[leukaemia]

Question 1

[leukaemia][basic]: 3 complications of leukaemia?

Answer 1

hyperviscosity
infection
bleeding

Question 2

[leukaemia][basic]: patients report what non-specific symptom?

Answer 2

drowsiness/tired

Question 3

[leukaemia][basic]: what is the cut off for neutropenia?

Answer 3

<=0.5 x10^9/L

Question 4

[leukaemia][basic]: in neutropenic patients … as a route for drug administration should be avoided

Answer 4

IM injections

check IVI sites

Question 5

[leukaemia][basic]: Septicaemia is assumes in neutropenic patients whose temperature is > … on one occasion

Answer 5

38

Question 6

[leukaemia][basic]:Septicaemia is assumed in neutropenic patients if their temperature is > .. on 2 seperate occasions

Answer 6

37.5

Question 7

[leukaemia][basic]: what is empirical treatment for septicaemia with neutropenia

Answer 7

Tazocin (pipercacillin + tazobactam)
+
Gentamicin

Question 8

[leukaemia][basic]: when would you add in gentamicin to treat septicaemia in a neutropenic patient?

Answer 8

Gram + suspected

or
infection source found e.g. hickmans line

Question 9

[leukaemia][basic]: if septicaemia with neutropenia persists post Abx Tx; where might the infection come from?

Answer 9

Central Line infection

Question 10

[leukaemia][basic]: If septicaemia + neutropenia persists post Abx Tx, what organisms might be suspected (2)

Answer 10

Fungi (aspergillus/ candida)

CMV

Question 11

[leukaemia][basic]:for how long is the course of Abx in septicaemis +neutropenia

Answer 11

5 days

or afebrile for 72

Question 12

[leukaemia][basic]: speticaemia+neutropenia: what WCC are you aiming for with Abx Tx?

Answer 12

> 0.5x10^9/L

Question 13

[leukaemia][basic]:what score indicates the risk of septic complications?

Answer 13

MASCC (multinational association for supportive care in cancer)

Question 14

[leukaemia][basic]: what 2 things are released in high concentrations in tumour lysis syndrome?

Answer 14

K+

Urate

Question 15

[leukaemia][basic]: what happens to cancer cells in tumour lysis syndrome

Answer 15

breakdown of cells after Tx

Question 16

[leukaemia][basic]: what organ is most affected in tumour lysis sydnrome

Answer 16

renal (renal injury)

Question 17

[leukaemia][basic]: which 2 cancers does tumour lysis syndrome usually affect

Answer 17

lymphomas

leukaemias

Question 18

[leukaemia][basic]: how can you prevent tumour lysis syndrome (drug Tx) in normal risk pts.

Answer 18

allopurinol pre-cytotoxics

+advise high fluid intake

Question 19

[leukaemia][basic]: what advice other than drug Tx for tumour lysis syndrome would you give before giving cytotoxics

Answer 19

high fluid intake

Question 20

[leukaemia][basic]: in patients at high risk of tumour lysis syndrome what pre-cytotoxic drug may be given?

Answer 20

recombinant uricase
(rasburicase)

Question 21

[leukaemia][basic]: > what WCC would manifest as hyperviscosity?

Answer 21

> 100 x10^9/L

Question 22

[leukaemia][basic]: describe leukostasis?

Answer 22

WBC thrombi formation

Question 23

[leukaemia][basic]: DIC: widespread coagualtion activation causes fibrin strand depostion: how can this affect RBCs

Answer 23

haemolysis of RBCs

Question 24

[leukaemia][basic]: DIC: what happens to blood concentrations of clotting factors and platelets

Answer 24

decreased

Question 25

[leukaemia][basic]: DIC: why is there a widespread activation of coagulation?

Answer 25

Release of pro-coagulants

Question 26

[leukaemia][basic]: DIC: clinical signs? (3)

Answer 26

Bleeding Bruising Renal failure

Question 27

[leukaemia][basic]: DIC: What organ may be affected by DIC

Answer 27

Kidney - renal failure

Question 28

[leukaemia][basic]: DIC: on Ix: platelet count?

Answer 28

Down

Question 29

[leukaemia][basic]: DIC: on Ix: fibrinogen?

Answer 29

Down (correlates with severity)

Question 30

[leukaemia][basic]: DIC: what are D-Dimers?

Answer 30

fibrinogen degradation products

Question 31

[leukaemia][basic]: DIC: D-Dimer count

Answer 31

up

Question 32

[leukaemia][basic]: DIC: PT?

Answer 32

Up

Question 33

[leukaemia][basic]: DIC: APTT

Answer 33

up

Question 34

[leukaemia][basic]: DIC: what would be seen on blood film

Answer 34

schistocytes (broken RBCs)

Question 35

[leukaemia][basic]: DIC: Tx is to treat the cause; how could you increase coagulation factors?

Answer 35

FFP

Question 36

[leukaemia][basic]: DIC: what is the cut off for tranfusion of platelets?

Answer 36

<50 x10^9/L

Question 37

[leukaemia][basic]: DIC: If there is severe sepsis or multiorgan failure what Tx option is available?

Answer 37

Activated protein C

Question 38

[leukaemia][basic]: DIC: what is activated protein c

Answer 38

anti-coagulant | inactivates factor 5 and 8

Question 39

[leukaemia][basic]: what Tx is available to give a septic patient to prevent progression to severe sepsis?

Answer 39

Ciprofloxacin

Question 40

[leukaemia][basic]: why would a fluoroquinolone (e.g. ciprofloxacin) be given to a patient in sepsis?

Answer 40

prevent progression to severe sepsis

Question 41

[leukaemia][basic]: leukaemia time course is acute/sub-acute/chronic timecourse?

Answer 41

acute

Question 42

[leukaemia][basic]: In a patient with neutropenic sepsis what organism is most likely to cause lung pneumonia?

Answer 42

Pneumocystis Jirovecii | fungus) (immunocompromised

Question 43

[leukaemia][basic]: what is empirical Tx for pneumocystis jirovecii?

Answer 43

Co-trimoxazole 120mg/kg/day IVI for 3 weeks

Question 44

[leukaemia][basic]: what may you see on CXR in pneumocystis jirovicii

Answer 44

normal CXR possible!

Question 45

[leukaemia][basic]: What is co-trimoxazole?

Answer 45

trimethoprim +sulfamethoxazole

Question 46

[leukaemia][basic]: DIC: what would you give to replace consumed fibrinogen?

Answer 46

Cryoprecipitate