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 Myeloid Lineage Lymphoid Lineage

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. Anisocytosis _______________________________________________________________
B. Eosinophilia _______________________________________________________________
C. Leukocytosis _______________________________________________________________
D. Poikilocytosis ______________________________________________________________
E. Thrombocytopenia __________________________________________________________

4. What is the typical WBC count? (p. 342) ______________________________________________

5. 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. Why are Rh-negative mothers given RhoGAM ? (p. 345) _________________________________

8. In the chart below, checkmark which coagulation factors are in the intrinsic vs. extrinsic coagulation
pathways. (p. 345)

Factor Extrinsic Pathway Intrinsic Pathway Both Pathways

I
II
V
VII
VIII
IX
X
XI
XII

9. What factors are vitamin K dependent? (p. 345) ________________________________________

10. Describe the four steps of primary hemostasis and platelet plug formation. (p. 346) ____________
______________________________________________________________________________

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

A. B. C. D E. F.

A. _______________________________ D. ______________________________
B. _______________________________ E. ______________________________
C. _______________________________ F. ______________________________

12. Indicate whether the lab findings in the chart are elevated, decreased, or normal. (pp. 349-353)

Anemia of
Hemochroma- Iron Pregnancy/
Lab Value Chronic Thalassemia
tosis Deficiency OCPs
Disease
Ferritin
Serum iron
Transferrin
% Transferrin

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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) _____________________________________________________

16. What are four causes of aplastic anemia? (p. 351) ______________________________________
______________________________________________________________________________

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

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

21. What type of cell is shown in the image?

In what condition is this cell seen? (p. 357)
___________________________________
___________________________________
___________________________________

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22. Which type of Hodgkins lymphoma is more common in women? (p. 357) ____________________

23. What will serum protein electrophoresis reveal in a patient with multiple myeloma? What will be
seen in the urine? (p. 358) _________________________________________________________

24. Match the disease with the genetic translocation most closely associated with it. (pp. 358-360)
_____ A. Burkitts lymphoma 1. t(8;14)
_____ B. Chronic myelogenous leukemia 2. t(9;22)
_____ C. Ewings sarcoma 3. t(11;14)
_____ D. Follicular lymphoma 4. t(11;22)
_____ E. M3 type of AML 5. t(14;18)
_____ F. Mantle cell lymphoma 6. t(15;17)

25. What are the four major groups of leukemias? Which type is associated with Auer rods? (pp. 359-
360) __________________________________________________________________________

26. Indicate whether the lab findings in the chart are elevated, decreased, or normal. (p. 361)

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

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

Bleeding Platelet
Drug PT PTT
Time Count

Aspirin
Clopidogrel/abciximab
Heparin
Warfarin

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 1. ADP receptor (platelets)
_____ B. Clopidogrel 2. B cells (CD20)
_____ C. Etoposide 3. bcr-abl tyrosine kinase
_____ D. 5-Fluorouracil 4. Estrogen receptor
_____ E. Imatinib 5. Glycoprotein IIb/IIIa receptor
_____ F. Rituximab 6. HER2 (erb-B2)
_____ G. Tamoxifen 7. Plasminogen
_____ H. tPA 8. Thymidylate synthase
_____ I. Trastuzumab 9. Topoisomerase II
_____ J. Vincristine 10. 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 Myeloid Lineage Lymphoid Lineage

B cell
Basophil
Erythrocyte
Eosinophil
Monocyte
Natural killer cell
Neutrophil
Platelet
T cell

2. Neutrophils, lymphocytes, monocytes, eosinophils, and basophils.

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3. A. Anisocytosis: Cells vary in size.

B. Eosinophilia: Increased number of RBCs.
C. Leukocytosis: Increased number of leukocytes.
D. Poikilocytosis: Cells vary in shape.
E. Thrombocytopenia: Decreased number of platelets.
3
4. 4,000-10,000/mm .

5. Neoplasm, asthma, allergic processes, collagen vascular diseases, and parasites.

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

9. Factors II, VII, IX, X, and proteins C and S.

10. 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.

Anemia of
Hemochroma- Iron Pregnancy/
Lab Value Chronic Thalassemia
tosis Deficiency OCPs
Disease
Ferritin normal normal
Serum iron normal normal
Transferrin normal
% Transferrin normal to normal

13. Four deletions: Hb Barts; three deletions: HbH disease; one or two deletions: asymptomatic.

14. History reveals abdominal colic and confusion. Physical exam shows wrist and foot drop and
Burtons lines on gingiva.

15. Megaloblastic anemia due to vitamin B12 deficiency is associated with neurologic symptoms.

16. Idiopathic, radiation and drug exposure, viral infection, and Fanconis anemia.

17. A-3, B-1, C-4, D-5, E-6, F-2.

18. Warm agglutinins (IgG): SLE, chronic lymphocytic leukemia, and certain drug reactions. Cold
agglutinins (IgM): chronic lymphocytic leukemia, Mycoplasma pneumoniae infection, and infectious
mononucleosis.

19. Painful abdomen, Pink urine, Polyneuropathy, Psychological disturbances, and Precipitated by
drugs (alcohol, barbiturates).

20.

Platelet Bleeding
Disorder PT PPT
Count Time

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

21. Reed Sternberg cell; Hodgkins lymphoma.

22. Nodular sclerosing.

23. An M-spike, representing a monoclonal antibody; IgG light chains (Bence-Jones proteins).

24. A-1, B-2, C-4, D-5, E-6, F-3.

25. AML (associated with Auer rods), ALL, CML, and CLL.

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26.

Chronic
Myeloproliferative Platelets RBCs WBCs
Disorder
CML
Essential

thrombocytosis
Myelofibrosis variable variable
Polycythemia vera

PHARMACOLOGY
27.

Bleeding Platelet
Drug PT PTT
Time Count

Aspirin normal normal normal

Clopidogrel/abciximab normal normal normal
Heparin normal normal
Warfarin normal normal

28. Heparin activates antithrombin, decreasing thrombin and Xa. Treat heparin overdose with
protamine sulfate.

29. Warfarin interferes with normal synthesis and -carboxylation of vitamin K-dependent clotting
factors. Treat warfarin overdose with intravenous vitamin K and fresh frozen plasma.

30. A-5, B-1, C-9, D-8, E-3, F-2, G-4, H-7, I-6, J-10.

31. A-2, B-5, C-3, D-6, E-4, F-1.

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