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Pathophys II - Exam 1 > Wright (Guest Lecturer) > Flashcards

Wright (Guest Lecturer) Flashcards

1
Q

what are the 3 types of CBC

A
  1. CBC w. no differential
  2. CBC w. automatic differential
  3. CBC .w manual differential
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2
Q

on a CBC, total WBC is the summation of

A
  1. segs (neutrophils)
  2. lymphocytes
  3. monocytes
  4. eosinophils
  5. basophils
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3
Q

the most numerous WBC on a normal CBC is

A

segs (neutrophils)

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4
Q

hematocrit should be __ x the value of hgb

A

3

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5
Q

what value on a CBC represents the actual count of cells

A

absolute

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6
Q

what are 2 components of a bone marrow aspiration

A
  1. molecular genetics
  2. flow cytometry
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7
Q

which test represents all cells and give you information about cell constitution

A

bone marrow bx

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8
Q

bone marrow aspiration involves the removal of

A

bone marrow fluid

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9
Q

bone bx involves the removal of

A

a small amt of bone w. marrow inside of it

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10
Q

what is hematopoiesis

A

the production of blood cells and platelets w.in the bone marrow

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11
Q

what are the 2 types of stem cells

A
  1. myeloid
  2. lymphoid
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12
Q

what is the average lifespan of a platelet

A

8-10 days

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13
Q

where are old platelets destroyed

A

spleen and liver

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14
Q

what is erythropoietin

A

hormone that increases production of RBCs

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15
Q

erythropoietin is released in response to

A

low O2

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16
Q

erythropoietin is produced in the

A

kidneys

liver

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17
Q

megakaryoblasts become megakaryocytes, which give rise to

A

platelets

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18
Q

hematocytoblasts become proerythroblasts, which give rise to

A

reticulocytes → become erythrocyte in 1-2 days

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19
Q

what 2 nutrients are needed in order for reticulocytes to mature into erythrocytes

A
  1. B9 (folic acid)
  2. B12
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20
Q

what is leukopoiesis

A

the formation of WBC

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21
Q

what are the 5 malignant disorders of hematopoiesis

A
  1. leukemia
  2. lymphoma
  3. myeloma
  4. myelodysplastic syndrome
  5. aplastic anemia
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22
Q

what are 5 non-malignant disorders of hematopoiesis

A
  1. nutritional deficiencies
  2. autoimmune disorders
  3. infectious etiology
  4. DIC
  5. TTP
  6. hypersplenism
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23
Q

what are the 6 myeloproliferative disorders

A
  1. AML
  2. CML
  3. myeloma
  4. essential thrombocythemia
  5. polycythemia vera
  6. myelofibrosis
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24
Q

what are the 4 lymphoproliferative disorders

A
  1. ALL
  2. CLL
  3. multiple myeloma
  4. lymphoma
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25
Q

what are the 3 most common malignant blood disorders

A
  1. leukemia → neoplastic cells in blood stream
  2. lymphoma → neoplastic cells in lymph
  3. myeloma → neoplastic plasma cells
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26
Q

leukemia is divided into what 2 categories

A

acute vs chronic

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27
Q

acute leukemia is composed of what type of cells

A

blast cells

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28
Q

chronic leukemia is composed of what type of cells

A

mature precursor cells

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29
Q

both acute and chronic leukemias can be

__ or

__ in origin

A

lymphoid

or myeloid

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30
Q

what are the 4 types of leukemia

A
  1. AML
  2. ALL
  3. CML
  4. CLL
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31
Q

list 3 risk factors for leukemia

A
  1. XRT exposure
  2. chemo exposure
  3. benzene exposure → 2nd hand smoke, plastics, pesticides etc
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32
Q

list 3 lab values characteristic of leukemia

A
  1. leukocytosis → monocytes and lymphocytes
  2. pancytopenia
  3. hypogammaglobulinemia
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33
Q

list 3 common symptoms of leukemia

A
  1. bone pain
  2. LAD
  3. splenomegaly
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34
Q

chronic leukemia is often diagnosed __

A

incidentally

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35
Q

what test is a must have for leukemia dx

A

bone marrow bx

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36
Q

besides bone marrow bx, what is another test that is helpful in evaluation of leukemia

A

flow cytometry

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37
Q

what is the most common leukemia in adults

A

AML

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38
Q

what is the must have lab finding for AML

A

blasts > 20%

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39
Q

what type of leukemia do you think of when you see Auer rods

A

AML

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40
Q

is AML curable?

A

yes

but it is lethal w.in weeks-months if untreated

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41
Q

what do you think of when you see >20% blasts and Auer rods

A

AML

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42
Q

name 3 complications of AML

A
  1. anemia
  2. infxn
  3. bleeding
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43
Q

stem cell transplant, bone marrow transplant, and hematopoietic cell transplantation (HCT) are all

A

SAME SAME!

thought you’d like that Heather ;)

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44
Q

what tx is administered prior to a stem cell transplant

A

very high dose chemo ‘

to kill all cells, including bone marrow cells

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45
Q

autologous stem cell transplant involves cells from

A

your own body

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46
Q

allogenic stem cells involve cells from

A

someone else

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47
Q

which type of stem cell transplant represents your best chance for remission

A

autologous

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48
Q

how does systemic racism affect stem cell transplantation

A

most of the database is white → better outcomes for white people

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49
Q

what is the most common childhood malignancy

A

ALL

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50
Q

what comorbidity increases incidence of ALL in peds

A

Down’s syndrome

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51
Q

most cases of ALL involve __ cell lineage

A

B

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52
Q

what type of cell will pathology show in ALL

A

blasts

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53
Q

if you see a question about a kid with cancer on the boards, what condition do they have

A

ALL

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54
Q

is ALL curable?

A

yes

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55
Q

ALL has a high risk for long term complications due to

A

high doses of chemo needed to treat

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56
Q

list 4 favorable prognostic factors for ALL

A
  1. hyperdiploid → >50 chromosomes/cell)
  2. 2-10 yo
  3. CD 10+
  4. low WBC count
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57
Q

list 4 poor prognostic factors for ALL

A
  1. hypodiploid
  2. < 2 yo or > 10 yo
  3. male
  4. high WBC → > 100,999 cells/ul
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58
Q

what type of immunotherapy targets CD-19 antigens

A

CAR-T therapy

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59
Q

what type of genetically modified cells does CAR-T therapy use

A

autologous T cells

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60
Q

what serious complication can CAR-T therapy cause

A

cytokine release encephalopathy syndrome

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61
Q

when is CAR-T therapy indicated

A

in a patient who has failed other therapies

usually 2nd or third line therapy for relapsed patients

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62
Q

what condition do you think of when you see Philadelphia chromosomes and BCR/ABLT genes

A

CML

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63
Q

CML involves uncontrolled proliferation of

A

mature/maturing granulocytes

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64
Q

what are the 3 phases of CML

A
  1. chronic
  2. accelerated
  3. acute → blast crisis
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65
Q

what is the cure for CML

A

stem cell transplant

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66
Q

what would be the most appropriate therapy for an older patient with CML

A

oral chemo

stem cell transplant poses risk and mortality

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67
Q

what type of leukemia is characterized by progressive accumulation of incompetent lymphocytes

A

CLL

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68
Q

what are 2 other names for CLL

A
  1. SLL (small lymphocytic lymphoma)
  2. non-Hodgkin lymphoma SLL
69
Q

what condition do you think of when you see gingerbread appearance and smudge cells

A

CLL

70
Q

CLL will have a lymphocyte count >

A

5,000

71
Q

is CLL curable

A

no

72
Q

stem cell transplants in CLL are

A

rarely done

increased risk for mortality

73
Q

what are 5 indications for active dz and tx in CLL

A
  1. progressive marrow failure
  2. progressive or massive splenomegaly
  3. progressive or symptomatic LAD
  4. progressive lymphocytosis
  5. constitutional symptoms
74
Q

name 4 constitutional symptoms in active CLL

A
  1. fatigue
  2. night sweats
  3. unintentional wt loss
  4. fevers
75
Q

lymphoma involves malignant neoplasms derived from (5)

A
  1. B cell progenitors
  2. T cell progenitors
  3. mature B cells
  4. mature T cells
  5. NK cells
76
Q

name 5 lab findings of lymphoma

A
  1. hypercalcemia
  2. hyperuricemia
  3. elevated LDH
  4. anemia
  5. thrombocytopenia
  6. neutropenia
77
Q

what are 2 PE findings associated w. lymphoma

A
  1. splenomegaly
  2. LAD
78
Q

constitutional symptoms in lymphoma are also called __

A

B symptoms

79
Q

what are 4 B (constitutional symptoms) in lymphoma

A
  1. fever
  2. night sweats
  3. unintentional wt loss
  4. fatigue
80
Q

what is the only differentiating factor between hodgkin and nonhodgkin lymphoma

A

Reed Sternberg cells

81
Q

which type of lymphoma is characterized by the presence of Reed Sternberg cells

A

Hodgkin

82
Q

the majority of lymphomas are

A

non-Hodgkin

83
Q

there are many types of non-hodgkin lymphomas, divided into __

and __;

both types have __ and

__ types

A

divided into: B cell and T cell

both types have: indolent (lazy) and aggressive types

84
Q

what condition do you think of when you see, painless cervical adenopathy, generalized pruritis, and pain in lymph nodes w. etoh consumption

A

hodgkin lymphoma

85
Q

only __ of hodgkin lymphoma pt’s have constitutional symptoms

A

⅓

86
Q

what is the most common presenting symptom in hodgkin lymphoma

A

painless cervical adenopathy of supraclavicular or infraclavicular nodes

87
Q

what is the neoplastic cell in hodgkin lymphoma

A

Reed Sternberg cell

88
Q

what are the 4 aggressive non hodgkin lymphomas

A
  1. diffuse large B cell (DLBCL)
  2. burkitt
  3. mantle cell
  4. peripheral T cell
89
Q

what is the most common lymphoma worldwide

A

diffuse large B cell lymphoma (DLBC)

90
Q

extranodal involvement in hodgkin lymphoma is __,

extranodal involvement in DLBC is __

A

rare in hodgkin

common in DLBC

91
Q

what is the main presenting symptom of DLBC

A

rapidly enlarging symptomatic mass on the neck or abdomen

92
Q

over half of DLBC patients will have elevated

A

LDH

93
Q

DLBC is __ and has a

__ prognosis

A

aggressive

poor

94
Q

what is the 2nd most common type of non-hodgkin lymphoma

A

follicular lymphoma

95
Q

what is the 2nd most common type of non-hodgkin lymphoma

A

follicular lymphoma

96
Q

follicular lymphoma is characterized by painless ___ adenopathy in what 4 regions

A

peripheral

cervical, axillary, inguinal, femoral

97
Q

follicular lymphoma is indolent, so is extranodal involvement common?

A

no → it’s lazy

98
Q

what patient population does Burkitt lymphoma make you think of

A

HIV (+)

99
Q

Burkitt lymphoma is a highly aggressive __ cell neoplasm

A

B

100
Q

what is the typical presenting symptom of Burkitt lymphoma

A

abdominal or retroperitoneal mass

101
Q

what complication is common in Burkitt lymphoma

A

tumor lysis syndrome

102
Q

what condition do you think of when you see nuclear staining for cyclin D1

A

mantle cell lymphoma

103
Q

mantle cell lymphoma can involve any region of the

A

GI tract

104
Q

what lymphoma is frequently caused by chronic gastritis from H.pylori infxns

A

marginal zone lymphoma (MALT)

105
Q

MALT commonly arises in ___ tissues of the ___

A

epithelial

stomach

106
Q

dx of MALT is done using __ instead of a bx

A

endoscopy

107
Q

lymphoplasmacytic lymphoma is same-same

A

waldenstrom macroglobulinemia

108
Q

what do you think of when you see smudge cells, IgM monoclonal gammopathy and Raynaud

A

lymphoplasmacytic lymphoma (Waldenstrom macroglobulinemia)

109
Q

non-hodgkin lymphoma involves __ groups of lymph nodes

A

discontinuous

110
Q

what are the 3 most common sites of LAD in non-hodgkin lymphoma

A

neck

inguinal

axillary

111
Q

what % of non-hodgkin lymphoma patients have constitutional symptoms

A

20

112
Q

what dz do you think of when you see plasma cell proliferation and older pt population (mean 66 yo)

A

multiple myeloma

113
Q

in multiple myeloma, excess plasma production in the bone marrow can cause (3)

A

osteolytic lesions

osteopenia

pathologic fx

114
Q

what condition do you think of when you see anemia, elevated creatinine, and hypercalcemia

A

multiple myeloma

115
Q

what UPEP finding is pathopneumonic for multiple myeloma

A

bence jones proteins

116
Q

what do you see on SPEP evaluation of multiple myeloma

A

M-spike

117
Q

what do you think of when you see punched out lytic lesions on imaging

A

multiple myeloma

118
Q

what are the 3 variation of multiple myeloma in order of least to most aggressive

A
  1. MGUS
  2. smoldering myeloma
  3. myeloma w. amyloidosis
119
Q

which variation of multiple myeloma has a very poor prognosis

A

myeloma w. amyloidosis

120
Q

what are the 2 gold standard diagnostic tests for multiple myeloma

A
  1. bone marrow bx showing 10% or higher plasma cells
  2. presence of end organ damage (CRAB)

→ must have both for dx

121
Q

what does CRAB stand for

A

hypercalcemia

renal insufficiency

anemia

bone lesions

→ end organ damage of MM

122
Q

is multiple myeloma a curable malignancy

A

no

w.o effective therapy, symptomatic pt’s die w.in median of 6 months

123
Q

what do you call a group of malignant hematopoietic stem cell disorders characterized by dysplastic and ineffective blood cell production

A

myelodysplastic syndrome (MDS)

124
Q

myelodysplastic syndrome (MDS) is characterized by one or all of what 3 lab findings

A

anemia

thrombocytopenia

leukopenia

125
Q

myelodysplastic syndrome (MDS) can progress to what dz

A

AML

126
Q

MDS must have __ % blasts, or it is

diagnosed as __

A

20%

AML

127
Q

what are the 4 steps of hemostasis

A
  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
Q

disorders of hemostasis are categorized into

A

primary

secondary

129
Q

primary hemostasis disorders involve problems with __ function

A

platelet

130
Q

primary disorders of hemostasis often present with

A

mucocutaneous bleeding or petechiae

131
Q

secondary disorders of hemostasis involve problems with the

A

coagulation cascade

132
Q

secondary disorders of hemostasis usually present with (2)

A

deep tissue hematomas

joint bleeding

133
Q

what are 3 mechanisms of primary hemostasis

A
  1. increased destruction of platelets
  2. decreased production of platelets
  3. platelet dysfxn
134
Q

disorders involving increased destruction of platelets can be divided into (3)

A
  1. immune mediated
  2. thrombotic microangiography (TMA)
  3. disseminated intravascular coagulation (DIC)
135
Q

name 3 conditions of immune mediated increased destruction of platelets

A
  1. immune thrombocytopenic purpura (ITP)
  2. heparin induced thrombocytopenia (HIT)
  3. thrombocytic thrombocytopenic purpura (TTP)
136
Q

ITP is divided into

A

primary → autoimmune

secondary → infectious dz

137
Q

what condition do you think of when you see petechiae, purpura, and bleeding

A

ITP

138
Q

what are the 3 stages of ITP

A
  1. newly diagnosed → <3 months
  2. persistent → 3-12 mo
  3. chronic → > 12 mo
139
Q

what drug is used to tx persistent ITP

A

steroids

140
Q

what is a norma platelet count

A

140,000

141
Q

at what platelet count do you see spontaneous bleeding in ITP pt’s

A

10,000 or below

142
Q

a lower platelet count of __ is not less concerning in ITP,

whereas normally you are concerned when platelets reach __

A

80,000

130,000

143
Q

what condition do you think of when you see antibody platelet factor 4 and thrombosis

A

heparin induced thrombocytopenia (HIT)

144
Q

what are 4 complications of HIT

A
  1. stroke
  2. MI
  3. limb ischemia
  4. DVT
145
Q

what condition do you think of when you see microvascular thrombosis and ADAMTS13

A

Thrombotic Thrombocytopenic Purpura (TTP)

146
Q

what is the pentad of TTP

A
  1. fever
  2. thrombocytopenia
  3. renal failure
  4. neurologic changes
  5. microangiopathic (hemolytic) anemia
147
Q

what condition do you think of when you see endothelial damage from shiga toxin or e.coli

A

hemolytic uremic syndrome (HUS)

148
Q

e.coli 0157H7 is pathopneumonic for

A

hemolytic uremic syndrome (HUS)

149
Q

HUS symptoms are similar to TTP but __ is more common in HUS

A

renal dysfxn

150
Q

what condition do you think of when you see activation of both clotting and fibrinolytic systems at the same time

A

disseminated intravascular coagulation (DIC)

bleeding and clotting at the same time

151
Q

name 4 causes of DIC

A
  1. obstetric conditions → placental abruption, septic abortion
  2. infxn-sepsis
  3. carcinomas of pancreas, prostate, lungs
  4. massive trauma
152
Q

what are 3 disorders of secondary hemostasis

A
  1. von Willebrand Dz
  2. hemophilia A
  3. hemophilia B
153
Q

what is the most common inherited bleeding disorder

A

von Willebrand Dz

154
Q

how most cases of von Willebrand inherited

A

autosomal dominant

155
Q

von willebrand dz is associated with which clotting factor

A

VIII

156
Q

what do you think of when you see bleeding in mucous membranes, epistaxis, and increased bleeding with menorrhagia

A

von Willebrand Dz

157
Q

what 2 coag labs will be elevated in von willebrand

A
  1. bleeding time
  2. PTT
158
Q

hemophilia A involves a deficiency of which clotting factor

A

VIII

159
Q

hemophilia often presents after a

A

dental procedure

160
Q

what is the most common cause of death in hemophiliacs

A

intracranial bleeding

161
Q

what coag panel lab will be elevated in hemophilia

A

PTT

162
Q

the only way to dx hemophilia is with what test

A

clotting factors

163
Q

hemophilia b involves what clotting factor

A

IX

164
Q

hypercoaguable states increase risk for

A

thromboembolism

165
Q

hypercoabuable states can be divided into __

or __

A

inherited

acquired

166
Q

name 4 acquired hypercoaguable states

A
  1. COVID
  2. immobility
  3. anything involving increased estrogen
  4. smoking
167
Q

what are 5 inherited hypercoaguable states

A
  1. factor V leiden
  2. prothrombin gene mutation
  3. protein s deficiency
  4. protein c deficiency
  5. anththrombin deficiency
168
Q

do you anticoagulate all pt’s with hypercoaguable states

A

no!

depends on risk factors

Pathophys II - Exam 1 (4 decks)

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