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240 Cards in this Set
- Front
- Back
- 3rd side (hint)
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a child was anemic since birth. In what disease would a splenectomy result in increased hematocrit?
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spherocytosis
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A person has macrocytic, megaloblastic anemia. Why should you not give folate alone?
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It might be B12 deficiency. If you give folate, the symptoms improve, but nerve damage continues
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Person has anemia, hypercalcemia, bone pain. Bone marrow cells are hypercellular with large nuclei. What's the dx, and what will be in the pee?
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Multiple myeloma. You will likely see Bence-Jones protein in the urine
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Which neoplasms are associated with AIDS?
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B-cell lymphoma, Kaposi's sarcoma
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What chemotherapeutic medicine should be avoided in patients with CHF?
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doxyrubicin
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what is the targeted therapy used to treat tumors with the Philadelphia chromosome (t(9:22)?
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Imatinib (also called gleevec) inhibits the bcr-abl tyrosine kinase in these tumors
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a 10-year old kid has a nonhealing ulcer on his leg and a small, calcified spleen. What drug could help this guy?
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hydroxyurea, which increases fetal hemoglobin
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Name the white blood cells in decreasing order of abundance in the body
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Neutrophil, Lymphocyte, Monocyte, Eosinophil, Basophil
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What does polycythemia mean?
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Too many RBCs
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A person with anisocytosis has.....?
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varying sizes of RBCs
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A person with poikilocytosis has.......?
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varying shapes of RBCs
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A person with reticulocytosis has.......?
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too many immature RBCs
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How long does an RBC live in the body?
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120 days
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What is the normal amount of leukocytes in each microliter of blood?
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4,000-10,000
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Which leukocyte has a butterfly-shaped nucleus and contains histamine, heparin, and LTD-4?
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basophils
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Which cell serves the same function as a basophil, but in the interstitium instead of the blood?
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mast cells
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Which leukocyte has a butterfly-shaped nucleus and uniform granules containing histamine and arylsulfate?
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eosinophils
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Which leukocyte defends against helminths and protozoans?
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eosinophils
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What 5 things will cause an increase in the number of eosinophils in the blood?
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1) neoplasms
2) asthma 3) allergic processes 4) collagen vascular disease 5) parasites |
NAACP
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Which leukocyte has a multilobed nucleus and has granules containing lysozyme, myeloperoxidase, and lactoferrin?
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neutrophils
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What percentage of all white blood cells are neutrophils?
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40-75%
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Which leukocyte has a kidney-shaped nucleus, frosted glass cytoplasm, and is big?
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Monocyte
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What do monocytes differentiate into when they move into tissues?
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macrophages
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Which chemical activates macrophages?
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gamma-interferon
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Which cells are the best antigen-presenting cells in the body?
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dendritic cells
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What are dendritic cells called when they are in the skin?
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langerhaans cells
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What do lymphocytes look like?
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big round nucleus, little cytoplasm
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What is MHCII and what does it do?
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a protein on the surface of monocytes, macrophages, dendritic cells, and B cells. It presents antigen to T-cells
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what do plasma cells look like?
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Off-center nucleus with spotty chromatin, lots of ER and golgi
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Which lymphocyte has CD 19 and CD20?
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B cells and plasma cells
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Which lymphocyte has CD3 and CD4 on its surface?
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Helper T cells
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Which lympcyte has CD3 and CD8 on its surface?
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cytotoxic T cells
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What percentage of circulating lymphocytes are T cells?
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80%
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Where do B cells live in the spleen?
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White pulp
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Where do B cells live in the lymph nodes?
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follicle
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Name the factors in order in the Intrinsic Coagulation Cascade
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12 ->11 -> 9, 9+8 -> 10, 10+5 -> prothrombin ->fibrinogen ->clot formation
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Name the factors in order in the Extrinsic Coagulation Cascade
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tissue factor + 7 ->10, 10+5 -> prothrombin ->fibrinogen -> clot formation
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Which coagulation factors need vitamin K?
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prothrombin, 7, 9, 10, protein C, and protein S
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What does protein C do?
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inactivates factors 5 and 8
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What turns on antithrombin?
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heparin
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What does antithrombin do?
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inactivates thrombin, 9, 10, and 11
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Which chemical activates plasminogen into plasmin?
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tPA
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What does plasmin do?
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cleaves fibrin, breaks up clots
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What does factor 12 activate besides factor 11?
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the bradykinin system
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What does the bradykinin system do?
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increase vasodilation
increase vessel permeability increase pain |
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What chemical is required for platelets to stick to exposed basement membrane?
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von willebrand factor
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Which two chemicals decrease platelet aggregation?
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prostacyclin and NO
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what chemical increases platelet aggregation?
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thromboxane
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Which blood type is the universal recipient?
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AB. A and B antibodies on cells, no antibodies in plasma
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Which blood type is the universal donor?
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O. no antibodies on the cells, both antibodies in the plasma
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Why are normal RBCs shaped the way they are?
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The bi-concave shape maximizes surface area for a given volume; better oxygen off-loading
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What disease results in spherocyte RBCs?
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Hereditary spherocytosis. Due to a defect in a structural protein
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What disease results in elliptocyte RBCs?
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hereditary elliptocytosis
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What disease results in macro-ovalocyte RBCs?
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megaloblastic anemia (B12 and folate deficiency), marrow failure
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What disease results in helmet cells and schistocyte RBCs?
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DIC, traumatic hemolysis
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What disease results in sickle-shaped RBCs?
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Sickle cell anemia
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What disease results in bite cell RBC's?
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G6PD deficiency
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What disease results in teardrop shaped RBCs?
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myeloid metaplasia with myelofibrosis
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What disease results in acanthocyte RBCs?
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abetalipoproteinemia. acanthocytes are spiky
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What disease results in target RBC's?
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HbC disease, Asplenia, Liver disease, Thalassemia
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What disease results in poikilocyte RBCs?
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TTP/HUS, microvascular damage, DIC
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What disease results in burr cell RBCs?
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TTP/HUS
(thrombotic thrombocytogenic purpura / hemolytic uremic syndrome) |
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What disease process results in basophilic stippling?
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Thalassemia, anemia, iron deficiency, lead poisoning
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What disease can cause hypersegmented PMNs?
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folate/B12 deficiency
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What 4 things cause microcytic, hypochromic anemia?
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1)iron deficiency
2)thalassemia 3)lead poisining 4)sideroblastic anemia (malignancy) |
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What is the MCV in a person with microcytic anemia?
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<80
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What are the 3 causes of macrocytic anemia?
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1)megaloblastic (lack folate/B12)
2)drugs that block DNA synthesis 3)marked reticulocytosis |
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What is the MCV in a person with macrocytic anemia?
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>100
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A person with decreased serum haptoglobin and increased serum LDH likely has what process going on?
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anemia due to RBC hemolysis
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What test is used to distinguish autoimmune RBC hemolysis with other forms of hemolysis?
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the coombs test
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A person has macrocytic anemia and neurological deficits. What is the problem?
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They are deficient in vitamin B12
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G6PD and PK deficiency result in what kind of anemia?
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normocytic, normochromic
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Acute hemorrhage results in what type of anemia?
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normocytic, normochromic
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Anemia due to iron deficiency. What are the lab values for serum iron, transferrin/TIBC, ferritin, %transferrin saturation?
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serum iron: low
transferrin/TIBC: high ferritin: low %transferring sat: very low |
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Anemia due to chronic disease. What are the lab values for serum iron, transferrin/TIBC, ferritin, %transferrin saturation?
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serum iron: low
transferrin/TIBC: low ferritin: high %transferrin sat: unchanged |
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Anemia due to pregnancy/OCP use. What are the lab values for serum iron, transferrin/TIBC, ferritin, %transferrin saturation?
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serum iron: unchanged
transferrin/TIBC: high ferritin: unchanged %transferrin sat: low |
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Anemia due to hemochromotosis. What are the lab values for serum iron, transferrin/TIBC, ferritin, %transferrin saturation?
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serum iron: high
transferrin/TIBC: low ferritin: high %transferrin sat: very high |
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What happens in aplastic anemia?
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destruction of the myeloid stem cell in bone marrow leads to marked pancytopenia
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What causes aplastic anemia?
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radiation, benzene, viruses, alkylating agents, chloramphenicol, idiopathic
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what are the symptoms of aplastic anemia?
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fatigue, malaise, pallor, purpura, mucosal bleeding, petechiae, infections
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In a person with with aplastic anemia, what do the blood cells look like?
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Cells look normal, there are just not very many of them
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How would you treat a person with aplastic anemia
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marrow transplant, blood transfusion, stop giving them the offending agent
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What is mutated in sickle cell disease?
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beta chain in hemoglobin (glutamic acid replaced with a valine)
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In general, what is the problem in alpha-thalassemia?
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underproduction of the alpha chain in hemoglobin
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In general, what is the problem in beta-thalassemia?
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underproduction of the beta chain in hemoglobin
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What stimulates sickling in a person with sickle cell disease?
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Low O2, dehydration
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What is the treatment for sickle cell disease?
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bone marrow transplant, hydroxyurea (to increase HgF), supportive treatments
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What are some of the complications of sickle cell disease?
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aplastic crisis, autosplenectomy, infections, vaso-occlusive crisis, renal papillary necrosis, splenic sequestration
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In general, what happens in a person with HgC disease?
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also a beta chain mutation, but not as serious as sickle cell
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What is the difference between beta-thal major and beta-thal minor>
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beta-thal minor = beta chain is present, but underproduced
beta-thal major = beta chain is completely absent |
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Which thalassemias result in intrauterine fetal dealth?
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HbH and Hb Barts, both of which are alpha thalassemias
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What does the body compensate with in alpha-thalassemia?
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nothing, all hemoglobins need alpha chains, so there is no compensatory mechanism
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What does the body compensate with in beta-thalassemia?
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increased HbF
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All hemolytic anemias present with what two signs?
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increased serum bilirubin (jaundice) and increased reticulocytosis
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What is the procedure for a direct Coomb's test?
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add anti-Ig antibodies to patient's RBCs. If RBC's agglutinate, then the test is positive
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What is the procedure for an indirect Coomb's test?
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normal RBC's added to patient's serum. If RBCs agglutinate, then the test is positive
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In autoimmune hemolytic anemia, where are the RBCs destroyed?
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extravascularly, so, in the liver and spleen
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What happens in Warm Autoimmune hemolytic anemia?
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IgG attacks RBCs in warm temperatures. Seen in lupus, CLL, or with drugs
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What happens in Cold Autoimmune hemolytic anemia?
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IgM attacks RBCs in cold temperatures. Seen in mono or mycoplasmic pneumonias
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What happens in erythroblastosis fetalis?
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seen in newborns when their blood Rh doesn't match the mom's Rh, and the mom's antibodies attack the baby's RBCs
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What happens in hereditary spherocytosis?
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defect in ankyrin or spectrin causes RBCs to be balls instead of disks.
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How do you diagnose hereditary spherocytosis?
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spherocytes on blood smear, negative coomb's test, osmotic fragility test
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What happens in paroxysmal nocturnal hemoglobinemia?
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membrane defects lead to complement-induced intravascular hemolysis
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What happens in microangiopathic anemia, and what are its 4 causes?
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intravascular hemolysis due to DIC, lupus, TTP/HUS, or malignant hypertension
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In general, what happens during DIC?
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activation of coagulation cascade, leads to tons of micro-thrombi that use up all the platelets, fibrin, and co-factors
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What are the 7 causes of DIC?
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sepsis, trauma, obstetric problems, pancreatitis, malignancy, nephrotic syndrome, transfusion
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What will lab findings be in DIC?
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elevated PT and PTT, high fibrin split products, high D-dimer, low platelet count
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What happens in Idiopathic Thrombogenic Purpura (ITP)?
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peripheral platelet destruction, antiplatelet antibodies, increased megakarycytes, microbleeds, bruising
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What happens in Thrombotic Thrombogenic Purpura (TTP)?
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platelet aggregation, thrombosis, high LDH, neuro and renal symptoms, fever
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What 5 things cause bleeding disorders due to platelet anomalies?
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1)ITP
2)TTP 3)DIC 4)aplastic anemia 5)medications |
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What 3 things cause bleeding disorders due to coagulation cofactor anomalies?
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1)Hemophilia A
2)Hemophilia B 3)von Willebrand disease |
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All bleeding disorders due to platelet anomalies present with:
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microhemorrhage, mucous membrane bleeding, petechiae, purpura, nosebleeds
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All bleeding disorders due to coagulation cofactor anomalies present with:
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macrohemorrhage, bleeding into joints, easy bruising, high PT or PTT
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A person who is deficient in Factor 8 has.....?
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Hemophilia A
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A person who is deficient in Factor 9 has......?
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Hemophilia B
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What happens in a person who has von Willebrand's disease?
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lack von Willebrand Factor, which binds platelets to exposed basement membrane. mild disease
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platelet count, bleeding time, PT, and PTT: high, low, or unchanged in Thrombocytopenia?
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platelet count: down
bleeding time: up PT: unchanged PTT: unchanged |
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platelet count, bleeding time, PT, and PTT: high, low, or unchanged in Hemophilia A?
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platelet count: unchanged
bleeding time: unchanged PT: unchanged PTT: high |
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platelet count, bleeding time, PT, and PTT: high, low, or unchanged in Hemophilia B?
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platelet count: unchanged
bleeding time: unchanged PT: unchanged PTT: high |
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platelet count, bleeding time, PT, and PTT: high, low, or unchanged in von Willebrand's Disease?
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platelet count: unchanged
bleeding time: high PT: unchanged PTT: high |
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platelet count, bleeding time, PT, and PTT: high, low, or unchanged in DIC?
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platelet count: low
bleeding time: high PT: high PTT: high |
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platelet count, bleeding time, PT, and PTT: high, low, or unchanged in Vitamin K deficiency?
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platelet count: unchanged
bleeding time: unchanged PT: high PTT: high |
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platelet count, bleeding time, PT, and PTT: high, low, or unchanged in Bernard-Soulier Disease?
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platelet count: low
bleeding time: high PT: unchanged PTT: unchanged |
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platelet count, bleeding time, PT, and PTT: high, low, or unchanged in Glanzmann's thrombasthenia?
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platelet count: unchanged
bleeding time: high PT: unchanged PTT: unchanged |
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Where is the defect in Bernard-Soulier Disease?
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defect in platelet adhesion
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Where is the defect in Glansmann's thrombasthenia?
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defect in platelet aggregation
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Which co-factors does the PT time measure?
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the extrinsic pathway, cofactors 5, 7, 10, and thrombin
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Which co-factors does the PTT time measure?
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the intrinsic pathway, every cofactor except 7
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Which disease is characterized by the appearance of Reed-Steenberg cells?
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Hodgkin's Disease
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What do you call a giant cell seen in a tumor, with a bilobed nucleus that looks like owl's eyes?
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Reed-Steenberg cell
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What normal cell does a Reed-Steenburger cell arise from?
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B cell
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Which type of lymphoma spreads contiguously from a single, localized source?
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Hodgkin's Lymphoma
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Which type of lymphoma appears in many nodes at once, and does not spread contiguously?
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Non-Hodgkin's Lymphoma
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hypergammaglobinemia is a sign for which type of lymphoma?
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Hodgkin's lymphoma
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which lymphoma does not present with fever, night sweats, or weight loss?
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non-Hodgkin's lymphoma
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Which virus is implicated in stimulating Hodgkin's lympoma?
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Epstein Barr Virus (EBV)
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Which lymphoma is associated with HIV and immunosuppression?
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non-Hodgkin's lymphoma
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Which lymphoma presents in people 20-40 years old?
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non-Hodgkins lymphoma
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Which lymphoma presents in people under 20, or over 40?
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Hodgkins Lymphoma
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Nodular sclerosing Hodgkin's Lymphoma is characterized by what?
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collagen banding and lacunar cells in lymph nodes, few Reed-Steenberg cells, lots of normal lymphocytes
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What is the biggest factor in deciding the prognosis of a person with Hodgkin's Lympnoma?
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Reed-Steenberg cells to lymphocytes ratio; the more RS cells compared to lymphos, the worse the prognosis
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Where is the tumor in Multiple Myeloma?
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In the bone marrow
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In multiple myeloma, what is the precursor cell to the tumorous cell?
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Plasma cell
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in Multiple Myeloma, what do the cancerous plasma cells look like?
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fried eggs, apparently.
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In multiple myeloma, what do the tumors secrete?
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Tons of IgG and IgA
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What are Benze-Jones protein?
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Ig light chains in the urine
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What are 6 of the symptoms of multiple myeloma?
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hypercalcemia, renal insufficiency, infections, anemia, amyloidosis, lytic bone lesions
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What are 3 lab results in a person with Multiple Myeloma?
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Benze-Jones protein in urine, M-spike on serum protein electrophoresis, RBCs stacked like poker chips on blood smear
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Of the non-hodgkins lymphomas, which one is cancer of T cells?
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Lymphoblastic Lymphoma
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what non-hodgkin's lymphoma presents in children with "starry sky" histology and is associated with EBV?
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Burkitt's Lymphoma
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Which gene translocation results in CML (chronic myelongenous leukemia)?
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t(9:22)
the Philadelphia chromosome |
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Which genetic transposition results in Burkitt's Lymphoma, and what gene does it activate?
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t(8:14)
c-myc is activated |
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Which genetic transposition results in Follicular Lymphomas, and what gene does it activate?
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t(14:18)
bcl-2 is activated |
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Which genetic transposition results in AML (acute myelogenous leukemia)?
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t(15:17)
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What drug do you use to treat Acute Myelogenous Leukemia (AML)?
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trans-retinoic acid, otherwise known as Vitamin A
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Which genetic transposition results in Ewing's Sarcoma?
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t(11:22)
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Which genetic transposition results in Mantle Cell Lymphoma in adults?
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t(11:14)
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What two things comprise the Leukemoid Reaction?
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increased band cells and increased levels of leukocyte alkaline phosphatase
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In general, what goes on in a person with leukemia?
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neoplasm in bone marrow. high abnormal WBCs, low RBCs, low platelets, infection, anemia, bleeding
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What population does ALL (acute lymphoblastic leukemia) usually present in?
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children
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What are the precursor cells to the neoplasms in ALL?
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lymphoblasts (immature B and T cells)
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Which cells are the precursors to the neoplasm in AML?
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myeloblasts (leukocyte pecursors)
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What are Auer Rods and where do they appear?
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needle-shaped clumps of granule material in the neoplastic myeloblast cells in AML
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Which population does CLL (chronic lymphoblastic leukemia) usually present in?
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Older adults, those over 60
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What 4 signs are associated with CLL?
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lymphadenopathy, hepatosplenomegaly, warm antibody anemia, smudge cells on peripheral smear
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What 3 signs are associated with CML?
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increased neutrophils, increased metamyelocytes, splenomegaly
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What is Hairy Cell Leukemia, and who does it affect?
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Mature B cell tumor, it affects old people
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What condition is caused by LangerHaans cells infiltrating the lungs in young adults?
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Histiocytosis X
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what is the mechanism of Warfarin?
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activates antithrombin, decreases thrombin and cofactor 10
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Does Heparin affect the PT or the PTT?
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The PTT
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What drug rapidly neutralizes heparin?
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Protamine sulfate
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Between Warfarin and Heparin, which can you give a pregnant woman?
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Heparin, it does not cross the placenta
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What happens during Heparin-Induced Thrombocytopenia?
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heparin binds platelets, causing antibodies to destroy those and over-activate others. results in hypercoagulable state
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How do Lepirudin and Bivalirudin work?
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directly bind to thombin and inactivates it
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How does Warfarin work?
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shuts down gamma-carboxylation of Vit-K dependant co-factors 7, 9, 10, thrombin, protein C and S
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Which pathway does Warfarin affect, and does it affect PT or PTT?
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Warfarin affects the extrinsic pathway, and affects PT
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How do thrombolytic drugs work?
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turn plasminogen into plasmin, which dissolves clots and inactivates thrombin
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When do you use thrombolytic drugs?
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early acute MI or early stoke. All other uses, the risk of bleeding is too great
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How do thrombolytic drugs affect PT, PTT, and platelet count?
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increase PT, increase PTT, no change in platelet count
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What surface protein on a platelet binds to other platelets during clot formation?
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GP2b/3a
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How does aspirin affect platelets?
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decreased thromboxane production by inhibiting COX1 and COX2
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What do ticlopidine and clopridogrel do?
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prevent GP2b/3a expression on platelet surfaces, so they have nothing to bind to
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What does abcixamab do?
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antibody that binds to GP2b/3a so that platelets are unable to aggregate
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What does methotrexate do?
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blocks the synthesis of thymidine, used to treat cancer
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What does fluorouracil (5-FU) do?
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blocks the synthesis of thymidine and other pyramidines, used to treat cancer
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What does mercaptopurine (6-MP) do?
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blocks the synthesis of purines, used to treat cancer
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What does cytarabine do?
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Damages DNA during the S-phase in cells. Used to treat cancer
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What does cisplatin do?
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Crosslinks DNA, causes cell apoptosis. Used to treat cancer
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What does dactinomycin do?
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Blocks RNA polymerase. Used to treat cancer
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What does doxorubicin do?
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intercalates between DNA base pairs. Used to treat cancer
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What does bleomycin do?
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cleaves DNA strands. Used to treat cancer
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What does etoposide do?
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Inhibits topoisomerase 1, leads to DNA strand breaks. used to treat cancer
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What does tamoxifen do?
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selectively blocks estrogen receptors. Used to treat breast cancer
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what do vinca alkaloids do?
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inhibit microtubule formation, leading to decreased mitosis. Used to treat cancer
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What does paclitaxel do?
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Inhibits microtubule breakdown, leading to decreased mitosis. Used to treat cancer
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Paclitaxel works best during which phase of the cell cycle?
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Mitosis
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Vinca alkaloids work best during which phase of the cell cycle?
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Mitosis
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Bleomycin works best during which phase of the cell cycle?
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G2
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etoposide works best during which phase of the cell cycle?
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S and G2
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Methotrexate works best during which phase of the cell cycle?
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S
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Fluorouracil works best during which phase of the cell cycle?
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S
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Which phase of the cell cycle does mercaptopurine work best in?
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S
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What phase of the cell cycle does cisplatin work best in?
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doesn't matter, works all the time
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which phase of the cell cycle does doxorubicin work best in?
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doesn't matter, works in all of them
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which phase of the cell cycle does dactinomycin work best in?
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doesn't matter, works all the time
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What do the nitrosourea drugs do?
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alkylate DNA. used to treat cancer
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What does busulfan do?
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alkylates DNA. Used to treat cancer
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What does hydroxyurea do?
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inhibits ribonucleotide reductase, decreases DNA synthesis. Used to treat cancer
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What phase of the cell cycle does hydroxyurea work best in?
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S
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How does prednisone work in treating cancer?
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stimulates apoptosis
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What does trastuzumab do? (herceptin)
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antibody that binds to HER-2 receptors. Used to treat breast cancer
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What does imatinib do? (gleevec)
|
antibody to bcr-abl tyrosine kinase that shows up due to the philadelphia chromosome
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these two drugs are vinca alkaloids:
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vincristine, vinblastine
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these 4 drugs are nitrosoureas:
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carmustine, lomustine, semustine, streptozocin
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What are 3 side effects of methotrexate?
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myelosuppression (fix with folinic acid), fatty change in liver, mucositis
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What are 2 side effects of fluorouracil?
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myelosuppression (cannot fix with folinic acid), photosensitivity
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What are 3 side effects of cytarabine?
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leukopenia, thrombocytopenia, megaloblastic anemia
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What are 2 side effects of cyclophosphamide?
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myelosuppression, hemorrhagic cystitis
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Which organs does mercaptopurine adversely affect?
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Liver, GI tract, bone marrow
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what is 1 side effect of the nitrosoureas?
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CNS toxicity (dizziness, ataxia)
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What are 2 side effects of cisplatin?
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nephrotoxicity and acoustic nerve damage
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What are 2 side effects of busulfan?
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pulmonary fibrosis, hyperpigmentation
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What are 3 side effects of doxorubicin?
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cardiotoxic, myelosupression, alopecia
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What is 1 side effect of dactinomycin?
|
myelosuppression
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what are 2 side effects of bleomycin?
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pulmonary fibrosis, skin changes. NOT myelosuppression, oddly enough
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What are 2 side effects of hydroxyurea?
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bone marrow suppression, GI upset
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what are 3 side effects of etoposide?
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myelosupression, GI irritation, alopecia
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what 1 side effect of tamoxifen?
|
increased risk of endometrial carcinoma
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What is 1 side effect of trastuzumab?
|
cardiotoxicity
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What is 1 side effect of imatinib?
|
fluid retention
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What are 2 side effects of vincristine?
|
neurotoxicity, paralytic ileus
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What is 1 side effect of vinblastine?
|
bone marrow suppression
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What are 2 side effects of paclitaxel?
|
myelosuppression and hypersensitivity
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Teardrop RBCs and a large spleen suggest which disease?
|
adenogenic myeloid metaplasia
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|
Age less than 15, mediastinal mass (thymic) TdT+
|
ALL - t12;21 best prognosis
t9;22 worst |
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Smudge cells
|
SLL
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Only leukemia due to deletion not translocation
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CLL/SLL
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CD5+ and CD20+, over age of 60, can present with AI hemolytic anemia
|
SLL/CLL
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TRAP mnemonic for hairy cell leukemia
|
Trapped in red pulp
Trapped in bone marrow so can't go to lymph nodes DRY TRAP |
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Tx for hairy cell leukemia
|
Cladribine, an adenosine analog
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