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Block 3 - Systems 1 > Pathology > Flashcards

Pathology Flashcards

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?

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?

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?

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

A
  • Younger than 70

- No major comorbidities

25
Q

List the four drugs classically used in treatment of multiple myeloma and the period of treatment they are associated with:

A
  1. Bisphosphonates&raquo_space; all periods of treatment
  2. Bortezomib&raquo_space; induction (approx 4 months)
  3. High dose melphalan
  4. Thalidomide&raquo_space; maintainence (approx 1 year)
26
Q

Flow cytometry can be used to …

A

Differentiate clonal from reactive and subtype lymphoproliferative disorders

27
Q

What are causes of clonal lymphocytosis?

A
  • CD5 lymphoproliferative disorders (including monoclonal B-cell lymphocytosis)
  • mantle cell lymphoma
  • marginal zone lymphoma
  • B-prolymphocytic leukemia
28
Q

Causes of reactive lymphocytosis:

A
  • Smoking
  • Infections (viral, pertussis)
  • Psychological stress
  • Medications (lithium, natalizumab)
29
Q

Risk factors for chronic lymphocytic leukemia:

A
  • Genetic
  • Living or working on farm or hairdressing
  • History of sun exposure
  • Age (median diagnosis @ 72)
30
Q

In terms of pathology chronic lymphocytic leukemia involves:

A

accumulation of small, mature lymphocytes in the blood, lymp nodes and bone marrow

31
Q

Whats the pathological difference between small lymphocytis lymphoma and chronic lymphocytic leukemia?

A

Small lymphocytosis lymphoma&raquo_space; mainly involves the lymph nodes

Chronic lymphocytosis lymphoma involves blood and bone

32
Q

Is it necessary to bone marrow biopsy to diagnose chronic lymphocytosis lymphoma?

A

Nope, bloods is enough

Needs to have:
>Large B-cell population in peripheral blood

33
Q

What is the diagnostic criteria for small lymphocytosis lymphoma?

A
  • small B-cell pop in peripheral blood
  • Lymphadenopathy or splenomegaly

CONFIRM with lymph node biopsy if possible

34
Q

How can genetic lesions in chronic lymphocytosis lymphoma be assessed?

A

Flourescence in situ hybridization (FISH)

35
Q

IGHV mutations are…

A

Immunoglobulin heavy chain variable region mutations

> > Their presence can be used to predict prognosis of chronic lymphocytosis lymphoma

36
Q

Presenting symptoms of chronic lymphocytosis lymphoma are:

A

TYPICALLY ASYMPTOMATIC AT PRESENTATION

>fatigue
>infections
>fevers
>weight loss
>sweats
>painless lymphadenopathy
37
Q

Chronic lymphocytosis lymphoma sequelae are (3 big groups):

A

-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
Q

What are the most common second malignancies associated with chronic lymphocytosis lymphomas:

A

Skin cancers

39
Q

What percentage of patients with chronic lymphocytosis lymphoma never require treatment?

A

25%

40
Q

What indicates a patient should be treated for chronic lymphocytosis lymphoma?

A
  • Disease related symptoms
  • Progressive marrow failure
  • Massive/progressive lymphadenopathy
  • Massive/progressive splenomegaly
  • Lots of rapidly diving lymphocytes
41
Q

What drugs are appropriate to treat chronic lymphocytosis lymphoma with is TP53 mutation or del(17)p is present?

A
  • Ibrutinib
  • Idelasib
  • Venetoclax
42
Q

What causes abnormal bleeding?

A
  • Abnormalities of vasculature
  • Defects of primary haemostasis (platelet disorders)
  • Defects of secondary haemostasis (procoagulant protein deficiency)
  • Accelerated breakdown of a clot (hyperfibrionlysis)
43
Q

What is anaemia?

A

Haemoglobin level below the lower limit for their demographic

NOTE: Anaemia is not a diagnosis, just a feature of underlying pathology

44
Q

What are the symptoms of anaemia?

A

-Pallor to the skin

  • Weakness
  • Fatigue
  • Lethargy
  • Decreased effort tolerance
  • Dizziness
  • Headaches
  • Tachycardia
  • Increased pilse pressure
  • Cardiac flow murmurs
45
Q

What causes the following symptoms of anaemia?:

  • Weakness
  • Fatigue
  • Lethargy
  • Decreased effort tolerance
  • Dizziness
  • Headaches
A

Impaired oxygen delivery to tissue

46
Q

What causes the following symptoms associated with anaemia?:

  • Tachycardia
  • Increased pulse pressure
  • Cardiac flow murmurs
A

Cardiac compensation

47
Q

What are some symptoms associated with anaemia among older patients?

A
  • Cardiac failure
  • Angina
  • Claudication (cramping the leg due to inadequate blood flow
  • confusion
48
Q

What determines the severity of an episode of anaemia?

A
  • Age of patient
  • How rapid onset was
  • Hb level
  • Degree of physiological compensatio
49
Q

List 5 ways red cell production can be negatively impacted:

A

1) Abnormal stem cells
2) Decreased erythropoietin
3) Defective DNA synthesis
4) Defective haemoglobin synthesis
5) Displacement of haemopoietic progenitors

50
Q

Aplastic anaemia involves abnormal….

A

stem cells

51
Q

Failure of which organ results in decreased erythropoietin?

A

Renal failure (because EPO i

Block 3 - Systems 1 (2 decks)

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