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Medicine Phase 2a Haematology > Leukemia > Flashcards

Leukemia Flashcards

1
Q

What are the 4 types of leukemia

A

Acute lymphoblastic
Chronic lymphocytic
Acute myeloid
Chronic myeloid

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2
Q

What is acute lymphoblastic leukemia

A

Acute malignant transformation of a clone of lymphoid progenitor cells

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3
Q

Clinical presentation of acute lymphoblastic leukemia

A 
Bone marrow failure: Anaemia, Bleeding, Infection
Bruising
SoB
Purpura
Malaise
Weight loss
Night sweats
Bone pain
(Hepatoslenomegaly more chronic)
Fatigue
Dizziness
Palpitations
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4
Q

Pathophysiology of acute lymphoblastic leukemia

A

Uncontrolled proliferation of precusor B or T cells
-> Accumulation of leukaemic cells in bone marrow, peripheral blood and other tissues.
Also a reduction in red cells, platelets and neutrophils

Often spreads to CNS

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5
Q

Genetic Aetiology of acute lymphoblastic leukemia

A

Down’s syndrome 20x risk

Pregnancy

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6
Q

Environmental Aetiology of acute lymphoblastic leukemia

A

Chemicals (benzene compounds)
Drugs (alkylating agents)
Ionising Radiation exposure

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7
Q

Epidemiology of ALL

A

Most common cancer in children

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8
Q

Diagnosis of ALL

A

Peripheral blood film - anaemia and thrombocytopenia

Bone marrow aspirate - Leukaemic blast cells

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9
Q

Treatment of ALL

A

Chemotherapy
Intrathecal methotrexate
Follow up maintenance

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10
Q

What chemotherapy drugs are given in the treatment of ALL

A

Vincristine, Dexamethasone, Asparaginase and Daunorubicin

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11
Q

Prognosis of ALL in children compared with adults

A 
Children = excellent prognosis (1 in 5 die)
Adults = poorer prognosis, only 30% cured
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12
Q

Which leukemia would show smudge cells in histological analysis

A

Chronic Lymphocytic Leukemia

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13
Q

Which leukaemia would show auer rods in histological analysis?

A

Acute myeloid leukemia

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14
Q

Which leukaemia has a propensity to involve the CNS?

A

Acute Lymphoblastic leukemia

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15
Q

What is chronic lymphocytic leukaemia

A

Chronic malignant transformation of a clone of mature lymphoid cells

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16
Q

Early clinical presentation of chronic lymphocytic leukaemia

A

Asymptomatic (indolent), but isolated lymphocytosis is frequent

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17
Q

Clinical presentation of chronic lymphocytic leukaemia when symptomatic

A 
Bone marrow failure
Nontender lymphadenopathy
Hepatosplenomegaly
Malaise
Weight loss
Night sweats

Anaemia
Bleeding and Infection due to bone marrow failure
Rubbery lymph nodes

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18
Q

Pathophysiology of chronic lymphocytic leukaemia

A

Uncontrolled proliferation and accumulation of mature B (or T) cells.
Autoimmune haemolysis can occur causing anaemia

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19
Q

Aetiology of chronic lymphocytic leukaemia

A

Genetic: Mutation (11q or 17p deletion for example)

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20
Q

Epidemiology of CLL

A

Most common leukaemia in the western world

21
Q

Diagnostic tests of CLL

A

FBC - Anaemia, raised White cell

Blood film - smudge cells

22
Q

Treatment of CLL

A

Incurable

Chlorambucil (with or without) prednisolone) -> decreases blood count -> Decreases lymphadenopathy and splenomegaly

23
Q

What is the most common cancer in children?

A

Acute lymphoblastic leukaemia

24
Q

What is the most common cancer in the Western world

A

Chronic lymphocytic leukaemia

25
Q

What is Acute Myeloid leukaemia

A

Acute malignant transformation of a clone of myeloid progenitor cells

26
Q

Clinical presentation of Acute Myeloid leukaemia

A

Fatigue, dizziness and palpitations.
Anaemia, bleeding and infection due to bone marrow failure.
Hepatosplenomegaly
Malaise, weight loss, night sweats

27
Q

Pathophysiology of Acute Myeloid leukaemia

A

Accumulation of leukaemia cells in bone marrow, peripheral blood and other tissues.
Additionally a reduction in red cells, platelets and neutrophils.
Rapidly progressing

28
Q

Aetiology of Acute Myeloid leukaemia

A 
Exact cause unknown
Risk factors include:
Myeloproliferative disease
Alkylating agents
Ionising radiation exposure
Down's syndrome
29
Q

Epidemiology of Acute Myeloid Leukaemia

A

Most common leukaemia in adults

Most common in older adults and elderly

30
Q

Diagnostic tests of Acute Myeloid Leukaemia

A

Peripheral blood film - anaemia, thrombocytopenia, AUER RODS (diagnostic)
Bone Marrow Aspirate - Leukaemia blast cells

31
Q

Low risk Treatment of AML

A

Chemotherapy in intervals to allow marrow recovery

32
Q

Intermediate treatment of AML

A

Chemotherapy followed by allogenic bone marrow transplant

33
Q

High risk treatment of AML

A

Only curable with allogenic BM transplantation

34
Q

What is Chronic Myeloid Leukaemia

A

Chronic malignant transformation of a clone of myeloid cells

35
Q

Clinical presentation of Chronic Myeloid Leukaemia

A

Insidious onset, fever, malaise, weight loss, (night) sweating.
Bone marrow failure, anaemia.
Massive splenomegaly.
Untreated, this lasts 3-4 years before progressing

36
Q

Pathophysiology of Chronic Myeloid Leukaemia

A

Insidious onset lasts 3-4 years ->Blast transformation -> Acute myeloid leukaemia -> death

37
Q

Aetiology of CML

A 
Ionising radiation is risk factor
Genetic: 95% of cases:
Philadelphia chromosome:
reciprocal translocation (t(;22)), creating fusion gene (BCR-ABL) with tyrosine kinase activity which alters cell growth
38
Q

Diagnostic tests of CML

A

FBC - anaemia, raised WBCs

Cytogenetics - Philadelphia stage

39
Q

Treatment of CML

A

Imatinib (tyrosine kinase inhibitor)
If in acute stage = chemotherapy
Allogeneic stem cell transplantation in <60 possible

40
Q

Sequelae of CML

A

AML

Myelofibrosis

41
Q

Leukaemia complications

A 
Death
Increased risk of infection
Haemorrhage: pulmonary, intracranial
Depression
Complication of chemotherapy
42
Q

Investigations

A

Bloods - FBC, WCC, platelets, U and Es, LFTs, ESR, CRP
Bone marrow biopsy, lymph node biopsy
Radiology - x-ray, ultrasound scan, CT scan, MRI

43
Q

How are ALL and AML classified

A

French-American-British (FAB) classification

44
Q

Conservative treatment of leukaemia

A

Patient education

Refer to Macmillan nurses

45
Q

Medical treatment of ALL

A

Induce remission and maintenance
To induce remission:
Dexamethasone, Vincristine, Anthracycline antibiotics, Cyclophosphamide
Maintenance:
Methotrexate, Mercaptopurine, Cytarabine, Hydrocortisone

46
Q

Medical treatment of AML in patients <60

A

Chemotherapy with an anthracycline and cytarabine or methotrexate

47
Q

Medical treatment of AML in patients >60

A

Palliative anthracycine, cytarabine or mitoxantrone

48
Q

What would you add to therapeutic regime if M3 type AML (Acute Promyelocytic leukemia - APML)

A

All-trans retinoic acid

Medicine Phase 2a Haematology (16 decks)

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