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Hematology Oncology > Oncology > Flashcards

Oncology Flashcards

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0
Q

History and PE of acute leukemias

A

Rapid onset w/ si/sx of anemia (pallor, fatigue), thrombocytopenia (petechiae, purpura, bleeding), and bone pain (medullary expansion and periosteal involvement)
Hsm and swollen/bleeding gums

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1
Q

Blasts

A

immature blood cells

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2
Q

BM findings in acute leukemia

A

BM with 20-30% blasts
AML = myeloblasts
ALL = lymphoblasts

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3
Q

AML vs ALL blasts appearance

A

AML: large, uniform myeloblasts with round or kidney-shaped nuclei and prominent nucleoli
ALL: large, uniform lymphoblasts- large cells w/ high N:C ratio

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4
Q

Leukostasis

A

Occurs when WBC is very high

Blasts occlude the microcirculation -> pulmonary edema, CNS symptoms, ischemic injury, and DIC

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5
Q

Leukemoid reaction vs. CML

A

Both have increased WBC count, but leukemoid reaction has increased LAP
Leukemoid reaction: leukocytosis 2/2 infection/sepsis

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6
Q

Auer rods

A

Rods present in APL

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7
Q

APL treatment

A

all-trans retinoic acid

-ATRA therapy

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8
Q

APL associations

A

Increased incidence of DIC

Chromosomal translocation: q15,17

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9
Q

Treatment of acute leukemia

A

Patients should be well hydrated prior to therapy
High WBC = start allopurinol to prevent TLS
Chemotherapeutic agents; antibiotics, transfusions, and colony-stimulating factors are also used
BM transplantation may be required for those who do not achieve remission

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10
Q

Treatment of leukostasis

A

Hydroxyurea +/- leukopharesis to rapidly decrease the WBC

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11
Q

Ages of leukemia

A

0-20: ALL
20-40: AML
40-60: CML
60-80: CLL

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12
Q

CLL

A

Clonal proliferation of functionally incompetent lymphocytes
-accumulates in BM, blood, LN, spleen, liver

Involves well-differentiated B cells

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13
Q

Diagnosis of CLL

-cell markers

A 
Biopsy is rarely required for diagnosis
Clinical picture (fatigue, malaise, infection, LAD, splenomegaly)
Flow cytometry: CD5, CD20, CD2 positive together (normally CD5 is T cell specific while CD20 and CD2 are B cell specific)

Peripheral smear: abundance of small, normal appearing lymphocytes and ruptured smudge cells on smear
-smudge cells 2/2 cover slip crushing fragile leukemic cells

Labs: granulocytopenia, anemia, thrombocytopenia 2/2 marrow infiltration

Abnormal leukemic function = hypogammaglobulinemia

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14
Q

Tx of CLL

A

Palliative treatment, often withheld until pts are symptomatic
-ie recurrent infection, anemia, thrombocytopenia, splenomegaly, LAD

Tx: chemo
Not curable, but long dz-free intervals can be achieved

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15
Q

CML

A

Clonal proliferation of myeloid progenitor cells -> leukocytosis with excess granulocytes and basophils
-sometimes increased erythrocytes and platelets also

CML = BCR-ABL translocation must be present (Philadelphia chromosome of q(9,22)

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16
Q

Sx of CML

A

Anemia, splenomegaly (LUQ pain and early satiety), hepatomegaly, constitutional symptoms

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17
Q

Disease phases of CML

A

Chronic: without treatment, usually anemia, splenomegaly, constitutional symptoms

Accelerated: transition to blast crisis -> increased peripheral and BM blood counts
-suspected when diff shows abrupt increase in basophils and thrombocytopenia

Blast crisis: resembles acute leukemia

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18
Q

Blast crisis

A

Occurs in CML
Increased basophils and thrombocytopenia
Resembles acute leukemia

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19
Q

Granulocytes in all stages of maturation

A

CML

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20
Q

Lab values in CML

A

Low LAP

High LDH, uric acid, and B12levels

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21
Q

Diagnosis of different leukemias

A

Acute: Circulating blasts in the peripheral blood, leukocytosis
CLL: Flow cytometry, lymphocytosis, granulocytopenia, anemia, thrombocytopenia, smudge cells
CML: luekocytosis (very high), granulocytes in all stages of maturation

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22
Q

Treatment of CML

A

Chronic: Imatinib, a non-receptor tyrosine kinase inhibitor

Blast crisis: same as for acute leukemia; can also involve dasatinib + stem cell transplantation

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23
Q

Hairy Cell Leukemia

Study These Flashcards
A

Malignancy of well-differentiates B lymphocytes, usually affects older males
Presents: pancytopenia, BM infiltration, splenomegaly
Hx: weakness, fatigue, bruising and petechiae, infection (esp w/ MAC), abdominal pain, early satiety, weight loss

24
Dx of Hairy Cell Leukemia
Hairy cells in the blood, marrow, or spleen TRAP staining: tartrate-resistant acid phosphatase staining of hairy cells, electron microscopy, and flow cytometry are helpful in distinguishing hairy cells CBC: leukopenia Peripheral smear: hairy cells OR monocytes with abundant pale cytoplasm and cytoplasmic projections
25
Treatment of Hairy Cell Leukemia
10% don't need therapy Those who develop progressive pancytopenia and splenomegaly need therapy -mainstay = nucleoside analogs ie cladribine Can also use splenectomy and IFN-a
26
Non-Hodgkins Lymphoma definition
Diverse group of diseases characterized by progressive clonal expansion of B cells, T cells, and/or NK cells -2/2 chromosomal translocation especially t(14,18), the inactivations of tumor suppressor genes, or the introduction of exogenous genes by oncogenic viruses
27
MALT gastric lymphoma
a/w H pylori infection
28
Origin of most NHLs
B cell origin
29
NHL disease staging
Ann Arbor classification | Based on number of nodes and whether the disease involves sites on both ides of the diaphragm
30
Hodgkins Disease definition
Predominantly B cell malignancy with an unclear etiology Types: -nodular sclerosing: peak in the 3rd decade -lymphocyte-depleting type: peak around age 60
31
Pel-ebstein fevers
1-2 weeks of high fever alternating with 1-2 afebrile weeks | -rare sign specific for Hodgkin's disease
32
Alcohol induced pain
Rare sign specific for Hodgkin's disease
33
Anemia + bone pain + renal failure
Multiple myeloma
34
Multiple myeloma: which cells
Clonal proliferation of malignant plasma cells, which then produce excessive Ig (IgA or IgG0 or Ig fragments
35
Diagnosis of Multiple Myeloma
>10% plasma cells in the bone marrow lytic bone lesions M protein
36
M proteins
Present in MM, MGUS, CLL, lymphoma, Waldenstrom's macroglobulinemia, and amyloidosis
37
Diagnostic tests for multiple myeloma
Skeletal survey, bone marrow biopsy, UPEP, SPEP,CBC
38
Treatment of Multiple Myeloma
Chemotherapy: melphalan + prednisone + other agents Melphalan = oral alkylating agent
39
Waldenstrom's macroglobulinemia
Clonal B cell disorder -> malignant monoclonal gammopathy Elevated IgM -> hyperviscosity syndrome, coagulation abnormalities, cryoglobulinemia, cold agglutinin disease (autoimmune hemolytic anemia), and amyloidosis
40
Cryoglobulinemia
IgM disorder usually seen in HCV | Palpable purpura + proteinuria + hematuria + arthralgias + hsm + hypocomplementemia
41
Cold agglutinins
IgM disorder which causes numbness upon cold exposure | -seen with EBV, mycoplasma infection, and Waldenstroms
42
Waldenstrom's symptoms
Lethargy, weight loss Raynaud's phenomenon Neuro problems: AMS, sensorimotor peripheral neuropathy, blurry vision Organ dysfxn affecting skin, GI, kidneys, lungs MGUS is a precursor
43
Waldenstrom's diagnosis
Labs: elevated ESR, uric acid, LDH, and alk phos BM biopsy: abnormal plasma cells with Dutcher bodies -Dutcher bodies = PAS + IgM deposits around the nucleus SPEP and UPEP and immunofixation are helpful
44
Treatment of Waldenstrom's
Plasmapharesis to remove excess IgG | Chemo to treat underlying pathology
45
Amyloidosis | -definition and classification
Extracellular deposition of protein fibrils Types: - AL: plasma cell dyscrasia. deposition of monoclonal light chains. a/w MM and Waldenstroms - AA: deposition of acute phase reactant serum amyloid A. a/w chronic inflammatory dz ie rheumatoid arthritis, infections, and neoplasms - Dialysis related: deposition of B2 microglobulin which accumulates in patients with long term dialysis requirements - Heritable: deposition of abnormal gene products ie transthyretin which is prealbumin; heterogenous group of disorders - Senile-systemic deposition of otherwise normal transthyretin
46
Major sites of amyloid deposition
Kidneys, heart, liver
47
Amyloidosis diagnosis
Tissue biopsy showing apple green birefringence on Congo red stain under polarized light
48
Definition of neutropenia
ANC < 1500
49
Acute neutropenia infections
S aureus, Pseudomonas, E. coli, Proteus, Klebsiella sepsis
50
Chronic/autoimmune neutropenia infections
Recurrent sinusitis, stomatitis, gingivitis, perirectal infection
51
Treatments for neutropenic fever
Broad spectrum antibiotics ie cefipime Anti-fungals G-CSF to shorten duration of neutropenia IVIG and allogenic BM transplant can help
52
Causes of secondary eosinophilia
``` NAACP Neoplasm Allergies Asthma Collagen vascular disease Parasites ```
53
CSF eosinophilia
Suggestive of drug reaction or infection with cocci or a helminth
54
Hematuria + eosinophilia
Schistosomiasis
55
Hyperacute transplant rejection | -timing, pathophys, tissue findings, prevention, tx
``` Timing: Within minutes Pathophys: 2/2 preformed antibodies Tissue findings: vascular thrombi; tissue ischemia Prevention: check ABO before Tx: cytotoxic agents ```
56
Acute transplant rejection | -timing, pathophys, tissue findings, prevention, tx
Timing: 5 days - 3 months Pathophys: T-cell mediated Tissue findings: tissue destruction ie increased GGT, alk phos, LDH, BUN, or Cr Prevention: n/a Tx: confirm w/ sampling of tissue; tx with corticosteroids, antilymphocyte antibodies ie OKT3, tacrolimus, or MMF
57
Chronic transplant rejection | -timing, pathophys, tissue findings, prevention, tx
Timing: months to years Pathophys: Chronic immune reaction causing fibrosis Tissue findings: gradual loss of organ function Prevention: n/a Treatment: No treatment
58
Graft vs Host Disease
T cells from the donor organ starts to attach the person needing the transplant -affected tissues include skin, liver, GI Timing: acute = 100 days Pathophys: 2/2 MHC incompatibilitiy Sx: skin changes, cholestatic liver dysfunction, obstructive lung disease, GI problems Tx: high-dose corticosteroids

Hematology Oncology (3 decks)

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