Malignant Heme Disorders

Question 1

patient presents with painless lymph node swelling, fever, night sweats, weight loss, pruritis. the lymphadenopathy arose in a single lymph node that spread, commonly starting in the cervical and supraclavicular regions. Dx?

Answer 1

hodgkin lymphoma

Question 2

what 2 diagnostics help to diagnose hodgkin lymphoma?

Answer 2

PET/CT chest, abdomen, pelvis
lymph node open biopsy

Question 3

what finding in lymph node open biopsy indicates hodgkin lymphoma?

Answer 3

reed-sternberg cells (large, abnormal lymphocytes with more than 1 nucleus)

Question 4

patient presents with painless swollen anterior cervical lymph nodes, they have fever, night sweats, weight loss, abdominal pain/fullness and obstruction, and enlarged facial bones/thyroid/tonsils. Dx?

Answer 4

non-hodgkin lymphoma

Question 5

what diagnostic is required to diagnose non-hodgkin lymphoma?

Answer 5

lymph node biopsy

Question 6

what finding in lymph node biopsy indicates non-hodgkin lymphoma?

Answer 6

malignant lymphoid cells

Question 7

what is the mainstay treatment for non-hodgkin lymphoma?

Answer 7

chemotherapy

Question 8

malignant proliferation of plasma cells originating in the bone marrow, producing excessive amounts of abnormal immunoglobins/light chains.

Answer 8

multiple myeloma

Question 9

what class of immunoglobulin is most commonly associated with multiple myeloma?

Answer 9

IgG

Question 10

in which patients does multiple myeloma occur in?

Answer 10

older adults

Question 11

patient presents with bone pain in the hips/spine/ribs, history of osteolytic bones lesions/pathologic fractures, has S&S of anemia, and mucosal bleeding, visual changes, and infections. Dx?

Answer 11

multiple myeloma

Question 12

what mnemonic helps us diagnose multiple myeloma?

Answer 12

CRAB

Calcium elevation
Renal Insufficiency
Anemia (normochromic/normocytic + rouleaux formations)
Bone disease

Question 13

what will urinalysis show to indicate multiple myeloma?

Answer 13

bence jones proteins (M or light chain proteins)

Question 14

stacking of RBCs due to abnormal albumin : globulin ratio.
what is it associated with?

Answer 14

rouleaux formation

multiple myeloma

Question 15

what is the diagnostic required to diagnose multiple myeloma?

Answer 15

bone marrow biopsy

Question 16

what is the treatment for multiple myeloma? (4)

Answer 16

induction therapy (choose 1):
lenalidomide / bortezomib

dexamethasone

chemotherapy
aggressive hydration
bisphosphonates

Question 17

what is the most common childhood malignancy that is a malignant proliferation of immune lymphoid stem cells in the bone marrow?

Answer 17

acute lymphoblastic leukemia (ALL)

Question 18

in which patients does acute lymphoblastic leukemia occur? (2)

Answer 18

4-5 yo
> 50 yo

Question 19

patient presents with history of being ill for days/weeks, petechiae, purpura, anemia findings, bone pain/arthralgias, headache, stiff neck, lymphadenopathy, cranial nerve palsies, and frequent infections. Dx?

Answer 19

acute lymphoblastic leukemia

Question 20

CBC reveals anemia, normal to slightly increased leukemic blast cells, and bone marrow biopsy is hypercellular with over 30% of them being lymphoblasts. Dx?

Answer 20

acute lymphoblastic leukemia

Question 21

WBC with a very large nucleus

Answer 21

blast cells

Question 22

what is the treatment for acute lymphoblastic leukemia?

Answer 22

intrathecal chemotherapy / cranial irradiation
maintenance chemo for 2-3 years

Question 23

what is the treatment for acute lymphoblastic leukemia that has relapsed?

Answer 23

bone marrow transplant

Question 24

most common in adults that is caused by proliferation of mature appearing lymphocytes in peripheral blood that invade the bone marrow, spleen, or lymph nodes.

Answer 24

chronic lymphoblastic leukemia

Question 25

patient presents with lymphadenopathy, splenomegaly, and leukemia cutis (flesh-colored-to-violaceous papules/plaques/nodules). Dx?

Answer 25

chronic lymphoblastic leukemia

Question 26

CBC reveals lymphocytosis, elevated WBC > 20,000, and peripheral blood smear reveals mature-appearing lymphocytes and smudge cells.

Answer 26

chronic lymphocytic leukemia

Question 27

remnants of cells that lack any identifiable cytoplasmic membrane or nuclear structure; AKA basket cells

Answer 27

smudge cells

Question 28

what is the treatment for chronic lymphoblastic leukemia if we decide to treat based on clinical indicators? (3)

Answer 28

chemotherapy
local radiation for painful lymphadenopathy
+/- transplant

Question 29

most common leukemia in adults that is caused by proliferation of abnormal myeloid cells that do not mature and affects WBCs, RBCs, and platelets.

Answer 29

acute myeloid leukemia

Question 30

patient presents with history of feeling ill for days, anemia findings, recurrent infections, bone pain, gingival hypertrophy, and leukemia cutis. Dx?

Answer 30

acute myeloid leukemia

Question 31

myeloblasts are present in BM or PBS, auer rods are on peripheral smear; myeloblasts are generally positive for peroxidase and sudan black histochemical stains. Dx?

Answer 31

acute myeloid leukemia

Question 32

what is the mainstay of treatment for acute myeloid leukemia? 2nd line treatment?

Answer 32

chemotherapy

allogenic bone marrow transplant

Question 33

caused by development of an abnormal chromosome called Philadelphia chromosome; proliferation of myeloid cells retain their capacity to differentiate/mature.

Answer 33

chronic myeloid leukemia

Question 34

CBC reveals elevated WBCs, increased granulocytes in all stages of maturity, thrombocytosis, and positive Philadelphia chromosome. Dx?

Answer 34

chronic myeloid leukemia

Question 35

what is the hallmark diagnostic finding for chronic myeloid leukemia?

Answer 35

BCR / ABL gene in peripheral blood smear or bone marrow biopsy

Question 36

what is the mainstay of treatment for chronic myeloid leukemia? what is the only proven curative therapy?

Answer 36

chemotherapy

allogenic bone marrow transplant