Immunology/Hematology Flashcards
(127 cards)
1
Q
1) Reed Sternberg cells (OO), Pel-Ebstein fevers (come & go every few weeks), and lymph node pain induced by alcohol consumption are highly specific for what lymphoma?
2) Reed Sternberg cells originate from B cells and are CD_/_ +
A
HODGKIN lymphoma
CD15/30+
2
Q
EBV, SLE, and RA increases risk of developing what lymphoma?
A
Hodgkin lymphoma
3
Q
GOAL and 3 drug treatment for CEREBRAL toxoplasmosis?
A
GOAL: inhibit folate (= stops toxoplasmosis parasite from spreading) + replace lost folate
1) pyrimethamine (inhibits DHF reductase)
2) sulfadiazine (sulfonamide)
3) leucovorin (folinic acid).
4
Q
A prolonged PT is associated with a deficiency in only one factor: ____
A
Factor 7.
Factor 7 is the only one standing outside (Extrinsic); all other factors (PTT) are inside (Intrinsic)
5
Q
Which factor is responsible for the activation of factor 7?
Which vitamin is responsible for the activation of factor 7?
A
factor 9!!!
Vitamin K
6
Q
Which immunosuppressant causes: Hyperglycemia, CMV infection, and PML of brain
A
Mycophenolate mofetil
7
Q
Which immunosupressants do NOT cause pancytopenia?
A
Tacrolimus
Cyclosporine
- these are neuro & nephro toxic
8
Q
which immunosuppressant causes :
Gingival hyperplasia!!
Hypertrichosis
hirsutism,
A
Cyclosporine
9
Q
How do you manage a displaced vs non displaced clavicular fracture?
A
Displaced (skin puncture, nerve damage, floating/shortened bone)= clavicular plate
non displaced = simple shoulder sling (will heal on own)
10
Q
Tx for Hepatitis B infection?
A
Supportive therapy. Hep B resolves on own. Do not immunize ppl with active HepB.
11
Q
What is the most effective way to prevent tumor lysis syndrome?
A
IV hydration!!
rasburicase/allopurinol are second line
12
Q
Newborn with echinocytes (burr cells), indirect bilirubinemia, and FHx of hydrops fetalis has what hereditary disorder?
A
Pyruvate kinase deficiency
13
Q
what is Ketotifen?
what eye condition does it treat?
A
Ketotifen is a second generation antihistamine
Tx seasonal allergy conjuctivitis
14
Q
what blood condition presents with:
- elevated RDW (size)
- low MCV
A
Iron deficiency anemia
15
Q
what blood condition presents with:
- elevated RDW (size)
- elevated MCV
A
B12 or folate deficiency
Liver disease
16
Q
Why is IDA so common in EXCLUSIVELY fed newborns (only breast milk or only cows milk)?
A
bc they aren’t intaking any meals high in Iron (breast milk and cows milk have no iron)
you must give them iron supplementation until they start eating iron enriched foods
17
Q
numerous BLASTS on a blood smear is red flag for what 2 blood cancers?
what are the CBC findings in this cancers?
A
BLASTS cells (immature cells) = LEUKEMIA - either lymphoid (ALL) or myeloid (AML) origin
CBC= -penia (since no cells mature, theres a decrease in cell lines)
- thrombocytopenia, neutropenia, anemia, dec B&T cells
18
Q
which acute leukemia is ALLways in children?
A
acute lymphoblastic leukemia (ALL)
19
Q
which acute leukemia is always in older adults?
A
acute myeloid leukemia (AML)
20
Q
which acute leukemia stains positive for myeloperoxidase?
A
Acute MYELOID Leukemia (AML)
21
Q
which acute leukemia stains positive for:
terminal deoxynucleotidyl transferase (TdT) and
Periodic acid-Schiff (PAS)
A
acute lymphoblastic leukemia (ALL)
22
Q
which cells are positive on flow cytometry for acute lymphoblastic leukemia (ALL) ?
A
since its lymphoblastic = lymph origin = B and T cells.
B cells: CD10, 19, 20
T cells: CD2, 3, 8
23
Q
which cells are positive on flow cytometry for acute myeloid leukemia (AML)?
A
CD13, CD33, CD34, CD117, and HLA-DR
24
Q
what translocations are associated with acute myeloid leukemia?
A
t(15:17)
especially in acute promyelocytic leukemia (M3 AML)
25
what translocations are associated with acute lymphoblastic leukemia?
t(12:21)== in B-ALL children = POOR prognosis
*hint: 21 = trisomy 21 = downs syndrome associated with ALL*
26
How can you remember which trisomy is associated with acute lymphoblast leukemia & where the leukemia metastasizes to?
ALL children are DOWN to grow up and have BRAINS and SEX (testes)
27
what acute leukemia presents with fever and testicular enlargement?
Acute lymphoblastic leukemia
28
auer rods are seen in which leukemia ?
AML & APML
29
what leukemia presents with gingival hyperplasia?
acute myeloid leukemia (AML)
30
what is the immediate management for a patient with Heparin induced thrombocytopenia (HIT)?
stop heparin!
switch to a NON-heparin anticoag typically a direct thrombin inhibitor (e.g., argatroban, bivalirudin) or a non-coumarin factor Xa inhibitor (e.g., rivaroxaban, dabigatran, fondaparinux).
31
how does Lauryn confirm G6PD deficiency before choosing it as an answer
anemia
| blood smear abnl : Heinz bodies
32
what are cryoglobulins?
regular proteins (IgG & IgM) in the blood that CLUMP together when its COLD outside
33
what are the symptoms of mixed cryoglobulinemia?
mixed = complement deposition = vasculitis
arthralgia
red, non blanching purpura/macules (bc vessels are extravasating blood & not filling back up)
hypocomplementemia
hematuria
and increased serum concentration of polyclonal IgG and IgM
34
Why are pts with mixed cryoglobulinemia positive for rheumatoid factor?
IgM has the activity of RF; the HIGH levels of serum IgM (+IgG) >>> + RF
35
what virus precipitates mixed cryoglobulinemia?
Hep C for Cryoglobulinemia. *also HIV*
all pts with cryoglobulinemia have Hep C so make sure you do a serology
36
anti-dsDNA is associated with what connective tissue diseases?
SLE
37
Anti-Sm is associated with what connective tissue diseases
SLE
38
Anti-Ro/SSA
| Anti-La/SSB is associated with what connective tissue diseases
Sjogrens
39
Anti-histone is associated with what connective tissue diseases
SLE
40
anti C1q is associated with what connective tissue diseases
SLE
41
anti Jo1 & anti Mi2 are anti-synthetase ABs associated with what connective tissue diseases
Polymyositis and dermatomyositis
Mi & Jo are synners
42
Anti-U1-RNP is a Anti-ribonucleoprotein antibodiy associated with what connective tissue diseases
mixed connective tissue disease
43
Anticentromere is associated with what connective tissue diseases
systemic sclerosis
Centromere Cyctemic Clerosis
44
Antiphospholipid antibodies is associated with
SLE
45
what are the 3 types of antiphospholipid antibodies that point to SLE?
which antiphospholipid AB prolongs aPTT?
```
anti-cardiolipin (most common type)
Anti-β2-glycoprotein 1 antibodies
lupus anticoagulant (LA)
```
lupus anticoagulant
46
Anti-cyclical citrullinated peptide antibodies are specific for what disease?
RA
47
Anti-DNA topoisomerase I antibodies is associated with what connective tissue diseases
systemic sclerosis
48
a prolonged BLEEDING TIME will always be mnemonic for what blood disorder?
what other mnemonic symptoms are there?
BLEEDING TIME = vWF (regardless of what PTT/PT says!!!!)
| ++++ nosebleeds/tooth bleeds
49
why may you see a prolonged PTT in addition to the prolonged BT seen in vWF disease?
Factor 8 circulates on vWF.
so no vWF factor = low F8 = prolonged PTT
50
what bleeding disorder presents with an isolated prolonged PTT?
Hemophilia A (Factor 8 deficiency)
51
Bernard-SOulier Syndrome
1 Giant Bernard is Injured & cant play outside
1 Bernard = Gp1B
Giant= giant PLTs
is injured= decreased PLTs
& cant play Outside = no adhesion = abnl ristOcetin cofactor assay
52
Prolonged BT + decreased PLTs + giant PLTs on smear (megakaryocytes) =
Bernard-Soulier OR Immune thrombocytopenic purpura
53
prolonged BT ++ normal PTT ++ normal PLTs =
Glanzmann thrombasthenia
54
Plts with abnormal aggregation studies =
Glanzmann thrombasthenia
55
Plts with abnormal adherence studies (risocetin cofactor assay) =
Bernard- soulier
56
a low serum iron and ferritin ==
IDA
57
mnemonic for hypersensitivity reactions
ACID
allergy/anaphylactic/atopic = HS Type 1
cytotoxic = HS Type 2
Immune complex = HS Type 3
Delayed = HS Type 4
58
patients deficiency in what immunoglobulin have anaphylactic blood transfusion reactions?
IgA deficiency
59
pathophys of T1HS rxns
preformed IgE crosslinks with mast cells & basophils to release histamine > urticaria
60
pathophys of T2HS rxn
cytotoxic = cell death
IgG/IgM ABs bind against natural antigens on cell surfaces >> complement signal to lyse/phagocytose the cell
antibody-dependent, cell-mediated cytotoxicity <3
61
The following are classified as what types of HS rxns and why?:
Graves disease
Bullous pemphigoid
Pemphigus vulgaris
Myasthenia gravis
Graves= ABs against TSH receptor
Bullous pemphigoid = ABs against antigens on hemidesmosomes
Pemphigus vulgaris= ABs against antigens desmoglein 1/3 on desmosomes
Myasthenia gravis= ABs against AchR>weakness
*Point: T2HS rxn = ABs against an antigen/receptor aka ADCC*
62
The following are classified as what types of HS rxns and why?:
Goodpasture syndrome
Rheumatic fever
Hyperacute transplant rejection
```
Goodpasture= ABs against alpha 3 antigen in Type 4 collagen > hemoptysis+hematuria
Rheumatic= ABs against strep antigens (molecular mimicry)
Hyperacute transplant rejection= ABs against class 1 MHC/HLA 1 antigens on the grafted/gifted organ
```
*Point: T2HS rxn = ABs against an antigen/receptor aka ADCC*
63
timeline & clx features for hyper acute transplant rejection
rejection occurs w/in minutes--48hrs
INTRAOPERATIVE FINDING (observed in OR/not subjective to pt): graft swells as soon as its perfused with host blood> thrombus> graft ischemia
64
how do you dx hyperacute transplant rejection?
MUST Biopsy: graft shows small vessel thrombosis> ischemia
65
how do you prevent hyperacute transplant rejection?
Confirm ABO/HLA compatibility first !!!!
66
The following are classified as what types of HS rxns and why?:
1) Acute hemolytic transfusion reaction
2) Autoimmune hemolytic anemia (AIHA)
3) Hemolytic disease of the fetus and newborn
4) Immune thrombocytopenic purpura (ITP)
5) Drug-induced neutropenia and agranulocytosis
6) Pernicious anemia
1) Hosts antiA/B ABs against donors RBC's A/B antigens
2) ABs against antigens > warm/cold agglutinins
3) Maternal antiRh- ABs against fetal Rh+ antigens
4) anti-platelet ABs to GP2B/3A antigens on platelets
5) methimazole, sulfasalazine, & trimethoprim/sulfamethoxazole
6) autoABs against the intrinsic factor antigen
67
Acute hemolytic transfusion reaction >>> urticaria. But why is it T2HS rxn and NOT T1HS rxn
Acute hemolytic transfusion reaction is caused by hosts antiA/B ABs against donors RBCs A/B antigens > rxn of urticaria, fever, Gi symptoms, anemia, jaundice
T1HS rxn = IgE crosslinking with mast cells/basophils === COMPLETELY different
68
what are the 2 types of autoimmune hemolytic anemia?
what antobodies are associated with each one?
cold agglutinin (IgM)
warm agglutinin (IgG)
69
lab findings for AIHA?
- LDH
- haptoglobin
- indirect bilirubin
- urinalysis
- elevated LDH
- LOW haptoglobin (dec bc it binds to Hg thats lysed from RBCs in order to preserve Fe/Hg== less freely circulating haptoglobin)
- elevated indirect bilirubin
- UA: urobilinogen (excess bili excreted in urine) & hemoglobinuria (lysed RBCs excreted in urine)
70
mnemonic for Cold induced AIHA
Malignancy (non Hodgkin, CLL)
Mono (EBV)
Mycoplasma
Macroglobulinemia Waldosterom
the Cold is M.M.M.M.Miserable
71
why are the T2 HS rxns often treated with IVIG in addition to systemic steroids?
IVIG = new ABs that wont attack against antigens == no more ADCC
72
pathophys of T3HS rxn
IgG-antigen COMPLEX >> deposited in TISSUES/VESSELS> complement activation> polys initiate cell death/inflammation>>>>> VASCULITIS
* with T3HS rxn there will always be:
- tissue/blood vessel vasculitis (usually kidneys & skin) affected by complex deposition*
73
The following are classified as what types of HS rxns and why?:
1) Serum sickness
2) ArThus reaction
3) Drug-induced hypersensitivity vasculitis
4) Hypersensitivity pneumonitis
1) human ABs form complexes w/ foreign/animal proteins > deposited in blood
2) human ABs form complexes w/ DTaP antigens > deposited in dermal vessels
3) human ABs form complexes w/ drug antigens > deposited in small vessels
4) human ABs form complexes w/ inhaled environmental antigens > lungs
74
The following are classified as what types of HS rxns and why?:
1) Polyarteritis nodosa (PAN)
2) Poststreptococcal glomerulonephritis
3) IgA nephropathy
4) Membranous nephropathy
5) Systemic lupus erythematosus (SLE)
1) IgG-HepB antigen complexes deposited in small vessel> vasculitis
2) weeks after strep infection, IgG-antigen complexes deposited in kidneys
3) hematuria directly after URI or GI infection (IgG-antigen complexes in kidneys)
4)
5)
75
what foreign/animal antigens, VACCINE, & DRUG do human ABs form complexes with in Serum sickness?
when does the serum sickness rxn occur?
antivenom/antitoxins (snake/bug bites)
HepB
Rutuximab
ABs take week to form so you will see pt with serum sickness (urticaria, fever, lymphadenopathy) 1-2 weeks after HepB or venom exposure
76
Clx skin feature of Arthus rxn
what type of HS rxn is Arthus?
Skin necrosis; at the location of IM dermal vaccine/booster injection
== T3 HS rxn
77
what drugs cause Cutaneous small vessel vasculitis / hypersensitivity vasculitis
it forms what kind of purpura?
propylthiouracil, hydralazine, or allopurinol
painful purpura
78
pathophys of T4HS rxn
PRE-sensitized T cells recognize antigens on either APCs (activates macrophages) or somatic cells>> T cell mediated cell death
79
what skin conditions are caused by T4 HS rxns?
TEN, DRESS, Steven Johnson
TB skin test, Candida skin test
Contact dermatitis
80
what transplant reactions are caused by T4 HS rxns?
acute (<6weeks) and chronic (>6weeks) transplant rejections; **bc hyper acute = T2HS**
graft vs host disease (donor T CELLS attack hosts organs)
81
why is Graft vs Host disease a T4HS rxn?
what organs are affected?
How is it used therapeutically?
a super lymphocytic organ is transplanted into host (aka allogenic hematopoietic stem cell transplant from a SIBLING for leukemia)
ALLLLL the T cells from donor are now in host and fight the hosts organs:
skin
intestines
liver
graft vs tumor effect
82
what 2 neuro diseases are T4HS rxns?
MS & GBS
83
what 3 autoimmune diseases are T4HS rxns
RA, diabetes, hashimoto
84
what is the cause of acute ischemic stroke in SCD pts vs average pts?
SCD pts have strokes bc sickled RBCs clog arteries
whereas
Average pt has stroke bc fatty thrombus clogs arteries
85
considering the difference btw the pathophys of SCD stroke vs avg stroke, how do you tx SCD stroke?
what do you never give a SCD stroke pt
Exchange transfusion therapy (MUST exchange all sickled RBCs for healthy RBCs) = removes stroke
never give SCD stroke pt antiplatelets/anticoags drugs bc
1) coagulation isnt the cause of stroke
2) it will just make them bleed out
86
what is a heterophile antibody test?
what is it used to dx?
This phenomenon results in the aggregation of horse erythrocytes when exposed to his serum (i.e., a positive heterophile antibody test).
EBV
87
lupus anticoagulant (LA) prolongs what blood paramater?
aPTT
88
what blood syndrome is positive for VDRL?
antiphospholipid syndrome
89
which acute leukemia present with FEVER & PAIN ?
Acute lymphoblastic leukemia (ALL)
*ALL CHILDREN on leukemia commercials are sad/in pain=ALL*
90
what is the definitive dx test for ALL?
bone marrow biopsy!!! (bc B & T cells come from the bone & that is where the issue is)
**do not choose peripheral smear!!! this is NOT as helpful as bone marrow biopsy = origin of the ALL**
91
what antibody finding is classic for Primary Biliary Cholangitis?
anti-mitochondrial antibody
aMa. M for Mamma. PBC is in hot Mammas (females) only
92
anti-smooth antibody is mnemonic for
autoimmune hepatitis
93
what are the 2 types of Cryoglobulinemia?
Type 1 = monoclonal = Plasma cell dyscrasia
Type 2 = polyclonal = mixed globulins
94
what diseases/conditions arise in Type 1 (monoclonal/Plasma cell dyscrasia) vs Type 2 (polyclonal/mixed) Cryoglobulinemia?
type 1 = MM & Waldosteron
type 2 = infections (Hep C/B, HIV) & autoimmune diseases (RA, Sjogren, SLE)
95
what is the mnemonic for Cryoglobulinemia (works for both Types <3 )
S K I N
S= skin
- t1 = hyperviscosity = raynauds & livedo reticularis
- t2= vasculitis = non blanchable (no blood refill), red purpura/macules
K= kidney
- t1= hyperviscosity = thrombosis
- t2= vasculitis= Membranoproliferative GN (hematuria)
I+ Intra-articular JOINTS = arthralgia & weakness
- both types
N=nerve damage
- t1= n/a
- t2= mononeuritis multiplex (non-contiguous nerve inflammation)
96
what is the main goal in treating symptomatic Cryoglobulinemia?
what drugs/therapy helps tx it?
you want to DECREASED the B cells!!!
(B cells> plasma cells> release cryoglobulins)
```
Rituximab = anti-CD20 B cells
or
Plasmapharesis (remove all the cryoblobulins)
```
97
which type of cyroglobulinemia is positive for RF but LOW in C3/C4?
Type 2 (Polyglonal/Mixed)
98
what is the mnemonic for the causes of Cold agglutinin AIHA?
Cold weather is MMMMMiserable
Malignancy (non-Hodgkin, CLL)
Mycoplasma
Mono
Macrogobulinemia Waldenstrom
99
what is the the skin finding of cold agglutinin AIHA that differentiates it from Cryoglobulinemia?
cold agglutinin AIHA = Acrocyanosis (PERSISTENTTT cyanosis; DOES NOT WAX/WANE LIKE RAYNAUDS)
100
what are the common causes for Warm agglutinin AIHA?
CLL
SLE
drugs (a-methyldopa, penicillin, phenytoin, rifampin)
101
what are the dx Direct Coombs/Agglutin Test (DAT) and Peripheral Blood Smear (PBS) findings for Cold vs Warm agglutinin AIHA?
Cold:
DAT: positive for C3d (will be low; C3 is low in Cold)
PBS: marked agglutination of RBCs
Warm:
DAT: positive for IgG (± C3d)
PBS: ABBUNDANT Spherocytes
102
what organ is enlarged in Warm agglutinin AIHA?
splenomegaly (due to partial phagocytosis of the spherocytic RBCs by splenic macrophages)
103
what is the difference in the onset of Cold agglutinin AIHA vs Warm agglutinin AIHA?
Cold = acute (days) onset *you want to leave the cold fast*
Warm = gradual (weeks) onset *you want to stay on a warm vaca for a long time*
104
difference in acute tx for Cold AIHA vs Warm AIHA
Cold = avoid the cold
Warm = STEROIDS (SLE) followed by IVIG
105
Immune thrombocytopenic purpura always follows
Infection (bacterial, viral) or a vaccination
106
what is the 1st line treatment for Immune thrombocytopenic purpura (ITP)
steroids +++ IVIG
107
true or false:
Spleenomegaly is common in Immune thrombocytopenic purpura.
FALSE. If theres spleenomegaly, it is NOT ITP
108
What is autosplenectomy?
what is the etiology?
autosplenectomy = Functional asplenia
found in SSD pts who have had recurrent splenic thrombi from vasoocculsive events>
spleen loses its macrophage function so can NO LONGER eat/kill bacteria.
109
treatment for an infection in a SSD pt with functional asplenia/autosplenectomy?
IV ceftriaxone
110
explain thrombolysis pathway
a CLOT/Thrombus is made up of fibrinogen.
Fibrinolytic/Thrombolytic drugs dissolve clots/thrombus from fibrinogen to plasmin (an enzyme)
Plasmin then breaksdown Fibrin into Fibrin degradation products (D-dimers)
111
what is the preceptor of fibrin (ie what comes before fibrin)?
Thrombin > Fibrin > FDPs (via Plasmin)
112
what cell line is elevated in aseptic/viral meningitis?
what cell line is elevated in bacterial meningitis?
aseptic/viral = elevated lymphocytes (monocytes=plasma cells= lymph origin)
bacterial= >1000 POLYS/NEUTROPHILS
113
What is the most common cause of Hemolytic Uremic Syndrome (HUS)?
Pathophys?
Clx findings?
E coli (Shiga-toxin E Coli or STEC)
Path: STEC lays microthrombi in vessel walls> HUS
Clx:
about a week of Adb pain/BLOODY diarrhea>>> dec PLTs (petechiae), microagiopathic hemolytic Anemia, SCHISTOCYTES
114
what is the marker/translocation for CML?
t(9:22)== characteristic for CML (but can also be seen in children/adults with ALL)
115
what subtype of Hodgkin Lymphoma has the BEST prognosis?
- lymphocytic rich classical HL
- nodular sclerosing classical HL
- nodular lymphocyte predominant HL
SO
lymphocytosis & nodules are GOOD PROGNOSIS in HL :)
116
what are signs of a POOR prognosis in Hodgkin Lymphoma?
↑↑↑↑↑ ESR
↑↑↑↑↑ LDH
Involvement of three or more lymph node areas
Large mediastinal tumor
117
14:18 is the marker for what cancer?
NHL- Follicular lymphoma
118
11:14 is the marker for what cancer?
NH- Mantle cell lymphoma
119
8:14 is the marker for what cancer?
NHL- Burkitts Lymphoma
120
Diffuse Large B cell lymphoma (DLBCL) is the most aggressive NHL bc its transforms into what MRI finding?
Primary CNS lymphoma (pts with HIV/EBV who have DLBCL)
121
Fanconi anemia is caused by what genetic defect? (PS: this is why there are so many chromosomal abnormalities)
AR defect in DNA crosslink repair > bone marrow failure
122
Fanconi anemia causes genetic/early PANCYTOPENIA & therefore has a 50% predisposition to developing what malignancies in early adulthood?
Acute myelogenous leukemia
Myelodysplastic syndromes
*both= pancytopenia of immature/early cell lines*
123
Fanconi anemia is a type of ______ anemia.
what are the BM biopsy findings?
Aplastic anemia
- Fanconi = defect in DNA cross link repair > BONE MARROW FAILURE
- Hypocellular fat-filled marrow (dry bone marrow tap)
124
what are the following characteristics of fanconi anemia?
- skeletal
- skin
- organ
- BLOOD
- skeletal: short stature, microcephaly, developmental delay, hypoplastic thumb
- skin: hypo/hyper pigmentation ++ cafe au lait spots
- organ: kidney, heart, EYE (strabismus/hypertelorism), and large ears (+/- deafness)
- blood: pancytopenia (recurrent infections & bleeding)
125
Fanconi anemia has what type of MCV?
High (>100)
126
what leukocyte alkaline phosphatase score does CML have? WHY?
LOW leukocyte alkaline phosphatase score!
CML might be myeloproliferative, but it is a proliferation of granulocytes in all stages (still immature leukocytes = low LAP)
127
smudge cells are mnemonic for:
CLL
