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MSRA > Haem/ onc > Flashcards

Haem/ onc Flashcards

1
Q

Which cytotoxic drug has the side effect of haemorrhagic cystitis?

A

Cyclophosphamide

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2
Q

Which cytotoxic drug has the side effect of pulmonary fibrosis?

A

Bleomycin

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3
Q

Which cytotoxic drugs have the side effect of peripheral neuropathy?

A

Vincristine, cisplatin

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4
Q

What are the most common causes of cancer death in the UK?

A
  1. Lung
  2. Colorectal
  3. Breast
  4. Prostate
  5. Pancreas
  6. Oesophagus
  7. Stomach
  8. Bladder
  9. Non-Hodgkin’s lymphoma
  10. Ovarian
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5
Q

Which cytotoxic drug causes hypomagnesaemia?

A

Cisplatin

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6
Q

Which cytotoxic drug causes myelosuppression, liver fibrosis and oral mucositis?

A

Methotrexate

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7
Q

Which cytotoxic drug causes myopathy?

A

Doxorubicin

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8
Q

Raised beta-human chorionic gonadotropin with a raised alpha-feto protein level is seen in which cancer?

A

Non-seminomatous testicular cancer

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9
Q

Raised AFP levels in women are suggestive of which cancer type?

A

Liver cancer

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10
Q

Calcitonin is a tumour marker of which thyroid cancer?

A

Medullary thyroid

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11
Q

Which cytotoxic drug causes ototoxicity?

A

Cisplatin

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12
Q

Which type of cancer is associated with aniline drugs?

A

Transitional cell carcinoma

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13
Q

Nitrosamines are chemical compounds found in food/ water/ medicaitons. Which cancer are they linked to?

A

Gastric/ oesophageal

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14
Q

Ca 15-3 is a tumour marker for which type of cancer?

A

Breast

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15
Q

AFP is associated with which cancers?

A

Liver
Testicular

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16
Q

Alflatoxin has been linked to which cancer type?

A

Hepatocellular

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17
Q

How to manage antiphospholipid syndrome in pregancy?

A

Aspirin + LMWH

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18
Q

What is the abx of choice empirically for neutropenic sepsis?

A

Piptaz

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19
Q

What medication can be given prior to chemo to help prevent tumour lysis syndrome?

A

Allopurinol

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20
Q

What is an acute haemolytic reaction?

A

Reaction to ABO incompatible blood

Occurs within minutes
Fever, abdo pain, hypotension

Send blood for coomb’s test
Fluid resuscitation

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21
Q

What is a non haemolytic febrile reaction?

A

Thought to be caused by antibodies reacting with white cell fragments in the blood product and cytokines that have leaked from the blood cell during storage

Fever chills

Stop or slow transfusion, paracetamol

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22
Q

What is aplastic crisis in sickle cell?

A

caused by infection with parvovirus
sudden fall in haemoglobin
bone marrow suppression causes a reduced reticulocyte count

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23
Q

What is sequestration crisis in sickle cell?

A

Caused by infection with parvovirus
Bone marrow suppression causes a reduced reticulocyte count
Sickle cells cause the spleen to become grossly enlarged > causes abdominal pain
Severe anaemia
Cardiovascular collapse due to loss of effective circulating volume

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24
Q

what is thrombotic crisis in sickle cell?

A

also known as painful crises or vaso-occlusive crises
precipitated by infection, dehydration, deoxygenation (e.g. high altitude)
painful vaso-occlusive crises should be diagnosed clinically - there isn’t one test that can confirm them although tests may be done to exclude other complications
infarcts occur in various organs including the bones (e.g. avascular necrosis of hip, hand-foot syndrome in children, lungs, spleen and brain

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25
Q

Howell-Jolly bodies are associated with which condition?

A

Hyposplenism

26
Q

Alpha thalassaemia - what are the three ways this can present?

A

A thalassaemia trait

HBH disease - microcytic anaemia, splenomegaly, jaundice, growth retardation
Severe cases need splenectomy + transfusions

Hb barts hydrops fetalis syndrome - severe, almost all die in utero

27
Q

Beta thalassaemia - what are the three ways this can present?

A

B thalassamia trait - asymptomatic

B thalassaemia intermedia - similar picture to HBH disease - require transfusions

B thalassaemia major - severe lifelong transfusion dependency, can develop iron overload - requiring iron chelating drugs

28
Q

Sickle disease - how does trait/ sickle cell anaemia and sickle cell disease present?

A

Sickle cell trait - asymptomatic

Sickle cell anaemia - risk of sickle crisis, chronic haemolysis, hypsplenism (due to splenic infarcts)

Sickle cell disease - both sickle cell and thallassaemia . Big clot risk.

29
Q

What vaccines should be given to those with sickle cell disease?

A

Pneumococcous, meningococcus, haemophilus

This is because they have hyposplenism due to repeated splenic infarcts. They should also be on lifelong prophylactic penicillin.

30
Q

What investigations are there for haemolysis?

A

Reticulocyte count
Serum unconjugated bilirubin
Serum haptoglobins
Urinary urobilinogen
Blood film
Coomb’s test - identifies antibodies bound to own red blood cells

31
Q

What might cause a prolonged prothrombin time?

A

Clotting factor deficiency
Warfarin
Liver disease
Vitamin K deficiency

32
Q

What might cause a prolonged APTT?

A

Deficiency in clotting factors 8 and 9
Heparin
Haemophilia
VWB disease
Antiphospholipid syndrome

33
Q

Which conditions are included in the hereditary thrombophilias? (cause clots)

A

Factor V Leiden
Antithrombin deficiency
Protein C + S deficiency

34
Q

What are the three things you see in antiphospholipid syndrome?

A

Recurrent thromboses
Recurrent miscarriage
Mild thrombocytopenia

Tx is aspirin/ warfarin - heparin in pregnancy

35
Q

What form of inheritance dose VWF deficiency (bleeding disorder - too bleedy) show?

What about haemophilia?

A

VWF deficiency - Autosomal dominant - men and women

Hameophilia - X- linked - men

35
Q

What drug is used for heparin reversal?

A

Protamine sulphate

36
Q

What conditions cause splenomegaly?

A

Infection - EBV, malaria

Congestion - Hepatic cirrhosis, cardiac failure

Haematological - Lymphoma, leukaemia, haemolytic anaemia, ITP, myeloproliferative disorders

Inflammatory disease - RA/ SLE

37
Q

What is MGUS - Monoclonal gammopathy of undetermined significance

What is myelodysplastic syndrome

What is myelofibrosis

?

A

MGUS - Paraprotein band on bloods but asymptomatic, can go on to develop myeloma.

Myelodyasplasia - Mild anaemia or can develop pancytopenia.

Myelofibrosis - fibrotic tissue in bone marrow so liver and spleen take over. Anaemia, fevers, gout, splenomegaly. Can progress to AML.

38
Q

What is richter’s transformation?

A

Ritcher’s transformation occurs when leukaemia cells enter the lymph node and change into a high-grade, fast-growing non-Hodgkin’s lymphoma. Patients often become unwell very suddenly.

39
Q

Heinz bodies are associated with which condition?

A

Thalassaemia and G6PD deficiency

40
Q

What is the reversal agent for dabigatran?

A

Idarucizumab

41
Q

What is acute sickle chest syndrome?

A

New pulmonary infiltrates on chest x-ray

Fever, cough, sputum, dyspnoea, hypoxia

42
Q

In patients with both B12 and folate deficiency - which must you replace first?

A

Must replace B12 first due to risk of cord degeneration

43
Q

Shisctocytes are associated with which bleeding disorder?

A

DIC

44
Q

What blood film abnormalities are seen in hyposplenism?

A

Howell-Jolly bodies
target cells
Pappenheimer bodies
acanthocytes
siderotic granules

45
Q

What are the biochemical signs of tumour lysis syndrome?

A

High potassium
High phosphate
Low calcium

Allopurinol is sometimes used as prophylaxis

46
Q

What is the transfusion threshold for patients with ACS?

A

80

47
Q

Which blood component has the highest risk of bacterial contamination?

A

Platelets

48
Q

How long before an operation should you stop the oral contraceptive pill?

A

4 weeks

49
Q

Deficiency in which clotting factors cause haemophilia?

A

Haemophilia A - VIII (8)
Haemophilia B - IX (9)

50
Q

What are the inherited versus acquired thrombophilias?

A

Inherited
Factor V Leiden
Protein C or S deficiency

Acquired
Antiphospholipid syndrome
Essential thrombocythaemia

51
Q

What is the preferred anticoagulant for antiphospholipid syndrome?

A

Warfarin

52
Q

What is the treatment for sickle cell disease?

A

Hydroxyurea
*Main SE is reduced sperm count in males (returns to normal after drug cessation)

Folic acid and Vit D replacement
Vaccinations

53
Q

What are the two types of sickle cell?

A

SS - can lead to severe crisis, all patients need to be on hydroxyurea if symptomatic

Sc - ophthalmology problems - need to refer to them, don’t all need to be on hydroxyurea

54
Q

What should you suspect if the MCV is ‘too low’ for the anaemia - eg Hb 100 but MCV 60?

A

Thalassaemia

55
Q

Which blood test changes might you see in haemolysis?

A

Normocytic anaemia
High bilirubin

56
Q

Which medications can cause B12 deficiency?

A

Colchicine
Metformin
PPI
Pregabalin
topiramate

57
Q

What is MGUS?

A

Monoclonal gammopathy - Paraprotein band but bence jones -ve
Low risk of transformation to myeloma and asymptomatic

**Note polyclonal gamopathy is different and doesn’t need investigated - it usually is just some sort of reactive change

58
Q

What is MBL?

A

Monoclonal B cell lymphocytsosis

Lymphocytes <5 (in CLL would be >5)
Small risk of progression to CLL

59
Q

Which cells are abnormal in myeloma?

A

Plasma cells

60
Q

What is Waldenstrom’s macroglobulinaemia?

A

MSRA (18 decks)

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