Haematological Malignancies and Lymphoproliferative Disorders — WACS Viva & Clinical Scenarios (Haematology and Medical Oncology)

Exam-style haematological malignancies and lymphoproliferative disorders viva scenarios with examiner probes and model answers for Internal Medicine candidates.

Scenarios covered

• SCENARIO 1: Acute Promyelocytic Leukaemia and Marrow Failure: A 28-year-old male presents to the emergency unit with a 3-day history of profound gingival bleeding, extensive ecchymoses, fever, and extreme fatigue. Full blood count reveals haemoglobin of 6.2 g/dL, white cell count of 2.1 x 10⁹/L, and platelets of 14 x 10⁹/L. Coagulation screen shows a prolonged prothrombin time, activated partial thromboplastin time, severe hypofibrinogenaemia (0.8 g/L), and elevated D-dimers. Peripheral blood smear demonstrates heavily granulated abnormal promyelocytes containing multiple Auer rods (faggot cells). Outline
• SCENARIO 2: Diagnostic Workup and Staging in Plasma Cell Myeloma: A 62-year-old woman presents with persistent lower back pain, progressive lethargy, and recurrent chest infections over 4 months. Laboratory investigations show haemoglobin of 7.8 g/dL, serum creatinine of 280 µmol/L, corrected serum calcium of 3.1 mmol/L, and an elevated total protein with a reversed albumin-globulin ratio. Discuss the step-by-step diagnostic evaluation required to confirm symptomatic plasma cell myeloma using modern CRAB and SLIM-CRAB criteria, risk stratification via the Revised International Staging System (R-ISS), and
• SCENARIO 3: Chronic Myeloid Leukaemia and Molecular Response Monitoring: A 44-year-old civil servant is referred from an outpatient clinic with massive splenomegaly extending 14 cm below the left costal margin, early satiety, night sweats, and a routine white blood cell count of 165 x 10⁹/L showing a full spectrum of granulocytic precursors with basophilia (5%) and eosinophilia. Explain the pathogenetic basis, the diagnostic confirmation strategy, first-line targeted pharmacological therapy, and the structured molecular monitoring protocol on the International Scale required to ensure optimal therapeutic
• SCENARIO 4: Endemic and HIV-Associated High-Grade Lymphomas: A 32-year-old HIV-seropositive male presents with a rapidly enlarging intra-abdominal mass, marked ascites, profound drenching night sweats, and marked weight loss over 3 weeks. Biopsy confirms Burkitt lymphoma with a Ki-67 proliferation index of approximately 100% and t(8;14) translocation. Formulate the clinical assessment, immediate preventive measures against tumour lysis syndrome using Cairo-Bishop criteria, central nervous system prophylaxis, and the principles of combination systemic therapy in the context of concurrent antiretroviral the
• SCENARIO 5: Chronic Lymphocytic Leukaemia and Autoimmune Complications: A 68-year-old retired teacher presents for evaluation of painless, generalized cervical, axillary, and inguinal lymphadenopathy discovered during a routine health check. Blood film and automated count show an absolute lymphocyte count of 45 x 10⁹/L with mature-appearing small lymphocytes and numerous smudge cells. Outline the required flow cytometric immunophenotyping panel, clinical staging systems (Rai and Binet), indications for initiating treatment versus active surveillance, and the clinical management of secondary autoimmune cyt