Myeloma and lymphoma

Question 1

3 diagnositic pitfalls for MM

Answer 1

1. non specific symptoms - back pain, anemia
2. can have no Sx
3. rare - 1%

Question 2

epi of MM

Answer 2

age 65

blacks more common

Question 3

What causes renal failure in MM

Answer 3

• tubular depostion (cast nephropathy)
• light chain deposition diseases
• volume depletion
• hypercalcemia
• nephrotoxins
• amyloidosis

Question 4

4 features of MM

Answer 4

CARB
Ca elevation
Renal disease
Anemia
Bone disease

Question 5

Sx suggestive of MM

Answer 5

• fatigue
• back/bone pain
• anemia
• renal failure
• recurrent infections
• peripheral neuropathy

Question 6

initial tests for MM

Answer 6

• CBC
• lytes
• Ca/albumin
• SPEP - serum protein electrophorsis
• immunofixation
• Ig quantitation
• urine bence jones

Question 7

what is seen in SPEP

Answer 7

• most important

- will see monoclonal ABs

Question 8

what does immunofixation do, and what is seen

Answer 8

• tells us what type of protein

- will see tight bands of with IgA or kappa

Question 9

what is bence jones urine

Answer 9

20% of MM have light chain production only

- will precipitate out in the urine

Question 10

what is MGUS

Answer 10

monoclonal gammopathy of unknown sig.

• prevalence increases with age
• see increased single M protein

Question 11

• what is sig. of MGUS

Answer 11

1% risk per year of prog. to MM or lymphoma

Question 12

when to worry about lymphadenopathy (4)

Answer 12

1. age - older is worse
2. char. of the node
3. location of node
4. clinical setting assoc. with node

Question 13

what are important char of the node

Answer 13

1. size over 3cm - bad
2. consistency
3. cervical - 50% of people normall have
4. inguinal - genreally common
5. supraclavicular - highest risk of malig

Question 14

4 things to ask about on Hx

Answer 14

1. cause for lymphadenopathy - sickness?
2. constitiutional Sx
3. epi clues - occup., animal, travel
4. meds - serum sickness

Question 15

3 parts to Phx

Answer 15

1. nodal exam
2. organomegaly
3. locatlized exam of what the node drains

Question 16

*4 common causes of generalized lymphadepopathy

Answer 16

1. malignany
2. infectious
3. autoimmine
4. drugs

Question 17

3 things to do with lymphadenopathy

Answer 17

1. wait 4 weeks and rexamine
2. no indication for ABs
3. streoids don’t help and mask Sx

Question 18

3 tests from least to most helpful

Answer 18

1. FNA - fairly useless - no arch.
2. core needles - gives 3d view
3. exisional LN biopsy - gold standard

Question 19

what is lymphoma

Answer 19

Ca of immune system cells

- 5th most common in NA

Question 20

4 general types of lymphoma

Answer 20

1. aggresive 46%
2. indolent - 38%
3. hodkins - 10%
4. zebras 6%

Question 21

features of aggressive

Answer 21

• rapid growth
• symptomatic
• fatal in months
• potential for cure
• diffuse large B-cell lymphomas

Question 22

features of indoleent

Answer 22

• slow growth
• often asymtomatic
• fta l in years
• incurable now
• follicular lymphoma

Question 23

Sx of lymphoma (4)

Answer 23

1. enlarged painless nodes
2. low blood cell counts
3. general Sx (fever, weight loss, night sweats, fatigue)
4. less than 20% of Sx at onset

Question 24

*** what is ann arbor staging based on

Answer 24

4 stages
- based on location and marrow biopsy
also:
A- absence of B Sx
B - fever night sweats wight loss

Question 25

3 tests for lymphoma

Answer 25

1. biopsy
   - node and marrow
2. labs
   - CBC
   - LDH
   - viral serologies
3. CT

Question 26

3 main treats for lymphoma

Answer 26

1. chemo
2. rads
3. mabs

Question 27

what is target for mab

Answer 27

CD20

• expressed on 90% of B-cell
• not internalized or hidded

Question 28

3 mechs of mabs

Answer 28

1. NK cells attack
2. apoptosis
3. complement