Hematology/Oncology

Question 1

what do azurophilic granules contain (lysosomes)

Answer 1

• proteinases, acid phosphatase, myeloperoxidase and beta-glucoronidase

Question 2

what are important chemotactic agents?

Answer 2

C5a, IL8, LTB4, kallikrein, plately-activating factor

Question 3

what stimulates macrophages?

Answer 3

y-interferon, can work as antigen presenting cells through MHC 2

Question 4

what are the causes of esosinophilia?

Answer 4

PACCMAN
Parasites
Asthma
Churg Strauss
Chronic adrenal insufficiency
Myeloproliferative disorders
Allergic
Neoplasia (hodgkins lymphoma)

Question 5

what type of hypersensitivity reaction do mast cells do?

Answer 5

type 1

Question 6

what are dendritic cells?

Answer 6

highly phagocytic APCs, function as link between innate and adaptive immune system. Have MHC 2 and Fc receptors (Langerhan cells in the skin)

Question 7

what are lymphocytes?

Answer 7

B, T and NK cells (B and T are adaptive), NK is innate

Question 8

which is humoral and which is cellular?

Answer 8

B=humoral (when antigen comes they differentiate into plasma cells that produce antibodies)
T=cellular (diff into cytotoxic T cells and T helper cells

Question 9

what are echinocytes?

Answer 9

burr cells- see them in liver disease, ESRD, pyruvate kinase deficiency

Question 10

what are sideroblasts?

Answer 10

see them in marrow with special prussian blue stain, extra iron

Question 11

what are target cells?

Answer 11

hbC, asplenia, liver disease, thalassemia

Question 12

what cells are seen in G6PD?

Answer 12

bite cells

Question 13

what causes basophilic stippling?

Answer 13

lead poisoning, myelodysplastic syndromes, thalassemias

Question 14

when can you see heinz bodies?

Answer 14

G6PD deficiency

Question 15

what is sideroblastic anemia?

Answer 15

the body has iron, but can’t incorporate into RBCs. Can be genetic or myelodysplastic (AML)

Question 16

what is fanconi anemia?

Answer 16

genetic disease with repaired response to DNA damage. Get bone marrow failure, short stature, abnormal thumbs, absent radii, skin hyperpigmentation (cafe au lait spots), abnormal facies, abnormal kidneys and decreased fertility

Question 17

what is Diamond Blackfan anemia?

Answer 17

only anemia (dec erythroid progenitor cells), not pancytopenia, including craniofacial malformations, thumb or upper limb abnormalities, cardiac defects, urogenital malformations, and cleft palate.

Question 18

What is Plummer Vinson syndrome?

Answer 18

triad of iron deficiency anemia, dysphagia and esophageal webs

Question 19

what is the inheritance of G6PD?

Answer 19

X linked recessive

Question 20

What is acute intermittent porphyria?

Answer 20

AD - porphobilinogen deminase- get abdo pain, blood in urine, polyneuropathy, psychological disturbance, precipitated by drugs

Question 21

what is porphyria cutanea tarda?

Answer 21

most common- enx-uroporphyrinogen decaroxylase (AD), get blistering photosensitivity and hyperpigmentation, worse with alcohol

Question 22

What is TTP and how does it present?

Answer 22

TTP- def in ADAMTS13 (vWF metalloprotease) so you get vWF multimers- presents with fever, thrombocytopenia, MAHA, neuro symptoms, renal failure- need plasmapheresis and steroids

Question 23

What are the two mixed platelet and coagulation disorders (think about things that affect bleeding time and coags)?

Answer 23

1. von Willebrand disease (AD, inc BT and PTT_ give desmopressin which releases vWF from endothelium
2. DIC

Question 24

What are the hereditary thrombosis syndromes leading to hypercoagulability?

Answer 24

1. Antithrombin deficiency (dec inhibition of 2a and 10a), but shouldn’t change PT, PTT or thrombin time)
2. Factor 5 Leiden (protein C can’t inactivate- preg loss, DVT, cerebral vein thromb)
3. Protein C & S deficiency (can’t inactivate 5 and 8- skin necrosis with hemorrhage after warfarin)
4. Prothrombin gene mutation (factor 2)

Question 25

which type of lymphoma is associated with Reed Sternberg cells?

Answer 25

Hodgkins (owl-eye, identical mirror image bilobed or binucleate) CD15, CD30

Question 26

what is a marker for pre-B and pre-T cells? What is a marker for just pre-B cells?

Answer 26

1. TdT+

2. CD10+

Question 27

which cancer is associated with philadelphia chr?

Answer 27

CML (t, 9, 22)

Question 28

what is langerhan cell histiocytosis?

Answer 28

get immature cells that don’t activate T cells properly, lytic bony lesions, skin rash, AOM, birbeck granules

Question 29

How does heparin work?

Answer 29

activates antithrombin so factor 2a and 10a inhibited, short half life
-reverse with protamine sulphate

Question 30

which anticoag crosses placenta?

Answer 30

warfarin

heparin does not (used in preg)

Question 31

how do clopidogrel and ticagrelor work?

Answer 31

ADP receptor inhibitor, irreversibly block ADP- block gpIIb/IIIa on platelet surface so you can’t get plt aggregation

Question 32

How does hydroxyurea work for cancer?

Answer 32

inhibits ribonucleotide reductase- you get decreased DNA synthesis (S phase) and myelosuppression

Question 33

How does Bevacizumab work?

Answer 33

inhibits VEGF-angiogenesis, blood vessel formation

Question 34

What is Imatinib used for?

Answer 34

BCR-ABL (philadelphia chr in CML) and c kit in GI stromal tumours

Question 35

How does Rituximab work?

Answer 35

monoclonal antibody against CD20 on B cells- for B cell neoplasms

Question 36

How does tamoxifen/raloxifene work?

Answer 36

selective estrogen receptor modulator (SERM), blocks estrogen receptors on ER + cells- for breast and bone

• tamoxifen (only partial in endometrium so can actually increase risk)
• raloxifene full antagonist in endometrium
• cause DVT and PE

Question 37

How does rasburicase work?

Answer 37

converts uric acid to allantoin

Question 38

What are the common toxicities?

1. cisplatin/carboplatin
2. vincristine
3. bleomycin/bisulfan
4. doxorubicin
5. trastuzumab
6. cyclophosphamide

Answer 38

1. cisplatin/carboplatin-ototoxicity, nephrotoxicity
2. vincristine- peripheral neuropathy
3. bleomycin/bisulfan-pulmonary fibrosis
4. doxorubicin-cardiotoxicity
5. trastuzumab-cardiotoxicity
6. cyclophosphamide-hemorrhagic cystisis