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YEAR 3 HAEMATOLOGY > Malignancies Cases > Flashcards

Malignancies Cases Flashcards

1
Q

A 65 year old man takes aspirin because of a previous history of TIA.

A

…

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2
Q

How does asprin work?

A

REDUCES PLATLET AGGREGATION - inhibits cyclooxygenase from working, inhibits arachadonic acid from turning into thrmoboxane A2.

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3
Q

which drugs prevent pletlet funciton?

A

clopidogrel, adciximab, ticagrelor.

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4
Q

how does dabigatran work?

A

small molecule whichh bind to and inactivates thrombin

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5
Q

54m scaffolder, tiredness over 2-3 weeks.

A

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6
Q

what other sy would oyu ask about?

A

SOB, dizziness, palpitations – anaemic symptoms
Bleeding, diet - ?cause of anaemia
Mood, appetite, sleep pattern, motivation - ?depression
Weight gain, constipation, skin and hair changes - ?hypothyroidism
Fevers, sweats, weight loss - ?infection, ?malignancy
Systemic enquiry

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7
Q

Over last 2 weeks - SOB and dizzy on climbing scaffold. Feeling hot and cold. Coughing up green phlegm.

A

…

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8
Q

on examination Very pale, Temp 38.5, Dull percussion note R base with decreased air entry,Petichiae around ankles, POTENTIALLY PNEUMONIA – CURB65,

A

…

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9
Q

what ix would you do?

A

fbc, film, coag screen, heametrics (b12, folate, ferritin), uande’s, lft’s, crp, suptum culture, cxr

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10
Q

fbc results: Hb 45, MCV 92, WCC 0.9, Neutrophils 0.3, Plts 12, what is the ddx?

A

A – Acute leukaemia, B – Aplastic anaemia, C - B12 deficiency, D – Metastatic ovarian cancer

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11
Q

referred to haematology: Gum hypertrophy/infiltration, Circulating blasts on blood film

A

…

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12
Q

what is the diagnosis and why?

A

Acute myeloid leukaemia (AML) - Short history, Uncontrolled proliferation of immature myeloid cells therefore acute

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13
Q

20m, Presents with 1 month history of gradually increasing neck swelling What questions do you want to ask?

A

WEIGHT LOSS, PAIN, MYELOMA HX, NIGHT SWEATS, LOSS OF APETITE, LENGTH OF TIME, CHANGE IN SIZE,

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14
Q

Weight loss of half a stone, Generalised itch, Night sweats, O/E 2x3 cm cervical lymphadenopathy, Also axillary lymphadenopathy, FBC – normocytic normochromic anaemia, eosinophilia

A

…

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15
Q

whata re the DDX?

A

Hodgkin’s Lymphoma
Non-Hodgkin’s lymphoma
Acute lymphoblastic leukaemia, Metastatic non haematological malignancy, Infections(viral – EBV, CMV, HIV, Bacterial – draining, local lymph nodes, TB, toxoplasma)

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16
Q

what further ix would you do?

A

Lymph node biopsy, Virology (particularly HIV)

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17
Q

what is the common px of lympoma?

A

Lymphadenopathy, Splenomegaly +/- hepatomegaly, B symptoms , fever >38oC, weight loss >10% body weight in 6 mths, night sweats, Symptomatic anaemia or other cytopenias

18
Q

on biopsy Reed-sternberg cells are seen (characteristic of OA and Hodgkins disease) Hodgkins disease…

A

Staged by PET-CT scan, Stage IIB, Combination chemotherapy - ABVD

19
Q

75m, intermittent claudication for 2yrs, admitted with painful toe

A

…

20
Q

what are the causes of high platelets?

A

Infections, Post surgery / trauma, Malignancy, Iron deficiency, Inflammation – IBD, Rheumatoid arthritis, Primary myeloproliferative disorder

21
Q

what Ix would you do for thrombocytosis?

A

FBC, Blood film, Inflammatory markers (ESR, CRP), Ferritin, JAK2, CALR & MPL mutation screening, Consider BCR-ABL, Other investigations if clinical suspicion of malignancy, Bone marrow examination not first line

22
Q

Ix results are: ESR 24mm/hr, CRP <4, Ferritin 3, Positive for JAK2 V617F mutation

A

…

23
Q

what is the diagnosis and Tx?

A

Iron deficient Polycythaemia Vera - Myeloproliferative disorder. Treatment - Aspirin, Venesection, Hydroxycarbamide.

24
Q

55m, low back pain getting progressively worse, tired last few months, previously fit and well, no weight loss.

A

…

25
Q

what are the key questions asked for back pain?

A

duration, is it getting worse, serevity, interference with sleep, radiation, leg weakness or numbness, bladder or bowel disturbance?

26
Q

what Ix would you do?

A

FBC, ESR, UandE, Ca, Phos, immunoglobulins and protein electrophoresis. Bence jones proteins, xray of the spine.

27
Q

on Ix there are igg kappa paraproteins, bony lytic lesions and a paraspinal mass

A

…

28
Q

what biopsies should you do? And what would be seen?

A

paraspinal mass shows plasmacytoma, Bone marrow aspirate shows myeloma

29
Q

what is myeloma?

A

cancer from plasma cells

30
Q

Tx of myeloma?

A 
Local – surgical decompression or radiotherapy
Systemic – induction chemotherapy (various regimens)
Bone protection (IV bisphosphonate Zolendronic acid)
Consolidation (autologous stem cell transplant
Maintenance (in clinical trial only in UK at present)
31
Q

83f, admitted for a bladder repair, denies other symptoms, On examination-marked splenomegaly

A

…

32
Q

what may be the cause of marked splenomegaly?

A

Low grade lymphoma, Chronic leukaemias (CML, CLL), Myeloproliferative disorders, Portal hypertension / liver disease, Infiltration from sarcoidosis, other malignancies, Infections eg chronic malaria, visceral Leishmaniasis

33
Q

blood film shows Leukoerythroblastic blood film with teardrop poikilocytes, blasts and giant platelets
Extensive reticulin fibrosis in bone marrow

A

…

34
Q

what do tear drop cells mean?

A

dacrocytes) are frequently associated with infiltration of the bone marrow by fibrosis, granulomatous inflammation, or hematopoietic or metastatic neoplasms.

35
Q

what are the characteristic features of myelofibrosis?

A

De novo and transformed can cause Splenomegaly (can be massive)
Symptoms from cytopenias or spleen
Weight loss, extreme tiredness
Leukoerythroblastic blood film, teardrop red cells
Marrow fibrosis – Reticulin stain
Most positive for one of JAK2/CALR/MPL mutations
Tx = Transfusion, hydroxycarbamide, thalidomide, JAK2 inhibitors (Ruxolitinib), allogeneic stem cell transplantation

36
Q

72f, Blood count prior to elective cholecystectomy, Otherwise asymptomatic
Hb 120g/l, WCC 38.1, Lymph 34.7, Neut 3.1, Platelet 230

A

…

37
Q

what are the possible causes of lymphocytosis?

A

Viral infection (e.g. EBV, CMV, HIV), Other infections – TB, brucellosis, syphilis, Vasculitis, Acute lymphoblastic leukaemia, Chronic lymphocytic leukaemia, Lymphoma

38
Q

blood film shows small, mature, homogenous lymphocytes, Smear Cells, Red cells and platelets are normal

A

…

39
Q

what is cytometry?

A

cells labelled by monoclonal antibodies conjugated to fluorochromes directed against cell surface markers

40
Q

what might be the underlying cause?

A

EBV, CMV, HIV serology, Brucella, syphilis serology, Monospot test.

YEAR 3 HAEMATOLOGY (17 decks)

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