Haematology & oncology

Question 1

Tumour lysis syndrome common with what cancers?

Answer 1

Lymphomas & leukaemias

Question 2

Signs and symptoms of TLS?

Answer 2

SYMPTOMS:
N&V/Diarrhoea
Muscle cramps
Weakness
Numbness/tingling
Decreased urination
Confusion
SIGNS:
Hyperkalaemia
Hypocalceamia
Hyperphosphataemia
Hyperuricaemia
Lactic acidosis

Question 3

Case typical of what:
Recurrent epistaxis
Recurrent iron deficiency
FHx of epistaxis
Platelets normal
Coagulation normal

Answer 3

Hereditory haemorrhagic telangectasia

Question 4

Case typical of what?:
Purpura/petichae post infection
Low platelets
Normal clotting

Answer 4

Immune thrombocytopenia

Question 5

Baby/infant presents with joint pain, swollen, hot and tender.
FBC normal
Coagulation tests - Factor VIII < 2%

Answer 5

Haemophilia A

Question 6

What is plasminogen/plasmin role?

Answer 6

Fibrinolysis - breakdown fibrin of clot

Fibrin degradation products measured as D-dimer test

Question 7

Intrinsic pathway of coagulation cascade?

Answer 7

Factors XII, XI, IX, VIII activate Factor X

Question 8

Extrinsic pathway of coagulation cascade?

Answer 8

Tissue factor and factor VII activate Factor X

Question 9

Final common part of coagulation cascade?

Answer 9

Factor XaVa activates:
Prothrombin to thrombin
Fibrinogen to fibrin

Question 10

Coagulation profile measuring extrinsic pathway?

Answer 10

Prothrombin time (PT or INR)

Question 11

Coagulation profile measuring intrinsic pathway?

Answer 11

Activated partial thromboplastin time (APTT)

Question 12

What is ITP?

Answer 12

Autoimmune thrombocytopenia:

Chronic and acute destruction of platelets (reducing lifespan), in spleen and liver

Question 13

Haemophilia A is deficiency in which clotting factor?

Answer 13

Factor VIII

Question 14

Haemophilia B is a deficiency in which clotting factor?

Answer 14

Factor IX (also known as Christmas disease)

Question 15

Vitamin K essential for which coagulation factors?

Answer 15

Factors II, VII, IX, X

Question 16

Tranexamic acid useful for what?

Answer 16

Useful for treating mucous membrane bleeds

• Epistaxis
• dental/mouth bleeds
• GI bleeds
• Menorrhagia

Question 17

Rivaroxiban/apixaban work on what factor?

Answer 17

Anti-Xa (they inhibit Factor Xa)

Question 18

Dabigatran work on what factor?

Answer 18

Anti-thrombin

Question 19

Coagulation profile:
Bleeding time - N
PT - increase
APTT - increase
TT - increase
Fibrinogen - decrease

Answer 19

Liver disease

Question 20

Coagulation profile:
Bleeding time - N
PT - N
APTT - Increase
TT - N
Fibrinogen - N

Answer 20

Haemophilia

Question 21

Coagulation profile:
Bleeding time - Increase
PT - N
APTT - increase
TT  - N
Fibrinogen - N

Answer 21

vonWillebrand Disease
NB APTT is prolongued because vWF normally has a protective effect on the degradation of Factor VIII (part of intrinsic pathway) and thus extends APTT.

Question 22

Coagulation profile:
Bleeding time - increase
PT - increase
APTT - increase
TT - increase
Fibrinogen - decrease

Answer 22

DIC

Question 23

Coagulation profile:
Bleeding time - increase
PT - N
APTT - N
TT - N
Fibrinogen - N

Answer 23

Thrombocytopenia

Question 24

Natural inhibitors of coagulation?

Answer 24

Protein C (and protein S)
Anti-thrombin
(Plasmin breaks down fibrin, but doesn't prevent coagulation initially)

Question 25

What is Factor V Leiden?

Answer 25

Mutated Factor V, which cannot be degraded by activated protein C, and thus causes hypercoagulability

Question 26

How does Protein C inhibit coagulation?

Answer 26

Protein S and thrombomodulin activate protein C, which then inhibits Factors VIIIa and Va, thus inhibiting thrombin activation

Question 27

What is Prothrombin G20210A?

Answer 27

Mutation in prothrombin gene, causing elevated prothrombin levels, and thus hypercoagulability

Question 28

Causes of microcytic anaemia

Answer 28

``` Find Those Small Cells Fe Deficiency Thalassaemia Sideroblastic anaemia Chronic disease ```

Question 29

Causes of macrocytic anaemia

Answer 29

``` FAT RBC Foetus (Pregnancy) Alcohol Thyroid Reticulocytosis B12/Folate deficiency Cirrhosis ```

Question 30

Causes of normocytic anaemia

Answer 30

``` ABBRA Anaemia of chronic disease Bone marrow failure Bone marrow infiltration Renal failure Acute haemorrhage ```

Question 31

Tumour marker for ovarian ca?

Answer 31

CA 125

Question 32

Tumour marker for pancreatic ca?

Answer 32

CA 19-9

Question 33

Tumour marker for breast Ca?

Answer 33

CA 15-3

Question 34

Tumour marker for prostate Ca?

Answer 34

PSA - prostate specific antigen

Question 35

Tumour marker for Hepatocellular Ca?

Answer 35

AFP - alpha-feto protein | ALSO for teratomas

Question 36

Tumour marker for for colorectal Ca?

Answer 36

CEA - carcinoembryonic cancer

Question 37

What is S100 a tumour marker for?

Answer 37

Melanoma | Schwannomas

Question 38

What is bombesin a tumour marker for?

Answer 38

Small cell Lung Ca Neuroblastoma Gastric Ca