Haem/ Onc

Question 1

Eastern Cooperative Oncology Group (ECOG) score - functional status for determination for oncological therapies

Answer 1

0 Fully active
1 Restricted physical activity, able to work
2 Able all self care unable to do work
3 Limited self care; in bed/ chair >50% day
4 Completely disabled
5 Dead

Question 2

t(14;18)

Answer 2

follicular lymphoma

increased BCL-2 transcription

Question 3

t(11;14)

Answer 3

Mantle cell lymphoma

deregulation of the cyclin D1 (BCL-1) gene

Question 4

t(8;14)

Answer 4

seen in Burkitt’s lymphoma

MYC oncogene is translocated to an immunoglobulin gene

Question 5

t(15;17)

Answer 5

seen in acute promyelocytic leukaemia (M3)

fusion of PML and RAR-alpha genes

Question 6

t(9;22) - Philadelphia chromosome

Answer 6

CML

Question 7

SIckel cell disaese - Sequestrian crisis

Answer 7

splenomegaly
hypotension
increased reticulocyte count

Question 8

Sickle cell disease: Vasculo-oclusive/ Thrombotic crisis

Answer 8

extremely severe, deep bone pain

organ infarcts

Question 9

Aplastic crises

Answer 9

caused by infection with parvovirus

sudden fall in haemoglobin

Question 10

CA 125
CA 19-9
CA 15-3

Answer 10

CA 125 Ovarian cancer
CA 19-9 Pancreatic cancer
CA 15-3 Breast cancer

Question 11

PSA
AFP 
CEA
S-100
Bombesin

Answer 11

S-100 - Melanoma, schwannomas
Bombesin - Small cell lung carcinoma, gastric cancer, neuroblastoma
PSA - Prostatic carcinoma
AFP - Hepatocellular carcinoma, teratoma
CEA - Colorectal cancer

Question 12

Factor V Leiden mutation results in…

Answer 12

activated protein C resistance

Question 13

Associated Carcinogens to cancers
Aflatoxin (produced by Aspergillus) 
Aniline dyes 
Asbestos 
Nitrosamines 
Vinyl chloride

Answer 13

Aflatoxin (produced by Aspergillus) - hepatocellular
Aniline dyes - Bladder (transitional cell ca)
Asbestos - Mesothelioma + bronchial
Nitrosamines - Oesophageal and gastric cancer
Vinyl chloride - Hepatic angiosarcoma

Question 14

Thrombotic thrombocytopenic purpura (TTP) features (5)

Answer 14

Thrombotic thrombocytopenic purpura (TTP) is classically characterised as a pentad of: thrombocytopenia, microvascular haemolysis, fluctuating neurological signs, renal impairment and fever.

Question 15

Thrombotic thrombocytopenia Mx

Answer 15

Plasma exchange

Question 16

t(15;17)

Answer 16

Acute Myeloid Leukaemia

Question 17

Thrombotic Thrombocytopenic Purpura pathophys

Answer 17

deficiency of ADAMTS13

Question 18

Methaemaglobinaemia pathophys

Answer 18

Methaemoglobinaemia = oxidation of Fe2+ in haemoglobin to Fe3+

Question 19

Desmopressin (DDAVP) MOA in von Willebrand disease

Answer 19

induces release of von Willebrand’s factor from endothelial cells

Question 20

Paroxysmal Nocturnal Haemaglobinuria diagnostic test

Answer 20

Flow cytometry for CD59 and CD55

Question 21

Herediatry angioedema Mx

Answer 21

acute - IV C1-inhibitor concentrate/ fresh frozen plasma

prophylaxis: anabolic steroid Danazol

Question 22

Chronic lymphocytic leukemia investigation (2)

Answer 22

Immunophenotyping - key diagnostic tool

Blood film - smudge cells

Question 23

Hereditary spherocytosis investigation

Answer 23

EMA binding test

Question 24

Hereditary spherocytosis features (3)

Answer 24

Normocytic anaemia
Gall stones
Family history
Splenomegaly

Question 25

Diseminated intravascular coagulation blood picture (5)

Answer 25

↓ platelets ↓ fibrinogen ↑ PT & APTT ↑ fibrinogen degradation products schistocytes due to microangiopathic haemolytic anaemia

Question 26

Thrombophillia most common cause

Answer 26

Factor V Leiden (protein C resistance)

Question 27

Chronic myeloid leukemia Mx

Answer 27

Imatinib - tyrosine kinase inhibitor

Question 28

Essential Thrombocytopenia Features (3) Mutation (1) Mx

Answer 28

Platelets >600, thrombosis and haemorrhage possible, burning sensation in hands JAK2 mutation Mx - Hydroxyurea (hydroxycarbamide)/ IFN alpha

Question 29

``` Burkitt's Lymphoma Gene translocation viral association microscopy findings Mx - chemotherapy - complication ```

Answer 29

c-myc gne translocation, t(8;14) EBV starry sky appearance Tumour lysis syndrome

Question 30

``` Blood film: Myelofibrosis Iron Def Anaemia Hyposplenism microangiopathic haemolytic anaemia Hereditary spherocytosis/ Autoimmune Haemolytic anaemia ```

Answer 30

``` "Tear Drop" Poikilocytes "Pencil" Poikilocytes Howell-jolly Schistocytes Spherocytes ```

Question 31

Cyclophosphamide MOA side effect (3)

Answer 31

MOA - cross-linking in DNA | Haemorrhagic cystitis, myelosuppression, Transitional cell Ca

Question 32

Bleomycin MOA SE

Answer 32

Degrades preformed DNA | Lung fibrosis

Question 33

Anthracyclines (doxyrubicin) MOA SE

Answer 33

inhibits DNA + RNA synthesis, Stabilise DNA-topoisomerase II complex Cardiomyopathy

Question 34

Methotrexate MOA SE (2)

Answer 34

Inhibit dihydrofolate reductase | Myelosuppression, Lung/ liver fibrosis

Question 35

Fluorouracil MOA SE

Answer 35

Thymidylate synthase inhibitor | Myelosuppression, mucositis, dermatitis

Question 36

Cytarabine MOA SE

Answer 36

pyrimidine antagonist, inhibit DNA polymerase | Myelosuppression, ataxia

Question 37

Vincristine MOA SE

Answer 37

inhibit microtubule formation | peripheral neuropathy

Question 38

Docetaxel MOA SE

Answer 38

prevent microtubule depolymerisation | Neutropenia

Question 39

Irinotecan MOA SE

Answer 39

inhibit topoisomerase I | myelosuppression

Question 40

cisplatin MOA SE (3)

Answer 40

cross-link DNA | Ototoxicity, peripheral neuopathy, hypomagnesaemia

Question 41

Hydroxyurea MOA SE

Answer 41

Inhibit ribonucleotide reductase | myelosuppression

Question 42

tumour lysis syndrome Mx

Answer 42

Rasburicase + IV fluid

Question 43

Polycythaemia rubra vera assosications (2)

Answer 43

myelofibrosis | AML

Question 44

Acute intermittent porphyria Features (3) Ix Mx

Answer 44

Abdominal, Neuro, psych symptoms Raise urinary porphobilinogen IV Haematin/ IV Glucose

Question 45

Chronic lymphocytic leukaemia is due to...

Answer 45

Monoclonal proliferation of B cell lymphocytes

Question 46

Haemophillia A deficiency in... | Haemophillia B deficiency in...

Answer 46

A - VIII | B - IX

Question 47

Rasburicase MOA

Answer 47

Rasburicase - a recombinant version of urate oxidase, an enzyme that metabolizes uric acid to allantoin

Question 48

Chronic Lymphocytic Leukaemia Features Ix

Answer 48

Often none - incidental lymphocytosis | Ix - immunophenotyping/ flow cytometry

Question 49

Myeloma | Features (3)

Answer 49

Hypercalcaemia, renal failure, high total protein

Question 50

Methaemaglobinuria causes

Answer 50

congenital - NADH methaemaglobin reductase def | Aquired - Co-Trimoxazole, dapsone, nitrates, sulphas, chloroquine

Question 51

Essential Thrombocystosis - Platelets >600 | Mx

Answer 51

Hydroxyurea/ hydroxycarbimide

Question 52

Waldenstrom Macroglobulinaemia | Features (3)

Answer 52

Older Hyperviscocity - strokes, headaches, blurred vision hepatosplenomegaly IgM

Question 53

Vitamin B12 is absorbed where...?

Answer 53

Actively in terminal ileum

Question 54

Methaemaglobinaemia Fx (1) Mx (1)

Answer 54

Normal pO2 with decreased oxygen saturations | Methylene Blue

Question 55

Felty syndrome features (3)

Answer 55

neutropenia splenomegaly rheumatoid arthritis

Question 56

Multiple Myeloma Features (4) Ix (1)

Answer 56

CRAB - hyperCalcaemia, Renal disfunction, Anaemia, bone pain | serum electrophoresis

Question 57

Contrast-enhanced CT coronary angiogram is the first line investigation for...

Answer 57

stable chest pain of suspected coronary artery disease aetiology