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haematology > malignancy > Flashcards

malignancy Flashcards

1
Q

what is the difference between leukaemia and lymphoma

A

leukaemia involves marrow and blood - haemopoiesis lost

lymphoma involves nodes - immune function lost

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2
Q

what cells are involved in acute myeloid leukaemia

A

common myeloid precursors eg myeloblasts

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3
Q

what cells are involved in acute lymphoblastic leukaemis

A

common lymphoid precurosr eg lymphoblasts

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4
Q

what is the difference in proliferation of abnormal proginators in acute leukaemia compared to myeloproliferative disorders

A

acute leukaemia = block in differentiation or maturation

myeloproliferative disorder - No block in differentiation or maturation

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5
Q

what type o fmutations are responsible for haematological cancers

A

acquired driver mutations

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6
Q

what is the difference between normal and malignant haemopoiesis in terms of clonality

A

norm- polyclonal

malignant - monoclonal

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7
Q

what is a clone in haematology

A

population of cells derived from single parent cell

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8
Q

which leukaemia can also involve nodes

A

chronic lymphoctic leukaemia

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9
Q

what do acute leukaemia present with

A

marrow failure

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10
Q

who gets AML and ALL respectively

A

AML- older people

ALL- children

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11
Q

how would Acute lymphoblastic leukaemia present

A

anaemia, infection, bleeding, bone pain , CNS /testes involvement

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12
Q

when are Auer rods seen and what are they

A

Acute myeloid leukaemia - abnormal granules in some blasts

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13
Q

what is seen on blood film in AML

A

decreased Hb, platelets and neutophils and increased wcc

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14
Q

what test is required for definitive diagnosis of AML

A

immunophenotyping

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15
Q

if someone had leukaemia and is neutropenic with fever what is suspected and done

A

gram negative bacteria and broad spec antibiotics given after samples obtained

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16
Q

what is some complications of chemotherapy treatment

A 
nausea and vomiting 
hair loss
liver and renal dysfunction
tumour lysis syndrom (1st cycle)
infection - PCP, bacterial, fungal

later- infertility, cardiomopathy if anthracyclines used

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17
Q

what are A symptoms and B symptoms of lymphoma

A

A - lymphadenopathy

B -fever , night seats , weight loss

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18
Q

what are other associated symptoms (esp hodgkins)

A

itch with out rash , pain with drinking alcohol

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19
Q

are lymph nodes tender in malignancy

A

no only in viral or bacterial

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20
Q

if surface of lymph node is irregular what would you expect

A

metastesis

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21
Q

consistency of lump in lymphoma and in metastatic cancer

A

lymphoma - rubbery

mets - hard

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22
Q

if inflam seen along side lymph node lump what is suspected

A

bacterial infection

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23
Q

when would the lymhpnode be tethered

A

in mets and sometimes bacterial

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24
Q

how is chronic lymphocytic leukaemia diagnosed

A

blood film (lymphocytosis) and immunophenotyping

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25
Q

how are lymphomas diagnosed

A

excision biopsy

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26
Q

what cell is involved in hodgkins lymphoma

A

B-cell

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27
Q

risk factors for lymphoma

specifically what autoimmune conditions

A 
immunosuppressed
autoimmun -sjogrens, coeliac 
infection - EBV, H.pylori 
genetic 
environment
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28
Q

what staging system is used in lymphoma

A

ANN ARBOUR

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29
Q

what marker is measured for prognosis

A

serum lactate dehdrogenase

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30
Q

when are reed sternberg cells seen

A

hodgkins lymphoma

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31
Q

what is a reed sternebrg cell

A

binucelated inflammatory cell

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32
Q

when does hodgkins lymphoma pek

A

3rd decade

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33
Q

how is hodgkins lymphoma treated

A

multi agent chemo +/- radiotherapy

34
Q

side effect of bleomycin

A

pneumonitis

35
Q

what is done in hodgekins if treatment resistant to chemotherapy

A

immunotherapy/stem cell transplant

36
Q

treatment of b - cell non hodkeins lymphoma

A

rituximab

37
Q

treatment of t cell NHL

A

brentuximab

38
Q

what is the fastest growing human tumour

A

burkitts lymphoma

39
Q

what cell is involved in burkitts lymphoma

A

b- cell

40
Q

what virus’ is burkitts assoc with

A

EBV and HIV

41
Q

what are extramedullary sites forb urkitts lymphoma

A

bone, CNS, testes , kidney

42
Q

what type of mutation adn on what gene is involved in burkitts

A

translocation involing c-myc genes

43
Q

what should be monitored for at the start of treatment esp burkitts lymhoma

A

tumour lyisis

44
Q

what is seen in tumour lysis syndrome

A

hyperkalaemia
hypocalcaemia
hyperphosphateamia
hyperuricaemia- renal falure

45
Q

what should be given in emergency management of lymphoma

A

steroids

46
Q

role of b cell

A

antigen presenting

antibody producing

47
Q

what produces antibodies

A

plasma cells

48
Q

what comprises and immunoglobulin

A

2 heavy chain (gives igM, A,D,E, G etc)

2 light chains (kappa and lambda )

49
Q

what antibodies are monomers

A

IgD, IgE, IgG

50
Q

what antibodies is a dimer

A

IgA

51
Q

what antibodies is a tetramer

A

IgM

52
Q

when b -cells leave the marrow what antibody do they originally express

A

IgM

53
Q

clock face nucleus

A

plasma cell

54
Q

what test is used to detect immunoglobulins on cells.

A

serum electrophoresis - identifies paraprotein

55
Q

what is a paraprotein

A

a monoclonal immunoglobulin

56
Q

electrophoresis identifies paraprotein, what test is used to classify what type

A

serum immunofixation

57
Q

where are bence jones protein sampled from

A

urine

58
Q

what is a bence jones protein

A

excess light chain production

59
Q

causes of paraproteinaemia

A 
MGUS
Myeloma
amyloid
waldstrom
others eg lymphoma
60
Q

what is the most common cause of paraproteinaemis

A

MGUS

61
Q

what do paraproteins do to the body

A

renal failure, immune suppression, hyperviscpsity and amyloid

62
Q

what type of antibodies are produced in myeloma

A

IgG- most common
IgA
Bence Jones - free light chain

63
Q

pepper pot skull

A

myeloms due to lytic bone lesion

64
Q

how does myeloma result in hyeprcalcaemia and pepper pot skull

A

produces IL-6 which upregulates osteoclasts and down regulates osteblasts
.osteoclasts encourage myeloma production
therefore pepper pot skull and hypercalcaemia

65
Q

what does bence jones do to kidneys

A

excess deposits in glomerulus - make casts

therefore cast nephropathythat block tubule

66
Q

what medication stops the production of light chains

A

steroids

67
Q

normal age of myeloma

A

65

68
Q

outline treatment of myeloma

A 
combo therpay including 
steroids-dexamethasone
alkylating agenst - cyclophosphamide
monoclonal antibodies - daratumab 
high dose chemo
69
Q

how is response to treatemnt measure

A

paraportein level.

70
Q

in the symptoms control for bone disease what drugs shoudl NOt be used

A

NSAIDs - use opiates for pain

71
Q

survival of myeloma

A

5-10 yrs - relapse inevitable

72
Q

what criteria is used to differentiate between MGUS and myeloma

A

CRAB

73
Q

what does MGUS stand for

A

monoclonal gammopathy of undetermines significance

precrsor to myeloma

74
Q

what paraprotein level is expected in MGUS

A

<30

75
Q

difference between myeloma and MGUS

A

no evidence of myelom end organ damage

76
Q

what is AMyloid pathophysiolody

A

build up of insolube b-pleated sheets

77
Q

congo red stain

A

amyloid

78
Q

what birefringement is seen in amyloid

A

apple green

79
Q

what test confirms amyloid

A

biopsy

80
Q

what paraprotein is involved in Waldsrtom macroglobulinaemia .

A

IgM paraprotein

81
Q

treatmnt of waldrostrom

A

plasmaphoresis - removes paraprotein

82
Q

what is waldrstom macroglobulinaemis

A

cross between lymphoma and myeloma

haematology (15 decks)

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