Heme/Onco IV

Question 1

leukemia vs. lymphoma

Answer 1

leukemia - bone marrow involvement
-cells in peripheral blood

lymphoma - lymph node

Question 2

leukemoid rxn

Answer 2

inflammatory response to infection

WBC elevated with neutro and band cells - left shift

increased leukocyte alk phos

Question 3

leukemoid rxn vs. CML

Answer 3

WBC elevated with band cells - left shift - in both

CML - no LAP
LR - elevated LAP - leukocyte alk phos

Question 4

hodgkin lymphoma

Answer 4

local group nodes

prognosis - stage - better than NHL

reed sternberg cells

bimodal distribution

EBV association

Question 5

non-hodgkin lymphoma

Answer 5

multiple peripheral nodes
extranodal involvement

majority B cells

incidence peak 20-40yo

HIV and autoimmune association

Question 6

reed stern berg cells

Answer 6

owl eyes

hodgkin lymphoma

CD15 and CD30 positive

better prognosis - stromal or lymph rxn to RS cells
-lympho rich - best prognosis

Question 7

burkitt lymphoma

Answer 7

t (8;14)
c-myc on 8 with heavy chain (14)
starry scar

endemic - jaw - african

associated with EBV

Question 8

diffuse large B cell lymphoma

Answer 8

older adults

MC type NHL in adults

Question 9

follicular lymphoma

Answer 9

t (14;18)
BCL2 and heavy chain

Bcl2 inhibit apoptosis

wax and wain painless lymphadenopathy

Question 10

mantle cell lymphoma

Answer 10

older males

t (11;14)
translocation cyclin D1 with heavy chain

CD5 positive

Question 11

sezary syndrome

Answer 11

mycosis fungoides

skin patch and plaque

cutaneous T cell lymphoma

atypical CD4 cells - cerebriform nuclei

Question 12

multiple myeloma

Answer 12

plasma cell - fried egg
-clock face

lots of IgG

AL - primary amyloid

punched out bone lesion

M spike

Ig light chain - bence jones proteinuria

rouleaux formation

Question 13

monoclonal gammopathy of undetermined significance

Answer 13

MGUS

monoclonal expansion of plasma cells

develop multiple myeloma at rate of 1-2% per year

Question 14

waldenstrom macroglobulinemia

Answer 14

M spike - IgM - vs. IgG (MM)

hyperviscous syndrome

blurry vision
raynauds

Question 15

pseudo pelger huet anomaly

Answer 15

neutrophil with bilobed nuclei

after chemo

Question 16

T cell ALL

Answer 16

mediastinal mass

with dow syndrome

Question 17

TdT

Answer 17

marker pre T and B cells

Question 18

CD10

Answer 18

only pre-B cell

Question 19

t(12;21)

Answer 19

better prognosis for ALL

Question 20

CLL

Answer 20

elderly

MC adult leukemia

CD20 and CD5 positive - B cells

smudge cells

Question 21

SLL - small lymphocytic leukemia

Answer 21

same as CLL

but CLL - higher peripheral blood lymphomcytosis

Question 22

hairy cell leukemia

Answer 22

mature B cell tumor in elderly

dry tap on aspiration

TRAP positive

Question 23

tartrate resistant acid phosphatase

Answer 23

TRAP

positive in hairy cell leukemia

Question 24

tx hairy cell leukemia

Answer 24

cladribine

pentostatin

Question 25

AML

Answer 25

65yo auer rod - M3 subtype increased myeloblasts on peripheral smear -

Question 26

t(15;17)

Answer 26

M3 AML all trans retinoic acid - vit A induce differentiation of myeloblasts

Question 27

CML

Answer 27

t (9;22) BCR-ABL fusion - philly blast crisis splenomegaly low LAP - low activity mature granulocytes

Question 28

imatinib

Answer 28

tx of CML BCR-ABL tyrosine kinase inhibitor

Question 29

all-trans retinoic acid

Answer 29

tx of M3 AML t (15;17)

Question 30

langerhans cell histiocytosis

Answer 30

disorder of dendrites lytic bone lesion - in child birbeck granule S-100 positive - mesodermal origin CD1a

Question 31

JAK2 mutation

Answer 31

hematopoietic growth factor signaling mutation in chronic myeloproliferative disorders (not CML)

Question 32

polycythemia vera

Answer 32

increased hematocrit JAK2 mutation itching after shower secondary - due to EPO level increase

Question 33

essential thrombocytosis

Answer 33

overproduction of platelets - abnormal bleeding and thrombosis bone marrow - large megakaryocytes

Question 34

myelofibrosis

Answer 34

obliteration of bone marrow -fibroblast activity teardrop RBCs - and dry tap

Question 35

relative polycythemia

Answer 35

dehydration and burn - decreased plasma volume

Question 36

appropriate absolute polycythemia

Answer 36

lung disease heart disease high altitude see more RBC with low O2 sat and elevated EPO

Question 37

inappropriate absolute polycythemia

Answer 37

see more RBC and no decreased O2 sat and elevated EPO renal cell carcinoma hepatocellular carcinoma hydronephrosis ectopic EPO