robbypowell's version from 2017-05-03 16:11

WBC disorders

Question Answer
Which gender has higher RBC counts?Men
What cells are the most numerous WBC's?Neutrophils (40-74% of leukocytes)
_____ expand during bacterial infection while _____ expand during viral infection (leukocyte types)Neutrophils (bacterial) Lymphocytes (viral)
____ & ____ expand during Tuberculosis infection (leukocytes)Monocytes & Neutrophils
What are the 2 primary Lymphatic Organs?Red Bone Marrow & Thymus
What are the 5 secondary Lymphatic Organs?Lymph nodes, Tonsils, Spleen, Peyer's patches, & MALT
The ____ breaks down RBC's, sequesters platelets, secondary immune response, & filters bloodspleen
Most H&N manifestations of WBC problems are due to ______ (leukocyte cell type)Neutrophils
Which two racial groups are known to have Benign Ethnic Neutropenia?Mediterranean & African
Patients with Neutropenia are specifically susceptible to _____ infectionsBacterial (S. Aureus, GM- bac, oral cavity, middle ear, perirectal area)
Peri-rectal area lesions are indicative of a problem with which leukocyte cell type?Neutrophils (Neutropenia)
Atypical, multiple, crater-like ulcers on the marginal gingiva or tongue that don't heal properly suggests what type of leukocyte problemNeutropenia (neutrophils)
____ _____ neutropenia is like other neutropenias, but it comes and goes periodically (every 3 weeks) with regular fluctuations in neutrophil counts leading to periodic bursts in mouth ulcersCongenital Cyclic neutropenia
SEVERE Neutropenia is called ________ and you will see a WBC < _____/uLAgranulocytosis; <200u/L
What are the Oral manifestations of Agranulocytosis? What disease does is resemble?Deep punched out ulceration of buccal mucosa and gingiva; ANUG
The biggest difference between Aplastic Anemia & Agranulocytosis is the _____ & count which are unaffected in AgranulocytosisPlatelet Count & RBC (Agranulocytosis is basically no neutrophils)
T/F: hyperplasia is reversibleTrue
Neoplasia or No?: Large Unilateral Cervical Lymph Node, enlarging over a 3 yr periodNeoplasia
Neoplasia or No?: Bi-lateral Tonsillar enlargementNo (benign hyperplasia)
Neoplasia or No?: Uni-lateral Tonsillar enlargementNeoplasia
______ is a term meaning increased numbers of WBC'sLeukocytosis
Neoplasia of neutrophils, basophils, and/or eosinophils is ______ (myeloid/lymphoid)myeloid
Neoplasia of lymphocytes, B/T cells, and/or natural killer cells is _____(myeloid/lymphoid)lymphoid
Hodgkin Lymphomas make up ______ of all lymphomas1/3
The only lymphoma "that really affects young adults" is _______ lymphomaHodgkin
What is the most common initial presentation of Hodgkin Lymphoma?Enlarged Cervical or Supraclavicular LN (70-75%)
When looking at a LN of a patient with Hodgkin's Lymphoma you should expect to see a (minority/majority)______ of neoplastic cells and a (minority/majority)_______ of cells reacting to themMinority (neoplastic); Majority (reacting)
"Reed-Sternberg" cells & "Popcorn" cells are associated with what condition?Hodgkin's Lymphoma
T/F: Needle aspiration is adequate to diagnose Hodgkin's LymphomaFalse (there are very few neoplastic cells, so they can be hard to capture in needle aspiration)
What Lymphomas are most common in the oral cavity?Diffuse large B-cell Lymphomas
_______ lymphomas are linked to several viruses (e.g. Epstein-Barr) & bacteria and there is an increased risk with immunodeficiencies (e.g. AIDS)Non-Hodgkin Lymphoma
A moth-eaten appearance and poorly defined radiolucencies in the jaws is suggestive of what type of LymphomaDiffuse Large B-Cell (DLB) Lymphoma
Starry-Sky histopath appearance (under microscope) is associated with what High Grade Non-Hodgkin's Lymphoma?Burkitt Lymphoma


Question Answer
2 Primary Hematopoietic "organs"Bone Marrow & Thymus
3 Secondary Lymphoid "organs"Spleen, Lymph Nodes, MALT
Common Lymphoid Stem cells give rise to what 3 lineages?B, T, & NK lineages (lymphocytes)
leukopenia, neutropenia, granulocytopenia, agranulocytosis, & lymphopenia are all terms for _____ levels WBC's in bloodDecreased
Increased WBC numbers in tissues, lymphoid organs, bloodWBC Hyperplasia
T/F: All Hematopoietic Neoplasia is malignantTrue
T/F: Only a few forms of Hematopoietic Neoplasia are malignantFalse (they are all malignant)
The majority of WBC's are _____ ... making up >40%Neutrophils
Normal WBC cell count is _____WBC's/ml4,000 - 11,000
What are the "first responders" to infection?Neutrophils
term for Leukocyte count <1500/ml (N=1800-8500)Neutropenia
7 Infections that can induce NeutropeniaViral hepatitis (A and B), Rubella, Measles, Varicella, HIV, Typhoid, TB
some Mediterranean, African, African-American populations experience what as an exception to normal cell countBenign Ethnic Neutropenia
Diagnostic Feature uncharacteristic of typical ulcers: crater-like, marginal gingival ulcer in the oral cavityNeutropenia
What 3 places will Neutropenia commonly have SA of Gram neg infections?Oral Cavity, Middle Ear, Perirectal Area
Term for Phagocyte DeficienciesAgranulocytosis
Diagnostic Feature for WBC deficiencies: Deep, punched-out ulcerations of buccal mucosa, gingiva (but no neutrophils under slide)Agranulocytosis
Urgent Medical attention required for this deficiency ____Agranulocytosis
Reversible & Reactive adaptation to stress causing increased cellular division/productionHyperplasia
Neutrophilia, granulocytosis are hyperplasias induced by what?Bacterial infections
Hyperplasia induced by Allergies, parasitic infestationsEosinophilia (Mastocytosis too)
Hyperplasia induced Notably by, myeloproliferative disease (malignant or premalignant conditions of myeloid cells)Basophilia
Hyperplasia induced by TuberculosisMonocytosis
Hyperplasia induced by viral infectionsLymphocytosis
term: expansion of any lymphoid tissue in response to antigensLymphoid Hyperplasia
enlargement of lymph nodesLymphadenopathy
inflammation of lymph nodesLymphadenitis
example of MALT HyperplasiaTonsillar Enlargement; Tonsillitis
T/F: Reactive Lymphoid Hyperplasia usually responds to antibioticsTrue
_____ lineage malignancies tend to associate with lymphoid tissues/organsLymphoid
_____ lineage malignancies tend to not associate with lymphoid tissues/organsMyeloid
Malignancies of what area tend to associate with both Lymphoid & Myeloid lineages?Bone Marrow
3 examples of Lymphoid NeoplasmsLymphomas, Leukemias, & Plasma Cell Malignancies
4 types of Myeloid disordersMyelodysplastic Syndrome, Myeloproliferative Disorder (e.g. Leukemia), Histocytic/Dendritic Neoplasms, Mast cell disorders
What cancer can be both/either Lymphoid Neoplasm and/or Myeloid disorder?Leukemia
Malignant neoplasia of mature lymphocytes and their precursorsLymphoma
Two major categories of LymphomaHodgkins & Non-Hodgkins
Most common initial presentation of Hodgkins Lymphoma (70-75%)Enlargement of Cervical and Supraclavicular lymph nodes
What type of cell can be seen under microscope with Hodgkins Lymphoma?Reed Sternberg cells
these cells are large and are either multinucleated or have a bilobed nucleus with prominent eosinophilic inclusion-like nucleoli (thus resembling an "owl's eye" appearance)... seen in what condition?Hodgkin's Lymphoma (Reed Sternberg cells)
All lymphomas are ______ (peripheral/precursor) neoplasmsPeripheral
Most common NHL in the head and neck areaB cell Lymphomas
Non-Hodgkins Lymphoma NOT in lymph nodes called ______ NHLextranodal NHL
example of Low Grade NHLSmall Lymphocytic Lymphoma (can evolve into Chronic LL)
2 most common Intermediate Grade LymphomasDiffuse large B cell lymphomas, Large T cell lymphomas
Diffuse large B cell lymphomas & Large T cell lymphomas are examples of what grade?Intermediate
Example of High grade LymphomaBurkitt's Lymphoma
What condition Associated with a chromosomal translocation t(8:14) (c-MYC)Burkitt's Lymphoma
rapidly growing lymphoma of childhoodBurkitt's Lymphoma
Eppstien Barr virus associated with what neoplasia?Burkitt's Lymphoma
Classification of Burkitt's Lymphoma in Malaria stricken countries, believed that Malaria lowers resistance to EBVEndemic Burkitt's
Classification of Burkitt's Lymphoma in non-malaria stricken countries that may or may not have involvement of EBV but w/o immunosuppressionSporadic Burkitt's
Classification of Burkitt's Lymphoma for patients with HIV or following organ transplantImmunosuppression Burkitt's Lymphoma
It is problematic to cure ____ grade lymphomasLOW
A cure is more achievable for ____ grade lymphomasHIGH (and Intermediate) (treatment more aggressive too)
Multiple Myeloma accounts for ___ to ___% of hematologic malignancies10-15%
Multiple Myeloma is more prevalent in what age group?Older adults
Deposition of extracellular proteinaceous materialAmyloidosis
Special stains for AmyloidosisCongo red & Thioflavin-T
What test should you run on a patient with Amyloidosis?Serum Protein Electrophoresis to evaluate for Multiple Myeloma
term describing leukemia of very immature leukocytes (blasts)Acute (A Cute Baby)
term describing leukemia of relatively mature leukocytesChronic
term describing leukemia of Lymphoid lineageslymphoblastic
term describing leukemia of myeloid lineagesMyelogenous
Rapid replacement of bone marrow by immature malignant cells results in anemia, bleeding problems and infectionsAcute Leukemia (M or L)
Leukemia with gradual onset, or progression from lymphomaChronic Leukemia

what condition?

Question Answer
WBC <200 /ml of bloodAgranulocytosis
Leukocyte count <1500/mlNeutropenia
Lack of neutrophils in ulcerAgranulocytosis
Enlarged, firm or rubbery lymph nodes, -/+ tender ... Usually less than 2 cmLymphoid Hyperplasia (e.g. Mononucleosis)
4 cm right upper cervical lymph node, somewhat tender to palpation; enlarging over last 3 years; no evidence of infectionNeoplastic Lymphoid Hyperplasia (didn't specify)
Reed Sternberg cells (owl's eye like appearance of B-cell derived cell)Hodgkin's Lymphoma
nodal; diffuse lymphoma of small, relatively normal appearing B lymphocytesSLL/CLL (Small/Chronic Lymphocytic Lymphoma)
lesion in oral cavity:Non-tender, ill-defined, firm swelling with Erythema and ulceration. esp. asymmettrically in Waldeyer's ringNon-Hodgkins Lymphoma
Vague pain or discomfort, Paresthesia, Poorly defined radiolucency on R-graph with advanced symptoms of Malaise, fever, sweating, and weight lossBone Lesions of NHL
Bone pain, pathologic fractures, Pancytopenia & Serum HypercalcemiaMultiple Myeloma (plasma cell myeloma)
•“Punched-out” radiolucenciesMultiple Myeloma (plasma cell myeloma)
increased blood immunoglobulin and/or Bence-Jones proteins in urineMultiple Myeloma (plasma cell myeloma)
neoplasia with Amyloid deposition in various soft tissuesMultiple Myeloma
Congo Red positive results on Oral soft tissue biopsyMultiple Myeloma (CR testing for Amyloid)
Fatigue, Weight loss, Paresthesia, Hoarseness, Edema, Orthostatic hypotension, Carpal Tunnel Syndrome, & Mucocutaneous lesions(multiple) Myeloma-Associated Amyloidosis
Oral symptoms of Macroglossia (Diffuse or nodular) Claudication of masticatorymuscles (increasing pain with jaw function, resolves with rest)Myeloma-associated Amyloidosis
vomiting, headache, nerve palsies; Anemia, bleeding disorder, infections, bone pain, lymphadenopathy, hepato-and splenomegalyLeukemia
leukemia with gingival involvementAcute Myelogenous Leukemia (AML)
leukemia with lymphoid tissue involvementAcute Lymphoblastic Leukemia (ALL)
Candidosis and wide-spread herpes simplex infections •Simulation of periapical inflammatory diseaseAcute Leukemia

Hodgkins or Non-Hodgkins Lymphoma?

Question Answer
Single group of nodes involved (cervical, mediastinal, paraaortic)Hodgkins
Spread by contiguityHodgkins
Rare in mesenteric and Waldeyer ringHodgkins
Extranodal uncommon except for spleenHodgkins
involved in Multiple groups of nodesNon-Hodgkins
Non-contiguous spreadNon-Hodgkins
Common in mesenteric nodes and Waldeyer ringNon-Hodgkins
Often extra nodalNon-Hodgkins
30% of all lymphomas (old data); (for 2013: 1/8)Hodgkins
common (WBC related) cancer of young adults (15-35 yo)Hodgkins
Most common initial presentation (70-75%): Enlargement of cervical and supraclavicular lymph nodesHodgkins
Reed-Sternberg cells seen under microscopeHodgkins

normal values

Question Answer
platelets ___-___k/uL150k-450k/uL (normal)
RBC ___-___ million / uL3500k-6000k/uL
WBC's (leukocytes) ___-___k / uL4k-10k/uL

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