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Question 1

ALL types

Answer 1

Common - 75%

T-cell only - 20%
B-cell only - 5%

Question 2

ALL epidemiology

Answer 2

Males

2-5 years

Question 3

ALL poor prognostic factors

Answer 3

Male 
Philadelphia chromosome 
< 2 years 
> 10 years 
WCC > 20

Question 4

ALL aetiology

Answer 4

Downs syndrome

Philadelphia chromosome - 22

Ionising radiation

Question 5

ALL presentation

Answer 5

1. Bone marrow infiltration
   
   • Bone pain
   • RBCs - SOB, lethargy, pallor
   • Platelets - Bruising, petechiae
2. Hepatosplenomegaly
3. Organ infiltration
   
   • Painless testicular enlargement
   • Neuro - CNS palsies and papilloedema

Question 6

ALL investigations

Answer 6

Bloods

• RBC - LOW
• WCC ^
• Neutrophils - LOW

U/E

• Urea ^
• Creatinine ^

CXR/MRI - Metastases

Bone marrow biopsy

LP - Pleocytosis

Question 7

ALL management

Answer 7

Induction - Vincristine

Consolidation - Doxorubicin

Maintenance - Methotrexate

Question 8

ALL complications

Answer 8

Neutropenic sepsis - Tazocin

Hyperuricaemia - Allopurinol

Secondary cancers
Stunted growth

Question 9

Tuberculosis types

Answer 9

Primary

• Ghon focus - Tubercle-laden macrophages
• Ghon focus + lymph nodes = Ghon complex
• Immunocompromised - Dissemination - Miliary tuberculosis

Secondary

• Immunocompromised - Initial infection reactivated
• Occurs in the apex of the lungs

Question 10

TB extra-pulmonary infection sites

Answer 10

CNS 
Vertebral bodies 
Cervical lymph nodes 
Renal 
GI tract

Question 11

TB screening

Answer 11

Mantoux test

• Subcutaneous injection of purified protein derivative
• Read result 2-3 days later
• < 6mm - Negative
• 6-15mm - Positive - Previous TB or BCG
• > 15mm - Positive - Active TB infection

Question 12

TB investigations

Answer 12

CXR

Sputum smear - Ziehl-Neelsen stain - Acid-fast bacilli

Question 13

TB false negatives

Answer 13

Miliary TB 
Sarcoidosis 
HIV 
Lymphoma 
< 6 months

Question 14

Active TB management

Answer 14

Initial phase - RIPE

• Rifampicin
• Isoniazid
• Pyrazinamide
• Ethambutol

Continuation phase - 4 months

• Rifampicin
• Isoniazid

Direct observed therapy

• Homeless
• Patients with poor concordance
• Prisoners

Question 15

Latent TB management

Answer 15

3 months…

• Rifampicin
• Isoniazid