Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
393 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
child has been anemic since birth. splenectomy would result in increasesd hematocrit in what dz?
|
spherocytosis
|
|
|
|
pt presents w/ fatigue, and blood tests show a macrocytic, megaloblastic anemia. what is the danger of givign folate alone
|
masks signs of neural damage with vit B12 deficiency
|
|
|
|
pt presents w/ anemia hypercalcemia, and bone pain on palpation; bone marrow biopsy shows a slide backed with cells that have a large, round, off center nucleus. What is the dx and what may be found on urinalysis
|
multiple myeloma (plasma cell neoplasm); Bence Jones protein (Ig light chains)
|
|
|
|
AIDS pt has just been diagnosed with CA. What dneoplasms are associated w/AIDS?
|
B cell lympnoma, kaposi's sarcoma.
|
|
|
|
Pt w/ new CA dx and known hx of CHF is being evaluated for chemotherapy. What chemotherapeutic agent shoudl be avoided in this pt?
|
Doxorubicin (cardiotoxic)
|
|
|
|
chromosome analysis reveals the presence of the philadelphia chromosome, t(9;22). What is the latest targeted therapy for this dz and how does it work
|
Imatinib (Gleevec) is used to treate CML; a monoclonal Ab against the bcr-able tyrosine kinase
|
|
|
|
these cells are anucleate, bioconcave giving them a large surface area: volume ratio for easy gas exchange.
|
erythrocyte
|
|
|
|
how do erythrocytes get their energy
|
mostly glucose (90%) 10% via HMP shunt
|
|
|
|
erythrocytes anarobically degrade glucose to _____
|
lactate
|
|
|
|
what is the survival time of erythrocytes
|
120 D
|
|
|
|
membrane of erythrocytes contain ______-_______ antiport which is important in the "physiologic chloride shifft," which allows the RBC to transport CO2 from the periphery to the lungs for elimination
|
cloride-bicarbinate antiport
|
|
|
|
erythrocytosis/polycythemia (def)
|
increased number of red cells
|
|
|
|
anisocytosis
|
RBCs of varying sizes
|
|
|
|
Poikilocytosis
|
RBCs of varyng shaPes
|
|
|
|
reticulocyte
|
immature erythrocyte
|
|
|
|
these blood cells are responsible for defence against infections.
|
leukocytes
|
|
|
|
give me leukocyte types (5)
|
granulocytes (basophils, eosinophils, neutrophils) and mononuclear cells (lymphocytes, monocytes
|
|
|
|
Normally leukocyte count
|
4000-10,000 per microliter
|
|
|
|
these blood cells mediate allergic reactions
|
basophils
|
|
|
|
basophils consist of ____ of all leukocytes
|
<1%
|
|
|
|
basophils have a _______ nucleus
|
bilobate
|
|
|
|
basophils have many granules that stain in this way ______
|
basophilic-stain redily wiht basic stains
|
|
|
|
give three contents of basophilic granules in basophils
|
heparin, histamine, leukotrienes (LTD-4)
|
|
|
|
these blood cells mediate type I hypersensitivity reactions.
|
mast cells
|
|
|
|
This drug prevents mast cell degranulation and is used to treat asthma
|
cromolyn sodium
|
|
|
|
Degranulation of mast cells involves release of these factors
|
histamine, heparin, eosonophil chemotactic factors
|
|
|
|
mast cells can bind to this Ab
|
IgE
|
|
|
|
Mast cells are very similar yet distinct from this cell type
|
basophils
|
|
|
|
Mast cells are found here
|
tissue
|
|
|
|
these cells defent against helminthic & protozoan infections and are hightly phagocytic for Ag-Ab complexes
|
eosinophil
|
|
|
|
eosinophils normally make up this percent of all leukocytes
|
1-6%
|
|
|
|
regarding appearance, eosinophils have a ____ nucleus & and are packed with large eosinophils granuls of uniform size
|
bilobate
|
|
|
|
eosinophils produce these 2 substances
|
histaminase and arylsulfatase
|
|
|
|
eosin=____ philic=_____
|
dye loving
|
|
|
|
causes of eosinophilia
|
NAACP neoplastic asthma allergic processes collagen vascular dz parasites
|
|
|
|
this blood cell is an acute inflammatory response cell
|
neutorphils
|
|
|
|
neutrophils make up _______ of WBCs
|
40-75%
|
|
|
|
neutrophils have a ______ nucleus
|
multilobed
|
|
|
|
hypersegmented polys are seen in __________
|
vit B12/folate deficiency
|
|
|
|
neutrophils have large, spherical, azurophilic primary granules that contain hydrolytic enzymes, lysosyme, myeloperoxidase, and lactoferrin--they are called this
|
lysosomes
|
|
|
|
these blood cells are large with a kidney-shaped nucleus. They have extensive "frosted glass" cytoplasm.
|
monocytes
|
|
|
|
mono=___ cyte=____
|
one cell
|
|
|
|
moncytes cells differentiate into _____in tissues
|
macrophages
|
|
|
|
these blood cells are small and round with a densely staining nucleus & a small amount of pale cytoplasm
|
lymphocytes
|
|
|
|
___ lymphocytes produce Ab
|
B
|
|
|
|
___ lymphocytes manifest the cellular immune response as well as regulhumoralate B lymphocytes and macrophages
|
T
|
|
|
|
B lymphocytes are part of the _______ immune response
|
humoral
|
|
|
|
B cells arise from stem cells in the _______ where they also mature
|
bone marrow mneu: B=bone marrow
|
|
|
|
After maturation B cells migrate to ______ (follicles of lymph nodes, white pulp of spleen, unencapsulated lymphoid tissue).
|
peripheral lymphoid tissue
|
|
|
|
When Ag is encountered, B cells differentiate into _____ and produce Ab.
|
plasma cells
|
|
|
|
Plasma cells recognize Ab because they have _______
|
memory
|
|
|
|
B lymphocytes can fx as antigen-presenting cell (APC) via _______
|
MHC II
|
|
|
|
these blood cells have an off-center nucleus, with clock face chromatin distribution, abundant RER and well developed Golgi apparatus
|
plasma cell
|
|
|
|
_________ is a plasma cell neoplasm
|
multiple myeloma
|
|
|
|
B cells differentiate into _______, which can produce large amounts of Ab specific to partifcular Ag
|
plasma cell
|
|
|
|
B lymphocytes have these cell markers
|
CD 19, CD20
|
|
|
|
this blood cells mediates cellular immune responses.
|
T lymphocyts
|
|
|
|
T cells originate from stem cells in the ________, but matures in the ________.
|
bone marrow thymus mneu: T is for Thymus
|
|
|
|
T cells differentiate into these three types of T cells
|
Cytotoxic T cells Helper T cells suppressor T cells
|
|
|
|
cytotoxic T cells have MHC ___ & CD____.
|
I,8 mneu: MHC x CD=8 (e.g., MHC 2 x CD4=8, & MHC 1 x CD8=8)
|
|
|
|
helper T cells have MHC ___ & CD____.
|
II, 4 mneu: MHC x CD=8 (e.g., MHC 2 x CD4=8, & MHC 1 x CD8=8)
|
|
|
|
CD stands for ______
|
cluster of differentiation
|
|
|
|
This cell has a long life in tissues. It Phagocytizes bacteria, cell debris, and senescent red cells & scavenges damaged cell and tissues.
|
macrophage
|
|
|
|
Macrophages differentiate from circulating blood _______
|
monocytes.
|
|
|
|
macrophages are activated by __________.
|
gamma-interferon
|
|
|
|
macrophages can fx as APC via _______.
|
MHC II
|
|
|
|
macro=______ phage=_______
|
large eater
|
|
|
|
these cells are professional APCs. They are the main inducers of primary Ab response.
|
dendritic cells
|
|
|
|
Dendritic cells express these two things on their cell serfaces
|
MHC II & Fc receptors (FcR)
|
|
|
|
dendritic cells are called ________ cells on skin
|
Langerhan cells
|
|
|
|
plasma - clotting factors =(e.g., fibrinogen)
|
serum
|
|
|
|
blood composition [chart p. 290]
|
--
|
|
|
|
these cells are professional APCs. They are the main inducers of primary Ab response.
|
dendritic cells
|
|
|
|
Dendritic cells express these two things on their cell serfaces
|
MHC II & Fc receptors (FcR)
|
|
|
|
dendritic cells are called ________ cells on skin
|
Langerhan cells
|
|
|
|
plasma - clotting factors =(e.g., fibrinogen)
|
serum
|
|
|
|
blood composition [chart p. 290]
|
--
|
|
|
|
name 3 coagulation factor inhibitors involved in fibrinolysis
|
protein C & S Antithrombin III tPA
|
|
|
|
Protein C & protein S inactivate these two steps in the coagulation cascade
|
Va & VIIIa
|
|
|
|
Protein C & protein S are dependant on this vitamen
|
K
|
|
|
|
antithrombin III inactivates these four steps in the coagulation pathway
|
thrombin, IXa, Xa, & XIa
|
|
|
|
antithrombin III is activated by this anticoagulant
|
heparin
|
|
|
|
tPA generates _______, which cleaves fibrin
|
plasmin
|
|
|
|
convergence of coagulation, compliment and kinin pathways [image p. 291]
|
--
|
|
|
|
neoplasmic progression
|
normal cells->hyperplasia-> carcinoma in situ/preinvasive -> invasive carcinoma ->metastatic focus
|
|
|
|
hyperplasia is
|
increased cell number
|
|
|
|
this type of "plasia" shows an abnormal proliferation of cells w/ loss of size, shape and orientation
|
dysplasia
|
|
|
|
in carcinoma in situ neoplasmic cells have NOT invaded _________
|
basement membrane
|
|
|
|
carcinoma in situ neoplasmic cells have a _____ nuclear/cytoplasmic ratio and clumped cromatin
|
high
|
|
|
|
in invasive carcinoma cells have invaded the basement membrane using _______ & _______
|
collagenases and hydrolases
|
|
|
|
invasive carcinoma can metastasize if they reach _______ or ________ vessel
|
blood or lymphatic
|
|
|
|
metastasis is
|
spread to distant organ
|
|
|
|
in order for neoplasmic cells to metastasize they must survive the host _______
|
immune system
|
|
|
|
in the "seed and soil" theory of metastasis what is the seed and what is the soil.
|
seed=tumor embolus soil=target organ-liver, lungs, bone, brain
|
|
|
|
this type of "plasia" is an increase in number of cells
|
hyperplasia
|
|
|
|
is hyperplasia reversible
|
yes
|
|
|
|
in this type of "plasia" 1 adult cell type is replaced by another
|
metaplasia
|
|
|
|
is metaplasia reversable
|
yes
|
|
|
|
metaplasia is often secondary to _______- as is the case w/ ________ metaplasia in trachea and bronchi of smokers
|
irritation. squamous
|
None
|
|
|
dysplasia
|
is abnormal growth with loss of cellular orietnation, shape, and size in comparison to normal tissue maturation
|
|
|
|
wat is concerning about dysplasia
|
it is often preneoplasmic
|
|
|
|
is dysplasia reversible
|
yes
|
|
|
|
In this type of "plasia" there are abnormal cells lacking differation.
|
anaplasia
|
|
|
|
in this type of cell "plasia" you see primitive cells of the same tissue, often equated with undifferentiated malignant neoplasms. You may see tumor giant cells.
|
anaplasia
|
|
|
|
this type of plasia describes a clonal proliferation of cells that is uncontrolled and excessive
|
neoplasia
|
|
|
|
the grade of a tumor referrs to the degree of __________ based on histologic appearance of tumor.
|
cellular differentiation
|
|
|
|
tumors are usually graded on a scale of ____ to _____
|
1-4
|
|
|
|
grade is often determined by the number of ______ per high power field
|
mitosis
|
|
|
|
_______ gives information about the character of the tumor itself versus _______ which tells us about the spread of the tumor in a specific pts
|
grade stage mneu: Stage=Spread
|
|
|
|
The ______ of a tumor tells us about the degree of localization/spread of a tumor based on the site and size of the primary lesion, spread to regional lymph nodes, presence of metastases
|
Stage
|
|
|
|
In the TNM staging system: T= N= M=
|
T=size of tumor N=Node involvement M=Metasteses
|
|
|
|
Given the tumor name tell what the cell type is and whether it is benigh or malignant. adenoma, papilloma
|
epithelium benign
|
|
|
|
Given the tumor name tell what the cell type is and whether it is benign or malignant. andinocarcinoma or papillary carcinoma
|
epithelium malignant
|
|
|
|
Given the tumor name tell what the cell type is and whether it is benign or malignant. leukemia, lymphoma
|
malignant tumor of the blood cells
|
|
|
|
Given the tumor name tell what the cell type is and whether it is benign or malignant. hemangioma
|
benign tumor of the blood vessels
|
|
|
|
Given the tumor name tell what the cell type is and whether it is benign or malignant. leiomyoma
|
benign tumor of the smooth mm
|
|
|
|
Given the tumor name tell what the cell type is and whether it is benign or malignant. leiomyosarcoma
|
malignant tumor of smooth mm
|
|
|
|
Given the tumor name tell what the cell type is and whether it is benign or malignant. rhabdomyoma
|
benign tumor of the skeletal mm
|
|
|
|
Given the tumor name tell what the cell type is and whether it is benign or malignant. rhabdomyosarcoma
|
malignant tumor of the skeletal mm
|
|
|
|
Given the tumor name tell what the cell type is and whether it is benign or malignant. osteosarcoma
|
malignant tumor of the bone
|
|
|
|
Given the tumor name tell what the cell type is and whether it is benign or malignant. osteoma
|
benign tumor of the bone
|
|
|
|
Given the tumor name tell what the cell type is and whether it is benign or malignant. lipoma
|
benign tumor of the fat cell
|
|
|
|
Given the tumor name tell what the cell type is and whether it is benign or malignant. liposarcoma
|
malignant tumor of the fat cell
|
|
|
|
a maature teratoma is a _______ (benign/malignant) tumor of > 1 cell type
|
benign
|
|
|
|
a immature teratoma is a _______ (benign/malignant) tumor of > 1 cell type
|
malignant
|
|
|
|
the term carcinoma implies an _________ origin, whereas sarcoma denotes a ________ origin. both terms imply malignancy
|
epithelial mesenchymal
|
|
|
|
give the neoplasm associated with the dz. down syndrom
|
ALL, AML mneu: we ALL fall DOWN
|
|
|
|
give the neoplasm associated with the dz. xeroderma pigmentosum, albinism
|
melanoma and basal, squamous cell carcinoma of the skin
|
|
|
|
give the neoplasm associated with the dz. chronic atrophic gastritis
|
gastric adenocarcinoma
|
|
|
|
give the neoplasm associated with the dz. pernicious anemia
|
gastric adenocarcinoma
|
|
|
|
give the neoplasm associated with the dz. postsurgical gastric remnance
|
gastric adenocarcinoma
|
|
|
|
give the neoplasm associated with the dz. tuberous sclerosis (facial angiofibroma, seizures, mental retardation)
|
astrocytoma and cardiac rhabdomyoma
|
|
|
|
give the neoplasm associated with the dz. actinic keratosis
|
squamous cell carcinoma of the skin
|
|
|
|
give the neoplasm associated with the dz. barret's esophagus (chronic GI reflux)
|
esophageal adenocarcinoma
|
|
|
|
give the neoplasm associated with the dz. Plummer-Vinson syndrome (atrophic glossitis, esophageal webs, anemia; all due to iron deficiency
|
squamous cell carcinoma of the esophagus
|
|
|
|
give the neoplasm associated with the dz. cirrhosis (alcoholic, hep B or C)
|
hepatocellular carcinoma
|
|
|
|
give the neoplasm associated with the dz. ulcerative colitis
|
colonic adenocarcinoma
|
|
|
|
give the neoplasm associated with the dz. paget's dz of the bone
|
secondary osteosarcoma and fibrosarcoma
|
|
|
|
give the neoplasm associated with the dz. immondeficiency states
|
malignant lymphomas
|
|
|
|
give the neoplasm associated with the dz. AIDS
|
aggressive malignant lymphomas (non-Hodgkin's) and Kaposi's sarcoma
|
|
|
|
give the neoplasm associated with the dz. Autoimmiune dz (e.g., Hashimoto's thyroiditis, myasthenia gravis)
|
benign and malignant thymomas
|
|
|
|
give the neoplasm associated with the dz. Acanthosis nigricans (hyperpigmentation and epidermal thickening
|
visceral malignancy (stomach, lung, breast, uterus)
|
|
|
|
give the neoplasm associated with the dz. dysplastic nevus
|
malignant melanoma
|
|
|
|
when oncogenes become functional, this results
|
Cancer
|
|
|
|
give the associated tumor for the oncogene: abl
|
CML
|
|
|
|
give the associated tumor for the oncogene: c-myc
|
burkitt's lymphmoma
|
|
|
|
give the associated tumor for the oncogene: bcl-2
|
follicular and undifferentiated lympomas
|
|
|
|
this oncogene inhibits apoptosis
|
bcl-2
|
|
|
|
give the associated tumor for the oncogene: erb-B2
|
breast ovarian, and gastric carcinomas
|
|
|
|
give the associated tumor for the oncogene: ras
|
colon carcinoma
|
|
|
|
give the associated tumor for the oncogene: L-myc
|
Lung tumor
|
|
|
|
give the associated tumor for the oncogene: N-myc
|
Neuroblastoma
|
|
|
|
give the associated tumor for the oncogene: ret
|
multiple endocrine neoplasia (MEN) types II & III
|
|
|
|
in this type of gene, loss of function of BOTH allels results in the expression of cancer
|
tumor suppressor gene
|
|
|
|
given the tumor suppressor gene and chromosome give the associated tumor: Rb gene on Chromosome 13q
|
retinoblastoma, osteosarcoma
|
|
|
|
given the tumor suppressor gene and chromosome give the associated tumor: BRCA1 & 2 on chromosome 17q & 13q
|
breast and ovarian CA
|
|
|
|
given the tumor suppressor gene and chromosome give the associated tumor: p53 on chromosome 17p
|
most human CA, Li-Fraumeni syndrome
|
|
|
|
given the tumor suppressor gene and chromosome give the associated tumor: p16 on 9p
|
Melanoma
|
|
|
|
given the tumor suppressor gene and chromosome give the associated tumor: p16 on chromosome 9p
|
melanoma
|
|
|
|
given the tumor suppressor gene and chromosome give the associated tumor: APC on chromosome 5q
|
colorectal CA
|
|
|
|
given the tumor suppressor gene and chromosome give the associated tumor: WT1 on chromosome 11q
|
Wilms' tumor
|
|
|
|
given the tumor suppressor gene and chromosome give the associated tumor: NF1 on chromosome 17q
|
Neurofibromatosis type 1
|
|
|
|
given the tumor suppressor gene and chromosome give the associated tumor: NF2 on chromosome 22q
|
Neurofibromatosis type 2
|
|
|
|
given the tumor suppressor gene and chromosome give the associated tumor: DPC on chromosome 18q
|
Pancreatic CA
|
|
|
|
given the tumor suppressor gene and chromosome give the associated tumor: DCC on chromosome 18q
|
colon CA
|
|
|
|
tumor markers should be used as the primary tool for CA dz. T or F
|
F
|
|
|
|
Tumor markers can be used to confirm a diagnosis. T or F
|
T
|
|
|
|
Tumor markers can be used to monitor tumor for recurrencce. T or F
|
T
|
|
|
|
Tumor markers can be used to monitor response to therapy. T or F
|
T
|
|
|
|
this tumor marker is used for screening for prostate carcinoma
|
Prostate Specific Antigen (PSA)
|
|
|
|
this tumor marker is is very nonspecific but is produced by ~ 70% of colorectal and pancreatic CA. It is also produced by gastric and breast carcinomas
|
Carcinoembrionic Ag (CEA)
|
|
|
|
this tumor marker is normally made in the fetus it is seen in hepatocellular carcinomas and germ cell tumors of the testis (e.g., yolk sac tumor)
|
alpha-fetoprotien.
|
|
|
|
this tumor marker is seen in Hydatidiform moles, choriocarcinomas, and Gestational trophoblastic tumors
|
B-HCG
|
|
|
|
this tumor marker is seen in ovarian and malignant epithelial tumors
|
CA-125
|
|
|
|
this tumor marker is seen in melanoma, neural tumors, astrocytomas
|
S-100
|
|
|
|
this tumor marker is seen in bone metasteses, obstructive biliary dz, and Paget's dz of the bone
|
Alk phosphatase
|
|
|
|
this tumor marker is seen in neuroblastoma, lung and gastric CA
|
Bombesin
|
|
|
|
this tumor marker is seen in harry cell leukemia (B-cell neoplasm
|
Tartrate-resistant acid phosphatase (TRAP)
|
|
|
|
these are laminated, concentric, calcific spherules seen in several CAs.
|
psamoma bodies
|
|
|
|
what 4 CA are psammoma bodies seen in
|
1) Papillary adenocarcinoma of thyroid 2) Serious papillary cystadenocarcinoma of ovary 3) Meningioma 4) Malignant mesothelioma mneu: PSaMMoma Papillary (thyroid) Serous (ovary) Meningioma Mesothelioma
|
|
|
|
Given the oncogenic virus, give the associated Cancer: HTLV-1
|
adult T-cell leukemia
|
|
|
|
Given the oncogenic virus, give the associated Cancer: HBV, HCV
|
hepatocellular carcinoma
|
|
|
|
Given the oncogenic virus, give the associated Cancer: EBV
|
Burkitt's lymphoma, nasopharyngeal carcinoma
|
|
|
|
Given the oncogenic virus, give the associated Cancer: HPV
|
Cervical carcinoma (16,18), penile/anal carcinoma
|
|
|
|
Given the oncogenic virus, give the associated Cancer: HHV-8
|
Kaposi's sarcoma, body cavity fluid B cell lymphoma
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: aflatoxins
|
liver (HCC)
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: vinyl chloride
|
liver (angiosarcoma)
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: CCl4
|
liver (centrilobular necrosis, fatty change)
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: nitrosamines
|
esophagus, stomach
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: cigarette smoke
|
larynx, lung
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: Asbestos
|
Lung (mesothelioma & bronchogenic carcinoma)
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: arsenic
|
skin (squamous cell carcinoma)
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: Naphthalene (aniline) dies
|
Bladder (transitional cell carcinoma
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: Alkylating agents
|
Blood (lleukemia
|
|
|
|
given the paraneoplastic effect, give the neoplasm: Cushing's syndrome due to ACTH
|
Small cell lung carcinoma
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: SIADH
|
small cell lung carcinoma and intracranial neoplasms
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: Hypercalcemia due to PTH, TGF alpha and beta, IL-1
|
squamous cell lung, renal cell, breast, multiple myeloma, bone mets
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: Polycytthemia due to increased erythropoietin
|
renal cell carcinoma or hemangioblastoma
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: Lambert-Eaton syndrome (mm weakness) due to Ab against presynaptic Ca++ channels at neuromuscular jx
|
thymoma, small cell lung Ca
|
|
|
|
given the chemical carcinogen, tell me the organ it acts on: Gout, urate nephropathy due to hyperuicemia due to excess nucleic acid turnover (i.e., cytotoxic tx)
|
leukemia & lymphoma
|
|
|
|
what percentage of brain tumors are from metastesis
|
50%
|
|
|
|
what primaries commonly metastasize to brain (5)
|
Lung, Breast, Skin (melanoma), Kidney (renal cell carcinoma), GI mneu: Lots of Bad Stuff Kills Glia
|
|
|
|
what are the most common sites of metastasis after regional lymph nodes
|
liver & lung
|
|
|
|
give the tumors that commonly metastasize to the liver in order of frequency
|
Colon>Stomach>Pancreas>Breast>Lung mneu: Cancer Sometimes Penetrates Benight Liver
|
|
|
|
what is more common liver mets or liver primary
|
mets>> primary liver tumors
|
|
|
|
what are the primary tumors that metastasize to the bone
|
Prostate, thyroid, testes, breast lung, kidney P.T. Barnum Loves Kids
|
|
|
|
What are the two most common tumors that metastasize to bone
|
breast & prostate
|
|
|
|
what is more common bone primaries or bone mets
|
BONE METS
|
|
|
|
incidence of prostate CA in males
|
32%
|
|
|
|
incidence of breast CA in females
|
32%
|
|
|
|
incidence of lung CA in males
|
16%
|
|
|
|
incidence of lung CA in females
|
13%
|
|
|
|
incidence of colon and rectal CA in males
|
12%
|
|
|
|
incidence of colon and rectal CA in females
|
13%
|
|
|
|
CA is the ___ leading cause of death in the US
|
2nd. Heart dz is 1st
|
|
|
|
mortality of lung CA in males
|
33%
|
|
|
|
mortality of lung CA in females
|
23%
|
|
|
|
mortality of Prostate CA in males
|
13%
|
|
|
|
mortality of Breast CA in females
|
18%
|
|
|
|
are lung CA deaths still rising in US despite nat'l efforts to prevent smoking
|
they've plateaud in males still rising in females
|
|
|
|
normal shape of RBC
|
bioconcave
|
|
|
|
given the RBC form give the condition: spherocytes
|
hereditary spherocytosis or autoimmune hemolysis
|
|
|
|
given the RBC form give the condition: elliptocyte
|
hereditary eliptocytosis
|
|
|
|
given the RBC form give the condition: macro-ovalocytes
|
megaloblastic anemia marrow failure
|
|
|
|
in a blood smear of a pt w/ megaloblastic anemia there will be macro-ovalocytes and also this
|
hypersegmented PMNs
|
|
|
|
given the RBC form give the condition: helmet cell, shistocyte
|
DIC or traumatic hemolysis
|
|
|
|
given the RBC form give the condition: Sickle cell
|
Sickle cell anemia
|
|
|
|
given the RBC form give the condition: Teardrop cell
|
myeloid metaplasia w/ myelofibrosis
|
|
|
|
given the RBC form give the condition: Acanthocytes
|
spiny appearance in abetalipoproteinemia
|
|
|
|
given the RBC form give the condition: Target cells
|
HbC dz, Asplenia, Liver dz, Thalassemia mneu: HALT
|
|
|
|
given the RBC form give the condition: Poikilocytes
|
Nonuniform shapes in TTP/HUS, microvascular damage, DIC
|
|
|
|
given the RBC form give the condition: Burr cell
|
TTP/HUS
|
|
|
|
MCV of microcytic hypocromic anemia
|
<80
|
|
|
|
MCV of macrocytic
|
>100
|
|
|
|
these vitamen deficiencies are associated with hypersegmented PMNs
|
vit B12 & folate
|
|
|
|
unlike folate deficiency, this vitamen deficiency is associated with neurological problems
|
vit B12
|
|
|
|
vit B12 deficiency is called
|
pernicous anemia
|
|
|
|
Decreased serum haptoglobin and increased serum LDH indicate this
|
RBC hemolysis
|
|
|
|
this test is used to distinguish between immune v. non-immune mediated RBC hemolysis
|
direct coombs test
|
|
|
|
iron deficiency, thalassemias, lead poisioning, and sideroblastic anemias cause this type of anemia
|
microcytic, hypochromic
|
|
|
|
pt labs show low serum iorn, increased TIBC, decreased ferritin. What is the dx.
|
iron deficiency (microcytic anemia)
|
|
|
|
pts blood smear shows target cells what is the dx?
|
thalassemia (microcytic anemia)
|
|
|
|
pt presents w/ vit B12/folate deficiency what type of anemia do you susbect
|
megaloblastic, macrocytic
|
|
|
|
drugs that block DNA synthesis (e.g., sulfa drugs, AZT) can cause this type of anemia
|
Macrocytic anemia
|
|
|
|
acute hemorrhage causes this type of anemia
|
normocytic, normochromic
|
|
|
|
normocytic normochromic anemia can be caused by enzyme defects such as (give 1)
|
G6PD deciciency or PK deficiency
|
|
|
|
normocytic normochromic anemia can be caused by RBC membrane defects such as _______
|
hereditary spherocytosis
|
|
|
|
normocytic normochromic anemia can be caused by bone marrow disorders such as
|
aplastic anemia, leukemeia
|
|
|
|
normocytic normochromic anemia can be caused by hemoglobinopathies such as
|
sickle cell dz
|
|
|
|
normocytic normochromic anemia can be caused by autoimmune _______ anemia
|
hemolytic
|
|
|
|
this type of anemia usually presents with the following labs: decreased TIBC, increased ferritin, increased storage of iron in bone marrow macrophages
|
anemia of chronic dz(ACD)
|
|
|
|
graphs [p. 298]
|
--
|
|
|
|
this is a pancytopenia characterized by severe anemia, neutorpenia, and thrombocytopenia that is caused by failure or destruction of multipotent myeloid stem cells, with inadequate production or release of differentiated cell lines
|
aplastic anemia
|
|
|
|
give 3 possible causes of aplastic anemia
- what drugs is particular - what viruses are associated - other causes |
radiation, benzene, chloramphenicol, alkylating agents, antimetabolites, viral agents (parovirus B19, EBV, HIV), Fanconi's anemia, idiopathic (immune mediated, primary stem-cell defect). May follow acute hepatitis.
|
None
|
|
|
pt presents with an infection. she reports malaise and fatigue. On physical exam she appears pale, with purpura, mucosal bleeding, and petechia. What are you concerned about. Blood smear shows pancytopenia w/ normal cell morphology.
|
aplastic anemia
|
|
|
|
how do you dx aplastic anemia.
|
bone marrow biopsy
|
|
|
|
What does bone marrow bipsy show.
|
hypocellular bone marrow with fatty infiltation
|
|
|
|
how do you tx aplastic anemia
|
withdraw the offending agent. allogenic bone marrow transplantation. rbc & platelet transfusion. G-GSF or GM-CSF.
|
|
|
|
this dz is caused by a HBS mutation which is a single amino acid replacement in B chain (substitution of normal glutamic acid w/ valine).
|
sickle cell anemia
|
|
|
|
what type of situation precipitates sickling
|
low O2 or dehydration (could be induced by exercise)
|
|
|
|
heterozygotes of sickle cell anemia is known as
|
sickle cell trait
|
|
|
|
heterozygotes of sickle cell trait are resistant to this dz
|
malaria (balanced polymorphism)
|
|
|
|
crescent shaped RBCs are known as ________
|
sickle cells
|
|
|
|
complications in homozygotes (sickle cell dz) can include aplastic crisis due to this viral infection
|
parovirus B19
|
|
|
|
complications in homozygotes (sickle cell dz) can include teh following (give 3)
|
autosplenectomy, increased risk of encapsulated organism infxn, salmonella osteomyelitis, painful crisis (vaso-occlusive), and splenic sequestration crisis.
|
|
|
|
new therapies for sickle cell anemia include
|
hydroxeourea (increased HgF) and bone marrow transplantation.
|
|
|
|
HbC or HbSC cell mutations cause this type of presentation
|
milder dz than HbSS
|
|
|
|
there are ___ alpha globin genes
|
4
|
|
|
|
in this disorder the alpha-golbin chain iis underproduce because of bad genes, 1-4. there is no compensatory increase in any other chains.
|
alpha thalassemia.
|
|
|
|
alpha thalassemia is present in these 2 continants
|
asia and africa
|
|
|
|
Beta thalassemia is present in these populations
|
mediterranean populations
|
|
|
|
this results in Beta 4 tetramers, lacks 3 alpha globin gnes
|
HbH
|
|
|
|
this dz involved gamma4 tetramers, and lacks all 4 alpha alpha globin genes and results in hydrops fetalis and intrauterine fetal dealth
|
Hb Barts
|
|
|
|
in this blood dyscrasia fetal hgb production is compensatorily increased but is inadequate.
|
B thalassemia
|
|
|
|
B thalassemia minor
|
Beta chain is underproduced (heterozygous)
|
|
|
|
Beta thalassemia major
|
Betea chain is absent
|
|
|
|
pt has severe anemia requiring blood transfuusion and skeletal deformities that arose as a result of marrow expansion. His frequent blood transfusions result in secondary hemochromatosis which eventually causes cardiac failure and death. what is his underlying condition.
|
Beta thalassemia
|
|
|
|
How severe is a heterozygote HbS/Beta thalassemia
|
mild to moderate dz
|
|
|
|
Beta thalassemia major
|
Betea chain is absent
|
|
|
|
pt has severe anemia requiring blood transfuusion and skeletal deformities that arose as a result of marrow expansion. His frequent blood transfusions result in secondary hemochromatosis which eventually causes cardiac failure and death. what is his underlying condition.
|
Beta thalassemia
|
|
|
|
How severe is a heterozygote HbS/Beta thalassemia
|
mild to moderate dz
|
|
|
|
pt ppresents with jaundice and increased serum bilirubin. Her retic count is also increased. What type of anemia do you suspect
|
hemolytic
|
|
|
|
why is retic count increased in hemolytic anemia
|
bone marrow compensating
|
|
|
|
what type of gallstones are commonly present in hemolytic anemias
|
pigment gallstones
|
|
|
|
this type of hemolytic anemia involves mostly extravascular hemolysis-often accelerated RBC destriction in liver Kupffer cells and spleen)
|
autoimmune anemia
|
|
|
|
what type of test do you do to test for hemolytic anemia
|
+ coombs test
|
|
|
|
this autoimmune hemolytic anemia is a chronic anemia commonly seen in pts with SLE, CLL, or with certain drugs (e.g., alpha-methyldopa)
|
Warm Agglutin
|
|
|
|
Warm agglutin involves this Ab
|
IgG mneu: WARM weather is GGGreat
|
|
|
|
this autoimmune hemolytic anemia is an acute anemia triggered by cold. Often seeen during recovery from Mycoplasma pneumonia or infectious mononucleosis
|
Cold agglutin
|
|
|
|
Cold agglutinin involves this Ab
|
IgM mneu: COLD ice cream. . .MMM
|
|
|
|
this type of autoimmune hemolytic anemia is seen in newborns due to Rh or other blood Ag incompatibility when the mother's Ab attack fetal RBCs
|
Erythroblast fetalis
|
|
|
|
In this test anti-Ig Ab is added to pts RBCs. There is agglutination if RBCs are coated with Ig
|
Direct Coombs test
|
|
|
|
In this test normal RBCs are added to pts serum. There is agglutination if serum has anti-RBC surface Ig
|
indirect Coombs
|
|
|
|
in this hemolytic anemia there is intrinsic, extravascular hemolysis due to spectrin or ankyrin defect. RBCs are small and round with no central pallor, meaning they have less menbrane, increased MCHC, and increased RDW.
|
hereditary spherocytosis
|
|
|
|
In hereditary spherocytosis pts are Cooombs ____, what test is then used to confirm
|
Coombs - Osmotic fragility test
|
|
|
|
This hemolytic anemia involves intravascular hemolysis due to a membrane defect leading to increased sensitivity of RBCs to the lytic activity of complement
|
Paroxysmal nocturnal hemoglobinuria
|
|
|
|
what will you see in the urin of a pt siwth paroxysmal nocturnal hemoglobinuria
|
increased urine hemosiderin
|
|
|
|
this form of hemolytic anemia involves intravascular hemolysis seen in DIC, TTP/HUS, SLE, or malignant hypertension.
|
microangiopathic anemia
|
|
|
|
what is seen on a blood smear in a pt with microangiopathic anemia
|
shistocytes (helmet cells)
|
|
|
|
this condition involves an activation iof the coagulation cascade leading to microthrombi and global consumpton of platelets, fibrin, and coagulation factors
|
DIC
|
|
|
|
give the most common cause of DIC
|
obstrectic complications
|
|
|
|
what are some other causes of DIC (give 2)
|
gram negative sepsis, transfusion, trauma, malignancy, acute pancreatitis, nephrotic syndrome.
|
|
|
|
what are the lab findings of DIC: PT __ PTT__ D-Dimer (fibrin split products)____ platelet count___ Blood smear ___________
|
PT ↑ PTT↑ D-Dimer (fibrin split products)↑ platelet count↓ Blood smear: helmet-shaped cellls and schistocytes
|
|
|
|
Give 3 examples of bleeding disorders resulting from platelet abnormalities:
|
1)idiopathic thrombocytopenic purpura (ITP) 2)Thrombotic thrombocytopenic purpura (TTP) 3)DIC 4) Aplastic anemia 5) caused by drugs
|
|
|
|
platelet abnormalities often result in this type of hemhorrage which involves mucus membrane bleeding, epistaxis, petechia, pupura, and increased bleeding time
|
microhemorrhage
|
|
|
|
pt presnts with microhemhorrage. Labs show antiplatelet antibodies and increased number of megakaryocytes. What platelet abnormality do you suspect
|
idiopathic thrombocytopenic purpura (ITP)
|
|
|
|
pt presnts with microhemhorrage and neurologic symptoms. Labs increased LDH. Blood smear shows schistocytes. What platelet abnormality do you suspect
|
Thrombotic thrombocytopenic purpura (TTP)
|
|
|
|
pt presnts with microhemhorrage. Labs increased D-Dimer (fibrin split products). Blood smear shows schistocytes. What platelet abnormality do you suspect
|
DIC
|
|
|
|
pt presnts with microhemhorrage and neurologic symptoms. Pt is a kidney transplant recepiant. What platelet abnormality do you suspect
|
platelet abnormality due to immunosuppressive drugs
|
|
|
|
Give 3 Coagulation factor defects that result in bleeding disorders
|
1) Hemophelia A 2) Hemophelia B 3) Von Willebrand's dz
|
|
|
|
Coagulation factor defects often involves this type of hemhorrage
|
Macrohemhorrage
|
|
|
|
macrohemorrhage often involves what lab changes in PT & PTT
|
increases
|
|
|
|
macrohemorrhage often involves easy bruising and hemarthroses. What is hemarthrosis?
|
bleeding into joints
|
|
|
|
Hemophilia A involves what factor deficiency
|
factor VIII
|
|
|
|
Hemophilia B involves what factor deficiency
|
factor IX
|
|
|
|
what is the most common coagulation factor defect
|
von willebrand'sdz
|
|
|
|
is Von Willebrand's dz mild or severe
|
mild
|
|
|
|
what is deficient in Von willebrands dz and what does this lead to
|
deficiency of von Willebrand factor resulting in defect of platelet adhesion
|
|
|
|
In von willebrand's dz there is a decrease in factor ___ survival
|
VIII
|
|
|
|
Different hemorrhagic disorders involve different lab values. Give the changes that exist in the following lab values with the d/o given: DZ: QUALITATIVE PLATELET DEFECT 1)Platelet count 2) Bleeding time 3) PT 4) PTT
|
increased bleeding time
|
|
|
|
Different hemorrhagic disorders involve different lab values. Give the changes that exist in the following lab values with the d/o given: DZ: THROMBOCYTOPENIA 1)Platelet count 2) Bleeding time 3) PT 4) PTT
|
decreased platelet count increased bleeding time
|
|
|
|
Different hemorrhagic disorders involve different lab values. Give the changes that exist in the following lab values with the d/o given: DZ: HEMOPHELIA A OR B 1)Platelet count 2) Bleeding time 3) PT 4) PTT
|
increased PTT
|
|
|
|
Different hemorrhagic disorders involve different lab values. Give the changes that exist in the following lab values with the d/o given: DZ: VON WILLEBRANDS DZ 1)Platelet count 2) Bleeding time 3) PT 4) PTT
|
increased bleeding time
|
|
|
|
Different hemorrhagic disorders involve different lab values. Give the changes that exist in the following lab values with the d/o given: DZ: DIC 1)Platelet count 2) Bleeding time 3) PT 4) PTT
|
decreased platelet count increased bleeding time increased PT & PTT
|
|
|
|
An example of a qualitative platelet defect would be bernard-soulier dz. What is deficient in this dz and what is the result
|
low GP Ib--resulting in a defect of platelet adhesion
|
|
|
|
An example of a qualitative platelet defect would be Glanzmann's thrombasthenia. What is deficient in this dz and what is the result?
|
low GP IIb-IIIa. resulting in a defect of platelet agGregation
|
|
|
|
PT involves this pathway including these 4 factors
|
extrinsic factors II,V,VII, & X
|
|
|
|
PTT involves this pathway including these factors
|
intrinsic all factors except VII
|
|
|
|
what is the most common type of Hodgkin's lymphoma
|
Nodular sclerosing (65-75%)
|
|
|
|
what is the prognosis of nodular sclerosing hodgkins lymphoma
|
excellent
|
|
|
|
doees NSH effect women or men more, how about age group
|
women more than men, primarily young adults
|
|
|
|
what is the perportion of reed sternburg (RS) cells to lymphocytes in nodular sclerosing Hodgkins lymphoma
|
3:1, Lymphos:RS cells
|
|
|
|
nodular sclerosing Hodgkins lymphoma has a special kind of RS cell what is it?
|
lacunar
|
|
|
|
this subtype of Hodgekin's lymphoma involves collagen banding
|
nodular sclerosing
|
|
|
|
this type of Hodgkins lymphoma has numerous lymphocytes and even more RS cells.
|
mixed cellularity (25%)
|
|
|
|
what is the prognosis for mixed cellularity hodgkins lymphoma
|
intermediate
|
|
|
|
this type of hodgkin's in more common in males under 35 y/o. It has far more lymphocytes than RS cells
|
lymphocyte predominant (6%)
|
|
|
|
what is the prognosis of lymphocyte predominant HL
|
excellent
|
|
|
|
this type of hodgekins lymphoma is rare. It effects older males with disseminated dz. the number of RS cells is high relative to the few lymphocytes. The prognosis of this HL is poor
|
lymphocyte depleted.
|
|
|
|
this is the distinctive tumor giant cell seen in hodgkins dz
|
reed sternberg cell
|
|
|
|
because teh RS cell is binucleate or bilobed w/ the 2 halves as mirror images it is sometimes called this type of cell. (think bird)
|
"owl eyes" cell
|
|
|
|
is the RS cell sufficient for dx of Hodgekins dz
|
no-neccessary but not sufficient
|
|
|
|
what varient of RS cells is found in nodular sclerosing hodgekins dz
|
lacunar cells
|
|
|
|
Non-Hodgkins lymphoma has several subtypes. This type presents in adulthood with a focal mass. It effects the B cells and is often low grade. It is similar to CLL
|
Small lymphocytic lymphoma
|
|
|
|
Non-Hodgkins lymphoma has several subtypes. This is the most common adult NHL. It involves B cells and is difficult to cure. There is an indolent cource.
|
Follicular lymphoma (small cleaved cell)
|
|
|
|
this dz is associated with t(14:18) and bcl-2 expression
|
Follicular lymphoma
|
|
|
|
what is bcl-2 responsible for
|
apoptosis
|
|
|
|
Non-Hodgkins lymphoma has several subtypes. This type usually effects older adults but 20% occurs in children. It is aggressive, but up to 50% are curable.
|
diffuse large cell
|
|
|
|
Does diffuse large cell NHL effect B or T cells?
|
80% B cells 20% mature T cells
|
|
|
|
Non-Hodgkins lymphoma has several subtypes. This type is most common in children. It commonly presents w/ ALL and a mediastinal mass. It is very aggressive
|
lymphoblastic lymphoma
|
|
|
|
what cells do lymphoblastic lymphoma attack
|
mature T cells
|
|
|
|
This type of lymphoma most often effects children. In africa it often presents with a jaw lesion. examination of bx under microscope will show "starry-sky" appearance (sheets of lymphocytes with interspersed macrophages.)
|
Burkitt's lymphoma
|
|
|
|
What virus is Burkitt's lymphoma ssociated with
|
EBV virus
|
|
|
|
what cells does Burkitt's lymphoma attack
|
B cells
|
|
|
|
This NHL is associated with t(8;14) c-myc gene moving next to heavy chain Ig gene (14)
|
Burkitt's
|
|
|
|
pt presents with infection and increased number of circulating leukocytes in the blood. Complications include anemia (low RBCs), hemorrhage (low platelets), bx of bone marrow, liver, spleen, & LN may show infiltrates of CA
|
leukemia
|
|
|
|
How do you leukemia dx?
|
usually bone marrow bx
|
|
|
|
this subtype of leukemia often effects children. bx shows lymphoblast. It is the most responsive to therapy and may spread to CNS & testes
|
ALL
|
|
|
|
this subtype of leukemia often effects adults. Bx shows myeloblasts & auer rods
|
AML
|
|
|
|
this subtype of leukemia often effects older adults. They often present with lymphadenopathy and hepatosplenomegly. There are few symptoms and often have an indulent course.
|
CLL
|
|
|
|
what would you see on peripheral blood smear of pt w/ CLL
|
increased smudge cells.
|
|
|
|
what type of autoimmune hemolytic anemia is CLL
|
warm antibody
|
|
|
|
what NHL is CLL very similar to.
|
SLL (small lymphocytic lymphoma.
|
|
|
|
this subtype of leukemia presents with splenomegly and labs show incerased neutrophils and metamyelocytes
|
AML
|
|
|
|
what chromosome and gene is CML associated with
|
Philadelphia chromosome (t[9;22],bcr-abl
|
|
|
|
what type of stem cell proliferation is involved in CML
|
myeloid
|
|
|
|
CML may accelerate to AML resulting in a _______
|
blast crisis
|
|
|
|
Leukocytes have very low levels of this in CML
|
alkaline phosphatase
|
|
|
|
chart [p.303]
|
--
|
|
|
|
these are peroxidase positive cytoplasmic inclusions in granulocytes and myeloblast.
|
auer bodies (rods)
|
|
|
|
Auer rods are primarily seen in thys type of leukemia
|
acute promyelocytic leukemia (M3).
|
|
|
|
treatment of AML M3 can release aurer rods resulting in this
|
DIC
|
|
|
|
leukemia classification[p.304]
|
--
|
|
|
|
chromosomal translocations can result in several disorders. Given the translocations give the associated disorder) t(9;22)(philadelphia chromosome)-->bcr-abl hybrid
|
CML
|
|
|
|
chromosomal translocations can result in several disorders. Given the translocations give the associated disorder) t(8:14)-->c-myc activation
|
Burkitt's lymphoma
|
|
|
|
chromosomal translocations can result in several disorders. Given the translocations give the associated disorder) t(14;18)->bcl-2 activation
|
follicular lymphomas
|
|
|
|
chromosomal translocations can result in several disorders. Given the translocations give the associated disorder) t(15;17)
|
M3 type of AML
|
|
|
|
M3 type of AML is responsive to this tx
|
trans retinoic acid
|
|
|
|
chromosomal translocations can result in several disorders. Given the translocations give the associated disorder) t(11;22)
|
ewing's sarcoma
|
|
|
|
chromosomal translocations can result in several disorders. Given the translocations give the associated disorder) t(11;14)
|
mantle cell lymphoma
|
|
|
|
This is the most common primary tumor arising within the bone in adults. It is a moloclonal plasma cell CA that arises in the marrow and produces large amounts of IgG or IgA
|
multiple myaloma
|
|
|
|
multiple myeloma plasma cells have this type of appearance (think breakfast foods)
|
fried egg
|
|
|
|
multiple myeloma produces IgG what percentage of the time and IgA what percentage of =the time
|
IgG=55% IgA=25%
|
|
|
|
multiple myeloma can cause destructive bone lesions that can result in this abnormal lab finding
|
hypercalcemia
|
|
|
|
what are some other complications that can come with multiple myeloma (3)
|
renal insufficiency susceptibility to infection anemia
|
|
|
|
multiple myeloma is associated with this dz where abnormal protiens build up in the organs
|
amyloidosis
|
|
|
|
what might you see on x-ray of a pt with multiple myeloma
|
punched otu lytic bone lesions on x-ray
|
|
|
|
what might you see on serum protein electrophoresis of a pt with multiple myeloma
|
monoclonal immunoglobin spike (M protien)
|
|
|
|
what might you see in urine of pt with multiple myeloma
|
bence jones protien
|
|
|
|
what is bence jones protein
|
Ig light chains
|
|
|
|
what does the blood smear show in pts with multiple myeloma
|
rouleau formation
|
|
|
|
what is rouleau formation
|
RBCs stacked like poker chips
|
|
|
|
pt presents with an M spike indicating increased levels of IgM. They have hyperviscosity symptoms and no lytic bone lesions. Is it multiple myeloma? What else might you suspect.
|
No Waldenstrom macroblobinemia
|
|
