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295 Cards in this Set
- Front
- Back
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Precursor lesion: ACtinic keratosis
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Cancer: Squamous cell carcinoma
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Precursor lesion: Atypical hyperplasia of ductal epithelium of breast
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Adenocarcinoma
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Precursor lesion: Chronic irritation at sinus orifice
third degree burns |
Squamous cell carcinoma
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Precursor lesion: Chronic ulcerative colitis
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Adenocarcinoma
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Precursor lesion: Complete hydatidfrom mole
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Choricarcinoma
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Precursor lesion: Dysplastic nevus
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Malignant melanoma
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Precursor lesion: Endometrial hyperplasia
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adenocarcinoma
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Precursor lesion: Glandular metaplasia of esophagus
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Adenocarcinoma
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Precursor lesion: Glandular metaplasia of stomach
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Adenocarcinoma
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Precursor lesion: Myelodysplastic syndrome
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Acute leukemia
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Precursor lesion: Regenerative nodules in cirrhosis
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Adenocarcinoma
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Precursor lesion: Scar tissue in lung
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Adenocarcinoma
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Precursor lesion: Squamous dysplasia of oropharynx, larynx, bronchus, cervix
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Squamous cell carcinoma
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Precursor lesion: Tubular adenoma of colon
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Adenocarcinoma
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Precursor lesion: vaginal adenosis
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Adenocarcinoma
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Precursor lesion: Villous adenoma of rectum
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Adenocarcinoma
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What is significant about the HBV immunization in relation to cancer?
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decreases risk of heptocellular carcinoma
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what is the significance of the HPV immunization in relation to cancer?
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decreases risk for cervical cancer
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what is the least common gynecololgical cancer in the US?
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Cervical cancer
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what is most responsible for decreasing the incidence/mortality rate for cervical cancer?
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Cervical Pap Smear
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Is the PSA a more specific or sensitive test?
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more sensitive test than specific
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what has the treatment of H. pylori infection done for the rate of gastric lymphoma/adenocarcinoma?
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decreased risk of developing it
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When treating GERD what type of cancer are you decreasing the risk of cancer?
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distal adenocarcinoma of esophagus
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what is the most common type of mutation in cancer?
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Point mutations
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Function of:
Proto-oncogene ABL |
non-receptor tyrosine kinase
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Function of: HER
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Receptor synthesis
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Function of: MYC
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Nuclear transcription
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Function of: N-MYC
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Nuclear transcription
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Function of: RAS
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guanosine triphosphate signal transduction
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Function of: RET
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receptor synthesis
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Function of: SIS
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growth factor synthesis
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Function of: APC
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prevents nuclear transcription
degrades catenin an activator of nuclear transcription |
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Function of: BRCA1/BRCA2
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Regulates DNS repair
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Function of:
TGF-b |
inhibits G1 to S phase
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Function of: TP 53
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inhibits G1 to S phase
Repairs DNA, activates BAX gene - initiates apoptosis |
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Function of VHL
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regulates nuclear transcription
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Function of WT1
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Regulates nuclear transcription
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what is the mutation and cancer associated with ABL proto-oncogene?
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Translocation
Chronic myelogenous leukemia (chromosome 22 in philadelphia chromosome) |
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what is the mutation and cancer associated with the HER proto-oncogene?
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Amplification
Breast carcinoma (marker of aggression) |
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what is the mutation and cancer associated with the MYC proto-oncogene?
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translocation
Burkitt's lymphoma |
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what is the mutation and cancer associated with the N-MYC gene?
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amplification
Neuroblastoma |
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what is the mutation and cancer associated with the RAS proto-oncogene?
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Point mutation
Leukemia lung, colon, pancreatic carcinomas |
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what is the mutation and cancer associated with the RET proto-oncogene?
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point mutation
multiple endocrine neoplasia IIa/IIb syndromes |
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what is the mutation and cancer associated with the SIS proto-oncogene?
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Overexpression
Osteogenic sarcoma, astrocytoma |
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what is the associated cancer with the APC gene?
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familial polyposis
- colorectal cancer |
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what is the associated cancer with the BRCA1/BRCA2 gene?
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breast
ovary prostate carcinoma |
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what is the associate cancer with the RB gene?
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Retinoblastoma
osteogenic sarcoma breast carcinoma |
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what is the associated cancer with the TGF-b gene?
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pancreatic and colorectal carcinoma
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what is the associated cancer with the TP53 gene?
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lung, colon, breast carcinomas,
Li-Fraumeni syndrome, breast carcinoma, brain tumors, leukemia, sarcomas |
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what is the associated cancer with the VHL gene?
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Von-HIppel-Lindau syndrome
cerebellar hemangioblastoma retinal angioma renal cell carcinoma pheochromocytoma |
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what is the associated cancer with the WT1 gene?
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Wilm's tumor
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what are proto-oncogenes?
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involved in normal growth and repair
functions of products are growth factors, growth factor receptors, signal transducers, nuclear transcribers |
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what is a suppressor genes function?
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protect against unregulated cell growth
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what is the BCL2 gene family responsible for?
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antiapoptosis genes
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what is the BAX gene?
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apoptosis gene
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what is the function of repair genes?
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correct errors in nucleotide pairings
excise pyrimidine dimers |
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what are the enzymes involved in dimer excision?
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endonucleases
exonucleases polymerase ligase |
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___________ is the agent most responsible for cancer and cancer deaths in the United states.
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Tobacco
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what is the sequence of chemical carcinogenesis?
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initiation
promotion progression |
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describe the excision repair mechanism.
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1. a DNA molecule is distorted by UV light induced thymine dimer
2. a specific endonuclease breaks one chain near the dimer 3. an exonuclease excises a small region containing the thymine dimer 4. 5'-3' synthesis of a new strand takes place, the correct base inserted by pairing with bases on the intact strand 5. Polynucleotide ligase effects the joining of strands, completing the repaired molecule |
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what type of cancer is the carcinogen Aflatoxin associated with?
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heptocellular carcinoma in association with HBV
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what is the associated cancer with alcohol?
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squamous cell carcinoma of the oropharynx and upper/middle esophagus; pancreatic and hepatocellular carcinomas
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what cancer are alkylating agents associated with?
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malignant lymphoma
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what cancer is arsenic associated with?
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squamous cell carcinoma of skin, lung cancer, liver, angiosarcoma
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what cancer is asbestos associated with?
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bronchogenic carcinoma, pleural mesothelioma
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what cancer is benzene associate with?
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acute leukemia
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what cancer is berylium associated with?
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bronchogenic carcinoma
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what cancer is Chromium associated with?
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bronchogenic carcinoma
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what cancer is cyclophosphamide associated with?
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transitional cell carcinoma of urinary bladder
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what cancer is Diethylstilbestrol associated with
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clear cell carcinoma of vagina/cervix
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what cancer is b-naphthylamine associated with?
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transitional cell carcinoma of urinary bladder
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what cancer is nickel associated with?
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bronchogenic carcinoma
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what cancer are oral contraceptives associated with?
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breast, cervical carcinomas
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what type of cancer is polycylic hydrocarbons associated with?
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squamous cell carcinoma: oral cavity, midesophagus, larynx, lung
Adenocarcinoma: distal esophagus, pancreas, kidney Transitional cell carcinoma: urinary bladder, renal pelvis |
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what cancer is polycinyl chloride associated with?
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liver angiosarcoma
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what type of cancer is silica associated with?
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bronchogenic carcinoma
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what are the RNA viruses that are associated with cancer?
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HCV
HTLV-1 |
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what are the DNA viruses that are associated with cancer?
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EBV
HBV HHV-8 HPV types 16 and 18 |
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what is the mechanism of action of HCV causing cancer and what cancer is it associate with ?
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produces postnecrotic cirrhosis
Hepatocellular carcinoma |
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what is the mechanism of action of HTLV-1 in the production of cancer?
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activates TAX gene, stimulates polyclonal T-cell proliferation, inhibits TP53 suppressor gene
Cancer: T0cell leukemia and lymphoma |
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how does EBV cause cancer? what type?
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promotes polyclonal-B cell proliferation which increases risk for t(8:14) translocation
Cancer: Burkitt's lymphoma, CNS lymphoma in AIDS, mixed cellularity Hodgkin's lymphoma, nasopharyngeal carcinoma |
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what is the mechanism of action of HBV in causing cancer?
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activates proto-oncogenes
inactivates TP53 suppressor gene Cancer: hepatocellular carcinoma |
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what is the mechanism of action of HHV-8 in causing cancer?
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acts via cytokines released from HIV and HSV
cancer: Kaposi's sarcoma in AIDs |
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what is the mechanism of action of HPV-16 & 18 in causing cancer?
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Type 16: E6 gene products inhibit TP53 supressor gene
Type 18: E7 gene product inhibits RB suppressor gene Cancer: squamous cell carcinoma of the vulva, vagina, cervix, anus, larynx, oropharynx |
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what is hemostasis?
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prevention of blood loss while maintaining maximal perfusion requires the interaction of the blood vessels, platelets, coagulation factors, and fibrinolytic agents
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what are the factors preventing thrombus formation in small blood vessels?
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heparin like molecules
PGI2 Protein C and S Tissue plasminogen activator |
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describe heparin like molecules
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enhance AT III activity
Neutralize activated serine protease coagulation factors Factors XII, XI, IX, and X; thrombin |
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describe PGI2
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prostacyclin
synthesized by intact endothelial cells PGH2 is converted by prostacyclin synthase to PGI2 Vasodilator inhibits platelet aggregation ASA does NOT inhibit synthesis of PGI2 by endothelial cells |
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describe Protein C and S
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Vitamin K dependent factors
inactivate factors V and VII enhance fibrinolysis |
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describe tissue plasminogen activator
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synthesized by endothelial cells
activates plasminogen to release plasmin Plasmin degrades coagulation factors and lyses fibrin clots |
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what factors enhance thrombus formation in small vessel injury?
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Thromboxane A2
Von Willebrand factor Tissue thromboplastin (factor III) |
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describe TXA2
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synthesized by platelets
PGH2 is converted to TXA2 by thromboxane synthase ASA irreversibly inhibits platelet COX > prevents formation of PGH2, the precursor for TXA2 other NSAIDS reversibly inhibit platelet COX Prostacyclin synthase in endothelial cells is minimally affected by NSAIDS Function in hemostasis: vasoconstriction, enhance platelet aggregation |
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describe Von Willebrand factor
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synthesized by endothelial cells and megakaryocytes
Synthesized in Weibel-Palade bodies in endothelial cells Platelets carry vWF in the a-granules |
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what is the function of vWF?
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1. platelet adhesion molecule
- binds platelets to exposed collagen - platelets have glycoprotein Ib receptor for vWF 2. Complexes with factor VIII coagulant activity in the circulation - Factor VIII:c is synthesized by the liver and other sites - VIII: vWF complex with VIII:c in circulation - prevents degradation of factor VIII:c - decreases in vWF secondarily decrease VIII:c activity |
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what does complex of VIII:vWF with VIII:c in circulation prevent?
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prevents degradation of factor VIII:c
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what is tissue thromboplastin (factor III)
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non-circulating ubiquitous substance
released from injured tissue activates factor VII in the extrinsic coagulation system |
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Put in order the most common causes of cancer:
Bacteria Virus Parasites |
Viruses > Bacteria > Parasites
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what is the most common cancer due to ionizing radiation?
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Leukemia
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what is the most common cause of cancer due to excessive UV light exposure?
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Basal cell carcinoma
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what is the most effective host defense against cancer?
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Cytotoxic CD8 T-cells
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how do NK cells attack cancer?
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direct killing and indirect killing through type II hypersensitivity
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what does TNM stand for in the staging criteria of cancer?
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T: tumor size
N: whether lymph nodes are involved M: refers to extranodal metastases |
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what is a poor prognostic diagnosis of staging of cancer?
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M > N > T
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what is the most common anemia in cancer?
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anemia of chronic disease
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why does a patient develop a macrocytic anemia?
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due to folate deficiency from rapid tumor growth
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what is myelophthisis anemia?
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anemia related to metastasis to the bone
immature hematopoetic elements in peripheral blood - nucleated RBCs, immature neutrophils in peripheral blood - tear drop RBCs indicate myelofibrosis secondary to bone metastasis |
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what type of hemostasis is found in cancer?
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thrombogenic hemostasis in malignancy
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why does a patient with a malignancy develop DIC?
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due to release of tissue thromboplastin from cancer cells
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what is the most common cause of death in cancer?
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Gram negative sepsis
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what is the most common paraneoplastic syndrome in cancer?
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Hypercalcemia
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what is Acanthosis nigricans associated with?
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may be associated with stomach cancer
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what are signs of ectopic hormone production?
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hypercalcemia
hyponatremia hypoglycemia hypercortisolism polycythemia |
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patient presents with this black verrucoid appearing lesion under the arm. what cancer might you be worried about your patient having?
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Stomach carcinoma
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patient presents with myasthenia gravis like symptoms of muscle weakness, and an antibody directed against calcium channels. What is this syndrome? What cancer might it be associated with?
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Eaton-Lambert Syndrome
Small cell carcinoma |
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What is a syndrome associated with Bronchogenic carcinoma?
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Hypertrophic osteoarthropathy
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what is hypertrophic osteoarthropathy?
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periosteal reaction of distal phalanx often associated with clubbing of nail
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what is the function of heparin like molecules?
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enhance ATIII activity
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what is the function of ATIII?
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neutralizes activated serine protease coagulation factors
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what is the function of PGI2?
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vasodilator
inhibits platelet aggregation |
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Protein C and S inactivate _______ and ________ and enhance _________.
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Protein C and S inactivate factors V and VIII, enhances fibrinolysis
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_______ activates plasminogen to release plasmin
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tPA
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what is the function of TXA2?
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vasoconstriction
enhances platelet aggregation |
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______ is a platelet adhesion molecule.
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vWF
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what is synthesized in Weibel Palade bodies in endothelial cells?
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vWF
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where is Factor VIII:c synthesized at?
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in the liver and reticuloendothelial cells
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If there is a decrease in vWF what does this secondarily decrease?
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decreases VIII:c
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what is the function of vWF?
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platelet adhesion
prevents degradation of VIII:c in plasma |
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what does tissue thromboplastin activate in the extrinsic coagulation system?
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Factor VII
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What platelet receptor binds GpIb?
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binds vWF
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what platelet receptor binds GpIIb-IIIa?
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binds to fibrinogen
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what drugs interfere with GpIIb-IIIa receptor function?
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Ticlopidine
Clopidegrel Abciximab |
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what are some important platelet storage proteins?
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ADP
vWF Fibrinogen |
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what is the function of a platelet?
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stabilizes intercellular adherens junctions in venular endothelial cells
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what factor is activated in the extrinsic coagulation system?
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Factor VIII
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what coagulation factors does factor VII activate?
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activates factor IX and X
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what coagulation factors are involved in the intrinsic pathway?
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XII, XI, IX, VIII
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What does Factor XIIa activate?
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activates the kininogen system
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where is vitamin K primarily synthesized?
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in the liver
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what coagulation factors are involved in the final common pathway?
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Factors X, V, II, I
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what is the function of Factor XIII?
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Factor XIII cross-links insoluble fibrin monomers
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what are the Vitamin K dependent factors?
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procoagulants II, VII, IX, X
anticoagulants Protein C and S |
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what is the function of calcium in the coagulation pathway?
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binds gamma-carboxylated vitamin K dependent factors
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what factors are consumed in a clot to produce serum?
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I, II, V, VIII
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if blood is drawn into a clot tube, a fibrin clot is formed. When the tube is spun down in a centrifuge, the supranate is called serum, What factors is the serum missing?
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Unlike plasma, serum is missing fibrinogen (I), prothrombin (II), factor V, and Factor VIII
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name three plasminogen activators.
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tPA
Streptokinase Urokinase |
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what is the function of Aminocaproic acid?
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inhibits plasminogen
inhibits fibrinolysis by competitively blocking plasminogen |
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what is a D-dimer?
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cross-linked fibrin monomer
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Describe the platelet sequence in hemostasis.
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Adhesion
Release reaction Synthesis of TXA2 temporary plug |
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what is the function of TXA2 in the platelet sequence in hemostasis?
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enhances fibrinogen attachment to GpIIb-IIIa receptors
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what is a temporary platelet plug held together by?
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Fibrinogen
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what is a stable platelet plug held together by?
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Fibrin
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what takes place in the vascular phase of small vessel hemostasis?
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vessel injury with activation of coagulation cascade
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what takes place in the platelet phase of small vessel hemostasis?
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platelet adhesion to vWF
Platelet release of aggregating agents Platelets synthesize TXA2 Temporary platelet plug |
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what does the end of the platelet phase of the small vessel hemostasis represent?
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end of bleeding time
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what happens in the coagulation phase of small vessel hemostasis?
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Formation of stable platelet plug
stable plug held together by Fibrin. Only disrupted by plasmin |
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what happens in the fibrinolytic phase of small vessel hemostasis?
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dissolution of platelet plug
reestablishment of blood flow |
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what is Bleeding Time test used to assess?
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test of platelet function to formation of temporary plug
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what is the Ristocetin cofactor assay?
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test for vWF function
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what does the Prothrombin time evaluate?
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Factors VII, X, V, II, I
- extrinsic pathway |
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what is an INR measurement?
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INR standardizes PT for warfarin therapy
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what test evaluates factors XII, XI, IX, VIII, X, V, II, I?
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Partial thromboplastin time (PTT)
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what increases with lysis of fibrinogen and fibrin in fibrin thrombi?
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FDPs
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what is a D-dimer assay specific for?
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D-Dimer assay is specific for lysis of fibrin thrombi (clots) and detects cross-links
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what can be detected with the TTP/HUS?
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platelet consumption + hemolytic anemia with schistocytes
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what are some common causes of thrombocytosis?
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chronic iron deficiency
malignancy splenectomy |
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what is the most common cause of a qualitative platelet defect?
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Aspirin
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what is senile purpura?
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vessel instability
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what is seen with platelet dysfunction?
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bleeding from superficial scratches, easy bruising
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what are the clinical findings in Thrombocytopenia?
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petechia
bleeding from superficial scratches easy bruising |
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what are the main causes of coagulation disorders?
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decreased production, inhibition, or consumption of platelets
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what are clinical findings in severe factor deficiencies?
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late rebleeding
hemarthroses retroperitoneal and deep muscular bleeding |
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what type of inheritance is hemophilia A?
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x-linked recessive
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what does the % of VIII:c have to do with hemophilia A?
|
correlate with severity
Mild disease: 5-25% of normal moderate disease: 1-4% of normal severe disease < 1% of normal |
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what does hemophilia B involve?
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x-linked recessive involving a deficiency of factor IX
It is clinically indistinguishable from hemophilia A |
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what are the laboratory findings in hemophilia A?
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decreased VIII:c
increased PTT |
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what type of inheritance is vWD?
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AD inheritance
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what is vWD associated with?
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mitral valve prolapse
marfan syndrome angiodysplasia |
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what is the most common hereditary coagulation disorder?
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vWD
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define vWD?
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combined platelet and coagulation disorder
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what are the laboratory findings in vWD?
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increased PTT
increased bleeding time decreased VIII:c decreased vWF |
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what is the treatment for vWD?
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desmopressin acetate
OCP |
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what activates the vitamin K dependent coagulation factors?
|
gamma-carboxylation
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|
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why must newborns get a vitamin K injection?
|
newborns lack bacterial colonization in bowel
no synthesis of vitamin K because breast milk contains very little vitamin K and Vitamin K levels normally decrease between days 2 and 5 in newborns |
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what is the most common cause of vitamin K deficiency in hospital patients?
|
due to antibiotic therapy
|
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what does warfarin inhibit?
|
epoxide reductase
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what effect does warfarin/rat poison have on vitamin K?
|
makes vitamin K dependent factors nonfunctional because it decreases the activation of vitamin K by epoxide reductase
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what effect does cirrhosis have on vitamin K?
|
decreases synthesis of vitamin-K dependent factors
decreases activation of vitamin K |
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what is the most common cause of DIC?
|
sepsis
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what is the main pathogenesis of DIC?
|
consumption of coagulation factors
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what type of disorder would DIC be classified as?
|
thrombohemorrhagic disorder
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the lab findings in DIC would be:
|
increased PT
increased PTT D-dimers increased Bleeding time decreased platelets |
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what is the most sensitive screen for DIC?
|
D-dimers
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what is the treatment for DIC?
|
treat the underlying disease most important
component replacement |
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what are the major causes of primary fibrinolysis?
|
open heart surgery
prostatectomy diffuse liver disease |
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what would the laboratory findings be in primary fibrinolysis?
|
+ test for FDPs
- test for d-dimers normal platelet count increased PT and PTT |
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Labs in secondary fibrinolysis:
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increase in FDPs
increase in D-dimers decrease in platelet count increase in PT and PTT |
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what is found in antiphospholipid syndrome? (APLS)
|
APAs: anticardiolipin antibody, lupus anticoagulant
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what type of disorder is APLS?
|
thrombosis syndrome
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what antibody can produce a false positive syphilis serologic test?
|
anticardiolipin antibody
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what are clinical findings in APLS?
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spontaneous abortions
strokes DVTs Hepatic vein thrombosis |
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Name 5 acquired causes of thrombosis?
|
Post-operative state with stasis of blood flow
Malignancy Folate/Vitamin B12 deficiency OCPs Hyperviscosity |
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what is the most common hereditary thrombosis syndrome?
|
Factor V Leiden
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what occurs in Factor V Leiden hereditary thrombosis syndrome?
|
Mutant form of Factor V cannot be degraded by protein C and S
|
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what is diagnostic for ATIII deficiency?
|
normal PTT after standard dose of heparin
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what is hemorrhagic skin necrosis associated with?
|
warfarin therapy in protein C deficiency
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what is the most common blood group?
|
Blood group O
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what are the characteristics of blood group O?
|
No blood group antigens are present on RBC membranes
- anti-A-IgM - anti-B-IgM - anti-A and anti-B IgG |
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what is the function of an M cell?
|
M cells transport A and B antigens in Peyer's patches to B lymphocytes
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what are the characteristics of Blood group A?
|
anti-B-IgM
increased incidence of gastic carcinoma |
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what blood group has anti-A-IgM?
|
Blood group B
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what is the least common blood group?
|
Blood group AB
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what antibodies does blood group AB have?
|
NO natural antibodies
|
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Do newborns have natural antibodies?
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NO, not at birth
IgG antibodies are of maternal origin |
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do the elderly have natural antibodies?
|
NO
frequently lose their natural antibodies |
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If an elderly patient were transfused with the wrong blood group, what would happen?
|
possibly, they may not have a hemolytic transfusion reaction because they frequently have lost their natural antibodies
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Can parents that have Blood group AB have a baby with O blood?
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NO
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If both parents have blood group O blood what type of blood must their child have?
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O
cannot have a child with AB, A, or B blood group |
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Can parents with blood group A or blood group B have a child with blood group O?
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YES
blood group A and B parents can have O children if both have AO and BO phenotypes |
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when determining the ABO group what does the forward typing test identify?
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blood group antigen
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when determining the ABO group what does the backward typing test identify?
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natural antibodies
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If a patients RBCs are added to a test tube with anti-A serum and agglutinate in a forward type test and then added to a anti-B serum test tube and do not agglutinate, what do these findings mean?
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Patient has A blood
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If a patients serum is added to a test tube with anti-B-IgM antibodies and agglutinates but does not agglutinate when added to an A test tube of RBCs what does this indicate?
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patient has blood group A serum
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what are the five Rh antigens?
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D
C c E e |
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what type of inheritance are the Rh antigens?
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autosomal dominant inheritance
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what does it mean to be Rh positive?
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D antigen positive
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what is alloimmunization?
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antibodies develop against foreign antigens
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what is the significance of atypical antibodies?
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may produce an HTR
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what type of blood products must a patient with an atypical antibody receive?
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individuals with an atypical antibody must receive blood lacking the antigen
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what is the Duffy antigen?
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Fy antigens are the binding site for infestation of RBCs by Plasmodium vivax
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what does it mean if you are Fy antigen negative?
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protection against P. vivax malaria
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what is the safest type of transfusion?
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autologous transfusion
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what is an autologous transfusion?
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process of collection, storage, and reinfusion of the individuals own blood
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what is the most common pathogen transmitted by transfusion? why?
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CMV
it is present in the donor lymphocytes |
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why must blood being given to a newborn be irradiated?
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must irradiate blood to destroy lymphocytes
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describe the major crossmatch?
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patient serum + donor RBCs
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what does a negative antibody screen ensure?
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a negative antibody screen ensures that a major crossmatch will be compatible
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what does a compatible crossmatch not guarantee?
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that the recipient will not develop atypical antibodies, a transfusion reaction, or an infection
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what blood group is the universal donor?
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Blood group O
anti-A-IgM and anti-B-IgM cannot hemolyze O RBCs |
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what blood group is the universal recipient?
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Blood group ABO
lack natural antibodies |
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describe an allergic reaction to a transfusion.
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IgE mediated
Type II HSR Most common transfusion reaction |
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describe a Febrile transfusion reaction.
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anti-HLA antibodies against donor leukocytes
Type II HSR |
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are there any HLA antigens on RBCs?
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NO
this is not detected in ABS |
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how are anti-HLS antigens developed?
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comes from previous exposure to HLA antigens (blood transfusion/transplant)
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what are packed RBCs used for?
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Purpose: to increase oxygen transport to tissues
Packed RBCs have less volume and a higher Hct than whole blood |
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when given packed RBCs how much should the patients Hb raise by?
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Each unit of packed RBCs should raise the Hb by 1 g/dL and the Hct by 3%
lack of an increment implies a hemolytic transfusion reaction or continued blood loss in the patient |
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what is the most common contaminate of stored blood?
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Yersinia enterocolitica, a pathogen that thrives on iron
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what is the purpose of using platelets?
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Purpose: stop medically significant bleeding related to thrombocytopenia or qualitative platelet defects
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do platelets have HLA antigens and ABO antigens present on them?
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Platelets have HLA and ABO antigens on their surface
They lack Rh antigens |
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how much should each unit of platelets increase a platelet count in a patient?
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each unit of platelets should raise the platelet count by 5000-10,000 cells/mm
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why would you give a patient fresh frozen plasma?
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treatment of multiple coagulation deficiencies or treatment of warfarin over anticoagulation if bleeding is life threatening
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what is the purpose of Cryoprecipiate?
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treatment of coagulation factor deficiencies involving fibrinogen and factor VIII
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what does cryoprecipitate contain?
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Fibrinogen
Factor VIII Factor XIII |
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what is used in place of cryoprecipitate in treating mild hemophilia A and von Willebrand disease?
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Desmopressin acetate
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what are acute hemolytic transfusion reactions due to?
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blood group incompatibility or presence of an atypical antibody
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what type of hemolysis is present in an ACute HTR?
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intravascular and extravascular hemolysis
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If you suspect an HTR in your patient, what do you do?
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keep IV open with normal saline
discontinue transfusion |
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what is the most common type of Hemolytic Disease of a newborn?
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ABO HDN
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what is the pathogenesis of ABO HDN?
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mother is blood group O
fetus is blood group A or B blood group O individuals have anti-A and B-IgG antibodies IgG antibodies cross the placenta and attach to fetal A or B RBCs Fetal splenic macrophages phagocytose RBCs causing mild anemia UCB from extravascular hemolysis is disposed of in the mothers liver |
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what is the most common cause of Jaundice in first 24 hours of life?
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ABO HDN
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in ABO HDN what type of Coombs test will be produced?
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Positive direct Coombs test on fetal cord blood RBCs
- due to anti-A or B-IgG antibodies coating fetal A or B RBCs |
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will spherocytes be present in the cord blood peripheral smear of a baby with ABO HDN?
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YES
due to macrophage removal of a portion of the RBC membrane |
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what causes Rh HDN?
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mother Rh negative
baby Rh positive |
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when compared to ABO HDN what are the levels of UCB and the severity of anemia?
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Rh HDN anemia and amount of UCB >>> ABO HDN
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in Rh HDN is the bilirubin unconjugated or conjugated?
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unconjugated bilirubin is free in the blood
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what is the cause of kernicterus in the fetus/infant?
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unconjugated bilirubin deposits in basal ganglia
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what type of Coombs test will Rh HDN produce?
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positive direct Coomb's test on fetal RBCs
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In which type of HDN is an exchange transfusion required?
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Rh HDN
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what protects the mother from Rh sensitization in Rh HDN?
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ABO incompatibility
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what prevents Rh HDN?
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Rh immune globulin (anti-D globulin)
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At what wavelength does bilirubin have an absorbance?
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450 nm
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what is used in the treatment of Jaundice in newborns?
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Blue fluorescent light or sunlight
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A patient has small cell carcinoma and has Cushings syndrome. What hormone is being release?
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ACTH
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A patient has Gynecomastia. What type of cancer could be associated with this? what hormone would be associated with this?
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Choriocarcinoma
hormone: HCG (LH analog that can stimulate the stroma in the breast of males) |
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You detect Hypercalcemia in a patient. What cancers could this be associated with? what hormone would be released causing this?
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Renal cell carcinoma
Squamous cell carcinoma Hormone: PTH related hormone |
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Your patient has small cell carcinoma and has hyponatremia. What hormone is causing this?
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ADH
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A patient presents to you with polycythemia. You determine that they have Renal cell carcinoma. What hormone is being released to cause the polycythemia?
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EPO
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A patient has medullary carcinoma of the thyroid. They are found to be hypocalcemic. What is causing this?
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Calcitonin
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Seborrheic keratosis, acanthosis nigrans, and hypertrophic osteoarthropy are associated with what type of cancer?
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Gastric adenocarcinoma
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Tumor marker:
AFP associated with? |
hepatocellular carcinoma
yolk sac tumor of ovary or testis |
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Tumor marker:
Bence Jones protein is associated with? |
multiple myeloma
Waldenstrom's macroglobinemia |
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Tumor marker CA 125 is associated with?
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surface derived ovarian cancer
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tumor marker CEA is associated with?
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Colorectal and pancreatic carcinoma
- monitor for recurrence |
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tumor marker PSA is associated with?
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prostate carcinoma
- also increased in prostate hyperplasia |
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If you are trying to identify a tumor and it stains positive using a cytokeratin stain, what is its origin?
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epithelial origin
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if you are trying to identify a tumors origin and it stains positive with Vimentin stain its origin is?
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connective tissue origin
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The tumor cells that you have biopsied are CD45 positive, what is its origin?
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malignant lymphoma
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what cancer is Cushing's syndrome associated with? What hormone is ectopically secreted?
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small cell carcinoma of lung
medullary carcinoma of thyroid - ACTH |
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what cancer is Gynecomastia associated with? ectopic hormone?
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choriocarcinoma (testis)
- hCG |
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what cancer is HYPERcalcemia associated with? ectopic hormone?
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Renal cell carcinoma
primary squamous cell carcinoma of lung Breast carcinoma Malignant lymphomas - PTH related protein Calcitriol |
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what cancer is HYPOcalcemia associated with? ectopic hormone?
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medullary carcinoma of thyroid
- Clacitonin |
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what cancer would HYPOglycemia be associated with? ectopic hormone?
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Hepatocellular carcinoma
- insulin like factor |
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Patient has cancer and is HYPOnatremic. what cancer does your patient most likely have? ectopic hormone being secreted?
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Small cell carcinoma of lung
- ADH |
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What cancers could possibly cause secondary polycythemia? ectopic hormone?
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Renal cell and hepatocellular carcinoma
- EPO |
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what is the most common paraneoplastic syndrome?
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HYPERcalcemia
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what is the most common cause of death in cancer?
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Gram negative sepsis
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