Thursday Wk 2 Heme 1

Question 1

__ is dz w sore throat, malaise, LAD, myalgia, splenomegaly, fever
caused by __ virus
infects B cells by binding __ cell surface receptor
__ T cells become activated to kill the virus
on smear, have abundant __ w cell membrane that __ to neighboring cells

CD4 t cells are much __

CD14 is cell marker for M/M
LPS binds to stimulate __

Answer 1

Mono
EBV
CD21
CD8
cytoplasm, conforms

reduced

monos/macros
macrophages

Question 2

Most women cancers are B__ and L__ and C__
L__ is numbr 1 killer, followed by __

__ is necessary for synthesis of NA, conversion of homocysteine to methionine, and one carbon carriers
all in form of T__ from DHFR

Thymidilate __ converts dUMP to dTMP
most enzymes require folate as __, this enzyme needs D__
particularly susceptible to low __ states

w/out TS, dUMP builds up, resulting in __ breaks and apoptosis
adding __ to mediate stops this proccess

Answer 2

breast, lung, colon
lung, breast

folate
tetrahydrofolate
synthase
THF, dihydrofolate
folate

DNA

Question 3

severe anemia following febrile illness in sickle cell pt w low reticulocytes indicates __ viral infection

describes __ crisis, as erythroid precursors are destroyed
less reticulocytes to replace __
virus is N__ and __DNA

EBV is E__ ds__ virus
HepE is n__ ss__+
HIV is E__ ssRNA__

enveloped ssRNA viruses include Orthomyoxyvirus like I, paramyoxyvirs like M/M and Rhabdovirus R

nonenveloped dsDNA viruses include A, P, P

Answer 3

parvoB19

aplastic
erythrocytes

nonenveloped, ssDNA

enveloped, DNA
nonenveloped, RNA
enveloped, +

influenza
measles, mumps, rabies

adenovirus, polyomavirus, papillomavirus

Question 4

pt w HIV is at high risk for __ viral infection
may result in EBV assc lymphomas like B, and P

Warfarin is eliminated by __ system in the liver
can be __ which upregulates metabolism
may also interact w C__ in intestine, reducing its therapeutic effect

Avoid warfarin and A__ as it inhibits p450 metabolism

Answer 4

EBV
burkitt lymphoma, primary CNS lymphoma

p450
upregulated
cholestyramine

amiodarone

Question 5

Rhesus antigen is __ on RBC surface
__ antigen is most immunogenic
when Rh neg mother has __ fetus, fetal RBC enter maternal circ and lead to prodxn of IgG antibody
w subsequent preg, Rh pos fetus are at risk for H___

to prevent, mothers are given __ at 28w gestation and postpartum
these antibodies bind __ fetal RBC for sequestration/elimination by the spleen

Anti-A/B antibodies are __ class

Answer 5

transmembrane protein
D
RH pos
hemolytic dz of newborn

Anti-D IgG
Rh pos

IgM

Question 6

SCD is AR disorder w DNA point __ mutation
changes glutamic acid to __ at codon 6

__ is myeloproliferative dz of hematopoeitic stem cells
mutation is __ involving JAK2
presents w __ RBC mass, inc plasma __ and low __
inc ___, thrmobosis, peptic ulceration or __
patient appears __ and ruddy
dx w low __ levels
tx w ___

Answer 6

missense
valine

PCV
J617F
inc, volue, EPO
platelts, pruritis
red
EPO
phlebotomy

Question 7

Relative polcythemia develops from D/D
plasma volume is __, everything else norma

Secondary polycythemia
Physiologic hypox has inc RBC __ and __ level, SaO2 is __

EPO producing tumor has high __ and ___ mass
other values __

Answer 7

dehydration, diuresis
dec

mass, EPO, low

EPO, rbc
normal

Question 8

Hemolytic dz of newborn aka E__
occurs in RH __ mother w rh __ child

positive __ test
profound A/J/K
hydrops __ present w edema
immature, nucleated __ and persistent extramedullary hematopoeisis in the /

Answer 8

erythroblastosis fetalis
neg, pos

coombs
anemia, jaundice, kernicterus
fetalis
RBC
liver/spleen

Question 9

Microcytic, hypochromic anemia in pt of mediterranean descent is B thal __
inc Hb __ conc
DNA mutation impairs trxn, P__ and trnsl of beta globin mRNA
leads to aberrant mRNA __ and chain termination
beta globin is deficient, w normal Hb and __ chains
inc formation of Hb __ and __

when alpha chain tetramers form, they __ and reduce membrane stability

Answer 9

minor
A2
processing
splicing
alpha
A2 and F

precipitate

Question 10

Peau d orange rash has __ skin tht is often itchy
skin is firm and __
w breast edema, likely indicates __ breast carcinoma
cancer cells obstruct __ drainage

Noninvasive BC
DCIS has __ necrosis, is pre__ and confined to __/__
Paget dz has __ lesion, w extension of DCIS into __

Answer 10

red
coarse
inflammatory
lymphatic

central, cancerous, duct/lobules

eczematous, ducts

Question 11

Invasive BC
Ductal carcinoma made of N and cords

Loblar carcinoma is small cells in __
mammary __ invaded

AA pt w recurrent episodes of ab pain that resolve w hydration, low Hct is __
sx of __ w vasoocclusive crisis of pulm vasculature
preceded by pulm __

in pt w HbS, occlusion results in splenic __
spleen shrinks and becomes __
over time, auto__ occurs and spleen becomes brown (hemosiderin) due to ingestion of RBC by splenic __ (__ hemolysis)

Answer 11

nests

single file
stroma

SCA
ACS
infection

infarct
fibrotic

splenectomy
macros
extravascular

Question 12

Unfractionated/LMH used for __ in surgeries
inc effect of __, which inhibits factor __ and thrombin
LMWH act on factor __ alone

Direct thrombin inhibs stop __ mediated fibrin formation
L/A used for HIT
D used for DVT prophylaxis

C/T inhibit ADP mediated platelet aggregation for unstable angina/nonSTEMI

Answer 12

DVT prophylaxis
AT3, Xa
Xa

thrombin
Lepirudin, argatroban
Dabigatran

Clopidigrel, ticlopidine

Question 13

use __ sulfate for heparin overdose
binds heparin, rendering no __ activity

__ is used for warfarin overdose
requires synthesis of __
takes time, so w life threatening hemorrhage, give __ instead
PCC__ contain VK dependent factors and can be used to tx bleeding

Answer 13

Protamine
anticoag

Vk
new factors
FFP
prothrobin complex concentrates

Question 14

G6PD inherited \_\_
causes hemolytic anemia w \_\_ stressors
pathognomonic \_\_ cells
G6PD part of \_\_ pathway
generates reducing agent \_\_
if no NADPH, reduced glutatione remains oxidized resulting in susceptibility of \_\_to injury

Glutathionine __ catalyzes reduction of oxidized glutathione
absence presents w __ sx

Answer 14

XLR
oxidative
bite
PP
NADPH
RBC

reductase
similar

Question 15

majority of cell cycle is spent in __
composed of __ for RNA/prot/lipid/carb synth
S for __ synthesis
G2 for __ synthesis

Rb is active in the __ form
when active, allows cell __ through cycle
assc w many __
found on chromo __

__ heparin is most likely to cause HIT
use direct thrombin inhibs H/L/A
stop heparin __

Glycoprotein 2B3A inhibs A, E, T

Answer 15

interphase
G1
DNA
ATP

hypophosphorylated
progression
cancers
13

unfractionated
hepirudin, lepirudin, argatroban

abciximab, eptifibatide, tirofiban

Question 16

PNH has mutation in __ gene
dec __ anchor proteins
helps attach cell surface proteins like __ and __
absence leads to complement mediated __

pt has J/F due to hemolytic anemia
hemoglobinuria and T__ at atypical sites, _cytopenia

chronic hemolysis w breakdown of RBC leads to __ in kidney
impairs __ fxn w interstitial scarring
inc risk of __

Answer 16

PICA
GPI
CD55, MAC
hemolysis

jaundice, fatigue
thrombosis, pan

iron overload
PT
Chronic kidney disease

Question 17

nucleolus is primary site for __ trxn
RNA poly 1 transcribes __ pre rRNA, processed into 18S, 5.8s, and 28 rRNA
thus it is restricted to __

nucleolus also fxns in maturation/assembly of __ subunis
protein components made in __ and transported to nucleolus
regulation occurs via controlling number of __ genes
process is altered in __

Answer 17

rRNA
45s
nucleolus

ribosomal
cytoplasm
active genes
malignany

Question 18

RNA poly 2 produces m__, s__ and M__
micro RNA causes gene __ via translation arrest/degredation

RNA poly 3 forms t__ and 5s rRNA
5s is essential component for __ subunit

Answer 18

mRNA, snRNA, microRNA
silencing

tRNA
60s

Question 19

Whole blood is mixed w __ anticoagulant to form packed RBC
when given in large quantity to pt, can chelate Ca w resulting __
Packed RBC usually lose __ to serum, resulting in hyperkalemia

Answer 19

citrate
hypoca
potassium

Question 20

pt w fever, oozing from IV, low fibrinogen and immature myeloids has __ w APL
look for promyelocytes w __

classic presentation is bleeding in setting of __, consumptive coag w low __ levels, inc fibrin __ products, inc PT/PTT, and low __

referred to as AML __

inversion 16 assc w M4Eo __ subtype of AML

Answer 20

DIC
auer rod

DIC, fibrinogen, degredation, platelet

M3

eosinophilic

Question 21

Keratin staining is marker for __ origin
Endothelium identified w stain for __ and __ factor

extent of tumor expansion determines __ of tumor
degree of differentiation determines __
such as w D__, A__ and __ figures

if tumor is confined to __ survival is high
if spread is __, less likely for survival

Answer 21

epithelial
CD34, vWf

stage
grade
differentiation, aneuploidy, mitotic

mucosa
further

Question 22

Familial E__ assc w B globin mutation w reduced binding of 23BPG
binds to dexoxy pocket in __ chains
lowers Hb affinity for O2, allowing for diffusion into __
binding pocket has __ charged AA, attracting __ groups on 23BPG
mutation results in inc Hb __ affinity

Fetal Hb is composed of __
does not bind __, this O2 affinity is much higher

Hb __ forms hexagonal crystals and results in red cell __ w chronic hemolytic anemia

Answer 22

erythrocytosis
B globin
peripheral tissues
pos, neg
O2

A2G2
23BPG

C, dehydration

Question 23

admin folate to B12 def pt can worsen __ and cause abnormal myelin __
depletes conc of __ cobalamin available, leading to development of neuro sx

Folate overdose antagonizes P__ leading to seizures

endemic Burkitt lymphoma presents w __ mass
assc w __ infection
t is __, assc w inc __ exp
starry sky appearance w macros and __ in sea of medium sized lymphs

Answer 23

demyelination, synthesis
methylated

phenytoin

jaw
EBV
8, 14, cMYC
apoptotic bodies

Question 24

Follicular lymphoma assc w __ translocation
overexpressed __
General LAD and affects __

young pt w fver, pharyngitis, LAD think __ as dx
atypical lymphs have abundant __ and lack bizarre __ differentiating it from ca
assc w __ and __ lymphoma and as well as __ carcinma

short segments of newly synthesized DNA on lagging strand are called __ fragments

Answer 24

14, 18
BCL2
elderly

IM
cytoplasm, nueli
Hodkin, NH, nasopharyngeal

Okazaki

Question 25

Unfractionated heparin is __ than LMW heparin
thus it can inhibit both _ and __, w more inactivation

tPA can only bind plasminogen in presence of __
thus, action is __ specific

Protein __/__ are depleted first w warfarin therapy
bridge pt w __ to prevent procoag state

Answer 25

larger
Xa and thrombin

fibrin
clot

C/S
heparin

Question 26

vomiting reflex controlled by __ in 4th ventricle w a CTZ
NTS in medulla receives info from AP, __ tract via vagus nerve, V__ system and CNS
NTS then projects to medullary nuclei to control __

5 major receptors __ musc, __ dopaminergic, __ histiaminic, __ Serotonin, and __ neurokin

5HT3 antags O/G/D prevent __ induced vomiting
block __ mediated N/V and block central __ in AP

NK 1 antags A also useful in chemo induced emeses
inhibit __ to prevent acute/delayed vomiting

D2 antags M also useful
se include D/D

Answer 26

AP
gi, vestibular
vomiting

M1, D2, H1, 5HT3, NK1

Odansetron, ganisetron, dolasetron
vagus, serotonin

Aprepitant
Substance P

Metoclopramide
dizzy, dystonic

Question 27

antimuscarinics S
Antihistamines D/M/P used for __ sickness and hyperemesis __

blasts in peripheral blood suggest __
ALL is most common in young __ up to YA

sx include F, Fatigue, P, P and bone pain
can see LAD, HSM
__ ALL more likely to cause thymic mass and SVC syndrome
can compress __ w dysphagia
or trachea w __

B/T cells both contain __
__ cells contain CD10, 19, 20
__ cells contain CD2-5, 7, 8

Answer 27

scopolamine
diphenhydramine, meclizine, promethazne
motion, gravidarum

leukemia
male

pallor, petechiae
T cell
esophagus
stridor

TdT
B
T

Question 28

acute megakaryoblastic leukemia seen in down syndrome pt w translocation __

Follicular lymphoma composed of __ small cleaved cells
typically pack __ and obscure normal architecture

__ inguinal LN found over the femoral triangle
drains cutaneous lymph from __ down
include __ genitalia and __ below dentate line
exception is __ penis and skin on posterior __ which go to deep inguinal LN

Answer 28

1, 22

centrocytes
follicles

superficial
umbilicus
external, anus
glans, calf

Question 29

pt w NSCLC __ may have a EML-4ALK mutation
inversion of short arm chromo __ that creates a fusion
results in constituitely active __ similar to CML
can tx w C__ Protein kinase inhib

other mutations in adenocarcinoma are E and K

Answer 29

adenocarcinoma
2
tyrosine kinase
crizotinb

EGFR, KRAS

Question 30

G6PD is rate limiting step of __
transforms G6P to 6-__
generates NADH and __
pathway necessary to make __ and protecting RBC against oxidative damage

adult w brain tumor showing necrosis, surrounded by tumor cells (pseudopalasading necrosis) has __
often see __ at periphery
arise from __

Cyst formation and rare mitoses indicates __ cyst in 3rd ventricle

Reticulin deposit and inflam infiltrates indicates __ xanthoastrocytoma

__ have whorled pattern of growth/Psammoma bodies

Answer 30

PPP
phosphogluconate
R5P
glutathione

GBM
capillaries
astrocytes

colloid

pleomorphic

meningiomas

Question 31

_ is AD disorder of heme sytnehsis w deficiency in \_\_ deaminase
pt presents w GI and \_\_ sx
key feature is \_\_ urine that darkens w light/air
tx by inhibiting \_\_
usually upregulated by all p450 \_\_
down regulated by \_\_/\_\_
avoid A/S
tx w \_\_ admin and \_\_ loading

DVT arises due to virchow triad of __ injury, venous __ and __ state

Answer 31

AIP
PBG
neuropsych
red urine
ALAS
inducers
heme, glucose
alcohol, smoking
heme, carbohydrate

endothelial, stasis, hypercoagulable

Question 32

Sickle cell anemia results in Hb molecules that aggregate in __ cx
sickle w low __,inc __ or D__
cannot pass through microvasculature, resulting in micro__ and painful __ crises

organs w slow blood movement S/L have less O2
organs w high metabolic demands B/H/P extracts lots of blood

also occurs w high levels of __ promoting the T state of deoxygenation

Answer 32

anoxic
O2, acidicity, dehydration
infarcts, vasoocclusive

spleen, liver
brain, heart, placenta

23BPG