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Clin Med Exam 4 (Lauren) > Leukemia, Lymphoma, MM > Flashcards

Leukemia, Lymphoma, MM Flashcards

1
Q

What is a normal WBC count?

A

4,400-11,000

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2
Q

What is the most common acute leukemia in adults?

A

AML

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3
Q

What is the median age of AML

A

65

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4
Q

Is it ever normal to have blast cells in the peripheral blood?

A

No

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5
Q

If you have an accumulation of leukemia blasts, could it be AML/

A

Yes

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6
Q

Can chemical exposure or chemo cause AML

A

Yes

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7
Q

What can myelodysplastic syndrome progress to?

A

AML

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8
Q

What are the genetic abnormalities associated with AML?

A

Trisomy 21

Fanconi

RUNX1

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9
Q

How do you diagnose AML?

A

Do a bone marrow aspiration and biopsy and look for blast cells forming 20% or more

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10
Q

What would you see on a peripheral smear of AML

A

Auer rods

Clumps of azurophilic granule material

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11
Q

What other labs would be high in AML?

A

Uric acid

LDH

Calcium

Potassium

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12
Q

Do Auer rods always indicate AML

A

No, can be seen in other myeloblast disorders

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13
Q

What kind of labs do you see with tumor lysis syndrome?

A

High potassium

High phosphate

High uric acid

Low calcium

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14
Q

Is tumor lysis syndrome an emergency?

A

YES

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15
Q

What cancer is associated with the Bcr-Abl1 gene?

A

CML

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16
Q

How does a Philadelphia chromosome come about?

A

Translocation of chromosomes 9 and 22

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17
Q

What are the 3 phases of CML?

A

Chronic

Accelerated

Blast

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18
Q

How do you treat CML?

A

Tyrosine kinase inhibitors

Monoclonal antibodies

Chemo

Allogenic stem cell transplant

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19
Q

What are the complications of CML that are emergencies?

A

Tumor lysis syndrome

Hyperleukocytosis (WBC over 100,000)

Hyperviscosity syndrome

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20
Q

Is it common to diagnose CML after a routine CBC?

A

Yes

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21
Q

What is the peak incidence of ALL?

A

2-5 yrs old

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22
Q

What are the signs and symptoms of ALL?

A

Fever

Fatigue

Pallor

Hepatosplenomegaly

Lymphadenopathy***

Testicular mass (painless and unilateral)

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23
Q

What will you see on a peripheral blood smear of ALL

A

“Small, uniform blasts with scant cytoplasm and inconspicuous nucleoli”

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24
Q

Which type of ALL is more common?

A

B precursor

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25
Q

What kind of ALL is also known as Burkett cell leukemia

A

Mature B-cell ALL

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26
Q

So your 4 year old patient is being treated with chemo for her ALL and her mom wants to take her to Disneyland. Is that ok?

A

No. These kids are at high risk of opportunistic infection and its what ends up killing them 5% of the time

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27
Q

What is the treatment for ALL?

A

Chemo

Monoclonal antibodies

Tyrosine kinase inhibitors

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28
Q

Do most children with ALL that are treated with chemo make a complete recovery?

A

Yes 98%

29
Q

What kind of leukemia:

“Progressive accumulation of functionally incompetent B cell lymphocytes”

A

CLL

30
Q

What is the most prevalent leukemia in western countries?

A

CLL

31
Q

What is the median age of diagnosis for CLL

A

70

32
Q

What is the most common finding at diagnosis of CLL

A

Organomegaly (lymphadenopathy, big spleen, big liver)

33
Q

What is the most common non-lymphoid organ affected by CLL?

A

The skin

“Leukemia cutis”

34
Q

What are the 2 stages of CLL

A

Indolent

Advanced

35
Q

What are some of the diagnostic tests that can be used for CLL?

A

CBC with diff

Flow cytometry

Bone marrow aspirate

Lymph node biopsy

36
Q

Do you need to treat every patient in early CLL?

A

No, may observe

37
Q

If you are going to treat your CLL patient, what are you going to do

A

Chemo

Rituximab

Radiation

Splenectomy

38
Q

What kind of B cells do you see with Hodgkin lymphoma?

A

Reed-Sternberg cells- multinucleated B cells

39
Q

40-50% of Hodgkin lymphoma patients also have this virus:

A

What is Epstein Barr virus

40
Q

What are the 6 main clinical features of Hodgkin Lymphoma

A
  1. Painless lymphadenopathy (especially cervical nodes)
  2. Mediastinal mass
  3. Pain after drinking alcohol
  4. B symptoms
  5. Fatigue
  6. Itchy, but no rash
41
Q

Which Ann Arbor stage:

1 lymph node or lymphoid organ

A

Stage 1

42
Q

What Ann Arbor stage:

2 or more groups of lymph nodes on the same side of the diaphragm

A

Stage II

43
Q

What Ann Arbor stage:

Lymph nodes on both sides of the diaphragm

A

Stage III

44
Q

What Ann Arbor stage:

Distant spread to bone marrow, liver, brain, spinal cord, or pleura

A

Stage IV

45
Q

What do we use the Ann Arbor staging system for?

A

Staging of Hodgkin lymphoma

46
Q

What kind of cells would you see in a lymph node biopsy that would confirm your diagnosis of Hodgkin lymphoma?

A

Reed-Sternberg cells

Multinucleated B cells/popcorn

47
Q

Combination chemotherapy cures Hodgkin lymphoma almost all the time! What is the draw back to that?!

A

Complications such as more cancer or heart disease

48
Q

When would we do a stem cell transplant for Hodgkin lymphoma

A

If it comes back or its not getting better with chemo

49
Q

In non-Hodgkin lymphomas, are they usually B or T cell?

A

90% B

50
Q

What are the associated conditions with non-Hodgkin lymphoma

A

HIV

Autoimmune disease (SLE, RA, )

Inflammatory GI disease (Crohn’s, H Pylori)

51
Q

What is the median age at diagnosis of nonhodgkin lymphoma

A

66

52
Q

When might you see a mediatsinal mass?

A

Non-Hodgkin lymphoma

T-Cell ALL

Hodgkin lymphoma

53
Q

What is a symptom of Burkitt lymphoma?

A

Abdominal fullness

54
Q

How do we diagnose non-hodgkin lymphoma

A

Biopsy lymph nodes that are 2cm+

CT to find areas of involvement or a preferred biopsy site

Bone marrow aspiration and biopsy

55
Q

What is the Lugano classification used for?

A

Staging of primary nodal lymphomas

56
Q

How do you treat non-hodgkin lymphoma that is indolent with 1-2 nodes involved?

A

Radiation alone

57
Q

What is it:

A malignancy of plasma cells

A

Multiple myeloma

58
Q

Plasma cells normally make antibodies. What do they make in multiple myeloma?

A

Paraproteins (abnormal immunoglobulin fragments)

59
Q

What will you see in the urine/plasma if you do protein electrophoresis on multiple myeloma?

A

M-spike

60
Q

How could you determine which type of paraprotein is present in multiple myeloma?

A

Protein electrophoresis

61
Q

What is the median age of dx for multiple myeloma

A

66

62
Q

What are some of the symptoms of hyperviscosity syndrome?

A

Spontaneous bleeding from mucous membranes

Retinopathy (visual disturbances)

Neurological symptoms

63
Q

What will you see on a peripheral blood smear in multiple myeloma?

A

Anemia

Rouleaux formation- RBCs stack up like coins

64
Q

What will you see in the urine in multiple myeloma? (Other than M-spike)

A

Bence-jones proteins

65
Q

What will you see on x-rays in multiple myeloma?

A

Lytic lesions “punched out appearance”

Generalized osteoporosis

66
Q

What are these associated with:

Bence jones proteins

Roleaux formation

M-spike

Punched out lesions

A

Multiple myeloma

67
Q

What does CRAB stand for

A

Calcium (>10.5)

Renal insufficiency (creatinine over 2)

Anemia (Hb <10)

Bone lesions

(Associated with multiple myeloma)

68
Q

What are the treatments for multiple myeloma?

A

Vertebroplasty/kyphoplasty

IV Bisphosphates to prevent loss of bone mass

Combination chemo

Autologous hematopoietic stem cell transplant

69
Q

If you see compression fractures in a stem, what disease do they have

A

Multiple myeloma

Clin Med Exam 4 (Lauren) (5 decks)

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