ALL

Question 1

What causes thymic enlargement, hepatosplenomegaly and testicular swelling in ALL?

Answer 1

Cancer infiltration

Question 2

What CNS symptoms can you get

Answer 2

Headaches, vomiting, nerve palsies

Question 3

Investigations for ALL and where you would get it from

Answer 3

FBC
U and E
LDH (high)

Morphology (blood film)
Cytochemistry (cell staining)
Flow cytometry (immunophenotyping)
Cytogenetics/molecular genetics (translocations)

CXR

BM aspirate from PSIS of hip

Question 4

What abnormalities may be seen in U and Es

Answer 4

High potassium
High phosphate
High uric acid
Hypocalcemia

Question 5

What does high potassium, high phosphate and high uric acid and low calcium symbolise?

Answer 5

Tumour lysis syndrome

Question 6

How do you treat tumour lysis syndrome

Answer 6

Allopurinol 300mg once daily for 7days, 2 days before any chemo
Hyperhydration 2-3L/24 hours
Cross match and platelet transfusion

Question 7

Why do you get low calcium in TLS

Answer 7

Hypocalcaemia
occurs as result of precipitation of calcium phosphate in soft tissues due to the acute development
of hyperphosphataemia

Question 8

What does the excess uric acid cause

Answer 8

AKI

Question 9

Management outline for ALL

Answer 9

Remission induction
Consolidation
Intensification
Maintenance

Question 10

How long does mx last for M and F

Answer 10

M = 3 years
F = 2 years

Question 11

If there is CNS involvement, where does the chemo go?

Answer 11

Intrathecally