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1
Q

MC form of acute leukemia in adults

A

AML

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2
Q

AML basics

A

ADULT PT
BLASTS
AUER RODS

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3
Q

AML s/s

A 
epistaxis 
menorrhagia 
anemia 
bone/joint pain 
infections 
gum hyperplasia 
splenomegaly
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4
Q

AML dx

A 
CBC = ↓ RBC, ↓ plt, ↓ mature WBC 
BM = myeloblasts with Auer Rods and 20%+ Blasts
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5
Q

AML tx

A

combination chemo/BM transplant

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6
Q

CML patho/etio

A

PHILADELPHIA CHROMOSOME - translocation chromosome 9 and 22

Adults

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7
Q

CML basics

A

ADULT PT
PHILADELPHIA CHROMOSOME
↑↑WBC
HYPERURICEMIA

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8
Q

CML s/s

A

Asxs until blastic crisis (acute leukemia)/incidental

↑ WBC –> hypermetabolic state –> fatigue, night sweats, low grade fever

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9
Q

CML dx

A

CBC = ↑↑WBC
BM = hypercellular left shift myelopoiesis; <5% blasts
Philadelphia Chromosome

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10
Q

CML tx

A

usually not emergent

chronic phase - TKI - Tyrosine Kinase i (-inibs)/stem cell transplant

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11
Q

Hyperleukocytosis Phase (WBC 100000+) in AML or CML tx

A

Leukaphoresis (filter out excess WBCs)

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12
Q

Auer Rods

A

AML

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13
Q

Philadelphia Chromosome

A

CML

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14
Q

Blasts > 20% + Auer Rods

A

AML

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15
Q

Blasts < 20% + marked elevated WBC

A

CML

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16
Q

MC childhood malignancy

A

ALL

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17
Q

ALL basics

A 
CHILD 
FEVER
BONE PAIN 
BLEEDING 
LYMPHADENOPATHY
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18
Q

ALL s/s

A

pancytopenia –> FEVER, fatigue, lethargy, bone pain
CNS –> Ha, vision, stiff neck, vomit
(METs MC to CNS and testes)

pallor, fatigue, bruising
splenomegaly, hepatomegaly, +/- mediastinal mass

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19
Q

ALL dx

A 
CBC = pancytopenia 
BM = hypercellular with > 20% blasts
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20
Q

ALL tx

A

very responsive to combination chemo (hydroxyurea)
remission 90%
relapse –> stem cell transplant

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21
Q

B CELL

A

CLL

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22
Q

CLL basics

A

ADULT
ASXS/INCIDENTAL
FATIGUE
SMUDGE CELLS

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23
Q

CLL s/s

A

MC ASXS/incidental LEUKOCYTOSIS on CBC
fatigue
lymphadenopathy
hepatomegaly, splenomegaly

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24
Q

CLL dx

A

CBC = ISOLATED LYMPHOCYTOSIS - ↑ WBC with 80% LYMPHOCYTES
smear = incompetent, well-differentiated lymphocytes with SMUDGE CELLS = fragile B cells smudge during slide prep
BM - INFILTRATED WITH LYMPHOCYTES

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25
Q

CLL tx

A

early/indolent –> observe
sxs/progressive –> chemo
curative –> stem cell transplant

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26
Q

fragile B cells that smudge during slide prep

A

SMUDGE CELLS IN CLL

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27
Q

smudge cells

A

CLL

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28
Q

pancytopenia CBC

hypercellular with 20%+ BLASTS BM

A

ALL

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29
Q

ALL etio

A

MC childhood malignancy
peak 3-7 yo
↑ risk in kids 5+ with Down Syndrome

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30
Q

Isolated Lymphocytosis
↑WBC with 80% blasts
Smudge Cells

A

CLL

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31
Q

Proliferation of a SINGLE clone of plasma cells
↓
↑ MONOCLONAL AB (IgG, IgA)

A

Multiple Myeloma

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32
Q

BREAK

A

Multiple Myeloma s/s

Bone pain - esp spine and ribs 
Recurrent infections - d/t leukopenia 
Elevated Calcium
Anemia 
Kidney Failure
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33
Q

Multiple Myeloma basics

A 
↑ monoclonal Ab IgG, IgA 
bone pain, HYPERCALCEMIA
BENCE JONES pro on urine 
punched out bone LYTIC LESIONS
ROULEAUX RBC formation
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34
Q

Multiple Myeloma dx

A

BM = plasmacytosis > 10% + 1+…

serum PRO electrophoresis = monoclonal M PRO spike
urine PRO electrophoresis = bence jones pro ; kappa or lambda light chains
x ray = punched out lytic bone lesions

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35
Q

Multiple Myeloma labs

A 
Hypercalcemia 
Anemia 
Rouleaux RBC formation 
↑ ESR 
↑ Cr
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36
Q

Multiple Myeloma tx

A

HCT - autologous hematopoietic stem cell transplant

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37
Q

Multiple Myeloma prognosis

A

poor = 2-4 y with tx, mos w/o tx

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38
Q

Auer Rods

A

AML

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39
Q

Smudge/Smear Cells

A

CLL

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40
Q

Philadelphia Chromosome

A

CML

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41
Q

Child with > 30 % blasts

42
Q

Philadelphia + tx

A

PO chemo (hydroxyurea, imatinib)

43
Q

Monoclonal Ab PRO spike

A

Multiple Myeloma

44
Q

Bence Jones PRO

A

Multiple Myeloma

45
Q

Rouleaux RBC formation

A

Multiple Myeloma

46
Q

Tumor Lysis Syndrome cause, labs, tx

A

complication 2-3 d post induction tx for AML/CML

hyperuricemia, ↑ K, ↓ Ca, ↑ Phosphate, AKI

tx - IVF + Allopurinol

47
Q

Tumor Lysis Syndrome tx

A

IVF + Allopurinol

48
Q

Highly Curable Lymphoma

49
Q

Hodgkin Lymphoma basics

A

Bimodal Age 20, 50
EBV
Painless Lymphadenopathy (mass in neck)
Reed-Sternberg Cells/Owl Eye appearance

50
Q

Hodkin Lymphoma patho/etio

A

B CELL PROLIFERATION with bi/multilobed nucleus “owl eye” (reed sternberg cells)

BIMODAL - peals 20 yo, 50+ yo

associated with EBV

51
Q

Hodgkin Lymphoma pts MC come to office for …

A

painless mass in neck (painless lymphadenopathy) that becomes painful with ETOH

52
Q

Hodgkin s/s

A

PAINLESS LYMPHADENOPATHY - firm nontender freely mobile ; etoh may induce pain ; hepatosplenomegaly ; esp supraclavicular, cervical, mediastinal
(UPPER BODY LYMPH NODES)

Advanced - SYSTEMIC “B” SXS - cyclical fever, night sweats, weight loss, anemia, pruritus

53
Q

Pel-Ebstein Fever

A

Cyclical Fever
in advanced “B” sxs Hodgkin Lymphoma
d/t ↑ cytokines

54
Q

Hodgkin dx

A

EXCISIONAL BIOPSY = REED STERNBERG CELL = large cells with bi/multilobar nucleus “OWL-EYE” d/t B CELL PROLIFERATION

CD15+/30+

MEDIASTINAL LYMPHADENOPATHY

55
Q

UPPER body lymph nodes
with contiguous spread to LOCAL lymph nodes
extranodal is rare

56
Q

PERIPHERAL, MULTI nodal involvement
with noncontiguous EXTRANODAL spread
MC to GI, skin

A

NON HODGKIN

57
Q

> 50 yo, ↑ risk with immunosuppression (HIV)

not associated with EBV

A

NON HODGKIN

58
Q

Associated with EBV

Bimodal

59
Q

B Cell: diffuse large B cell

T Cell, natural killer cells

A

NON HODGKIN cell type

60
Q

Reed-Sternberg Cells are pathognomonic - B cell proliferation with bilobed or multilobed nucleus “owl eye”

A

HODGKIN cell type

61
Q

HIV pt with GI sxs and painless lymphadenopathy

62
Q

more rapid onset of symptoms

63
Q

SOB, intussusception, bowel obstruction and abdominal mass

64
Q

Peripheral lymph nodes most common

65
Q

Systemic “B” sxs are rare in …

66
Q

Starry Sky appearance

A

Burkitt Lymphoma (NHL)

67
Q

Burkitt Lymphoma (NHL) etio, patho, s/s

A

Very fast growing NHL originating from B cells
MC in male young adults/kids
MC in Africa - specific geographic distribution
Associated with EBV and AIDS

abdominal pain and fullness - sporadic
jaw involvement
histology = starry sky

68
Q

NHL extranodal sites

A

MC GI
2 - SKIN
3 - CND
testes, mediastinal

69
Q

Treat with rituximab, chemotherapy, variable course

70
Q

Chemotherapy, radiation therapy – is highly curable compared to Non-Hodgkin Lymphoma

71
Q

Reed–Sternberg cells confirm the diagnosis.

72
Q

low-risk stage IA and IIA disease –> XRT

Stage IIIB, IV –> ABVD chemo - adriamycin, bleomycin, vinblastine, dacarbazine

73
Q

Starry Sky histology

A

Burkitt Lymphoma NHL

74
Q

Owl Eyes

75
Q

Rouleaux RBC formation

A

Multiple Myeloma

76
Q

Auer Rods

77
Q

Smudge/Smear Cells

A

CLL (B Cell)

78
Q

Philadelphia Chromosome

79
Q

Pancytopenia –> anemia, thrombocytopenia, neutropenia, splenomegaly, gingival hyperplasia, bone pain

80
Q

Monoclonal (M) PRO spike MC IgG

A

Multiple Myeloma

81
Q

class of acquired clonal blood disorders
d/t ineffective hematopoieisis
with apoptosis of myeloid precursors

A

myelodysplastic syndromes (MDS)

82
Q

group of diverse bone marrow disorders in which the bone marrow does not produce enough healthy blood cells

83
Q

“bone marrow failure disorder”

84
Q

MDS etio, causes, prognosis

A

MC ELDERLY

usually idiopathic
radiation exposure, immunosupps, toxins

variable prognosis but generally poor/progress to acute leukemia

85
Q

MDS s/s

A

early - ASXS
Pancytopenia incidental finding

manifestations of anemia, thrombocytopenia, neutropenia

86
Q

? are a hallmark feature of MDS and are responsible for some of the symptoms that MDS patients experience — infection, anemia, spontaneous bleeding, or easy bruising.

A

Low blood cell counts

87
Q

Myelodysplastic syndrome may present as excessive bleeding due to …

A

thrombocytopenia

88
Q

In MDS, peripheral blood smear shows at least ? % of immature blood cells.?

A

10%+ immature blood cells

89
Q

MDS dx

A

BM biopsy = DYSPLASTIC MARROW CELLS with blasts or ringed sideroblasts

CBC with peripheral smear = nl/↑ MCV, ↓ reticulocyte, ↓ RBC, ↓ WBC, ↓ plt ; dysplastic RBC, dysplastic WBC, normal plt

90
Q

Myelodysplastic syndrome are pre-leukemias with a high risk of conversion to ?

91
Q

MDS tx mainly supportive - mainstay ?

A

RBC and plt transfusions

Erythropoietin may help reduce # of transfusions

BM transplant only potential cure

92
Q

low blood cell counts in elderly

93
Q

Patients with multiple myeloma are prone to infections with encapsulated organisms such as …

A

Strept pneumoniae and H influenzae

94
Q

Igs coat RBC and neutralize the ionic charge than normally repels RBCs

A

RBC rouleaux formation in Multiple Myeloma

95
Q

Urinalysis: Ig light chains (Bence Jones protein).

A

Multiple Myeloma

96
Q

B symptoms are common - fever, weight loss, night sweats

97
Q

Peripheral, multiple lymph nodes: axillary, abdominal, pelvic inguinal, femoral.
Non-Contiguous, extranodal spread: GI and skin most common

98
Q

Associated with EBV (40% of patients)

99
Q

Painless lymphadenopathy + Reed-Sternberg cells + Bimodal age distribution (15-35) and (>60)

100
Q

Strikingly Increased WBC count > 100,000

+ hyperuricemia + Adult patient

PANCE (6 decks)

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