Heme/Onc- Leukemia & Lymphoma

Question 1

Presentation Hodgkin Lymphoma

Answer 1

• 15-35 or >60yo
• B symptoms
• Painless lymphadenopathy (tender if rapid)
• Large supraclavicular node
• Mediastinal Mass (cough, SOB, chest pain)
• Pruritus

Question 2

Diagnosis of Hodgkin lymphoma

Answer 2

Lymph node biopsy

Reed-Sternberg cells (orphan Annie cells) is specific for HL

Question 3

Labs in Hodgkin lymphoma

Answer 3

Elevated lactate dehydrogenase
Eosinophilia
Normocytic anemia
Lymphopenia

Question 4

Diagnosis: chest pain after drinking beer, mediastinal mass on CXR

Answer 4

Hodgkin lymphoma

severe pain in areas of lymphadenopathy following alcohol. Alcohol induces vasodilation within lymph nodes causing capsular distention.

Question 5

Chronic Myeloid leukemia translocation

Answer 5

t(9;22)
Increases Tyrosine Kinase activity
Causes Leukemogenesis.

Question 6

Findings CML

Answer 6

Leukocytosis:
Increased granulocytes (basophils) 
Neutrophil precursors (promyleoctes, myelocytes)

Splenomegaly (chronic phase)
Normochromic, normocytic anemia

Question 7

Clinical symptoms CML

Answer 7

Asymptomatic 
Adults 45-85
Fatigue
Night Sweats 
Weight loss; early satiety; abdominal fullness (splenomegaly)

Question 8

Treatment CML

Answer 8

Tyrosine Kinase inhibitors

Imatinib, Dastinib

Question 9

Ddx CML and leukamoid reaction

Answer 9

LR: leukocyte alkaline phosphatase (LAP) +, normal cell distribution

CML: LAP-, ^ basophils, T(9;22)

Question 10

What does an enlarging spleen in CML signify

Answer 10

accelerated phase. transformation to AML or ALL

Question 11

S&S non Hodgkin Lymphoma

Answer 11

Progressive painless lymphadenopathy
B symtoms
Elevated LDH

Question 12

How are chronic autoimmunes ate risk for NHL

Answer 12

Persistent B-cell stimulation
Immune Dysregulation
Exposure to immunosuppressive agens

Question 13

B symptoms

Answer 13

Fever
Night sweats
Weight loss

Question 14

ALL presentation

Answer 14

Child 2-5yo
B symptoms 
Anemia
Brusing 
Bone Pain (long bones)
Hepatosplenomegaly 
Mediastinal mass
Lymphadenopathy

Question 15

Evaluation of ALL

Answer 15

CBC
Bone Marrow biopsy
Lumbar puncture to evaluate for CNS involvement

Question 16

4yo with leg pain, started after fall. Cytopenia, Fever & bruises

Answer 16

ALL… Bone pain classically affecting long bones more at night and refuses to walk.

Systemic findings point away from trauma

Question 17

S&S hereditary hemochromatosis

Answer 17

Hyperpigmentation 
Arthralgia
Chondrocalcinosis 
Hepatic fibrosis/ cirrhosis 
Diabetes 
Dilated cardiomyopathy

Question 18

Complication of hereditary hemochromatosis

Answer 18

Hepatocellular carcinoma

Question 19

Diagnosis hereditary hemochromatosis

Answer 19

Initial: iron studies
Confirmed: HFE mutation

Question 20

Treatment hereditary hemochromatosis

Answer 20

Seria phlebotomy.

Reduces risk for cirrhosis and HCC