Lymphadenopathy

Question 1

what are the possible differentials of lymphadenopathy?

Answer 1

INDAM

infections/inflammation 
neoplasms 
drugs or toxins 
autoimmune 
metabolic

Question 2

what are the B symptoms seen in lymphoma?

Answer 2

fever
night sweats
weight loss (10% over 6 months)

Question 3

how can lymphoma present?

Answer 3

painless lump
B symptoms
itch
alcohol induced pain

Question 4

describe the characteristics of the lymphadenopathy seen in lymphoma

Answer 4

painless
rubbery 
soft 
smooth 
no inflammation 
not tethered

Question 5

what investigations are done into lymphadenopathy?

Answer 5

FBC
biochemistry
biopsy
imaging

Question 6

what is seen on FBC in chronic lymphocytic leukaemia (CLL)?

Answer 6

lymphocytosis

Question 7

how is CLL diagnosed?

Answer 7

FBC

immunophenotyping

Question 8

what is needed for a definitive diagnosis of lymphoma?

Answer 8

biopsy

Question 9

what sample is taken for biopsy in lymphoma?

Answer 9

excise the whole node

Question 10

what tests are done on the biopsy sample in lymphoma?

Answer 10

immunohistochemistry

genetic analysis

Question 11

what is CD20 a marker of?

Answer 11

B cells

Question 12

what is CD30 a marker of?

Answer 12

hodgkin lymphoma

Question 13

what genetic tests can be done for lymphoma?

Answer 13

chromosome analysis

FISH or PCR

Question 14

what genetic abnormality can be seen in follicular lymphoma?

Answer 14

T(14;18)

Question 15

what genetic abnormality can be seen in burkitt lymphoma?

Answer 15

T (8;14)

Question 16

what are the two types of lymphoma?

Answer 16

hodgkin

non hodgkin

Question 17

what is the most common type of NHL?

Answer 17

B cell

Question 18

what are the risk factors for lymphoma?

Answer 18

immunosuppression
autoimmune disorders
infections
genetics

Question 19

what staging system is used to stage lymphoma?

Answer 19

ann arbor staging system

Question 20

what is a stage I lymphoma?

Answer 20

involves only one lymph node or extra lymph node area

Question 21

what is a stage II lymphoma?

Answer 21

involves two or more lymph nodes on one side of the diaphragm

Question 22

what is a stage III lymphoma?

Answer 22

involves two or more lymph nodes on both sides of the diaphragm

Question 23

what is a stage IV lymphoma?

Answer 23

disseminated disease or diseases affected multiple extra nodal areas

Question 24

how is the presence of B symptoms noted in the staging of lymphoma?

Answer 24

adding B to the stage

i.e. IIB

Question 25

what blood test can be done to provide information about prognosis in lymphoma?

Answer 25

lactate dehydrogenase (LDH)

Question 26

when is the peak incidence of hodgkin lymphoma?

Answer 26

third decade

Question 27

what infection has a link with hodgkin lymphoma?

Answer 27

EBV

Question 28

describe the lymph node spread in hodgkin lymphoma

Answer 28

orderly - affects one side of the diaphragm before the other

Question 29

what cell is seen on histology in hodgkin lymphoma?

Answer 29

reed-sternberg cells

Question 30

how is hodgkin lymphoma managed?

Answer 30

multi-agent chemotherapy ± radiotherapy

Question 31

what are the possible long term toxicity effects of treatment in hodgkin lymphoma?

Answer 31

secondary cancers cardiovascular disease infertility

Question 32

what can be done for patients with hodgkin lymphoma who are not responding to chemotherapy?

Answer 32

immunotherapy or stem cell transplant

Question 33

what is the most common high grade NHL?

Answer 33

diffuse large B cell lymphoma

Question 34

what types of NHL can often have extra-nodal disease?

Answer 34

T cell NHL | burkitt lymphoma

Question 35

how is NHL managed?

Answer 35

multi agent chemotherapy ± radiotherapy

Question 36

what monoclonal antibody can be used for B cell NHL?

Answer 36

rituximab

Question 37

what monoclonal antibody can be used for T cell NHL?

Answer 37

brentuximab

Question 38

what viruses are associated with burkitt lymphoma?

Answer 38

EBV | HIV

Question 39

what genetic abnormalities are seen in burkitt lymphoma?

Answer 39

chromosomal translocations involving c-myc

Question 40

what characterises tumour lysis?

Answer 40

``` hypokalaemia hypercalcaemia hyperphosphataemia hyperuricaemia renal failure ```

Question 41

what type of drug can be added to chemo regimens for lymphoma?

Answer 41

steroids