Kaplan Heme/Lymph 1

Question 1

What condition are Birbeck granules associated with?

Answer 1

Langerhans cell histiocytosis (Histiocytosis X)

Question 2

What cancer is Philidelphia chromosome associated with?

Answer 2

Chronic myeloid leukemia (and occassionally acute lymphocytic leukemia

Question 3

what molecular marker is used to diagnose hairy cell leukemia?

Answer 3

tartrate-resistant acid phosphatase

Question 4

what hematologic disorder is associated with elevate leukocyte alkaline phosphatase

Answer 4

myeloid metaplasia

Question 5

explain the ristocetin test

Answer 5

ristocetin will only cause platelet agglutination in the presence of vWF so if you add it to blood and no agglutination occurs you can diagnose a deficiency of vWF

Question 6

why is desmopressin an effective treatment for vWF disease?

Answer 6

desmopressin triggers release of vWF from Weibel-Palade bodies of endothelial cells

Question 7

what do Reed Sternberg cells look like on histology and what disease are they associated with

Answer 7

“owl-eye”, bilobed “mirror-image” nucleus which may have a large nucleolus and clear halo around it
Hodgkin’s Lymphoma

Question 8

what component of the eosinophilic granules of an esosinophil is involved in parasite destruction

Answer 8

major basic protein

Question 9

what is chromium-51 used for

Answer 9

to measure RBC survival

Question 10

what processes are evidenced by decreased ESR

Answer 10

slower sedimentation and settling suggests sickle cell anemia (due to abnormal shape), polycythemia (many cells), CHF (mechanism unknown)

Question 11

what kind of pathogens would elicit a high neutrophil count on the CBC differential

Answer 11

extracellular bacteria and parasites

Question 12

what kind of pathogens would elicit a Th1 response

Answer 12

intracellular bacteria and viruses

Question 13

A patient presenting with headaches and fatigue who has a past medical history of alcohol abuse and nodular liver on X-ray is shown to have 68% Hct and reticulocytosis as well as nucleated red cells. What’s the likely diagnosis?

Answer 13

hepatocellular carcinoma

Question 14

what does DIC do to fibrin degredation products, PT, PTT and bleeding time

Answer 14

increases FDP (low platelets due to coagulation), increases PT, increases PTT and increases bleeding time

Question 15

what do ITP, TTP and HUS do to PT and PTT

Answer 15

nothing;
bleeding time is increased and platelet count decreased, but nothing happens to PT and PTT since coag factors aren’t involved

Question 16

celecoxib is contraindicated in patients with what general allergy

Answer 16

allergy to sulfa drugs

Question 17

of the three analgesics acetaminophen, NSAIDs and COX-2 inhibitors, which is safest for a patient with history of cardiovascular disease

Answer 17

acetaminophen;

NSAIDs and COX-2 inhibitors have cardiovascular toxicity risk

Question 18

what makes aspirin different from other NSAIDs

Answer 18

it is an irreversible cyclooxygenase inhibitor and it exerts more of its effects on COX-1 rather than COX-2

Question 19

what is the protein defect in hereditary spherocytosis

Answer 19

spectrin

Question 20

what are the weeks when fetal erythropoesis occurs in the four main organs that produce fetal blood

Answer 20

yolk sac (3-8 weeks)
liver (6 weeks-birth)
spleen (10-28 weeks)
bone marrow (18 weeks-adulthood)

Question 21

what marker is upregulated in hairy cell leukemia and what CBC findings would you see

Answer 21

tartrate-resistant acid phosphatase

hairy cell leukemia causes pancytopenia

Question 22

what disease are Birbeck granules associated with

Answer 22

Langerhans cell histiocytosis (histiocytosis X)

Question 23

a cell that is granular on H&E and has a metachromatic cytoplasm on Giemsa stain

Answer 23

mast cell

Question 24

what molecules do mast cells release

Answer 24

histamine, serotonin, platelet activating factor, leukotrienes

Question 25

lytic bone lesions and monoclonal kappa light chains in urine suggest what disease

Answer 25

multiple myeloma

Question 26

what are Schuffer dots and what genus and species of pathogen do they indicate

Answer 26

multiple, scattered brick-red dots;

Schuffer dots are found in erythrocytes infected with Plasmodium vivax or ovale

Question 27

which plasmodium species can cause relapse?

which of these is found in the Western hemisphere?

Answer 27

vivax and ovale;

vivax is found in the Western hemisphere

Question 28

in a patient for whom Auer rods are seen on blood smear, what treatment should be given

Answer 28

ATRA (all trans retinoic acid) to treat APML (AML type M3)

Question 29

if a patient present with an ovarian mass and on blood smear you observe many small lymphocytes with interspersed macrophages surrounded by clear spaces what oncogene is involved in the patient’s cancer

Answer 29

c-myc;

the smear described is the characteristic “starry sky” appearance of Burkitt lymphoma

Question 30

what are Heinz bodies made of

Answer 30

oxidized and denatured hemoglobin

Question 31

what’s the mnemonic for DiGeorge syndrome

Answer 31

CATCH-22: cardiac abnormalities, abnormal facies (low set ears and shortened philtrum), thymic aplasia, clef palate, hypocalcemia (due to absent parathyroid glands)
deletion on chromosome 22

Question 32

in a patient with psoriasis who has recently traveled to South America, what antimalarial would you use to treat

Answer 32

atovaquone-proguanil (not chloroquine because the patient came from a known resistant area and chloroquine exacerbates psoriasis symptoms)

Question 33

what does fibronectin do

Answer 33

fibronectin is a serum protein that acts as an opsonin for phagocytes in blood clots