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Gen Med (Haem) > Leukaemias and Lymphomas > Flashcards

Leukaemias and Lymphomas Flashcards

1
Q

What investigation can be used to identify normal progenitors and stem cells?

A

Immunophenotyping

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2
Q

What investigation can be used to identify mature lymphoid cells?

A

Immunophenotyping

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3
Q

What investigation can be used to identify mature non-lymphoid cells?

A

Morphology (i.e. blood count and film)

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4
Q

Leukaemias are tumours where?

A

The bone marrow

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5
Q

Lymphomas are tumours where?

A

The lymph nodes

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6
Q

Which is usually more clinically aggressive- acute or chronic leukaemias?

A

Acute

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7
Q

Acute leukaemias are caused by uncontrolled proliferation of what cells?

A

Partially developed white blood cells (blast cells)

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8
Q

Which type of acute leukaemia is more commonly seen in children?

A

Acute lymphoblastic leukaemia

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9
Q

Which type of acute leukaemia is more commonly seen in older individuals?

A

Acute myeloid leukaemia

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10
Q

In acute leukaemia, in what peripheral organs and tissues may blast cells, particularly lymphoblasts, settle in?

A

Liver, spleen, lymph nodes and thymus

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11
Q

What are the 3 main symptoms of acute leukaemias as a result of anaemia, thrombocytopenia and leukopenia?

A

Fatigue, easy bruising/bleeding, increased susceptibility to infections

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12
Q

What symptom may occur in individuals with acute leukaemia due to increased cell production in the bone marrow?

A

Pain and tenderness in the bones

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13
Q

What are the first line investigations for acute leukaemias?

A

Full blood count and peripheral blood film

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14
Q

A peripheral blood film showing the presence of lots of blast cells is suggestive of what diagnosis?

A

An acute leukaemia

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15
Q

What investigation is required to confirm acute leukaemia and what will it show?

A

Bone marrow biopsy showing > 20% blast cells

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16
Q

What is the first line treatment for both types of acute leukaemia?

A

Chemotherapy

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17
Q

What is the most common malignancy affecting children?

A

Acute lymphoblastic leukaemia

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18
Q

What age is the peak incidence of ALL?

A

2-3 years

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19
Q

Are boys or girls more likely to be affected by ALL?

A

Boys

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20
Q

What feature is present in up to 50% of new cases of ALL, which may represent infection or a constitutional symptom?

A

Fever

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21
Q

What investigation may be used to assess for CNS involvement of ALL?

A

Lumbar puncture

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22
Q

After induction and consolidation chemotherapy, how long is maintenance chemotherapy given for in those with ALL? What is the aim of this?

A

Up to 3 years, to reduce the risk of recurrence

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23
Q

What treatment may be offered to those with ALL who continue to relapse despite adequate treatment with chemotherapy?

A

Stem cell transplant

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24
Q

What is the 5-year survival rate of ALL in children?

A

80-90%

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25
Q

AML may occur as a primary disease or following a secondary transformation from what conditions?

A

Myeloproliferative disorders

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26
Q

Bony pain and lymphadenopathy are more likely to be features of which type of acute leukaemia?

A

ALL

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27
Q

Organomegaly, haemorrhage and DIC are more likely to be features of which type of acute leukaemia?

A

AML

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28
Q

The formation of mediastinal or abdominal masses is more likely to be a feature of which type of acute leukaemia?

A

AML

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29
Q

What type of anaemia is typically seen in acute leukaemias?

A

Normocytic anaemia

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30
Q

Auer rod cells on a peripheral blood film is suggestive of what diagnosis?

A

AML

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31
Q

Which type of bacteria can cause fulminant life-threatening sepsis in neutropenic patients?

A

Gram negative bacteria

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32
Q

What should be suspected if a neutropenic patient has a persisting fever and is unresponsive to antibiotics?

A

Fungal infection

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33
Q

Immature B cells known as smudge/smear cells are seen on a peripheral blood film of individuals with what condition?

A

Chronic lymphocytic leukaemia

34
Q

What investigation can be used to make a definitive diagnosis of chronic myeloid leukaemia?

A

Genetic testing

35
Q

The Philadelphia chromosome is present in more than 95% of patients with which condition?

A

CML

36
Q

The Philadelphia chromosome describes a translocation between the long arms of which two chromosomes?

A

9 and 22

37
Q

The BCR-ABL gene is the hallmark of what condition?

A

CML

38
Q

At what age does chronic myeloid leukaemia typically present?

A

60-70 years

39
Q

Chronic myeloid leukaemia can develop into what other malignancy?

A

Acute leukaemia, most commonly AML

40
Q

What is the first line treatment for chronic myeloid leukaemia?

A

Imatinib

41
Q

What type of drug is imatinib?

A

Tyrosine kinase inhibitor

42
Q

Chronic lymphocytic leukaemia is caused by a monoclonal proliferation of well differentiated lymphocytes which are almost always which type of cell?

A

B cells

43
Q

What is the most common form of leukaemia seen in adults?

A

CLL

44
Q

Hypogammaglobulinaemia leading to recurrent infections is a potential complication of which leukaemia?

A

CLL

45
Q

Chronic lymphocytic leukaemia may progress to what other malignancy?

A

High-grade non-Hodgkin’s lymphoma (Richter’s transformation)

46
Q

Reed-Sternberg cells are pathognomonic of what condition?

A

Hodgkin’s lymphoma

47
Q

When are the two peaks of Hodgkin’s lymphoma?

A

In the 3rd and 7th decades of life

48
Q

Describe how a lymph node with lymphoma will feel?

A

Enlarged, painless, ‘rubbery’

49
Q

Alcohol induced lymph node pain is seen in which condition?

A

Hodgkin’s lymphoma

50
Q

What complications can mediastinal lymph node involvement of a lymphoma lead to?

A

Bronchial or SVC obstruction

51
Q

What type of anaemia is seen in lymphoma?

A

Normocytic anaemia

52
Q

What happens to LDH in Hodgkin’s lymphoma?

A

Increased

53
Q

What is the investigation of choice for lymphoma?

A

Lymph node excision biopsy

54
Q

What staging system is used for lymphomas?

A

Ann-Arbor system

55
Q

What stage would a lymphoma be that is confined to a single lymph node?

A

Stage 1

56
Q

What stage would a lymphoma be that involves two or more nodal areas on the same side of the diaphragm?

A

Stage 2

57
Q

What stage would a lymphoma be that involves nodes on both sides of the diaphragm?

A

Stage 3

58
Q

What stage would a lymphoma be that has spread beyond the lymph nodes to the liver or spleen?

A

Stage 4

59
Q

Each stage of lymphoma can be further classified as A or B, what is meant by A?

A

No systemic features other than pruritus

60
Q

Each stage of lymphoma can be further classified as A or B, what is meant by B?

A

System features such as weight loss, fever or night sweats

61
Q

How are early stage Hodgkin’s lymphomas treated?

A

Radiotherapy +/- chemotherapy

62
Q

How are late stage Hodgkin’s lymphomas treated?

A

Chemotherapy

63
Q

What is the most common subtype of Hodgkin’s lymphoma?

A

Nodular sclerosing

64
Q

Which subtype of Hodgkin’s lymphoma has the best prognosis?

A

Lymphocyte predominant

65
Q

Which subtype of Hodgkin’s lymphoma has the worst prognosis?

A

Lymphocyte depleted

66
Q

Gastric MALT lymphomas are caused by what?

A

H pylori infection

67
Q

Do systemic symptoms typically occur earlier in Hodgkin’s or non-Hodgkin’s lymphoma?

A

Hodgkin’s

68
Q

Is extranodal disease more common in Hodgkin’s or non-Hodgkin’s lymphoma?

A

Non-Hodgkin’s

69
Q

Which type of non-Hodgkin’s lymphomas have a better prognosis- low-grade or high-grade?

A

Low-grade

70
Q

Which type of non-Hodgkin’s lymphoma is more likely to be curable- low-grade or high-grade?

A

High-grade

71
Q

What treatment may be used for localised low-grade non-Hodgkin’s lymphoma?

A

Radiotherapy

72
Q

What treatment is used for high-grade non-Hodgkin’s lymphoma?

A

R-CHOP chemotherapy regimen

73
Q

What type of lymphoma is Burkitt’s lymphoma?

A

High grade B cell non-Hodgkin’s lymphoma

74
Q

The endemic (African) form of Burkitt’s lymphoma typically affects where?

A

The maxilla or mandible

75
Q

The sporadic form of Burkitt’s lymphoma typically affects where?

A

The abdomen

76
Q

The sporadic form of Burkitt’s lymphoma is mostly seen in individuals with what underlying condition?

A

HIV

77
Q

Burkitt’s lymphoma is associated with the c-myc gene translocation, this is usually between which chromosomes?

A

8 and 14

78
Q

What virus is strongly implicated in the development of Burkitt’s lymphoma?

A

EBV

79
Q

Microscopy showing a ‘starry sky’ appearance is suggestive of what diagnosis?

A

Burkitt’s lymphoma

80
Q

How is Burkitt’s lymphoma treated?

A

Chemotherapy

81
Q

Itch without a rash is most likely to be associated with which type of lymphoma?

A

Hodgkin’s lymphoma

82
Q

Is non-Hodgkin’s lymphoma more commonly B cell or T cell?

A

B cell

Gen Med (Haem) (12 decks)

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