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Hemeonc

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Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
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1. Back pain - hemoglobinuria
Inc vasodiltion - inc perm - inc pain
Protein C or S deficiency
Protoporphyrin
Common a few days after oxidative stress in a pt with G6PD

2. What is monoclonal expansion without symptoms associated with multiple myeloma?
Inc bleeding time - microhemorrhage: mucuous membrane bleeding - epitaxis - petechiae - purpura - possible thrombocytopenia
Signs and sx of aplastic anemia
Aspirin
MGUS - monoclonal gammopathy of undetermined significance

3. What are the main associations with multiple myeloma?
Inc suscept to infxn - primary amyloidosis - punched out lytic bone lesions - M spike - Ig light chains in urine - Rouleaud formations (stacked RBCs)
Polycythemia vera
Protein S - cleaves and invactivates Va and VIIIa
Porphobilinogen deaminase aka uroporphyrinogen I synthase

4. Causes of iron def?
Factor V resistant to activated protein C's inhibition
Glucose and heme - which inhibit ALA synthase
HbSS
Bleeding - malnutrition/absorption - inc demand pregs

5. What are the labs and tx for HS?
Positive osmootic fragility test and splenectomy
Antigen - antibody
B12 def
Bernard soulier

6. Where does All spread
CNS and testis
Hydroxyurea - bone marrow transplant
Multiple myeloma
TRAP (tartrate resistant acid phosphatase

7. What symptoms are associated with Hodgkin lymphoma
Megakaryocytes
B symptoms - fever night sweats - weight loss
Idiopathic thrombocytopenia (ITP)
B6

8. What is the purpose of the fibrin mesh
Adult T cell lymphoma - presents with cutaneous lesions
Deoxygenated HbS polymerizes - low O2 or dehydration precipiates sickling - anemia and veno - occlusive disease
Acts to stabilize platelet plug
DIC

9. Serum iron - transferrin - ferritin lab values for anemia of chronic disease
Bimodal - men>women - except for nodular sclerosing type
Gp1b
Down - down - up
Deficiency in factor VIII

10. What CD molecules are on RS cells
Deoxygenated HbS polymerizes - low O2 or dehydration precipiates sickling - anemia and veno - occlusive disease
CD15 and CD30 pos
Allogenic bone marrow transplant - RBC/platelet transfusion - C- GSF - or GM- CSF
Pos

11. What converts plasminogen to plasm and What does plasmin do?
Pyruvate kinase def - extravascular
Neoplastic - asthma - allergic processes - collagen vacsular disease - parasites
Inc lymphoctes - and less RS cells
TPA - cleavage of fibrin mesh

12. What is the Ddx for for a macrocytic anemia
Folate/B12 - nonmegaoblastic anemias - liver dz - EtOH (non folate/B12) reticulocytosis - metabolic disorder - drugs
20 to 40
Glanzmann's throbmasthenia - GpIIb/IIIa - nl platelets - inc BT
Neoplastic - asthma - allergic processes - collagen vacsular disease - parasites

13. bcl -2 t(14;18) adults
G6PD
Follicular lymphoma - indolent course
Inducers of primary antibody response
Prothrombin gene mutation

14. inc WBC count with left shift - inc leukocyte alkaline phosphatase - often due to infection
AML
Leukemoid reaction
Langerhans cell histiocytosis
Nodular sclerosing

15. philadelphia chromosome - blood looks like marrow
Reed - sternberg cells
B12 in fatty acid pathways leads to subacute combined degeneration
CML
Alpha thal - asian and african american

16. Intrinsic pathway coagulation defect and defect in platelet plug formation - most common inherited bleeding disorder - AD
TRAP (tartrate resistant acid phosphatase
Dec plasma volume
VWD
Peripheral neuropathy - posterior columns (vibration/proprioception) - lateral corticospinal (spasticity) - dementia

17. Upregulated growth of leukocytes in bone marro
Factor V Leiden
TXA2 - dec blood flow - inc platelet aggregation
Glanzmann's throbmasthenia
Leukemia

18. What is the age breakdown for hodgkins
Anti Rh
Gp1b - bernard - soulier - dec platelets (giant platelets not counted) - inc BT
Bimodal - men>women - except for nodular sclerosing type
All trans retinoic acid

19. Elliptocyte
Hereditary elloptocytosis
Multiple myeloma
Plasma cell
Hairy cell leukemia

20. Where do B cells arise from - mature - and migrate to...
HIV or immunosupression
Mantle cell - older males
Burkitt lymphoma
Marrow - marrow - follicles of lymph nodes - white pulp of spleen (unencapsulated lymphoid tissue)

21. What are some causes of warm agglutinin autoimmune hemolytic anemia?
M3 AML (acute promyelocytic leukemia)
Induces differentiation of myeloblasts
SLE - CLL - alpha methyldopa
Plasma cell

22. Blood type B
Alpha thal - asian and african american
B antigena and A antibodes
Cold - seen in CLL - mycoplasma pneumoniae infections or infectious mononucleosis
B6 therapy (pyrodixine)

23. What are the two substances produced by eosinophils help limit the reaction following mast cell degranulation?
Fibrinogen
Histaminase and arylsulfatase
Abciximab
Round densly staining nucleus with a small amount of pale cytoplasm

24. Does CML have a JAK2 mut
Megaloblastic anemia (also hypersegmented PMNs - marrow failure)
No
MHC II and Fc receptors
B12 def

25. What is the enzyme defect in Porphyria cutanea tarda
Leukemia
Inc vasodiltion - inc perm - inc pain
Hairy cell leukemia
Uroporphyrinogen decarboxylase

26. When do you see MAHA?
Hereditary spherocytosis
Aplastic anemia - pancytopenia
Hodgkin
DIC - TTP- HUS - SLE malignant HTN - prostethic heart valves - aortic stenosis

27. Where are basophils found?
Yes - via MHC II
Indirect coombs - agglutinate if serum anti RBC surface Ig
Blood
8-10 days

28. dec haptoglobin - inc LDH - hemoglobin in urine (paroxysmal nocturnal hemoglobinuria - mechanical destruction as in aortic stenosis or a prosthetic valve
Paroxysmal nocturnal hemoglobinuria
Complications of sickle cell anemia
Intravascular hemolysis
Dec plasma volume

29. X linked - dec glutathione inc RBC susceptibility to oxidative stress
5- FU - AZT - hydroxyurea
Kidney - Gi - microcytic anemai in both - kids = mental retardation and adults = headache - memory loss - demyelination
ADP binding to receptors causes upregulation of GpIIb/IIIa expression at platelet surface
G6PD

30. adults - auer rods - inc circulating myeblasts on peripheral smear
M3 AML (acute promyelocytic leukemia)
AML
Intravascular
DNA synth impaired - maturation of nucleus delayed relative to maturation of cytoplasm

31. Who are the professional APCs?
Idiopathic thrombocytopenia (ITP)
Alpha thal - asian and african american
Dendritic cells?
Induces differentiation of myeloblasts

32. What is the mutation in HbS
Incactivates II - VII - IX - X - XI - XII
MAHA
Valine for glutamate
CML to AML or All

33. inhibition of ferrochelatase and ALA dehydrogenase leading to dec heme synthesis - also inhibition of rRNA degradation
Lead lines on gingivae and epiphyses of long bones on xray - Encephalopathy and Erythrocyte basophilic stippling - Abdominal colic and Anemia - Drops - wrist and foot drop -
Polycythemia vera
HbSS
Lead poisoning - rRNA causes aggregration of ribosomes and basophilic stippling

34. What are the etiologies of folate def
Leukemoid reaction
Malnutrition - malabsoprtion - impaired metabolism - inc requirement as in an hemolytic anemia or pregnancy
Howell Jolly bodies
HbSS

35. Eosinophils are highly phagocytic For what kind of complex?
1 to 6
5- FU - AZT - hydroxyurea
Antigen - antibody
Inc HbA2 on electrophoresis

36. What the alpha granules contain in platelets?
Inc bleeding time - microhemorrhage: mucuous membrane bleeding - epitaxis - petechiae - purpura - possible thrombocytopenia
VWF and fibrinogen
B6
MHC II and Fc receptors

37. What do auer rods stain with
Aspirin
No platelet clumping
Peroxidase
Sideroblastic anemia

38. Plasma cell neoplasm
T(9;22) bcr abl
DIC
Multiple myeloma
EBV

39. hypersegmented PMNs - glossitis - dec B12 - inc homocysteine - inc methymalonic acid
Anemia of chronic disease - Aplastic anemia - kidney disease
Hereditary elloptocytosis
B12 def
DNA synth impaired - maturation of nucleus delayed relative to maturation of cytoplasm

40. Wilm's tumor - RCC - HCC - hydronephrosis
Polycythemia vera with inc plasma volume - inc RBCs - inc EPO
HyperCalcemia - Renal insuff - Anemia - Bone lytic lesions/Back pain
Myelofibrosis (marow is crying being its fibrosed'
Dec plasma volume

41. What are the pro aggregation factors?
DIC - TTP/HUS - traumatic hemolysis
Bimodal - men>women - except for nodular sclerosing type
TXA2 - dec blood flow - inc platelet aggregation
Langerhans cells

42. What causes the physiologic chloride shift and What does the chloride shift do?
Tissue
Beta 4
Fc
Chloride bicarb antiport system - - allows transport of C02 from periph to lungs

43. What are the likely exposures of kids and adults for lead poisoning
Kids= exposure to lead paint - adults = battery - ammunition factory
Uroporphyrin (tea colored urine)
Myelofibrosis (marow is crying being its fibrosed'
90% anearobically from glucose to lactate - 10% from HMP shunt

44. Fibrotic obliteration of bone marow with teardrop cells

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45. What is the most common hodgkin lymphoma
Nodular sclerosing
Inc bleeding time - microhemorrhage: mucuous membrane bleeding - epitaxis - petechiae - purpura - possible thrombocytopenia
Fe def - thal - pb poison - sideroblastic anemia
Bimodal - men>women - except for nodular sclerosing type

46. What percentage of WBCs are eosinophils?
ADP binding to receptors causes upregulation of GpIIb/IIIa expression at platelet surface
Inc vasodiltion - inc perm - inc pain
Both alpha and beta thal
1 to 6

47. Serum iron - transferrin - ferritin lab values for pregs - OCP use
Insufficient intake as with strict vegans - malabsorption as in crohns - pernicious anemia - diphyllobothrium
Anemia of chronic disease - Aplastic anemia - kidney disease
Aplastic anemia - pancytopenia
Nl - up - nl

48. What activates the intrinsic pathway?
Collagen - BM - activated platelets
HyperCalcemia - Renal insuff - Anemia - Bone lytic lesions/Back pain
Mantle cell - older males
Bone marrow infiltration - myelofibrosis

49. What is HbH
Beta 4
Plasma cell
B antigena and A antibodes
Intravascular

50. What is the ddx for aplastic anemia

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