L31/32:Hem

Question 1

An older adult comes into clinic with bone pain, anemia, and elevated creatine. They state they have felt they keep getting sick lately. Which condition is this?

Answer 1

Multiple Myeloma

Question 2

In plasma cell disorders, the monoclonal plasma cells produce monoclonal immunoglobulins that is identified on serum protein electrophoresis as a monoclonal spike, also known as…
A. IgG
B. M protein
C. IgM
D. IgA

Answer 2

B. M protein

Question 3

Which test is used to identify the subtype of immunoglobulin and the light chain (kappa/lamda) present on the immunoglobulin responsible for the monoclonal spike seen on serum protein electrophoresis?

Answer 3

Serum immunofixation

Question 4

True or False: Monoclonal immunoglobulins are found in serum of patients with multiple myeloma and Wldenstroms macroglobulinemia

Answer 4

True

Question 5

Clonal bone marrow plasma cells ≥10% or biopsy-proven bony/
extramedullary plasmacytoma suggests a dx of…

Answer 5

multiple myeloma

Question 6

Waldenstrom Macroglobulinemia is a malignancy of lymphoplasmacytoid cells that secrete ___

Answer 6

IgM

Question 7

Unlike multiple myeloma, in Waldenstrom Macroglobulinemia, patients present with ____ and ____

Answer 7

lymphadenopathy and hepatosplenomegaly

Question 8

True or False: There are no lytic lesions in Waldenstrom Macroglobulinemia

Answer 8

True

Question 9

____: Bone marrow infiltration by IgM plasma cells and lytic bone lesions

Answer 9

IgM Myeloma

Question 10

True or False: Hyperviscosity is a symptom of multiple myeloma

Answer 10

False - symptom ov Waldenstrom Macroglobulinemia

Question 11

Monoclonal IgM on serum protein electrophoresis (SPEP) test, as well as Rouleaux formation in peripheral blood RBC suggests….

Answer 11

Waldenstrom Macroglobulinemia

Question 12

_____: Clonal stem cell disorder that occurs in patients who have the Philadelphia chromosome (translocation between chromosome 9 and 22)

Answer 12

Chronic Myeloid Leukemia

Question 13

True or False: Chronic Myeloid Leukemia results in abnormally low expression of tyrosine kinase gene and abnormal proliferation of granulocytes

Answer 13

False -
1) while yes, there is abnormal proliferation of granulocytes
2) there is tyrosine kinase that is “on”

Question 14

A 55 y/o patient presents with fatigue, night sweats, sternal tenderness, and splenomegaly. Which condition do they have?
A. Waldenstrom Macroglobulinemia
B. Chronic Myeloid Leukemia
C. IgM Myeloma
D. Multiple Myeloma

Answer 14

B. Chronic Myeloid Leukemia

Question 15

True or False: Leukocytosis with left shift + hypercellular bone marrow with left shift suggests Multiple Myeloma

Answer 15

False - suggests Chronic Myeloid Leukemia

Question 16

Three stages of CML? Features?

Answer 16

1) Chronic Phase: Increased WBC - due to granulocyte proliferation
2) Accelerated: blast count 10-20%
3) Blast phase: Blast >20% in blood/bone marrow

Question 17

Treatment for CML?

Answer 17

Tyrosine kinase inhibitors

Question 18

_____: Elevated red cell mass in the absence of a secondary condition

Answer 18

Polycythemia Vera (PV)

Question 19

Mutation in auto-inhibitory, pseudokinase domain of tyrosine kinase JAK-2 is most closely associated with which condition…

Answer 19

PV (polycythemia vera)

Question 20

Expanded blood volume and hyperviscosity are clinical features of polycythemia vera. How does this manifest?

Answer 20

1) Headaches
2) Fatigue
3) Blurred vision

Question 21

True or False: General pruritus occurs in polycythemia vera, as well as hepatomegaly and engorged retinal veins

Answer 21

False - all true, except there’s splenomegaly (not hepato)

Question 22

Increased Hb and Hematocrit, decreased erythropoietin, as well as (+) JAK2 mutation suggests which condition….
A. MM
B. PV
C. Chronic Myeloid Leukemia

Answer 22

B. PV

Question 23

How do you decreased blood viscosity and improve oxygenation in PV patients?

Answer 23

Phlebotomy

Question 24

Which type of bone marrow transplantation is prone to graft vs. host disease vs. rejection?
A. Autologous
B. Syngeneic
C. Allogeneic

Answer 24

C. Allogeneic

Question 25

Indications for Bone marrow transplant?
BOM NAH

Answer 25

Breast CA
Ovarian CA
Myeloma

Non-Hod Lymp
Hod Lymph
AML

Question 26

Which of the following receives granulocyte colony stimulating factor?
A. Bone Donor
B. Bone Recipient

Answer 26

A. Bone Donor

Question 27

What are the two types of Acute Leukemias?

Answer 27

Acute Myeloid Leukemia (AML)

Acute Lymphoblastic Leukemia (ALL)

Question 28

____: A hematologic malignancy characterized by an increase in the number of myeloid cells in the marrow and ARREST in their maturation, frequently resulting in hematopoetic insufficiency WITH/WITHOUT leukocytosis

Answer 28

Acute Myeloid Leukemia (AML)

Question 29

Answer 29

Question 30

Pancytopenia with circulating blast cells is a hallmark of which condition?

Answer 30

AML

Question 31

Auer rods suggest bone marrow ___

Answer 31

AML

Question 32

_____: Surface marker molecules that are cell membrane proteins (glycoproteins) or receptors (antigens) – allows for identification of MULTIPLE cell lines

Answer 32

Cluster Differentiation antigens (CD)

Question 33

__ ___ helps to identify if blast cells are
myeloid or lymphoid or bi-phenotypic in acute
leukemia based on cluster differentiation
antigens

Answer 33

Flow cytometry

Question 34

True or False: APL (AML M3) is the most curable subtype of AML but DIC is a complication

Answer 34

True