Lymphatic Pathologies

Question 1

What is Lymphadenopathy?

Answer 1

the palpable enlargement (>1cm) of lymph nodes

Question 2

How is a lymphadenopathy classified?

Answer 2

Localised: one body part

general: 2 or more areas = underline disease

Question 3

What leads to splenomegaly?

Answer 3

INFECTIONS
e.g. glandular fever, TB, syphilis , HIV

PORTAL HYPERTENSION
e.g. cirrhosis, cardiac failure

LYMPHOID DISORDERS
e.g. leukaemia, lymphoma, multiple myeloma

RBC DISORDERS
e.g. thalassaemia (haemolytic anaemia)

INFLAMMATORY CONDITIONS

Question 4

What is glandular fever?

Answer 4

Acute infection of B lymphocytes with Epstein-Barr Virus (EBV)

Question 5

How is glandular fever transmitted?

Answer 5

Usually through close personal contact - most commonly saliva
Mucosal secretions of the respiratory tract, genital tract, blood

Question 6

What is the pathophysiology of glandular fever?

Answer 6

EBV initially infects the oropharynx, nasopharynx and salivary epithelial cells

Later extends into lymphoid tissues and B cells

ADAPTIVE IMMUNE RESPONSE
Unaffected B cells produce antibodies against EBV

Cytotoxic T cells attack virus-infected B-cells directly

Enlargement of lymphoid tissue occurs due to:

Proliferation of lymphocytes
Removal of dead and damaged B cells

Question 7

Clinical features of glandular fever?

Answer 7

Long incubation period: 30-50 days

Classical symptoms: fever, sore throat, cervical lymphadenopathy, fatigue

Progression of disease: generalised lymphadenopathy, splenomegaly, hepatomegaly

Rare complications (~5%): ocular, cardiac, CNS involvement

Question 8

What is the management for glandular fever?

Answer 8

Rest
analgesics
antipyretics

treatment of secondary bacterial infection

Question 9

What is leukaemia?

Answer 9

Proliferation of malignant leucocytes in the bone marrow

Overcrowding causes malignant cells to spill into blood

Question 10

What is lymphoma?

Answer 10

Proliferation of malignant lymphocytes in lymphatic system

Formation of discrete tumours

Question 11

What is multiple myeloma?

Answer 11

Proliferation of malignant plasma cells in the bone marrow

Question 12

How is leukaemia classified?

Answer 12

Lymphoid leukaemia
Myeloid leukaemia

Acute leukaemia – rapid growth of immature cells (referred to as ‘blasts’)
Chronic leukaemia : slow growth

Question 13

What are the 4 types of leukaemia?

Answer 13

Acute lymphoblastic leukaemia (ALL)

Acute myeloid leukaemia (AML)

Chronic lymphocytic leukaemia (CLL)

Chronic myeloid leukaemia (CML)

Question 14

what is the Aetiology of leukaemia?

Answer 14

combination of genetics

environmental risk factors

Question 15

What are the clinical features of leukaemia?

Answer 15

rapid onset of symptoms

• Anaemia (↓ RBCs): fatigue, pallor, weakness
• Decreased immunity (↓normal WBCs): fever, mouth ulcers, recurrent infections
• Bleeding tendencies

OTHER:
bone pain

Splenomegaly, hepatomegaly, lymphadenopathy

Non-specific features

Nervous system infiltration

Question 16

Management for acute Leukaemia?

Answer 16

blood marrow biopsy + combination of chemotherapy.

Question 17

What are the clinical features of chronic leukaemia?

Answer 17

splenomegaly, extreme fatigue, weight loss, night sweats, fever

Question 18

Management for chronic Leukaemia?

Answer 18

CLL - observation/ antibodies/ late chemo

CML - tyrosine kinase inhibitors

Question 19

How is lymphoma classified?

Answer 19

Hodgkin’s lymphoma

Non-Hodgkin’s lymphoma

Question 20

Risk factors for lymphoma?

Answer 20

Family history

Certain infections
Epstein-Barr Virus, HIV, HCV, HTLV, Herpes Virus-8, H. pylori

Obesity

Iatrogenic immunosuppression

Autoimmune conditions: RA, SLE

Exposure to ionizing radiation or mutagenic chemicals

Question 21

Clinical features of hotchkins lymphoma?

Answer 21

no spread

Lymphadenopathy

compresive features

B symptoms: fever, sweats, wt loss

Other: fatigue, anorexia, pruitis

Question 22

Clinical features of non-hotchkins lymphoma?

Answer 22

can spread to other organs

Lymphadenopathy

compresive features

B symptoms: fever, sweats, wt loss

Question 23

Management of non-hotchkins lymphoma?

Answer 23

Chemotherapy

Radiotherapy

Antibody therapy

Corticosteroids

Stem cell transplant
prognosis 75% cured

Question 24

Aetiology for multiple myeloma?

Answer 24

Chromosomal mutations play a key role
Exact aetiology unknown

Risk assoc. w/ radiation exposure

Familial predisposition?

Question 25

Pathophysiology of multiple myeloma?

Answer 25

Myeloma cells: neoplastic plasma cells that produce excessive amounts of abnormal antibodies (M proteins)

Result: decreased immunity, overcrowded marrow

Antibody fragments (light-chains) are also produced and accumulate in tissues and organs

Result: amyloidosis leads to renal failure

Myeloma cells form discrete tumours (plasmacytomas) within bone
Release of osteolytic cytokines destroys overlying cortical bone

Result: radiographic ‘punched-out’ lesions (1-4cm in diameter)

Question 26

Clinical features of multiple myeloma?

Answer 26

bone destruction

marrow overcrowding

extra-osseous plasmacytomas

Question 27

What is HIV?

Answer 27

HIV is the pathogen responsible for acquired immunodeficiency syndrome (AIDS)

It is a retrovirus and carries its genetic material as RNA (not DNA)

Question 28

Modes of transmission of HIV?

Answer 28

• Exchange of body fluids
• Children infected in placenta
• occupational exposures

Question 29

What is the pathophysiology

behind HIV?

Answer 29

Entry into cell

Conversion of viral RNA

Dormancy

Activation

Host cell death

Question 30

Stages of HIV

Answer 30

STAGE 1: ACUTE INFECTION

STAGE 2: CHRONIC INFECTION (CLINICAL LATENCY)

STAGE 3: ACQUIRED IMMUNE DEFICIENCY SYNDROME

Question 31

Management of HIV

Answer 31

MAINTAIN PHYSICAL & MENTAL HEALTH:

POST-EXPOSURE PROPHYLAXIS

PRE-EXPOSURE PROPHYLAXIS