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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. Teardrop cell
MGUS - monoclonal gammopathy of undetermined significance
Bone marrow infiltration - myelofibrosis
EBV
Dec plasma volume

2. After an injury - What does vWF bind to begin platelet plug formation?
Extravascular hemolysis
Lung disease - congenital heart diseaes - and high altitude
Hodgkin
Exposed collagen upon endothelial damage

3. What does hairy cell leukemia stain with
Diffuse Large b cell lymphoma
Hereditary spherocytosis - G6PD - sickle cell
TRAP (tartrate resistant acid phosphatase
Intrinsic - all factors except - VII - XIII

4. HTLV-1
Up - down - up
Marrow - marrow - follicles of lymph nodes - white pulp of spleen (unencapsulated lymphoid tissue)
Adult T cell lymphoma - presents with cutaneous lesions
Beta chain underproduced - asymptomatic - heterozygote

5. What is the pathogenesis of aplastic anemia with kidney disease
Decrease EPO
Follicular lymphoma - indolent course
40 to 75
M3 AML (acute promyelocytic leukemia)

6. Impaired synthesis of DAF leading to inc complement mediated desctruction of RBCs via the GPI ancho
Follicular lymphoma - indolent course
B6
Paroxysmal nocturnal hemoglobinuria
Macrohemorrhage - hemarthroses - easy bruising

7. What do you see in peripheral smear in a pt with G6PD?
Bite cells and Heinz bodies
All < 15 - AML = median onset around 60 - CML = 30 to 60 - and CLL > 60
Intravascular
TAIL - thalassemias - anemia of chronic disease - iron def - lead poisoning

8. What reveresible things can a sideroblastic anemia
Mantle cell lymphoma
Yes - via MHC II
Polycythemia vera with inc plasma volume - inc RBCs - inc EPO
Lead - and EtOH

9. What signal activates MACS
IFN gama
Gp1b - bernard - soulier - dec platelets (giant platelets not counted) - inc BT
DIC
Chloride bicarb antiport system - - allows transport of C02 from periph to lungs

10. Basophilic nuclear remnants fonud in RBCs
Beta thal
Howell - Jolly bodies - hypo/asplenia
HbC disease - Asplenia - Liver disease - thalassemia - 'HALT the hunter said to his target'
Glycine and succinyl - coa

11. What does LEAD stand for in lead poisoning?
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 -
Blasts > 5%
No antigen - both antibodies
Lead poisoning - rRNA causes aggregration of ribosomes and basophilic stippling

12. What is the pathogenesis of TTP?
ADP and Ca
No
Lacunar in nodular sclerosing variant
Inc large vWF multimers - inc platelet aggregation and thrombosis

13. What cell is primarily involved in non Hod lymph
B cells
Spleen
T(12;21)
Contiguous

14. What activates the fibrinolytic pathway?
Glanzmann's throbmasthenia
Idiopathic thrombocytopenia (ITP)
XIIa activates kallikrein - which activates plasmin (and converts HMWK to bradykinin
EBV

15. What is the are the presenting symptoms of lead poisoning in kids and adults
B symptoms - fever night sweats - weight loss
Lacunar in nodular sclerosing variant
Kidney - Gi - microcytic anemai in both - kids = mental retardation and adults = headache - memory loss - demyelination
Plasma cell

16. What is the effect of ACE on bradykinin
They bind vWF via GpIb
Tissue factor converst the VII and VIIa
Round densly staining nucleus with a small amount of pale cytoplasm
Inactivates it

17. What is the age breakdown for hodgkins
G6PD
XIIa activates kallikrein - which activates plasmin (and converts HMWK to bradykinin
Bimodal - men>women - except for nodular sclerosing type
M3 AML (acute promyelocytic leukemia)

18. normal RBCs added to patient's serum
Dendritic cells?
Paroxysmal nocturnal hemoglobinuria
Histaminase and arylsulfatase
Indirect coombs - agglutinate if serum anti RBC surface Ig

19. What the alpha granules contain in platelets?
PGI2 - NO inc blood flow - dec platelet aggregation
B12/folate def
VWF and fibrinogen
Inc serum iron - normal TIBC - inc ferratin

20. What virus is associated with Burkitt lymphoma
Glucose and heme - which inhibit ALA synthase
EBV
Paraprotein spike - monoclonal protein
Nl - up - nl

21. Tdt+ - CAllA+ - kids in the marrow - adolescent males with mediastinal mass
Bimodal - men>women - except for nodular sclerosing type
Liver disease - abetalipoproteinemia - acntho = spiny
AML
All

22. Ringed sideroblasts
Sideroblastic anemia
Heinz bodies - seen in alpha thal and G6PD
All trans retinoic acid
8-10 days

23. What is a metabolic disorder tht can cause macrocytic anemia?
Cold - seen in CLL - mycoplasma pneumoniae infections or infectious mononucleosis
Orotic aciduria
Macrohemorrhage - hemarthroses - easy bruising
IFN gama

24. What do they express on their surface?
8-10 days
Nl PT - elevated PTT - intrinsic pathway defect
MHC II and Fc receptors
Howell - Jolly bodies - hypo/asplenia

25. Deficiency in GpIIb/IIIa

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26. Aplastic crisis after parvovirus - autosplenectomy - salmonella osteomyelitis - painful crisis - renal papillary necrosis - splenic sequestration
Complications of sickle cell anemia
B symptoms - fever night sweats - weight loss
Inc HbF and dec HbS
All

27. Which pathway and factors are tested in the PTT test
Extrinsic - I - II - V - VII and X
Kids= exposure to lead paint - adults = battery - ammunition factory
Intrinsic - all factors except - VII - XIII
Mycosis fundgoides/Sezary syndrome

28. What causes the jaundice in extravascular hemolysis
HIV or immunosupression
Intravascular hemolysis
Inc UCB
Protoporphyrin (blood)

29. How are plasma cells characterized?
Inactivates it
Protoporphyrin (blood)
Off center nuclues - clock face chromatin
Bone marrow - thymus - blood (80% of circulating lymphos are T)

30. What does plasmin do?
Sheets of lymphocytes interspersed with macs
Von Willebrand's disease
Degrades fibrin mesh and converts C3 to C3a
Deoxygenated HbS polymerizes - low O2 or dehydration precipiates sickling - anemia and veno - occlusive disease

31. What condition can result from treating AML M3 from the release of the Auer rods
Multiple myeloma
DIC
No lytic bone lesions in WM
Kidney - Gi - microcytic anemai in both - kids = mental retardation and adults = headache - memory loss - demyelination

32. What are the labs and tx for HS?
ADP and Ca
Inactivates it
B antigena and A antibodes
Positive osmootic fragility test and splenectomy

33. What is the mutation in HbS
Valine for glutamate
Causes of DIC: Sepsis (gram neg) - Trauma - Obstetric complications - acute Pancreatitis - Malignancy - Nephrotic syndrome - Tranfusion
Anti Rh
B6

34. Serum iron - transferrin - ferritin lab values for pregs - OCP use
Howell Jolly bodies
Peripheral neuropathy - posterior columns (vibration/proprioception) - lateral corticospinal (spasticity) - dementia
Indirect coombs - agglutinate if serum anti RBC surface Ig
Nl - up - nl

35. When do you see MAHA?
Schistocytes - helmet cells
DIC - TTP- HUS - SLE malignant HTN - prostethic heart valves - aortic stenosis
Radiation/drugs - viral agents - fanconi's anemia - idiopathic may follow acute hepatitis
Bite cells and Heinz bodies

36. Fibrotic obliteration of bone marow with teardrop cells

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37. What does the large SA:volume ratio in RBCs help facilitate?
All trans retinoic acid
CML to AML or All
Ticlopidine/clopidogrel
Easy gas exchange

38. What are the presenting symptoms of porphyria cutanea tarda
Blistering cutaneous photosens - most common porphyria
Ticlopidine/clopidogrel
Down - up - down
Paraprotein spike - monoclonal protein

39. fatigue - malaise - pallor - purpura - mucosal bleeding - petechiae - infection
TAIL - thalassemias - anemia of chronic disease - iron def - lead poisoning
Deoxygenated HbS polymerizes - low O2 or dehydration precipiates sickling - anemia and veno - occlusive disease
Def in factor IX
Signs and sx of aplastic anemia

40. inc HbF on electrophoresis
Inc serum iron - normal TIBC - inc ferratin
Both alpha and beta thal
Erythroblastosis fetalis - Rh or other blood antigen incompatibility
VWF and fibrinogen

41. When is the peak incidence for nonHod lymphoma
20 to 40
Round densly staining nucleus with a small amount of pale cytoplasm
CML
Acts to stabilize platelet plug

42. Mutation in 3' untranslated region associated with venous clots
Ferrocheletase and ALA dehydrogenase
No
PENTAD: neurologic sx - renal sx - fever - thrombocytopenia - MAHA
Prothrombin gene mutation

43. Wilm's tumor - RCC - HCC - hydronephrosis
Antigen - antibody
Polycythemia vera with inc plasma volume - inc RBCs - inc EPO
Lung disease - congenital heart diseaes - and high altitude
Beta chain absent - homozgote - severe anemia requiring blood transfusion - secondary hemochromatosis

44. What are some classic examples of extravascular hemolysis
Hereditary spherocytosis - G6PD - sickle cell
Dendritic cells?
Beta chain absent - homozgote - severe anemia requiring blood transfusion - secondary hemochromatosis
G6PD

45. What is the Ddx for a normocytic - normochromic anemia?
ATIII def
DIC - TTP- HUS - SLE malignant HTN - prostethic heart valves - aortic stenosis
Hemolytic or non hemolytic - and then for the hemolytiuc - intravascular hemolysis or extravascular hemolysis
Inc HbA2 on electrophoresis

46. what proteins can be defective in HS?
T(9;22) bcr abl
Ankryin - band 4.1 or spectrin
Intrinsic - all factors except - VII - XIII
Diffuse Large b cell lymphoma

47. What virus can cause an aplastic crisis in pts with HS?
Parvovirus
Nodular sclerosing
Myelofibrosis (marow is crying being its fibrosed'
Hodgkin

48. Bone pain plus anemia
Dec platelet survival and inc megakaryocytes - thrombocytopenia and inc BT
Multiple myeloma
Birbeck granules
Howell - Jolly bodies - hypo/asplenia

49. philadelphia chromosome - blood looks like marrow
ATIII def
Valine for glutamate
Signs and sx of aplastic anemia
CML

50. What state is commonly associated with nonHod lymphoma
Anemia of chronic disease - Aplastic anemia - kidney disease
Hereditary spherocytosis
HIV or immunosupression
40 to 50

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