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Bone Marrow Failure
Clinical Medicine II
| Question | Answer |
|---|---|
| Three types of malignant neoplasms | leukemia, lymphoma, multiple myeloma |
| Bone marrow failure | aplastic anemia, myelodysplastic syndrome |
| Myeloproliferative conditions | polycythemia vera |
| Tumors of hematopoietic and lymphoid tissue | malignant neoplasms |
| 4 classifications of malignant neoplasms | morphologic, immunophenotypic, genetic, clinical features |
| Diff b/w acute and chronic leukemia | acute: undifferentiated, rapid, chronic: mature cells, prolonged onset |
| Lymphoid cells, types leukemia, and other cancers | t and b cells, ALL, CLL, lymphoma: hodgin, NHL, Multiple myeloma |
| Myeloid cells, types | granulocytes, monocytes, AML, CML |
| Tumor involving lymph tissue | lymphoma |
| Two most common types of leukemia in adults, peds | AML and CLL Peds: ALL |
| In general what leads to leukemia | chromosomal translocations→activate oncogenes and ↓Tumor Suppressor genes |
| What happens within the cell | nl cell development arrested, rapid proliferation of tumor cells→↓apoptosis so may cells, nl cells can’t form |
| What are the 3 results w/I the body | anemia, thrombocytopenia, neutropenia |
| Causes or etiology of leukemia | exposures: carcinogenic, radiation, chemo,benzene, hair dyes, genetic, pesticides |
| What congenital d/oss predisposed for leukemia | down syndrome, congenital neutropenia, fanconi anemia, neurofibromatosis |
| D/O of blood and blood forming organs | leukemia |
| Fatigue, weakness doe, dizziness | anemia |
| Infections/fever, oral throat, respiratory, uti, skin infx | neutropenia |
| Bleeding-skin, bums, mucous membranes, GI, GU, brusing | thrombocytopenia |
| Reasons for bone pain, LUQ pain | medullary bone marrow cancer, splenomegaly |
| What is a painless mass | lymphadenopathy |
| What are B symptoms | generalized wt loss, fever, drenching night sweats |
| Signs of leukemia | anemia, neutropenia, thromobycytopenia: petchiae, eccymoses, spleen, liver enlargement and lymphadenopathy |
| How do we Dx leukemia | CBC: anemia, neutropenia, thrombocytopenia Peripheral smear: could see proliferation specific cells, dx lineage. bone marrow aspirate |
| Diagnosis for AML, CML, ALL, CLL | auer rods, Philidelphia chromosome, CLL: smudge cells |
| When is CML seen | middle aged |
| Tx in general for leukemia | supportive therapy, chemo, HSCT, observation |
| Three stages of chemo | (remission) indusction, consolidation: post remission therapy, maintenance therapy |
| What should we monitor for w/ chemo | cytopenias: infx, bleeding, tumor lysis syndrome |
| Most electrolytes are elevated→renal failure | tumor lysis syndrome |
| 3 ways to use HSCT | bone marrow, peripheral blood, umbilical core blood |
| What is autologous and allogenic mean | autologous: self, allogenic: someone else: problem: graph vs. host dz |
| 3 phases of CML | initial: chronic, Accerlerated phase (transitional), blastic phase: similar to acute |
| What is associated w/ Philadelphia chromosome | CML 9 and 22 cross over aka BCR-ABL gene |
| Two types of lymphoid neoplasms | lymphocytic keukemia ALL, CLL and lymphoma: Hodking and Non Hodgkin lymphoma |
| What are proliferation of lymphoid cell lines in the bone marrar and peripheral blood | lymphocytic leukemia |
| Wjere does lymphocytic leukemia infiltrate | into lymph organs, such as lymph nodes, spleen, liver: can present w/ mas |
| Two types of lymphoid leukemias | ALL: 85%B cell 15% T cell and CLL: B cell 90% both may/may not have a lesion |
| Symtoms include for ALL | mild b symptoms, bone pain, HSM , LAD, CNS, mediastinal mass |
| Symptoms included for CLL | painless LAD, B symptoms, HSM, skin |
| What is lymphoma | a lymphoid tissue mass, two main types: Hodgkin and non Hodgkin (all others) |
| What are reed-sternberg cells associated with | hodgkin lymphoma |
| What is HL associated with | EBV, immunosuppression, familial link: exposures and genetics |
| Clinical signs of HL | nontender lymphadenopthay: cervical and supraclavicular, Mediastinal mass: SOB, B sxs, pruritus, splenomegaly |
| Dx of HL | CBC often nl, lymph node biopsy ++ for reed-sternberg cells |
| HL tx | radiation alone, chemo alone, combined often very high survival |
| Main dx of HL | lymph node progression in order, and reed-sternberg cells, involves B cells |
| Malignant solid tumors of lymph tissue | can begin in any region of lymphatic sxs: Non-hodgkins lymphoma |
| Types of NHL | small lymphocytic lymphoma, mantle cell lymphoma, burkitt lymphoma, large B;cell lymphoma, involves many types of cells |
| When do you biopsy a lymph node | >2cm, persistence >4-6weeks, progressive increase in size |
| NHL presentation | lymphadenopathy, HSM, B sxs, fever unknown origin |
| What will t-cell involvement present as | skin rash and pruritis |
| Sxs associated w/ extranodal tissues w/ NHL | pain in chest, abd, bone, GI: N/V anorexia abd fullness, CNS lethargy FND |
| Dx of NHL | lymph node/tissue biopsy, bone marrow biopsy, morphology and phenotype, CBCs, chemistries, LFTs LDH Imaging |
| When do you think NHL | painless masses, or abnl size etc |
| NHL tx | radiation chemo bio therapy watchful waiting |
| Monoclonal abs given to carry drugs, toxins or radioactive material directly to cancer cells | biology therapy |
| When is NHL prognosis worse | >60yo, increase LDH, stage III or IV, involved extranodal dz sites >1, ↓ fxn capacity |
| Tumors of differentiated B cells | plasma cell neoplasms, arise in bone marrow |
| Two types of plasma cell neoplasm | PCM: single plasmacytoma, MM: multiple myeloma lesions |
| Causes of MM | rad, benzene, herbicides, insecticides, old age, |
| Sxs for multiple myeloma (CRAB) | calcium (elevation), renal failure, anemia, bone lesions |
| Why is calcium elevated | extensive skeletal destruction d/t osteoclast activation →↑Ca+ in blood |
| Clinical signs of MM | ↑Ca+ and bone pain d/t destruction of bone, can see osteoporosis, frxs, especially in spine ribs and w/movement |
| What is the anemia in MM | bone marrow suppression, ↓ RBC d/t infiltration of tumor cells Signs: fatigue SOB, weakness |
| How do we dx MM w/ UA | casts (sediments), and bence jones proteremia |
| Fragments of abs in the urine | bence-jones proteiremeia |
| Stacked blood cells d/t excess proteins in blood | Rouleaux formation |
| Different methods for MM dx | UA, blood smear, monoclonarl proteins in serum/urine, bone marrow biopsy:clonal plasma cells, radiographs |
| Tests to identify MM | XR for osteolytic lesions, CT, MRI |
| TX MM | narcotics, bisphosphonates to prevent bone lesion, erythropoietin or blood trfx, abx/vaccines, metabolic |
| Is MM curable | no,no tx: 6m death w/ tx: 2-5yrs |
| Causes of bone marrow failure | bone marrow replacement: tumor, fibrosis, Congenital: fanconi anemia, acquired: aplastic and myelodysplasia |
| Diminished or absent hematopoietic precurses in the bone marrow | aplastic anemia dx: pancytopenia sxs |
| Causes of aplastic anemia | many drugs, chemicals,viruses, radiation, idiopathic |
| Patho of AA | autoimmune, immune suppression |
| Clinical signs of AA infections, mucosal hemorrhage: thrombocytopenia, fatigue, cardiopulmonary compromise: anemia, pallor, but NL liver spleen lymph nodes | |
| Dx AA | pancytopenia, normocytic cells, but reduced number no abnormal cells anywhere in any bx or smears |
| Tx AA | withdraw causative agents, supportive care, HPCT, immunosuppression |
| Problem w/ AA | can progress to AML, MDS, and PNH |
| Ineffective blood cell production | myelodysplastic syndrome: cytopenias, dysmorphic, |
| Risks of MDS | >65yo, radiation, benzene chemo etc |
| Dx of MDS | CBC: anemia, smear: could be normo, marcrocytic, but bone marrow aspirate/biopsy will be hypercelluar w/ abnl cells |
| Prognosis of MDS | 50% 3yr, many will progress to AML will vary |
| Myeloproliferative d/o | polycythemia vera: huge number of RBC’s |
| Sxs of PCV | vertigo, tinnitus, HA, visual disteracnes, HTN, thrombosis, TIA splenomegaly, excoriations, GI distress (all d/t ↑RBC) |
| Dx of PCV | CBC Erythrocytosis +/- leukocytosis, hypercellularity on bone marrow aspirate, low erythropoietin, O2 low |
| Tx of PCV | phlebotomy and aspirin |
| Untreated PCV complications | thrombosis, AML progression, can do well for years |
| Cell number and appearance/fxn of cells in AA, Myeloid, polycythemia vera | AA: pancytopenia, no fxn, Myleoid: Anemia/nl Fxn: abnl PV: erythrocytosis Fxn nl |
Created by:
becker15
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