Blood and cancer

Question 1

Triad of bone marrow failure

Answer 1

anaemia
thrombocytopenia
neutropenia

Question 2

Triad of tissue infiltration

Answer 2

bone pain
hepatosplenomegaly
lymphandenopathy

Question 3

1st line investigations in suspected leukaemia

Answer 3

FBC
Blood film
CXR
Clotting screen

Question 4

Specialist investigations in leukaemia

Answer 4

Bone marrow aspirate

LP

Question 5

Features of Kawasaki disease

Answer 5

High grade fever >5 days 
Conjuntival infection 
Bright red cracked lips 
Strawberry tongue 
Cervical lymphadenopathy
Red palms of hands and soles

Question 6

Treatment of Kawasaki disease

Answer 6

Aspirin IV

Question 7

AB for suspected meningococcal disease

Answer 7

• ceftriaxone

Question 8

steroids given in x but not y?

Answer 8

bacterial meningitis

NOT meningococcal septicaemia

Question 9

commonest cause of anaemia in children

Answer 9

iron deficiency

Question 10

3 main causes of iron deficiency anaemia

Answer 10

insufficient intake
malabsorption
chronic blood loss

Question 11

severe side effects of low iron

Answer 11

decreased cognitive and psychomotor performance

Question 12

blood film for iron deficiency anaemia

Answer 12

hypo-chromic, microcytic cells

Question 13

Management for iron deficiency anaemia

Answer 13

dietary advice - limit milk intake
iron replacement therapy (continue 2-3 months after target levels met)
RARE - transfusion

Question 14

what protein is dysfunctional in sickle cell anaemia in children?

Answer 14

beta globin chain - causes RBC to deform when deoxygenated

Question 15

sickle cell crisis =

Answer 15

deformed RBC get stuck

Question 16

sickle cell crisis triggers

Answer 16

hypoxia 
cold 
dehydration 
excessive exercise 
infection 
stress

Question 17

up to which month is sickle cell not a problem in new borns

Answer 17

6m - foetal hb still in the blood

Question 18

acute treatment in sickle cell crisis

Answer 18

analgesia
oxygenation
treatment of the associated sepsis

Question 19

long term treatment in sickle cell disease

Answer 19

prophylactic penicillin
appropriate vaccinations
close monitoring for complications

can give steroids / blood transfusion

HSCT - replace BM - extreme, reserved for severe disease

Question 20

genetic inheritance of thalassaemia

Answer 20

autosomal recessive

Question 21

what is affected in a RBC in thalassaemia?

Answer 21

globin chain - alpha / beta

Question 22

thalassaemia major =

Answer 22

total absence of the production of that globin chain

Question 23

thalassaemia intermedia =

Answer 23

milder symptoms

Question 24

thalassaemia trait =

Answer 24

asymptomatic

Question 25

type of anaemia in thalassaemia =

Answer 25

microcytic

Question 26

clinical features of thalassaemia =

Answer 26

``` delayed growth congestive HF splenomegaly bone deformity increased risk of infections iron overload ```

Question 27

management of thalassaemia

Answer 27

regular blood transfusions check iron levels iron chelation HSCT

Question 28

Causes of anaemia in children due to RBC being destroyed....

Answer 28

``` G6PD Sickle cell Thalassaemia Drug induced / viral haemolytic anaemia Physiological anaemia of the new born ```

Question 29

Causes of anaemia in children due to RBC being lost

Answer 29

Haemorrhagic disease of the new born Cows milk protein enteropathy Clotting disorders Menstruation

Question 30

Causes of anaemia in children due to body producing RBC too slowly

Answer 30

Iron deficiency Chemo Leukaemia

Question 31

What is immune thrombocytopenic purpura?

Answer 31

Viral trigger leads to development of platelet membrane glycoprotein AB So autoimmune destruction of platelets

Question 32

clinical features of immune thrombocytopenic purpura

Answer 32

low platelets petechial rash excessive purpura bruising unexplained bleeding

Question 33

Therapy for ITP if significant bleeding

Answer 33

IV Ig and oral corticosteroids / IV anti D | Should do bone marrow aspirate before giving the corticosteroids

Question 34

Henoch Scholein Purpura =

Answer 34

Ig A vasculitis

Question 35

what is IgA vasculitis precipitated by?

Answer 35

infections and vaccinations

Question 36

Clinical features of IgA vasculitis

Answer 36

Purpuric rash Arthralgia - especially knees and ankles Abdo pain Renal compromise

Question 37

rash in HUS / IgA vasculitis

Answer 37

Raised purpuric rash over buttocks and extensor surfaces of the limbs.

Question 38

Ddx for purpuric rash but platelets normal

Answer 38

HSP Viral infection NAI Meningitis / Septicaemia

Question 39

Ddx for purpuric rash but platelets low

Answer 39

acute lymphoblastic leukaemia

Question 40

follow up for HUS / IgA vasculitis

Answer 40

BP and urine dip

Question 41

Investigations in acute IgA vasculitis

Answer 41

``` BP Urine dip Renal function Albumin FBC Clotting ```

Question 42

Management of IgA vasculitis

Answer 42

symptomatic - pain relief but NOT NSAIDS IF RENAL IMPAIRMENT

Question 43

Neuroblastoma =

Answer 43

cancer along sympathetic chain / adrenal glands

Question 44

Wilms tumour =

Answer 44

nephroblastoma

Question 45

Ewings sarcoma =

Answer 45

central skeleton cancer

Question 46

Osteosarcoma =

Answer 46

long bone cancer

Question 47

What can a rhabdomyosarcoma be found?

Answer 47

Bladder Pelvis Nasopharynx Parameningeal