Term
| 30 yo man presents with 38.7C temp, drenching night sweats, and weight loss of six months' duration. PE reveals cervical lymphadnopathy. What is the next step in diagnosis? |
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Definition
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Term
| What cells are manignant in Hodgkin's lymphoma? |
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Definition
| neoplastic Reed-Sternberg cells wihcha are of B-cell origin. EVB infections play a role in the pathogenesis of this disease among young adults. |
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Term
| What are the symptoms of Hodgkin's Lymphoma? |
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Definition
Cervical lymphadenopathy
Spleen is most commonly involved intra-abdominal site.
B-Symptoms: 10% wt loss, night sweats requiring a change of clothes, fever >38.5 (worse prognosis) |
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Term
| How do you diagnose Hodgkin's Lymphoma? |
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Definition
Biopsy of enlarged lymph node that shows RS cells.
Staging based on Ann Arbor system and prognostic factors.
Do Chest, Abd, Pelvic CT as well as bilateral bone marrow biopsies with aspirates. |
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Term
| What is the treatment of Hodgkin's Lymphoma? |
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Definition
| Doxorubicin, Bleomycin, vinblastine, and darcarbazine (ABVD coctail) with or without RT of the involved area. |
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Term
| What is Non-Hodgkin's Lymphoma (NHL)? |
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Definition
| Classified as low, intermediate, or high grade on basis of histologic type. Associated with EBV, Burkitt's lymphoma; HIV with CNS lymphoma: HTLV with T-cell lymphoma; and H-pylori with gastric MALToma. |
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Term
| What are the symptoms of Non-Hodgkin's Lymphoma? |
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Definition
| Similar to other lymphomas including the possibility of B-sympotoms. |
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Term
| How do you diagnose Non-Hodgkin's Lymphoma? |
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Definition
LDH: Increased
Do bilateral bone marrow aspirate
Do enlarged Lymph note biopsy |
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Term
| How do you treat Non-Hodgkin's Lymphoma? |
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Definition
Cyclophosphamide, hydroxydoxorubacin, vincristine, and prednisone (CHOP)
Add Rituximab for (R-CHOP)-improves outcomes |
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Term
| How do you treat High Grade NHL? |
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Definition
May be complicated by tumor lysis syndrome (hyperkalemia, hyperphosphatemia, hyperuiricemia, hypocalcemia.
Treat with aggressive hydration and allopurinol. |
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Term
| How do you treat MALToma? |
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Definition
| Antibiotics for initial therapy. |
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Term
| How do you treat HIV-related NHL? |
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Definition
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Term
| 65 yo woman presents with back pain and fatigue. Routine lab testing reveals anemia and renal failure. A diagnosis of multiple myeloma is suspected. What is the next step? |
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Definition
SPEP (serum protein electrophoresis)
UPEP (urine protein electrophoresis) |
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Term
| Describe Multiple Myeloma. |
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Definition
| Malignancy of plasma cells within bone marrow, often with unbalanced excessive production of immunoglobulin heavy/light chains. Typically seen in older adults. |
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Term
| What are the symptoms of MM? |
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Definition
Back pain, hypercalcemic symptoms (stones, bones, abdominal moans, and psychiatric overtones)
Pathologic fractures, fatigue, and frequent infection
PE: Pallor, fever, bone tenderness, and lethargy. |
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Term
| What other plasma cell disorder is simiar to MM? |
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Definition
| Waldenstroem's macroglobulinemia: predominance of IgM as well as a higher incidence of cold agglutinins and hyperviscosity syndrome (visual disturbance, dizziness, headache - treat with plasmapharesis) |
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Term
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Definition
SPEP- will show IgG
UPEP- will show Bence Jones protein
Bone Marrow aspirate - plasma cells >10%
Full body skeletal survey-Punched-out osteolytic lesions of skull and long bones
LAP: normal levels (lesions are lytic, not blastic) |
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Term
| What is the Chemotherapy used for MM? |
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Definition
Melphalan and steroids +/- thalidomide or bortezomib.
Autologous stem cell transplantation is usedfor pts <60 and in advanced stages |
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Term
| How do you treat hypercalcemia associated with MM? |
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Definition
Hydration
Glucocorticoids
Diuresis |
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Term
| How do you treat the bone pain associated with MM? |
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Definition
| Bisphosphonates and local radiation. |
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Term
| How do you treat renal failure associated with MM? |
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Definition
| Hydration to aid in the excretion of light-chain immunoglobulins |
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Term
| How do you treat infections associated with MM? |
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Definition
Vaccinate against preventable infections
Diagnose early and treat aggressively. |
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Term
| How do you treat anemia associated with MM? |
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Definition
| Erythropoietin administration |
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