Hematology/oncology Flashcards
(175 cards)
1
Q
Hemophelia A is a deficiency in which clotting factor?
A
Factor VIII
2
Q
A patient who presents with hemarthroses, increased partial thromboplastin time (PTT) and factor VIII deficiency should make you think of what diagnosis?
A
hemophelia A
3
Q
What test measure the overall speed at which blood clots by means of two consecutive series of biochemical reactions knowns as the intrinsic pathway and common pathway of coagulation?
A
partial thromboplastin time
4
Q
If you want to measure coagulation factors I, II, V, VIII, X , XI, and/or XII, which test will you want to perform, PTT or PT?
A
PTT
5
Q
Factor I is also known as:
A
Fibrinogen
6
Q
Factor II is also known as:
A
prothrombin
7
Q
Factor V is also known as:
A
proaccerlerin
8
Q
Factor VIII is also known as:
A
anti-hemophilic factor
9
Q
Factor X is also known as:
A
Stuart-Power factor
10
Q
Factor XI is also known as:
A
plasma thromboplastin atencedent
11
Q
Factor XII is also known as:
A
Hageman factor
12
Q
What test measures the speed of clotting by means of the extrinsic pathway?
A
Prothrombin time (PT)
13
Q
Hemophilia A and hemophilia B are X-linked dominant or x-linked recessive?
A
x-linked recessive
14
Q
Hemophilia B is also known as:
A
Christmas Diseasee
15
Q
x-linked recessive factor IX deficiency should make you think of what diagnosis?
A
Hemophilia B
16
Q
a patient presents with a minor laceration but excessively large amounts of bleeding for the size of the laceration. This should make you think of what clotting disorder?
A
hemophilia B
17
Q
a patient presents complaining of randomly bleeding from her gums and nose. This should make you think of what clotting disorder?
A
Hemophilia B
18
Q
a prolonged activated partial thromboplastin time (aPTT) and a NORMAL PT should make you think of what clotting disorder?
A
hemophilia B
19
Q
What is first line treatement for Hemophilia B/Christmas Dz?
A
recombinant factor IX
20
Q
what is the first line treatment for hemophilia A?
A
recombinant factor VIII
21
Q
A patient with a decreased synthesis of factor VIII should make you think of what diagnosis?
A
Hemophilia A
22
Q
A patient with a decreased synthesis of factor IX should make you think of what diagnosis?
A
Hemophilia B/Christmas Dz
23
Q
What is the most common inherited bleeding disorder?
A
Von Willebrand Disease (Factor XI)
24
Q
Von Willebrand contributes to fibrin clot formation by carrying what other clotting factor?
A
factor VIII
25
A patient presents with complaints of bruising like a peach, bleeding randomly from their skin, and prolonged bleeding from their mouth and anus. They state that their dad had the same problems. What is the most likely diagnosis?
Von Willebrand Dz
26
decreased factor VIII and prolonged bleeding time but a normal PT/INR should make you think of what diagnosis?
Von Willebrand Dz (VWF)
27
What is first line treament for Von Willebrand Dz?
desmopressin (DDAVP)
28
Is Von Willebrand Dz autosomal recessive or autosomal dominant?
autosomal dominant
29
Primary Immune Thrombocytopenia (aka Idiopathic Thrombocytopenia purpura) is most commonly caused by:
antiplatelet antibodies
30
A 5 year old who presents with petechiae, purpura, epistaxis, and gingival bleeding 2 weeks after testing positive for influenza should make you think of what diagnosis?
Primary Immune Thrombocytopenia (aka Idiopathic Thrombocytopenia Purpura; ITP)
31
What do you expect a patient with primary immune thrombocytopenia's platelet count to be?
< 50,000
32
Primary immune thrombocytopenia usually presents acutely in children ages 2-6 and chronically in what other age group?
Adults 20-50 y.o.
33
What is first line treatment for children with primary immune thrombocytopenia?
supportive
34
ADAMTS13 should make you think of what diagnosis?
Thrombotic thrombocytopenic purpura (TTP)
35
A female patient presents to the clinic with her friend. Her friend states that the patient is very confused, is complaining of her head pounding, and has vomited 5 times on the drive over to the clinic. This triad of symptoms is a common presentation for which hematologic condition?
thrombotic thrombocytopenic purpura (TTP)
36
Name the classic pentab for thrombotic thrombocytopenic purpura (TTP)
fever, thrombocytopenia, anemia, neurologic findings, renal failure
37
Labs on a patient complaining of HA, fever, vomiting, and confusion show elevated LDH, elevated indirect bilirubin and thrombocytopenia. What is the most likely hematologic condition?
thrombotic thrombocytopenic purpura (TTP)
38
thrombocytopenia
low platelet level
39
rash of purple spots d/t small blood vessels leaking blood into the skin, joints, intestines, or organs
purpura
40
True/False: if you are suspicious of TTP, start treatment before you have definitive Dx.
True
41
What is first line treatment for thrombotic thromobcytopenic purpura (TTP)?
plasmapheresis
42
process in which the plasma is separated from the blood cells and then either replaced with another solution such as saline or albumin, or the plasma is treated and then returned to the body.
plasmapheresis
43
After injecting a bolus of heparin, the patient's skin at the injection site begins to necros. What is the most likely diagnosis?
heparin-induced thrombocytopenia (HIT)
44
A patient presents to the ED with a DVT. He has a history of recently starting heparin. You suspect he has heparin-induced thrombocytopenia (HIT). You would expect what percent decrease in his platelets?
50%
45
What is first line treatment for HIT?
stop the heparin, use direct thrombin inhibitor
46
Name two direct thrombin inhibitors
dabigatran (Pradaxa)
apixaban (Eliquis)
rivaroxiaban (Xarelto)
47
Hemorrhage from multiple sites (severe trauma) and increased PT, PTT, and fibrin split products as well as a DECREASE in fibrinogen should make you think of what diagnosis?
Disseminated intravascular coagulation (DIC)
48
What hematologic condition is summarized by severe trauma that causes massive bleeding --> body responds by large scale activation of the clotting cascade --> widespread thrombi --> consumption of all the platelets, so cannot clot anymore --> diffuse bleeding?
disseminated intravascular coagulation (DIC)
49
What is first line treatment for DIC?
reversal of the underlying cause
50
If platelet count falls below 20,000 in DIC, what is best treatement option?
platelet transfusion or fresh frozen plasma (FFP)
51
a clotting factor deficiency
hemophilia
52
Which factor helps platelets stick together and bind to factor VIII?
von Willebrand's factor
53
immature platelets recently released from the bone marrow
megathrombocytes
54
Normal platelet count
between 150,000 and 450,000
55
A very rare disorder that causes microscopic clots throughout the small blood vessels of the body
Thrombotic thrombocytopenic purpura (TTP)
56
What two signs are common to find on the skin and the mucous membranes in any platelet dysfunction?
Petechiae & purpura
57
Name 3 potential causes of disseminated intravascular coagulation (DIC)
```
pre-eclampsia
placental abruption
massive tissue injury
sepsis
shock
```
58
a disease characterized by the overproduction of white blood cells
leukemia
59
The overproduction of lymphocytes characterizes what type of leukemia?
lymphocytic leukemia
60
The overproduction of red blood cells as well as some white cells and platelets characterizes what type of leukemia?
myelogenous leukemia
61
which form of lympohcytic leukemia is typically found in children between 2-5y.?
Acute lymphocytic leukemia (ALL)
62
also known as B cell leukemia
Chronic lymphocytic leukemia (CLL)
63
the MC type of leukemia
chronic lymphocytic leukemia (CLL)
64
the most common cancer in children?
acute lymphocytic leukemia (ALL)
65
hepatosplenomegaly & lymphoblasts on peripheral smear in a 2-5 year old child should make you think of what diagnosis?
acute lymphocytic leukemia (ALL)
66
Most common leukemia in adults in Western countries
Chronic lymphocytic leukemia (CLL)
67
isolated lyphocytosis & smudge cells should make you think of what diagnosis?
Chronic lymphocytic leukemia (CLL)
68
What is the leading cause of death in chronic lymphocytic leukemia?
infection
69
Auer rods should make you think of what diagnosis?
Acute Myeloid Leukemia (AML)
70
Philadelphia chromosome should make you think of what diagnosis?
Chronic Myelogenous Leukemia (CML)
71
bcr-abl gene should make you think of what diagnosis?
Chronic Myelogenous Leukemia (CML)
72
In chronic myelogenous leukemia (CML), what is the only currative treatment?
Allogenic hematopoietic stem cell transplant (HSCT)
73
What is the name of the oral tyrosine kinase inhibitor used in the treatment of chronic myelogenous leukemia (CML)
imatinib
74
Which of the lymphomas is associated with EBV and has a "starry sky" pattern seen on pathology?
Burkitt lymphoma
75
A rapidly growing tumor/mass over the jaw should make you think of what type of lymphoma?
Burkitt lymphoma
76
a patient presents with a painless supraclavicular lymph node and on biopsy you note Ree-Sternberg cells. What is the most likely diagnosis?
Hodgkin lymphoma
77
"owl's eyes" or Reed-Sternbergy cells should make you think of what diagnosis?
Hodgkin lymphoma
78
The most common cause of non-solid organ cancer-related death
Non-Hodgkin lymphoma
79
GI symptoms and persistent, painless peripheral lymphadenopathy should make you think of what diagnosis?
Non-hodgkin lymphoma
80
A CBC w/ WBC's as high as 150,000 with elevated granulocytes should make you think of what diagnosis?
chronic myelogenous leukemia (CML)
81
What age range is non-hodgkin lymphoma more prevelant?
between 20-40y
82
Pancytopenia with circulating blasts should make you think of what diagnosis?
Acute myelogenous leukemia (AML)
83
punches out lesions on XR of the skull should make you think of what diagnosis?
multiple myeloma
84
Rouleaux formation of RBCs should make you think of what diagnosis?
multiple myeloma
85
An elderly patient presents with back and rib pain. What cancer diagnosis should be on your differential?
multiple myeloma
86
hyperCalcemia, Renal insufficiency, Anemia, lytic Bone lessions/Back pain or CRABB should make you think of what diagnosis?
multiple myeloma
87
Bence-Jones proteins on urine protein electrophoresis should make you think of what diagnosis?
multiple myeloma
88
Lytic lesions on XR should make you think of what diagnosis?
multiple myeloma
89
low counts for all three types of blood cells: RBCs, WBCs, and platelets
pancytopenia
90
Myeloid progenitor cells become what other cells?
```
platelets
erythrocytes
monocytes
neutrophils
basophils
eosinophils
```
91
Lymphoid progenitor cells become what other cells?
T-cells
| B-cells
92
low mean corpuscular volume (MCV < 80)
microcytic anemia
93
normal mean corpuscular volume (MCV 80-100)
normocytic anemia
94
increased mean corpuscular volume (MCV > 100)
macrocytic anemia
95
Name three potential causes for microcytic anemia
1. iron deficiency anemia
2. thalassemic disorders
3. anemia of chronic dz/anemia of inflammation
4. sideroblastic anemia (lead, alcohol, drugs)
5. Copper deficiency
6. hemolysis
96
Name three potential causes of normocytic anemia.
1. acute blood loss
2. anemia of chronic dz
3. bone marrow suppression
4. chronic renal insufficiency
5. hypothyroidism
6. hypopituitarism
7. hemolysis
97
Name three potential causes of macrocytic anemia.
1. excessive ethanol use
2. folate deficiency
3. Vitamin B12 deficiency
4. AML
5. reticulocytosis
6. liver dz
7. hypotheyroidism
8. drug induced anemia (hydroxyurea, AZT, chemo)
98
Howell-Jolly bodies should make you think of what diagnosis?
Macrocytic anemias (B12 def., folate def., sickle cell, celiac dz)
99
What are the two most common causes of megaloblastic anemia?
folic acid def., or Vit. B12 def.
100
Which megaloblastic anemia may present with neurologic symptoms?
Vitamin B12 def. anemia
101
Name the only disorder that will cause an increase in mean corpuscular hemoglobin concentration (MCHC).
Hereditary spherocytosis
102
a peripheral smear that shows spherocytes and Howell-Jolly bodies should make you think of what diagnosis?
Hereditary spherocytosis
103
What is first line treatment for Hereditary spherocytosis?
daily folic acid
104
sickled cells on peripheral smear & Hgb S on hemoglobin electrophoresis should make you think of what diagnosis?
sickle cell anemia
105
microcytic anemia w/ normal or ↑ serum Fe or no response to Fe Tx should make you think of what diagnosis?
thalassemia
106
EPISODIC hemolytic anemia associated with sulfa drugs, fava beans, infections should make you think of what diagnosis?
G6PD deficiency
107
microspherocytes and Coombs NEGATIVE should make you think of what diagnosis?
hereditary spherocytosis
108
microspherocytes and Coombs POSITIVE should make you think of waht diagnosis?
autoimmune hemolytic anemia
109
dark urine that is worse in the morning should make you think of what diagnosis?
Paroxysmal nocturnal hemoglobinuria
110
hemoglobin electrophoresis with normal Hgb ratios should make you think of what diagnosis?
Alpha Thalassemia
111
hemoglobin electrophoresis with ↓ HgbA, ↑HgbF should make you think of what diagnosis?
Beta Thalassemia
112
Normal coags + thrombocytopenia, hemolytic anemia, kidney damage, neurologic symptoms, and fever should make you think of what diagnosis?
TTP
113
normal coags + thrombocytopenia, hemolytic anemia, and kidney damage should make you think of what diagnosis?
hemolytic uremic syndrome (HUS)
114
These occur if the bone marrow responds to the increased RBC destruction by trying to match it with increased RBC production
reticulocytes (immature RBCs)
115
immature RBCs
reticulocytes
116
This enzyme is found in abundance in RBCs. If you have an ↑ in RBC destruction, you will have an ↑ in this enzyme
LDH
117
if ↑ in RBC destruction overwhelms the liver's UGT enzyme conjugating ability, you will see an increase in indirect or direct bilirubin?
indirect (unconjugated)
118
an ↑ in indirect or direct bilirubin can lead to dark urine production?
direct (conjugated)
119
fragmented RBCs seen on peripheral smear, resulting from ↑ RBC destruction in the spleen, liver, or small blood vessels
schistocytes
120
This protein binds to free Hgb to reduce its oxidative toxicity
haptoglobin
121
anemia caused by ↑ RBC destruction when the rate of destruction exceeds the bone marrow's ability to replace destroyed cells
hemolytic anemia
122
Name the two types of hemolytic anemia
intrinsic (inherited) & extrinsic (acquired)
123
Name four types of intrinsic/inherited hemolytic anemias
1. sickle cell anemia
2. Thalassemia
3. G6PD deficiency
4. Hereditary spherocytosis
124
Name at least four types of extrinsic/acquired hemolytic anemias
1. autoimmune hemolytic anemia
2. DIC
3. TTP
4. HUS
5. paroxysmal nocturnal hemoglobinuria
6. hypersplenism
125
clumping of RBCs d/t IgM auto-antibodies coating the surface of RBCs, leading to ↑RBC destruction by macrophages
auto agglutination
126
small dense basophilic RBC inclusions that are usually removed by the spleen
Howell-Jolly bodies (usually a sign of decreased spleen function)
127
degmacyte
bite cells
128
bite-like deformity d/t phagocyte removal of denatured Hgb
bite cells (degmacyte)
129
name two conditions in which you might see degmacytes.
Thalassemia & G6PD deficiency
130
Name two conditions in which you might see schistocytes.
hemolytic anemias & microangiopathic dz (TTP, HUS, DIC, prosthetic valves)
131
"helmet-shaped" RBCs d/t mechanical damage in small vessels
keratocytes
132
Name two conditions in which you might see keratocytes
microangiopathic Dz (TTP, HUS, DIC, prosthetic valves)
133
coarse blue granules evenly distributed throughout the RBC
basophilic stippling
134
Name two conditions in which you might see basophilic stippling.
sideroblastic anemia, lead poisoning, Thalassemias
135
abnormal coags (prolonged PT and PTT) should make you think of what diagnosis?
disseminated intravascular coagulation (DIC)
136
What lab test tells you how much Fe is currently stored in the body?
Ferritin (Ferrit IN storage)
137
↓ Ferritin =
Fe deficiency anemia
138
↑ Ferritin =
anemia of chronic disease
139
measures the amount of Fe bound to transferrin
Serum Fe
140
Binds to free Fe to reduce the oxidative damage associated with free Fe; transports Fe through the body to be used
transferrin (TRANSports Fe)
141
an indirect way to measure transferrin levels
total iron binding capacity (TIBC)
142
Fe deficiency = ↑ or ↓ in transferrin & ↑ or ↓ in TIBC?
↑ & ↑; more transferrin leads to ↓ transferrin saturation %
143
anemia of chronic disease = ↑ or ↓ in transferrin & ↑ or ↓ in TIBC?
↓ & ↓; transferrin is an acute phase reactant aimed at decreasing Fe availability to microbes.
144
What is the best way to distinguish between Fe deficiency & anemia of chronic disease?
TIBC & Ferritin levels
145
Fe deficiency anemia = ↑ or ↓ in serum Fe (iron), ↑ or ↓ in ferritin, & ↑ or ↓ in TIBC
↓ serum Fe (iron), ↓ ferritin, & ↑ TIBC
146
Anemia of chronic Dz = ↑ or ↓ in serum Fe (iron), ↑ or ↓ in ferritin, & ↑ or ↓ in TIBC
↓ serum Fe (iron), ↑ ferritin, & ↓ TIBC
147
↑ serum Fe = Fe overload states, like you would see in:
hemochromatosis or thalassemias
148
Neutrophils with > 5 lobes
hypersegmented neutorphils
149
Hypersegmented neutrophils should make you think of what two diagnoses?
B12 deficiency & Folate deficiency
150
RBCs w/ numerous, small, evenly spaced projections d/t abnormal cell membrane
Burr Cells (echinocytes)
151
Burr cells should make you think of what disease?
Uremia (also pyruvate kinase deficiency & hypophosphatemia)
152
few, large, spiny, irregular projections on the RBC membrane
Spur Cells (acanthocytes)
153
Burr cells
echinocytes
154
spur cells
acanthocytes
155
Spur cells or acanthocytes should make you think of waht diseases?
liver dz, post splenectomy, Thalassemia, autoimmune hemolytic anemia, renal dz
156
hypochromic RBC with round area of central pigment
target cell (codocyte)
157
codocyte
target cell
158
Target cells/codocytes should make you think of what two diagnoses?
sickle cell & Thalassemia
159
These cells are usually associated with hyperchromia.
Spherocytes
160
Spherocytes should make you think of what diagnosis?
warm autoimmune hemolytic anemia; hereditary spherocytosis
161
A high reticulocyte count signifies a: ↑ or ↓ in blood loss or a ↑ or ↓ in RBC destruction
↑ in blood loss or an ↑RBC destruction (body is making more baby RBCs because they are being lost through blood loss or destroyed = leads to either an intrinsic or extrinsic hemolytic dz)
162
A low reticulocyte count signifies a: failure of or a ↑ or ↓ in RBC production.
Failure of or ↓ in RBC production (body isn't making baby RBCs = leads to microcytic, normocytic, or macrocytic anemias)
163
Name 4 microcytic anemias
1. IDA
2. Lead poisoning
3. Thalassemia
4. EARLY anemia of chronic dz
164
Where is Vit. B12 absorbed?
terminal Ileum
165
↑ serum homocysteine & ↑ methylmalonic acid should make you think of what anemia diagnosis?
Vit. B12 deficiency anemia
166
The most common cause of iron deficiency anemia (IDA)?
blood loss
167
pagophagia, pica, angular cheilitis, and koilonychia should make you think of what diagnosis?
IDA
168
pagophagia
ice craving
169
koilonychia
nail spooning
170
What is the most common anemia found in children?
plumbism (lead poisoning anemia)
171
acquired sideroblastic anemia is commonly caused by:
plumbism/lead poisoning
172
Name the three anemias that usually present with hypochromic, microcytic anemia.
IDA, Thalassemia, nad early anemia of chronic disease. (lead poisoning should be in differential, but not most commonly seen in practice)
173
"lead lines" on XR should make you think of what diagnosis?
lead poisoning anemia (plumbism)
174
What is first line treatment for lead poisoning?
Succimer (it SUCCs to eat lead)
175
granules of iron accumulate in the mitochonidria surrounding the nucleus
ringed sideroblasts
