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295 Cards in this Set
- Front
- Back
Precursor lesion: ACtinic keratosis
|
Cancer: Squamous cell carcinoma
|
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Precursor lesion: Atypical hyperplasia of ductal epithelium of breast
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Adenocarcinoma
|
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Precursor lesion: Chronic irritation at sinus orifice
third degree burns |
Squamous cell carcinoma
|
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Precursor lesion: Chronic ulcerative colitis
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Adenocarcinoma
|
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Precursor lesion: Complete hydatidfrom mole
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Choricarcinoma
|
|
Precursor lesion: Dysplastic nevus
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Malignant melanoma
|
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Precursor lesion: Endometrial hyperplasia
|
adenocarcinoma
|
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Precursor lesion: Glandular metaplasia of esophagus
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Adenocarcinoma
|
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Precursor lesion: Glandular metaplasia of stomach
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Adenocarcinoma
|
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Precursor lesion: Myelodysplastic syndrome
|
Acute leukemia
|
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Precursor lesion: Regenerative nodules in cirrhosis
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Adenocarcinoma
|
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Precursor lesion: Scar tissue in lung
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Adenocarcinoma
|
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Precursor lesion: Squamous dysplasia of oropharynx, larynx, bronchus, cervix
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Squamous cell carcinoma
|
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Precursor lesion: Tubular adenoma of colon
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Adenocarcinoma
|
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Precursor lesion: vaginal adenosis
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Adenocarcinoma
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Precursor lesion: Villous adenoma of rectum
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Adenocarcinoma
|
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What is significant about the HBV immunization in relation to cancer?
|
decreases risk of heptocellular carcinoma
|
|
what is the significance of the HPV immunization in relation to cancer?
|
decreases risk for cervical cancer
|
|
what is the least common gynecololgical cancer in the US?
|
Cervical cancer
|
|
what is most responsible for decreasing the incidence/mortality rate for cervical cancer?
|
Cervical Pap Smear
|
|
Is the PSA a more specific or sensitive test?
|
more sensitive test than specific
|
|
what has the treatment of H. pylori infection done for the rate of gastric lymphoma/adenocarcinoma?
|
decreased risk of developing it
|
|
When treating GERD what type of cancer are you decreasing the risk of cancer?
|
distal adenocarcinoma of esophagus
|
|
what is the most common type of mutation in cancer?
|
Point mutations
|
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Function of:
Proto-oncogene ABL |
non-receptor tyrosine kinase
|
|
Function of: HER
|
Receptor synthesis
|
|
Function of: MYC
|
Nuclear transcription
|
|
Function of: N-MYC
|
Nuclear transcription
|
|
Function of: RAS
|
guanosine triphosphate signal transduction
|
|
Function of: RET
|
receptor synthesis
|
|
Function of: SIS
|
growth factor synthesis
|
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Function of: APC
|
prevents nuclear transcription
degrades catenin an activator of nuclear transcription |
|
Function of: BRCA1/BRCA2
|
Regulates DNS repair
|
|
Function of:
TGF-b |
inhibits G1 to S phase
|
|
Function of: TP 53
|
inhibits G1 to S phase
Repairs DNA, activates BAX gene - initiates apoptosis |
|
Function of VHL
|
regulates nuclear transcription
|
|
Function of WT1
|
Regulates nuclear transcription
|
|
what is the mutation and cancer associated with ABL proto-oncogene?
|
Translocation
Chronic myelogenous leukemia (chromosome 22 in philadelphia chromosome) |
|
what is the mutation and cancer associated with the HER proto-oncogene?
|
Amplification
Breast carcinoma (marker of aggression) |
|
what is the mutation and cancer associated with the MYC proto-oncogene?
|
translocation
Burkitt's lymphoma |
|
what is the mutation and cancer associated with the N-MYC gene?
|
amplification
Neuroblastoma |
|
what is the mutation and cancer associated with the RAS proto-oncogene?
|
Point mutation
Leukemia lung, colon, pancreatic carcinomas |
|
what is the mutation and cancer associated with the RET proto-oncogene?
|
point mutation
multiple endocrine neoplasia IIa/IIb syndromes |
|
what is the mutation and cancer associated with the SIS proto-oncogene?
|
Overexpression
Osteogenic sarcoma, astrocytoma |
|
what is the associated cancer with the APC gene?
|
familial polyposis
- colorectal cancer |
|
what is the associated cancer with the BRCA1/BRCA2 gene?
|
breast
ovary prostate carcinoma |
|
what is the associate cancer with the RB gene?
|
Retinoblastoma
osteogenic sarcoma breast carcinoma |
|
what is the associated cancer with the TGF-b gene?
|
pancreatic and colorectal carcinoma
|
|
what is the associated cancer with the TP53 gene?
|
lung, colon, breast carcinomas,
Li-Fraumeni syndrome, breast carcinoma, brain tumors, leukemia, sarcomas |
|
what is the associated cancer with the VHL gene?
|
Von-HIppel-Lindau syndrome
cerebellar hemangioblastoma retinal angioma renal cell carcinoma pheochromocytoma |
|
what is the associated cancer with the WT1 gene?
|
Wilm's tumor
|
|
what are proto-oncogenes?
|
involved in normal growth and repair
functions of products are growth factors, growth factor receptors, signal transducers, nuclear transcribers |
|
what is a suppressor genes function?
|
protect against unregulated cell growth
|
|
what is the BCL2 gene family responsible for?
|
antiapoptosis genes
|
|
what is the BAX gene?
|
apoptosis gene
|
|
what is the function of repair genes?
|
correct errors in nucleotide pairings
excise pyrimidine dimers |
|
what are the enzymes involved in dimer excision?
|
endonucleases
exonucleases polymerase ligase |
|
___________ is the agent most responsible for cancer and cancer deaths in the United states.
|
Tobacco
|
|
what is the sequence of chemical carcinogenesis?
|
initiation
promotion progression |
|
describe the excision repair mechanism.
|
1. a DNA molecule is distorted by UV light induced thymine dimer
2. a specific endonuclease breaks one chain near the dimer 3. an exonuclease excises a small region containing the thymine dimer 4. 5'-3' synthesis of a new strand takes place, the correct base inserted by pairing with bases on the intact strand 5. Polynucleotide ligase effects the joining of strands, completing the repaired molecule |
|
what type of cancer is the carcinogen Aflatoxin associated with?
|
heptocellular carcinoma in association with HBV
|
|
what is the associated cancer with alcohol?
|
squamous cell carcinoma of the oropharynx and upper/middle esophagus; pancreatic and hepatocellular carcinomas
|
|
what cancer are alkylating agents associated with?
|
malignant lymphoma
|
|
what cancer is arsenic associated with?
|
squamous cell carcinoma of skin, lung cancer, liver, angiosarcoma
|
|
what cancer is asbestos associated with?
|
bronchogenic carcinoma, pleural mesothelioma
|
|
what cancer is benzene associate with?
|
acute leukemia
|
|
what cancer is berylium associated with?
|
bronchogenic carcinoma
|
|
what cancer is Chromium associated with?
|
bronchogenic carcinoma
|
|
what cancer is cyclophosphamide associated with?
|
transitional cell carcinoma of urinary bladder
|
|
what cancer is Diethylstilbestrol associated with
|
clear cell carcinoma of vagina/cervix
|
|
what cancer is b-naphthylamine associated with?
|
transitional cell carcinoma of urinary bladder
|
|
what cancer is nickel associated with?
|
bronchogenic carcinoma
|
|
what cancer are oral contraceptives associated with?
|
breast, cervical carcinomas
|
|
what type of cancer is polycylic hydrocarbons associated with?
|
squamous cell carcinoma: oral cavity, midesophagus, larynx, lung
Adenocarcinoma: distal esophagus, pancreas, kidney Transitional cell carcinoma: urinary bladder, renal pelvis |
|
what cancer is polycinyl chloride associated with?
|
liver angiosarcoma
|
|
what type of cancer is silica associated with?
|
bronchogenic carcinoma
|
|
what are the RNA viruses that are associated with cancer?
|
HCV
HTLV-1 |
|
what are the DNA viruses that are associated with cancer?
|
EBV
HBV HHV-8 HPV types 16 and 18 |
|
what is the mechanism of action of HCV causing cancer and what cancer is it associate with ?
|
produces postnecrotic cirrhosis
Hepatocellular carcinoma |
|
what is the mechanism of action of HTLV-1 in the production of cancer?
|
activates TAX gene, stimulates polyclonal T-cell proliferation, inhibits TP53 suppressor gene
Cancer: T0cell leukemia and lymphoma |
|
how does EBV cause cancer? what type?
|
promotes polyclonal-B cell proliferation which increases risk for t(8:14) translocation
Cancer: Burkitt's lymphoma, CNS lymphoma in AIDS, mixed cellularity Hodgkin's lymphoma, nasopharyngeal carcinoma |
|
what is the mechanism of action of HBV in causing cancer?
|
activates proto-oncogenes
inactivates TP53 suppressor gene Cancer: hepatocellular carcinoma |
|
what is the mechanism of action of HHV-8 in causing cancer?
|
acts via cytokines released from HIV and HSV
cancer: Kaposi's sarcoma in AIDs |
|
what is the mechanism of action of HPV-16 & 18 in causing cancer?
|
Type 16: E6 gene products inhibit TP53 supressor gene
Type 18: E7 gene product inhibits RB suppressor gene Cancer: squamous cell carcinoma of the vulva, vagina, cervix, anus, larynx, oropharynx |
|
what is hemostasis?
|
prevention of blood loss while maintaining maximal perfusion requires the interaction of the blood vessels, platelets, coagulation factors, and fibrinolytic agents
|
|
what are the factors preventing thrombus formation in small blood vessels?
|
heparin like molecules
PGI2 Protein C and S Tissue plasminogen activator |
|
describe heparin like molecules
|
enhance AT III activity
Neutralize activated serine protease coagulation factors Factors XII, XI, IX, and X; thrombin |
|
describe PGI2
|
prostacyclin
synthesized by intact endothelial cells PGH2 is converted by prostacyclin synthase to PGI2 Vasodilator inhibits platelet aggregation ASA does NOT inhibit synthesis of PGI2 by endothelial cells |
|
describe Protein C and S
|
Vitamin K dependent factors
inactivate factors V and VII enhance fibrinolysis |
|
describe tissue plasminogen activator
|
synthesized by endothelial cells
activates plasminogen to release plasmin Plasmin degrades coagulation factors and lyses fibrin clots |
|
what factors enhance thrombus formation in small vessel injury?
|
Thromboxane A2
Von Willebrand factor Tissue thromboplastin (factor III) |
|
describe TXA2
|
synthesized by platelets
PGH2 is converted to TXA2 by thromboxane synthase ASA irreversibly inhibits platelet COX > prevents formation of PGH2, the precursor for TXA2 other NSAIDS reversibly inhibit platelet COX Prostacyclin synthase in endothelial cells is minimally affected by NSAIDS Function in hemostasis: vasoconstriction, enhance platelet aggregation |
|
describe Von Willebrand factor
|
synthesized by endothelial cells and megakaryocytes
Synthesized in Weibel-Palade bodies in endothelial cells Platelets carry vWF in the a-granules |
|
what is the function of vWF?
|
1. platelet adhesion molecule
- binds platelets to exposed collagen - platelets have glycoprotein Ib receptor for vWF 2. Complexes with factor VIII coagulant activity in the circulation - Factor VIII:c is synthesized by the liver and other sites - VIII: vWF complex with VIII:c in circulation - prevents degradation of factor VIII:c - decreases in vWF secondarily decrease VIII:c activity |
|
what does complex of VIII:vWF with VIII:c in circulation prevent?
|
prevents degradation of factor VIII:c
|
|
what is tissue thromboplastin (factor III)
|
non-circulating ubiquitous substance
released from injured tissue activates factor VII in the extrinsic coagulation system |
|
Put in order the most common causes of cancer:
Bacteria Virus Parasites |
Viruses > Bacteria > Parasites
|
|
what is the most common cancer due to ionizing radiation?
|
Leukemia
|
|
what is the most common cause of cancer due to excessive UV light exposure?
|
Basal cell carcinoma
|
|
what is the most effective host defense against cancer?
|
Cytotoxic CD8 T-cells
|
|
how do NK cells attack cancer?
|
direct killing and indirect killing through type II hypersensitivity
|
|
what does TNM stand for in the staging criteria of cancer?
|
T: tumor size
N: whether lymph nodes are involved M: refers to extranodal metastases |
|
what is a poor prognostic diagnosis of staging of cancer?
|
M > N > T
|
|
what is the most common anemia in cancer?
|
anemia of chronic disease
|
|
why does a patient develop a macrocytic anemia?
|
due to folate deficiency from rapid tumor growth
|
|
what is myelophthisis anemia?
|
anemia related to metastasis to the bone
immature hematopoetic elements in peripheral blood - nucleated RBCs, immature neutrophils in peripheral blood - tear drop RBCs indicate myelofibrosis secondary to bone metastasis |
|
what type of hemostasis is found in cancer?
|
thrombogenic hemostasis in malignancy
|
|
why does a patient with a malignancy develop DIC?
|
due to release of tissue thromboplastin from cancer cells
|
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what is the most common cause of death in cancer?
|
Gram negative sepsis
|
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what is the most common paraneoplastic syndrome in cancer?
|
Hypercalcemia
|
|
what is Acanthosis nigricans associated with?
|
may be associated with stomach cancer
|
|
what are signs of ectopic hormone production?
|
hypercalcemia
hyponatremia hypoglycemia hypercortisolism polycythemia |
|
patient presents with this black verrucoid appearing lesion under the arm. what cancer might you be worried about your patient having?
|
Stomach carcinoma
|
|
patient presents with myasthenia gravis like symptoms of muscle weakness, and an antibody directed against calcium channels. What is this syndrome? What cancer might it be associated with?
|
Eaton-Lambert Syndrome
Small cell carcinoma |
|
What is a syndrome associated with Bronchogenic carcinoma?
|
Hypertrophic osteoarthropathy
|
|
what is hypertrophic osteoarthropathy?
|
periosteal reaction of distal phalanx often associated with clubbing of nail
|
|
what is the function of heparin like molecules?
|
enhance ATIII activity
|
|
what is the function of ATIII?
|
neutralizes activated serine protease coagulation factors
|
|
what is the function of PGI2?
|
vasodilator
inhibits platelet aggregation |
|
Protein C and S inactivate _______ and ________ and enhance _________.
|
Protein C and S inactivate factors V and VIII, enhances fibrinolysis
|
|
_______ activates plasminogen to release plasmin
|
tPA
|
|
what is the function of TXA2?
|
vasoconstriction
enhances platelet aggregation |
|
______ is a platelet adhesion molecule.
|
vWF
|
|
what is synthesized in Weibel Palade bodies in endothelial cells?
|
vWF
|
|
where is Factor VIII:c synthesized at?
|
in the liver and reticuloendothelial cells
|
|
If there is a decrease in vWF what does this secondarily decrease?
|
decreases VIII:c
|
|
what is the function of vWF?
|
platelet adhesion
prevents degradation of VIII:c in plasma |
|
what does tissue thromboplastin activate in the extrinsic coagulation system?
|
Factor VII
|
|
What platelet receptor binds GpIb?
|
binds vWF
|
|
what platelet receptor binds GpIIb-IIIa?
|
binds to fibrinogen
|
|
what drugs interfere with GpIIb-IIIa receptor function?
|
Ticlopidine
Clopidegrel Abciximab |
|
what are some important platelet storage proteins?
|
ADP
vWF Fibrinogen |
|
what is the function of a platelet?
|
stabilizes intercellular adherens junctions in venular endothelial cells
|
|
what factor is activated in the extrinsic coagulation system?
|
Factor VIII
|
|
what coagulation factors does factor VII activate?
|
activates factor IX and X
|
|
what coagulation factors are involved in the intrinsic pathway?
|
XII, XI, IX, VIII
|
|
What does Factor XIIa activate?
|
activates the kininogen system
|
|
where is vitamin K primarily synthesized?
|
in the liver
|
|
what coagulation factors are involved in the final common pathway?
|
Factors X, V, II, I
|
|
what is the function of Factor XIII?
|
Factor XIII cross-links insoluble fibrin monomers
|
|
what are the Vitamin K dependent factors?
|
procoagulants II, VII, IX, X
anticoagulants Protein C and S |
|
what is the function of calcium in the coagulation pathway?
|
binds gamma-carboxylated vitamin K dependent factors
|
|
what factors are consumed in a clot to produce serum?
|
I, II, V, VIII
|
|
if blood is drawn into a clot tube, a fibrin clot is formed. When the tube is spun down in a centrifuge, the supranate is called serum, What factors is the serum missing?
|
Unlike plasma, serum is missing fibrinogen (I), prothrombin (II), factor V, and Factor VIII
|
|
name three plasminogen activators.
|
tPA
Streptokinase Urokinase |
|
what is the function of Aminocaproic acid?
|
inhibits plasminogen
inhibits fibrinolysis by competitively blocking plasminogen |
|
what is a D-dimer?
|
cross-linked fibrin monomer
|
|
Describe the platelet sequence in hemostasis.
|
Adhesion
Release reaction Synthesis of TXA2 temporary plug |
|
what is the function of TXA2 in the platelet sequence in hemostasis?
|
enhances fibrinogen attachment to GpIIb-IIIa receptors
|
|
what is a temporary platelet plug held together by?
|
Fibrinogen
|
|
what is a stable platelet plug held together by?
|
Fibrin
|
|
what takes place in the vascular phase of small vessel hemostasis?
|
vessel injury with activation of coagulation cascade
|
|
what takes place in the platelet phase of small vessel hemostasis?
|
platelet adhesion to vWF
Platelet release of aggregating agents Platelets synthesize TXA2 Temporary platelet plug |
|
what does the end of the platelet phase of the small vessel hemostasis represent?
|
end of bleeding time
|
|
what happens in the coagulation phase of small vessel hemostasis?
|
Formation of stable platelet plug
stable plug held together by Fibrin. Only disrupted by plasmin |
|
what happens in the fibrinolytic phase of small vessel hemostasis?
|
dissolution of platelet plug
reestablishment of blood flow |
|
what is Bleeding Time test used to assess?
|
test of platelet function to formation of temporary plug
|
|
what is the Ristocetin cofactor assay?
|
test for vWF function
|
|
what does the Prothrombin time evaluate?
|
Factors VII, X, V, II, I
- extrinsic pathway |
|
what is an INR measurement?
|
INR standardizes PT for warfarin therapy
|
|
what test evaluates factors XII, XI, IX, VIII, X, V, II, I?
|
Partial thromboplastin time (PTT)
|
|
what increases with lysis of fibrinogen and fibrin in fibrin thrombi?
|
FDPs
|
|
what is a D-dimer assay specific for?
|
D-Dimer assay is specific for lysis of fibrin thrombi (clots) and detects cross-links
|
|
what can be detected with the TTP/HUS?
|
platelet consumption + hemolytic anemia with schistocytes
|
|
what are some common causes of thrombocytosis?
|
chronic iron deficiency
malignancy splenectomy |
|
what is the most common cause of a qualitative platelet defect?
|
Aspirin
|
|
what is senile purpura?
|
vessel instability
|
|
what is seen with platelet dysfunction?
|
bleeding from superficial scratches, easy bruising
|
|
what are the clinical findings in Thrombocytopenia?
|
petechia
bleeding from superficial scratches easy bruising |
|
what are the main causes of coagulation disorders?
|
decreased production, inhibition, or consumption of platelets
|
|
what are clinical findings in severe factor deficiencies?
|
late rebleeding
hemarthroses retroperitoneal and deep muscular bleeding |
|
what type of inheritance is hemophilia A?
|
x-linked recessive
|
|
what does the % of VIII:c have to do with hemophilia A?
|
correlate with severity
Mild disease: 5-25% of normal moderate disease: 1-4% of normal severe disease < 1% of normal |
|
what does hemophilia B involve?
|
x-linked recessive involving a deficiency of factor IX
It is clinically indistinguishable from hemophilia A |
|
what are the laboratory findings in hemophilia A?
|
decreased VIII:c
increased PTT |
|
what type of inheritance is vWD?
|
AD inheritance
|
|
what is vWD associated with?
|
mitral valve prolapse
marfan syndrome angiodysplasia |
|
what is the most common hereditary coagulation disorder?
|
vWD
|
|
define vWD?
|
combined platelet and coagulation disorder
|
|
what are the laboratory findings in vWD?
|
increased PTT
increased bleeding time decreased VIII:c decreased vWF |
|
what is the treatment for vWD?
|
desmopressin acetate
OCP |
|
what activates the vitamin K dependent coagulation factors?
|
gamma-carboxylation
|
|
why must newborns get a vitamin K injection?
|
newborns lack bacterial colonization in bowel
no synthesis of vitamin K because breast milk contains very little vitamin K and Vitamin K levels normally decrease between days 2 and 5 in newborns |
|
what is the most common cause of vitamin K deficiency in hospital patients?
|
due to antibiotic therapy
|
|
what does warfarin inhibit?
|
epoxide reductase
|
|
what effect does warfarin/rat poison have on vitamin K?
|
makes vitamin K dependent factors nonfunctional because it decreases the activation of vitamin K by epoxide reductase
|
|
what effect does cirrhosis have on vitamin K?
|
decreases synthesis of vitamin-K dependent factors
decreases activation of vitamin K |
|
what is the most common cause of DIC?
|
sepsis
|
|
what is the main pathogenesis of DIC?
|
consumption of coagulation factors
|
|
what type of disorder would DIC be classified as?
|
thrombohemorrhagic disorder
|
|
the lab findings in DIC would be:
|
increased PT
increased PTT D-dimers increased Bleeding time decreased platelets |
|
what is the most sensitive screen for DIC?
|
D-dimers
|
|
what is the treatment for DIC?
|
treat the underlying disease most important
component replacement |
|
what are the major causes of primary fibrinolysis?
|
open heart surgery
prostatectomy diffuse liver disease |
|
what would the laboratory findings be in primary fibrinolysis?
|
+ test for FDPs
- test for d-dimers normal platelet count increased PT and PTT |
|
Labs in secondary fibrinolysis:
|
increase in FDPs
increase in D-dimers decrease in platelet count increase in PT and PTT |
|
what is found in antiphospholipid syndrome? (APLS)
|
APAs: anticardiolipin antibody, lupus anticoagulant
|
|
what type of disorder is APLS?
|
thrombosis syndrome
|
|
what antibody can produce a false positive syphilis serologic test?
|
anticardiolipin antibody
|
|
what are clinical findings in APLS?
|
spontaneous abortions
strokes DVTs Hepatic vein thrombosis |
|
Name 5 acquired causes of thrombosis?
|
Post-operative state with stasis of blood flow
Malignancy Folate/Vitamin B12 deficiency OCPs Hyperviscosity |
|
what is the most common hereditary thrombosis syndrome?
|
Factor V Leiden
|
|
what occurs in Factor V Leiden hereditary thrombosis syndrome?
|
Mutant form of Factor V cannot be degraded by protein C and S
|
|
what is diagnostic for ATIII deficiency?
|
normal PTT after standard dose of heparin
|
|
what is hemorrhagic skin necrosis associated with?
|
warfarin therapy in protein C deficiency
|
|
what is the most common blood group?
|
Blood group O
|
|
what are the characteristics of blood group O?
|
No blood group antigens are present on RBC membranes
- anti-A-IgM - anti-B-IgM - anti-A and anti-B IgG |
|
what is the function of an M cell?
|
M cells transport A and B antigens in Peyer's patches to B lymphocytes
|
|
what are the characteristics of Blood group A?
|
anti-B-IgM
increased incidence of gastic carcinoma |
|
what blood group has anti-A-IgM?
|
Blood group B
|
|
what is the least common blood group?
|
Blood group AB
|
|
what antibodies does blood group AB have?
|
NO natural antibodies
|
|
Do newborns have natural antibodies?
|
NO, not at birth
IgG antibodies are of maternal origin |
|
do the elderly have natural antibodies?
|
NO
frequently lose their natural antibodies |
|
If an elderly patient were transfused with the wrong blood group, what would happen?
|
possibly, they may not have a hemolytic transfusion reaction because they frequently have lost their natural antibodies
|
|
Can parents that have Blood group AB have a baby with O blood?
|
NO
|
|
If both parents have blood group O blood what type of blood must their child have?
|
O
cannot have a child with AB, A, or B blood group |
|
Can parents with blood group A or blood group B have a child with blood group O?
|
YES
blood group A and B parents can have O children if both have AO and BO phenotypes |
|
when determining the ABO group what does the forward typing test identify?
|
blood group antigen
|
|
when determining the ABO group what does the backward typing test identify?
|
natural antibodies
|
|
If a patients RBCs are added to a test tube with anti-A serum and agglutinate in a forward type test and then added to a anti-B serum test tube and do not agglutinate, what do these findings mean?
|
Patient has A blood
|
|
If a patients serum is added to a test tube with anti-B-IgM antibodies and agglutinates but does not agglutinate when added to an A test tube of RBCs what does this indicate?
|
patient has blood group A serum
|
|
what are the five Rh antigens?
|
D
C c E e |
|
what type of inheritance are the Rh antigens?
|
autosomal dominant inheritance
|
|
what does it mean to be Rh positive?
|
D antigen positive
|
|
what is alloimmunization?
|
antibodies develop against foreign antigens
|
|
what is the significance of atypical antibodies?
|
may produce an HTR
|
|
what type of blood products must a patient with an atypical antibody receive?
|
individuals with an atypical antibody must receive blood lacking the antigen
|
|
what is the Duffy antigen?
|
Fy antigens are the binding site for infestation of RBCs by Plasmodium vivax
|
|
what does it mean if you are Fy antigen negative?
|
protection against P. vivax malaria
|
|
what is the safest type of transfusion?
|
autologous transfusion
|
|
what is an autologous transfusion?
|
process of collection, storage, and reinfusion of the individuals own blood
|
|
what is the most common pathogen transmitted by transfusion? why?
|
CMV
it is present in the donor lymphocytes |
|
why must blood being given to a newborn be irradiated?
|
must irradiate blood to destroy lymphocytes
|
|
describe the major crossmatch?
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patient serum + donor RBCs
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what does a negative antibody screen ensure?
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a negative antibody screen ensures that a major crossmatch will be compatible
|
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what does a compatible crossmatch not guarantee?
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that the recipient will not develop atypical antibodies, a transfusion reaction, or an infection
|
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what blood group is the universal donor?
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Blood group O
anti-A-IgM and anti-B-IgM cannot hemolyze O RBCs |
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what blood group is the universal recipient?
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Blood group ABO
lack natural antibodies |
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describe an allergic reaction to a transfusion.
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IgE mediated
Type II HSR Most common transfusion reaction |
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describe a Febrile transfusion reaction.
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anti-HLA antibodies against donor leukocytes
Type II HSR |
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are there any HLA antigens on RBCs?
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NO
this is not detected in ABS |
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how are anti-HLS antigens developed?
|
comes from previous exposure to HLA antigens (blood transfusion/transplant)
|
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what are packed RBCs used for?
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Purpose: to increase oxygen transport to tissues
Packed RBCs have less volume and a higher Hct than whole blood |
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when given packed RBCs how much should the patients Hb raise by?
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Each unit of packed RBCs should raise the Hb by 1 g/dL and the Hct by 3%
lack of an increment implies a hemolytic transfusion reaction or continued blood loss in the patient |
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what is the most common contaminate of stored blood?
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Yersinia enterocolitica, a pathogen that thrives on iron
|
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what is the purpose of using platelets?
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Purpose: stop medically significant bleeding related to thrombocytopenia or qualitative platelet defects
|
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do platelets have HLA antigens and ABO antigens present on them?
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Platelets have HLA and ABO antigens on their surface
They lack Rh antigens |
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how much should each unit of platelets increase a platelet count in a patient?
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each unit of platelets should raise the platelet count by 5000-10,000 cells/mm
|
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why would you give a patient fresh frozen plasma?
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treatment of multiple coagulation deficiencies or treatment of warfarin over anticoagulation if bleeding is life threatening
|
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what is the purpose of Cryoprecipiate?
|
treatment of coagulation factor deficiencies involving fibrinogen and factor VIII
|
|
what does cryoprecipitate contain?
|
Fibrinogen
Factor VIII Factor XIII |
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what is used in place of cryoprecipitate in treating mild hemophilia A and von Willebrand disease?
|
Desmopressin acetate
|
|
what are acute hemolytic transfusion reactions due to?
|
blood group incompatibility or presence of an atypical antibody
|
|
what type of hemolysis is present in an ACute HTR?
|
intravascular and extravascular hemolysis
|
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If you suspect an HTR in your patient, what do you do?
|
keep IV open with normal saline
discontinue transfusion |
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what is the most common type of Hemolytic Disease of a newborn?
|
ABO HDN
|
|
what is the pathogenesis of ABO HDN?
|
mother is blood group O
fetus is blood group A or B blood group O individuals have anti-A and B-IgG antibodies IgG antibodies cross the placenta and attach to fetal A or B RBCs Fetal splenic macrophages phagocytose RBCs causing mild anemia UCB from extravascular hemolysis is disposed of in the mothers liver |
|
what is the most common cause of Jaundice in first 24 hours of life?
|
ABO HDN
|
|
in ABO HDN what type of Coombs test will be produced?
|
Positive direct Coombs test on fetal cord blood RBCs
- due to anti-A or B-IgG antibodies coating fetal A or B RBCs |
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will spherocytes be present in the cord blood peripheral smear of a baby with ABO HDN?
|
YES
due to macrophage removal of a portion of the RBC membrane |
|
what causes Rh HDN?
|
mother Rh negative
baby Rh positive |
|
when compared to ABO HDN what are the levels of UCB and the severity of anemia?
|
Rh HDN anemia and amount of UCB >>> ABO HDN
|
|
in Rh HDN is the bilirubin unconjugated or conjugated?
|
unconjugated bilirubin is free in the blood
|
|
what is the cause of kernicterus in the fetus/infant?
|
unconjugated bilirubin deposits in basal ganglia
|
|
what type of Coombs test will Rh HDN produce?
|
positive direct Coomb's test on fetal RBCs
|
|
In which type of HDN is an exchange transfusion required?
|
Rh HDN
|
|
what protects the mother from Rh sensitization in Rh HDN?
|
ABO incompatibility
|
|
what prevents Rh HDN?
|
Rh immune globulin (anti-D globulin)
|
|
At what wavelength does bilirubin have an absorbance?
|
450 nm
|
|
what is used in the treatment of Jaundice in newborns?
|
Blue fluorescent light or sunlight
|
|
A patient has small cell carcinoma and has Cushings syndrome. What hormone is being release?
|
ACTH
|
|
A patient has Gynecomastia. What type of cancer could be associated with this? what hormone would be associated with this?
|
Choriocarcinoma
hormone: HCG (LH analog that can stimulate the stroma in the breast of males) |
|
You detect Hypercalcemia in a patient. What cancers could this be associated with? what hormone would be released causing this?
|
Renal cell carcinoma
Squamous cell carcinoma Hormone: PTH related hormone |
|
Your patient has small cell carcinoma and has hyponatremia. What hormone is causing this?
|
ADH
|
|
A patient presents to you with polycythemia. You determine that they have Renal cell carcinoma. What hormone is being released to cause the polycythemia?
|
EPO
|
|
A patient has medullary carcinoma of the thyroid. They are found to be hypocalcemic. What is causing this?
|
Calcitonin
|
|
Seborrheic keratosis, acanthosis nigrans, and hypertrophic osteoarthropy are associated with what type of cancer?
|
Gastric adenocarcinoma
|
|
Tumor marker:
AFP associated with? |
hepatocellular carcinoma
yolk sac tumor of ovary or testis |
|
Tumor marker:
Bence Jones protein is associated with? |
multiple myeloma
Waldenstrom's macroglobinemia |
|
Tumor marker CA 125 is associated with?
|
surface derived ovarian cancer
|
|
tumor marker CEA is associated with?
|
Colorectal and pancreatic carcinoma
- monitor for recurrence |
|
tumor marker PSA is associated with?
|
prostate carcinoma
- also increased in prostate hyperplasia |
|
If you are trying to identify a tumor and it stains positive using a cytokeratin stain, what is its origin?
|
epithelial origin
|
|
if you are trying to identify a tumors origin and it stains positive with Vimentin stain its origin is?
|
connective tissue origin
|
|
The tumor cells that you have biopsied are CD45 positive, what is its origin?
|
malignant lymphoma
|
|
what cancer is Cushing's syndrome associated with? What hormone is ectopically secreted?
|
small cell carcinoma of lung
medullary carcinoma of thyroid - ACTH |
|
what cancer is Gynecomastia associated with? ectopic hormone?
|
choriocarcinoma (testis)
- hCG |
|
what cancer is HYPERcalcemia associated with? ectopic hormone?
|
Renal cell carcinoma
primary squamous cell carcinoma of lung Breast carcinoma Malignant lymphomas - PTH related protein Calcitriol |
|
what cancer is HYPOcalcemia associated with? ectopic hormone?
|
medullary carcinoma of thyroid
- Clacitonin |
|
what cancer would HYPOglycemia be associated with? ectopic hormone?
|
Hepatocellular carcinoma
- insulin like factor |
|
Patient has cancer and is HYPOnatremic. what cancer does your patient most likely have? ectopic hormone being secreted?
|
Small cell carcinoma of lung
- ADH |
|
What cancers could possibly cause secondary polycythemia? ectopic hormone?
|
Renal cell and hepatocellular carcinoma
- EPO |
|
what is the most common paraneoplastic syndrome?
|
HYPERcalcemia
|
|
what is the most common cause of death in cancer?
|
Gram negative sepsis
|