Haematology/Oncology

Question 1

What causes bone lesions with no organomegaly?

Answer 1

Multiple myeloma

Question 2

What causes organomegaly with no bone lesions?

Answer 2

Waldenstrom’s macroglobinaemia

Question 3

What is the action of docetaxel?

Answer 3

Inhibits microtubule depolymerisation and dissasembly, reducing free tubulin

Question 4

What is the action of vincristine/vinblastine?

Answer 4

Inhibits formation of microtubules

Question 5

What is the action of cyclophosphamide?

Answer 5

Causes cross-linking in DNA

Question 6

What is the action of bleomycin?

Answer 6

Degrades preformed DNA

Question 7

What is the action of doxorubacin?

Answer 7

Inhibits DNA and RNA synthesis

Question 8

What is the action of methotrexate?

Answer 8

Inhibits dihydrofolate reductase and thymidylate synthesis

Question 9

What is the action of cisplatin?

Answer 9

Causes cross-linking in DNA

Question 10

What is the action of irinotecan?

Answer 10

Inhibits topoisomerase I which prevents relaxation of supercoiled DNA

Question 11

What is the normal function of microtubules?

Answer 11

Guide movement during intracellular transport and help bind internal organelles

Question 12

What causes t9:22?

Answer 12

CML

Question 13

What causes t15:17?

Answer 13

APML

Question 14

What causes t8:14?

Answer 14

Burkitt’s lymphoma

Question 15

What causes t14:18?

Answer 15

Follicular lymphoma

Question 16

What causes t11:14?

Answer 16

Mantle Cell Lymphoma

Question 17

A patient presents with jaw swelling, night sweats and weight loss. What is the most likely diagnosis?

Answer 17

Burkitt’s lymphoma

Question 18

Which virus is most commonly implicated in Burkitt’s lymphoma?

Answer 18

EBV

Question 19

Microscopy for a patient presenting with fevers and night sweats shows a starry sky appearance. What is the most likely diagnosis?

Answer 19

Burkitt’s lymphoma

Question 20

A patient presents with lethargy. A blood film is taken which shows tear drop poikilocytes. What is the most likely diagnosis?

Answer 20

Myelofibrosis

Question 21

What causes myelofibrosis?

Answer 21

Hyperplasia of abnormal megakaryocytes

Release of platelet derived growth factor leads to stimulation of fibroblasts

Question 22

Which medication should be started long term to reduce acute crises in sickle cell disease?

Answer 22

Hydroxycarbamide

Question 23

How does hydroxycarbamide work in sickle cell disease?

Answer 23

It increases production of foetal haemoglobin (HbF) which reduces intravascular concentrations of HbS - meaning less likely red blood cell polymerisation and precipitation

Question 24

What causes leukaemoid reaction?

Answer 24

Severe haemolysis
Severe infection
Massive haemorrhage
Bone marrow infiltration from metastatic malignancy

Question 25

How do you differentiate leukaemoid reaction from CML?

Answer 25

LR: High leucocyte alkaline phosphatase score Dohle bodies in white cells (toxic granulation) Left shift of neutrophils CML: Philadelphia chromosome t9:22 Low leucocyte alkaline phosphatase score

Question 26

What condition would show howell-jolly bodies, target cells, pappenheimer bodies, siderotic granules and acanthocytes on blood film?

Answer 26

Coeliac disease causing hyposplenism

Question 27

What condition would cause bite cells on blood film?

Answer 27

G6PD

Question 28

What condition would cause tear drop poikilocytes on blood film?

Answer 28

Myelofibrosis

Question 29

What condition would cause schistocytes on blood film?

Answer 29

Microangiopathic haemolytic anaemia

Question 30

What should you give to a patient on warfarin with major bleeding?

Answer 30

IV vitamin K and prothrombin complex or FFP if unavailable

Question 31

What should you give to a patient with an INR >8.0 and minor bleeding?

Answer 31

IV vitamin K, repeat if still high after 24 hours Restart warfarin when INR <5.0

Question 32

What should you give to a patient with an INR >8.0 and no bleeding?

Answer 32

Oral vitamin K Repeat if still high after 24 hours Restart warfarin when INR <5.0

Question 33

Which medication is used for reversal of dabigatran?

Answer 33

Idarucizumab

Question 34

Which medication is used for reversal of apixaban/rivaroxaban?

Answer 34

Andexanet alfa