FINAL Flashcards
1
Q
What type of parasite is Malaria?
A
Obligate intracellular protozoan
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
3
Q
What do merozoites infect?
A
Erythrocytes
Through **ring cell stage **back to schizont
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,
5
Q
MALARIA Diagnosis
What do you see on a peripheral smear?
A
RING FORM
6
Q
What other pathogen has ring-forms in RBC?
A
Plasmodium and Babesiosis
7
Q
First line treatment for Malaria
A
Chloroquine
if restistant: quinine sulfate, atovoquone/proguanil, mefloquine
8
Q
Name the pathogen
Double Stranded DNA virus
aka Human Herpes Virus-4 (HHV4)
A
EBV
9
Q
How is EBV transmitted?
A
Close Saliva contact (Kissing disease)
resp. droplets/blood transfusion
10
Q
What symptoms are seen with MONO?
A
Fever, Pharyngitis, fatigue, and rash
11
Q
Hepatosplenomegaly is caused by what?
A
Lymphocyte infilitration
12
Q
What test is done to diagnose EBV?
A
Monospot Test
EBV serology
Peripheral Smear: Atypical lymphocytes
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
14
Q
CD4 Count > 500 v. < 100
A
> 500 = oral hairy leukoplakia
<100 Non hodgkin B Cell lymphoma, CNS lymphopma
15
Q
Which of the following is seen in EMV infectious mononucleosis?
A
Atypical lymphocytes
16
Q
What are Dohle Bodies?
A
RER remnants
17
Q
When evaluating bone marrow, what is the normal myeloid:erythroid ratio?
A
3:1
18
Q
Patient presents with >20% myeloid blast cells in bone marrow .. What is your diagnosis
A
Acute Myelogenous Leukemia (AML)
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
20
Q
What chromosome indicates an unfavorable progonsis in Acute Myelogenous Leulemia?
A
Philadephia Chromosome (9:22)t
21
Q
Mutated constitutively activated tyrosine kinases results in
A
excessive proliferation
22
Q
What mutation is seen in Chronic myelogenous leukemia?
A
Philadelphia chromosome (9,22) –> BCR-ABL Fusion Gene
23
Q
What mutation is seen in Polycythemia vera, Primary myelofibrosis and essential thrombocytothemia?
A
JAK2 Point Mutations
24
Q
t(9;22)
A
Philadelphia Chromosome
25
What do **BCR-ABL fusion genes** cause?
accelerated automatic cellular divison
26
What are the **2 phases** of **polycythemia vera**?
| too many RBCs
**Polycythemic** and **Spent** Phases
27
In **Essential thrombocytosis**, patients have **elevated** counts of ?
| **What about polycythemia and marrow fibrosis**
Elevated PLATELETS
no polycthemia/marrow fibrosis
28
# What group do these belong to?
CML: CNL, CEL
PV
ET
MF
MYELOPROLIFERATIVE SYNDROMES
29
Hallmarks of **MPS**?
Clonal
Malignant
Natural Progression
30
What type of somatic **mutations** do you see in patients with **MPS**?
JAK2, CALR, MPL
31
what **mutation** is responsible for **loss of inhibition** of kinase domains causing cell proliferation?
JAK2
32
**secondary** causes of **Polycythemia Vera**
COPD, sleep apnea, obseity, high altitude
33
**treatment goal** of polycythemia vera
Control the symptoms
34
Which **MFS** has a normal life expectancy but **INCREASES the risk of thrombosis/vascular events**?
Essential Thrombosis
35
This treatment is used for **Myelofibrosis** and is a **JAK inhibitor**
| Decreased spleen sie/INC quality of life
Ruxolitinib
36
What is the treatment for **chronic eosinophilic leukemia**
Pemigatinib
37
in a **protein electropheresis of a myeloma**, what region shows a **monoclonal spike**?
GAMMA region
38
**plasma cell neoplasms** **secrete** what type of **protein**?
Paraprotein (M-Protein = Ig)
39
What is the **pre-malignant condition** of a **myeloma**?
Monoclonal Gammopathy of Undetermined Significane (**MGUS**)
| 1% risk of progression to MM per year
40
In **Smoldering Multiple myeoloma**, what is the % of risk of progressing each year?
| no CRAB
10% vs 1% (MGUS)
41
What does CRAB indicate?
Ca;cium
Renal Impairment
Anemia
Bone Lesions
| seen in patients with multiple myeoloma
42
Patient with **multiple myeolma** has a **blood** **smear** done, what do you see?
**Rouleaux** Formation = **stacking** Of RBC
43
# Multiple Myeoloma
**Bone survey** is the gold standard, but what diagnostic mode is more **sensitive** to **lytic lesions** and is preferred?
**CT without contrast** of whole body
44
# AL Systemic Amyloidosis
**Plasma cell neoplasms** are associated with what?
production of **monoclonal Ig light chain** (Lambda > Kappa)
45
Hallmark **clinical** features of **AL Systemic Amyloidosis**:
Periorbital purpura (Guaxinin eyes)
Macroglossia
Proteinuria
46
Precursor B Cell Neoplasms
Immature B cells
ALL
47
Peripheral B Cell Neoplasms
Mature B Cells
CLL, SLL
Follicular Lymphoma
Multiple Myeoloma
48
What is the **definitive diagnosis of ALL**?
**>35% of blasts** in marror/circulation
**>Detection of B and or T lymphocyte**-specific markers
49
# ALL
What are the **precursors** for **B-cell tumors**
TdT, CD10, CD19
50
What disease has **SMUDGE** cells?
CLL
51
What are the **precursors** for **CLL**?
CD19, CD20, CD23, **CD5 = t cell marker now overexpressed**
52
**Starry Sky Pattern** is seen in what lymphoid neoplasm?
| body macrophases engulging debris
Burkitt's Lymphoma
53
**Reed-Sternberg** cells are hallmark to what lymphoma?
HODGKINS Lymphoma
54
What is the most common **subtype** of **Hodgkins Lymphoma**?
**Nodular Sclerosis**
Reed-sternberg cell **lacunar** variant
**Fibrous bands** divide cellular areas into nodules
| PAX5 transciripton factor
55
What subtype of hodgkins lymphpma, shows **reed sternberg cell mononuclear variant**? EBV**+**
**Mixed** **Cellularity**
more eosinophils in infiltrate
Males > Females
56
What **precursor** would you see with **Hodgkin lymphoma**?
CD15, CD30
57
What is the most common lymphoid neoplasm in adults?
Diffuse Large B Cell Lymphoma
| 2nd MC = FOLLICULAR LYMPHOMA
58
What **translocation** is associated with **Follicular Lymphoma**?
**t(14:18)**
heavy chain Ig(14) with BCL-2(18)
| BCL-2 = apotoptosis inhibitor
59
Treatment for Follicular Lymphoma
RITUXIMAB = ANti-CD20 Monoclonal Ab
60
What Non-Hodgkin **lymphoma** is associated with **microorganisms** and **chronic inflammation**?
Marginal Zone Lymphoma
61
What type of B Cells would you see **histologically** if a patient has **Diffuse Large B Cell Lymphoma**?
Large Neoplastic B Cells
62
What is the hallmark **translocation** in **Mantle Cell lymphoma**?
**t(11;14) leads to overexpression of Cyclin D1** and heavy chain Ig(14)
63
Hallmark **translocation** in **Burkitt Lymphoma**?
t(8,14)
leads to overexpression of myc
64
Difference in **origin** between **Leukemia vs. Lymphoma**?
Leukemia --IN Bone Marrow
Lymphoma -- outside marror (lymph node)
65
CD5+ B Cell Neoplasm =
CLL/SLL
66
You see **smudge** cells on a blood **smear** -->
| crushed little lymphocytes
CLL/SLL
67
How do you treat CLL?
treat lightly: **Ibrutinib** (BTK inhibitor)
**Venetoclax-obinutuzumab** (BCL-2-inhibitor-antiCD20 ab)
68
You perform **TRAP staining** on your blood smear and notice **filamentous hair like projections**
**Hairy Cell Leukemia**
= **chronic** leukemia of B cells
**CD103+**
| blood lakes in spleen
69
**left supraclavicular node** and it drains the left head, neck, chest, **abdomen**, pelvis and bilateral lower extremities
VIRCHOW's Node
70
What nodes drain **gastrointestinal, abdominal, thoracic, or retroperitoneal cancers**
Left Supraclavicular Nodes
| Right drains lung/mediastinum
71
"B" Symptoms
Fever, Night Sweats, and unexplained weight loss
72
MIAMI =
Malignancies
Infections
Autoimmune disorders
Misc./unusual conditions
Iatrogenic Causes (Med)
73
Growth promoting oncogenes
cMyc
Ras protein
74
Growth inhibiting tumor suppressor genes
p53
75
genes that regulate apoptosis
t(8,14) burkitt lymphoma
76
**genes** involved in **DNA repair**
Xeroderma pigmentosa: Excision repair mutation results in lack of proper repair of DNA
77
What **tumor marker** is associated with **retinoblastoma/osteosarcoma**
RB
78
What **tumor marker** is associated with **Lung/Colon/Breast**?
TP53
79
**-stim** drugs do what?
Bone Marrow **GROWTH** factors
**Side Effect = hypersensitivity/anaphylaxsis**
Filgrastim = accelerates neutrophil recovery
Molgramostim = immunostimulatory
Sargramostim = accel. BM repopulation after chemo
80
What is a **complication** of bone marrow tranplants?
GRANULOCYTOPENIA
Fungal -- candida
Viral -- HSV/CMV
Parasitic = PCP/toxoplasmosis
| not really at risk for bacterial watch out for CDIFF
81
How do you treat candida
Fluconazole
| inhibits ergosterol synthesis
82
How do you treat HSV
| viral
Acyclovir = viral DNA syn inhibitor
83
How do you treat CMV
| viral
Ganciolovir = dna pol inhibitor -- halts replication
84
How do you treat **PCP** or **Toxoplasmosis**
| Parasitic
SMX/TMP
85
Time frame for Hyperacute, Acute, Chronic
Hyperacute = Minutes
Acute = Weeks -- Months
Chronic = Years
86
What drug **inactivates** **NF-KB**
| key inflammatory transcription factor
PREDNISONE
87
What **two drugs inactivate calcineurin**
-- **DEC NFAT activation** = transcription factor for many cytokines
Cyclosporine and Tacrolimus
| AE = nephrotoxicity, HTN, Hyperglycemia, Neurotoxicity
88
What drug **inhibits mTOR**
SIROLIMUS
| AR = hyperlipidemia/hypergylcemia
89
What drug **decreases purine synthesis**
Azathioprine
| CAUTION WITH ALLOPURINOL
90
What drugs can be given to treat **gastrointestinal toxicity due to chemotherapy**?
Serotonin Antagonist (5HT3)
Neurokinin-1 receptor antagonist
Synthetic cannabinoids
91
Name the drug that a has the unique toxicity: **hemorrhagic cystitis**
Cyclophosphamide
92
**Busulfan** can cause
pulmonary fibrosis
93
**Nitrosoureas** can cause what type of toxicity
Neurotoxicity
94
Which drug is used for testicular, bladder, ovary, gastrointestinal and carcinoma
**NEPHROTOXICITY/OTOTOXICITY**
CISPLATIN
95
What drug is **better tolerated than cisplatin**?
Carboplatin
96
**MOA** of **methotrexate**
**inhibits folic acid reducatase**
97
What is the **antidote** to **methotrexate overdose**?
Leucovorin
| bypasses DFHR
98
How do you **treat tumor lysis syndrome**?
Allopurinol
99
What is used to **treat hairy cell leukemia**?
Cladribine
| Clip Hairy Cells
100
There is an **advantage** when you **combine which drug with 5-Fluorouracil**?
Levucovorin
| potentiates the effects of 5-FU
101
Which **two** plant alkaloids **inhibit** topoiisomerase **II**
Etoposide and Teniposide
| **IRINOTECAN -- INHIBITS TOP I**
102
What two drugs are resposinsble for the **hyper stabilization of microtubules preventing breakdown**?
Paclitaxel and Docetaxel
| Turbo Tax stabilize society by collecting money
103
What drug causes **peripheral neuropathy**?
| Blocks Mitosis
Vincristine
| crisp the nerves
104
What **antitumor antibiotic** causes **cardiotoxicity**?
| causes free radical formation
Doxorubicin
105
**Tamoxifen** and **Raloxifene** are **estrogen receptor antagonists**.
Which one **increases the risk of endometrial cancer** while the **other does not?**
Tamoxifen -- INC risk of end. cx
Raloxfine -- DOES NOT inc risk
106
What does **AROMATASE** do?
| Anastr**ozole** and Letr**ozole**
converts androgens into estrogen
107
What drug is used in **CML** chromosomal translocation **t(9,22**)
Imatinib/Dasatinib
108
**Trastuzumab**: MOA = **monoclonal ab against HER-2** -- inhibits cell signaling
What is an **ADVERSE EFFECT**?
CARDIOTOXICITY
| Heartceptin damages the heart
109
**Cetuximab**: MOA = monoclonal ab **against EGFR**
What type of **rash** does it cause?
acneiform-like facial rash
110
What drug is can cause an **infusion** **reaction**?
| monoclonal ab against CD20
**Rituximab
pre treat with antihistamine/acetaminophen**
111
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**
Bortezomib/Carfilzomib
| AE = inc risk of herpes zoster - give prophylatic antiviral
112
this micronutrient deficiency results in **hemolytic anemia**
VITAMIN A
113
this micronutrient deficiency results in **hypochromic, microcytic sideroblastic anemia**
VIT B6
114
this micronutrient deficiency results in **megalobastic anemia**
B9 = folate
B12 = coblamin
115
this micronutrient deficiency results in **normochromic microcytic anemia**
VIT C
116
this micronutrient deficiency results in **microcytic,hypochromic anemia**
IRON
117
**Reversible dementia** is due to what macronutrient deficiency?
B12
118
What is **required** for the **absorption of B12**?
intrinsic factor
119
What type of **diet** is recommended for someone with **sickle cell anemia**?
HIGH CALORIE/HIGH PROTEIN
smaller, frequent feedings for poor tolerance
120
Dysgeusia =
Alterations in taste
121
**debulking** is advocated for what type of cancers?
ovarian, RCC, testicular, and CNS
122
**STAGING** is used to **assign survival rates** at what time?
at time of diagnosis
123
**Most common brain cancer overall** =
Metastatic disease = secondary brain tumors
| Glioblastoma = MC primary brain tumor
124
What is the **most common type of breast cancer**?
Invasive ductal carcinoma
125
**Sister Mary Joseph's nodule** is associated to what type of cancer?
| metastatic umbilical nodule
Gastric Cancer
