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33 Cards in this Set
- Front
- Back
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Hereditary thrombosis syndromes
1. factor V leiden 2. ATIII deficiency 3. protein C or S deficiency |
1. mutant factor V cannot be degraded by protein C
2. inherited deficiency of ATIII, reduced inc in PTT after administration of heparin 3. decreased ability to inactivate factors 5 and 8, inc risk of hemorrhagic skin necrosis following warfarin |
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Pathologic RBC forms
1. macro-ovalocyte 2. helmet cell/shistocyte 3. bite cell 4. teardrop cell 5. acanthocyte (spur) 6. target cell 7. burr cell 8. basophilic stippling 9. Heinz bodies 10. Howell Jolly bodies |
1. megaloblastic anemia (+ hypersegmented PMNs)
2. DIC, TTP/HUS, traumatic hemolysis 3. G6PD deficiency 4. myeloid metaplasia w/ myelofibrosis 5. liver disease, abetalipoproteinemia 6. HbC disease, Asplenia, Liver disease Thalassemia (HALT) 7. TTP/HUS 8. thalassemias, anemia of chronic disease, iron deficiency, lead poisoning (TAIL) 9. denatured Hb leds to formation of bite cells- alpha thalassemia, G6PD deficiency 10. basophilic nuclear remnants, hypo/asplenia |
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Anemias
1. microcytic (MCV <80) 2. macrocytic (MCV >100) 3. normocytic |
1. iron def (low serum iron, low ferritin, high TIBC), thalassemias, lead poisoning
2. megaloblastic B12/folate def, DNA synthesis inhibitors (AZT, sulfa, phenytoin), merked reticulocytosis 3. hemorrhage, enzyme defects, membrane defects, BM disorders, sickle cell, ACD (low TIBC, inc ferritin) |
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Microcytic anemias/Porphyrias: affected enzyme (accumulated substrate)
1. lead poisoning 2. acute intermittent porphyria 3. porphyria cutanea tada |
1. ferrochelatase, ALA dehydratase (coproporphyrin, ALA)
2. uroprophyrinogen I synthase (porphobilinogen and delta-ALA) 3. uroporphyrinogen decarboxylase (uroporphyrin- tea colored) |
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Hemolytic anemias
1. warm agglutinin 2. cold agglutinin 3. hereditary spherocytosis 4. paroxysmal nocturnal hemoglobinuria 5. microangiopathic anemia |
1. IgG, chronic anemia, SLE/CLL, extravascular
2. IgM, acute anemia, M. pneumoniae 3. extravascular hemolysis, ankyrin, band 3.1, spectrin defect, inc MCHC, inc RDW, assoc w/ splenomegaly, aplastic crisis (B19) 4. intravascular, inc sensitivity to complement lysis, inc urine hemosiderin 5. intravascular hemolysis, SLE/DIC/TTP/HUS (mechanical RBC destruction through narrowed vessels) |
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Coomb's Test
1. clinical use 2. direct test 3. indirect test |
1. diagnosis of autoimmune hemolytic anemias (+)
2. anti-Ig Ab added to blood sample, agglutination indicates RBCs coated with Ig 3. normal RBCs added to sample serum, agglutination indicates anti-RBC surface Ig |
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DIC
1. what is it? 2. causes 3. lab findings 4. blood smear |
1. activation of coag cascade uses up platelets and coag factors and produces microthrombi
2. G- sepsis, trauma, obstetric complications 3. inc PT, inc PTT, inc FDPs (d-dimer) 4. dec platelets, helmet cells, schistocytes |
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Platelet abnormalities
1. what kind of hemorrhage? 2. ITP 3. TTP |
1. microhemorrhage: MM bleedings, petechiae, inc bleeding time
2. anti-Gp IIb/IIIa antibodies, inc megakaryocytes 3. deficiency of vWf-cleaving metalloproteinase (inc vWF > inc platelet aggregation); fever, neurologic/renal symptoms |
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Coagulation factor defects
1. hemophilia A 2. hemophilia B 3. Von willebrand's disease |
1. factor 8 def
2. vfactor 9 def 3. vWF def, most common, defect of platelet aggregation leads to dec factor 8 |
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*PT
1. tests which factors? 2. prolonged by? *PTT 1. tests which factors? 2. prolonged by? |
*PT
1. 1, 2, 5, 7, 20 2. defects in extrinsic coagulation cascade (DIC, Vit K def) *PTT 3. all factors except 7 and 13 4. defects in intrinsic coagulation (Hem A, Hem B, VW disease, DIC, Vit K def) |
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Defects in platelet plug
1. cause increased... 2. glanzmann's thrombasthenia 3. bernard-soulier 4. VW disease |
1. increased bleeding time
2. dec Gp IIb/IIIa (platelet-platelet aggregation) 3. dec Gp Ib (platelet-collagen adhesion) 4. dec VWf (platelet-collagen) |
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Reed Sternberg cells
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Hodgkin's, owl's eyes, CD 30+, 15+, B cell origin, lacunar and nodular sclerosis variants
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Lymphomas: Hodgkin's vs. Non-Hodgkin's
1. incidence/associated with... 2. node involvement 3. constitutional symptoms 4. LAD |
1. H: EBV, young and old, RS cells; NH: HIV, IS, 20-40yo
2. H: localized, single group of nodes, contiguous spread; NH: multiple peripheral nodes, extranodal involvement, noncontiguous spread 3. H: "B" symptoms (fever, night sweats, weight loss); NH: fewer signs/symptoms 4. H: mediastinal lymphadenopathy |
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Hodkin's lymphoma: RS cells, lymphocytes, prognosis (correlates with RS:lymph ratio), comments
1. nodulcar sclerosing (65-75%) 2. mixed cellularity (25%) 3. lymphocyte predominant (6%) 4. lymphocyte depleted (rare) |
1. RS+, lymph+++, excellent prognosis, most common, lacunar cells, women > men, young adults
2. RS++++, lymph +++, intermediate prognosis, numerous RS cells 3. RS+, lymph++++, excellent prognosis, males<35yo 4. RS high relative to lymphocytes, poor prognosis, older males with dissiminated disease |
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Multiple myeloma
1. cause 2. Ig/RBC abnormalities 3. presentation: think CRAB 4. if asymptomatic... |
1. monoclonal plasma cell cancer (fried egg appearance)
2. monoclonal Ig spike (M protein/spike), Ig light chains in urine (Bence Jone proteins), roleaux RBC formation 3. hyperCalcemia, Renal insufficiency, Anemia, Bone/back pain 4. monoclonal gammopathy of undetermined significance |
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Non Hodgkins: occurs in..., cell type, genetics, comments
1. SLL 2. follicular 3. diffuse large cell 4. mantle cell 5. lymphoblastic 6. Burkitt's |
1. adults, B cells, like CLL but with focal mass
2. most common lymphoma in adults, B cells, t(14; 18), bcl-2 expression (inhibits apoptosis) 3. mostly a5 dults, some children, 80% B cells/20% T cells 4. adults, B cells, t(11;14), poor prognosis, CD5+ 5. most common in children, immature T cells, ALL and mediastinal mass, very aggressive 6.children, B cells, t(8;14) c-myc gene moves next to heavy chain Ig gene, starry sky, EBV, jaw lesion |
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Chromosomal translocations
1. CML 2. Burkitt's 3. follicular 4. AML-M3 5. Ewing's sarcoma 6. mantle cell lymphoma |
1. t(9; 22), bcr-abl, Philadelphia csome
2. t(8; 14), c-myc 3. t(14;18), bcl-2 4. t(15; 17), responds to ATRA 5. t(11; 22) 6. t(11; 14) |
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Acute lymphocytic leukemia (ALL)
1. age of onset 2. cells and markers 3. sites of spread |
1. children <15
2. lymphoblasts, Tdt+ 3. CNS, testes |
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Acute myelocytic leukemia (AML)
1. age of onset 2. histology 3. treatment |
1. mean is 60yo
2. Auer rods: peroxidase positive cyto inclusions which may be released during AML tx > DIC 3. all-trans-retinoic acid (vit A) |
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Chronic lymphocytic leukemia (CLL)
1. age of onset 2. symptoms 3. histology 4. similar to... 5. anemia |
1. adults >60yo
2. few symptoms, LAD, HSM 3. SLL which is in tissue 4. auto immune hemolytic anemia (warm antibody, IgG) |
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Chronic myeloid leukemia
1. age of onset 2. cells 3. genetics 4. vs. leukemoid rxn 5. tx |
1. adults 30-60yo
2. myeloid stem cells, blast crisis 3. 9;22, bcr-able, Philadelphia csome 4. dec leukocyte alkaline phosphatase 5. imatinib (anti bcr-abl) |
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Hairy Cell leukemia
1. age of onset 2. cells 3. stains |
1. elderly
2. mature B cells 3. TRAP positive (tartrate-resistant acid phosphatase) |
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Langerhans cell histiocytosis
1. what is it? 2. markers 3. old names |
1. proliferative disorders of dendritic (langerhan's) cells from monocyte lineage
2. S-100, CD1a, birbeck granules on EM 3. letterer-siwe, hand-schuller-chrisitian, eosinophilic granulomas |
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Heparin
1. MOA 2. safe during.. 3. antidote 4. LMWH 5. HIT 6. HIT tx |
1. catalyzes activation of antithrombin III, dec thrombi, dec Xa
2. follow PTT 3. protamine sulfate 4. enoxaparin: acts more on Xa, longer half life, no lab monitoring 5. heparin binds platelets inducing auto-Abs against platelets and overacts the remaining ones > thrombocytopenic, hypercoag state 6. lepirudin/bivalirudin: directly inhibit thrombin, used as alternative to heparin |
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Warfarin (Coumadin)
1. MOA 2. lab monitoring 3. clinical use 4. antidote |
1. interferes gamma-carboxylation of vit K dependent clotting factors 2, 7, 9, 10, protein C and S
2. prolongs PT (effects extrinsic path), monitor with INR 3. chronic anticoag, don't use in pregnancy 4. IV Vit K, fresh frozen plasma |
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Thrombolytics
1. examples 2. MOA 3. clinical use |
1. streptokinase, urokinase, tPA (alteplase), APSAC (anistreplase)
2. aid conversion of plasminogen to plasmin > thrombin cleavage > inc PT, inc PTT, no change in platelets 3. early MI, early ischemic stroke |
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Aspirin (ASA)
1. MOA 2. lab monitoring 3. toxicity |
1. acetylates and irreversibly inhibits COX1/2; prevents conversion of arachidonic acid to txA2
2. inc bleeding time, normal PT/PTT 3. gastric ulcer, Reye's, tinnitus (CN 7) |
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Clopidogrel, ticlopidine
1. MOA 2. clinical use 3. toxicity |
1. irreversibly blocks ADP receptors, prevents gp IIb/IIIa expression
2. acute coronary syndrome, coronary stenting 3. neutropenia (ticlopidine) |
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Abciximab
1. MOA 2. clinical use |
1. monoclonal Ab, binds gp IIb/IIIa on activated platelets, prevents aggregation
2. coronary angioplasty |
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Methotrexate
1. what is it? 2. MOA 3. clinical use 4. toxicity/antidote |
1. folic acid analog (inhibits S phase)
2. inhibits DHF reductase > dec dTMP > dec DNA synthesis 3. leukemia, lymphoma, abortion, RA, psoriasis 4. myelosuppresion, give leucovorin (folinic acid) "rescue" |
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5-fluorouracil
1. what is it? 2. MOA 3. clinical use 4. toxicity |
1. pyrimidine analog (S phase specific)
2. activated to 5f-dUMP that binds folic acid > inhibitst thymidylate synthase > dTMP > dec DNA synthesis 3. colon cancer, basal cell carcinoma (topical) 4. myelosuppression, doesn't reverse with lecovorin, can "rescue" with thymidine |
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Cyclophosphamide
1. MOA 2. clinical use 3. toxicity |
1. alkylating agetns that covalently x-link DNA at guanine N-7
2. non-hodgkin's, breast and ovarian carcinomas, immunosuppressants 3. myelosuppression, hemorrhagic cystitis (give with mesna) |
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Chemo drugs: MOA (any unusual toxicity)
1. g-mercaptopurine (G-MP) 2. cytarabine (ara-c) 3. nitrosoureas 4. busulfan 5. cisplatin, carboplatin 6. doxorubicin, daunorubicin 7. dactinomycin (actinomycin D)- what's its use? 8. bleomycin 9. hydroxyurea 10. etoposide (VP-16) 11. prednisone 12. tamoxifen, raloxifene 13. trastuzamab (herceptin) 14. imatinib/gleevec 15. vincristine 16. paclitaxel |
1. blocks purine synthesis (inc toxicity with allopurinol)
2. inhibits DNA polymerase (megaloblastic anemia) 3. alkylating agent (can cross BBB > dizziness, ataxia) 4. alkylating agent (pulm fibrosis, hyperpigmentation) 5. cross link DNA (nephrotoxic, acoustic nerve damage) 6. free radicals, intercalates in DNA (cardiotoxic, red urine, toxic extravasation) 7. intercalates in DNA (kid tumors: wilms, ewings, rhabdomyosarcoma) 8. forms free radicals, breaks DNA (pulm fibrosis, skin changes) 9. inhibits ribonucleotide reductase, dec DNA synthesis (s phase) 10. inhibits topoisomerase II and inc DNA degradation 11. triggers apoptosis (cushing symptoms- hyperglyc, osteoporosis, HTN) 12. SERM, antag in breast, agonist in bone (tamoxifen inc risk of endometrial carcinoma) 13. monoclonal Ab against her-2/erb-b2 (cardiotoxic) 14. inhibits bcr-able tyrosine kinase for CML (fluid retention) 15. bind tubulin, block mitotic spindle (neurotoxic/areflexia, paralytic ileus) 16. binds tublin, prevents mitotic spindle break down (hypersensitivity) |
