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米国にて内科修行中。何ができるか模索している過程を記録していく

Hematology and Oncology (memo from NEJM knowledge plus and MKSAP)

・target platelet count in the setting of intracranial hemorrhage

100,000,  transfusion as needed

 

・management of superior vena cava syndrome secondary to small cell lung cancer

chemotherapy

 

・diagnosis of polycythemia vera

elevated Hb, JAK2 mutation, no secondary cause of erythrocytosis

 

・diagnosis of patient without bleeding history who has normal PT and elevated aPTT failing to fully correct on mixing study

acquired hemophilia (acquired antibody to factor VIII)

 

・Tx for acquired homophilia (acquired factor VIII inhibitor)

recombinant activated factor VIIa (bypass the need for factor VIII)

 

・hemophilia

A: factor VIII deficiency, B: factor IX deficiency

normal PT, elevated aPTT, fully corrected by mixing study

 

・breast cancer screening for 29 yo female with PMH of lymphoma status post mantle radiation

mammography and MRI yearly 

 

・Tx indication for primary myelofibrosis

high risk feature:  > 65 yo, fever, night sweat, weight loss > 10%,  Hb < 10, WBC > 25000, circulating blast > 1%

 

・factor V Leiden

itself is not indicated for life-long anticoagulation (risk: 5-fold for initial VTE, 1.5-fold for recurrent VTE)

 

・elevation in both homocysteine and methylmalonic acid

vit B12 deficiency (only homocysteine elevated in folate deficiency)

 

・diagnosis of symptomatic multiple myeloma

require organ damage (kidney dysfunction, hypercalcemia, anemia or bone disease)-> Tx

asymptomatic MM -> observation 

 

・Dx of recurrent bacterial infection with vitiligo and pernicious anemia

common variable immunodeficiency 

 

・above what percent of clonal plasma cell on bone marrow biopsy to diagnose multiple myeloma

10%

 

・follow-up patient with stage IIIC ovarian cancer status post chemotherapy

CA125 every 4 months

 

・management of non-small cell lung cancer with pleural effesion 

chemotherapy (no radiation)

 

・Tx for persistent hypoxia in acute chest syndrome due to sickle cell disease

transfusion 

 

 ・symptoms of sickle cell trait

hematuria due to renal papillary necrosis

(chest pain, SOB, joint pain: not increase frequency in sickle cell trait)

 

・pregnant female with h/o idiopathic venous thromboembolism

require antepartum and postpartum heparin prophylaxis

 

・mild anemia, microcytosis, target cell, normal hemoglobin electrophoresis

alfa thalassemia trait

 

・Tx for acute lymphoblastic leukemia

induction chemotherapy

 

・gestational thrombocytopenia

benign clinical course, usually no intervention

 

・Tx for secondary iron overload

iron chelation (deferasirox)

 

・hemolytic episode after using trimethoprim-sulfamethoxazole

glucose-6-phosphate dehydrogenase deficiency 

 

・diagnosis of paroxysmal nocturnal hemoglobinuria

flow cytometric analysis for CD55 and CD59

 

・cause of pure red cell aplasia

large granular lymphocytosis, parvo B19, thymoma, myelodyplasia

 

・acute kidney injury in multiple myeloma

vulnerable to NSAIDs and intravenous contrast dye

 

・hydroxyurea for sickle cell anemia

cause macrocytosis

 

・rapid reversal of warfarin

vitamin K iv and prothrombin complex concentrate

 

・incidentally found several pulmonary nodules 2-4 mm with smoking history

follow up CT in 12 months (< 4mm with risk factor -> f/u 12mo)

 

・Gleason score in prostate cancer

6: lowest score of cancer,  8-10: poorly differentiated

 

・breast cancer Tx

tamoxifen to hormone receptor positive, increase risk of VTE -> ovarian ablation if h/o VTE

aromatase inhibitor to hormone receptor positive cancer in postmenopausal pt

trastuzumab to HER2 positive

 

・management of lobular carcinoma in situ in premenopausal female after excisional biopsy

tamoxifen (LCIS nealy always estrogen receptor positive)

 

・adverse effect of bevacizumab

HTN, bleeding, thrombose, intestinal perforation

 

・multiple lymphadenopathy, splenomegaly, bone marrow show cyclin D1 and t(11:14) translocation

Mantle cell lymphoma

 

・management of cancer of unknown primary site with axillay lymphadenopathy, negative mammography and MRI

mastectomy with axillary lymph dissection (treat as stage II breast cacner)

 

 ・management of prostate cancer with Gleason score of 8 and PSA of 22

androgen deprivation therapy and radiation (for high risk group: Gleason: 8-10, PSA > 20, sugery not indicated)

 

・management of asymptomatic well-differentiated metastatic carcinoid tumor

observation, f/u CT in 3-4 months

 

・empiric Tx for cancer of unknown primary site, retroperitoneal node Bx reveal pooly differentiated carcinoma in young man

cisplatin-based chemotherapy 

 

・next step for incidentally found kidney mass by non-contrast CT

ultrasound to evaluate whether the mass is cyst or solid

 

・initial mangement of SVC syndrome

mediastinoscopy and biopsy (Tx differ based on histology)

 

・management of well-differentiated invasive ductal cancer, mass: 2cm, no palpable lymphadenopathy

lumpectomy, sentinel lymph node biopsy, radiation

 

・Tx of anal cancer

radiation Tx with chemotherapy for stage I,II,III (potentially cured without surgery)

 

・testicular mass with elevated beta-hCG and AFP

nonseminoma germ cell tumor

(elevated AFP rule out seminoma, beta-hCG elevated in both seminoma and nonseminoma)

 

・management of recurrent diffuse large B-cell lymphoma

high-dose chemotherapy and autologous hematopoietic stem cell transplantation

 

 ・management of hot flush secondary to tamoxifen Tx for breast cancer patient

venlafaxine (SNRI)

 

・management for patient who present with seizure secondary to isolated brain metastasis from melanoma

surgical resection for symptomatic relief

 

 ・next step following surgery for high-risk, early stage bladder cancer

intravesicular BCG (bacillus Callmette-Guerin) immunotherapy

 

・management of tumor lysis syndrome

aggressive hydartion and diuresis, (hemodialysis), rasburicase, allopurinol

 

・management of oligometastatic colorectal cancer isolated to liver

partial hepatectomy

 

・management of bone metastasis likely from recurrent breast cancer

bone biopsy (assess hormone receptor and others to guide Tx)

 

・postoperative surveillance colorectal cancer

physical exam, CEA every 3-6 months, colonoscopy 1 year after, then every 3-5 years, chest/abdomen/pelvic CT annually for 3 years

 

・stage I rectal cancer (cancer penetrate into, but not fully through rectal wall with no lymph node metastases)

surgery (no chemotherapy after surgery)