Hematology and Oncology Flashcards
List the 3 most common cancers in women
- breast
- lung (most deaths)
- colorectal
Cancer immunotherapy often includes administration of monoclonal antibodies against a target overexpressed on the cancer cell surface. The Fc portion of the antibody binds ____ cells via CD___ leading to cytotoxicity
natural killer
CD16
What clotting factors are produced initially by the liver in an inactive form and then activated by vitamin K dependent carboxylatoin
II
VII
IX
X
PT will be prolonged in cirrhosis primarily due to what deficiency
factor VII (shortest half life, produced by the liver, and part of the extrinsic pathway which effects PT)
Nitrates are oxidizing agents that are effective in treating ___ poisoning due to their ability to induce methemoglobinemia which contains ___ instead of _____
cyanide
ferric (FE3+)
ferrous (Fe4+)
(cyanide binds ferric iron m ore avidly than to mitochondrial cytochrome enzymes, diminshing cyanides toxic effect)
Patients with sickle cell disease become functionally asplenic within the first few years of like which dramatically increases the risk for infections with encapsulated organsims, particularly ____
streptococcus pneumoniae
also at increased risk for salmonella osteolmyelits
What medications are most commonly known to cause pancytopenia
antiseizure: carbamazepine, valproic acid
sulfonamides
nifedipine
Thrombotic thrombocytopenic purpura is a thrombotic microangiopathy resulting in ____ and ____ which are both findings that are essential for making the diagnosis
microangiopathic hemolytic anemia
thrombocytopenia
Thrombotic thrombocytopenia purpura is triggered by a severe deficiency in ______
ADAMTS13
What kind of receptor is HER2
tyrosine kinase
Tx for HER2 positive breast cancer
trastuzumab
What is the result of mycoplasma pneumoniae causing cross-reacting IgM antibodies
mild, transient hemolytic anemia
CD19 is only expressed by what cells
B cells
Vincristine has what classic toxicity and it stops the cell cycle at what stage
neurotoxicity (peripheral neuropathy) M phase (disrupts neuronal microtubules)
HbF contains __ globin instead of ___ globin seen in HbA
gamma
beta
Diagnostic lab values for DIC
prolonged PT/PTT
thrombocytopenia (due to consumption of coagulation factors and platelets)
Erythropoietin signal transduction is primarily mediated by _____ which promotes erythrocyte precursor survival
JAK2/STAT
Porphyria cutanea tarda is causes photosensitivity (blistering) and hyperpigmentation and is caused by a deficiency in what enzyme
late steps in porphyrin synthesis: uroporphyrinogen decarboxylase
acute intermittent porphyria causes abdominal and neurological symptoms and is caused by a deficiency in what enzyme
early steps of porphyrin synthesis: porphobilinogen deaminase
Parvovirus is what type of virus? (DNA/RNA, positive sense, negative sense, single strand, double strand, enveloped, nonenveloped)
nonenveloped sing-stranded DNA virus
In Von Willebrand disease, how platelet levels, PT and PTT be affected
platelets and PT normal
PTT prolonged due to low levels of factor VIII
What are the main side effects of cyclin dependent kinase inhibitors
inhibit cellular replication in rapidly dividing cells (bone marrow, neutropenia, leukopenia, anemia)
What can cause peripheral neuromuscular excitability (paresthesia, muscle spasms) following a blood transfusion
citrate anticoagulants can chelate plasma calcium –> hypocalcemia
What is the underlying pathology of primary/hereditary hemochromatosis
mutation in HFE protein that causes enterocytes and hepatocytes to detect falsely low iron levels –> increased DMT1 expression on enterocytes to increased iron intestinal absorption and hepatocytes decrease hepcidin synthesis which increases ferroportin expression allowing increased iron secretion into circulation
what are the clinical features of primary hemochromatosis
micronodular cirrhosis
diabetes mellitus
skin pigmentation (bronze diabetes)
increased risk for hepatocellular carcinoma, congestive heart failure, and testicular atrophy
enoxaparin MOA
low molecular weight heparin
What type of leukemia can cause respiratory symptoms such as a child presenting with dyspnea, tachypnea, and inspiratory stridor as well as dysphagia with solid foods
T-cell acute lymphoblastic leukemia (ALL)
can cause a mediastinal mass
What is the MOA of emicizumab treating hemophilia A
mimics activity of factor VII
bispecific monoclonal antibody that binds both factor IXa and factor X bringing them in close proximity to allow for factor X activiation
Sickle cell anemia results from a point mutation that substitutes ____ in the place of ____
valine
glutamic acid
Why does unfractionated heparin have equal activity against factor Xa and thrombin while LMWH has greater activity against factor Xa than thrombin
only unfractionated heparin has pentasaccharide chain long enough to bind to both antithrombin and thrombin which is required to inactivate thrombin
both of them can bind anitithrombin, though, which is all that is needed to increase its ability to inactivate factor Xa
Symptoms of colicky abdominal pain, constipation, and peripheral neuropathy in the presence of a microcytic anemia with normal iron studies suggests what diagnosis
lead poisoning
what does a peripheral smear in lead poisoning show
microcytic anemia that may reveal basophilic stippling
What are causes of target cells (RBCs)
reduced cell volume: thalassemia, iron deficiency
excessive cell membrane: obstructive liver disease, postsplenectomy
How does carbon monoxide poisoning affect O2 binding to hemoglobin
heme binds CO stronger than O2 but it also decreases hemoglobin O2 unloading
A 50 yr old man with painless mass in his neck that fluctuates in size and has a t(14;18) chromosomal translocation has overexpression of what gene and type of lymphoma is this
BCL2 (18) follicular lymphoma (a non hodgkin lymphoma)
Apixaban blocks the conversion of ___ to ____
prothrombin
thrombin
(direct factor Xa inhibitor)
In erythrocytosis, a normal red blood cell mass indicates what as the cause of polycythemia
plasma volume contraction (relative erythrocytosis)
How does multiple myeloma cause bone pain
secretes RANKL and destroys osteoprotegerin –> increased RANK activity –> osteoclast differentiation and inhibition of osteoblasts –> purely radiolucent/osteolytic bone lesions
What chemotherapy agent can cause lung toxicity that usually manifests as pulmonary fibrosis
bleomycin
what is the MOA of bleomycin
binds to iron and oxygen molecules to create free radicals that cause DNA strand breaks
What location of enlarged lymph nodes is unlikely to be caused by common childhood infections and is concerning for malignancy: anterior cervical posterior cervical submandibular submental supraclavicular
supraclavicular
How does the BCL2 protein normally inhibit apoptosis
blocking the release of proapoptotic factors (cytochrome C protein) from the mitochondria
What lymphoma presents with a painless waxing and waning (fluctuating) lymphadenopathy
follicular lymphoma (most common indolent (painless) non hodgkin lymphoma in adults)
Vitamin B12 is an essential cofactor in the recycling of ____ to ____ which is required for amino acid, purine, and thymidine synthesis
5-methyl-tetrahydrofolate
tetrahydrofolate
(B12 = colbalamin)
____ is a polypeptide synthesized by the _____ that acts as a regulator of intestinal iron absorption and iron release by macrophages
hepcidin
liver
(hypoxia and high erythropoiesis –> low hepcidin –> increased intestinal absorption and stimulate iron release from macrophages)
what complication of multiple myeloma can lead to renal failure, heart failure, and neurologic dysfunction
amyloidosis (light chains form insoluble fibrils)
Acute promyelocytic leukemia is associated with what chromosomal translocation
t(15;17)
Auer rods = ______
acute myelogenous leukemia (includes acute promyelocytic leukemia)
Tumor lysis syndrome has what effect on the following: potassium uric acid phosphorus lactate dehydrogenase
potassium: increased (–> hypocalcemia)
uric acid: increased
phosphorous: increase
lactate dehydrogenase: increased
What causes the delay in warfarin’s therapeutic effect
it only blocks the generation of new clotting factors, therapeutic effect is delayed 3-5 days until preexisting clotting factors are consumed
What 3 things can cause a left shift in the hemoglobin oxygen dissociation curve
increased pH
decreased 2,3-bisphosphoglycerate (increased in low O2 and decreases O2 affinity allowing release in peripheral tissues)
decreased
temperature (stabilizes bonds)
hemolytic anemia, hypercoagulability, and pancytopenia are characteristic of what disease
paroxysmal nocturnal hemoglobinuria
Paroxysmal nocturnal hemoglobinuria is caused by an acquired mutation of the ___ gene which is involved in the synthesis of _______
PIGA
glycosylphosphatidylinositol (GPI) anchor
what is the pathogenesis of paroxysmal nocturnal hemoglobinuria
mutation in gene for GPI anchor synthesis –> CD55 (decay-accelerating factor) and CD59 (MAC inhibitory protein) deficiencies –> complement mediated hemolysis (no inhibition of complement on RBC)
flow cytometry is the gold standard for diagnosis of paroxysmal nocturnal hemoglobinuria which will show absence of ___ and ____
CD55
CD59
megaloblastic anemia with neurologic dysfunction is due to what deficiency
B12
What lymphoma has presence of macrophages and apoptotic bodies in a see of medium-sized lymphocytes
Burkitt
Burkitt lymphoma is associated with what chromosome translocation
t(8;14)
8: c-Myc
Acute intermittent porphyria can cause neurologic symptoms and abdominal pain due to deficiency of what enzyme and can be treated by decreasing activity of what enzyme
porphobilinogen deaminase aminolevulinate synthase (rate limiting enzyme in hepatic pathway of heme)
Methotrexate is a _____ antagonist which competitively inhibits the enzyme _____ which catalyzes the synthesis of ______.
folic acid
dihydrofolate (DHF) reductase
tetrahydrofolate
Lecovorin/folinic acid has what affect on methotrexate vs 5-FU chemotherapeutic effects
methotrexate: inhibited (bc leucovorin bypasses the DHF reductase step that is inhibited by methotrexate)
5-FU: potentiates toxicity (5-FU requires presence of reduced folate inorder to form complexes with thymidylate synthase)
list 3 B cell markers
CD19
CD20
CD23
A patient with anemia, thrombocytopenia, and leukocytosis with a predominance of CD-20 positive cells has high suspicion of what diagnosis
chronic lymphocytic leukemia (CLL)
The restocetin cofactor assay measures platelet agglutination via binding of ____ receptors to ____. It is abnormal in what deficiency?
glycoprotein 1b
vWF deficiency
The primary immune response to EBV is through what cells which appear in the peripheral blood smear as what
CD8 T lymphocytes
reactive (atypical) CD8 T cells
jaundice, dark urine, normocytic anemia, reticulocytosis, and bite cells are indicative of what diagnosis
glucose 6 phosphate dehydrogenase deficiency
Rasburicase MOA
recombinant version of urate oxidase
converts uric acid into allantoin that is more soluble
used in tumor lysis syndrome
Erythrocytes always convert glucose to pyruvate but have what alternate pathway of doing so that does not generate ATP
bisphosphoglycerate mutase converts 1,3BPG into 2,3BPG
2,3BPG is converted to 3 phosphoglycerate by bisphosphoglycerate phosphatase and neither of these steps yield ATP
vWF functions as a promotor of platelet adhesion at sites of vascular injury by binding ____ to ____
platelet glycoproteins (primarily Gp1b) subendothelial collagen on injured blood vessel walls
Hemoglobin C is caused by a ___ mutation that results in a ___ residue being substituted by ____ in the beta globin chain
missense
glutamate
lysine
Rank the speed of hemoglobin movement during gel electrophoresis:
hemoglobin A
hemoglobin S
hemoglobin C
hemoglobin A> HbS>HbC
Deferoxamine MOA in blood transfusion
chelation therapy
prevents iron-induced cardiotoxicity and congestive heart failure from developing
chromosome translocation t(15;17) causes what leukemia and forms a fusion of what genes
acute promyelocytic leukemia (M3 variant of AML)
15 = PML gene
17 = RARA gene (retinoic acid receptor alpha)
____ is a monoclonal antibody directed against the CD20 antigen
rituximab
If a patient has elevated WBC with an increase in myelocytes and decreased leukocyte alkaline phosphatase, what is the diagnosis
CML (chronic myelogenous leukemia)
Isoniazid inhibits pyridoxine phosphokinase leading to impaired activation of pyridoxine (B6) which is a cofactor for ____. Inhibition of this could cause _____ anemia
delta aminolevulinic acid synthase (catalyzes rate limiting step of heme synthesis)
sideroblastic (anemia caused by impaired heme production)
explain how HUS causes thrombocytopenia and hemolytic anemia
shiga toxin causes capillary endothelial damage –> platelet activation –> microthrombi –> erythrocyte damage
How does G6PD effect the following: reticulocytes, lactate dehydrogenase, haptoglobin
reticulocytes: increased
lactate dehydrogenase: increased
haptoglobin: decreased (binds free circulating hemoglobin)
(all due to RBC lysis)
Multiple myeloma is a malignancy of what cell type
plasma cells
What is the diagnosis of a patient presenting with thrombocytopenia, microangiopathic hemolytic anemia, renal insufficiency, neurologic symptoms and fever
TTP (thrombotic thrombocytopenic purpura)
Describe the pathogenesis of thrombotic thrombocytopenic purpura (TTP)
formation of autoantibody inhibitors against ADAMTS13 which usually cleaves ultralarge vWF –> aggregation and activation of platelets
Which is more suggestive of malignancy: polyclonal proliferation of lymphocytes or monoclonal
monoclonal
How does demsmopressin help treat patients with symptomatic vWF disease
transiently increases vWF and factor VIII release from endothelial cells
Burkitt lymphoma is associated with what chromosome translocation
t(8;14)
Myc overexpression which functions as a transcription activator –> cell growth and proliferation
What causes a increase in mean corpuscular hemoglobin concentration in spherocytosis
mild dehydration of the red blood cells
Precursors to what cells stain positive for Tdt, CD10, CD19
Bcell
What is the pathogenesis of disseminated intravascular coagulation (DIC)
widespread formation of microvascular thrombi leads to consumption of platelets, coagulation factors, and fibrinogen. Subsequent activation of anticoagulant proteins leads to low protein C/S. Most patients have bleeding complications and end organ damage to lungs or kidneys
How does myoglobin oxygen binding differ from hemoglobin
myoglobin reaches saturation at a much lower partial pressure of oxygen than hemoglobin (1 mm Hg vs 26) and it does not experience heme-heme interactions bc it only has a single heme group so does not have sigmoid shape curve
A patient on LMWH that develops thrombocytopenia and deep venous thrombosis 5-10 days after starting LMWH after a right hip arthroplasty is suspicious of what diagnosis
HIT type 2
heparin induced thrombocytopenia
what causes thrombocytopenia in HIT type 2
destruction of antibody coated platelets by splenic macrophages
what platelet receptor normally promotes platelet binding binding to fibrinogen
glycoprotein iib/iiia
The factor V leiden mutation, causes factor Va resistance to what? which causes atypical venous thrombosis
resistant to inactivation by activated protein C
Multiple myeloma is sometimes treated with lenalidomide, what is its MOA
increases the binding affinity of E3 ubiquitin ligase complex to specific transcription factors that are overexpressed in myeloma cells –> destruction by proteasome
How are the following affected in anemia secondary to menstrual blood loss: serum ferritin circulating transferrin MCV hypersegmented neutrophils serum folate
serum ferritin: low circulating transferrin: high MCV: low hypersegmented neutrophils: none serum folate: normal
What type of leukemia is a B cell neoplasm that infiltrates bone marrow causing fibrosis and bone marrow failure and infiltrates the splenic red pulp causing massive splenomegaly
hairy cell leukemia
lymphocytes have cytoplasmic projections
What is the best test to monitor the anticoagulation effect of warfarin? Heparin?
warfarin: PT (or INR)
heparin: PTT
In DIC due to gram-negative sepsis, the coagulation cascade is activated by ____ leading to widespread deposition and the consumption of coagulation factors and platelets with eventual bleeding
bacterial endotoxins
What is seen on peripheral blood smear of DIC
schistocytes
What effect does anemia of chronic disease have on total iron binding capacity
its either normal or low
PCR requires what 4 things
primers that are complementary to the regions of DNA flanking the segment of interest
thermostable DNA polymerase
deoxynucleotide triphosphates
source DNA template strand
What is the most common cause of cancer death in both women and men
lung cancer
How does intravenous glucose help treat acute intermittent porphyria which may present with abdominal pain, peripheral neuropathy, neuropsych symptoms, and reddish brown urine
downregulates ALA synthase activity
how does methemoglobinemia affect oxygen binding
methemoglobin is unable to carry oxygen
how is PO2 of arterial blood altered in CO poisoning, anemia, and polycythemia
it is unchanged in all of these conditions bc PO2 is a measure of dissolved O2 in blood and does not account for O2 bound to hemogobin
A patient with factor VII deficiency likely has normal or abnormal of the following: PT, PTT, bleeding time
PT: prolonged
PTT and bleeding time: normal
What effects does unfractionated heparin have on thrombin time
PTT
activity of factor Xa
thrombin time: prolonged
PTT: prolonged
Activity of factor Xa: decreased
What is the genetic cause of beta thalassemia
DNA mutations that effect the transcription, processing, and translation of beta globin mRNA most commonly causing aberrant precursor mRNA splicing or premature chain termination during translation –> beta globin deficiency
In a patient with beta thalassemia who has routine blood cell transfusions a liver biopsy shows Kupffer cells containing coarse, yellow-brown cytoplasmic granules which are most likely composed of what
hemosiderin (iron storage complex)
MOA hydroxyurea used in sickle cell patients
increases expression of gamma globin chains –> increased circulating fetal hemoglobin
What has the classic histopatholgy description of uniform, round, medium sized tumor cells with basophilic cytoplasm and a proliferation fraction of >99%
Burkitt lymphoma (basophilic= lymphocytes)
What chromosome translocation is seen in CML
t(9;22)
BCR-ABL –> constitutive tyrosine kinase activity
____ converts heme to _____, a pigment that causes the greenish color to develop in bruises several days after injury
heme oxygenase
biliverdin
Patients of advanced age have increased bone marrow ___ and reduced bone marrow ____, leading to impaired bone marrow reserve
fat
mass
What is the role of haptoglobin
binds circulating hemoglobin and reduces renal excretion of free hemoglobin, preventing tubular injury
How might cystic fibrosis cause coagulopathy
decreased fat soluble vitamin absorption –> low vit K –> decreased activation of II, VII, IX, X
6-mercaptopurine (6-MP) is an immunosuppression drug that is inactivated by what 2 enzymes?
reduced function of either of these enzymes causes increased levels of active metabolites of 6-MP, leading to increased risk for toxicity
xanthine oxidase
thiopurine methyltransferase
Pyruvate kinase deficiency causes splenomegaly how?
failure of glycolysis –> insufficient ATP to maintain erythrocyte structure –> spleen parenchyma removes deformed erythrocytes –> red pulp hyperplasia
What anticoagulant prolong both the PTT and PT but have no affect on the thrombin time
direct factor Xa inhibitors
what medications prolong the thrombin time
medications that directly or indirectly inhibit thrombin (unfractionated heparin and dabigatran)
Desmopressin can alleviate bleeding through vWF release from what cells?
endothelial
What inherited bleeding disorder causes prolonged bleeding time and prolonged PTT but does not affect the PT
von Willebrand disease
If a 2 wk old baby has 70% Hemoglobin F, 20% hemoglobin A, and 10% hemoglobin S do they have sickle cell or sickle cell trait
sickle cell trait
Paroxysmal nocturnal hemoglobinuria can cause what renal pathology
hemosiderosis
iron deposition in kidney from chronic hemolysis
what cause of hemolytic anemia will display an absence of CD55 on RBC
paroxysmal nocturnal hemoglobinuria
What causes autosplenectomy in sickle cell patients
repetitive splenic infarctions caused by microvessel occlusion –> small, firm splenic remnant
Anemia of chronic disease is caused by elevated inflammatory cytokine levels, mainly _______
hepcidin
How does hepcidin cause anemia of chronic disease
increases sequestration of iron within the reticuloendothelial system and reduce circulating iron levels
In anemia of chronic disease, how are circulating iron levels and bone marrow iron levels affected
circulating: low
bone marrow: high
What is the pathogenesis of primary myelofibrosis
atypical megakaryocytic hyperplasia which stimulates fibroblast proliferation, resulting in progressive replacement of the marrow space by extensive collagen deposition
Apart from chronic myelogenous leukemia, the chronic myeloproliferative disorders frequently harbor a mutation in what
nonreceptor cytoplasmic tyrosine kinase, JAK2
–> constitutive tyrosine phosphorylation activity –> STAT activation and enters nucleus –> transcription
What cause of hepatocellular carcinoma will show intranuclear fragments of foreign DNA within hepatic lesions
Hepatitis B (integrates into host genome and produces oncogenic viral protein: HBx)
_____ deficiency is associated with coiled hair, perifollicular keratosis, hemorrhage, easy bruising, bleeding gums and loose teeth. The PT, PTT, and platelet count are normal.
vitamin C
Primary myelofibrosis causes massive splenomegaly how?
extramedullary hematopoiesis –> expansion of red pulp
____ is characterized by aggregates of packed follicles that obscure the normal lymph node architecture
follicular lymphoma
90% of patients with follicular lymphoma have the ___ translocation, which causes the overexpression of the ___ protein
t(14;18)
BCL-2 (antiapoptotic)
Primary myelofibrosis is a myeloproliferative disorder associated with the clonal expansion of ____
megakaryoctes
Pure red cell aplasia is associated with what 3 pathologies
thymoma
lymphocytic leukemias
parvovirus B19
Howell-Jolly bodies on peripheral smear reflect what?
splenic dysfunction (seen in sickle cell)
Where does uric acid precipitate in the nephron as seen in tumor lysis syndrome
distal tubules and collecting duct
acidic environments –> precipitate; alkalization of urine prevents crystallization
Which of the following would decrease warfarin's therapeutic effects: amiodarone cimetidine phenytoin phenobarbital metronidazole rifampin carbamazepine
carbamazepine phenytoin phenobarbital rifampin (the others listed are CYP450 inhibitors which would increase warfarin effects)
Megaloblastic anemia in a patient who developed a heavy drinking problem in this past year is due to what
folate deficiency (B12 deficiency would take years to deplete)
What lysosomal storage disorder presents with bone pain, hepatosplenomegaly, and cytopenias and is due to a beta glucocerebrosidase deficiency
Gaucher
What causes rouleaux formation and what pathologies is it seen in
elevated levels of circulating proteins which disrupts the repulsive electrostatic charge on the erythrocyte surface and causes stacked aggregation
can been seen in inflammatory conditions that increase acute phase reactants (fibrinogen), it is classicaly linked with multiple myeloma and Waldenstrom macroglobunemia which generate high levels of monoclonal paraprotein (immunoglobulins)
How do proteasome inhibitors (bortezomib) treat cancer
they blog the degradation of ubiquitinated proteins by the proteasome, which leads to accumulation of abnormally folded proteins that trigger cellular apoptosis
Cancer cells avoid immune recognition by overexpressing _____ which binds its receptor on cytotoxic T cells and inhibits their response (T-cell exhaustion)
programmed death ligand 1 (PD-L1)
The most common cause of elevated platelet counts in all age groups is what?
reactive thromobocytosis (high levels of inflammatory cytokines prompt liver to release thrombopoietin. It is seen in chronic infection, rheumatologic disease, and burns)
What is seen on blood smear of leukemoid reaction
numerous mature neutrophils which may have reactive morphologic features such as Dohle bodies, toxic granulation, and cytoplasmic vacuoles
what lab value can help distinguish leukemoid reaction from CML
leukocyte alkaline phosphatase ( enzyme found in maturing neutrophils)
leukemoid reaction: normal or increased
CML: decreased (bc abnormal maturing neutrophils have decreased levels)
95% of patients with polycythemia vera have what gene mutation
V617F mutation involving the JAK2 gene –> hematopoietic cells more sensitive to growth factors
what are the clinical manifestations of polycythemia vera
increased RBC and plasma volume and low EPO levels
also can have elevated platelet and/or WBC count
thrombotic events from blood hyperviscocity
peptic ulceration and aquagenic pruritus from histamine release form neutrophils
gouty arthritis from increased cell turnover
what is seen on peripheral blood smear of lead poisoning
basophilic stippling
on a background of hypochromic microcytic anemia
EBV infection induces _______ which react to antigens from animal erythrocytes
heterophile antibodies
EBV is associated with what malignancies
Burkitt lymphoma
nasopharyngeal carcinoma
(and central nervous system lymphoma in HIV positive patients)
Why is nephrotic syndrome a hypercoaguble state
loss of anticoagulant factors, especially antithrombin III
LMWH binds _____ and predominately acts on _____
antithrombin III
factor Xa
etoposide MOA
inhibits sealing activity of topoisomerase II
what are topoisomerase I inhibitors
irinotecan
topotecan
An anterior mediastinal mass with elevated serum levels of alpha fetoprotein and beta hCG is classic for a ____ tumor
nonseminomatous germ cell tumor
After exposure to various anticancer agents, tumor cells can become resistant due to what cell function
human multidrug resistance (MDR1) gene codes for P-glycoprotein, a transmembrane ATP-dependent efflux pump protein that has a broad specificity for hydrophobic compounds that can both reduce influx of drugs into cytosol and increase efflux from the cytosol thereby preventing the action of chemotherapeutic agents
what are two characteristic markings of myelodysplastic syndrome
1 or more cytopenias
dysplasia of erythrocytes and neutrophils
What deficiency presents with dysphagia (from esophageal web formation), koilonychia (spoon-shaped nails), and a shiny red tongue
iron deficiency
enoxaparin MOA
a LMWH that functions like heparin in that it binds and activated antithrombin III
What causes DIC in abruptio placentae (placental bleeding between uterine wall and placenta)
decidual damage and ischemia –> tissue factor release into maternal circulation –> coagulation
How can ceftriaxone lead to a hemolytic anemia
penicillins and cephalosporins are common triggers for drug-induced hemolytic anemia because they can bind to the erythrocyte surface and act as haptens for IgG attachement –> clearance by splenic macrophages
Auer rods are deformed azurophilic granules found in the cytoplasm of myeloblasts that stain positively for ______
myeloperoxidase
Hemophilia is an X linked recessive bleeding disorder due to decreased levels of ____ (hemophilia A) or ____ (hemophilia B)
A: factor VIII
B: factor IX
A patient’s red blood cells are incubated in a hypotonic solution with glycerol and hemoglobin is released, the control sample does not release hemoglobin. What is the diagnosis
hereditary spherocytosis
what test of hemostatic function is generally abnormal in hemophilia
partial thromboplastin time (PTT)
What is the purpose of the Kozak consesnus sequence position before and AUG codon
identifies the specific AUG codon that serves as the initiator of translation, mutations affecting the Kozak consensus sequence can significantly impair protein translation
with increased bone marrow erythropoiesis, accelerated release of immature RBC into the blood stream cause them to contain bluish cytoplasm due to what
residual ribosomal RNA
diminished thymidine synthesis is likely due to wat cause of megaloblastic anemia
vitamin B12 deficiency
Parvovirus primarily attacks erythroid progenitor cells due to tropism for an erythrocyte cell surface receptor, infection of the erythroid progenitor cells prevents RBC maturation leading to formation of ______ which can be seen on blood smear
giant pronormoblasts (several times larger than surrounding RBCs with glassy, intranuclear viral inclusion
Auer rods = ____
AML
How does renal disease cause excessive bleeding
uremic toxins in circulation impair platelet aggregation and adhesion –> qualitative platelet disorder (numbers are normal)
30% of patients with SLE have _______ antibodies which can caue paradoxical aPTT prolongation and a false positive RPR/VRDL
antiphospholipid
Patients with antiphospholipid antibodies are at risk for ____ and ____
venous and arterial thromboembolism
unexplained, recurrent pregnancy loss
all trans retinoic acid induces remission in about 90% of patients with what cancer
acute promyelocytic leukemia (M3 variant of acute myelogenous leukemia)
