Lymphadenopathy Flashcards
What is characteristic of benign lymphadenopathy
Swollen, tender, large lymph nodes
What characteristics are characteristic of lymphoma
Rubbery and moveable, nontender
What characteristics are characteristic of metastatic disease
Hard, nonmobile, nontender.
What are the 2 red flags in history of lymphadenopathy
- Duration >2 weeks
- Unresponsive to antibiotics
What symptoms are suggestive of malignancy
B symptoms (fever, night sweats, weight loss)
All suggestive of lymphoma
Anterior cervical vs posterior cervical lymph node infection causes
Anterior cervical- bacterial pharyngitis (group A strep)
Posterior Cervical- EBV (mono)
What is the common cause of supraclavicular lymph nodes
Malignancy until proven otherwise
Left versus right supraclavicular node
Left- Virchow’s node (malignancy of stomach, gallbladder, pancreas)
Right: Mediastinum, lung
Most common lymph node characteristics
Firm, fixed, non-tender, rapidly enlarging
Are mobile or fixed lymph nodes more concerning?
Fixed is more concerning, says that the pathology has spread
Is warmth or regular temperature more concerning in lymph nodes?
Regular temperature/no warmth is more concerning. Inflammation due to infection is less concerning
Texture differences in lymph nodes and concern level with each
Squishy/fluctuating- suggests infections and inflammatory
Rubbery– suggests lymphoma
Hard- Suggests malignancy
Which cells are a key characteristic of Hodgkin lymphoma
Reed-Sternberg cells on biopsy
A versus B symptoms for hodgkin lymphoma
A- patients lack constitutional symptoms
B- B symptoms ( fever, night sweats, weight loss >10% of BW)
Where are Reed-Sternberg cells found/which disease?
Hodgkin’s lymphoma
ABVD side effects
- Decreased Blood Counts
- Hair loss
- Nausea/Vomiting
- Neuropathy
(LOW WBC and low Hgb)
What do you use to treat Hodgkin lymphoma
ABVD- cardiotoxic, called red devil
Most common side effects of immunotherapy
Due to immune response- T cells attack cancer, but can cause thyroiditis, dermatitis, colitis, pneumitis
- Rash
- Diarrhea
- Fatigue
-Diabetes, Hepatitis
Side effect of immune checkpoint inhibitors (Induce autoimmune response to use our own immune system to kill cancer)
Which type of lymphoma uses immunotherapy
Hodgkin’s lymphoma
Which immunotherapy drugs are used to treat hodgkin’s lymphoma
Checkpoint inhibitors (PD1 inhibitors) Nivolumab (Opdivo) and Pembrolizumab (Keytruda)
What are non-Hodgkin lymphomas categorized into
Low grade/indolent lymphomas vs high grade/Aggressive lymphomas
What are you primarily ordering a chest xray for if your patient has non-hodgkin lymphoma
mediastinal masses, which is an oncological emergency
Low grade treatment for non-hodgkin lymphoma
Local radiation
chemotherapy
High grade treatment for non-hodgkin lymphoma
Treatment is urgent
Myelosuppressive chemo
Radiation
SCT or CAR-T
Primary site of disease in leukemia vs lymphoma
Leukemia- bone marrow
Lymphoma- Lymph nodes
What are the hallmarks of multiple myeloma
CRAB
Plasma cell infultration–> end organ damage–> HypERcalcemia, lytic bone lesions, anemia, renal dysfunction
C-HyperCALcemia
R- Renal dysfunction
A-Anemia
B-Bone lesions
What is the greatest risk factor for developing multiple myeloma
Age
What are 4 hallmark symptoms of Multiple myeloma
Symptoms of hypercalcemia
Kidney infection, oliguria
Anemia- FATIGUE
Bone pain
C-HyperCALcemia
R- Renal dysfunction
A-Anemia
B-Bone lesions
Is multiple myeloma cureable?
NO it is incurable– prognosis is poor, even with good advances in medicines
Hypercalcemia symptoms
Bones (Abnormal bone remodeling, fracture risk)
Stones (Increased risk for kidney stones)
Groans (abdominal cramping, constipation)
Psychiatric overtones (lethargy, depression)
Hallmark Labs of multiple myeloma
- Anemia (Normocytic, normochromic, rouleaux formation on smear)
-Hypercalcemia
-Kidney injury- elevated creatinine
-X-ray- osteolytic bone lesions
***Serum protein electrophoresis- M spike
What results do you see on an SPEP for multiple myeloma
Albumin highest, gamma furthest away (M spike)
Stacked coins on a peripheral blood smear indicates which disorder
Multiple myeloma
High gamma gobulins brings the RBCs together into a stacked coin apperance (Rouloux red blood cells)
Your patient has punched out lesions on their x ray. which disease is this characteristic of?
Multiple myeloma
Myeloma is cureable, true or false?
False- prognosis is poor, but many treatments for palliative care
What do you use CAR-T for
Acute Lymphoblastic Leukemia (ALL)
Non-Hodgkin lymphoma
When do you use an immunotherapy with Leukemia/Lymphoma
Hodgkin’s Lymphoma
Your patient is complaining of red body fluids. Which medicine should you confirm they are on?
Chemotherapy- Red Devil- ABVD for Hodgkin lymphoma
