Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Skin, Lymph, Blood > Dr. Pence - Leukemia And Lymphoma Case Studies > Flashcards

Dr. Pence - Leukemia And Lymphoma Case Studies Flashcards

1
Q 
66yo males comes in with anemia for 2 years 
Dx him with MDS which is ?
Comes in with fever, tachy, HTN, petechiae, conjunctiva pallor bilaterally, bruising 
- low WBC
- low plt
- low hct
- low hgb
BS : 25% blasts, large nuclei 
= what is it and how to confirm
A

MDS : macrocytic anemia, pre-leukemic (only anemia sx)

AML , confirm with flow cytometry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MDS is what

A

Happens usually after 70yo, genetic mutation causes damage to hematopoietic cells = no hematopoiesis

  • macrocytic
  • pre-leukemic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ANC is what what does it mean

A

Absolute N count = (WBC) (N% + Band%)

Neutropenia = ANC < 1,500, severe Neutropenia = < 500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How to TX AML and neutropenic fever

A
  1. Get urine (1) and blood culture (2 different sites)
  2. CXR (for pneumonia)
  3. Begin ABs
  4. Confirm AML confirmed by BM biopsy
  5. Begin chemotherapy (treat AML), 2 weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are them most common infection to get for a neutropenic fever
What is the most severe infection you can get

A
  1. Gram + staph or strep

2. Gram - pseudomonas,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How to TX for neutropenic fever

A
  1. Cefepime, Piperacillin-tazobactam, Meropenem, Ceftazidine (covers pseudomonas and gram +)
  2. Is line infection of soft tissue infection (think MRSA) and add Vancomycin
  3. If still not removed : it’s probably fungal so add anti-fungal (Amphotericin B, Voriconazole)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How to confirm AML

A

BM biopsy of at least 20% blasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How to administer chemotherapy

A

Central line with 2 catheters and into the SVC that’s next to the RA + with abs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

While on chemo for a while pt is still having a fever and you see the pt has a fungal
What do I need to do

A

Remove central line and replace it (since fungal is sticky) and then you give them anti-fungal + CSF(nupogen)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How to dx gram -, gram + fungal

A

Gram - : pink
Gram + : purple
Fungal : Silver stain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Induction
Consolidation
Maintenance
Meaning is chemotherapy

A
  • chemotherapy given to get to remission
  • intensified chemotherapy to make sure no cancer cells are left
  • long term therapy or drug to prevent relapse (Stem cell transplant is only successful in younger populations and 20% of the time)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ALL is common in what populations

A

Children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ALL SX

A

Fatigue, anemia, bleeding, infection, cytopenia,
+ LYMPHADENOPATHY + SPLENOMEGALY (not seen in AML)
+ at least 20% Lymphoblastic found in BM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

38yo mother of 2 children, Weakness, bruising, heavy menstruation
Tachy, purpura, conjunctiva pallor bilaterally
- low WBC
- LOW plt
- hct
- hgb
High PT, PTT, low fibrinogen, high D-dimer
BS : blasts with Auer rods in them

A

DIC (thrombin, bleeding, fibrin deposition—> ischemia and organ failure)
- usually in malignancy (blasts have more tissue factor) or sepsis
APL : 15:17 translocation a type of AML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Panocytopenia

A

Aplastic Anemia
AML/ALL
DIC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

DIC TX

A

Right away as fast as you can give fluids and platelet transfusion, factor replacement (esp if you see Aure rods and suspect APL)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What does it usually mean when you see Auer rods

A

APL (15:17) a type of AML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

APL/AML is what

A
  • PML + RARa next to each other
  • Need to give them RA that it will like
  • has tissue factor and annexin on surface of cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Tissue factor

Annexin2

A

TF : F10a —> F2a —> Fibrin

Annexin 2 : Plasmin —> D-diners from fibrinogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What specific chemo do you give someone who has APL

A

ATRA : all-trash retinoic acid replaces the RA (VIT A derivative) = short lived
ATO : Arsenic trioxide (causes blasts to force differentiation or apoptosis) = longer lived
** give both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

68yo F elderly women comes in saying she’s fatigues even though she’s had a cream cheese bagel and her stomach is full
10lb weight loss in 2mos, abd fullness, very fatigued
- moderate spelomegally
- EXTREME HIGH WBCs
- low hct
- mild low hgb
- plt normal
- normal MCV
- normal Retic count
- LOW Leukocyte Alkaline Phosphate
BS : all types of cells (mostly mature WBCs)

A

CML

LOW LAP : alkaline phosphatase + reactive cells (that are reacting to infection, autoimmune or stressed)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

WBC : normal is 4-11

  1. 20-30
  2. Over 50
A
  1. Infection, autoimmune, stress

2. Leukemia (C-diph rip roaring infection)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is LAP score

A

LOW LAP : alkaline phosphatase + reactive cells (that are reacting to infection, autoimmune or stressed) = probability uncontrolled overproduction reason
HIGH LAP : means infection, stress, autoimmune

24
Q

Confirming CML

A
  1. BS : many mature WBCs
  2. High Buffy layer when continuing blood (CBC says high WBCs)
  3. Low LAP score
  4. Hypercellular BM
  5. Pseudo-Gaucher cells
  6. Philadelphia chr
25
Q

CML has what type of anemia

A

Normocytic mild anemia

You can see high number of platelets

26
Q

Reason for CML splenomegaly

A

Due to increased production happening extramedullary when BM cant keep up making right amount and good functioning WBCs

27
Q

Pseudo-Gaucher cells

A

High blue M that clean up debri in CML

28
Q

CML translocation

A

9:22
ABL-BCR
Philadelphia chr
Turns on tyrosine kinase

29
Q

How to TX CML

A

Gleevec/Imatinib

Blocks TK

30
Q

Testing for Philadelphia chr

A
  1. FISH fluorescent
  2. PCR : most sensitive (1 in 100,000) to find a 9:22 translocation
    * flow cytometry is not that great
31
Q

Special thing about CML

A

It has 3 stages

32
Q

3 stages of CML

A
  1. Chronic CML phase : fatigue, asymptomatic, CBC has hgih WBCs
  2. Accelerated CML : 10-19% blasts circulating, low Plt,
  3. Plast phase CML : 20% higher blasts
33
Q

Causes of Lymphadenopathy

A 
M L malignancy 
I : infection 
A : autoimmune 
M : miscellaneous 
I : Iatrogenic (vaccination)
34
Q

When to really looks into a lymphadenopathy

A
  1. older then 40yo
  2. Longer then 4-6 weeks
  3. More then 2 locations
  4. SUPRACLAVICULAR : everything drains to this so can be any organ or place
  5. Fever, night sweats, weight loss, heptatosplenomegally
    * (Hard, 4cm or bigger, subclavian)* = DO BIOPSY
35
Q

Tender Lymphadenopathy

A

Usually benign , HOWEVER

**However Burkitts and DLBCL (rapid growth of LN = Very tender) and very aggressive

36
Q

FINE NEEDLE BIPOSY

A

Not that great
Only good if you know exactly what you’re looking for (past patient
(Marker detection in flow cytometry)

37
Q

Core needle biopsy

A

Good way to do a biopsy and then look at cells under microscope and see what is happening in the BM

38
Q

Excisional biopsy

A

GOLD STANDARD
Best way to Dx lymphoma (** only way to dx Hodgkin lymphoma and see the owl cells)
Take entire LN out , full picture of the LN

39
Q

14yo F with abd pain in ER
CT : large abd mass next to appendix
- after 2 days of Abs the mass grew by 50%
- she went to surgery
- a bunch of cells in on of the LNs that looks like a starry night
What is it

A

Burkitts Lymphoma

  • Ruptured appendix = provide Ab and IV
  • appendix has many LN
40
Q

Burkitt lymphoma translocation

A

8:14
IgH/MYC
Very aggressive

41
Q

Burkitt Lymphoma TX

A

High risk of intracranial involvement
1. Chemotherapy + chemotherapy with intrathecal into CSF

(Easy to tx since its fast growing and you target all fast growing cells, however it has room for many complications)

42
Q

Female with Burkitts lymphoma tx with chemotherapy has stoped making urine
- BUN and Cr are very high : kidney failure or down
What’s happened

A

Tumor Lysis Syndrome

43
Q

Tumor Lysis Syndrome what 4 things happen in

A
  1. High K = arrhythmia (sudden cardiac death)
  2. High Uremic acid (nucleuic acids from cells become uremic acid crystals and acute tubular necrosis)
  3. High P (binds to free Ca+2 and hides them)
  4. LOW Ca+2
44
Q

Tumor Lysis Syndrome happens when

A

With rapid killing of tumor cells that are fast growing (there contents spill out)

  • DLBCL
  • Hodgkin
  • Burkitts
45
Q

How to TX TLS

A

Give fluids before chemotherapy (flushing kidneys constantly)**
ALLOPURINOL : xanthine oxidase inhibitor (no uric acid)

46
Q

TX hyperkalemia

A

Furosemide/LASIX (pee it out)

  • give glucose/insulin to help since this takes time
  • if that doesn’t work dialysis
47
Q

TX hyperuricemia

A

Rasburicase (allows urate oxidase to happen from uric acid neutralizing it)
** can cause hemolytic anemia in G6PD patients** KNOW THAT**

48
Q

TX Hyperphosphatemia or hypocalemia

A

Calcium Gluconate

49
Q

22yo male home from college and fatigues easily CP when drinking alcohol
Night sweats, fever, jocks itch
PE : 10lb last, no lymphadenopathy or splenomegally
What should I order :???? Nd what do I SEE????
What biopsy ??? And what should you see

A 
CXR : mediastinal widening (unable to see aortic arch )
Excisional biopsy (owl cells, and t-cells all around it)
Hodgkin lymphoma (with B sx)
50
Q

Hodgkin Lymphoma is what type of lymphoma

A 
Highly inflammatory 
Has 4 stages 
1. Neck
2. Axillar
3. Below liver
4. Many parts involved
51
Q

Hodgkin lymphoma TX

A

21-28days chemotherapy

52
Q

Hodgkin Lymphoma likes hiding where

A

Mediastinum

53
Q 
Elderly male, petechiae, fatigue, conjunctiva pallor bilaterally, axillary and cervical Lymphadenopathy 
- high WBCs
- high plt
- high hgb
BS: many mature lymphocytes (90%)
WHAT DOES HE HAVE
- he was already DX with this years ago and was told not to worry about it 
WHAT DOES HE HAVE NOW
A

BS : monoclonal B-cells
CLL (+ thrombocytopenia and anemia)
Richters Transformation (due to thrombocytopenia and anemia)——> IT BECAME DLBCL

54
Q

Richters Transformation

A

CLL ——> DLBCL or another small grade lymphoma to high grade lymphoma

55
Q

CLL with Richters Transformation TX

A

Chemotherapy + RITUXIMAB = CD20 inhibitor (better outcome the more fit and healthy the patient is)
= treat the DLBCL

56
Q

How to monitor CLL

A

Look for B SXs to see if there is a possibility of a Richters Transformation to DLBCL or another HGIH grade lymphoma

57
Q

What can be more effective then Rituximab

A

CD19 targeting drug since that is absolutely all B-cells from the stem cells

Skin, Lymph, Blood (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions