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Year 2 > Myeloma > Flashcards

Myeloma Flashcards

1
Q

Pathophysiology

A
  1. Clonal expansion of abnormal, proliferating plasma cells producing a monoclonal paraprotein (IgG or IgA)
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2
Q

What would be seen in the urine in people with Myeloma

A

Excretion of light chains in the urine due to paraproteinaemia

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3
Q

What age group does Myeloma tend to effect

A

Elderly

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4
Q

Three clinical features of a myeloma

A
  1. Bone destruction
  2. Bone marrow infiltration with plasma cells
  3. Kidney Injury
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5
Q

Consequence of bone destruction

A

Fractures of long bones or vertebral collapse

Hypercalcaemia

Plasmacytosis

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6
Q

Consequence of Bone marrow infiltration with plasma cells

A

Anaemia

Thrombocytopenia

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7
Q

How does kidney injury occur

A

Position of light chains in renal tubules

Hypercalcaemia

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8
Q

Cytogenetic analysis should show what in patients with myeloma

A

FISH should show abnormal chromosome 13 and hypodiploidy

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9
Q

How else does myeloma effect the bone

A
  1. Dysfunction of bone remodelling
  2. Leads to lesions in spine, skull + long bones

Increased osteoclastic activity with no increased osteoblast formation of bone

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10
Q

Symptoms of Myeloma

A
  1. Bone pain (backache)
  2. Anaemia
  3. Recurrent infections
  4. Renal failure
  5. Hypercalcaemia
  6. Thrombocytopenia
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11
Q

What should we see in blood tests in people with myeloma

A

NORMAL BLOOD COUNT

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12
Q

What is the erythrocyte sedimentation rate in myeloma

A

High

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13
Q

What should we see on a blood film

A

Rouleaux formation as a consequence of paraprotein formation and plasma cells

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14
Q

Serum calcium levels in myeloma

A

Raised

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15
Q

Total protein count in myelomas

A

Raised

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16
Q

What would radiological signs of myeloma be

A
  1. Skeletal survey - Show characteristics of lytic lesions, most easily seen in the skull
  2. MRI spine is useful is there is back pain (shows collapse)
17
Q

How is Symptomatic Myeloma diagnosed

A

If either the following is present:

  1. Significant Paraproteinaemia
  2. Increased bone marrow plasma cells
18
Q

How is asymptomatic myeloma diagnosed

A
  1. Significant paraproteinaemia + marrow plasmocytosis
19
Q

What is considered significant paraproteinaemia

A

IgG>30g/dL

20
Q

What is a plasmacytoma

A
  1. Isolated tumour of neoplastic plasma cells
21
Q

What indicates a poor prognosis of myeloma

A
  1. Reduced serum albumin
  2. Increased serum betamicorglobulin
  3. Increased LDH
22
Q

Is Myeloma curable

A

No

23
Q

What ethnicity does Myeloma tend to effect

A

Afro-caribbeans

24
Q

How does Myeloma cause back pains

A

Activation of osteoclasts increase bone turnover and lytic lesions

Osteoblasts are inhibited reducing new bone formation

25
Q

What two compounds activate osteoclasts

A

RANK ligans and IL-3

26
Q

What molecules inhibit osteoblasts

A

HGF and Dkk-1

27
Q

Why does myeloma result in recurrent bacterial infections

A

Neutropenia - causes high neutrophil count in healthy individuals

28
Q

How is Myeloma treated

A

All patients given bisphosphonate

29
Q

Name a bisphosphonate

A

Zolendronbte

30
Q

Role of Bisphosphonate

A

Reduces bone pain and fracture rates

31
Q

Why do we avoid NSAIDS

A

Risk of renal impairment

32
Q

How is anaemia corrected

A

Transfusion of RBCs and erythropoietin

33
Q

how to prevent renal damage

A

And rehydrate with 3L a day to prevent further renal damage

34
Q

How is acute renal failure from myeloma treated

A

Renal dialysis

35
Q

Describe the chemotherapy used for myeloma

A
  1. CTD - Cyclophosphamide, Thalidomide, Dexamethasone

2. VAD (Vincristine, Adriamycin, Dexamethasone)

36
Q

How many cycles of CTD can you do

A

8

37
Q

How many cycles of VAD can you do

A

6

38
Q

When is CTD chosen as treatment

A

Less fit people

39
Q

How do Bisphosphonates function

A

They inhibit osteoclasts so reduce bone resorption

Year 2 (155 decks)

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