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A. Block C Paediatrics > Leukaemia > Flashcards

Leukaemia Flashcards

1
Q

Which of the following organs are typically affected in haematological cancers?

1 - bone
2 - lymphoid tissue (lymph nodes, spleen)
3 - bone marrow
4 - extra-nodal (liver, adrenal glands, testes, breast)
5 - all of the above

A

5 - all of the above

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2
Q

Splenomegaly can be seen haematological cancer. If the patient has a very large spleen, where would you start your palpation to detect the spleen?

1 - below the liver
2 - left iliac fossa
3 - right iliac fossa
4 - hypogastric region

A

3 - right iliac fossa

  • splenomegaly is enlarged to account for additional function to process blood
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3
Q

Splenomegaly can be seen haematological cancer. Which of the following is NOT a common cause of splenomegaly?

1 - ileum obstruction
2 - haematological (myeloproliferative, myelofibrosis)
3 - lymphoproliferative disorders (chronic lymphocytic leukemia)
4 - haemolytic states
5 - thalassaemia major
6 - viral infection
7 - portal hypertension
8 - RA

A

1 - ileum obstruction

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4
Q

Leukaemia which relates to leukocytes is a malignant (uncontrolled) proliferation of primitive haematopoetic cells in the bone marrow. Which blood cells can be affected in leukaemia?

1 - RBCs
2 - WBCs
3 - Platelets
4 - all of the above

A

4 - all of the above
- leukocytes are WBCs, but leukaemia can affect any cells

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5
Q

Leukaemia which relates to leukocytes is a malignant (uncontrolled) proliferation of primitive haematopoetic cells in the bone marrow. Which of the following occurs in the bone marrow of patients with leukaemia?

1 - bone marrow failure
2 - bone marrow fills with blast cells
3 - poor maturation of RBCs causes anaemia
4 - all of the above

A

4 - all of the above

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6
Q

When comparing leakaemia and lymphoma, which is a solid and which is a liquid tumour?

A
  • leukaemia = liquid (blood)
  • lymphoma = solid (lymph nodes)
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7
Q

When comparing leukaemia and lymphoma, which cells are generally affected?

A
  • leukaemia = myeloid and lymphoid cells (all bone marrow cells)
  • lymphoma = lymphoid cells (B, T and NK cells)
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8
Q

When looking at cell lines from the bone marrow we talk about haemopoietic stem cells, which are then able to differentiate into myeloid and lymphoid stem cells. Which of the following is NOT classed as a myeloid stem cell?

1 - erythrocyte
2 - thrombocyte (platelet)
3 - monocyte
4 - natural killer cell
5 - granulocyte

A

4 - natural killer cell
- these are classed as lymphoblasts

  • granulocyte = eosinophil, neutrophil, basophil
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9
Q

When looking at cell lines from the bone marrow we talk about haemopoietic stem cells, which are then able to differentiate into myeloid and lymphoid stem cells. Which of the following is NOT classed as a lymphoblast stem cell?

1 - pre-B cell
2 - thrombocyte (platelet)
3 - Pre-T cell
4 - natural killer cell

A

2 - thrombocyte (platelet)

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10
Q

Leukaemia can be divided into acute and chronic leukaemia. Acute leukaemia can be further divided into:

  • acute myeloid leukaemia (AML)
  • acute lymphoblastic leukaemia (ALL)

Is AML common in children or old age?

A
  • old age
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11
Q

Leukaemia can be divided into acute and chronic leukaemia. Acute leukaemia can be further divided into:

  • acute myeloid leukaemia (AML)
  • acute lymphoblastic leukaemia (ALL)

Is ALL common in children or old age?

A
  • children
  • most common malignancy in children
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12
Q

What is the incidence of acute lymphoblastic leukaemia (ALL)?

1 - 3 / 1000
2 - 3 / 10,000
3 - 3 / 100,000
4 - 3 / 1,000,000

A

3 - 3 / 100,000

440 cases in UK each year

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13
Q

Acute lymphoblastic leukaemia (ALL) is the most common cause of malignancy in children. What age is this typically diagnosed?

1 - <12 months
2 - 0-4 years
3 - 1-7 years
4 - 5-10 years

A

2 - 0-4 years

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14
Q

Which genetically inherited condition increases the risk of developing acute lymphoblastic leukaemia (ALL) by 30?

1 - down syndrome
2 - cystic fibrosis
3 - type 1 diabetes
4 - patua syndrome

A

1 - down syndrome

Risk of developing Acute myeloid leukaemia is increased by 130

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15
Q

Acute leukaemia is typically caused by mutations to the precursor blood cells in the bone marrow. In acute lymphoblastic leukaemia (ALL), affecting mostly children, what is the most common cause of this?

1 - chromosomal abnormality
2 - poor differentiation of in zygote
3 - genetic mutation passed on by parent
4 - all of the above

A

1 - chromosomal abnormality
- chromosomal translocation
- abnormal chromosomal number

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16
Q

Acute leukaemia is typically caused by mutations to the precursor blood cells in the bone marrow. In acute lymphoblastic leukaemia (ALL), affecting mostly children, the most common cause of this is due to chromosomal abnormalities. Which 2 of the following are common in ALL?

1 - 12 and 21
2 - 13 and 14
3 - 9 and 22
4 - 18 and 21

A

1 - 12 and 21
3 - 9 and 22
- Philadelphia chromosome

  • 13 and 14 is called the robertsonian translocations
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17
Q

Acute leukaemia is typically caused by mutations to the precursor blood cells in the bone marrow. In acute lymphoblastic leukaemia (ALL) affecting mostly children, the most common cause of this is due to chromosomal abnormalities, with the 2 most common in ALL being 12 and 21 and 9 and 22 (Philadelphia chromosome). What do these chromosomal abnormalities typically cause?

1 - DNA mutations
2 - abnormal protein formation
3 - mRNA damaged
4 - golgi tendon organ is dysfunctional

A

2 - abnormal protein formation
- affects cellular function and cell division

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18
Q

Acute leukaemia is typically caused by mutations to the precursor blood cells in the bone marrow. Acute lymphoblastic leukaemia (ALL), affecting mostly children, can be further divided into 2 categories. Which 2 of the following are correct?

1 - pre-B cell ALL
2 - pre-megakaryoblast ALL
3 - pre-T cell ALL
4 - pre-myeloblast ALL

A

1 - pre-B cell ALL
3 - pre-T cell ALL

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19
Q

Which of the following is NOT true in acute lymphoblastic leukaemia (ALL), affecting mostly children?

1 - immature lymphoid cells affected
2 - grows rapidly
3 - most common malignancy in children
4 - large amount of cytoplasm on histology

A

4 - large amount of cytoplasm on histology
- typically there is very little cytoplasm

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20
Q

In patients with leukaemia, the bone marrow is unable to effectively make blood cells as the bone marrow is full of immature blood cells. What happens to the level of WBC, RBC and platelets in leaukaemia?

A
  • all will be low

Symptoms for leukaemia can be vague and non-specific

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21
Q

Leukaemia can present with a variety of symptoms. A low number of which of the following cells can cause bruising, epistaxis and petechial rash (non-blanching rash due to small blood vessels leaking)?

1 - B cells
2 - platelets
3 - RBCs
4 - WBCs

A

2 - platelets

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22
Q

Leukaemia can present with a variety of symptoms. Which of the folliwng is the main cause for bone pain?

1 - high B cells
2 - low platelets
3 - high lymphoblasts
4 - low lymphoblasts

A

3 - high lymphoblasts

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23
Q

Leukaemia can present with a variety of symptoms. All of the following are caused by low WBCs and RBCs, EXCEPT which one?

1 - increased risk of infection
2 - testicular enlargement
3 - pallor
4 - lethargy

A

2 - testicular enlargement

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24
Q

Leukaemia can present with a variety of symptoms. All of the following are RED flags for haematological malignancy according to NICE, EXCEPT which one?

1 - persistent fatigue
2 - unexplained fever
3 - unexplained persistent infection
4 - generalised lymphadenopathy
5 - hepatomegaly
6 - unexplained bruising / bleeding
7 - persistent/unexplained bone pain

A

5 - hepatomegaly

Can occur but not a red flag sign

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25
Q

Which of the following symptoms are present in patients with acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (ALL)?

1 - fatigue with anaemia and malaise
2 - bone and joint pain (enlarged bone marrow)
3 - easy bruising
4 - increased risk of infection
5 - fever with no clear cause
6 - right upper quadrant fullness and early satiety
7 - dyspnoea
8 - thrombocytopenia (low platelets) or disseminated intravascular coagulopathy (DIC)

A

5 - right upper quadrant fullness and early satiety

  • the left upper quadrant is typically affected due to splenomegaly
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26
Q

In acute lymphoblastic leukaemia patients B cells can be affected which can cause Bone marrow failure and a Big spleen. How can we remember which of the following is NOT one of the 3 main things can happen to a patient with B cell acute lymphoblastic leukaemia remember this?

1 - B is for Bone marrow failure
2 - B is for Big spleen
3 - B is for blood loss
4 - B cells affected

A

3 - B is for blood loss

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27
Q

In acute lymphoblastic leukaemia, affecting mostly children, patients T cells can be affected. This is most common in Teenage boys and causes Thoracic lymphadenopathy.
Which of the following is NOT one of the 3 main things can happen to a patient with T cell acute lymphoblastic leukaemia remember this?

1 - T is for Time, with slow progression
2 - T is for Teenage boys affected
3 - T is for Thoracic lymphadenopathy
4 - T is for T cells affected

A

1 - T is for Time, with slow progression

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28
Q

When trying to diagnose acute lymphoblastic leukaemia (ALL), affecting mostly children, what would we expect to see a lot of on a blood film?

1 - platelets
2 - immature blast cells
3 - B cells
4 - T cells

A

2 - immature blast cells

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29
Q

When trying to diagnose acute lymphoblastic leukaemia (ALL), which of the following would we expect to be high?

1 - platelets
2 - WCC
3 - B cells
4 - T cells

A
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30
Q

When trying to diagnose acute lymphoblastic leukaemia (ALL), we can use imaging such as CT and X-ray. What are we looking for on these imaging modalities?

1 - cardiomegaly
2 - consolidation
3 - lymphadenopathy
4 - bowel dilation

A

3 - lymphadenopathy
- specifically mediastinal and abdominal lymphadenopathy

Echocardiogram will also need to be done to ensure safety for cardiotoxic medication

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31
Q

Acute leukaemia is typically caused by mutations to the precursor blood cells in the bone marrow. Acute myeloid leukaemia (AML) can be further divided into multiple categories. One of the most common is called Acute promyelocytic leukaemia (APL), caused by a chromosomal abnormality. What is the abnormality?

1 - 12 and 21
2 - 13 and 14
3 - 9 and 22
4 - 15 and 17

A

4 - 15 and 17
- disrupts retinoic acid receptor gene, which is essential for normal cell division

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32
Q

Which of the following is NOT true in Acute myeloid leukaemia (AML)?

1 - immature lymphoid cells affected
2 - grows rapidly
3 - common in older adults
4 - large amount of blast (immature cells) in the circulation)
5 - auer rods are present in histology

A

1 - immature lymphoid cells affected
- AML affects myeloid cells

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33
Q

In acute meloid leukaemia (AML), we can use the mnemonic A.M.L to remember the 3 key things to diagnose a patient, not including >20% blasts. Which of the following is NOT one of these 3 things?

1 - A = auer rods
2 - M = myeloperoxidase
3 - M = massive splenomegaly
4 - L = leukaemia in older patients

A

3 - M = massive splenomegaly
- not specific to AML

  • myeloperoxidase = granules that stain for positive for Myeloperoxidase
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34
Q

Which condition is often associated with both Acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL)?

1 - Edwards’ syndrome (trisomy 18)
2 - Down syndrome (trisomy 21)
3 - Patau’s syndrome (trisomy 13)
4 - Turner syndrome

A

2 - Down syndrome (trisomy 21)

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35
Q

When trying to diagnose acute myeloid leukaemia (AML), do we expect to see the WCC to be high, low or normal?

A
  • can be all 3 so not a great marker

Typically low though

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36
Q

Typically the 1st test used to diagnose acute myeloid leukaemia (AML) and acute lymphoid leukaemia (ALL) is what?

1 - bone marrow biopsy
2 - Immunophenotyping
3 - genetic testings
4 - blood smear

A

4 - blood smear

  • ALL = shows lots of lymphoblast cells
  • AML = shows lots of myeloblasts cells
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37
Q

Typically the 1st test used to diagnose acute myeloid leukaemia (AML) and acute lymphoid leukaemia (ALL) is blood smear that shows increased lymphoblast cells (ALL) and myeloblasts cells in AML. The normal % of blast cells in a healthy patient is around 2%. What can this increase to in AML and ALL?

1 - >4%
2 - >12%
3 - >20%
4 - >65%

A

3 - >20%
- can be used for diagnosis purposes

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38
Q

Following a blood smear, typically what test is used to diagnose acute myeloid leukaemia (AML) and acute lymphoid leukaemia (ALL)?

1 - bone marrow biopsy
2 - Immunophenotyping
3 - genetic testings
4 - extensive blood profiling

A

1 - bone marrow biopsy
- sample taken from the iliac crest

  • AML has auer rods
  • ALL does NOT have auer rods
39
Q

Immunophenotyping can be used to help diagnose a patient with suspected acute myeloid leukaemia (AML) and acute lymphoid leukaemia (ALL). How does immunophenotyping help diagnose?

1 - specific markers on cells
2 - specific antigens on cells
3 - identify the size of the cells
4 - all of the above

A

4 - all of the above

40
Q

Leukaemia can typically cause all of the following, EXCEPT which one?

1 - bradycardia
2 - tachycardia
3 - fever
4 - tachypneic

A

1 - bradycardia

41
Q

If we suspect leukaemia, would the clotting profile be ok or abnormal?

A
  • primary haemostasis will be impaired due to low platelets

A FBC would confirm pancytopenia low platelets, WBC and RBC count)

42
Q

Patients with acute myeloid leukaemia (AML) are often taking a medication to address the high levels of urate in the blood due to tumour lysis. What medication is typically given to patients?

1 - rifampicin
2 - cyclizine
3 - omalizumab
4 - allopurinol

A

4 - allopurinol
- high urate is common malignancy due to lysis of tumours, which is the same medication use din acute gout

43
Q

Tumour lysis is when there is a rapid cancer cell death (lysis). is this dangerous?

A
  • Yes

Can be life threatening

44
Q

Tumour lysis is when there is a rapid cancer cell death (lysis) can be life threatening. During tumour lysis, which of the following are released in high amounts?

1 - uric acid
2 - phosphate
3 - K+
4 - all of the above

A

4 - all of the above

Can lead to hypocalcaemia and then hyperphosphataemia.

Essentially, causes acute nephropathy and acute renal failure

45
Q

Tumour lysis is when there is a rapid cancer cell death (lysis) can be life threatening, causing acute nephropathy and acute renal failure. What is the treatment for this?

1 - Na+ infusion to balance electrolytes
2 - blood drain to dilute
3 - hyperdiuresis via excessive and often forced fluids
4 - all of the above

A

3 - hyperdiuresis via excessive and often forced fluids

Given alongside allopurinol

46
Q

Will lactate dehydrogenase be high or low in leukaemia?

A
  • high

Released from cells due to high cell turnover

47
Q

Will urate levels be high or low in leukaemia?

A
  • high
  • Released from cells during breakdown
48
Q

Patients with acute myeloid leukaemia (AML) and acute lymphoid leukaemia (ALL) can have an increased risk of infection due to pancytopenia which is common in both conditions, which is anaemia, leukopenia and thrombocytopenia. How can this be managed?

1 - admit the patient to hospital to protect them from infections and treat with antibiotics
2 - ensure they do not leave their house and provide antibiotics
3 - provide antibiotics, regardless of the location
4 - all of the above

A

4 - all of the above

49
Q

In patients with acute myeloid leukaemia (AML) and acute lymphoid leukaemia (ALL) the induction therapy (1st therapy given in an attempt to induce remission) is what?

1 - chemotherapy
2 - radiotherapy
3 - immunotherapy
4 - bone marrow transplantation

A

1 - chemotherapy
- cytotoxic drugs are given that are able to kill cancer cells
- can take months to years

50
Q

In patients with acute myeloid leukaemia (AML) and acute lymphoid leukaemia (ALL) the induction therapy (1st therapy given in an attempt to induce remission) is chemotherapy. What is the definition of remission in leukaemia?

1 - no symptoms for >12 months
2 - no signs of blast cells on blood smears
3 - immune cells are normal
4 - no detectable leukaemia on microscopy

A

4 - no detectable leukaemia on microscopy

51
Q

Systemic anti-cancer therapy (SACT) is given to patients as part of an induction therapy. Which of the following is NOT typically part of SACT?

1 - chemotherapy
2 - blood transfusions
3 - immunotherapy
4 - targeted therapies

A

2 - blood transfusions

52
Q

Systemic anti-cancer therapy (SACT) is given to patients as part of an induction therapy. Which of the following is a core drug that can be used as an immunotherapy drug in acute myeloid leukaemia (AML) and acute lymphoid leukaemia (ALL)?

1 - Naloxone
2 - Cyclizine
3 - Rituximab
4 - Linagliptin

A

3 - Rituximab
- binds to CD20 on B cells and induces apoptosis

53
Q

Systemic anti-cancer therapy (SACT) is given to patients as part of an induction therapy. Which of the following is the class of drugs that is the example of targeted therapy that we were taught?

1 - tyrosine kinase inhibitors
2 - ion channel antagonist
3 - GPCR antagonist
4 - tyrosine kinase agonist

A

1 - tyrosine kinase inhibitors
- most evidence is in chronic myeloid leukaemia

54
Q

Systemic anti-cancer therapy (SACT) is given to patients as part of an induction therapy as the 1st line treatment with the aim of remission. If a patient goes into relapse, what will they then be offered?

1 - palliative care
2 - radiotherapy
3 - clinical trials with experimental drugs
4 - 2nd round of induction therapy

A

3 - clinical trials with experimental drugs

55
Q

Acute leukaemia is typically caused by mutations to the precursor blood cells in the bone marrow. Acute myeloid leukaemia (AML) can be further divided into multiple categories. One of the most common is called Acute promyelocytic leukaemia (APL), which is caused by a chromosomal translocation of chromosomes 15 and 17. This interrupts the normal retinoic acid gene which is important for cell division. How can this be treated?

1 - chemotherapy alone
2 - radiotherapy and steroids
3 - all-trans retinoic acid
4 - all of the above together

A

3 - all-trans retinoic acid
- binds to retinoic acid receptors on blast cells
- blast cells then develop into mature nautrophils
- neutrophils eventually undergo programmed cell death and reduce the number of blasts in the patient

56
Q

In patients, where induction therapy has not been successful, they may be offered allogeneic transplantations, which involves a donor, typically a sibling or unrelated donor) providing a sample to help the treat the patient. What is the 1st stage in this process?

1 - get a sample from the donor
2 - whole body radiation from the recipient
3 - chemotherapy for the recipient
4 - whole body radiation for the donor

A

2 - whole body radiation from the recipient
- idea is to wipe out all immature blast cells before healthy cells from the donor are given

57
Q

In patients, where induction therapy has not been successful, they may be offered allogeneic transplantations, which involves a donor, typically a sibling or unrelated donor) providing a sample to help the treat the patient. Is the preference to use cells from the bone marrow or stem cells?

A
  • stem cells
  • donors sample is treated to remove T cells
  • donors must be match to recipient using human leukocyte antigens (HLA)
58
Q

In patients with leukaemia access to the blood is required. Which of the following are typically used?

1 - Peripherally inserted central catheter (PICC) line
2 - PORT
3 - Hickman line
4 - all of the above

A

4 - all of the above

Essentially central line access is important given how many blood samples will be needed and chemotherapy given

  • ALWAYS CHECK PLACEMENT USING A CHEST X-RAY
59
Q

What is the cure rate for children with acute lymphoblastic Learning?

1 - 2%
2 - 30%
3 - 90%
4 - 100%

A

3 - 90%

60
Q

What is the cure rate for adults with acute lymphoblastic Learning?

1 - 20%
2 - 40%
3 - 70%
4 - 100%

A

2 - 40%

61
Q

Chronic leukaemia can be further divided into:

  • chronic myeloid leukaemia (CML)
  • chronic lymphocytic anaemia

What is the incidence of CML?

1 - 4.2 cases per 100
2 - 4.2 cases per 1000
3 - 4.2 cases per 10,000
4 - 4.2 cases per 100,000

A

4 - 4.2 cases per 100,000
- accounts for around 15% of all leukaemias

62
Q

Chronic leukaemia can be further divided into:

  • chronic myeloid leukaemia (CML)
  • chronic lymphocytic leukaemia (CLL)

What is the age does CML typically occur in?

1 -15-30
2 - 25-40
3 - 40-60
4 - >75

A

3 - 40-60

63
Q

Chronic leukaemia can be further divided into:

  • chronic myeloid leukaemia (CML)
  • chronic lymphocytic leukaemia (CLL)

Which is more common?

A
  • chronic lymphocytic leukaemia (CLL)
  • accounts for 1% of all new cancer diagnoses
  • accounts for 25% of all leukaemia’s
64
Q

In chronic and acute leukaemia do any of the haemopoetic stem cells mature at all?

A
  • acute = cells do no develop past blast phase
  • chronic = partial maturation
  • lack of correct maturation means cells are present but don’t work properly
65
Q

In the 2 types of chronic leukaemia, one has cells that grow too rapidly, and one has cells that do not die when they should, which is which?

  • chronic myeloid leukaemia (CML)
  • chronic lymphocytic leukaemia (CLL)
A
  • CML = cells grow too quickly
  • CLL = cells don’t die when they should
66
Q

Chronic leukaemia can be further divided into:

  • chronic myeloid leukaemia (CML)
  • chronic lymphocytic leukaemia (CLL)

What is the incidence of CML?

1 - 5 cases per 100,000
2 - 5 cases per 10,000
3 - 5 cases per 1000
4 - 5 cases per 100

A

1 - 5 cases per 100,000

67
Q

One of the most common causes of chronic leukaemia is chromosomal abnormalities. Which of the following is NOT a type of chromosomal abnormalities that can lead to chronic leukaemia?

1 - chromosomal deletion
2 - trisomy
3 - isochromosome
4 - translocation

A

3 - isochromosome
- chromosomes are mirror replicates of one another

  • chromosomal deletion = only 1 chromosome is present
  • trisomy = 3 chromosomes are present called non-disjunction that occurs in anaphase
  • translocation = chromosomes mix
68
Q

Chromosomal abnormalities is one of the most common causes of chronic leukaemia. Which chromosomal abnormality accounts for 80% of all cases of chronic myeloid leukaemia (CML)?

1 - Cri du chat syndrome
2 - Klinefelter syndrome
3 - Turner syndrome
4 - Philadelphia chromosome

A

4 - Philadelphia chromosome
- 9 and 22 chromosome translocation
- forms a BCR-ABL gene involved in tyrosine kinase which essentially causes rapid uncontrolled cell replication

69
Q

Which of the following is NOT true for chronic myeloid leukaemia (CML)?

1 - commonly caused by Philadelphia chromosome
2 - can affect all myeloid cell lineage
3 - rapid onset and progression
4 - basophils are very high in blood, when typically they are low

A

3 - rapid onset and progression
- typically this is slow onset, but does have some accelerated phases

70
Q

Chronic myeloid leukaemia (CML) can affect all myeloid cell lineages, but which cell is typically elevated in the blood, when normally the levels are low?

1 - basophils
2 - eosinophils
3 - natural killer cell
4 - monocyte

A

1 - basophils

71
Q

Which of the following is NOT a common sign or symptoms of Chronic myeloid leukaemia (CML)?

1 - hepatosplenomegaly
2 - anaemia and fatigue
3 - bleeding
4 - features of gout
5 - enlarged and tender rubbery lymph nodes

A

5 - enlarged and tender rubbery lymph nodes
- common in chronic lymphocytic leukaemia (CLL)

72
Q

In chronic myeloid leukaemia (CML) which of the following test results is commonly observed?

1 - high WBC
2 - low Hb
3 - high urate
4 - high B12
5 - all of the above

A

5 - all of the above

73
Q

What is the median survival rate of chronic myeloid leukaemia (CML)?

1 - 1-2 years
2 - 5-6 years
3 - 10-20 years
4 - >35 years

A

2 - 5-6 years

74
Q

In chronic myeloid leukaemia (CML) a specific medication has been developed over the last 10 years. What medication is this targeted against?

1 - ensure disconjunction in high risk patients
2 - BCR-ABL inhibitors
3 - all-trans retinoic acid
4 - steroids targeting blast cells

A

2 - BCR-ABL inhibitors
- accounts for 80% of all CML

75
Q

In patients, where induction therapy has not been successful, they may be offered allogeneic transplantations, which involves a donor, typically a sibling or unrelated donor) providing a sample to help the treat the patient. However, not all patients with chronic myeloid leukaemia (CML) are offered this, and it is rarely a 1st line therapy, why?

1 - doesn’t always work
2 - not enough donors
3 - too expensive
4 - high morbidity and mortality

A

4 - high morbidity and mortality

76
Q

Which of the following is NOT a common sign or symptoms of Chronic lymphocytic leukaemia (CML)?

1 - night sweats and weight loss
2 - anaemia and fatigue
3 - infection prone
4 - features of gout
5 - bilateral cervical lymphadenopathy

A

4 - features of gout
- common in chronic myeloid leukaemia (CML)

77
Q

Can splenomegaly and hepatomegaly occur in Chronic lymphocytic leukaemia (CML)?

A
  • yes
78
Q

Patients with Chronic lymphocytic leukaemia (CML) are at specific risk of developing infections due to poorly functioning lymphocytes cells. Which of these cells is typically affected the most?

1 - natural killer cells
2 - B cells
3 - T cells
4 - all equally affected

A

2 - B cells
- can cause hypoimmunoglobulinaemia

79
Q

In Chronic lymphocytic leukaemia (CML) which of the following test results is commonly observed?

1 - high lymphocytes
2 - low Hb
3 - low neutrophils
4 - low platelets
5 - all of the above

A

5 - all of the above

80
Q

In chronic lymphocytic leukaemia (CML), autoimmune haemolysis can occur. What is this?

1 - immunoglobulins are high causing an increased sensitivity to infection
2 - antibodies are produced against RBCs
3 - antibodies are produced against the bone marrow
4 - all of the above

A

2 - antibodies are produced against RBCs
- causes low Hb and platelets

81
Q

If a patient presents with jaundice, raised WBC, specifically lymphocytes, which of the following should we suspect?

1 - acute myeloid leukaemia
2 - acute lymphoblastic leukaemia
3 - chronic lymphocytic leukaemia
4 - chronic myeloid leukaemia

A

3 - chronic lymphocytic leukaemia
- could be due to an autoimmune haemolysis

82
Q

If we suspect a patient has chronic lymphocytic leukaemia and an autoimmune haemolysis, which of the following tests should be performed to confirm the diagnosis as part of a haemolysis screen?

1 - lactate dehydrogenase
2 - reticulocyte count
3 - billiruben
4 - direct antiglobulin test (DAT)
5 - all of the above

A

5 - all of the above

83
Q

In chronic myeloid leukaemia (CML) and chronic lymphocytic leukaemia (CLL) a blood smear is often the first test performed to diagnose patients. What would we expect to see in CML?

1 - reduced monocytes and granulocytes
2 - increased RBCs
3 - increased monocytes and granulocytes
4 - smudge cells

A

3 - increased monocytes and granulocytes

84
Q

In chronic myeloid leukaemia (CML) and chronic lymphocytic leukaemia (CLL) a blood smear is often the first test performed to diagnose patients. What would we expect to see in CLL?

1 - reduced monocytes and granulocytes
2 - increased RBCs
3 - increased monocytes and granulocytes
4 - smudge cells

A

4 - smudge cells
- these are broken B cells

85
Q

In chronic myeloid leukaemia, what % of blast cells present in the bone marrow would classify a patient as having chronic chronic myeloid leukaemia?

1 - >2%
2 - >10%
3 - >20%
4 - >50%

A

2 - >10%

86
Q

Hairy cell leukaemia is a rare form of chronic myeloid leukaemia caused by a mutation. Which mutation causes this?

1 - BCR-ABL gene
2 - BRAF gene
3 - HER2 gene
4 - MMR gene

A

2 - BRAF gene
- gene involved in cell survival, essentially with this mutation cells dont die

87
Q

Which of the cells in the image below is a neutrophil?

A
  • a is a neutrophil
  • multi lobulated cell
88
Q

Which of the cells in the image below is a eosinophil?

A
  • b is esinophil
  • stains very pink of H&E stain
89
Q

Which of the cells in the image below is a basophil??

A
  • c is basophil
  • appears like a large platelet with no clear nucleus
90
Q

Which of the cells in the image below is a monocyte?

A
  • d is a monocyte
  • nucleus looks like a kidney bean
91
Q

Which of the cells in the image below is a lymphocyte?

A
  • e is a lymphocyte
  • nucleus fills most of the cell
92
Q

Which of the cells in the image below is a blast cell?

A
  • f is a blast cell
  • irregular nuclear and cytoplasm has odd shape
93
Q

An 80 year old gentleman presents with anaemia, elevated reticulocytes and bilirubin, and has lymphocytosis. What is the most likely cause of his anaemia?

1 - acute leukaemia
2 - autoimmune haemolytic anaemia
3 - bone marrow infiltration
4 - bleeding
5 - chronic myeloid leukaemia

A

2 - autoimmune haemolytic anaemia

A. Block C Paediatrics (50 decks)

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