, then every 5 years thereafter.
500
These chemotherapy drugs are classically used for induction therapy in Acute Myelocytic Leukemia (AML).
What are anthracyclines and cytarabine?
("7 + 3" -- 7 days Cytarabine + 3 days Anthracycline)
Consolidation therapy consists of conventional chemo for patients at low risk and allogeneic HSCT for patients at high risk.
500
In the context of colorectal cancer screening, what is the recommended screening interval for a patient undergoing the following strageties:
FIT
FIT-DNA
CT Colonography
Flexible Sigmoidoscopy with FIT
FIT: Annual
FIT-DNA: Every 3 years
CT Colonography: Every 5 years
Flexible Sigmoidoscopy with FIT: Sigmoidoscopy every 10 years with FIT Annually
If any are abnormal, proceed with colonoscopy. The alternative strategies also have less evidence and lower demonstrated mortality benefit than colonoscopy
500
For patients with febrile neutropenia who are clinically eligible for outpatient treatment, give 4 of the 6 psychosocial and logistic requirements listed in the ASCO guidelines to qualify patients for outpatient treatment.
1) residence ≤1 hour or ≤30 miles (48 km) from the clinic or hospital, (2) patient's primary care physician or oncologist agrees to outpatient management, (3) ability to comply with logistic requirements, including frequent clinic visits, (4) family member or caregiver at home 24 hours/day, (5) access to a telephone and transportation 24 hours/day, and (6) no history of noncompliance with treatment protocols