Oncology and Haematology

Question 1

Poor prognostic features in ALL

Answer 1

male
<2 years
WCC >50
CNS disease
T cell phenotype

Question 2

what features are predictive of poor outcome in neuroblastoma

Answer 2

N-myc amplification
>18 months
raised LDH, NSE and ferritin
low TRK levels

Question 3

Histological findings in ALL

Answer 3

high nuclear to cytoplasmic ration
blast cells: large nucleus
auer rods (also seen in AML andmyeloproliferative disorders)

Question 4

Biopsy finding in hodgkins lymphoma

Answer 4

lymphocytic and histiocytic cells = total replacement of nodular architecture with large cells
seen in 70-80%

Question 5

G0 phase of cell cycle

Answer 5

resting stage
cells haven’t started to divide
can last hours to years
when cell is signalled to reproduce moves to G1

cells here are the most resistant to chemotherapy

Question 6

G1 phase of cell cycle

Answer 6

part of interphase
cell makes more proteins and copying organelles ready for dividing
lasts 20-30 hours

Question 7

S phase

Answer 7

part of interphase
DNA is copied
full replica of each of the 46 choromosomes

Question 8

G2 phase of cell cycle

Answer 8

part of interphase
occurs just before mitosis
cell continues to grow making more proteins and organelles before entering mitosis

Question 9

M phase

Answer 9

mitosis
cell separation
formation of two seperate daughter cells

Question 10

Order of cell cycle

Answer 10

G0
G1
S
G2
M

Question 11

Basophilic stippling on blood film

Answer 11

lead poisoning

Question 12

features of lead poisoning

Answer 12

basophilic strippling on blood film
encephalopathy
microcytic hypochromic anaemia
wrist/foot drop
abdo pain

Question 13

Wilm’s tumour / nephroblastoma

Answer 13

tumour of kidney
unilateral kidney mass can be B/L
sx: nausea and vomiting, poor appetite, weight loss, abdo pain, fever, haematuria, HTN

can be associated with WAGR syndrome. micro-deletion on short arm of chromosome 11

Question 14

Von Willebrands Disease

Answer 14

AD or AR (AD more common)
normal blood film and FBC
increased APTT and prolonged bleeding time
decreased factor VIII
decreased platelet activation to ristocetin
low VW factor - synthesised in endothelium

Question 14

Chloromas

Answer 14

solid extramedullary manifestation of aML
localised myeloblast collection
most common presentations:gingival hypertrophy, skin changes and features of spinal cord injury

Question 15

Haemophilia A

Answer 15

factor VIII deficieny
X linked recessive
normal bleeding time and PT
prolonged APTT
normal platelet function

Question 16

Haemophilia B

Answer 16

factor IX deficiency
x linked recessive
APTT increased and bleeding time prolonged
normal FBC and blood film
normal INR

Question 17

Hereditary spherocytosis

Answer 17

AD 75% AR 25%
blood film: spheroidal cells and reiculocytosis
aplastic anaemia
red cell: hypochromic
LFTs: haemolysis = increased bili, LDH

Question 18

Hodgkins lymphoma

Answer 18

non tender lymphadenopathy
B symptoms

non-hodgkins, less common presents more aggressively in younger children

Question 19

benefits of using combination therapy chemo

Answer 19

decreases chance of drug resistance
target tumour cells at different stages of cell cycle
minimises side effects

Question 20

hemorrhagic disease of the newborn

Answer 20

caused by vit K deficiency
born at home/ dont get vit K
bleeding from umbilical cord day 5
normal plts, high INR and APTT

Question 21

Neonatal alloimmune thrombocytopenia

Answer 21

low plts, normal coag
Mum has normal plts
platelet equivalant of rhesus disease of newborn, newborn has platelet antigen inherited from father, mother has antibodies against the antigen