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150 Cards in this Set
- Front
- Back
Situations in which ESR is increased?
|
1. Infections
2. Inflammatory disease 3. Malignant neoplasms 4. GI disease (Ulcerative Colitis [UC]) 5. Pregnancy |
|
Situations in which ESR is decreased?
|
1. Polycythemia
2. Sickle cell anemia 3. Congestive heart failure 4. Microcytosis 5. Hypofibrinogenemia |
|
Main mechanism of increased ESR?
|
Aggregation of RBCs; RBC aggregates have a higher density than plasma
|
|
Acanthocytes (spur cell) are assosciated with which pathology?
|
1. Liver disease
2. Abetalipoproteinemia |
|
Basophilic stippling is assosciated with which pathology?
|
Baste the ox TAIL:
1. Thalassemias 2. Anemia of chronic disease (ACD) 3. Iron deficiency 4. Lead (Pb) poisoning |
|
Bite cells are assosciated with which pathology?
|
G6PD deficiency
|
|
Macro-ovalocytes are assosciated with which pathology?
|
1. Megaloblastic anemia
2. Marrow failure |
|
Schistocytes (helmet cells) are assosciated with which pathology?
|
1. DIC
2. TTP/HUS 3. Traumatic hemolysis |
|
Spherocytes are assosciated with which pathology?
|
1. Spherocytosis
2. Autoimmune hemolysis |
|
Teardrop cells are assosciated with which pathology?
|
1. Bone marrow infiltration (e.g., myelofibrosis)
|
|
Target cells are assosciated with which pathology?
|
HALT said the hunter to his target
1. HbC disease 2. Asplenia 3. Liver disease 4. Thalassemia |
|
Describe the proess of Heinz body production?
|
Oxidation of iron from ferrous to ferric form leads to denatured Hb precipitation and damage to RBC membrane ––> formation of bite cells
Seen with a-thalassemia, G6PD deficiency |
|
What are Howell-Jolly bodies?
|
Basophilic nuclear remnants found in RBCs
Seen in patients with functional hyposplenia or asplenia |
|
Microcytic anemias
|
1. IDA
2. ACD 3. Thalassemias 4. Lead (Pb) poisoning 5. Sideroblastic anemia |
|
Macrocytic anemias
|
May be subdivided into megaloblastic and nonmegaloblastic anemia
Megaloblastic anemias 1. Folate deficiency 2. B12 deficiency Non-megaloblastic anemia 1. Liver disease 2. Alcoholism 3. Reticulocytosis 4. Metabolic disorders 5. Drugs |
|
What is the Plummer-Vinson syndrome?
|
Triad of:
1. IDA 2. Esophageal web (dysphagia for solids but not liquids) 3. Atrophic glossitis |
|
a-thalassemias are most prevalent in which people?
|
Asian and African
|
|
Findings in lead poisoning
|
Lead Lines on gingival and on epiphyses of long bones
Encephalopathy and Erythrocyte basophilic stippling Abdminal colic ("lead colic") and siderblastic Anemia Drops - wrist and foot |
|
Treatment of lead poisoning
|
1. Succimer (kids)
2. Dimercaprol |
|
Findings in folate deficiency?
|
1. Hypersegmented neutrophils
2. Glossitis 3. Decreased folate levels 4. Increased homocysteine 5. Normal methylmalonic acid |
|
Drugs that can cause folate deficiency?
|
1. Methotrexate
2. Trimethoprim |
|
Findings in B12 deficiency
|
1. Hypersegmented neutrophils
2. Glossitis 2. Decreased B12 4. Increased homocysteine 5. Increased methylmalonic acid 6. Neurological symptoms |
|
Viral agents that may cause aplastic anemia?
|
1. Parvovirus B19
2. EBV 3. HIV 4. CMV 5. HCV |
|
Most common cause of aplastic anemia?
|
Idiopathic
|
|
Most common known cause of aplastic anemia?
|
Drugs;
1. Benzene 2. Chloramphenicol 3. Antimetabolites |
|
Symptoms of aplastic anemia?
|
1. Fever
2. Fatigue 3. Bleeding 4. Petechia 5. Infection |
|
Primary iron storage in the body?
|
Ferritin
|
|
Lead (Pb) poisoning leads to anemia by blocking which enzymes?
|
1. Ferrochelatase
2. ALA dehydratase |
|
What are porphyrias?
|
Conditions of defective heme synthesis that lead to accumulation of heme precurosors
|
|
Symptoms of porphyria cutanea tarda?
|
1. Blistering cutaneous photosensitivity
2. Most common porphyria 3. Tea-coloured urine (due to accumulation of uroporphyrin) |
|
Leukemia vs lymphoma?
|
Leukemia – lymphoid neoplasms with widespread involvement of bone marrow. Tumor cells are found in peripheral blood
Lymphoma – Discrete tumor masses arising from lymph nodes. Presentations often blur definitions |
|
What is leukemoid reaction?
|
Increased WBC count with left shift (e.g., 80% bands) and increased leukocyte ALP, usually due to infection.
Often confused with leukemia |
|
What are Reed-Sternberg cells? And where are they seen?
|
1. Distinctive tumor giant cells, seen in Hodgkin's disease
2. They are binucleate or bilobed, with the 2 halves as mirror images ("owl's eyes") 3. Necessary, but not sufficient for diagnosis of Hodgkin's disease |
|
Neoplasms of mature B cells (non-Hodgkin's lymphoma)
|
1. Burkitt's lymphoma
2. Diffuse large B-cell lymphoma 3. Mantle cell lymphoma 4. Follicular lymphoma |
|
Neoplasms of mature T cells (non-Hodgkin's lymphoma)
|
1. Adult T-cell lymphoma
2. Mycosis fungoides/Sézary syndrome |
|
Genetics of Burkitt's lymphoma?
|
t(8;14), c-myc gene moves next to heavy-chain Ig gene (14); Associated with EBV
|
|
Genetics of Mantle cell lymphoma?
|
t(11;14) Deactivation of cyclin D regulatory gene; poor prognosis, CD5+
|
|
Genetics involved in Follicular lymphoma?
|
t(14;18) bcl-2 expression; difficult to cure; bcl-2 inhibits apoptosis
|
|
Genetics of adult T-cell lymphoma?
|
Caused by HTLV-1; especially affects populations in Japan, West Africa, and the Caribbean
|
|
Findings in Burkitt's lymphoma?
|
1. "Starry sky" appearance, sheets of lymphocytes with interspersed macrophages
2. Jaw lesion in endemic form in Africa; pelvis or abdomen in sporadic form |
|
Findings in adult T-cell lymphoma?
|
1. Adults present with cutaneous lesions; very aggressive
|
|
Findings in mycosis/Sézary syndrome?
|
Adults present with cutaneous patches/nodules; indolent CD4+
|
|
Most common primary tumor arising within bone in the elderly?
|
Multiple myeloma
|
|
What is multiple myeloma?
|
Monoclonal plasma cell ("fried-egg" appearance) cancer that arises in the marrow and produces large amounts of IgG (55%) or IgA (25%).
Most common in those >40-50 years of age |
|
Mnemonics for multiple myeloma?
|
CRABB
HyperCalcemia Renal insufficiency Anemia Bone lytic lesions Back pain Multiple Myeloma: Monoclonal M protein spike |
|
ALL presents most commonly in?
|
<15 years. May present with bone marrow involvement in childhood or mediastinal mass in adolescent males.
|
|
Findings in ALL? (4)
|
1. Bone marrow increased by massive amounts of lymphoblasts.
2. TdT+ and CALLA+ 3. t(12;21) –> better prognosis 4. May spread to CNS and testes |
|
SLL/CLL is most commonly seen in
|
Age >60 years.
|
|
Findings in CLL?
|
1. Often asymptomatic
2. Smudge cells in peripheral blood 3. "Warm" autoimmune hemolytic anemia |
|
Difference between SLL and CLL?
|
CLL has increased peripheral blood lymphocytosis, otherwise the same.
|
|
AML is most commonly seen in
|
Median onset 60 years
|
|
Findings in AML
|
1. Auer rods
2. Massively increased circulating myeloblasts 3. t(14;17) M3 AML subtype responds to all-trans retinoic acid (Vit A), inducing differentiation of myeloblasts 4. DIC is a common presentation |
|
CML is most commonly seen in?
|
30-60 years of age
|
|
Findings in CML
|
1. Defined by the Philadelphia chromosome (t[9;22], bcd-abl)
2. Myeloid stem cell proliferation 3. Presents with increased neutrophils, metamyelocytes, basophils 4. Splenomegaly 5. May accellerate and transform to AML or ALL 6. Very low leukocyte alkaline phosphatase |
|
What are Auer bodies (rods)?
|
Peroxidase-positive cytoplasmic inclusions in granulocytes and myeloblasts. Commonly seen in acute promyelocytic leukemia (M3). Treatment of AML M3 can release Auer rods, which leads to DIC.
|
|
t(9;22) translocation is associated with which disorder?
|
CML (bcr-abl hybrid)
|
|
t(8;14) translocation is associated with which disorder?
|
Burkitt's lymphoma (c-myc activation)
|
|
t(14;18) translocation is associated with which disorder?
|
Follicular lymphomas (bcl-2 activation)
|
|
t(15;17) translocation is associated with which disorder?
|
M3 type of AML
|
|
t(11;22) translocation is associated with which disorder?
|
Ewing's sarcoma
|
|
t(11;14) translocation is associated with which disorder?
|
Mantle cell lymphoma
|
|
What is Langerhans cell histiocytosis (LCH)?
|
1. Proliferative disorder of dendritic cells from monocyte lineage
2. Unknown etiology 3. Functionally immature and do not stimulate T-cells via APC 4. Birbeck granules ("tennis rackets" on EM) are characteristic |
|
Appropriate absolute polycythemia is associated with which diseases?
|
1. Lung disease
2. Congenital heart disease 3. High altitude |
|
Inappropriate absolute polycythemia is associated with which diseases?
|
1. RCC
2. Wilms' tumor 3. Cysts 4. Hepatocellular carcinoma (HCC) 5. Hydronephrosis Due to ectopic EPO |
|
Antineoplastics work at three main levels, what are they?
|
1. Nucleotide synthesis
2. DNA 3. Cellular division |
|
Antineoplastics that work at the level of nucleotide synthesis?
|
1. Methotrexate and 5-FU: decreased thymidine synthesis
2. 6-MP: decreased purine synthesis |
|
Antineoplastics that work at the level of DNA?
|
1. Alkylating agents, cisplatin: cross-link DNA
2. Dactinomycin, doxorubicin: DNA intercalators 3. Etoposide: inhibits topoisomerase II |
|
Antineoplastics that interfere with cell division?
|
1. Vinca alkaloids: inhibit microtubule formation
2. Paclitaxel: inhibits microtubule disassembly |
|
Mechanism of action of methotrexate (MTX)?
|
Folic acid analog that inhibits dihydrofolate reductase –> decreased dTMP –> decreased DNA and protein synthesis
|
|
Mechanism of action of 5-FU?
|
Pyridmidine analog bioactivated to 5F-dUMP, which covalently complexes folic acid. Inhibits thymidylate synthase.
|
|
Mechanism of action of 6-mercaptopurine (6-MP)?
|
Purine (thiol) analog –> decreases de novo purine synthesis
|
|
Mechanism of action of 6-thioguanine (6-TG)?
|
Purine (thiol) analog –> decreases de novo purine synthesis
|
|
Mechanism of action of Cytarabine (ara-C)?
|
Pyrimidine analog –> inhibition of DNA polymerase
|
|
Toxicitiy of vincristine, vinblastine?
|
VinBLASTine BLASTs Bone marrow (suppression)
Vincristine – neurotoxicity and paralytic ileus |
|
Mechanism of action of vincristine, vinblastine?
|
Alkaloids that bind to tubulin in M-phase and block polymerization of microtubules so that mitotic spindle cannot form
Mnemonic: Microtubules are the vines of your cells |
|
Situations in which ESR is increased?
|
1. Infections
2. Inflammatory disease 3. Malignant neoplasms 4. GI disease (Ulcerative Colitis [UC]) 5. Pregnancy |
|
Situations in which ESR is decreased?
|
1. Polycythemia
2. Sickle cell anemia 3. Congestive heart failure 4. Microcytosis 5. Hypofibrinogenemia |
|
Main mechanism of increased ESR?
|
Aggregation of RBCs; RBC aggregates have a higher density than plasma
|
|
Acanthocytes (spur cell) are assosciated with which pathology?
|
1. Liver disease
2. Abetalipoproteinemia |
|
Basophilic stippling is assosciated with which pathology?
|
Baste the ox TAIL:
1. Thalassemias 2. Anemia of chronic disease (ACD) 3. Iron deficiency 4. Lead (Pb) poisoning |
|
Bite cells are assosciated with which pathology?
|
G6PD deficiency
|
|
Macro-ovalocytes are assosciated with which pathology?
|
1. Megaloblastic anemia
2. Marrow failure |
|
Schistocytes (helmet cells) are assosciated with which pathology?
|
1. DIC
2. TTP/HUS 3. Traumatic hemolysis |
|
Spherocytes are assosciated with which pathology?
|
1. Spherocytosis
2. Autoimmune hemolysis |
|
Teardrop cells are assosciated with which pathology?
|
1. Bone marrow infiltration (e.g., myelofibrosis)
|
|
Target cells are assosciated with which pathology?
|
HALT said the hunter to his target
1. HbC disease 2. Asplenia 3. Liver disease 4. Thalassemia |
|
Describe the proess of Heinz body production?
|
Oxidation of iron from ferrous to ferric form leads to denatured Hb precipitation and damage to RBC membrane ––> formation of bite cells
Seen with a-thalassemia, G6PD deficiency |
|
What are Howell-Jolly bodies?
|
Basophilic nuclear remnants found in RBCs
Seen in patients with functional hyposplenia or asplenia |
|
Microcytic anemias
|
1. IDA
2. ACD 3. Thalassemias 4. Lead (Pb) poisoning 5. Sideroblastic anemia |
|
Macrocytic anemias
|
May be subdivided into megaloblastic and nonmegaloblastic anemia
Megaloblastic anemias 1. Folate deficiency 2. B12 deficiency Non-megaloblastic anemia 1. Liver disease 2. Alcoholism 3. Reticulocytosis 4. Metabolic disorders 5. Drugs |
|
What is the Plummer-Vinson syndrome?
|
Triad of:
1. IDA 2. Esophageal web (dysphagia for solids but not liquids) 3. Atrophic glossitis |
|
a-thalassemias are most prevalent in which people?
|
Asian and African
|
|
Findings in lead poisoning
|
Lead Lines on gingival and on epiphyses of long bones
Encephalopathy and Erythrocyte basophilic stippling Abdminal colic ("lead colic") and siderblastic Anemia Drops - wrist and foot |
|
Treatment of lead poisoning
|
1. Succimer (kids)
2. Dimercaprol |
|
Findings in folate deficiency?
|
1. Hypersegmented neutrophils
2. Glossitis 3. Decreased folate levels 4. Increased homocysteine 5. Normal methylmalonic acid |
|
Drugs that can cause folate deficiency?
|
1. Methotrexate
2. Trimethoprim |
|
Findings in B12 deficiency
|
1. Hypersegmented neutrophils
2. Glossitis 2. Decreased B12 4. Increased homocysteine 5. Increased methylmalonic acid 6. Neurological symptoms |
|
Viral agents that may cause aplastic anemia?
|
1. Parvovirus B19
2. EBV 3. HIV 4. CMV 5. HCV |
|
Most common cause of aplastic anemia?
|
Idiopathic
|
|
Most common known cause of aplastic anemia?
|
Drugs;
1. Benzene 2. Chloramphenicol 3. Antimetabolites |
|
Symptoms of aplastic anemia?
|
1. Fever
2. Fatigue 3. Bleeding 4. Petechia 5. Infection |
|
Primary iron storage in the body?
|
Ferritin
|
|
Lead (Pb) poisoning leads to anemia by blocking which enzymes?
|
1. Ferrochelatase
2. ALA dehydratase |
|
What are porphyrias?
|
Conditions of defective heme synthesis that lead to accumulation of heme precurosors
|
|
Symptoms of porphyria cutanea tarda?
|
1. Blistering cutaneous photosensitivity
2. Most common porphyria 3. Tea-coloured urine (due to accumulation of uroporphyrin) |
|
Leukemia vs lymphoma?
|
Leukemia – lymphoid neoplasms with widespread involvement of bone marrow. Tumor cells are found in peripheral blood
Lymphoma – Discrete tumor masses arising from lymph nodes. Presentations often blur definitions |
|
What is leukemoid reaction?
|
Increased WBC count with left shift (e.g., 80% bands) and increased leukocyte ALP, usually due to infection.
Often confused with leukemia |
|
What are Reed-Sternberg cells? And where are they seen?
|
1. Distinctive tumor giant cells, seen in Hodgkin's disease
2. They are binucleate or bilobed, with the 2 halves as mirror images ("owl's eyes") 3. Necessary, but not sufficient for diagnosis of Hodgkin's disease |
|
Neoplasms of mature B cells (non-Hodgkin's lymphoma)
|
1. Burkitt's lymphoma
2. Diffuse large B-cell lymphoma 3. Mantle cell lymphoma 4. Follicular lymphoma |
|
Neoplasms of mature T cells (non-Hodgkin's lymphoma)
|
1. Adult T-cell lymphoma
2. Mycosis fungoides/Sézary syndrome |
|
Genetics of Burkitt's lymphoma?
|
t(8;14), c-myc gene moves next to heavy-chain Ig gene (14); Associated with EBV
|
|
Genetics of Mantle cell lymphoma?
|
t(11;14) Deactivation of cyclin D regulatory gene; poor prognosis, CD5+
|
|
Genetics involved in Follicular lymphoma?
|
t(14;18) bcl-2 expression; difficult to cure; bcl-2 inhibits apoptosis
|
|
Genetics of adult T-cell lymphoma?
|
Caused by HTLV-1; especially affects populations in Japan, West Africa, and the Caribbean
|
|
Findings in Burkitt's lymphoma?
|
1. "Starry sky" appearance, sheets of lymphocytes with interspersed macrophages
2. Jaw lesion in endemic form in Africa; pelvis or abdomen in sporadic form |
|
Findings in adult T-cell lymphoma?
|
1. Adults present with cutaneous lesions; very aggressive
|
|
Findings in mycosis/Sézary syndrome?
|
Adults present with cutaneous patches/nodules; indolent CD4+
|
|
Most common primary tumor arising within bone in the elderly?
|
Multiple myeloma
|
|
What is multiple myeloma?
|
Monoclonal plasma cell ("fried-egg" appearance) cancer that arises in the marrow and produces large amounts of IgG (55%) or IgA (25%).
Most common in those >40-50 years of age |
|
Mnemonics for multiple myeloma?
|
CRABB
HyperCalcemia Renal insufficiency Anemia Bone lytic lesions Back pain Multiple Myeloma: Monoclonal M protein spike |
|
ALL presents most commonly in?
|
<15 years. May present with bone marrow involvement in childhood or mediastinal mass in adolescent males.
|
|
Findings in ALL? (4)
|
1. Bone marrow increased by massive amounts of lymphoblasts.
2. TdT+ and CALLA+ 3. t(12;21) –> better prognosis 4. May spread to CNS and testes |
|
SLL/CLL is most commonly seen in
|
Age >60 years.
|
|
Findings in CLL?
|
1. Often asymptomatic
2. Smudge cells in peripheral blood 3. "Warm" autoimmune hemolytic anemia |
|
Difference between SLL and CLL?
|
CLL has increased peripheral blood lymphocytosis, otherwise the same.
|
|
AML is most commonly seen in
|
Median onset 60 years
|
|
Findings in AML
|
1. Auer rods
2. Massively increased circulating myeloblasts 3. t(14;17) M3 AML subtype responds to all-trans retinoic acid (Vit A), inducing differentiation of myeloblasts 4. DIC is a common presentation |
|
CML is most commonly seen in?
|
30-60 years of age
|
|
Findings in CML
|
1. Defined by the Philadelphia chromosome (t[9;22], bcd-abl)
2. Myeloid stem cell proliferation 3. Presents with increased neutrophils, metamyelocytes, basophils 4. Splenomegaly 5. May accellerate and transform to AML or ALL 6. Very low leukocyte alkaline phosphatase |
|
What are Auer bodies (rods)?
|
Peroxidase-positive cytoplasmic inclusions in granulocytes and myeloblasts. Commonly seen in acute promyelocytic leukemia (M3). Treatment of AML M3 can release Auer rods, which leads to DIC.
|
|
t(9;22) translocation is associated with which disorder?
|
CML (bcr-abl hybrid)
|
|
t(8;14) translocation is associated with which disorder?
|
Burkitt's lymphoma (c-myc activation)
|
|
t(14;18) translocation is associated with which disorder?
|
Follicular lymphomas (bcl-2 activation)
|
|
t(15;17) translocation is associated with which disorder?
|
M3 type of AML
|
|
t(11;22) translocation is associated with which disorder?
|
Ewing's sarcoma
|
|
t(11;14) translocation is associated with which disorder?
|
Mantle cell lymphoma
|
|
What is Langerhans cell histiocytosis (LCH)?
|
1. Proliferative disorder of dendritic cells from monocyte lineage
2. Unknown etiology 3. Functionally immature and do not stimulate T-cells via APC 4. Birbeck granules ("tennis rackets" on EM) are characteristic |
|
Appropriate absolute polycythemia is associated with which diseases?
|
1. Lung disease
2. Congenital heart disease 3. High altitude |
|
Inappropriate absolute polycythemia is associated with which diseases?
|
1. RCC
2. Wilms' tumor 3. Cysts 4. Hepatocellular carcinoma (HCC) 5. Hydronephrosis Due to ectopic EPO |
|
Antineoplastics work at three main levels, what are they?
|
1. Nucleotide synthesis
2. DNA 3. Cellular division |
|
Antineoplastics that work at the level of nucleotide synthesis?
|
1. Methotrexate and 5-FU: decreased thymidine synthesis
2. 6-MP: decreased purine synthesis |
|
Antineoplastics that work at the level of DNA?
|
1. Alkylating agents, cisplatin: cross-link DNA
2. Dactinomycin, doxorubicin: DNA intercalators 3. Etoposide: inhibits topoisomerase II |
|
Antineoplastics that interfere with cell division?
|
1. Vinca alkaloids: inhibit microtubule formation
2. Paclitaxel: inhibits microtubule disassembly |
|
Mechanism of action of methotrexate (MTX)?
|
Folic acid analog that inhibits dihydrofolate reductase –> decreased dTMP –> decreased DNA and protein synthesis
|
|
Mechanism of action of 5-FU?
|
Pyridmidine analog bioactivated to 5F-dUMP, which covalently complexes folic acid. Inhibits thymidylate synthase.
|
|
Mechanism of action of 6-mercaptopurine (6-MP)?
|
Purine (thiol) analog –> decreases de novo purine synthesis
|
|
Mechanism of action of 6-thioguanine (6-TG)?
|
Purine (thiol) analog –> decreases de novo purine synthesis
|
|
Mechanism of action of Cytarabine (ara-C)?
|
Pyrimidine analog –> inhibition of DNA polymerase
|
|
Toxicitiy of vincristine, vinblastine?
|
VinBLASTine BLASTs Bone marrow (suppression)
Vincristine – neurotoxicity and paralytic ileus |
|
Mechanism of action of vincristine, vinblastine?
|
Alkaloids that bind to tubulin in M-phase and block polymerization of microtubules so that mitotic spindle cannot form
Mnemonic: Microtubules are the vines of your cells |