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Year 3 > Week 20 - Case 1,2,3 > Flashcards

Week 20 - Case 1,2,3 Flashcards

1
Q

what should happen if someone as B symptoms of fever, weight loss, night sweats and a neck lump

A

referred to the haematologist as an urgent 2 week wait referral

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2
Q

does leukaemia present with lymphadenopathy

A

rarely - this is more in keeping with lymphoma

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3
Q

what are the characterisitcs of Reed-Sternberg cells

A

large cells that are either multi-nucleated cells, or have bilobed nuclei

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4
Q

where are lymphocytes present

A

in the circulation, bone marrow, lymph noes and other organs that form the reticulo-endothelial system, such as the liver and spleen

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5
Q

how are Non-Hodgkin’s lymphoma characterised

A

by diffuse, or nodular abnormal lymphocytes

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6
Q

what are the types of Hodgkin’s lymphoma

A

nodular sclerosis
mixed cellularity
lymphocyte depleted

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7
Q

what are the types of non hodkins lymphoma

A

High grade e.g. Diffuse Large B-cell Lymphoma & Burkitt’s Lymphoma
Lymphocyte-rich Low-grade: Follicular lymphoma

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8
Q

what are low grade tumours

A

these tumours grow slowly and may not require treatment for long periods

when they do need treatment, they are likely ro respond well to chemotherapy, but thet are very rarely cured

follicular lymphomas are low grade non-hodgkin lymphoma

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9
Q

what is the common used clincial staging system

A

the Ann Arbor System

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10
Q

what are the stages of the Ann Arbor system

A

Stage 1 : One group of lymph nodes is affected.
Stage 2: Two or more groups of nodes are affected, but the lymphoma is restricted to one side of the diaphragm only.
Stage 3: Lymphadenopathy is evident on both sides (above and below) of the diaphragm.
Stage 4: The lymphoma has spread beyond the lymph nodes to other organs such as the spleen, bone marrow, liver or lungs.

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11
Q

why is a letter code added to each of the above stages

A

A or B is added to indicate whether or not the patient has systemic symptoms such as weight loss, fevers, or night sweats

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12
Q

what is radiotherapy

A

the use of ionising radiation to treat malignant disease

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13
Q

what does radiotherapy preferentially treat

A

dividing cells and can be targeted to include the tumour and avoid normal tissue

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14
Q

what are the late side effects of treatment

A

risk of second cancers, and cardiac or hormonal problems, depending on what treatments patients recieve

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15
Q

is follicular NHL curable

A

no

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16
Q

what does the term purpura describe and what does it signify

A

purpura is the appearance of a non-blanching purple-red spots of the skin

it signifies bleeding vessels near the surface and can also occur in the mucous membrane

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17
Q

what are larger purpura called

A

ecchymoses

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18
Q

what size are petechiae normally

A

normally <1cm in size

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19
Q

if a bone marrow biopsy shows >20% blasts what is the most likely diagnosis

A

confirms the diagnosis of acute myeloblastic leukaemia (AML)

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20
Q

can ALL present with blasts

A

ALL can also present with blasts

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21
Q

in acute forms of leukaemia what is the peripheral blood film dominated bt

A

the immature cells which will be referred to as acute myeloblastic or lymphoblastic leukaemia

22
Q

when does ALL develop

A

when a B/T precursor stage lymphoid progenitor cell becomes genetically altered through somatic changes and undergoes uncontrolled prolideration

23
Q

when is ALL usually diagnosied

A

in those aged under 20 yeats

24
Q

what is a key risk factor for CLL

A

being over 60 years old

25
Q

what is CLL diagnosed by

A

full blood count with differential, blood smear showing smudge cells, and flow cytometry

26
Q

when does incidence of CML peak

A

65-74 years

27
Q

how is diagnosis of CML confirmed

A

Diagnosis should be confirmed by the presence of the Philadelphia chromosome and/or the BCR-ABL1 transcripts in peripheral blood or bone marrow cells.

28
Q

what kind of sepsis can chemotherapy make more lilely

A

Chemotherapy can have an effect on your bone marrow, reducing the amount of neutrophils made. This can put patients at an increased risk of infection and neutropenic sepsis. It is essential that this is recognised early, and that he receives intravenous antibiotics within 1 hour.

29
Q

what is the management of neutropenic sepsis

A

IV tazocin
blood transfusion
intravenous fluids

30
Q

what is Filgrastim

A

a recombinant human granulocyte colony stimulating factor that stimulates the production of neutrophils

31
Q

what does a combination of back pain, normochromic anaemia and hypercalcaemia make you concerned about

A

malignancy

this would include spinal metastasis, from a yet unknown primary or multiple myeloma

32
Q

what is pamidronate

A

a bisphosphonate used to treat hypercalcaemia

33
Q

what are the classcial symptoms of myeloma

A

CRaB

Hypercalcaemia
renal impairment
anaemia
bony lesions

34
Q

when should serum calcium levels always be interpreted

A

after correction for albumin

35
Q

how does symptomatic hypercalcaemia present

A

with confusion, disorientation, muscle weakness, constipation, anorexia, polyuria and polydipsia

36
Q

in newly diagnosed myeloma patients, what percentage have renal impairement and why

A

20-40%

typically due to light chain deposition within the distal and collecting renal tubules, or hypercalcaemia

37
Q

what kind of imaging is used to identify lytic lesions in myeloma

A

MRI

38
Q

what are detected in the urine of patients with multiple myeloma

A

Bence Jones proteins - monoclonal globulins

39
Q

what is diagnosis of multiple myeloma based on

A

serum and urine protein electrophoresis, bone marrow examination and whole body low dose CT demonstrating lytic lesions

40
Q

what is shown in the bone marrow that confirms the diagnosis of multiple myeloma

A

monoclonal plasma cells in the marrow - approximately 20%

41
Q

Which is the most common haematological malignancy in the UK?

A

Non-Hodgkin’s Lymphoma.
13,413 new cases in UK 2013.

42
Q

What factors are important in the choice of chemotherapy in a 30 year old man with lymphoma?

A

patient wishes
past medical history
histology

43
Q

What factors have been shown to be strongly associated with development of haematological malignancies?

A

infection
unknown
previous treatment for cancer
reduced immunity

44
Q

Which of the following conditions can be cured?

Advanced stage follicular lymphoma
Classical Hodgkin’s lymphoma.
Multiple Myeloma.
Diffuse large B cell Lymphoma.
Acute myeloid leukaemia.

A

classical Hodgkin’s lymphoma

Diffuse large B cell lymphoma

acute myeloid leukaemia

45
Q

what is primary myelofibrosis

A

chronic progressive pyeloproliferative neoplasm

46
Q

what is the median survival of primary myelofibrosis

A

approximately 6 years

47
Q

what are the hallmarks of primary myelofibrosis

A

bone marrow fibrosis, extramedullary haemotopoeisis, leukoerythroblastosis, and splenomegaly

48
Q

what should be considered as treatment for patients with symptomatic and/or high risk primary myelofibrosis

A

treatment with Janus Kinase inhibitors and haemopoieitc stem cell transplants

49
Q

what is death in primary myelofibrosis usually due to

A

due to bone marrow failure (haemorrhage, anaemia or infection), transformation to acute leukaemia, portal or pulmonary hypertension, heart failure, cachexia, or severe myeloid metaplasia with organ damage.

50
Q

what is secondary/reactive myelofibrosis

A

fibrosis in the bone marrow due to another disorder, drug treatment or toxic agent

51
Q

what are the risk factors for myelofibrosis

A

radiation exposure
industrial solvent exposure
age >65 years
cytogenetic abnormalities

52
Q
A

Year 3 (63 decks)

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