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MRCP - Passmed > Haem + onc > Flashcards

Haem + onc Flashcards

1
Q

Which organisms most commonly cause neutropenic sepsis?

A

Coagulase -ve gram +ve bacteria

particularly staph epidermis

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2
Q

What are auer rods? what conditions are they seen in?

A

Large, pink / red needle shaped structures in cytoplasm of myeloid cells

Seen in AML
Also in APML, high grade myelodysplastic syndromes and myeloproliferative disorders

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3
Q

What are some features of APML?

A

Presents younger than other forms of AML (avg 25yrs)

DIC / Thrombocytopaenia at presentation

Good prognosis

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4
Q

Genetic cause of APML

A

t(15;17) translocation - fusion of PML and RAR-alpha genes –> blocks the maturation of myeloid cells and leads to an accumulation of promyelocytes.

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5
Q

APML mx?

A

Treated with all-trans retinoic acid (ATRA) -> forces immature granulocytes into maturation to resolve blast criseses prior to definitive chemo

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6
Q

Bloods in DIC? Blood film?

A

↓ platelets

↓ fibrinogen

↑ PT & APTT

↑ fibrinogen degradation products

schistocytes due to microangiopathic haemolytic anaemia

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7
Q

How can you distinguish between Waldenstrom’s macroglobulinaemia and multiple myeloma?

A

Waldenstrom’s macroglobulinaemia - Organomegaly with no bone lesions

Multiple myeloma - Bone lesions with no organomegaly

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8
Q

What are some features of Waldenstroms macroglobulinaemia?

Mx?

A

systemic upset: weight loss, lethargy
hyperviscosity syndrome e.g. visual disturbance (the pentameric configuration of IgM increases serum viscosity)
hepatosplenomegaly
lymphadenopathy
cryoglobulinaemia e.g. Raynaud’s

Mx - rituximab based combination chemo

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9
Q

Ix findings for waldenstrom’s macroglobulinaemia?

A

Monoclonal IgM paraproteinaemia (M - Macroglobulinaemia)

BM biopsy - diagnostic - infiltration of BM with lymphoplasmacytoid lymphoma cells

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10
Q

What genetic abnormality is associated with chronic myeloid leukaemia (CML)?

A

Philidelphia chromosome - t(9;22)
seen in 95% of cases

NB also seen in 25% of adults with ALL - poor prognostic feature in these cases

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11
Q

What genetic abnormality is seen in Burkitt’s lymphoma?

A

t (8;14) seen in Burkitt’s lymphoma

MYC oncogene is translocated to an immunoglobulin gene

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12
Q

What genetic abnormality is seen in Mantle cell lymphoma?

A

t(11;14) is seen in mantle cell lymphoma

deregulation of BCL-1 gene

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13
Q

What genetic abnormality is seen follicular lymphoma?

A

t(14;18) - increased BCL-2 transcription

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14
Q

What are some intravascular causes of haemolytic anaemia?

A

mismatched blood transfusion
G6PD deficiency*
red cell fragmentation: heart valves, TTP, DIC, HUS
paroxysmal nocturnal haemoglobinuria
cold autoimmune haemolytic anaemia

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15
Q

Extravascular causes of haemolysis

A

haemoglobinopathies: sickle cell, thalassaemia
hereditary spherocytosis
haemolytic disease of newborn
warm autoimmune haemolytic anaemia

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16
Q

What does haptoglobin do?

A

Binds to free Hb which is released in intravascular haemolysis - hence depleted in intravascular causes

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17
Q

What happens to free Hb once haptoglobin is saturated? how is this detected?

A

As haptoglobin becomes saturated haemoglobin binds to albumin forming methaemalbumin (detected by Schumm’s test).

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18
Q

Bloods in Warfarin?

A

PT - Prolonged

APTT - Normal
Bleeding time - Normal
Plts - Normal

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19
Q

Bloods in Aspirin use?

A

Bleeding time - prolonged

PT - Normal
APTT - Normal
Plts - Normal

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20
Q

Bloods in heparin use?

A

APTT - Prolonged
PT - Normal (usually) / prolonged

Bleeding time - normal
Plts - Normal

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21
Q

How does ITP present?

A

Commonly in older females - isolated thrombocytopaenia usually incidentally on bloods

If sx:
- petechiae, purpura, bleeding (epistaxis) -> catastrophic bleeding is not common

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22
Q

What is Evans syndrome?

A

When ITP is associated with AIHA

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23
Q

How can you distinguish between Ig in Cold and Warm AIHA?

A

Warm = Greece IgG
Cold = Moscow IgM

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24
Q

What can be seen in blood film in hereditary spherocytosis post surgery and why?

A

Howell-Jolly bodies - these are remnants of RBC nucleus normally removed by spleen

Hence visible post splenectomy

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25
Q

What causes raised MCHC?

A

Hereditary spherocytosis

AIHA - associated w/ spherocytosis

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26
Q

What causes reduced MCHC

A

Microcytic anaemia eg IDA

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27
Q

What is disproportionate microcytic anaemia? when is this seen?

A

This is when MCV is far more reduced than drop in Hb

Seen in B-thalassaemia trait

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28
Q

Blood film findings in hyposplenism? examples?

A

target cells
Howell-Jolly bodies
Pappenheimer bodies
siderotic granules
acanthocytes

eg. coeliac / post-splenectomy

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29
Q

Bloods film features in IDA?

A

target cells
‘pencil’ poikilocytes

if combined with B12/folate deficiency a ‘dimorphic’ film occurs with mixed microcytic and macrocytic cells

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30
Q

‘Tear drop’ poikilocytes are suggestive of which condition?

A

Myelofibrosis

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31
Q

What blood film feature is found in intravascular haemolysis?

A

Schistocytes

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32
Q

What are hypersegemented neutrophils suggestive of?

A

Megaloblastic anaemia

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33
Q

What are some examples of aromatase inhibitors? main adverse effects?

A

Anastrazole and Letrozole - used in ER +ve breast ca -> prevents androgen conversion into oestrogens (reducing peripheral oestrogen synthesis)

Adverse:
- Osteoporosis -> DEXA recommended when initiating
- Hot flushes
- Arthralgia + Myalgia
- Insomnia

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34
Q

Which medication should be used for chemo associated N+V?

A

Low risk - metoclopramide

High risk - 5HT3 antagonists eg ondansetron esp combined w dex

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35
Q

What genetic condtion is associated w young age tumours esp sarcomas + leukaemias? gene?

A

Li-Fraumeni Syndrome

p53 gene (sarcoma <45y & 1st degree relative any cancer + other family member any cancer <45y or sarcoma any age)

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36
Q

What is BRCA2 associated with in men?

A

Prostate Ca

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37
Q

Main symptoms of SVCO?

A

MOST COMMON - Dyspnoea

Swelling of face, neck and arms - ?oedema

Headaches - worse in AM

Visual disturbance

Pulseless JV distension

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38
Q

What is a leukaemoid reaction?

A

Presence of immature cells ef myeloblasts, promyelocytes and nucleated RBCs in peripheral blood

Due to infiltration of BM -> immature cells being pushed out
OR
Raised demand for new cells

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39
Q

What are some causes of leukaemoid reactions?

A

Severe infection
Severe haemolysis
Massive haemorrhage
Met Ca w/ BM infiltraion

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40
Q

How can you distinguish between leukaemoid reaction + myelofibrosis and CML?

A

Leucocyte Alkaline phosphatase (LAP) - raised in reactive response

CML - Low LAP

Leukaemoid reaction + Myelofibrosis - High LAP

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41
Q

What is HTLV1 and what ca is it associated with?

A

HTLV1 = human T cell lymphotropic virus

Associated w/ Adult T cell leukaemia

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42
Q

What ca is EBV associated with?

A

Hodgkins lymphoma
Burkitts lymphoma
Nasopharyngeal caricinoma

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43
Q

What ca is associated with HIV-1

A

High grade B cell lymphoma

44
Q

What ca is associated w malaria?

A

Burkitts lymphoma

45
Q

Starry sky appearance on microscopy suggests which ca? what does this describe?

A

Burkitts lymphoma

Starry sky = lymphocyte sheets interspersed w/ macrophages with dead apoptotic tumour cells

46
Q

Electrolyte imbalances in Tumour Lysis Syndrome?

A

hyperkalaemia
hyperphosphataemia
hypocalcaemia
hyperuricaemia
acute renal failure

47
Q

How can you distinguish between aplastic crises and sequestration crises in Sickle cells in blood test?

A

Aplastic - BM suppression -> reduced reticulocyte count

Sequestration - raised reticulocyte count

48
Q

Inheritance pattern and mutation in hereditary angioedema?

Ix?

A

Autosomally dominant

Low plasma levels of C1-inhibitor (C1 inh, C1 esterase inhibitor)

Ix - Low C2 and C4 - even between attacks

49
Q

What are the main adverse effects associated with Cisplatin?

A

Nephrotoxicity - main dose limiting issue

Ototoxicity

Peripheral neuropathy

Hypomagnesaemia

50
Q

Features of TTP? Protein involved?

A

microangiopathic haemolytic anaemia, thrombocytopaenic purpura, neurological dysfunction, renal dysfunction and fever

Inhibition of ADAMTS13 - cleaves the large multimers of vWF

51
Q

What are the features of transfusion associated graft v host disease? how can this risk be reduced?

A

GVHD - graft v host disease

G - Gut (enteritis)
V
H - Hepatitis
D - Dermatitis

Irradiated blood products -

52
Q

Which drugs can trigger haemolysis in those with G6PD deficiency?

A

Anti-malarials: primaquine

ciprofloxacin

sulph- group drugs: sulphonamides, sulphasalazine, sulfonylureas

53
Q

Mx of APML?

A

All-trans retinoic acid (ATRA) - forces immature granulocytes into maturation

This resolves a blast crisis before definitive chemo

54
Q

What does anaemia with raised reticulocytes tell us?

A

Bleeding or haemolysis

55
Q

low antibody levels, specifically in immunoglobulin types IgG, IgM and IgA. → recurrent chest and other infections

Is suggestive of which disorder?

A

Common variable immunodeficiency

can predispose to AI disorders + lymphoma

56
Q

Most common sx of SVCO?

A

Dyspnoea

57
Q

What does Rituximab target?

A

Mab targeting CD20 on B cells -> B cell depletion + immunosuppression

58
Q

When is leucocyte alkaline phosphatase low?

A

chronic myeloid leukaemia
pernicious anaemia
paroxysmal nocturnal haemoglobinuria
infectious mononucleosis

59
Q

When is leucocyte alkaline phosphatase raised?

A

myelofibrosis
leukaemoid reactions
polycythaemia rubra vera
infections
steroids, Cushing’s syndrome
pregnancy, oral contraceptive pill

60
Q

What are the different translocations involved in blood cancers?

A

T8: 14 –> Burkitts (also has 8 letters)
T8: 21 –> Acute Myeloid L (before C)
T9: 22 –> Chronic Myeloid L
T11:14 –> Cell (Mantle) ‘Middle’ Lymphoma - 11 looks like mantlepiece
T14:18 –> Follicular Lymphoma
T15:17 –> Promyelocytic

+ Lymphomas always have a 14

61
Q

Which ca shows raised levels of bombesin?

A

Small cell lung carcinoma

Gastric ca

Neuroblastoma

62
Q

Which ca has raised levels of S-100?

A

Melanomas

Schwannomas

63
Q

How can you distinguish between Waldenstroms macroglobulinaemia and MM?

A

Waldenstrom’s macroglobulinaemia (type of NHL) - Organomegaly with no bone lesions

Multiple myeloma - Bone lesions with no organomegaly

64
Q

MoA of Irinotecan? adverse effect?

A

Inhibits topoisomerase I which prevents relaxation of supercoiled DNA

Can lead to myelosuppression

65
Q

MoA of cyclophosphamide? Adverse effects?

A

Cyclophosphamide - alkylating agent causing crosslinking in DNA

Can cause haemorrhagic cystitis, myelosuppression and transitional cell ca

66
Q

Which cytotoxic drugs act on microtubules?

A

Vincristine + vinblastine - inhibits formation of microtubules

Docetaxel - prevents microtubule depolymerisation + disassembly -> decreasing free tubulin

67
Q

What is Meigs syndrome?

A

Ovarian fibroma associated w pleural effusion + ascites

68
Q

Most common organism in neutropenic sepsis?

A

Coagulase+ve Gram +ve cocci usually staph epidermis then other staph and strep species

69
Q

Activated protein C resistance is also known as?

A

Factor V leiden

70
Q

Antiphospholipid syndrome in pregnancy mx?

A

Aspirin + LMWH

71
Q

Anti-emetic that is a neurokinin1 receptor blocker (NK1)?

A

Aprepitant

72
Q

How do Metoclopramide, domperidone, and haloperidol act as anti-emetics?

A

Dopamine blocking effecs

73
Q

How are acute haemolytic crises managed in hereditary spherocytosis?

A

Generally supportive

Transfusion if necessary

74
Q

What effect does the philipdelphia chromosome have on mortality in blood cancers?

A

Philadelphia translocation, t(9;22):

good prognosis in CML

poor prognosis in AML + ALL

75
Q

recurrent bacterial infections (e.g. Chest)
eczema
thrombocytopenia

Is suggestive of which condition? blood also show what?

A

Wiskott-Aldrich syndrome - primary immunodeficiency due to combined B+T cell dysfunction (mutated WASP gene)

Also see low IgM

76
Q

What is the major determining factor in the use of cryoprecipitate in bleeding?

A

Fibrinogen levels <1.5g/L

77
Q

Which type of hodgkins lymphoma has the best and worst prognosis?

A

Lymphocyte predominant - best
Lymphocyte depleted - worst

Mixed cellularity
Nodular sclerosing
Both offer good prognosis

78
Q

Ix of choice for CLL?

A

Immunophenotyping

79
Q

Smudge / Smear cells are seen in which haem condition?

A

CLL

80
Q

Mx of ITP?

A

Platelet count >30*109/L = Observation

Platelet count <30*109/L = Oral prednisolone

Emergency treatment: life-threatening or organ threatening bleeding = Platelet transfusion, IV methylprednisolone and intravenous immunoglobulin

81
Q

What is Evans syndrome?

A

ITP associated with AIHA

82
Q

What is given to prevent haemorhagic cystitis seen with cyclophosphamide?

A

Mesna

83
Q

Raynauds is seen in which type of cryoglobulinaemia?

A

Type 1

84
Q

What should be used instead of an osmotic fragility test for hereditary spherocytosis?

A

EMA binding test

85
Q
A
86
Q

What are the diagnostic criteria for MM?

A

The diagnostic criteria for multiple myeloma requires one major and one minor criteria or three minor criteria in an individual who has signs or symptoms of multiple myeloma.

Major criteria
Plasmacytoma (as demonstrated on evaluation of biopsy specimen)
30% plasma cells in a bone marrow sample
Elevated levels of M protein in the blood or urine

Minor criteria
10% to 30% plasma cells in a bone marrow sample.
Minor elevations in the level of M protein in the blood or urine.
Osteolytic lesions (as demonstrated on imaging studies).
Low levels of antibodies (not produced by the cancer cells) in the blood.

87
Q

How can you distinguish between MM and MGUS?

A

Differentiating features from myeloma
> normal immune function
> normal beta-2 microglobulin levels
> lower level of paraproteinaemia than myeloma (e.g. < 30g/l IgG, or < 20g/l IgA)
> stable level of paraproteinaemia
> no clinical features of myeloma (e.g. lytic lesions on x-rays or renal disease)

88
Q

the presence of HCV infection (PCR positive), positive rheumatoid factor, low complement levels, and purpuric rash

Suggests which condition?

A

hepatitis C virus (HCV) associated mixed cryoglobulinaemia

89
Q

What medications can be safe in G6PD deficiency?

A

hepatitis C virus (HCV) associated mixed cryoglobulinaemia

90
Q

Mx of acute and prophylaxis against hereditary angioedema?

A

Acute - IV C1 inh concentrate or FFP if not available

Prophylaxis - Anabolic steroid danazol

91
Q

What are the features of lead poisoning?

A

abdominal pain
peripheral neuropathy (mainly motor)
neuropsychiatric features
fatigue
constipation
blue lines on gum margin (only 20% of adult patients, very rare in children)

92
Q

How can you distinguish between TTP and HUS?

A

TTP has neurological signs too

93
Q

Most common presenting complaint in myelofibrosis?

A

lethargy

94
Q

Where is B12 absorbed?

A

B12 is actively absorbed in terminal ileum

95
Q

What can occur in 10-15% of those with Waldenstroms macroglobulinaemia?

A

Hyperviscosity syndrome

96
Q

Why does CKD increase risk of VTE?

A

Loss of antithrombin III - most common cause of this deficiency

97
Q

Mx of neoplastic spinal cord compression?

A

High dose oral dex whilst awaiting MRI

98
Q

Difference between TACO and TRALI?

A

TACO - HTN

TRALI - Hypotension

99
Q

Which drugs can cause methaemoglobinaemia?

A

sulphonamides, nitrates (including recreational nitrates e.g. amyl nitrite ‘poppers’), dapsone, sodium nitroprusside, primaquine

100
Q

B12 replacement regime?

A

if no neurological involvement 1 mg of IM hydroxocobalamin 3 times each week for 2 weeks, then once every 3 months

if a patient is also deficient in folic acid then it is important to treat the B12 deficiency first to avoid precipitating subacute combined degeneration of the cord

101
Q

Can you get aplastic anaemia with PNH?

A

Yes - though not necessarily directly

102
Q

What are the main bloods in tumour lysis syndrome?

A

Raised urate
Raised K
Raised PO4

Low Ca

Laboratory TLS is defined by ≥2 of the following occurring 3 days prior or 7 days post initiation of treatment for cancer:
Uric acid ≥ 476 µmol/L or 25% increase from baseline
Potassium ≥ 6.0 mmol/L or 25% increase from baseline
Phosphate ≥ 1.45 mmol/L (adults) or ≥2.1 mmol/L (children) or 25% increase
Calcium ≤ 1.75 mmol/L or 25% decrease from baseline

Clinical TLS is defined by: laboratory TLS plus at least one of the following:
Creatinine ≥1.5 x the upper limit of normal
Cardiac arrhythmia
Seizure
Sudden death

103
Q

How can you distinguish between higher spinal cord compression than L1 v cauda equina?

A

Presence of UMN signs

104
Q

Mx of alcoholic hepatitis?

A

Glucocorticoids eg pred

Pentoxyphylline sometimes used -not shown to improve surivial rates whereas glucocorticoids do

105
Q

Mx of hyatid cysts?

A

Surgery is mainstay - cyst walls must not be ruptured during removal and contents sterilised first

MRCP - Passmed (17 decks)

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