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Pedia > Leukemia, Lymphoma > Flashcards

Leukemia, Lymphoma Flashcards

1
Q

Pancytopenia
Without organomegally

Dx?

A

Aplastic Anemia

until proven otherwise

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2
Q

Pancytopenia

With organomegaly

A

Leukemia

Until proven otherwise by bone marrow aspiration

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3
Q

Confirms diagnosis of leukemia

A

BMA

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4
Q

Leukemia only present in adults

A

CLL

Chronic Lymphocytic Leukemia

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5
Q

Use of antigen and antibody (similar to blood typing)

Important in distinguishing SUBTYPE of leukemia

They are the clusters of differentiation (CD)

A

Flow cytometry

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6
Q

CD 13

CD 33

A

AML

Acute Myelogenous Leukemia

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7
Q

CD 10

CALLA

A

Pre B ALL

Very good prognosis

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8
Q

CD 19
CD 20
CD 22

A

B Acute Lymphocytic Leukemia

B ALL

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9
Q

CD 3
CD 5
CD 7

A

T Acute Lymphocytic Leukemia

T ALL

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10
Q

Differentiates from myeloid to lymphoid

A

Immunohistochemistry

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11
Q

Myelofibroblast

IHC

A

Myeloperoxidase
Sudan Black B
Specific esterase

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12
Q

Monoblast IHC

A

Non specific esterase

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13
Q

Lymphoblast IHC

A

Periodic Acid Schiff

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14
Q

Herald of leukemia

A

blast

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15
Q

Metastatic pattern of acute leukemia

A 
Spinal fluid CNS 7/10 
Liver
Spleen 
Lymph node
Testicles
Extramedullary tumors in AML
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16
Q

Areas that systemic chemotherapy can’t reach hence give directed therapy

A

Sanctuary sites CNS

Direct therapy intrathecal

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17
Q

Ecchymosis, bruises, petechiae
History of infection or fever 2 weeks prior to consult

Isolated thrombocytopenia

A

ITP

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18
Q

Transient Myeloproliferative Disease is most commonly seen in

A

Down Syndrome

Anemia, thrombocytopenia and high WBC with blast - 75% resolves

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19
Q

40% of patients with Down will later develop

A

AML

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20
Q

Radiation is contraindicated to age

A

3 and below

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21
Q

Anti emetic post chemotherapy

5HT3 antagonist

A

Ondansentron

22
Q

If patients are not properly hydrated or prepared before initiation of chemotherapy, this occurs

A

Tumor lysis syndrome

23
Q

Destruction of lymphoblast

Release of K -> Hyperkalemia, cardiac arrhythmia

Release of nucleic acid -> Purine catabolism, hyperuricemia, uric acic crystals, acute renal failure

Hyperphosphatemia -> Calcium-phosphate imbalance

A

Tumor lysis syndrome

24
Q

Peak at 2-3 years of age
Boys

Common in Down syndrome, Bloom
Syndrome, Ataxia-telangiectasia, Fanconi anemia

Radiation exposure

B-cell and EBV

A

Acute Lymphoblastic Leukemia

25
Q 
Recurrent fever (lagnatin) 61% 
Easy bruisability (pasain)
Limping (bone and joint pain)

CLADS, hepatomegaly

Bone marrow failure (pallor, fatigue, exercise intolerance, bruising, epistaxis) from infection or disease

URTI 1-2 months prior

Purpuric, petechial lesions, mucous membrane hemorrhage

A

Acute Lymphocytic Leukemia

ALL

26
Q

ALL subtypes

A

L1 - homogenous, 85% children
L2 - varied structure, 14% children
L3 - burkitt, 1-2% children

27
Q

Large blasts, prominent nucleoli
Stippled homogenous chromatin structure
Abdundant cytoplasmic vacuolation (bubble type)?

A

ALL L3

Burkitt’s leukemia

28
Q

Philadelphia chromosome

A

T (9;22)
BCR-ABL

ALL
CML

29
Q

Good risk factor for ALL

A

Age 1-9 years at diagnosis

Initial WBC <5,000

30
Q

Peak at 15-19 years

Hypercellular marrow consisting of a monotonous pattern of cells

Subcutaneous nodules, blueberry muffin lesions
Infiltration of gingiva
Discrete masses chloromia in orbit and epidural spaces, granulocytic sarcoma in absence of bone marrow involvement

DIC

A

Acute Myelogenous Leukemia

31
Q

AML management needs bone marrow transplant except subtype

A

M3
Promyelocytic Leukemia
Acute Promyelocytic Leukemia

32
Q

M3 Acute Promyelocytic Leukemia can be treated with

A

All-trans-retinoic acid (ATRA)
targeted therapy
Anthracycline
Cytarabine p

33
Q

T (15,17)

PML RARA receptor for ATRA

A

M3 Acute Promyelocytic Leukemia

34
Q

Mutation with this gene has Very poor prognosis but has available targeted therapy (AML)

A

FLT 3 mutation

35
Q

L UQ pain
Priapism
Splenomegaly

WBC 184,000 (Leukocytosis)

BMA numerous granulocytes (granulocytic hyperplasia) myeloid cells at all stages of differentiation

c t (9;22)

A

Chronic Myelogenous Leukemia

36
Q

Differentiates myeloproliferative disease from infection

A

LAP Leukocyte Alkaline Phosphatase score

High LAP - infection

37
Q

Low LAP

A

Leukemia

38
Q

Drug for CML

A

Imatinib (Cleevec)

80% 10 year disease event free survival

39
Q

Tyrosine kinase inhibitor targetting the BCR-ABL tyrosine kinase in CML

A

Imatinib (Cleevec)

40
Q

Temporarily decreases WBC in CML
Treats symptomatic patients by decreasing platelet and WBC
Prevents hyperviscosity but does not cure

A

Hydroxyurea - cytoreductase chemotherapy

41
Q

Ablates the philadelphia chromosomes

Flu-like symptoms

A

Interferon IV

42
Q

Phases of CML

A

Chronic - stable
Accelerated - increase in blasts
Blastic - blast >20%, may be AML (80%) or ALL (20%)

43
Q

Most common cancer in adolescents

A

Lymphoma

44
Q 
On and off fever
Painless, firm, rubbery cervical lymph node
Unexplained weight loss >10% 
Nigh sweats, unresponsive to antibiotic
Negative TB, skin test, CXR
Widened mediastinum

Lymph node biopsy: Reed Sternberg Cells

A

Hodgkin Lymphoma

45
Q

Bimodal peak 15-35, after 50

EBV, HSV 6, CMV

Ann-arbor Staging

Painless cervical lymphnode
Night sweats+ Weight loss

BMA: Normal
CXR: Mediastinal widening
CT: Enlarged abdominal LN

Better prognosis

A

Hodgkin Lymphoma

46
Q

Hodgkin Pathognomonic of

A

Reed Sternberg Cells

47
Q

More common lymphoma in aged 2-4 years

A

Non-Hodgkin Lymphoma

48
Q

Non-hodgkin Subtypes

A

Lymphoblastic lymphoma - intrathoracic or mediastinal supradiaphragmatic mass, CNS and BM

Burkitt - abdominal, head and neck, BM and CNS

Diffuse large B cell - abdominal or mediastinal

Anaplastic large cell - primary cutaneous, sytemic disease

B symptoms - fever, night sweat, weight loss

49
Q 
Contiguous Lymph nodes
Reed - Sternberg
Ann-arbor staging
Easier to treat
Adolescent
A

Hodgkin

50
Q

Affects any lymph nide
Starry sky appearance
St. Jude Staging/Murphy staging
More common in children 2-4 years old

A

Non-Hodgkin Lymphoma

51
Q

+ blasts
Aurer rods in promyelocyte
Myeloperoxidase +
Sudan black

A

Acute promyelocytic leukemia

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