1A: Dt 15 - 3

Front 1

WBC differential from highest to lowest.

Back 1

NLMEB
Nphils
Lymphocytes
Monocytes
Ephils
Bhpils

Front 2

Spectrin:
Role

Back 2

Allow for biconcave shape of RBCs

Front 3

What is the source of energy for RBCs?

Back 3

Glucose and only glucose.

Front 4

Anisocytosis vs Poikilocytosis

Back 4

Anisocytosis = varying sizes
Poikilocytosis = varying shapes

Front 5

What are causes of polycythemia?

Back 5

Renal Cell Carcinoma
HCC
Pheochromocytoma
Hemangioblastoma
Chronic hypoxia (COPD, high altitude, obstructive sleep apnea)
Down Syndrome (65% at birth)
Polycythemia vera (excess RBCs despite low EPO)

Front 6

What is the lifespan of platelets?
Where are they stored?

Back 6

PLT lifespan = 8-10 days
Stored in spleen

Front 7

This cell mediates type I hypersensitivity reactions.

Back 7

Mast cells

Front 8

Cromolyn:
MOA
Use

Back 8

Prevents mast cell degeneration; used to tx asthma

Front 9

What are the causes of eosinophilia?

Back 9

D NAAACP
Drugs
Neoplasm
Allargy, Asthma (Churg-Straus)
Addison's (adrenal insuff)
AIN
Collagen vasc dz
Parasites (Loeffler's ephilic pneumonitis due to Ascaris lumbricoides)

Front 10

Type of phagocyte in:
Brain
Liver
Joints

Back 10

Brain-microglia
Liver-Kupffer cell
Joints-A cells

Front 11

B cells:
CD Markers
Role

Back 11

CD19, CD20

When antigen encountered, diff into plasma cells and produce antibodies.
Exhibit memory.
Can function as APC via MHC II

Front 12

What organelle is most prominent in plasma cells?

Why?

Back 12

Plasma cell needs to make a lot of protein which is to be exported (immunoglobulins), therefore, has abundant RER.

Front 13

T lymphocytes:
CD Markers

Back 13

Th: CD3, CD4
Tc: CD3, CD8

Front 14

What clotting factor initiates the extrinsic pathway?

Back 14

VII

Front 15

What clotting factor initiates the intrinsic pathway?

Back 15

XII

Front 16

Which coagulation pathway forms kallikrein and bradykinin?

Back 16

Intrinsic PW (XII)

Front 17

Hemophilia A vs B:
General

Back 17

Hemophilia A: Ate--Eight--deficiency in VIII

Hemophilia B: Benign--Nine--deficiency in IX

Front 18

What is the effect of IV citrate on cogaulation?

Back 18

IV citrate = calcium binder
Calcium is essential to coagulation

Dec'd available Ca2+-->Dec'd coaguln

Front 19

What is the role of antithrombin?
AKA?

Back 19

Antithrombin = Factor IIIa (activated)

Factor III inhibits thrombin (factor IIa), IX, X, XI, XII

Front 20

What is the result of a vitamin K deficiency on coagulation factors?

Back 20

Dec'd synthesis of factors II, VII, IX, X, Protein C, protein S

Front 21

Heparin:
MOA
Use
AE
Antitode

Back 21

Cofactor for activation of antithrombin (IIIa); decreases thrombin, and Xa (short half-life)

Use: Immediate anticaoag for PE, stroke, acute coronary syndrome, MI, DVT

Safe in pregnancy

AE: HIT, osteoporosis

Antidote: Protamine sulfate (positively charged molecule that will bind negatively charged heparin)

Front 22

Enoxaparin:
Drug Class
MOA
Use
AE

Back 22

LMW Heparin; acts more on Xa; better avaoilability and longer half-life

RIsk HIT, not easily reversible

Front 23

Heparin-induced thrombocytopenia:
Pathophys
Tx

Back 23

Heparin binds PLT factor IV-->leads to Ab production-->activates PLTs leading to their clearance and resulting in thrombocytopenic, hypercoag state (it's paradoxical)


Tx: Lepirudin or bivalirudin in addition to warfarin

Front 24

Leiprudin:
MOA
Use

Back 24

Directly inhibit thrombin; used as alternative to heparing for anticoagulating pts with HIT

Front 25

Warfarin:
MOA
Use
Labs to monitor it
AE
Antidote

Back 25

Interferes with synthesis of vitamin K-dependent clotting factors II, VII, IX, X, protein C, protein S (DiSCo started in 1972--10(X),9(IX),7(VII),2(II))

Has effect on extrinsic PW, increasing PT (WEPT); use INR to standardize PT values

AE: TERATOGEN, bleeding

Antidote: IV Vitamin K, fresh frozen plasma

Front 26

What are the effects of bradykinin?

Back 26

Inc'd vasodilation
Inc'd perm
Inc'd pain
Angioedema--swelling from lips to larynx (DANGEROUS)

Front 27

What thrombogenic factors are located inside vascular endothelial cells?

Back 27

vWF
Thromboplastin
tPA
PGl2

Front 28

vWF:
Cells that synthesize it
Functions
Signs of deficiency

Back 28

Made by endothelial cells and megakaryocytes

Fn:
Complexes with and stabilizes Factor VIII (deficiency-->inc'd PTT)
PLT adhesion to vessel wall and to other platelets (deficiency-->Inc'd bleeding time)

Front 29

Describe the steps required to achieve platelet adhesion and aggregation.

Begin with endothelial cell damage.

Back 29

Endothelial cell damage-->Release vWF-->binds exposed collagen

vWF binds GpIb on PLT (adhesion of PLT)

PLT is activated and now secretes ADP, PDGF, thromboxane A2 (vasoconstriction, PLT agg), Calcium (for coag pw), and thrombin (fibrinogen-->fibrin)

Aggregation of PLT via GpIIb/IIIa

Front 30

How exactly does ASA affect the coagulation cascade?

Back 30

Inhibit COX-->dec'd TXA2 synthesis and thus dec'd PLT aggregation

Front 31

What is the effect of clopidogrel on the coagulation cascade?

What other drug has this same effect?

Back 31

Clopidogrel and ticlopidine:
Irreversibly inhibit ADP receptors required to insert GpIIb/IIIa receptor into PLT cell membrane (thus, dec'd agg)

Front 32

What is the effect of abciximab on the coagulation cascade?

Back 32

Abciximab directly inhibit GbIIb/IIIa to dec PLT agg

Front 33

What allows RBCs to change shape as they pass through vessels?

Back 33

Spectrin

Front 34

What are some of the different causes of polycythemia?

Back 34

Excess EPO:
-RCC
-Pheo
-Hemangioblastoma
-Chronix hypoxia (COPD, OSA)

Polycythemia vera
Down Syndrome

Front 35

What coagulation factor is deficient in hemophilia A?

Back 35

VIII

Front 36

What coagulation factor is deficient in hemophilia B?

Back 36

IX

Front 37

What clotting factors require vitamin K for synthesis?

Back 37

X, IX, VII, II
C, S

DiSCo started in 1972

Front 38

What are the treatments for overdose of heparin and warfarin?

Back 38

Heparin--protamine sulfate

Warfarin--FFP, vitamin K

Front 39

What lab value is used to monitor the following medications: heparin, warfarin, enoxaparin?

Back 39

Heparin: PTT
Warfarin: PT/INR
Enoxaparin: Xa

Front 40

What is the treatment for heparin-induced thrombocytopenia?

Back 40

Lepirudin or bivalirudin

Front 41

Schistocyte vs Spherocyte::
Appearance
Cause

Back 41

Schistocyte: helmet cell; seen in DIC, TTP/HUS, traumatic hemolysis

Spherocyte = round; hereditary spherocytosis, autoimmune hemolysis

Front 42

Which RBC form:
Lead poisoning

Back 42

Basophilic stippling

Front 43

Which RBC form:
G6PD deficiency

Back 43

Heinz bodies, bite cells

Front 44

Which RBC form:
DIC

Back 44

Schistocyte (helmet cell)

Front 45

Which RBC form:
Abetalipoproteinemia

Back 45

Acanthocytes (spur cell)--also seen in liver dz (acantho = spiny)

Front 46

Which RBC form:
Asplenia

Back 46

Howell-Jolly BOies

Front 47

Back 47

acanthocyte (spur cell): seen in liver dz, abetalipoproteinemia

Front 48

Back 48

Basophilic stippling--Baste the ox TAIL
Thalassemias
Anemia of chronid dz
Iron def
Lead poisoning

Front 49

Hb C vs Hb S:
Structure

Back 49

Hb C: alpha2-beta2; glu-->lys in beta chain

Hb S: alpha2-beta2: glu-->val in beta chain

Front 50

Hg Bart vs Hb H:
Structure

Back 50

Hg Bart: gamm-4; no alpha chains (severe alpha-thal)

Hb H: beta-4; no alpha chains (severe alpha-thal)

Front 51

Back 51

Target cells--due to increase in SA:V ratio from Fe def anemia (dec'd cell volume) or in obstructive liver dz (inc'd cell membrane)

Front 52

Back 52

Target cell

Front 53

Back 53

Thalassemia major--blood disorder caused by defect in beta-chain synthesis in Hgb. Note presence of target cells.

Front 54

Back 54

Fe def anemia; microcytosis and hypochromia can be seen

Front 55

Back 55

Sickle cell anemia--note sickled cells as well as anisocytosis, poikilocytosis, and nucleated RBCs

Front 56

alpha-thalassemia:
Subtypes

Back 56

–a–aa: silent carrier
– – -aa: alpha-thalasssemia trait
– – - –a: HbH
– – - – –: Hydrops fetalis (Hb Barts)

Front 57

beta-thalasemia:
Subtypes

Back 57

-b: beta-thal minor; usually asyx
- -: beta-thal major; severe anemia requiring blood transfusion (worry about secondary hemochromatosis), skeletal deformities

Front 58

Lead poisoning:
Affected enzyme
Presentation
Treatment

Back 58

Affected enzyme: Ferrochelatase, ALA dehydratase (aminolevulinic acid = ALA)

Microcytic anemia, GI and kidney dz, lead lines on gingivae and on epiphyses of long bones on x-ray
Basophilic stippling
Wrist, foot drop

Children-->MR
Adults-->HA, memory loss, demyelination

Tx:
Sucks to be a kid with lead poisoning-->Succimer

Adults-->Dimercaprol and EDTA

Front 59

Sideroblastic anemia:
Pathophys
Treatment

Back 59

Defect in heme synthesis due to X-linked defect in aminolevulinic acid synthase gene

Tx: pyridoxine (B6 tx)

Presents with ringed sideroblasts (with iron-laden mitochondria)

Front 60

Transferrin:
Role

Back 60

Transports iron in blood

Front 61

Ferritin:
Role

Back 61

Stored form of iron

Front 62

Iron deficiency anemia vs Anemia of chronic disease:
Serum Fe
TIBC
Ferritin
Fe/TIBC

Back 62

Iron def anemia
Fe: low
TIBC: high
Ferritin: low
Fe/TIBC: low low

Anemia of chronic dz:
Fe: low
TIBC: low
Ferritin: high (elevated in infections)
Fe/TIBC: normal or high

Front 63

Hemochromatosis:
Serum Fe
TIBC/Transferrin
Ferritin
Fe/TIBC

Back 63

Serum Fe: high
TIBC/Transferrin: low
Ferritin: high
Fe/TIBC: high high

Front 64

Pregnancy/OCP:
TIBC/transferrin
Fe/TIBC

Back 64

TIBC/transferrin high (dec'd transferrin)
Fe/TIBC low

Front 65

Lead poisoning:
Serum Fe
TIBC/Transferrin
Fe/TIBC

Back 65

Lead takes up iron's spot in heme synthesis so:
Serum Fe: high
TIBC/Transferrin: low
Fe/TIBC: high

Front 66

Folate deficiency:
Findings
Causes

Back 66

Hyperseg'd nphils
Glossitis
Inc'd homocysteine, nl MMA

Causes:
EtOH (malnutrition), malabsorption, impaired metabolism (MTX, trimethroprim), inc'd requirement (hemolytic anemia, pregnancy)

Front 67

B12 deficiency:
Findings
Cause

Back 67

Hyperseg'd nphils, glossitis, elevated homocysteine, ELEVATED MMA (methylmalonic acid)

Causes:
Insufficient intake (strict vegans)
Malabs (Crohn's dz)
Pernicious anemia
Diphyllobothrium latum (fish tapeworm)

NEURO SYX (B12 needed for FA synth--think myelin):
Peripheral neuropathy with sensorimotor dysfn
Posterior columns (vibration/proprioception)
Lateral corticospinal (spasticity)
Dementia

Front 68

Normocytic, normochromic anemia:
Intravascular vs Extravascular causes

Back 68

Intravascular:
Paroxysmal nocturnal hemoglobinuria
Autoimmune hemolytic anemia
Mechanical destruction (aortic stenosis, prosthetic valves)

Extravascular:
Hereditary spherocytosis
G6PD def
Pyruvate kinase def
Sickle Cell
HgC defect

Front 69

Nonhemolytic, normocytic anemia:
Causes

Back 69

Anemia of chronic dz
Aplastic anemia (destruction of myeloid cells)
Kidney dz (low EPO)

Front 70

Anemia of chronic disease:
Pathophys

Back 70

Inflammn-->inc'd hepcidin-->dec'd release of Fe from macs

Dec'd iron, dec'd TIBC, dec'd ferritin

Can become microcytic, hypochromic in long-standing dz

Front 71

Aplastic anemia:
Findings

Back 71

Pancytopenia characterized by severe anemia, neutropenia, thrombocytopenia

Normal cell morphology, but hypocellular bone marrow with fatty infiltration

Can be due to: radiation, drugs, alkylating agents, parvovirus, EBV, HIV, HCV, immune mediated; stem cell defect

Front 72

What are the causes of megaloblastic anemia?

Back 72

MAPLE
MTX
AZT
Phenytoin
Liver Dz
Ethanol

Front 73

G6PD Deficiency:
Pathophys

Back 73

X-linked
Defect in G6PD-->dec'd glutathione-->inc'd RBC susceptibility to oxidant stress

Front 74

What are the complications of Sickle Cell Disease?

Back 74

-Aplastic crisis (due to parvovirus B19 infection)
-Autosplenectomy-->inc'd risk infection w/encapsulated organisms; functional splenic dysfn occurs in early childhood

-Salmonella osteomyelitis

-Pain crisis (vaso-occlusive)

-Renal papillary necrosis (due to low O2 in papilla) and microhematuria (medullary infarcts)

Splenic sequestration crisis (infarcts)

Front 75

Cause of anemia:
Microcytic anemia + swallowing difficulty + glossitis

Back 75

Plummer-Vinson Syndrome (which is assocd w/Fe def anemia)

Front 76

Cause of anemia:
Microcytic anemia + > 3.5% HbA2

Back 76

beta-thal minor

Front 77

Cause of anemia:
Megaloblastic anemia not correctable by B 12 or folate

Back 77

Orotic aciduria

Front 78

Cause of anemia:
Megaloblastic anemia along with peripheral neuropathy

Back 78

B12 def

Front 79

Cause of anemia:
Microcytic anemia + basophilic stippling

Back 79

Lead poisoning

Front 80

Cause of anemia:
Microcytic anemia reversible with B6

Back 80

Sideroblastic anemia

Front 81

Cause of anemia:
HIV positive patient with macrocytic anemia

Back 81

Zidovudine

Front 82

Cause of anemia:
Normocytic anemia + red urine in the morning

Back 82

Paroxymal Nocturnal hemoglobinuria

Front 83

Cause of anemia:
Normocytic anemia and elevated creatinine

Back 83

Chronic kidney dz resulting in low EPO levels

Front 84

Cold agglutinins:
Pathophys
Causes

Back 84

Cold ice cream? MMMMMM

Nearly always IgM; antibodies against RBCs interact at low temp (4ºC): IgM-->RBC antigen-->compliment fixation-->MAC lysis

Occurs with Mycoplasma pneumoniae, EBV, some malignancies

Front 85

Warm agglutinins:
Pathophys
Causes

Back 85

Warm weather is GGGreat

Antibodies react against RBC antigens at body temp, nearly always IgG

Seen in:
Viruses--EBV, HIV
SLE
Malignancies (CLL, NHL)
Congenital Immune Abnlts

Front 86

Direct vs Indirect Coomb's:
General
Uses

Back 86

Direct Coomb's (DAT):
Prepared Ab's added to pt's washed RBC to detect presence of immunogllobulins already present on RBC
(+) in Hemolytic Dz of Newborn, Drug-induced hemolytic anemia, Hemolytic transfusion rxns

Indirect Coomb's:
Pt's serum incubated w/normal RBC to detect presence of Ab's

(+) when ab's present to foreign blood (used to test blood prior to transfusion), screening for maternal Ab's to a fetus' blood

Front 87

Microangiopathic anemia:
Pathophys
Findings

Back 87

RBCs damaged when passing thorugh obstructed or narrowed vessel lumina

Seen in DIC, SLE, malignant HTN, TTP

Schistocytes seen on blood smea due to mechanical destruction of RBCs

Front 88

Macroangiopathic anemia:
Pathophys

Back 88

Prosthetic heart valves and aortic stenosis cause hemolytic anemia 2º to mechanical destruction

Front 89

What is the rate-limiting step of heme?

Back 89

aminolevulinic acid synthase (Glycine + succinyl-CoA-->aminolevulinic acid)

Front 90

Acute intermittent porphyria:
Presentation
Affected enzyme
Accumulated substrate

Back 90

Painful abdomen with normal CT (due to neuro dysfn)
Port wine urine
Polyneuropathy
Psych disturbances
Precipitated by drugs

Acute: think acute abdomen (pain) and acute psychoses

Affects Porphobilinogen deaminse (uroporphyrinogen-I-synthase)-->results in porphobilinogen, ALA, uroporphyrin buildup in urine

Front 91

Porphyria Cutanea Tarda:
Presentation
Affected enzyme
Accumulated substrate

Back 91

Blistering cutaneous photosensitivity; most common porphyria
Also associated with hypertrichosis, facial hyperpigmentation, elevated LFTs, HCV, EtOH

Enzyme affected: uroporphyrinogen decarboxylase

Buildup of uroporphyrin in urine

Front 92

Hemophilia A/B:
Effect on bleed time
Presentation

Back 92

Both will increase PTT; PT will be normal because hemophilia only affects INTRINSIC PW

Presents with hemarthroses, easy bruising

Front 93

Vitamin K deficiency:
Effect on bleed time
Presentation

Back 93

Inc'd PT and PTT (general coagulation effect--both extrinsic and intrinsic pw's)

Front 94

Platelet disorders:
General presentation

Back 94

Microhemorrhage-->mucous membrane bleeding, epistaxis, petechiae, purpura, dec'd platelet count

Front 95

Bernard-Soulier Disease:
Effect on platelet count
Effect on bleed time
Pathophys

Back 95

Dec'd PC
Inc'd BT

Dec'd GpIb-->defect in platelet-to-collagen adhesion; can't form platelet plug

Front 96

Glanzmann's thrombasthenia:
Effect on platelet count
Effect on bleed time
Pathophys

Back 96

Normal PC (no thrombocytopenia)
Inc'd BT

Dec'd GpIIb/IIIa-->defect in platelet-to-platelet aggregation; defect in PLT plug formation

Blood smear shows no platelet clumping

Front 97

Idiopathic thrombocytopenia purpura:
Effect on platelet count
Effect on bleed time
Pathophys
Treatment

Back 97

Dec'd PC
Inc'd BT

anti-GpIIb/IIIa Ab's-->peripheral platelet destruction-->dec'd PLT survival

Inc'd # megakaryocytes

Tx: Steroids

Front 98

Thrombotic thrombocytopenic purpura:
Effect on platelet count
Effect on bleed time
Pathophys

Back 98

Dec'd PC
Inc'd BT

Deficiency of ADAMTS13 (vWF metalloprotease)-->dec'd degradation of vWF multimers

Large vWF multimers-->inc'd platelet agg and thrombosis

Labs: schistocytes, inc'd LDH
Neuro and renal syx, fever, low PLT, microangiopathic hemolytic anemia

Front 99

vonWillebrand's disease:
Effect on platelet count
Effect on bleed time
Effect on PT/PTT
Pathophys

Back 99

Normal PC, elevated BT, normal PT

Dec'd vWF-->nromal or elevated PTT 9depends on severity; vWF carries/protects factor VIII)

Leads to defect in intrinsic PW coag, defect in PLT plug formation (no platelet-to-collagen adhesion)

Mild but common

Front 100

DIC:
Effect on platelet count
Effect on bleed time
Effect on PT/PTT
Pathophys
Labs

Back 100

Dec'd PC
Inc'd BT
Inc'd PT/PTT

Widespread activation of clotting-->deficiency in clotting factors-->bleed state

Causes: STOP Making New Thrombi:
Sepsis, Trauma, Ob complications, Pancreatitis, Malignancy, Nephrotic syndrome, Transfusion

Labs: schistocytes, inc'd fibrin split products (D-dimers), dec'd fibrinogen, dec'd FV, FVIII

Front 101

What is the rate-limiting step in heme synthesis?

Back 101

ALA synthase (aminolevulate)

Front 102

What is the cause of ITP?

Back 102

Anti GpIIb/IIIa-ab's-->PLT destruction

Front 103

What is the defect in Bernard-Soulier disease?

Back 103

Def of GpIb

Front 104

What is the most common inherited bleeding disorder?

Back 104

vW Dz

Front 105

What are some of the hereditary syndromes of thrombosis?

Back 105

Factor V Leiden mutation
Prothrombin gene mutation
Antithrombin III def
Prot C def
Prot S def

Front 106

Hematologic tests/findings:
Ham's test

Back 106

Used to dx Paroxysmal Nocturnal Hemoglobinuria

Front 107

Hematologic tests/findings:
DEB test

Back 107

Used to dx Fanconi's anemia

Front 108

Hematologic tests/findings:
Heinz bodies

Back 108

G6PD def

Front 109

Hematologic tests/findings:
D-dimers

Back 109

Fibrin degradation products seen in DIC (or big clot like emboli, DVTs)

Front 110

Hematologic tests/findings:
Basophilic stippling

Back 110

BASt the ox TAIL
Thal
Anemia of chronic dz
Iron def anemia
Lead poisoning

Front 111

Hematologic tests/findings:
Osmotic fragility test

Back 111

Used to dx hereditary spherocytosis

Front 112

Hematologic tests/findings:
(+) ristocetin test

Back 112

Used to dx von Willebrand's Dz

Front 113

Leukemia vs Lymphoma:
General

Back 113

Leukemia--lymphoid neoplasms w/widespread involvement of BM. Tumor cells found in peripheral blood

Lymphoma--discrete tumor masses arising from LNs

Presentation often blur definitions

Front 114

Hodgkin's Lymphoma:
Key Finding
Nodal Involvement (Pattern)
Presentation
Associated Virus

Back 114

Presence of Reed-Sternberg cells = HALLMARK

Lozalized, single group of nodes involved; contiguous spread

B symptoms--fever, night sweats, weight loss

50% cases a/w EBV

Front 115

Non-Hodgkin's Lymphoma:
Nodal Involvement (Pattern)
Presentation
Associated Virus

Back 115

May be associated with HIV, immunosuppression

Multiple, peripheral nodes; extranodal involvement common, NONCONTIGUOUS SPREAD

Peak incidence 20-40

Front 116

Nodular sclerosing lymphoma:
Hodgkin's/Non-Hodgnkin's
Prognosis

Back 116

Most common HODGKIN'S lymphoma; excellent prognosis bc has high lymphocyte and low R-S cells

Front 117

Back 117

Burkitt's lymphoma--starry sky appearance from macrophage ingestion of tumor cells

Front 118

Back 118

Hodgkin's Disease (Reed-Sternberg cells)--binucleate RS cells displaying prominent inclusion-like nucleoli surrounded by lymphocytes and other reacting inflammatory cells. RS cell is necessary but insufficient pathologic finding for diagnosis of Hodgkin's disease.

Front 119

Back 119

Acute lymphocytic leukemia--affects children less than 10 years of age

Front 120

Back 120

Acute myelocytic leukemia with Auer rods (long arrow); affects adolescents to young adults, but most commonly diagnosed in older adults.

Front 121

Back 121

Chronic lymphocytic leukemia--lymphocytes are excessively fragile and are easily destroyed during slide preparation, forming "smudge cells". Affects individuals older than 60 years of age.

Front 122

Back 122

Chronic myeloid leukemia: promyelocytes and myelocytes seen adacent to a vascular structure. Affects individuals from 30 to 60 years of age.

Front 123

Burkitt's lymphoma;
Genetics
Histologic appearance
Virus association

Back 123

t(8;14) c-myc gene

Starry sky appearance

Associated with EBV

Front 124

t(11;14)

Back 124

Mantle cell lymphoma

Front 125

CD5+ Lymphoma

Back 125

Mantle cell lymphoma

Front 126

t(14;18)

Back 126

Follicular lymphoma

Front 127

bcl-2 expression

Back 127

Follicular lymphoma

Front 128

Acute vs Chronic Leukemia:
General

Back 128

Acute:
Rapid onset, rapidly progressive
Over 50% myeloblasts (AML) or lymphoblasts (ALL) in BM
Numerous blast cells in smear (>20%)
Often a/w pancytopenia

Chronic leukemia:
Insidious onset, gradual progression
Mature cells (<5% blasts)
Can be either CML or CLL
A/w HSM and LAD

Front 129

ALL:
Characteristics

Back 129

Bone pain common
Good prognosis in children
PAS(+) (periodic acid-schiff stain)

Front 130

AML:
Characteristics

Back 130

AUER RODS
CD13/33+
PAS(-)
Median age of onset is 50

Front 131

CLL:
Characteristics

Back 131

Adults over 50
B cell markers (CD19/20?)
SMUDGE CELLS

Front 132

CML:
Characteristics

Back 132

80% progress to AML
Adults 25-60
PHILADELPHIA CHROMOSOME (t9;22) ALWAYS PRESENT

Front 133

Multiple Myeloma:
Pathophys
Presentation

Back 133

Monoclonal plasma cell cancer (fried egg appearance) that arises in marrow and produces large amounts of IgG (55%) or IgA

CRAB presentation:
hyperCa2+
Renal insuff
Anemia
Bone lytic lesions/Back pain

Front 134

Why does multiple myeloma exhibit a protein spike?

Back 134

Multiple Myeloma results in overproduction of a single antibody form a plasma cell; so will see an M protein spike when graphing out subunits of Ig's (gamma subunit)

Front 135

Rouleaux formation:
What is it?
a/w?

Back 135

Stacked poker chip formation of RBCs
Seen in multiple myeloma

Front 136

Back 136

Multiple Myeloma--classic bone lytic lesions

Front 137

Back 137

Multiple myeloma--abundance of plasma cells. RBCs will often be seen in rouleaux formation, stacked like poker chips.

Front 138

Why does multiple myeloma cause hypercalcemia?

Back 138

Make cytokines that build oblasts, stimulate oclasts.

Front 139

What is a leukemoid reaction?

Back 139

Often confused w/leukemia; inc'd WBC count with left shift (e.g., 80% bands) and inc'd leukocyte alk phos, usually due to infection.

Front 140

Which chronic myeloproliferative disorder is Philadelphia chromosome positive?

Back 140

CML

Front 141

Which chronic myeloproliferative disorder is JAK2 mutation positive?

Back 141

Polycythemia vera
Essential thrombocytosis
Myelofibrosis

(CML is only negative)

Front 142

Polycythemia vera:
What is it?
Presentation

Back 142

Abnl clone of hematopoietic stem cells increasingly sensitive to growth factors

Erythrocytosis despite low EPO

Results in HA, HSM, hyperviscosity

Front 143

Essential thrombocytosis:
What is it?

Back 143

Production of PLT despite low thrombopoietin levels

Front 144

Myelofibrosis:
What is it?

Back 144

Fibrotic obliteration of bone marrow

See tear drop cells (bone marrow is crying because it's fibrosed :( )

Front 145

Teardrop cells

Back 145

Myelofibrosis

Front 146

What is the role of JAK2?

Back 146

Plays role in hematopoietic GF signaling

Front 147

Most common leukemia in children

Back 147

"ALL"

Front 148

Most common leukemia in adults in US

Back 148

"CLL"

Front 149

Most common lymphoma in US

Back 149

"Diffuse large B-cell lymphoma"

Front 150

Reed-Sternberg cells

Back 150

"Hodgkin's lymphoma"

Front 151

AML a/w Down syndrome

Back 151

"M7AML"

Front 152

Leukemia with more mature cells and less than 5% blasts

Back 152

"Chronic leukemia"

Front 153

AML that are CD13 and CD33 (+)

Back 153

"M0-M6AML"

Front 154

Particularly a/w EBV

Back 154

"Burkitt's and Hodgkin's Lymphomas"

Front 155

Characteristic Auer rods

Back 155

"AML (particularly M2 and M3)"

Front 156

A/w long term celiac disease

Back 156

"Intestinal T Cell Lymphoma"

Front 157

Greater than 20% blasts in marrow

Back 157

"Acute leukemia"

Front 158

Myelodysplastic syndromes have a tendency to progress to ________

Back 158

"AML"

Front 159

Myeloproliferative disorders may progress to _________

Back 159

AML

Front 160

AML that is CD 41 and CD 61 (+)

Back 160

"M7AML"

Front 161

PAS(+) acute leukemia

Back 161

"ALL"

Front 162

Commonly presents with bone pain

Back 162

ALL

Front 163

Viscous blood, headache, plethora, splenomegaly, and low erythropoietin

Back 163

"Polycythemia vera"

Front 164

Leukemia equivalent of Burkett's lymphoma

Back 164

"L3 or B variant ALL"

Front 165

Lymphoma equivalent of CLL

Back 165

Small lymphocytic lymphoma

Front 166

Numerous basophils, splenomegaly, and negative for leukocyte alkaline phosphatase (LAP)

Back 166

"CML"

Front 167

Most common neonatal leukemia

Back 167

M7AML

Front 168

Always positive for the Philadelphia chromosome (t9;22)

Back 168

CML

Front 169

Only AML that is CD 13 and CD 33 (-)

Back 169

M7 AML

Front 170

"Starry-sky pattern" due to phagocytosis of apoptotic tumor cells

Back 170

Burkitt's lymphoma

Front 171

Always associated with the BCR-ABL genes

Back 171

CML

Front 172

A/w Sjogren syndrome, Hashimoto's thyroiditis, and H. pylori

Back 172

Marginal cell MALToma

Front 173

Acute leukemia positive for peroxidase

Back 173

AML

Front 174

Solid sheets of lymphoblasts in marrow

Back 174

ALL

Front 175

PAS(-) acute leukemia

Back 175

AML

Front 176

Compare the age distribution of those affected by Hodgkin's lymphoma to those affected by non-Hodgkin's lymphoma.

Back 176

HL: bimodal, young and old

NHL: 20-40 (fills gap)

Front 177

What is the most common type of NHL in adults?

In children?

Back 177

Adults: Diffuse large B cell lymphoma

Children: Lymphoblastic lymphoma

Front 178

What lab findings are indicative of disseminated intravascular coagulation?

Back 178

Elevated PT/INR
Elevated PTT
Eleveated BT
Dec'd PLT
Elevated D-dimer

Front 179

What is the structure of HbH?

What disease results in its production?

Back 179

4 beta subunits

alphta-thal

Front 180

What is the structure of Hb Barts?

What disease results in its production?

Back 180

4 gamma subunits

hydrops fetalis

Front 181

Hematologic disease:
(+)Ham's test

Back 181

Paroxysmal nocturnal hemoglobinuria

Front 182

Hematologic disease:
Heinz bodies

Back 182

G5PD def

Front 183

Hematologic disease:
Basophilic stippling

Back 183

Pb poisoning

Front 184

Hematologic disease:
(+)osmotic fragility test

Back 184

Hereditary spherocytosis

Front 185

Hematologic disease:
(+)DEB test

Back 185

Fanconi's anemia

Front 186

Hematologic disease:
D-dimers

Back 186

DIC

Front 187

Hematologic disease:
Coomb's (+)

Back 187

Used to ID autoimmune hemolytic anemia

Front 188

Hematologic disease:
Coomb's (-)

Back 188

Used to ID non-autoimmune hemolytic anemia

Front 189

Hematologic disease:
( +) ristocetin test

Back 189

vW Dz

Front 190

What are the causes of aplastic anemia?

Back 190

Radiation, Benzene, EBV, Fanconi's anemia, etc.

Front 191

A patient develops hypercalcemia from the most common primary tumor arising within bones in adults.

What lab findings you expect in this patient?

Back 191

Multiple myeloma

Expect:
monoclonal Ab spike
Punched out lytic bone lesions
Bence-Jones proteins in urine
Rouleaux formation on blood smear

Front 192

What findings are a/w hereditary spherocytosis?

Back 192

Poz osmotic fragility test
Coombs' neg
Pigmented gallstones
Splenomegaly
Anemia
Jaundice

Front 193

What lab findings allow you to distinguish iron deficiency anemia from a microcytic, hypochromic anemia resulting from thalassemia?

Back 193

Fe def:
Dec'd Serum Fe
Inc'd TIBC
Dec'd Ferritin
NO TARGET CELLS

Thal:
Nl Fe
Nl TIBC
Nl Ferritin
TARGET CELLS PRESENT

Front 194

A child anemic since birth now has been cured with splenectomy.

What is the disease?

Back 194

Hereditary spherocytosis

Front 195

A patient with anemia, hypercalcemia, and bone pain receives a bone marrow biopsy which reveals plasma cells (large, round, off-center nucleus).

What is the diagnosis and what would you expect to see on urinalysis?

Back 195

Multiple myeloma

Won't see anything on U/A, need UPEP (electrophoresis for your pee) to see Bence-Jones Proteins

Front 196

What neoplasms are a/w AIDS?

Back 196

Kaposi's
Invasive squamous cell cancer
CNS
lymphoma
NHL

Front 197

A heart failure patient is newly diagnosed with cancer and is being evaluated for chemotherapy.
Which chemotherapeutic agent should be avoided in this pt?

Back 197

Doxorubicin or Daunorubicin--cardiotoxicity!

Front 198

Chromosomal analysis of a leukemia patient reveals the presence of the Philadelphia chromosome t(9;22).

What is the treatment?

Back 198

Imatinib

Front 199

After a normal spontaneous vaginal delivery, the new mom bleeds profusely from her vagina and later from her gums.

What abnormal lab values would you suspect?

Back 199

DIC probably to amniotic fluid embolism!

Inc'd BT
Inc'd PT, PTT
Dec'd PLT
Inc'd D-Dimer

Front 200

A 11 year-old child presents with a chronic non healing ulcer on his foot and imaging shows a small calcified spleen.
What drug can improve his symptoms?

Back 200

This is sickle cell; tx w/hydroxyurea to create HgF to better carry O2 to tissues

Front 201

NSAIDs inhibit the production of which substance important in platelet aggregation?

Back 201

Thromboxane

Front 202

Does HbF have more or less affinity for 2,3-bisphosphoglycerate?

Back 202

Less affinity

Front 203

MOA:
Streptokinase

Back 203

Converts plasminogen to plasmin

Front 204

MOA:
ASA

Back 204

Irreversible COX-1 inhibitor

Front 205

MOA:
Clopidogrel

Back 205

blocks ADP receptors

Front 206

MOA:
Abciximab

Back 206

Binds GpIIb/IIIa

Front 207

MOA:
Tirofiban

Back 207

Binds GpIIb/IIIa

Front 208

MOA:
Ticlopidine

Back 208

Blocks ADP receptors

Front 209

MOA:
Enoxaparin

Back 209

Catalyzes Antithrombin III formation and activation

Front 210

MOA:
Eptifibatide

Back 210

Binds GpIIb/IIIa