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Question 1
What are hematological cancers
malignancies affecting blood, bone marrow, or the lymphatic system, often caused by the rapid, uncontrolled growth of abnormal white blood cells
Question 2
What percentage of newly diagnosed cancers are hematologic cancers?
15%
10%
7%
2%
Question 3
What percentage of all diagnosed cancers are leukemias?
2.5%
4%
1%
3%
Question 4
How many Americans are diagnosed with lymphoma each year?
100,000
90,000
60,000
80,000
Question 5
Main categories of hematologic cancers
Sarcomas, Carcinomas, Adenomas
Lymphomas, Leukemias, Multiple Myeloma
Gastrointestinal Cancers, Hepatic Cancers, Pancreatic Cancers
Cardiac Cancers, Pulmonary Cancers, Renal Cancers
Question 6
Types of lymphomas?
Gastrointestinal Cancers
Multiple Myeloma
Leukemias
Hodgkin's Lymphoma Non-Hodgkin's Lymphoma
Question 7
Subtypes of Non-Hodgkin's lymphoma?
Chronic Myeloid Leukemia
Acute Lymphocytic Leukemia
Follicular Lymphoma
• Burkitt's Lymphoma • Diffuse Large B-Cell Lymphoma (DLBCL) • Follicular Lymphoma
Question 8
Types of Leukemias
• Acute lymphocytic leukemia • acute myeloid leukemia • chronic lymphocytic leukemia
Question 9
What is the primary function of a myeloid stem cell?
To form muscle tissue
To produce hormones
To differentiate into red blood cells, platelets, and granulocytes
To differentiate into lymphoid stem cells
Question 10
Main types of granulocytes produced from myeloid stem cells?
Eosinophils, Neutrophils, Basophils
Monocytes, Lymphocytes, Neutrophils
Eosinophils, Basophils, Lymphocytes
Eosinophils, Neutrophils, Monocytes
Question 11
What do lymphoblasts differentiate into?
Mesenchymal stem cell
Myeloid stem cell
Erythroid stem cell
B lymphocytes, T lymphocytes, and natural killer cells
Question 12
3 types of Hodgkin's Lymphoma
• Classic- 4 subtypes • Nodular lymphocyte predominant • HL, not otherwise classifiable
Question 13
What is the most common type of lymphoma in young adults?
Leukemia
Lymphogranuloma Venereum
Hodgkin’s Lymphoma
Multiple Myeloma
Question 14
Which virus is associated with Hodgkin’s Lymphoma?
Epstein-Barr Virus
Human Papillomavirus
Herpes Simplex Virus
Cytomegalovirus
Question 15
What is the key histologic feature of Hodgkin’s Lymphoma?
Schwann Cell
Plasma Cell
Megakaryocyte
Erythroblast
Question 16
What are the typical enlarged lymph nodes affected in Hodgkin's Lymphoma?
Arms and legs
Head and feet
Shoulders and hips
Neck, mediastinum, axillary, and groin region
Question 17
Which B symptoms are associated with Hodgkin's Lymphoma?
Shortness of breath, cough, and chest pain
Low-grade fever, weight loss, and night sweats
Headache, blurred vision, and dizziness
Nausea, vomiting, and diarrhea
Question 18
What does the 'A' or 'B' designation denote in the staging of Hodgkin’s Lymphoma?
The number of lymph nodes involved
The stage of the disease
The presence of fever or night sweats
The location of the primary lymph node
Question 19
What is a rare oral manifestation of Hodgkin's Lymphoma?
Increased saliva production
Enlargement of the tonsillar tissue in Waldeyer’s ring and paleness of the oral mucosa
White patches in the mouth
Swollen gums and tooth loss
Question 20
What is the Waldeyer ring?
A collection of lymph nodes in the armpit
A group of salivary glands
A set of muscles in the neck
A ring of lymphoid tissues in the throat
Question 21
Stage I Hodgkin’s Lymphoma characterized by?
Involvement of the spleen
Involvement of a single lymph node region or a single extralymphatic site
Diffuse extralymphatic disease
Involvement of multiple lymph node regions
Question 22
Parts of the Waldeyer ring?
Palatine Tonsils
Lingual tonsils
Tubal Tonsils
• Pharyngeal tonsils • tubal tonsils • palatine tonsils • lingual tonsils
Question 23
Stage II Hodgkin’s Lymphoma characterized by?
involvement of 2+ lymph node regions on same side of diaphragm
Question 24
Stage III Hodgkin’s Lymphoma characterized by?
Involvement of lymph node regions on both sides of the diaphragm
Question 25
What does Stage IV Hodgkin’s Lymphoma involve?
Involvement of two or more lymph node regions on the same side of the diaphragm
Diffuse extralymphatic disease (e.g., in liver, bone marrow, lung, skin)
Involvement of the spleen
Involvement of localized lymph node regions
Question 26
What percentage of diagnosed lymphomas fall into the category of Non-Hodgkin’s Lymphoma?
90%
70%
60%
85%
Question 27
Which age group is most commonly affected by Non-Hodgkin’s Lymphoma?
Teenagers
Children
Infants
Adults, but can be seen in children
Question 28
Physical presentations of Non-Hodgkin’s Lymphoma?
Muscle pain
Headaches
Skin rashes
Fever
Question 29
Oral presentation of Non-Hodgkin’s Lymphoma?
Bad breath
Tooth decay
– Swelling of the soft tissue of the oral mucosa – Enlargement of the minor or minor salivary glands –
Osteolytic (radiolucent) lesion in the jaw bones
Gum bleeding
Question 30
Lesion in the jaw bones related to Non-Hodgkin’s Lymphoma?
Osteolytic (radiolucent) lesion
Cystic lesion
Sclerotic lesion
Fibrous lesion
Question 31
Pathophysiology of Chronic Lymphocytic Leukemia
Slow lymphocytic infiltrate of the bone marrow
Question 32
What type of lymphoma is Burkitt's lymphoma?
Aggressive type of Non-Hodgkin’s, B-cell lymphoma
Indolent type of Non-Hodgkin’s lymphoma
T-cell lymphoma
Chronic type of Non-Hodgkin’s lymphoma
Question 33
What is the molecular abnormality associated with Burkitt's lymphoma?
t(11;14)(q13;q32)
t(14;18)(q22;q21)
t(8;14)(q24;q32)
t(14;18)(q32;q21)
Question 34
Types of Burkitt's lymphoma?
– Endemic: children of central african descent – Sporadic: older children and adults in Western countries – Immunodeficiency associated
Immunosuppressed individuals
Children of Central African descent
Residents of equatorial regions
Question 35
Oral presentation of CLL
• Pallor throughout the oral cavity • Infection of the oral soft tissue
Question 36
Clinical presentation of endemic Burkitt's Lymphoma
• Rapidly growing tumor (abdominal organs) • Abdominal tumors accompanied by pain/vomiting
Slowly growing tumor with a predilection for the chest
Tumor with a predilection for the skin
Tumor with a predilection for the brain
Question 37
What is a key oral presentation of endemic Burkitt's Lymphoma?
Small tumor of the maxilla or mandible without symptoms
Tumor of the mandible exhibiting swelling
Tumor of the maxilla exhibiting bleeding
• Large tumor of maxilla or mandible w/ pain or paresthesia • Displacement of teeth; involves oral soft tissues • poorly-defined osteolytic lesions
Question 38
What is the common age group affected by Acute Lymphocytic Leukemia (ALL)?
Middle-aged adults
Teenagers
Elderly
young children
Question 39
Physical presentation of Acute Lymphocytic Leukemia (ALL)?
– Enlargement of lymphoid organs – Pallor, fever, fatigue, bone pain – Excessive bleeding and anemia
Bone pain
Fever
Fatigue
Question 40
Oral presentation of Acute Lymphocytic Leukemia (ALL)?
Bad breath
Tooth decay
Gum swelling
Oral ulceration, infections, and paresthesia
Question 41
What is the form of leukemia typically seen in adult patients?
Acute Myeloid Leukemia (AML)
Pediatric Leukemia
Chronic Myeloid Leukemia (CML)
Chronic Lymphocytic Leukemia (CLL)
Question 42
Which type of cells is involved in the proliferation seen in AML?
myeloblast
platelets
lymphocytes
monocytes
Question 43
Physical presentation with AML?
• Pallor, bone pain, and flu-like symptoms • Anemia, petechiae and bruising of the skin • Enlargement of lymph nodes, tonsillar tissue and spleen • Poor wound healing and recurrent infections
Constipation
Nausea
Headache
Question 44
Oral presentations of Acute Myeloid Leukemia?
Gingival hyperplasia
Oral microbial infections
Paresthesia
• Submucosal hemorrhage, mucosal ulceration, severe periodontitis •
Gingival hyperplasia
• Oral microbial infections • Paresthesia
Question 45
What type of lymphocytes form the tumor in Chronic Lymphocytic Leukemia (CLL)?
Immature T lymphocytes
Mature clonal B lymphocytes
partially mature clonal B lymphocytes
Partially mature clonal T lymphocytes
Question 46
What is the most common form of leukemia in adults?
Acute Lymphocytic Leukemia (ALL)
Hodgkin Lymphoma
Chronic Myeloid Leukemia (CML)
Chronic Lymphocytic Leukemia (CLL)
Question 47
Physical presentations of CLL?
Fever
– B-symptoms –
Lymphadenopathy
– Bleeding tendency, anemia, and slow wound healing
Weight loss
Nausea
Question 48
What type of cells are affected in Chronic Myeloid Leukemia?
Fully mature myeloid cells
Neoplasm of partially mature myeloid cells
Immature lymphoid cells
Mature red blood cells
Question 49
Which chromosome abnormality is associated with Chronic Myeloid Leukemia?
t(11;14) Chromosome
t(9;22)
Philadelphia Chromosome
t(10;21) Chromosome
t(14;18) Chromosome
Question 50
Physical symptoms of Chronic Myeloid Leukemia?
• B-symptoms, fatigue, excessive bleeding, and infection • Enlarged abdomen (splenomegaly) • Bleeding, anemia, and infection
nausea
headache
diarrhea
Question 51
What is another focus of pts in remission
Side effects of post cancer treatment therapy 1. Graft vs Host Disease 2. Radiation-Induced ORN 3. MRONJ
Question 52
What type of cells is primarily affected in Multiple Myeloma?
plasma cells
White blood cells
Red blood cells
Platelets
Question 53
What protein product is secreted by abnormal cells in Multiple Myeloma?
K-protein
L-protein
N-protein
H-protein
Question 54
What is the primary age group affected by Multiple Myeloma?
adults over the age of 40
infants under the age of 1
young adults aged 25-35
children under the age of 10
Question 55
Physical presentations of multiple myeloma?
Hypercalcemia
Diabetes
– Hypercalcemia, renal failure, anemia, amyloidosis, and lytic bone lesions – Back pain, headaches, and fever – Increase risk of excessive bleeding and infection
Rheumatoid arthritis
Question 56
Oral manifestations of multiple myeloma?
Enlargement of the soft tissue
Tooth decay
Salivary gland swelling
Gum recession
Question 57
What condition is depicted in the clinical image?
Rheumatoid arthritis
Psoriasis
Scleroderma
Amyloid deposition with Multiple Myeloma
Question 58
What condition is depicted in the images?
Oral Leukemia
Oral Cancer
Single Myeloma
Oral Lymphoma
Question 59
What is the primary visual symptom shown in the images?
Oral Lichen Planus
Oral Bacterial Infection
Oral Herpes
Oral Amyloid Deposition
Question 60
What type of medical imaging is shown in the image?
Axial CT Scan
Lateral Cephalogram (multiple myeloma)
Anteroposterior X-ray
Sagittal MRI
Question 61
What condition is indicated by the arrows in the image?
Fibrous Dysplasia
Sarcoidosis
Osteoporosis
Multiple Myeloma
Question 62
Diagnostic modalities
Medical history
Biopsy
– Physical examination – Medical history – CBC with Differential – Diagnostic imaging – Blood and urine analysis – Peripheral Blood smear – Biopsy – Immunophenotyping – Cytogenetic testing
X-ray imaging
Question 63
Dental considerations prior to cancer therapy - Pretreatment
Orthodontic adjustments
1. Risk of infection 2. Exposure to infectious diseases 3. Bleeding tendency/anemia 4. Eradication of oral disease prior to cancer therapy 5. Patient education
Prevention of cavities
Dental implants
Question 64
Dental considerations prior to cancer therapy - During Treatment
6. Side effects associated with cancer therapy 7. Coordinating dental treatment with cancer therapy
Teeth whitening
Risk of infection
Exposure to infectious diseases
Question 65
What is the importance of addressing oral disease before cancer therapy?
Eradication of oral disease prior to cancer therapy
Preventing tooth decay
Enhancing dental aesthetics
Reducing dental sensitivity
Question 66
What is the importance of coordinating dental treatment with cancer therapy?
To reduce dental costs
To minimize complications and optimize patient outcomes
To enhance dental appearance
To avoid dental pain
Question 67
Management for hematologic cancers?
Immunotherapy
Radiation
• Chemotherapy • Radiation • Stem cell transplantation • Surgery • Prednisone – often used in combination with other type of therapy • Biologic therapy (Immunotherapy + Targeted therapy) •
Bisphosphonates
Surgery
Question 68
Oral side effects of cancer therapy
1. radiation induced caries 2. oral mucositis 3. fungal infection/candidiasis/oral thrush
Gingivitis
Dental Caries
Periodontitis
Question 69
What is the primary focus of dental considerations during remission?
Changes to the nasal cavity
Changes to the ear cavity
Temporary changes to the oral cavity
Permanent changes to the oral cavity and overall health after cancer treatment • trismus • growth/dev changes in children