Oncology Flashcards
1
Q
Hematopoiesis occurs via stepwise maturation of a [marker]-positive hematopoietic stem cell
A
Hematopoiesis occurs via stepwise maturation of a CD34-positive hematopoietic stem cell
2
Q
Chemotherapy with alkylating agents can cause leukopenia due to damage to stem cells and decreased WBCs, especially _
A
Chemotherapy with alkylating agents can cause leukopenia due to damage to stem cells and decreased WBCs, especially neutrophils
3
Q
[WBC change] is the earliest change seen after whole body radiation treatment
A
Lymphopenia is the earliest change seen after whole body radiation treatment
* Lymphocytes are highly sensitive to radiation
4
Q
High cortisol states (exogenous corticosteroids or Cushing syndrome) can induce apoptosis of [immune cells]
A
High cortisol states (exogenous corticosteroids or Cushing syndrome) can induce apoptosis of lymphocytes
5
Q
High cortisol states impair _ which can result in neutrophilic leukocytosis
A
High cortisol states impair leukocyte adhesion which can result in neutrophilic leukocytosis
* Causes the marginated pool of neutrophils to fall into the blood
6
Q
Eosinophilia in the context of malignancy; think _
A
Eosinophilia in the context of malignancy; think hodgkin lymphoma
7
Q
Basophilia in the context of malignancy; think _
A
Basophilia in the context of malignancy; think chronic myeloid leukemia (CML)
8
Q
EBV classically results in a _ leukocytosis comprised of reactive _ cells
A
EBV classically results in a lymphocytic leukocytosis comprised of reactive CD8+ cells
* EBV will infect the oropharynx, liver, and B cells
9
Q
EBV causes lymphadenopathy due to T-cell hyperplasia in the [lymph node region]
A
EBV causes lymphadenopathy due to T-cell hyperplasia in the paracortex
* Recall outer cortex= B cells, paracortex= T cells
10
Q
EBV causes splenomegaly due to T-cell hyperplasia in the [spleen region]
A
EBV causes splenomegaly due to T-cell hyperplasia in the periarterial lymphatic sheath (PALS)
11
Q
Dormancy of EBV in [cells] leads to increased risk for [malignancy]
A
Dormancy of EBV in B cells leads to increased risk for B-cell lymphoma
12
Q
Acute leukemia can be defined as a neoplastic proliferation of blasts in the bone marrow (greater than _ percent blasts)
A
Acute leukemia can be defined as a neoplastic proliferation of blasts in the bone marrow (> 20% blasts)
13
Q
Three general symptoms that are expected in acute leukemia include: _ , _ , _
A
Three general symptoms that are expected in acute leukemia include: anemia , bleeding , infection
* Due to blasts crowding out normal hematopoiesis resulting in fewer RBCs, platelets, neutrophils
14
Q
Blasts tend to be [size], immature cells with [nuceloli]
A
Blasts tend to be large, immature cells with punched out nucleoli
* They will also have little cytoplasm
15
Q
The neoplastic accumulation of lymphoblasts ( > 20% blasts) in the bone marrow is [specific cancer]
A
The neoplastic accumulation of lymphoblasts ( > 20% blasts) in the bone marrow is acute lymphoblastic leukemia (ALL)
16
Q
Cells in ALL will stain positive for _
A
Cells in ALL will stain positive for TdT
* TdT is a DNA polymerase found in the nucleus of lymphoblasts only
* It will not be found in myeloid blasts or mature lymphocytes
17
Q
ALL is most common in [population]
A
ALL is most common in children
18
Q
Of the ALLs, [type] is most common
A
Of the ALLs, B-ALL is most common
19
Q
_ is usually characterized by lymphoblasts (TdT+) that express CD10, CD19, CD20
A
B-ALL is usually characterized by lymphoblasts (TdT+) that express CD10, CD19, CD20
20
Q
T-ALL is characterized by lymphoblasts (TdT+) that express markers _
A
T-ALL is characterized by lymphoblasts (TdT+) that express markers CD2-CD8
21
Q
B-ALL has an excellent response to chemo and good prognosis; however, it requires prophylaxis to the _ and _
A
B-ALL has an excellent response to chemo and good prognosis; however, it requires prophylaxis to the scrotum and CSF
* These are regions where the chemo can’t cross a BB or BT barrier
22
Q
B-ALL in children is commonly associated with [translocation]
A
B-ALL in children is commonly associated with t(12;21)
* Good prognosis
23
Q
B-ALL in adults has a poor prognosis and is associated with [translocation]
A
B-ALL in adults has a poor prognosis and is associated with t(9;22)
* This is Philadelphia+ ALL (classic translocation seen in CML)
24
Q
T-ALL is most common in [population] with [presentation]
A
T-ALL is most common in teenagers with thymic (mediastinal) mass
* Will sometimes be called acute lymphoblastic lymphoma because the malignant cells form a mass
25
The neoplastic accumulation of myeloblasts ( > 20% blasts) in the bone marrow is [specific cancer]
The neoplastic accumulation of myeloblasts ( > 20% blasts) in the bone marrow is **acute myeloid leukemia**
26
Myeloblasts are usually characterized by positive cytoplasmic staining for _
Myeloblasts are usually characterized by positive cytoplasmic staining for **myeloperoxidase (MPO)**
* *Recall granulocytes are derived from myeloblasts and need MPO to kill microorganisms via oxygen dependent killing
27
Auer rods are crystal aggregates of _ and are found most commonly in _
Auer rods are crystal aggregates of **MPO** and are found most commonly in **AML or APL**
28
AML is most common in [population]
AML is most common in **older adults (50-60s)**
29
_ is a subclassification of AML that involves numerous auer rods and increases the risk for DIC
**Acute promyelocytic leukemia (APL)** is a subclassification of AML that involves numerous auer rods and increases the risk for DIC
30
Acute promyelocytic leukemia is characterized by [translocation]
Acute promyelocytic leukemia is characterized by **t(15;17)**
31
APL involves a translocation of the _ on chromosome 17 to chromosome 15
APL involves a translocation of the **retinoic acid receptor (RAR)** on chromosome 17 to chromosome 15
* *Disrupting RAR blocks maturation and leads to accumulation of promyelocytes*
32
Treatment for APL is with _
Treatment for APL is with **all-trans-retinoic acid (ATRA)**
* *Binds the altered RAR and causes blasts to mature and eventually die*
33
_ is a subclassification of AML that involves infiltration of the gums
**Acute monocytic leukemia** is a subclassification of AML that involves infiltration of the gums
34
Acute monocytic leukemia involves the proliferation of monoblasts and usually lacks _
Acute monocytic leukemia involves the proliferation of monoblasts and usually lacks **MPO**
35
_ is a proliferation of megakaryoblasts; lack MPO
**Acute megakaryoblastic leukemia** is a proliferation of megakaryoblasts; lack MPO
36
_ is associated with children with Down syndrome, usually *after age 5*
**ALL** is associated with children with Down syndrome, usually *after age 5*
37
_ is associated with children with Down syndrome, usually *before age 5*
**Acute megakaryoblastic leukemia** is associated with children with Down syndrome, usually *before age 5*
* *Subtype of AML*
38
AML can occur secondary to pre-existing _ ; which usually involve cytopenias and are likely to kill the patient from bleeding or infection
AML can occur secondary to pre-existing **myelodysplastic syndromes** ; which usually involve cytopenias and are likely to kill the patient from bleeding or infection
39
AML can present in a patient following exposure to _
AML can present in a patient following exposure to **alkylating agents or radiotherapy**
40
_ is defined as neoplastic proliferation of mature circulating lymphocytes; characterized by a high WBC count
**Chronic leukemia** is defined as neoplastic proliferation of mature circulating lymphocytes; characterized by a high WBC count
41
The most common leukemia overall is _
The most common leukemia overall is **chronic lymphocytic leukemia (CLL)**
42
Chronic lymphocytic leukemia is characterized by a neoplastic proliferation of naive B cells that co-express [marker] and [marker]
Chronic lymphocytic leukemia is characterized by a neoplastic proliferation of naive B cells that co-express **CD5** and **CD20**
* *Recall that CD5 should normally only be found on T cells*
43
Smudge cells on PBS are classic for [malignancy]
Smudge cells on PBS are classic for **chronic lymphocytic leukemia (CLL)**
* *"Crushed little lymphocytes"*
44
Peripheral blood smear of CLL will show increased _ and _
Peripheral blood smear of CLL will show increased **lymphocytes** and **smudge cells**
45
When CLL involves the lymph nodes and leads to generalized lymphadenopathy it is called _
When CLL involves the lymph nodes and leads to generalized lymphadenopathy it is called **small lymphocytic lymphoma (SLL)**
46
Name (3) possible complications of CLL
Name (3) possible complications of CLL:
1. **Hypogammaglobulinemia**
2. **Autoimmune hemolytic anemia**
3. **Diffuse large B-cell lymphoma** transformation
47
Hairy cell leukemia involves neoplastic proliferation of [cells] characterized by [feature]
Hairy cell leukemia involves neoplastic proliferation of **mature B cells** characterized by **hairy cytoplasmic processes**
48
Hairy cell leukemia will be positive for _
Hairy cell leukemia will be positive for **TRAP (tartrate-resistant acid phosphatase)**
49
Clinical features of hairy cell leukemia include [spleen] and _ on bone marrow aspiration, (with/without) lymphadenopathy
Clinical features of hairy cell leukemia include **splenomegaly** and **dry tap** on bone marrow aspiration, **without** lymphadenopathy
* *Cells get TRAPed in the red pulp and bone marrow and can't get to the lymph node*
* *Marrow fibrosis present*
50
Hairy cell leukemia can be treated with adenosine deaminase inhibitor, _
Hairy cell leukemia can be treated with adenosine deaminase inhibitor, **2-CDA (cladribine)**
51
Adult T-cell leukemia/lymphoma is a proliferation of [cells]
Adult T-cell leukemia/lymphoma is a proliferation of **CD4+ T cells**
52
Adult T-cell leukemia/lymphoma is associated with [virus]
Adult T-cell leukemia/lymphoma is associated with **HTLV-1 (human T-cell leukemia virus-1)**
53
Clinical features of Adult T-Cell Leukemia/Lymphoma may resemble [malignancy]
Clinical features of Adult T-Cell Leukemia/Lymphoma may resemble **multiple myeloma**
* *Shared features: rash, lymphadenopathy, hepatosplenomegaly, lytic bone lesions with hypercalcemia*
54
_ is a neoplastic proliferation of mature CD4+ T cells that infiltrate the skin, producing rash/plaques/nodules
**Mycosis fungoides** is a neoplastic proliferation of mature CD4+ T cells that infiltrate the skin, producing rash/plaques/nodules
55
Aggregates of neoplastic cells in the skin are called _ (in mycosis fungoides)
Aggregates of neoplastic cells in the skin are called **Pautrier microabscesses** (in mycosis fungoides)
56
When neoplastic mycosis fungoides cells spread to involve the blood it produces [syndrome]
When neoplastic mycosis fungoides cells spread to involve the blood it produces **Sezary syndrome**
57
Sezary syndrome is characterized by lymphocytes with _ nuclei on PBS
Sezary syndrome is characterized by lymphocytes with **cerebriform** nuclei on PBS
58
Myeloproliferative disorders are _
Myeloproliferative disorders are **neoplastic proliferations of mature myeloid cells (all lineages are increased but classified by the dominant cell produced)**
59
Complications of myeloproliferative disorders include _ and _ due to high cell turnover and progression to either marrow fibrosis or _
Complications of myeloproliferative disorders include **hyperuricemia** and **gout** due to high cell turnover and progression to either marrow fibrosis or **AML**
60
CML involves a proliferation of mature myeloid cells, especially _
CML involves a proliferation of mature myeloid cells, especially **granulocytes and their precursors**
* *Recall that basophils are classically increased*
61
CML is driven by a [translocation]
CML is driven by a **t(9,22)**
* *Philadelphia chromosome*
62
CML involves t(9:22) which generates a _ fusion protein with increased _ activity
CML involves t(9:22) which generates a **BCR-ABL** fusion protein with increased **tyrosine kinase** activity
63
First line treatment of CML is _
First line treatment of CML is **imatinib**
* *Blocks tyrosine kinase activity*
64
Splenomegaly is common with CML; however enlargement may suggest progression to _
Splenomegaly is common with CML; however enlargement may suggest progression to **AML**
* *CML can progress to AML or ALL since the mutation is in a pluripotent stem cell*
65
A reactive neutrophilic leukocytosis may also be called a _ reaction
A reactive neutrophilic leukocytosis may also be called a **leukemoid** reaction
66
Three ways to differentiate CML from leukemoid reaction
Three ways to differentiate CML from leukemoid reaction
1. **Negative LAP stain** (pos in functional neutrophils)
2. **Increased basophils**
3. **t(9:22)**
67
Polycythemia vera is a neoplastic proliferation of mature myeloid cells, especially _
Polycythemia vera is a neoplastic proliferation of mature myeloid cells, especially **RBCs**
* *Granulocytes and platelets are also increased*
68
Polycythemia vera is associated with a _ mutation
Polycythemia vera is associated with a **JAK2 kinase** mutation
69
Symptoms of PV are manifestations related to _
Symptoms of PV are manifestations related to **hyperviscosity of blood**
* Blurry vision, headache
* Risk of venous thrombosis (hepatic vein, portal vein, dural sinus)
* Flushed face due to congestion
* Itching, especially after bathing
70
First line treatment for PV is _ ; second line treatment is _
First line treatment for PV is **phlebotomy** ; second line treatment is **hydroxyurea**
71
In reactive polycythemia you would expect EPO to be _ , while in PV it should be _
In reactive polycythemia you would expect EPO to be **increased** , while in PV it should be **decreased**
72
SaO2 should be _ in PV but _ in reactive polycythemia
SaO2 should be **normal** in PV but **low** in reactive polycythemia
* *Only reactive polycythemia is driven by a demand for oxygen*
* *In the case of ectopic EPO production from RCC EPO could be high and SaO2 normal*
73
_ is a neoplastic proliferation of mature myeloid cells, especially platelets
**Essential thrombocythemia** is a neoplastic proliferation of mature myeloid cells, especially platelets
* RBCs and granulocytes also increased
74
Essential thrombocythemia is associated with _ mutations
Essential thrombocythemia is associated with **JAK2 kinase** mutations
75
Symptoms of ET are either related to an increase risk of _ or _
Symptoms of ET are either related to an increase risk of **thrombosis** or **bleeding**
* *Although you have excess platelets, they become dysfunctional*
76
Of the myeloproliferative diseases, _ is one that rarely progresses to marrow fibrosis or acute leukemia and is less likely to cause hyperuricemia or gout
Of the myeloproliferative diseases, **essential thrombocytopenia** is one that rarely progresses to marrow fibrosis or acute leukemia and is less likely to cause hyperuricemia or gout
77
Myleofibrosis is a neoplastic proliferation of mature myeloid cells, especially _ which have a role in the pathogenesis of fibrosis
Myleofibrosis is a neoplastic proliferation of mature myeloid cells, especially **megakaryocytes** which have a role in the pathogenesis of fibrosis
* *50% of cases due to JAK2 kinase mutations*
78
Megakaryocytes produce excess _ causing the marrow fibrosis in myelofibrosis
Megakaryocytes produce excess **platelet-derived growth factor (PDGF)** causing the marrow fibrosis in myelofibrosis
79
Myelofibrosis can be identified on PBS by the presence of _
Myelofibrosis can be identified on PBS by the presence of **tear-drop RBCs, nucleated RBCs, immature granulocytes**
80
Myelofibrosis patients are at increased risk of _ , _ , _ and splenomegaly due to _
Myelofibrosis patients are at increased risk of **infection** , **thrombosis** , **bleeding** and splenomegaly due to **extramedullary hematopoiesis**
81
Painful lymphadenopathy is more often seen in cases of _
Painful lymphadenopathy is more often seen in cases of **acute lymphadenitis from infection**
* *Therefore more likely to be benign*
82
Painless lymphadenopathy can be seen with chronic inflammation, metastatic carcinoma, or _
Painless lymphadenopathy can be seen with chronic inflammation, metastatic carcinoma, or **lymphoma**
83
Lymphoma is a neoplastic proliferation of _
Lymphoma is a neoplastic proliferation of **lymphoid cells that forms a mass**
* *May arise in lymph node or extranodal tissue*
84
Lymphoma can be divided into _ (60%) or _ (40%)
Lymphoma can be divided into **NHL** (60%) or **HL** (40%)
85
Categorize the types of NHL by cell size
1. **Small B cells**- follicular lymphoma, mantle cell lymphoma, marginal zone lymphoma, small lymphocytic lymphoma
2. **Intermediate-sized B cells**- Burkitt lymphoma
3. **Large B cells**- diffuse large B cell lymphoma
86
NHL more often arises in [age]
NHL more often arises in **late adulthood**
87
HL more often arises in [age]
HL more often arises in **young adults**
88
(NHL/ HL) tends to spread diffusely, often extranodal
**NHL** tends to spread diffusely, often extranodal
89
HL tends to spread _
HL tends to spread **contiguously, rarely extranodal**
90
Small B cell malignancies are neoplastic proliferation of [marker] B cells that expand the region for which they are named
Small B cell malignancies are neoplastic proliferation of **CD20+** B cells that expand the region for which they are named
* Ex: follicular lymphoma, mantle cell lymphoma, marginal zone lymphoma
* *Will commonly present late in adulthood and with painless lymphadenopathy*
91
Follicular lymphoma is driven by [translocation]
Follicular lymphoma is driven by **t(14;18)**
92
In follicular lymphoma, _ on chromosome 18 translocates to the _ on chromosome 14
In follicular lymphoma, **BCL2** on chromosome 18 translocates to the **Ig heavy chain** on chromosome 14
* *This results in an overexpression of BCL2 since the Ig heavy chain locus on chromosome 14 is a highly active region*
93
A functional BCL2 will _ apoptosis of cells
A functional BCL2 will **block** apoptosis of cells
94
BCL2 _ the mitochondrial membrane and prohibits _ from leaking into the cytoplasm
BCL2 **stabilizes** the mitochondrial membrane and prohibits **cytochrome c** from leaking into the cytoplasm
* *Blocking apoptosis*
95
It is problematic to overexpress BCL2 in the follicle because _
It is problematic to overexpress BCL2 in the follicle because **cells that fail somatic hypermutation are not able to be killed by apoptosis**
96
Treatment for follicular lymphoma is reserved for patients who are symptomatic and involves low dose chemo or _ (anti-CD20 antibody)
Treatment for follicular lymphoma is reserved for patients who are symptomatic and involves low dose chemo or **Rituximab** **(anti-CD20 antibody)**
97
Tingible body macrophages will be _ in the germinal centers in follicular lymphoma
Tingible body macrophages will be **absent** in the germinal centers in follicular lymphoma
* *Distinguishing feature from reactive follicular hyperplasia when there is apoptosis occuring still (macrophages react to clean up debris)*
* Also lose normal architecture and polyclonality
98
Mantle cell lymphoma is driven by [translocation]
Mantle cell lymphoma is driven by **t(11;14)**
99
In mantle cell lymphoma, _ on chromosome 11 translocates to _ on chromosome 14
In mantle cell lymphoma, **cyclin D1** on chromosome 11 translocates to **Ig heavy chain locus** on chromosome 14
100
Overexpression of cyclin D1 in mantle cell lymphoma promotes _
Overexpression of cyclin D1 in mantle cell lymphoma promotes **G1/S transition** allowing neoplastic proliferation
* Cyclin D phosphorylates (with help of cyclin dependent kinase)
101
The marginal zone is formed by post-germinal center B cells and so lymphoma here is associated with _
The marginal zone is formed by post-germinal center B cells and so lymphoma here is associated with **chronic inflammatory states**
* ex: Hashimoto thyroiditis, Sjogren, H pylori
102
MALToma is a [malignancy] at mucosal sites
MALToma is a **marginal zone lymphoma** at mucosal sites
* Gastric MALToma may regress with treatment of H pylori
103
Burkitt lymphoma is an intermediate B cell lymphoma associated with _ that classically presents in [age]
Burkitt lymphoma is an intermediate B cell lymphoma associated with **EBV** that classically presents in **child or young adult with extranodal mass**
104
The African form of Burkitt lymphoma usually involves the _ while the sporatic form involves the _
The African form of Burkitt lymphoma usually involves the **jaw** while the sporatic form involves the **abdomen**
105
_ is the most common translocation associated with Burkitt lymphoma
**t(8;14)** is the most common translocation associated with Burkitt lymphoma
106
Burkitt lymphoma is associated with a translocation of _ to the Ig heavy chain locus on chromosome 14
Burkitt lymphoma is associated with a translocation of **c-myc** to the Ig heavy chain locus on chromosome 14
* *c-myc is an oncogene that promotes cell growth*
107
_ is characterized by a high mitotic index and starry-sky appearance on microscopy
**Burkitt lymphoma** is characterized by a high mitotic index and starry-sky appearance on microscopy
108
There is a risk, particularly in _ patients of progression to diffuse large B cell lymphoma
There is a risk, particularly in **follicular lymphoma** patients of progression to diffuse large B cell lymphoma
* *Presents as an enlarging lymph node*
109
The most common form of NHL is _
The most common form of NHL is **diffuse large B-cell lymphoma**
* These cells grow diffusely in sheets and are poorly differentiated
* Clinically aggressive and high grade cancer
110
**Hodgkin lymphoma** is a neoplastic proliferation of large B cells with multilobed nuceli and prominent nucleoli, which are called _
**Hodgkin lymphoma** is a neoplastic proliferation of large B cells with multilobed nuceli and prominent nucleoli, which are called **Reed-Sternberg cells**
111
Reed-Sternberg cells are classically positive for [marker] and [marker]
Reed-Sternberg cells are classically positive for **CD15** and **CD30**
112
Reed-Sternberg cells secrete _ which can result in B symptoms, attract other immune cells, and sometimes lead to fibrosis
Reed-Sternberg cells secrete **cytokines** which can result in B symptoms, attract other immune cells, and sometimes lead to fibrosis
113
The bulk of the tumor in HL is made up by _
The bulk of the tumor in HL is made up by **reactive inflammatory cells**
* Whcih are recruited via reed-sternberg cells secreting cytokines
* Versus NHL the whole mass is made up by the malignant cells
114
Name (4) subtypes of HL
Name (4) subtypes of HL
1. **Nodular sclerosis**
2. **Lymphocyte-rich**
3. **Mixed cellularity**
4. **Lymphocyte-depleted**
115
The most common subtype of HL (70% of cases) is _
The most common subtype of HL (70% of cases) is **nodular sclerosis**
116
Of all types of HL, _ has the best prognosis
Of all types of HL, **lymphocyte-rich** has the best prognosis
* *Lymphocyte depleted is the most aggressive type and usually seen in older adults or HIV positive individuals*
117
Young adult female presents with an enlarging cervical or mediastinal lymph node; histology shows lymph node divided by bands of sclerosis; Reed-sternberg cells are present in lake-like spaces; what's the diagnosis?
Young adult female presents with an enlarging cervical or mediastinal lymph node; histology shows lymph node divided by bands of sclerosis; Reed-sternberg cells are present in lake-like spaces; **Nodular sclerosis HL**
118
Multiple myeloma is a malignant proliferation of [cells] in the bone marrow
Multiple myeloma is a malignant proliferation of **plasma cells** in the bone marrow
119
The most common primary malignancy of the bone is _ but the most common malignant lesion of the bone overall is _
The most common primary malignancy of the bone is **multiple myeloma** but the most common malignant lesion of the bone overall is **metastatic cancer**
120
Multiple myeloma may be associated with high [cytokine levels] which stimulates plasma cell growth and Ig production
Multiple myeloma may be associated with high **IL-6** which stimulates plasma cell growth and Ig production
121
Clinical features of multiple myeloma can be remembered with the mneumonic _
Clinical features of multiple myeloma can be remembered with the mneumonic **CRAB**
122
The bone pain and hypercalcemia in multiple myeloma is mediated by _ activation via neoplastic plasma cells
The bone pain and hypercalcemia in multiple myeloma is mediated by **RANK receptor** activation via neoplastic plasma cells
* *Recall that rank receptors are found on osteoclasts*
123
_ are classic on x-ray of multiple myeloma
**Lytic "punched out" lesions** are classic on x-ray of multiple myeloma
* *Specifically of the vertebrae and skull*
124
_ is a classic finding on serum protein electrophoresis (SPEP) for multiple myeloma
**M spike** is a classic finding on serum protein electrophoresis (SPEP) for multiple myeloma
* *Neoplastic plasma cells are producing immunoglobulin*
* *M spike represents albumin and Ig*
125
Multiple myeloma is associated with increased serum proteins, specifically [Immunoglobulin]
Multiple myeloma is associated with increased serum proteins, specifically **IgG or IgA**
126
The most common cause of death in multiple myeloma is _
The most common cause of death in multiple myeloma is **infection**
* Increased risk of infection because the monoclonal antibodies lack antigenic diversity
127
Increased serum protein in multiple myeloma has the effect of _ on RBCs
Increased serum protein in multiple myeloma has the effect of **decreasing charge between RBCs**
* *Leads to rouleaux formation*
128
In multiple myeloma, free light chains circulate in the serum and deposit in the tissues causing [amyloidosis]
In multiple myeloma, free light chains circulate in the serum and deposit in the tissues causing **primary AL amyloidosis**
129
Myeloma kidney is a build up of _ in the kidney tubules that can lead to renal failure
Myeloma kidney is a build up of **free light chain** in the kidney tubules that can lead to renal failure
130
In MM, free light chain is excreted in the urine as _ protein
In MM, free light chain is excreted in the urine as **Bence Jones** protein
131
Increased serum protein with M spike on SPEP but no other features of multiple myeloma is diagnostic of _
Increased serum protein with M spike on SPEP but no other features of multiple myeloma is diagnostic of **monoclonal gammopathy of undetermined significance (MGUS)**
* *No lytic bone lesions, hypercalcemia, AL amyloid, or Bence Jones proteinuria*
132
Monoclonal gammopathy of undetermined significance (MGUS) is most common in [age]
Monoclonal gammopathy of undetermined significance (MGUS) is most common in **elderly**
133
Waldenstrom macroglobulinemia is a B cell lymphoma with monoclonal [immunoglobulin] production
Waldenstrom macroglobulinemia is a B cell lymphoma with monoclonal **IgM** production
* *IgM pentamers are very large = MACROglobulinemia*
134
All of the clinical manifestations of Waldenstrom macroglobulinemia are a result of [hematologic effect] due to high IgM
All of the clinical manifestations of Waldenstrom macroglobulinemia are a result of **hyperviscosity** due to high IgM
* Generalized lymphadenopathy
* M spike
* Visual and neuro deficits (retinal hemorrhages or strokes)
* Bleeding from defective platelet aggregation
135
Acute complications of Waldenstrom macroglobulinemia are treated with _
Acute complications of Waldenstrom macroglobulinemia are treated with **plasmapheresis**
* To remove IgM from the serum
136
_ is a neoplastic proliferation of Langerhan cells
**Langerhan cell histiocytosis** is a neoplastic proliferation of Langerhan cells
* *Recall that Langerhan cells are specialized dendritic cells primarily in the skin*
* *Derived from bone marrow monocytes*
137
Langerhans cell histiocytosis is [marker] and [marker] positive on immunohistochemistry
Langerhans cell histiocytosis is **CD1a+** and **S-100+** positive on immunohistochemistry
138
Langerhans cell histiocytosis has classic [finding] on electron microscopy
Langerhans cell histiocytosis has classic **Birbeck (tennis racket)** on electron microscopy
139
Leukemias can be [cells] while lymphomas are [cells]
Leukemias can be **myeloid or lymphoid** while lymphomas are **lymphoid**
140
Leukemias typically present with CBC abnormalities while lymphomas tend to present with _
Leukemias typically present with CBC abnormalities while lymphomas tend to present with **lymphadenopathy**
* *There is overlap!*
141
(Lymphoma/leukemia) is a discrete tumor mass arising from lymph nodes
**Lymphoma** is a discrete tumor mass arising from lymph nodes
142
