Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Hematology > Multiple Myeloma > Flashcards

Multiple Myeloma Flashcards

1
Q

What is multiple myeloma

A

DisseminatedDisease due to malignant transformation of differentiated B cells
Usually secrete monoclonal immunoglobulin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Crab features of multiple myeloma

A

C- hypercalcemia
R- renal impairment
A- anemia
B- bone disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is monoclonal gammopathy in multiple myeloma

A

Peak in only one type of antibody

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Percentage of clonal plasma cells on bone marrow examination in multiple myeLoma

A

60% or more

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the defining events in multiple myeloma

A

60% or more Clonal plasma cell on bone marrow examination

Involved or uninvolved free light chain ratio of 100 or greater in serum
At least 100 mg/L of involved free light chain

More than one focal lesion on MRI at least 5 mm or greater

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Second most present hematological disease

A

Multiple myeLoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Percentage of multiple myeloma in all cancer

A

One percent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is plasmacytoma

A

Collection of plasma cells anywhere in the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Percentage of multiple myeLoma in hematological malignancies

A

10 to 13 %

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

People at risk of multiple myeLoma

A

Old people around 70 years

2/3 more than 65yo when diagnosed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is monoclonal gammopathy of undetermined significance ( MGUS)

A

Prolonged asymptomatic phase that may last for years where there is monoclonal gammopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

When do you say that there is a symptomatic or smoldering myeloma

A

Same laboratory as multiple myeLoma (calcium, renal function , high plasma cells in bone marrow ..)

no organ or tissue damage with no clinical features

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Percentage of chance that an asymptomatic myeloma becomes multiple myeloma

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pathogenesis of multiple myeLoma

A

Class switching, somatic hyper mutation and  Immunoglobulin gene recombination in plasma cell which becomes myeloma cell

Overexpression of adhesion molecule of adhesion molecule on plasma cell clone
Overexpression of Extracellular matrix proteins, matrix stromal cells, intercellular adhesion molecules, vascular cell adhesion molecules

It direction leading to secretion of interleukins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the phenotype of malignant plasma cell

A

High CD38
High CD138
Low cD45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why is there hyperviscosity syndrome in multiple myeloma

A

increased protein content and large molecular size, abnormal polymerization, and abnormal shape of immunoglobulin molecules.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Presentation of hyperviscosity syndrome

A

Confusion

disorientation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What determines the severity of Hyperviscosity syndrome inmultiple myeLoma

A

If it’s a IgA ( dimer) or IgM( pentamer )because they have the biggest size

19
Q

Why is there a reduced immunity in multiple myeloma

A

Reduce the production of normal immunoglobulin

20
Q

What disease is a hallmark of multiple myeloma

A

Bone disease

21
Q

Why is there bone disease such as osteolysis in multiple myeLoma

A

Osteoclast activity increase -> secretion of osteoclast activating factors (TNF-alpha, IL6, IL1, hepatocytes growth factors, parathyroid hormone, RANKL, VEGF ,MIP-1a)
memorize RANK-L and MIP-1a

Decreased osteoprotegerin OPG

22
Q

Bone disease progression in multiple my Loma

A

Osteoporosis -> Lytic lesions -> Pathological fractures

23
Q

What are the cytogenetic changes in multiple myeloma

A

Multiple structural chromosome changes

13q loss
Hyperdiploidy
Hypodiploidy
Chrom 8, 13,14, loss 
Del(17p)
24
Q

Presentation of multiple myeloma

A

Skeletal (bone pain, fractures , paraplegia ,quadriplegia)
marrow infiltration (Marrow failure anemia, neutropenia, thrombocytopenia)
infection
renal failure
Symptoms of hyper viscosity
Thrombosis
Bleeding

25
Q

Why is there infection in multiple myeloma

A

Due to decreased normal immunoglobulin

26
Q

Why is there a renal failure in multiple my Loma

A

Obstruction of distal renal tubules by proteinaceous casts -> atrophy, interstitial fibrosis

Hypercalcemia
infection
uric acid
amyloidosis

27
Q

What are some prothrombotic abnormalities in multiple my Loma

A

High factor VIII
Acquired activated protein C resistance
HYPOfibrinolysis
Immune modulatorY DRUGS like thalidomide and lenalidomide used to treat MM

28
Q

Why is there a bleeding in multiple myeloma

A

Non-functional platelets
interference with fibrin polymerization
thrombocytopenia from bone suppression suppression

29
Q

Diagnosis of MM

A 
Full blood counts - thin film rouleaux, leucoerythroblastosis 
ESR increased 
Bone marrow > 10% plasma cells
Paraprotein in serum 
Bence jones protein in urine 
Reduced normal IgG and albumin 
Serum B2 microglobulin increased
C reactive protein increased 
Skeletal survey
30
Q

What are the diagnostic criteria for MM

A

Paraprotein in serum and or urine
Bone marrow clonal plasma cell/ plasmacytoma
Tissue impairment or myeloma related organs with end organ damage - crab manifestation

31
Q

Poor prognostic factors in MM

A 
More than 65 years old
Poor performance status
HB < 8.5 G/DL
Hypercalcemia
Advanced lytic bone lesions
Abnormal renal function 
Serum albumin < 30g/l
B2 microglobulin > 6mg
High C reactive protein
32
Q

Staging of MM

A 
Stage l
• Beta-2 microglobulin < 3.5g/dL and albumin ≥3.5g/dL
Stage Il
• Beta-2 microglobulin <3.5g/dL
Albumin <3.5 g/dL OR
• Beta-2 microglobulin level ≥3.5 to <5.5 g/dL
Stage Ill
• Beta-2 microglobulin ≥5.5 g/dL
33
Q

Supportive treatment of MM

A 
Transfusion - anemia 
Analgesics - pain 
Allopurinol - Uric acid
Hydration and steroids - serum calcium
Biphosphonates , radiotherapy - lytic lesions 
Orthopedic surgery - fractures
Hydration, steroids, treat infection - renal failure
Antibiotics - infection 
Radiotherapy - pain , fractures
34
Q

Drugs given in primary induction for therapy in transplant candidates

A 
Bortezomib 
dexamethasone
 doxorubicin
Thalidomide
Lenalidomide

VAD - first line

35
Q

Treatment used for relapse or refractory disease

A 
Different agent than one used in first line 
Bortezomid 
Cyclophosphamide
Dexamethasone 
Car fil zombi 
Thalidomide
Lenalidomide
Pomalidomide
36
Q

Median survival from diagnosis in MM

A

4 to 5 years

37
Q

What’s presentation shows the worst prognosis

A

Renal failure

38
Q

Features of plasma cell

A

Eccentric nucleus
Basophilic cytoplasm
Perinuclear halo

39
Q

Differential diagnosis of MM

A

Monoclonal gammopathy of undermine significance

Smoldering multiple myeloma

Plasmacytoma

Amyloidosis

Waldenstrom macroglobulinemia

Heavy chain disease

40
Q

What is Amyloidosis

A

Disorder of protein folding which were soluble but now are deposited as beta pleated sheet

41
Q

Complication of Amyloidosis

A

Dysfunction and organ failure

42
Q

Types of Amyloidosis

A

AL
AA
familial amyloid

43
Q

Classical features of amyloidosis

A

Malabsorption
Nephrotic syndrome
Cardiomyopathy

Macroglossia
Carpal tunnel syndrome
Peripheral neuropathy
Purpura

44
Q

What is waldenstrom macroglobulinaemia

A

Presence of paraprotein IgM leading to organ infiltration and hyper viscosity

Hematology (24 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions