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Hematology > Week 5 + Week 6 > Flashcards

Week 5 + Week 6 Flashcards

1
Q

Lab Tests:

  • for TB
  • for HIV
  • for Syphilis
  • For Lupus
A
  • for TB = PPD
  • for HIV = ELISA
  • for Syphilis = RPR
  • For Lupus = ANA
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2
Q

Left vs Right axillary drainage + clinical significance

A

Right = only drains upper right side therefore cannot have any malignancy from the legs, colon, neck, etc.

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3
Q

Lymph Node Biopsy: 3 Variables

- Note: do AFTER labs.

A
  • abnormal chest x-ray
  • Size > 2 cm
  • ENT symptoms: Dysphagia, etc.
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4
Q

Lymph Node Groin

A

May see single lymph node in women w/ subclinical UTI

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5
Q

Secondary Lymphatic Organs

- 6 different ones

A
  • Lymph Nodes
  • Tonsil Lymphoid Tissue
  • Spleen
  • Peyer’s Patches
  • Skin
  • MALT
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6
Q

Thymus produce _______ (endocrine function)

A

Thymosin

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7
Q

Areas of communication between Superficial and Deep Lymphatics

A
  • Inguinal, Axillary, Cervical.
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8
Q

F(x) of lacteals

A

Lymphatic capillaries that absorb ingested fats: located in villi of small intestine

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9
Q

Right vs Left Lymphatic Drainage

A

Right: Right lymphatic duct => Right subclavian vein
Left: Thoracic Duct => Left subclavian vein

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10
Q

Venous vs Lymphatic Edema

- Presence of Ulcers

A

Venous Source

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11
Q

Venous vs Lymphatic Edema

- Pitting Edema

A

Venous Source

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12
Q

Venous vs Lymphatic Edema

- Non Pitting Edema

A

Lymphatic Source

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13
Q

Venous vs Lymphatic Edema

- Stemmer’s Sign

A

Lymphatic Source: Inability to pinch together skin over dorsal aspect of 2nd toe (kind of related to the non pitting aspect of lymphatic)

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14
Q

Lymphedema: Primary

- 3 different types + Ages

A
  • Congenital: Young
  • Praecox = presents after birth but before 35 yo
  • Tarde (like “Tardy”) = Appears after 35 yo
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15
Q

Lymphedema: Secondary type

- Filariasis

A
  • 90% caused by wuchereria bancrofti (parasitic filarial nematode)
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16
Q

Lymphangitis:

- Description + Most likely agent

A
  • Infectious process spreading along lymphatic channels from site of origin
  • Often caused by Group A strep.
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17
Q

Bursa of Fabricus (primary in ____)

  • Definition
  • Human equivalent (2ndary in humans)
A
  • Derived from the cloaca of birds where the stem cells are induced to mature into B lymphocytes
  • In humans: GALT (Tonsils, Peyers Patches of the Ileum, Appendix.
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18
Q

Histology of primary vs secondary lymphoid organs

A
  • Primary = no reticular fibers

- Secondary = rich in reticular fibers, reticulo-endothelial cells.

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19
Q

Thymus:

  • Function of Thymic Corpusules
  • Aka…
A
  • AKA Hassal’s Corpuscles, unkbown function but they increase with age.
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20
Q

Lymph Node:

- Diffuse Cortex

A

Diffuse: Predominantly by T-lymphocytes

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21
Q

Lymph Node:

- Nodule

A

Nodules: B-Lymphocyte Zones = humoral immunity (esp germinal centers)
- B cells => Plasma => Ig => Tagging Ag => complement

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22
Q

B cell: Non-Hodkin Lymphomas

- ALL = ______ B cell

A
  • Stem Cell
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23
Q

B cell: Non-Hodkin Lymphomas

- Burkitt = ______ B cell

A
  • Immature
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24
Q

B cell: Non-Hodkin Lymphomas

- CLL/SLL = ______ B cell (Chronic Lymphocyte Leukemia/Small Lymphocytic Lymphoma = same)

A
  • Pre-antigen exposure
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25
Q

B cell: Non-Hodkin Lymphomas

- Myeloma = ______ B cell

A
  • Antibody producing B-Cell
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26
Q

__________ Lymphoma has increased risk of herpes zoster infections.

A

-Hodkin’s Lymphoma

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27
Q

“Fish-Flesh”

A

Description of Lymph Node Pathology in Hodgkin’s disease

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28
Q

Staging of Hodgkin’s Disease (Stage I - IV)

A
  • Stage I: 1 Lymph Node
  • Stage II: 2+ lymph nodes on SAME side of Diaphragm
  • Stage III: Lymph nodes on both sides of the diaphragm, including spleen.
  • Stage IV: Multiple or disseminated foci of involvement of one or more extralymphatic organs w/ or w/o lymphatic involvement.
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29
Q

Sarcoidosis: Multisystemic (most common areas)

- Caseating or Non-caseating

A

Lungs + Lymph Nodes (L + L)

- Non-caseating!

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30
Q

Red Flag Descriptions for Sarcoidosis (3)

A
  • Potato Nodes on Chest X-ray (Hilar Lymphadenopathy)
  • Asteroid Bodies (star shaped crystals) + Schaumann Bodies (calcified lamellar structures) = Histology

Note: Spontaneous Recovery

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31
Q

Ehrlichia Chaffeensis + Anaplasma Phagocytophilum

  • Species (+ remember sketchymicro)
  • Transmission via..
A
  • Rickettsia Species
  • Ehrlichia Chaffeensis = Lone Star Tick (main reservoir = white tailed deer)
  • Anaplasma Phagocytophilum = Black legged ticks like Babesia and Borrelia (hence likely co-infection)
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32
Q

Francisella Tularensis

- Disease Types (2)

A
  • Oculograndular tularemia

- Oropharyngeal tularensis: Exudative pharyngitis and cervical lymphadenopathy

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33
Q

yersinia pestis: Virulence Factor (2)

A
  • F1 Capsule: Protects against phagocytosis

- Yops protein: Type III Secretion!

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34
Q

Post bath pruritus indicate __________

A

Polycythemia rubra vera (Note, due to basophils and mast cells secreting histamine)

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35
Q

Malaria: __________ invade(s) only young red blood cells + severity of symptoms.

A
  • P. vivax and P. ovale only invade young RBCs.

- Hemolytic anemia does occur, may be severe.

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36
Q

Malaria: __________ invade(s) cells of all ages + severity of symptoms.

A
  • Both P. Malariae and P. falciparum invade red cell of all ages.
  • P. Malariae = Very mild symptoms
  • P. Falciparum = severe symptoms
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37
Q

Risk of splenic rupture: Prominent splenomegaly

A

Infectious mononucleosis

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38
Q

Patient takes ampicillin or amoxicillin and develops a maculopapular rash. This patient has ________ disease

A

kissing disease = infectious mononucleosis

- Also has cervical lymphadenopathy.

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39
Q

Thrombosis of the hepatic vein is called __________ and causes ______________

A

1) Budd-Chiari Syndrome = Cirrhosis, hepatosplenomegaly, collateral veins, jaundice, ascites.

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40
Q

Deficiency of glucocerebrosidase is called ________. Possible ______ and _______ symptoms

A

Guacher’s Disease; anemia and thrombocytopenia

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41
Q

________ leads to build up of shingomyelin due to lack of _______ leading to mainly ___________

A
  • Niemen-pick
  • sphingomyelinase
  • thrombocytopenia.
42
Q

Spleen develops from __________ and begins it’s development in the ______________

A
  • Dorsal mesentery

- Dorsal mesogastrium

43
Q

Dorsal mesogastrium rotates ________ which includes ________ ligament.

A
  • Laterally

- leinorenal (spleno-renal)

44
Q

Anterior mesogastrium rotates __________ which includes __________ ligament.

A
  • Medially

- gastro-splenic

45
Q

spleen is a(n) _____peritroneal structure

A

-intraperitoneal

46
Q

Splenorenal ligament contains _________ and _________

A
  • splenic vessels + tail of pancreas
47
Q

gastrosplenic ligament contains ________ and _________

A
  • short gastric vessels + left gastro-epiploic branches of splenic artery.
48
Q

portal triad contains these 3 structures

A
  • Hepatic artery, hepatic portal vein, and bile duct.
49
Q

Branches of celiac axis to know (3)

A
  • left gastric artery, hepatic artery, and splenic artery.

- Note: Splenic artery raises from the celiac axis, RIGHT of the midline. (relative to what?)

50
Q

Distributed Splenic Artery vs Bundled Splenic Artery

A
  • Distributed = prefers partial splenectomy (difficult to do complete splenectomy)
  • Bundled = easier to do complete splenectomy
51
Q

Occlusion of this branch may cause pancreatitis

A

Pancreatica magna = most important aberrant branch

52
Q

Splenic artery branches

A
  • Superior terminal = short gastric vessels
  • Medial terminal = hilum of the spleen
  • Inferior terminal = left gastroepiploic artery
53
Q

Function of Marginal Zone

A
  • Area between Red and White Pulp

- Directs old RBCs to the Red Pulp and Blood antigens to White Pulp.

54
Q

SMV (Superior mesenteric vein) drains blood from __________, _________ and empties into the____________

A
  • Right colon up to the middle portion of tranverse colon

- hepatic portal vein

55
Q

IMV (Inferior mesenteric vein) drains blood from ________, ________, _______ and anastomose with ______

A
  • Large bowel, splenic flexure, and descending colon

- splenic vein then returns blood back into the hepatic portal vein.

56
Q

Splenic plexus consists of _____, _______, and ______

A
  • branches of celiac plexus, left celiac ganglion, and the right vagus nerve.
57
Q

Splenic plexus accompanies the __________

A

splenic artery

58
Q

Splenic plexus are mainly _________

A

sympathetic + uses norepinephrine

59
Q

The following embryological structure(s) recanalize during portal hypertension:

A
  • Round ligament of the liver (ligamentum teres): formally umbilical veins. (this is the one he emphasized.)
  • Technically any venous structure can serve as collateral pathway such as epigastric veins etc.
60
Q

3 Immunizations needed before splenectomy: think encapsulated

A
  • Haemophilus Influenza (type B)
  • Meningococcus (serogroup C)
  • Polyvalent pneumococcal vaccine)

Note: Haemophilus influenza is a bacterium but the influenza vaccine is caused by a virus therefore you should recommend the annual viral vaccine to splenectomized patient.

61
Q

OPSI: Symptoms of _____, _____, and ______

A

Septic Shock, DIC, and Multiple Organ Failure

62
Q

OPSI: Highest risk in _______ and ____ years out of splenectomy. Most worried about the bug, _______.

A

Children and 2 years out of splenectomy. Most worried about Strep pneumonia.
- Also H. influenzae type B, Strep Type B, and Staph Aureus

63
Q

Breakdown of RBCs: Hemoglobin breaks down into ____, ____, and _____.

A

Biliverdin, carbon monoxide, and Ferrous iron 2+.

64
Q

Follicular B cells vs Marginal Zone B cells

- Results in terms of antibodies

A
  • Follicular B cells => protein antigen + helper T cells => germinal center reaction => Isotype-switching therefore IgG, IgA, and IgE. (Long lived plasma cells)
  • Marginal Zone B cells => Mainly IgM, short lived plasma cells
65
Q

“Onion Skin”

A
  • Reactive Splenomegaly: Systemic Lupus

Note: Technically also seen in Tay Sachs disease

66
Q

Hand-Schuller-Christian Disease: Splenomegaly scheme
- Pathogenesis + Triad of disease

(Type of Langerhan Cell Histiocytosis)

A
  • malignant proliferation of Langerhan Cells: 2-5 yo kids
  • Triad: Radiolucent lesions of the skull, Diabetes Insipidus, Exophthalmos
  • Other Sx: Deafness
67
Q

Litterer-Siwe Disease (Not as important as Hand-Schuller-Christian Disease it seems like)
- Part of Splenomegaly scheme

(Type of Langerhan Cell Histiocytosis)

A
  • Sx: hemorrhagic skin lesions are common. Massive hepatosplenomegaly, + progressive bone marrow involvement (typical symptoms of -penias)
68
Q

Birbeck Granules

A
  • Racquet shaped tubular structure

Histologic Features of Langerhan Cell Histiocytosis (Eosinophilic Granuloma, Hand-Schuller-Christian Disease, and Litterer-Siwe Diease)

Necessary for Dx.

69
Q

Eosinophilic Granuloma Sx.

- (Type of Langerhan Cell Histiocytosis)

A
  • solitary or multiple. Can see lytic lesions on the skull/vertebrae.
  • accounts for 70% of LCH cases, eventual recovery but bone lesion may have to be curetteted.
70
Q

Hx of Benzene exposure or previous radiation exposure is a clue for __________. Can see _____ in blood smear

A

Myelofibrosis, tear drop cells.

71
Q

Dx: for Infectious Mono

A

Monospot Test = heterophile antibodies that cross reacts with and agglutinates sheep or horse RBCs.

72
Q

Presentation of Enlargement of tongue points towards _________

A

Amyloidosis: Usually a lot of different organs involved.

73
Q

Diagnosis of Amyloidosis:

A

Congo Red Stain + Apple Green color birefringence.

74
Q

Amyloid is made of ______ and ______ arranged in ________

A

95% fibrillar proteins
5% glycoproteins
beta-pleated sheets

75
Q

AL Amyloid vs AA Amyloid

A

L = Light Chain while AA = Amyloid A.

  • AL Amyloid formed by neoplastic B cells via cancerous source
  • AA Amyloid is derived from the liver via reaction to infection, inflammations, neoplasms, or IV drug use.
76
Q

Most common cause of death in amyloidosis patients

A

Renal failure = glomerulus shows large eosinophilic pale spheres with total obliteration = non-selective proteinurea.

77
Q

Virchow’s Triad

A
  • Venous Stasis
  • Hypercoaguable State
  • Vascular injury
78
Q

Most common acquired thromophilia + strong correlation w/ pregnancy loss

A

Antiphospholipid antibody syndrome

79
Q

Work up for Possible Clot (2 assessments)

A
  • Venous Compression Ultrasound = Rule out DVT
  • D-dimer assays = sensitive but not specific for thrombosis, therefore more of a screening test. Negative assay helps rule out but positive test does not rule in.
80
Q

Serological (laboratory work up) is done after ____________ because _________

A
  • Done post acute thrombotic event because active thrombosis may alter level of some proteins.
81
Q

Vasoconstricters released during vascular spasm

A

Endothelin-1 + Thromboxane A2

82
Q

Vasodilators released during vascular spasm

A

PGI2 and NO

83
Q

the “troponin” of the blood vessels is _______ which activates _______

A

Excitation-contraction coupling

- calmodulin, Ca2+ binds to it, myosin light chain kinase

84
Q

__________ stops the cross-bridge cycling

A

Myosin phosphatase

85
Q

_____ state is the reason why tension can be maintained without ATP use.

A

Latch State

86
Q

Serum is plasma minus ________

A

clotting factors

87
Q

Plasma proteins consist of _______, ______, and _______

A

Albumin, Globulins, and Fibrinogen

88
Q

Last area of electrophoresis where circulating antibodies form

A

gammaglobulin (which includes circulating antibodies)

89
Q

Platelet granules contain _______, a potent vasoconstrictor

A

Serotonin

90
Q

Aspirin MOA

A

Block COX-1 which interferes with TXA2 production

91
Q

Vorapaxar MOA

A

Blocks thrombin receptor (PAR-1)

92
Q

Abciximab, tirofiban, eptifibitide MOA

A

Blocks IIb/IIIa receptor (fibrinogen receptor)

93
Q

Clopidogrel MOA

A

Blocks ADP receptor (P2Y12)

94
Q

Prothrombinase complex is composed of:

A

Calcium, Xa, Va, Prothrombin (II). => output: Thrombin IIa

95
Q

Initiation of coagulation pathway is inhibited by _________

A

TFPI: Tissue Factor Pathway Inhibitor

96
Q

Amplification of coagulation factors is due to ______ which goes and effects _____ and ______

A
  • Thrombin Burst (IIa) => XIIIa, and fibrinogen.
97
Q

Fibrinolysis inhibitors are ______ and _______. While it is activated by ________

A
  • PAI (Plasminogen activator inhibitor) and Alpha 2-antiplasmin
  • tPA
98
Q

Antiphospholipid antibody syndrome (autoimmune, therefore seen with other autoimmune diseases like SLE)

  • Definition
  • Inherited type vs acquired type
A
  • Definition: Autoantibodies directed against numerous negatively charged phospholipids
  • Inherited Type = coagulation on VENOUS SIDE
  • Acquired Type = coagulation on ARTERIAL + VENOUS SIDE
99
Q

During the Initiation and Priming stage, Thrombin affects activation of ______, ________, _______, and ______

A

5a, 8a, 9a, and platelet activation

100
Q

Thrombin Burst = amplification of ______ and _______

A

Fibrin + XIIIa.

Hematology (7 decks)

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