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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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This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.

1. poikilocytosis
Varying shapes
Inc bleeding time - microhemorrhage: mucuous membrane bleeding - epitaxis - petechiae - purpura - possible thrombocytopenia
Sideroblastic anemia
HyperCalcemia - Renal insuff - Anemia - Bone lytic lesions/Back pain

2. What does bradykinin do?
Antigen - antibody
Inc vasodiltion - inc perm - inc pain
Anti Rh
B12 def

3. Ddx for microcytic anemia
Aplastic anemia - pancytopenia
Hydrolytic enzymes - lysozyme - myeloperoxidase - lactoferrin
Fe def - thal - pb poison - sideroblastic anemia
Histamine - heparin - and eosinohil chemotactic factors

4. Basophilica stippling
AB - no antibodies
Folate def
TAIL - thalassemias - anemia of chronic disease - iron def - lead poisoning
Beta chain underproduced - asymptomatic - heterozygote

5. Which enzyme converts vit k to activated vit k - and what substance inhibits this enzyme
Epoxide reductase - warfarin inhibits
Lung disease - congenital heart diseaes - and high altitude
Ankryin - band 4.1 or spectrin
Kids= exposure to lead paint - adults = battery - ammunition factory

6. What is the therapy for the M3 variant?
Acts to stabilize platelet plug
Howell - Jolly bodies - hypo/asplenia
All trans retinoic acid
Glanzmann's throbmasthenia - GpIIb/IIIa - nl platelets - inc BT

7. What are the age ranges for the various leukemias
All < 15 - AML = median onset around 60 - CML = 30 to 60 - and CLL > 60
Inactivates it
Idiopathic thrombocytopenia (ITP)
All

8. What are the likely exposures of kids and adults for lead poisoning
Beta 4
Ferrocheletase and ALA dehydrogenase
ATIII def
Kids= exposure to lead paint - adults = battery - ammunition factory

9. What is the affected enzyme in lead poisoning
TXA2 - dec blood flow - inc platelet aggregation
IFN gama
Ferrocheletase and ALA dehydrogenase
M3 AML (acute promyelocytic leukemia)

10. Which lymphoma is characterized by localized involvement with a single group of nodes and mediastinal lymphadenopathy
Bite cells and Heinz bodies
Hodgkin
Yes - via MHC II
Bernard soulier

11. Ringed sideroblasts
IFN gama
Sideroblastic anemia
Sickle cell
Indirect coombs - agglutinate if serum anti RBC surface Ig

12. Elderly - mature b cell tumor with filamentous - hairlike projections
Hodgkin
Hairy cell leukemia
Round densly staining nucleus with a small amount of pale cytoplasm
Paraprotein spike - monoclonal protein

13. What do plasma cells do
Hereditary elloptocytosis
Inc UCB
Inc vasodiltion - inc perm - inc pain
Produce antibody - lots of RER and golgi

14. What is the presenting scenario for TTP?
Hodgkin
Dec plasma volume
PENTAD: neurologic sx - renal sx - fever - thrombocytopenia - MAHA
Schistocytes - helmet cells

15. What is the tx for aplastic anemia
Causes of DIC: Sepsis (gram neg) - Trauma - Obstetric complications - acute Pancreatitis - Malignancy - Nephrotic syndrome - Tranfusion
Beta thal
Kids= exposure to lead paint - adults = battery - ammunition factory
Allogenic bone marrow transplant - RBC/platelet transfusion - C- GSF - or GM- CSF

16. What activates the intrinsic pathway?
Dec synthesis of factors 1972 - protein C/S
Collagen - BM - activated platelets
B6
Intravascular hemolysis

17. abnormal clone of hematopoetic stem cells are increasingly sensitive to growth factors - inc RBC - JAK2 mut
Inducers of primary antibody response
Inc HbA2 on electrophoresis
All < 15 - AML = median onset around 60 - CML = 30 to 60 - and CLL > 60
Polycythemia vera

18. What is the purpose of the fibrin mesh
Sickle cell
Acts to stabilize platelet plug
Bone marrow - thymus - blood (80% of circulating lymphos are T)
Uroporphyrin (tea colored urine)

19. what proteins can be defective in HS?
MGUS - monoclonal gammopathy of undetermined significance
Ankryin - band 4.1 or spectrin
Langerhans cells
Inc vasodiltion - inc perm - inc pain

20. Which pathway and factorrs are tested by the PT coag test
Multiple myeloma
Fibrinogen bind GpIIb/IIIa and links platelts
ADP and Ca
Extrinsic - I - II - V - VII and X

21. What are the azuraphilic granules in PMNs
Parvovirus
Abciximab
Mycosis fundgoides/Sezary syndrome
Lysosomes

22. What is the treatment to prevent a woman from forming anti Rh antibody?
Fc
TPA - cleavage of fibrin mesh
Rhogam - Rh antigen immunoglobulin
B symptoms - fever night sweats - weight loss

23. When is the peak incidence for nonHod lymphoma
B12/folate def
5- FU - AZT - hydroxyurea
Allogenic bone marrow transplant - RBC/platelet transfusion - C- GSF - or GM- CSF
20 to 40

24. What cell is primarily involved in non Hod lymph
They bind vWF via GpIb
...
B symptoms - fever night sweats - weight loss
B cells

25. What does ectopic EPO produce
Examples of oxidative stress
Inc lymphoctes - and less RS cells
Epoxide reductase - warfarin inhibits
Inappropriate absolute with inc RBCs and EPO

26. What are some causes of warm agglutinin autoimmune hemolytic anemia?
2 to 10
SLE - CLL - alpha methyldopa
VWF and fibrinogen
Complications of sickle cell anemia

27. Serum iron - transferrin - ferritin lab values for pregs - OCP use
Dec platelet survival and inc megakaryocytes - thrombocytopenia and inc BT
Nl - up - nl
1 to 6
Beta thal

28. What is the defect in beta thal?
Splicing sites and promotor sequences
120 days
Ringed sideronblasts with iron laden mitochondria
Neoplastic - asthma - allergic processes - collagen vacsular disease - parasites

29. Serum iron - transferrin - ferritin lab values for hemochromatosis
Beta 4
Glycine and succinyl - coa
Sickle cell
Up - down - up

30. How do platelet disorders present?
Inhibits thrombin - ixa - xa - xiia - and activated by heparin
Inc bleeding time - microhemorrhage: mucuous membrane bleeding - epitaxis - petechiae - purpura - possible thrombocytopenia
DIC - TTP/HUS - traumatic hemolysis
Schistocytes and inc LDH

31. Is G6PD intravascular or extravascular
Howell - Jolly bodies - hypo/asplenia
B6 therapy (pyrodixine)
Intravascular
Inc

32. What does ADP do?
Helps platelts adhere to endothelium
Ewing sarcoma
No
M3 AML (acute promyelocytic leukemia)

33. bcl -2 t(14;18) adults
Antigen - antibody
Follicular lymphoma - indolent course
Blod - tissue - MACS
GpIIb/IIIa

34. Where are monocytes typically found - where do they go - and What do the differentiate into?
Blod - tissue - MACS
Bimodal - men>women - except for nodular sclerosing type
Multiple myeloma
Uroporphyrinogen decarboxylase

35. What does LEAD stand for in lead poisoning?
Hereditary spherocytosis - autoimmune hemolysis
Sickle cell anemia
Peroxidase
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 -

36. What is the treatment for lead poising?
G6PD
Kids= exposure to lead paint - adults = battery - ammunition factory
EBV
Dimercaprol and EDTA 1st line of treatment - succimer for kids - it sucks to be a kid who eats lead

37. Which infections can cause MAHA?
Acts to stabilize platelet plug
Down - down - up
Signs and sx of aplastic anemia
Malaria - Babesia

38. What is makes a leukemia acute
Inflammation leads to inc hepcidin causing a dec in release from iron from macs: dec serum fe - dec TIBC - inc ferritin
Nl - up - nl
Kidney - Gi - microcytic anemai in both - kids = mental retardation and adults = headache - memory loss - demyelination
Blasts > 5%

39. can be asymptomatic - often in older adults - peripheral blood lymphcytosis with smudge cells and warm antibody autoimmune hemolytic anemia
CLL (SLL without the peripheral lymphocytosis
Induces differentiation of myeloblasts
They bind vWF via GpIb
Blood

40. What is monoclonal expansion without symptoms associated with multiple myeloma?
Liver disease - abetalipoproteinemia - acntho = spiny
Inc
MGUS - monoclonal gammopathy of undetermined significance
Inc bleeding time - microhemorrhage: mucuous membrane bleeding - epitaxis - petechiae - purpura - possible thrombocytopenia

41. Serum iron - transferrin - ferritin lab values for lead poisoning anemia
Decrease EPO
CNS and testis
Extravascular hemolysis
Up - down - nl

42. What does antithrombin do and What activates it?
T(9;22) bcr abl
Produce antibody - lots of RER and golgi
TXA2 - dec blood flow - inc platelet aggregation
Inhibits thrombin - ixa - xa - xiia - and activated by heparin

43. What do you see a starry sky appearance in Burkitt
Sheets of lymphocytes interspersed with macs
Ticlopidine/clopidogrel
Aplastic anemia - pancytopenia
Lead - and EtOH

44. What does 'Neutrophils Like Making Everything Better' stand for?
Lysine for glutamate at position 6
WBC diff highest to lowest: neutrophils - lymphocytes - monocytes - eosinophils - basophils
Diffuse Large b cell lymphoma
Ewing sarcoma

45. What vitamin is a cofactor for the first step of heme synthesis
B6
IgG - Warm is GREAT
Easy gas exchange
Peripheral neuropathy - posterior columns (vibration/proprioception) - lateral corticospinal (spasticity) - dementia

46. What do you see on peripheral smear with sideroblastic anemia
AML
Nl - up - nl
Adult T cell lymphoma - presents with cutaneous lesions
Ringed sideronblasts with iron laden mitochondria

47. What distinguishes multiple myeloma fromk Waldenstroms macroglobulinemia?
Factor V resistant to activated protein C's inhibition
No lytic bone lesions in WM
VIII
Mantle cell lymphoma

48. What are the presenting symptoms of acute intermittent porphyria
Folate/B12 - nonmegaoblastic anemias - liver dz - EtOH (non folate/B12) reticulocytosis - metabolic disorder - drugs
XIIa activates kallikrein - which activates plasmin (and converts HMWK to bradykinin
Lung disease - congenital heart diseaes - and high altitude
Painful abdomen (also in lead poisoning) - red wine colored urine - polyneuropathy - psychological distrubances - precipated by drugs -

49. What is the pattern of involvement and spread for nonHod lympho
Essential thrombocytosis
Histamine - heparin - and eosinohil chemotactic factors
Multiple - peripheral nodes - extranodal involvement - noncontiguous spread
1 to 6

50. How does the therapy for M3 vairant work?
Thrombotic thrombocytopenic purpura
Fc
T(12;21)
Induces differentiation of myeloblasts