Wright (Guest Lecturer) Flashcards
1
Q
what are the 3 types of CBC
A
- CBC w. no differential
- CBC w. automatic differential
- CBC .w manual differential
2
Q
on a CBC, total WBC is the summation of
A
- segs (neutrophils)
- lymphocytes
- monocytes
- eosinophils
- basophils
3
Q
the most numerous WBC on a normal CBC is
A
segs (neutrophils)
4
Q
hematocrit should be __ x the value of hgb
A
3
5
Q
what value on a CBC represents the actual count of cells
A
absolute
6
Q
what are 2 components of a bone marrow aspiration
A
- molecular genetics
- flow cytometry
7
Q
which test represents all cells and give you information about cell constitution
A
bone marrow bx
8
Q
bone marrow aspiration involves the removal of
A
bone marrow fluid
9
Q
bone bx involves the removal of
A
a small amt of bone w. marrow inside of it
10
Q
what is hematopoiesis
A
the production of blood cells and platelets w.in the bone marrow
11
Q
what are the 2 types of stem cells
A
- myeloid
- lymphoid
12
Q
what is the average lifespan of a platelet
A
8-10 days
13
Q
where are old platelets destroyed
A
spleen and liver
14
Q
what is erythropoietin
A
hormone that increases production of RBCs
15
Q
erythropoietin is released in response to
A
low O2
16
Q
erythropoietin is produced in the
A
kidneys
liver
17
Q
megakaryoblasts become megakaryocytes, which give rise to
A
platelets
18
Q
hematocytoblasts become proerythroblasts, which give rise to
A
reticulocytes → become erythrocyte in 1-2 days
19
Q
what 2 nutrients are needed in order for reticulocytes to mature into erythrocytes
A
- B9 (folic acid)
- B12
20
Q
what is leukopoiesis
A
the formation of WBC
21
Q
what are the 5 malignant disorders of hematopoiesis
A
- leukemia
- lymphoma
- myeloma
- myelodysplastic syndrome
- aplastic anemia
22
Q
what are 5 non-malignant disorders of hematopoiesis
A
- nutritional deficiencies
- autoimmune disorders
- infectious etiology
- DIC
- TTP
- hypersplenism
23
Q
what are the 6 myeloproliferative disorders
A
- AML
- CML
- myeloma
- essential thrombocythemia
- polycythemia vera
- myelofibrosis
24
Q
what are the 4 lymphoproliferative disorders
A
- ALL
- CLL
- multiple myeloma
- lymphoma
25
what are the 3 most common malignant blood disorders
1. leukemia → neoplastic cells in blood stream
2. lymphoma → neoplastic cells in lymph
3. myeloma → neoplastic plasma cells
26
leukemia is divided into what 2 categories
acute vs chronic
27
acute leukemia is composed of what type of cells
blast cells
28
chronic leukemia is composed of what type of cells
mature precursor cells
29
both acute and chronic leukemias can be
\_\_ or
\_\_ in origin
lymphoid
or myeloid
30
what are the 4 types of leukemia
1. AML
2. ALL
3. CML
4. CLL
31
list 3 risk factors for leukemia
1. XRT exposure
2. chemo exposure
3. benzene exposure → 2nd hand smoke, plastics, pesticides etc
32
list 3 lab values characteristic of leukemia
1. leukocytosis → monocytes and lymphocytes
2. pancytopenia
3. hypogammaglobulinemia
33
list 3 common symptoms of leukemia
1. bone pain
2. LAD
3. splenomegaly
34
chronic leukemia is often diagnosed \_\_
incidentally
35
what test is a must have for leukemia dx
bone marrow bx
36
besides bone marrow bx, what is another test that is helpful in evaluation of leukemia
flow cytometry
37
what is the most common leukemia in adults
AML
38
what is the must have lab finding for AML
blasts \> 20%
39
what type of leukemia do you think of when you see Auer rods
AML
40
is AML curable?
yes
*but it is lethal w.in weeks-months if untreated*
41
what do you think of when you see \>20% blasts and Auer rods
AML
42
name 3 complications of AML
1. anemia
2. infxn
3. bleeding
43
stem cell transplant, bone marrow transplant, and hematopoietic cell transplantation (HCT) are all
SAME SAME!
*thought you'd like that Heather ;)*
44
what tx is administered prior to a stem cell transplant
very high dose chemo '
*to kill all cells, including bone marrow cells*
45
autologous stem cell transplant involves cells from
your own body
46
allogenic stem cells involve cells from
someone else
47
which type of stem cell transplant represents your best chance for remission
autologous
48
how does systemic racism affect stem cell transplantation
most of the database is white → better outcomes for white people
49
what is the most common childhood malignancy
ALL
50
what comorbidity increases incidence of ALL in peds
Down's syndrome
51
most cases of ALL involve __ cell lineage
B
52
what type of cell will pathology show in ALL
blasts
53
if you see a question about a kid with cancer on the boards, what condition do they have
ALL
54
is ALL curable?
yes
55
ALL has a high risk for long term complications due to
high doses of chemo needed to treat
56
list 4 favorable prognostic factors for ALL
1. hyperdiploid → \>50 chromosomes/cell)
2. 2-10 yo
3. CD 10+
4. low WBC count
57
list 4 poor prognostic factors for ALL
1. hypodiploid
2. \< 2 yo or \> 10 yo
3. male
4. high WBC → \> 100,999 cells/ul
58
what type of immunotherapy targets CD-19 antigens
CAR-T therapy
59
what type of genetically modified cells does CAR-T therapy use
autologous T cells
60
what serious complication can CAR-T therapy cause
cytokine release encephalopathy syndrome
61
when is CAR-T therapy indicated
in a patient who has failed other therapies
usually 2nd or third line therapy for relapsed patients
62
what condition do you think of when you see Philadelphia chromosomes and BCR/ABLT genes
CML
63
CML involves uncontrolled proliferation of
mature/maturing granulocytes
64
what are the 3 phases of CML
1. chronic
2. accelerated
3. acute → blast crisis
65
what is the cure for CML
stem cell transplant
66
what would be the most appropriate therapy for an older patient with CML
oral chemo
*stem cell transplant poses risk and mortality*
67
what type of leukemia is characterized by progressive accumulation of incompetent lymphocytes
CLL
68
what are 2 other names for CLL
1. SLL (small lymphocytic lymphoma)
2. non-Hodgkin lymphoma SLL
69
what condition do you think of when you see gingerbread appearance and smudge cells
CLL
70
CLL will have a lymphocyte count \>
5,000
71
is CLL curable
no
72
stem cell transplants in CLL are
rarely done
*increased risk for mortality*
73
what are 5 indications for active dz and tx in CLL
1. progressive marrow failure
2. progressive or massive splenomegaly
3. progressive or symptomatic LAD
4. progressive lymphocytosis
5. constitutional symptoms
74
name 4 constitutional symptoms in active CLL
1. fatigue
2. night sweats
3. unintentional wt loss
4. fevers
75
lymphoma involves malignant neoplasms derived from (5)
1. B cell progenitors
2. T cell progenitors
3. mature B cells
4. mature T cells
5. NK cells
76
name 5 lab findings of lymphoma
1. hypercalcemia
2. hyperuricemia
3. elevated LDH
4. anemia
5. thrombocytopenia
6. neutropenia
77
what are 2 PE findings associated w. lymphoma
1. splenomegaly
2. LAD
78
constitutional symptoms in lymphoma are also called \_\_
B symptoms
79
what are 4 B (constitutional symptoms) in lymphoma
1. fever
2. night sweats
3. unintentional wt loss
4. fatigue
80
what is the only differentiating factor between hodgkin and nonhodgkin lymphoma
Reed Sternberg cells
81
which type of lymphoma is characterized by the presence of Reed Sternberg cells
Hodgkin
82
the majority of lymphomas are
non-Hodgkin
83
there are many types of non-hodgkin lymphomas, divided into \_\_
and \_\_;
both types have __ and
\_\_ types
divided into: B cell and T cell
both types have: indolent (lazy) and aggressive types
84
what condition do you think of when you see, painless cervical adenopathy, generalized pruritis, and pain in lymph nodes w. etoh consumption
hodgkin lymphoma
85
only __ of hodgkin lymphoma pt's have constitutional symptoms
⅓
86
what is the most common presenting symptom in hodgkin lymphoma
painless cervical adenopathy of supraclavicular or infraclavicular nodes
87
what is the neoplastic cell in hodgkin lymphoma
Reed Sternberg cell
88
what are the 4 aggressive non hodgkin lymphomas
1. diffuse large B cell (DLBCL)
2. burkitt
3. mantle cell
4. peripheral T cell
89
what is the most common lymphoma worldwide
diffuse large B cell lymphoma (DLBC)
90
extranodal involvement in hodgkin lymphoma is \_\_,
extranodal involvement in DLBC is \_\_
rare in hodgkin
common in DLBC
91
what is the main presenting symptom of DLBC
rapidly enlarging symptomatic mass on the neck or abdomen
92
over half of DLBC patients will have elevated
LDH
93
DLBC is __ and has a
\_\_ prognosis
aggressive
poor
94
what is the 2nd most common type of non-hodgkin lymphoma
follicular lymphoma
95
what is the 2nd most common type of non-hodgkin lymphoma
follicular lymphoma
96
follicular lymphoma is characterized by painless ___ adenopathy in what 4 regions
peripheral
cervical, axillary, inguinal, femoral
97
follicular lymphoma is indolent, so is extranodal involvement common?
no → it's lazy
98
what patient population does Burkitt lymphoma make you think of
HIV (+)
99
Burkitt lymphoma is a highly aggressive __ cell neoplasm
B
100
what is the typical presenting symptom of Burkitt lymphoma
abdominal or retroperitoneal mass
101
what complication is common in Burkitt lymphoma
tumor lysis syndrome
102
what condition do you think of when you see nuclear staining for cyclin D1
mantle cell lymphoma
103
mantle cell lymphoma can involve any region of the
GI tract
104
what lymphoma is frequently caused by chronic gastritis from H.pylori infxns
marginal zone lymphoma (MALT)
105
MALT commonly arises in ___ tissues of the \_\_\_
epithelial
stomach
106
dx of MALT is done using __ instead of a bx
endoscopy
107
lymphoplasmacytic lymphoma is same-same
waldenstrom macroglobulinemia
108
what do you think of when you see smudge cells, IgM monoclonal gammopathy and Raynaud
lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia)
109
non-hodgkin lymphoma involves __ groups of lymph nodes
discontinuous
110
what are the 3 most common sites of LAD in non-hodgkin lymphoma
neck
inguinal
axillary
111
what % of non-hodgkin lymphoma patients have constitutional symptoms
20
112
what dz do you think of when you see plasma cell proliferation and older pt population (mean 66 yo)
multiple myeloma
113
in multiple myeloma, excess plasma production in the bone marrow can cause (3)
osteolytic lesions
osteopenia
pathologic fx
114
what condition do you think of when you see anemia, elevated creatinine, and hypercalcemia
multiple myeloma
115
what UPEP finding is pathopneumonic for multiple myeloma
bence jones proteins
116
what do you see on SPEP evaluation of multiple myeloma
M-spike
117
what do you think of when you see punched out lytic lesions on imaging
multiple myeloma
118
what are the 3 variation of multiple myeloma in order of least to most aggressive
1. MGUS
2. smoldering myeloma
3. myeloma w. amyloidosis
119
which variation of multiple myeloma has a very poor prognosis
myeloma w. amyloidosis
120
what are the 2 gold standard diagnostic tests for multiple myeloma
1. bone marrow bx showing 10% or higher plasma cells
2. presence of end organ damage (CRAB)
→ **must have both for dx**
121
what does CRAB stand for
hypercalcemia
renal insufficiency
anemia
bone lesions
→ end organ damage of MM
122
is multiple myeloma a curable malignancy
no
w.o effective therapy, symptomatic pt's die w.in median of 6 months
123
what do you call a group of malignant hematopoietic stem cell disorders characterized by dysplastic and ineffective blood cell production
myelodysplastic syndrome (MDS)
124
myelodysplastic syndrome (MDS) is characterized by one or all of what 3 lab findings
anemia
thrombocytopenia
leukopenia
125
myelodysplastic syndrome (MDS) can progress to what dz
AML
126
MDS must have __ % blasts, or it is
diagnosed as \_\_
20%
AML
127
what are the 4 steps of hemostasis
1. endothelial injury → platelet plug formation
2. propagation of clotting by coagulation cascade
3. termination of clotting by antithrombotic mechanisms
4. removal of clot by fibrinolysis
128
disorders of hemostasis are categorized into
primary
secondary
129
primary hemostasis disorders involve problems with __ function
platelet
130
primary disorders of hemostasis often present with
mucocutaneous bleeding or petechiae
131
secondary disorders of hemostasis involve problems with the
coagulation cascade
132
secondary disorders of hemostasis usually present with (2)
deep tissue hematomas
joint bleeding
133
what are 3 mechanisms of primary hemostasis
1. increased destruction of platelets
2. decreased production of platelets
3. platelet dysfxn
134
disorders involving increased destruction of platelets can be divided into (3)
1. immune mediated
2. thrombotic microangiography (TMA)
3. disseminated intravascular coagulation (DIC)
135
name 3 conditions of immune mediated increased destruction of platelets
1. immune thrombocytopenic purpura (ITP)
2. heparin induced thrombocytopenia (HIT)
3. thrombocytic thrombocytopenic purpura (TTP)
136
ITP is divided into
primary → autoimmune
secondary → infectious dz
137
what condition do you think of when you see petechiae, purpura, and bleeding
ITP
138
what are the 3 stages of ITP
1. newly diagnosed → \<3 months
2. persistent → 3-12 mo
3. chronic → \> 12 mo
139
what drug is used to tx persistent ITP
steroids
140
what is a norma platelet count
140,000
141
at what platelet count do you see spontaneous bleeding in ITP pt's
10,000 or below
142
a lower platelet count of __ is not less concerning in ITP,
whereas normally you are concerned when platelets reach \_\_
80,000
130,000
143
what condition do you think of when you see antibody platelet factor 4 and thrombosis
heparin induced thrombocytopenia (HIT)
144
what are 4 complications of HIT
1. stroke
2. MI
3. limb ischemia
4. DVT
145
what condition do you think of when you see microvascular thrombosis and ADAMTS13
Thrombotic Thrombocytopenic Purpura (TTP)
146
what is the pentad of TTP
1. fever
2. thrombocytopenia
3. renal failure
4. neurologic changes
5. microangiopathic (hemolytic) anemia
147
what condition do you think of when you see endothelial damage from shiga toxin or e.coli
hemolytic uremic syndrome (HUS)
148
e.coli 0157H7 is pathopneumonic for
hemolytic uremic syndrome (HUS)
149
HUS symptoms are similar to TTP but __ is more common in HUS
renal dysfxn
150
what condition do you think of when you see activation of both clotting and fibrinolytic systems at the same time
disseminated intravascular coagulation (DIC)
*bleeding and clotting at the same time*
151
name 4 causes of DIC
1. obstetric conditions → placental abruption, septic abortion
2. infxn-sepsis
3. carcinomas of pancreas, prostate, lungs
4. massive trauma
152
what are 3 disorders of secondary hemostasis
1. von Willebrand Dz
2. hemophilia A
3. hemophilia B
153
what is the most common inherited bleeding disorder
von Willebrand Dz
154
how most cases of von Willebrand inherited
autosomal dominant
155
von willebrand dz is associated with which clotting factor
VIII
156
what do you think of when you see bleeding in mucous membranes, epistaxis, and increased bleeding with menorrhagia
von Willebrand Dz
157
what 2 coag labs will be elevated in von willebrand
1. bleeding time
2. PTT
158
hemophilia A involves a deficiency of which clotting factor
VIII
159
hemophilia often presents after a
dental procedure
160
what is the most common cause of death in hemophiliacs
intracranial bleeding
161
what coag panel lab will be elevated in hemophilia
PTT
162
the only way to dx hemophilia is with what test
clotting factors
163
hemophilia b involves what clotting factor
IX
164
hypercoaguable states increase risk for
thromboembolism
165
hypercoabuable states can be divided into \_\_
or \_\_
inherited
acquired
166
name 4 acquired hypercoaguable states
1. COVID
2. immobility
3. anything involving increased estrogen
4. smoking
167
what are 5 inherited hypercoaguable states
1. factor V leiden
2. prothrombin gene mutation
3. protein s deficiency
4. protein c deficiency
5. anththrombin deficiency
168
do you anticoagulate all pt's with hypercoaguable states
no!
depends on risk factors
