Haem/Onc

Question 1

Chronic Lymphocytic Leukaemia
-Definition?
-Median age at diagnosis?
-Overexpression of what anti-apoptoic protein?
-Presentation?
-Signs?
-Abnormality in blood test?
-Blood film?
-Immunophenotyping markers?
-Cytogenetics good and poor prognosis?
-Standard treatment?
-Chemotherapy option?
-Immunotherapy option?

Answer 1

-Clonal expansion of B Lymphocytes
-70
-BCL2
-Asymptomatic/B signs
-Lymphadenopathy
-Lymphocytosis (+Anaemia/Thrombocytopenia in severe)
-Smudge Cells
-CD5+, CD19+, CD20+, CD 23+
-Del 13Q (Good prognosis) (Deletion 17Q Poor prognosis)
-Watchful waiting
-FCR (fludarabine, cyclophosphamide, rituximab)
-Ibrutinib (BTK Inhibitor) or Venetoclax (BCL-2 Inhibitor)

Question 2

Chronic Myeloid Leukaemia
-Definition?
-Median age of diagnosis?
-Pathophysiology?
-Symptoms?
-Blast crisis?
-Blood investigations?
-Thrombocytosis or thrombocytopenia?
-Peripheral blood smear?
-Why is LDH grossly elevated?
-Management?

Answer 2

-Myeloproliferative disorder caused by uncontrolled proliferation of myeloid stem cells
-50 to 60
-Translocation (9.22) leading to Philadelphia chromosome and formation of BCR-ABL1 fusion gene
-B Symptoms + Splenomegaly
-Transformation to acute leukemia (>20% blasts)
-Leucocytosis, granulocyte precursors Myelocytes + metamyelocytes), Basophilia, Eosinophilia,
-Thrombocytosis (early) Thrombocytopenia (Late)
-Predominance of mature granulocytes and precursors
-Increased cell turnover
-Tyrosine kinase inhibitors (Dasatinib -> Blocks BCR-ABL tyrosine kinase activity)

Question 3

Acute Myeloid Leukaemia
-Genetic risk factors?
-Cytogenetic abnormalities?
-Peripheral blood smear?
-Bone marrow biopsy?
-Induction therapy?

Answer 3

-Down syndrome+Fanconi syndrome
-T8:21, T15.17 (Acute promyelocytic leukaemia)
-Blast cells + Auer Rods (Posthegemonic)
-Over 20% blasts = diagnostic
-7 + 3 chemotherapy

Question 4

Myelodysplastic syndromes
-When to suspect?
-Diagnostic findings on BM biopsy?
-Best prognosis?
->20% blasts means?

Answer 4

-Macrocytic anaemias + Cytopenia’s in the elderly
-Bone marrow >10% dysplasia or ringed sideroblasts
-Del 5Q -> Tx with lenalidomide
-Progression to AML

Question 5

Myelofibrosis
-Driver mutations?
-Symptoms?
-Signs
-Peripheral blood smear?
-BM Biopsy?
-Targeted therapy?

Answer 5

-JAK2 (60%), CALR (20%), MPL (5%)
-B Symptoms
-Massive Splenomegaly
-Tear drop cells (Dacrocytes, circulating nucleated cells, Immature granulocytes)
-Fibrosis
-Ruxolitinib (JAK2 inhibitor)

Question 6

Burkitt’s lymphoma is an aggressive non-hodgkins lymphoma characterised by over expression of what gene?

Answer 6

c-MYc

Question 7

Overexpression of BCL2 is associated with what cancer?

Answer 7

B-Cell Non-Hodgkins lymphoma

Question 8

Hodgkins Lymphoma
-Epidemiology
-Most common subtype?
-Pathophysiology?
-Clinical features?
-Associated with what virus?
-Management
-Anti CD30 antibody used

Answer 8

-Bimodal (15-34) (>55)
-Nodular Sclerosis
-Reed-Sternberg cells
-B Symptoms + Lymphadenopathy
-EBV
-Chemo (ABVD) regime
-Brentuximab

Question 9

Hodgkins Lymphoma
Ann Arbor classification
Stage 1
Stage 2
Stage 3
Stage 4

Answer 9

1) Single lymph node
2) >2 Lymph node regions on the same diaphragm
3) Lymph node involvement both sides of diaphragm
4) Disseminated involvement