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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
Q

Cause of Pain Crisis in Anemic patient with Jaundice ?

A

Sickle Cell Anemia ( parvovirus-19)
Pain crisis is due to Sickle disease and b-thalassemia

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26
Q

What causes Sickle cell anemia ?

A

Assault to RBC due to hypoxia / dehydration&raquo_space; Vascular congestion&raquo_space;sickle&raquo_space; thrombosis&raquo_space;DIC
Missense mutation of b-Hgb

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27
Q

Child (3yr)
Chalky ,White retinal mass in the central eye
Esotropia
Vision , movement ,reflex intact

A

Retinoblastoma ( Rb TSG)
-Cong Cataract
-abnormal vitreous /retina
Inflammation

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28
Q

Retinoblastoma secondary malignancies ??

A

Soft tissue sarcoma
Osteosarcoma
Malignant melanoma
Mets via : SAS, Blood ,lymph

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29
Q

Rx of Retinoblastoma ?

A

Removal of Optic Nerve to prevent brain metastasis

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30
Q

Increased Hgb
Hct 62%(high)
Plt high
Blur vision , rib pain

A

Primary polycythemia Vera ( EPO normal or decreased )

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31
Q

EPO level in secondary PCV ?

A

Increased due to renal stimuli
( Eg : Renal tumor , hypoxia, high altitude , EPO receptor mutation )

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32
Q

Polycythemia can cause what carcinoma?

A

Renal Cell Ca
HCC

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33
Q

How can VSD or PDA causes Polycythemia Vera ?

A

L»R shunt first ,later pulmonary Vascular resistance allow R»L shunt&raquo_space; deoxygenated blood&raquo_space; Cyanosis&raquo_space; EPO stimulation&raquo_space; RBC increased

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34
Q

3 types of Myeloproliferative disorders

A

Increased RBC ( PCV)
Increased WBC ( AML)
Increased Plt ( 1 essential thrombocytosis )

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35
Q

Painless jaundice + Abd pain + RUQ mass

A

Pancreatic cancer

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36
Q

Whipple procedure

A

Resection of
Antrum + part of duodenum +head of pancreas + GB

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37
Q

Most common brain tumor in child

A

Medullablastoma
Cerebellar tumor
Hydrocephalus ( large ,shiny scalp , visible veins,downward gaze ,increase ICP)

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38
Q

Most common brain tumor in adult

A

Glioblastoma ( Butterfly gliomas)
Cerebral Hemisphere + Corpus callosum

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39
Q

Oligodendroma

A

Slow growing > transient symptoms
Frontal lobes
Glial cells ( made up myelin of axon )
Parasthesia + weakness

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40
Q

Recent infection
Elevated calcium /Cr
Back pain
M protein

A

Multiple Myeloma

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41
Q

Bence Jone protein

A

Multiple myeloma

42
Q

Punch out lytic bone lesions

A

Multiple myeloma

43
Q

Baby
Abdominal mass
Watery diarrhea
Irritable

A

Neuroblastoma (SNS malignancy)
Neuroblast migration along sympathetic ganglia of adrenal medulla

44
Q

Hypersegmented Neutrophil
Macrocytic Anemia

A

B12( Megaloblastic Anemia )

45
Q

Subacute combined degeneration of dorsal column of Spinal Cord

A

B12 deficiency
Loss of Vibration + Proprioception

46
Q

Hemoptysis
Vocal hoarseness
LOW/LOA
SOB
Sputum : Atypical cells

A

Pancoast Syndrome
Lung cancer ( UL )

47
Q

Pancoast syndrome

A

UL lung
Pain/ numbness in ipsilateral arm
Horner syndrome
Recurrent laryngeal n compression
Paraneoplastic syndrome
Neck or facial swelling ( SVC obstruction )

48
Q

Tired
Abd pain
Joint pain ,muscle ache
Gum tooth blue

A

Lead poison

49
Q

Child
Diffuse Purpura
Epitaxis
Large platelets ,Prolonged BT
coomb test :Pos

A

ITP
Coomb : + because Antibodies to plt

50
Q

Mechanism of low platelet count ?

A
  1. Splenic sequestration
    2.Decrease production ( Aplastic Anemia , clopidogrel ,aspirin ,SC failure ,leukemia )
    3.increase destruction ( MAHA, TTP,ITP , Heparin,Quinidine)
51
Q

Cells of Ovarian teratoma

A

Bone , cartilage ,hair , teeth ,glands

52
Q

Child (8 month)
Deep bleeding + Briuise over knees + increase aPTT ,normal BT

A

Hemophilia A - factor VIII
Bleeding Joints/ muscles /CNS

53
Q

Rx of Hemophillia

A

Mild - decompression
Severe - Factor VIII recombinant

54
Q

Non-tender palpable neck or supraclavicular mass
Fever +night sweat+ fatigue
Owl eye

A

Hodgkin lymphoma
Reed stenberg cells
B cells
CD 15+/30+

55
Q

High transferrin
Low TIBC
High serum Iron
High ferritin

A

Hereditary Hemochromatosis

56
Q

Causes of DIC

A

Infection including sepsis
Malignancy
Pregnancy complication ( abruption of placenta , amniotic fluid embolism)
Trauma
Snake venom

57
Q

Guaiac Test

A

FOBT for CRC and GC

58
Q

Most common adult blood cancer

A

CML
mature granulocytes : Neut/ESO/Baso, platelet
Splenomegaly

59
Q

ABL-BCR gene fusion

A

AML
Tyrosine kinase activity increase
Avoid apoptosis

60
Q

Imatinib

A

TKI used in AML

61
Q

Abd tenderness ,decreased bowel sound
Abdominal mass involving ileum
Lymphoid cells

A

Burkit lymphoma ( most common NHL type )
Involved GI ( mostly ileocecal / peritoneum )

62
Q

Starry Sky cells

A

Burkitt Lymphoma

63
Q

Maxillary /mandibular mass
African/endemic
Fever/sweat

64
Q

EBV /HIV /AIDS associated lymph nodes mass

A

Burkitt Lymphoma

65
Q

Flushing
Erythema
GI symptoms ( chronic Watery diarrhea)

A

Caricinoid syndrome
Arising from Small bowel carcinoid tumor

66
Q

Breast cancer types

A

1.Sporadic ( HER2) - cell cycle pathway of Estrogen /progesterone signaling
2.Hereditary (BRCA 1/2)- defect in DNA mismatch repair

67
Q

HbF increase in

A

B-thalassemia Major

68
Q

HbA2 increases in

A

B-thalassemia minor

69
Q

Alpha thalassemia major

A

Deletion of 3 alpha alleles -HbH (or )
all/4 alpha alleles-Hb Bart( Hydrops fatalis )

70
Q

Alpha thalasssemia minor

A

Deletion of 2 alleles- trait
Deletion of 1 alleles - silent Carrier

71
Q

Hypocellluar marrow with fatty infiltrate
Pancytopenia ( infection + bleeding + pallor + purpura)

A

Aplastic Anemia

72
Q

Adult (65 yrs)
Auer Rod ( needle like projection )
LOW/LOA , Bleeding , Cellulitis increased Blast

73
Q

Most common childhood leukemia

A

ALL
Increased immature white cells
Anemia
Increased LDH

74
Q

Porphobilinogen deinase deficiency
Elevated ALA synthase , Increase ALA

A

Acute intermittent porphyria

75
Q

Transplant rejection types

A

Acute
Subacute
Chronic

76
Q

What happen in acute transplant rejection ?

A

Preformed antibodies to graft organs ( antigen) leads to immediate immune response

77
Q

Subacute transplant rejection

A

After 1 week
Donor MHC cells started immune response in host ( T cells recognize and attack graft t/s)

78
Q

Chronic transplant rejection

A

Weeks and months
Vascular damage mostly
Complement/ T cells /cytokines infiltrate

79
Q

Who undergoes HSC transplant or BM transplant are at risk of what condition after procedure ?

A

GVHD
Donor immune system attacks host cells antigen ( Donor T cells attack host tissue )

80
Q

Initial Rx for ITP

A

Corticosteroid
Later IVIG ( raise plt count)
Splenectomy (refractory cases)

81
Q

Antibody to GpIIb/IIIa
Bleeding disorder
Most common children after viral infection /immunization

82
Q

Defect enzyme ADAMTS13
Autoantibody to platelet
Seen in female mostly

83
Q

Seen in children with E.coli (undercook beef)
Renal insufficiency
Petechiae
MAHA

84
Q

Increase BT
Decrease plt count / increase Megakaryocyte BM
Schistocytes
Normal PT/aPTT

A

MAHA
(TTP & HUS )

85
Q

Genetic Gp In deficiency
Plt adhesion impaired

A

BSS ( Barnard Siulier Syndrome)
Plt decrease
Large plt

86
Q

Gp IIb/IIIa deficiency (genetic)

A

Glanzman ( platelet disorder)

87
Q

Drugs that Irreversibly inactivate COX

88
Q

Function of thrombin

A

Stabilize platelet plug by converting fibrinogen to fibrin also called 2 Homeostasis

89
Q

2 homeostasis disorder

A

Rebleeding after Sx
Tooth extraction
Coagulation factor defect
Hemophilia

90
Q

Abnormal platelet agglutination test ( Ricocetin test)
Increase BT , aPTT
Mucosal /skin bleeding

A

VWF defects
Rx: Desmopressin

91
Q

FVIII deficiency
X linked
Male

A

Hemophilia A

92
Q

Vit K deficiency causes;

A

Newborn - lack of K+ producing gut flora
Malabsorption / Malnutrition
Long term antibiotic uses

93
Q

Warfarin overdose Rx :

A

Vit K IV 10 mg
FFP
4 or 3 Prothrombin complex concentrate
May be tranxenemic acid

94
Q

Screening test for DIC

A

D-diner ( usually elevated )

95
Q

MOA of aminocaproic acid

A

Blocks activation of plasminogen

96
Q

Types of embolus

A

Arthelerosclerotic (cholesterol plague)
Fat (bone fracture /soft tissue injury)
Gas ( decompression sickness / laparoscopic Sx)
Amniontic ( dyspnea/ neurologic symptoms /DIC)

97
Q

PE presentation

A

Pleuritic chest pain
Hemoptysis
Dyspnea /SOB
Pleural effusion
V/Q mismatch
Elevated D dimer
Wedge shape infarct

98
Q

Primary Pycythemia aka

A

Polycythemia Vera

99
Q

Polycythemia Vera Dx criteria

A

JAK - 2 mutation
Erythrocytosis (high RBC/WBC/plt)

100
Q

Hematocrit In polycythemia Vera

A

Male >0.50
F > 0.48

101
Q

JAK -2 negative PV criteria

A

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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