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92 Cards in this Set

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Auer rods on peripheral smear indicate...
acute myeloblastic leukemia (AML)
60 year old male with severe anemia, decreased neutrophil count, and small, abnormal B lymphocytes in the bone marrow (>30%) with levels at 90,000 per cubic millimeter. Has painless cervical lymphadenopathy and hepatosplenomegaly. Likely diagnosis?
Chronic lymphocytic leukemia (CLL)
Bone marrow aspiration and biopsy reveals the presence of the Philadelphia (Ph) chromosome in dividing marrow cells. Likely diagnosis?
Chromic myeloblastic leukemia (CML)
Follicular, cleaved cell, lymphocytic, histolytic
Hodgkins Lymphoma
Reed Sternberg cell
Hodgkin's lymphoma
Plasma cells, monoclonal protein
Multiple myeloma
What disease is characterized by abnormal monoclonal protein, anemia, and lytic bone lesions?
Multiple myeloma
30 year old white male with 3 month history of painless enlargement of bilateral cervical lymph nodes, fever, and night sweats. Likely diagnosis?
Hodgkin's disease
What hematologic measurement is abnormal in chronic heavy alcohol use?
Mean corpuscular volume
Most frequent cause of B12 deficiency in patients with classic pernicious anemia
Lack of intrinsic factor
In thalassemia anemia, what causes the anemia?
Shortened lifespan of RBCs
Teenage African American female presents with severe bone and joint pain. CBC shows severe anemia and elevate leukocyte and platelet counts. Most likely diagnosis?
Sickle cell disease
What 2 tests are used to confirm the diagnosis of homozygous sickle cell disease?
Peripheral smear and hemoglobin electrophoresis
The most helpful test to distinguish megaloblastic from nonmegaloblastic macrocytic anemia
Peripheral smear
What is the most common initial presentation of sickle cell disease?
Failure to thrive in a child at risk
4 year old with fever, bleeding, bone pain, generalized lymphadenopathy, splenomegaly, hepatomegaly. CBC shows anemia, leukocytosis (100,000 immature WBC) and thrombocytopenia. Prognosis is good. Likely diagnosis?
Acute lymphocytic leukemia
Type of anemia characterized by small red blood cells, MCV <76
Microcytic anemia
Name the classic types of microcytic anemia
Iron deficiency anemia, thalassemia, sideroblastic anemia, anemia of chronic disease, lead poisoning
Type of anemia characterized by large red blood cells, MCV >100
Macrocytic anemia
Causes of megaloblastic anemia
B12 (cobalamine) deficiency, folate deficiency, and drugs. May be idiopathic.
Type of anemia in which serum iron is decreased and TIBC is increased
Iron deficiency anemia
Basophilic stippling of RBCs is noted. Likely dx?
Lead poisoning
Classify the 2 types of macrocytic anemia
Megaloblastic and nonmegaloblastic
RBC with low hemoglobin and an enlarged area of central pallor
Hypochromic
RBC with a loss of central pallor, stains more densely, and is often microcytic.
Spherocyte
RBC that is hypochromic with a central darkening of hemoglobin. Seen in liver disease, thalassemia.
Target cell
Fragmented helmet or triangular-shaped RBC
Schistocyte
Elongated RBC with pointed ends
Sickle cell
Type microcytic hypochromic anemia that demonstrates low serum iron and low TIBC. Unresponsive to iron therapy.
Anemia of chronic disease/inflammation
3 possible etiologies of normocytic normochromic anemia
Blood loss, hemolysis, decreased production
In a patient presenting with normochromic normocytic anemia, what is the next test to classify the anemia according to marrow response?
Reticulocyte count
Low MCV, low RBC, high RDW, low serum Fe, high/nml TIBC
Iron deficiency anemia
Low MCV, normal/high RBC, normal RDW, high/norm serum Fe, normal TIBC
Thalassemia
Normal/low MCV, normal RBC, low serum Fe, low TIBC
Anemia of chronic disease
Pancytopenia, anemia, leukopenia, neutropenia, thrombocytopenia
Aplastic anemia
What is the best test to determine whether a patient as a hemolytic anemia?
Reticulocyte count and blood smear
A patient with a history of gastric carcinoma is pale and mildly icteric with a beefy, red, sore tongue. He presents with numbness in his feet, weakness, and ataxia. Peripheral blood smear shows macrocytosis and hypersegmented polymorphonuclear lymphocytes. This is due to deficiency of what vitamin?
B12
60 year old male with no symptoms and no abnormalities on physical exam has a CBC that shows hemoglobin of 9.0, leukocytes 40,000, and peripheral smear shows 97% small lymphocytes. Likely dx?
Chronic lymphocytic leukemia
What are the two most common histologic subtypes of Hodgkin's disease?
Nodular sclerosing and mixed cellularity
What are B symptoms?
Fever, drenching night sweats, fatigue, weight loss
What is the best test to determine whether a patient as a hemolytic anemia?
Reticulocyte count and blood smear
Increased ferritin, increased iron, decrease TIBC, hematocrit 20-30%
Sideroblastic anemia
59 year old African American with long-standing history of RA. Hemoglobin is 9, hematocrit 27. Iron and TIBC normal. Likely dx?
Anemia of chronic disease
A megaloblastic anaemia due to vitamin B12 deficiency dependent on impaired absorption of vitamin B12
Pernicious anemia
What test confirms the diagnosis of pernicious anemia?
Schilling test
What test is used to assess a patient's ability to absorb Vitamin B12 from the bowel?
Schilling test
What test will distinguish thalassemia minor from iron deficiency anemia?
Serum ferritin determination
Treatment for thalassemia minor
Supportive
Hypochromic microcytic anemia with increased serum iron, normal TIBC, increased ferritin, and normal HbA2
Sideroblastic anemia
Normal serum iron, normal TIBC, normal ferritin, elevated HbA2
Beta-thalassemia trait
What type of anemia requires a bone marrow aspiration for definitive diagnosis?
Sideroblastic anemia
Most likely vitamin deficiency related to pancytopenia
Folate
What factor is produced in the stomach and required for intestinal absorption of Vitamin B12?
Intrinsic factor
What is the most common cause of B12 deficiency?
Pernicious anemia (lack of intrinsic factor)
What is the most common cause of folate deficiency?
Inadequate dietary intake
What test is used to monitor progression of HIV infection and responses to therapy?
Plasma viral load
Most common presentation for Non-Hodgkin's lymphoma
Painless lymphadenopathy
What is the first step after finding a 1cm mobile, soft thyroid nodule with no associated lymphadenopathy?
Fine needle aspiration
Most common type of thyroid cancer
Papillary
What test excludes the diagnosis of polycythemia vera if it is suspected?
Elevated plasma erythropoietin level
What coagulation factor is NOT vitamin K dependent?
Factor VIII
What tumor marker is measured for testicular cancer?
alpha-fetoprotein
What tumor marker is measured for colon cancer?
Carcinoembryonic antigen (CEA)
What tumor marker is measured for ovarian cancer?
CA 125
What tumor marker is measured for prostate cancer?
PSA
What tumor marker is measured for carcinoid tumor?
5-HIAA
A Negri body is a pathognomonic sign of what disease?
Rabies
What type of megaloblastic anemia is associated with neurologic deficits?
Vitamin B12 deficiency
Headache, dizziness, visual disturbances, generalized itching, facial plethora, moderate splenomegaly. Likely diagnosis?
Polycythemia vera
The presence of Heinz bodies on peripheral smear indicates...
G6PD deficiency
What is the most common congenital hemolytic anemia in the white population?
Hereditary spherocytosis
What are the causes of microangiopathic hemolytic anemia?
disseminated intravascular coagulation, thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, and artificial heart valves
Hemoglobin electrophoresis confirms the diagnosis of what 2 types of anemia?
Thalassemia and sickle cell disease
What viruses may cause aplastic anemia?
Hepatitis and parvovirus B19
What is the most common type of childhood leukemia?
Acute lymphocytic leukemia. 75% of cases occur in children less than 15 years of age. The rest of the cases occur after age 50.
What type of leukemia is most commonly seen in elderly men?
Chronic lymphocytic leukemia
What is the first-line chemotherapy agent for chronic lymphocytic leukemia?
Chlorambucil
Which ALL patient generally has a better prognosis: a child or an adult?
98% of children achieve complete remission after 4 weeks of chemotherapy, and 70% of children will be cured. Only 30-40% of adults will be cured.
What 2 types of leukemia may have the Philadelphia chromosome?
Acute lymphocytic leukemia (its presence indicates a poorer prognosis) and Chronic myelogenous leukemia (present in 95% of cases)
What is the most common form of adult leukemia in Western countries?
Chronic lymphocytic leukemia
Which type of leukemia will have smudge cells on the peripheral blood smear?
Chronic lymphocytic leukemia
What is the most deadly phase of chronic myelogenous leukemia?
Acute blast crisis phase (>30% blasts in blood or bone marrow)
What type of leukemia have lymphocytes with hairlike cytoplasmic projections?
Hairy cell leukemia
Hodgkin's lymphoma has a bimodal age distribution. When are they?
The first peak is in the second and third decades of life, the second peak is after the age of 50
What type of lymphoma may be linked with EBV?
Hodgkins
What does the presence of B symptoms in Hodgkins lymphoma indicate?
Poor prognosis
What test will confirm your diagnosis of multiple myeloma?
Protein electrophoresis may show IgM proteins or Bence Jones proteins
Hemophilia A is a deficiency of what coagulation factor?
Factor VIII
Hemophilia B is a deficiency of what coagulation factor?
Factor IX
What disease is an autoimmune bleeding disorder in which patients develop antibodies against their own platelets?
Idiopathic Thrombocytopenic Purpura (ITP)
Name some things that can cause disseminated intravascular coagulation.
Obstetric complications (amniotic fluid embolism, retained dead fetus, abruptio placenta), transfusion reactions, malignancy, trauma (brain injury, crush injury, burns), infection or sepsis, acute pancreatitis, ARDS
What lab test can be used to monitor effective response to treatment in patients with iron-deficiency anemia?
Reticulocyte count