Lymphadenopathy

Question 1

What is characteristic of benign lymphadenopathy

Answer 1

Swollen, tender, large lymph nodes

Question 2

What characteristics are characteristic of lymphoma

Answer 2

Rubbery and moveable, nontender

Question 3

What characteristics are characteristic of metastatic disease

Answer 3

Hard, nonmobile, nontender.

Question 4

What are the 2 red flags in history of lymphadenopathy

Answer 4

1. Duration >2 weeks
2. Unresponsive to antibiotics

Question 5

What symptoms are suggestive of malignancy

Answer 5

B symptoms (fever, night sweats, weight loss)
All suggestive of lymphoma

Question 6

Anterior cervical vs posterior cervical lymph node infection causes

Answer 6

Anterior cervical- bacterial pharyngitis (group A strep)
Posterior Cervical- EBV (mono)

Question 7

What is the common cause of supraclavicular lymph nodes

Answer 7

Malignancy until proven otherwise

Question 8

Left versus right supraclavicular node

Answer 8

Left- Virchow’s node (malignancy of stomach, gallbladder, pancreas)
Right: Mediastinum, lung

Question 9

Most common lymph node characteristics

Answer 9

Firm, fixed, non-tender, rapidly enlarging

Question 10

Are mobile or fixed lymph nodes more concerning?

Answer 10

Fixed is more concerning, says that the pathology has spread

Question 11

Is warmth or regular temperature more concerning in lymph nodes?

Answer 11

Regular temperature/no warmth is more concerning. Inflammation due to infection is less concerning

Question 12

Texture differences in lymph nodes and concern level with each

Answer 12

Squishy/fluctuating- suggests infections and inflammatory
Rubbery– suggests lymphoma
Hard- Suggests malignancy

Question 13

Which cells are a key characteristic of Hodgkin lymphoma

Answer 13

Reed-Sternberg cells on biopsy

Question 14

A versus B symptoms for hodgkin lymphoma

Answer 14

A- patients lack constitutional symptoms
B- B symptoms ( fever, night sweats, weight loss >10% of BW)

Question 15

Where are Reed-Sternberg cells found/which disease?

Answer 15

Hodgkin’s lymphoma

Question 16

ABVD side effects

Answer 16

• Decreased Blood Counts
• Hair loss
• Nausea/Vomiting
• Neuropathy
  (LOW WBC and low Hgb)

Question 17

What do you use to treat Hodgkin lymphoma

Answer 17

ABVD- cardiotoxic, called red devil

Question 18

Most common side effects of immunotherapy

Answer 18

Due to immune response- T cells attack cancer, but can cause thyroiditis, dermatitis, colitis, pneumitis
- Rash
- Diarrhea
- Fatigue
-Diabetes, Hepatitis
Side effect of immune checkpoint inhibitors (Induce autoimmune response to use our own immune system to kill cancer)

Question 19

Which type of lymphoma uses immunotherapy

Answer 19

Hodgkin’s lymphoma

Question 20

Which immunotherapy drugs are used to treat hodgkin’s lymphoma

Answer 20

Checkpoint inhibitors (PD1 inhibitors) Nivolumab (Opdivo) and Pembrolizumab (Keytruda)

Question 21

What are non-Hodgkin lymphomas categorized into

Answer 21

Low grade/indolent lymphomas vs high grade/Aggressive lymphomas

Question 22

What are you primarily ordering a chest xray for if your patient has non-hodgkin lymphoma

Answer 22

mediastinal masses, which is an oncological emergency

Question 23

Low grade treatment for non-hodgkin lymphoma

Answer 23

Local radiation
chemotherapy

Question 24

High grade treatment for non-hodgkin lymphoma

Answer 24

Treatment is urgent
Myelosuppressive chemo
Radiation
SCT or CAR-T

Question 25

Primary site of disease in leukemia vs lymphoma

Answer 25

Leukemia- bone marrow Lymphoma- Lymph nodes

Question 26

What are the hallmarks of multiple myeloma

Answer 26

CRAB Plasma cell infultration--> end organ damage--> HypERcalcemia, lytic bone lesions, anemia, renal dysfunction C-HyperCALcemia R- Renal dysfunction A-Anemia B-Bone lesions

Question 27

What is the greatest risk factor for developing multiple myeloma

Answer 27

Age

Question 28

What are 4 hallmark symptoms of Multiple myeloma

Answer 28

Symptoms of hypercalcemia Kidney infection, oliguria Anemia- FATIGUE Bone pain C-HyperCALcemia R- Renal dysfunction A-Anemia B-Bone lesions

Question 29

Is multiple myeloma cureable?

Answer 29

NO it is incurable-- prognosis is poor, even with good advances in medicines

Question 30

Hypercalcemia symptoms

Answer 30

Bones (Abnormal bone remodeling, fracture risk) Stones (Increased risk for kidney stones) Groans (abdominal cramping, constipation) Psychiatric overtones (lethargy, depression)

Question 31

Hallmark Labs of multiple myeloma

Answer 31

- Anemia (Normocytic, normochromic, rouleaux formation on smear) -Hypercalcemia -Kidney injury- elevated creatinine -X-ray- osteolytic bone lesions ***Serum protein electrophoresis- M spike

Question 32

What results do you see on an SPEP for multiple myeloma

Answer 32

Albumin highest, gamma furthest away (M spike)

Question 33

Stacked coins on a peripheral blood smear indicates which disorder

Answer 33

Multiple myeloma High gamma gobulins brings the RBCs together into a stacked coin apperance (Rouloux red blood cells)

Question 34

Your patient has punched out lesions on their x ray. which disease is this characteristic of?

Answer 34

Multiple myeloma

Question 35

Myeloma is cureable, true or false?

Answer 35

False- prognosis is poor, but many treatments for palliative care

Question 36

What do you use CAR-T for

Answer 36

Acute Lymphoblastic Leukemia (ALL) Non-Hodgkin lymphoma

Question 37

When do you use an immunotherapy with Leukemia/Lymphoma

Answer 37

Hodgkin's Lymphoma

Question 38

Your patient is complaining of red body fluids. Which medicine should you confirm they are on?

Answer 38

Chemotherapy- Red Devil- ABVD for Hodgkin lymphoma