Clinical Haematology/Oncology Flashcards
1
Q
Features of G6PD deficency
A
Neonatal jaundice Intravascular haemolysis Gallstones Splenomegaly Heinz bodies
2
Q
Drugs inducing haemolysis in G6PD
A
Anti-malarials: primaquine
Ciprofloxacin
Sulphonamides, sulphasalzine, sulfonylureas
3
Q
Raised leucocyte alkaline phosphatase
A
Myelofibrosis Leakaemoid reactions Polycythaemia rubra vera Infections Steroids Pregnancy OCP
4
Q
Cyclophosphamide; MoA
A
Causes cross linking in DNA
5
Q
Cyclophosphamide: SE
A
Haemorrhagic cystitis
Myelosuppression
Transitional cell carcnioma
6
Q
Bleomycin: MoA
A
Degrades performed DNA
7
Q
Bleomycin; SE
A
Lung fibrosis
8
Q
Anthracyclines; MoA
A
Stabilises DNA complex
Inhibits DNA and RNA synthesis
9
Q
Anthracyclines; SE
A
Cardiomyopathy
10
Q
Methotrexate: MoA
A
Inhibits dihydrofolate reductase
11
Q
Methotrexate: SE
A
Myelosuppression, mucositis, liver fibrosis, lung fibrosis
12
Q
Flurouracil; MoA
A
Pyrimidine analogue inducing cell cycle arrest and apoptosis
13
Q
Flurouracil; SE
A
Myelosuppression, mucositis, dermatitis
14
Q
Vincristine, vinblastine; MoA
A
Inhibits microtubule formation
15
Q
Vincristine; SE
A
Reversible peripheral neuropathy, paralytic ileus
16
Q
Vinlastine; SE
A
Myelpsuppression
17
Q
Cisplastin; MoA
A
cross linking in DNA
18
Q
Cistplastin; SE
A
Ototoxicity, peripheral neuropathy, hypo Mg
19
Q
Hereditary angioedema; causes
A
AD condition assoicated with low plasma levels of C1 inhibitor
20
Q
Hereditary angioedema; screening
A
Serum C4
21
Q
Hereditary angioedema; features
A
Painful macular rash
Painless, non-pruritic swelling of SC tissues
22
Q
Hereditary angioedema; acute Mx
A
IV C1-inhibitor concentrate, FFP
23
Q
TTP; what?
A
Abnormally larger and sticky multimers of VWB factor causing platelet aggregation
24
Q
TTP; features
A
Fever, neuro signs, microangiopathic haemolytic anaemia, thrombocytopenia, renal failure
25
Methaemoglobinaemia; what?
Haemoglobin which has been oxidised from Fe2+ to Fe3+
26
Methaemoglobinaemia; acquired causes
Drugs; sulphonamides, nitrates, dapsone, sodium nitroprusside, primaquine
27
Methaemoglobinaemia; features
'chocolate' cyanosis, dyspnoea, anxiety, headache, acidosis, arrhythmias, seizures, coma, normal pO2 but decreased saturations
28
CML; genetic associations
Philadelphia chromosome
| Translocation between long arm of chromosome 9 and 22 (t9:22)(q34; q11)
29
CML; managment
Imatinib
30
Imatinib; MoA
Tyrosine kinase inhibitor
31
Acute promyelocytic leukaemia M3; what?
associated with t(15;17)
| Fusions of PML and RAR-alpha genes
32
AML; film
Auer rods
33
Cryoglobulinaemia; Type 1
Monoclonal; IgG or IgM
| Associations; MM, Waldenstrom macroglobulinaemia, Raynauds
34
Cryoglobulinaemia; Type 2grens
Mixed monoclonal and polyclonal
Usually with Rh factor
Associations; HCV, RA, Sjogren's, lymphoma
35
Cryoglobulinaemia; Type 3
Polyclonal
| Associations; RA, Sjo
36
vWB; what?
AD bleeding disorder
37
vWB; Ix
Prolonged bleeding time
APPT
Reduced VIII
38
vWB; Mx
Tranexamic acid
| Desmopressin
39
Paroxysmal nocturnal haemoglobinuria; what?
Acquired disorder leading to intravascular haemolysis
40
Paroxysmal nocturnal haemoglobinuria; features
Haemolytic anameia
Pancytopenia
Haemoglobinuria
Thrombosis
41
Paroxysmal nocturnal haemoglobinuria; Ix
Flow cytometry of blood to detect CD59 and CD55
42
MGUS; what?
Common condition causes paraproteinaemia
43
MGUS; difference from myeloma
Normal immune function
Normal beta-2 levels
Lower and stable paraproteinaemia
No CF of myeloma
44
B Cell deficinecy
Shitty B Cells
- selective IgA deficinecy
- Burton's
- CVID
45
Combined B & T cell deficnecy
WASH your Bs and Ts
- Wiskott Aldrichs
- Ataxic telangectasia
- SCID
- Hyper IgM
46
Selective Oestrogen Receptor Modulators
Tamoxifen
| Used is oestrogen +ve breast ca
47
Aromatase inhibitors
Reduce peiperhal oestrogen synthesis
Anastrozole and letrozole
Used in ER + breast ca
48
Waldenstrom's macroglobulinaemia; features
```
Monoclonal IgM paraproteinaemia
Hyperviscosity
HSM
LN
Cryoglobulinaemia
```
49
Tumour lysis syndrome; Rx
Rasburicase
50
Rasburicase; MoA
Metabolises uric acid to allantoin
51
Intravascular haemolysis
```
Mismatched blood transfusion
G6PD deficiency
Red cell fragmentation
PNH
Cold autoimmune haemolysis
```
52
Extravascular haemolysis
Haemoglobinopathies
Hereditary spherocytosis
Haemolysis disease of newborn
Warm autoimmune haemolysis
53
Sickle cell disease: thrombotic crisis precipitant
Infection, dehydration, deoxygenation
54
Sickle cell disease: thrombotic crisis features
Pain
55
Sickle cell disease: sequestration crises
Sickling within organs causing pooling of blood with worsening anaemia
Associated with high reticulocyte count
56
Sickle cell disease: acute chest syndrome
Dyspnoea, chest pain, pulmonary infiltrates, low pO2
57
Sickle cell disease: aplastic crises
Sudden infection with parvovirus
Sudden fall in Hb
Bone marrow suppression and reduced reticulocyte count
58
Hogdkins Lymphoma: Staging I
single LN
59
Hogdkins Lymphoma: Staging II
2+ LN on same side of diaphragm
60
Hogdkins Lymphoma: Staging III
nodes on both sides of diaphragm
61
Hogdkins Lymphoma: Staging IV
Beyond LN
62
Hogdkins Lymphoma: Staging A
No systemic symptoms
63
Hogdkins Lymphoma: Staging B
B symptoms
64
Polycythaemia Vera; cause
JAK2 mutations
65
Polycythaemia Vera; features
Hyperviscosity, pruritus, splenomegaly, haemorrhage, plethoric appearance, low ESR
66
Polycythaemia Vera; Mx
Aspirin, venesection, chemotherapy
67
Wiskott-Aldrich Sx; features
Recurrent bacterial infections
Eczema
Thrombocytopenia
Low IgM
68
What is acute intermittent porphyria?
Rare AD condition
| Results in accumulation of breakdown of haem produtcts
69
Acute intermittent porphyria: features
```
Abdo pain, vomiting
Neuro
Psychiatric
HTN
Tachycardia
```
70
Acute intermittent porphyria: Mx
Deep red urine
| Raised urinary porphobilinogen
71
Skin prick test
Most common
| Used for food allergies and pollen
72
RAST
Used for food allergies, pollen and wasp venom
73
Skin patch testing
Contact dermatitis
74
Target cells
```
Sickle cell
Thalassaemia
IDA
Hyposplenism
Liver disease
```
75
Tear drop
| Poikilocytes
Myelofibrosis
76
Spherocytes
Hereditary spherocytosis
| Autoimmune haemolytic anaemia
77
Basophilic stippling
Lead poisoning
Thalassaemia
Sideroblastic anaemia
Myelodysplasia
78
Howell-Jolly bodies
Hyposplenism
79
Heinz Bodies
G6PD deficiency
| Alpha thalassaemia
80
Schistocytes
| 'Helmet cells'
Intravascular haemolysis
Mechanical heart valve
DIC
81
Pencil pikilocytes
IDA
82
Burr cells
Uraemia
| Pyruvate kinase deficiency
83
SERM e.g.
tamoxifen
84
SERM: SE
menstrual disturbance
hot flushes
VTE
endometrial Ca
85
Aromatase inhibitors e.g.
anastrazole
| letrozole
86
Aromastase inhibitors: SE
```
OP
Hot flushes
Arthralgia
Myalgia
Insomnia
```
87
Aplastic anaemia: Mx
```
Blood products
Prevention and treatment of infection
Anti-thymocyte globulin (ATG)
Anti-lymphocyte globulin (ALG)
Stem cell transplant
```
88
CLL: features
```
Lymphocytosis
Anorexia
Weight loss
Bleeding, infections
LN
```
89
CLL: blood film
smudge cells
90
CLL: Ix
immunophenotyping
91
Hereditary spherocytosis: features
failure to thrive
jaundic, gallstones
Splenomegaly
Aplastic crisis
92
Hereditary sphereocytosis: Ix
EMA binding test
93
Leukaemoid reaction: causes
Severe infection / haemolysis
Massive haemorrhage
Metastatic cancer
94
Leaukaemoid reaction: features
High leucocyte alkaline phosphatase score
Dohle bodies in WC
Left shift of neutrophils
95
What is sideroblastic anaemia?
Deposition of iron in mitochrondira due to failure of RC incompletely forming haem
96
Sideroblastic anaemia: Blood film
Basophilic striping of RBCs
97
Sideroblastic anaemia: bone marrow
Prussian blue staining
98
Thymoma associations
```
Myasthenia gravis
red cell aplasia
dermatomyositis
SLE
SIADH
```
99
CA 15-3
Breast cancer
100
S-100
Melanoma
| Schwannonmas
101
Bombesin
Small cell LC
Gastric Ca
Neuroblastoma
102
What is warm haemolytic anaemia?
Haemolysis at body temperature
| Tends to be extra vascular
103
What is cold haemolytic anaemia?
Haemolysis at 4oC and is complement mediated
104
Warm haemolytic anaemia e.g.
SLE
Lymphoma, CLL
Methyldopa
105
Cold haemolytic anaemia e.g.
Lymphoma
Mycoplasma
EBV
106
t(9;22)
Philadelphia chromosome
| CML
107
t(15;17)
Acute promyelocytic leukaemia
108
t(8;14)
Burkitt's lymphoma
109
t(11;14)
Mantle cell lymphoma
110
t(14;18)
Follicular lymphoma
111
Hairy cell leukaemia; features
Pancytopenia
Splenomegaly
Vasculitis
TRAP stain positive
112
Lead poisoning; features
```
Abdo pain
Peripheral neuropathy
Fatigue
Constipation
Blue lines on gum margin
```
113
Lead poisoning; FBC
Basophilic stripping and clover leaf
114
Polycythaemia; causes
```
Dehydration
Stress
Rubra vera
COPD
Altitude
OSA
```
115
What is factor v leiden?
Resistance to protein C
116
CLL: Indications for Rx
```
Progressive marrow failure
Massive LN or splenomegaly
Progressive lymphocytosis
B symptoms
Autoimmune cytopaenias
```
117
Universal Donor
AB RhD negative
118
Aflatoxin
HCC
119
Aninline dyes
TCC
120
Asbestos
Mesothelioma and bronchial carcinoma
121
Nitrosamines
Oesophageal and gastric cancer
122
Vinyl chloride
Hepatic angiosarcoma
123
AML: features
```
Anaemia
Neutropenia
Thrombocytopenia
Splenomegaly
Bone pain
```
124
AML: poor prognostic features
>60 years
>20% blasts after chemo
Deletions of chromosome 5 or 7
125
Blood products - Non-haemolytic febrile reaction: features
Fever / chills
| RBC 1-2%, platelets 10-30%
126
Blood products - Non-haemolytic febrile reaction: Mx
Stop / slow transfusion
Paracetamol
Monitor
127
Blood products - Minor allergic reaction: features
Prutitus
| Uriticaria
128
Blood products - Minor allergic reaction: Mx
Temporarily stop
Antihistamine
Monitor
129
Blood products - acute haemolytic reaction: features
Fever, abdo pain, hypotension
130
Blood products - acute haemolytic reaction: Mx
Stop transfusion
Confirm diagnosis (identity, send blood back)
Supportive care
131
Eosinophilia: pulmonary causes
```
Asthma
Allergic bronchopulmonary aspergillosis
Churg-Strauss
Loffler's
Tropical pulmonary eosinophilia
Eosinophilic pneumonia
Hyperesoinophilic syndrome
```
132
Eosinophilia: infective
Schistosomiasis
Nematodes
Cestodes
