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Block 3 - Systems 1 > Pathology > Flashcards

Pathology Flashcards

(51 cards)

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1
Q

What are CD markers?

A

CD = Cluster of differentiation, they are surface proteins which can be used to differentiate erythrocytes

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2
Q

5 tests relevant to multiple myeloma:

A
  • Skeletal survey
  • Serum electrophoresis
  • Serum calcium
  • Serum free light chain assay
  • 24 hour urine electrophoresis
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3
Q

Tests involving electrophoresis are looking for what?

A

Abnormal proteins

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4
Q

Plasma cells are …. and they produce …

A
  • Terminally differentiated B-cells

- Antibodies

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5
Q

Myeloma plasma cells make …. the clinical relevance of this is ….

A

Monoclonal proteins which serve no function

They can be detected, so aid diagnosis of bone tumours (myelomas)

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6
Q

In immunoglobulin structure the base is …. while the top of the y is …

A
  • Constant

- Variable

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7
Q

In immunoglobulin structure the heavy chain is…

A

The inner Y shape, continuous from the base to tip (long)

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8
Q

What are the two types of light chain in immunoglobulins?

A
  • K (kappa)

- L (lambda)

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9
Q

Serum free light chain assays look at what part of the immunoglobulin?

A

The light chain, specifically the ratio of Lambda to Kappa chains

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10
Q

What does the CRAB acronym for multiple myeloma symptoms stand for?

A

C- High calcium level
R- Renal damage
A- Anaemia
B- Bone destruction

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11
Q

What is the precursor to multiple myeloma?

A

MGUS&raquo_space;> small amounts of the monoclonal proteins produced by the rubbish plasma cells can be found, but no symptoms

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12
Q

What is smouldering myeloma?

A

Where lots of monoclonal proteins are being produced by rubbish plasma cells, but there is no organ damage yet

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13
Q

How many cases of MGUS will progress to multiple myeloma per year?

A

1%

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14
Q

Risk factors for multiple myeloma are:

A
  • Age (increasing)
  • Male
  • Race (more likely among individuals of African descent)
  • Obesity
  • Radiation exposure
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15
Q

Of the CRAB symptoms which are the most commonly presenting ones?

A
  • Bone lesions

- Anaemia

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16
Q

Which test detects the majority of multiple myeloma cases?

A

Serum electrophoresis

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17
Q

What are the sequelae of myeloma bone diseases?

A
  • Low trauma fractures
  • Pain
  • Reduced quality of life
  • Cord compression
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18
Q

Renal disease associated with myeloma is cause by what?

A

light chain cast nephropathy

> > free immunoglobulin light chains form plugs in the renal tubules

(note= assume renal disease if light chains > 500mg/L)

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19
Q

Factors in addition to light chain cast nephropathy which may contribute to renal disease in multiple myeloma:

A
  • Dehydration
  • Hypercalcemia
  • Amylodosis
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20
Q

List the steps of amylodiosis in multiple myeloma:

A

> Cloned dysfunctional plasma cell overproduces unstable immunoglobulin light chains
>Light chains misfold, exposing hidden epitopes which allow interbinding of rubbish light chains
»Can simply deposit in this form causing heart damage
»Can form amyloid fibrils in ordered B-pleated structure which deposit in organs

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21
Q

What organ damage is associated with amyloidosis caused by multiple myeloma?

Study These Flashcards
A
  • Renal
  • Periorbital perpura
  • Macroglossia
  • Nail dystrophy
  • Soft tissue damage
  • Heart problems
22
Q

Why are autologous stem cell transplants used in the treatment of myelomas?

Study These Flashcards
A

Because chemo blitzs the stem cell populations&raquo_space; stops death due to that

23
Q

What is the process of autologous stem cell transplants?

Study These Flashcards
A

> remove stem cells from patient using aphresis machine
> freeze them
> replace in patient after chemo

24
Q

What factors decide if a patient is eligible for

Study These Flashcards
A
  • Younger than 70

- No major comorbidities

25
List the four drugs classically used in treatment of multiple myeloma and the period of treatment they are associated with:
1. Bisphosphonates >> all periods of treatment 2. Bortezomib >> induction (approx 4 months) 3. High dose melphalan 4. Thalidomide >> maintainence (approx 1 year)
26
Flow cytometry can be used to ...
Differentiate clonal from reactive and subtype lymphoproliferative disorders
27
What are causes of clonal lymphocytosis?
- CD5 lymphoproliferative disorders (including monoclonal B-cell lymphocytosis) - mantle cell lymphoma - marginal zone lymphoma - B-prolymphocytic leukemia
28
Causes of reactive lymphocytosis:
- Smoking - Infections (viral, pertussis) - Psychological stress - Medications (lithium, natalizumab)
29
Risk factors for chronic lymphocytic leukemia:
- Genetic - Living or working on farm or hairdressing - History of sun exposure - Age (median diagnosis @ 72)
30
In terms of pathology chronic lymphocytic leukemia involves:
accumulation of small, mature lymphocytes in the blood, lymp nodes and bone marrow
31
Whats the pathological difference between small lymphocytis lymphoma and chronic lymphocytic leukemia?
Small lymphocytosis lymphoma >> mainly involves the lymph nodes Chronic lymphocytosis lymphoma involves blood and bone
32
Is it necessary to bone marrow biopsy to diagnose chronic lymphocytosis lymphoma?
Nope, bloods is enough Needs to have: >Large B-cell population in peripheral blood
33
What is the diagnostic criteria for small lymphocytosis lymphoma?
- small B-cell pop in peripheral blood - Lymphadenopathy or splenomegaly CONFIRM with lymph node biopsy if possible
34
How can genetic lesions in chronic lymphocytosis lymphoma be assessed?
Flourescence in situ hybridization (FISH)
35
IGHV mutations are...
Immunoglobulin heavy chain variable region mutations >>Their presence can be used to predict prognosis of chronic lymphocytosis lymphoma
36
Presenting symptoms of chronic lymphocytosis lymphoma are:
TYPICALLY ASYMPTOMATIC AT PRESENTATION ``` >fatigue >infections >fevers >weight loss >sweats >painless lymphadenopathy ```
37
Chronic lymphocytosis lymphoma sequelae are (3 big groups):
-Impaired immunity (both types) >>increased risk of infections >>increased risk of second malignancies ``` -Autoimmune cytopenias >>Haemolytic anaemia >>thrombocytopenia >>red cell aplasia >>neutopenia ``` -Transformation to high grade lymphoma
38
What are the most common second malignancies associated with chronic lymphocytosis lymphomas:
Skin cancers
39
What percentage of patients with chronic lymphocytosis lymphoma never require treatment?
25%
40
What indicates a patient should be treated for chronic lymphocytosis lymphoma?
- Disease related symptoms - Progressive marrow failure - Massive/progressive lymphadenopathy - Massive/progressive splenomegaly - Lots of rapidly diving lymphocytes
41
What drugs are appropriate to treat chronic lymphocytosis lymphoma with is TP53 mutation or del(17)p is present?
- Ibrutinib - Idelasib - Venetoclax
42
What causes abnormal bleeding?
- Abnormalities of vasculature - Defects of primary haemostasis (platelet disorders) - Defects of secondary haemostasis (procoagulant protein deficiency) - Accelerated breakdown of a clot (hyperfibrionlysis)
43
What is anaemia?
Haemoglobin level below the lower limit for their demographic NOTE: Anaemia is not a diagnosis, just a feature of underlying pathology
44
What are the symptoms of anaemia?
-Pallor to the skin - Weakness - Fatigue - Lethargy - Decreased effort tolerance - Dizziness - Headaches - Tachycardia - Increased pilse pressure - Cardiac flow murmurs
45
What causes the following symptoms of anaemia?: - Weakness - Fatigue - Lethargy - Decreased effort tolerance - Dizziness - Headaches
Impaired oxygen delivery to tissue
46
What causes the following symptoms associated with anaemia?: - Tachycardia - Increased pulse pressure - Cardiac flow murmurs
Cardiac compensation
47
What are some symptoms associated with anaemia among older patients?
- Cardiac failure - Angina - Claudication (cramping the leg due to inadequate blood flow - confusion
48
What determines the severity of an episode of anaemia?
- Age of patient - How rapid onset was - Hb level - Degree of physiological compensatio
49
List 5 ways red cell production can be negatively impacted:
1) Abnormal stem cells 2) Decreased erythropoietin 3) Defective DNA synthesis 4) Defective haemoglobin synthesis 5) Displacement of haemopoietic progenitors
50
Aplastic anaemia involves abnormal....
stem cells
51
Failure of which organ results in decreased erythropoietin?
Renal failure (because EPO i

Block 3 - Systems 1 (2 decks)

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