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RR Prep > Hematology/oncology > Flashcards

Hematology/oncology Flashcards

1
Q

Hemophelia A is a deficiency in which clotting factor?

A

Factor VIII

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2
Q

A patient who presents with hemarthroses, increased partial thromboplastin time (PTT) and factor VIII deficiency should make you think of what diagnosis?

A

hemophelia A

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3
Q

What test measure the overall speed at which blood clots by means of two consecutive series of biochemical reactions knowns as the intrinsic pathway and common pathway of coagulation?

A

partial thromboplastin time

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4
Q

If you want to measure coagulation factors I, II, V, VIII, X , XI, and/or XII, which test will you want to perform, PTT or PT?

A

PTT

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5
Q

Factor I is also known as:

A

Fibrinogen

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6
Q

Factor II is also known as:

A

prothrombin

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7
Q

Factor V is also known as:

A

proaccerlerin

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8
Q

Factor VIII is also known as:

A

anti-hemophilic factor

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9
Q

Factor X is also known as:

A

Stuart-Power factor

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10
Q

Factor XI is also known as:

A

plasma thromboplastin atencedent

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11
Q

Factor XII is also known as:

A

Hageman factor

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12
Q

What test measures the speed of clotting by means of the extrinsic pathway?

A

Prothrombin time (PT)

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13
Q

Hemophilia A and hemophilia B are X-linked dominant or x-linked recessive?

A

x-linked recessive

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14
Q

Hemophilia B is also known as:

A

Christmas Diseasee

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15
Q

x-linked recessive factor IX deficiency should make you think of what diagnosis?

A

Hemophilia B

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16
Q

a patient presents with a minor laceration but excessively large amounts of bleeding for the size of the laceration. This should make you think of what clotting disorder?

A

hemophilia B

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17
Q

a patient presents complaining of randomly bleeding from her gums and nose. This should make you think of what clotting disorder?

A

Hemophilia B

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18
Q

a prolonged activated partial thromboplastin time (aPTT) and a NORMAL PT should make you think of what clotting disorder?

A

hemophilia B

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19
Q

What is first line treatement for Hemophilia B/Christmas Dz?

A

recombinant factor IX

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20
Q

what is the first line treatment for hemophilia A?

A

recombinant factor VIII

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21
Q

A patient with a decreased synthesis of factor VIII should make you think of what diagnosis?

A

Hemophilia A

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22
Q

A patient with a decreased synthesis of factor IX should make you think of what diagnosis?

A

Hemophilia B/Christmas Dz

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23
Q

What is the most common inherited bleeding disorder?

A

Von Willebrand Disease (Factor XI)

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24
Q

Von Willebrand contributes to fibrin clot formation by carrying what other clotting factor?

A

factor VIII

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25
Q

A patient presents with complaints of bruising like a peach, bleeding randomly from their skin, and prolonged bleeding from their mouth and anus. They state that their dad had the same problems. What is the most likely diagnosis?

A

Von Willebrand Dz

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26
Q

decreased factor VIII and prolonged bleeding time but a normal PT/INR should make you think of what diagnosis?

A

Von Willebrand Dz (VWF)

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27
Q

What is first line treament for Von Willebrand Dz?

A

desmopressin (DDAVP)

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28
Q

Is Von Willebrand Dz autosomal recessive or autosomal dominant?

A

autosomal dominant

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29
Q

Primary Immune Thrombocytopenia (aka Idiopathic Thrombocytopenia purpura) is most commonly caused by:

A

antiplatelet antibodies

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30
Q

A 5 year old who presents with petechiae, purpura, epistaxis, and gingival bleeding 2 weeks after testing positive for influenza should make you think of what diagnosis?

A

Primary Immune Thrombocytopenia (aka Idiopathic Thrombocytopenia Purpura; ITP)

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31
Q

What do you expect a patient with primary immune thrombocytopenia’s platelet count to be?

A

< 50,000

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32
Q

Primary immune thrombocytopenia usually presents acutely in children ages 2-6 and chronically in what other age group?

A

Adults 20-50 y.o.

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33
Q

What is first line treatment for children with primary immune thrombocytopenia?

A

supportive

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34
Q

ADAMTS13 should make you think of what diagnosis?

A

Thrombotic thrombocytopenic purpura (TTP)

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35
Q

A female patient presents to the clinic with her friend. Her friend states that the patient is very confused, is complaining of her head pounding, and has vomited 5 times on the drive over to the clinic. This triad of symptoms is a common presentation for which hematologic condition?

A

thrombotic thrombocytopenic purpura (TTP)

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36
Q

Name the classic pentab for thrombotic thrombocytopenic purpura (TTP)

A

fever, thrombocytopenia, anemia, neurologic findings, renal failure

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37
Q

Labs on a patient complaining of HA, fever, vomiting, and confusion show elevated LDH, elevated indirect bilirubin and thrombocytopenia. What is the most likely hematologic condition?

A

thrombotic thrombocytopenic purpura (TTP)

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38
Q

thrombocytopenia

A

low platelet level

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39
Q

rash of purple spots d/t small blood vessels leaking blood into the skin, joints, intestines, or organs

A

purpura

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40
Q

True/False: if you are suspicious of TTP, start treatment before you have definitive Dx.

A

True

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41
Q

What is first line treatment for thrombotic thromobcytopenic purpura (TTP)?

A

plasmapheresis

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42
Q

process in which the plasma is separated from the blood cells and then either replaced with another solution such as saline or albumin, or the plasma is treated and then returned to the body.

A

plasmapheresis

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43
Q

After injecting a bolus of heparin, the patient’s skin at the injection site begins to necros. What is the most likely diagnosis?

A

heparin-induced thrombocytopenia (HIT)

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44
Q

A patient presents to the ED with a DVT. He has a history of recently starting heparin. You suspect he has heparin-induced thrombocytopenia (HIT). You would expect what percent decrease in his platelets?

A

50%

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45
Q

What is first line treatment for HIT?

A

stop the heparin, use direct thrombin inhibitor

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46
Q

Name two direct thrombin inhibitors

A

dabigatran (Pradaxa)
apixaban (Eliquis)
rivaroxiaban (Xarelto)

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47
Q

Hemorrhage from multiple sites (severe trauma) and increased PT, PTT, and fibrin split products as well as a DECREASE in fibrinogen should make you think of what diagnosis?

A

Disseminated intravascular coagulation (DIC)

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48
Q

What hematologic condition is summarized by severe trauma that causes massive bleeding –> body responds by large scale activation of the clotting cascade –> widespread thrombi –> consumption of all the platelets, so cannot clot anymore –> diffuse bleeding?

A

disseminated intravascular coagulation (DIC)

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49
Q

What is first line treatment for DIC?

A

reversal of the underlying cause

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50
Q

If platelet count falls below 20,000 in DIC, what is best treatement option?

A

platelet transfusion or fresh frozen plasma (FFP)

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51
Q

a clotting factor deficiency

A

hemophilia

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52
Q

Which factor helps platelets stick together and bind to factor VIII?

A

von Willebrand’s factor

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53
Q

immature platelets recently released from the bone marrow

A

megathrombocytes

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54
Q

Normal platelet count

A

between 150,000 and 450,000

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55
Q

A very rare disorder that causes microscopic clots throughout the small blood vessels of the body

A

Thrombotic thrombocytopenic purpura (TTP)

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56
Q

What two signs are common to find on the skin and the mucous membranes in any platelet dysfunction?

A

Petechiae & purpura

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57
Q

Name 3 potential causes of disseminated intravascular coagulation (DIC)

A 
pre-eclampsia
placental abruption
massive tissue injury
sepsis
shock
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58
Q

a disease characterized by the overproduction of white blood cells

A

leukemia

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59
Q

The overproduction of lymphocytes characterizes what type of leukemia?

A

lymphocytic leukemia

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60
Q

The overproduction of red blood cells as well as some white cells and platelets characterizes what type of leukemia?

A

myelogenous leukemia

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61
Q

which form of lympohcytic leukemia is typically found in children between 2-5y.?

A

Acute lymphocytic leukemia (ALL)

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62
Q

also known as B cell leukemia

A

Chronic lymphocytic leukemia (CLL)

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63
Q

the MC type of leukemia

A

chronic lymphocytic leukemia (CLL)

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64
Q

the most common cancer in children?

A

acute lymphocytic leukemia (ALL)

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65
Q

hepatosplenomegaly & lymphoblasts on peripheral smear in a 2-5 year old child should make you think of what diagnosis?

A

acute lymphocytic leukemia (ALL)

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66
Q

Most common leukemia in adults in Western countries

A

Chronic lymphocytic leukemia (CLL)

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67
Q

isolated lyphocytosis & smudge cells should make you think of what diagnosis?

A

Chronic lymphocytic leukemia (CLL)

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68
Q

What is the leading cause of death in chronic lymphocytic leukemia?

A

infection

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69
Q

Auer rods should make you think of what diagnosis?

A

Acute Myeloid Leukemia (AML)

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70
Q

Philadelphia chromosome should make you think of what diagnosis?

A

Chronic Myelogenous Leukemia (CML)

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71
Q

bcr-abl gene should make you think of what diagnosis?

A

Chronic Myelogenous Leukemia (CML)

72
Q

In chronic myelogenous leukemia (CML), what is the only currative treatment?

A

Allogenic hematopoietic stem cell transplant (HSCT)

73
Q

What is the name of the oral tyrosine kinase inhibitor used in the treatment of chronic myelogenous leukemia (CML)

A

imatinib

74
Q

Which of the lymphomas is associated with EBV and has a “starry sky” pattern seen on pathology?

A

Burkitt lymphoma

75
Q

A rapidly growing tumor/mass over the jaw should make you think of what type of lymphoma?

A

Burkitt lymphoma

76
Q

a patient presents with a painless supraclavicular lymph node and on biopsy you note Ree-Sternberg cells. What is the most likely diagnosis?

A

Hodgkin lymphoma

77
Q

“owl’s eyes” or Reed-Sternbergy cells should make you think of what diagnosis?

A

Hodgkin lymphoma

78
Q

The most common cause of non-solid organ cancer-related death

A

Non-Hodgkin lymphoma

79
Q

GI symptoms and persistent, painless peripheral lymphadenopathy should make you think of what diagnosis?

A

Non-hodgkin lymphoma

80
Q

A CBC w/ WBC’s as high as 150,000 with elevated granulocytes should make you think of what diagnosis?

A

chronic myelogenous leukemia (CML)

81
Q

What age range is non-hodgkin lymphoma more prevelant?

A

between 20-40y

82
Q

Pancytopenia with circulating blasts should make you think of what diagnosis?

A

Acute myelogenous leukemia (AML)

83
Q

punches out lesions on XR of the skull should make you think of what diagnosis?

A

multiple myeloma

84
Q

Rouleaux formation of RBCs should make you think of what diagnosis?

A

multiple myeloma

85
Q

An elderly patient presents with back and rib pain. What cancer diagnosis should be on your differential?

A

multiple myeloma

86
Q

hyperCalcemia, Renal insufficiency, Anemia, lytic Bone lessions/Back pain or CRABB should make you think of what diagnosis?

A

multiple myeloma

87
Q

Bence-Jones proteins on urine protein electrophoresis should make you think of what diagnosis?

A

multiple myeloma

88
Q

Lytic lesions on XR should make you think of what diagnosis?

A

multiple myeloma

89
Q

low counts for all three types of blood cells: RBCs, WBCs, and platelets

A

pancytopenia

90
Q

Myeloid progenitor cells become what other cells?

A 
platelets
erythrocytes
monocytes
neutrophils
basophils
eosinophils
91
Q

Lymphoid progenitor cells become what other cells?

A

T-cells

B-cells

92
Q

low mean corpuscular volume (MCV < 80)

A

microcytic anemia

93
Q

normal mean corpuscular volume (MCV 80-100)

A

normocytic anemia

94
Q

increased mean corpuscular volume (MCV > 100)

A

macrocytic anemia

95
Q

Name three potential causes for microcytic anemia

A
  1. iron deficiency anemia
  2. thalassemic disorders
  3. anemia of chronic dz/anemia of inflammation
  4. sideroblastic anemia (lead, alcohol, drugs)
  5. Copper deficiency
  6. hemolysis
96
Q

Name three potential causes of normocytic anemia.

A
  1. acute blood loss
  2. anemia of chronic dz
  3. bone marrow suppression
  4. chronic renal insufficiency
  5. hypothyroidism
  6. hypopituitarism
  7. hemolysis
97
Q

Name three potential causes of macrocytic anemia.

A
  1. excessive ethanol use
  2. folate deficiency
  3. Vitamin B12 deficiency
  4. AML
  5. reticulocytosis
  6. liver dz
  7. hypotheyroidism
  8. drug induced anemia (hydroxyurea, AZT, chemo)
98
Q

Howell-Jolly bodies should make you think of what diagnosis?

A

Macrocytic anemias (B12 def., folate def., sickle cell, celiac dz)

99
Q

What are the two most common causes of megaloblastic anemia?

A

folic acid def., or Vit. B12 def.

100
Q

Which megaloblastic anemia may present with neurologic symptoms?

A

Vitamin B12 def. anemia

101
Q

Name the only disorder that will cause an increase in mean corpuscular hemoglobin concentration (MCHC).

A

Hereditary spherocytosis

102
Q

a peripheral smear that shows spherocytes and Howell-Jolly bodies should make you think of what diagnosis?

A

Hereditary spherocytosis

103
Q

What is first line treatment for Hereditary spherocytosis?

A

daily folic acid

104
Q

sickled cells on peripheral smear & Hgb S on hemoglobin electrophoresis should make you think of what diagnosis?

A

sickle cell anemia

105
Q

microcytic anemia w/ normal or ↑ serum Fe or no response to Fe Tx should make you think of what diagnosis?

A

thalassemia

106
Q

EPISODIC hemolytic anemia associated with sulfa drugs, fava beans, infections should make you think of what diagnosis?

A

G6PD deficiency

107
Q

microspherocytes and Coombs NEGATIVE should make you think of what diagnosis?

A

hereditary spherocytosis

108
Q

microspherocytes and Coombs POSITIVE should make you think of waht diagnosis?

A

autoimmune hemolytic anemia

109
Q

dark urine that is worse in the morning should make you think of what diagnosis?

A

Paroxysmal nocturnal hemoglobinuria

110
Q

hemoglobin electrophoresis with normal Hgb ratios should make you think of what diagnosis?

A

Alpha Thalassemia

111
Q

hemoglobin electrophoresis with ↓ HgbA, ↑HgbF should make you think of what diagnosis?

A

Beta Thalassemia

112
Q

Normal coags + thrombocytopenia, hemolytic anemia, kidney damage, neurologic symptoms, and fever should make you think of what diagnosis?

A

TTP

113
Q

normal coags + thrombocytopenia, hemolytic anemia, and kidney damage should make you think of what diagnosis?

A

hemolytic uremic syndrome (HUS)

114
Q

These occur if the bone marrow responds to the increased RBC destruction by trying to match it with increased RBC production

A

reticulocytes (immature RBCs)

115
Q

immature RBCs

A

reticulocytes

116
Q

This enzyme is found in abundance in RBCs. If you have an ↑ in RBC destruction, you will have an ↑ in this enzyme

A

LDH

117
Q

if ↑ in RBC destruction overwhelms the liver’s UGT enzyme conjugating ability, you will see an increase in indirect or direct bilirubin?

A

indirect (unconjugated)

118
Q

an ↑ in indirect or direct bilirubin can lead to dark urine production?

A

direct (conjugated)

119
Q

fragmented RBCs seen on peripheral smear, resulting from ↑ RBC destruction in the spleen, liver, or small blood vessels

A

schistocytes

120
Q

This protein binds to free Hgb to reduce its oxidative toxicity

A

haptoglobin

121
Q

anemia caused by ↑ RBC destruction when the rate of destruction exceeds the bone marrow’s ability to replace destroyed cells

A

hemolytic anemia

122
Q

Name the two types of hemolytic anemia

A

intrinsic (inherited) & extrinsic (acquired)

123
Q

Name four types of intrinsic/inherited hemolytic anemias

A
  1. sickle cell anemia
  2. Thalassemia
  3. G6PD deficiency
  4. Hereditary spherocytosis
124
Q

Name at least four types of extrinsic/acquired hemolytic anemias

A
  1. autoimmune hemolytic anemia
  2. DIC
  3. TTP
  4. HUS
  5. paroxysmal nocturnal hemoglobinuria
  6. hypersplenism
125
Q

clumping of RBCs d/t IgM auto-antibodies coating the surface of RBCs, leading to ↑RBC destruction by macrophages

A

auto agglutination

126
Q

small dense basophilic RBC inclusions that are usually removed by the spleen

A

Howell-Jolly bodies (usually a sign of decreased spleen function)

127
Q

degmacyte

A

bite cells

128
Q

bite-like deformity d/t phagocyte removal of denatured Hgb

A

bite cells (degmacyte)

129
Q

name two conditions in which you might see degmacytes.

A

Thalassemia & G6PD deficiency

130
Q

Name two conditions in which you might see schistocytes.

A

hemolytic anemias & microangiopathic dz (TTP, HUS, DIC, prosthetic valves)

131
Q

“helmet-shaped” RBCs d/t mechanical damage in small vessels

A

keratocytes

132
Q

Name two conditions in which you might see keratocytes

A

microangiopathic Dz (TTP, HUS, DIC, prosthetic valves)

133
Q

coarse blue granules evenly distributed throughout the RBC

A

basophilic stippling

134
Q

Name two conditions in which you might see basophilic stippling.

A

sideroblastic anemia, lead poisoning, Thalassemias

135
Q

abnormal coags (prolonged PT and PTT) should make you think of what diagnosis?

A

disseminated intravascular coagulation (DIC)

136
Q

What lab test tells you how much Fe is currently stored in the body?

A

Ferritin (Ferrit IN storage)

137
Q

↓ Ferritin =

A

Fe deficiency anemia

138
Q

↑ Ferritin =

A

anemia of chronic disease

139
Q

measures the amount of Fe bound to transferrin

A

Serum Fe

140
Q

Binds to free Fe to reduce the oxidative damage associated with free Fe; transports Fe through the body to be used

A

transferrin (TRANSports Fe)

141
Q

an indirect way to measure transferrin levels

A

total iron binding capacity (TIBC)

142
Q

Fe deficiency = ↑ or ↓ in transferrin & ↑ or ↓ in TIBC?

A

↑ & ↑; more transferrin leads to ↓ transferrin saturation %

143
Q

anemia of chronic disease = ↑ or ↓ in transferrin & ↑ or ↓ in TIBC?

A

↓ & ↓; transferrin is an acute phase reactant aimed at decreasing Fe availability to microbes.

144
Q

What is the best way to distinguish between Fe deficiency & anemia of chronic disease?

A

TIBC & Ferritin levels

145
Q

Fe deficiency anemia = ↑ or ↓ in serum Fe (iron), ↑ or ↓ in ferritin, & ↑ or ↓ in TIBC

A

↓ serum Fe (iron), ↓ ferritin, & ↑ TIBC

146
Q

Anemia of chronic Dz = ↑ or ↓ in serum Fe (iron), ↑ or ↓ in ferritin, & ↑ or ↓ in TIBC

A

↓ serum Fe (iron), ↑ ferritin, & ↓ TIBC

147
Q

↑ serum Fe = Fe overload states, like you would see in:

A

hemochromatosis or thalassemias

148
Q

Neutrophils with > 5 lobes

A

hypersegmented neutorphils

149
Q

Hypersegmented neutrophils should make you think of what two diagnoses?

A

B12 deficiency & Folate deficiency

150
Q

RBCs w/ numerous, small, evenly spaced projections d/t abnormal cell membrane

A

Burr Cells (echinocytes)

151
Q

Burr cells should make you think of what disease?

A

Uremia (also pyruvate kinase deficiency & hypophosphatemia)

152
Q

few, large, spiny, irregular projections on the RBC membrane

A

Spur Cells (acanthocytes)

153
Q

Burr cells

A

echinocytes

154
Q

spur cells

A

acanthocytes

155
Q

Spur cells or acanthocytes should make you think of waht diseases?

A

liver dz, post splenectomy, Thalassemia, autoimmune hemolytic anemia, renal dz

156
Q

hypochromic RBC with round area of central pigment

A

target cell (codocyte)

157
Q

codocyte

A

target cell

158
Q

Target cells/codocytes should make you think of what two diagnoses?

A

sickle cell & Thalassemia

159
Q

These cells are usually associated with hyperchromia.

A

Spherocytes

160
Q

Spherocytes should make you think of what diagnosis?

A

warm autoimmune hemolytic anemia; hereditary spherocytosis

161
Q

A high reticulocyte count signifies a: ↑ or ↓ in blood loss or a ↑ or ↓ in RBC destruction

A

↑ in blood loss or an ↑RBC destruction (body is making more baby RBCs because they are being lost through blood loss or destroyed = leads to either an intrinsic or extrinsic hemolytic dz)

162
Q

A low reticulocyte count signifies a: failure of or a ↑ or ↓ in RBC production.

A

Failure of or ↓ in RBC production (body isn’t making baby RBCs = leads to microcytic, normocytic, or macrocytic anemias)

163
Q

Name 4 microcytic anemias

A
  1. IDA
  2. Lead poisoning
  3. Thalassemia
  4. EARLY anemia of chronic dz
164
Q

Where is Vit. B12 absorbed?

A

terminal Ileum

165
Q

↑ serum homocysteine & ↑ methylmalonic acid should make you think of what anemia diagnosis?

A

Vit. B12 deficiency anemia

166
Q

The most common cause of iron deficiency anemia (IDA)?

A

blood loss

167
Q

pagophagia, pica, angular cheilitis, and koilonychia should make you think of what diagnosis?

A

IDA

168
Q

pagophagia

A

ice craving

169
Q

koilonychia

A

nail spooning

170
Q

What is the most common anemia found in children?

A

plumbism (lead poisoning anemia)

171
Q

acquired sideroblastic anemia is commonly caused by:

A

plumbism/lead poisoning

172
Q

Name the three anemias that usually present with hypochromic, microcytic anemia.

A

IDA, Thalassemia, nad early anemia of chronic disease. (lead poisoning should be in differential, but not most commonly seen in practice)

173
Q

“lead lines” on XR should make you think of what diagnosis?

A

lead poisoning anemia (plumbism)

174
Q

What is first line treatment for lead poisoning?

A

Succimer (it SUCCs to eat lead)

175
Q

granules of iron accumulate in the mitochonidria surrounding the nucleus

A

ringed sideroblasts

RR Prep (8 decks)

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