lowy heme

adenopathy locations

generalized

axillary

cervical

supraclavicular

hilar adenopathy

epitrochlear

inguinal

which adenopathy locations are of greatest concern

axillary, supraclavicular, epitrochlear

breast ca adenopathy

axillary

bronchogenic carcinoma adenopathy

hilar

chancroid adenopathy

inguinal

colon ca adenopathy

left supraclavicular

gastric ca adenopathy

left supraclavicular

herpes simplex adenopathy

inguinal

HIV adenopathy

generalized

lymphoma adenopathy

axillary, generalized, hilar

lymphogranuloma venereum adenopathy

inguinal

mediastinal/pulmonary malignancy adenopathy

hilar

mononucleosis adenopathy

cervical

ovarian ca adenopathy

left supraclavicular

pharyngitis adenopathy

cervical

sarcoidosis adenopathy

cervical, hilar

secondary syphilis adenopathy

inguinal

SLE adenopathy

cervical

primary syphilis adenopathy

inguinal

toxoplasmosis adenopathy

cervical, generalized

TB adenopathy

hilar

adenopathy and sore throat

mono, pharyngitis

adenopathy and genital lesions

primary syphilis and herpes simplex

adenopathy and maculopapular rash

secondary syphilis

adenopathy and IV drug use

HIV

adenopathy and weight loss/night sweats

lymphoma, TB, metastatic ca

adenopathy and exposure to cat

cat scratch dz, toxo

adenopathy labs

CBC w/ diff

blood smear

urethral/cervical culture

PPD

heterophil antibody to r/o mono

HIV antibody testing

RPR to r/o syphilis

CXR to r/o TB and ca

CT for mets

node biopsy

r/o mono in adenopathy

heterophil antibody

r/o syphilis in adenopathy

RPR

r/o TB and ca in adenopathy

CXR

lymphoma is ca of

lymphatic system

what is lymphoma

abnl growth/accumulation of lymphocytes in lymph nodes/spleen/other organs

neoplastic proliferation of lymphoid cells in lymph nodes and extranodal tissue

painless lymph nodes, ± fever, night sweats, weight loss, chronic fatigue, itchy skin, abdominal pain/fullness

lymphoma

lymphoma RF

age, male, EBV, HIV, weakened immune system, chemical exposure

dx lymphoma

node biopsy and CT for staging

Reed Sternberg cells indicate

Hodgkin’s lymphoma

where does lymphoma like to met to

BM, liver, lungs

what are the classic lymphoma “B sx”

fever, weight loss, night sweats

what do B sx indicate

advanced dz stage and tumor burden

slightly worse prognosis independent of stage

lymphoma stage I

one lymph node

lymphoma stage II

more than one lymph node on the same side of the diaphragm

lymphoma stage III

more than one lymph node and on both sides of the diaphragm

lymphoma stage IV

metastatic

leukemia is a progressive malignant d/o of the

blood

what is leukemia

irregular production of leukocytes that obstruct BM

immature abnl production suppresses nl cell production

how is leukemia classified

acute vs chronic

type of leukocyte involved (lymphoblastic vs myeloblastic)

fatigue, fever, night sweats, infections, pallor, SOB, weight loss, bone pain, anemia, purpura, petichiae, ecchymosis, hemorrhage

leukemia

why do leukemia pts get bone pain and where is it typically

BM expansion in long bones of arms/legs, ribs, breastbone

how does leukemia kill you

infections

nutritional deficiencies

multiple organ failure

treatments

fatigue from anemia, bleeding from thrombocytopenia, fever, infection from leukopenia, bone pain from BM expansion

acute leukemia

which leukemia is typically asx

chronic

dx acute leukemia

blood smear

BM bx shows blasts

dx chronic leukemia

blood smear

BM bx

m/c leukemia in children

ALL

m/c acute leukemia in adults

AML, also most fatal

m/c chronic leukemia in adults

CLL

ALL BM bx shows

>20% lymphoblasts

ALL is often seen with what other d/o

Down’s syndrome

AML BM bx shows

>20% myeloblasts

Auer rods on blood smear

AML

who gets AML and how do they die

30-60 yo

infections or bleeds kill them

lymphocytes and smudge cells on blood smear

CLL

leukemia, asx, splenomegaly

CLL (esp >50 yo) and CML

proliferation of mature myeloid cells

CML

what is a reed sternberg cell

large bilobed nucleus and nucleolar inclusion bodies (owl’s eyes)

what is a starry sky pattern on mass biopsy

lymphoid cells w/ nonconvoluted nuclei and coarse chromatin along w/ many macrophages

why do chemo pts get allopurinol

prevent consequences of tumor lytic syndrome

why does tumor lytic syndrome happen during chemo

large amount of neoplastic cell destruction during tx

hyperphosphatemia, hypocalcemia, hyperuricemia, hyperkalemia

tumor lytic syndrome

may lead to AKF

what are erythrocytes

transport O2 and CO2

life span of 120 days

produced in BM, production stimulated by erythropoietin in response to hypoxia/decreased tissue O2 tension

what are the granulocytes

neutrophils, basophils, eosinophils

what causes increased granulocytes

Parasites

Allergies

Asthma

Malignancy

what are the agranulocytes

monocytes and lymphocytes

where are agranulocytes produced

BM

where do lymphocytes mature

lymph nodes

what are blasts

precursor cells

what are thrombocytes/platelets

involved in clotting/preventing bleeding

nl 150,000-450,000 u/L

lifespan 7-10 days

tumors of the hematopoietic and lymphoid tissues

leukemias, lymphomas, myelomas

what proliferates in ALL

lymphoid stem cells

immature lymphocytes and lymphoblasts with no further differentiation

what are possible causes of ALL

radiation, benzene, chemo

ALL labs

pancytopenia

increased WBC

increased lymphoblasts

increased uric acid

increased LDH

Philadelphia chromosome

Philadelphia chromosome

translocation of 9 and 22

associated w/ ALL and CML

tx ALL

chemo

AML is uncontrolled proliferation of

hematopoietic/blast cells

causes of AML

strong correlation to toxins, ionizing radiation, trisomy 21

AML labs

increased blasts

Auer rods

anemia

thrombocytopenia

increased uric acid

increased LDH

tx AML

chemo

what is CLL

an indolent lymphoproliferative d/o

asx, fatigue, lethargy, weight loss, enlarged cervical lymph nodes, splenomegaly

CLL

CLL labs

absolute lymphocytosis (>5,000)

anemia

thrombocytopenia

smudge cells on blood smear

hypogammaglobulinemia

tx CLL

chemo but not curable

what kind of d/o is CML

myeloproliferative: excessive growth of differentiated cells

fatigue, weight loss, night sweats, malaise, splenomegaly, rarely lymphadenopathy

CML

CML labs

increased WBC

Philadelphia chromosome

increased uric acid

Hodgkin’s lymphoma is a malignant d/o of

lymphoreticular system

how does Hodgkin spread

orderly predictable fashion to adjacent lymph tissues

Hodgkin age distribution

15-35 and >50

painless neck lump/cervical lymphadenopathy, fever, night sweats, weight loss, malaise, pruritis, alcohol ingestion causes pain in lymph nodes

Hodgkin

dx Hodgkin

Reed Sternberg cells: large abnl cells w/i lymph nodes