lymphatic system diseases

Question 1

Differentiate the terms lymphadenopathy and lymphadenitis

Answer 1

lymphadenopathy-palpable enlargement of lymph node (>1cm)

lymphadenopathy-includes pain and other signs of inflammation

Question 2

Explain how a lymphadenopathy may be classified. Provide examples for each type of classification

Answer 2

Localised-present in one body area e.g. dental or tonsillar infection-cervical lymphadenitis OR lower extremity infections- axillary or inguinal node involvement

General-present in 2 or more non-contiguous nodal groups e.g. glandular fever, lymphoma, leukaemia, metastatic neoplasia, HIV infection, tuberculosis

Question 3

list 5 associated disorders of splenomegaly

Answer 3

1. RBC disorders
2. Inflammatory disorders
3. lymphoid disorders
4. infection
5. portal HTN

Question 4

define Glandular Fever

Answer 4

acute infection of B lymphocytes with the Epstein-Barre Virus (EBV)

EBV initially infects oropharynx, nasopharynx & salivary epithelial cells
Extends to B cells & lymphoid tissue
Adaptive immune response
Uninfected B cells produce antibodies against EBV
Cytotoxic T cells attack infected B cells
Enlargement of lymphoid tissues due to proliferation of lymphocytes and removal of dead/damaged B cells

Question 5

define leukaemia

Answer 5

Proliferation of malignant leucocytes in bone marrow

Question 6

define lymphoma

what are the 2 types?

Answer 6

Proliferation of malignant leucocytes in lymphatic system
Formation of discrete tumours

Hodgkin’s Lymphoma-Reed-Sternberg cell
Non-Hodgkin’s Lymphoma

Question 7

define multiple myeloma

identify some clinical features

Answer 7

Lymphoid malignancy of bone marrow characterised by the uncontrolled replication of plasma cells (immunoglobulin producing cells)
Proliferation of malignant plasma cells in bone marrow
OLD CRABI
older populations
hyper-calcaemia
renal failure
anaemia
bony lesions
infection

Question 8

HIV attacks what type of immune cell?
HIV is a retro-virus because…
identify the 3 stages of HIV

Answer 8

attacks immune cells possesing the CD4 glycoprotein e.g. T-helper lymphocytes
retrovirus because it carries it’s genes as RNA (not DNA)
1. acute infection
2. chronic infection (clinical latency)
3. AIDS (CD4+ lymphocyte count of <200 cells/mcL

Question 9

what is the name given to discrete tumours formed in multiple myeloma? how may these present?

Answer 9

plasmacytomas; intraoseous or extraosseous

Question 10

List the classes of anti-retroviral medications that can be used in the management of HIV infection

Answer 10

1. entrance inhibitors-inhibits initial entry of HIV into cell
2. reverse transcriptase inhibitors-inhibits process of transcribing HIV RNA into DNA
3. integrase inhibitors-prevents the integration of HIV genome into our own genome
4. protease inhibitors-inhibits the production of new proteins

*used on combinations to inhibit viral replication and progression to AIDS

Question 11

compare and contrast Hodgkin’s from Non-Hodgkin’s lymphoma

Answer 11

Hodgkin’s Lymphoma:
due to Reed-Sternberg Cell
Single chain, or chain of related nodes

Non-Hodgkin’s Lymphoma:
originates in multiple sites

clinical features for both:
compressive features e.g. dysphagia, dyspnoea
B symptoms e.g. fever, night sweatsweight loss
constitutional symptoms e.g. fatigue, anorexia, pruitis