Lymphomas & chemotherapy flashcards
18 high-yield MRCP Part 1 cards from the Intellect Medicos Haematology & Oncology course. Try to answer each question before you open it — then study them properly with spaced repetition, which brings each card back just before you would forget it.
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What is the gold-standard diagnostic investigation for suspected lymphoma?
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Excisional lymph node biopsy.
Why? It preserves nodal architecture and gives tissue for immunohistochemistry, flow cytometry, FISH and molecular tests.
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Rituximab is a monoclonal antibody against which antigen?
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CD20 (on B cells).
Why? It destroys CD20-positive B cells, so it is used in B-cell lymphomas (R-CHOP), CLL and autoimmune disease such as ITP and TTP.
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What is the dose-limiting toxicity of doxorubicin (used in R-CHOP and ABVD)?
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Cardiotoxicity — dose-dependent dilated cardiomyopathy.
Why? Anthracyclines generate free radicals that damage cardiac myocytes; risk rises with cumulative dose.
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What is the main dose-limiting toxicity of vincristine?
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Peripheral neuropathy (also constipation and paralytic ileus).
Why? Vinca alkaloids disrupt microtubules, including those in long peripheral nerve axons.
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Which bladder toxicity is caused by cyclophosphamide, and which drug prevents it?
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Haemorrhagic cystitis; prevented with mesna (plus good hydration).
Why? The metabolite acrolein irritates the bladder lining; mesna binds and neutralises it.
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Which drug in the ABVD regimen causes pulmonary fibrosis?
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Bleomycin.
Why? The lungs lack the enzyme that inactivates bleomycin, so it damages lung tissue; risk rises with cumulative dose and age.
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What is the standard first-line chemotherapy for Hodgkin lymphoma?
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ABVD — doxorubicin (Adriamycin), bleomycin, vinblastine, dacarbazine — ± radiotherapy.
Why? Hodgkin lymphoma is highly curable with this regimen.
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Follicular lymphoma: ______ (BCL2). Mantle cell lymphoma: t(11;14) (cyclin D1). Burkitt lymphoma: t(8;14) (c-MYC).
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t(14;18)
Why? Each translocation moves an oncogene next to the immunoglobulin heavy-chain gene on chromosome 14, switching it on.
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Follicular lymphoma: t(14;18) (BCL2). Mantle cell lymphoma: ______ (cyclin D1). Burkitt lymphoma: t(8;14) (c-MYC).
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t(11;14)
Why? Each translocation moves an oncogene next to the immunoglobulin heavy-chain gene on chromosome 14, switching it on.
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Follicular lymphoma: t(14;18) (BCL2). Mantle cell lymphoma: t(11;14) (cyclin D1). Burkitt lymphoma: ______ (c-MYC).
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t(8;14)
Why? Each translocation moves an oncogene next to the immunoglobulin heavy-chain gene on chromosome 14, switching it on.
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What is the first-line treatment of localised gastric MALT lymphoma?
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Helicobacter pylori eradication therapy.
Why? Most gastric MALT lymphomas are driven by chronic H. pylori infection and regress when it is eradicated.
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Which two surface markers are typically positive on Reed–Sternberg cells?
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CD15 and CD30.
Why? These identify classical Hodgkin lymphoma; CD30 is the target of brentuximab vedotin.
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The commonest subtype of classical Hodgkin lymphoma is ______; the subtype with the worst prognosis is ______.
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nodular sclerosis; lymphocyte-depleted
Why? Nodular sclerosis affects young adults with mediastinal disease and lacunar cells; lymphocyte-depleted affects older or immunocompromised patients.
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What is the standard staging investigation for Hodgkin lymphoma and aggressive non-Hodgkin lymphomas?
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PET-CT.
Why? FDG-PET detects metabolically active nodal and extranodal disease and is also used to assess treatment response.
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What is the standard first-line chemoimmunotherapy for diffuse large B-cell lymphoma?
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R-CHOP: rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone.
Why? DLBCL is the commonest NHL; it is aggressive but curable in many patients with R-CHOP.
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Endemic (African) Burkitt lymphoma typically involves the ______, whereas sporadic Burkitt usually presents as an ______ mass.
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jaw; ileocaecal (abdominal)
Why? Endemic disease is strongly linked to EBV and malaria; sporadic disease to HIV. Both carry t(8;14) with MYC overexpression and a "starry sky" histology.
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Which autoimmune disease is most strongly associated with thymoma?
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Myasthenia gravis.
Why? The abnormal thymus fails to delete autoreactive T cells, promoting antibodies against the acetylcholine receptor.
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Which oncogenic virus causes Kaposi sarcoma and primary effusion lymphoma?
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Human herpesvirus 8 (HHV-8).
Why? HHV-8 drives endothelial and B-cell proliferation, especially in immunosuppression (e.g. HIV).