Haematology + oncology

Question 1

Beta Thallassaemia

Answer 1

Absent B bands on electrophoresis
Microcytic anaemia
Low HCT
Appropriate reticulocyte count
Normal iron studies

Question 2

SSD

Answer 2

Sickle cells on peripheral blood film
HbS on electrophoresis

Question 3

Alpha Thalassaemia

Answer 3

alpha bands on electrophoresis

Question 4

Carcinoid tumour vitamin deficiency

Answer 4

Nician B3 deficiency (Pellagra)
Increased tryptophan metabolism to serotonin
B3 is derived from tryptophan

Question 5

Carcinoid tumour diagnosis

Answer 5

Increased urine 5-OH-indoleacetic acid levels
Cromogranin A increased often in liver metastasis

Question 6

Bowel colic in colorectal CA

Answer 6

Buscopan

Question 7

N+V from functional bowel obstruction in renal cancer

Answer 7

Metoclopramide

Question 8

N+V due to mechanical bowel obstruction

Answer 8

Cyclizine

Question 9

N+V from hypercalcaemia

Answer 9

Haloperidol

Question 10

Haemophilia
- inheritance
- cause
- diagnosis

Answer 10

X-linked recessive

A = Factor VIII deficiency
B = Factor IX deficiency

Raised aPTT
Factor VIII/IX assay to confirm

Question 11

Haemochromatosis features

Answer 11

Diabetes mellitus
Arthralgia
Hepatomegaly
Hypogonadism
Skin pigmentation

Question 12

Paroxysmal nocturnal haemoglobinaemia
- Triad
- blood Ix
- treatment

Answer 12

Chronic compliment mediated haemolysis

1. Acquired haemolytic anaemia
2. Large vessel thrombosis
3. Insufficient haematopoiesis

Raised LDH and reticulocytes indicates intravascular haemolysis

eculizumab, anticoagulation, steroids, bone marrow transplant

Question 13

eculizumab

Answer 13

Inhibits compliment C5 activation and formation of cytolytic attack complex

Question 14

Henoch-schonlein purpura
- cause/mechanism
- features
- management

Answer 14

• IgA complex deposition in the skin and kidneys
• Purpuric rash, arthritis, nephritis, abdominal pain, GI bleeding, orchitis
• Self-limiting in most cases, monitor, supportive treatment for nephritis

Question 15

Asbestos cancers

Answer 15

Lung adenocarcinoma
Mesothelioma
Renal adenocarcinoma
Gastrointestinal lymphoma

Question 16

G6PD deficiency
- Inheritance
- Mechanism of disease

Answer 16

X-linked recessive
Cannot tolerate oxidative stress -> haemolytic anaemia triggered by infection, drugs, broad beans

Question 17

Hereditary spherocytosis
- Inheritance
- Presentation
- Complications

Answer 17

Autosomal dominant - abnormal RBC membrane

Mild intermittent jaundice, anaemia

Blood film: spherocytes, raised reticulocyte count

Aplastic crisis (parvovirus B19)
Megaloblastic crisis (Folate deficiency)

Question 18

ITP management

Answer 18

1. Oral prednisolone
2. Pooled normal IVIG (if bleeding or requires urgent invasive procedure)

Question 19

Bowel colic from cancer
- treatment

Answer 19

Hyoscine butylbromide 300mcg TDS

Question 20

Vitamin deficiency in carcinoid syndrome

Answer 20

Niacin B3 deficiency
B3 derived from tryptophan. Increased tryptophan metabolism to produce large amounts of serotonin -> decreased B3 production

Question 21

CAs most a/w hypercalcaemia

Answer 21

Breast + lung SCC, MM (via PTHrP secretion)