First Aid for the USMLE Step 1 2011 EXPRESS workbook

page 125

Hematology and Oncology

Questions ANATOMY
1. In the chart below, checkmark which types of blood cells are derived from myeloid vs. lymphoid stem cells. (p. 342) Blood Cell Type B cell Basophil Erythrocyte Eosinophil Monocyte Natural killer cell Neutrophil Platelet T cell 2. List the types of white blood cells in order of decreasing prevalence. (pp. 342-343) _____________ ______________________________________________________________________________ 3. Define the follow terms. (pp. 342-343) A. B. C. D. E. 4. 5. Anisocytosis _______________________________________________________________ Eosinophilia _______________________________________________________________ Leukocytosis _______________________________________________________________ Poikilocytosis ______________________________________________________________ Thrombocytopenia __________________________________________________________ Myeloid Lineage Lymphoid Lineage

What is the typical WBC count? (p. 342) ______________________________________________ What five conditions can cause eosinophilia? (p. 343) ___________________________________ ______________________________________________________________________________

6.

B lymphocytes are produced in the _______________ (bone marrow/thymus) and mature in the _______________ (bone marrow/thymus). T lymphocytes are produced in the _______________ (bone marrow/thymus) and mature in the _______________ (bone marrow/thymus). (p. 344)

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PHYSIOLOGY
7. 8. Why are Rh-negative mothers given RhoGAM ? (p. 345) _________________________________ In the chart below, checkmark which coagulation factors are in the intrinsic vs. extrinsic coagulation pathways. (p. 345) Factor I II V VII VIII IX X XI XII 9. 10. What factors are vitamin K dependent? (p. 345) ________________________________________ Describe the four steps of primary hemostasis and platelet plug formation. (p. 346) ____________ ______________________________________________________________________________ Extrinsic Pathway Intrinsic Pathway Both Pathways

PATHOLOGY
11. Identify each cell type and its associated pathology. (pp. 348-349)

A.

B.

C.

E.

F.

A. _______________________________ B. _______________________________ C. _______________________________ 12.

D. ______________________________ E. ______________________________ F. ______________________________

Indicate whether the lab findings in the chart are elevated, decreased, or normal. (pp. 349-353) Anemia of Chronic Disease Hemochromatosis Iron Deficiency Pregnancy/ OCPs

Lab Value Ferritin Serum iron Transferrin % Transferrin

Thalassemia

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13.

In -thalassemia, what is the condition called when all four -globin genes are deleted? When three are deleted? When one or two are deleted? (p. 349) ________________________________ ______________________________________________________________________________

14.

What are the major history and physical exam findings of lead poisoning? (p. 350) _____________ ______________________________________________________________________________

15.

What clinical findings differentiate megaloblastic anemia due to folate deficiency versus that due to vitamin B12 deficiency? (p. 350) _____________________________________________________ What are four causes of aplastic anemia? (p. 351) ______________________________________ ______________________________________________________________________________

16.

17.

Match the intrinsic hemolytic normocytic anemia with its characteristic. (p. 352) _____ A. G6PD deficiency _____ B. HbC defect _____ C. Hereditary spherocytosis _____ D. Paroxysmal nocturnal hemoglobinuria _____ E. Pyruvate kinase deficiency _____ F. Sickle cell anemia 1. 2. 3. 4. 5. 6. GLU LYS mutation GLU VAL mutation Heinz bodies Howell-Jolly bodies Increased hemosiderin in urine Rigid RBCs

18.

Which autoimmune hemolytic anemias are associated with warm agglutinins? With cold agglutinins? (p. 353) ______________________________________________________________ ______________________________________________________________________________

19.

What are the 5 Ps of acute intermittent porphyria? (p. 354) ______________________________ ______________________________________________________________________________

20.

Indicate whether the lab findings in the chart are elevated, decreased, or normal. (pp. 355-356) Platelet Count Bleeding Time

Disorder DIC Glanzmanns thromboasthenia Hemophilia ITP/TTP Vitamin K deficiency von Willebrands disease

PT

PPT

21.

What type of cell is shown in the image? In what condition is this cell seen? (p. 357) ___________________________________ ___________________________________ ___________________________________

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22. 23.

Which type of Hodgkins lymphoma is more common in women? (p. 357) ____________________ What will serum protein electrophoresis reveal in a patient with multiple myeloma? What will be seen in the urine? (p. 358) _________________________________________________________ Match the disease with the genetic translocation most closely associated with it. (pp. 358-360) _____ A. Burkitts lymphoma _____ B. Chronic myelogenous leukemia _____ C. Ewings sarcoma _____ D. Follicular lymphoma _____ E. M3 type of AML _____ F. Mantle cell lymphoma 1. 2. 3. 4. 5. 6. t(8;14) t(9;22) t(11;14) t(11;22) t(14;18) t(15;17)

24.

25.

What are the four major groups of leukemias? Which type is associated with Auer rods? (pp. 359360) __________________________________________________________________________ Indicate whether the lab findings in the chart are elevated, decreased, or normal. (p. 361) Chronic Myeloproliferative Disorder CML Essential thrombocytosis Myelofibrosis Polycythemia vera

26.

Platelets

RBCs

WBCs

PHARMACOLOGY
27. Indicate how the drugs in the chart affect the lab findings. (pp. 362-363) Bleeding Time Platelet Count

Drug Aspirin Clopidogrel/abciximab Heparin Warfarin

PT

PTT

28.

What is the mechanism of action of heparin? How is overdose treated? (p. 362) ______________ ______________________________________________________________________________

29.

What is the mechanism of action of warfarin? How is overdose treated? (p. 362) ______________ ______________________________________________________________________________

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30.

Match the drug with its target. (pp. 363-368) _____ A. Abciximab _____ B. Clopidogrel _____ C. Etoposide _____ D. 5-Fluorouracil _____ E. Imatinib _____ F. Rituximab _____ G. Tamoxifen _____ H. tPA _____ I. Trastuzumab _____ J. Vincristine 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. ADP receptor (platelets) B cells (CD20) bcr-abl tyrosine kinase Estrogen receptor Glycoprotein IIb/IIIa receptor HER2 (erb-B2) Plasminogen Thymidylate synthase Topoisomerase II Tubulin

31.

Match the patient with the drug he or she is most likely taking. (pp. 365-366) _____ A. Patient preparing for bone marrow transplantation has 1. Bleomycin PFTs consistent with restrictive lung disease 2. Busulfan _____ B. Patient with colon cancer has myelosuppression 3. Cyclophosphamide not reversible with leucovorin 4. Doxorubicin _____ C. Patient with non-Hodgkins lymphoma is having 5. 5-Fluorouracil hemorrhagic cystitis 6. Methotrexate _____ D. Patient with leukemia is having myelosuppression reversible with leucovorin _____ E. Patient with solid tumor is having dilated cardiomyopathy _____ F. Patient with testicular cancer has PFTs consistent with restrictive lung disease

Answers ANATOMY
1. Blood Cell Type B cell Basophil Erythrocyte Eosinophil Monocyte Natural killer cell Neutrophil Platelet T cell Myeloid Lineage Lymphoid Lineage

2.

Neutrophils, lymphocytes, monocytes, eosinophils, and basophils.

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3.

A. B. C. D. E.

Anisocytosis: Cells vary in size. Eosinophilia: Increased number of RBCs. Leukocytosis: Increased number of leukocytes. Poikilocytosis: Cells vary in shape. Thrombocytopenia: Decreased number of platelets.
3

4. 5. 6.

4,000-10,000/mm . Neoplasm, asthma, allergic processes, collagen vascular diseases, and parasites. Bone marrow; bone marrow; bone marrow; thymus.

PHYSIOLOGY
7. To prevent the development of anti-Rh IgG, which can cause erythroblastosis fetalis in a subsequent fetus.

8. Factor I II V VII VIII IX X XI XII Extrinsic Pathway Intrinsic Pathway Both Pathways

9. 10.

Factors II, VII, IX, X, and proteins C and S. Injury: Endothelial damage prompts vWF binding to exposed collagen. Adhesion: Platelets bind 2+ vWF and release ADP/Ca . Activation: GpIIb/IIIa is expressed. Aggregation: Fibrinogen binds GpIIb/IIIa and links platelets.

PATHOLOGY
11. A = Bite cell: G6PD deficiency. B = Ringed sideroblast: sideroblastic anemia. C = Schistocyte: microangiopathic hemolytic anemia (DIC, TTP, HUS). D = Teardrop cell: bone marrow infiltration or myelofibrosis. E = Target cell: HbC disease, asplenia, liver disease, thalassemia. F = Heinz bodies: -thalassemia, G6PD deficiency.

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12. Lab Value Ferritin Serum iron Transferrin % Transferrin 13. 14. Anemia of Chronic Disease normal to Hemochromatosis Iron Deficiency Pregnancy/ OCPs normal normal Thalassemia normal normal normal normal

Four deletions: Hb Barts; three deletions: HbH disease; one or two deletions: asymptomatic. History reveals abdominal colic and confusion. Physical exam shows wrist and foot drop and Burtons lines on gingiva. Megaloblastic anemia due to vitamin B12 deficiency is associated with neurologic symptoms. Idiopathic, radiation and drug exposure, viral infection, and Fanconis anemia. A-3, B-1, C-4, D-5, E-6, F-2. Warm agglutinins (IgG): SLE, chronic lymphocytic leukemia, and certain drug reactions. Cold agglutinins (IgM): chronic lymphocytic leukemia, Mycoplasma pneumoniae infection, and infectious mononucleosis. Painful abdomen, Pink urine, Polyneuropathy, Psychological disturbances, and Precipitated by drugs (alcohol, barbiturates).

15. 16. 17. 18.

19.

20. Disorder DIC Glanzmanns thromboasthenia Hemophilia ITP/TTP Vitamin K deficiency von Willebrands disease 21. 22. 23. 24. 25. Platelet Count normal normal normal normal Bleeding Time normal normal PT normal normal normal normal PPT normal normal

Reed Sternberg cell; Hodgkins lymphoma. Nodular sclerosing. An M-spike, representing a monoclonal antibody; IgG light chains (Bence-Jones proteins). A-1, B-2, C-4, D-5, E-6, F-3. AML (associated with Auer rods), ALL, CML, and CLL.

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26. Chronic Myeloproliferative Disorder CML Essential thrombocytosis Myelofibrosis Polycythemia vera Platelets variable RBCs WBCs variable

PHARMACOLOGY
27. Drug Aspirin Clopidogrel/abciximab Heparin Warfarin 28. Bleeding Time normal normal Platelet Count normal normal normal normal PT normal normal PTT normal normal

Heparin activates antithrombin, decreasing thrombin and Xa. Treat heparin overdose with protamine sulfate. Warfarin interferes with normal synthesis and -carboxylation of vitamin K-dependent clotting factors. Treat warfarin overdose with intravenous vitamin K and fresh frozen plasma. A-5, B-1, C-9, D-8, E-3, F-2, G-4, H-7, I-6, J-10. A-2, B-5, C-3, D-6, E-4, F-1.

29.

30. 31.

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