First Aid Express 2016 workbook: HEMATOLOGY & ONCOLOGY page 1 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 2016, watch the corresponding First Aid Express 2016 videos, and then answer the workbook questions. Facts in First Aid for Corresponding First Aid Workbook the USMLE Step 1 2016 Express 2016 videos questions 378.1–381.1 Anatomy (2 videos) 1–10 381.2–385.2 Physiology (2 videos) 11–14 386.1–404.2 Pathology (9 videos) 15–30 405.1–413.4 Pharmacology (3 videos) 31–35 Copyright © 2016 by MedIQ Learning, LLC All rights reserved v1.0 page 2 First Aid Express 2016 workbook: HEMATOLOGY & ONCOLOGY Questions ANATOMY 1. Define the following terms. (p 378) A. Anisocytosis _______________________________________________________________ B. Poikilocytosis _______________________________________________________________ C. Thrombocytopenia __________________________________________________________ 2. What do the dense granules of platelets contain? (p 378) ________________________________ 3. What do the α-granules of platelets contain? (p 378) ____________________________________ 4. List the types of white blood cells in order of decreasing prevalence. (pp 378) ________________ ______________________________________________________________________________ 5. What conditions can cause hypersegmentation of neutrophils? (p 378) _____________________ ______________________________________________________________________________ 6. CD14 is a cell surface marker for which cell type? (p 379) _______________________________ 7. What five conditions can cause eosinophilia? (p 379) ___________________________________ ______________________________________________________________________________ 8. What molecules are released by basophils? (p 379) ____________________________________ ______________________________________________________________________________ 9. 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 380) 10. What type of cell has an off-center nucleus, abundant RER, and a clock-face chromatin dis- tribution? (p 381) ______________________________________________________________ Copyright © 2016 by MedIQ Learning, LLC All rights reserved v1.0 page 3 First Aid Express 2016 workbook: HEMATOLOGY & ONCOLOGY PHYSIOLOGY 11. Why are Rh-negative mothers given RhoGAM? (p 382) _________________________________ ______________________________________________________________________________ 12. In the chart, check which coagulation factors are in the intrinsic vs. the extrinsic coagulation pathways. (p 384) 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 384) ________________________________________________________________________ ______________________________________________________________________________ 14. Describe the four steps of primary hemostasis and platelet plug formation. (p 385) ____________ ______________________________________________________________________________ ______________________________________________________________________________ PATHOLOGY 15. Identify each cell type and its associated pathology. (pp 386-387) A. B. C. D. E. F. A. _______________________________ D. ______________________________ B. _______________________________ E. ______________________________ C. _______________________________ F. ______________________________ Copyright © 2016 by MedIQ Learning, LLC All rights reserved v1.0 page 4 First Aid Express 2016 workbook: HEMATOLOGY & ONCOLOGY 16. In α-thalassemia, what is the condition called when all four α-globin genes are deleted? When three are deleted? When one or two are deleted? (p 388) ________________________________ ______________________________________________________________________________ 17. Indicate whether the lab findings in the chart are elevated, decreased, or normal. (pp 388, 389, 391, 393) Anemia of Iron Pregnancy/ Hemo- Lab Value Chronic Deficiency OCPs chromatosis Disease Ferritin Serum iron Transferrin % Transferrin 18. In lead poisoning what enzymes are affected and what substrates are accumulated? (p 389) ___ ______________________________________________________________________________ 19. What clinical manifestations do folate deficiency and vitamin B12 deficiency have in common? What sets them apart? (p 390) __________________________________________________________ 20. What are four causes of aplastic anemia? (p 391) ______________________________________ ______________________________________________________________________________ 21. Match the intrinsic hemolytic normocytic anemia with its characteristic. (p 392) _____ 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 incidence of acute leukemias _____ F. Sickle cell anemia 6. Rigid RBCs 22. Which autoimmune hemolytic anemias are warm and which are cold? (p 393) _______________ ______________________________________________________________________________ 23. What are the “5 P’s” of acute intermittent porphyria? (p 395) _____________________________ ______________________________________________________________________________ Copyright © 2016 by MedIQ Learning, LLC All rights reserved v1.0 First Aid Express 2016 workbook: HEMATOLOGY & ONCOLOGY page 5 24. Indicate whether the lab findings in the chart are elevated, decreased, or normal. (pp 396-398) Platelet Bleeding Disorder PT PTT Count Time DIC Glanzmann thrombasthenia Hemophilia TTP Vitamin K deficiency von Willebrand disease 25. Which type of Hodgkin lymphoma is equally prevalent in men and women? (p 399) ___________ ______________________________________________________________________________ 26. What type of cell is shown by the arrow in the image? In what condition is this cell seen? (p 399) ________________________________________ ________________________________________ ________________________________________ 27. Match the disease with the genetic translocation most closely associated with it. (pp 400-403) _____ A. Burkitt lymphoma 1. t(8;14) _____ B. Chronic myelogenous leukemia 2. t(9;22) _____ C. Follicular lymphoma 3. t(11;14) _____ D. M3 AML 4. t(14;18) _____ E. Mantle cell lymphoma 5. t(15;17) 28. What will serum protein electrophoresis reveal in a patient with multiple myeloma? What will be seen in the urine? (p 401) _________________________________________________________ 29. What are the four major groups of leukemia? Which type is at risk for DIC upon initiation of treatment and why? (p 402) _______________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 30. Indicate whether the lab findings in the chart are elevated, decreased, or normal. (p 404) Chronic Myeloproliferative Platelets RBCs WBCs Disorder CML Essential thrombocytosis Myelofibrosis Polycythemia vera Copyright © 2016 by MedIQ Learning, LLC All rights reserved v1.0 page 6 First Aid Express 2016 workbook: HEMATOLOGY & ONCOLOGY PHARMACOLOGY 31. What is the mechanism of action of heparin? How is overdose treated? (p 406) ______________ ______________________________________________________________________________ 32. What is the mechanism of action of warfarin? How is overdose treated? (p 406) _____________ ______________________________________________________________________________ 33. Indicate how the drugs in the chart affect the lab findings. (pp 406-407) Bleeding Platelet Drug PT PTT Time Count Aspirin Clopidogrel/abciximab Heparin Warfarin 34. Match the drug with its target. (pp 409-413) _____ 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 35. Match the patient with the drug he or she is most likely taking. (pp 409-410) _____ 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-Hodgkin 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 Copyright © 2016 by MedIQ Learning, LLC All rights reserved v1.0 First Aid Express 2016 workbook: HEMATOLOGY & ONCOLOGY page 7 Answers ANATOMY 1. A. Anisocytosis: Cells vary in size. B. Poikilocytosis: Cells vary in shape. C. Thrombocytopenia: Decreased number of platelets. 2. ADP and calcium. 3. von Willebrand factor, fibrinogen, and fibronectin.