Heme/Onc/Lymph U WORLD Questions Flashcards
new HA, intracranial mass, biopsy, age 60s, with areas of necrosis surrounded by columns of tumor cells, capillaries at the periphery =
this is the _____ primary brain neoplasm in adults
pathology feature
origin cell
glioblastoma multiforme
most common
pseudopalisading necrosis
astrocyte
given several units of packed red blood cells, develop tingling and hypocalcemia due to ______chelation by ______ that is added to stored blood
calcium
citrate
exposure status determined then followed during study =
exposure status determined after study =
prospective cohort
retrospective cohort
dermatomyositis occurs during _____ and is characterized by proximal muscle weakness, heliotrope rash in periorbital and cheek region, and ____, which are erythematous plaques over the joints.
muscle biopsy will show
strong associated with lung, colorectal, and _____ cancers
malignancy
Gottron Papules
perimysial infiltrates
ovarian
sickle cell anemia is autosomal _______ inheritance and can be confirmed by __________ electrophoresis. the abnormal hemoglobin is designated _____
recessive
hemoglobin
HbS
radiation therapy induces DNA damage through ______ and formation of free radicals
DNA double strand breaks
factors II, VII, IX, and X are _______ dependent coagulation factors synthesized in the _______. Factor _____ has the shortest half life. Failure of ________, which assess the extrinsic and common pathway of coagulation, to correct with vitamin K supplementation indicates ________ deficiency
Vitamin K
LIver
VII
Prothrombin time
VII
______blotting is used to ID proteins. ________ blotting is used to ID RNA sequences. ______ blotting IDs specific DNA sequences in an unknown sample
Western
Northern
Southern
dizziness, HA, pruritus after showering, ruddy complexion, splenomegaly =
increased platelets, RBC mass, and decreased EPO is due to increased bone marrow sensitiity to ____ which results in polycythemia _____, typically with mutation _____
normal platelet count, increased RBC mass, and increased EPO is usually due to an inappropriate _____ producing _____
incrased EPO and RBC mass in the presence of decreased SaO2 is a _______ response
polycythemia
Growth factors
vera
JAK2/V617F
EPO
Tumor
physiologic
anemia, reticulocytosis, and increased indirect bilirubin indicates _______anemia. RBCs w/o central pallor are called_____, and can be acquired or hereditary. Hereditary _______ can be due to mutations involving ____, band 3, or ______, while acquired ______ is due to autoimmune disorder. Both of these will show an elevation in _________
hemolytic
spherocytes
spherocytosis
ankyrin, spectrin
spherocytosis
Mean corpuscular hemoglobin concentration MCHC
HIV pol genes are responsible for _______ to antiretroviral therapy. Env gene mutations enable _____ from host neutralizing antibodies
acquired resistance
escape
newborn w/ jaundice, hepatomegaly, edema, low hemoglobin, + direct Coombs, extramedullary hematopoeisis =
due to _______ antibodies developed during a prior _____ pregnancy which cause severe autoimmune hemolytic anemia and hydrops fetalis
erythroblastosis fetalis (Rh sensitization)
maternal anti RhD IgG
RhD+
chemokine receptor ______ acts as a coreceptor that enables the HIV virus to ____ cells. HIV virus uses ___ as a primary receptor, and both _____ and ____ are bound to HIV viral outer envelope protein gp120
CCR5
enter
CD4
CD4 and CCR5
fever, bleeding gums, sore throat, several myeloblasts with abundant _______ cytoplasm and a large number of coarse rod shaped intracytoplasmic granules called ____ rods that stain for ________ indicate _______ type M3
basophilic
Auer
peroxidase
AML
all NSAID impair platelet aggregation except ____ which is a _____ selective inhibitor and has no side effects of bleeding and GI ulceration
Celecoxib
COX2
mature erythrocytes lose their ability to synthesize heme when they ______ their ________
lose
mitochondria
folate deficiency inhibits the synthesis of ______, which leads to defective ______ synthesis and megaloblastic anemia. THis can be overcome w/ _______ supplementation
deoxythymidine monophosphate (dTMP)
DNA
Thymidine
tRNA that is mischarged with the incorrect amino acid will _________________ amino acid into the polypeptide chain
incorporate the wrong
Neutrophils roll via the loose binding of ______ or _______ to L -selectin on neutrophils or ________ on endothelial cells
Neutrophils firmly attach to the endothelium (tight adhesion and crawling) via binding of ________ to _______ on enodthelial cells
Neutrophils migrate out of vasculature (transmigration) via attachment to _______
Sialyl Lewis X
PSGL1
E/P selectin
LFA-1
ICAM-1
PECAM-1
chemotherapy induced emesis can be treated w/ _______ and _______ that act as 5HT3 receptor antagonists
Ondansetron
Granisetron
mTOR pathway = binding of growth factor, autophosphorylation of _____ residues, activation of _______, activation of ______, then activation of _____ which translocates to the nucleus
tyrosine
PIP3
AKT
mTOR
bone pain, fatigue, kidney disease, hypercalcemia, anemia is typical of ________ which is due to neoplastic B lymphocytes that mature into plasma cells and synthesize large amounts of ________. These plasma cells are susceptible to the effects of proteasome inhibitors such as ________, a boronic acid containing dipeptide
Multiple myeloma
Ig or Ig fragments
bortezomib
a left shift on O2-Hbg dissociation curve can be caused by _________ (3) and indicates
a right shift can be caused by _____(3) and indicates
inc in pH, dec 2,3BPG, dec temp
O2 less available to tissues
dec in pH, inc 2,3BPG, inc temp
O2 more available to tissues
Meningococcal meningitis that progresses to DIC results in _______ on peripheral blood smear, which are fragmented erythrocytes
schistocytes
_______ can reverse the toxicity of methotrexate in non cancerous cells of the GI mucosa and bone marrow. This drug is also called ________
Leucovorin
Folinic acid
6-MP is degraded by _____, which can be inhibited by ____. Both 6-MP and 6-thioguanine are prodrugs that require activation by _______
XO
allopurinol
HGPRT
hemolytic anemia due to medication induced oxidative stress is indicative of _______. Antimalarial drugs usually precede the hemolysis. Peripheral blood smear shows RBCs w/ ______, dark intracellular inclusions that stain w/ supravital stain. This disorder follows ______ recessive inheritance
G6PD deficiency
Heinz bodies
X linked
diffuse large B cell lymphoma is the most common type of NHL and is typically treated w/ ________, which act during the ______ phase of the cell cycle and can cause _______
vincristine, vinblastine
M
peripheral neuropathy (stocking and glove)
dysplasia is ____ change in epithelial cells, which CIS is _______, and invasive carcinoma shows
reversible
irreversible
invasion of basement membrane
fatigue, weak, conjuvtival pallor, decrease hemoglobin =
bruising =
high lipid content of bone marrow =
all of which suggestive of ______, which will present w/ increased production of ________
anemia
thrombocytopenia
hematopoetic cell aplasia
aplastic anemia
EPO
+TdT, CD10, CD19 =
+CD2-8, TdT, CD1a =
precursor B-ALL
precursor T-ALL
anemia, megaloblastic anemia, neuro deficits =
can be due to a ___diet
B12 deficient
strict vegan
female, fatigue, hypochromic, microcytic anemia =
bluish color on RBCs after treatment due to =
iron deficient anemia
reticulocytosis (increased ribosomal RNA)
CD8 T cell mediated apoptosis results in rapid cell death due to activation of ______
caspases
SLE can present in women w/ arthralgias and decreased erythrocytes, leukocytes, and platelets. This is called ______
pancytopenia
HIV infection can cause reactivation of latent _____ and result in ________ lymphomas, including ______ lymphoma
EBV
EBV induced
Burkitt
aspirin is an NSAID that ________ inhibits _______ via acetylation
irreversibly
COX 1 and 2
sickle cell can present with jaundice, lower back pain, extremity pain, and anemia. this results in ____ of the spleen due to repeated ________ infarcts
fibrosis and atrophy
splenic
sickle cell patients have increased __________ requirements due to high RBC turnover. THis can result in ________ anemia as well
folic acid
megaloblastic
industrial worker or child with weakness, cramping abdominal pain due to ________
peripheral blood smear will show
physical exam will show
lead poisoning
coarse basophilic stippling
blue lead lines on teeth and gingiva
carbon monoxide poisoning will ______ carboxyhemoglobin, but will have no effect on _______
increase
partial pressure oxygen
methemoglobin
PCR requires knowledge of the nucleotide sequence of the regions ______ the target exon
flanking
three most common cancer incidence in women are _______ respectively
three most common cancer death in women, respectively
Breast, Lung, colon
Lung, breast, colon
kid w/ hemolytic anemia, jaundice, splenomegaly, spherocytes (lack central zone of pallor) =
hereditary spherocytosis
sickle cell anemia experiencing aplastic crisis is due to infection of erythroid progenitor cells with _____, which is a nonenveloped ________ virus
parvovirus B19
ssDNA
t(14;18) is associated w/ ______ overexpression and _____ lymphoma
BCL2
follicular
anti RhD Ig administered usually at _____weeks
28
erythematous itch breast rash w/ skin texture of orange peel =
caused by cancerous cells ________ drainage
peu d orange, inflammatory breast cancer
obstructing lymphatic
HbF is composed of 2 ____ units and 2 ____ units
Adult hemoglobin is composed of 2 ____ and 2 _____
alpha
gamma
alpha
beta
cutaneous lymph from the umbilicus down, including the anus below the dentate line, drain to the ________ lymph nodes
exceptions are (2)
superficial inguinal
glans penis
posterior calf
t(15;17) is associated w/ ____ and is a translocation involving _______ and the PML gene
often presents with fatigue, easy bruising, and _____
APML
RARA
gum bleeding
methemoglobinemia causes a dusky discoloration of the skin similar to _____ when patients are exposed to high levels of _______ in labs. The partial pressure of oxygen in these patients is
cyanosis
nitrates
unchanged
sickle cell patients are functionally _______, which increases risk for infection by __________ and ________, which are encapsulated.
The most common cause of osteomyelitis in sickle cell patients is ______
asplenic
Strep pneumo
H influenza
Salmonella
weakness, fatigue, loss of expression of gene coding for protein on basolateral surface of hepatocytes and enterocytes that interacts w/ transferrin receptor
Disorder =
protein =
leads to =
inc risk of developing =
primary hemochromatosis
HFE protein, decreased hepcidin synthesis and DMT1 overexpression
Iron overload
liver cirrhosis and hepatocellular carcinoma
newborn with intracranial hemorrhage, “natural” newborn period, born on time w/o complications?
diagnosis if Vitamin K prophylaxis had been given ?
Vitamin K deficiency = impaired clotting factor carboxylation
abusive head trauma = subdural hemorrhage and ICB
monoclonal antibodies that block ______ and ______ help prevent T cell inhibition and promote T cell mediated destruction of tumor cells
used in?
PD-1 and CTLA-4
advanced melanoma
patient presents with abdominal pain, low hemoglobin, platelets, inc bilirubin, inc lactate dehydrogenase, low haptoglobin, mesenteric vein thrombosis, absence of CD55 on RBC =
gene =
renal =
paroxysmal nocturnal hemoglobinuria (complement mediated hemolytic anemai)
PIGA
hemosiderosis due to iron deposition
hepatocellular carcinoma can be caused by Hepatitis B which is _____ virus, or Hepatitis C which is a ______ virus
DNA
RNA
renal cortical cells sense _____ and release ____
hypoxia
EPO
Rituximab is a monoclonal AB directed against the _____ antigen and used in aggressive lymphomas
CD20
the C1 complement molecule binds to the ____ region of the ______ Ig chain in the region near the hinge point
Ig___ is a better activator of complement
Fc
Heavy
M
a reduced ability to relase oxygen within the peripheral tissues results in renal hypoxia and compensatory
erythrocytosis
family history of osteosarcomas, breast cancer, brain tumors, adrenal tumors, leukemias =
gene
Li Fraumeni
TP53, AD, TumorSuppressor
young, multiday history of nausea, constipation, severe, poorly localized abdominal pain, anxiety, difficulty concentrating, poor sleep, tingling of limbs, several similar episodes in past =
exacerbated by:
treated w/
due to downregulation of
urine
acute, intermittent porphyria
alcohol, drugs, or calorie restriction
IV heme preparation
Aminolevulinate synthase
port wine colored, PBG, ALA +
the binding of oxygen to hemoglobin drives the release of ____ and ___ from hemoglobin, called the Haldane effect. High concentrations of CO2 and H+ in peripheral tissues facilitates ______ from hemoglobin, called the Bohr effect
H+ and CO2
oxygen unloading
spleen acts as a blood filter capable of removig circulating encapsulated pathogens such as (3)
Strep Pneumo
H Influ
N. Meningitidis
rate limiting enzyme in pentose phosphate pathway
deficient =
interconversion of ribose 5 - phosphate and fructose 6 phosphate is mediated by
G6PD
no NADPH = hemolytic anemia
transketolase
baby african american boy with painful swelling in hands and feet =
due to
lab value
dactylitis
Sickle cell
low haptoglobin
pneumonia + sepsis can result in ______ which is benign leukocytosis (>50,000). Peripheral blood smear will show _____ bodies, which are light blue (______) peripheral granules in neutrophils
leukemoid reaction
Dohle
basophilic
chemotherapy that leads to rapid lysis of neoplastic cells can result in =
patients can be given ______ which protects normal organs by converting ______ into more soluble metabolites
tumor lysis syndrome
rasburicase or allopurinol
uric acid
the human mutli drug resistant gene ______ encodes for a _______ that is a transmembrane ATP dependent efflux pump and is responsible for preventing the action of various _________ agents
MDR1
glycoprotein
chemo
heparin increases the effect of the naturally occurring anticoagulant ______ by binding it and is used for prophylaxis against _____ in nonambulatory post operative patients. This drug, in LMW form is called ____
antithrombin III
DVT
enoxaparin
patients bleed, coagulation cascade active, PT and PTT prolonged, low fibrinogen and increased FDP =
not bleeding, only platelets activated, normal PT and PTT, normal fibrinogen
increased partial thromboplastin time, everything else normal =
DIC (gram neg. rod infection)
TTP- HUS (fever, neuro, acute renal failure, thrombocytopenia, and microangiopathic hemolytic anemia)
vWF disease
high peak gamma globulin region on serum protein electrophoresis w/ M protein =
presents w/
multiple myeloma
anemia, lytic bone lesions, renal insufficiency, hypercalcemia, amyloid deposition
HbS aggregates in a _____ state, low ____, and high ______ state
deoxygenated
pH
2.3 BPG
Mediterranean, mild anemia, microcytic, increased hemoglobin A2, hypochromia, poikilocytes (spherocytes + target cells), asymptomatic =
caused by mutations in
beta thalassemia minor
defective transcription, processing, and translation of betaglobin mRNA
young man, recurrent jaundice, pallor, icterus, mild splenomegaly no hepatomegaly or LAD, inc lactate dehydrogenase, low Hg, RBCs release hemoglobin in hypotonic solution w/ glycerol (osmotic fragility) =
treatment?
complications??
hereditary spherocytosis
splenectomy
pigmented gallstones, aplastic crises from parvovirus B19
CD4 virus
CD21 virus
Erythrocyte P antigen
HIV gp120
EBV gp 350
Parvovirus B19
glutamic acid to valine substition at position 6 in beta globin gene =
missense mutation
sickle cell
GAG to GTG in DNA strand
warfarin inhibits ______ which can lead to skin and fat necrosis seen in the first few days of warfarin therapy
protein C and S
high dose opioid treatments in metastatic cancer commonly require _______ and _____ in order to maintain bowel regularity
adequate fluid intake and daily laxatives
proliferation signals activate _____ which results in hyperphosphorylation of the _____ protein, inactivating it. When this protein is inactive, cells are allowed to transition from G1 to S, thus increasing activity of dihydrofolate reducatse and DNA polymerase
CDK4
Rb
new onset neurologic symptoms, hemolytic anemia w/ schistocytes, thrombocytopenia, acute kidney injury =
deficiency of ____ leads to large uncleaved cWF multimers
treat with
thrombotic thrombocytopenic purpura
ADAMTS13
plasma exchange therapy
metalloproteinases are zinc containing enzymes that _____ the _______ of the basement membrane, allowing tumor cell invasion
degrade
ECM
extramedullary hematopoiesis in a child causes a range of skeletal problems such as _______ and is due to ______ such as B thalassemia major
maxillary overgrowth (chipmunk facies)
chronic hemolytic anemia
large, binucleated cells w/ an owls eye appearance are called _____ cells and are diagnostic of _____
Reed Steinberg
Hodgkin lymphoma