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Y1 - Path - Exam 5 > 2-4. Lectures > Flashcards

2-4. Lectures Flashcards

1
Q

what are the 3 ways to loose oxygen carrying capacity?

A
  1. bleeding
  2. hemolysis (RBC destruction)
  3. Diminished erythropoiesis (production)
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2
Q

which disorder is pictured in the histo slide?

A

Hypochromic microcytic anemia;

(a type of iron deficiency anemia)

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3
Q

what is dietary folate and vitamin B12 involved in?

A

Both involved in DNA synthesis (purine) and their effect on erythropoiesis is similar

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4
Q

how are megaloblasts formed in megaloblastic anemia?

A

Deficiency in dietary Folate or Vitamin B12 –> delay in DNA synthesis causes a delay in nuclear maturation and cell division –>

cytoplasmic components mature normally and continue to accumulate during delay, resulting in enlarged RBC precursors (megaloblasts) and enlarged RBCs, other cells in body as well

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5
Q

what disorder is in the histo image?

A

blue stain indicates immature red blood cells (megalobasts)

part of megaloblastic anemia

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6
Q

which disorder is this pathognomonic for?

A

hypersegmented nuclei of neutrophils –>

indicative of MEGALOBLASTIC ANEMIA

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7
Q

what vitamin deficiency and subsequent anemia is associated with DEMYELINATING DISEASE

A

Vitamin B12 deficiency –> megaloblastic anemia and demyelinating disease of peripheral nerves and spinal cord

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8
Q

pernicious anemia: define

A

Vitamin B12 deficiency due to INADEQUATE synthesis or defective funciton of intrinsic factor

  • autoantibodies to parietal cells, or intrinsic factor itself
  • gastric atrophy or gastrectomy (limits synthesis of IF), resection of distal ileum, malabsorption disease, Crohn’s disease (which dec absorption absorption of vitamin bound to IF)
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9
Q

which symptoms are most associated with:

  • anemia
  • thrombocytopenia
  • neutropenia
A
  • anemia - petechiae
  • thrombocytopenia - ecchymosis
  • neutropenia - persistent infxns
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10
Q

what lymphoid disorder is pictured below?

A

neutrophilic leukocytosis;

neutrophil concentration is increased; more specific than leukocytosis

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11
Q

what condition is pathognomonic for DOHLE BODIES

A

(intra-cytoplasmic structures composed of agglutinated ribosomes; they will increase in number with inflammation and increased granulocytopoiesis);

indicate IMMATURE NEUTROPHILS –>

LEUKOCYTOSIS

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12
Q

what are the morphological abnormalities of WBCs in:

  • cytoplasm
  • nucleus
A
  • cytoplasm
    • May-Hegglin anomaly
    • Chediak-Higashi syndrome
    • Toxic changes (acute inflammation)
  • nucleus
    • Pelger-Huet anomaly
    • Hypersegmentation
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13
Q

what is a May-Hegglin Anomaly caused by?

A
  • rare genetic disorder assoc w/ defect in MYH 9 gene
  • triad:
    • thromobcytopenia
    • giant platelets
    • dohle-like bodies
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14
Q

what is a Pelger-Huet Anomaly?

A
  • hyposegmentation (bilobed) of nucleus
    • (round, oval, or bilobed nuclei w/ pinched appearance)
    • overly mature clumped chromatin
  • similar appearance of most cells
  • clinically insignificant; common AD inherited nuclear aberration
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15
Q

what is a Pseudo-Pelger-Huet anomaly?

A
  • acquired phenomenon w/ nuclei that are less dense than true PH cells;
  • may have hypogranular cytoplasm
    • may be clinically significant
    • found in high stress situations: (burns, drug rxns, infxns, myelodysplastic syndromes, chronic granulocytic leukemia, acute leukemia)
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16
Q

what are the causes of hypersegmentation of neutrophils?

A
  • hereditary cause is autosomal dominant and clinically significant
  • acquired form vitamin B12 and folate deficiency or POINT MUTATIONS affect DNA replication
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17
Q

why does it not make sense to “define a margin” when treating lymphoid hyperplasia?

A
  • When treating cancer, we usually need a margin that clears a tumor;
  • but the margin “doesn’t make sense” because the lymphocytes are everywhere and move around – so margins are not as relevant in hematopoietic disease (because they are systemic)
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18
Q

what disorder is pictured in the histo slide?

A

REACTIVE LYMPHOID HYPERPLASIA;

HETEROGENOUS –> appears more reactive

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19
Q

what are lymphoid neoplasms that arise in bone marrow and circulate in blood?

A

leukemia

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20
Q

which lymphoid neoplasms appear at tumor masses in lymph nodes or lymphoid aggregates in organs?

A

lymphomas

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21
Q

how do tumors of plasma cells (e.g. multiple myeloma) present?

A

as masses in bone w/ systemic symptoms related to production of large amounts of Ig chains

22
Q

where do lymphoid neoplasms tend to spread?

A

to lymph nodes and other tissues (spleen, liber, bone marrow)

lymphomas, myelomas can spill over into blood giving a leukemic picture, and leukemias can form masses

23
Q

which common lymphomas in adults are what cell origin?

A

B cell origin

  • Derived from follicle where cells usually undergo regulated somatic hypermutation that places cells at risk of mutations
  • common chromosomal translocations involve the ig gene loci

T cells are more genetically stable, fewer lymphomas

24
Q

which antigen marker is associated w/ progenitor or stem cells

A

CD34+ (can be myeloid or lymphoid)

25
Q

which antigen marker is associated w/ T CELLS

A

CD3

CD3-T Cells

26
Q

which antigen marker is associated w/ B CELL

A

CD19

19 are still Babies

27
Q

what is the disorder in the histo image?

A

SMALL LYMPHOCYTIC LYMPHOMA –> CHRONIC LYMPHOBLASTIC LEUKEMIA;

• Image is of a lymph node
• NO Architecture - indicative of clonal process –> homogeneous (monomorphic)
Effaced lymph node architecture

28
Q

what disorder is in the histo image?

A

CHRONIC LYMPHOCYTIC LEUKEMIA;

• CLL –> small round lymphocytes (chromatin is mature) – “SMUDGE CELL” on peripheral blood is indicative of CLL or SLL

29
Q

what is the disorder in the histo image?

A

FOLLICULAR LYMPHOMA;

• germinal center proliferations (of follicle - an abnormal follicle)

Germinal cell has taken over

30
Q

what disorder is on the histo image?

what genetic markers should you look for?

A

DIFFUSE LARGE B CELL LYMPHOMA (DLBCL);

  • HISTO: Sheets of large cells
  • Marker: CD19 or CD20
31
Q

what disorder is in the histo image?

A

BURKITT LYMPHOMA;

Histo: light color are the macrophages entering and clearing up (appear like “STARRY SKY” on histo –> due to MYC translocation)

32
Q

which cell type of lymphomas tend to be worse?

A

T CELL LYMPHOMAS TEND TO BE WORSE THAN B CELL LYMPHOMAS

33
Q

what disorder is in the histo image?

A

MULTIPLE MYELOMA;

• Binucleate w/ immunoglobulins that are forming
• Secreting more proteins which may be detected

34
Q

what disorder is images?

A

MULTIPLE MYELOMA;

  • if marrow is involved –> you need:
    • more than 10% plasma cells in the marrow w/ lytic/ lucent lesions, hypercalcemia, anemia
    • and less 60% plasma cells – considered myeloma event
  • There is a spectrum
35
Q

these histo images are of what disorder?

A

MULTIPLE MYELOMA;

  • When has lambda light chain –> make deposits such as amyloidosis
  • (RIGHT) Brown glass appearance; indicates amyloid around the vessels
    • Apple-green birefringence w/ congo red stainin –> STAINS FOR AMYLOID
36
Q

describe the staging of Hodgkin Lymphoma?

A
  • Stage I: single lymph node chain
  • stage II: more than 1 chain on same side of diagram
  • stage III: both sides of diaphragm
  • stage IV: widely disseminated disease
37
Q

what disorder is in the histo image?

A

HODGKIN LYMPHOMA;

  • Heterogeneity (still indicating clonal) – these are reacting to neoplastic cells –> secreting diff’t cytokines attracting mixed infiltrate in the backgroud
  • (usually can’t excluse based on FNA-fine needle aspirate or biopsy)
38
Q

how do these 2 histo images of myeloid neoplasms differ?

A
  • LEFT - younger individual, MORE cellular
  • RIGHT - older patients, DECREASED cellularity
39
Q

what features classify the MYELODYSPLASTIC SYNDROMES?

A
  • NUMBER of lineages displaying dysplasia
  • % blasts in peripheral blood/ bone marrow
  • cytogenetic aberrations identified
40
Q

what defines ACUTE LEUKEMIA?

A

20% blasts in peripheral blood/bone marrow

41
Q

what disorder is pictured in the histo image?

A

Myelodysplastic syndromes (MDS);

abnormal cells in the marrow; more neutrophils w/ granulocytes

42
Q

what is the myeloproliferative neoplasm that has INCREASE IN RED CELLS IN THE BLOOD

A

Polycythemia vera

43
Q

what is the myeloproliferative neoplasm that has INCREASE IN PLATELETS

A

Essential thrombocytopenia

44
Q

which two disorders that require evidence of translocation to diagnose?

A

Burkitt’s lymphoma: t(8;14) MYC –> IGH

Chronic Myeloid Leukemia: t(9;22) philadelphia

45
Q

what disorder is in the histo slide?

A

CHRONIC MYELOID LEUKEMIA;

46
Q

what disorder is in the histo image?

what is the defining characteristic?

A

Acute Myeloid Leukemia;

Auer Rods - slender, long inclusions (indicate myeloid lineage) –> these patients may die due to coagulative failure (DIC)

47
Q

what disorder is in the histo image?

A

LANGERHANS CELLS HISTIOCYTOSIS;

  • birbeck granules: “zipper - tennis racket shape cells”
48
Q

hemorrhagic diseases are disorders characterized by abnormal bleeding,

either spontaneous or following trauma or surgery.

What are the 3 factors that control bleeding and can be defective?

A
  • integrity of blood vessel wall
  • platelet function
  • clotting cascade to produce fibrin mesh
49
Q

which lab test is an obsolete test?

A

bleeding time: time (in minutes) for a standardized skin puncture to stop bleeding; clinical measure of platelet function

50
Q

which lab test measures extrinsic and common pathways?

which lab test measures intrinsic and common pathways?

A
  • Extrinsic pathway: prothrombin time (PT) –> tissue thromboplastin and calcium added to blood
  • Intrinsic pathway: partial thromboplastin time (PTT) –> kaolin, phospholipid and Ca added to blood
51
Q

what is the normal function of Von Willebrand factor in clotting cascade?

A
  • primary function is binding to other proteins, in particular factor VIII, and it is important in platelet adhesion to wound sites
  • It is not an enzyme and, thus, has no catalytic activity.
52
Q

what disorder is in the histo image?

A

MICROANGIOPATHIC HEMOLYTIC ANEMIA (MAHA)

defined by schistocytes

Y1 - Path - Exam 5 (4 decks)

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