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Heme/Onc by Minnie: AH Update > SAS/Review > Flashcards

SAS/Review Flashcards

1
Q

What do pathologist look at when they are grading a lymphoma?

What do they look at for staging?

A
  • Grading
    • Look at the cell morphology
    • Cell size, atypia, mitosis
  • Staging
    • Bone marrow biopsy
    • ​Look at tumor and clinical features
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2
Q

How long does it take for Warfarin to have an anticoagulant effect?

A

At least 5 days (may be longer)

Warfarin affects the synthesis of clotting factors, so need to wait for existing ones to die off before there is an effect

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3
Q

What is the difference between a proto-ocogene and an oncogene?

A
  • Proto-oncogene
    • A gene that promotes normal cell growth, that is under regulatory control
  • Oncogene
    • Promotes cell growth in cancer cells - NOT under regulatory control
    • Proto-oncogenes that lose their regulation (ex: by being translocated to a different spot) become oncogenes
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4
Q

A patient with 3 months of fatigue, fever, night sweats, and painless cervical lymphadenopathy has her lymph node biopsied.

What is the histological finding and cell of origin indicated by the arrow?

A

Reed-Sternberg cell

Cell of origin = B cell

Seen in Hodgkin Lymphoma

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5
Q

List 2 things that caues hepcidin levels to increase

List 1 thing that causes hepcidin levels to decrease

A

Increases with infection, inflammation

Decreases with iron deficiency

Hepcidin decreases iron absorption from the gut

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6
Q

What is the next diagnostic step for any abnormal finding on breast imaging (mammogram)?

A

Biopsy

Even if no other concerns for malignancy, need to biopsy

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7
Q

What kind of cell is this?

A

Neutrophil

But abnromal because too many lobes

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8
Q

List 2 things that increase a patient’s risk of delayed hemolytic transfusion reaction

A
  • Previous pregnancies
  • Previous blood transfusion

Basically, exposure to another person’s blood (even if the same type)

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9
Q

What cell has the following immunohistochemical markers?

CD3+

CD45+

A

T cell

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10
Q

Which type of cancer is most strongly associated with environmental exposures like aniline dyes?

A

Transitional cell carcinoma of the bladder

Vs. squamous cell, which is more associated with inflammation

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11
Q

How will hemolysis affect reticulocyte count?

A

Hemolysis will increase reticulocyte count

  • The body will try to make more cells to replace the ones that are dying -> increased reticulocytes*
  • If reticulocyte count is inappropriately low, indicates there is a problem with erythropoiesis*
  • Will be low in aplastic anemia, megaloblastic anemia, iron deficiency, ALL*
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12
Q

List 4 conditions that would result in schistocyte formation

A

DIC

TTP

Cardiac valve dysfunction

HELLP

  • All have microangiopathic hemolytic anemia -> schistocytes*
  • Note: autoimmune hemolytic anemia -> spherocytes*
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13
Q

What are the symptoms of SVC syndrome?

A
  • Facial plethora
  • Dilated collateral veins along the chest
  • Extremity edema
  • Headaches due to vascular congestion
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14
Q

Which hematologic malignancy has the best prognosis?

A

Childhood ALL

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15
Q

Which malignancy is associated with HTLV1?

A

Adult T-lymphocyte leukemia

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16
Q

Which subdividion of AML is the most curable?

A

Acute Promyelocytic Leukemia

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17
Q

Which translocation results in expression of BCL2?

Which hematologic malignancy is this associated with?

A

t(14;18)

Follicular lymphoma

Overexpression of BCL-2 = resistance to apoptosis in germinal centers

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18
Q

List the 3 stages (and their characteristics) of the natural history of CML

A
  • Chronic phase
    • Leukocytosis
    • Left shift
    • Basophilia
  • Accelerated phase
    • Progressive splenomegaly
    • Basophilia
    • Thromobcytosis/thrombocytopenia
    • More blasts
  • Blast phase
    • Acute leukemia (myeloid, lymphoid, or bi-phenotpyic)
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19
Q

The platelet glycoprotein 1b receptor binds to…

A

Von Willebrand Factor

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20
Q

Describe the general treatment approach for a patient with stage III (muscle invasive) gastric cancer

A
  • Neoadjuvant chemo
    • Goal is to downstage the tumor
  • Surgical resection
  • Adjuvant chemo if any lymph nodes are involved
    • Goal is to serilize the surgical field, decrease local recurrence

Note: in this scenario, radiation can be given after surgery WITH chemo, if pt did not have chemo before; radiation is only used alone for palliative sx control

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21
Q

What is the reversal agent for heparin?

A

Protamine sulfate

Also works for unfractionated heparin

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22
Q

What are the two malignancies associated with this histological finding?

(Just the picture)

Which one is most likely, given that schistocytes are present?

A

Auer Rods

  • Acute mylogenous leukemia
    • Especially Acute promylocytic leukemia - most likely dx with schistocytes
    • APL is a subtype of AML
  • Chronic mylogenous leukemia (sometimes)

Auer rods are only seein in cells of myloid origin, and they are always malignant

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23
Q

What labs will help you distinguish between a clotting factor deficiency vs. inhibitor?

A

Mixing study

Mix pt blood with normal plasma

  • If PT/PTT improves, pt is deficient
  • If PT/PTT do not improve, pt has an inhibitor
    • The inhibitor/antibody/whatever in the pts blood binds to the normal factors in the plasma, thus inactivating them
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24
Q

What is the appropriate managment for a patient with hemochromatosis who also has low hemoglobin?

A

Iron chelator

If normal hemoglobin, do phlebotomy

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25
Q

How does hepcidin affect iron metabolism…

  • In the gut?
  • In the body?
A

Hepcidin…

  • Decreases iron absorption from the gut
  • Slows iron transport out of hepatocytes and macrophages

More hepcidin = less usable iron

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26
Q

What hematopologic malignancy is associated with the following immunohistochemical markers?

CD19+

TdT+

A

B-Cell Lymphoid Leukeimia (B-ALL)

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27
Q

What treatment should you give for a patient wtih a Factor VIII inhibitor who is actively bleeding?

A

Activated prothrombin complex concentration

  • Bypasses need for other clotting factors*
  • Plasmapheresis or clotting factor concentrates won’t work bc the inhibitor will inactivate them*
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28
Q

What is the disease-defining translocation of acute promyelocytic leukemia?

A

t(15;17)

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29
Q

How do anti-PD-1 antibodies work to treat cancer?

A

If a tumor expresses PDL-1, it can bind to PD-1 (the receptor) on a T-cells, thus inactivating the T cell

  • An anti-PDL-1 antibody will bind to PD-L1, preventing it from binding to its receptor on the T cell
  • This allows the T-cell to become activated against the tumor cell
  • Signal to activate the T cell: MCH on tumor binds T-cell receptor AND tumor B7 binds CD23*
  • Note: CTLA-4 can get in the way of co-stimulation, so blocking this -> even more T cell activation*
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30
Q

Which virus is associated with nasopharyngeal carcinoma?

A

Ebstein Barr Virus

EBV also associated with: Burkitt’s Lymphoma, lymphoproliferative disese in post-transplant setting

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31
Q

Describe the presentation of acute promyelocytic leukemia

A
  • Young patinet
  • Low blood counts
  • Bleeding/bruising (could be intracranial bleed)
  • DIC
    • Elevated D-dimer, PT, PTT
  • t(15;17) translocation is diagnostic*
  • Treat emergently with all-trans retinoid acid (don’t wait for cytology)*
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32
Q

For breast cancer, is more aggressive surgery (ex: mastectomy instead of lumpectomy) associated with better outcomes?

A

No!

Standard of care now is to do lumpectomy with sentinal LN dissection; only do full axillary LN dissection if there is evidence of spread

In general, there are just more side effects (but not better outcomes) with more aggressive surgery

33
Q

List 2 patient populations that are at an increased risk of aplastic crisis after a parvovirus B-19 infection

A

People with chronic hemolytic anemias (Sickle cell)

People who are immunosuppressed (HIV)

34
Q

What is the mechanism of transfusion related lung injury?

A

Antibodies in the transfused blood attack the pt’s white blood cells (especially in the lung)

-> Fever, chills, shortness of breath, hypoxia

35
Q

What is the normal percentage of cells in bone marrow?

A

100 - pt age

The rest should be fat

  • Ex: a 20 year old pt will have 80% cells in their bone marrow*
  • Less is concerning for aplastic anemia*
36
Q

In a patient with newly diagnosed breast cancer, what are the indications for genetic testing?

A

Pt is young (≤ 50)

Extensive family hx of breast cancer (especially dx at a young age)

But always test tumor markers (ex: ER, PR, HER2)

37
Q

What is the most significant toxicity associated with doxorubicin?

A

Cardiomyopathy

38
Q

What kind of lymphoma is this?

A

Follicular lymphoma

39
Q

Describe the diagnostic criteria for antiphospholipid antibody syndrome

A

At least 1 clinical criteria and 1 laboratory criteria

  • Clinical
    • Vascular thormbosis
    • Pregnancy morbidity
  • Laboratory
  • (must be present on 2+ occasions, at least 12 weeks apart)*
    • Lupus anticoagulant
    • Anticardiolipin antibody (IgG or IgM, med-high titer)
    • Anti-Beta2-Glycoprotein I antibody (IgG or IgM, high titer)
40
Q

Which ancillary studies require fresh tissue?

A

Cytogenetics

Flow cytometry

If fresh tisuse is not available, can still do FISH, Molecular analysis, immunohistochemistry

41
Q

In follicular lymphoma, which of the following is more concerning?

  1. A singular, small, high-grade lesion
  2. Several diffuse low-grade lesions
A

a. A singular, small, high-grade lesion

Tumor grade is more importnat than spread in evaluating follicular lymphoma

High grade = bad :(

42
Q

A patient with small cell lung cancer complains of weight gain and facial puffiness.

What paraneoplastic syndrome does she most likely have?

A

Excess ACTH

Expect poor wound healing, thin skin, easy bruising, striae, other signs of too much cortisol

43
Q

After chemotherapy, when do you expect white counts to be the lowest?

A

7 days after chemo

44
Q

What cell has the following immunohistochemical markers?

CD 138+

Cytoplasmic Ig

A

Plasma cell

45
Q

Which lymph nodes are most commonly involved in Classic Hodgkin Lymphoma?

A

Cervical

Mediastinal also common

46
Q

List 4 malignancies associated with EBV

A
  • Hodgkin’s lymphoma
  • Burkitt’s Lymphoma (non-Hodgkin)
  • Nasopharyngeal carcinoma
  • Lymphoproliferative disease in post-transplant setting
47
Q

Which type of lung cancer is most likely to occur in nonsmokers?

A

Adenocarcinoma

Bronchogenic and bronchioalveolar?

Can occur in smokers and nonsmokers

Squamous, small cell, and large cell are all strongly assoicated with smoking

48
Q

What is the treatment for a patinet with DVT who also has heparin-induced thrombocytopenia?

A

Direct thrombin inhibitor (IV administration)

  • Normal tx for DVT is heparin (or LMWH)*
  • If pt has HIT, heparin will not help - use direct thrombin inhibitor*
49
Q

What pathogen is associated with gastric carcinoma?

A

H. Pylori

50
Q

What is the next diagnostic step in an adult patient who present with anemia and occult blood in the stool?

A

Colonoscopy

Note: at this point it would be a dianostic test (not a screening test) since there are sx of something wrong

51
Q

Reed-Sternberg cells:

  • Histological markers (3):
  • Associated malignancy:
A
  • Histological markers: CD30+, CD15+
    • ​CD30 and CD15 are specific
  • Associated malignancy: Hodgkin Lymphoma
  • Hodgkin Lymphoma is a B cell lymphoma, but mising some B cell markers (CD20-, CD45-)*
  • Note: Most common nodular sclerosing type is CD20-, but less common nodular lymphocytic type is CD20+*
  • Thank you @Will Schwartz!*
52
Q

What is the most likely diagnosis for this patient?

Most likely clinical manifestation?

A

Hereditary eliptocytosis

-> intermittent hemolysis

53
Q

What blood type should be given to patients with unknown blood type requiring emergent transfustion?

A

O negative

54
Q

What is the most common symptom of a pancoast tumor in its early stages?

A

Sharp shoulder pain

As the tumor grows, can radiate toward the armpit, shoulder blade, and scapula, cause Horner’s syndrome

Invades the thoracic inlet

55
Q

What is the next diagnostic step for a patient with symptoms of nerve impingement in the left arm, chronic cough, Horner’s syndrome, and a 40 pack/year smoking history?

A

MRI of the neck

Will be able to see the specific nerve impingement

56
Q

Chronic Myeloid Leukemia can progress to which two other malignanies?

A

B-cell Lymphoblastic Leukemia* (aka ALL of the B cell)

Acute Mylogenous Leukemia

*Strange that it can go from myeloid -> lymphoid malignancy but apparently it happens

57
Q

How do you reverse Warfarin?

A

Vitamin K

And maybe

Fresh frozen plasma or Clotting factor concentrate

  • Vitamin K stops warfarin for inhibiting VKOR; but takes time to work*
  • If pt is actively bleeding, give FFP or clotting factors in addition*
58
Q

Are these lymphoid or myeloid cells?

A

Lymphoid

59
Q

A patient presents with the following:

  • Fever
  • Confusion
  • Severe thrombocytopenia
  • Mild anemia
  • Schistocytes on peripheral blood smear
  • Normal D-dimer

What is the most likely diagnosis?

Appropriate treatment?

A

TTP

Treat emergently with plasmapheresis

60
Q

Which viruses (2) are associated with HCC?

A

HBV, HCV

61
Q

What is the difference in presentation between febrile nonhemolytic transfusion reaction and transfusion-related acute lung injury?

A

Transfusion-related acute lung injury will have shortness of breath and hypoxia

  • Febrile nonhemolytic transfusion reaction will not have hypoxia
62
Q

Which chemotherapy agent (that we’ve talked about) is most likely to cause heart issues?

A

Doxorubicin (an anthracycline)

Also trastuzumab

63
Q

List 3 chromosomal abnromalities that may be present in patinet with therapy-related MDS (t-MDS)

A
  • Loss of a portion of chromosome 5
  • Loss of a portion of chromosome 7
  • 11q23 translocation
    • Associatied with topoisomerase inhibiors specifically

t-MDS can be seen in pts who have received chemotherapy or radiation

64
Q

Which malignancies (3) are associated with EBV?

A
  • Hodgkin lymphoma
  • Burkitt lymphoma (type of NHL)
  • Nasophryngeal carcinoma
65
Q

What is the next diagnostic step for any patient with a low platelet count?

A

Review the peripheral blood smear

66
Q

Which hematopoietic malignancy would show these markers:

  • CD10+
  • CD19+
  • CD3-
A

B-cell ALL (B-cell lymphoblastic leukemia)

67
Q

Which hemolytic anemia results spherocyte formation (vs. schistocytes)?

A

Autoimmune hemolytic anemia

68
Q

What is the mechanism that causes heparin-induced thrombocytopenia?

A

Immune response to heparin

  • Body forms immune complex
  • Results in platelet activation

Note - not all antibodies will result in platelet activation and HIT

69
Q

In general, what is the treatment approach to non-metasatic gastric cancer?

A

Goal = cure

  • Neoadjuvant chemo
    • Goal is to downstage the tumor
  • Then surgery
    • Goal is to remove all or as much as possible
  • Then more chemo
    • Goal is to eliminate micro-metastatic disease
70
Q

What is the (pathophysiologic) cause of idiopathic TTP?

A

ADAMTS13 deficiency

  • Supposed to cleave and inactivate vWF
  • Without ADAMTS13, vWF goes nuts, causing thrombi everywehre
  • Fever, CNS confusion, low platelets, schistocytes present, normal D-dimer*
  • Treat emergently with plasmapheresis*
71
Q

What B-cell lineage is associatd with classic Hodgkin Lymphoma?

A

PAX5+

72
Q

In which phase(s) of the cell cycle does doxorubicin work?

A

Any!

Doxorubicin is not cell-cycle specific

Doxorubicin is an anthracycline - it keeps coming up that it causes cardiotoxicity

73
Q

Are these lymphoid or myeloid cells?

A

Myeloid

74
Q

Which marker will always be present in AML?

A

MPO+

May also have CD13+, CD33+

Will never have B cell markers like CD19

75
Q

What might cause a patinet with G6PD deficiency to have normal G6PD levels?

A

Acute attack

  • If a pt is presenting with hemolysis after TMP-SMX anda peripheral smear with bite cells, but normal G6PD levels, they still most likely have G6PD*
  • Confirm by testing G6PD levels after the acute attack is over*
76
Q

Will somebody with Vitamin B12 deficiency have an increased LDH?

A

Yes

(Not sure why, suggest an edit if you can explain!)

77
Q

How does Factor V Leiden mutation affect the coagulation cascade?

(Effect and mechanism)

A

Increased risk of venous thrombosis

  • Factor V Leiden mutation makes Factor Va resistant to inactivation by Protein C
  • It also sucks at helping Protein C inactivate Factor VIIIa
  • Result is increased coagulability, which manifests as increased risk of DVT

Some increased risk of arterial thrombosis in some cases (CAD), but DVT is more important to remember

78
Q

What conditions are associated with hypersegmented neutrophils?

A

Megaloblastic anemias

(more than 4 lobes)

Heme/Onc by Minnie: AH Update (36 decks)

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