48 Questions
What is the peak age of onset for Acute Lymphoblastic Leukemia (ALL)?
2-10 years, with a peak at 4 years old
Which of the following is NOT a common clinical manifestation of Acute Lymphoblastic Leukemia (ALL)?
Hepatomegaly and splenomegaly
What is the typical survival rate for Chronic Myelocytic Leukemia (CML) without treatment?
1-3 years
Which of the following is a characteristic of Chronic Lymphocytic Leukemia (CLL)?
Characterized by the accumulation of mature lymphocytes
What is the typical 5-year survival rate for Acute Lymphoblastic Leukemia (ALL) with treatment?
75%
Which of the following is a characteristic of Chronic Leukemias?
Usually affects older adults
What is the most common type of non-Hodgkin lymphoma in children?
Small noncleaved cell lymphoma (Burkitt's and non-Burkitt's)
Which of the following is NOT a common clinical feature of extranodal non-Hodgkin lymphoma?
Lymphadenopathy and B symptoms
Which of the following is the most common type of leukemia in children?
Acute lymphoblastic leukemia (ALL)
Which of the following is a common chromosomal abnormality seen in Acute Lymphoblastic Leukemia (ALL)?
t(8;14) translocation
Which of the following is NOT a common risk factor for the development of Hodgkin's lymphoma?
Helicobacter pylori (H. pylori) infection
What is the primary difference between Acute Lymphoblastic Leukemia (ALL) and Lymphoblastic Lymphoma?
ALL is a blood-based disease, while Lymphoblastic Lymphoma is a solid tumor
What is the characteristic histological finding of the Reed Sternberg cell in Hodgkin's lymphoma?
Owl eyes nuclei
Which of the following is NOT a general type of leukemia?
Acute myeloid leukemia (AML)
What is the principal pathogenetic problem in acute leukemias?
Block in differentiation of blood cells
What is the most common cause of cancer death in children under 15 years of age?
Acute lymphoblastic leukemia (ALL)
Which of the following is a characteristic feature of acute myeloblastic leukemia (AML)?
Presence of Auer rods within the leukemic cells
What is the most common treatment for Hodgkin's lymphoma?
Chemotherapy ABVD or BEACOPP
Which of the following is the most common cause of neutrophilia?
Stress, exercise, or pain
What is the primary diagnostic test used to confirm infectious mononucleosis?
Monospot test
Which of the following is the most common clinical presentation of reactive lymphadenitis?
Swollen and tender lymph nodes
Which of the following is the most common cause of encephalitis in immunocompetent individuals?
Herpes simplex virus
Which of the following is the most common clinical presentation of cat-scratch disease?
Fever, lymphadenopathy, and skin lesions
Which of the following is a characteristic of stage III Hodgkin Lymphoma or Non-Hodgkin Lymphoma?
Involvement of lymph nodes, spleen, or both on both sides of the diaphragm
According to the Cotswold Modification of Ann Arbor Staging, what is the criteria for stage IV Hodgkin Lymphoma or Non-Hodgkin Lymphoma?
Extranodal involvement, such as in the bone marrow, lung, or liver
What is the criteria for stage II Hodgkin Lymphoma or Non-Hodgkin Lymphoma according to the Cotswold Modification of Ann Arbor Staging?
Involvement of lymph nodes in ≥ 2 regions on the same side of the diaphragm
Which of the following conditions is characterized by an increase in neutrophils?
Neutrophilia
What is the causative agent of mononucleosis?
Epstein-Barr virus
What is the criteria for stage I Hodgkin Lymphoma or Non-Hodgkin Lymphoma according to the Cotswold Modification of Ann Arbor Staging?
Involvement of only 1 lymph node region
What is the criteria for stage E Hodgkin Lymphoma or Non-Hodgkin Lymphoma according to the Cotswold Modification of Ann Arbor Staging?
Extranodal involvement adjacent to an involved lymph node
Which of the following conditions is caused by inflammation of the brain?
Encephalitis
What is the causative agent of Cat-Scratch Disease?
Bartonella henselae
Which of the following conditions is characterized by swollen lymph nodes in response to an infection or other stimulus?
Reactive lymphadenitis
Which of the following is the most common cause of cat-scratch disease?
Bartonella henselae
Which of the following is a characteristic feature of cat-scratch disease in children?
Regional lymphadenopathy, most frequently in the axilla and neck regions
Which of the following is a potential complication of cat-scratch disease?
Encephalitis
Which of the following is the most common cause of reactive lymphadenitis in children?
Epstein-Barr virus infection (mononucleosis)
Which of the following is a characteristic finding in reactive lymphadenitis due to viral infections?
Paracortical lymphoid hyperplasia in the T-cell region
Which of the following is the most common cause of encephalitis in immunocompetent individuals?
Herpes simplex virus
What is the primary diagnostic test used to confirm infectious mononucleosis?
Monospot test
Which of the following conditions is characterized by an increase in neutrophils?
Leukocytosis
Which of the following is a characteristic feature of cat-scratch disease in children?
Fever and lymphadenopathy
What is the causative agent of Cat-Scratch Disease?
Bartonella henselae
Which of the following is a potential complication of cat-scratch disease?
Encephalitis
Which of the following is the most common cause of reactive lymphadenitis in children?
Viral infections
Which of the following is a characteristic finding in reactive lymphadenitis due to viral infections?
Rubbery lymph nodes
Which of the following is the most common clinical presentation of cat-scratch disease?
Fever and lymphadenopathy
Which of the following conditions is characterized by swollen lymph nodes in response to an infection or other stimulus?
Reactive lymphadenitis
Study Notes
Acute Lymphoblastic Leukemia (ALL)
- Peak age: 2-10 years old
- 80% of cases occur in children
- Normal WBC count with excessive lymphoblasts
- With treatment, 75% of children remain free of disease in > 5 years
Clinical Manifestations of Leukemia
- Bone marrow replacement of normal parenchyma by neoplastic cells
- Alteration of stem cell: differentiated cell
- Symptoms:
- Fatigue
- Leukopenia
- Anemia
- Thrombocytopenia
- Bleeding diathesis
- Skin rash
- Systemic alteration
- Decrease immunologic functions
- Hepatosplenomegaly
- Infiltration of the gums
- Nonspecific symptoms:
- Fever
- Weight loss
- Petechia
- Echymosis
- Purpura
Chronic Leukemias
- Usually affects older adults
- Median age of onset: 65 years old
- Represents 1/3 of all leukemias
- Male predominance: 2:1
- Predominant cells are mature cells of the bone marrow (“Well differentiated” lymphocytes)
- Characterized by the accumulation of lymphocytes in the blood and lymphocytic organs
- Often patients are asymptomatic and can have anemia
- Two main types:
- Chronic Myelocytic Leukemia (CML)
- Chronic Lymphocytic Leukemia (CLL)
Chronic Myelocytic Leukemia (CML)
- Age of onset: 25-60 years old
- Poor prognosis, only 3 years of survival rate
- Characterized by WBC count of 50,000 to 300,000 with increased granulocytes in all states of maturation
- 90% have Philadelphia chromosome
Hodgkin’s Lymphoma
- Characterized by Reed Sternberg cell (owl eyes nuclei)
- Prognosis: Good
- Treatment: Chemotherapy (ABVD, BEACOPP)
Leukemias Classification
- Four general types:
- Acute Lymphoblastic Leukemia (ALL)
- Acute Myeloblastic Leukemia (AML)
- Chronic Lymphocytic Leukemia (CLL)
- Chronic Myeloid Leukemia (CML)
Acute Leukemias
- Principal pathogenetic problem: block in differentiation
- Abrupt stormy onset
- Laboratory findings: Absolute leukocytosis (>100,00 WBC/ul but >50% is 25% of marrow population
- The disease usually affects all ages, but usually occurs in younger patients
- Predominant cell type: BLAST cells (immature cells)
- Leading cause of cancer death in children under 15 years of age and the seventh most common form of cancer death overall
Acute Leukemias (continued)
- Two major types:
- Acute Myeloblastic Leukemia (AML)
- Common in infants and middle age or older
- Mean age: 50 years old
- Characterized by normal WBC count with excessive myeloblasts
- Auer Rods may be seen within leukemic cells in the blood
- Acute Myeloblastic Leukemia (AML)
Non-Hodgkin Lymphoma
- Classification based on:
- Cell type:
- Precursors cells: B cells, T cells
- Mature cells: natural killer (NK) cells
- Location (nodal or extranodal)
- Tumor grade
- Cell type:
- Clinical features:
- Nodal disease:
- B symptoms (20-50%)
- Lymphadenopathy
- Hepatosplenomegaly
- Cytopenias (decrease RBC, WBC, platelets)
- Extranodal disease:
- GI (15%): inflammation can evolve to ulcer and perforation of stomach or small intestine
- Liver/spleen: diffuse hepatosplenomegaly
- Skin: rash
- Bone: pathologic fractures (pain-swelling)
- CNS: epidural SCC, peripheral nerve infiltration, CNS lymphoma (1%)
- Nodal disease:
Cat-Scratch Disease
- Caused by Bartonella henselae
- Disease of childhood (90% younger than 18 years old)
- Regional lymphadenopathy (most frequent axilla and neck)
- Nodal enlargement approximately 2 weeks after feline scratch
- Nodal inflammation could last 2-4 months
- Complications:
- Encephalitis
- Osteomyelitis
- Thrombocytopenia
- Treatment: supportive, broad-spectrum ophthalmic drops (Fluroquinolones)
- Systemic antibiotics are recommended for moderate to severe disease
- Treat immunocompromised patients with doxycycline, azithromycin, trimethoprim/sulfamethoxazole, and ciprofloxacin
Test your knowledge on the clinical manifestations of Acute Lymphoblastic Leukemia (ALL) such as bone marrow alterations, symptoms like fatigue and bleeding diathesis, and systemic effects like decreased immunologic functions. Explore the peak age of 2-10 years, normal WBC count with excessive lymphoblasts, and treatment outcomes.
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