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C. Year 3: SBOM > Lymphoma - Non-Hodgkin Lymphoma > Flashcards

Lymphoma - Non-Hodgkin Lymphoma Flashcards

1
Q

Non-hodgkin lymphoma (NHL) is essentially a tumour derived from lymphocytes, specifically B and T cells. What is the incidence of NHL?

1 - 2 / 100,000
2 - 2 / 10,000
3 - 2 / 1000
4 - 2 / 100

A

2 - 2 / 10,000
- doubled since 1970

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2
Q

Is Non-hodgkin lymphoma (NHL) or Hodgkin lymphoma more common?

A
  • NHL
  • account for >90% of lymphoid cancers
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3
Q

Is Non-hodgkin lymphoma (NHL) more common in developed or less developed countries?

A
  • developed countries
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4
Q

Non-hodgkin lymphoma (NHL) account for aprox 90% of all lymphoid cancers. Which of the following is the most common type of NHL?

1 - immature B cell
2 - mature B cell
3 - immature T cell
4 - mature T cell

A

2 - mature B cell
- most common sub-types are Diffuse Large B cell Lymphoma (DLBCL) and Follicular Lymphoma

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5
Q

B cells are the most common cause of Non-hodgkin lymphoma (NHL). Which of the following receptors on the B cell is involved in NHL?

1 - CD10
2 - CD20
3 - CD4
4 - CD8

A

2 - CD20
- medication can target CD20

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6
Q

Although T cell and natural killer cell lymphomas are rare, which ethnicity are more at risk of developing these?

1 - Caucasian
2 - Irish and Welsh
3 - Asia and Caribbean
4 - South East Asian

A

3 - Asia and Caribbean

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7
Q

Enteropathy associated T cell lymphomas are a rare form of Non-hodgkin lymphoma (NHL), but which ethnicity are more susceptible to this?

1 - Caucasian
2 - Irish and Welsh
3 - Asia and Caribbean
4 - South East Asian

A

2 - Irish and Welsh
- gut associated
- shared HLA types and coeliac risk

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8
Q

Burkitt’s lymphoma is a high-grade B-cell non-Hodgkin’s lymphoma that is rapidly growing and aggressive. There are 3 main types:

  • endemic
  • sporadic
  • immunodeficiency associated BL

However, they are all caused by which gene?

1 - MYC gene
2 - BCR-ABL gene
3 - BRAF gene
4 - HER2 gene

A

1 - MYC gene
- c-MYC
- myelocytomatosis oncogene
- Ch 8q24

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9
Q

Burkitt’s lymphoma is a high-grade B-cell non-Hodgkin’s lymphoma that is rapidly growing and aggressive. There are 3 main types:

  • endemic
  • sporadic
  • immunodeficiency associated BL

Which of the above subtypes of Burkitt’s lymphoma are all the following associated with?

1 - Equatorial Africa, Papua New Guinea, most common malignancy in childhood in these areas
2 - Epstein–Barr virus in all patients
3 - Jaw/other facial bones site for presentation in 50%
4 - Geographical distribution of endemic malaria a factor in pathogenesis (associated with chronic co-infection)

A
  • endemic
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10
Q

Burkitt’s lymphoma is a high-grade B-cell non-Hodgkin’s lymphoma that is rapidly growing and aggressive. There are 3 main types:

  • endemic
  • sporadic
  • immunodeficiency associated BL

Which of the above subtypes of Burkitt’s lymphoma are all the following associated with?

1 - seen throughout the world
2 - majority present with abdominal masses (ileo-caecal)
3 - Epstein–Barr virus in 30%
4 - commonly affects children (30-50% of childhood lymphoma) and adults (1-2% of adult lymphomas)

A
  • sporadic
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11
Q

Burkitt’s lymphoma is a high-grade B-cell non-Hodgkin’s lymphoma that is rapidly growing and aggressive. There are 3 main types:

  • endemic
  • sporadic
  • immunodeficiency associated BL

Which of the above subtypes of Burkitt’s lymphoma are all the following associated with?

1 - associated with HIV, can be a manifestation of AIDS
2 - Epstein–Barr virus 25-40%

A
  • immunodeficiency associated BL
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12
Q

Burkitt’s lymphoma is a high-grade B-cell non-Hodgkin’s lymphoma that is rapidly growing and aggressive. There are 3 main types:

  • endemic
  • sporadic
  • immunodeficiency associated BL

Which virus is commonly associated with all 3 subtypes of Burkitt’s lymphoma?

1 - HIV
2 - influenza
3 - EBV
4 - HPV

A

3 - EBV

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13
Q

Burkitt’s lymphoma is a high-grade B-cell non-Hodgkin’s lymphoma that is rapidly growing and aggressive. There are 3 main types:

  • endemic
  • sporadic
  • immunodeficiency associated BL

Which of the following would be a common finding on histology in Burkitts lymphoma?

1 - reed-sternberg cells
2 - hodgin cells
3 - starry sky appearance
4 - all of the above

A

3 - starry sky appearance
- very aggressive and highly proliferative disease so when packed together they appear like stars

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14
Q

To distinguish between Non-hodgkin lymphoma (NHL) or Hodgkin lymphoma we use a specific cell, what is this cell?

1 - reed sternberg cells
2 - cytomegalovirus
3 - aeur rods on blood smears
4 - raised basophils

A

1 - reed sternberg cells

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15
Q

Non-hodgkin lymphoma (NHL) is an umbrella term, but which of the following is required to reach a definitive diagnosis of the NHL sub category?

1 - MDT
2 - Morphology
3 - Immunophenotyping
4 - Genetic features (increasingly)
5 - Clinical features and stage
6 - all of the above

A

6 - all of the above

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16
Q

When comparing leakaemia and lymphoma, which is a solid and which is a liquid tumour?

A
  • leukaemia = liquid (blood)
  • lymphoma = solid (lymph nodes)
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17
Q

Typically in Non-hodgkin lymphoma (NHL), where do the tumours grown?

1 - deep lymph nodes
2 - mucosa-associated lymphoid tissue (MALT)
3 - superficial lymph nodes
4 - bone marrow

A

3 - superficial lymph nodes
- called nodal lymphomas
- 75% of patients present with this

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18
Q

Typically in Non-hodgkin lymphoma (NHL) tumours grow in the lymph nodes. However, when they grow elsewhere is called extra-nodal disease, which occurs in 50% of patients. All of the following are extra-nodal sites where lymphomas can occur. Which is the most common?

1 - skin
2 - sinuses
3 - GIT
4 - waldeyer ring

A

3 - GIT
- 50% of patients will have lymphoma here
- can cause obstruction and bowel symptoms
- most commonly occurs in stomach and is associated with Helicobacter pylori

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19
Q

Which of the following is NOT typically a systemic symptom of Non-hodgkin lymphoma (NHL)?

1 - fever
2 - weight gain
3 - night sweats
4 - pancytopenia

A

2 - weight gain
- typically causes weight loss and is a sign of disseminated disease

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20
Q

There are 2 subcategories of Hodgkin lymphoma:

  • Nodular lymphocyte predominant Hodgkin Lymphoma (NLPHL)
  • Classical Hodgkin Lymphoma (cHL)

Do both of these need to be treated immediately?

A
  • no
  • NLPHL is treated like a mild non-hodgkin lymphoma
  • essentially a monitor and see approach
21
Q

Mediastinal lymphadenopathy can be dangerous and is a medical emergency. Why can mediastinal lymphadenopathy cause a medical emergency?

1 - cardiomegaly
2 - obstruct pulmonary arteries
3 - superior vena cava obstruction
4 - increased afterload

A

3 - superior vena cava obstruction
- collateral veins are prominent to overcome blockage

22
Q

Superior vena cava obstruction (SVCO) can be a medical emergency in patients with mediastinal lymphadenopathy. Which of the following can occur due to SVCO?

1 - collateral veins are prominent to overcome blockage
2 - SOB and cough
3 - oedema (brain, neck, chest)
4 - headaches, confusion
5 - raised JVP
6 - facial plethora
7 - all of the above

A

7 - all of the above

23
Q

When trying to diagnose hodgkin and non-Hodgkin lymphoma, which of the following would NOT routinely be performed?

1 - FBC (Hb can be low)
2 - full lymph node examination
3 - renal/liver/bone profiles
4 - MRI
5 - lactate dehydrogenase
6 - Erythrocyte sedimentation rate (ESR) (typically raised)

A

4 - MRI
- typically perform a chest X-ray 1st to assess for mediastinal masses

  • LDH is a tumour marker in hodgkin lymphoma and cell turnover
24
Q

Which of the following is NOT a differential for lymphadenopathy, other than Hodgkin and non-Hodgkin lymphoma?

1 - infection (EBV, HIV, etc.)
2 - COPD
3 - tuberculosis
4 - lymphomas (HL and NHL)
5 - metastatic
6 - chronic lymphocytic leukaemia

A

2 - COPD

25
Q

What tests is used to make a definitive diagnosis in a patient with suspected Hodgkin lymphoma or non-Hodgkin lymphoma?

1 - core nodal biopsy, or whole node
2 - CT scan
3 - tumour markers in blood
4 - blood smear

A

1 - nodal biopsy
- used to confirm the presence of reed-sternberg cells

26
Q

Hodgkin and non-Hodgkin lymphoma need to be staged using FDG-PET/CT scans. There are 4 stages, stage I - IV based on the Lugano staging. Which of the following matches stage I?

1 - nodes on both sides of the diaphragm or nodes above the diaphragm with spleen involvement
2 - 1 node or a group of adjacent nodes
3 - additional non-contagious extralymphatic involvement
4 - >2 nodal groups on the same side of the diaphragm

A

2 - 1 node or a group of adjacent nodes

A or B is given with the stage

  • A = no symptoms
  • B = weight loss, fever and/or drenching night sweats
27
Q

Hodgkin and non-Hodgkin lymphoma need to be staged using FDG-PET/CT scans. There are 4 stages, stage I - IV based on the Lugano staging. Which of the following matches stage I?

1 - nodes on both sides of theI diaphragm or nodes above the diaphragm with spleen involvement
2 - 1 node or a group of adjacent nodes
3 - additional non-contagious extralymphatic involvement
4 - >2 nodal groups on the same side of the diaphragm

A

> 2 nodal groups on the same side of the diaphragm

  • can also include bulky disease
  • A = no symptoms
  • B = weight loss, fever and/or drenching night sweats
28
Q

Hodgkin and non-Hodgkin lymphoma need to be staged using FDG-PET/CT scans. There are 4 stages, stage I - IV based on the Lugano staging. Which of the following matches stage III?

1 - nodes on both sides of theI diaphragm or nodes above the diaphragm with spleen involvement
2 - 1 node or a group of adjacent nodes
3 - additional non-contagious extralymphatic involvement
4 - >2 nodal groups on the same side of the diaphragm

A

1 - nodes on both sides of theI diaphragm or nodes above the diaphragm with spleen involvement

  • A = no symptoms
  • B = weight loss, fever and/or drenching night sweats
29
Q

Hodgkin and non-Hodgkin lymphoma need to be staged using FDG-PET/CT scans. There are 4 stages, stage I - IV based on the Lugano staging. Which of the following matches stage IV?

1 - nodes on both sides of theI diaphragm or nodes above the diaphragm with spleen involvement
2 - 1 node or a group of adjacent nodes
3 - additional non-contagious extralymphatic involvement
4 - >2 nodal groups on the same side of the diaphragm

A

3 - additional non-contagious extralymphatic involvement

  • A = no symptoms
  • B = weight loss, fever and/or drenching night sweats
30
Q

In Non-Hodgkins lymphoma where the symptoms are insidious but are not causing the patient any symptoms, would we aim to cure these patients?

A
  • no
  • often wait and see approach
31
Q

In Non-Hodgkins lymphoma, typically if a patient has no symptoms we do not aim to cure and monitor instead. However, if the patient develops symptoms, we aim to address the symptoms. Which of the following are examples of this approach?

1 - if related to infection e.g. Mucosa-associated lymphoid tissue (MALT) lymphoma and H.Pylori, antibiotics to eradicate the infection is sufficient
2 - bulky disease (e.g. pressing on important organs) or symptoms then SACT with chemotherapy/targeted therapy/immunotherapy
3 - occasional role for radiotherapy
4 - all of the above

A

4 - all of the above

32
Q

In patients with high grade non-hodgkins lymphoma, do we always aim to cure?

A
  • yes
33
Q

In patients with high grade non-hodgkins lymphoma, we always aim to cure using Systemic Anti-Cancer Therapy (SACT). Which of the following is NOT typically part of the SACT therapy?

1 - surgery
2 - chemotherapy
3 - targeted therapy
4 - immunotherapy

A

1 - surgery

34
Q

In patients with high grade non-hodgkins lymphoma, we always aim to cure using Systemic Anti-Cancer Therapy (SACT). Which includes:

  • chemotherapy
  • targeted therapy
  • immunotherapy

Sometimes combined therapy is used which includes radiotherapy and chemotherapy. Which of the following are 2 examples of this?

1 - elderly patients who may not withstand the standard SACT
2 - if SACT is not available at tertiary centre
3 - if patient fails to meet the criteria for SACT
4 - earlier/limited stage disease

A

1 - elderly patients who may not withstand the standard SACT
4 - earlier/limited stage disease

  • typically chemotherapy is given followed by radiotherapy
35
Q

In patients with Burkitts lymphoma, do we always aim to cure?

A
  • yes
  • aggressive form that can impact upon the CNS
36
Q

In patients with Burkitts lymphoma, we always aim to cure. Which 2 of the following treatment modalities are often used in Burkitts lymphoma?

1 - immune therapy
2 - chemotherapy
3 - radiotherapy
4 - targeted therapy

A

1 - immune therapy
2 - chemotherapy

  • chemotherapy that crosses the BBB and is injected directly into spinal fluid
37
Q

Which of the following is NOT routinely checked prior to giving treatment for non-Hodgkins lymphomas?

1 - echocardiogram
2 - EEG
3 - creatine clearance (CrCl)
4 - advise on tumour lysis risk and risk in uric acid
5 - may need to take medications to clear uric acid
6 - hydrate

A

2 - EEG

38
Q

Patients with non-hodgkiun lymphoma may go into relapse following treatment. Which of the following would be used following the 1st relapse?

1 - palliative care
2 - enrol onto clinical trials for new treatments
3 - 2nd round of chemo, CAR-T or
autologous stem cell transplant

A

3 - 2nd round of chemo, CAR-T or
autologous stem cell transplant

CAR-T and autologous stem cell transplant BOTH have specific inclusion criteria

39
Q

Patients with non-hodgkiun lymphoma may go into relapse following treatment. Which of the following would be used following the 2nd relapse?

1 - palliative care
2 - enrol onto clinical trials for new treatments
3 - 2nd round of chemo, CAR-T or
autologous stem cell transplant

A

2 - enrol onto clinical trials for new treatments

  • anything beyond a 2nd relapse patients should receive palliative care
40
Q

Patients with Non-Hodgkins lymphoma will receive chemotherapy in an attempt to cure them. However, this can cause which of the following that is classed as a medical emergency?

1 - cardiogenic shock
2 - neutropneic sepsis
3 - hypovolaemic shock
4 - obstructive shock

A

2 - neutropneic sepsis
- chemotherapy wipes out all haemopoetic stem cells as well as the malignant cells
- essentially it leaves the body defenceless to infection and sepsis

41
Q

Neutropneic sepsis is a medical emergency in patients who may have received chemotherapy, such as Non-Hodgkins lymphoma. Are gram + or gram - most dangerous during neutropneic sepsis?

A
  • gram - bacteria
  • examples such as Escherichia coli, Klebsiella sp, Enterobacter sp, and Pseudomonas aeruginosa
42
Q

Neutropneic sepsis is a medical emergency in patients who may have received chemotherapy, such as Non-Hodgkins lymphoma. Gram - are the most dangerous during neutropneic sepsis. Which of the following should be implemented immediately in neutropneic sepsis?

1 - blood cultures
2 - fluid resuscitation
3 - broad spectrum antibiotics immediately
4 - inotropes based on ITU input
5 - all of the above

A

4 - inotropes based on ITU input
5 - all of the above

43
Q

What is the 5 year survival rate for Non-Hodgkin lymphoma?

1 - 24%
2 - 40%
3 - 74%
4 - 100%

A

3 - 74%

44
Q

Which type of Burkitts lymphoma is most strongly associated with Epstein Barr Virus?

1 - endemic Burkitts lymphoma
2 - sporadic Burkitts lymphoma
3 - immunodeficiency associated Burkitts lymphoma

A

1 - endemic Burkitts lymphoma
- all patients with this have EBV

45
Q

Which type of lymphoma is associated with a biomodal age distribution?

1 - Hodgkins lymphoma
2 - Natural Killer cell lymphoma
3 - Non-Hodgkin lymphoma
4 - T cell lymphoma

A

1 - Hodgkins lymphoma

46
Q

A starry sky histological appearance is seen in which of the following?

1 - Burkitts lymphoma
2 - Follicular lymphoma
3 - HIV
4 - Hodkins lymphoma
5 - T cell lymphoma

A

1 - Burkitts lymphoma

47
Q

Lymphoma staging is best performed using which of the following?

1 - bone marrow biopsy
2 - CT scan
3 - MRI scan
4 - FDG-PET/CT scan
5 - ultrasound

A

4 - FDG-PET/CT scan

48
Q

A 50 year old man is diagnosed with follicular lymphoma after a CT scan is done for other reasons. Lymph nodes are noted, but he has no other symptoms. How would you manage this patient?

1 - active surveillance
2 - CAR-T
3 - chemotherapy
4 - immunotherapy
5 - radiotherapy

A

1 - active surveillance

49
Q

Which type of Burkitts lymphoma is most strongly associated with Epstein Barr Virus?

1 - endemic Burkitts lymphoma
2 - sporadic Burkitts lymphoma
3 - immunodeficiency associated Burkitts lymphoma

A

1 - endemic Burkitts lymphoma
- all patients with this have EBV

C. Year 3: SBOM (50 decks)

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