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Heme/Onc Flashcards

1
Q

Anemia, reticulocytosis and increased indirect bilirubin indicates?

A

hemolytic anemia

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2
Q

peripheral blood smear of dysmorphic red blood cells without central pallor describes what?

A

spherocytes

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3
Q

In hemolysis what happens to:
retiulcytes?
LDH?
Haptoglobin

A

Reticulocytosis
incr. LDH
decreased haptoglobin

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4
Q

name two tests for Heridiatry spherocytosis& whats deficient ?

A

Increased MCHC=> membrane loss & RBC dehyration
Osmotic fragility testing

Spectrin

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5
Q

What is used to reverse methotrexate toxicity?

A

Folinic acid (leucovorin)

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6
Q

And what two situations is allopurinol used? How does it work?

A

Noncompetitive inhibitors of xanthene oxidase used in the treatment of :

gout
Tumor lysis syndrome (also use Rasburicase)

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7
Q

When and how does filgrastim work?

A

G-CSF analog stimulate proliferation/differentiation of granulocytes in patients with NEUTROPENIA

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8
Q

When is Mezna used? Which drugs is a given with concurrently?

What does a bind?

A

Hemorrhagic cystitis
Cyclophosphamide, ifosfamide

Acrolein

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9
Q

What do you use to treat anthracycline induced cardiotoxicity?

A

Dexrazoxane

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10
Q

Where does isotype switching occur? Which receptor is necessary?

A

Germinal centers of lymph nodes requires interaction OCD 40 receptor on B cells

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11
Q

Where does the VDJ recombination occur?

A

During B cell maturation within the bone marrow

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12
Q 
Name what these diagnostic test correlate to:
Panpanicolaou smear
Cryoglobulins
Hemadsorption in cell culture
Heterophile antibodies
A

Human papilloma virus
Hepatitis C virus
Influenza/parainfluenza
EBV

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13
Q

Which cells exert master control over other cells involved in iron metabolism?

A

Hepatic parenchymal cells due to intercellular binding protein FERRITIN

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14
Q

Purpose of lactoferrin where it is secreted?

A

Renal tubular cells

Finds two free iron in the urine and recovers from metabolic use

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15
Q

What carries out the non-oxidative reactions of the HMP shunt?

Oxidative?

A

Transketolase
Transaldolase

G6Phosphate dehydrogenase =RLS

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16
Q

Which chemo drug would cause burning on urination and urgency?

A

Cyclophosphamide ifosfamide

Induced hemorrhagic cystitis

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17
Q

Which chemo drug would be associated with CHF symptoms?

A

Doxorubicin

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18
Q

Dry cough, exertional dyspnea, pulmonary toxicity is a side effect of which chemotherapy drug?

A

Bleomycin = >progressive pulmonary fibrosis

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19
Q

Alkylating agents of chemotherapeutic agents are associated which which type of symptoms?

A

Tarry stools

Fatigue

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20
Q

Which chemotherapy drug would cause abdominal pain and jaundice what type of drug is this?

A

Mercaptopurine

S-phase specific purine Analog

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21
Q

What diseases associated with factor X I deficiency ? When is bleeding seen?

A

Hemophilia see

bleeding only occurs in surgical procedures

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22
Q

What metabolizes pro carcinogens?

A

Cytochrome P450 MONOOXYGENASE

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23
Q

YOUR MOM

A

is LOVELY

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24
Q

Homocysteine to cystathione
Cofactors
Enzyme

A

Serine, vitamin B6

Cystathionine synthetase

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25
Cystathionine to cysteine
Vitamin B6 | Cystathionase
26
Homocystine to methionine Cofactors Enzyme What byproducts are produced?
Methylcobalamin, 5-methyl tetrahydrofolate Methionine synthase THF4, cobalamin
27
folic acid to THF ? What inhibits this? (2)
folic acid--> DHFReductase |--- methotrexate DHF--> DHFReductase |--- methotrexate THF THF--->DHF by thymidylate synthetase ( |--- 5-FU)
28
How does leucovorin rescue work?
follinic acid (leucovorin) is not require the action I'm dihydrofolate reductase to be converted to THF and it's unaffected by methotrexate poisoning
29
Germ tubes/true hyphae are diagnostic of which fungi? (aka positive germ tube test) Three potential manifestations?
Canada albicans Oral thrush Vulvovaginal candidiasis-White discharge Cutaneous candidiasis-maceration/fissuring
30
Attributable risk percentage =?
ARP = (risk and exposed -risk and unexposed)/ risk and exposed USE: ARP = (RR -1)/RR
31
HbS mutation location? How does this affect hemoglobin molecules?
valine in place of glutamic acid @ 6th amino acid position in beta subunits Promotes hydrophobic interactions among hemoglobin molecules = > polymerization of HbS molecules and red blood cell distortion
32
Wiskott Aldridge syndrome triad?
Eczema, thrombocytopenia, B & T lymphocytes deficiency.
33
AML is associated with which cytogenic abnormality?
t(15:17)
34
Why does Erythroblastosis fetalis, or hemolytic disease of the newborn not occur in parens with maternal blood type A or B? why would it occur in type O mothers
Anti-A & Anti-B antibodies are IgM and cannot cross the placenta. type O antibodies are IgG
35
Which mitochondrial enzyme activates caspases?
Cytochrome C
36
What type of lymphocytes respond to an active EBV infxn?
Activated CD8 cytotoxic positive T lymphocytes
37
What diseases are associated with multiple myeloma? at age ~70yrs
Anemia Hypercalcemia Bone resorption (secretion of IL-1-osteoclastic actv. factor) and IL-6 ==> PUNCHED OUT LYTIC LESION Increased susceptibility to infection (M protein, Bence-Jones protein, Rolleaux formation, Increased ESR AL amyloid(MM & Monoclonal Plasma cell dyscrasia) Renal failure
38
Drug of choice and HeparinInducedThrombocytopenia?
Direct thrombin inhibitors: Hiruden Lepiruden Argatroban *** do not require ATIII
39
Which drug shares the same pathogenesis of Glanzmann's thrombastenia? and how?
Abciximab GPIIb/IIIa blocked/deficient in drug/disease respectively
40
What is used to prevent the renal sometimes Timberledge the syndrome?
allopurinol | Rasbicurase
41
side effect of dapsone?
Methemoglobinemia
42
What worsens G6PD deficiency? (bite cells) 4+descriptions
Infections Drugs-dapsone, TMP-SMX, antimalarials Diabetic ketoacidosis Fava beans
43
What recesses of clozapine work on? | What life-threatening side effect is associated with this drug?
D4 | Agranulocytosis
44
Which drug can cause aplastic anemia/pancytopenia?
Chloramphenicol
45
The presence of an oligoclonal IgG band in multiple sclerosis indicates this disease is?
Autoimmune disorder
46
4 features of anaplastic tumors? (anaplastic=COMPLETE LACK OF CELL DIFFERENTIATION)
1 cells coalesce due to loss of cell polarity 2 cellular and nuclear pleomorphism 3 disproportionately large nuclei, giant multinucleated tumor cells 4 mitotic figures
47
What activates and what blocks Delta aminolevulinate synthase?
Activate: alcohol, barbiturates, hypoxia Inhibit: heme, glucose
48
What converts fibrinogen to fibrin
Thrombin
49
What converts prothrombin to thrombin? | What cofactors are required for this?
factor Xa | Calcium, factor V, platelets phospholipid
50
Lead blocks what from being made by inhibiting which enzyme? ferrochelatase blocks what from being made?
Porphobilinogen ALA Synthetase HEME
51
When would you see schistocytes schistocytes schistocytes?
HUS TTP DIC Prosthetic valve
52
Main differentiating symptoms of TTP vs HUS
TTP: adult, neurologic involvement HUS:children, renal involvement
53
When does Henonch Schloein Purpura usually occur? Symptoms/Manifestations? Tx
children age 3-10 Leukocytoclastic vasculitis due to depositions of IGA complexes Abdominal pain, lower extremity purpura, arthralgias, renal involvement
54
How might desmopressin affect bleeding disorders? Which bleeding disorder is a used to treat?
Releases von Willebrand factor and factor VIII from endothelial cells Mild to moderate hemophilia A
55
CD14
Monocyte macrophage cell lineage
56
High oxygen affinity hemoglobins leads to which type of shifts? what happens to P50 w/ this? What happens to renal system, red blood cells?
Left shift, Decreased P50 Renal hypoxia, increased EPO synthesis = > erythrocytosis
57
4 associated left findings with intravascular hemolytic anemia
DECREASED serum haptoglobin levels INCREASED LDH hemoglobin bilirubin
58
Type/MOA: Enoxaparin Fondaparinux Unfractionated Heparin
E-LMWH that more specifically binds Antitrhombin (more than it does thrombin) to inactivate Factor Va F- pentasaccharide factor Va inhibitor UH- binds both antithrombin and thrombin (inactivating it) and is most antithrombotic
59
what occurs 4-12 days post Subarachnoid hemorrhage? how do you prevent this?
Vasospasm CCBs=nimodipine
60
all mycoplasma species are resistant to which types of drugs? WHAT CANNOT TREATS THESE INFXNS? 4
drugs that affect peptidoglycan wall because they are intracellular- penicillins, cephalosporins, carbapenems, vancomycin Erythromycin/Tetracyclines
61
what laboratory finding is seen in uremic platelet dysfunction?
increased BT only
62
When does HBS aggregate?
Deoxygenated state
63
4 common features of sarcoidosis?
Erythema nodosum, arthralgias, granulomas, elevated serum ACE levels
64
What is diagnostic of PNH?
CD 55, CD 59 deficiencies; these deficiencies disallow the inactivation of compliment
65
distinguish btw relative & absolute erythrocytosis?
relative-normal RBC mass | absolute-Incr. RBC mass
66
Increased Hematocrit= ?
Erythrocytosis > 52% males > 48% females
67
Subunits of HbF? when does switch to HbA occur? subunits in this
2 alpha 2 gamma @6mo of life 2 alpha 2beta
68
AL amyloid associated with which 2 diseaes and what is seen under polarized light?
Apple green birifrengence with congo red stain Multiple Myelolma Monoclonal plasma cell dyscrasias (clockface purple cells)
69
Haptoglobin MOA? Why would these levels decrease in Intravascular hemolysis?
binds to free Hb and promotes uptake by the RES. Decr. when significant quantities of Hb are released into circulation (seems wrong but this is right - in UWORLD)
70
What drugs increases fetal Hb?
Hydroxyurea
71
What bug uses this method of Infection? pharynx--> lymphatics--> meninges
H.Influenzae
72
What bug uses this method of infection? Middle ear-->contiguous tissue--> meninges
S.pnuemonia
73
what bug uses this method of infection? Primary Lung focus--> blood--> meninges
Mycobacterium tuberculosis & S. Pneumonia
74
what bug uses this method of infection? Pharynx-->Blood-->Choroid Plexus--> Meninges
Neisseria Meningitidis
75
what 3 things are associated with red cell aplasia?
thyoma lymphocytic leukemias ParvovirusB19
76
What has a similar presentation to CML? how do you differentiate between the 2?
Leukemoid reaction => elevated white cell count neutrophil alkaline phosphatase level LEUKORXN= Elevated CML=Decreased
77
Nitrites
Causes Methemeaglobinemia and Treats Cyanide poisoning.
78
which _______ can cause Serotonin syndrome? analgesic antiemetic antibiotic
tramadol ondasteron Linezolid
79
aplastic anemia (3 symptoms)
pancytopenia low reticulocyte count absent splenomegaly dry bone marrow aspirate; fat cells & fibrous stroma
80
The lower the MAC the ______ the potency?
higher
81
Vitamin B12 Deficiency vs Folate Deficiency
BOTH Megaloblastic anemia B12 is associated with neurologic deficiency.
82
Abdominal pain, hepatomegaly, Pancreatic calcifications suggest what? what is this usually due to?
Chronic Pancreatitis due to ethanol abuse
83
Rifampin MOA?
blocks action of bacterial DNA dependent RNA polymerase inhibiting transcription
84
Where do pancoast syndrome tumors usually occur? what characterizes this disorder?
in the superior sulcus of the lung apex ipsilateral horners syndrom rib destruction, atrophy of hand muscles pain in C8-T1 T2 nerve roots
85
what would you use to treat lyme disease?
doxycycline or | penicillin-type antibiotics
86
what inhibits the synthesis of mycolic acids?
isoniazid
87
What type of cancer is associated with Epstein-Barr virus?
Primary CNS lymphoma
88
what enzyme does heparin activate
AntiThrombin III
89
DIC due to: (3 common) Path Lab findings
sepsis, burn injury, acute pancreatitis fragmented RBCs, Thrombocytopenia Lab Test prolonged PT & PTT decreased fibrinogen, Factor V, Factor VIII
90
difference btw Brachiocephalic and SVC drainage?
SVC drains bilateral Brachiocephalic veins Brachiocephalic drains UNILATERAL jugular & cephalic veins (Same symptoms as SVC syndrome but to ONE SIDE)
91
Metastatic Carcinoid tumor test 4 common symptoms? When are these symptoms present when are they absent?
5-hydroxyIndoleacetic acid Vasomotor instability: cutaneous flushing, dizzy GI probs: secretory diarrhea & abd. pain Bronchoconstricion Right sided valvular Heart disease Absent when confined to INTESTINE present outside intestine/ WHEN metastasized to LIVER
92
Features of Polycythemia Vera (PRIMARY)
DECR. EPO incr. RBC MASS Incr. Plasma Volume levels ALL CELL LINEAGES INCREASED JAK2 V617F mutation Incr. Sensitivity to Growth factors
93
Secondary Polycythemia vera 2 causes Findings
Hypoxia EPO-producing tumor ***ONLY RBC Lineage is increased Incr. RBC Mass Incr. EPO NORMAL plasma vol.

UWORLD QuestionQuestions (12 decks)

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