Malignancy

Question 1

Characteristic blood film findings in chronic lymphocytic leukaemia?

Answer 1

Smudge cells

Question 2

CLL with new B symptoms - what is this called?

Answer 2

Richter’s transformation

Question 3

Mnemonic to remember the ages at which the different leukaemias affect patients?

Answer 3

ALL CeLL mates have CoMmon AMbitions

Acute lymphoblastic - 4-45 years old
Chronic Lymphocytic - >55 years old
Chronic Myeloid - >65 years old
Acute myeloid - >75 years old

Question 4

Referral criteria for children to hospital when suspecting leukaemia?

Answer 4

New onset petechiae or splenomegaly requires urgent referral to hospital

If a patient is presenting with symptoms suspect of leukaemia they should have a FBC within 48 hours

Question 5

What are the investigations for leukaemia?

Answer 5

FBC initially along with a blood film

LDH

Bone marrow biopsy

CXR - mediastinal lymphadenopathy

Lymph node biopsy

Lumbar puncture

CT, MRI, PET scans

Question 6

Associations of Acute lymphoblastic leukaemia?

Answer 6

Blast cell proliferation leading to overall pancytopenia

Philadelphia chromosome

Question 7

Chronic myeloid leukaemia pathophysiology?

Answer 7

There are three phases

Chronic phase - asymptomatic, found on incidental findings

Accellerated phase - blast cells 10-20%. Becomes more symptomatic, develop anaemia and thrombocytopenia

Blast phase: Blasts >30%. Severe symptoms and thrombocytopenia.

Question 8

What is the Philadelphia chromosome most associated with?

Answer 8

Acute lymphoblastic leukaemia

Chronic myeloid leukaemia

Question 9

What types of cancers are associated with tumour lysis syndrome?

Answer 9

Cancers that have a high cell turnover such as leukaemia, high grade lymphomas and all cancers that are highly responsive to chemotherapy.

Question 10

Electrolyte changes in tumour lysis syndrome?

Answer 10

Hyperkalaemia

Hypocalcaemia

Hyperphosphataemia

Question 11

Which cancer are Auer rods associated with?

Answer 11

Acute myeloid leukaemia

Question 12

Which cancer are smear/smudge cells associated with?

Answer 12

Chronic lymphocytic leukaemia

Question 13

Which cancer is plasma cells associated with?

Answer 13

Myeloma

Question 14

What are the X-ray signs in multiple myeloma?

Answer 14

Raindrop skull, punched out lesions, lytic lesions

Question 15

What is the clinical presentation of multiple myeloma?

Answer 15

Calcium elevated

Renal impairment

Anaemia

Bone pathology - including pathological fractures and lytic lesions on imaging.

Question 16

What is the chemotherapy regimen for multiple myeloma?

Answer 16

Dexamethasone, Thalidomide and Bartezomid

Question 17

What is the management for bone pathology in multiple myeloma?

Answer 17

Manage the symptoms appropriately.

Initially, bone pain can be managed with medications including bisphosphonates (e.g. Alendronic acid or IV Risendronate in severe disease).

Radiotherapy and surgical interventions can also be considered.

Question 18

What are some examples of myeloproliferative disorders?

Answer 18

CML

Polycythemia

Primary myelofibrosis

Question 19

Clinical features of Hodgkins lymphoma?

Answer 19

• Lymph node enlargement
• B symptoms: fever, night sweats, weight loss
• Alcohol induced pain in lymph nodes
• Chest pain, cough, dyspnoea

Question 20

What are the risk factors for lymphoma?

Answer 20

Family history 
Age
EBV
Hepatitis B + C
HIV
Smoking
Previous radiotherapy, chemotherapy, immunosuppression

Question 21

Diagnosis of Hodgkins lymphoma?

Answer 21

PET CT scan

Normal CT if the above is unavailable

Question 22

Typical cell seen on blood films in Hodgkins lymphoma?

Answer 22

Reed-Sternberg cell