20 Approach to a Patient with WBC Disorders, Lymphadenopathy and Splenomegaly

Question 1

May be a benign incidental finding or a presenting sign of an underlying disease

Answer 1

Lymphadenopathy

Question 2

Clinical approach to patients with lymphadenopathy

Answer 2

History and physical exam
Age
Lymph nodes
Lab investigation

Question 3

Removal of senescent RBCs
Antibody synthesis
Removal of antibody coated bacteria and antibody coated blood cells

Answer 3

Spleen

Question 4

Space between the spleen can go to, not where the spleen is normally located

Answer 4

Traube’s space

Question 5

Common s/s of splenomegaly

Answer 5

Heaviness/LUQ fullness

Early satiety

Question 6

Form of mucopolyssacharidosis or accumulation of GAGs

Answer 6

Gaucher’s disease

Question 7

Neoplastic transformation of WBC precursors

Answer 7

Maturation arrest
Uncontrolled proliferation
Evasion of apoptosis

Question 8

Condensed granules that look like sticks in the cytoplasm

Differentiation of leukemia

Answer 8

Auer rods

Question 9

Nonspecific signs and symptoms as a consequence of cytopenias

Answer 9

Leukemia

Question 10

Diagnosis of leukemia

Reads how many of the cells express a particular signature

Answer 10

Flow cytometry

Question 11

Definitive Ags for AML

Answer 11

Cytoplasmic MPO

Question 12

Definitive Ags for ALL T-cells

Answer 12

Cytoplasmic CD3
Surface CD3
T cell receptor CD7-bright

Question 13

Strongly associated Ags with AML

Answer 13

CD117

Question 14

Strongly associated Ags with ALL-B cell

Answer 14

Cytoplasmic CD79a

Cytoplasmic CD22, CD19, CD-10 bright

Question 15

Strongly associated Ags with ALL-T cell

Answer 15

CD7 bright

Question 16

Moderately associated Ags with AML

Answer 16

CD13

CD33

Question 17

Moderately associated Ags with ALL-B cell

Answer 17

TdT-moderate to bright

Question 18

Moderately associated Ags with ALL-T cell

Answer 18

CD5

CD2

Question 19

Treatment modalities for leukemia

Answer 19

Transfusion (supportive)
Chemotherapy
Bone marrow transplant (curative)

Question 20

TKI inhibitors for CML

Answer 20

Imatinib

Question 21

Chromosomal aberration resulting in abnormal transcription factors that affect development of B and T cells

Answer 21

ALL

Question 22

Chromosomal deletion or possible somatic hypermutation of postgerminal or naive B cells

Answer 22

CLL

Question 23

Oncogenic mutations impede differentation, accumulating immature myeloid blasts in marrow

Answer 23

AML

Question 24

Tyrosine kinase pathway related chromosomal translocation (Philadelphia chromosome)

Answer 24

CML

Question 25

Immature B or T cell (marrow)

Answer 25

ALL

Question 26

Peripheral B or T cell (lymph nodes)

Answer 26

CLL

Question 27

Immature myeloid lineage cells (marrow)

Answer 27

AML

Question 28

Pluripotent hematopoietic stem cell (marrow)

Answer 28

CML

Question 29

Condensed chromatin, scant cytoplasm, small nucleoli

Answer 29

ALL

Question 30

Smudge cells, condensed chromatin, scant cytoplasm

Answer 30

CML

Question 31

Auer rods (abnormal lysosomes), myeloblasts, monoblasts

Answer 31

AML

Question 32

Hypercellular marrow, elevated eosinophils and basophils

Answer 32

CML

Question 33

Stormy onset, symptoms related to depressed marrow function, bone pain, CNS manifestations

Answer 33

ALL

Question 34

Asymptomatic or nonspecific, LAD, hepatosplenomegaly

Answer 34

CLL

Question 35

Anemia symptoms, spontaneous bleeding, petechiae and eccymoses

Answer 35

AML

Question 36

Insidious onset, mild anemic symptoms, splelenomegaly

Answer 36

CML

Question 37

Anemia, thrombocytopenia, variable WBC’s, >30% lymphoblasts

Answer 37

ALL

Question 38

Sustained antibodies, lymphocytosis > 5000/uL, low platelets in 20-30%

Answer 38

CLL

Question 39

Anemia, neutropenia, thrombocytopenia, >30% myeloblasts, auer rods

Answer 39

AML

Question 40

Asymptomatic WBC > 50000

Symptomatic WBC > 200000-1000000, some blast forms, increased eosinophils and basophils

Answer 40

CML

Question 41

Most common leukemia among children

Answer 41

ALL

Question 42

Most common leukemia among adults, twice as common in men

Answer 42

CLL

Question 43

Most common leukemia among adults

Answer 43

AML

Question 44

Most common leukemia among ages 20-50, and rare in children

Answer 44

CML