uworld leukemia

Question 1

what is necesasrry for the diagnosis of TTP?

Answer 1

MAHA and thombocytopenia

Question 2

what’s the problem in b thalaseemia?

Answer 2

mrna formation

Question 3

pure red cell aplasia associated with?

Answer 3

when you lose red cells and nothing else.

thymoma, lymphocytic leukemias, parvovirus b19

Question 4

what happens after autosplenetomy in SS?

Answer 4

predisposed to infections

Question 5

sickle cell patient has macrocytic anemia now, why?

Answer 5

increased folate requirement

can happen in other hemolytic anemias too

Question 6

what is the mutation in polycythemia vera?

Answer 6

its with the jaks2 (cystplasmi tyrosine kinase) which phosphorylate the erythropeiten receptor and then the stats -> uncontrolled proliferation

Question 7

an alcohol man has a prolonged PT and wont even correct with witamin k, whats the problem?

Answer 7

f7 defiency because its the shortest half life and he has cirrhosis

Question 8

a woman has hypertension who is pregnant and you can see a hematoma, shes having a placental abruption. she then bleeds from her vagina, gums, IV sites. whats happening?

Answer 8

she has DIC from the release of tissue factor (thromboplastin) into circulation

amniotic fluid relase (embolism) into maternal circulation can also cause DIC but would have hypotensenion and shock, not hypertension

Question 9

which breast tumor marker means more agressive?

Answer 9

her2, but use the traztuzumab

estrogen/progesterone recetpro better

Question 10

who is at risk for lead poisoning?

Answer 10

industrial workers like miners

Question 11

a 4 year old boy dies of an overhwelming infection, erythroid cells are found in the liver and spleen, this indicates what?

Answer 11

chronic hemolysis, seen often in sever chronic hemolytic anemias, like beta thalsemmia

Question 12

a smoker has notived weight gain, easy brusing, and skin getting darker, he also has abdominal epigastric pain and HTN. he has a mass in his lung field. Whats the deal?

Answer 12

ACTH production by the mass in the lung

Question 13

a woman has a leukemoid reaction (increased LAP) what what you also see

Answer 13

dhole bodies in the neutrophils, which are basophilic oval inclusions in mature neutrophils

Question 14

a 30 yo man with a history of hiv has abdominal distention and anorexia, ct scan shows ascites and a large mass surrounding the small intesting. the mass has a high proliferatin fraction (ki-67 fraction) of > 99%. which infection is associated with the development of this condition?

Answer 14

EBV

this man has burkitt lymphoma

EBV is associated with 40% of immunodifiency derived burkitt lymphomas and nearly all of the endemic ones

Question 15

a 32 year old woman with dvts and pe has a normal ptt, add protein c and ptt still remains unchagned. whats up?

Answer 15

factor v leiden

Question 16

a 12 year old sickle boy dies. spleen is firm and brown, this is most likely due to?

Answer 16

vaso occlusion -> splenic infarctions -> evneutal autosplenectomy

brown is from the hemosiderosis from all the extravascular hemolysis

Question 17

a 3 day old baby has 99th percent head circunference, bulging anterior fontanelle, and downaward driven eyes. whats up?

Answer 17

vit k defiency, parents refused injection

causes intracranial hemmorhage (told in stem)

Question 18

whats the worst prognosis for colon cancer?

Answer 18

penetration into the mecularis mucosa (stage is more important than grade, which is what all the other choices were)

Question 19

an 8 year old boy has a one week history of fever and throat pain is brought to the ED with sever dyspnea, tachypnea, and inspiratory stridor. He has also been having dysphagia for solif food for two weeks. he has?

Answer 19

t all

Question 20

a man dies of hepatocellulae carcinoma, all the cells of his liver have dna fragments integrated into their DNA. whats is it?

Answer 20

HBV which once integrated can continue to synthesise oncogenic genes like HBx that inactivate p53 tumor supressor

Question 21

a 41 year old previously healthy woman has weakness and fatigue. She has epistaxis and mucosal pallowshe has?

Answer 21

aml, just thought it was a good description

Question 22

decreased activity of what gene would increase risk of many cancers?

Answer 22

p53 because it is a tumor suppresor! only option that was a supressor

Question 23

a boy after a dental extraction has bleeding. what to treat with?

Answer 23

thrombin, you had to assume he had a hemophilia

he cant make the the thrombin so just give it to him

Question 24

question about lab value in HUD

Answer 24

said you would see elevated indirect bilirubin and LDH

Question 25

a woman has muscle weakness, weight loss, subjective fevers, and occasional abdominal discomfort. A photo is shown with nodular lesions on her hands. what is this associated with?

Answer 25

overian adenocarcinoma

she has dermatomyositis, similar to polymyosits but with additional skin findings

you get proximal muscle weakness, grotton’s papules, heliotrope rash around eye lids and permysial infiltrate on biopsy

can occur alone or as paraneoplastic syndrome

Question 26

a 60 year old hhad a valve replacement due and has helmet cells and burr cells…..

Answer 26

mechanical trauma

Question 27

blc2 normally inhibits?

Answer 27

cell death cascade

Question 28

g6pd answer?

Answer 28

heriditary enzyme deficiency

Question 29

man with aortic valve replacement and helmet cells, wat lab value?

Answer 29

decreased haptoglobin

Question 30

hematopoesis of the myeloid lineage

Answer 30

myeloid prognitor -> myeloblast, promyelocyte (almost always a malignancy when seen in peripheral smear) -> myelocyte, metamyelocyte (can sometimes be seen in leukemoid reaction) -> band and NEBs (both can normally be seen in peripheral blood smear

Question 31

tumor invasion process

Answer 31

1. detach from each other by decreased expression of e-cadherins
2. adhere to the basement membrane with laminins
3. invade the basement membrane with metalloproteinases

Question 32

42 year old man has fever and persistent sore throat, bruises on his trunk. blood oozing from IV catheters.

Answer 32

aml

Question 33

a person with heriditary sperhocytosis is at risk for?

Answer 33

pigmented gallstones because extravscula hemolysis

also showed ldh

Question 34

a man has chronic pancreatitis from being an alchy, whats the problem with his macrocytic cells?

Answer 34

impaired thymidine synthesis (an purine)

could be from folate or b12

Question 35

a man with colon cancer is expressing egfr, an inhibitor is used, what would make ineffective?

Answer 35

kras mutation

Question 36

a man with polycythemia vera with ruddy complexion, what is causing?

Answer 36

increased bone marrow sensitivity to growth factors

Question 37

dysplasia is?

Answer 37

reversible

Question 38

a man devlops dic from n minigitidis what would u see on smear?

Answer 38

schistocytes

Question 39

a man with bladder (transitional cell/urothelial) cancer and what would be the most imortant prognostic factor?

Answer 39

the stage, if it has involved the muscular layer of the bladder

Question 40

warfarin skin necrosis is related to?

Answer 40

underlying protein c or s deficiecny

Question 41

a man with multiple bouts of fever and sore throat depsite antibiotic therapies, bruises easily and feels run down has?

Answer 41

aml

Question 42

what would you see in the renal biposy of a man with paroxysmal nocturnall hemoglobinuria?

Answer 42

hemosiderosis

Question 43

what two key factors are most important in granulation tissue and neoplastic tissue to create bllood vessels?

Answer 43

vegf and fribroblast growth factor

Question 44

a 6 year old kid has B all, what is it?

Answer 44

a neoplasm of precursos b cells

Question 45

what does c myc do?

Answer 45

its a transcription activator

Question 46

a person has iron deficiency and is treated with iron and several weeks later on peripheral you see enlarged RBCs that appear blue on wright giemsa stain. the bluish color is due to?

Answer 46

ribosomal RNA

Question 47

can TTP have renal involvement?

Answer 47

yes

Question 48

mono sighn?

Answer 48

petechial of the palat

Question 49

family history of lots of tumors?

Answer 49

tp53 which is responsible for le fraumeni

Question 50

iron deficiency in older men or post menopausual women?

Answer 50

think gi malagnancy

Question 51

sepsis can be caused by?

Answer 51

gram - endotoxin or gram + (eg peptidoglycans and lipoteichoic acids)