AGACNP ANCC Boards- Heme-onc Questions and Answers

AGACNP ANCC Boards- Heme-onc Questions and Answers MCV (mean corpuscular volume) normal is 80-100 MCHC (mean corpuscular hemoglobin concentration) "chromic" "chromic" = color normal is 32-36% Iron Deficiency Anemia microcytic, hypochromic Irone Deficiency Anemia Causes *most common cause of anemia (except in elderly) caused by blood loss (female bleed, GI bleed, etc), inadequate iron intake, impaired absoprtion of iron Iron Deficiency Anemia Diagnostics Low serum iron low serum ferritin (iron stores) high TIBC (binding capacity) (450) high RDW (red cell distribution width) ** low MCV low MCHC (hypochromic) low Hgb low RBC low Hct Iron Def Anemia s/s PICA- unusual food craving such as ice, clay etc dyspnea and mild fatigue w exercise headache weakness palpitations Which lab value is expected in iron deficiency anemia? Elevated MCHC Elevated TIBC Elevated MCV None of the above elevated TIBC Thalassemia genetically inherited disorder resulting in abnormal Hgb production and microcytic, hypochromic anemia incidence in meditteranean, african american, middle easter, indian and asian populations Thalassemia labs Normal TIBC Normal Ferritin Low MCV Low MCHC Decrease Hgb Decrease alpha or beta Hgb chains thalassemia minor heterozygous for beta thalessemia thalassemia major homozygous for beta thalassemia Thalassemia Management -no tx for mild to moderate forms -RBC transfusion/splenectomy for severe form -iron is contraindicated Your patient is a 30 Greek F with microcytic anemia who has just returned from the middle east. What lab is not expected in her anemia? Low serum ferritin (15) Low Hgb TIBC 300 MCHC 32% low serum ferritin Folic Acid Deficiency macrocytic normochromic -tea and toast diet, alcoholic sx: fatigue, DOE, pallor, headache, GLOSSITIS* **no neuro sx (differentiates it from B12 def) Pernicious Anemia macrocytic normochromic -malabsorption of B12 due to deficiency of intrinsic factor pernicious anemia sx + neuro findings weakness, glossitis, palpitations + Babinski sign (toes fan up/out) pernicious anemia tx cyanocobalamin (vitamin B12) 100mcg IM x 1 week then maintenance treatment which is lifelong* Alcoholics and anemia folic acid deficiency anemia of chronic disease normochromic (32-36%), normocytic (mcv 80-100) the most common in-hospital anemia AND most common in the elderly population -tx is NOT to give iron but to treat the underlying cause anemia of chronic dz labs MCV is normal MCHC is normal serum iron is LOW TIBC is LOW Ferritin is HIGH (100) Which of the following is not associated with anemia of chronic disease? HIV COPD SLE ulcerative colitis? COPD AML -80% of acute leukemia in adults -hx of exposure to benzene, radiation, chemo -remission rates from 50 to 85% ALL -pancytopenia with circulating blasts -more common in children -bone pain, fever, infections -bone marrow with 20% blasts plus markers TDT and cALLa -CNS prophylaxis with ARA-C CLL **most common leukemia in adults WBC 60 absolute lymphocyte count 50 median surivival is 10 years CML Philadelphia chromosome (t922 and BCR-ADL also seen) differential w PMNs occurs most often in persons aged 40 or older generalized lympadenopathy + weight loss think leukemia Test to confirm diagnosis of leukemia bone marrow aspiration Tumor Lysis Syndrome Chemotherapy can cause massive destruction of cells leading the creation of uric acid which can be toxic to the kidneys leading to Acute Tubular Necrosis. You can try to prevent this with hydration and allopurinol. TLS Labs hyperuricemia hyperkalemia hyperphophatemia hypocalcemia Lymphoma Staging I = 1 node group II = 2 groups, same side of diaphragm III = both sides of diaphragm, extension into organ(spleen) IV = BM or liver any lymph node 1cm lasting 4-6 weeks not associated w infection, next step biopsy Non-Hodgkin's Lymphoma cause unkown, viral? most common neoplasm ages 20-40 y/o less predictable of a spread than Hodgkins dz Hodgkins Lymphoma Reed-Sternberg cells usually presents with cervical adenopathy and spreads in a predictable fashion along lymph node groups most common in men average age is 32 Lymphoma present in R axilla and R neck. What stage? Stage II 32 yo presents with c/o fever, night sweats and unexplained wt loss. Upon exam you note a swollen cervical lymph node. A subsequent CXR reveals mediastinal adenopathy. Which of the following is the dx? Hodgkins Lymphoma What does allopurinol prevent in Non-Hodgkin Lymphoma? a. Gout b. hypokalemia c. nausea and vomiting d. tumor lysis syndrome D- TLS How to differentiate SLE from ITP? bone marrow aspiration Tx for ITP high dose corticosteroids IV gamma globulin pereferred to steroids in HIV patient What is the DIC confirmatory test? increase in FDPs (45) (gives a predictive accuracy of 96%) thrombocytopenia PLTs 50k DIC Labs thrombocytopenia (PLTS 50k) fibrinogen 170 mg/dL decrease RBCs incresse FDPs prolonged PT (19 seconds) prolonged PTT (42 seconds) + Ddimer FFP replace clotting factors cryoprecipitate to maintain fibrinogen level What race is at highest risk for cancer african american male (as per cdc website)