Ppal99 Dissecting The Usmle 1,2,3 Leukocytes

Front 1

Neutrophil

Back 1

The Phagocyte (has anti-microbials, most--abundant)

Front 2

Eosinophil

Back 2

The Parasite Destroyer, Allergy Inducer

Front 3

Basophil

Back 3

The Allergy Helper (IgE receptor=> histamine release)

Front 4

Monocyte

Back 4

The Destroyer=> MP (hydrolytic enzymes, coffee-bean nucleus)

Front 5

Lymphocyte

Back 5

The Warrior => T, B, NK cells

Front 6

Platelets

Back 6

The Clotter (no nuclei, smallest cells)

Front 7

Naming Pattern

Back 7

--------blast
Pro-----cyte
--------cyte
Meta---cyte

Front 8

Blast:

Back 8

baby hematopoietic cell "Blast them all"

Front 9

Band

Back 9

baby neutrophil (has maximal killing power)

Front 10

Embryology of Hematopoietic Cells: how do RBC grow?

Back 10

>>Blood Dwellers:
>>Normoblast ⇨ Reticulocyte ⇨ RBC

Front 11

Embryology of Hematopoietic Cells: how do platelets grow?

Back 11

Blood Dwellers
Megakaryoblast ⇨ Platelet "big to little"

Front 12

Embryology of Hematopoietic Cells: how do macrophages grow?

Back 12

Blood Dwellers:
Monoblast ⇨ Monocyte ⇨ MP

Front 13

Embryology of Hematopoietic Cells: how are Tcells, B cells made

Back 13

Tissue Dwellers:
Lymphoblast ⇨ Lymphocytes ⇨
• NK cells
• T cells (T H=CD4, T K=CD8)
• B cells=> plasma cells

Front 14

Embryology of Hematopoietic Cells: how do PMN's, Eosinophils and basophils grow?

Back 14

Myeloblast ⇨ Band "stab" cell ⇨ WBC "leukocyte" ⇨ Granulocytes:
• PMNs = "neutrophils"
• Eosinophils
• Basophils =>mast cells

Front 15

what is demargination?

Back 15

90% of WBC are marginated along blood vessels (most are mature), 10% are in circulation
Under extreme stress the body will demarginate even immature WBC

Front 16

what compounds can cause demargination?
what happens to the levels of eosinophils, t cells and PMNs?

Back 16

Steroids/Cortisol/Epi => demargination (w/ low eosinophils, low T cells, high PMNs)

Front 17

describe the steps of demargination?
what is involved in step 1
what causes step 2

Back 17

1) Pavementing:
Selectins: select mature WBC out of circulation
Integrins: (via ICAM-1) integrate WBC into endothelium
2) Margination= flatten (Epi and cortisol cause this)
3) Diapedesis = moves like a slinky looking for a break in endothelium
4) Migration = slide into the tissue

Front 18

what Viruses can cause decreased WBCs "Leukopenia"?

Back 18

Parvo B-19, Hep E, Hep C

Front 19

Decreased WBCs "Leukopenia" Drugs?

Back 19

AZT, Benzene, Chloramphenicol, Vinblastine

Front 20

+High PMNs: Dx

Back 20

"Stress demargination"

Front 21

+Blasts (<5%): Dx

Back 21

"Leukemoid Rxn =extreme demargination, looks like leukemia" (Ex: burn pt)

Front 22

+Blasts (>5%): Dx

Back 22

Ieukemia

Front 23

+ Bands (immature neutrophils, max germ-killing ability): Dx

Back 23

"left shift" = > have Infection

Front 24

what is Agranulocytosis? and what drug causes them?

Back 24

( ⇩WBC):
• Carbamazepine
• Ticlopidine
• Clozapine
• PTU

Front 25

what is the earliest sign of agranulocytosis?

Back 25

stomatitis is earliest sign

Front 26

what would the levels of RBC, WBC
and platelets of Myelodysplastic
Syndromes be like

Back 26

⇧stem cells => ⇧ RBC, WBC, platelets

Front 27

what are the Myelodysplastic Syndromes

Back 27

Polycythemia Rubra Vera
Essential Thrombocythemia
Myelofibrosis
Aplastic anemia

Front 28

Polycythemia Rubra Vera:
pathogenesis
associated syndromes (4)
Tx

Back 28

>>Hct >60%, ⇩Epo, ''puritis after bathing"
>>Gout, splenomegaly, ruddy appearance/cyanosis
>>Tx: Phlebotomy

Front 29

Essential Thrombocythemia
describe and what does it lead to?
stain and what does it lead to?

Back 29

Plt > 600k ⇨ stroke/DVT / PE/MI
stainable Fe, ⇨decreased c-mpl (TPOr)

Front 30

Myelofibrosis:
pathogenesis
cells
prognosis

Back 30

fibrotic marrow => teardrop cells, extramedullary hematopoiesis, poor prognosis

Front 31

Aplastic anemia:
pathogenesis
lab

Back 31

bone marrow replaced with fat, low retics

Front 32

drugs that can cause Aplastic anemia:

Back 32

AZT, Benzene , Chloramphenicol, Vinblastine

Front 33

Viruses that can cause aplastic anemia:

Back 33

Parvo-B-l9, Hep E, Hep C

Front 34

Plasma Neoplasms:
pathogenesis
name all 3 diseases

Back 34

>>produce lots of Ab
>>ie.Waldenstrom
Macroglobulinemia
Monoclonal Gammopathy of Undetermined Significance
Multiple Myeloma

Front 35

Waldenstrom Macroglobulinemia:
Ig
spike

Back 35

IgM, hyperviscous, M spike

Front 36

Monoclonal Gammopathy of Undetermined Significance:
define
presentation

Back 36

old people w / gamma spike
• peripheral neuropathy

Front 37

Multiple Myeloma:
presentation, Ig, urine, RBC, prognosis, xray

Back 37

>>old people with back pain
• Multiple "punched out" osteolytic lesions
• IgG--(M-spike)
• mu light chain (Bence-Jones proteinuria)
• Rouleaux

Front 38

Multiple myeloma prognosis
albumin, vascularity, Ca, LDH, IL-6, Creatinine

Back 38

has poor prognosis:
⇩albumin, ⇧vascularity, ⇧Ca, ⇧LDH, ⇧IL-6, ⇧Creatinine

Front 39

MM 3 Dx test:

Back 39

Serum protein electrophoresis, bone marrow biopsy,
skeletal survey

Front 40

MM Tx:

Back 40

Melphalan + Prednisone

Front 41

Histiocyte (MP) Neoplasms:
Langerhans Cell Histocytosis "Histocytosis X": 4 clues

Back 41

• Kids w / eczema, "punched out" skull lesions
diabetes insipidus
exophthalmos

Front 42

what compound is toxic to leukemia cells

Back 42

Arsenic is toxic to leukemia cells

Front 43

what are the Leukemias?

Back 43

Acute
Chronic
Myeloid
Lymphoid

Front 44

Acute

Back 44

started in bone marrow, squeezes RBC out of marrow

Front 45

Chronic

Back 45

started in periphery, not constrained => will expand

Front 46

Myeloid leukemia
what cells are involved
test

Back 46

⇧RBC, WBC, platelets (⇩lymphoid cells) =>do bone marrow biopsy

Front 47

Lymphoid leukemia
what cells are involved
test

Back 47

⇧NK, T, B cells: (⇩myeloid cells) => do lymph node biopsy

Front 48

what is the most common leukemia?

Back 48

ALL

Front 49

which leukemia has the worst prognosis?

Back 49

AML

Front 50

which of the leukemias has the best prognosis

Back 50

CLL

Front 51

ALL/AML/CML/CLL
Age
Gender

Back 51

ALL/AML/CML/CLL
age: 0-15/ 15-30/ 30-50/>50
gender: Male/ Male/ Female/Male

Front 52

2 subtypes of ALL
which one has a bad prognosis?

Back 52

Morphologic:
Ll: scant cytoplasm
L2: irregular nuclei
L3 = B-ALL
Phenotypic:
B-ALL: TdT(-)
T-ALL: mediastinal mass (bad)

Front 53

3 subtypes of AML

Back 53

M3 "Promyelocytic Leukemia" t(15;17)
M5: bleeding gums
M7: Down's, anti-platelet ab

Front 54

3 subtypes of CML

Back 54

a) Chronic: ⇧WBC
b) Accelerated: ⇩RBC,⇩platelets
c) Blastic:⇧blast cells, Red plaques

Front 55

tx for AML M3

Back 55

Tx: Retinoic Acid

Front 56

subtype of CLL and average survival.

Back 56

Diffuse lymphadenopathy
Average survival: 3 yrs

Front 57

DX: Infxn: Bacterial
Bleeding/ petechiae
Teardrop cells
Low energy state
Bone pain
Thrombocytopenia

Back 57

AML and ALL

Front 58

presentation of CML

Back 58

Go everywhere macrophages go

Front 59

presentation of cells in CLL

Back 59

Small mature
lymphocytes,
"soccer ball"
nuclei

Front 60

5 markers : AML
which one indicates good chemo response?
which one indicates bad prognosis?
which one indicates good prognosis?

Back 60

PAS stain ( + )
TdT ( + )
Calla ( + ) = > good chemo response
t(4,11): bad prog
t(12,21): good prog

Front 61

markers: ALL

Back 61

Sudan Stain
Auer rods (M3)
MPO

Front 62

3 markers: CML

Back 62

t(9 ,22) ·"Philadelphia chromosome"
bcr-abl
⇩LAP

Front 63

3 markers: CLL
which one has good prognosis

Back 63

CD 19,20
Smudge cells = fragile WBCs.
Mutated Vh genes: good prog

Front 64

AML and ALLTx:

Back 64

daunorubicin

Front 65

CML tx:

Back 65

Imatinib "Gleevac"

Front 66

CLL tx:

Back 66

Chlorambucil

Front 67

Lymphomas: presentation

Back 67

recurrent uticaria and eosinophilia

Front 68

Hodgkin's: age range

Back 68

20-40 y/o

Front 69

Non-Hodgkin's:
who is at risk
location
what is increased?

Back 69

ileum (⇧lymphoid tissue), affects
immunocompromised

Front 70

Pathology Staging: hodgkins
what stage has a 90% cure
what is A
what is B

Back 70

I: 1 group of lymph nodes
II: 2 groups (same side of diaphragm, 90% cure)
III: 2 groups across diaphragm
IV: metastasis (lymph node => organ)

A = without symptoms
B = sx: weight loss, fever, night sweats

Front 71

Pathology Staging: non- hodgkins

Back 71

Histology Staging:
I: limited to first layer
II: second layer
III: local invasion
IV: metastases

Front 72

what should you check for for non-hodgkins lymphoma

Back 72

Colon Cancer => do colonoscopy
HIV => ELIZA

Front 73

4 common types of hodgkin's lymphoma
which one has the best prognosis?
which one has the worst prognosis?
which one has the low Reed strenburg cell?

Back 73

EBV
a) Lympho Predom: best prognosis
b) Lymphocyte Depleted: worst prog
c) Mixed lymphocyte/ histiocyte
d) Nodular Sclerosis: low RS

Front 74

2 B-cell: most common Types of non-hodgkins lymphomas
tranlocation
markers
biopsy
virus

Back 74

Follicular: t(14,18), bcl2
Burkitt: t(8, 14), c-myc, starry MP, EBV

Front 75

what indicates a poor prognosis in hodgkins lymphoma? and tx

Back 75

Albumin <4: poor prognosis
tx; MOPP or ABVD

Front 76

Reed-Sternberg
describe
CD
type of cells

Back 76

B cells with bad Ig,owl's eyes, CD30, lacunar cells

Front 77

Tcell non hodgkins lymphoma: 2 types and describe
describe each

Back 77

T -cell: rare
Mycosis Fungoides: "bathing suit" rash
Sezary syndrome: cerebriform cells = MF
mets to blood

Front 78

two types of burkitts lymphoma and which one has a poor prognosis?

Back 78

• American kids: abdominal mass
• Poor: jaw mass

Front 79

ChemoTx: hodgekins and non-hodgekins

Back 79

Hodgekins: MOPP or ABVD
NH: CHOP