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USMLE Step 1 Quick Notes > Hematology/Oncology > Flashcards

Hematology/Oncology Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the MCV for thalassemia?

A

Low (microcytosis)

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2
Q

What is the cause of chronic anemia in elderly without any known precipitating cause?

A

B12 deficiency –> give parenterally

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3
Q

What does tumor lysis syndrome cause?

A

Occurs during chemo for high grade lymphomas, leukemias etc. Large numer of destroyed tumor cells cause leakage of ions leading to hypocalcemia, hyperphosphatemia, hyperuremia (can cause gout), hyperkalemia (can cause arrhythmia)

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4
Q

What is the inheritance pattern of G6PD deficiency?

A

XR

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5
Q

What is deep bleeding associated with?

A

Factor deficiencies

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6
Q

What is mucosal bleeding associated with?

A

Platelet defect (like vWD disease)

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7
Q

How do you distinguish vWD from ITP on just a clinical presentation?

A

vWD will have more chronic bleeding vs ITP is more insidious onset

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8
Q

What is cilostazole?

A

Phosphodiesterase inhibitor that inhibits platelet aggregation and causes vasodilation

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9
Q

What causes the green color in bruises?

A

Heme oxygenase which converts heme to green biliverdin

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10
Q

How does HbF bind oxygen better?

A

It has decreased affinity for 2,3 BPG (left shift)

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11
Q

Why do you see skin necrosis with warfarin?

A

Can exacerbate already existing protein C deficiency which prevents clotting

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12
Q

What is mycosis fungoides?

A

Proliferation of CD4 cells; red patches/plaques; cereberiform nuclei, powdery chromatin
When in the blood it is sezary

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13
Q

What causes megaloblastic anemia and increased orotic acid (crystals in urine)?

A

Orotic Aciduria from deficiency in UMP synthase

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14
Q

If you have orotic aciduria what can’t you make?

A

Pyrimidines

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15
Q

Diagnosis: koilonychias (spoon nails), dysphagia?

A

Iron deficiency anemia

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16
Q

What is heme generated in the liver used for?

A

CYP450

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17
Q

What causes circumoral pallor?

A

Fifth’s disease

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18
Q

What has EML4-ALK gene fusion that causes constitutive TK activity?

A

Non small cell lung cancer

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19
Q

Why do people with whole blood transfusion develop hypocalcemia?

A

Contains citrate which causes hypocalcemia

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20
Q

What does normal urinary excretion of radiolabeled B12 mean?

A

B12 defciency

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21
Q

What does impaired urinary excretion of radiolabeled B12 mean?

A

Malabsorption or pernicious anemia. 2nd dose of radiolabeled b12 but w/ IF: normal urinary excretion than diagnosis is pernicious anemia, if not then it is malabsorption

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22
Q

What are the cells that are seen with EBV blood smear?

A

Atypical CTL (even though it infects B cells)

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23
Q

What is the bluishness in cells on peripheral blood smear with giemsa stain?

A

rRNA

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24
Q

What can the mediastinal mass in T-ALL cause?

A

SVC syndrome, dysphagia, respiratory sx

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25
Q

What is a side effect of Ticlodipine?

A

Neutropenia (pw/ mouth ulcers and fever)

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26
Q

Where are Weibel palade bodies made?

A

Endothelial cells

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27
Q

How does Desmopressin effect endothelial cells?

A

Activates endothelial cells to make more vWF and factor VIII

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28
Q

What do you use for heparin toxicity?

A

Protamine sulfate

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29
Q

What do you use for tpa toxicity?

A

Aminocaproic acid and tranexamic acid

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30
Q

What values of SaO2 and PO2 do you need to have for hypoxic erythrocytosis?

A

SaO2

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31
Q

What is relative erythrocytosis?

A

No increase in RBC mass itself and is due to dehydration and diuresis that makes it seem like erythrocytosis

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32
Q

What do you think if you see iron deficiency anemia in post menopausal woman or if male?

A

Think occult blood (or chronic blood loss)

33
Q

What is pure red cell aplasia associated with?

A

Pure red cell aplasia is hypoplasia of BM erythroid precursors. Associated with thymoma, lymphocytic leukemia, parvovirus

34
Q

With what do you see painless waxing and waning lymphadenopathy?

A

Follicular lymphoma

35
Q

What are sickle cell patients predisposed to?

A

Folic acid deficiency and macrocytic change due to high erythrocyte turnover

36
Q

What do you have increased sensitivity to in polycythemia vera?

A

Mutation PV causes hematopoeitic cells to be more sensitive to growth factors like GM-CSF and erythropoetin

37
Q

What type of receptor is JAK2 mutation associated with?

A

Cytoplasmic tyrosine kinase

38
Q

What produces arylsulfatase?

A

Eosinophil

39
Q

What does cromolyn sodium do?

A

Prevents mast cell degranulation

40
Q

What type of mutation do you have in beta thalassemia?

A

Point mutations in splices sites and promoter sequences

41
Q

What is fanconi syndrome?

A

Decreased reabsorption of amino acids, uric acid, glucose, phosphate, bicarb. All passed into urine

42
Q

What do you use to screen for hereditary spherocytosis?

A

Eosin maleimide binding test

43
Q

What do you see burr cells with?

A

Pyruvate kinase deficiency

44
Q

What do you see rigid RBCs with?

A

Pyruvate Kinase deficiency

45
Q

What is eculizumab?

A

Used for PNH

46
Q

What do you use to treat acute intermittent porophyria

A

Heme and glucose (downregulate ALAS)

47
Q

What triggers acute intermittent porphyria?

A

Sulfonamides, barbiturates, progesterone, alcohol, starvation

48
Q

What is the inheritance pattern of vWD?

A

AD

49
Q

What causes rapid fibrosis of BM in primary myelofibrosis?

A

Increased PDGF

50
Q

Which of the lymphoma/leukemia had DIC?

A

AML - APL

51
Q

Which one had hypecalcemia?

A

Multiple myeloma, ATLL

52
Q

What is waldenstorm?

A

Like multiple myeloma but have IgM spike, no lytic bone lesions, and hyperviscosity

53
Q

Which one is CD5+

A

Mantle cell lymphoma

54
Q

Who do you give cryoprecipitate to?

A

Those with coagulation deficiencies involving fibrinogen and factor VIII

55
Q

What is pseduo-pelger-huet anomaly?

A

Neutrophils bilobed nuclei (two nuclear masses with a thin filament of chromatin) typically seen after chemo

56
Q

What cancers cause polycythemia via ectopic EPO production?

A

Hepatocellular carcinoma and renal cell carcinoma

57
Q

What are the side effects of heparin?

A

Osteoporosis, HIT, bleeding

58
Q

Which of the ADP receptor inhibitors is reversible?

A

Ticagrelor

59
Q

What is a major side effect of ADP receptor inhibitors?

A

TTP/HUS

60
Q

What does PNH increase risk for?

A

Acute leukemias

61
Q

What do you see on liver histology due to MTX?

A

Macrovesicular fatty change

62
Q

What activates 6-MP/Azathioprine?

A

HGPRT

63
Q

What drug do you use for childhood tumors?

A

Dactinomycin

64
Q

How does bleomycin work?

A

Causes free radical formation inducing breaks in DNA

65
Q

Which drug was used for brain tumors?

A

Nitrosureas (carmustine, lomustine etc) because they cross BBB

66
Q

How does Ironotecan/Topotecan work?

A

Inhibits toposisomerase I so it inhibits DNA unwinding

67
Q

What is etoposide used for?

A

Testicular and small cell lung cancer

68
Q

What is topotecan used for?

A

Ovarian and small cell lung cancers

69
Q

How does hydroxyurea work?

A

Inhibits ribonucleotide reductase

70
Q

What is a side effect of Trastuzmuab?

A

Cardiotoxicity

71
Q

Which drugs increase risk for PML

A

Natalizumab and Ritxumab

72
Q

What does the spleen look like in sickle cell patients?

A

Fibrosis and atrophy because of repeated infarctions

73
Q

Why is there macrocytosis in sickle cell patients?

A

High turnover of RBC causes folate deficiency

74
Q

Why is heparin a safer choice than warfarin in pregnant women?

A

Heparin is a large charged water soluble molecule that does not cross the placenta. Wafarin is lipophilic and does (it also binds albumin)

75
Q

What are the lab findings in DIC?

A

Low fibrinogen, prolongated PT & PTT, thrombocytopenia, increased D-dimer

76
Q

What medication is an analog of the carboxyl terminal of the delta chain of fibrinogen?

A

Apiciximab, eptafibatide (GpII/IIIa inhibitor)

The carboxyl terminal is the part that binds the GpII/III receptor

77
Q

What is the MCC of heritable hypercoagulability?

A

Factor V leiden

78
Q

What do you think when LUQ pain in sickle cell patient?

A

Splenic pathology!

USMLE Step 1 Quick Notes (17 decks)

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