Anemia, reticulocytosis and increased indirect bilirubin indicates?
hemolytic anemia
peripheral blood smear of dysmorphic red blood cells without central pallor describes what?
spherocytes
In hemolysis what happens to:
retiulcytes?
LDH?
Haptoglobin
Reticulocytosis
incr. LDH
decreased haptoglobin
name two tests for Heridiatry spherocytosis& whats deficient ?
Increased MCHC=> membrane loss & RBC dehyration
Osmotic fragility testing
Spectrin
What is used to reverse methotrexate toxicity?
Folinic acid (leucovorin)
And what two situations is allopurinol used? How does it work?
Noncompetitive inhibitors of xanthene oxidase used in the treatment of :
gout
Tumor lysis syndrome (also use Rasburicase)
When and how does filgrastim work?
G-CSF analog stimulate proliferation/differentiation of granulocytes in patients with NEUTROPENIA
When is Mezna used? Which drugs is a given with concurrently?
What does a bind?
Hemorrhagic cystitis
Cyclophosphamide, ifosfamide
Acrolein
What do you use to treat anthracycline induced cardiotoxicity?
Dexrazoxane
Where does isotype switching occur? Which receptor is necessary?
Germinal centers of lymph nodes requires interaction OCD 40 receptor on B cells
Where does the VDJ recombination occur?
During B cell maturation within the bone marrow
Name what these diagnostic test correlate to: Panpanicolaou smear Cryoglobulins Hemadsorption in cell culture Heterophile antibodies
Human papilloma virus
Hepatitis C virus
Influenza/parainfluenza
EBV
Which cells exert master control over other cells involved in iron metabolism?
Hepatic parenchymal cells due to intercellular binding protein FERRITIN
Purpose of lactoferrin where it is secreted?
Renal tubular cells
Finds two free iron in the urine and recovers from metabolic use
What carries out the non-oxidative reactions of the HMP shunt?
Oxidative?
Transketolase
Transaldolase
G6Phosphate dehydrogenase =RLS
Which chemo drug would cause burning on urination and urgency?
Cyclophosphamide ifosfamide
Induced hemorrhagic cystitis
Which chemo drug would be associated with CHF symptoms?
Doxorubicin
Dry cough, exertional dyspnea, pulmonary toxicity is a side effect of which chemotherapy drug?
Bleomycin = >progressive pulmonary fibrosis
Alkylating agents of chemotherapeutic agents are associated which which type of symptoms?
Tarry stools
Fatigue
Which chemotherapy drug would cause abdominal pain and jaundice what type of drug is this?
Mercaptopurine
S-phase specific purine Analog
What diseases associated with factor X I deficiency ? When is bleeding seen?
Hemophilia see
bleeding only occurs in surgical procedures
What metabolizes pro carcinogens?
Cytochrome P450 MONOOXYGENASE
YOUR MOM
is LOVELY
Homocysteine to cystathione
Cofactors
Enzyme
Serine, vitamin B6
Cystathionine synthetase
Cystathionine to cysteine
Vitamin B6
Cystathionase
Homocystine to methionine
Cofactors
Enzyme
What byproducts are produced?
Methylcobalamin, 5-methyl tetrahydrofolate
Methionine synthase
THF4, cobalamin
folic acid to THF ?
What inhibits this? (2)
folic acid–>
DHFReductase |— methotrexate
DHF–>
DHFReductase |— methotrexate
THF
THF—>DHF by thymidylate synthetase ( |— 5-FU)
How does leucovorin rescue work?
follinic acid (leucovorin) is not require the action I’m dihydrofolate reductase to be converted to THF and it’s unaffected by methotrexate poisoning
Germ tubes/true hyphae are diagnostic of which fungi? (aka positive germ tube test)
Three potential manifestations?
Canada albicans
Oral thrush
Vulvovaginal candidiasis-White discharge
Cutaneous candidiasis-maceration/fissuring
Attributable risk percentage =?
ARP = (risk and exposed -risk and unexposed)/ risk and exposed
USE:
ARP = (RR -1)/RR
HbS mutation location?
How does this affect hemoglobin molecules?
valine in place of glutamic acid @ 6th amino acid position in beta subunits
Promotes hydrophobic interactions among hemoglobin molecules = > polymerization of HbS molecules and red blood cell distortion
Wiskott Aldridge syndrome triad?
Eczema, thrombocytopenia, B & T lymphocytes deficiency.
AML is associated with which cytogenic abnormality?
t(15:17)
Why does Erythroblastosis fetalis, or hemolytic disease of the newborn not occur in parens with maternal blood type A or B?
why would it occur in type O mothers
Anti-A & Anti-B antibodies are IgM and cannot cross the placenta.
type O antibodies are IgG
Which mitochondrial enzyme activates caspases?
Cytochrome C
What type of lymphocytes respond to an active EBV infxn?
Activated CD8 cytotoxic positive T lymphocytes
What diseases are associated with multiple myeloma? at age ~70yrs
Anemia
Hypercalcemia
Bone resorption (secretion of IL-1-osteoclastic actv. factor) and IL-6 ==> PUNCHED OUT LYTIC LESION
Increased susceptibility to infection (M protein, Bence-Jones protein, Rolleaux formation, Increased ESR
AL amyloid(MM & Monoclonal Plasma cell dyscrasia)
Renal failure
Drug of choice and HeparinInducedThrombocytopenia?
Direct thrombin inhibitors:
Hiruden
Lepiruden
Argatroban
*** do not require ATIII
Which drug shares the same pathogenesis of Glanzmann’s thrombastenia? and how?
Abciximab
GPIIb/IIIa blocked/deficient in drug/disease respectively
What is used to prevent the renal sometimes Timberledge the syndrome?
allopurinol
Rasbicurase
side effect of dapsone?
Methemoglobinemia
What worsens G6PD deficiency? (bite cells) 4+descriptions
Infections
Drugs-dapsone, TMP-SMX, antimalarials
Diabetic ketoacidosis
Fava beans
What recesses of clozapine work on?
What life-threatening side effect is associated with this drug?
D4
Agranulocytosis
Which drug can cause aplastic anemia/pancytopenia?
Chloramphenicol
The presence of an oligoclonal IgG band in multiple sclerosis indicates this disease is?
Autoimmune disorder
4 features of anaplastic tumors? (anaplastic=COMPLETE LACK OF CELL DIFFERENTIATION)
1 cells coalesce due to loss of cell polarity
2 cellular and nuclear pleomorphism
3 disproportionately large nuclei, giant multinucleated tumor cells
4 mitotic figures
What activates and what blocks Delta aminolevulinate synthase?
Activate: alcohol, barbiturates, hypoxia
Inhibit: heme, glucose
What converts fibrinogen to fibrin
Thrombin
What converts prothrombin to thrombin?
What cofactors are required for this?
factor Xa
Calcium, factor V, platelets phospholipid
Lead blocks what from being made by inhibiting which enzyme?
ferrochelatase blocks what from being made?
Porphobilinogen
ALA Synthetase
HEME
When would you see schistocytes schistocytes schistocytes?
HUS
TTP
DIC
Prosthetic valve
Main differentiating symptoms of TTP vs HUS
TTP: adult, neurologic involvement
HUS:children, renal involvement
When does Henonch Schloein Purpura usually occur?
Symptoms/Manifestations?
Tx
children age 3-10
Leukocytoclastic vasculitis due to depositions of IGA complexes
Abdominal pain, lower extremity purpura, arthralgias, renal involvement
How might desmopressin affect bleeding disorders?
Which bleeding disorder is a used to treat?
Releases von Willebrand factor and factor VIII from endothelial cells
Mild to moderate hemophilia A
CD14
Monocyte macrophage cell lineage
High oxygen affinity hemoglobins leads to which type of shifts? what happens to P50 w/ this?
What happens to renal system, red blood cells?
Left shift, Decreased P50
Renal hypoxia, increased EPO synthesis = > erythrocytosis
4 associated left findings with intravascular hemolytic anemia
DECREASED serum haptoglobin levels
INCREASED LDH hemoglobin bilirubin
Type/MOA:
Enoxaparin
Fondaparinux
Unfractionated Heparin
E-LMWH that more specifically binds Antitrhombin (more than it does thrombin) to inactivate Factor Va
F- pentasaccharide factor Va inhibitor
UH- binds both antithrombin and thrombin (inactivating it) and is most antithrombotic
what occurs 4-12 days post Subarachnoid hemorrhage?
how do you prevent this?
Vasospasm
CCBs=nimodipine
all mycoplasma species are resistant to which types of drugs?
WHAT CANNOT TREATS THESE INFXNS? 4
drugs that affect peptidoglycan wall because they are intracellular- penicillins, cephalosporins, carbapenems, vancomycin
Erythromycin/Tetracyclines
what laboratory finding is seen in uremic platelet dysfunction?
increased BT only
When does HBS aggregate?
Deoxygenated state
4 common features of sarcoidosis?
Erythema nodosum, arthralgias, granulomas, elevated serum ACE levels
What is diagnostic of PNH?
CD 55, CD 59 deficiencies; these deficiencies disallow the inactivation of compliment
distinguish btw relative & absolute erythrocytosis?
relative-normal RBC mass
absolute-Incr. RBC mass
Increased Hematocrit= ?
Erythrocytosis
> 52% males
> 48% females
Subunits of HbF?
when does switch to HbA occur? subunits in this
2 alpha
2 gamma
@6mo of life
2 alpha
2beta
AL amyloid associated with which 2 diseaes and what is seen under polarized light?
Apple green birifrengence with congo red stain
Multiple Myelolma
Monoclonal plasma cell dyscrasias (clockface purple cells)
Haptoglobin MOA?
Why would these levels decrease in Intravascular hemolysis?
binds to free Hb and promotes uptake by the RES.
Decr. when significant quantities of Hb are released into circulation (seems wrong but this is right - in UWORLD)
What drugs increases fetal Hb?
Hydroxyurea
What bug uses this method of Infection?
pharynx–> lymphatics–> meninges
H.Influenzae
What bug uses this method of infection?
Middle ear–>contiguous tissue–> meninges
S.pnuemonia
what bug uses this method of infection?
Primary Lung focus–> blood–> meninges
Mycobacterium tuberculosis
&
S. Pneumonia
what bug uses this method of infection?
Pharynx–>Blood–>Choroid Plexus–> Meninges
Neisseria Meningitidis
what 3 things are associated with red cell aplasia?
thyoma
lymphocytic leukemias
ParvovirusB19
What has a similar presentation to CML?
how do you differentiate between the 2?
Leukemoid reaction => elevated white cell count
neutrophil alkaline phosphatase level
LEUKORXN= Elevated
CML=Decreased
Nitrites
Causes Methemeaglobinemia and Treats Cyanide poisoning.
which _______ can cause Serotonin syndrome?
analgesic
antiemetic
antibiotic
tramadol
ondasteron
Linezolid
aplastic anemia (3 symptoms)
pancytopenia
low reticulocyte count
absent splenomegaly
dry bone marrow aspirate; fat cells & fibrous stroma
The lower the MAC the ______ the potency?
higher
Vitamin B12 Deficiency vs Folate Deficiency
BOTH Megaloblastic anemia
B12 is associated with neurologic deficiency.
Abdominal pain, hepatomegaly, Pancreatic calcifications suggest what?
what is this usually due to?
Chronic Pancreatitis due to ethanol abuse
Rifampin MOA?
blocks action of bacterial DNA dependent RNA polymerase inhibiting transcription
Where do pancoast syndrome tumors usually occur?
what characterizes this disorder?
in the superior sulcus of the lung apex
ipsilateral horners syndrom
rib destruction, atrophy of hand muscles
pain in C8-T1 T2 nerve roots
what would you use to treat lyme disease?
doxycycline or
penicillin-type antibiotics
what inhibits the synthesis of mycolic acids?
isoniazid
What type of cancer is associated with Epstein-Barr virus?
Primary CNS lymphoma
what enzyme does heparin activate
AntiThrombin III
DIC due to: (3 common)
Path
Lab findings
sepsis, burn injury, acute pancreatitis
fragmented RBCs, Thrombocytopenia
Lab Test prolonged PT & PTT
decreased fibrinogen, Factor V, Factor VIII
difference btw Brachiocephalic and SVC drainage?
SVC drains bilateral Brachiocephalic veins
Brachiocephalic drains UNILATERAL jugular & cephalic veins (Same symptoms as SVC syndrome but to ONE SIDE)
Metastatic Carcinoid tumor test
4 common symptoms? When are these symptoms present when are they absent?
5-hydroxyIndoleacetic acid
Vasomotor instability: cutaneous flushing, dizzy
GI probs: secretory diarrhea & abd. pain
Bronchoconstricion
Right sided valvular Heart disease
Absent when confined to INTESTINE
present outside intestine/ WHEN metastasized to LIVER
Features of Polycythemia Vera (PRIMARY)
DECR. EPO
incr. RBC MASS
Incr. Plasma Volume levels
ALL CELL LINEAGES INCREASED
JAK2 V617F mutation
Incr. Sensitivity to Growth factors
Secondary Polycythemia vera
2 causes
Findings
Hypoxia
EPO-producing tumor
***ONLY RBC Lineage is increased
Incr. RBC Mass
Incr. EPO
NORMAL plasma vol.