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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. What percentage of WBCs are eosinophils?
Common a few days after oxidative stress in a pt with G6PD
HyperCalcemia - Renal insuff - Anemia - Bone lytic lesions/Back pain
1 to 6
Incactivates II - VII - IX - X - XI - XII

2. What are the age ranges for the various leukemias
Glanzmann's throbmasthenia - GpIIb/IIIa - nl platelets - inc BT
DIC
All < 15 - AML = median onset around 60 - CML = 30 to 60 - and CLL > 60
B12/folate def

3. What are the neuro sx of B12 def?
Peripheral neuropathy - posterior columns (vibration/proprioception) - lateral corticospinal (spasticity) - dementia
Factor V Leiden
Leukemia
Inc vasodiltion - inc perm - inc pain

4. t(11:22)
Ewing sarcoma
Splicing sites and promotor sequences
Leukemia
90% anearobically from glucose to lactate - 10% from HMP shunt

5. philadelphia chromosome - blood looks like marrow
CML
Factor V resistant to activated protein C's inhibition
Sheets of lymphocytes interspersed with macs
Reed - sternberg cells

6. What are the presenting symptoms of porphyria cutanea tarda
Varying sizes
Cold - seen in CLL - mycoplasma pneumoniae infections or infectious mononucleosis
Blistering cutaneous photosens - most common porphyria
Hydrolytic enzymes - lysozyme - myeloperoxidase - lactoferrin

7. Drug that inhbits the GpIIb/IIIa directly
Abciximab
Glycine and succinyl - coa
...
IgG - Warm is GREAT

8. What is the result of thrombocytopenia or platelet dysfunction?
Hairy cell leukemia
Petechiae
HbSS
Extravascular

9. What portion of IgE can mast cells bind
Fc
Hairy cell leukemia
Blood
Common a few days after oxidative stress in a pt with G6PD

10. Tdt+ - CAllA+ - kids in the marrow - adolescent males with mediastinal mass
B antigena and A antibodes
B12 def
Down - down - up
All

11. Inherited deficiency of antithrombin; reduced inc in PTT after administration of heparin
All
Easy gas exchange
ATIII def
Splicing sites and promotor sequences

12. Upregulated growth of leukocytes in bone marro
Defect in 4 - not compatible with life - defect in 3 - HbH disease - defect in 1/2 not associated with sig anemia
Factor V Leiden
AML
Leukemia

13. What is the treatment for acute intermittent porphyria
Erythroblastosis fetalis - Rh or other blood antigen incompatibility
Intravascular hemolysis
A antigen and B antibodies
Glucose and heme - which inhibit ALA synthase

14. Acanthocyte (spur cell)
Liver disease - abetalipoproteinemia - acntho = spiny
CD15 and CD30 pos
Kids= exposure to lead paint - adults = battery - ammunition factory
Spleen

15. Where does All spread
MHC II and Fc receptors
CNS and testis
Howell Jolly bodies
Extravascular

16. What does NAACP stand for - in regards to the causes of eosinophiia?
Fc
Plasma cell
Neoplastic - asthma - allergic processes - collagen vacsular disease - parasites
Liver disease - abetalipoproteinemia - acntho = spiny

17. What does the large SA:volume ratio in RBCs help facilitate?
T(9;22) bcr abl
No platelet clumping
Down - up - down
Easy gas exchange

18. What is HbH
Ticlopidine/clopidogrel
Splicing sites and promotor sequences
Incactivates II - VII - IX - X - XI - XII
Beta 4

19. When do you see MAHA?
SLE - CLL - alpha methyldopa
DIC - TTP- HUS - SLE malignant HTN - prostethic heart valves - aortic stenosis
Bernard soulier
B12/folate def

20. Which pathway and factorrs are tested by the PT coag test
Low O2 in papilla; can also get microhematuria from medullary infarcts
Ticlopidine/clopidogrel
Extrinsic - I - II - V - VII and X
No platelet clumping

21. Causes of iron def?
B antigena and A antibodes
Bleeding - malnutrition/absorption - inc demand pregs
Erythroblastosis fetalis - Rh or other blood antigen incompatibility
Hemolytic or non hemolytic - and then for the hemolytiuc - intravascular hemolysis or extravascular hemolysis

22. Ddx for microcytic anemia
Fe def - thal - pb poison - sideroblastic anemia
Marrow - marrow - follicles of lymph nodes - white pulp of spleen (unencapsulated lymphoid tissue)
Beta chain absent - homozgote - severe anemia requiring blood transfusion - secondary hemochromatosis
Africa = Jaw lesion - US = pelvis or abdomen

23. What is the characteristic spread of Hodgkin Lymphoma
Decrease EPO
Contiguous
Glanzmann's throbmasthenia
Inflammation leads to inc hepcidin causing a dec in release from iron from macs: dec serum fe - dec TIBC - inc ferritin

24. Deficiency in GpIIb/IIIa

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25. What does decreasing heme do to ALA synthase activity?
Leukemia
Schistocytes - inc fibrin split products (D- dimers) - dec fibrinogen - dec factors V and VIII
HbSS
Inc

26. What are the etiologies of B12 def
Varying sizes
Insufficient intake as with strict vegans - malabsorption as in crohns - pernicious anemia - diphyllobothrium
VIII
Inc large vWF multimers - inc platelet aggregation and thrombosis

27. What the alpha granules contain in platelets?
VWF and fibrinogen
Alpha thal - asian and african american
Porphyrias
Induces differentiation of myeloblasts

28. Teardrop cell
Off center nuclues - clock face chromatin
Porphobilinogen deaminase aka uroporphyrinogen I synthase
Deoxygenated HbS polymerizes - low O2 or dehydration precipiates sickling - anemia and veno - occlusive disease
Bone marrow infiltration - myelofibrosis

29. Macro - ovalocyte
Mantle cell lymphoma
HyperCalcemia - Renal insuff - Anemia - Bone lytic lesions/Back pain
Insufficient intake as with strict vegans - malabsorption as in crohns - pernicious anemia - diphyllobothrium
Megaloblastic anemia (also hypersegmented PMNs - marrow failure)

30. What symptoms are associated with Hodgkin lymphoma
B symptoms - fever night sweats - weight loss
Idiopathic thrombocytopenia (ITP)
Produce antibody - lots of RER and golgi
VWF carries/protects factor VIII

31. Where are mast cells found
Tissue
AML
Folate/B12 - nonmegaoblastic anemias - liver dz - EtOH (non folate/B12) reticulocytosis - metabolic disorder - drugs
Heinz bodies - seen in alpha thal and G6PD

32. What are some causes of warm agglutinin autoimmune hemolytic anemia?
Reed - sternberg cells
SLE - CLL - alpha methyldopa
Common a few days after oxidative stress in a pt with G6PD
CNS and testis

33. What are the etiologies of folate def
Malnutrition - malabsoprtion - impaired metabolism - inc requirement as in an hemolytic anemia or pregnancy
Inc suscept to infxn - primary amyloidosis - punched out lytic bone lesions - M spike - Ig light chains in urine - Rouleaud formations (stacked RBCs)
Positive osmootic fragility test and splenectomy
Varying shapes

34. What percentage if WBCs are polys?
Degrades fibrin mesh and converts C3 to C3a
Exposed collagen upon endothelial damage
40 to 75
Deoxygenated HbS polymerizes - low O2 or dehydration precipiates sickling - anemia and veno - occlusive disease

35. What virus is associated with 50% of Hodgkin lymphoma
DIC
EBV
Protoporphyrin (blood)
Glucose and heme - which inhibit ALA synthase

36. What is the receptor for vWF
Gp1b
Hairy cell leukemia
DIC
Von Willebrand's disease

37. What do auer rods stain with
Peroxidase
Hydroxyurea - bone marrow transplant
Gp1b
Extravascular

38. What does 'Neutrophils Like Making Everything Better' stand for?
Inc
Dec synthesis of factors 1972 - protein C/S
WBC diff highest to lowest: neutrophils - lymphocytes - monocytes - eosinophils - basophils
Paraprotein spike - monoclonal protein

39. What percentage of WBCs are monocytes?
Defect in 4 - not compatible with life - defect in 3 - HbH disease - defect in 1/2 not associated with sig anemia
Hairy cell leukemia
Dec
2 to 10

40. lymphoid neoplasms with widespread involvement of bone marrow - tumor cells usually foind in peripheral blood
Leukemia
DIC
Plasma cell
Extravascular

41. What activates protein C and What does activated protein C do?
Macrohemorrhage - hemarthroses - easy bruising
Beta chain underproduced - asymptomatic - heterozygote
Hairy cell leukemia
Protein S - cleaves and invactivates Va and VIIIa

42. What are the presenting symptoms of acute intermittent porphyria
Ringed sideronblasts with iron laden mitochondria
Inappropriate absolute with inc RBCs and EPO
Painful abdomen (also in lead poisoning) - red wine colored urine - polyneuropathy - psychological distrubances - precipated by drugs -
Pos

43. Which infections can cause MAHA?
Inc HbA2 on electrophoresis
Down - up - down
90% anearobically from glucose to lactate - 10% from HMP shunt
Malaria - Babesia

44. What role does antithrombin play?
VIII
Incactivates II - VII - IX - X - XI - XII
Inc serum iron - normal TIBC - inc ferratin
Ferrocheletase and ALA dehydrogenase

45. dec haptoglobin - inc LDH - hemoglobin in urine (paroxysmal nocturnal hemoglobinuria - mechanical destruction as in aortic stenosis or a prosthetic valve
Inhibits thrombin - ixa - xa - xiia - and activated by heparin
Intravascular hemolysis
Antigen - antibody
Inc RBC - dec O2 sat - inc EPO

46. Eosinophils are highly phagocytic For what kind of complex?
Mantle cell - older males
Antigen - antibody
AB - no antibodies
They bind vWF via GpIb

47. discrete tumor masses arising from lymph nodes
Both alpha and beta thal
Lysosomes
Lymphoma
T(9;22) bcr abl

48. What are the likely exposures of kids and adults for lead poisoning
Parvovirus
Pyruvate kinase def - extravascular
Intravascular hemolysis
Kids= exposure to lead paint - adults = battery - ammunition factory

49. Elderly - mature b cell tumor with filamentous - hairlike projections
Hairy cell leukemia
Cold - seen in CLL - mycoplasma pneumoniae infections or infectious mononucleosis
Ringed sideronblasts with iron laden mitochondria
Bernard soulier

50. Basophilica stippling
Follicular lymphoma - indolent course
DIC
Uroporphyrin (tea colored urine)
TAIL - thalassemias - anemia of chronic disease - iron def - lead poisoning