Usmle: Hematology/oncology

Front 1

Pluripotent hematopoietic cells give rise to what three lineages?

Back 1

1. RBC,
2. Myeoloid= NEB + Monocytes + Platelets,
3. Lymphoid= B cells + T cells
------------
What WBC are most abundant? N, B/T-cells, Monocytes, E,B
---------
anything over 10K leukocytes is HIGH

Front 2

Erythrocyte= 120 days= trades Cl- for Bicarb in lungs via antiporter
**buffers H+ near the muscles

Back 2

Anisocytosis= various sizes
----VS-----
Poikilocytosis= different shapes
---Vs-----
Energy= anerobic= lactate is end product

Front 3

Differential for Bisophilic stippling?

Back 3

1. Thal,
2. Anemia (chronic or iron)
3. Lead poisoning

Front 4

What does the Bisophil contain inside?

Back 4

Heprarin, Histamine, LTD4
-----VS-----
Mast Cell= Heparin, Histamine, and attracts Eosinophils = degranulation prevented by Cromolyn Sodium

Front 5

Eosinophilia degrades Histamine and arylsulfatase after they are called over by Mast Cells. What do Eosinophils love to destroy?

Back 5

Helminths and Protozoa

Front 6

What is the differential for too many Eosinophils?

Back 6

Neoplasms, Asthma, Allergies, Collagen Dx, PARASITES

Front 7

Where do you see HYPERsegmented PMN?

Back 7

B12/Folate def. in alcoholics

Front 8

What regulate B cells and Macs?

Back 8

T cells

Front 9

Where do B cells(CD20) migrate too?

Back 9

Follicles in Lymphnodes + White pulp of SPLEEN + un-encapsualted lymphoid tissue
---------VS-------
Plasma cell= a lot of RER, Golgi, off-center nucleus== too much= Multiple Myeoloma

Front 10

What has MHC-I and Fc Receptors whos only function is APC?

Back 10

Dendritic Cells

Front 11

What is the order of the Intrinsic Cascade?
*** All pathways require Ca++ to function

Back 11

PTT= 12-11-9-10
-----VS------
Extrinsic=PT= 7 + Tissue factor
----VS---
common pathway= 10a-thrombin-fibrin-CLOT

Front 12

How would you prevent clotting?

Back 12

PTT= Protein C/S= blocks 8a + 5a= need Vitamin K= Factor V Leiden= Protein C cannot block 5a= excess clotting
-------VS-----
PTT= Heparin=>Antithrombin 3= blocks 11,9,10=No thrombin= no clotting

Front 13

Collagen, basement membrane, and activated platelets activate FACTOR 12 which causes what?

Back 13

Clotting cascade activates KALLIKREIN via 12a ==>
1. Kinin Cascade= Bradykinin(vasodilation, permeability, PAIN) ==>
2. Fibrinolytic system= +Plasmin
----VS------
Plasminogen activates compliment cascade

Front 14

What is the only Blood group with antibodies against A and B on the plasma?

Back 14

Type O= universal donor because RBC do not have A or B on surface
--------VS------
Type AB= has no antibodies against either so it can accept either one

Front 15

What is the differential for Helmet cells and Schistocytes?

Back 15

DIC + traumatic hemolysis

Front 16

What does a TEARDROP rbc indicate?

Back 16

Myeoloid metaplasia with myeloid fibrosis (no BEN,M,P)
----VS----
spiky rbc= aBETAlipoproteinemia
-----VS------
target cell= HALT=HbC Dx, Aspleenia, Liver Dx, Thal.

Front 17

What is the differential for RBC that are Poikilocytes + Burr cells?

Back 17

HUS

Front 18

Psammoma bodies= Ca++ collection differential?

Back 18

cancers;
Thyroid (papillary adenocarcinoma),
Ovary(serous papillary cystadenocarcinoma),
Meningioma,
Mesothelioma

Front 19

Microcytic Anemia

Back 19

Fe++ low= HIGH TIBC
---Vs---
Thal= target cells
---Vs---
Lead Poisoning= Basophilic stippling
----VS---
Sideroblastic anemias

Front 20

Macrocytic Anemia

Back 20

Blocked DNA synthesis= Vitamin B12/Folate (HYPERsegmented PMNs) + Sulfa drugs + AZT

Front 21

Normocytic Anemias=normochromic= ADAM

Back 21

-Acute Hemorrhage,
-Deficiencies (G6PD,PK), Anemias(aplastic,autoimmne[+coombs],Chronic disease[LOW TIBC]),
-Membrane(spherocytosis, sickle cell disease)

Front 22

What blood markers aid in the diagnosis of Hemolytic Anemia?

Back 22

Low Haptoglobin + High LDH

Front 23

What infectious agents cause Aplastic Anemia=Pancytopenia + fatty infiltration?

Back 23

HBV,
Parvo,
HIV
= overcome with G-CSF + GM-CSF + BM transfussion

Front 24

What precipitates sickle cell anemia= BM expansion?

Back 24

Dehydration + Low O2 + Parvovirus(=aplastic crisis) + No spleen(=>salmonella osteomyelitis)
---------Tx-------- Hydroxyurea=>+HbF=prevents sickeling

Front 25

What are the outcomes of Beta-Thal?

Back 25

Bone deformaties from BM expansion, anemia, 2* Hemochromatosis

Front 26

What cells destroy RBC via extrahemolytic anemia?

Back 26

Liver: Kupffer cells + Spleen Macs

Front 27

How is Hereditary spherocytosis confirmed?

Back 27

osmotic fragility test

Front 28

Autoimmune anemias= extravascular= agglutinate at different temperatures depending?

Back 28

Cold= IgM=acute ==> MYCOPLASMA PNEUMONIAE, MONO
----vs----
Warm=IgG=chronic= SLE,CCL, alpha-methyldopa
-----vs----
Fetus attacked by mother's IgG= Reythroblastosis fetalis

Front 29

Hereditary Spherocytosis has 2 membrane defects= round, small, no central pallor?

Back 29

1. Spectrin
2. Ankyrin
------vs------
ACQUIRED
increased urine hemosiderin==> membrane defect= increase sensitivity to compliment system at night= Paroxysmal Nocturnal Hemoglobinuria

Front 30

Microangiopathic anemia is caused by DIC= intravascular hemolysis= What does DIC do?

Back 30

too many microthrombi= uses up all the platelets, fibrin, coagulation factors=>
-High PT and PTT(Intrinsic)
-high D-dimer= fibrin split products
-low platelets
=trauma on RBC= schistocytes=helmet cells
-------
Caused= STOP MNT
S; sepsis= gram negative
T; trauma
O: obstetrics= #1
P: pancreatitis
M: malignancy
N: Nephrotic syndrome
T: transfusion

Front 31

What BLEEDING disorders are associated with PLATELET abnormalities?

Back 31

-ITP= Ab against platelets= get large megakaryocytes trying compensate for loss=#1 ini kids= non-blanching purple skin lesions= follows viral infection
----vs----
-TTP= Microangiopathic anemia=FEVER, high LDH, schistocytes=> renal problems, neuro problems
----vs-----
-DIC= schistocytes + a lot of D-dimers
----vs-----
-Aplastic Anemia= pancytpenia= Ab against multipotent MYELOID germ cells
------vs-----
-Immunosuppresant Rx=

Front 32

What bleeding disorders are associated with CLOTTING FACTOR defects?

Back 32

Hemophilias:
A= No Factor 8 (activates factor 10: needs Ca++; normally blocked by Antithrombin=heparin and C/S)
--vs----
B= no Factor 9 = also works on Factor 10
---vs----
#1 bleeding disorder= no vonWilibrand= causes platelets to adhere to each other=> decrease Factor 8 survival

Front 33

What is the difference between Macro and Micro hemorrhage?

Back 33

Platelet Disorder= MICRO= mucous membrane bleeding, nose bleeds, petechiae, purpura= bleed for a lone time
------vs------
Coagulation=MACRO= bleed into joints, easy bruising, Long PT/PTT

Front 34

What level of platelets is considered THROMBOCYTOPENIA?

Back 34

below 100K
---vs----
generalized bleeding= 10K

Front 35

PT vs PTT

Back 35

PT= 2,5,7,10= extrinsic
-----
PTT= NOT 7= Intrinsic

Front 36

How can you differentiate amongst the differential for an INCREASED BLEEDING TIME?
**with the exception of Hemophilias that DO NOT have increase bleeding time

Back 36

Only Long Bleeding Time=
-Qualitative platelet defect=Glanzmann/Bernard-S=problems with clumping
=========
LOW platelets=
1. Thrombocytopenia
---vs-----
2. DIC= high PT/PTT
===============
Only increase PTT= Hemophilias
---vs---
PT increase= vW

Front 37

How can you distinguish between Hodgkin's and Non-Hodgkins Lymphoma?

Back 37

H= fever, night sweats=>Reed-Sternberg cells= CD30+= 1 group of node w/o spread to others= Mediastinal=spread to other people=>EBV association=Young and old=> good prognosis if there is little Reed-Sternberg cells
------------vs------
NH= HIV/i= multiple nodes + spread to other nodes NOT other people=>peak #'s in adulthood

Front 38

Young women with Fever, night sweats, previous history of MONO (EBV), and mediastinal lymphadenopathy, increased Lymphocytes with few RS cells(from B cells)= Owl Eyes(2 nuclei with halos). Prognosis?

Back 38

#1=Excellent= nodular sclerosing type=LACUNAR CELLS(kinda like RS)
----VS-----
RS> lymphocytes= poor= often found in older male individuals with mixed cellularity=MONOnuclear RS cells

Front 39

What is the #1 1* tumor that originates in the bone of adults, has BM cells that look like eggs(blue cytoplasm), associated with Amyloidosis?

Back 39

Multiple Myeloma= high IgG>A
-XR= punched out lytic lesions
-U/A= light chains=k=Bence-Jones protein=> toxic=renal insufficiency
-RBC= Roleau formation= stacked poker chips
-Hypercalcemia= bone lysis= vertebral compression fractures
-M spike in electrophoresis= M protein
----vs----
IgM spike in Waldenstrom's macroglobulinemia= hyperviscosity

Front 40

What are the 2 most common NH Lymphomas in CHILDREN?

Back 40

1. Burkitt's= B cells= t 8:14 =starry sky(stars=macs, sky=B cells)= EBV= jaw lesions (endemic in africa) vs. Pelvic lesion (sporadic)
----Vs---
2. Lymphoblastic lymphoma= immature T cells = Aggressive= ALL

Front 41

Which is the only ADULT NH lymphoma not associated with B cells 100%?

Back 41

Diffuse Large Ce11= 80% adults= 80% B-cells= t 11:14 = Aggressive= 50% cure rate

Front 42

What is the most common NH Lymphoma in adults?

Back 42

Follicular lymphoma=B cell= t 14:18=bcl-2(apoptosis)= hard to cure
----vs----
Mantle Cell= also has bad prognosis but associated with CD5+= t 11:14

Front 43

What is a leukemia?

Back 43

Increased Leukocytes= wbc=BEN,M= MYELOID origin
----vs----
Lymphoma= increased B/T-cells=Lymphoid origin

Front 44

What is the cause of the symptoms associated with LEUKEMIA= swollen BM?

Back 44

-anemia= decrease RBC due to increase lymphocytes in BM
-infections= low MATURE wbc
-hemorrhage= low platelets
--------
hepatospleenomegaly= infiltration of excess wbc into tissues= chronic only

Front 45

Age stratification of Leukemia by age:
*Young/really old= drastic effects
*adults= more mature cells= milder

Back 45

<10= ALL=spread to CNS + balls= also associated with lymphomas (Lymphoblastic lymphoma=T-cell)
----------
Adults= AML= Auer Rods
----------
<60= CML= high PMN's= Philly trans.
----------
60+=CLL= smudge cells=hemolytic anemia(warm IgG)= no Ig producing B cells

Front 46

An adult with AML(M3;15:17) was treated and developed DIC. Why?

Back 46

Auer bodies released= found in cytoplasm of granulocytes (BEN)= peroxidase positive

Front 47

Leukemia classification:

Back 47

L1/L2/L3= T/B-cells
---vs----
M= CFU-S=>
-CFU-GM= BN,M= CML (M3)

Front 48

A young adult smoker develops Histiocytosis X=macs in skin?

Back 48

Monocytes enter lung= Langerhan's cells proliferate= BIRBECK Granules=CD1+= Eczematous rashes

Front 49

What is the difference in PB smear of IgM and IgG?

Back 49

IgM= agglutination= cold=Raynaud's phenomena
---vs----
IgG= stacked coins

Front 50

Iron deficiency can cause Plummer Vinson Syndrome?

Back 50

Cheliosis, esophageal web(solid dysphagia), achlorhydra(reccurent infections, IF def), glossitis

Front 51

only cause of an increase in RDW?

Back 51

Iron deficiency

Front 52

Basophilic stippling is found in Microcytic Anemias?

Back 52

Stippling= persistance of ribosomes

Front 53

Causes of Sideroblastic Anemia= nucleated RBC with trapped Iron in BM= pappenheimer bodies are inside?

Back 53

#1= Alcohol, lead poisoning, PYRODIXINE deficiency

Front 54

How is a ringed sideroblast formed?

Back 54

Iron enters mitochondria but without Pyrodixine(B6) Heme cannot be made and therefore is trapped and forms a ring inside the rbc

Front 55

What is the only heavy metal that deposits in the Epiphysis of bones?

Back 55

lead => causes bone infarctions = Dactylitis= swollen and painful hands also seen with SCD

Front 56

Why is there an increase in Protoporhoryn and ALA?

Back 56

Lead destroys: Pherochetolase + ALA D

Front 57

What does Lead poisoning do to the tissues of the body?

Back 57

Lead line in teeth, ATN in the PCT(prevents re-absorption), Nerve Palsy(peroneal=foot drop, Radial=hand drop, Ulnar= claw hand)

Front 58

What is the differential for a TEAR DROP cell in the PB smear?

Back 58

only B12 Def(think IF problem), Myelofibrosis, Thal.

Front 59

Where is Folate vs. B12 absorbed?

Back 59

Folate= Jejunum= alcohol and birth control pills blocks abs.
-----vs-----
B12= Ileum= site Crohn's disease

Front 60

What is an infectious cause of aplastic anemia(nothing made in BM)?

Back 60

HCV

Front 61

Why does Celiac Disease present with a Normocytic anemia and an increase RDW?

Back 61

MCV= avg of micro + macro= form iron and folate/b12 def from malabsorption
-----vs-----
RDW= detects variations of the sizes of RBC's

Front 62

What does polychromasia mean?

Back 62

Pronounced hematopoesis in the BM=> obs also spherocytes=> Brisk hemolysis= remember that spherocytes become that way because Spleen macs take a bite at them= damage

Front 63

What does one black dot in a RBC indicate= howell Jowell Body?

Back 63

Spleen is not working

Front 64

Sickle Cell Disease can be diagnosed by what cells in the PB smear?

Back 64

Sickle cells with Bull's Eye Target cells in the background
-----vs---
target cells also caused by alcoholism= increased cholesterol in membrane

Front 65

Think Heinz Bodies with…

Back 65

Hb oxidant damage= increased process if G6PD deficiency and the lack GSH= overtly stimilated with Infection(no MPO because no NADPH for Monocytes/PMN's)
----
DO NOT confuse with Howell Jolly Body=nuclear remnant=just on dot vs many dots in RBC with Heinz bodies

Front 66

LARGE lysosomes inside a PMN in a child with recurrent infections?

Back 66

Chediak-Higashi Syndrome= AR= enzymes are not transported to phagolysosomes

Front 67

What does a LAP score mean?

Back 67

elevated means a lot of MATURE PMN's= indication of infection found with a Leukmoid reaction(50K+ wbc's= can be Lymphocytes=whooping cough,BEN)

Front 68

When do you see Monocytosis?

Back 68

Malignancy + chronic inflammation= gray cytoplasm + Kidney shape nucleus + vacuoles
-------vs----
Lymphocytosis= found in viral infections
----vs-----
Basophilia= deeply staining granules= PRV and CML (LAP= 0 + Philly chromosome)

Front 69

What are the ATYPICAL lymphocytes in infectious mononucleosis?

Back 69

T cells= blue cytoplasm that is large= responding to infected B-cells

Front 70

What is Agnogenic Myeloid Metaplasia?

Back 70

Hematopoetic cells leave BM and travel to spleen= cause tear drops and causes fibrosis of BM

Front 71

CALLA and CD10+ is?

Back 71

ALL

Front 72

Hairy Cell Leukemia only infiltrates ther RED pulp of the SPLEEN. What STAIN comfirms HCL?
**** NO SWOLLEN LYMPHNODES!!!

Back 72

Tartrate resistant acid phosphatase stain is positive in these neoplastic B cells

Front 73

What AML (auer rods) variant presents in your gums?

Back 73

Monocytic Leukemia
-----vs-----
M3= DIC treat with Vitamin A

Front 74

Palpable Purpura on the legs of a child?

Back 74

Henoch-schonlein purpura= #1 vasculitis in kids= Antibodies(IgA) against IgA=> forms complexes bind to SMALL vessels and cause damage= Type III

Front 75

What genetic disease predisposes you to Lymphomas and Leukemias because they have B/T cell defects?

Back 75

Ataxia Telangiectasia= instability DNA AR=because of bad DNA repair enzymes= recurrent SINUSITIS
----VS----
SXR= Waskott-Aldrich Syndrome= Eczema and similar symptoms

Front 76

Malignant Lymphomas have ..

Back 76

a fish flesh structure

Front 77

Most common Hodgkins Lymphoma in a woman?

Back 77

nodular sclerosing= anterior mediastinum= instead of RS cells you have Lacunar cells