1. Kurt has Onset usually sudden d.

Regularity of nuclear outline

Replaces the normal tissues of the marrow e. Cell size
Results in anemia, granulocytopenia , f. None of the above
thrombocytopenia. 6. ALL:
Malaise, fatigue and pallor Burkitt type
Vulnerable to infection, easily bruising, 3-5%
petechiae, epistaxis , fever chills Blasts are large and primitive appearing and
Bone pains, swelling of joints, cranial nerve homogenous
paralysis, inc. ICP, Finely stippled chromatin
Superficial lymph node enlargement, One or more vesicular nucleoli
splenomegaly and hepatomegaly Cytoplasm is intensely basophilic
Cytoplasmic vacuolation frequent
He had a bleeding, his Leukocyte count from Vacuoles stain oil red O
10,000 100,000 cu/mm Poor prognosis responds poorly to
Leukemic lymphoid blast are predominant chemoTx
Aleukemic leukemia blasts are not found in PS a. L3
but abundant in BM. b. L2
BM always hypercellular 7. Cytochemical classification used for ALL:
Heavily infiltrated or replaced by lymphoid cells Sudan black B
BM fibrosis 10-15% Myeloperoxidase
Thrombocytopenia and anemia is always Acif phosphatase
present Non specific esterase
He has what type of leukemia? Tdt- marker for primitive lymphoid cells
a. Acute lymphoblastic leukemia ALL negative for Sudan black and
b. Acute myelogenous leukemia myeloperoxidase
c. Acute lymphocytic leukemia some ALL cells are weakly + to sudan black B
2. Classification of leukemia is done by? 8. PAS reaction for ALL:
a. FAB L1 strongly +
b. GAB L2- low
c. AABB L3- negative
3. Classification of Leukemia wherein: 9. CD assoc with ALL
a. CD5
Blasts are small about twice the size of small b. Cd7
lymphocyte c. Cd10
Uniform , lack variation in sizes d. Cd13
Chromatin finely dispersed but appear e. Cd19
more clump in smaller cells f. Cd33
Nuclear shape is regular some degree of g. Hla-dr
folding , clefting and indentation 10. Most common CD associated with CLL
Nucleoli usually not visible a. CALLA
Cytoplasm scanty , slightly basophilic b. CD10
Vacuoles not present c. CD22
Best prognosis during therapy d. CD2
a. L1 e. A AND B
b. L2 11. cells of burkitts leukemia are positive for
4. Classification of leukemia whrein: HLA-DR, CD19, sCD22, CD24
Most cells are more than the twice the diameter weak expression of CD10 - 1/3
of a small lymphocyte less than 5% of ALL cases
Marked difference in cell size cytoplasmic Immunoglobulin (cIg) and
Chromatin ranges from dispersed to coarse and TdT are not present
condensed -= mixed corresponds to L3
Nucleoli always visible A. B CELL ALL
Nuclei cleaving , indentation and folding are B. PRO-B CELL
characteristic C. PRE B CELL
Nuclear size are irregular 12. presence of HLA DR, TdT, CD19, CD20 and
a. L2 CD24.
b. L1 CALLA (CD10) may be present
5. All but one are main differences of l1 and l2, capable of synthesizing m-heavy chain
except: cytoplasmic Ig (cIg) m is present
a. Nuclear cytoplasmic ratio sIg is absent
c. Presence, prominence and frequency of 10-15% found in ALL in children and adult
nucleoli majority are classified as L1
 chromosomal abnormality t(1;19) are found in this a. prednisone
group b. methotrexate
A. PRE-B CELL 22. folic acid antagonist, inhibits dna synthesis
B. PRO B CELL a. methotrexate
C. B CELL b. 6-mercaptopurne
13. Presence of HLA DR , TdT, CD10, Cd19, 23. purine antagonist, interfere purine syn.
CD24, and sometimes CD20 Inhibit DNA and RNA syn.
cells lack sIg, cIg, and m heavy chain a. 6-mercaptopurine
85% in child b. Cyclophosphamide
75% in adult
highest remission rate 24. syn . Alkalyting agent , in. DNA syn
5% children t(9;22) phil chromosome a. cyclophosphamide
20% adults - t(9;22) phil chromosome b. daunorubicin
Pre early B - +HLA DR,TdT,CD19,CD34
CD34 is found in hematopoetic stem cells 25. antibiotic , in. DNA and RNA syn
5% in children , 11% adult a. daunorubicin
Chromosomal t(4;11) nonresponsive to b. l-asparaginase
therapy 26. enzyme (E.coli) , lysis of lymphoblasts
A. PRO B CELL ( deprive cells of L-asparagine)
B. PRE B CELL a. L-asparaginase
C. B CELL b. Cytarabine
14. includes CD7, CD5, CD2 27. Pyrimidine antimetabolite, inhibits dna synthesis
cytoplasmic CD3and CD6 maybe present a. Cytarabine
15% in childhood and adults b. Vincristine
higher in males 5:1 ratio 28 proliferation and accumulation of
half of patients have mediastinal (thymic) lymphocytes (usu. B-cells) that are relatively
mass unresponsive to antigenic stimuli.
very high leukocytes counts 29 Dormant and accumulate in the blood, BM,
higher incidence of CNS involvement LN, spleen
carries poorer prognosis 30 Rarely caused by T cell proliferation
A. T CELL ALL 31 Males, older age (50 -60yo) , inherited or
B. B CELL ALL acquired
15. used to predict therapeutic outcomes 32 Ionizing radiation, HTLV virus, genetic
A. KARYOTYPING 33. More common in men
B. PHENOTYPING Fatigue, reduced exercise tolerance,
16. CHROMOSOMAL TRANSLOCATIONS FOR bruising, pallor, jaundice asso with anemia,
PRE B CELL fever due to infection, bone tenderness,
a. t(1;9) weight loss, edema from LN obstruction,
b. t (8;14) erythroderma pruritus
c. t(9;22) Benign to severe
17. CHROMOSOMAL TRANSLOCATIONS FOR Some may live 10-15 years without TX
PRo B CELL Aggressive ones about a 3-5years
d. t(1;9) Splenomegaly , hepatomegaly may involve
e. t (8;14) other organs like gonads, kidneys, skin,
f. t(9;22) prostate, walls of GI tracts.
34. Absolute lymphocyte count 10k -150k
18. CHROMOSOMAL TRANSLOCATIONS FOR b cumm. 1M cu mm found in more aggressive
cell burkitt CELL conditions
g. t(1;9) Lymphocytes appear normal but larger
h. t (8;14) Nuclei with clumped or condensed chromatin
i. t(9;22) Nucleoli are prominent
Cytoplasm are abundant, non-granular,
19. conditions to do bm transplantion moderately basophilic
a. Considered in patient who relapse and Lymphocyte are more fragile than normal
achieve a second remission smudge cells
b. Response rate in ALL are high Neutrophils are decreased
c. Allogenic transplant is preferred Aggressive dse. Have granulocytopenia,
d. All of the above thrombocytopenia and anemia
20. plant alkaloid ,inhibits RNA Autoimmune hemolysis - + DAT triggered by
a. vincristine viral infxn, drugs, dse. Progression
b. prednisone Lymphocytes contain glycogen PAS+
21. steroid, lysis of blasts Plasma Igs dec.
 BM aspiration not necessary Leukemic reticuloendotheliosis (EWALD
30% more lymphocytes in BM with 1923)
lymphocytosis DX Dse. is described as large spleen with
Erythroid cells in BM megaloblastic with EH circulating mononulear cells with numerous
35. Hans has Absolute lymphocyte count cytoplasmic projections
10k -150k cumm Lymphocytes appear normal Anemia , bleeding , infection, paraneoplastic
but larger complications, autoimmune syndrome,
Nuclei with clumped or condensed chromatin paraproteinemias
Lymphocyte are more fragile than normal weakness, bleeding, fatigue and infection
smudge cells scant to abundant , agranular , light grayish
Neutrophils are decreased blue cytoplasm
Have granulocytopenia, thrombocytopenia loose and lacy
and anemia 90% - splenomegaly
Autoimmune hemolysis - + DAT triggered by Occ. Liver enlargement
viral infxn, drugs, dse. Progression a. Hairy cell leukemia
Lymphocytes contain glycogen PAS+ b. Pll
Plasma Igs dec. c. CLL
BM aspiration not necessary 53. Most consistent feature of HCL
36. More prominent dx a. Pancytopenia
a. 30% more lymphocytes in BM with b. Leukopenia
lymphocytosis 54. Most common causes of leukopenia
b. 40% lymphocyte in bm a. Granulocytopenia
c. 60% b. Monocytopenia
37. Clymphocytic is associated with what anemia? c. Lymphocytopenia
a. Megaloblastic d. A and B
b. Aplastic 55. induces partial to complete remission
38. (14q) , t(11;14) is most common a. pentostatin
39. Alteration in chromosome 11,6,18,3,17 and 8 b. 2-chlorodeoxyadenosine
40. B-CLL express low amts. Of sIg, but inc. cIg c. Cladribine
41. Goals of therapy are d. All of the above
a. the relief of symptoms 56. Most common malignant dse of plasma cells
b. prevention of complications generally affects older individuals (50-75yrs).
c. treat disease itself
d. a and b a. Multiple myeloma
42. Galton 1974 b. Plasma cell myeloma
43. More on men age 60yo c. A and b
44. Prolif. of abnormal cells in spleen , BM, d. None
sometimes liver 57. Transformation occurs at the hematopoietic
45. Low Ig stem cell
46. T lymphocytes are below normal a. CALLA (CD10)
Ling is a 60 year old man with the ff b. CALLA CD11
manifestations fatigue, weight loss, impressive 58. leading to bone resorption and lytic bone dis.
splenomegaly, leucocyte count of 1M, with a a. Osteoclast activating factor
large mononuclear with an oval to round b. Osteoblast
nucleus, coarse chromatn strand with 1-2 59. Leukemia with Anemia , infection and
vesicular nucleoli w/ perinuclear condensations, bleeding
cytoplasm is agranular and basophilic, Cells also infiltrate LN, spleen, and other
Glycosuria and hyperglycemia
organs
Increased risk of infection decreased
a. Prolymphocytic leukemia
b. Lymphoblastic leukemia production of normal Igs sp. asso. in primary
47. PLL chromosome immune response
a. Chromosome 1, 6 M proteins- may cause the clinical
b. Chromosome 2,6 manifestations
48. Pll is with what trisomy L chains ( bence jones proteins)
a. 12 filtered out by the kidney glomeruli
b. 11 with massive reabsorption in the proximal
c. 13 tubules. In time entire nephron will be
49. T (6;12), T (11;14) damaged. renal failure
50. CD103 positive 60. Sentinel prime Skeletal pains is the chief
51. Low CD5 expression
52. 2% of all leukemias complaint
 Back pains, as his pathologic fracture a. PCL
Anemia b. MM
Renal insufficiency 68. NN anemia Hge, hemodilution from
Weakness and fatigue hypovolemia, dec. red cell survival
Bleeding episode Retic count N or dec
Susceptibility to infection Platelets and leukocytes are in ref range
a. MM Inc ESR rouleaux formation
b. BM BM shows variation of cell types (small
c. CM lymphocytes, plasmacytoid lymphocytes, plasma
61. NN anemia, Hb 7-12g/dl
cells)
Rouleaux formation
Mast cells maybe inc.
Blood film bluish tinge macroscopically
a. Waldenstroms macroglobulinemia
Slight neutropenia
b. MM
No plasma cells seen in early stage
69. Retinal abnormalities preceding retinal Hge and
Abnormal plasma cells late stage but rare
ESR increased due elevated Se. globulins neurologic changes - hyperviscosity
Cellular inclusions like Dutcher bodies Mast cells may be increased; electrophoresis
crystalline features of abn. Igs monoclonal peak in beta gamma region
Russell bodies rounded accumulations of Ig in Prolonged APTT and TT
70. the most common infiltration of plasmacytoid
the cisternae of rough ER of the cytoplasm
Few IgA myeloma flame cells abundant lymphocytes into duodenal or jejunal wall ,
producing malabsorption and abdominal distress
cytoplasm with reddish tinge of ribosomal
.respiratory tract IgA involved in few cases
proteins
a. a- HCD
b. beta-HCD
d. MM
71. common in young people
e. BM
a. alpha- HCD
f. CM
b. beta- HCD
62. Chemistry- Protein electrophoresis monoclonal
72. mostly in older men
peak a. gamma HCD
63. Tx: splenomegaly b. beta HCD
64. Radiologic evidence osteoporosis and lytic 73. rarest form relate to CLL
bone dse. a. u HCD
65. BJP worst prognosis b. gamma HCD
66. Urine protein studies , CBC, Xray, may be for 74. Atypical lymphocyte and plasma cells seen PB
monitoring dse process generally composed of immunoblast,
67. when circulating plasma cells exceed lymphocytes and plasma cells like WM
2000/cumm. 75. spike in beta gamma region
Can occur on late manifestation of MM but is a 76. gamma H chain in IEP no L chain
more discreet entity 77. mature plasma and vacuolated PC
Occur in younger 78. seen in BM in 2/3 of cases
Complain of bone pain and show less osteolysis 79. vacuoles dont contain IG
> incidence of LAD and hepatosplenomegaly 80. Only HCD that secrete L chain in urine usually
a. pcl kappa
b. dcl 81. Abnormality in H &L chain assembly
82. closely related to plasma cells dis. But few may
68. PS - > 2000/cu.mm of plasma cells have polyclonal forms
83. Amyloid is composed of L chain fragments
Pancytopenia 84. from the variable regions of Ig
85. l- chain often involved
Inc. ESR 86. Secondary Amyloidosis related to chronic illness.
Amyloid is not related to Ig
Abnormal plasma cells are small with little
87. Cause is unknown
cytoplasm Environmental , EBV
7th mc cause of cancer deaths in US
BM infiltration are diffuse and proliferating cells Common in 20s decline at 40s but rises during
are about 45% advance stage
More common in men 3:2
Serum and protein studies will differentiate this Clinical feature rapid cervical enlarge- ment of
disorder from more common lymphocytic cervical LN, mediastinal mass Xray,fever , <night
leukemias sweats, weight loss> (B-symptoms)
 A symptoms no symptoms
Dse spreads in orderly fashion
Advanced cases involved blood
a. HODGKIN
b. NONHODGKIN
88. NN anemia 10%
Retic ct N or low
BM seldom involved except in advanced stage
Laboratory
se iron and TIBC reduced, DAT+, inc ESR,
inc. Se. Globulins, ceruloplasmin, leukocyte
alk.phos,LDH and transaminase
Hyperuricemia renal failure
a. HODGKIN
b. NONHODGKIN
89. Known before as lymphosarcoma
90. Rudolf Virchow
91. 3x more common than HD
92. Cong. Immunodefeciency , Ataxia telangiectasia,
wiskott-aldrich syn, IgA def., SCId
93. Rheu. Arthritis, sjogrens syn, SLE
94. Immunosuppresive drugs
95. AIDS
96. EBV, HTLV
97. Painless LN enlargement
98. Cervical LN
99. Fever , night sweats, weight loss 30% esp with
advanced stages
100. Blood counts are normal even with BM
involvements
101. Chemistries like inc alk.phos,LDH,uric
a.,may also occur like in HD