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Oncology General
Oncology
| Question | Answer |
|---|---|
| Philadelphia chromosome | CML |
| Painless LAD (us. Neck or axilla), LAD in orderly fashion; “B” signs + pruritis; splenomegaly; LN pain after drinking alcohol | Hodgkins lymphoma |
| Fatigue, PM sweats, weight loss, painless LAD or neck mass: suggestive of: | Lymphoma |
| Painless LAD, Scattered; “B” signs = | Non-Hodgkins lymphoma |
| Most common leukemia | CLL |
| Acute leukemia: 80-90% children | ALL (usu dx at 3-7 yo) |
| Acute leukemia: Primarily adults | AML (median onset 60 yo) |
| most common Hodgkin Lymphoma | Nodular sclerosing (other: lymphocyte predominant, mixed cellularity, lymphocyte depletion) |
| B symptoms include: | Fever, night sweats, weight loss, fatigue |
| virus found in 40-50% of cases of Hodgkin Lymphoma | EBV |
| Rai system used to: | stage/prognosis of chronic leukemia/ CLL (WBC, HSM, anemia) (stage 0 prog > stage 4) |
| acute leukemia S/S | epistaxis, gingival bleed, menorrhagia; GN infxn/low WBC: pna & cellulitis; pain sternum/tib/femur; LA & HSM in ALL > AML |
| chronic leukemia pathophys: | CLL: clonal malig of B cells; CML: myeloproliferative dz |
| CML 3 phases | chronic, accelerated, acute (blast crisis: >30% blasts) |
| Richter syndrome = | 5% of CLL: isolated node => aggressive large-cell lymphoma |
| Ann Arbor system used to stage: | Hodgkin dz; degree of LN/ extralymphatic involvement |
| 90% NHL arise from: | B lymphs |
| MDS: risk factors include exposure to: | Benzene, radiation, chemotx agents (esp alkylating agents & anthracyclines) |
| Important to differentiate btw multiple myeloma and: | MGUS (monoclonal gammopathy of unknown significance) |
| Disorder in which bone marrow is replaced with scar tissue, leading to anemia | Myelofibrosis |
| Dz occurs when blood cells do not develop into mature cells, but rather stay in an immature stage within the BM | MDS |
| Etiology of multiple myeloma; assoc with: | Etiology unknown; assoc w/pesticides, paper production, leather tanning, exposure to radiation from nukes |
| Replacement of normal bone marrow by plasma cells leads to bone marrow failure = | Multiple myeloma |
| Malignancy of B lymphocytes | Waldenstrom’s Macroglobulinemia: overproduction of monoclonal macroglobulin (IgM antibody) |
| Hyperviscosity syndrome (N/V, visual disturbances, mucosal/ GI bleed); cold hypersensitivity, peripheral neuropathy, HSM, engorged retinal veins = | Waldenstrom |
| CML S/S | Fever (w/o infxn); bone pain; LUQ pain (enlarged spleen); night sweats; bleeding & bruising; petechiae; fatigue ; weakness |
| ALL prognosis | 80% of children will be cured with chemo; 20-40% of adults will be cured |
| AML Etiology | Poss: exposure to toxins (benzenes, radiation, chemotherapy) |
| Leukemias treated w/tumor lysis ppx | AML & CLL & NHL |
| Non-Hodgkin Dz types | Follicular; Burkitt; Diffuse lg B-cell; Marginal zone; Cutaneous T-cell; Anaplastic large cell |
| Oncologic emergencies | Febrile neutropenia; SVC syndrome; tumor lysis syndrome; hypercalcemia; cord compression (myelomas) |
| Can affect T or B lymphocytes | ALL |
| Bulky lymphadenopathy seen in: | CLL; NHL |
| Next-door dz | HL |
| Drenching night sweats | CLL, Hodgkins |
| Skin infxn/shingles: seen in: | CLL |
| Leukemias w/meningitis | AML/ALL |
| Immunoproliferative diseases | Waldenström; Multiple Myeloma; MGUS |
| Engorged retinal veins: seen in: | P vera; waldenstrom |
| Lytic lesions in the back or skull | Multiple myeloma |
| acute leukemia prognosis | >50% kids w/ALL cured w/CT (induction + consolidation); >70% AML adults <60 yo complete remission (40% cure) |
| CML tx | Gleevec (ST1571 = imatinib); allo BMT may be curative (>80% <40 yo) |
| CLL tx | CT, xrt for bulky adenopathy, tumor lysis Ppx (allopurinol), BMT; palliative, once dz is advanced |
| Hodgkin dz tx | xrt = initial for low risk stage; combo CT (ABVD) cures >50% |
| NHL tx | xrt for single LN; rituximab +/- CT (R-ICE/CHOP); tumor lysis ppx; allo BMT poss for aggressive dz |
| multiple myeloma tx | CT (lenalidomide, dex, doxorubicin); poss local xrt, auto BMT; bisphosphonates |
| Thalidomide may be part of tx for: | Myelofibrosis, MDS, multiple myeloma |
| Waldenstrom mgmt | If asx follow expectantly; Plasmapheresis for hyperviscosity; CT, poss BMT; median survival 3-5 yrs |
| Role of surgery in NHL | Diagnostic |
| Only curative tx for MDS | Allogeneic BMT |
| Most common mets from osteosarcoma are: | pulmonary |
| Osteosarcoma histologic subtypes (3) | Osteoblastic (most common). Chondroblastic. Fibroblastic |
| Osteosarcoma pathology | Malignant spindle cell => osteoid deposited btw trabeculae => destroys compact bone & replaces it w/abnormal callus & osteoid. Periosteal rxn: tumor lifts off periosteum |
| Osteosarcoma dx studies | X-ray. Radionuclide bone scan. CT to assess bony destruction. CT chest to r/o bony mets |
| Most common primary benign bone tumor | Osteochondroma (3:1 M:F). Mostly distal femur, proximal humerus, tibia, femur |
Created by:
Abarnard
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