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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 2014,
watch the corresponding First Aid Express 2014 videos, and then answer the workbook
questions.

Facts in First Aid for Corresponding First Aid Workbook

the USMLE Step 1 2014 Express 2014 videos questions
374.1376.5 Anatomy (2 videos) 110
377.1379.2 Physiology (2 videos) 1114
380.1398.1 Pathology (9 videos) 1530
398.2407.2 Pharmacology (3 videos) 3135

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page 2 First Aid Express 2014 workbook: HEMATOLOGY & ONCOLOGY

Questions

ANATOMY
1. Define the following terms. (p. 374)
A. Anisocytosis _______________________________________________________________
B. Poikilocytosis _______________________________________________________________
C. Thrombocytopenia __________________________________________________________

2. What do the dense granules of platelets contain? (p. 374) ________________________________

3. What do the -granules of platelets contain? (p. 374) ____________________________________

4. What is the typical WBC count? (p. 374) ______________________________________________

5. List the types of white blood cells in order of decreasing prevalence. (pp. 374) ________________
______________________________________________________________________________

6. CD14 is a cell surface marker for which cell type? (p. 375) ________________________________

7. What five conditions can cause eosinophilia? (p. 375) ___________________________________

______________________________________________________________________________

8. What molecules are in the granules of basophils cells? (p. 375) ___________________________

______________________________________________________________________________

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. 376)

10. What type of cell has an off-center nucleus, abundant RER, and a clock-face chromatin dis-
tribution? (p. 376) ______________________________________________________________

PHYSIOLOGY
11. Why are Rh-negative mothers given RhoGAM? (p. 377) _________________________________

______________________________________________________________________________

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12. In the chart, check which coagulation factors are in the intrinsic vs. the extrinsic coagulation
pathways. (p. 377)

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. 378) ________________________________________________________________________

______________________________________________________________________________

14. Describe the four steps of primary hemostasis and platelet plug formation. (p. 378) ____________
______________________________________________________________________________

______________________________________________________________________________

PATHOLOGY
15. Identify each cell type and its associated pathology. (pp. 380-381)

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

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

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page 4 First Aid Express 2014 workbook: HEMATOLOGY & ONCOLOGY

16. Indicate whether the lab findings in the chart are elevated, decreased, or normal. (pp. 382-387)

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

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. 382) ________________________________
______________________________________________________________________________

18. What are the major history and physical exam findings of lead poisoning? (p. 383) _____________
______________________________________________________________________________

19. What clinical manifestations do folate deficiency and vitamin B12 deficiency have in common? What
sets them apart? (p. 384) __________________________________________________________

20. What are four causes of aplastic anemia? (p. 385) ______________________________________
______________________________________________________________________________

21. Match the intrinsic hemolytic normocytic anemia with its characteristic. (p. 386)
_____ 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

22. Which autoimmune hemolytic anemias are associated with warm agglutinins? With cold
agglutinins? (p. 387) ______________________________________________________________

______________________________________________________________________________

23. What are the 5 Ps of acute intermittent porphyria? (p. 388) ___________________________

______________________________________________________________________________

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24. Indicate whether the lab findings in the chart are elevated, decreased, or normal. (pp. 389-390)

Platelet Bleeding
Disorder PT PTT
Count Time

DIC
Glanzmann thromboasthenia
Hemophilia
ITP/TTP
Vitamin K deficiency
von Willebrand disease

25. Which type of Hodgkin lymphoma is equally prevalent in men and women? (p. 391) ___________
______________________________________________________________________________

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

In what condition is this cell seen? (p. 392)
___________________________________
___________________________________
___________________________________

27. Match the disease with the genetic translocation most closely associated with it. (pp. 392-395)
_____ 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. 393) _________________________________________________________

29. What are the four major groups of leukemias? Which type is at risk of DIC upon initiation of
treatment and why? (pp.394-395)____________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

30. Indicate whether the lab findings in the chart are elevated, decreased, or normal. (p. 397)

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

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page 6 First Aid Express 2014 workbook: HEMATOLOGY & ONCOLOGY

PHARMACOLOGY
31. Indicate how the drugs in the chart affect the lab findings. (pp. 398-400)

Bleeding Platelet
Drug PT PTT
Time Count

Aspirin
Clopidogrel/abciximab
Heparin
Warfarin

32. What is the mechanism of action of heparin? How is overdose treated? (p. 400) _______________

______________________________________________________________________________

33. What is the mechanism of action of warfarin? How is overdose treated? (p. 400) ______________

______________________________________________________________________________

34. Match the drug with its target. (pp. 400-406)

_____ 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. 403-404)
_____ 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

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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 and fibrinogen.

3
4. 4,00010,000/mm .

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

6. Macrophages.

7. Neoplasm, asthma, allergic processes, connective tissue diseases, and parasites.

8. Histamine, heparin, and eosinophil chemotactic factors.

8. 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.

12.
Factor Extrinsic Pathway Intrinsic Pathway Both Pathways
I
II
V
VII
VIII
IX
X
XI
XII

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page 8 First Aid Express 2014 workbook: HEMATOLOGY & ONCOLOGY

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.

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

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
Burton 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 Fanconi 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, Port wine-colored urine, Polyneuropathy, Psychological disturbances, and
Precipitated by drugs, alcohol, and starvation.

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24.

Platelet Bleeding
Disorder PT PTT
Count Time
DIC
Glanzmann thromboasthenia normal normal normal
Hemophilia normal normal normal
ITP/TTP normal normal
Vitamin K deficiency normal normal
von Willebrand disease normal normal

25. Nodular sclerosing.

26. Reed Sternberg cell; Hodgkin lymphoma.

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

28. An M-spike, representing a monoclonal antibody; IgG 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.

30.

Chronic
Myeloproliferative Platelets RBCs WBCs
Disorder
CML
Essential

thrombocytosis
Myelofibrosis variable variable
Polycythemia vera

PHARMACOLOGY
31.

Bleeding Platelet
Drug PT PTT
Time Count

Aspirin normal normal normal

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

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page 10 First Aid Express 2014 workbook: HEMATOLOGY & ONCOLOGY

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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