Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > Cancer + Haem Qs > Flashcards

Cancer + Haem Qs Flashcards

1
Q

Which leukaemia can have thrombocytosis?

A

CML

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Poor prognosis factors of ALL

A

Being Male
Child being under 2 or over 10
Having B or T cell surface markers on blood film
WCC being above 20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

People on treatment for leukaemia with chemo are at risk of tumour lysis syndrome (PUKE CALCIUM) what prophylaxis is used and if it occurs what treatment is used?

A

Prophylaxis - Allopurinol

Treat with - Rasburicase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Which type of hodgkins lymphoma has the best prognosis?

A

Lymphocyte predominant type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What 4 types of hodgkins are there in order of most common to rare

A

1 - nodular sclerosing (* lacunar cells)
2 - mixed cellularity
3 - lymphocyte predominant (best prognosis )
4 - lymphocyte depleted ( worst prognosis )

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what genetic change is associated with burkitts lymphoma

A

c-myc gene translocation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Examples of B symptoms when in Hodgkins lymphoma indicate poor prognosis

A

Weight loss 10% 6 months
fever 38+
night sweats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which lymphoma can cause tumour lysis syndrome

A

Burkitts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most common form of non hodgkins lymphoma

A

Diffuse large B cell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Non hodgkins lymphoma can be grouped as?

A

High grade (grow quickly so need tx quick) = Diffuse large B cell lymphoma ( B or T lytmphomas)

MALT, Burkitt, mantle cell etc are all low grade lymphomas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Whats the different in Ann arbour stage IIIB and IIIA

A

way to stage hodgkins lymphoma

if patient has B symptoms too = IIIB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is MALT lymphoma like

A

px with chronic gastritis, campylobacter organism positive and infiltrates of lymphoid cells

–> triple therapy with omeprazole, amoxicillin , clarithrymycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

which is better for lymphoma investigation, lymph node aspirate biopsy or excision biopsy

A

excision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

aplastic crisis in sickle cell?

A

infection with parvovirus B19 = temporary cessation of erythropoiesis= drop in haemoglobin and reduced reticulocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Hb electrophoresis for

Minor Alpha thalassemia
HbH Alpha thalassemia
Beta thalassaemia
Sickle cell disease

A

Minor Alpha thalassemia:
Normal HbA2 + HbF + HbH

HbH Alpha thalassemia:
Lowish HbA2, Highish HbF, HbH present

Beta thalassaemia:
Raised HbA2, raised HbF, absent HbA

Sickle cell disease:
HbS present + no HbA + raised HbF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Investigate haemophilia?

A

Both for haemophilia A (factor 8 def) and B (factor 9 def) because they are in the intrinsic pathway

prolonged APTT (with normal PT)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

myelofibrosis features

A

Myeloproliferative disorder

bone marrow fibrosis = bone marrow failure

causes massive splenomegaly + pancytopenia

Tear drop poikilocyte on blood film and dry tap as failure to aspirate bone marrow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

essential thrombocythaemia?

A

Myeloproliferative disorder

high number of platelets
JAK 2 mutation in 50% patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Polycythaemia 1st line management?

A

venesection to keep haemoglobin in norm range

can also do chemo and aspirin as antiplatelet therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

types of polycythaemia? (increase in haemoglobin)

A

polycythaemia vera (Vera meaning primary) is a myeloproliferative disorder

relative polycythaemia - normal r.b.c but low plasma

absolute/true polycythaemia - increased cell mass

secondary polycythaemia - excess erythropoietin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

polycythaemia risk factor

what can polycythaemia itself be a risk factor for?

A

Budd chiari

can cause AML / myelofibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

EPO dependent vs independant polycythaemia?

A

Dependent = secondary

independent = primary (vera)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is aplastic anaemia?

A

: type of anaemia caused by bone marrow failure
Normochromic normocytic anaemia
Leads to a decrease of all cells (pancytopenia) – i.e. leukopenia, anaemia, thrombocytopaenia

e.g. in myelofibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

mutation in polycythaemia vera?

A

JAK 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

PUKE calcium acroynm?

A

Tumour lysis syndrome (can occur when treating leukaemias with chemo)

  • Phosphorous
  • uric acid
  • potassium
  • ELEVATED

Calcium reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

CML gene link?
other features

A

BCR - ABL

  • hyperviscosity of blood
  • massive splenomegaly
  • increases myeloid cells e.g basophilia + eosinophilia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

NH lymphoma risk factors?

A

H.pylori = MALT lymphoma
exposure to pesticides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Subtypes of hodgkins?

A

Nodular slcerosing (70%) - lacunar cells,
Mixed cellularity (20%) - loads reed sterbergs
Lymphocyte predominant - best prognosis
lymphocyte depletion - worst prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Alcohol induced lymph pain?

A

Hodgkins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Single group of lymph nodes vs multiple nodes affected?

A

Single = hodgkins ( cervical/supraclavicular nodes)

multiple nodes = non hodgkins (or mets)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Px with HIV get what lymphoma?

A

Burkitts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Virus linked with Hodgkins?

A

EBV

33
Q

(pathological fractures)
Pagets disease summary

A

isolated ALP elevation
normal calcium pth phosphate etc

tx with bisphosphonates

pelvis affected

34
Q

(pathological fractures)
malignant bone tumours

A

plain x-ray then biopsy to confirm

35
Q

Sclerotic lesions on X-ray?

A

met prostate cancer

36
Q

Osteolytic lesions on X-ray?

A

mets kidney/thyroid/lung/ multiple myeloma, pagets

37
Q

warfarin
- what is it
- how to reverse its action
- goal INR
- goal INR exception
-

A

vitamin K antagonist, affects factor 7 mostly so the intrinsic)

give vit K / can give FFP/PCC for rapid reversal

2 - 3 INR

2.5 - 3.5 for mitral valve replacement

38
Q

Heparin vs LMWH?

A

Unfractioned IV - short acting, monitor via APTT, affects antithrombin

e.g. enoxaparin - SubCut, long acting, monitor vita anti-factor 10a. Lower risk of heparin induced thrombocytopenia

39
Q

How does Aspirin work?1

A

Inhibit COX 1 + 2, blocks thomboxane A2 synthesis and reducing platelet aggregation

40
Q

How do P2Y12 receptor antagonists work? give examples

A

Clopidogrel and ticagrelor

inhibits activation of platelets

41
Q

A 30 year old male presents with fatigue and bruising. Bone marrow biopsy shows the presence of large numbers of abnormal promyelocytes (neutrophil precursors) but very few mature neutrophils.

Cytogenetics reveal a t(15;17) translocation is also present.

Given the findings, which of the following is the most likely diagnosis?

A

AML

42
Q

virus linked with burkitts?

A

EBV

43
Q

acute transfusion reactions

A

TRALI

Allergic

Haemolytic

Non-haemolytic febrile

44
Q

delayed transfusion reactions?

A

Delayed haemolytic transfusion reactions

transfusion-associated graft vs host

post transfusion purpura

45
Q

how does acute haemolytic transfusion reaction present?

A

Abdo pain, fever, hypotension

46
Q

When do you stop the transfusion
slow the transfusion
temporarily stop transfusion?

A

Stop:
- acute haemolytic
- major allergic reaction (anaphylaxis)

Temporarily:
- Minor allergic reaction (antihistamine, chlorphenamine)

slow:
- febrile non haemolytic (give antipyretic)

47
Q

which alpha thalassaemia causes anaemia?

A

1 allele = carrier = silent no symptoms
2 alleles = trait = microcytic hypochromic, no anaemia
3 alleles = HbH disease = anaemia!!!
4 alleles = barts disease = death

48
Q

asymptomatic mild microcytic hypochromic anaemia?

A

Minor beta thalassaemia

if had symptoms / splenomegaly this could be major beta or alpha thalassaemia (HbH type)

but skeletal deformaties are specific to major beta

49
Q

sickle cell trait vs sickle cell disease

A

Normal HbAA (Both parents give HbA gene)

Trait HbAS (One HbA one HbS)

disease HbSS (both HbS)

50
Q

vaso-occlusive crisis in sickle cell px?

A

persistent pain in skeleton, chest, abdomen

causes infarction due to haemolysis of the sickle cells

51
Q

Gold standard for sickle cell ix?

A

Electropheresis

HbS is seen
No HbA
Raised HbF

52
Q

howell jolly bodies + target cells + sickle shaped cells?

A

Signs of hyposplenism in a px with sickle cell disease

53
Q

hydroxyurea?

A

given to increase HbF levels in a px with sickle cell to reduce frequency and duration of crises

54
Q

What are the myeloproliferative disorders?
(platelet counts 450+)

A

Chronic myeloid leukaemia (increases baso+eosinophils despite being leukaemia)

polycythaemia vera

essential thrombocytosis

primary myelofibrosis

55
Q

myeloproliferative disorders - essential thrombocytosis summary

A

megakaryocyte proliferation in the bone marrow, increases the number of platelets

diagnosis 50-70 yrs old

JAK2 found in 50% px

FBC platelets 600+

Mx =
hydroxycarbamide to reduce platelet count
antiplatelet therapy - aspirin

56
Q

myeloproliferative disorders - primary myelofibrosis summary

A

Haematopoietic stem cell involvement

You get porgressive bone marrow fibrosis causing BM failure and hence a try tap on aspiration

tear drop poikilocytes on blood film

massive splenomegaly

pancytopenia

57
Q

myeloproliferative disorders -polycythaemia vera summary

A

erythroid cell involvement

conjunctivial plethera
ruddy complexion
erythromelagia

risk factor for budd chari and AML/myelofibrosis

58
Q

why may you see high urate and LDH on myeloproliferative disorders?

A

Due to the increased cell turnover

59
Q

what types of polycythaemia is there?

A

Vera/primary = proliferative disorder

absolute / true = increased cell mass

relative = normal cell mass but low plasma volume

secondary = increased erythropoietin (chronic hypoxia e.g. COPD, high altitude or HCC, renal carcinoma, EPO abuse)

60
Q

What can cause pancytopenia? (low RBC,WBC, platelets)

A

aplastic anaemia (BM failure) = normochromic normocytic anaemia

Myelofibrosis

Multiple myeloma

Methotrexate

Acute + Chronic leukaemia

Chemo/radiotherapy

B12/folate def

Lymphoma

61
Q

Investigation plan for pancytopenia?

A

Noticed on FBC ->

Refer for urgent evaluation ->

Repeat FBC + blood smear ->

(also get done LFTs, B12, coagulation profile, viral serology - EBV/HIV, autoimmune)

Bone marrow aspirate and trephine biopsy (cytogenics or immunophenotyping done)

62
Q

painless lymphadenopathy in what leukaemia?

A

lymphoblastic

63
Q

specialist referral to which <24s?

A

24< with petechiae / hepatosplenomegaly

64
Q

CML management?

A

Tyrosine kinase = Imatinib

65
Q

AML vs ALL?

A

AML = in children, risk of down syndrome

ALL = adult with hx of myeloproliferative disorder

66
Q

High percentage of small mature lymphocytes?

A

In CLL

also see smudge cells on smear
richter transformation to Non hodgkins lymphoma

67
Q

Warfarin surgery rules?

A

5 days before Op
get INR to 1.5, use Vit K if needed

can give heparin in the mean time if still required for the px leading up to the op

68
Q

Monitoring warfarin vs heparin?

A

Warfarin = monitor INR / PT
Heparin = monitor PTT

69
Q

P450 inducer warfarin reactions?

‘SCARS’

A

P450 inducers will REDUCE INR hence warfarin activity

Smoking
Circ -alcohol
Anti-epileptics
Rifampcin
St John wart

70
Q

P450 inhibitors warfarin reaction?

‘ASS ZOLES’

A

P450 Inhibitors will increase warfarin activity

Antibiotics
SSRIs
Sodium valproate
Omepra’zole’

71
Q

what can cause DIC

  • STOP MT
A

S scorpion bite / snake bite
T trauma
O obstetric condition
P pancreatitis
M malignancy
T transfusion

causes clotting, bleeding
- organ failure + petechiae, purpura

72
Q

Investigation for DIC?

A

LOW FIBRINOGEN

high D dimer

Prolonged PT, APTT,

shistiocytes

73
Q

How to mx DIC?

A

Fresh frozen plasma + cryoprecipitate

74
Q

Sickle cell:

when in life does it ptt

what worsens sickling

a hand sign?

two emergency situations and how to find out

A

6 months of age

infection, dehydration, hypoxia, acidosis

dactylitis

sequestration + acute chest syndrome
sequestration = high reticulocytes
aplastic crisis = low reticulocytes + v big Hb decrease

75
Q

Who is allergic transfusion reaction common in

A

IgA deficient px

76
Q

What is high in B thalassaemia?

A

HbA2 (2 alpha 2 delta chains)

as HbA (2 alpha 2 beta) cannot be made

77
Q

Haemophila A (80%)
Haemophilia B (20%)

Genetic link?

mild, mod, severe ppt?

What will be increased, PT or APTT, what Ix to do to confirm diagnosis?

Mx?

A
  • X linked (men have it much more)

mild = haematoma after bad trauma
mod = haematoma after mild trauma
severe = spontaneous bleeds

APTT (intrinsic pathway, factor 8/9)

Plasma levels of 8 + 9

Mx = factor concentrate, desmopressin for mod A
can give antifibrinolytics to prevent clot breakdown e.g. tranexamic acid

78
Q

differentiate AML and ALL

A

ALL (child) will have FEVER too

79
Q

Medication to reduce

A

Year 3 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions