Rx_3.3 (HemOnc)

Question 1

Presentation/dx criteria of multiple myeloma

Answer 1

• monoclonal plasma cell proliferation ==> serum myeloma protein (M protein)
  
  • ==> M spike on serum protein electrophoresis
• dx criteria
  
  • renal insuffiency
  • anemia
  • proteinuria <== Bence Jones’ protein = monoclonal light chains
    
    • urine dipstick neg. for albumin
  • bone pain/lytic bone lesions
  • hypercalcemia

Question 2

Schistosoma mansoni presentation

Answer 2

• parasitic fluke
• ==> fever, hepatosplenomegaly, peripheral eosinophilia
• suspect in person w/recent travel history to M. East, sub-saharan Africa, S. America + exp. to fresh water

Question 3

Characteristics of Babesia microti

Answer 3

• blood parasite ==> babesiosis = malaria-like illness
• ==> fever + hemolytic anemia (RBC lysing when parasites are released)

Question 4

Characteristics of Trichinella

Answer 4

• ==> muscle inflammation + periorbital edema
• comes from eating undercooked meat.

Question 5

CLL course/presentation

Answer 5

• pts. > 60
• usually asymptomatic
• ==> accumulation of immune incompetent mature B lymphs ==> hypogammaglobulinemia ==> risk for bacterial infection (reccurent)
• eventually ==> hepatosplenomegaly, lymphocytosis, and smudge cells

Question 6

Characteristics of ALL (acute lymphoblastic leukemia)

Answer 6

• B-ALL or T-ALL
• associated w/Down syndrome
• T-ALL ==> mediastinal mass
• Age < 15 yrs
• markers
  
  • TdT+ = premature T & B cells
  • CD10+ = pre-B cells only

Question 7

Cause of gray baby syndrome + presentation

Answer 7

• chloramphenicol
• sx
  
  • cyanotic
  • difficult to arouse
  • abdominal distention
  • hypotension

Question 8

Chloramphenicol: MOA, use, toxicity effects

Answer 8

• MOA: blocks peptidyltransferase @ 50S ribosomal subunit
• use
  
  • meningitis (H. flu, N. mening, S. pneumo)
  • Rickettsia
  • limited use due to toxicity, but still used in developing countries
• Toxicity
  
  • gray baby syndrome
    
    • preme infants that lack liver UDP-glucuronyl transferase
  • aplastic anemia
  • anemia

Question 9

Ototoxicity associated w/antibiotics

Answer 9

• aminoglycosides
• vancomycin

Question 10

Vincristine/vinblastine: toxicity

Answer 10

• vincristine
  
  • neurotoxicity
  • paralytic ileus
• vinblastine
  
  • “vinblastine blasts bone” = bone marrow suppression

Question 11

Peripheral smear in ALL

Answer 11

• lymphoblasts
  
  • cells w/large nuclei + condensed chromatin & scant cytoplasm

Question 12

Presentation of ALL

Answer 12

• abrupt onset of sx of bone marrow suppression
  
  • weakness & fatigue due to anemia
  • easy bleeding & petechiae due to thrombocytopenia
  • susc. to infection due to neutropenia
• fever

Question 13

Common sickle cell presentation

Answer 13

• african-american child
• ischemic pain secondary to vaso-occlusion in microvasculature
  
  • commonly limb/foot and abdomen
• ongoing autosplenectomy

Question 14

Tx for sickle cell dz

Answer 14

• hydroxyurea ==> increased fetal hemoglobin production in place of hemoglobin S
• ==> reduced chance of RBC sickling + complications
• used to reduce painful event and recurrence of acute chest syndrome
• in acute crisis, e.g. acute chest:
  
  • exchange transfusion w/fresh donor blood or plasma

Question 15

Characteristics of Ann Arbor staging of lymphoma

Answer 15

• I = single lymph node or single extralymphatic organ
• II == two sites on same side of diagram
• III = two sites on both sides of the diagram
• IV = disseminated disease
• A = w/out constitutional sx
• B = w/constitutional sx (fever, night sweats, weight loss)

Question 16

Pregnant woman w/vaginal bleeding + uterus larger than expected for gest. age + elevated serum B-hCG ==> dx?

Answer 16

• hydatidiform mole = cystic swelling of chorionic villi
• partial vs. complete
  
  • fertilization of egg that has lost chromosomes
  • fertilization by two sperm
  • partial = some fetal tissue, some norm. villi
  • complete = no fetal tissue, no norm. villi

Question 17

Risk with hydatidiform mole

Answer 17

• mole ==> choriocarcinoma w/out remobal

Question 18

Dx?

Answer 18

• auer rods
• AML (acute promyelocytic variant)

Question 19

Dx?

Answer 19

• Heinz bodies = denatured, precipitated hemoglobin
• seen @ alpha-thal & G6PD deficiency

Question 20

Dx?

Answer 20

• Howell-Jolly body = basophillic nuclear remnants found in RBCs
• seen @ patients w/asplenia or fxn hyposplenia

Question 21

Dx?

Answer 21

• Mallory bodies = intracytoplasmic eosinophilic inclusion
• seen @ alcoholic hepatitis

Question 22

Answer 22

• councilman bodies = apoptotic hepatocytes seen in various types of liver failure