Joseph Hall

Question 1

What is the glass test used for?

Answer 1

Push a glass against the rash, if you can see the rash through the glass the test is positive for a petechial rash.

Question 2

What is the relationship between appetite and sickness?

Answer 2

Release of IL-18 cytokine
Binds to receptors on the BST-LH (bed nucleus of the stria terminalis- lateral hypothalamus) neuronal pathway, which interferes with GABA and glutamate release.
This means that the lateral hypothalamus isn’t stimulated enough, so we do not feel as hungry.
Bacteria need glucose, by not eating we reduce availability for them

Question 3

At what age is the liver palpable till in children?

Answer 3

Should be palpable in newborns for 2cm, >3.5cm is cause for concern
Gap gradually decreases
10-16 under 1cm can be felt

Question 4

How to classify non-blanching and petechial rashes?

Answer 4

Non-blanching rashes are caused by bleeding under the skin. Petechiae are small (< 3mm), non blanching, red spots on the skin caused by burst capillaries.

Purpura are larger (3 – 10mm) non-blanching, red-purple, macules or papules created by leaking of blood from vessels under the skins.

Question 5

5 ddx for petechial rashes

Answer 5

meningococcal septicaemia
HSP
ITP
Acute leukaemia
HUS
mechanical
traumatic 
viral illness e.g influenza

Question 6

5 causes of lymphadenopathy (MIAMI)

Answer 6

Malignancy
Infection
Autoimmune
Miscellaneous
Iatrogenic

Question 7

3 types of anaemia?

Answer 7

microcytic
normocytic
macrocytic

Question 8

5 ddx for macrocytic anaemia

Answer 8

acute GI bleeding
trauma 
iron, B12, folate deficiency 
leukaemia 
pregnancy

Question 9

5 causes of hepatomegaly

Answer 9

inflammation
infiltration
obstruction
storage abnormalities
vascular congestion

Question 10

5 causes of splenomegaly

Answer 10

•	Alcohol induced
•	Hepatic steatosis 
•	Tumours 
•	Haemolytic anaemia
•	SCA
•	Acute anaemia
•	Malaria
•	TB
•	Viral hepatitis
•	Infective endocarditis
•	Leukaemia
•	Lymphoma 
•

Question 11

4 emergencies associated with childhood malignancy

Answer 11

o SVC syndrome- caused by compression or obstruction of the SVC usually as a result of a thrombosis or mass

o Spinal cord compression- mass or tumour pressing on the spinal cord, weakness, gait abnormalities, numbness etc.

o Tumour lysis syndrome- when a tumour cell dies and releases potassium, phosphates and nucleic acids into the blood stream. This leads to hyperuricemia and hypocalcaemia. Usually seen in ALL and high-grade lymphomas. Symptoms include decreased urine output, respiratory distress, oedema, nausea and vomiting, muscle cramps and twitching, cardiac arrhythmias.

o Septic shock

Question 12

what is myeloma?

Answer 12

tumour comprised of plasma cells

Question 13

2 proteins detectable in myeloma?

Answer 13

paraprotein

Bence-Jones proteins

Question 14

why do you get renal failure in myeloma?

Answer 14

proteins get stuck in the kidneys

Question 15

4 symptoms of myeloma

Answer 15

pain, fatigue, recurring infections, kidney damage, peripheral neuropathy

Question 16

5 symptoms of lymphoma

Answer 16

fatigue, lumps in neck, armpits or groin, fever, night sweats, SOB, unexplained weight loss, itchy skin

Question 17

5 symptoms of AML

Answer 17

fever, SOB, bruising, bleeding, petechiae, weakness, loss of appetite, weight loss.

Question 18

5 symptoms of ALL

Answer 18

fever, bruising, bleeding, petechiae, bone/joint pain, painless lumps in the neck, armpits and groin, pain or feeling of fullness below the ribs- hepatomegaly caused by infiltration of leukaemic cells, weakness, anaemia, loss of appetite

Question 19

5 symptoms of CML

Answer 19

exhaustion, fever, drenching night sweats, unexplained weight loss and pain or a feeling of fullness below the ribs- sometimes asymptomatic

Question 20

5 symptoms of CLL

Answer 20

painless lumps in the lymph nodes, weakness, feeling tired, pain or feeling of fullness below the ribs, fever and infection, bleeding, petechiae, night sweats, unexplained weight loss

Question 21

What is DIC

Answer 21

o Overactive clotting

o Clotting factors are used up which can lead to bleeding

Question 22

role of the spleen x3

Answer 22

o Clearance of microorganisms and particulate antigens from the blood stream.
o Synthesis of immunoglobulin G (IgG), properdin (an essential component of the alternate pathway of complement activation), and tuftsin (an immunostimulatory tetrapeptide)
o Removal of abnormal red blood cells (RBCs)

Question 23

What are CD2 and CD10 what are they markers for?

Answer 23

CD2 is a glycoprotein receptor found on NK cells and T cells. It plays an important role in the activation of helper T cells. It is shown that T cell lymphoid malignancies have a low CD2 markers and AML may have an increased CD2 expression

CD10 is a marker for B-ALL, various other cancers including breast, hepatocellular carcinoma vs non-hepatocellular carcinoma, Burkitt lymphoma, follicular lymphoma.

Question 24

Why is potassium low in leukemia?

Answer 24

• Inadequate intake
• Caused by the treatment vomiting, nausea
• Antibiotics and steroids can increase renal losses
• Damage to renal tubule cells via leukemic cells
• Blast crisis

Question 25

CI, cautions, side effect and MOA of vincristine

Answer 25

o CI: intrathecal injection- severe neurotoxicity and death o Cautions: irritant to tissues, ileus, neuromuscular disease o Side effects: hypersensitivity, rash, SIADH, abdominal cramps, adrenal disorder, anaemia, decreased appetite, alopecia, constipation, coronary artery disease, diarrhoea, dizziness, headache, hypotension, bronchospasm following administration, neurotoxicity o MOA: vinca alkaloid- inhibits mitosis at metaphase by interacting with tubulin

Question 26

CI, cautions, side effect and MOA of aspariginase

Answer 26

o CI: history of pancreatitis, serious haemorrhage, serious thrombosis, pre-existing coagulopathy o Cautions: diabetes- may raise blood glucose, hypersensitivity reactions, hypertriglyceridaemia (severe), increased risk of acute pancreatitis. o Side effects: abdominal pain, agitation, anaemia, decreased appetite, back pain, bronchospasm, diarrhea, DIC, dizziness, drowsiness, embolism and thrombosis, haemorrhage, hallucination, hyperglycaemia, hypersensitivity o MOA: breaks down L-asparagine to aspartic acid and ammonia, which interrupts protein synthesis in tumour cells.

Question 27

CI, cautions, side effect and MOA of dexamethasone

Answer 27

o CI: avoid live virus vaccines, systemic infection, injections containing benzyl alcohol in neonates. o Cautions: congestive heart failure, diverticulitis, epilepsy, glaucoma, hypertension, hypothyroidism, recent MI o Side effects: anxiety, fluid retention, GI discomfort, headache, impaired healing, increased risk of infection, menstrual cycle irregularities, nausea, skin reactions, weight gain. o MOA: reduces leukocyte migration to sites of inflammation, inhibit NFk-b and promote anti-inflammatory genes like IL-10.

Question 28

distinguish between 1y and 2y immunodeficiencies

Answer 28

* Primary immunodeficiency- inherited immune disorders resulting from genetic mutations, usually present at birth and diagnosed in childhood. * Secondary immunodeficiency- acquired as a result of disease or environmental factors e.g. chemotherapy, HIV infection, malnutrition. These are more common than PID.

Question 29

Prophylaxis of TLS

Answer 29

can give fluids and allopurinol rasburicase if intermediate risk DO NOT GIVE RASBIURICASE AND ALLOPURINOL

Question 30

Tx of established TLS

Answer 30

o Hydration- NOT POTASSIUM BASED o Give rasburicase at 0.2mg/kg as long as no CIs. Duration is determined by clinical response. o don’t treat asymptomatic hypoCa o Symptommatic hypocalcaemia can be treated with a short infusion of calcium gluconate. o K>6mmol/L or an increase in 25% over baseline should have cardiac monitoring o Fluid overload that is hard to control, hyperK, hyperuricaemia, hyperphosphataemia of hypoCa are indications for renal dialysis -Peritoneal dialysis not recommended, Should continue until adequate recovery

Question 31

MOA of calcium gluconate

Answer 31

Oral calcium salt | Prevents arrhythmias by raising the depolarization requirements, thereby reducing contractility

Question 32

MOA of ametop cream

Answer 32

Contains tetracaine Blocks sodium ion channels involved in initiation and conduction of neuronal impulses

Question 33

what is piptazobactam and MOA

Answer 33

combination of piperacillin and tazobactam- broadens the spectrum it can be used for. Interferes with cell wall synthesis. Binds to specific penicillin binding proteins. Cell lysis then occurs by cell wall autolytic enzymes. May also interfere with autolysin inhibitors.

Question 34

MOA of gentamicin

Answer 34

aminoglycoside, binds irreversibly to 30S subunit proteins and 16S rRNA, interfering with protein synthesis. Interferes with the initiation complex resulting in the misreading of mRNA therefore incorrect AAs are inserted into the polypeptide.

Question 35

MOA of methotrexate

Answer 35

Inhibits enzymes responsible for nucleotide synthesis, thus preventing cell division.

Question 36

what is the philadelphia chromosome

Answer 36

Gene that codes for a tyrosine kinase with increased enzymatic activity. Fusion of 2 chromosomes leading to the production of a BCR-ABL oncogene- abnormal tyrosine kinase activity.

Question 37

MOA of allopurinol

Answer 37

inhibits xanthine oxidase, which converts hypoxanthine to xanthine to uric acid.

Question 38

Rasburicase MOA

Answer 38

catalyses enzymatic oxidation of uric acid into inactive and soluble metabolites- allantoin