Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

USMLE Step 1 Systems > Heme/Onc > Flashcards

Heme/Onc Flashcards

1
Q

Superficial inguinal nodes drain what?

A

All skin from the umbilicus down, including anus up to the dentate line

EXCEPT posterior calf = popliteal lymph nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What LN drain the testes?

A

abdominal aortic LN (follow blood supply)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Pure Red Cell Aplasia caused by what?

A
  1. Thymoma or Lymphocytic Leukemias
    - inhibition of erythroid progenitors by IgG autoAb or CD8 T cells
    - should undergo CT scan to try and remove thymoma
  2. Parvovirus B19
    - virus infects and destroys proerythroblasts
    - dx: anti-B19 IgM antibodies in serum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How to differentiate AML vs. ALL?

A

Presence of AUER RODS (linear, purple red inclusions) in the blasts.

Q 1570

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Histology of Lead Poisoning

A

Microcytic Hypochromic Anemia
Basophilic Stippling

Q1865

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is PAH handled in the renal system?

A
  1. Freely filtered from glomerulus
  2. Secreted by proximal tubules thru carrier proteins

Estimate of renal plasma flow. RPF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

G6PD inheritance pattern

A

X-linked recessive.

Hemolytic anemia when under oxidative stress (such as anti-malarial drugs).

Smear shows heinz bodies (dark, intracellular inclusions that stain with crystal violet)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

t(14;18) translocation

A 
Follicular Lymphoma (Non-Hodgkin's Lymphoma) 
- Bcl2 (anti-apoptotic) translocated from chr 18 to 14 onto heavy chain Ig

Indolent - waxing, waning LAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do tumor cells get resistance against certain chemotherapeutic agents?

A

MDR1 (human multidrug resistance gene 1)
codes for P-glycoprotein (transmembrane protein(
which is an ATP dependent efflux pump.

Can decrease hydrophobic compounds getting into cytosol and increase their efflux out of cytosol.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What mutation in polycythemia vera?

A

JAk2 - non-receptor tyrosine kinase.

Somatic (non-hereditary)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How is the presentation of B-cell ALL different from T-cell ALL?

A

T-cell presents with sx related to mediastinal compression - resp sx, dysphagia, superior vena cava syndrome.

B-cell presents with fever, malaise, bleeding, bone pain, HSM.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What causes subacute cerebellar degeneration in a pt with hx of lung cancer?

A

Paraneoplastic Autoimmune. Immune response against tumor cells cross-reacts with Purkinje neuron antigens - Anti-Yo, Anti-P/Q, Anti-Hu,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What deficiency is associated with hemophilia A and B and increased what time?

A

Hemophilia A = VIII
Hemophilia B = IX

Increased PTT (extrinsic and common pathway)

Sx: hemarthrosis, easy bruising, inc. PTT
Tx: recombinant VIII

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What antineoplastic drug is a analog of adenosine but inhibits adenosine deaminase so it can reach high intracellular concentrations?

A

Cladribine - used for hair cell leukemia.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What bleeding condition do we administer DDAVP for and what does it do?

A

Von willebrand’s disease.

Increases vwf - can stop bleeding in mild cases of von willebrand’s.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What immunological disease presents with a painless waxing and waning lymphadenopathy?

A

Follicular Lymphoma

  • indolent Non-Hodgkin B cell lymphoma
  • t(14,18) - overexpression of bcl2 oncogene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Lymph node enlargement - what characteristic would make it malignant?

A

Monoclonal proliferation of lymphocyte.

Ex: Monoclonal T cell-R gene rearrangement.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hemoglobin A, S, C - where would they be on protein electrophoresis? What mutations cause the latter two?

A

Hemo A = negatively charged
Hemo S = Glu (+) -> Valine (-)
Hemo C = Glu (+) -> Lysine (+)

Speed of movement towards (+) electrode:
A > S > C

Q1470

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Patients with familial retinoblastoma have an increased risk of what other malignancy?

A

Osteosarcoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

MOA of warfarin.

A

Inhibits vit K dependent carboxylation of glutamic residues of 1972, C, S.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does the glu -> val in the beta globin subunit of HbS cause disease?

A

Fits in a complementary hydrophobic binding site on alpha-hemaglobin chain –> causes polymerization/aggregation of HbS molecules when in their deoxygenated form (under anoxic conditions, increased acidity, dehydration)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What organelles do RBC lack?

A

Nucleus and Mitochondria (cannot synthesize heme since part of heme synthesis occurs in the mitochondria)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What reactions are B12 and folate a part of ?

A

Both: Homocysteine -> Methionine
B12: Methylmalonyl CoA -> Succinyl CoA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Disease associated with t(15;17) translocation

A

AML - translocation of retinoic acid receptor from 17 to 15 -> forms the PML/RARalpha -> abnl retinoic acid receptor -> inhibits myeloblast differentiation -> AML

AML Responsive to all-trans retinoic acid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Why would RBCS stain blue on Wright-Giemsa stain?
Reticulocytes with residual rRNA. Ex: In Fe deficiency anemia, once you treat with Fe, you get enhanced erythropoiesis - accelerated release of mature and these immature reticulocytes into circulation.
26
Findings of DIC
Inc. PT, PTT Thrombocytopenia, Microangiopathic Hemolytic Anemia Low Fibrinogen Elevated fibrin split products (D-dimers) Low factor V and VIII levels
27
``` What are the diseases and translocations associated with the following: t(9,22) t(8;14) t(11;14) t(14;18) t(15;17) t(8,21) ```
``` t(9,22) = CML = Philadelphia (bcr-abl) t(8;14) = Burkett's = c-myc t(11;14) = Mantle cell = cyclin-D t(14;18) = Follicular = bcl-2 t(15;17) = AML = retinoic acid receptor t(8,21) = AML (why Down's is more common) ```
28
What disorder associated with persistent activation of JAK/STAT?
Myelofibrosis Polycythemia Vera Essential Thrombocytosis
29
Sx and Mech: Acute Intermittent Porphyria
Porphobilinogen -> Hydromethylbilane Deficient enzyme: HMB synthase/Porphobilinogen Deaminase Sx: 5 P's - painful abd - psych - polyneuropathy - port wine colored urine* - precipitated by drugs, EtOH, starvation Tx: Glucose, heme (inhibit ALA synthase)
30
Sx and Mech: Porphyria Cutanea Tarda
Uroporphyrinogen III -> Coproporphyrinogen III Deficient enzyme: Uroporphyrinogen Decarboxylase Sx: - Blistering photosensitivity - Hypertrichosis - Facial hyperpigmentation - may be associated with Hep C, ETOH, Inc. ALT/AST
31
Sx and Mech: Sideroblastic Anemia
Glycine + Succinyl CoA -> d-aminolevulinic acid Deficient Enzyme: Aminolevulinic acid synthase Sx: Microcytic, hypochromic anemia - ringed sideroblasts (Fe laden macrophages) - inc. Fe, Ferritin. Normal TIBC Tx: Pyridoxine B6 (ALA synthase cofactor)
32
Sx and Mech: Lead Poisoning
1. Aminolevulinic acid dehydratase: aminolevulinic acid -> porphobilinogen 2. Ferrochelatase: Protoporphyrin + Fe -> Heme 3. Inhibits rRNA degradation -> retain aggregates of rRNA (basophilic stippling) Sx: LEAD - lead lines on gingivae and metaphyses of long bones - encephalopathy - abd colic, sideroblastic anemia - drops - wrist and foot drop Smear: - sideroblastic anemia - basophilic stippling RF: old houses with chipped paint, battery/ammunition/radiator factory Tx: - EDTA, Dimercaprol - Succimer
33
Hemophilia A and B are what type of inheritance?
X-linked!
34
Why perform splenectomy in pt with hereditary spherocytosis?
Decrease hemolysis, Improve Anemia, DECREASE biliary gallstones!
35
Recurrent infections + defect in tyr kinase in B cells
Bruton's X-linked agammaglobulinemia.
36
Presentation of Acute Leukemia
Anemia - pallor Thrombocytopenia - like mucosal bleeding, etc Leukopenia - infection (white patches on mucosa = thrush) HSM/Lymphadenopathy Blast Cells
37
What is basophilic stippling?
rRNA remnants Anemia of Chronic Disease Thalassemia Lead Poisoning Alcohol abuse.
38
How does desmopressin work for Hemophilia A?
Increase VIII and vWF release from endothelial cells.
39
Area Postrema = ?
Dorsal surface of the Medulla. "ChemoR trigger zone" Responsible for the vomiting induced by chemotherapy. This area has absent BBB - fenestrated - sample chemicals in the blood.
40
How to prevent Tumor Lysis Syndrome?
Rasburicase (urate oxidase): uric acid --> allantoin (which can be excreted in the urine) Tumor Lysis = hyperK, Hyperuricemia, HyperPhos, HypoCa
41
How do nitrates cause cyanosis?
Fe2+ (ferrous) ---nitrates---> Fe3+ (ferric) = methemoglobin can't bind O2. PaO2 is still normal.
42
What anticoagulant causes neutropenia?
TIclopidine
43
Neurologic effects of Vit B12 deficiency?
Subacute combined degeneration. 1. Posterior columns 2. LCST
44
What is the primary when mets biopsy shows large, rounded, polygonal cells with clear cytoplasm?
RENAL CELL CARCINOMA!
45
How to prevent nephrotoxicity with cisplastin?
Amifostine (free radical scavenger) | IV NS - chloride diuresis.
46
What histologic changes characterize the spleen in a pt with sickle cell?
Fibrosis and Atrophy. Rpted splenic infarctions -> scarring, fibrosis, atrophy
47
Chronic lymphedema (such as from axillary node dissection in masectomy) leads to?
Angiosarcoma (Lymphagiosarcoma) = Stewart Treves Syndrome
48
What chemo drug causes hemorrhagic cystitis? How to prevent?
Cyclophosphamide - give Mesna (binds toxic metabolites in the urine)
49
Hemolytic Anemia + Hypercoagulability + Pancytopenia
Paroxysmal Nocturnal Hemoglobinuria Anemia: Absence of GPI anchor - decreased CD55 (DAF) and CD59 (MAC inhibition) -> increased complement mediated hemolysis. Hypercoag: release of free hemoglobin and thrombotic factors from lysed rbcs Pancytopenia: it's a stem cell disorder.
50
What anticoagulant most effective in inactivating thrombin?
Unfractionated Heparin - equal effectiveness against thrombin and Xa. LMWH - only Xa.
51
Dactylitis associated with what?
Dactylitis = painful swelling of hands/feet. Associated with Sickle cell - infarction of marrow, trabeculae within bones of extremities leads to this.
52
How do you treat acute intermittent porphyria?
Heme or Glucose. Decrease activity of ALA synthase and porphyrin synthesis.
53
Follicular Lymphoma - what translocation and increases activity of what gene?
t(14;18) -> bcl2 oncogene Presents as painless, waxing and waning lymphadenopathy.
54
Basophilic Stippling
ACiD alcohol is LeThal anemia of chronic disease alcohol abuse lead poisoning thalassemias Caused by a decrease in the enzyme that degrades rRNA.
55
Pathologic RBC forms associated with G6PD
Heinz bodies - oxidation of hemoglobin sulfhydryl groups -> denatured hemoglobin precipitation (can be many) - crystal violet. Bite cells - phagocytosis of those
56
Ringed sideroblast
Sideroblastic Anemia, Lead poisoning, Myelodysplastic Messed up heme synthesis -> excess Fe accumulates around nucleus.
57
Teardrop
BM infiltration - Myelofibrosis "BM sheds a tear bc its been forced out of its home in the bone marrow"
58
Acanthocyte
irregularly spiky. | Abetalipoproteinemia, Liver disease
59
Target cells
``` HALT HbC disease Asplenia Liver disease Thalassemia ```
60
Plummer Vinson
esophageal webs Fe deficiency anemia atrophic glossitis
61
Sideroblastic Anemia
Defect in heme synthesis X-linked: d-ala synthase gene Acquired: Myelodysplastic, Pb, Alcohol, B6 def, Cu def, INH Smear: ringed sideroblast in BM Labs: inc. Fe, Ferritin, nl TIBC Tx: Pyridoxine B6 (cofactor for d-ala synthase
62
X-linked anemia
``` Sideroblastic Anemia (d ALA synthase) G6PD deficiency ```
63
``` What are the chains associated with the following types of hemoglobin: HbA HbA2 HbH HbC HbS HbBart HbF ```
``` HbA = a2b2 HbA2 = a2d2 HbH = b4 (alpha thal 3 allele deletion) HbC = a2 beta-c2 (beta-c: glu (-) -> lys (+)) HbS = a2 beta-s2 (beta-s: glu (-) -> val (neutral)) HbBart = g4 (alpha thal 4 allele deletion) HbF = a2g2 ```
64
Sx of PNH
1. Coombs (-) hemolytic anemia 2. Pancytopenia 3. Venous Thrombosis Mech: Complement mediated RBC lysis (impaired synthesis of GPI anchor for DAF that protects RBC from complement)
65
Direct vs. Indirect Coombs
Direct = test antibody. - Anti-Ig antibodies (Coombs reagent) added - if RBCS are coated with Ig - will agglutinate) Indirect = test antigen - normal RBCs added to patients serum. - then add coombs reagent - if serum has anti-RBC surface Ig, will agglutinate.
66
What are the direct thrombin inhibitors? | What are they used for clinically?
Argatroban Bivalirudin Used for anticoagulating patients with HIT.
67
What are the direct factor Xa inhibitors?
Apixaban | Rivaroxaban

USMLE Step 1 Systems (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions