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First Aid Express 2018 workbook: HEMATOLOGY & ONCOLOGY page 1

Hematology & Oncology


Questions

ANATOMY
1. Define the following terms. (p 396)

A. Anisocytosis _______________________________________________________________

B. Poikilocytosis ______________________________________________________________

C. Reticulocyte _______________________________________________________________

2. What do the dense granules of platelets contain? (p 396) ________________________________

3. What do the α-granules of platelets contain? (p 396) ____________________________________

4. List the types of white blood cells in order of decreasing prevalence. (p 396) _________________

______________________________________________________________________________

5. What conditions can cause hypersegmentation of neutrophils? (p 396) ______________________

______________________________________________________________________________

6. CD14 is a cell surface marker for which cell type? (p 397) ________________________________

7. What seven conditions can cause eosinophilia? (p 397) __________________________________

______________________________________________________________________________

8. What molecules are released by basophils? (p 397) ____________________________________

______________________________________________________________________________

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 398)

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10. What type of cell has an off-center nucleus, abundant RER, and a clock-face chromatin distribution?

(p 399) _________________________________________________________________________

PHYSIOLOGY
11. Why are Rh-negative mothers given anti-D IgG? (p 400) __________________________________

______________________________________________________________________________

12. In the chart, check which coagulation factors are in the intrinsic vs. the extrinsic coagulation
pathways. (p 401)

Factor Extrinsic Pathway Intrinsic Pathway Both Pathways

II

VII

VIII

IX

XI

XII

13. Which factors are vitamin K dependent? How does warfarin inhibit the activation of these factors?

(p 402) _________________________________________________________________________

______________________________________________________________________________

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First Aid Express 2018 workbook: HEMATOLOGY & ONCOLOGY page 3

14. Describe the four steps of primary hemostasis and platelet plug formation. (p 403) ____________

______________________________________________________________________________

______________________________________________________________________________

PATHOLOGY
15. Identify each cell type and its associated pathology. (pp 404-405)

A. B. C. D. E. F.

A. _______________________________ D. ______________________________

B. _______________________________ E. ______________________________

C. _______________________________ F. ______________________________

16. In α-thalassemia, what is the condition called when all four α-globin genes are deleted? When three
are deleted? When two are deleted? When one is deleted? (p 406) __________________________

______________________________________________________________________________

17. What clinical manifestations do folate deficiency and vitamin B12 deficiency have in common? What

sets them apart? (p 408) __________________________________________________________

______________________________________________________________________________

18. What are four causes of aplastic anemia? (p 409) ______________________________________

______________________________________________________________________________

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19. Match the intrinsic hemolytic normocytic anemia with its characteristic. (p 410)

_____ 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. Increased incidence of acute leukemias

_____ E. Pyruvate kinase deficiency 5. Increased fragility in osmotic fragility test

_____ F. Sickle cell anemia 6. Rigid RBCs

20. Which autoimmune hemolytic anemias are warm and which are cold? (p 411) ________________

______________________________________________________________________________

21. Indicate whether the lab findings in the chart are elevated, decreased, or normal. (p 412)

Anemia of Pregnancy/
Iron Hemo-
Lab Value Chronic
Deficiency chromatosis
Disease OCPs

Ferritin

Serum iron

Transferrin

% Transferrin

22. In lead poisoning what enzymes are affected and what substrates are accumulated? (p 413) ____

______________________________________________________________________________

23. What are the “5 P’s” of acute intermittent porphyria? (p 413) _____________________________

______________________________________________________________________________

______________________________________________________________________________

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First Aid Express 2018 workbook: HEMATOLOGY & ONCOLOGY page 5

24. Indicate whether the lab findings in the chart are elevated, decreased, or normal. (pp 414-416)

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 most common? (p 417) ______________________________

______________________________________________________________________________

26. What type of cell is shown by the arrow in the image?


In what condition is this cell seen? (p 417)

________________________________________

________________________________________

________________________________________

27. Match the disease with the genetic translocation most closely associated with it. (pp 418, 420)

_____ A. Acute myelogenous leukemia 1. t(8;14)

_____ B. Burkitt lymphoma 2. t(9;22)

_____ C. Chronic myelogenous leukemia 3. t(11;14)

_____ D. Follicular lymphoma 4. t(14;18)

_____ E. Mantle cell lymphoma 5. t(15;17)

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28. What will serum protein electrophoresis reveal in a patient with multiple myeloma? What will be seen
in the urine? (p 419) _________________________________________________________

29. What are the four major groups of leukemia? Which type is at risk for DIC upon initiation of treatment
and why? (p 420) ________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

30. Indicate whether the lab findings in the chart are elevated, decreased, or normal. (p 421)

Chronic
Myeloproliferative Platelets RBCs WBCs
Disorder

CML

Essential
thrombocytosis

Myelofibrosis

Polycythemia vera

PHARMACOLOGY
31. What is the mechanism of action of heparin? How is overdose treated? (p 423) ______________

______________________________________________________________________________

32. What is the mechanism of action of warfarin? How is overdose treated? (p 424) _____________

______________________________________________________________________________

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First Aid Express 2018 workbook: HEMATOLOGY & ONCOLOGY page 7

33. Match the drug with its target. (pp 425-431)

_____ 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. HER-2 (c-erbB2)

_____ G. Tamoxifen 7. Plasminogen

_____ H. tPA 8. Thymidylate synthase

_____ I. Trastuzumab 9. Topoisomerase II

_____ J. Vincristine 10. Tubulin

34. Match the patient with the drug he or she is most likely taking. (pp 427-428)

_____ A. Patient with previous 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 leukemia has myelosuppression 5. 5-Fluorouracil

reversible with leucovorin 6. Methotrexate

_____ D. Patient with non-Hodgkin lymphoma has hemorrhagic

cystitis

_____ E. Patient with solid tumor has dilated cardiomyopathy

_____ F. Patient with testicular cancer has PFTs consistent with restrictive lung disease

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Answers

ANATOMY
1. A. Anisocytosis: Cells vary in size.

B. Poikilocytosis: Cells vary in shape.

C. Reticulocyte: Immature RBC.

2. ADP and calcium.

3. von Willebrand factor, fibrinogen, and fibronectin.

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

5. Vitamin B12 and folate deficiency.

6. Macrophages.

7. Parasites, asthma, Churg-Strauss syndrome, chronic adrenal insufficiency, myeloproliferative


disorders, allergic processes, and neoplasia (eg, Hodgkin lymphoma).

8. Histamine, heparin, and leukotrienes.

9. Bone marrow; bone marrow; bone marrow; thymus.

10. Plasma cell.

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

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First Aid Express 2018 workbook: HEMATOLOGY & ONCOLOGY page 9

12.

Factor Extrinsic Pathway Intrinsic Pathway Both Pathways

I √

II √

V √

VII √

VIII √

IX √

X √

XI √

XII √

13. Factors II, VII, IX, X, and proteins C and S. Warfarin inhibits the enzyme vitamin K epoxide reductase,
which is necessary to convert vitamin K to its reduced form so that it can go on to activate these
factors.

14. 1. Injury: Endothelial damage occurs.

2. Exposure: Prompts vWF binding to exposed collagen.

3. Adhesion: Platelets bind vWF via the GpIb receptor and release ADP/Ca2+.

4. Activation: ADP binds the ADP receptor, and GpIIb/IIIa is expressed. Aggregation: Fibrinogen
binds GpIIb/IIIa and links platelets.

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PATHOLOGY
15. A = Degmacyte (bite cell): G6PD deficiency. B = Ringed sideroblast: sideroblastic anemia. C =
Schistocyte: microangiopathic hemolytic anemia (DIC, TTP, HUS). D = Dacrocyte (teardrop cell):
bone marrow infiltration (eg myelofibrosis). E = Target cell: HbC disease, asplenia, liver disease,
thalassemia. F = Heinz bodies: G6PD deficiency.

16. Four deletions: Hb Barts; three deletions: HbH disease; two deletions: α-thalassemia minor; one
deletion: α-thalassemia minima.17.Both folic acid and vitamin B12 deficiency can cause
megaloblastic anemia. Only vitamin B12 deficiency, however, is associated with neurologic
symptoms, such as subacute combined degeneration. Also B12 deficiency is associated with
increased methylmalonic acid, unlike folic acid deficiency.

18. Idiopathic, radiation and drug exposure, viral agents, and Fanconi anemia.

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

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

21.

Anemia of Pregnancy/
Iron Hemo-
Lab Value Chronic
Deficiency choromatosis
Disease OCPs

Ferritin ↑ ↓ normal ↑

Serum iron ↓ ↓ normal ↑

Transferrin ↓ ↑ ↑ ↓

% Transferrin normal ↓↓ ↓ ↑↑

22. Enzymes: Ferrochelatase and ALA dehydratase. Substrates: Protoporphyrin and ALA (blood)

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First Aid Express 2018 workbook: HEMATOLOGY & ONCOLOGY page 11

23. Painful abdomen, Port wine-colored urine, Polyneuropathy, Psychological disturbances, and
Precipitated by drugs (eg, cytochrome P-450 inducers), alcohol, and starvation.

24.

Platelet Bleeding
Disorder PT PTT
Count Time

DIC ↓ ↑ ↑ ↑

Glanzmann thromboasthenia normal ↑ normal normal

Hemophilia normal normal normal ↑

TTP ↓ ↑ normal normal

Vitamin K deficiency normal normal ↑ ↑

von Willebrand disease normal ↑ normal normal / ↑

25. Nodular sclerosing.

26. Reed-Sternberg cell; Hodgkin lymphoma.

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

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

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.

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30.

Chronic
Myeloproliferative Platelets RBCs WBCs
Disorder

CML ↑ ↓ ↑

Essential
↑ — —
thrombocytosis

Myelofibrosis variable ↓ variable

Polycythemia vera ↑ ↑ ↑

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

32. Warfarin interferes with normal synthesis and γ-carboxylation of vitamin K-dependent clotting factors.
Treat warfarin overdose with vitamin K, fresh frozen plasma, or PCC.

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

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

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