Cancer and haematology

Question 1

Which tumour marker would be most likely to be elevated with pancreatic or gallbladder cancer?

Answer 1

CA 19-9

Question 2

Tumour marker for liver cancer

Answer 2

AFP

Question 3

Tumour marker for colorectal cancer

Answer 3

CEA

Question 4

what are the investigations found in addisson’s disease?

Answer 4

low Na+, high K+, high urea

Question 5

what is nephritic syndrome

Answer 5

haematuria, hypertension, oliguria, oedema

Question 6

which organism is most likely for osteomyelitis in sick cell patients?

Answer 6

salmonella enteritidis

Question 7

which is the most likely organism for osteomyelitis?

Answer 7

staph aureus

Question 8

define acute lymphoblastic leukaemia

Answer 8

malignancy of lymphoid cells of B or T cell lineages, leading to uncontrolled proliferation of immature blast cells

Question 9

what is the most common malignancy in childhood?

Answer 9

ALL (L for little)

Question 10

define acute myeloid leukaemia

Answer 10

malignancy of blast cells from the marrow myeloid elements

can arise de novo or on background of myeloproliferative conditions, prev chemo, ionising radiation or genetic

Question 11

what age does AML usually occur?

Answer 11

around 65y, M for mature. incidence increases with age

Question 12

what are symptoms related to bone marrow failure?

Answer 12

anaemia: SOB on exertion, weakness, leukopenia(sx of): recurrent infections, thrombocytopenia: bleeding and bruising (more common in AML)

Question 13

what is tumour lysis syndrome?

Answer 13

large number of cancer cells die within a short period, releasing their contents in to the blood.
increase in phosphate, phosphorus, urea, decrease calcium due to increase in phosphorus

Question 14

define multiple myeloma

Answer 14

malignant clonal proliferation of plasma cells (derived from B lymphocytes)- single clone of plasma cells produce a single immunoglobulin -> monoclonal band, paraprotein in serum/ urine electrophoresis

Question 15

what are the clinical features of MM?

Answer 15

CRABBI
Calcium: hypercalcemia (increased osteoclastic bone resorption releasing ca++)
Renal: monoclonal Ig-> light chain deposition in renal tubules- thirst, amyloidosis
Anaemia
Bleeding: bm crowding-> thrombocytopenia
Bones: bm infiltrates-> lytic bone lesions
Infection

Question 16

FBC result in MM?
ESR

Answer 16

normochromic, normocytic anaemia, leukopenia
ESR raised (faster due to rouleux formation)

Question 17

blood film MM

Answer 17

rouleux formation

Question 18

serum/ urine electrophoresis in MM
urine ix in MM

Answer 18

paraprotein monoclonal band
urine- bence jones proteins

Question 19

BM biopsy in MM

Answer 19

increased clonal plasma cells >10%

Question 20

CXR in T cell ALL

Answer 20

mediastinal widening

Question 21

which leukaemias are ass with philadelphia chromosome?

Answer 21

ALL (worse prognosis) and CML (better prognosis)

Question 22

define chronic lymphocytic leukaemia

Answer 22

accumulation of B cells that have escaped apoptosis

Question 23

blood film in CLL

Answer 23

smudge cells (small mature lymphocytes)

Question 24

what is hodgkin’s lymphoma characterised by?

Answer 24

reed-sternberg cells; binucleate ‘mirror cells’ on biopsy

alcohol can induce pain

Question 25

what is the peak age in HL?

Answer 25

bimodal: 20-35 and 50-70

Question 26

risk factors of HL?

Answer 26

EBV, SLE, HIV, affected sibling, obesity

Question 27

what is NHL further classified by?

Answer 27

low grade: slow diving, widely disseminated at dx, often incurable
high grade: rapid onset lymphadenopathy, more aggressive but better prognosis if identified and treated

Question 28

staging of lymphomas:

Answer 28

Ann Arbor historically, now Lugano classification

Question 29

what disorders come under myeloproliferative neoplasms

Answer 29

myelofibrosis, polycythaemia vera, essential thrombocytosis

Question 30

define myeloproliferative neoplasms

Answer 30

clones of haematopoietic stem cells proliferate in the bone marrow, yet retain its ability to differentiate

Question 31

define essential thrombocytosis

Answer 31

clonal proliferation of megakaryocytes leading to persistently raised platelets, often asymptomatic

Question 32

define polycythaemia vera

Answer 32

malignant proliferation of a clone derived from one pluripotent marrow cell, with the erythroid progenitor offspring avoids apoptosis even in the absence of EPO

Question 33

mx of polycythaemia vera

Answer 33

aspirin, venesection, chemotherapy

Question 34

dx of PV

Answer 34

increased red cell mass, ix for JAK2 mutation

Question 35

define primary myelofibrosis

Answer 35

hyperplasia of megakaryocytes, produces excess platelet derived growth factor, leading to marrow fibrosis and metaplasia

Question 36

what can essential thrombocytopenia and PV progress to

Answer 36

myelofibrosis or AML

Question 37

what are causes of microcytic anaemia?

Answer 37

TAILS
thalassemia
anaemia of chronic disease (more commonly a normocytic, normochromic picture)
IDA
lead poisoning
sideroblastic anaemia

Question 38

blood film of IDA

Answer 38

microcytic, hypochromic cells with poikilocytosis (shape variation), and anisocytosis (size variation), target cells

Question 39

define pernicious anaemia

Answer 39

autoimmune disease resulting in severe B12 deficiency

autoantibodies against parietal cells
blocking antibodies- prevent IF-B12 binding (most common)
binding antibodies- prevent IF binding to ileal receptors

Question 40

where is B12 absorbed in gut

Answer 40

terminal ileum (IF-B12 complex on brush border- resistant to pancreatic protease degredation)

Question 41

what is intrinsic factor secreted by?

Answer 41

gastric parietal cells- binds to B12