Myeloma, Waldenstroms, and Spleen - Parks

Question 1

What are Bence Jones proteins

Answer 1

monoclonal light chains in the urine

Question 2

In multiple myeloma, the first bones to show osteolytic lesions is the (blank)

Answer 2

vertebral columns

Question 3

Multiple myeloma is a clonal expansion of (blank) cells

Answer 3

plasma cells

Question 4

After the vertebral column, what other bones are sights of lesions of multiple myeloma?

Answer 4

ribs, skull, and lymph nodes

Question 5

Why do patients with multiple myeloma have hypercalcemia?

Answer 5

Myeloma plasma cells have osteoclastic activity via RANKL and DKK1 which results in hypercalcemia

Question 6

T/F: myeloma osteoclasts break down the marrow

Answer 6

true

Question 7

What is the calcium phosphate molecule broken down by MM plasma cells?

Answer 7

hydroxyappetite

Question 8

What are four concerns of hypercalcemia?

Answer 8

Heart arrythmias, renal disease, depression, and kidney stones

Question 9

T/F: multiple myeloma can lead to osteoporosis

Answer 9

not necessarily; osteoporosis is a system wide issue while myeloma lesions are local

Question 10

T/F: compression factures and pathologic fractures of the humerus are common in MM

Answer 10

true

Question 11

“Flaming” plasma cells are indicative of (MM/Waldenstroms)

Answer 11

MM

Question 12

Malignant plasma cells make high levels of (functional/disfunctional) Ig

Answer 12

dysfunctional

Question 13

T/F: Myelomas only secrete the light chain portion of Abs

Answer 13

false; they secrete the whole chain

Question 14

Myelomas produce (all/one) type(s) of Igs

Answer 14

one type of Ig onnly

Question 15

An M spike or protein spike would be indicative of (blank)

Answer 15

myelomas

Question 16

Multiple myeloma shows an M spike in which two types of Ig?

Answer 16

IgA or IgG

Question 17

Waldenstroms Macroglobulinemia presents as what type of Ig spike?

Answer 17

IgM

Question 18

High levels of Ig can result in hyper(blank)

Answer 18

viscosity

Question 19

Despite making lots of Ig, pts with myeloma or waldenstroms have hypo(blank)

Answer 19

hypogammaglobulinemia

Question 20

You need (cell mediated/humoral) immunity to fight bacterial infections

Answer 20

humoral

Question 21

Pts with myeloma or waldenstroms have a difficult time fighting (viral/bacterial) infections

Answer 21

bacterial

Question 22

T/F: myelomas actively suppress normal Ig production

Answer 22

true

Question 23

The (heavy/light) chain can be filtered by the kidneys and seen in the urine as a diagnostic test for myeloma

Answer 23

light

Question 24

Will myelomas present with both kappa and lambda chains in the urine?

Answer 24

NO, they are monoclonal so they will only present with one type or the other

Question 25

(blank) are toxic to tubular lining cells

Answer 25

ligh chains

Question 26

High levels of Bence Jones proteins can form (blanks) within kidney tubules

Answer 26

casts

Question 27

T/F: hypercalcemia is injurious to kidney function

Answer 27

ture

Question 28

In MM, renal failure occurs in (blank)%, and renal disease occurs in (blank)%

Answer 28

25% for renal failure | 50% for renal disease

Question 29

T/F: MM pts can get calcium stones

Answer 29

true

Question 30

What the hell is Rouleaux? What the fuck does it mean?

Answer 30

Coin stacks of RBCs, may indicate myeloma

Question 31

What issue with Hgb do MM pts have?

Answer 31

anemia

Question 32

What type of anemia do MM pts get?

Answer 32

normochromic normocytic anemia

Question 33

Why do MM pts get anemia?

Answer 33

the sheets of plasma cells in the marrow pushes out all other precursors

Question 34

What type of protein precipitates in the cold and can cause ischemic necrosis?

Answer 34

cyroglobulins

Question 35

What are the cardinal symptoms of multiple myeloma?

Answer 35

``` HIRF Hypercalcemia Infections Renal failure Fatigue/anemia ```

Question 36

t(11;14) or hyperdiploidy has a (standard/worse) prognosis of MM while t(4;14) and csome 1 abnormalities have a (standard/worse) prognosis

Answer 36

t(11;14)/hyperdiploidy: standard | t(4;14)/csome 1: worse prognosis

Question 37

Waldenstrom's arises from which B cell maturation stage?

Answer 37

Plasma cytoid cell; after mature b cell but before plasma cell

Question 38

CLL and NHL comes from what B cell maturation stage?

Answer 38

mature B cell

Question 39

multiple myeloma comes from what B cell maturation stage?

Answer 39

plasma cell

Question 40

Sezary syndrome comes from what T cell maturation stage?

Answer 40

Peripheral T cell

Question 41

Waldenstroms pts present with what type of symptoms from hyperviscosity syndrome?

Answer 41

neurologic: can't see, can't think, psychosis

Question 42

The linked sausage effect is seen when you examine what body part and what does it indicate?

Answer 42

retinal vessels, hyperviscosity most likely from waldenstroms

Question 43

T/F: Waldenstroms can lead to both cold agglutinins and cryoglobulins

Answer 43

true

Question 44

If someone presents with anemia, fatigue, and a bone marrow biopsy showing high levels of plasma cytoid cells, you think they have (MM/Waldenstroms)

Answer 44

waldenstroms

Question 45

T/F: Waldenstroms will present with bone lesions, fractures, and bone pain

Answer 45

FALSE; NO BONE INVOLVEMENT

Question 46

Does MM or Waldenstroms present with HSM and lymphadenopathy?

Answer 46

Waldenstroms: you get the IgM deposits

Question 47

What brain issue can arise from hyperviscosity?

Answer 47

encephalopathy

Question 48

Does Raynaud's present with MM or Waldenstroms?

Answer 48

Waldenstroms

Question 49

pts that have raynaud's from Waldenstroms is caused by what mechanism? Is this primary or secondary raynaud's?

Answer 49

from IgM irritating the endothelial cells; secondary

Question 50

Waldenstrmoss is caused by a (gain/loss) of function of MYD88,

Answer 50

gain of function

Question 51

gain of function of MYD88 in Waldenstrom's will lead to over expression of what transcription factor?

Answer 51

NF-kB