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Wright Heme lecture Flashcards

1
Q

Name the 4 main types of leukemia.

A

Acute Myeloid leukemia
Chronic Myeloid Leukemia
Acute Lymphoblastic Leukemia
Chronic Lymphocytic Leukemia

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2
Q

What are the signs and symptoms of leukemia?

A 
Leukocytosis
Pancytopenia
Hypogammaglobulinemia
Bone pain
LAD
spelnomegaly
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3
Q

What test should be done in all patients suspected to have leukemia

A

Bone marrow biopsy

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4
Q

What is the most common leukemia in adults?

A

AML

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5
Q

What pathologic finding is diagnostic of AML

A

Auer rods on biopsy

Circulating blasts >20%

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6
Q

First line treatment for AML

A

Chemo then Stem cell transplant

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7
Q

Prognosis for AML

A

not great, only 1/3 of patients are cured

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8
Q

What is the most common childhood malignancy?

A

Acute lymphoblastic leukemia

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9
Q

Peak incidence of ALL?

A

2-5 y.o.

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10
Q

Increased incidence of ALL with what genetic disorder?

A

Down Syndrome

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11
Q

Most common cell linages effected by ALL?

A

B cell lineage( 85%), then T (15%), then NK (1%)

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12
Q

Treatment for ALL?

A

Chemo

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13
Q

Prognosis for ALL?

A

Curable, with 85% 5 year survival, but high dose chemo in kids increases risk of long term complications

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14
Q

Good prognostic indicators in ALL?

A

Hyperdiploid (>50 chromosomes per cell)
2-10 y.o.
CD10 +
low WBC count

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15
Q

Poor prognostic indicators in ALL?

A

Hypodiploid
<2 or >10 y.o.
Male gender
High WBC count (>100k)

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16
Q

What is CAR-T therapy?

A

Therapy for ALL that removes T cells and trains them to attack neoplastic B cells. It is so effective that the B cells are killed so rapidly it causes cytokine storm.

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17
Q

What leukemia is a Philadelphia chromosome seen in?

A

Chronic Myeloid Leukemia

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18
Q

Philadelphia chromosome results from fusion of 2 genes. What are they?

A

ABL on chromosome 9 and BCR on chromosome 22

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19
Q

After what age are most CML diagnoses made?

A

After age 50

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20
Q

What are the treatment options for CML?

A

Stem cell transplant - risky but curative

Oral chemotherapy - low risk, can manage disease but not cure it

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21
Q

Chronic Lymphocytic leukemia is most often diagnosed after what age?

A

after age 70

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22
Q

CLL more common in men or women?

A

Men

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23
Q

What pathology finding on cytology is suggestive of CLL?

A

Gingersnap appearance of cells

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24
Q

What are the 2 main categories of lymphoma and how do you distinguish between them?

A

Hodgkin Lymphoma - presence of reed sternberg cells on biopsy
Non-Hodgkin lymphoma - absence of reed sternberg cells on biopsy.

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25
Indolent lymphomas
Fuck My Life, Sike follicular marginal zone, lymphoplasmocytic, small lymphocytic
26
Aggressive lymphomas
``` Big Deal, Many Problems Burrkitt Diffuse Large B cell Mantle Cell Peripheral T cell ```
27
What lymphoma has pain in lymph nodes with alcohol comsumption?
Hodgkin Lymphoma
28
What lymphoma is amenable to surgical excision?
Hodgkin Lymphoma
29
What is the most common lymphoma worldwide?
Diffuse Large B cell lymphoma
30
Common presenting symptom in Diffuse Large B cell lymphoma?
Rapidly enlarging symptomatic mass
31
Prognosis of Diffuse Large B cell lymphoma?
Not great, most patients present with advanced disease. | Curable in half of cases
32
Second most common non hodgkin lymphoma
Follicular Lymphoma
33
Painless peripheral adenopathy is a common symptom in what diagnosis?
Follicular lymphoma
34
Follicular lymphoma has a good prognosis, but it can progress to what other types of lymphoma?
Diffuse Large B cell or Burkitt lymphoma
35
What is a common location for a mass in Burkitt lymphoma?
Abdominal or retroperitoneal
36
What medication should be prescribed to patients with Burkitt lymphoma before treatment and why?
Alopurinol Burkitt lymphoma can cause tumor lysis syndrome, where large amounts of potassium, phosphate, and nucleic acids are released in circulation
37
Nuclear staining for cyclin D1 is positive. What is the most likely diagnosis
Mantle Cell lymphoma
38
Where does mantle cell lymphoma occur?
Any region of the GI tract
39
A patient with chronic gastritis from H. pylori is most susceptible to what lymphoma?
MALT (mucosa associated lymphoid tissue) lymphoma
40
MALT lymphoma is what type of lymphoma?
Marginal zone lymphoma
41
What lymphoma is associated with an IgM monoclonal gammopathy, Raynaud phenomenon, and smudge cells?
Lymphoplasmacytic lymphoma
42
Why is non-hodgkin lymphoma not amenable to surgical excision?
It involves discontinuous groups of lymph nodes
43
What organ is often involved with non-hodgkin lymphoma?
The spleen
44
Multiple myeloma is a cancer of what type of cells?
Plasma cells (fully matured B cells that produce antibodies)
45
You should consider multiple myeloma in a patient with what lab findings?
Anemia and hypercalcemia
46
What labs should you order in a multiple myeloma work up? What findings indicate multiple myeloma?
SPEP - M spike | UPEP - Bence Jones proteins
47
What findings on x ray are concerning for multiple myeloma?
Lytic lesions | Pathologic fracture
48
What are the symptoms of multiple myeloma?
``` CRAB Hypercalcemia Renal Failure Anemia Bone (pain, lytic lesions, pathologic fx) ```
49
Prognosis for multiple myeloma?
Bad. Median survival of 6 months | Non-curable but stem cell transplant can prolong life
50
Signs and symptoms of immune thombocytopenic purpura
signs of capillary rupture
51
Define chronic, persistent, and newly diagnosed ITP
Chronic >12 months Persistent 3-12 months newly diagnosed <3 months
52
Deficiency in what enzyme can cause TTP?
ADAMTS13 protease
53
What happens to vWF in TTP?
vWF accumulates into long chains on endothelial surfaces capable of binding large amounts of platelets.
54
Triad of symptoms for TTP? | Pentad?
Triad: Thrombocytopenia, neurologic changes, microangipathic anemia Pentad: the above triad plus fever and renal failure
55
Hemolytic uremic syndrome is caused by what type of infections?
GI infections
56
HUS should be treated with antibiotics? T/F
False - it will cause release of more toxins worsening symptoms
57
What does vWF do?
Carrier for factor VIII
58
What is the most common inherited bleeding disorder?
Von Willebrand disease
59
In Von Willebrand disease, what happens to PTT and PT?
PTT increases | PT normal
60
Hemophilia A is caused by a deficiency of factor ___
VIII
61
Hemophilia B is caused by a deficiency of factor ___
IX
62
A hypercoagulable state increases risk for _____
thromboembolism

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