Haematology

Question 1

Management of CML

Answer 1

Imatinib (tyrosine kinase inibitor cuases aptosis of cells expressing BCR-ABL. second generation TKIs, dasatinib and nilotinib.
response: >= 3 log reduction of the baseline quantitative BCR-ABL assay.
interferon alpha is sometimes helpful in the chronic phase.

Question 2

Differentiation of Peptic ulcers

Answer 2

GORD, NSAiD or ASA, malignant ulcer, hypersecerory( gastrinoma, or carcinoma), others( stress ulcer, chemo, bisphosphanite, ) intestinal angina, pancreatitis

Question 3

Hugesplenamegaly

Answer 3

CML,Myelofibrosis, malaria

Question 4

Indications for thrombophilia investigations

Answer 4

recurrent venous thromboses
venous thrombosis before age of 45
thrombosis at an unusal site: portal vein, cavernous sinus, hepatic vein
adverse family history of venous thrombosis
in young women prior to commencing hormonal contraception

Question 5

tests for thrombophilia

Answer 5

FBC and ESR, factor v leiden, antiphospholipid antibodies, anthrombin III, protein C and S, prothrombin gene mutation, plasma homocysteine, occasionally PNH testing flow cytometry, occasionally factor VIII and XI levels.

Question 6

Melphalan

Answer 6

Chemotherapy drug belongs to class of nitrogen mustard alkylating agents, attaches to the alkyl group to the guainmine base of DNA

Question 7

Cytarabine

Answer 7

Chemo, mainly in the treatment of cancers of white cells, such as AML and non hodgkin’s lymphoma, kills cancer cells by intefering with DNA synthesis antimetabolic agetn

Question 8

Etoposide

Answer 8

cytotoxic anticancer, topoisomerase inhibitor. Etoposide cuases erros in DNA synthesis and promotes apoptosis of the cancer cell

Question 9

risk categories of AML

Answer 9

good risk- t(15:17), t(8:12) inv 16

poor risk - del 7, complex karyotypes

Question 10

poor risk features of CLL

Answer 10

CD38 positivity
adverse cytogenetics (trisomy 12, 11q, del 17q etc)
unmutated igH status
ZAP 70 positivity
rapid lymphocyte doubling time (<6 months)
bone marrow failure
advanced age

Question 11

causes of neutrophilia (>7.5

Answer 11

1. infection: bacterial
2. inflammation: burn, tissue necrosis, MI, PE, collagen vasclular disease
3. toxin and drugs: corticosteroid, beta agonist, GCSF, cigarette smoking
4. stress: endogenous glucocorticoids and catecholamines
   5 marrow stimulation: hemolytic anaemia, immune thrombocytopenia
5. asplenia
6. Neoplasm
7. leukemoid reaction: >50, + left shift, not due to leukemia, unlike CML, increased LAP