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150 Cards in this Set

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Situations in which ESR is increased?
1. Infections
2. Inflammatory disease
3. Malignant neoplasms
4. GI disease (Ulcerative Colitis [UC])
5. Pregnancy
Situations in which ESR is decreased?
1. Polycythemia
2. Sickle cell anemia
3. Congestive heart failure
4. Microcytosis
5. Hypofibrinogenemia
Main mechanism of increased ESR?
Aggregation of RBCs; RBC aggregates have a higher density than plasma
Acanthocytes (spur cell) are assosciated with which pathology?
1. Liver disease
2. Abetalipoproteinemia
Basophilic stippling is assosciated with which pathology?
Baste the ox TAIL:
1. Thalassemias
2. Anemia of chronic disease (ACD)
3. Iron deficiency
4. Lead (Pb) poisoning
Bite cells are assosciated with which pathology?
G6PD deficiency
Macro-ovalocytes are assosciated with which pathology?
1. Megaloblastic anemia
2. Marrow failure
Schistocytes (helmet cells) are assosciated with which pathology?
1. DIC
2. TTP/HUS
3. Traumatic hemolysis
Spherocytes are assosciated with which pathology?
1. Spherocytosis
2. Autoimmune hemolysis
Teardrop cells are assosciated with which pathology?
1. Bone marrow infiltration (e.g., myelofibrosis)
Target cells are assosciated with which pathology?
HALT said the hunter to his target
1. HbC disease
2. Asplenia
3. Liver disease
4. Thalassemia
Describe the proess of Heinz body production?
Oxidation of iron from ferrous to ferric form leads to denatured Hb precipitation and damage to RBC membrane ––> formation of bite cells

Seen with a-thalassemia, G6PD deficiency
What are Howell-Jolly bodies?
Basophilic nuclear remnants found in RBCs

Seen in patients with functional hyposplenia or asplenia
Microcytic anemias
1. IDA
2. ACD
3. Thalassemias
4. Lead (Pb) poisoning
5. Sideroblastic anemia
Macrocytic anemias
May be subdivided into megaloblastic and nonmegaloblastic anemia

Megaloblastic anemias
1. Folate deficiency
2. B12 deficiency

Non-megaloblastic anemia
1. Liver disease
2. Alcoholism
3. Reticulocytosis
4. Metabolic disorders
5. Drugs
What is the Plummer-Vinson syndrome?
Triad of:
1. IDA
2. Esophageal web (dysphagia for solids but not liquids)
3. Atrophic glossitis
a-thalassemias are most prevalent in which people?
Asian and African
Findings in lead poisoning
Lead Lines on gingival and on epiphyses of long bones
Encephalopathy and Erythrocyte basophilic stippling
Abdminal colic ("lead colic") and siderblastic Anemia
Drops - wrist and foot
Treatment of lead poisoning
1. Succimer (kids)
2. Dimercaprol
Findings in folate deficiency?
1. Hypersegmented neutrophils
2. Glossitis
3. Decreased folate levels
4. Increased homocysteine
5. Normal methylmalonic acid
Drugs that can cause folate deficiency?
1. Methotrexate
2. Trimethoprim
Findings in B12 deficiency
1. Hypersegmented neutrophils
2. Glossitis
2. Decreased B12
4. Increased homocysteine
5. Increased methylmalonic acid
6. Neurological symptoms
Viral agents that may cause aplastic anemia?
1. Parvovirus B19
2. EBV
3. HIV
4. CMV
5. HCV
Most common cause of aplastic anemia?
Idiopathic
Most common known cause of aplastic anemia?
Drugs;
1. Benzene
2. Chloramphenicol
3. Antimetabolites
Symptoms of aplastic anemia?
1. Fever
2. Fatigue
3. Bleeding
4. Petechia
5. Infection
Primary iron storage in the body?
Ferritin
Lead (Pb) poisoning leads to anemia by blocking which enzymes?
1. Ferrochelatase
2. ALA dehydratase
What are porphyrias?
Conditions of defective heme synthesis that lead to accumulation of heme precurosors
Symptoms of porphyria cutanea tarda?
1. Blistering cutaneous photosensitivity
2. Most common porphyria
3. Tea-coloured urine (due to accumulation of uroporphyrin)
Leukemia vs lymphoma?
Leukemia – lymphoid neoplasms with widespread involvement of bone marrow. Tumor cells are found in peripheral blood

Lymphoma  – Discrete tumor masses arising from lymph nodes. Presentations often blur definitions
What is leukemoid reaction?
Increased WBC count with left shift (e.g., 80% bands) and increased leukocyte ALP, usually due to infection.

Often confused with leukemia
What are Reed-Sternberg cells? And where are they seen?
1. Distinctive tumor giant cells, seen in Hodgkin's disease
2. They are binucleate or bilobed, with the 2 halves as mirror images ("owl's eyes")
3. Necessary, but not sufficient for diagnosis of Hodgkin's disease
Neoplasms of mature B cells (non-Hodgkin's lymphoma)
1. Burkitt's lymphoma
2. Diffuse large B-cell lymphoma
3. Mantle cell lymphoma
4. Follicular lymphoma
Neoplasms of mature T cells (non-Hodgkin's lymphoma)
1. Adult T-cell lymphoma
2. Mycosis fungoides/Sézary syndrome
Genetics of Burkitt's lymphoma?
t(8;14), c-myc gene moves next to heavy-chain Ig gene (14); Associated with EBV
Genetics of Mantle cell lymphoma?
t(11;14) Deactivation of cyclin D regulatory gene; poor prognosis, CD5+
Genetics involved in Follicular lymphoma?
t(14;18) bcl-2 expression; difficult to cure; bcl-2 inhibits apoptosis
Genetics of adult T-cell lymphoma?
Caused by HTLV-1; especially affects populations in Japan, West Africa, and the Caribbean
Findings in Burkitt's lymphoma?
1. "Starry sky" appearance, sheets of lymphocytes with interspersed macrophages
2. Jaw lesion in endemic form in Africa; pelvis or abdomen in sporadic form
Findings in adult T-cell lymphoma?
1. Adults present with cutaneous lesions; very aggressive
Findings in mycosis/Sézary syndrome?
Adults present with cutaneous patches/nodules; indolent CD4+
Most common primary tumor arising within bone in the elderly?
Multiple myeloma
What is multiple myeloma?
Monoclonal plasma cell ("fried-egg" appearance) cancer that arises in the marrow and produces large amounts of IgG (55%) or IgA (25%). 

Most common in those >40-50 years of age
Mnemonics for multiple myeloma?
CRABB 
HyperCalcemia
Renal insufficiency
Anemia
Bone lytic lesions
Back pain

Multiple Myeloma: Monoclonal M protein spike
ALL presents most commonly in?
<15 years. May present with bone marrow involvement in childhood or mediastinal mass in adolescent males.
Findings in ALL? (4)
1. Bone marrow increased by massive amounts of lymphoblasts. 
2. TdT+ and CALLA+
3. t(12;21) –> better prognosis
4. May spread to CNS and testes
SLL/CLL is most commonly seen in
Age >60 years.
Findings in CLL?
1. Often asymptomatic
2. Smudge cells in peripheral blood
3. "Warm" autoimmune hemolytic anemia
Difference between SLL and CLL?
CLL has increased peripheral blood lymphocytosis, otherwise the same.
AML is most commonly seen in
Median onset 60 years
Findings in AML
1. Auer rods
2. Massively increased circulating myeloblasts
3. t(14;17) M3 AML subtype responds to all-trans retinoic acid (Vit A), inducing differentiation of myeloblasts
4. DIC is a common presentation
CML is most commonly seen in?
30-60 years of age
Findings in CML
1. Defined by the Philadelphia chromosome (t[9;22], bcd-abl)
2. Myeloid stem cell proliferation
3. Presents with increased neutrophils, metamyelocytes, basophils
4. Splenomegaly
5. May accellerate and transform to AML or ALL
6. Very low leukocyte alkaline phosphatase
What are Auer bodies (rods)?
Peroxidase-positive cytoplasmic inclusions in granulocytes and myeloblasts. Commonly seen in acute promyelocytic leukemia (M3). Treatment of AML M3 can release Auer rods, which leads to DIC.
t(9;22) translocation is associated with which disorder?
CML (bcr-abl hybrid)
t(8;14) translocation is associated with which disorder?
Burkitt's lymphoma (c-myc activation)
t(14;18) translocation is associated with which disorder?
Follicular lymphomas (bcl-2 activation)
t(15;17) translocation is associated with which disorder?
M3 type of AML
t(11;22) translocation is associated with which disorder?
Ewing's sarcoma
t(11;14) translocation is associated with which disorder?
Mantle cell lymphoma
What is Langerhans cell histiocytosis (LCH)?
1. Proliferative disorder of dendritic cells from monocyte lineage
2. Unknown etiology
3. Functionally immature and do not stimulate T-cells via APC
4. Birbeck granules ("tennis rackets" on EM) are characteristic
Appropriate absolute polycythemia is associated with which diseases?
1. Lung disease
2. Congenital heart disease
3. High altitude
Inappropriate absolute polycythemia is associated with which diseases?
1. RCC
2. Wilms' tumor
3. Cysts
4. Hepatocellular carcinoma (HCC)
5. Hydronephrosis

Due to ectopic EPO
Antineoplastics work at three main levels, what are they?
1. Nucleotide synthesis
2. DNA
3. Cellular division
Antineoplastics that work at the level of nucleotide synthesis?
1. Methotrexate and 5-FU: decreased thymidine synthesis
2. 6-MP: decreased purine synthesis
Antineoplastics that work at the level of DNA?
1. Alkylating agents, cisplatin: cross-link DNA
2. Dactinomycin, doxorubicin: DNA intercalators
3. Etoposide: inhibits topoisomerase II
Antineoplastics that interfere with cell division?
1. Vinca alkaloids: inhibit microtubule formation
2. Paclitaxel: inhibits microtubule disassembly
Mechanism of action of methotrexate (MTX)?
Folic acid analog that inhibits dihydrofolate reductase –> decreased dTMP –> decreased DNA and protein synthesis
Mechanism of action of 5-FU?
Pyridmidine analog bioactivated to 5F-dUMP, which covalently complexes folic acid. Inhibits thymidylate synthase.
Mechanism of action of 6-mercaptopurine (6-MP)?
Purine (thiol) analog –> decreases de novo purine synthesis
Mechanism of action of 6-thioguanine (6-TG)?
Purine (thiol) analog –> decreases de novo purine synthesis
Mechanism of action of Cytarabine (ara-C)?
Pyrimidine analog –> inhibition of DNA polymerase
Toxicitiy of vincristine, vinblastine?
VinBLASTine BLASTs Bone marrow (suppression)
Vincristine – neurotoxicity and paralytic ileus
Mechanism of action of vincristine, vinblastine?
Alkaloids that bind to tubulin in M-phase and block polymerization of microtubules so that mitotic spindle cannot form

Mnemonic: 
Microtubules are the vines of your cells
Situations in which ESR is increased?
1. Infections
2. Inflammatory disease
3. Malignant neoplasms
4. GI disease (Ulcerative Colitis [UC])
5. Pregnancy
Situations in which ESR is decreased?
1. Polycythemia
2. Sickle cell anemia
3. Congestive heart failure
4. Microcytosis
5. Hypofibrinogenemia
Main mechanism of increased ESR?
Aggregation of RBCs; RBC aggregates have a higher density than plasma
Acanthocytes (spur cell) are assosciated with which pathology?
1. Liver disease
2. Abetalipoproteinemia
Basophilic stippling is assosciated with which pathology?
Baste the ox TAIL:
1. Thalassemias
2. Anemia of chronic disease (ACD)
3. Iron deficiency
4. Lead (Pb) poisoning
Bite cells are assosciated with which pathology?
G6PD deficiency
Macro-ovalocytes are assosciated with which pathology?
1. Megaloblastic anemia
2. Marrow failure
Schistocytes (helmet cells) are assosciated with which pathology?
1. DIC
2. TTP/HUS
3. Traumatic hemolysis
Spherocytes are assosciated with which pathology?
1. Spherocytosis
2. Autoimmune hemolysis
Teardrop cells are assosciated with which pathology?
1. Bone marrow infiltration (e.g., myelofibrosis)
Target cells are assosciated with which pathology?
HALT said the hunter to his target
1. HbC disease
2. Asplenia
3. Liver disease
4. Thalassemia
Describe the proess of Heinz body production?
Oxidation of iron from ferrous to ferric form leads to denatured Hb precipitation and damage to RBC membrane ––> formation of bite cells

Seen with a-thalassemia, G6PD deficiency
What are Howell-Jolly bodies?
Basophilic nuclear remnants found in RBCs

Seen in patients with functional hyposplenia or asplenia
Microcytic anemias
1. IDA
2. ACD
3. Thalassemias
4. Lead (Pb) poisoning
5. Sideroblastic anemia
Macrocytic anemias
May be subdivided into megaloblastic and nonmegaloblastic anemia

Megaloblastic anemias
1. Folate deficiency
2. B12 deficiency

Non-megaloblastic anemia
1. Liver disease
2. Alcoholism
3. Reticulocytosis
4. Metabolic disorders
5. Drugs
What is the Plummer-Vinson syndrome?
Triad of:
1. IDA
2. Esophageal web (dysphagia for solids but not liquids)
3. Atrophic glossitis
a-thalassemias are most prevalent in which people?
Asian and African
Findings in lead poisoning
Lead Lines on gingival and on epiphyses of long bones
Encephalopathy and Erythrocyte basophilic stippling
Abdminal colic ("lead colic") and siderblastic Anemia
Drops - wrist and foot
Treatment of lead poisoning
1. Succimer (kids)
2. Dimercaprol
Findings in folate deficiency?
1. Hypersegmented neutrophils
2. Glossitis
3. Decreased folate levels
4. Increased homocysteine
5. Normal methylmalonic acid
Drugs that can cause folate deficiency?
1. Methotrexate
2. Trimethoprim
Findings in B12 deficiency
1. Hypersegmented neutrophils
2. Glossitis
2. Decreased B12
4. Increased homocysteine
5. Increased methylmalonic acid
6. Neurological symptoms
Viral agents that may cause aplastic anemia?
1. Parvovirus B19
2. EBV
3. HIV
4. CMV
5. HCV
Most common cause of aplastic anemia?
Idiopathic
Most common known cause of aplastic anemia?
Drugs;
1. Benzene
2. Chloramphenicol
3. Antimetabolites
Symptoms of aplastic anemia?
1. Fever
2. Fatigue
3. Bleeding
4. Petechia
5. Infection
Primary iron storage in the body?
Ferritin
Lead (Pb) poisoning leads to anemia by blocking which enzymes?
1. Ferrochelatase
2. ALA dehydratase
What are porphyrias?
Conditions of defective heme synthesis that lead to accumulation of heme precurosors
Symptoms of porphyria cutanea tarda?
1. Blistering cutaneous photosensitivity
2. Most common porphyria
3. Tea-coloured urine (due to accumulation of uroporphyrin)
Leukemia vs lymphoma?
Leukemia – lymphoid neoplasms with widespread involvement of bone marrow. Tumor cells are found in peripheral blood

Lymphoma  – Discrete tumor masses arising from lymph nodes. Presentations often blur definitions
What is leukemoid reaction?
Increased WBC count with left shift (e.g., 80% bands) and increased leukocyte ALP, usually due to infection.

Often confused with leukemia
What are Reed-Sternberg cells? And where are they seen?
1. Distinctive tumor giant cells, seen in Hodgkin's disease
2. They are binucleate or bilobed, with the 2 halves as mirror images ("owl's eyes")
3. Necessary, but not sufficient for diagnosis of Hodgkin's disease
Neoplasms of mature B cells (non-Hodgkin's lymphoma)
1. Burkitt's lymphoma
2. Diffuse large B-cell lymphoma
3. Mantle cell lymphoma
4. Follicular lymphoma
Neoplasms of mature T cells (non-Hodgkin's lymphoma)
1. Adult T-cell lymphoma
2. Mycosis fungoides/Sézary syndrome
Genetics of Burkitt's lymphoma?
t(8;14), c-myc gene moves next to heavy-chain Ig gene (14); Associated with EBV
Genetics of Mantle cell lymphoma?
t(11;14) Deactivation of cyclin D regulatory gene; poor prognosis, CD5+
Genetics involved in Follicular lymphoma?
t(14;18) bcl-2 expression; difficult to cure; bcl-2 inhibits apoptosis
Genetics of adult T-cell lymphoma?
Caused by HTLV-1; especially affects populations in Japan, West Africa, and the Caribbean
Findings in Burkitt's lymphoma?
1. "Starry sky" appearance, sheets of lymphocytes with interspersed macrophages
2. Jaw lesion in endemic form in Africa; pelvis or abdomen in sporadic form
Findings in adult T-cell lymphoma?
1. Adults present with cutaneous lesions; very aggressive
Findings in mycosis/Sézary syndrome?
Adults present with cutaneous patches/nodules; indolent CD4+
Most common primary tumor arising within bone in the elderly?
Multiple myeloma
What is multiple myeloma?
Monoclonal plasma cell ("fried-egg" appearance) cancer that arises in the marrow and produces large amounts of IgG (55%) or IgA (25%). 

Most common in those >40-50 years of age
Mnemonics for multiple myeloma?
CRABB 
HyperCalcemia
Renal insufficiency
Anemia
Bone lytic lesions
Back pain

Multiple Myeloma: Monoclonal M protein spike
ALL presents most commonly in?
<15 years. May present with bone marrow involvement in childhood or mediastinal mass in adolescent males.
Findings in ALL? (4)
1. Bone marrow increased by massive amounts of lymphoblasts. 
2. TdT+ and CALLA+
3. t(12;21) –> better prognosis
4. May spread to CNS and testes
SLL/CLL is most commonly seen in
Age >60 years.
Findings in CLL?
1. Often asymptomatic
2. Smudge cells in peripheral blood
3. "Warm" autoimmune hemolytic anemia
Difference between SLL and CLL?
CLL has increased peripheral blood lymphocytosis, otherwise the same.
AML is most commonly seen in
Median onset 60 years
Findings in AML
1. Auer rods
2. Massively increased circulating myeloblasts
3. t(14;17) M3 AML subtype responds to all-trans retinoic acid (Vit A), inducing differentiation of myeloblasts
4. DIC is a common presentation
CML is most commonly seen in?
30-60 years of age
Findings in CML
1. Defined by the Philadelphia chromosome (t[9;22], bcd-abl)
2. Myeloid stem cell proliferation
3. Presents with increased neutrophils, metamyelocytes, basophils
4. Splenomegaly
5. May accellerate and transform to AML or ALL
6. Very low leukocyte alkaline phosphatase
What are Auer bodies (rods)?
Peroxidase-positive cytoplasmic inclusions in granulocytes and myeloblasts. Commonly seen in acute promyelocytic leukemia (M3). Treatment of AML M3 can release Auer rods, which leads to DIC.
t(9;22) translocation is associated with which disorder?
CML (bcr-abl hybrid)
t(8;14) translocation is associated with which disorder?
Burkitt's lymphoma (c-myc activation)
t(14;18) translocation is associated with which disorder?
Follicular lymphomas (bcl-2 activation)
t(15;17) translocation is associated with which disorder?
M3 type of AML
t(11;22) translocation is associated with which disorder?
Ewing's sarcoma
t(11;14) translocation is associated with which disorder?
Mantle cell lymphoma
What is Langerhans cell histiocytosis (LCH)?
1. Proliferative disorder of dendritic cells from monocyte lineage
2. Unknown etiology
3. Functionally immature and do not stimulate T-cells via APC
4. Birbeck granules ("tennis rackets" on EM) are characteristic
Appropriate absolute polycythemia is associated with which diseases?
1. Lung disease
2. Congenital heart disease
3. High altitude
Inappropriate absolute polycythemia is associated with which diseases?
1. RCC
2. Wilms' tumor
3. Cysts
4. Hepatocellular carcinoma (HCC)
5. Hydronephrosis

Due to ectopic EPO
Antineoplastics work at three main levels, what are they?
1. Nucleotide synthesis
2. DNA
3. Cellular division
Antineoplastics that work at the level of nucleotide synthesis?
1. Methotrexate and 5-FU: decreased thymidine synthesis
2. 6-MP: decreased purine synthesis
Antineoplastics that work at the level of DNA?
1. Alkylating agents, cisplatin: cross-link DNA
2. Dactinomycin, doxorubicin: DNA intercalators
3. Etoposide: inhibits topoisomerase II
Antineoplastics that interfere with cell division?
1. Vinca alkaloids: inhibit microtubule formation
2. Paclitaxel: inhibits microtubule disassembly
Mechanism of action of methotrexate (MTX)?
Folic acid analog that inhibits dihydrofolate reductase –> decreased dTMP –> decreased DNA and protein synthesis
Mechanism of action of 5-FU?
Pyridmidine analog bioactivated to 5F-dUMP, which covalently complexes folic acid. Inhibits thymidylate synthase.
Mechanism of action of 6-mercaptopurine (6-MP)?
Purine (thiol) analog –> decreases de novo purine synthesis
Mechanism of action of 6-thioguanine (6-TG)?
Purine (thiol) analog –> decreases de novo purine synthesis
Mechanism of action of Cytarabine (ara-C)?
Pyrimidine analog –> inhibition of DNA polymerase
Toxicitiy of vincristine, vinblastine?
VinBLASTine BLASTs Bone marrow (suppression)
Vincristine – neurotoxicity and paralytic ileus
Mechanism of action of vincristine, vinblastine?
Alkaloids that bind to tubulin in M-phase and block polymerization of microtubules so that mitotic spindle cannot form

Mnemonic: 
Microtubules are the vines of your cells