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Hemeonc

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Answer 50 questions in 15 minutes.
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1. What is the most common nonhodgkin lymphoma
Inc HbA2 on electrophoresis
Inflammation leads to inc hepcidin causing a dec in release from iron from macs: dec serum fe - dec TIBC - inc ferritin
HyperCalcemia - Renal insuff - Anemia - Bone lytic lesions/Back pain
Diffuse Large b cell lymphoma

2. discrete tumor masses arising from lymph nodes
CD15 and CD30 pos
Histamine - heparin - and eosinohil chemotactic factors
HbC disease - Asplenia - Liver disease - thalassemia - 'HALT the hunter said to his target'
Lymphoma

3. What is the treatment for acute intermittent porphyria
Ticlopidine/clopidogrel
Dec
ADP and Ca
Glucose and heme - which inhibit ALA synthase

4. What is the receptor for vWF
Gp1b
Liver disease - abetalipoproteinemia - acntho = spiny
WBC diff highest to lowest: neutrophils - lymphocytes - monocytes - eosinophils - basophils
Polycythemia vera

5. Basophilic nuclear remnants fonud in RBCs
DIC
Deoxygenated HbS polymerizes - low O2 or dehydration precipiates sickling - anemia and veno - occlusive disease
Howell - Jolly bodies - hypo/asplenia
Inc

6. Which maternal antibodies cross the placenta - anti A/B or anti Rh
All < 15 - AML = median onset around 60 - CML = 30 to 60 - and CLL > 60
Def in factor IX
Anti Rh
Her next Rh+ fetus

7. What does Vit K deficiency cause?
Inducers of primary antibody response
Dec synthesis of factors 1972 - protein C/S
Cromolyn sodium
G6PD

8. Impaired synthesis of DAF leading to inc complement mediated desctruction of RBCs via the GPI ancho
Peroxidase
Paroxysmal nocturnal hemoglobinuria
Cromolyn sodium
TPA - cleavage of fibrin mesh

9. Upregulated growth of leukocytes in bone marro
Inc bleeding time - microhemorrhage: mucuous membrane bleeding - epitaxis - petechiae - purpura - possible thrombocytopenia
Leukemia
Inc large vWF multimers - inc platelet aggregation and thrombosis
Dimercaprol and EDTA 1st line of treatment - succimer for kids - it sucks to be a kid who eats lead

10. Tdt+ - CAllA+ - kids in the marrow - adolescent males with mediastinal mass
5- FU - AZT - hydroxyurea
Beta thal
No platelet clumping
All

11. What is monoclonal expansion without symptoms associated with multiple myeloma?
Kidney - Gi - microcytic anemai in both - kids = mental retardation and adults = headache - memory loss - demyelination
T(9;22) bcr abl
MGUS - monoclonal gammopathy of undetermined significance
Epoxide reductase - warfarin inhibits

12. Serum iron - transferrin - ferritin lab values for anemia of chronic disease
Down - down - up
Factor V resistant to activated protein C's inhibition
Peroxidase
DDAVP (desmopressin) which releases stored vWF stored in endothelium

13. What do you see in peripheral smear in a pt with G6PD?
CNS and testis
Bite cells and Heinz bodies
Anti Rh
Dec plasma volume

14. What do you see on peripheral smear with sideroblastic anemia
DIC - TTP/HUS - traumatic hemolysis
Ringed sideronblasts with iron laden mitochondria
Folate/B12 - nonmegaoblastic anemias - liver dz - EtOH (non folate/B12) reticulocytosis - metabolic disorder - drugs
Beta chain absent - homozgote - severe anemia requiring blood transfusion - secondary hemochromatosis

15. Which cell is neoplastic in multiple myeloma
Howell - Jolly bodies - hypo/asplenia
Sickle cell
Mantle cell - older males
Plasma cell

16. What is the treatment for lead poising?
A antigen and B antibodies
Liver disease - abetalipoproteinemia - acntho = spiny
Dimercaprol and EDTA 1st line of treatment - succimer for kids - it sucks to be a kid who eats lead
Langerhans cell histiocytosis

17. What does hairy cell leukemia stain with
Inc bleeding time - microhemorrhage: mucuous membrane bleeding - epitaxis - petechiae - purpura - possible thrombocytopenia
TRAP (tartrate resistant acid phosphatase
Glanzmann's throbmasthenia - GpIIb/IIIa - nl platelets - inc BT
Histaminase and arylsulfatase

18. What are dendritic cells called in the skin?
Bernard soulier
Langerhans cells
Africa = Jaw lesion - US = pelvis or abdomen
Glanzmann's throbmasthenia - GpIIb/IIIa - nl platelets - inc BT

19. What virus is associated with 50% of Hodgkin lymphoma
Leukemia
Factor V Leiden
EBV
Lung disease - congenital heart diseaes - and high altitude

20. What is the pathogenesis of sickle cell
Sheets of lymphocytes interspersed with macs
Inc vasodiltion - inc perm - inc pain
Protoporphyrin
Deoxygenated HbS polymerizes - low O2 or dehydration precipiates sickling - anemia and veno - occlusive disease

21. Where does All spread
Birbeck granules
Burkitt lymphoma
CNS and testis
Intravascular

22. What do the labs show for TTP?
Schistocytes and inc LDH
Mantle cell lymphoma
Bone marrow - thymus - blood (80% of circulating lymphos are T)
CML to AML or All

23. What percentage of WBCs are basophils - and What is found in their basophilic granules?
Direct coombs - agglutinate if RBCs are coated with Ig
HbC disease - Asplenia - Liver disease - thalassemia - 'HALT the hunter said to his target'
Liver disease - abetalipoproteinemia - acntho = spiny
< 1% - heparin - histamine - LTD-4 - other vasoactive amines

24. fatigue - malaise - pallor - purpura - mucosal bleeding - petechiae - infection
Radiation/drugs - viral agents - fanconi's anemia - idiopathic may follow acute hepatitis
Deficiency in factor VIII
Signs and sx of aplastic anemia
Multiple myeloma

25. What substances are released in mast cell degranulation
Bernard soulier
Histamine - heparin - and eosinohil chemotactic factors
All < 15 - AML = median onset around 60 - CML = 30 to 60 - and CLL > 60
Inc serum iron - normal TIBC - inc ferratin

26. What does NAACP stand for - in regards to the causes of eosinophiia?
Neoplastic - asthma - allergic processes - collagen vacsular disease - parasites
Varying sizes
Dimercaprol and EDTA 1st line of treatment - succimer for kids - it sucks to be a kid who eats lead
Dendritic cells?

27. What is the are the presenting symptoms of lead poisoning in kids and adults
Macrohemorrhage - hemarthroses - easy bruising
Multiple myeloma
Dendritic cells?
Kidney - Gi - microcytic anemai in both - kids = mental retardation and adults = headache - memory loss - demyelination

28. What converts plasminogen to plasm and What does plasmin do?
Factor V Leiden
No
TPA - cleavage of fibrin mesh
Bimodal - men>women - except for nodular sclerosing type

29. What activates the fibrinolytic pathway?
HIV or immunosupression
Collagen - BM - activated platelets
Allogenic bone marrow transplant - RBC/platelet transfusion - C- GSF - or GM- CSF
XIIa activates kallikrein - which activates plasmin (and converts HMWK to bradykinin

30. Which infections can cause MAHA?
Multiple - peripheral nodes - extranodal involvement - noncontiguous spread
Malaria - Babesia
Folate/B12 - nonmegaoblastic anemias - liver dz - EtOH (non folate/B12) reticulocytosis - metabolic disorder - drugs
No platelet clumping

31. Deficiency in GpIb
No antigen - both antibodies
G6PD
Langerhans cell histiocytosis
Bernard soulier

32. hypersegmented PMNs - glossitis - dec B12 - inc homocysteine - inc methymalonic acid
Hereditary spherocytosis - G6PD - sickle cell
Helminth infections major basic protein
B12 def
Gp1b - bernard - soulier - dec platelets (giant platelets not counted) - inc BT

33. What is the Ddx for for a macrocytic anemia
Fibrinogen
90% anearobically from glucose to lactate - 10% from HMP shunt
Folate/B12 - nonmegaoblastic anemias - liver dz - EtOH (non folate/B12) reticulocytosis - metabolic disorder - drugs
Von Willebrand's disease

34. How are plasma cells characterized?
Induces differentiation of myeloblasts
Off center nuclues - clock face chromatin
Gp1b - bernard - soulier - dec platelets (giant platelets not counted) - inc BT
Painful abdomen (also in lead poisoning) - red wine colored urine - polyneuropathy - psychological distrubances - precipated by drugs -

35. t(8;14) c - myc gene
AB - no antibodies
VWF and fibrinogen
Burkitt lymphoma
Blood

36. How does the therapy for M3 vairant work?
Induces differentiation of myeloblasts
Langerhans cell histiocytosis
Multiple myeloma
Spleen

37. What does ectopic EPO produce
Inappropriate absolute with inc RBCs and EPO
Extrinsic - I - II - V - VII and X
Inc suscept to infxn - primary amyloidosis - punched out lytic bone lesions - M spike - Ig light chains in urine - Rouleaud formations (stacked RBCs)
No antigen - both antibodies

38. What causes the jaundice in extravascular hemolysis
Bernard soulier
Rhogam - Rh antigen immunoglobulin
Def in factor IX
Inc UCB

39. Which pathway and factorrs are tested by the PT coag test
Glycine and succinyl - coa
40 to 50
Extrinsic - I - II - V - VII and X
VWD

40. hemolytic in a newborn - dec ATP and rigid RBCs
Bleeding - malnutrition/absorption - inc demand pregs
Inc UCB
Pyruvate kinase def - extravascular
Helps platelts adhere to endothelium

41. What is the treatment for sideroblastic anemia
Inc HbA2 on electrophoresis
Eleveated PT - PTT
Hereditary elloptocytosis
B6 therapy (pyrodixine)

42. t(11;14)
Glycine and succinyl - coa
Mantle cell lymphoma
Her next Rh+ fetus
Schistocytes - helmet cells

43. In hemophilia A or B What do you see in the coag tests
Nl PT - elevated PTT - intrinsic pathway defect
Radiation/drugs - viral agents - fanconi's anemia - idiopathic may follow acute hepatitis
Glanzmann's throbmasthenia
Inc large vWF multimers - inc platelet aggregation and thrombosis

44. What do labs show in ITP?
Dec platelet survival and inc megakaryocytes - thrombocytopenia and inc BT
No platelet clumping
CLL (SLL without the peripheral lymphocytosis
B6 therapy (pyrodixine)

45. What is the defect in beta thal?
Splicing sites and promotor sequences
Rhogam - Rh antigen immunoglobulin
8-10 days
Lacunar in nodular sclerosing variant

46. What is the effect of ACE on bradykinin
Exposed collagen upon endothelial damage
Up - down - up
Inc suscept to infxn - primary amyloidosis - punched out lytic bone lesions - M spike - Ig light chains in urine - Rouleaud formations (stacked RBCs)
Inactivates it

47. inc WBC count with left shift - inc leukocyte alkaline phosphatase - often due to infection
Leukemoid reaction
VWF and fibrinogen
Inc large vWF multimers - inc platelet aggregation and thrombosis
Follicular lymphoma - indolent course

48. philadelphia chromosome - blood looks like marrow
Both alpha and beta thal
Low in CML
Inc bleeding time - microhemorrhage: mucuous membrane bleeding - epitaxis - petechiae - purpura - possible thrombocytopenia
CML

49. When is the peak incidence for nonHod lymphoma
20 to 40
Lysosomes
Mantle cell - older males
Protoporphyrin

50. What are the likely exposures of kids and adults for lead poisoning
Kids= exposure to lead paint - adults = battery - ammunition factory
Collagen - BM - activated platelets
Fe def - thal - pb poison - sideroblastic anemia
Hereditary spherocytosis - autoimmune hemolysis

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Hemeonc

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