Hematology / Oncology - Specific Findings

Question 1

PT

Answer 1

Tests function of common extrinsic coagulation pathway, factors I, II, V, VII, and X

Question 2

PTT

Answer 2

Tests function of common intrinsic coagulation pathway, all factors EXCEPT for VII and XIII

Question 3

Follicular Lymphoma - Gene Translocation

Answer 3

t(14;18) - translocation of heavy-chain Ig (14) and BCL-2 (18)

Question 4

DIC - Lab Findings

Answer 4

Elevated D-dimer / decreased fibrinogen
Decreased factors V and VIII / elevated PT and PTT
Decreased platelet count
Schistocytes seen on smear - RBCs are damaged by passage through obstructed vessel lumen

Question 5

Reed-Sternberg Cells

Answer 5

Classic finding in Hodgkin Lymphoma; neoplastic cells of B-cell origin

CD15+, CD30+
Bi-nucleated / bi-lobed with “Owl Eye” appearance

Question 6

Burkitt Lymphoma - Gene Translocation

Answer 6

t(8;14) - translocation of c-myc (chromosome 8) and Ig heavy chain (chromosome 14)

Question 7

Diffuse large B-cell lymphoma - Gene Translocation

Answer 7

t(14;18)

Question 8

Mantle Cell Lymphoma - Gene Translocation

Answer 8

t(11;14) - translocation of cyclin D1 (chromosome 11) and Ig heavy chain (chromosome 14)

Question 9

“Starry Sky”

Answer 9

Describes the appearance of lymph nodes seen in Burkitt’s lymphoma; characterized by sheets of lymphocytes interspersed with macrophages

Question 10

Basophilic Stippling of RBCs

Answer 10

Seen in lead poisoning

Pb inhibits ribonucleases in RBCs causing accumulation of rRNA, which appears basophilic on smear

Question 11

Burton Lines

Answer 11

Seen in lead poisoning

Evident at the metaphyses of long bones on X ray

Question 12

Amyloidosis - Staining

Answer 12

Congo red stain shows amyloid (Ig light chain) deposits with apple green birefringence under polarized light

Question 13

M-spike on serum protein electrophoresis

Answer 13

Represents high levels of monoclonal Ig light chain in the serum

Finding in Monoclonal Gammopathy of Undetermined Significance (<3g/dL) and Multiple Myeloma

Question 14

Bence-Jones Protein

Answer 14

Monoclonal Ig light chain in the urine

Finding in multiple myeloma

Question 15

Osmotic Fragility Test

Answer 15

Positive osmotic fragility test seen in Hereditary Spherocytosis

Question 16

Which clotting factors are monitored by PT/INR?

Answer 16

Common & Extrinsic Pathway factors:

I
II
V
VII
X 

Affected by Warfarin

Question 17

Which clotting factors are monitored by PTT?

Answer 17

Common & Intrinsic Pathway Factors:

(All except VII and XIII)

Affected by Heparin

Question 18

Prolonged PTT - NOT correctable by 1:1 mixing with FFP

Answer 18

Anti-phospholipid antibody syndrome (“Lupus anticoagulant”)

Question 19

Which HLA type is associated with psoriatic arthritis, ankylosing spondylitis, arthritis of inflammatory bowel disease, and reactive arthritis?

Answer 19

HLA-B27

Question 20

Which HLA types are associated with SLE?

Answer 20

HLA-DR2

HLA-DR3

Question 21

Which HLA type is associated with rheumatoid arthritis?

Answer 21

HLA-DR4

Question 22

Sunburst pattern on long bone X ray

Answer 22

Osteosarcoma

Question 23

Which autoantibody is most specific for SLE? What other autoantibodies are seen?

Answer 23

anti-dsDNA is the most SPECIFIC

anti-nuclear antibodies (ANA)
anti-Smith antibodies
anti-cardiolipin antibodies - false positive on tests for syphilis, prolonged PTT
anti-histone antibodies - sensitive for drug-induced lupus

Question 24

Libman-Sacks endocarditis

Answer 24

Wart-like (non-infectious) vegetations on both sides of a valve

Commonly seen in SLE

Question 25

How do gout crystals look under microscopy?

Answer 25

Uric acid crystals from aspirated joint fluid are needle-shaped and negatively bi-refringent (yellow under parallel light, blue under perpendicular light)

Question 26

M-spike on serum protein electrophoresis - IgG or IgA

Answer 26

Multiple Myeloma

Question 27

M spike on serum protein electrophoresis - IgM

Answer 27

Waldenstrom macroglobulinemia

Question 28

5 “Ps” - Painful abdomen, port-wine colored urine, polyneuropathy, pyschiatric disturbances, precipitated by drugs, alcohol, starvation

Answer 28

Acute Intermittent Porphyria

Deficiency of porphobilinogen deaminase with accumulation of porphobilinogen in blood and urine

Question 29

“Soap bubble” on X-ray

Answer 29

Giant Cell Tumor - benign tumor of bone, usually seen at the epiphyseal ends of long bones (distal femur, proximal tibia)

Question 30

Heinz Body

Answer 30

Precipitates of hemoglobin seen within the RBCs of patients with hemolytic anemia due to G6PD Deficiency upon exposure to oxidizing agents

Question 31

TdT

Answer 31

Marker of pre-T and pre-B cells

Positive in acute lymphoblastic leukemia (ALL)

Question 32

CD10

Answer 32

Marker of pre-B cells

Positive in acute B-ALL

Question 33

Direct Coomb’s Test

Answer 33

i.e. used to diagnose warm agglutinin hemolysis

anti-Ig antibody is added to patient’s serum; if patient’s own RBCs are coated with Ig then agglutination occurs

Question 34

Indirect Coomb’s Test

Answer 34

i.e. used to asses blood compatibility before transfusion

Normal RBCs are added to patient’s serum; RBCs will agglutinate if patient’s serum as anti-RBC surface Ig

Question 35

Oat Cells

Answer 35

Neoplastic proliferation of neuroendocrine Kulchitsky cells; small, blue cells resembling lymphocytes but 2x bigger

Stain chromogranin A +

Question 36

Target Cells

Answer 36

DDx = HALT

Heboglobin C Disease
Asplenia
Liver Disease
Thalassemias

Question 37

Sarcoidosis - Lab findings

Answer 37

Elevated serum ACE levels
Elevated CD4 / CD8 ratio
Hypercalcemia

Question 38

Sarcoidosis - Imaging findings

Answer 38

Bilateral hilar lymphadenopathy

Coarse reticular opacities

Question 39

Sarcoidosis - Other associated clinical findings

Answer 39

Restrictive lung disease (interstitial fibrosis)
Erythema nodosum
Bell’s palsy
Uveitis