Exam III Review

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Exam III Review
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A few notes to keep in mind while studying Dont
forget to check the notes section under each
slide for answers and comments on each
question. You may want to answer each question
before moving on to the next slide, because after
several questions I put an explanatory slide or
two, and if you see those, it might give away the
answer. And we wouldnt want that.
3
Who is this man?

• Michael Kors
• Isaac Mizrahi
• Manolo Blahnik
• John Cleese
• Christian Louboutin

4
Which line goes with each video?
Charlie the unicorn 1 http//www.youtube.com/watch
?vJ7VjUYGpsWM

• Starfish! Love me love me!
• Sparkle! Sparkle!
• Shun the non-believer! Shuuuunnnnn!

Charlie the unicorn 2 http//www.youtube.com/watch
?vQFCSXr6qnv4
Charlie the unicorn 3 http//www.youtube.com/watch
?veaCCkfjPm0o
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Anemia
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Which of the following is a sign of red cell
destruction?

• ? haptoglobin
• ? LDH
• ? bilirubin
• ? reticulocytes
• ? LAP

7
Your patient is a 68 year old male who has very
pale, almost bluish fingertips. When you question
him about this, he says that it gets worse when
hes out in the cold, and that his doctor says he
has some kind of anemia. Which of the following
is probably true?

• He is making IgG antibodies against his red cells
• His DAT would be negative
• The spleen is the major site of red cell
  destruction in this patient
• His blood smear would show schistocytes
• Complement is attacking his red cells

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Autoimmune Hemolytic Anemia
Things you must know

• Warm AIHA
• IgG
• Spleen
• Spherocytes
• Cold AIHA
• IgM, complement
• Intravascular hemolysis
• Agglutination

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Cold AIHA
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What is the defect in hereditary spherocytosis?

• A point mutation in a hemoglobin chain gene
• Absence of one or more hemoglobin chain genes
• Absence of a red cell enzyme
• A spectrin abnormality
• Inability to incorporate iron into hemoglobin

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z
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Your apparently healthy, 75-year-old grandfather
was found to have an abnormality on his blood
smear during a routine physical. His indices are
as follows
RBC 3.5 x 1012/L (4.5-6.0) WBC 10 x 109/L
(4-11) Plt 300 x 109/L (150-450)
Hgb 8 g/dL (12-16) MCV 70 fL(80-100) RDW 15
(12 13.5)
What should be done next?

• Check his blood smear at his next annual physical
• Give him iron replacement
• Perform a complete physical, including testing
  for blood in the stool
• Give him steroids
• Do a bone marrow biopsy

13
Your next patient, a 65 year old Finnish
bachelor, is a self-proclaimed heavy drinker. He
has the following indices
RBC 3.5 x 1012/L (4.5-6.0) WBC 7.2 x 109/L
(4-11) Plt 420 x 109/L (150-450)
Hgb 8 g/dL (12-16) MCV 110 fL(80-100) RDW
13 (12 13.5)
What is the most likely diagnosis?

• Iron-deficiency anemia
• Thalassemia
• Megaloblastic anemia
• Hereditary spherocytosis
• Sickle cell anemia

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Megaloblastic anemia
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Acute Leukemia
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Patients with which of the following leukemias
may go into DIC if given routine chemotherapeutic
agents?

• Acute monoblastic leukemia
• Acute promyelocytic leukemia
• Acute lymphoblastic leukemia
• Chronic myeloid leukemia
• Chronic lymphocytic leukemia

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AML-M3
AML-M3 (acute promyelocytic leukemia)
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All of the following terms are said only by
uneducated peasants who have not taken pathology
at the U of M dental school, EXCEPT

• Acute lymphocytic leukemia
• Chronic myeloblastic leukemia
• Chronic lymphoid leukemia
• Leukemoid reaction
• Chronic myeloid leukemia

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Which of the following leukemias is likely to
show a panmyelosis

• Acute lymphoblastic leukemia
• Acute monoblastic leukemia
• Acute erythroblastic leukemia
• Chronic lymphocytic leukemia
• Chronic myeloid leukemia

20
A bone marrow biopsy shows 5 myeloblasts and
some funny-looking neutrophils and precursors.
The most likely diagnosis is

• Acute myeloid leukemia
• Acute lymphoblastic leukemia
• Myelodysplastic syndrome
• Bacterial infection
• Chronic myeloid leukemia

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Myelodysplastic Syndrome

• Dysmyelopoiesis increased blasts
• May evolve into AML
• Older patients, usually
• Asymptomatic or marrow failure
• Macrocytic anemia
• Treatment depends on age, aggressiveness

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Dyserythropoiesis (dysmyelopoiesis in red cells)
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Dysgranulopoiesis (dysmyelopoiesis in neutrophils)
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While looking around a blood smear, you notice a
blast with an Auer rod in it. This patient has

• A bacterial infection
• No disease, unless 20 of the nucleated cells
  have Auer rods
• A myelodysplastic syndrome
• Acute myeloid leukemia
• Acute lymphoblastic leukemia

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Auer rods
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Acute lymphoblastic leukemia

• Often has a good prognosis
• Never occurs in children
• Is classified according to morphologic appearance
• Is only diagnosed when 20 or more of the
  nucleated cells are lymphoblasts
• Is an indolent disease

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Which of the following is a GOOD prognostic
indicator in acute lymphoblastic leukemia?

• Age less than 1
• A WBC gt10,000
• B-lineage immunophenotype
• Normal cytogenetics
• Age gt10

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CHRONIC Leukemia
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In which of the following disorders is basophilia
usually present?

• Chronic myeloid leukemia
• Polycythemia vera
• Essential thrombocythemia
• Chronic lymphocytic leukemia
• Myeloma

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Chronic Myeloid Leukemia
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Which of the following is characterized by
extramedullary hematopoiesis and teardrop-shaped
red cells?

• Chronic myeloid leukemia
• Polycythemia vera
• Chronic lymphocytic leukemia
• Chronic myelofibrosis
• Acute myeloid leukemia

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Chronic Myelofibrosis
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The cells in chronic lymphocytic leukemia have
which of the following immunophenotypes?

• CD19-, CD5-
• CD19, CD5-
• CD19-, CD5
• CD19, CD5

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Deaths due to CLL are usually the result of

• Bone marrow failure
• Infection
• Second malignancies
• Extramedullary organ infiltration
• Bleeding

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LYmphoma
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The most common cause of an enlarged lymph node
is

• Metastatic carcinoma
• Lymphoma
• Leukemia
• Infection
• Amyloidosis

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Tingible body macrophages

• Are present in follicular lymphoma
• Are present in Burkitt lymphoma
• Are present in primary follicles
• May themselves be malignant
• Are present in Hodgkin disease

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Reactive lymph node
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Reactive lymph node
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Burkitt lymphoma
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Which of the following is potentially curable
with antibiotics?

• Small lymphocytic lymphoma
• MALT lymphoma
• Follicular lymphoma
• Lymphoblastic lymphoma
• Mycosis fungoides

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A 56 year old male has several scaly skin
lesions. A biopsy of one of the skin lesions
shows small collections of cerebriform T cells
within the dermis. What is the most likely
diagnosis?

• Small lymphocytic lymphoma
• MALT lymphoma
• Follicular lymphoma
• Lymphoblastic lymphoma
• Mycosis fungoides

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Mycosis fungoides/Sézary syndrome
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Which of the following pairings is accurate?

• Mycosis fungoides T-cell ALL
• B-lymphoblastic lymphoma B-cell ALL
• CLL SLL
• Burkitt lymphoma B-cell precursor ALL

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Which of the following is the most common
hematopoietic malignancy in young adults between
the ages of 20 and 30?

• Acute lymphoblastic leukemia
• Chronic lymphocytic leukemia
• Hodgkin disease
• Myeloma
• Polycythemia vera

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hemostasis
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Which factors?

• TF, VII, X, V, II, I
• XI, IX, VIII, X, V, II, I

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Which factors?

• TF, VII, X, V, II, I
• XI, IX, VIII, X, II, I

49
Which of the following initiates the coagulation
cascade IN VIVO?

• XII
• Thrombin
• Tissue factor
• X
• Prekallikrein

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INR
PTT
SEXtrinsic
SINtrinsic
XIa
XI
TF VII
IX
IX
VIII
X
V
thrombin
fibrin
sexy
sinful
clot
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What does von Willebrand factor do?

• Binds platelets to each other
• Binds platelets to the subendothelium
• Binds platelets to the phospholipid surface
• Carries factor VII
• Cleaves factor V

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(No Transcript)
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Which of the following is true?

• The intrinsic system is activated first, and then
  the extrinsic system is turned on later
• The extrinsic system is weak and short-lived
• The extrinsic system is only important in vitro
• Factors V and VII are only important in vitro

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Which of the following anti-clotting substances
acts on factors V and VIII?

• ATIII
• Protein C
• TFPI
• Plasmin
• t-PA

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Which of the following is a cofactor?

• XII
• X
• VIII
• VII
• II

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What are the ingredients in a PTT?

• Plasma phospholipid
• Plasma thromboplastin
• Plasma calcium
• Plasma thrombin
• Plasma plasmin

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Which test evaluates the extrinsic pathway?

• PT (INR)
• PTT
• PPTT
• PTTP
• PPTTTHHH

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Which of the following is true regarding the
bleeding time?

• It is a highly reliable and reproducible test
• The sample is evaluated using an optical
  densitometer
• It evaluates platelet function in vivo
• It is a commonly ordered test
• It evaluates the coagulation system

59
What is the most common inherited bleeding
disorder?

• von Willebrands disease
• Hemophilia A
• Hemophilia B
• Factor V Leiden
• TTP

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Which disorders may show factor-type bleeding?

• von Willebrands disease
• Hemophilia A
• Both
• Neither

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Patients with which of the following diseases
always have a normal PTT?

• von Willebrands disease
• Hemophilia A
• Hemophilia B
• Factor V Leiden

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TTP

• May present with CNS deficits
• Is caused by a toxin produced by E. coli
• Is treated supportively
• Does not show a microangiopathic blood picture