Chronic Myeloid Leukemia and Lymphoid Leukemias MCQs

The description typical of acute sarcoidosis - erythema nodosum, oligoarthropathy and hilar lymphadenopathy. This usually has a good prognosis, with resolution over 6-8 weeks. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 367, Pg: 2833

Cystitis is a risk factor for recurrent cystitis and pyelonephritis. ASB is common among elderly and catheterized patients but does not in itself increase the risk of death. infection does not play a primary role in chronic interstitial nephritis; the primary etiologic factors in this conditions are analgesic abuse, obstruction, reflux, and toxin exposure. In the presence of underlying renal abnormalities Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 135, Pg: 1078

The clinical clues to chronicity of renal impairment is symptoms of azotemia > 3 months, renal osteodystrophy, bilaterally scarred kidneys and broad cast in urinary sediments. Anemia can occur in both AKI and CKD. Disorders of Calcium and Phosphorus homeostasis can also be seen in AKI and CKD. Renal osteodystrophy(bone changes) and small sized kidney with a destroyed renal parenchyma, with increased echogenicity and thinned out cortex with isosthenuria and broad cast are the only conclusive findings of chronicity. However, anemia and Ca Phosphate levels in AKI are not the rule but exception. Hence anemia is the best option here. Reference: Harrison's Principles of Internal medicine, 21 st edition, Ch: 52, Pg: 332, 333.

Chronic hepatitis B afflicts 248 million people worldwide (2 billion overall have been infected; endemic areas include Asia and sub-Saharan Africa) Whereas, 71 million people are infected with HCV, with the highest rates in central and east Asia, north Africa, and the Middle East. Hence prevalence of hepatitis B is greater Risk of chronicity is maximum with hepatitis C infection (85% risk) Reference : Harrison's Principles of Internal Medicine, 21 st Ed, Ch: 341, Pg: 2592

Myelodysplastic syndrome (MDS) is a clonal hematopoietic stem cell disorder characterized by disordered cell proliferation, impaired differentiation, and aberrant hematopoiesis, resulting in cytopenias and risk of progression to leukemia . Both chromosomal and genetic instability have been implicated; both are aging-related . Cytogenetic abnormalities are found in approximately one-half of patients. Aneuploidy (chromosome loss or gain) is more frequent than translocations . Loss of all or part of chromosomes 5, 7, and 20, and trisomy of 8 may be related to etiology ( 11q23 following topoisomerase II inhibitors ). The type and number of cytogenetic abnormalities strongly correlate with the probability of leukemic transformation and survival. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 102, Pg: 801

Criteria of accelerated-phase CML (Chronic Myeloid Leukemia) includes the presence of - 15% or more peripheral blasts 30% or more peripheral blasts plus promyelocytes 20% or more peripheral basophils Cytogenetic clonal evolution (presence of chromosomal abnormalities inaddition to Ph) Thrombocytopenia 9 /L ( unrelated to therapy ) Accelerated phase of CML is historically associated with median survival of Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 105, Pg: 821

Induction regimens are centered around vincristine, glucocorticoids, and anthracyclines with or without cyclophosphamide or cytarabine. L-Asparaginase is the only ALL-specific drug and is now more intensively used in adults. Pegylated asparaginase has the advantage of a significantly longer period of asparagine depletion. Dexamethasone is often preferred to prednisone because it penetrates the blood-brain barrier and also acts on resting leukemic blast cells Reference: Harrison's Principles of internal medicine 21st ed chap 106 pg. 831

Chronic Lymphocytic Leukemia (CLL) is primarily a disease of older adults , with a median age at diagnosis of 71 years. Reference: Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 107, Pg: 834