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Cancer + Haem Qs Flashcards

1
Q

Which leukaemia can have thrombocytosis?

A

CML

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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

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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

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4
Q

Which type of hodgkins lymphoma has the best prognosis?

A

Lymphocyte predominant type

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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 )

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6
Q

what genetic change is associated with burkitts lymphoma

A

c-myc gene translocation

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7
Q

Examples of B symptoms when in Hodgkins lymphoma indicate poor prognosis

A

Weight loss 10% 6 months
fever 38+
night sweats

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8
Q

Which lymphoma can cause tumour lysis syndrome

A

Burkitts

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9
Q

What is the most common form of non hodgkins lymphoma

A

Diffuse large B cell

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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

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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

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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

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13
Q

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

A

excision

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14
Q

aplastic crisis in sickle cell?

A

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

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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

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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)

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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

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18
Q

essential thrombocythaemia?

A

Myeloproliferative disorder

high number of platelets
JAK 2 mutation in 50% patients

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19
Q

Polycythaemia 1st line management?

A

venesection to keep haemoglobin in norm range

can also do chemo and aspirin as antiplatelet therapy

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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

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21
Q

polycythaemia risk factor

what can polycythaemia itself be a risk factor for?

A

Budd chiari

can cause AML / myelofibrosis

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22
Q

EPO dependent vs independant polycythaemia?

A

Dependent = secondary

independent = primary (vera)

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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

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24
Q

mutation in polycythaemia vera?

A

JAK 2

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25
PUKE calcium acroynm?
Tumour lysis syndrome (can occur when treating leukaemias with chemo) - Phosphorous - uric acid - potassium - ELEVATED Calcium reduced
26
CML gene link? other features
BCR - ABL - hyperviscosity of blood - massive splenomegaly - increases myeloid cells e.g basophilia + eosinophilia
27
NH lymphoma risk factors?
H.pylori = MALT lymphoma exposure to pesticides
28
Subtypes of hodgkins?
Nodular slcerosing (70%) - lacunar cells, Mixed cellularity (20%) - loads reed sterbergs Lymphocyte predominant - best prognosis lymphocyte depletion - worst prognosis
29
Alcohol induced lymph pain?
Hodgkins
30
Single group of lymph nodes vs multiple nodes affected?
Single = hodgkins ( cervical/supraclavicular nodes) multiple nodes = non hodgkins (or mets)
31
Px with HIV get what lymphoma?
Burkitts
32
Virus linked with Hodgkins?
EBV
33
(pathological fractures) Pagets disease summary
isolated ALP elevation normal calcium pth phosphate etc tx with bisphosphonates pelvis affected
34
(pathological fractures) malignant bone tumours
plain x-ray then biopsy to confirm
35
Sclerotic lesions on X-ray?
met prostate cancer
36
Osteolytic lesions on X-ray?
mets kidney/thyroid/lung/ multiple myeloma, pagets
37
warfarin - what is it - how to reverse its action - goal INR - goal INR exception -
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
Heparin vs LMWH?
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
How does Aspirin work?1
Inhibit COX 1 + 2, blocks thomboxane A2 synthesis and reducing platelet aggregation
40
How do P2Y12 receptor antagonists work? give examples
Clopidogrel and ticagrelor inhibits activation of platelets
41
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?
AML
42
virus linked with burkitts?
EBV
43
acute transfusion reactions
TRALI Allergic Haemolytic Non-haemolytic febrile
44
delayed transfusion reactions?
Delayed haemolytic transfusion reactions transfusion-associated graft vs host post transfusion purpura
45
how does acute haemolytic transfusion reaction present?
Abdo pain, fever, hypotension
46
When do you stop the transfusion slow the transfusion temporarily stop transfusion?
Stop: - acute haemolytic - major allergic reaction (anaphylaxis) Temporarily: - Minor allergic reaction (antihistamine, chlorphenamine) slow: - febrile non haemolytic (give antipyretic)
47
which alpha thalassaemia causes anaemia?
1 allele = carrier = silent no symptoms 2 alleles = trait = microcytic hypochromic, no anaemia 3 alleles = HbH disease = anaemia!!! 4 alleles = barts disease = death
48
asymptomatic mild microcytic hypochromic anaemia?
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
sickle cell trait vs sickle cell disease
Normal HbAA (Both parents give HbA gene) Trait HbAS (One HbA one HbS) disease HbSS (both HbS)
50
vaso-occlusive crisis in sickle cell px?
persistent pain in skeleton, chest, abdomen causes infarction due to haemolysis of the sickle cells
51
Gold standard for sickle cell ix?
Electropheresis HbS is seen No HbA Raised HbF
52
howell jolly bodies + target cells + sickle shaped cells?
Signs of hyposplenism in a px with sickle cell disease
53
hydroxyurea?
given to increase HbF levels in a px with sickle cell to reduce frequency and duration of crises
54
What are the myeloproliferative disorders? (platelet counts 450+)
Chronic myeloid leukaemia (increases baso+eosinophils despite being leukaemia) polycythaemia vera essential thrombocytosis primary myelofibrosis
55
myeloproliferative disorders - essential thrombocytosis summary
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
myeloproliferative disorders - primary myelofibrosis summary
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
myeloproliferative disorders -polycythaemia vera summary
erythroid cell involvement conjunctivial plethera ruddy complexion erythromelagia risk factor for budd chari and AML/myelofibrosis
58
why may you see high urate and LDH on myeloproliferative disorders?
Due to the increased cell turnover
59
what types of polycythaemia is there?
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
What can cause pancytopenia? (low RBC,WBC, platelets)
aplastic anaemia (BM failure) = normochromic normocytic anaemia Myelofibrosis Multiple myeloma Methotrexate Acute + Chronic leukaemia Chemo/radiotherapy B12/folate def Lymphoma
61
Investigation plan for pancytopenia?
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
painless lymphadenopathy in what leukaemia?
lymphoblastic
63
specialist referral to which <24s?
24< with petechiae / hepatosplenomegaly
64
CML management?
Tyrosine kinase = Imatinib
65
AML vs ALL?
AML = in children, risk of down syndrome ALL = adult with hx of myeloproliferative disorder
66
High percentage of small mature lymphocytes?
In CLL also see smudge cells on smear richter transformation to Non hodgkins lymphoma
67
Warfarin surgery rules?
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
Monitoring warfarin vs heparin?
Warfarin = monitor INR / PT Heparin = monitor PTT
69
P450 inducer warfarin reactions? 'SCARS'
P450 inducers will REDUCE INR hence warfarin activity Smoking Circ -alcohol Anti-epileptics Rifampcin St John wart
70
P450 inhibitors warfarin reaction? 'ASS ZOLES'
P450 Inhibitors will increase warfarin activity Antibiotics SSRIs Sodium valproate Omepra'zole'
71
what can cause DIC - STOP MT
S scorpion bite / snake bite T trauma O obstetric condition P pancreatitis M malignancy T transfusion causes clotting, bleeding - organ failure + petechiae, purpura
72
Investigation for DIC?
LOW FIBRINOGEN high D dimer Prolonged PT, APTT, shistiocytes
73
How to mx DIC?
Fresh frozen plasma + cryoprecipitate
74
Sickle cell: when in life does it ptt what worsens sickling a hand sign? two emergency situations and how to find out
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
Who is allergic transfusion reaction common in
IgA deficient px
76
What is high in B thalassaemia?
HbA2 (2 alpha 2 delta chains) as HbA (2 alpha 2 beta) cannot be made
77
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?
- 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
differentiate AML and ALL
ALL (child) will have FEVER too
79
Medication to reduce

Year 3 (14 decks)

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