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American Board of Internal Medicine COPY > Oncology - Blood > Flashcards

Oncology - Blood Flashcards

1
Q

A 60-year old smoker with large cervical lymphadenopathy likely has __ and the preferred diagnostic approach is __.

A
  1. Squamous cell carcinoma of head/neck

2. Needle biopsy

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2
Q

What are the two categories of lymphoma? Describe cure rates and age of onset.

A
  1. Indolent - Incurable, age >40

2. Aggressive - 50% curable, any age

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3
Q

What are B symptoms (3)?

A
  1. Weight loss >10% over six months
  2. Fever >38C
  3. Recurrent night sweats
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4
Q

What is the difference between Leukemia and Lymphoma?

A

Leukemia

 - neoplastic cells in peripheral blood 
 - neoplastic cells packed in bone marrow

Lymphoma

 - neoplastic cells NOT detected in peripheral blood
 - neoplastic cells confined to lymph nodes and BM
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5
Q

What are three classes of lymphoid malignancies?

A
  1. B-Cell
  2. T-Cell / NK-cell
  3. Hodgkin’s
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6
Q

What type of blood neoplasm is associated with Helicobacter pylori? What is it also known as?

A 
Gastric MALT (mucosa-associated lymphatic tissue) Lymphoma
	- AKA Extranodal Marginal-Zone Lymphoma
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7
Q

Follicular Lymphoma

  1. Indolent or Aggressive
  2. Treatment options (3)
  3. Chromosomal rearrangement
A
  1. Indolent (70% of all indolent) with aggressive progression 3% year up to 30% in 10 years
  2. a. Watchful waiting
    b. Radiotherapy for Stage I (single lymph node)
    c. Rituximab
  3. bcl-2 (t[14;18])
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8
Q

What is the pharmacoodynamics of Rituximab?

A

Anti-CD20 Monoclonal Antibody

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9
Q

Lymphoplasmacytic Lymphoma

  1. Indolent or Aggressive
  2. Hyperviscosity Syndrome
    a. Diagnostic lab value
    b. Manifestations (3)
    c. Treatment (2)
  3. Associated chronic disease
  4. Eponym
A
  1. Indolent
  2. Serum viscosity > 4 centipoises (ULN 1.8) leads to:
    a. Retinopathy with visual blurring
    b. CHF
    c. Mental status changes
    • **Treatment = plasmapharesis + Rituximab
  3. HCV with treatment inducing remission
  4. Waldenstrom’s Macroglobulinemia
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10
Q

Chronic Lymphocytic Leukemia

  1. Indolent or Aggressive
  2. Treatment options (3)
  3. Lymphomatous counterpart
  4. Blood smear appearance
A
  1. Indolent
  2. a. Watchful waiting
    b. Radiotherapy for Stage I (single lymph node)
    c. Rituximab
  3. Small lymphocytic lymphoma
  4. Smudge cell - bare nucleus
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11
Q

Marginal-Zone B-Cell Lymphoma

  1. Indolent or Aggressive
  2. Three types
  3. Associated chronic disease (2)
A
  1. Indolent
  2. a. Splenic - treat with splenectomy
    b. Extranodal MALT - mucosa-associated lymphoid tissue
    c. Nodal
  3. HCV and H. pylori - treatment inducing remission
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12
Q

Hairy Cell Leukemia

  1. Indolent or Aggressive
  2. Treatment (2)
  3. Difficulty in work-up?
A
  1. Indolent
  2. Purine analogs: Cladridine or Pentostatin
  3. Bone marrow fibrotic and not easily aspirated
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13
Q

Mycosis Fungiodes

  1. Indolent or Aggressive
  2. Manifestation
  3. Eponym for advanced stage
A
  1. Indolent
  2. Waxing-waning eczematous plaques
  3. Sezary syndrome - usually with erythroderma
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14
Q

What is clinically distinct about Hodgkin’s Lymphoma (3)?

A
  1. Malignant Reed Sternberg Cells - B cells with bilobed nucleus (like owl’s eye)
  2. Contiguous disease spread usually from cervical lymph node
  3. Cure > 75% with chemotherapy with/without radiation
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15
Q

Diffuse Large B-Cell Lymphoma

  1. Indolent or Aggressive
  2. Treatment and cure rate
  3. Relapse treatment
A
  1. Aggressive
  2. R-CHOP with 50% cure
  3. Stem-cell transplant after re-induction therapy with R-ICE (Rituximab, Ifosfamide, Carboplatin, Etoposide)
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16
Q

A young nonsmoker with large cervical lymphadenopathy likely has __ and the preferred diagnostic approach is __.

A
  1. Lymphoma

2. Lymph node excision

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17
Q

Burkitt’s Lymphoma

  1. Indolent or Aggressive
  2. Demographics
  3. Organ involvement
  4. Lab abnormality
A
  1. HIGHLY Aggressive
  2. Endemic pediatric disease in Africa, contains EBV genome
  3. Masses involving gastrointestinal tract
  4. Very high LDH
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18
Q

Mantle Cell Lymphoma

  1. Indolent or Aggressive
  2. Cure rate
A
  1. Aggressive

2. Incurable after treatment with anthracycline-based chemotherapy

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19
Q

Post-Transplantation Lymphoproliferative Disease

  1. Indolent or Aggressive
  2. Associated virology
  3. Treatment (2 options)
A
  1. Aggressive
  2. EBV
  3. Stop immunosuppressants or Rituximab
20
Q

Primary CNS Lymphoma

  1. Indolent or Aggressive
  2. Organ involvement
  3. Poor prognostic factors (2)
A
  1. Aggressive
  2. Confined to craniospinal axis without systemic disease
  3. Age > 60 and HIV
21
Q

Describe these Hodgkin’s prognostic groupings

  1. Early Favorable
  2. Early Unfavorable
  3. Advanced
A 
1. Early Favorable
     Stage IA or IIA
     No extranodal sites
     ESR < 50
     Size < 10 cm
     < 3 lymph node groups
2. Early Unfavorable
     Stage IA or IB or IIA or IIB
     ESR > 50
     Size >10
     > 3 lymph node groups
3. Advanced Stage
     Stage III or IV or IIB
     Size > 10 cm
22
Q

What risk is increased after treatment for Hodgkin’s Lymphoma (5)?

A
  1. Solid tumors (lung and breast) from radiation
  2. AML or myelodysplastic syndrome from topoisomerase II inhibitors
  3. Fatal MI from radiation to coronary arteries
  4. Azospermia from alkylating agents
  5. Amenorrhea for women > 30yo from alkylating agents
23
Q

What are the major criteria in the diagnosis of Multiple Myeloma (3)?

A
  1. Plasmacytoma on tissue biopsy
  2. Bone marrow clonal plasma cell > 30%
  3. High M-protein (IgG or IgA) or Bence-Jones proteinuria
24
Q

What are treatment options for these Hodgkin’s prognostic groupings?

  1. Early Favorable
  2. Early Unfavorable
  3. Advanced
A
  1. ABVDx4 -OR- ABVDx2 plus radiation
  2. ABVDx4 -AND- radiation
  3. ABVDx6
25
Q

What is ABVD?

A

Adriamycin (doxorubicin/hydroxydaunorabicin)
Bleomycin
Vinblastine
Dacarbazine

26
Q

Consider this in patients with neutropenic fever… and fever x 5 days and continued neutropenia on antibiotics.

A

Antifungal therapy (itraconazole vs. amphotericin B)

27
Q

Consider this in patients with neutropenic fever… and high risk for gram-positive infections (intravascular lines)

A

Vancomycin (discontinue after 3 days if negative cultures)

28
Q

Consider this in patients with neutropenic fever… and never-positive cultures and afebrile x 48 hours and neutrophil count > 500

A

Stop antibiotics

29
Q

Consider this in patients with neutropenic fever… and positive cultures that turn negative and signs of infection are gone and neutrophil count > 500

A

Continue antibiotics for 7 additional days

30
Q

Acute Lymphoblastic Leukemia

  1. Indolent or Aggressive
  2. Clinical findings (3)
  3. Treatment and cure rate
A
  1. HIGHLY Aggressive
  2. Younger patients with:
    • cytopenias
    • bulky lymphadenopathy
    • CNS involvement
  3. Stem cell transplant with 40% cure
31
Q

List some causes of pancytopenia (10)

A
  1. AML - blasts fill marrow
  2. Aplastic Anemia - empty marrow
  3. Myelodysplasia - excess apoptosis maturing cells
  4. PNH - Coca-Cola urine
  5. Myelofibrosis
  6. NHL
  7. Drugs
  8. HIV
  9. Low Vitamin B12 or folate
  10. Acute EtOH
32
Q

What is treatment for asymptomatic or mildly symptomatic patients with hyponatremia from SIADH (2)?

A
  1. Fluid restrict 500-1000 mL/d

2. Demeclocycline

33
Q

What are clinical features of Multiple Myeloma (5)?

A
  1. Calcium elevated
  2. Renal insufficiency
  3. Anemia
  4. Boney lytic lesions or osteopenia
  5. SPEP with monoclonal spike
34
Q

What are Auer rods and what do they indicate?

A
  1. Needle-shaped pink crystals in blast cell

2. Acute Myeloid Leukemia

35
Q

What should one think about in a patient with Multiple Myeloma who presents with acute onset of back pain?

A

Vertebral lytic lesion causing cord compression

36
Q

What malignancy is associated with a Rouleaux on blood smear?

A

Multiple Myeloma - occurs because of high protein

37
Q

What is R-CHOP?

A 
Rituximab
Cyclophosphamide
Doxorubicin
Vincristine
Prednisone
38
Q

Describe the staging for Lymphoma

A

Stage I - one group LN
Stage II - two groups LN, one side of diaphragm
Stage III - LN above and below diaphragm
Stage IV - Nonlymphoid organs: BONE MARROW, liver, lung

A - No B symptoms
B - Night sweats, fever, weight loss

39
Q

What side effect can Doxorubicin cause?

A

Dose-dependent irreversible cardiomyopathy

40
Q
  1. What is a medicine treatment option for relapsed and refractory Multiple Myeloma?
  2. What is a major side effect?
A

Bortezomib - painful peripheral neuropathy

41
Q

What is POEMS Syndrome?

A

POEMS - rare plasma cell dyscrasia with:

 * Polyneuropathy
 * Organomegaly
 * Endocrinopathy (hypogonadism)
 * Monoclonal Gammopathy
 * Skin manifestations
42
Q
  1. What are three clinical features of Paroxysmal Nocturnal Hemoglobinuria?
  2. What lab test is used to confirm the diagnosis?’
  3. What is treatment?
A
  1. Pancytopenia, hemolytic anemia (Coombs-negative, iron poor), and thrombosis
  2. Flow cytometry to detect CD55 and CD59 deficiency on cell surfaces, which help reduce RBC sensitivity to complement
  3. Eculizumab
43
Q
  1. Which clinical features do patients with CLL have that CML does not have (2)?
  2. What diagnostic test can be done for CLL?
A
  1. CLL with
    a. Rubbery lymphadenopathy
    b. Smudge cells
  2. Flow cytometry for monoclonal lymphocytes
44
Q
  1. What are complications of CLL (4)?

2. Which of these is treated with an infusion?

A
  1. Infections (most common cause of death)***
  2. Autoimmune Hemolytic Anemia
  3. ITP
  4. Richter’s Syndrome - transformation to aggressive non-Hodgkin lymphoma

***Treated with IVIG for immunoglobulinemia

45
Q

What are manifestations of Amyloidosis (8)?

A
  1. Autonomic dysfunction (orthostasis, delayed gastric, ED)
  2. Periorbital purpura
  3. GI macroglossia
  4. Heart failure from restrictive cardiomyopathy (low voltage EKG)
  5. Hepatomegaly from CHF or amyloid (high alkph, normal AST/ALT)
  6. Nephrotic renal insufficiency (severe proteinuria)
  7. Carpal tunnel and arthropathy
  8. Neuropathy (painful sensory, later motor)
46
Q

How is Amyloidosis diagnosed (2)?

A
  1. Biopsy (abdominal fat pad, rectal or duodenal mucosa) with Congo-red stain reveal apple-green birefringence
  2. Confirmation of AL with plasma cell dyscrasia

American Board of Internal Medicine COPY (15 decks)

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