USMLE Hem Onc Flashcards Preview

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Flashcards in USMLE Hem Onc Deck (62):
1

EBV is associated with what cancers?

HL, NHL, Nasopharyngeal Carcinoma

2

What complication might people who receive more than one body's worth of transfusions experience?

Hypocalcemia as citrate binds up calcium

3

Shifting partial pressure of O2 at 50% Hb concentration from 26-20 mmHg will result in what response?

Erythrocytosis b/c left shift = higher affinity

4

What is the mechanism behind megaloblastic macrocytic anemia?

Diminished thymidine synthesis

5

What do you use to rapidly reverse warfarin?

Fresh frozen plasma

6

What serum level do you monitor for DIC?

Serum fibrinogen

7

What does blocking the HIV gp41 protein inhibit?

Viral penetration into the cells

8

What drug do you use to prevent DIC in pregnancy?

Heparin

9

What kind of receptor is JAK2?

Non-receptor tyrosine kinase

10

Biopsy reveals uniform, round medium-size tumour cells with basophilic cytoplasm and a proliferation fraction (Ki-67 fraction) of >99%. Dx and cause?

Burkitt's lymphoma from EBV infection.

11

What drugs do you have to watch out for when using methotrexate/6MP/6TG?

Allopurinol and febuxostat b/c block xanthine oxidase, which metabolizes MTX/6MP

12

Where is vWF released from?

Weibel Palade bodies and platelets

13

Platelet binding onto vWF leads to the release of what chemicals?

ADP (promotes GpIIbIIIa expression) and TxA2

14

Transient vasoconstriction in response to bleeding is triggered by?

Neural stimulation and endothelin

15

What should be on your differential for a presentation of hemophilia A/B/C?

Coagulation factor inhibitor, distinguish with a mixing study

16

What test do you use to follow liver failure?

PT

17

How do you diagnose VWD?

With a ristocetin cofactor assay test showing decreased agglutination

18

How do you differentiate between DIC and a disorder of fibrinolysis?

PC is normal and no D-dimer (only fibrinogen broken down) in fibrinolysis disorders

19

Squamous cells and keratin debris in clot. What kind of clot is it?

Amniotic fluid clot.

20

Vessel thrombosis, lens subluxation, mental disability, and long slender fingers. Dx?

Cystathionine beta synthase deficiency (requires B6 to convert homocysteine to cystathionine)

21

Embolus with cholesterol crystals. What kind is it?

Atherosclerotic

22

Lymphocytic lymphocytosis. DDx?

Viral infections (handled by CD8+ T cells)
B. Pertussis

23

Eosinophilia ddx?

Parasites, allergy, Hodgkin Lymphoma **via increased IL-5

24

Basophilia ddx?

CML

25

Monocytosis ddx?

Chronic inflammation, malignancy

26

What cancer do you expect in kids with Down syndrome > 5 y/o and children generally?

ALL

27

What cancer do you expect in kids with DS

Acute megakaryoblastic leukemia

28

Lymphocytes with smudge cells that are CD5 and CD20 positive. Dx?

Chronic lymphocytic leukemia (of naive B cells)

29

What's the most serious complication of CLL?

Transformation into large B cell lymphoma

30

Leukemia that infiltrates the gums. Dx?

Acute monoblastic leukemia

31

Blasts that are positive for MPO and Auer rods?

AML

32

Blasts that are positive for tDt (DNA polymerase)?

ALL

33

What distinguishes CML from a typical lymphoid reaction?

LAP -ve, t9:22, basophilia

34

Itching post bathing - what disease and why?

Polycythemia vera b/c of mast cells

35

What distinguishes PV from typical reactive polycythemia?

Reactive polycythemia = low SaO2, high Epo.
PV = normal SaO2, low Epo.

36

How do you distinguish follicular lymphoma from normal LAD from infection?

1) No white spaces in germinal centres
2) Monoclonality
3) Bcl2 expression in follicles

37

Teardrop cell with leukoerythroblastic smear and splenomegaly. Dx?

Myelofibrosis (Myeloproliferative d/o)

38

Painless LAD with proliferation that expands region immediately adjacent to the follicle. Dx?

Mantle Cell Lymphoma

39

What diseases put you at risk for a marginal zone lymphoma?

Hashimoto's, Sjogren's, H. pylori gastritis (MALToma)

40

LAD with high mitotic rate and starry sky appearance. Dx?

Burkitt lymphoma

41

Bulk of LAD is reactive cells and fibrosis. Dx?

Hodgkin's Lymphoma

42

Lymph node bx divided by broad bands of fibrosis?

Hodgkin's Lymphoma, nodular sclerosis subtype (most common)

43

Spoon shaped nails, anemia, pica. Dx?

IDA

44

What are some causes of B12 deficiency?

Pernicious anemia, Pancreatic insufficiency, damage to the terminal ileum (Crohn's)

45

How do you differentiate between B12 and folate deficiency macrocytic anemia?

Methylmalonic acid is high in B12, normal in folate.

46

Increased RDW and MCHC, splenomegaly with macrophage hypertrophy. Dx?

Hereditary spherocytosis

47

What conditions do you see spherocytes in?

Major Sickle Spheres
B-thal Major
Sickle Cell Anemia
Hereditary spherocytosis

48

5 month old kid comes in with swollen hands and feet. Dx?

Sickle Cell Disease

49

What is the most common cause of death in paroxysmal nocturnal hemoglobinuria?

Thrombosis b/c complement attacks platelets and causes activation of coagulation cascade.

50

What are you in danger of progressing to in PNH?

AML b/c of acquired mutation in myeloid stem cells

51

What are you in danger of progressing to in PNH?

AML b/c of acquired mutation in myeloid stem cells

52

Why does the PTT rise in vWD?

Because vWF escorts F VIII

53

Heinz bodies and bite cells in blood. Dx

G6PD deficiency

54

A person comes with a Mycoplasma or infectious mono infection with anemia. What kind of anemia is it?

IHA, cold agglutinin, IgM

55

What do you give to reverse heparin?

Protamine sulfate

56

What is leucovorin used for?

Rescues BM in MTX, can't in 5-FU

57

t8:14

Burkitt Lymphoma (c-myc)

58

IL3

like GMCSF

59

t9:22

Philadelphia Chromosome Bcr Abl CML

60

t11:14

Mantle Cell Lymphoma (cyclin D1 activation)

61

t14:18

Follicular Lymphoma (BCl2)

62

t15:17

Acute promyelocytic leukemia (Vit A, tx with ATRA)