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USMLE STEP1 📚👩🏻‍⚕️ > Hemato-Oncology > Flashcards

Hemato-Oncology Flashcards

1
Q

What metal poisoning can Porphyria cause ?

A

Lead through inhibition of ALA in heme synthesis

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2
Q

Basophillic stripping (aggregates of ribosomes or fragments of ribosomal RNA precipitated throughout the cytoplasm of circulating erythrocyte)

A

(Basophilic stippling occurs because of imperfect RNA resolution and abnormal ribosomal structure)

Causes include :

1.lead poisoning
2.Hemolysis
3.Thalassemia

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3
Q

Lead poison

A

Basophillia stripping
Blue Burton line on Gum
Demyelination of motor axon
Memory deficit
Arthralgia Myalgia
GI symptoms

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4
Q

How to know duration of lead poison ?

A

FEP -check intoxication of past 120 days
Serum lead - exposure within 3 weeks

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5
Q

Plummer Vinson syndrome

A

Atropic glossitis
Esophageal web
Microcytic anemia

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6
Q

CRAB mnemonic

A

Multiple Myeloma

Elevated Calcium , Renal Failure , Anemia, Bone lesion

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7
Q

MGUS

A

Monoclonal Gammopathy of undetermined Significance
M protein ( Immunoglobulin ) < 3 g/dl
Asymptomatic
30% May progress to MM

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8
Q

ABVD regime

A

HL
Adriamycin/Docorubicin
Bleomycin
Vinblastine
Decarbazine

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9
Q

Androgen Excess (Hirtuism+acne+irregular period ) + Adnexal mass +Ovarian Ca ?

A

Sertoli leydig ovarian tumor
(Sex cord stromal tumor) -Benign

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10
Q

Sertoli cell / Leydig cell of ovary function ?

A

S- convert Testosterone to estrogen (Spermatogenesis)
L-secrete testosterone

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11
Q

vWF disease

A

Factor VIII carrier
Platelet adhesion
Deep Bleeding (Joint )
(Platelet disorder )

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12
Q

Adult , Bloody diarrhea
5 cardinal signs
1.Renal Insufficiency ,
2.Anemia
3.Fever ,
4.CNS problems,
5.Thrbocytopenia

A

TTP/HUS
E.coli toxin&raquo_space; endo cells damage >thrombosis+plt activation

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13
Q

Rx of TTP/HUS

A

Plasma Exchange
Immunosuppressant

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14
Q

Painless , round,firm,non-illuminating testicular mass ,elevated LDH

A

Testicular tumor (Seminoma)

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15
Q

Translluminate testicular mass + Cystic fluid collection

A

Hydrocele,Vericocele

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16
Q

Painful testicular mass+ elevated WBC

A

Epidydimitis /Orchitis

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17
Q

Most common germ cell tumor of women

A

Dysgerminoma (ovarian Tumor)
IncreaseD ALP ,LDH

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18
Q

Causes of increased b-HCG

A

normal pregnancy
Gestational trophoblastic disease ( Choriocarcinoma , Hydatiform mole ,ectopic pregnancy )

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19
Q

Child
Increased MCHC
normocystic anemia(Intravascular Hemolysis )
Small ,Round RBC

A

H. Spherocytosis
Osmotic fragility Test
Direct Coomb - Neg

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20
Q

Most common lung cancer

A

NSCLC
1. Adenocarcinoma ( Acinar)
2.squamous cell carcinoma (hilum )

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21
Q

Which lung ca are not related to smoking risk?

A

Large cell lung cancer
Bronchoalveolar Ca

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22
Q

Risk factors of SCLC

A

Smoking
Asbestos
Aromatic carbon
Ionizing radiation

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23
Q

What condition (syndrome ) is associated with SCLC ?

A

Lambert Eaton MG (Paraneoplastic Syndrome )
Ca channel antibodies at pre-syneptic NMJ

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24
Q

Lambert Eaton MG features

A

Ptosis
Diplopia
Muscle weakness

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25
Cause of Pain Crisis in Anemic patient with Jaundice ?
Sickle Cell Anemia ( parvovirus-19) Pain crisis is due to Sickle disease and b-thalassemia
26
What causes Sickle cell anemia ?
Assault to RBC due to hypoxia / dehydration >> Vascular congestion >>sickle >> thrombosis >>DIC Missense mutation of b-Hgb
27
Child (3yr) Chalky ,White retinal mass in the central eye Esotropia Vision , movement ,reflex intact
Retinoblastoma ( Rb TSG) -Cong Cataract -abnormal vitreous /retina Inflammation
28
Retinoblastoma secondary malignancies ??
Soft tissue sarcoma Osteosarcoma Malignant melanoma Mets via : SAS, Blood ,lymph
29
Rx of Retinoblastoma ?
Removal of Optic Nerve to prevent brain metastasis
30
Increased Hgb Hct 62%(high) Plt high Blur vision , rib pain
Primary polycythemia Vera ( EPO normal or decreased )
31
EPO level in secondary PCV ?
Increased due to renal stimuli ( Eg : Renal tumor , hypoxia, high altitude , EPO receptor mutation )
32
Polycythemia can cause what carcinoma?
Renal Cell Ca HCC
33
How can VSD or PDA causes Polycythemia Vera ?
L>>R shunt first ,later pulmonary Vascular resistance allow R>>L shunt >> deoxygenated blood >> Cyanosis >> EPO stimulation >> RBC increased
34
3 types of Myeloproliferative disorders
Increased RBC ( PCV) Increased WBC ( AML) Increased Plt ( 1 essential thrombocytosis )
35
Painless jaundice + Abd pain + RUQ mass
Pancreatic cancer
36
Whipple procedure
Resection of Antrum + part of duodenum +head of pancreas + GB
37
Most common brain tumor in child
Medullablastoma Cerebellar tumor Hydrocephalus ( large ,shiny scalp , visible veins,downward gaze ,increase ICP)
38
Most common brain tumor in adult
Glioblastoma ( Butterfly gliomas) Cerebral Hemisphere + Corpus callosum
39
Oligodendroma
Slow growing > transient symptoms Frontal lobes Glial cells ( made up myelin of axon ) Parasthesia + weakness
40
Recent infection Elevated calcium /Cr Back pain M protein
Multiple Myeloma
41
Bence Jone protein
Multiple myeloma
42
Punch out lytic bone lesions
Multiple myeloma
43
Baby Abdominal mass Watery diarrhea Irritable
Neuroblastoma (SNS malignancy) Neuroblast migration along sympathetic ganglia of adrenal medulla
44
Hypersegmented Neutrophil Macrocytic Anemia
B12( Megaloblastic Anemia )
45
Subacute combined degeneration of dorsal column of Spinal Cord
B12 deficiency Loss of Vibration + Proprioception
46
Hemoptysis Vocal hoarseness LOW/LOA SOB Sputum : Atypical cells
Pancoast Syndrome Lung cancer ( UL )
47
Pancoast syndrome
UL lung Pain/ numbness in ipsilateral arm Horner syndrome Recurrent laryngeal n compression Paraneoplastic syndrome Neck or facial swelling ( SVC obstruction )
48
Tired Abd pain Joint pain ,muscle ache Gum tooth blue
Lead poison
49
Child Diffuse Purpura Epitaxis Large platelets ,Prolonged BT coomb test :Pos
ITP Coomb : + because Antibodies to plt
50
Mechanism of low platelet count ?
1. Splenic sequestration 2.Decrease production ( Aplastic Anemia , clopidogrel ,aspirin ,SC failure ,leukemia ) 3.increase destruction ( MAHA, TTP,ITP , Heparin,Quinidine)
51
Cells of Ovarian teratoma
Bone , cartilage ,hair , teeth ,glands
52
Child (8 month) Deep bleeding + Briuise over knees + increase aPTT ,normal BT
Hemophilia A - factor VIII Bleeding Joints/ muscles /CNS
53
Rx of Hemophillia
Mild - decompression Severe - Factor VIII recombinant
54
Non-tender palpable neck or supraclavicular mass Fever +night sweat+ fatigue Owl eye
Hodgkin lymphoma Reed stenberg cells B cells CD 15+/30+
55
High transferrin Low TIBC High serum Iron High ferritin
Hereditary Hemochromatosis
56
Causes of DIC
Infection including sepsis Malignancy Pregnancy complication ( abruption of placenta , amniotic fluid embolism) Trauma Snake venom
57
Guaiac Test
FOBT for CRC and GC
58
Most common adult blood cancer
CML mature granulocytes : Neut/ESO/Baso, platelet Splenomegaly
59
ABL-BCR gene fusion
AML Tyrosine kinase activity increase Avoid apoptosis
60
Imatinib
TKI used in AML
61
Abd tenderness ,decreased bowel sound Abdominal mass involving ileum Lymphoid cells
Burkit lymphoma ( most common NHL type ) Involved GI ( mostly ileocecal / peritoneum )
62
Starry Sky cells
Burkitt Lymphoma
63
Maxillary /mandibular mass African/endemic Fever/sweat
Burkitt
64
EBV /HIV /AIDS associated lymph nodes mass
Burkitt Lymphoma
65
Flushing Erythema GI symptoms ( chronic Watery diarrhea)
Caricinoid syndrome Arising from Small bowel carcinoid tumor
66
Breast cancer types
1.Sporadic ( HER2) - cell cycle pathway of Estrogen /progesterone signaling 2.Hereditary (BRCA 1/2)- defect in DNA mismatch repair
67
HbF increase in
B-thalassemia Major
68
HbA2 increases in
B-thalassemia minor
69
Alpha thalassemia major
Deletion of 3 alpha alleles -HbH (or ) all/4 alpha alleles-Hb Bart( Hydrops fatalis )
70
Alpha thalasssemia minor
Deletion of 2 alleles- trait Deletion of 1 alleles - silent Carrier
71
Hypocellluar marrow with fatty infiltrate Pancytopenia ( infection + bleeding + pallor + purpura)
Aplastic Anemia
72
Adult (65 yrs) Auer Rod ( needle like projection ) LOW/LOA , Bleeding , Cellulitis increased Blast
AML
73
Most common childhood leukemia
ALL Increased immature white cells Anemia Increased LDH
74
Porphobilinogen deinase deficiency Elevated ALA synthase , Increase ALA
Acute intermittent porphyria
75
Transplant rejection types
Acute Subacute Chronic
76
What happen in acute transplant rejection ?
Preformed antibodies to graft organs ( antigen) leads to immediate immune response
77
Subacute transplant rejection
After 1 week Donor MHC cells started immune response in host ( T cells recognize and attack graft t/s)
78
Chronic transplant rejection
Weeks and months Vascular damage mostly Complement/ T cells /cytokines infiltrate
79
Who undergoes HSC transplant or BM transplant are at risk of what condition after procedure ?
GVHD Donor immune system attacks host cells antigen ( Donor T cells attack host tissue )
80
Initial Rx for ITP
Corticosteroid Later IVIG ( raise plt count) Splenectomy (refractory cases)
81
Antibody to GpIIb/IIIa Bleeding disorder Most common children after viral infection /immunization
ITP
82
Defect enzyme ADAMTS13 Autoantibody to platelet Seen in female mostly
TTP
83
Seen in children with E.coli (undercook beef) Renal insufficiency Petechiae MAHA
HUS
84
Increase BT Decrease plt count / increase Megakaryocyte BM Schistocytes Normal PT/aPTT
MAHA (TTP & HUS )
85
Genetic Gp In deficiency Plt adhesion impaired
BSS ( Barnard Siulier Syndrome) Plt decrease Large plt
86
Gp IIb/IIIa deficiency (genetic)
Glanzman ( platelet disorder)
87
Drugs that Irreversibly inactivate COX
Aspirin
88
Function of thrombin
Stabilize platelet plug by converting fibrinogen to fibrin also called 2 Homeostasis
89
2 homeostasis disorder
Rebleeding after Sx Tooth extraction Coagulation factor defect Hemophilia
90
Abnormal platelet agglutination test ( Ricocetin test) Increase BT , aPTT Mucosal /skin bleeding
VWF defects Rx: Desmopressin
91
FVIII deficiency X linked Male
Hemophilia A
92
Vit K deficiency causes;
Newborn - lack of K+ producing gut flora Malabsorption / Malnutrition Long term antibiotic uses
93
Warfarin overdose Rx :
Vit K IV 10 mg FFP 4 or 3 Prothrombin complex concentrate May be tranxenemic acid
94
Screening test for DIC
D-diner ( usually elevated )
95
MOA of aminocaproic acid
Blocks activation of plasminogen
96
Types of embolus
Arthelerosclerotic (cholesterol plague) Fat (bone fracture /soft tissue injury) Gas ( decompression sickness / laparoscopic Sx) Amniontic ( dyspnea/ neurologic symptoms /DIC)
97
PE presentation
Pleuritic chest pain Hemoptysis Dyspnea /SOB Pleural effusion V/Q mismatch Elevated D dimer Wedge shape infarct
98
Primary Pycythemia aka
Polycythemia Vera
99
Polycythemia Vera Dx criteria
JAK - 2 mutation Erythrocytosis (high RBC/WBC/plt)
100
Hematocrit In polycythemia Vera
Male >0.50 F > 0.48
101
JAK -2 negative PV criteria
Red cell mass >25% Hematocrit high BM histology consistent with PV With at least 2 of the following : Splenomegaly Low serum EPO Neut leukocytosis , thrombocytosis

USMLE STEP1 📚👩🏻‍⚕️ (13 decks)

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