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Block 7 Week 1 > Multiple Myeloma and Waldenstroms-Parks > Flashcards

Multiple Myeloma and Waldenstroms-Parks Flashcards

1
Q

What kind of neoplasm is multiple myeloma?

A

B cell neoplasma of older people

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2
Q

What is the median age of multiple myeloma?

A

70 years old

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3
Q

What is the manifestations of multiple myelom?

A

osteolytic bone lesions

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4
Q

In multiple myeloma, you commonly see (blank) in the serum

A

monocolonal protein with monoclonal light chains in the urine (bence jones protein)

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5
Q

In multiple myeloma, you will have increased osteoclast activity that results in (Blank)

A

hypercalcemia

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6
Q

Multiple myeloma will inhibit osteoblasts via (blank) and increase osteoclast activity via (blank)

A

DKK1

RANKL

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7
Q

Osteoprogenin (which stimulats osteoclast activity) is secreted by osteoblasts and bone marrow stem cells. It is degraded by (blank) receptors expressed on myeloma plasma B cells

A

CD138

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8
Q

you get lots of (blank) in multiple myeloma do to osteolytic lesions

A

fractures

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9
Q

In veterbral body you can get (blank) fractures-> the patients lose height, cause back pain, -> suspect myeloma

A

compression

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10
Q

How do you do immunoelectrophoresis?

A

you first electrophorese both serum then you but anti IgG into center well

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11
Q

What will the immunoelectrophoresis look like in multiple myeloma?

A

Normally you get an array of different clones but with myeloma you have mono clony so instead of getting an array of imungolobulins attaching, you will only have one antibody.

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12
Q

Most myelomas are (blank) and (blank)

A

IgG and IgA

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13
Q

Most myelomas are (blank) and (Blank)

A

IgG and IgA

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14
Q

IgD and IgE are found in some myelomas but typically these are associated with (blank)

A

Waldersontrons macroglobulenemia

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15
Q

Do you ever get IgM myeloma?

A

very rarely

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16
Q

In (blank) it involves a heavy chain and a light chain

A

multiple myeloma

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17
Q

Patients with myeloma frequently get (blank)

A

infections

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18
Q

What organisms cause infections associated with mutiple myeloma?

A

strep pneumonia, H influenze, N meningitidis

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19
Q

What do the malignant plasma cells associated with multiple myeloma suppress?

A

the normal good plasma cells so that normal cells cannot secrete immunoglobulin.
**since you dont have Ig you get bacterial infections

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20
Q

Can you test for myeloma in urine? Why?

A

yes
light chains can be filtered by kidneys, heavy chains cannot so you can find monoclonal light chains in urine (either kappa or lambda)

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21
Q

light chains are also called (blank) and they are toxic to the (blank)

A

bence jones proteins
tubular lining cells of the kidney
so people w/ multiple myeloma have kidney failure

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22
Q

Renal failure occurs in (blank) percent of myelomas

A

25

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23
Q

Renal disease occurs in over (blank) percent of myelomas

A

50

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24
Q

What does hypercalcemia do to your tubular lining cells?

A

affects them an can cause kidney stones

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25
Q

(blank) is a major complaint in myeloma

26
Q

What causes rouleaux and where do you see it?

A

in myelomas, cuz you get lowering of the zeta potential and hence stacking of the RBCs

27
Q

Myeloma causes you to get gangrene because of (blank)

A

cryoglobulins

28
Q

What are the 7 major clinical findings of multiple myeloma?

A 
Hypercalcemia/bone issues
renal failure
fatigue/anemia
recurrent infections
neuro symptoms
nausea and vomiting
bleeding/clotting disorders
29
Q

What percent of multiple myeloma patients have hyperdiploid? What will this cause?

A

50%

trans cyclin D1 dysregulation

30
Q

What percent of mutiple myeloma patients have non-hyperdiploid? what will this cause?

A

50%
cis cycling ds dysregulation
trans cyclin D2 disregulation

31
Q

What chromosome problem is associated with poor prognosis for MM?

A

t4,14 and chromosome 1

32
Q

High risk disease and poor prognosis are defined by the presentce of one of the following in each category,,,,,?

A

hypodiploidy, t (4,14), deletion 17p13; high levels of serum b2-microglobulin or lactate dehydrogenase

33
Q

Standard risk disease is define by the presenct of (blank) or (blank)

A

hyperdiploidy or t(11;14)

34
Q

What is lymphoplasmacytic lymphoma also known as?

A

Waldenstrom’s macroglobulinemia

35
Q

(blank) parallel pathways of normal differentiation

A

Lymphoid malignancies

36
Q

Walden storm is only (blank) immunoglobulin and a light chain

37
Q

Igm is a (Blank) thats why it gets stuck places.

38
Q

(blank) is what you get when you clot the blood (factors are all there)

39
Q

(bank) is anticoagulated, i.e unclotted bloo

40
Q

You can get visual disturbances, dizziness, headaches altered state of consciousness in (blank)

A

waldenstroms

41
Q

You can get a “linked sausage effect” in waldens called (blank)

A

hyperviscosity syndrome

42
Q

Waldenstroms has cryglobulings that give you a (blank)

43
Q

(blank) can occur with atypical mycoplasm pneumonia, infectious mononucleosis, etc. (Blank) occur in multiple myeloma, hepatitis C

A

Cold agglutinins

Cryoglobulins

44
Q

(blank) can given you a cold agglutin that can agglutinate the blood and cause anemia.

A

Waldenstroms

45
Q

What are the symptoms of macroglobulinemia?

A 
fatigue
peripheral neuropathy
Raynaud's phenomenon/cold sensitivity
hepatosplenomegaly/lymphadenopathy
Bleeding
visual disturbances
CHF
dyspnea
cutaneous lesions
Bence Jones proteinuria
46
Q

DO you have osteolytic lesions in waldens?

A

No, instead you get your bone marrow wiped out

47
Q

Do you get hepatosplenomegaly in waldenstroms?

A

YES!!!!! (but remember in myeloma you do not!!!)

48
Q

WHy can you get encephalopathy is waldenstroms?

A

cuz of hyperviscosity syndrome

49
Q

(blank) phenomenon is characterized by triphasic color change

50
Q

(blank) often heralds the onset of systemic scleroderma

51
Q 
What can these cause:
collagen vascuar disease
arterial occlusive disease
pulmonary hypetensions
neurologic disorders
blood dyscrasias 
trauma
drugs
A

Raynaud phenomenon

52
Q

Raynauds phenomenon is seen in (waldenstroms/multiple myeloma)

A

Waldenstroms

53
Q

Why do you have wayyyy to many B cells in waldenstroms?

A

because you have a MYD88 protein abnormality that results in a gain of fucntion that consistently turns NFK on which leads to increased B cell proliferation and decreased apoptosis.

54
Q

What will be affected if you have B9 (folate) issues or a malignant disease and is typically secondarily involved?

55
Q

What are causes of massive splenomegaly?

A 
thalassemia
visceral leishmaniasis
hyperactive malarial splenomegaly syndrome
mycobacterium avium complex
lymphomas
myeloproliferative neoplasms
gauchers disease
56
Q

What does the spleen do?

A

formation, storage, destruction of RBCs and antibodies-> filters blood and removes abnormal or foreign material

57
Q

(blank) occurs when the size of the spleen is increased by cells or tissue components or by vascular engorgement.

A

Hypersplenism

58
Q

Hypersplenism will augments the spleens (blank) and even normal blood cells experience a delayed transit and temporary sequestration.

A

filtering functions

59
Q

When you have hyperspelnism you cant function blood cels right so you get a lot of cells stuck in it and it causes (blank) and (Blank) but they are just fine sitting in teh spleen whereas (blanK) get destroyed and cause anemia

A

neutropenia and thrombocytopenia

RBCs

60
Q

T or F

some patients with a splenic infarct have no pain

61
Q

Beta 2 microglubin is a Very important prognostic serum marker for (balnk). Patients with a serum level of less than (blank) have a 43 month median survival. Patients with levels greater than (blank) have a 12 month median survival .

A

multiple myeloma

  1. 004 gm/L
  2. 004 gm/L

Block 7 Week 1 (10 decks)

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