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120 Cards in this Set
- Front
- Back
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What characteriistics of lymph nodes are considered normal?
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solf, flat, submandibular nodes, <1dm in children and adults
inguinal nodes up to 2cm in health adults. |
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What is the most common causes of lymphadenopathy?
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>2/3 nonspecific causes or URI
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What percentage of lymphadenopathy are malignant?
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<1%
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What constitutes localized lymphadenopathy? What constitutes generalized?
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localized: involvement of s single anatomic area
generalized: 3 or more noncontiguous areas |
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If you find a benign lymph node <1cm, what do you want to exclude initially?
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mono and toxoplasmosis
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What are the characteristics of lymphoma?
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large, discrete, symmetric, rubbery, mobile, firm, nontender
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What are the characteristics of metastatic cancer in the lymph nodes?
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hard, nontender, nonmovable
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What are the causes of tender lymph nodes?
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from rapid enlargement:
- inflammatory process - acute leukemia |
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What can cause splenomegaly?
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Mono, sarcoidosis, toxoplasmosis, cat-scratch disease
lymphoma acute or chronic leukemia SLE other hematological disorders |
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You are doing an exam on a patient when you find large, tender lymph nodes n the occipital region. What might you suspect (generally)?
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An infection of the scalp
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If you have preauricular lymph nodes, what might be the origin?
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conjunctivitis
cat-scratch disease |
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URI, oral and dental lesions, mononucleosis, and other viral illness might cause what lymphadenopathy?
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cervical
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URI, oral and dental lesions, mononucleosis, and other viral illness might cause what lymphadenopathy?
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cervical
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Where is metastatic cancer primarily from?
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head and neck, breast, lung, and thyroid
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True or False: Supraclavicular and scalene lymphadenopathy is ALWAYS abnormal.
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True
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Supraclavicular and scalene lymph nodes drain what regions?
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regions of the lung and retroperitoneal space
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What might supraclavicular and scalene lymphadenopathy imply?
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lymphomas, other cancers, infectious processes
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Specifically, supraclavicular nodes get metastasis from what cancers?
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lung, breast, testis, or ovarian cancers
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What infectious processes might cause supraclavicular lymphadenopathy?
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tuberculosis, sarcoidosis, toxoplasmosis
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Virchow's node primarily gets metastasis from what area?
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from a GI primary
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What causes axillary lymphadenopathy?
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injuries or infections of upper extremity
melanoma, lymphoma, breast cancer |
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What causes inguinal lymphadenopathy?
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infections or trauma of lower extremity
STD's - LV (from chlamydia), primary syphilis, herpes, chancroid lymphomas, metastatic cancer from rectum, genitalia, LE (melanoma) |
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In a young patient, what would cause mediastinal lymphadenopathy?
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mononucleosis, sarcoidosis, tuberculosis
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In an older individual, what would you suspect with mediastinal lymphadenopathy?
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primary lung cancer, lymphomas, metastatic cancer (lung usually), tuberculosis, fungal infection, sarcoidosis
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What are some important findings if you detect mediastinal lymph nodes?
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cough or wheezing from airway compression
hoarseness from recurrent laryngeal nerve involvement dysphagia from esophageal compression swelling of neck, face, or arms due to compression of superior vena cava or subclavian vein |
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What is the most common cause of intraabdominal or retroperitoneal lymphadenopathy?
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usually malignancy
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What labs are important in with lymphadenopathy
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CBC - leukemias, EBV, CMV, lymphoma
Serological studies CXR CT, MRI, US - differentiate from malignant lymph nodes Lymph node biopsy |
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When doing a lymph node biopsy, what do you do first?
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biopsy any mucosal legion
then excisional biopsy of the LARGEST node first |
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What are the symptoms of splenomegaly?
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pain and heaviness in LUQ
early satiety |
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If you suspect splenomegaly, what imaging do you do?
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US
CT, MRI |
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What is the differential for massive splenomegaly?
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Non-Hodgkin's lymphoma
Chronic lymphocytic leukemia (CLL) Hairy cell leukemia Chronic myelogenous leukemia (CML) Myelofibrosis with myeloid metaplasia Polycythemia vera |
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What is the most significant risk factor for cancer?
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Age
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What methods are used to diagnose cancer?
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invasive tissue biopsy
fine-needle aspiration (thyroid nodules) histology, tumor markers, history (if there is no apparent primary site) |
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What is used to clinically stage cancer?
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PE
radiographs isotopic scans CT and other imaging |
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What classification is used for colorectal cancers? Hodgkin's disease?
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Duke's classification
Ann Arbor classification |
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What are the most common side effects of cancer treatment?
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Nausea and vomiting
Febrile neutropenia Myelosuppression |
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What drugs can be used to treat the nausea and vomiting associated with cancer treatment?
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Prochlorperazine (Compazine)
Dexamethasone Ondansetron (Zofran) Reglan |
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True or False: Cancer therapy is more toxic and less effective with malnutrition.
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True
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What drug can be used to increase nutrition in cancer patients?
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Megestrol acetate (Megace)
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What are the most common causes in death in cancer patients?
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Infection --> circulatory failure
Respiratory failure Hepatic failure Renal failure |
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What age(s) does Hodgkin's Disease peak?
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peak in 20s, peak in 60s
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What are the risk factors for Hodgkin's Lymphoma?
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HIV
EBV |
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In Hodgkin's Lymphoma, what are the clinical findings?
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one or more enlarged lymph nodes in neck, armpit, or groin
fever night sweats weight loss generalized pruritis |
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When should you suspect Hodgkin's lymphoma?
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persistent and painless enlargement of lymph nodes without an apparent infection
enlarge lymph nodes in chest and abdomen found on CXR or CT |
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How do you diagnose Hodgkin's lymphoma?
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Biopsy of affected lymph node: Reed Sternberg cells (large cancer cells with >1 nucleus)
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What are the stages of Hodgkin's lymphoma?
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Anne Arbor:
Stage I - one lymph node region involved Stage II - involvement of two lymph node areas on one side of the diaphragm Stage III - lymph node regions involved on both sides of the diaphragm Stage IV - disseminated disease with bone marrow or liver involvement A - lacks constitutional symptoms B - 10% weight loss over 6 months, fever, or night sweats |
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If Hodgkin's Lymphoma is suspected, what tests would you do?
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CBC
Sed rate Liver and kidney function CT or chest, abdomen, and pelvis PET scan |
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What is th emost sensitive test for determining the stage and evaluating response to treatment in Hodgkin's Lymphoma?
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PET scan
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Radiation and limited chemotherapy is used to treat what stage(s) of Hodgkin's lymphoma?
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Stage IA and IIA
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How do you treat Stage IIIB and IV Hodgkin's Lymphoma?
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combined chemotherapy
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What is the 10-year survival rate of IA and IIA Hodgkin's lymphoma? 5-year survival for Stage IIIB and IV?
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>80%
50-60% |
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What are the side effects of chemotherapy?
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Temporary or permanent sterility
Increased risk of infection Reversible hair-loss Potential damage to other organs (heart and lungs) Risk of developing leukemia Risk of non-Hodgkin's lymphoma or other cancers |
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Non-Hodgkin's lymphoma develops from what cells? What is the most common cell?
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B or T lymphocytes
B lymphocytes most common |
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What are the risk factors for non-Hodgkin's lymphoma?
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organ transplant patients
HIV other immunodeficiency states |
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What is the etiology of non-Hodgkin's lymphoma?
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Infectious agents (H. pylori, gastric MALT lympoma)
Chemical exposure |
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What are the clinical findings of non-Hodgkin's lymphoma?
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Painless lymphadenopathy, isolated or widespread
Cough and SOB (nodes in the chest) Anorexia, constipation, abdominal pain, swelling in legs (lymph nodes in abdomen) lymphomas in bloodstream and bone marrow - anemia - neutropenia - thrombocytopenia - FUO Constitutional symptoms |
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What are the clincal findings in children with non-Hodgkin's lymphoma?
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anemia, rashes, neurological symptoms (weakness and abnormal sensation)
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How do you diagnose non-Hodgkin's lymphoma?
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Biopsy of enlarged lymph node
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How do you stage non-Hodgkin's lymphoma?
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Ann Arbor (same as Hodgkin's)
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How do you treat non-Hodgkin's lymphoma stage I and II indolent?
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radiation limited to site of lymphoma and adjacent areas
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How do you treat non-Hodgkin's lymphoma stage I and II aggressive?
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combination chemotherapy with localized radiation
allogeneic transplantation |
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How do you treat non-Hodgkin's lymphoma stage III and IV indolent?
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combination or single chemotherapy
Rituximab |
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How do you treat non-Hodgkin's lymphoma stage III and IV aggressive?
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combination chemotherapy
- CHOP - cyclophophamide - hydroxydoxorubicin - vincristine - prednisone |
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What is multiple myeloma?
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malignancy of plasma cells characterized by replacement of the bone marrow, bone destruction, and paraprotein formation
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What is the etiology of multiple myeloma?
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unknown
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What are the clinical findings of multiple myeloma?
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Bone pain (back and ribs)
Bone lesions Pathologic fractures Susceptibility to bacterial infections Renal failure Hyperviscosity Neurologic symptoms |
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In patients with multiple myeloma, what's the most common cause of their renal failure?
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hypercalcemia
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What infections are multiple myeloma patients particularly susceptible to?
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pneumonias and pyelonephritis
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The hyperviscosity in multiple myeloma patients can cause what?
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impaired circulation
Raynaud's phenomenon |
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The neurological symptoms of multiple myeloma are caused by what?
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hypercalcemia (lethargy, weakness, depression, confusion)
hyperviscosity (headaches, fatigue, visual disturbances, retinopathy) bony damage and collapse (cord compression, radicular pain, loss of bowel and bladder control) |
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How do you diagnose multiple myeloma?
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marrow plasmocytosis
lytic bone lesions serum and/or urine M component |
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What is the differential for multiple myeloma?
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monoclonal gammopathy of undetermined significance (MGUS)
metastatic carcinoma lymphoma bone neoplasms (sarcoma) |
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What are the characteristic lab findings associated with multiple myeloma?
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normochromic, normocytic anemia
Rouleaux formation on peripheral smear |
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What lab findings do you see with multiple myeloma?
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normochromic, normocytic anemia
Rouleaux formation on peripheral smear hypercalcemia (bone lysis) high BUN/Cr high uric acid high sed rate high total protein proteinuria high LDH hyperviscosity low sodium low ion gap abnormal serum protein electrophoresis normal serum alk phos |
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True or False: Since multiple myeloma has bone lesions, a bone scan can be helpful in diagnosis.
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False: They are not helpful since lesions are not blastic.
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On imaging, what do you expect to see in multiple myeloma?
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punched out lytic lesions or osteoporosis
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How do you treat multiple myeloma?
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systemic chemotherapy
symptomatic supportive care hydration bisphosphonates control hypercalcemia and hyperuricemia treat anemia with epoetin alfa |
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What drugs do you want to avoid in patients with multiple myeloma?
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nephrotoxic drugs
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In younger patients with multiple myeloma, what might you consider as a treatment?
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autologous bone marrow transplantation
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How do you treat the anemia associated with multiple myeloma?
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epoetin alfa
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What is the prognosis for multiple myeloma?
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median survival - 3 years
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What is chronic myelogenous leukemia?
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a myeloproliferative disorder that results in overproduction of myeloid cells
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What is the characteristc chromosomal abnormality associated with chronic myelogenous leukemia (CML)?
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Philadelphia chromosome
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What age group gets CML?
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middle age (median age 42)
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What do CML patients present with?
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fatigue
night sweats low-grade fever abdominal fullness related to splenomegaly elevated WBC found incidentally |
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What are the CML symptoms related to leukostasis?
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blurred vision
respiratory distress priapism WBC sometimes >500,000 |
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On examination, what do you see in CML patients?
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splenomegaly
sternal tenderness fever without infection bone pain blast crisis - bleeding and infection |
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What lab values would you expect to see in a patient with chronic myelogenous leukemia?
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left shift myeloid series
mature forms dominating blasts <5% basophilia and eosinophilia platelet count normal or elevated elevated B12 elevated uric acid Philadelphia chromosome |
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What signs/symptoms do you see as a patient progesses to accelerated and blast phases?
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progressive anemia
thrombocytopenia blasts increase in blood and marrow >30% |
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What is the differential for CML?
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leukocytosis secondary to infection
other myeloproliferative diseases |
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How do you treat CML?
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Emergent leukopheresis with myelosuppressive therapy (for extreme leukocytosis)
Imatinib mesylate (chronic disease) allogeneic bone marrow transplant |
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What is the curative treatment for CML?
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allogeneic bone marrow transplant
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What is acute leukemia?
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malignancy of the hematopoietic cells
malignant cell loses it's ability to mature and differentiate cells proliferate in an uncontrolled fashion and replace normal bone marrow elements |
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What causes acute leukemia?
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often no clear cause
radiation toxins (benzene) chemotherapeutic agents |
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What is the most common cancer in children?
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acute lymphoblastic leukemia (ALL)
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What are the most common infections with acute leukemia patients?
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Gram negative bacteria (E. coli, klebsiella, pseudomonas) or fungi (candida, aspergillus)
Cellulitis, pneumonia, perirectal infections |
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What is hyperleukocytosis? What symptoms does it have?
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elevated blast count usually >200,000
impaired circulation - headache, confusion, dyspnea |
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What do you do for hyperleukocytosis?
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emergent leukapheresis and chemotherapy
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In acute leukemia, what might you see on examination?
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pale
purpura and petechiae stomatitis and gum hypertrophy variable enlargement of liver, spleen, and lymph nodes bony tenderness over sternum, tibia, and femur |
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What labs do you expect with acute leukemia?
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pancytopenia with circulating blasts >20%
hyperuricemia DIC |
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What marker do you see with ALL?
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surface markers characteristic of primitive lymphoid cells
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What characteristic cell do you see with AML?
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Auer rod - eosinophilic needle-like inclusion in cytoplasm
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How is ALL classified?
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by immunologic phenotype:
- common - early B lineage - T cell |
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What's the differential for AML?
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other myeloproliferative syndromes (ex. CML, MDS)
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What is the differential for ALL?
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CML, lymphoma, hairy cell leukemia, mononucleosis, pertussis
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What is the criteria for remission in acute leukemia?
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Normal peripheral blood
Normal bone marrow Normal clinical status |
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What are the treatments for acute leukemias?
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chemotherapy
autologous and allogeneic transplantation |
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What is chronic lymphocytic leukemia (CLL)?
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clonal malignancy of B lymphocytes
usually indolent, with slowly progressive accumulation of long lived small lymphocytes immunoincompetent cells |
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What are the clinical manifestations of CLL?
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immunosuppression
bone marrow failure organ infiltration with lymphocytes |
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Who usually gets CLL?
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people over the age of 50 (90%)
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What are the symptoms of CLL?
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fatigue
lymphadenopathy enlargement of spleen and liver most are incidentally discovered to have lymphocytosis |
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How do you stage CLL?
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Stage 0 - lymphocytosis only
Stage 1 - lymphocytosis + lymphadenopathy Stage 2 - organomegaly Stage 3 - Anemia Stage 4 - Thrombocytopenia |
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What is prolymphocytic leukemia?
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a more aggressive variant of CLL
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What is Richter's syndrome?
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a large cell lymphoma that can occur with CLL
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What labs would you expect to see with CLL?
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WBC >20,000
75-98% circulating cells are lymphs normal hematocrit and platelet count at presentation bone marrow variable infiltrated with small lymphs |
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What is the differential for CLL?
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Viral infections
pertussis |
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How do you treat early CLL?
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no specific treatment
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What are the indications for treatment of CLL?
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progressive fatigue
symptomatic lymphadenopathy anemia thrombocytopenia |
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If a patient with CLL also has an autoimmune hemolytic anemia or immune thrombocytopenia, how do you treat it?
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prednisone or splenectomy
avoid fludarabine (a treatment for standard CLL) |
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In CLL patients, who gets allogeneic transplants?
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patients whose disease is not controlled by standard therapies
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