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*USMLE Step 1, Organ Systems > Hematology & Oncology > Flashcards

Hematology & Oncology Flashcards

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USMLE® Step 1 flashcards
1
Q

Acute leukemia

- Bone marrow smear

A

Neoplastic proliferation of blasts in the bone marrow, which exhibits hypercellularity with > 20% blasts (leukemic cells)

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2
Q

Acute leukemia

- Hematopoiesis

A

Blasts (leukemic cells) “crowd out” normal hematopoiesis, thereby suppressing the proliferation of other hematopoietic precursors

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3
Q

Acute leukemia

- Peripheral blood smear: WBC

A
  • Blasts (leukemic cells) enter the bloodstream and metastasize throughout the body
  • Leukocytosis 2/2 large, immature cells with punched out nucleoli (blasts)
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4
Q

Acute leukemia

- Peripheral blood smear: RBC

A

Normocytic to macrocytic anemia

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5
Q

Acute leukemia

- Macrocytic anemia

A

Macrocytic anemia in the setting of folate deficiency 2/2 increased production of leukemic cells

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6
Q

Acute leukemia

- Peripheral blood smear: Platelets

A

Thrombocytopenia

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7
Q

Acute leukemia

- Peripheral blood smear: Platelets

A

Thrombocytopenia

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8
Q

Acute lymphoblastic anemia (ALL)

- Lymphoblast surface marker(s)

A
  • Neoplastic proliferation of lymphoblasts (> 20%) in the bone marrow

TdT+ (Terminal deoxynucleotidyl transferase)

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9
Q

TdT

A

TdT - Enzyme responsible for adding nucleotides to the V, D, J regions of the antibody gene to generate antibody diversity

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10
Q

B-ALL

- Surface marker(s)

A

TdT+, CD10+ (CALLA), CD19+, CD20+

CALLA - Common acute lymphoblastic leukemia antigen

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11
Q

T-ALL

- Surface marker(s)

A

TdT+, CD1a+, CD2+, CD3+, CD4+, CD5+, CD7+, CD8+

CD3 - TCR complex

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12
Q

Cytogenetic abnormality a/w B-ALL in children

A

t(12;21)

Good prognosis

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13
Q

Cytogenetic abnormality a/w B-ALL in adults

A

t(9;22) = Ph+ ALL

Poor prognosis

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14
Q

Cytogenetic abnormality a/w B-ALL in infants

A

t(11;23)

Poor prognosis

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15
Q

B-ALL + T-ALL

- Clinical features of leukemic spread

A
  • Generalized lymphadenopathy
  • Hepatosplenomegaly
  • BONE PAIN/TENDERNESS 2/2 bone marrow expansion by leukemic cells (blasts)
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16
Q

Site(s) of leukemic spread in B-ALL

A
  • CNS, TESTES
  • Treatment requires PROPHYLACTIC CHEMOTHERAPY (direct injection) to the SCROTUM and the CSF because chemotherapeutic agents do not cross the blood-testis and blood-brain barriers
17
Q

Site(s) of leukemic spread in T-ALL

A

Skin

18
Q

T-ALL

- Classic clinical presentation

A

Mediastinal/thymic mass in a young (teenage) boy

T-ALL = Acute lymphoblastic LYMPHOMA

19
Q

T-ALL presents as a mediastinal/thymic mass that can compress surrounding structures (3), leading to specific clinical findings

A
  1. Great vessels - Superior vena cava syndrome
  2. Esophagus - Dysphagia
  3. Trachea - Dyspnea, stridor
20
Q

Acute myelogenous anemia (AML)

- Myelobast marker(s)

A
  • Neoplastic proliferation of myeloblasts (> 20%) in the bone marrow
  • Myeloperoxidase (MPO)
  • Crystal aggregates of MPO may be seen as AUER RODS (fuzed azurophilic granules)
21
Q

Cytogenetic abnormality a/w APL (M3 AML)

A

t(15;17)

Translocation of the retinoic acid receptor (RARα) on chromosome 17 to the PML gene on chromosome 15

22
Q

APL treatment

A

All-trans-retinoic acid (ATRA)

Normally, RARα plays a role in the proper differentiation of myeloid precursors. RARα interacts with RA to effect transcription of genes required for maturation.

t(15;17) produces an abnormal RAR that is unable to signal for differentiation of myeloid precursors. Disruption of RAR blocks maturation, and promyelocytes (blasts) accumulate.

Treatment with ATRA binds the abnormal RAR and stimulates the differentiation of myeloblasts into mature granulocytes, which eventually die; induces remission in about 90% of patients with APL.

23
Q

APL treatment complication

A

DIC 2/2 Auer rods - Cytolysis of blasts releases Auer rods

24
Q

Cytogenetic abnormality a/w acute myelomonocytic leukemia + bone marrow eosinophilia (M4eo)

A

EOSINOPHILIC AML

inv(16)

25
Q

AML subtype(s) a/w gingival infiltration

A
  • Acute monoblastic leukemia

- Acute myelocytic leukemia

26
Q

AML subtype(s) a/w nonspecific esterase positivity

A
  • Acute monoblastic leukemia

- Acute myelocytic leukemia

27
Q

AML subtype(s) a/w PAS positivity

A
  • Acute erythroid leukemia

- PAS+ erythroblasts

28
Q

AML subtype(s) a/w platelet peroxidase positivity

A
  • Acute megakaryocytic leukemia
29
Q 
AML subtype(s) a/w bone marrow fibrosis 
- Mechanism
A
  • Acute megakaryocytic leukemia

- Megakaryoblasts produce excess PDGF, causing BM FIBROSIS

30
Q

Cytogenetic abnormality a/w acute megakaryocytic leukemia in infants/children

A
  • t(1;22)

- Poor prognosis

31
Q

Leukemia a/w Down syndrome in patient

A

Acute megakaryocytic leukemia (M7 AML)

32
Q

Leukemia a/w Down syndrome in patient > 5 y/o

A

ALL

*USMLE Step 1, Organ Systems (3 decks)

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