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Block 4 Year 3 > Week 20 - fatigue and neck lumps > Flashcards

Week 20 - fatigue and neck lumps Flashcards

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1
Q

What are the 2 lineages of hematopoiesis ?

A

myeloid and lymphoid

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2
Q

What is haematopoiesis ?

A

the process which all mature blood cells are produced from the haematopoietic stem cell

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3
Q

Where does haematopoiesis occur ?

A

In the bone marrow

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4
Q

Name the blood cells that originate from the myeloid linage ?

A
  • neutrophils
  • basophils
  • eosinophils
  • macrophages (monocytes)
  • thrombocytes (platelets)
  • erythrocytes (RBCs)
  • mast cells
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5
Q

Name the blood cells that originate from the lymphoid linage ?

A
  • T lymphocytes
  • B lymphocytes
  • natural killer cells
  • plasma cells
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6
Q

What does it suggest when ‘blast’ cells are found in the peripheral blood/circulation ?

A

a haematological malignancy

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7
Q

Where are ‘blast’ cells normally found?

A

in the bone marrow in small quantities

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8
Q

What are ‘blast’ cells ?

A

the immature form of a cell

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9
Q

What structures make up the lymphatic system ?

A
  • lymph nodes
  • lymphatic vessels
  • bone marrow + thymus (organs where immune cells develop)
  • spleen
  • organs where immune cells are stored/collect
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10
Q

What renal conditions can cause fever and tiredness?

A

urinary infections

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11
Q

What cardiac conditions can cause fever and tiredness?

A
  • pericarditis
  • infective endocarditis
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12
Q

What endocrine conditions can cause fever and tiredness?

A
  • hypo/hyperthyroidism
  • diabetes
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13
Q

What neuro conditions can cause fever and tiredness?

A
  • meningitis
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14
Q

What resp conditions can cause fever and tiredness?

A
  • pneumonia
  • covid
  • TB
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15
Q

What gastro conditions can cause fever and tiredness?

A
  • cholangitis
  • diverticulitis
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16
Q

What are ‘coryzal symptoms’ ?

A

symptoms of upper respiratory tract infection …
- runny nose
- sneezing
- nasal stuffiness
- sore throat
- cough
etc

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17
Q

What are the ‘B symptoms’ ?

A
  • fever
  • weight loss (>10% body weight)
  • drenching night sweats
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18
Q

What is another name for glandular fever ?

A

infectious mononucleosis or “mono”

Epstein-barr virus causes this

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19
Q

What are B symptoms signs of ?

A

haematological cancer = lymphoma

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20
Q

What do malignant nodes usually feel like ?

A

hard, painless and tethered to surrounding structures

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21
Q

What could be some differentials for hilar lymphadenopathy on CXR ?

A
  • lymphoma
  • sarcoidosis
  • TB
  • metastatic spread
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22
Q

What is the best type of biopsy for diagnosing lymphoma ? why ?

A

complete lymph node excision because the cells are far clearer this way and therefore needle biopsy has a risk of false negative

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23
Q

What are the types of lymphoma ?

A
  1. Hodgkin lymphoma
  2. Non-Hodgkin lymphoma (there are several types of this)
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24
Q

What is the most common type of lymphoma …
a) hodgkin lymphoma ?
b) non-hodgkin lymphoma ?

A

Non-Hodgkin lymphoma

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25
Q

What is the difference between lymphoma and leukaemia ?

A

lymphoma = originates in lymph nodes or spleen and spreads through lymphatic system

leukaemia = originates in bone marrow and spreads through the blood stream

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26
Q

What are the hallmark tumour cells of Hodgkin lymphoma seen on biopsy called ?

A

Reed-Sternberg cells

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27
Q

What are Reed-Sternnerg cells and what do they indicate ?

A

large, abnormal lymphocytes with more than one nucleus

their presence indicates hodgkin lymphoma

28
Q

When staging lymphoma, what do the letters A and B mean ?

A

the numbers indicate spread of the cancer through the lymphatic system but the letters A/B refer to whether or not the patient presented with B symptoms

eg. someone who did have B symptoms would be a stage 1B/2B/3B/4B and someone who didn’t would be stage 1A/2A/3A/4A

29
Q

What is the name of the A/B staging system in lymphoma ?

A

Ann Arbor system

30
Q

Are lymph nodes in the neck usually palpable ?

A

No

unless in children, they often can be!

31
Q

In terms of shape, what should a healthy lymph node be most similar to…
a) a football ?
b) a rugby ball ?

A

rugby ball

they’re quite a similar shape to kidneys!

32
Q

What size lymph node is clinically relevant in lymphadenopathy?

A

> 1cm in adults
2cm in kids

33
Q

What are the 2 causes of lymphadenopathy ?

A
  • inflammatory (most common)
  • malignancy
34
Q

What are the most common inflammatory causes of cervical lymphadenopathy?

A
  • bacterial/viral infection to scalp, tonsils, teeth, ear etc
  • TB
  • HIV
35
Q

Which bacteria is the most common cause of inflammatory cervical lymphadenopathy ?

A

streptococcus A

36
Q

Which virus is the most common cause of inflammatory cervical lymphadenopathy ?

A

adenovirus

37
Q

Which types of cancer are most commonly the cause of metastasis to the neck nodes ?

A
  • larynx/pharynx/mouth squamous carcinoma (mucosal membranes)
  • thyroid cancer
  • salivary gland cancer
  • skin cancer (squamous, melanoma)
38
Q

How do you investigate for cervical lymphadenopathy?

A
  • head/neck exam (baso thyroid exam)
  • endoscopy
  • imaging (USS, CT, MRI, PET)
  • biopsy
39
Q

What are some red flags in a history presenting with a neck lump that indicate cancer?

A
  • unilateral pain, especially in the ear when swallowing
  • persistent vocal hoarseness (>3 weeks)
  • dysphasia (liquids or solids)
40
Q

What are the risk factors for head/neck cancer ?

A
  • smoking
  • alcohol
  • HPV
  • cannabis
41
Q

Which type of head/neck cancer does HPV increase risk of ?

A

tonsil cancer

42
Q

What level of weight loss is a significant B sign for lymphoma ?

A

> 10% of weight lost in the last 3 months

43
Q

How does a PETCT scan hep in diagnosis of malignancies ?

A

metabolically active cells take up more of the contrast so shows spread of malignancy

a malignant node will be brighter than any other reactive node due to larger uptake of contrast

44
Q

What does stage 1 lymphoma mean ?

A

There is 1 lymph node area affected

45
Q

What does stage 2 lymphoma mean ?

A

2 lymph node areas involved on the same side of the diaphragm

46
Q

What does stage 3 lymphoma mean ?

A

lymph node areas affected on both sides of the diaphragm (above and below)

47
Q

What does stage 4 lymphoma mean ?

A

Involvement from extra-nodal tissues eg bone marrow, liver, spleen, lungs

48
Q

What are the causes of hodgkin lymphoma ?

A

vast majority have no clear cause

otherwise some rare cases of…
- strong familial link
- previous Epstein barr virus infection
- person with reduced immunity

49
Q

What is the treatment for hodgkin’s lymphoma ?

A

chemo therapy

50
Q

What is the prognosis for hodgkin’s lymphoma ?

A

> 80% are cured and relapse after 5 years is rare

51
Q

What is the most common type of non-hodgkin lymphoma (NHL) ?

A

Diffuse Large B cell lymphoma

52
Q

How is LDH linked to lymphoma?

A

a high LDH blood test suggests a rapid growth and a poor prognosis for non-hodgkin’s lymphoma patients

LDH = lactate dehydrogenase

53
Q

How is Diffuse Large B cell lymphoma treated ?

A

chemotherapy combined with immunotherapy

54
Q

What can be a bad side effect/ complication of chemotherapy ?

A

neutropenic sepsis

55
Q

What is the prognosis of Diffuse Large B Cell lymphoma (NHL) ?

A

50% of patients are cured and relapse is rare after 5 years

(NHL = non-hodgkin’s lymphoma)

56
Q

What is the second most common type of non/hodgkin’s lymphoma (NHL) ?

A

follicular NHL

57
Q

Is follicular non-hodgkin’s lymphoma painful ?

A

No! it is often painless and therefore not diagnosed for a while

58
Q

What is the prognosis of follicular non-hodgkin’s lymphoma ?

A
  • responds well to treatment but is “incurable”
  • recurrent relapses
  • 50% of patients will survive 10yrs post diagnosis
59
Q

How is follicular non-hodgkin’s lymphoma treated ?

A

chemo or radiotherapy

60
Q

Are the majority of non-hodgkin lymphomas …
a) T cell lymphomas ?
b) B cell lymphomas ?

A

B cell lymphomas = vast majority

61
Q

Where are T cell lymphomas predominantly found ?

A

in the skin, can look similar to eczema or psoriasis

62
Q

What type of common examination is important to do for a patient presenting with lymphadenopathy ?

A

abdo exam for hepato-splenomegaly

because the liver and spleen are part of the reticulo-endothelial system

63
Q

What are the 2 main subgroups of non hodgkin lymphoma ?

A
  • low grade = slow growth
  • high grade = rapid growth
64
Q

Which subgroup of non hodgkin lymphomas are more likely to be cured…
a) high-grade?
b) low grade?

A

high grade (rapid growing ones)

65
Q

Who needs to be present in an MDT discussing a patient with lymphoma ?

A
  • a haematologist
  • a clinical oncologist to give advice on radiotherapy
  • a radiologist to interpret scans
  • a specialist histopathologist to review biopsy
  • a specialist nurse
66
Q

What advice is given to women of child bearing age when going through standard ABVD chemo for lymphoma ?

A
  • fertility will remain intact
  • periods may be disrupted during treatment
  • don’t get pregnant during/6 months after treatment
  • delay pregnancy until 2 years post diagnosis if possible as this is the most likely period for recurrence
67
Q

What are some long term/late side effects of treatment for hodgkin’s lymphoma ?

A

depending on treatment, patients should know there’s a risk of

  • second cancers
  • cardiac issues
  • hormonal issues

especially if they do not stop smoking

Block 4 Year 3 (4 decks)

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