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Clinical Medicine I > Leukemia and Lymphoma > Flashcards

Leukemia and Lymphoma Flashcards

1
Q

Leukopenia is a WBC count less than…

A

< 4.5k

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2
Q

leukocytosis is a WBC count…

A

> 11K

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3
Q

This leukemia:

is the most common acute leukemia in adults

Average age is 65 yo

rare and rarely fatal,

A

acute myeloid leukemia (AML)

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4
Q

A 65 yo patient w/ a hx of benzene exposure complains of anemic sxs, neutropenic sxs (fever), bleeding, and ophthalmic changes.

What do you suspect based off this hx?

A

AML

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5
Q

For a pt. you suspect of AML, what should you expect to see on CBC with Diff and in the peripheral smear

A

+ pancytopenia
+ 20% blasts
+ Auer Rods on peripheral smear

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6
Q

For a pt. you suspect of AML, what would a CMP show? What two other labs might help with a dx?

A

elevated creatinine, liver fxn, increased potassium, calcium

elevated Uric Acid and elevated LDH

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7
Q

Can auer rods be seen in disorders other than AML?

A

Yes, they are pathognomonic only of myeloblasts

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8
Q

You suspect a patient has AML.

Labs indicate the following:

+ pancytopenia
+ elevated LDH, Uric Acid
+ elevated calcium and potassium
+ Auer Rods

What test do you want ot order to confirm you dx?

A

bone marrow aspiration and biopsy showing 20% blasts

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9
Q

Induction tx for AML includes what?

A

chemotherapy for 6 mo

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10
Q

consolidation therapy for AML includes what?

A

stem cell transplant

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11
Q

What is a common progression to AML?

A

Myelodysplastic syndromes

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12
Q

This disease is characterized by abnormal cell maturation, and ineffective blood cell production leading to pancytopenia.

it is commonly asymptomatic and found incidentally on CBC

Cure is via bone marrow transplant

It can progress to AML?

A

myelodysplastic syndrome

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13
Q

This disease occurs 12-24 hours after cytotoxic therapy

is associated with high mortality

and occurs when massive tumor cells lyse to release contents (K, PO3, nucleic acid)

A

tumor lysis syndrome

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14
Q

What should you expect to see on labs in tumor lysis syndrome?

A

hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia

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15
Q

how do you treat TLS?

A

prevention, monitor cardiac fx

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16
Q

This leukemia is associated with the BCR-ABL1 fusion gene, the philadelphia chromosome and tyrosine kinase activation…

A

chronic myeloid leukemia (CML)

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17
Q

A 50 yo male pt. presents c the following after routine blood work. Pt. appears asymptomatic:

  • hx of ionizing radiation
  • profound leukocytosis (WBC > 100k)
  • B sxs
  • Splenomegaly
  • fatigue

What do you suspect?

A

CML

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18
Q

When a patient c CML is in blast crisis, what would be present?

A

20% blast cells

fatigue, fever, extramedullary blasts, splenomegally

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19
Q

How do you diagnose a pt. you suspect of CML?

A

identification of philadelphia chromosome or BCR-ABL gene

20
Q

CML can be treated with…

A

Tyrosine Kinase Inhibitors

Monoclonal Abs

Chemo

Allogenic Stem Cell Transplant

21
Q

Complications of CML include…

A

tumor lysis syndrome

hyperleukocytosis

hyperviscosity syndrome

Tx with leukapheresis/plasma exchange

22
Q

A 2 year old male patient of caucasian descent c NF1 presents c. the following…

Hx:
+ Fever, Fatigue, Pallor, Bone pain
+ hx genetic disorders

PE:
+hepatosplenomegaly, nontender LAD

Labs:
+ Neutropenia, anemia, thrombocytopenia
+ elevated LDH

Peripheral smear:
+ 20% lymphoblasts

What do you suspect, and what test do you want to Dx?

A

suspect ALL

Get bone marrow biopsy

23
Q

70-80% of childhood ALL is what subtype?

A

precursor B-Cell ALL

24
Q

Precursor B-Cell ALL has a favorable or unfavorable prognosis?

A

favorale

25
Q

80% of this type of ALL express CD10

A

Precursor B-Cell ALL

26
Q

What type of ALL has the following features…

Hyperleukocytosis at Dx
Older age
mediastinal mass
intramedullary disease

A

T-Cell ALL

27
Q

This type of ALL is also called burkitt cell lymphoma

it presents with CNS sx and bulky extramedullary disease

A

Mature B-Cell ALL

28
Q

Standard treatment for ALL is…

A

2 year course of chemotherapy

29
Q

This type of leukemia has the following characteristics…

Median age of 70 yo, only adults

+ B cell lymphocytosis

organomegaly

Skin changes (leukemia cutis, macules, papules, etc)

may be treated with observation if early stage 1

A

CLL

30
Q

A pt. presents c the following:

Painless cervical LAD

Mediastinal mass on CXR

Pain after EtOH

B Sxs

Fatigue

Pruritus s rash

This presentation is concerning for what?

A

hodgkins lymphoma

31
Q

A patient is positive for the following:

supraclavicular LAD
splenomegaly
hepatomegaly

Reed-Sternberg cells.

This is concerning for what?

A

Hodgkins lymphoma

32
Q

You are concerned a pt. may have hodgkins lymphoma. What can confirm the diagnosis? What do you need to stage the disease?

A

Dx via lymph node biopsy showing + Reed Sternberg cells

Get CT/PET to stage

33
Q

Describe the treatment options for HL.

A

Chemo, very effective

Radiation in bulky disease

stem cell transplant for relapse or persistent disease

34
Q

A patient c. HL presents with bilateral cervical LAD, bulky disease, distant spread.

How should this affect prognosis?

A

worse prognosis

35
Q

90% of non-hodgkin lymphoma is derived from…

A

B lymphocytes

36
Q

A pt. presents c. the following on H&P:

  • Diffuse, painless, persistent LAD
  • Mediastinal mass
  • B sxs
  • Extra lymphatic sites like bone marrow.

This is concerning for what?

A

NHL

37
Q

Diffuse large B cell lymphoma

burkitt lymphoma

adult t cell leukemia-lymphoma

precursor B and T lymphoblastic leukemia/lymphoma

These conditions are associated with what…

A

aggressive NHL

B Sxs

Elevated LDH, Uric Acid

38
Q

Dx for NHL is done via…

A

lymph node biopsy

CT/PET

Bone Marrow aspiration

39
Q

A patient with slow growing indolent NHL is treated with…

A

radiation alone

40
Q

Aggressive, intermediate or high grade NHL is treated with…

A

chemo + immunotherapy + autologous stem cell transplant

41
Q

this disease is a malignancy of plasma cells.

A

multiple myeloma

42
Q

when performing protein electrophoresis on a patient suspicious for multiple myeloma, what you expect ot find?

A

paraproteins, M-Spike

43
Q

A patient presents c. the following on H & P:

Fatigue, back pain, weakness, parasthesia in LE, incontinence, weight loss.

What is this concerning for?

A

multiple myeloma

44
Q

A pt. presents with the following lab findings:

M-Spike on protein electrophoresis

+ bence-jones proteins in urine

+ lytic lesions and osteoporosis on X-Ray

This is concerning for what?

A

multiple myeloma

45
Q

CRAB stands for what? It is concerning for what disease?

A

Calcium > 10.5
Renal Insufficiency
Anemia
Bone Lesions

concerning for multiple myeloma

46
Q

Tx of multiple myeloma…

A

hem/onc

combination chemo

Iv bisphosphonates to prevent bone loss

autologous hemopoietic cell transplant

47
Q

Pt. presents with

bone pain in spine and ribs

recurrent infections

hypercalcemia

anemia

kidney failure.

What does this concern for?

A

Multiple myeloma.

Bones BREAK in multiple myeloma

(Bone pain, Recurrent infx, Elevated calcium, Anemia, Kidney failure)

Clinical Medicine I (25 decks)

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