Heme+Onco USMLERX Workbook

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First Aid Express 2013 workbook: HEMATOLOGY & ONCOLOGY
page 1
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Hematology & Oncology

How to Use the Workbook with the Videos
Using this table as a guide, read the Facts in First Aid for the USMLE Step 1 2013,
watch the corresponding First Aid Express 2013 videos, and then answer the workbook
questions.
Facts in First Aid
for the USMLE
Step 1 2013
344.1347.1
347.2349.3
350.1353.1
354.1357.2
358.1360.3
361.1363.2
364.1366.3
367.1369.2
369.3375.1
Corresponding First Aid Express

2013 video
Workbook
questions
Hematology & Oncology Anatomy
110
Hematology & Oncology Physiology

Hematology & Oncology Pathology
part 1
part 2
partThis
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part 4
part 5
Pharmacology part 1
Pharmacology part 2
1114
1518
16, 1922
2324
2528
2830
3133
3435
____________________________________________________________________________________________________________________
Copyright 2013 by MedIQ Learning, LLC All rights reserved v1.2

page 2
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Questions
ANATOMY
1.
Define the following terms. (pp. 344-345)

A.
Anisocytosis _______________________________________________________________
B.
Leukocytosis _______________________________________________________________
C.
Poikilocytosis _______________________________________________________________
D.
Thrombocytopenia __________________________________________________________
2.
What do the dense granules of platelets contain? (p. 344) ________________________________
3.
What do the -granules of platelets contain? (p. 344) ____________________________________
4.
What is the typical WBC count? (p. 344) ______________________________________________
5.
CD14 is a cell surface marker for which cell type? (p. 345) _______________________________
6.
What five conditions can cause eosinophilia? (p. 345) ___________________________________

______________________________________________________________________________
7.
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downloaded
on: 5/14/2013
7:46 PM
List the types of white bloodThis
cells
inisorder
of decreasing
prevalence.
(pp. 345-346) ____________
______________________________________________________________________________
8.
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). (pp. 346-347)
9.
What molecules are in the granules of mast cells? (p. 346) ________________________________
10.
What type of cell has an off-center nucleus, abundant RER, and a clock-face chromatin
distribution? (p. 346) ______________________________________________________________
PHYSIOLOGY
11.
Why are Rh-negative mothers given RhoGAM? (p. 347) _________________________________
____________________________________________________________________________________________________________________

page 3
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12.
In the chart, check which coagulation factors are in the intrinsic vs. the extrinsic coagulation
pathways. (p. 348)
Factor
Extrinsic Pathway
Intrinsic Pathway
Both Pathways
I
II
V
VII
VIII
IX
X
XI
XII
13.
Which factors are vitamin K dependent? How does warfarin inhibit the activation of these factors?
(p. 348) ________________________________________________________________________
14.
Describe the four steps of primary hemostasis and platelet plug formation. (p. 349) ____________
______________________________________________________________________________
PATHOLOGY
15.
Identify each cell type and its associated pathology. (pp. 350-351)
A.
16.

B.
C.
D.
E.
F.
A. _______________________________
D. ______________________________
B. _______________________________
E. ______________________________
C. _______________________________
F. ______________________________
Indicate whether the lab findings in the chart are elevated, decreased, or normal. (pp. 352-355)
Lab Value
Anemia of
Chronic
Disease
Hemochromatosis
Iron
Deficiency
Pregnancy/
OCPs
Thalassemia
Ferritin
Serum iron
Transferrin
% Transferrin
____________________________________________________________________________________________________________________

page 4
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17.
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. 352) ________________________________
______________________________________________________________________________
18.
What are the major history and physical exam findings of lead poisoning? (p. 353) _____________
______________________________________________________________________________
19.
What clinical manifestations do folate deficiency and vitamin B12 deficiency have in common? What
sets them apart? (p. 354) __________________________________________________________
20.
What are four causes of aplastic anemia? (p. 355) ______________________________________

______________________________________________________________________________
21.
Match the intrinsic hemolytic normocytic anemia with its characteristic. (p. 356)
_____ A. G6PD deficiency
_____ B. HbC defect
_____ C. Hereditary spherocytosis
_____ D. Paroxysmal nocturnal hemoglobinuria
_____ E. Pyruvate kinase deficiency
_____ F. Sickle cell anemia
22.
1.
2.
3.
4.
5.
6.
GLU LYS mutation

GLU VAL mutation
Heinz bodies
Howell-Jolly bodies
Increased hemosiderin in urine
Rigid RBCs
Which autoimmune hemolytic anemias are associated with warm agglutinins? With cold
agglutinins? (p. 357) ______________________________________________________________
______________________________________________________________________________
23.

What are the 5 Ps of acute intermittent porphyria? (p. 358) ___________________________

______________________________________________________________________________
24.
Indicate whether the lab findings in the chart are elevated, decreased, or normal. (pp. 359-360)
Disorder
Platelet
Count
Bleeding
Time
PT
PPT
DIC
Glanzmanns thromboasthenia
Hemophilia
ITP/TTP
Vitamin K deficiency
von Willebrands disease
25.
What type of cell is shown in the image?

In what condition is this cell seen? (p. 361)
___________________________________
___________________________________
___________________________________
____________________________________________________________________________________________________________________

page 5
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26.
Which type of Hodgkins lymphoma is more common in women? (p. 362) ____________________
27.
What will serum protein electrophoresis reveal in a patient with multiple myeloma? What will be
seen in the urine? (p. 363) _________________________________________________________
28.
Match the disease with the genetic translocation most closely associated with it. (pp. 362-365)
_____ A. Burkitts lymphoma
_____ B. Chronic myelogenous leukemia
_____ C. Ewings sarcoma
_____ D. Follicular lymphoma
_____ E. M3 type of AML
_____ F. Mantle cell lymphoma
29.
1.
2.
3.
4.
5.
6.
t(8;14)
t(9;22)
t(11;14)
t(11;22)
t(14;18)
t(15;17)
What are the four major groups of leukemias? Which type is at risk of DIC upon initiation of
treatment and why? (pp.364-365)___________________________________________________
_______________________________________________________________________________
30.
Indicate whether the lab findings in the chart are elevated, decreased, or normal. (p. 366)
Chronic
Myeloproliferative
Disorder
Platelets
RBCs
WBCs
CML
Essential
thrombocytosisThis copy belong to the User: 61838
Myelofibrosis
Polycythemia vera
PHARMACOLOGY
31.
Indicate how the drugs in the chart affect the lab findings. (pp. 367-368)
Drug
Bleeding
Time
Platelet
Count
PT
PTT
Aspirin
Clopidogrel/abciximab
Heparin
Warfarin
32.
What is the mechanism of action of heparin? How is overdose treated? (p. 368) _______________
______________________________________________________________________________
33.
What is the mechanism of action of warfarin? How is overdose treated? (p. 368) ______________
______________________________________________________________________________
____________________________________________________________________________________________________________________

page 6
____________________________________________________________________________________________________________________
34.
Match the drug with its target. (pp. 371-373)

_____ A. Abciximab
_____ B. Clopidogrel
_____ C. Etoposide
_____ D. 5-Fluorouracil
_____ E. Imatinib
_____ F. Rituximab
_____ G. Tamoxifen
_____ H. tPA
_____ I. Trastuzumab
_____ J. Vincristine
35.
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
Match the patient with the drug he or she is most likely taking. (pp. 371-372)
_____ 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
____________________________________________________________________________________________________________________

page 7
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Answers
ANATOMY
1.
A.
Anisocytosis: Cells vary in size.
B.
Leukocytosis: Increased number of leukocytes.
C.
Poikilocytosis: Cells vary in shape.
D.
Thrombocytopenia: Decreased number of platelets.
2.
ADP and calcium.
3.
Von Willebrand factor and fibrinogen.
4.
4,00010,000/mm .
5.
Macrophages.
6.
Neoplasm, asthma, allergic processes, collagen vascular diseases, and parasites.
7.
Neutrophils, lymphocytes, monocytes, eosinophils, and basophils.
8.
Thismarrow;
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Bone marrow; bone marrow; bone
thymus.
9.
Histamine, heparin, and eosinophil chemotactic factors.
10.
Plasma cell.
PHYSIOLOGY
11.
To prevent the development of anti-Rh IgG, which can cause erythroblastosis fetalis in a
subsequent fetus.
12.
Factor
Extrinsic Pathway
Intrinsic Pathway
Both Pathways
II
VII
VIII
IX
X
XI
XII
____________________________________________________________________________________________________________________

page 8
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13.
Factors II, VII, IX, X, and proteins C and S. Warfarin inhibits the enzyme epoxide reductase, which
is necessary to convert vitamin K to its reduced form so that it can go on to activate these factors.
14.
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
15.
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.
16.
Lab Value
Anemia of
Chronic
Disease
Hemochromatosis
Iron
Deficiency
Pregnancy/
OCPs
Thalassemia
Ferritin
normal
normal
Serum iron
normal
normal
Transferrin
normal
normal
% Transferrin
normal to

17.
Four deletions: Hb Barts; three deletions: HbH disease; one or two deletions: asymptomatic.
18.
History reveals abdominal colic and confusion. Physical exam shows wrist and foot drop and
Burtons lines on gingiva.
19.
Both folic acid and vitamin B12 deficiency can cause megaloblastic anemia. Only vitamin B12
deficiency, however, is associated with neurologic symptoms, such as peripheral neuropathy,
posterior column degeneration, spasticity, and dementia.
20.
Idiopathic, radiation and drug exposure, viral infection, and Fanconis anemia.
21.
A-3, B-1, C-4, D-5, E-6, F-2.
22.
Warm agglutinins (IgG): SLE, chronic lymphocytic leukemia, and certain drug reactions.
Cold agglutinins (IgM): chronic lymphocytic leukemia, Mycoplasma pneumoniae infection, and
infectious mononucleosis.
23.
Painful abdomen, Pink urine, Polyneuropathy, Psychological disturbances, and Precipitated by

drugs (alcohol, barbiturates).
____________________________________________________________________________________________________________________

page 9
____________________________________________________________________________________________________________________
24.
Platelet
Count
Disorder
Bleeding
Time
PT
PPT
Glanzmanns thromboasthenia
normal
normal
normal
Hemophilia
normal
normal
normal
normal
normal
Vitamin K deficiency
normal
normal
von Willebrands disease
normal
normal
DIC
ITP/TTP
25.
Reed Sternberg cell; Hodgkins lymphoma.
26.
Nodular sclerosing.
27.
An M-spike, representing a monoclonal antibody; IgG light chains (Bence Jones proteins).
28.
A-1, B-2, C-4, D-5, E-6, F-3.
29.
AML, ALL, CML, and CLL. AML can be associated with DIC upon initiation of treatment because
the leukemia cells contain Auer rods composed of the enzyme peroxidase, which is released into
the bloodstream when treatment causes cells to lyse.
30.
Chronic
Myeloproliferative
Disorder
Platelets
CML
Essential
thrombocytosis
Myelofibrosis
RBCs
WBCs
variable
variable
Polycythemia vera
PHARMACOLOGY
31.
Drug
Bleeding
Time
Platelet
Count
PT
PTT
Aspirin
normal
normal
normal
Clopidogrel/abciximab
normal
normal
normal
Heparin
normal
normal
Warfarin
normal
normal
____________________________________________________________________________________________________________________

page 10
____________________________________________________________________________________________________________________
32.
Heparin activates antithrombin, decreasing thrombin and Xa. Treat heparin overdose with
protamine sulfate.
33.
Warfarin interferes with normal synthesis and -carboxylation of vitamin K-dependent clotting
factors. Treat warfarin overdose with intravenous vitamin K and fresh frozen plasma.
34.
A-5, B-1, C-9, D-8, E-3, F-2, G-4, H-7, I-6, J-10.
35.
A-2, B-5, C-3, D-6, E-4, F-1.

____________________________________________________________________________________________________________________

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This copy belong to the User: 61838

This copy is downloaded on: 5/14/2013 7:46 PM

Hematology & Oncology

Corresponding First Aid Express

Hematology & Oncology Anatomy

Hematology & Oncology Physiology

This copy belong to the User: 61838

Define the following terms. (pp. 344-345)

What do the dense granules of platelets contain? (p. 344) ________________________________

What do the -granules of platelets contain? (p. 344) ____________________________________

What is the typical WBC count? (p. 344) ______________________________________________

What five conditions can cause eosinophilia? (p. 345) ___________________________________

Why are Rh-negative mothers given RhoGAM? (p. 347) _________________________________

This copy belong to the User: 61838

This copy belong to the User: 61838

This copy belong to the User: 61838

What are four causes of aplastic anemia? (p. 355) ______________________________________

GLU LYS mutation

This copy belong to the User: 61838

What are the 5 Ps of acute intermittent porphyria? (p. 358) ___________________________

What type of cell is shown in the image?

This copy belong to the User: 61838

This copy belong to the User: 61838

Match the drug with its target. (pp. 371-373)

ADP receptor (platelets)

This copy belong to the User: 61838

Anisocytosis: Cells vary in size.

Leukocytosis: Increased number of leukocytes.

Poikilocytosis: Cells vary in shape.

Thrombocytopenia: Decreased number of platelets.

ADP and calcium.

Von Willebrand factor and fibrinogen.

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

Neutrophils, lymphocytes, monocytes, eosinophils, and basophils.

Histamine, heparin, and eosinophil chemotactic factors.

This copy is downloaded on: 5/14/2013 7:46 PM

This copy belong to the User: 61838

A = Bite cell: G6PD deficiency. B = Ringed sideroblast: sideroblastic anemia. C = Schistocyte:

This copy belong to the User: 61838

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

Painful abdomen, Pink urine, Polyneuropathy, Psychological disturbances, and Precipitated by

This copy belong to the User: 61838

von Willebrands disease

Reed Sternberg cell; Hodgkins lymphoma.

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

This copy belong to the User: 61838

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

This copy belong to the User: 61838

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