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HEME Lymph > FINAL > Flashcards

FINAL Flashcards

1
Q

What type of parasite is Malaria?

A

Obligate intracellular protozoan

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2
Q

What type of cells does plasmodium sporozite infect first?

A

Liver Cells –> matures into schizont form –> rupture and release merozoite stage into blood

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3
Q

What do merozoites infect?

A

Erythrocytes

Through **ring cell stage **back to schizont

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4
Q

What is a hallmark symptom of Malignant tertian of plasmodium falciparum

A

Black Water Fever
due to capillary blockage;
Convulusions, coma, cardiac failure,

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5
Q

MALARIA Diagnosis

What do you see on a peripheral smear?

A

RING FORM

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6
Q

What other pathogen has ring-forms in RBC?

A

Plasmodium and Babesiosis

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7
Q

First line treatment for Malaria

A

Chloroquine

if restistant: quinine sulfate, atovoquone/proguanil, mefloquine

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8
Q

Name the pathogen

Double Stranded DNA virus
aka Human Herpes Virus-4 (HHV4)

A

EBV

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9
Q

How is EBV transmitted?

A

Close Saliva contact (Kissing disease)
resp. droplets/blood transfusion

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10
Q

What symptoms are seen with MONO?

A

Fever, Pharyngitis, fatigue, and rash

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11
Q

Hepatosplenomegaly is caused by what?

A

Lymphocyte infilitration

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12
Q

What test is done to diagnose EBV?

A

Monospot Test
EBV serology
Peripheral Smear: Atypical lymphocytes

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13
Q

A patient with EBV was misdiagnosed and treated for strep throat with Penicillin or Amoxicllin…What does the patient present with?

A

Diffuse Maculopapular Rash

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14
Q

CD4 Count > 500 v. < 100

A

> 500 = oral hairy leukoplakia
<100 Non hodgkin B Cell lymphoma, CNS lymphopma

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15
Q

Which of the following is seen in EMV infectious mononucleosis?

A

Atypical lymphocytes

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16
Q

What are Dohle Bodies?

A

RER remnants

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17
Q

When evaluating bone marrow, what is the normal myeloid:erythroid ratio?

A

3:1

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18
Q

Patient presents with >20% myeloid blast cells in bone marrow .. What is your diagnosis

A

Acute Myelogenous Leukemia (AML)

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19
Q

Patient is diagnosed with Acute Myelogenous Leukemia … you see abnormal azurophilic granules in a bone marrow aspirate, which are called what?

A

Auer Rods

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20
Q

What chromosome indicates an unfavorable progonsis in Acute Myelogenous Leulemia?

A

Philadephia Chromosome (9:22)t

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21
Q

Mutated constitutively activated tyrosine kinases results in

A

excessive proliferation

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22
Q

What mutation is seen in Chronic myelogenous leukemia?

A

Philadelphia chromosome (9,22) –> BCR-ABL Fusion Gene

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23
Q

What mutation is seen in Polycythemia vera, Primary myelofibrosis and essential thrombocytothemia?

A

JAK2 Point Mutations

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24
Q

t(9;22)

A

Philadelphia Chromosome

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25
Q

What do BCR-ABL fusion genes cause?

A

accelerated automatic cellular divison

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26
Q

What are the 2 phases of polycythemia vera?

too many RBCs

A

Polycythemic and Spent Phases

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27
Q

In Essential thrombocytosis, patients have elevated counts of ?

What about polycythemia and marrow fibrosis

A

Elevated PLATELETS
no polycthemia/marrow fibrosis

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28
Q

What group do these belong to?

CML: CNL, CEL
PV
ET
MF

A

MYELOPROLIFERATIVE SYNDROMES

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29
Q

Hallmarks of MPS?

A

Clonal
Malignant
Natural Progression

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30
Q

What type of somatic mutations do you see in patients with MPS?

A

JAK2, CALR, MPL

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31
Q

what mutation is responsible for loss of inhibition of kinase domains causing cell proliferation?

A

JAK2

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32
Q

secondary causes of Polycythemia Vera

A

COPD, sleep apnea, obseity, high altitude

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33
Q

treatment goal of polycythemia vera

A

Control the symptoms

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34
Q

Which MFS has a normal life expectancy but INCREASES the risk of thrombosis/vascular events?

A

Essential Thrombosis

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35
Q

This treatment is used for Myelofibrosis and is a JAK inhibitor

Decreased spleen sie/INC quality of life

A

Ruxolitinib

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36
Q

What is the treatment for chronic eosinophilic leukemia

A

Pemigatinib

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37
Q

in a protein electropheresis of a myeloma, what region shows a monoclonal spike?

A

GAMMA region

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38
Q

plasma cell neoplasms secrete what type of protein?

A

Paraprotein (M-Protein = Ig)

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39
Q

What is the pre-malignant condition of a myeloma?

A

Monoclonal Gammopathy of Undetermined Significane (MGUS)

1% risk of progression to MM per year

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40
Q

In Smoldering Multiple myeoloma, what is the % of risk of progressing each year?

no CRAB

A

10% vs 1% (MGUS)

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41
Q

What does CRAB indicate?

A

Ca;cium
Renal Impairment
Anemia
Bone Lesions

seen in patients with multiple myeoloma

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42
Q

Patient with multiple myeolma has a blood smear done, what do you see?

A

Rouleaux Formation = stacking Of RBC

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43
Q

Multiple Myeoloma

Bone survey is the gold standard, but what diagnostic mode is more sensitive to lytic lesions and is preferred?

A

CT without contrast of whole body

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44
Q

AL Systemic Amyloidosis

Plasma cell neoplasms are associated with what?

A

production of monoclonal Ig light chain (Lambda > Kappa)

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45
Q

Hallmark clinical features of AL Systemic Amyloidosis:

A

Periorbital purpura (Guaxinin eyes)
Macroglossia
Proteinuria

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46
Q

Precursor B Cell Neoplasms
Immature B cells

A

ALL

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47
Q

Peripheral B Cell Neoplasms
Mature B Cells

A

CLL, SLL
Follicular Lymphoma
Multiple Myeoloma

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48
Q

What is the definitive diagnosis of ALL?

A

>35% of blasts in marror/circulation
>Detection of B and or T lymphocyte-specific markers

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49
Q

ALL

What are the precursors for B-cell tumors

A

TdT, CD10, CD19

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50
Q

What disease has SMUDGE cells?

A

CLL

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51
Q

What are the precursors for CLL?

A

CD19, CD20, CD23, CD5 = t cell marker now overexpressed

52
Q

Starry Sky Pattern is seen in what lymphoid neoplasm?

body macrophases engulging debris

A

Burkitt’s Lymphoma

53
Q

Reed-Sternberg cells are hallmark to what lymphoma?

A

HODGKINS Lymphoma

54
Q

What is the most common subtype of Hodgkins Lymphoma?

A

Nodular Sclerosis
Reed-sternberg cell lacunar variant
Fibrous bands divide cellular areas into nodules

PAX5 transciripton factor

55
Q

What subtype of hodgkins lymphpma, shows reed sternberg cell mononuclear variant? EBV+

A

Mixed Cellularity
more eosinophils in infiltrate
Males > Females

56
Q

What precursor would you see with Hodgkin lymphoma?

A

CD15, CD30

57
Q

What is the most common lymphoid neoplasm in adults?

A

Diffuse Large B Cell Lymphoma

2nd MC = FOLLICULAR LYMPHOMA

58
Q

What translocation is associated with Follicular Lymphoma?

A

t(14:18)
heavy chain Ig(14) with BCL-2(18)

BCL-2 = apotoptosis inhibitor

59
Q

Treatment for Follicular Lymphoma

A

RITUXIMAB = ANti-CD20 Monoclonal Ab

60
Q

What Non-Hodgkin lymphoma is associated with microorganisms and chronic inflammation?

A

Marginal Zone Lymphoma

61
Q

What type of B Cells would you see histologically if a patient has Diffuse Large B Cell Lymphoma?

A

Large Neoplastic B Cells

62
Q

What is the hallmark translocation in Mantle Cell lymphoma?

A

t(11;14) leads to overexpression of Cyclin D1 and heavy chain Ig(14)

63
Q

Hallmark translocation in Burkitt Lymphoma?

A

t(8,14)
leads to overexpression of myc

64
Q

Difference in origin between Leukemia vs. Lymphoma?

A

Leukemia –IN Bone Marrow
Lymphoma – outside marror (lymph node)

65
Q

CD5+ B Cell Neoplasm =

A

CLL/SLL

66
Q

You see smudge cells on a blood smear –>

crushed little lymphocytes

A

CLL/SLL

67
Q

How do you treat CLL?

A

treat lightly: Ibrutinib (BTK inhibitor)
Venetoclax-obinutuzumab (BCL-2-inhibitor-antiCD20 ab)

68
Q

You perform TRAP staining on your blood smear and notice filamentous hair like projections

A

Hairy Cell Leukemia
= chronic leukemia of B cells
CD103+

blood lakes in spleen

69
Q

left supraclavicular node and it drains the left head, neck, chest, abdomen, pelvis and bilateral lower extremities

A

VIRCHOW’s Node

70
Q

What nodes drain gastrointestinal, abdominal, thoracic, or retroperitoneal cancers

A

Left Supraclavicular Nodes

Right drains lung/mediastinum

71
Q

“B” Symptoms

A

Fever, Night Sweats, and unexplained weight loss

72
Q

MIAMI =

A

Malignancies
Infections
Autoimmune disorders
Misc./unusual conditions
Iatrogenic Causes (Med)

73
Q

Growth promoting oncogenes

A

cMyc
Ras protein

74
Q

Growth inhibiting tumor suppressor genes

A

p53

75
Q

genes that regulate apoptosis

A

t(8,14) burkitt lymphoma

76
Q

genes involved in DNA repair

A

Xeroderma pigmentosa: Excision repair mutation results in lack of proper repair of DNA

77
Q

What tumor marker is associated with retinoblastoma/osteosarcoma

A

RB

78
Q

What tumor marker is associated with Lung/Colon/Breast?

A

TP53

79
Q

-stim drugs do what?

A

Bone Marrow GROWTH factors
Side Effect = hypersensitivity/anaphylaxsis
Filgrastim = accelerates neutrophil recovery
Molgramostim = immunostimulatory
Sargramostim = accel. BM repopulation after chemo

80
Q

What is a complication of bone marrow tranplants?

A

GRANULOCYTOPENIA
Fungal – candida
Viral – HSV/CMV
Parasitic = PCP/toxoplasmosis

not really at risk for bacterial watch out for CDIFF

81
Q

How do you treat candida

A

Fluconazole

inhibits ergosterol synthesis

82
Q

How do you treat HSV

viral

A

Acyclovir = viral DNA syn inhibitor

83
Q

How do you treat CMV

viral

A

Ganciolovir = dna pol inhibitor – halts replication

84
Q

How do you treat PCP or Toxoplasmosis

Parasitic

A

SMX/TMP

85
Q

Time frame for Hyperacute, Acute, Chronic

A

Hyperacute = Minutes
Acute = Weeks – Months
Chronic = Years

86
Q

What drug inactivates NF-KB

key inflammatory transcription factor

A

PREDNISONE

87
Q

What two drugs inactivate calcineurin
– DEC NFAT activation = transcription factor for many cytokines

A

Cyclosporine and Tacrolimus

AE = nephrotoxicity, HTN, Hyperglycemia, Neurotoxicity

88
Q

What drug inhibits mTOR

A

SIROLIMUS

AR = hyperlipidemia/hypergylcemia

89
Q

What drug decreases purine synthesis

A

Azathioprine

CAUTION WITH ALLOPURINOL

90
Q

What drugs can be given to treat gastrointestinal toxicity due to chemotherapy?

A

Serotonin Antagonist (5HT3)
Neurokinin-1 receptor antagonist
Synthetic cannabinoids

91
Q

Name the drug that a has the unique toxicity: hemorrhagic cystitis

A

Cyclophosphamide

92
Q

Busulfan can cause

A

pulmonary fibrosis

93
Q

Nitrosoureas can cause what type of toxicity

A

Neurotoxicity

94
Q

Which drug is used for testicular, bladder, ovary, gastrointestinal and carcinoma
NEPHROTOXICITY/OTOTOXICITY

A

CISPLATIN

95
Q

What drug is better tolerated than cisplatin?

A

Carboplatin

96
Q

MOA of methotrexate

A

inhibits folic acid reducatase

97
Q

What is the antidote to methotrexate overdose?

A

Leucovorin

bypasses DFHR

98
Q

How do you treat tumor lysis syndrome?

A

Allopurinol

99
Q

What is used to treat hairy cell leukemia?

A

Cladribine

Clip Hairy Cells

100
Q

There is an advantage when you combine which drug with 5-Fluorouracil?

A

Levucovorin

potentiates the effects of 5-FU

101
Q

Which two plant alkaloids inhibit topoiisomerase II

A

Etoposide and Teniposide

IRINOTECAN – INHIBITS TOP I

102
Q

What two drugs are resposinsble for the hyper stabilization of microtubules preventing breakdown?

A

Paclitaxel and Docetaxel

Turbo Tax stabilize society by collecting money

103
Q

What drug causes peripheral neuropathy?

Blocks Mitosis

A

Vincristine

crisp the nerves

104
Q

What antitumor antibiotic causes cardiotoxicity?

causes free radical formation

A

Doxorubicin

105
Q

Tamoxifen and Raloxifene are estrogen receptor antagonists.
Which one increases the risk of endometrial cancer while the other does not?

A

Tamoxifen – INC risk of end. cx
Raloxfine – DOES NOT inc risk

106
Q

What does AROMATASE do?

Anastrozole and Letrozole

A

converts androgens into estrogen

107
Q

What drug is used in CML chromosomal translocation t(9,22)

A

Imatinib/Dasatinib

108
Q

Trastuzumab: MOA = monoclonal ab against HER-2 – inhibits cell signaling
What is an ADVERSE EFFECT?

A

CARDIOTOXICITY

Heartceptin damages the heart

109
Q

Cetuximab: MOA = monoclonal ab against EGFR
What type of rash does it cause?

A

acneiform-like facial rash

110
Q

What drug is can cause an infusion reaction?

monoclonal ab against CD20

A

Rituximab
pre treat with antihistamine/acetaminophen

111
Q

This drug is a proteasome inhibitor used in treating multiple myeloma, but causes an accumulation of toxic misfolded proteins and propapoptotic proteins – apoptosis of plasma cells

A

Bortezomib/Carfilzomib

AE = inc risk of herpes zoster - give prophylatic antiviral

112
Q

this micronutrient deficiency results in hemolytic anemia

A

VITAMIN A

113
Q

this micronutrient deficiency results in hypochromic, microcytic sideroblastic anemia

A

VIT B6

114
Q

this micronutrient deficiency results in megalobastic anemia

A

B9 = folate
B12 = coblamin

115
Q

this micronutrient deficiency results in normochromic microcytic anemia

A

VIT C

116
Q

this micronutrient deficiency results in microcytic,hypochromic anemia

A

IRON

117
Q

Reversible dementia is due to what macronutrient deficiency?

A

B12

118
Q

What is required for the absorption of B12?

A

intrinsic factor

119
Q

What type of diet is recommended for someone with sickle cell anemia?

A

HIGH CALORIE/HIGH PROTEIN
smaller, frequent feedings for poor tolerance

120
Q

Dysgeusia =

A

Alterations in taste

121
Q

debulking is advocated for what type of cancers?

A

ovarian, RCC, testicular, and CNS

122
Q

STAGING is used to assign survival rates at what time?

A

at time of diagnosis

123
Q

Most common brain cancer overall =

A

Metastatic disease = secondary brain tumors

Glioblastoma = MC primary brain tumor

124
Q

What is the most common type of breast cancer?

A

Invasive ductal carcinoma

125
Q

Sister Mary Joseph’s nodule is associated to what type of cancer?

metastatic umbilical nodule

A

Gastric Cancer

HEME Lymph (2 decks)

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