Hubbard 1 CIS

Question 1

causes of leukocytosis

Answer 1

• benign causes more common than malignant causes!!
• anything that can cause inflammation can cause leukocytosis!
• drugs!!! (glucocorticoids)

Question 2

pts who smoke might have what?

Answer 2

neutrophilia

Question 3

causes of neutropenia

Answer 3

• benign causes much more common than malignant
• infections, esp viruses
• drugs!!

Question 4

neutropenia- other causes?

Answer 4

• medications
• nutritional deficiencies
• sequestration

Question 5

old person marrow

Answer 5

-takes longer for bone marrow to release white cells

Question 6

acute and chronic leukemia

Answer 6

• acute- immature precursor cells (blast cells)

- chronic- more mature appearing cells

Question 7

Leukemia- etiology

Answer 7

• toxins, drugs, chemicals
• benzene- AML!!
• treatment-related AML (pts who received chemotherapy for other cancers)
• alkylators!!
• radiation (except CLL)
• virus-mediated chromosomal alterations
• hereditary dz
• myelodysplastic syndromes

Question 8

older pts with mild pancytopenia and macrocytosis- dx?

Answer 8

-myelodysplasia or early AML!!

Question 9

philadelphia chromosome

Answer 9

• major genesis- chromosomal damage
• CML
• chrom 9 and 22 translocation

Question 10

cornerstone dx in all leukemias

Answer 10

-chromosomal studies (cytogenetics)

Question 11

acute leukemia- clinical presentation

Answer 11

• rapid onset

- if untreated- median survival is <3 months

Question 12

chronic leukemia- clinical presentation

Answer 12

• very slow onset, chronic course

- 1/2 of pts with CLL are still alive and have not required tx 6 yrs after dx

Question 13

leukemia- presentation

Answer 13

• fever, easy bruising, fatigue, weight loss, SOB
• acute leukemias- bone pain
• chronic- usually asymptomatic

Question 14

Sweet’s syndrome

Answer 14

(AFND- acute febrile neutrophilic dermatosis)

• cutaneous manifestation of AML
• bx shows myeloblasts in dermis
• tx- management of AML

Question 15

Auer rods

Answer 15

• azurophilic rods in cytoplasm in pts with AML

- resemble a bundle of sticks (fagot cells)

Question 16

gingival hypetrophy

Answer 16

-most common in M4 and M5 variants (monocytic) variants of AML

Question 17

smudge cells

Answer 17

-in CLL

Question 18

DIC in what pt? tx? cytogenetic?

Answer 18

acute promyelocytic leukemia

• fibrinogen low, D-dimer elevated
• tx- ATRA (all-trans retinoic acid)
• t(15;17)

Question 19

leptomeningeal carcinomatosis- in who? cytogenetic? tx?

Answer 19

• in 30% of pts with ALL- diplopia is a sx
• t(4;11)
• intrathecal methotrexate!!

Question 20

AML- M1 and M2- cytogenetics

Answer 20

-t8;21

Question 21

myelodysplastic syndrome- cytogenetics

Answer 21

• trisomy 8
• 7q-
• inversion 16

Question 22

how to evaluate a lymphoproliferative disorder

Answer 22

-peripheral blood lymphocyte flow cytometry

Question 23

TRAP stain of peripheral blood lymphocytes- used for?

Answer 23

-HAIRY cell leukemia!

Question 24

RAI stage- (for CLL)- peripheral blood flow cytometry

Answer 24

• 0- lymphocytosis
• 1- plus lymphadenopathy
• 2- plus hepatosplenomegaly
• 3- plus anemia (Hg < 11)
• 4- plus thrombocytopenia (platelets < 100,000)

Question 25

CLL- tx?

Answer 25

-observation (if indolent- may never require tx

Question 26

lymphoma- clinical pearls

Answer 26

- LNs are non-tender, rubbery - pain in LNs after beer drinking (in HL) - back pain, leg edema- suggest retroperitoneal LN enlargement

Question 27

Richter's syndrome

Answer 27

- CLL- develops into diffuse large B-cell lymphoma | - tough to kill

Question 28

B symptoms

Answer 28

- fever, drenching night sweats, 10% weight loss in last 6 months - likely paraneoplastic - worse prognosis

Question 29

inc risk for primary CNS lymphoma?

Answer 29

-immunosuppressed pts

Question 30

lymphomas can be linked to an infectious agent

Answer 30

- EBV- HD, Burkitt | - H pylori- gastric MALT lymphoma

Question 31

cervical adenopathy- consider?

Answer 31

-infection, lymphoma, unusual disorders (Kikuchi dz, TB)

Question 32

Hodgkin lymphoma- tx?

Answer 32

- early stage- radiation | - late stage- chemotherapy

Question 33

Burkitt lymphoma- cytogenetifsc

Answer 33

t8;22

Question 34

Ann Arbor stage (for lymphomas)

Answer 34

- 1A- 1 LN on 1 side of diaphragm - IIA- 2 noncontiguous LNs on 1 side of diaphragm - IIIA- both sides of diaphragm - IVA- mult sites on both sides of diaphragm OR bone marrow involvement!