blood cancers

Question 1

which cell lines are granulocytes?

Answer 1

basophil, eosinophil, neutrophil

Question 2

what is the limit for neutrophilia?

Answer 2

> 9 ANC

Question 3

what happens to the neutrophil proportion in the blood during an infection?

Answer 3

left shift

Question 4

what are the neutrophil compartments in the blood?

Answer 4

marginal pool and circulating pool

Question 5

what is the normal order of wbc differential?

Answer 5

Neutrophil
Lymphocyte
Monocyte
Eosinophil
Band
Basophil
never let monkeys eat bad bananas

Question 6

what is a red flag in neutrophilia?

Answer 6

blasts

Question 7

what is the most common cause of reactive neutrophilia?

Answer 7

glucocorticoids

Question 8

what does basophilia indicate?

Answer 8

CML

Question 9

what mutation is responsible for CML?

Answer 9

Ph (9;22 translocation), BCR-ABL mutation

Question 10

what does a blast crises indicate?

Answer 10

CML–>AML

Question 11

what is the most effective Tx for CML?

Answer 11

gleevec/imatinib

Question 12

how does gleevec work?

Answer 12

bind BCR-ABL kinase domain and stops proliferation

Question 13

what is the limit for neutropenia?

Answer 13

<1.5 ANC

Question 14

what is Kostmann syndrome?

Answer 14

congenital severe neutropenia with risk of AML

Question 15

how can we identify febrile neutropenia?

Answer 15

temp>38 in pt with ANC<0.5

Question 16

how is febrile neutropenia treated?

Answer 16

broad spec IV antibiotics and GCSF

Question 17

what are the organisms most commonly associated with neutropenic pts?

Answer 17

staph aureus, coagulase (-) staph, gram - bacteria, fungi (candida, aspergillus)

Question 18

what cytomarker is indicative of leukemia?

Answer 18

CD34

Question 19

what PBS feature points to AML?

Answer 19

auer rods (crystallized granules)

Question 20

what is leukostasis?

Answer 20

In AML, high blasts count occludes vessels and damage endothelium (ischemia/bleeds).

Cause dyspnea, hypoxia, confusion

Question 21

what causes DIC in AML?

Answer 21

blast secretes TF

Question 22

what are symptoms of TLS?

Answer 22

cardiac arrhythmia (K+), renal failure (uric acid)

Question 23

what’s the difference between cell cycle specific and non specific agents?

Answer 23

specific-target divide cells only

nonspecific-toxic to all cells

Question 24

why is combined chemo preferred over single agent?

Answer 24

different spectrum of toxicity and resistance to treat cancer

Question 25

which cells are most impacted by chemo?

Answer 25

sperm/ova (rapid division), BM, hair/nails, gut mucosa

Question 26

what is a syngeneic transplant?

Answer 26

from identical twin

Question 27

what is the graft vs leukemia effect?

Answer 27

T cells protect against malignancy in transplanted organ

Question 28

which part of the body is BMT retrieved from?

Answer 28

Pelvic (rich in HPSC)

Question 29

what is SIADH and what disease does it usually present with?

Answer 29

ADH secretion-->low Na levels, common in small cell lung cancer with neuroendocrine metastasis

Question 30

what does MAH present with?

Answer 30

bone pain, kidney stones, abd pain, confusion

Question 31

what are the clinical presentations of hyperviscosity syndrome?

Answer 31

bleeds, visual disturbances, poor tissue perfusion

Question 32

where do most B cell lymphomas happen?

Answer 32

germinal centre

Question 33

how does hodgkin lymphoma present?

Answer 33

cervical adenopathy, B symptoms

Question 34

what is the difference between lymphoma and leukemia?

Answer 34

lymphoma: originate from solid organs, stay in organs leukemia: originate in BM, cells circulate blood

Question 35

why is CLL considered both a leukemia and a lymphoma?

Answer 35

can originate from BM or LN

Question 36

what are examples of aggressive lymphomas? why are they called this?

Answer 36

T cell lymphoma, Burkitts, DLBCL grow quickly, can be life threatening at early stage, need urgent Tx. curable

Question 37

what does Ann Arbor stage 4 indicate in lymphoma?

Answer 37

metastatic disease

Question 38

How do you stage lymphomas?

Answer 38

PET scan

Question 39

how do autologous and allogeneic SCT differ in terms of mechanism to fight lymphoma?

Answer 39

autologous: relies on chemo to Tx allogeneic: relies on new immune system (graft vs lymphoma) to tx

Question 40

what is the Tx for CLL?

Answer 40

FLK3 inhibitor

Question 41

what is the distinction between reactive and neoplastic lymphocytosis?

Answer 41

reactive-polyclonal, mostly T cells neoplastic-monoclonal, mostly B cells

Question 42

why must we exclude neoplasm when diagnosing mono?

Answer 42

mono has symptoms similar to B symptoms

Question 43

reactive lymphocytes are also called

Answer 43

atypical lymphocytes

Question 44

which lymphoid cell line is affected in CLL?

Answer 44

Bcells

Question 45

what is the PBS indication of CLL?

Answer 45

smudge cells

Question 46

what are the flow cytometry markers for CLL?

Answer 46

CD5, 19, 23 need 5E9 of these cells for Dx

Question 47

what is methotrexate?

Answer 47

chemo drug, cause pancytopenia

Question 48

what is MGUS?

Answer 48

type of plasma cell dyscasias, low level monoclonal gammopathy (benign). <10% plasma cells in BM

Question 49

what are the characteristics of MM?

Answer 49

>10% BM plasma cells, >30g/l proteins in urine hypercalcemia, renal, anemia, bone disease (CRAB)

Question 50

what causes AL amyloidosis?

Answer 50

organ deposition of abnormal insoluble protein in beta pleats

Question 51

what is MM?

Answer 51

BM cancer with monoclonal plasma cell proliferation

Question 52

what are the complications of MM?

Answer 52

skeletal destruction, marrow infiltration (anemia), RF, Ig reduction (infection)

Question 53

what PBS signs are associated with MM?

Answer 53

monoclonal plasma cells, rouleaux RBC

Question 54

how do you treat MM?

Answer 54

only if symptomatic: chemo (proteosome inhibitors), bisphosphonates for bones, pain control, hydration

Question 55

what is the evolution pathway of meyloma?

Answer 55

MGUS-->asymptomatic/smoldering myeloma-->symptomatic myeloma