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Hemeonc

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Answer 50 questions in 30 minutes.
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1. Which pathway and factorrs are tested by the PT coag test
Extrinsic - I - II - V - VII and X
ADP and Ca
Inc vasodiltion - inc perm - inc pain
Africa = Jaw lesion - US = pelvis or abdomen

2. Defect in platelet to collagen adhesion - receptor - disorder - platelet count and BT
Incactivates II - VII - IX - X - XI - XII
Bone marrow infiltration - myelofibrosis
Heinz bodies - seen in alpha thal and G6PD
Gp1b - bernard - soulier - dec platelets (giant platelets not counted) - inc BT

3. How are the nucleus and the cytoplasm characterized for lymphocytes
B6 therapy (pyrodixine)
Round densly staining nucleus with a small amount of pale cytoplasm
B cells
All < 15 - AML = median onset around 60 - CML = 30 to 60 - and CLL > 60

4. What is the Ddx for nonhemolytic normocytic anemia
Paroxysmal nocturnal hemoglobinuria
40 to 50
Extravascular hemolysis
Anemia of chronic disease - Aplastic anemia - kidney disease

5. What are the extrinsic hemolytic normocytic anemias?
...
Deoxygenated HbS polymerizes - low O2 or dehydration precipiates sickling - anemia and veno - occlusive disease
Plummer - vinson syndrome
Glanzmann's throbmasthenia

6. bcl -2 t(14;18) adults
Epoxide reductase - warfarin inhibits
HbSS
Down - up - down
Follicular lymphoma - indolent course

7. Deficiency in GpIIb/IIIa

8. What begins the extrinsic pathway?
Sheets of lymphocytes interspersed with macs
Marrow - marrow - follicles of lymph nodes - white pulp of spleen (unencapsulated lymphoid tissue)
B symptoms - fever night sweats - weight loss
Tissue factor converst the VII and VIIa

9. What is the age breakdown for hodgkins
Complications of sickle cell anemia
Bimodal - men>women - except for nodular sclerosing type
Exposed collagen upon endothelial damage
SLE - CLL - alpha methyldopa

10. Where does All spread
Alpha thal - asian and african american
2 to 10
They bind vWF via GpIb
CNS and testis

11. What does NAACP stand for - in regards to the causes of eosinophiia?
Beta chain absent - homozgote - severe anemia requiring blood transfusion - secondary hemochromatosis
Peroxidase
Off center nuclues - clock face chromatin
Neoplastic - asthma - allergic processes - collagen vacsular disease - parasites

12. What is the therapy for CML (philly chrom)
Inducers of primary antibody response
Howell - Jolly bodies - hypo/asplenia
ADP and Ca
Imatinib - anti bcr abl

13. What is the therapy for the M3 variant?
B antigena and A antibodes
Heinz bodies - seen in alpha thal and G6PD
All trans retinoic acid
Marrow - marrow - follicles of lymph nodes - white pulp of spleen (unencapsulated lymphoid tissue)

14. What is makes a leukemia acute
Lacunar in nodular sclerosing variant
Blasts > 5%
MAHA
Intravascular hemolysis

15. deficiency in ADAMTS13 leading to dec degradation of vWF
Pos
DIC
...
Thrombotic thrombocytopenic purpura

16. What is the characteristic spread of Hodgkin Lymphoma
Paraprotein spike - monoclonal protein
WBC diff highest to lowest: neutrophils - lymphocytes - monocytes - eosinophils - basophils
Contiguous
Helps platelts adhere to endothelium

17. What does CRAB stand for in multiple myeloma
HIV or immunosupression
HyperCalcemia - Renal insuff - Anemia - Bone lytic lesions/Back pain
DIC
Painful abdomen (also in lead poisoning) - red wine colored urine - polyneuropathy - psychological distrubances - precipated by drugs -

18. What is the general pathology of a macrocytic anemia?
DNA synth impaired - maturation of nucleus delayed relative to maturation of cytoplasm
B symptoms - fever night sweats - weight loss
Schistocytes - helmet cells
Mantle cell lymphoma

19. normal RBCs added to patient's serum
Indirect coombs - agglutinate if serum anti RBC surface Ig
They bind vWF via GpIb
Fc
Helminth infections major basic protein

20. What causes the jaundice in extravascular hemolysis
Extravascular hemolysis
Down - down - up
Howell Jolly bodies
Inc UCB

21. What is the clinical picture of hemophilia A or B
Macrohemorrhage - hemarthroses - easy bruising
Birbeck granules
Produce antibody - lots of RER and golgi
Dec synthesis of factors 1972 - protein C/S

22. What does hairy cell leukemia stain with
TRAP (tartrate resistant acid phosphatase
Anemia of chronic disease - Aplastic anemia - kidney disease
Lead - and EtOH
Glycine and succinyl - coa

23. Drug that inhbits the GpIIb/IIIa directly
Low O2 in papilla; can also get microhematuria from medullary infarcts
Heinz bodies - seen in alpha thal and G6PD
TPA - cleavage of fibrin mesh
Abciximab

24. What is the receptor for vWF
Helps platelts adhere to endothelium
Hereditary spherocytosis - autoimmune hemolysis
90% anearobically from glucose to lactate - 10% from HMP shunt
Gp1b

25. What is the tx for vWD
DDAVP (desmopressin) which releases stored vWF stored in endothelium
Bernard soulier
Glycine and succinyl - coa
Dec synthesis of factors 1972 - protein C/S

26. inc HbF on electrophoresis
Up - down - up
Both alpha and beta thal
Malnutrition - malabsoprtion - impaired metabolism - inc requirement as in an hemolytic anemia or pregnancy
Intravascular hemolysis

27. What is the age group most commonly affected by multiple myeloma
Factor V Leiden
40 to 50
Imatinib - anti bcr abl
Howell - Jolly bodies - hypo/asplenia

28. Which cell is neoplastic in multiple myeloma
Lacunar in nodular sclerosing variant
Plasma cell
Intrinsic - all factors except - VII - XIII
Inc suscept to infxn - primary amyloidosis - punched out lytic bone lesions - M spike - Ig light chains in urine - Rouleaud formations (stacked RBCs)

29. What converts plasminogen to plasm and What does plasmin do?
AB - no antibodies
Pos
IFN gama
TPA - cleavage of fibrin mesh

30. What are the main associations with multiple myeloma?
Multiple myeloma
Induces differentiation of myeloblasts
Inc suscept to infxn - primary amyloidosis - punched out lytic bone lesions - M spike - Ig light chains in urine - Rouleaud formations (stacked RBCs)
Paraprotein spike - monoclonal protein

31. What reveresible things can a sideroblastic anemia
T(12;21)
Antigen - antibody
Lead - and EtOH
DIC

32. What percentage of WBCs are basophils - and What is found in their basophilic granules?
< 1% - heparin - histamine - LTD-4 - other vasoactive amines
Polycythemia vera
TAIL - thalassemias - anemia of chronic disease - iron def - lead poisoning
Blasts > 5%

33. philadelphia chromosome - blood looks like marrow
Birbeck granules
CML
ATIII def
VWF carries/protects factor VIII

34. Serum iron - transferrin - ferritin lab values for pregs - OCP use
Nl - up - nl
Peroxidase
Insufficient intake as with strict vegans - malabsorption as in crohns - pernicious anemia - diphyllobothrium
DIC - TTP/HUS - traumatic hemolysis

35. What symptoms are associated with Hodgkin lymphoma
Neoplastic - asthma - allergic processes - collagen vacsular disease - parasites
90% anearobically from glucose to lactate - 10% from HMP shunt
B symptoms - fever night sweats - weight loss
Reed - sternberg cells

36. How is beta thal minor dx
Factor V resistant to activated protein C's inhibition
Inc HbA2 on electrophoresis
CNS and testis
VWF and fibrinogen

37. Fibrotic obliteration of bone marow with teardrop cells

38. What do labs show in DIC?
AML
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 -
Schistocytes - inc fibrin split products (D- dimers) - dec fibrinogen - dec factors V and VIII
Peroxidase

39. Blood type B
Hemolytic or non hemolytic - and then for the hemolytiuc - intravascular hemolysis or extravascular hemolysis
Extravascular
B antigena and A antibodes
Birbeck granules

40. What is the are the presenting symptoms of lead poisoning in kids and adults
ATIII def
Kidney - Gi - microcytic anemai in both - kids = mental retardation and adults = headache - memory loss - demyelination
Easy gas exchange
Mantle cell - older males

41. What is appropriate absolyte polycythemia associated with
Bernard soulier
Tissue factor converst the VII and VIIa
TAIL - thalassemias - anemia of chronic disease - iron def - lead poisoning
Lung disease - congenital heart diseaes - and high altitude

42. What activates the fibrinolytic pathway?
Rhogam - Rh antigen immunoglobulin
B12 in fatty acid pathways leads to subacute combined degeneration
XIIa activates kallikrein - which activates plasmin (and converts HMWK to bradykinin
...

43. abnormal clone of hematopoetic stem cells are increasingly sensitive to growth factors - inc RBC - JAK2 mut
Polycythemia vera
Blistering cutaneous photosens - most common porphyria
MGUS - monoclonal gammopathy of undetermined significance
Indirect coombs - agglutinate if serum anti RBC surface Ig

44. poikilocytosis
Multiple myeloma
Paraprotein spike - monoclonal protein
Eleveated PT - PTT
Varying shapes

45. Tdt+ - CAllA+ - kids in the marrow - adolescent males with mediastinal mass
No
Extravascular hemolysis
All
Defect in 4 - not compatible with life - defect in 3 - HbH disease - defect in 1/2 not associated with sig anemia

46. When is the peak incidence for nonHod lymphoma
Megaloblastic anemia (also hypersegmented PMNs - marrow failure)
AB - no antibodies
20 to 40
Glycine and succinyl - coa

47. hypersegmented PMNs - glossitis - dec folate - inc homocysteine - nl methylmalonic acid
Folate def
No lytic bone lesions in WM
Adult T cell lymphoma - presents with cutaneous lesions
ADP and Ca

48. Where are 1/3 of platelets stored
Schistocytes and inc LDH
Spleen
Sickle cell
Folate def

49. When do you see MAHA?
Inc serum iron - normal TIBC - inc ferratin
Idiopathic thrombocytopenia (ITP)
Multiple myeloma
DIC - TTP- HUS - SLE malignant HTN - prostethic heart valves - aortic stenosis

50. t(11;14)
Mantle cell lymphoma
Leukemia
Inc vasodiltion - inc perm - inc pain
Peripheral neuropathy - posterior columns (vibration/proprioception) - lateral corticospinal (spasticity) - dementia

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Hemeonc

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