Haematological Malignancies

Question 1

Recall the paediatric and adult thresholds for clinically significant lymphadenopathy

Answer 1

Adult >1cm or 1.5cm at level 2
Child > 2cm

Or any node that is persistent and has associated head and neck symptoms

Question 2

Outline 6 potential bacterial causes of cervical lymphadenopathy

Answer 2

1. Streptococcus Group A
2. Staph Aureus
3. Strep Pneumonia
4. Anaerobes e.g. Fusobacterium (teeth)
5. Bartonella - cat scratch disease
6. Note - Toxoplasmosis is a parasitic infection not a bacteria!

Question 3

Name the 4 main viral causes of cervical lymphadenopathy

Answer 3

1. Adenovirus
2. Rhinovirus
3. Coxsackie viruses A and B
4. EBV

Question 4

Name the most commonly implicated organism in atypical TB infection

Answer 4

Mycobacterium avium

Question 5

Outline the 4 most common types of metastatic nodes found in the neck

Answer 5

1. Mucosal squamous carcinoma
2. Thyroid cancer
3. Salivary gland cancer
4. Skin cancer (squamous or melanoma)

Question 6

Recall the 5 main types of cancer which may metastasise to the cervical lymph nodes

Answer 6

1. Breast
2. Stomach
3. Lung
4. Pancreas
5. Thyroid

Question 7

Recall the cell types that characterised Hodgkin’s and Non Hodgkin’s lymphoma respectively

Answer 7

Hodgkin’s - Reid Sternberg cells

Non Hodgkin’s - Diffuse or nodular abnormal lymphocytes

Question 8

Give an example of a low grade non hodgkin’s lymphoma

Answer 8

Follicular lymphomas

Question 9

Give 2 examples of high grade non hodgkin lymphomas

Answer 9

1. Diffuse large B cell lymphoma

2. Burkitt’s lymphoma

Question 10

Outline the 4 clinical stages of lymphoma

Answer 10

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 both above and below the diaphragm
Stage 4 - The lymphoma has spread beyond the lymph nodes to other organs e.g. Spleen, bone marrow, liver or lungs

Question 11

Define Reed-Sternberg cells

Answer 11

Large cells that are either multinucleated cells or have bilobed nuclei - characteristically seen in Hodgkin’s lymphoma

Question 12

Outline the bimodal distribution of Hodgkin’s Lymphoma

Answer 12

Seen in patients between 15-30 years of age or those older than 50 yrs

Question 13

Outline the 4 principle histological stages of Hodgkin’s lymphoma

Answer 13

1. Lymphoctye predominant
2. Nodular sclerosis
3. Mixed cellularity
4. Lymphocyte depleted

Question 14

What is the most common symptom associated with Hodgkin’s lymphoma?

Answer 14

Painless lymphadenopathy

Question 15

Recall the ‘B symptoms’

Answer 15

1. Fever
2. Weight loss
3. Night sweats

Question 16

Define the term leukaemia

Answer 16

Malignant neoplastic process involving one of the white blood cell lines

Question 17

Myeloid leukaemia involved what type of white blood cell?

Answer 17

Neutrophils

Question 18

Name the 2 most common forms of leukaemia in children and young adults

Answer 18

AML - Acute myeloid leukaemia

ALL - Acute lymphocytic leukaemia

Question 19

Suggest 3 potential risk factors for the development of lymphoma

Answer 19

1. Family history
2. Reduced immunity
3. Infection (EBV)

Question 20

Suggest 4 differentials for the development of purpuric/echymotic rashes

Answer 20

1. TTP - Thrombotic thrombocytopenic purpura
2. HUS - Haemolytic uraemia syndrome
3. Infections e.g. meningioccocal sepsis
4. Haemotalogical malignancy e.g. leukaemia

Question 21

Name the immunotherapy agent used in the treatment of diffuse large B cell lymphoma

Answer 21

Rituximab

Question 22

What are the FBC derangements associated with multiple myeloma?

Answer 22

1. Anemia

2. Thrombocytopenia

Question 23

Briefly outline the classical presentation of multiple myeloma

Answer 23

Older patient with significant back pain that is associated with anemia and hypercalcaemia

Question 24

What are Bence Jones proteins?

Answer 24

Monoclonal globulins that may be detected in the urine and are pathognomonic of multiple myeloma