H/L CIS

Question 1

2 symptoms of CLL to know?

Answer 1

Painless swelling of LN, most commonly cervical

B symptoms

Question 2

4 clinical signs of PE for CLL? Also, what is rarely seen in CLL in contrast to other lymphomas?

Answer 2

LAD, most commonly seen in cervical, supraclavicular and axillary.
Big spleen
Big liver
Skin involvement 
Rarely is GI mucosa involved

Question 3

3 lab abnormalities associated with CLL?

Answer 3

Lymphocytosis above 5000 in peripheral blood and bone marrow
Cytopenias: neutropenia, anemia and thrombocytopenia
Low antibody

Question 4

Diagnostic evaluation of a patient suspected of having CLL should include what 3 things?

Answer 4

Complete blood count with differential
Examine the peripheral smear
Immunophenotypic analysis of circulating lymphocytes

Question 5

What will the peripheral blood smear obviously show and what 2 morph features?

Answer 5

Lymphocytosis

Pro lymphocytes and smudge cells

Question 6

What are the two criteria to diagnose CLL?

Answer 6

Absolute b count over 5k and most of them are small mature looking B cells

Clonality of B cells by flow cytometry

Question 7

The majority of the population of B cells should express the following pattern of monoclonal B cell markers?

Answer 7

Low levels of SmIg
Low levels of Either kappa or lambda light chains, not both
Expression of cd19,20,23 and cd5

Question 8

What are the 5 variables for predicting mortality of patients presenting with pneumonia and how many points do you give for each positive variable? How do we interpret it?

Answer 8

Confusion
BUN over 20
RR over 30
BP less than 90/60
Age over 65
1 point for each positive.
0 or 1 point treat as outpatient and mortality around 1
2 points treat as inpatient and mortality around 10
3 or greater treat in ICU and mortality is 20-40

Question 9

6 differentials for CLL?

Answer 9

Monoclonal B cell lymphocytosis
B cell prolymphocytic leukemia
Mantle cell lymphoma 
Marginal zone lymphoma 
Hair cell
LL

Question 10

4 genetic features of CLL? What two things are different about monoclonal B cell lymphocytosis? What to remember about mantle cell, 2 things? 3 markers for hairy cell? 2 markers for LL?

Answer 10

Deletion of 11, 13 and 17, Trisomy 12.
Lymphocyte number is not over 5k and no symptoms
Cyclin d1 and t11:14
11, 103, and 123
IgM and cd20

Question 11

Top 3 pathogens causing outpatient community acquired pneumonia? Top 3 causing inpatient, not admitted? Top 3 pathogens causing inpatient and admitted to ICU?

Answer 11

Mycoplasma pneumonia, respiratory viruses, and strep pneumonia
Strep pneumonia, respiratory viruses, and mycoplasma pneumonia
Strep pneumonia, legionella, gram negative bacilli

Question 12

How would we immunize a healthy 65 year or older patient for pneumococcal?

Answer 12

Give them 1 dose of 13 and then 1 dose of 23 a year later.

5 years later of 23 if they already had a 23.

Question 13

What if that healthy 65 year old had a 23 but not a 13?

Answer 13

Give 1 dose of 13 after 23.

Question 14

What is the recommended vaccination for 19-64 years old with chronic medical conditions including smoking and drinking?

Answer 14

I dose of 23

Question 15

How do you vaccinate a patient 19 years or older who has an immunocompromised condition?

Answer 15

1 dose of 13 followed by 1 dose of 23 8 weeks later followed by another dose of 23 5 years later.
If they are 65 or older, they need only 1 dose after 65 but 5 years after the previous 23

Question 16

How do you vaccinate 19 year or older with CSF leak or cochlear implant?

Answer 16

1 dose of 13 followed by 23 at least 8 weeks later and then at 65 give last dose of 23 but 5 years after previous dose of 23