Pathology EMQ template.

Name: Ime Eka

Theme: Chronic myeloid leukaemia

OPTION LIST

A	Allogenic blood transfusion	I	Dosatinib
B	Allogenic stem cell transplantation	J	Fresh frozen plasma
C	Autologous blood transfusion	K	Golimumab
D	Autologous stem cell transplantation	L	Hydroxychloroquine
E	Azathioprine	M	IFN-α infusion
F	Daunorubicin infusion	N	Imatinib
G	Donor granulocyte infusion	O	Methotrexate
H	Donor lymphocyte infusion	P	None of the above

For each scenario below, choose the most appropriate treatment option from the list above. Each option may be used once, more than once or not at all.

1. A 50 year old man presents with weight loss, fatigue and night sweats. He is diagnosed with chronic myeloid leukaemia and treatment is commenced. Several months later it becomes clear that he is resistant to the main class pharmaceutical agents that were used.

2. A 57 year old woman is known to have chronic myeloid leukaemia. She presents acutely unwell, with 25% myeloblasts on her blood film, and is appropriately treated. 24 months later she relapses.

3. A 60 year old woman presents with weight loss and lethargy. On examination, she is cachectic with splenomegaly. Her white cell count is 150 x 10⁹/l. Her blood film showed 25% myeloblasts. Cytogenetic analysis showed presence of the Philadelphia chromosome.

4. A 55 year old man presents with weight loss and lethargy. On examination, he is cachectic with splenomegaly. His white cell count was 135 x 10⁹/l. Cytogenetic analysis showed presence of the Philadelphia chromosome.

5. A 57 year old man with a history of chronic myeloid leukaemia presents with night sweats, fatigue and weight loss. He was started on first line therapy 6 months ago but his doctor is concerned that he has relapsed. He wants to try a new treatment option.

ANSWERS

1. B

2.H

3. B

4. N

5. I