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Haematology Week 3 2018/19 > Peer tutoring for Haem cancers > Flashcards

Peer tutoring for Haem cancers Flashcards

1
Q

What causes the difference in presentation between acute and chronic leukaemias?

A

Acute - total block of proliferation, so you only get progenitor cells which can’t function –> pancytopaenia

Chronic - some proliferation preserved so you still get functioning cells

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2
Q

Which form of leukaemia is more commonly seen in children?

A

Lymphoblastic

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3
Q

Which form of leukaemia is more commonly seen in the elderly?

A

Myeloid

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4
Q

Which forms of leukaemia are more common in

a) elderly
b) paediatric

patients?

A

a) Myeloid

b) Lymphoblastic

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5
Q

What do blast cells look like on a blood film?

A

Large in diameter

High nuclear:cytoplasmic ratio

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6
Q

What is the most common childhood cancer?

A

Acute lymphoblastic leukaemia (ALL)

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7
Q

What is the presentation of pancytopaenia?

A

Anaemia

Recurrent infection

Abnormal bleeding

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8
Q

What is the presentation of acute lymphoblastic leukaemia?

A

Typically a child with acute onset anaemia, infection and abnormal bleeding

Examination reveals hepato/splenomegaly

Blood film shows lymphoblasts

FBC shows raised white cell count

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9
Q

How is the

a) anaemia

b) increased infection risk

c) abnormal bleeding

of pancytopaenia managed?

A

a) Blood transfusion

b) Prophylactic antibiotics

c) Platelet transfusion

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10
Q

Which combination of chemotherapy and immunosuppression is used to treat ALL?

A

Vincristine

Prednisolone

wipes out the immune system, start from scratch

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11
Q

What is the typical presentation of CLL?

A

Asymptomatic

Examination: non-tender lymphadenopathy, hepato/splenomegaly

Blood film: lymphocytosis, smear cells

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12
Q

Smear cells are a blood film finding of which malignancy?

A

Chronic lymphoblastic leukaemia (CLL)

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13
Q

What is a blood film finding specific to CLL?

A

Smear cells

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14
Q

How is CLL treated?

A

Chemotherapy + radiotherapy

IV Ig injections

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15
Q

What is a mnemonic for remembering the symptoms of multiple myeloma?

A

CRAB

Hypercalcaemia

Renal impairment

Anaemia

Bacterial infection / Back pain

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16
Q

Where do myeloma patients often feel pain?

A

Back pain

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17
Q

Why do patients with multiple myeloma develop hypercalcaemia?

Which organs does a raised serum calcium damage?

A

Bony involvement (inflammation causes osteoclast activation, raises serum calcium)

Kidneys (renal impairment, plus the paraproteins cause damage too)

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18
Q

What is a blood film finding of multiple myeloma?

A

Rouleaux formation

i.e a “stack of coins” appearance, with RBCs overlapping

19
Q

What is found in the urine of patients with multiple myeloma?

A

Bence Jones proteins

Paraproteins secreted by the malignant plasma cells

20
Q

Describe the CRAB presentation of multiple myeloma.

A

Hypercalcaemia

Renal impairment

Anaemia

Bacterial infection

21
Q

Which demographic of patients tends to develop multiple myeloma?

What does this mean for management?

A

Elderly

Intensive treatment isn’t likely to be in the patient’s best interest

22
Q

What is the management of multiple myeloma in patients unfit for chemotherapy?

A

Analgesia

Bisphosphonates

23
Q

What is the management of multiple myeloma in younger, fitter patients?

A

VAD

Vincristine

Adriamycin

Dexamethasone

> Immune reset

24
Q

Which malignancy causes acute onset pancytopaenia, typically in older patients?

A

Acute myeloid leukaemia (AML)

25
Q

What is the presentation of AML?

A

Older patient who is anaemic, bleeding abnormally and recurrently infected

Examination reveals hepato/splenomegaly

Blood film / biopsy shows myeloblasts and Auer rods

26
Q

What are blood film findings specific to AML?

A

Myeloblasts

Auer rods

27
Q

AML typically affects older patients, who are subsequently treated with replacement and chemotherapy.

How can it be treated in young patients?

A

Bone marrow transplant

28
Q

Chemotherapy can lead to which inflammatory arthropathy?

Why?

A

Gout

Uric acid released when cells are killed off by chemotherapy

29
Q

CML, like the other leukaemias, causes a ___ on FBC.

A

pancytopaenia

30
Q

What is the specific cause of CML?

A

TRANSLOCATION OF BCR-ABL GENE (9:22)

ON PHILADELPHIA CHROMOSOME

31
Q

Which specific drug is used to treat CML?

A

Imatinib

Targets BCR-ABL tyrosine kinase affected by the 9:22 translocation on the Philadelphia chromosome

32
Q

What are three named lymphomas you need to know about?

A

Hodgkins lymphoma

Non-Hodgkins lymphoma

Burkitt’s lymphoma

33
Q

What is the difference between Hodgkins and Non-Hodgkins lymphoma?

A

Hodgkins lymphoma shows Reed-Sternberg cells on blood film

Non-Hodgkins does not

This is the important difference

34
Q

What does a Reed-Sternberg cell look like?

Which malignancy is it a feature of?

A

B lymphocyte with a DOUBLE NUCLEUS

Hodgkins lymphoma

35
Q

What is the presentation of Hodgkins lymphoma?

A

Young patient with non-tender lymphadenopathy

B symptoms - fever, weight loss, night sweats

Pain on drinking alcohol

Rash without itch

36
Q

Are B symptoms (fever, weight loss, night sweats) specific to Hodgkins or Non-Hodgkins lymphoma?

A

B symptoms seen in both

37
Q

Hodgkins lymphoma is more common in patients who have undergone which procedure?

A

Transplant

38
Q

How is lymphoma investigated?

A

Lymph node biopsy

39
Q

Following lymph node biopsy, which staging system is used for lymphoma?

A

Ann Arbor staging

40
Q

Describe the Ann-Arbor system for staging Hodgkins/NH lymphomas.

A

A: no systemic symptoms

B: systemic symptoms

I: one lymph node affected

II: two nodes affected, both on same side of the diaphragm

III: nodes affected on both sides of diaphragm

IV: spread beyond lymph nodes

so AI, BIV etc.

41
Q

What are the mnemonics used to remember the treatment regimes for

a) multiple myeloma
b) Hodgkins lymphoma
c) Non-Hodgkins lymphoma?

A

a) VAD
b) ABVD
c) R-CHOP-21

42
Q

What is the ABVD management plan for Hodgkins lymphoma?

A

Adriamycin

Bleomycin

Vincristine

Dexamethasone

43
Q

What is the R-CHOP-21 management plan for Non-Hodgkins lymphoma?

A

R-CHOP-21

Rituximab

Cyclophosphamide

Doxorubicin

Vincristine

Prednisolone

21 day course of this

The letters don’t match up with the generic drug names which sort of defeats the point of a mnemonic

Haematology Week 3 2018/19 (10 decks)

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