FA + MTB 3 Flashcards
1
Q
T cell ALL can present as
A
Mediastinal mass (presenting as SVC-like syndrome)
2
Q
Acute lymphoblastic leukemia/lymphoma (ALL)-better prognosis if
A
t(12;21)
3
Q
Acute lymphoblastic leukemia/lymphoma (ALL) may spread to
A
CNS and testes
4
Q
Acute lymphoblastic leukemia/lymphoma (ALL) markers
A
- TdT+ (pre-T and pre-B cells)
2. CD10+ (pre-B cells only)
5
Q
CLL markers
A
CD20 and CD5 and CD23 B cell neoplasm
6
Q
Smudge cells in the peripheral smear leukemia
A
CLL
7
Q
Richter transformation
A
CLL/SLL transformation into aggressive large B cell lymphoma
8
Q
Hairy cell leukemia
Age and type of cells
A
Adults males
Mature B cells (with hair-like cells projections) –> fuzzy appearing on LM
9
Q
Hair cell leukemia cells morphology/presentation
A
Cells with filamentous, hair-like cells projections (fuzzy appearing on LM)
presents with massive splenomegaly
peripheral lymphadenopathy is very uncommon
10
Q
Hair cell leukemia - aspiration?
A
dry because of Marrow fibrosis
11
Q
Hair cell leukemia cells detection
A
- Stains TRAP (Tatrate-resistant acid phosphate)
2. Flow cytometry (largely replaced TRAP)
12
Q
Hair cell leukemia treatment
A
- Cladribine
2. Pentostatin
13
Q
Auer robs
A
Perioxidase + cytoplasmic inclusions seen mostly in M3 AML
14
Q
AML risk factors
A
- Prior exposure to alkylating chemotherapy
- Radiation
- Myeloroliferative disorders
- Myelodysplastic
- Down syndrome
15
Q
AML common presentation
A
DIC
16
Q
AML M3 treatment
A
If t(15;17).. M3 subtype respond to all trans retinoic acid (vit A), inducing differentiation of meyloblasts
17
Q
Philadelphia ch
A
t(9;22)
BCR-ABL
18
Q
CML cells
A
Mature and Maturing granoulocytes
Neutrophils
Metamyelocytes
Basophils
19
Q
Blast crisis
A
CML transform to AML or ALL
20
Q
CML vs leukemoid reaction
A
CML has very low LAP as a result of low activity in malignant neutrophils (vs benign neutrophilia)
21
Q
t8;14
A
Burkitt lymphoma (c-myc)
22
Q
t9;22
A
Philadelphia (BCR-ABL)
- CML
- rarely ALL
23
Q
t11;14
A
Mantle (cyclin d1)
24
Q
t14;18
A
Follicular lymphoma (BCL-2)
25
t12;21
Better prognosis ALL
26
t15;17
M3 AML subtype respond to vit A
27
Langerhans cell histiocytosis present in a child as
1. Lytic bone lesions
2. Skin rash
3. Recurrent otitis with a mass involving the mastoid
28
Langerhans cell histiocytosis - T cells activation
Cells are functionally immature and do not effectively stimulate primary T cells via antigen presentation
29
Langerhans cell histiocytosis markers
S-100 (mesodermal origin)
| CD1a
30
Histological feature of Langerhans cell histiocytosis
Birdeck granules (tennis racket or rob shape on EM) are characteristic
31
Polycythemia vera definition/symptoms
A form of 1ry polycythemia --> disorder oh high Hct
1. Intense itching after hot shower (due to increased basophils)
2. Erythromelalgia (rare, severe, burning pain and red blue discoloration) due to blood clots in vessel
32
Polycythemia vera respond to
phlebotomy, hydroxyuream ruxolitinib (JAK1/2 inhibitor)
33
types of polyceythemia
1. relative
2. Appropriate absolute
3. inappropriate absolute
4. Polycythemia vera
34
types of polyceythemia and O2 saturation
1. relative: normal
2. Appropriate absolute: decreased
3. inappropriate absolute: normal
4. Polycythemia vera: normal
35
Relative polycythemia - associations
1. dehydration
| 2. burns
36
Appropriate absolute polycythemia - associations
1. lung disease
2. congenital heart disease
3. high altitude
37
Inappropriate absolute polycythemia - associations
1. malignancy: renal, hepatocellular etc
2. hydronephrosis
(ECTOPIC EPO secretions)
38
Essential thrombocytosis definition / symptoms
massive proliferation of megakaryocytes and platelets
symptoms: 1. Bleeding 2. Thrombosis
3. Erythromelalgia may occur
39
Myelofibrosis - definition
Obliteration of bone marrow due to increased fibroblast activity in response to proliferation of monoclonal cell lines
(pathoma: neoplastic prolif of mature myeloid cells, esp megak --> PDGF --> marrow fibrosis)
40
Chronic myeloproliferative disorders - JAK2
Polycythemia vera: +
Essential thromb: + (30-50%)
Myelofibrosis: + (30-50%)
CML: -
41
Chronic myeloproliferative disorders - PHILDELFIA
CML
42
Polycythemia vera - cells
increased RBC, WBC, platelets
43
Essential thromb - cells
increased platelets
44
myelofibrosis - cells
decreased RBCs
| variable WBCs and platelets
45
CML
decreased RBCs
| increased WBCs and platelets
46
lung cancer - who should be treated with surgery
- the size is not the most important factor
- if the lesions is large but is surrounded by normal lung and there is enough remaining lung function post resection, the surgery is still possible
47
lung cancer - the surgery is not possible if
1. bilateral disease or lymph nodes involved on opposite size
2. malignant pleural effusion
3. heart, carina, aorta, or cena cava is involved
48
lung cancer screen
annually with low-dose chest cancer in those with:
| adults 55-80 who with 30 pack year smoking history
49
ovarian cancer - most accurate test
| ovarian cancer - initial test
most accurate: biopsy
| initial: U/S
50
ovarian cancer - treatment
the only cancer in which removing large amounts of locally metastatic disease will benefit the patient. Remove all visible tumor and pelvic organs and give chemotherapy
51
Azathioprine, 6-mercaptopurine, 6-thioguanine side effects
1. Myelosuppresion 2. GI. 3. Liver
52
Cladribine (2-CDA) clinical use / toxicity
Hairy cell leukemia
1. Myelosupression
2. Nephrotoxicity
3. Neurotoxicity
53
Cytarabine (arabinofuranosyl cytidine) clinical use / toxicity
```
AML
LYMPHOMAS
1. Leukopenia
2. Thrombocytopenia
3. Megaloblastic anemia
```
54
Methotrexate (MTX) toxicity
1. Myelosupression (REVERSIBLE WITH LEUCOVORIN)
2. Hepatotoxicity
3. Mucositis (mount ulcers)
4. Pulmonary fibrosis
55
5-fluorouracil toxicity
Myelosupression (NOT REVERSIBLE WITH LEUCOVORIN)
56
Antitumor antibiotics
1. Bleomycin
2. Dactinomycin (actinomycin D)
3. Doxorubicin, daunorubicin
57
Bleomycin side effects
1. Pulmonary fibrosis
2. MINIMAL myelosupression
3. Skin hyperpigmentation
58
Dactinomycin (actinomycin D) side effects
Myelosuppression
59
Doxorubicin,
| Daunorubicin side effects
Toxic to tissues following extravasation
1. Dilated cardiomyopathy
2. Alopecia
3. Myelosuppression
60
How to prevent dilated cardiomyopathy with doxorubicin or daunorubicin administration
Dexrazoxane, an iron chelatin agent
61
Alkylating agents
Busulfan
Cyclophosphamide, isosfamide
Nitrosoureas (carmustine, iomustine, semustine, streptozocin)
62
Busulfan side effects
1. Severe myelosuppression (almost always)
2. Pulmonary fibrosis
3. Hyperpigmentation
63
Nitrosoureas toxicity
Cns: 1. Dizziness 2. Ataxia 3. Convulsion
64
Cyclophosphamide, ifosfamide toxicity
1. Myelosuppresion
| 2. Hemorrhagic cystitis
65
Partially Prevent hemorrhagic cystitis in Cyclophosphamide, ifosfamide by:
Mesna (thiol group of mesna binds toxic metabolitis)
66
Microtubule inhibitors
1. Paclitaxel, and others taxols
2. Vincristine
3. Vinblastine
67
Paclitaxel toxicity
1. Myelosuppression
2. Alopecia
3. Hypersensitivity
4. Neuropathy
68
Vinblastin toxicity
Myelossupression
69
Vincristine toxicity
1. Neurotoxicity: (areflexia, peripheral neuritis)
| 2. Paralytic ileus
70
Hydroxyurea clinical use
1. Melanoma
2. CML
3. Sickle cell anemia (increases HbF)
71
Hydroxyurea toxicity
1. SEVERE myelosuppression
| 2. GI upset
72
Imatinib clinical use
1. CML (BCR-ABL)
| 2. GI stromal tumors (c kit)
73
Imatinib toxicity
Fluid retention
74
Rituximab toxicity
Increased risk of progressive multifocal leukoencephalopathy
75
Cisplatin carboplatin toxicity
1. Nephrotoxicity
2. Ototoxicity
3. peripheral neuropathy
76
How to prevent cisplatin or carboplatin associated nephrotoxicity
Amifostine (free radical scavenger) chloride (saline) diuresis
77
Etoposide, tenoposide - mechanism of action
Inhibits topoisomerase 2--> dna degradation
78
Etoposide tenoposide toxicity
1. Myelosuppression
2. Gi upset
3. Alopecia
79
Irinotecan, topotecan mechanism of action
Inhibit topoisomerase 1 and prevent DNA unwinding and replication
80
Irinotecan, topotecan toxicity
1. Severe myelosuppression
| 2. Diarrhea
81
Trastuzumab (herceptin) toxicity / clinical use
Cardiotoxicity
| Her2 + breast cancer and gastric cancer
82
SERMs (tamoxifen, raloxifene) clinical
Tamoxifen: breast cancer treatment
Raloxifene: prevent osteoporosis
Both: breast cancer prevention
