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MRCP > Haem/Onc > Flashcards

Haem/Onc Flashcards

1
Q

Antiphospholipid syndrome Rx in pregnancy

A

Initially aspirin alone

LMWH once foetal heartbeat on USS, usually discontinued at 34 weeks

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2
Q

APLS in pregnancy complications

A 
Recurrent miscarriage
Intrauterine growth restriction
Pre eclampsia
Placental abruption
Pre term delivery
VTE
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3
Q

Oral Opiate conversion rates
Codeine to morphine
Tramadol to morphine
Morphine to oxycodone

A

Divide by 10
Divide by 10
Divide by 1.5

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4
Q

Oral to sub cut morphine conversions
Oral morphine to subcut
Oral morphine to subcut diamorphine
Oral oxycodone to subcut diamorphine

A

Divide by 2
Divide by 3
Divide by 1.5

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5
Q

Cyclophosphamide MoA

A

Alkylation agent, causes cross linking of DNA

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6
Q

Cyclophosphamide side effects

A

Haemorrhagic cystitis
Myelosupression
TCC

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7
Q

Bleomycin MoA

A

Degrades preformed DNA

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8
Q

Bleomycin side effects

A

Lung fibrosis

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9
Q

Doxorubicin MoA

A

Stabilises dNA-topoisomerase II complex - inhibits DNA and RNA synthesis

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10
Q

Doxorubicin side effects

A

Cardiomyopathy

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11
Q

Methotrexate MoA

A

Inhibits dihydrofolate reductase and thymidylate synthesis

Anti folate

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12
Q

MTX side effects

A

Myelosupression
Live fibrosis
Lung fibrosis

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13
Q

Fluorocil (5-FU) MoA

A

Pyridimine analogue - induces cell cycle arrest and apoptosis by blocking thymidylate synthesis (during S phase)

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14
Q

Fluorouracil (5-FU) side effects

A

Myelosupression
Mucositis
Dermatitis

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15
Q

6 mecaptopurine MoA

A

Purine analogue, activated by HGRPTase, decreases purine synthesis

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16
Q

6 mecaptopurine side effects

A

Myelosupression.

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17
Q

Cytarabine MoA

A

Pyridimine antagonist. Interferes with DNA synthesis at S phase and inhibits DNA polymerase

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18
Q

Cytarabine side effects

A

Myelosupression

Ataxia

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19
Q

Vincristine/vinblastine MoA

A

Inhibits formulation of microtubules

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20
Q

Vincristine side effects

A

Reversible peripheral neuropathy

Paralytic ileum

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21
Q

Vinblastine side effects

A

Myelosupression

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22
Q

Cisplatin MoA

A

Causes cross linking in DNA

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23
Q

Cisplatin side effects

A

Ototoxicity
Peripheral neuropathy
Hypomagnesaemia

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24
Q

Hydroxyurea (hydroxycarbamide) MoA

A

Inhibits ribonucleotide reductase, decreases DNA synthesis

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25
Q

Hydroxyurea (hydroxycarbamide) side effects

A

Myelosupression

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26
Q

G6PD demographics and inheritance

A

More common in Mediterranean and African

XLR

27
Q

G6PD pathophys

A

Decreased G6PD leads to decrease in glutathione, increased red cell susceptibility to oxidative stress

28
Q

Features of G6PD (5)

A 
?neonatal jaundice 
Intravascular haemolysis 
Gallstones 
?splenomegaly
Heinz bodies on bloods films
29
Q

G6PD Dx

A

Enzyme assay

30
Q

G6PD triggers

A 
Antimalarials (primaquine) 
Ciprofloxacin
Sulphur drugs
Favs beans 
Infection
31
Q

Vitamin B12 absorption

A

Bound to intrinsic factor (produced by parietal cells in stomach)
Active absorption in terminal ileum
Minor passive absorption not bound to IF

32
Q

Causes of B12 deficiency

A 
Pernicious anaemia
Post gastrectomy
Poor diet 
Disorders of terminal ileum - Crohns, blind loop
Metformin (rare)
33
Q

B12 deficiency Rx

A

If no neuro involvement 3 weekly IM hydroxycobalamin for 2 weeks, then once every 3 months
NB - if also folate deficient Rx B12 first to prevent SCDC

34
Q

ECOG score 0

A

Fully active, at predisease functionality

35
Q

ECOG 1

A

Restricted in strenuous physical activity but ambulatory and able to carry out work of light sedentary nature - house work, Office work

36
Q

ECOG 2

A

Ambulatory, capable of all self care , unable to carry out any work Activites
Up and about >50% waking hours

37
Q

ECOG 3

A

Limited self care

In bed >50% waking hours

38
Q

ECOG 4

A

Completely disabled
No self care
Totally confined to bed/chair

39
Q

ECOG 5

A

Dead

40
Q

CML translocation

A

T(9;22) Philadelphia chromosome
-> Abelson proto-oncogene moved to BCR gene on Ch22
BCR-ABL fusion protein has excess tyrosine kinase activity
Poor prognostic indicator in ALL

41
Q

Acute promyelocytic leukaemia (M3) genetics

A

Fusion of PML and RAR alpha genes

42
Q

Burkitts Lymphoma genetics

A

T(8;14)

MYC oncogene translocated onto an immunoglobulin gene

43
Q

Mantle cell lymphoma genetics

A

t(11;14)

Deregulation of cyclinD1 (BCL1) gene

44
Q

Squamous cell cancer features (4)

A

Typically central
Associated with PTHrP secretion
Strongly associated with finger clubbing
Hypertrophic pulmonary osteoarthropathy

45
Q

Adenocarcinoma lung features (3)

A

Typically peripheral
Most common lung ca in non smokers
Majority who develop it are smokers however

46
Q

Large cell lung Ca features (3)

A

Typically peripheral
Anaplastic, poorly differentiated, poor prognosis
May secrete bHCG

47
Q

Acute haemolytic transfusion reaction MoA

A 
ABO incompatibility 
Massive intravascular haemolysis 
Symptoms minutes after transfusion 
- fever
- Abdo and chest pain 
- agitation 
- Hypotension
48
Q

Acute haemolytic transfusion rxn Rx

A

Stop transfusion
Fluid resus with NS
Inform lab

Complications
DIC, AKI

49
Q

Non haemolytic febrile reaction MoA

A

HLA incompatibility

Often result of sensitisation by previous pregnancies or transfusions

50
Q

Pathphysiology of hypercoagulable state in pregnancy

A

Increased factor VII, VIII, X
Decreased protein S
Uterus presses on IVC -> venous stasis in legs

51
Q

VTE Rx in pregnancy

A

Sub cut LMWH

52
Q

Indications for Rx in CLL (6)

A

Progressive marrow failure - development of worsening anaemia and/or thrombocytopenia
Massive >10cm or progressive LAN
Massive >6cm or progressive splenomegaly
Progressive lymphocytosis >50% inc over 2 months, or lymphocyte doubling time <6 months
Autoimmune cytopenias - eg ITP
Systemic Sx - weight loss >10% in 6/12, Fever >38 for >2/52, extreme fatigue, night sweats

53
Q

CLL management

A

If no indication for Rx them monitor with regular FBC

Fludarabine, cyclophosphamide and rituximab (FCR)

54
Q

AML M0

A

Undifferentiated

55
Q

AML M1

A

Without maturation

56
Q

AML M2

A

With granulocytic maturation

57
Q

AML M3

A

acute promyelocytic

58
Q

AML M4

A

granulocytic and monocytic maturation

59
Q

AML m5

A

Monocytic

60
Q

AML M6

A

Erythroleukaemia

61
Q

AML M7

A

Megakaryoblastic

62
Q

Pigment laden macrophages on colonoscopy

A

Laxative abuse

63
Q

Rasburicase MoA, indication

A

recombinant version of urate oxidase, coverts uric acid to allantoin
Preventing tumour lysis syndrome

MRCP (17 decks)

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