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MRCP > Haem/Onc > Flashcards

Haem/Onc Flashcards

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1
Q

Antiphospholipid syndrome Rx in pregnancy

A

Initially aspirin alone

LMWH once foetal heartbeat on USS, usually discontinued at 34 weeks

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2
Q

APLS in pregnancy complications

A 
Recurrent miscarriage
Intrauterine growth restriction
Pre eclampsia
Placental abruption
Pre term delivery
VTE
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3
Q

Oral Opiate conversion rates
Codeine to morphine
Tramadol to morphine
Morphine to oxycodone

A

Divide by 10
Divide by 10
Divide by 1.5

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4
Q

Oral to sub cut morphine conversions
Oral morphine to subcut
Oral morphine to subcut diamorphine
Oral oxycodone to subcut diamorphine

A

Divide by 2
Divide by 3
Divide by 1.5

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5
Q

Cyclophosphamide MoA

A

Alkylation agent, causes cross linking of DNA

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6
Q

Cyclophosphamide side effects

A

Haemorrhagic cystitis
Myelosupression
TCC

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7
Q

Bleomycin MoA

A

Degrades preformed DNA

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8
Q

Bleomycin side effects

A

Lung fibrosis

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9
Q

Doxorubicin MoA

A

Stabilises dNA-topoisomerase II complex - inhibits DNA and RNA synthesis

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10
Q

Doxorubicin side effects

A

Cardiomyopathy

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11
Q

Methotrexate MoA

A

Inhibits dihydrofolate reductase and thymidylate synthesis

Anti folate

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12
Q

MTX side effects

A

Myelosupression
Live fibrosis
Lung fibrosis

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13
Q

Fluorocil (5-FU) MoA

A

Pyridimine analogue - induces cell cycle arrest and apoptosis by blocking thymidylate synthesis (during S phase)

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14
Q

Fluorouracil (5-FU) side effects

A

Myelosupression
Mucositis
Dermatitis

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15
Q

6 mecaptopurine MoA

A

Purine analogue, activated by HGRPTase, decreases purine synthesis

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16
Q

6 mecaptopurine side effects

A

Myelosupression.

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17
Q

Cytarabine MoA

A

Pyridimine antagonist. Interferes with DNA synthesis at S phase and inhibits DNA polymerase

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18
Q

Cytarabine side effects

A

Myelosupression

Ataxia

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19
Q

Vincristine/vinblastine MoA

A

Inhibits formulation of microtubules

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20
Q

Vincristine side effects

A

Reversible peripheral neuropathy

Paralytic ileum

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21
Q

Vinblastine side effects

A

Myelosupression

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22
Q

Cisplatin MoA

A

Causes cross linking in DNA

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23
Q

Cisplatin side effects

A

Ototoxicity
Peripheral neuropathy
Hypomagnesaemia

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24
Q

Hydroxyurea (hydroxycarbamide) MoA

A

Inhibits ribonucleotide reductase, decreases DNA synthesis

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25
Hydroxyurea (hydroxycarbamide) side effects
Myelosupression
26
G6PD demographics and inheritance
More common in Mediterranean and African | XLR
27
G6PD pathophys
Decreased G6PD leads to decrease in glutathione, increased red cell susceptibility to oxidative stress
28
Features of G6PD (5)
``` ?neonatal jaundice Intravascular haemolysis Gallstones ?splenomegaly Heinz bodies on bloods films ```
29
G6PD Dx
Enzyme assay
30
G6PD triggers
``` Antimalarials (primaquine) Ciprofloxacin Sulphur drugs Favs beans Infection ```
31
Vitamin B12 absorption
Bound to intrinsic factor (produced by parietal cells in stomach) Active absorption in terminal ileum Minor passive absorption not bound to IF
32
Causes of B12 deficiency
``` Pernicious anaemia Post gastrectomy Poor diet Disorders of terminal ileum - Crohns, blind loop Metformin (rare) ```
33
B12 deficiency Rx
If no neuro involvement 3 weekly IM hydroxycobalamin for 2 weeks, then once every 3 months NB - if also folate deficient Rx B12 first to prevent SCDC
34
ECOG score 0
Fully active, at predisease functionality
35
ECOG 1
Restricted in strenuous physical activity but ambulatory and able to carry out work of light sedentary nature - house work, Office work
36
ECOG 2
Ambulatory, capable of all self care , unable to carry out any work Activites Up and about >50% waking hours
37
ECOG 3
Limited self care | In bed >50% waking hours
38
ECOG 4
Completely disabled No self care Totally confined to bed/chair
39
ECOG 5
Dead
40
CML translocation
T(9;22) Philadelphia chromosome -> Abelson proto-oncogene moved to BCR gene on Ch22 BCR-ABL fusion protein has excess tyrosine kinase activity Poor prognostic indicator in ALL
41
Acute promyelocytic leukaemia (M3) genetics
Fusion of PML and RAR alpha genes
42
Burkitts Lymphoma genetics
T(8;14) | MYC oncogene translocated onto an immunoglobulin gene
43
Mantle cell lymphoma genetics
t(11;14) | Deregulation of cyclinD1 (BCL1) gene
44
Squamous cell cancer features (4)
Typically central Associated with PTHrP secretion Strongly associated with finger clubbing Hypertrophic pulmonary osteoarthropathy
45
Adenocarcinoma lung features (3)
Typically peripheral Most common lung ca in non smokers Majority who develop it are smokers however
46
Large cell lung Ca features (3)
Typically peripheral Anaplastic, poorly differentiated, poor prognosis May secrete bHCG
47
Acute haemolytic transfusion reaction MoA
``` ABO incompatibility Massive intravascular haemolysis Symptoms minutes after transfusion - fever - Abdo and chest pain - agitation - Hypotension ```
48
Acute haemolytic transfusion rxn Rx
Stop transfusion Fluid resus with NS Inform lab Complications DIC, AKI
49
Non haemolytic febrile reaction MoA
HLA incompatibility | Often result of sensitisation by previous pregnancies or transfusions
50
Pathphysiology of hypercoagulable state in pregnancy
Increased factor VII, VIII, X Decreased protein S Uterus presses on IVC -> venous stasis in legs
51
VTE Rx in pregnancy
Sub cut LMWH
52
Indications for Rx in CLL (6)
Progressive marrow failure - development of worsening anaemia and/or thrombocytopenia Massive >10cm or progressive LAN Massive >6cm or progressive splenomegaly Progressive lymphocytosis >50% inc over 2 months, or lymphocyte doubling time <6 months Autoimmune cytopenias - eg ITP Systemic Sx - weight loss >10% in 6/12, Fever >38 for >2/52, extreme fatigue, night sweats
53
CLL management
If no indication for Rx them monitor with regular FBC Fludarabine, cyclophosphamide and rituximab (FCR)
54
AML M0
Undifferentiated
55
AML M1
Without maturation
56
AML M2
With granulocytic maturation
57
AML M3
acute promyelocytic
58
AML M4
granulocytic and monocytic maturation
59
AML m5
Monocytic
60
AML M6
Erythroleukaemia
61
AML M7
Megakaryoblastic
62
Pigment laden macrophages on colonoscopy
Laxative abuse
63
Rasburicase MoA, indication
recombinant version of urate oxidase, coverts uric acid to allantoin Preventing tumour lysis syndrome

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